U.S. patent application number 14/315040 was filed with the patent office on 2015-06-11 for treatment and prophylaxis of amyloidosis.
This patent application is currently assigned to ONCLAVE THERAPEUTICS LIMITED. The applicant listed for this patent is ONCLAVE THERAPEUTICS LIMITED. Invention is credited to Jose SALDANHA, Dale B. SCHENK, Peter A. SEUBERT.
Application Number | 20150158937 14/315040 |
Document ID | / |
Family ID | 40825109 |
Filed Date | 2015-06-11 |
United States Patent
Application |
20150158937 |
Kind Code |
A1 |
SCHENK; Dale B. ; et
al. |
June 11, 2015 |
TREATMENT AND PROPHYLAXIS OF AMYLOIDOSIS
Abstract
Methods useful for effecting prophylaxis or treatment of
amyloidosis, including AA Amyloidosis and AL amyloidosis, by
administering peptides comprising neoepitopes, such as AA fragments
from a C-terminal region of AA, and antibodies specific for
neoepitopes of aggregated amyloid proteins, for example, antibodies
specific for the C-terminal region of AA fibrils. Antibodies for
inhibition of formation and/or increasing clearance of amyloid
deposits in a patient thus effecting prophylaxis or treating
amyloid disease.
Inventors: |
SCHENK; Dale B.;
(Burlingame, CA) ; SEUBERT; Peter A.; (San
Francisco, CA) ; SALDANHA; Jose; (Enfield,
GB) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ONCLAVE THERAPEUTICS LIMITED |
DUBLIN |
|
IE |
|
|
Assignee: |
ONCLAVE THERAPEUTICS
LIMITED
DUBLIN
IE
|
Family ID: |
40825109 |
Appl. No.: |
14/315040 |
Filed: |
June 25, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12811049 |
Jun 10, 2013 |
8791243 |
|
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PCT/US08/88493 |
Dec 29, 2008 |
|
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14315040 |
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61095932 |
Sep 10, 2008 |
|
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61007544 |
Dec 28, 2007 |
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Current U.S.
Class: |
435/358 ;
435/320.1; 435/325; 536/23.53 |
Current CPC
Class: |
A61P 17/02 20180101;
A61K 51/1018 20130101; A61P 7/00 20180101; A61P 17/00 20180101;
A61P 35/00 20180101; C07K 2317/56 20130101; A61P 29/00 20180101;
A61P 35/02 20180101; C07K 2317/24 20130101; C07K 2317/52 20130101;
C07K 2317/32 20130101; Y10S 530/809 20130101; A61K 49/16 20130101;
A61P 17/06 20180101; C07K 2317/34 20130101; A61P 25/02 20180101;
A61P 9/00 20180101; A61P 19/02 20180101; A61K 39/0008 20130101;
A61P 25/00 20180101; A61P 31/06 20180101; C07K 2317/565 20130101;
C07K 2317/567 20130101; C07K 16/18 20130101; C07K 2317/92 20130101;
A61P 43/00 20180101; A61K 49/00 20130101; A61P 1/04 20180101; A61P
25/28 20180101; A61P 31/08 20180101; A61K 2039/505 20130101; A61P
19/04 20180101; A61P 31/04 20180101; A61P 11/00 20180101; A61P
13/12 20180101; A61P 19/00 20180101 |
International
Class: |
C07K 16/18 20060101
C07K016/18 |
Claims
1.-90. (canceled)
91. A nucleic acid encoding a humanized light chain variable region
or a humanized heavy chain variable region, wherein the nucleic
acid specifically hybridizes under stringent hybridization
conditions to a nucleic acid having a nucleotide sequence that is
the complement of a nucleic acid that encodes the humanized light
chain variable region or humanized heavy chain variable region set
forth as any one of SEQ ID NOs: 155, 156, 157, 161, 162 and
163.
92. The nucleic acid of claim 91, which encodes a humanized light
chain variable region comprising the amino acid sequence of any one
of SEQ ID NOs: 155, 156 and 157.
93. The nucleic acid of claim 92, which encodes the amino acid
sequence of SEQ ID NO. 157.
94. A nucleic acid encoding a humanized heavy chain variable region
comprising the amino acid sequence of any one of SEQ ID NOs: 161,
162 and 163.
95. The nucleic acid of claim 94, which encodes the amino acid
sequence of SEQ ID NO. 163.
96. The nucleic acid of claim 92, which further comprises a nucleic
acid encoding a light chain constant region.
97. The nucleic acid of claim 96, wherein the light chain constant
region is a human kappa constant region.
98. The nucleic acid of claim 94, which further comprises a nucleic
acid encoding a heavy chain constant region.
99. The nucleic acid of claim 98, wherein the heavy chain constant
region is a human IgG1 constant region.
100. A vector comprising at least one of (a) a nucleic acid
encoding a humanized light chain variable region comprising the
amino acid sequence set forth as any one of SEQ ID NOs: 155, 156
and 157, and (b) a nucleic acid encoding a heavy chain variable
region comprising the amino acid sequence set forth as any one of
SEQ ID NOs: 161, 162 and 163.
101. The vector of claim 100, which comprises the nucleic acid of
(a) and a promoter that controls expression of the nucleic acid of
(a).
102. The vector of claim 101, wherein the nucleic acid of (a)
encodes the amino acid sequence of SEQ ID NO: 157.
103. The vector of claim 102, wherein the nucleic acid further
encodes a human kappa constant region.
104. The vector of claim 100, which comprises the nucleic acid of
(b) and a promoter that controls expression of the nucleic acid of
(b).
105. The vector of claim 104, wherein the nucleic acid of (b)
encodes the amino acid sequence of SEQ ID NO: 163.
106. The vector of claim 105, wherein the nucleic acid further
encodes a human IgG1 constant region.
107. The vector of claim 100, further comprising a promoter that
controls expression of the nucleic acid of (a) or the nucleic acid
of (b).
108. The vector of claim 100 comprising the nucleic acid of (a) and
the nucleic acid of (b).
109. The vector of claim 108, further comprising a promoter that
controls expression of the nucleic acid of (a) and the nucleic acid
of (b).
110. The vector of claim 108, further comprising a first promoter
that controls expression of the nucleic acid of (a) and a second
promoter that controls expression of the nucleic acid of (b).
111. A host cell comprising at least one of (a) a nucleic acid
encoding a light chain variable region comprising the amino acid
sequence set forth as any one of SEQ ID NOs: NOs: 155, 156 and 157,
and (b) a nucleic acid encoding a heavy chain variable region
comprising the amino acid sequence set forth as any one of SEQ ID
NOs: 161, 162 and 163.
112. The host cell of claim 111, which is a mammalian host
cell.
113. The host cell of claim 112, which is a CHO cell.
114. The host cell of claim 111 comprising the nucleic acid of (a)
and the nucleic acid of (b).
115. The host cell of claim 111 comprising a vector comprising the
nucleic acid of (a) or the nucleic acid of (b).
116. The host cell of claim 114, wherein the vector comprises a
promoter that controls expression of the nucleic acid of (a) or the
nucleic acid of (b).
117. The host cell of claim 1101 comprising a vector comprising the
nucleic acid of (a) and the nucleic acid of (b).
118. The host cell of claim 111 comprising a first vector
comprising the nucleic acid of (a) and a second vector comprising
the nucleic acid of (b).
119. The host cell of claim 117, wherein the vector comprises a
promoter that controls expression of the nucleic acid of (a) and
the nucleic acid of (b).
120. The host cell of claim 117, wherein the vector comprises a
first promoter that controls expression of the nucleic acid of (a)
and a second promoter that controls expression of the nucleic acid
of (b).
121. The host cell of claim 111, wherein the host cell expresses
the light chain variable region set forth as any one of SEQ ID NOs:
155-157.
122. The host cell of claim 111, wherein the host cell expresses
the heavy chain variable region set forth as any one of SEQ ID NOs:
161-163.
123. The host cell of claim 111, wherein the host cell expresses
the light chain variable region set forth as any one of SEQ ID NOs:
155-157 and the heavy chain variable region set forth as any one of
SEQ ID NOs: 161-163.
124. The host cell of claim 111, wherein the host cell expresses an
antibody comprising a light chain variable region comprising an
amino acid sequence set forth as SEQ ID NO: 157.
125. The host cell of claim 111, wherein the host cell expresses an
antibody comprising a heavy chain variable region comprising an
amino acid sequence set forth as SEQ ID NO: 163.
126. The host cell of claim 111, wherein the host cell expresses an
antibody comprising a light chain variable region comprising an
amino acid sequence set forth as SEQ ID NO: 157 and a heavy chain
variable region comprising an amino acid sequence set forth as SEQ
ID NO: 163.
127. The host cell of claim 111, comprising the nucleic acid of (a)
linked to a nucleic acid encoding a human kappa constant region,
and the nucleic acid of (b) linked to a nucleic acid encoding a
human IgG1 constant region.
128. The host cell of claim 127, wherein the host cell expresses an
antibody comprising a light chain variable region comprising an
amino acid sequence set forth as SEQ ID NO: 157 and a heavy chain
variable region comprising an amino acid sequence set forth as SEQ
ID NO: 163.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] This is a continuation of U.S. application Ser. No.
12/811,049, filed on Jun. 10, 2013 and which issued as U.S. Pat.
No. 8,791,243, which is a national stage filing of International
Application No. PCT/US2008/088493 filed Dec. 29, 2008, which claims
priority to U.S. Provisional Application No. 61/095,932, filed Sep.
10, 2008, and to U.S. Provisional Application No. 61/007,544, filed
Dec. 28, 2007, each of which is incorporated herein by reference in
its entirety.
TECHNICAL FIELD
[0002] The invention resides in the technical fields of immunology
and medicine.
BACKGROUND OF THE INVENTION
[0003] Amyloidosis is a general term that describes a number of
diseases characterized by the existence of pathological forms of
amyloid proteins, often involving extracellular deposition of
protein fibrils, which form numerous "amyloid deposits" or "amyloid
plaques," which may occur in local sites or systematically. These
deposits or plaques are composed primarily of a naturally occurring
soluble protein or peptide, assembled into extensive insoluble
deposits 10-100 .mu.m in diameter in a variety of tissue sites. The
deposits are composed of generally lateral aggregates of fibrils
that are approximately 10-15 nm in diameter. Amyloid fibrils
produce a characteristic apple green birefringence in polarized
light, when stained with Congo Red dye. Generally, the fibrillar
composition of these deposits is an identifying characteristic for
the various forms of amyloid disease.
[0004] The peptides or proteins forming the plaque deposits are
often produced from a larger precursor protein. More specifically,
the pathogenesis of amyloid aggregates such as fibril deposits
generally involves proteolytic cleavage of an "abnormal" precursor
protein into fragments that aggregate into anti-parallel f3 pleated
sheets.
[0005] The fibrillar composition of these deposits is an
identifying characteristic for the various forms of amyloid
disease. For example, intracerebral and cerebrovascular deposits
composed primarily of fibrils of beta amyloid peptide (.beta.-AP)
are characteristic of Alzheimer's disease (both familial and
sporadic forms), islet amyloid protein peptide (IAPP; amylin) is
characteristic of the fibrils in pancreatic islet cell amyloid
deposits associated with type II diabetes, and
.beta.2-microglobulin is a major component of amyloid deposits
which form as a consequence of long term hemodialysis treatment.
More recently, prion-associated diseases, such as Creutzfeld-Jacob
disease, have also been recognized as amyloid diseases.
[0006] In general, primary amyloidoses of the disease are
characterized by the presence of "amyloid light chain-type"
(AL-type) protein fibrils, so named for the homology of the
N-terminal region of the AL fibrils to the variable fragment of
immunoglobulin light chain (kappa or lambda).
[0007] The various forms of disease have been divided into classes,
mostly on the basis of whether the amyloidosis is associated with
an underlying systematic illness. Thus, certain disorders are
considered to be primary amyloidoses, in which there is no evidence
for preexisting or coexisiting disease. In secondary or reactive
(AA type) amyloidosis characterized by the presence deposition of
amyloid protein A (AA) fibrils, there is an underlying or
associated chronic inflammatory or infectious disease state.
[0008] Heredofamilial amyloidoses may have associated neuropathic,
renal, or cardiovascular deposits of the ATTR transthyretin type.
Other heredofamilial amyloidoses include other syndromes and may
have different amyloid components (e.g., familial Mediterranean
fever which is characterized by AA fibrils). Other forms of
amyloidosis include local forms, characterized by focal, often
tumor-like deposits that occur in isolated organs. Other
amyloidoses are associated with aging, and are commonly
characterized by plaque formation in the heart or brain. Also
common are amyloid deposits associated with long term hemodialysis.
These and other forms of amyloid disease are summarized in Table 1
(Tan, S. Y. and Pepys, Histopathology 25:403-414, 1994; Harrison's
Handbook of Internal Medicine, 13.sup.th Ed., Isselbacher, K. J.,
et al, eds, McGraw-Hill, San Francisco, 1995) and are described in
U.S. Pat. Nos. 6,875,434, 6,890,535, 6,913,745, 6,923,964, and
6,936,246, which are incorporated by reference herein in their
entirety.
TABLE-US-00001 TABLE 1 Classification of Amyloid Diseases Amyloid
Protein/ Protein Protein Peptide Precursor Variants Clinical AA
Serum Amyloid A Reactive (secondary) Protein (ApoSSA) Amyloidosis:
Familial Mediterranean fever Familial amyloid nephropathy with
urticaria and deafness (Muckle- Wells syndrome) AA Serum amyloid A
Reactive systemic protein amyloidosis associated (ApoSSA) with
systemic inflammatory diseases AL Monoclonal Ak, A, Idiopathic
(primary) immunoglobulin light (e.g., Amyloidosis: myeloma or
chains (kappa, lambda) AkIII) macroglobulinemia- associated;
systemic amyloidosis associated with immunocyte dyscrasia;
monoclonal gammopathy; occult dyscrasia; local nodular amyloidosis
associated with chronic inflammatory diseases AH IgG (1(.gamma.1))
A.gamma.l Heavy chain amyloidosis associated with several
immunocyte dyscrasias ATTR Transthyretin (TTR) At least 30 Familial
amyloid known polyneuropathy point (e.g., Met 30, mutations
Portuguese) ATTR Transthyretin (TTR) e.g., Familial amyloid Met 111
cardiomyopathy (Danish) ATTR Transthyretin (TTR) Wild- Systemic
senile type TTR amyloidosis or Ile 122 AapoAI ApoAI Arg 26 Familial
amyloid polyneuropathy Agel Gelsolin Asn 187 Familial amyloidosis
(Finnish) Acys Cystatin C Gln 68 Hereditary cerebral hemorrhage
with amyloidosis (Icelandic) A.beta. Amyloid .beta. protein
Various: Alzheimer`s disease precursor (e.g. .beta.- Gln 618,
Down`s syndrome APP.sub.695) Hereditary cerebral hemorrhage
amyloidosis (Dutch) Sporadic cerebral amyloid angiopathy Inclusion
body myositis AB.sub.2M Beta.sub.2 microglobulin Associated with
chronic hemodialysis Acal (Pro)calcitonin (Pro) Medullary carcinoma
of calcitonin thyroid AANF Atrial natriuretic factor Focal Senile
Amyloidoses: A.beta. .beta.-amyloid precursor Isolated atrial
amyloid protein Brain SVEP.sup.a -- Seminal vesicles AB.sub.2M
Beta.sub.2 microglobulin Prostate Keratin Primary localized
cutaneous amyloid (macular, papular) PrP Prion precursor protein
Scrapie Sporadic Creutzfeldt-Jacob (33-35 kDa cellular protein
Disease form) 27-30 kDa Kuru (transmissible spongiform
encephalopathies, prion diseases) AIAPP Islet amyloid Islets of
Langerhans polypeptide (IAPP) Diabetes type II, Insulinoma Peptide
e.g., precalcitonin Exocrine amyloidosis, hormones, associated with
fragments APUDomas .sup.aSeminal vesicle exocrine protein
[0009] Often, fibrils forming the bulk of an amyloid deposit are
derived from one or more primary precursor proteins or peptides,
and are usually associated with sulfated glycosaminoglycans. In
addition, amyloid deposits may include minor proteins and peptides
of various types, along with other components, such as
proteoglycans, gangliosides and other sugars, as described in more
detail in the sections that follow.
[0010] AA fibrils are composed of peptide fragments that range in
size but are generally about 8000 daltons (AA peptide or protein)
formed by proteolytic cleavage of serum amyloid A protein (SSA), a
circulating apolipoprotein which is present in HDL particles and
which is synthesized in hepatocytes in response to such cytokines
as interleukin (IL)-1 and IL-6, as well as tumor necrosis factor
.alpha.. See Husby, G. et al. Amyloid 1, 119-137 (1994). The
proteolytic cleavage results in the pathologic deposition of an
.about.76-residue N-terminal two thirds of the SAA protein. In
humans, the plasma concentration of SAA normally is .about.0.1
mg/ml but can increase over 1,000-fold in response to an
inflammatory stimulus. As part of this process, the SAA molecule
undergoes proteolysis and the N-terminal cleavage product is
deposited systemically as AA fibrils in vital organs, including the
liver, spleen, kidneys, and adrenal glands. Deposition is also
common in the heart and gastrointestinal tract.
[0011] Generally, AA amyloidosis is a manifestation of diseases
that provoke a sustained acute phase response. Such diseases
include chronic inflammatory disorders, chronic local or systemic
microbial infections, and malignant neoplasms. AA amyloid diseases
include, but are not limited to inflammatory diseases, such as
rheumatoid arthritis, juvenile chronic arthritis, ankylosing
spondylitis, psoriasis, psoriatic arthropathy, Reiter's syndrome,
Adult Still's disease, Behcet's syndrome, and Crohn's disease. AA
deposits are also produced as a result of chronic microbial
infections, such as leprosy, tuberculosis, bronchiectasis,
decubitus ulcers, chronic pyelonephritis, osteomyelitis, and
Whipple's disease. Certain malignant neoplasms can also result in
AA fibril amyloid deposits. These include such conditions such as
Hodgkin's lymphoma, renal carcinoma, carcinomas of gut, lung and
urogenital tract, basal cell carcinoma, and hairy cell leukemia. AA
amyloid disease may also result from inherited inflammatory
diseases such as Familial Mediterranean Fever. Additionally, AA
amyloid disease may result from lymphoproliferative disorders such
as Castleman's Disease.
[0012] AA Amyloidosis is insidious and progressive. Symptoms are
generally presented in later stages of the disease. Frequently the
patient is undiagnosed until significant organ damage has occurred.
AA fibrils are deposited in vital organs leading to organ
dysfunction and subsequently to death. The five year survival rate
is 45-50%. Median survival after diagnosis is 4-8 years. End stage
Renal Disease is the cause of death in 40-60% of cases. See
Gillmore J. D. et al., Lancet 358:24-9 (2001).
[0013] Currently, there are no approved specific, amyloid-directed
treatments for any of the amyloid diseases, including AA
Amyloidosis. See Gillmore J. D. et al., Lancet 358:24-9 (2001).
Where there is an underlying or associated disease state, therapy
directed towards decreasing the production of amyloidogenic protein
by treating the underlying disease. For example, current treatment
strategy for AA Amyloidosis is to target underlying inflammation,
reducing ApoSSA levels to below 10 mg/l. Currently employed
therapies include chemotherapy (cholorambucil and MTX),
immuno-suppressants (azathioprine), anti-inflammatory drugs
(colchicine) and TNF inhibitors. The invention thus fulfills a
longstanding need for therapeutic regimes for preventing or
ameliorating the effects of AA Amyloidosis.
SUMMARY OF THE INVENTION
[0014] The present invention provides an isolated human, humanized,
or chimeric antibody, or antigen-binding fragment thereof, that
specifically binds to an epitope within residues 70-76 of human
amyloid A peptide, for example, an epitope within residues 70-76 of
SEQ ID NO: 2 or an epitope comprising residues set forth as SEQ ID
NOs: 4, 5, 6, 7, 8, 9, 10, or 11. Antibodies or antigen-binding
fragments of the invention include those that compete for binding
to human amyloid A peptide with antibody 2A4 produced by ATCC
Accession Number PTA-9662 or with antibody 7D8 produced by ATCC
Accession Number PTA-9468. Additional antibodies of the invention
compete for binding to human amyloid A peptide with an antibody
having a light chain variable region set forth as residues 20-131
of SEQ ID NO: 152 or residues 20-131 of 153 and a heavy chain
variable region set forth as residues 20-138 of SEQ ID NO: 154.
[0015] The disclosed antibodies include humanized and chimeric
versions of antibody 2A4 produced by ATCC Accession Number PTA-9662
or a humanized or chimeric version of antibody 7D8 produced by ATCC
Accession Number PTA-9468.
[0016] For example, representative antibodies and antigen-binding
fragments comprise a light chain variable region comprising one or
more complementarity regions of a 2A4 light chain variable region
set forth as residues 20-131 of SEQ ID NO: 152 or one or more
complementarity regions of a 7D8 light chain variable region set
forth as residues 20-131 of SEQ ID NO: 153. As another example,
representative antibodies and antigen-binding fragments comprise a
light chain variable region comprising two complementarity regions
of a 2A4 light chain variable region set forth as residues 20-131
of SEQ ID NO: 152 or two complementarity regions of a 7D8 light
chain variable region set forth as residues 20-131 of SEQ ID NO:
153. Additional representative antibodies and antigen-binding
fragments comprise a light chain variable region comprising three
complementarity regions of a 2A4 light chain variable region set
forth as residues 20-131 of SEQ ID NO: 152 or three complementarity
regions of a 7D8 light chain variable region set forth as residues
20-131 of SEQ ID NO: 153. Representative humanized versions of a
2A4 or 7D8 antibody comprise at least one light chain framework
residue selected from the group consisting of L87 and L90 (Kabat
numbering convention), which is occupied by Y and F, respectively,
and wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region. Representative
antibodies and antigen-binding fragments comprise at least one
light chain framework residue selected from the group consisting of
+7, +14, +15, +17, +18, +50, +75, +88, +92, and +109 (linear
numbering), which is occupied by T, S, L, D, Q, K, Y, L, F, and L,
respectively, and wherein the remainder of the light chain variable
region is occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region. For example,
representative antibodies and antigen-binding fragments comprise at
least one light chain framework residue selected from the group
consisting of +75 and +92 (linear numbering), which is occupied by
Y and F, respectively, and wherein the remainder of the light chain
variable region is occupied by a corresponding residue in a human
acceptor immunoglobulin light chain variable region. In other
representative antibodies and antigen-binding fragments of the
invention, the light chain variable region comprises a framework
residue at +105 (linear numbering) occupied by Q.
[0017] For example, antibodies and antigen-binding fragments of the
invention include those comprising a light chain variable region
comprising a framework residue at +7 (linear numbering) occupied by
T, wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +14 (linear numbering) occupied by S,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +15 (linear numbering) occupied by L,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +17 (linear numbering) occupied by D,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +18 (linear numbering) occupied by Q,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +50 (linear numbering) occupied by K,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +75 (linear numbering) occupied by Y,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +88 (linear numbering) occupied by L,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +92 (linear numbering) occupied by F,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +109 (linear numbering) occupied by L,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region; and antibodies and
antigen-binding fragments a light chain variable region comprising
a framework residue at +105 (linear numbering) occupied by Q,
wherein the remainder of the light chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin light chain variable region.
[0018] Human acceptor immunoglobulin light chain variable regions
used in the invention include human kappa subgroup 2 light chain
variable region (Kabat convention), for example, human subgroup 2
light chain variable region from human germline VKIIA19/A3, such as
human Vk light chain variable region comprising a sequence set
forth as SEQ ID NO: 166 or 167. In particular aspects of the
invention, antibodies and antigen-binding fragments comprise a
light chain variable region comprising an amino acid sequence set
forth as residues 20-131 of SEQ ID NO: 152, residues 20-131 of SEQ
ID NO: 153, or set forth as SEQ ID NO: 155, 156, 157, 158, 159,
160, 174, 175, or 176.
[0019] Representative antibodies and antigen-binding fragments of
the invention also include those comprising a heavy chain variable
region comprising one or more complementarity regions of a 2A4
heavy chain variable region set forth as residues 20-138 of SEQ ID
NO: 154, for example, a heavy chain variable region comprising two
complementarity regions of a 2A4 heavy chain variable region set
forth as residues 20-138 of SEQ ID NO: 154, or a heavy chain
variable region comprising three complementarity regions of a 2A4
heavy chain variable region set forth as residues 20-138 of SEQ ID
NO: 154. Representative humanized 2A4 and 7D8 antibodies and
antigen-binding fragments comprise at least one heavy chain
framework residue selected from the group consisting of H37, H49,
H70, and H93 (Kabat numbering convention), which is occupied by I,
A, F, or V, respectively, and wherein the remainder of the heavy
chain variable region is occupied by a corresponding residue in a
human acceptor immunoglobulin heavy chain variable region.
Representative humanized antibodies and antigen-binding fragments
comprise at least one heavy chain framework residue selected from
the group consisting of +10, +15, +19, +37, +49, +73, +78, +79,
+80, +87, +95, +99, +119 (linear numbering), which is occupied by
R, K, K, I, A, F, Q, S, M, N, M, V, or A, respectively, and wherein
the remainder of the heavy chain variable region is occupied by a
corresponding residue in a human acceptor immunoglobulin heavy
chain variable region. For example, representative humanized
antibodies and antigen-binding fragments comprise at least one
heavy chain framework residue selected from the group consisting of
+37, +49, +73, and +99 (linear numbering), which is occupied by I,
A, F, or V, respectively, and wherein the remainder of the heavy
chain variable region is occupied by a corresponding residue in a
human acceptor immunoglobulin heavy chain variable region.
[0020] For example, antibodies and antigen-binding fragments of the
invention include those comprising a heavy chain variable region
comprising a framework residue at +10 (linear numbering) occupied
by R, wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +15 (linear numbering) occupied by K,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +19 (linear numbering) occupied by K,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +37 (linear numbering) occupied by I,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +49 (linear numbering) occupied by A,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +73 (linear numbering) occupied by F,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +78 (linear numbering) occupied by Q,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +79 (linear numbering) occupied by S,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +80 (linear numbering) occupied by M,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +87 (linear numbering) occupied by N,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +95 (linear numbering) occupied by M,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +99 (linear numbering) occupied by V,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region; and antibodies and
antigen-binding fragments a heavy chain variable region comprising
a framework residue at +109 (linear numbering) occupied by A,
wherein the remainder of the heavy chain variable region is
occupied by a corresponding residue in a human acceptor
immunoglobulin heavy chain variable region.
[0021] Human acceptor immunoglobulin heavy chain variable regions
include a human gamma subgroup 3 heavy chain variable region (Kabat
convention), for example, human gamma subgroup 3 heavy chain
variable region comprising a sequence set forth as SEQ ID NO: 165,
such as a heavy chain variable region comprising an amino acid
sequence set forth as residues 20-138 of SEQ ID NO: 154 or set
forth as SEQ ID NO: 161, 162, or 163.
[0022] Additional representative antibodies and antigen-binding
fragments comprise a light chain variable region comprising three
complementarity determining regions of a 2A4 light chain variable
region set forth as residues 20-131 of SEQ ID NO: 152 or three
complementarity regions of a 7D8 light chain variable region set
forth as residues 20-131 of SEQ ID NO: 153, and a heavy chain
variable region comprising three complementarity regions of a 2A4
heavy chain variable region set forth as residues 20-138 of SEQ ID
NO: 154. For example, such antibodies and antigen-binding fragments
include those having a light chain variable region comprising three
complementarity determining regions set forth as SEQ ID NOs: 168,
169, and 170, and a heavy chain variable region comprising three
complementarity regions set forth as SEQ ID NOs: 171, 172, and 173.
As another example, such antibodies and antigen-binding fragments
include those having a light chain variable region comprising three
complementarity determining regions set forth as SEQ ID NOs: 177,
169, and 170, and a heavy chain variable region comprising three
complementarity regions set forth as SEQ ID NOs: 171, 172, and 173.
As another example, such antibodies and antigen-binding fragments
include those comprising a light chain variable region comprising
an amino acid sequence set forth as residues 20-131 of SEQ ID NO:
152 or as residues 20-131 of SEQ ID NO: 153, and a heavy chain
variable region comprising an amino acid sequence set forth as
residues 20-138 of SEQ ID NO: 154. As another example, such
antibodies and antigen-binding fragments include those having a
light chain variable region comprising an amino acid sequence set
forth as SEQ ID NO: 155, 156, 157, 158, 159, 160, 174, 175, or 176,
and a heavy chain variable region comprising an amino acid sequence
set forth as SEQ ID NO: 161, 162, or 163.
[0023] In particular aspects of the invention, an antibody or
antigen-binding fragment comprises a light chain variable region
comprising an amino acid sequence set forth as SEQ ID NO: 155, and
a heavy chain variable region comprising an amino acid sequence set
forth as SEQ ID NO: 161; a light chain variable region comprising
an amino acid sequence set forth as SEQ ID NO: 155, and a heavy
chain variable region comprising an amino acid sequence set forth
as SEQ ID NO: 162; a light chain variable region comprising an
amino acid sequence set forth as SEQ ID NO: 155, and a heavy chain
variable region comprising an amino acid sequence set forth as SEQ
ID NO: 163; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 156, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
161; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 156, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
162; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 156, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
163; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 157, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
161; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 157, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
162; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 157, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
163; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 158, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
161; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 158, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
162; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 158, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
163; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 159, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
161; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 159, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
162; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 159, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
163; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 160, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
161; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 160, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
162; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 160, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
163; SEQ ID NO: 174, and a heavy chain variable region comprising
an amino acid sequence set forth as SEQ ID NO: 161; a light chain
variable region comprising an amino acid sequence set forth as SEQ
ID NO: 174, and a heavy chain variable region comprising an amino
acid sequence set forth as SEQ ID NO: 162; a light chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
174, and a heavy chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 163; a light chain variable region
comprising an amino acid sequence set forth as SEQ ID NO: 175, and
a heavy chain variable region comprising an amino acid sequence set
forth as SEQ ID NO: 161; a light chain variable region comprising
an amino acid sequence set forth as SEQ ID NO: 175, and a heavy
chain variable region comprising an amino acid sequence set forth
as SEQ ID NO: 162; a light chain variable region comprising an
amino acid sequence set forth as SEQ ID NO: 175, and a heavy chain
variable region comprising an amino acid sequence set forth as SEQ
ID NO: 163; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 176, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
161; a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 176, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
162; or a light chain variable region comprising an amino acid
sequence set forth as SEQ ID NO: 176, and a heavy chain variable
region comprising an amino acid sequence set forth as SEQ ID NO:
163.
[0024] Also provided are isolated nucleic acids encoding a human,
humanized, or chimeric antibody, or antigen-binding fragment
thereof, that specifically binds to an epitope within residues
70-76 of human amyloid A peptide, including all such antibodies and
antigen-binding fragments as described herein above and as set
forth in the claims. Further provided are cells expressing such
nucleic acids.
[0025] In other aspects, the present invention provides an isolated
antibody, or antigen-binding fragment thereof, which specifically
binds to an epitope comprising X.sub.1EDX.sub.2 in an aggregated
amyloid protein, wherein X.sub.1 and X.sub.2 are any amino acid.
Such antibodies and antigen-binding fragments include human,
humanized, or chimeric antibodies, and antigen-binding fragments
thereof, for example, those that specifically bind to an epitope
within residues 70-76 of human amyloid A peptide.
[0026] Additional representative antibodies and antigen-binding
fragments include those wherein X.sub.1 is H, T, F, S, P, A, L, C,
Q, R, E, K, D, G, V, Y, I, or W, and wherein X.sub.2 is T, S, E, R,
I, V, F, D, A, G, M, L, N, P, C, K, Y, or Q; or X.sub.1 is H, T, F,
S, P, or A and wherein X.sub.2 is T, S, E, R, I, V, F, D, or A; or
X.sub.1 is H, T, F, or A; or X.sub.2 is T, S, E, D, or A; or
X.sub.1 is H, T, F, or A and X.sub.2 is T, S, E, D, or A; or
X.sub.1 is H, T, or A and X.sub.2 is T, S, E, or A; or X.sub.1 is H
or A and X.sub.2 is T, S, or A; or X.sub.1 is H and X.sub.2 is T or
A; or X.sub.1 is A and X.sub.2 is S, T, E or V; or X.sub.1 is A and
X.sub.2 is S, T or E; or X.sub.1 is T and X.sub.2 is E; or X.sub.1
is F and X.sub.2 is D; or X.sub.1 is S and X.sub.2 is E, F or A; or
X.sub.1 is P and X.sub.2 is E, I or F. For example, such antibodies
and antigen-binding fragments bind an epitope consisting of an
amino acid sequence selected from the group consisting of GHEDT
(SEQ ID NO: 3), HEDT (SEQ ID NO: 12), AEDS (SEQ ID NO: 13), AEDT
(SEQ ID NO: 14), HEDA (SEQ ID NO: 15), TEDE (SEQ ID NO: 16), FEDD
(SEQ ID NO: 17), SEDE (SEQ ID NO: 18), AEDE (SEQ ID NO: 19), PEDE
(SEQ ID NO: 20), PEDI (SEQ ID NO: 21), PEDF (SEQ ID NO: 22), AEDV
(SEQ ID NO: 23), SEDF (SEQ ID NO: 24), and SEDA (SEQ ID NO: 25); or
an epitope consisting of an amino acid sequence selected from the
group consisting of GHEDT (SEQ ID NO: 3), HEDT (SEQ ID NO: 12),
AEDS (SEQ ID NO: 13), AEDT (SEQ ID NO: 14), HEDA (SEQ ID NO: 15),
TEDE (SEQ ID NO: 16), FEDD (SEQ ID NO: 17), SEDE (SEQ ID NO: 18),
AEDE (SEQ ID NO: 19), PEDE (SEQ ID NO: 20), PEDI (SEQ ID NO: 21),
PEDF (SEQ ID NO: 22), SEDF (SEQ ID NO: 24), and SEDA (SEQ ID NO:
25); or an epitope consisting of an amino acid sequence selected
from the group consisting of GHEDT (SEQ ID NO: 3), HEDT (SEQ ID NO:
12), AEDS (SEQ ID NO: 13), AEDT (SEQ ID NO: 14), HEDA (SEQ ID NO:
15), and TEDE (SEQ ID NO: 16). The disclosed epitopes may be found
in an aggregated amyloid protein, for example, an epitope
comprising an amino acid sequence selected from the group
consisting of GHGAEDS (SEQ ID NO: 4), GHDAEDS (SEQ ID NO: 5),
GDHAEDS (SEQ ID NO: 7), STVIEDS (SEQ ID NO: 8), and GRGHEDT (SEQ ID
NO: 9); or an epitope comprising an amino acid sequence GHGAEDS
(SEQ ID NO:4); or an epitope comprising amino acids HEDT (SEQ ID
NO: 12); or an epitope comprising amino acids HEDA (SEQ ID NO: 15);
or an epitope comprising amino acids AEDS (SEQ ID NO: 13) or an
epitope comprising amino acids AEDT (SEQ ID NO: 14); or an epitope
comprising amino acids TEDE (SEQ ID NO: 16); or an epitope
comprising the amino acid sequence AEDV (SEQ ID NO: 23); or an
epitope comprising the amino acid sequence SEDF (SEQ ID NO: 24) or
PEDF (SEQ ID NO: 22); or an epitope of comprising an amino sequence
selected from the group consisting of PEDS (SEQ ID NO: 26), PEDL
(SEQ ID NO: 27), TEDV (SEQ ID NO: 28), AEDE (SEQ ID NO: 19), SEDI
(SEQ ID NO: 29) and TEDT (SEQ ID NO: 30); or an epitope comprising
an amino sequence selected from the group consisting of LEDG (SEQ
ID NO: 31), AEDM (SEQ ID NO: 32), HEDS (SEQ ID NO: 33), CEDD (SEQ
ID NO: 34), QEDS (SEQ ID NO: 35), REDS (SEQ ID NO: 36), TEDG (SEQ
ID NO: 16), QEDR (SEQ ID NO: 38), TEDL (SEQ ID NO: 39), PEDN (SEQ
ID NO: 40), EEDP (SEQ ID NO: 41), LEDL (SEQ ID NO: 42), KEDA (SEQ
ID NO: 43), SEDC (SEQ ID NO: 44), EEDD (SEQ ID NO: 45), SEDK (SEQ
ID NO: 46), DEDD (SEQ ID NO: 47), DEDG (SEQ ID NO: 13), LEDE (SEQ
ID NO: 49), GEDA (SEQ ID NO: 13), VEDF (SEQ ID NO: 51), YEDE (SEQ
ID NO: 52), IEDL (SEQ ID NO: 53), WEDY (SEQ ID NO: 54), DEDW (SEQ
ID NO: 55), SEDL (SEQ ID NO: 56), YEDQ (SEQ ID NO: 57), LEDW (SEQ
ID NO: 58), YEDR (SEQ ID NO: 59) and PEDK (SEQ ID NO: 60).
[0027] The antibodies and antigen-binding fragments described
herein include those that bind to the amyloid protein in monomeric
form with an affinity of less than about 10.sup.7 M.sup.-1.
Representative amyloid proteins include serum amyloid A protein
(SAA), immunoglobulin light chain protein (such as V.lamda.6 Wil
and V.kappa.), human islet amyloid precursor polypeptide (IAPP),
beta amyloid peptide, transthyretin (TTR), and ApoA1.
[0028] Also provided are isolated nucleic acids encoding an
antibody, or antigen-binding fragment thereof, which specifically
binds to an epitope comprising X.sub.1EDX.sub.2 in an aggregated
amyloid protein, wherein X.sub.1 and X.sub.2 are any amino acid,
including all such antibodies and antigen-binding fragments as
described herein above and as set forth in the claims. Further
provided are cells expressing such nucleic acids.
[0029] The present invention further provides methods of
therapeutically treating or prophylactically treating a subject
having AA amyloidosis using a human, humanized, or chimeric
antibody, or antigen-binding fragment thereof, that specifically
binds to an epitope within residues 70-76 of human amyloid A
peptide, for example, an epitope within residues 70-76 of SEQ ID
NO: 2. Subjects that may benefit from the disclosed therapeutic
methods of treating AA amyloidosis include those subjects suffering
from an amyloid disease selected from the group consisting of
rheumatoid arthritis, juvenile chronic arthritis, ankylosing
spondylitis, psoriasis, psoriatic arthropathy, Reiter's syndrome,
Adult Still's disease, Behcet's syndrome, Crohn's disease, leprosy,
tuberculosis, bronchiectasis, decubitus ulcers, chronic
pyelonephritis, osteomyelitis, Whipple's disease, Hodgkin's
lymphoma, renal carcinoma, carcinomas of gut, lung and urogenital
tract, basal cell carcinoma, hairy cell leukemia, Familial
Mediterranean Fever, and Castleman's Disease. Subjects that may
benefit from the disclosed prophylactic methods include those
subjects susceptible to or at risk of developing any of the
foregoing disorders.
[0030] Also provided are methods of therapeutically treating or
prophylactically treating a subject having amyloidosis associated
with an aggregated amyloid protein comprising the amino acid
sequence ED using an antibody or antigen-binding fragment that
specifically binds to an epitope comprising X.sub.1EDX.sub.2 in an
aggregated amyloid protein, wherein X.sub.1 and X.sub.2 are any
amino acid. Subjects that may benefit from the disclosed
therapeutic methods of treating amyloidosis associated with an
aggregated amyloid protein include those subjects suffering from AA
amyloidosis, AL amyloidosis, Alzheimer's disease, Mild Cognitive
Impairment, amyloid polyneuropathy, Mediterranean fever,
Muckle-Wells syndrome, reactive systemic amyloidosis associated
with systemic inflammatory diseases, myeloma or macroglobulinemia
associated amyloidosis, amyloidosis associated with immunocyte
dyscrasia, monoclonal gammopathy, occult dyscrasia, and local
nodular amyloidosis associated with chronic inflammatory diseases.
Subjects that may benefit from the disclosed prophylactic methods
include those subjects susceptible to or at risk of developing any
of the foregoing disorders. In one aspect of the invention, the
amyloid protein comprises the sequence AEDV (SEQ ID NO: 23), and
the amyloidogenic disease treated therapeutically or
prophylactically using the disclosed methods is AA amyloidosis, AL
amyloidosis, amyloid polyneuropathy, Mediterranean fever,
Muckle-Wells syndrome, reactive systemic amyloidosis associated
with systemic inflammatory diseases, myeloma or macroglobulinemia
associated amyloidosis, amyloidosis associated with immunocyte
dyscrasia, monoclonal gammopathy, occult dyscrasia, and local
nodular amyloidosis associated with chronic inflammatory
diseases.
[0031] The disclosed therapeutic and prophylactic methods are
useful for treating human subjects.
[0032] Representative indices of efficacious therapeutic treatment
include slowing the progression of amyloidosis, inhibiting
deposition of amyloid fibril aggregates, and/or clearing of amyloid
fibril aggregates. Representative indices of efficacious
prophylactic treatment include delaying onset of amyloidosis and/or
reducing a risk of amyloidosis.
[0033] Still further provided are methods of detecting an amyloid
deposit associated with AA amyloidosis in a subject human,
humanized, or chimeric antibody, or antigen-binding fragment
thereof, that specifically binds to an epitope within residues
70-76 of human amyloid A peptide, which antibody or antigen-binding
fragment is bound to a detectable label, and then detecting the
detectable label in the subject. Additional methods comprise
detecting an aggregated amyloid protein comprising the amino acid
sequence ED using an antibody or antigen-binding fragment that
specifically binds to an epitope comprising X.sub.1EDX.sub.2 in an
aggregated amyloid protein, wherein X.sub.1 and X.sub.2 are any
amino acid. The foregoing detection methods may be used, for
example, for monitoring onset or progression of disease or therapy
in any of the above-noted diseases and disorders. As for the
treatment methods disclosed herein, such monitoring may be
performed in humans as well as non-human subjects. Useful
detectable labels include radiolabels, such as .sup.125I. In
performing such detection methods, the step of detecting the
detectable label may be accomplished by non-invasive techniques,
such as SPECT/CT imaging and NMR spectroscopy.
[0034] Still further provided are methods of active immunotherapy
of a subject having AA amyloidosis using an agent that induces an
immune response to residues 70-76 of amyloid A peptide effective to
induce an immune response comprising antibodies against residues
70-76 of an amyloid A peptide. Representative agents for inducing
the immune response include residues 70-76 of amyloid A peptide or
a subfragment of at least 3 contiguous residues thereof having
fewer than 20 contiguous amino acids from an AA peptide. These
methods are useful both therapeutically and/or prophylactically for
treatment of the subjects described herein above with respect to
passive immunotherapy, i.e., by administering an antibody or
antigen-binding fragment that specifically binds to residues 70-76
of amyloid A peptide. Indices of therapeutic and prophylactic
efficacy are also as noted herein above with respect to passive
immunotherapy.
[0035] The foregoing summarizes particular aspects of the
invention, and additional aspects of the invention are described
herein.
BRIEF DESCRIPTION OF THE DRAWINGS
[0036] FIG. 1: Sequence alignment of human SAA1, human SAA2, human
SAA3 and human SAA4.
[0037] FIG. 2: Sequence alignment of human SAA1 and human AA1.
[0038] FIG. 3: Sequence alignment of human SAA2 and human AA2.
[0039] FIG. 4: Sequence alignment of human SAA3 and human AA3.
[0040] FIG. 5: Sequence alignment of human SAA4 and human AA4.
[0041] FIG. 6: Sequence alignment of human AA1, human AA2, human
AA3 and human AA4.
[0042] FIG. 7: Sequence alignment of the last seven residues of
human AA1, human AA2, human AA3 and human AA4.
[0043] FIG. 8: Sequence alignment of mouse SAA1, mouse SAA2, mouse
SAA3 and mouse SAA4.
[0044] FIG. 9: Sequence alignment of mouse SAA1 and mouse AA1.
[0045] FIG. 10: Sequence alignment of mouse SAA2 and mouse AA2.
[0046] FIG. 11: Sequence alignment of mouse SAA3 and mouse AA3.
[0047] FIG. 12: Sequence alignment of mouse SAA4 and mMouse
AA4.
[0048] FIG. 13: Sequence alignment of mouse AA1, mouse AA2, mouse
AA3 mouse AA4.
[0049] FIG. 14: Sequence alignment of the last seven residues of
mouse AA1, mouse AA2, mouse AA3 mouse AA4.
[0050] FIG. 15: Sequence alignment of human SAA1 and mouse
SAA1.
[0051] FIG. 16: Sequence alignment of human AA1 and mouse AA1.
[0052] FIG. 17: Sequence alignment of human SAA1 and mouse SAA1
Fragment.
[0053] FIG. 18: Sequence alignment of human SAA1 alpha, human SAA1
beta, and human SAA1 gamma.
[0054] FIG. 19: Sequence alignment of human SAA2 alpha and human
SAA2 beta.
[0055] FIG. 20: Sequence comparison of SAA proteins. The peptide
region used to generate 2A4, 8G9 and 7D8 is shown in dashed lines.
The 8 amino acid insert between positions 67 and 68 in the Shar Pei
sequence is indicated by the underline and arrow. Alignment
performed with CLUSTALW.
[0056] FIG. 21: Germline sequences of V.kappa. light chains.
[0057] FIG. 22: Germline sequences of V.lamda. light chains.
[0058] FIG. 23: Amino acid sequence of V.lamda.6 Wil.
[0059] FIG. 24: X-ray crystal of V.lamda.6 Wil showing position of
Glu50-Asp51.
[0060] FIG. 25: X-ray crystal of V.lamda.6 Wil showing position of
Glu81-Asp82
[0061] FIG. 26: Binding kinetics of Elan mAbs to synthetic
V.lamda.6 Wil fibrils. BIAcore measurements of the interaction of
mAbs 2A4, 7D8 and 8G9 at 6.6 nM to immobilized V.lamda.6 Wil
fibrils. The calculated KD for each interaction was .about.1
nM.
[0062] FIG. 27: Concentration-dependent binding kinetics of mAb 7D8
to synthetic V.lamda.6 Wil fibrils. The antibody interaction at a
concentration of 6.6-33.3 nM to immobilized V.lamda.6 Wil fibrils
was measured by BIAcore.
[0063] FIG. 28: Binding kinetics of mAb 7D8 to synthetic
V.sub..lamda.6 Wil fibrils in the presence of the p39 and p41
peptides. The interaction of the mAb 7D8 at 6.6 nM with immobilized
V.sub..lamda.6 Will fibrils was measured by BIAcore in the presence
of peptides p39 and p41 at 1 or 20 .mu.g/mL.
[0064] FIG. 29: Reactivity of monoclonal antibodies with AL.lamda.
tissue amyloid deposits.
[0065] FIG. 30: Biodistribution of .sup.125I-labeled mAb 7D8 in
mice bearing a human AL.lamda. amyloidoma.
[0066] FIG. 31: Interaction of anti-AA of culture supernatants with
murine-derived AA fibrils. Results of mAb culture supernatants
binding murine AA AEF. Upper and lower panels are data on first and
second culture fluid harvest, respectively.
[0067] FIG. 32: SDS-PAGE analysis of protein A-purified 2A4, 8G9
and 7D8 mAbs.
[0068] FIG. 33: Binding of purified mAbs to immunizing (p#39) and
control peptide (p#41).
[0069] FIG. 34: Binding to murine AA amyloid extract (AEF).
[0070] FIG. 35: Binding of purified mAbs to human renal AA amyloid
extract.
[0071] FIGS. 36A-36E: Sequences of murine 2A4, 7D8, and 8G9 light
chain and heavy chain variable regions (FIG. 36A); sequences of
humanized 2A4/8G9 and 7D8 light chain variable regions (FIGS.
36B-36C); sequences of human light chain variable regions used as
acceptor frameworks (FIG. 36D); sequences of humanized 2A4/7D8/8G9
heavy chain variable regions and human heavy chain variable region
used as acceptor framework (FIG. 36E). Underlining, CDRs; double
underlining, leader sequences; lower case, back mutations.
DETAILED DESCRIPTION OF THE INVENTION
[0072] The invention provides an isolated antibody or
antigen-binding fragment thereof, which specifically binds to an
epitope including X.sub.1EDX.sub.2 in an aggregated amyloid
protein, wherein X.sub.1 and X.sub.2 are any amino acid.
[0073] Representative antibodies of the invention also include
antibodies or fragments thereof that (a) compete for binding to an
epitope including X.sub.1EDX.sub.2 with a 2A4, 7D8, or 8G9
antibody; (b) bind to the same epitope including X.sub.1EDX.sub.2
as a 2A4, 7D8, or 8G9 antibody; (c) include an antigen binding
domain of a 2A4, 7D8, or 8G9 antibody; or (d) include the six
complementarity determining regions (CDRs) of a 2A4, 7D8, or 8G9
antibody.
[0074] The invention also provides an isolated antibody variable
region including (a) a light chain variable region of an antibody
derived from a 2A4, 7D8, or 8G9 antibody; or (b) a heavy chain
variable region of an antibody derived from a 2A4, 7D8, or 8G9
antibody.
[0075] The invention also provides an isolated nucleic acid
encoding an antibody light chain variable region or heavy chain
variable region including (a) a nucleotide sequence that encodes a
light chain or heavy chain variable region of a 7D8, 2A4, or 8G9
antibody; (b) a nucleotide sequence that is identical to a
nucleotide sequence of a 7D8, a 2A4, or an 8G9 antibody that
encodes a light chain or heavy chain variable region; (c) a
nucleotide sequence that is substantially identical to a nucleotide
sequence of (a) or (b); or (d) a nucleic acid that specifically
hybridizes to a nucleic acid having a nucleotide sequence that is
the complement of a nucleotide sequence of (a) or (b) under
stringent hybridization conditions.
[0076] Cells expressing the antibodies and antigen-binding
fragments of the present invention are also provided. The invention
further provides cells expressing nucleic acids of the
invention.
[0077] The invention also includes methods of treating amyloid
diseases and methods of prophylaxis of amyloid diseases using the
antibodies and antigen-binding fragments of the invention.
Currently, there are no approved specific amyloid-directed
treatments for any of the amyloid diseases, including AA
Amyloidosis and AL amyloidosis. See Gillmore J. D. et al., Lancet
358:24-9 (2001). Where there is an underlying or associated disease
state, therapy directed towards decreasing the production of
amyloidogenic protein by treating the underlying disease. For
example, current treatment strategy for AA Amyloidosis is to target
underlying inflammation, reducing ApoSSA levels to below 10 mg/l.
Currently employed therapies include chemotherapy (cholorambucil
and MTX), immuno-suppressants (azathioprine), anti-inflammatory
drugs (colchicine) and TNF inhibitors. The invention provides
pharmaceutical compositions and methods for treating a number of
amyloid diseases, including amyloidosis, such as, for example, AA
amyloidosis and AL amyloidosis. According to one aspect, the
invention includes pharmaceutical compositions that include, as an
active ingredient, an agent that is effective to induce an immune
response in a patient against an amyloid component. The agent can
be a peptide comprising a fragment consisting of the amino acid
sequence X.sub.1EDX.sub.2 derived from an amyloid protein. The
agent can be an antibody that specifically binds to an epitope
comprising X.sub.1EDX.sub.2. In other embodiments, the agent can be
an antigen-binding fragment of an antibody. Such compositions will
generally also include excipients and in preferred embodiments may
include adjuvants. In further preferred embodiments, the adjuvants
include, for example, aluminum hydroxide, aluminum phosphate,
MPL.TM., QS-21 (STIMULON.TM.) or incomplete Freund's adjuvant.
According to a related embodiment, such pharmaceutical compositions
may include a plurality of agents effective to induce an immune
response against more than one amyloid component in the
patient.
[0078] In a related embodiment, the agent is effective to produce
an immune response directed against an aggregated amyloid protein,
such as a fibril peptide or protein amyloid component. Preferably,
such a fibril peptide or protein is derived from a fibril precursor
protein known to be associated with certain forms of amyloid
diseases, as described herein. Such precursor proteins include, but
are not limited to, Serum Amyloid A protein (ApoSSA),
immunoglobulin light chain, immunoglobulin heavy chain, ApoAI,
transthyretin, lysozyme, fibrogen .alpha. chain, gelsolin, cystatin
C, Amyloid .beta. protein precursor (.beta.-APP), Beta.sub.2
microglobulin, prion precursor protein (PrP), atrial natriuretic
factor, keratin, islet amyloid polypeptide, a peptide hormone, and
synuclein. Such precursors also include mutant proteins, protein
fragments and proteolytic peptides of such precursors. In a
preferred embodiment, the agent is effective to induce an immune
response directed against a neoepitope formed by a fibril protein
or peptide, with respect to a fibril precursor protein. That is, as
described in more detail herein, many fibril-forming peptides or
proteins are fragments of such precursor proteins, such as those
listed above. When such fragments are formed, such as by
proteolytic cleavage, epitopes may be revealed that are not present
on the precursor and are therefore not immunologically available to
the immune system when the fragment is a part of the precursor
protein. Agents directed to such epitopes may be preferred
therapeutic agents, since they may be less likely to induce an
autoimmune response in the patient. Preferably, such agents
preferentially produce an immune response directed against a
pathological form of the amyloid protein, for example, an
aggregated amyloid protein, relative to nonpathological forms of
the amyloid protein.
[0079] According to a related embodiment, pharmaceutical
compositions of the invention include agents directed to amyloid
aggregates, such as those selected from the group including, but
not limited to the following aggregated (e.g., fibril) peptides or
proteins: AA, AL, ATTR, AApoA1, Alys, Agel, Acys, A.beta.,
AB.sub.2M, AScr, Acal, AIAPP and synuclein-NAC fragment. The full
names and compositions of these peptides are described herein. Such
peptides can be made according to methods well known in the art, as
described herein.
[0080] The methods comprise administering to the patient an
effective dosage of an antibody that specifically binds to an
epitope comprising X.sub.1EDX.sub.2 in an amyloid protein, wherein
X.sub.1 is H, T, F, S, P, A or any other amino acid residue
immediately preceding ED in such amyloid protein; and wherein
X.sub.2 is T, S, E, R, I, V, F, A or any other amino acid residue
immediately following ED in such amyloid protein. In some methods,
the patient is suffering from an amyloidosis associated with an
aggregated amyloid protein comprising the amino acid sequence ED.
Some antibodies specifically bind to an epitope consisting of such
X.sub.1EDX.sub.2. In some antibodies, X.sub.1 is H, T, F, S, P, or
A and X.sub.2 is T, S, E, D, R, I, V, F or A. In some such
antibodies, when X.sub.1 is H, X.sub.2 is T or A; when X.sub.1 is
A, X.sub.2 is S, T, E or V; when X.sub.1 is T, X.sub.2 is E; when
X.sub.1 is F, X.sub.2 is D; when X.sub.1 is S, X.sub.2 is E, F or
A; and when X.sub.1 is P, X.sub.2 is E, I or F. In some antibodies,
X.sub.1 is H, T, F, S, P, or A and X.sub.2 is T, S, E, D, R, I, V,
F or A, with the proviso that if X.sub.1 is A, X.sub.2 is not V. In
some antibodies, when X.sub.1 is A, X.sub.2 is S, T or E.
[0081] Some antibodies specifically bind an epitope comprising the
amino acid sequence GHEDT, (SEQ ID NO: 3), HEDT, (SEQ ID NO: 12),
AEDS, (SEQ ID NO 13), AEDT (SEQ ID NO: 14), HEDA (SEQ ID NO: 15),
TEDE, (SEQ ID NO: 16), FEDD, (SEQ ID NO: 17), SEDE, (SEQ ID NO:
18), AEDE, (SEQ ID NO: 19), PEDE, (SEQ ID NO: 20), PEDI, (SEQ ID
NO: 21), PEDF, (SEQ ID NO: 22), AEDV, (SEQ ID NO: 23), SEDF (SEQ ID
NO: 24), or SEDA, (SEQ ID NO: 25).
[0082] Some antibodies specifically bind to a peptide comprising an
amino acid sequence selected from the group consisting of GHEDT,
(SEQ ID NO: 3), HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO: 13), AEDT,
(SEQ ID NO: 14), HEDA, (SEQ ID NO: 15), TEDE, (SEQ ID NO: 16),
FEDD, (SEQ ID NO: 17), SEDE, (SEQ ID NO: 18), AEDE, (SEQ ID NO:
19), PEDE, (SEQ ID NO: 20), PEDI, (SEQ ID NO: 21), PEDF, (SEQ ID
NO: 22), SEDF, (SEQ ID NO: 24), and SEDA, (SEQ ID NO: 25). Some
antibodies specifically bind to a peptide comprising an amino acid
sequence selected from the group consisting of GHEDT, (SEQ ID NO:
3, HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO: 13), AEDT, (SEQ ID NO:
14), HEDA, (SEQ ID NO: 15), and TEDE, (SEQ ID NO: 16).
[0083] Some antibodies specifically bind to an epitope within
residues 70 to 76 of AA. Some antibodies specifically bind to an
epitope within residues 71 to 75 of AA. Some antibodies are raised
to a peptide comprising GHEDT, (SEQ ID NO: 3).
[0084] Some antibodies specifically bind to a peptide comprising
the amino acid sequence PEDS, (SEQ ID NO: 26), PEDL, (SEQ ID NO:
27), TEDV, (SEQ ID NO: 28), AEDE, (SEQ ID NO: 19), SEDI, (SEQ ID
NO: 29), and TEDT, (SEQ ID NO: 30). Some antibodies specifically
bind to a peptide comprising the amino acid sequence LEDG, (SEQ ID
NO: 31), AEDM, (SEQ ID NO: 32), HEDS, (SEQ ID NO: 33), CEDD, (SEQ
ID NO: 34), QEDS, (SEQ ID NO: 35), REDS, (SEQ ID NO: 36), TEDG,
(SEQ ID NO: 37), QEDR, (SEQ ID NO: 38), TEDL, (SEQ ID NO: 39),
PEDN, (SEQ ID NO: 40), EEDP, (SEQ ID NO: 41), LEDL, (SEQ ID NO:
42), KEDA, (SEQ ID NO: 43), SEDC, (SEQ ID NO: 44), EEDD, (SEQ ID
NO: 45), SEDK, (SEQ ID NO: 46), DEDD, (SEQ ID NO: 47), DEDG, (SEQ
ID NO: 48), LEDE, (SEQ ID NO: 49), GEDA, (SEQ ID NO: 50), VEDF,
(SEQ ID NO: 51), YEDE, (SEQ ID NO: 52), IEDL, (SEQ ID NO: 53),
WEDY, (SEQ ID NO: 54), DEDW, (SEQ ID NO: 55), SEDL, (SEQ ID NO:
56), YEDQ, (SEQ ID NO: 57), LEDW, (SEQ ID NO: 58), YEDR, (SEQ ID
NO: 59), and PEDK, (SEQ ID NO: 60).
[0085] Some antibodies specifically bind to a peptide comprising
the amino acid sequence AEDV, (SEQ ID NO: 23). Some antibodies
specifically bind to a peptide comprising the amino acid sequence
SEDF, (SEQ ID NO: 24) or PEDF, (SEQ ID NO: 22). Some antibodies
specifically bind to a peptide comprising the amino acid sequence
AEDS, (SEQ ID NO: 13). Some antibodies specifically bind to a
peptide comprising the amino acid sequence PEDI (SEQ ID NO: 21),
AEDV, (SEQ ID NO 23), SEDF, (SEQ ID NO: 24), SEDA, (SEQ ID NO: 25),
SEDE, (SEQ ID NO: 18), AEDE, (SEQ ID NO: 19), and PEDE, (SEQ ID NO:
20). Some antibodies bind to a peptide comprising the amino acid
sequence TEDE, (SEQ ID NO: 16).
[0086] Some antibodies specifically bind to a peptide comprising
the amino acid sequence AEDV, (SEQ ID NO: 23). Some antibodies
specifically bind to a peptide comprising the amino acid sequence
SEDF, (SEQ ID NO: 24) or PEDF, (SEQ ID NO: 22). Some antibodies
specifically bind to a peptide comprising the amino acid sequence
AEDS, (SEQ ID NO: 13). Some antibodies specifically bind to a
peptide comprising the amino acid sequence PEDI (SEQ ID NO: 21),
AEDV, (SEQ ID NO 23), SEDF, (SEQ ID NO: 24), SEDA, (SEQ ID NO: 25),
SEDE, (SEQ ID NO: 18), AEDE, (SEQ ID NO: 19), and PEDE, (SEQ ID NO:
20). Some antibodies bind to a peptide comprising the amino acid
sequence TEDE, (SEQ ID NO: 16).
[0087] Any of the antibodies described above can be administered in
the methods described above to treat or effect prophylaxis of a
disease characterized by the deposition of an amyloid protein, such
as, for example, an amyloid protein comprising the amino acid
sequence ED. In some methods, if the amyloid protein comprises the
amino acid sequence AEDV, (SEQ ID NO: 23), then the antibody is not
administered to treat or effect prophylaxis of Alzheimer's disease
or Mild Cognitive Impairment. The amyloid protein can be any of
serum amyloid A protein, immunoglobulin light chain protein, such
as, for example, V.lamda.6 Wil or V.kappa., human islet amyloid
precursor polypeptide (IAPP), beta amyloid peptide, transthyretin
(TTR) or ApoA1.
[0088] Optionally, the patient is human. Optionally, the antibody
specifically binds to a peptide whose residues consist of SEQ ID
NOS. 4, 5, 6, 7, 8, 9, 10, or 11. Optionally, the antibody
specifically binds to an epitope within residues 70-76 of (SEQ ID
NO: 2). Optionally, the antibody is a human antibody, humanized
antibody or chimeric antibody. Optionally, the human antibody is of
human isotype IgG1, IgG4, IgG2 or IgG3. Optionally, the humanized
antibody is of human isotype IgG1, IgG4, IgG2 or IgG3. Optionally,
the chimeric antibody is of human isotype IgG1, IgG4, IgG2 or IgG3.
Optionally, the antibody is a mouse antibody. Optionally, the
antibody is a polyclonal antibody. Optionally, the antibody is a
monoclonal antibody.
[0089] In some treatment methods, the antibody comprises two copies
of the same pair of light and heavy chains. In other methods, the
antibody is a bispecific antibody comprising a first light and
heavy chain pair that specifically binds to the epitope of A.beta.
and a second light and heavy chain pair that specifically binds to
an Fc receptor on microglial cells. In other methods, a chain of
the antibody is fused to a heterologous polypeptide.
[0090] Some treatment methods, the dosage of antibody is at least 1
mg/kg body weight of the patient. In other methods, the dosage of
antibody is at least 10 mg/kg body weight of the patient.
[0091] In some treatment methods, the antibody is administered with
a carrier as a pharmaceutical composition. In other methods,
wherein the antibody is a human antibody to AA prepared from B
cells from a human immunized with an AA peptide. Optionally, the
human immunized with AA peptide is the patient. In some methods,
the antibody is administered intraperitoneally, orally,
intranasally, subcutaneously, intramuscularly, topically or
intravenously.
[0092] In some treatment methods, the antibody is administered by
administering a polynucleotide encoding at least one antibody chain
to the patient and the polynucleotide is expressed to produce the
antibody chain in the patient. Optionally, the polynucleotide
encodes heavy and light chains of the antibody and the
polynucleotide is expressed to produce the heavy and light chains
in the patient.
[0093] Some of the above treatment methods further comprise
administering an effective dosage of at least one other antibody
that binds to a different epitope of AA. Some of the above
treatment methods further comprise monitoring the patient for level
of administered antibody in the blood of the patient. In other
methods, the antibody is administered in multiple dosages over a
period of at least six months. In other methods, the antibody is
administered as a sustained release composition.
[0094] The invention further provides methods of effecting
prophylaxis of AA amyloidosis in a patient susceptible to AA
amyloidosis. The methods comprise administering to the patient an
effective dosage of an antibody that specifically binds to an
epitope within residues 70 to 76 of AA. Optionally, the patient is
human. Optionally, the antibody specifically binds to a peptide
whose residues consist of SEQ ID NOS. 4, 5, 6, 7, 8, 9, 10, or 11.
Optionally, the antibody specifically binds to an epitope within
residues 70-76 of (SEQ ID NO: 2). In some methods, the patient
suffers from an underlying amyloid disease selected from the group
consisting of rheumatoid arthritis, juvenile chronic arthritis,
ankylosing spondylitis, psoriasis, psoriatic arthropathy, Reiter's
syndrome, Adult Still's disease, Behcet's syndrome, Crohn's
disease, leprosy, tuberculosis, bronchiectasis, decubitus ulcers,
chronic pyelonephritis, osteomyelitis, Whipple's disease, Hodgkin's
lymphoma, renal carcinoma, carcinomas of gut, lung and urogenital
tract, basal cell carcinoma, hairy cell leukemia, Familial
Mediterranean Fever, and Castleman's Disease.
[0095] The invention further provides a human, humanized, or
chimeric antibody that specifically binds to an epitope within
residues 70 to 76 of AA. Optionally, the humanized antibody
specifically binds to an epitope within residues 70 to 76 of AA.
Optionally, the humanized antibody is a humanized version 7D8
antibody (ATCC Accession Number PTA-9468). Optionally, the
humanized antibody is a humanized version 7D29 antibody.
Optionally, the humanized antibody is a humanized version 7D19
antibody. Optionally, the humanized antibody is a humanized version
7D47 antibody. Optionally, the humanized antibody is a humanized
version 7D39 antibody. Optionally, the humanized antibody is a
humanized version 7D66 antibody. Optionally, the humanized antibody
is a humanized version 8G9 antibody. Optionally, the humanized
antibody is a humanized version 8G3 antibody. Optionally, the
humanized antibody is a humanized version 8G4 antibody. Optionally,
the humanized antibody is a humanized version 8G51 antibody.
Optionally, the humanized antibody is a humanized version 8G22
antibody. Optionally, the humanized antibody is a humanized version
8G30 antibody. Optionally, the humanized antibody is a humanized
version 8G46 antibody. Optionally, the humanized antibody is a
humanized version 2A4 antibody (ATCC Accession Number PTA-9662).
Optionally, the humanized antibody is a humanized version 2A20
antibody. Optionally, the humanized antibody is a humanized version
2A44 antibody. Optionally, the humanized antibody is a humanized
version 2A77 antibody. Optionally, the humanized antibody is a
humanized version 2A13 antibody. Optionally, the humanized antibody
is a humanized version 2A14 antibody.
[0096] The invention further provides pharmaceutical compositions.
The pharmaceutical compositions comprise an antibody that
specifically binds to an epitope within residues 70 to 76 of AA,
and a pharmaceutically acceptable carrier. Some pharmaceutical
compositions comprise a human, humanized, or chimeric antibody that
specifically binds to an epitope within residues 70 to 76 of AA,
and a pharmaceutically acceptable carrier. Other pharmaceutical
compositions comprise an antibody that specifically binds to an
epitope within residues 70 to 76 of AA and a pharmaceutically
acceptable carrier, where the isotype of the antibody is human
IgG1, and a pharmaceutically acceptable carrier. In some
pharmaceutical compositions the isotype of the antibody is human
IgG2, IgG3, or IgG4. In some pharmaceutical compositions the
antibody is human. In some pharmaceutical compositions the antibody
is humanized. In some pharmaceutical compositions the antibody is
chimeric. In some pharmaceutical compositions the antibody is a
polyclonal antibody. In some pharmaceutical compositions the
antibody is a monoclonal antibody.
[0097] In some pharmaceutical compositions the antibody comprises
two copies of the same pair of light and heavy chains. In some
pharmaceutical compositions the antibody is a bispecific antibody
comprising a first light and heavy chain pair that specifically
binds to the epitope of AA and a second light and heavy chain pair
that specifically binds to an Fc receptor on microglial cells. In
some pharmaceutical compositions a chain of the antibody is fused
to a heterologous polypeptide. In some pharmaceutical compositions
the carrier is a physiologically acceptable diluent for parenteral
administration. Some pharmaceutical compositions are adapted to be
administered intraperitoneally, orally, intranasally,
subcutaneously, intramuscularly, topically or intravenously. Some
pharmaceutical compositions are adapted to be administered in
multiple dosages over a period of at least six months. Some
pharmaceutical compositions are adapted to be administered as a
sustained release composition. Some pharmaceutical compositions
further comprise at least one other antibody that binds to a
different epitope of AA.
[0098] The invention provides methods of treating AA amyloidosis in
a patient. The methods comprise administering an agent that induces
an immune response to AA70-76 in a regime effective to induce an
immune response comprising antibodies against AA70-76 in a regime
effective to induce an immune response comprising antibodies
against AA70-76. In some methods the patient is human. Optionally,
the agent comprises AA70-76 or a subfragment of at least 3
contiguous residues thereof and has fewer than 20 contiguous amino
acids from an AA peptide. Optionally, the agent is a peptide having
a sequence selected from the group consisting of SEQ ID NOS 4, 5,
6, 7, 8, 9, 10 and 11. and subfragments of at least 3 contiguous
residues thereof and has fewer than 20 amino acids from an AA
peptide. Optionally, the agent is linked at its N and C termini to
first and second heterologous polypeptides. Optionally, the agent
is linked at its N terminus to a heterologous polypeptide, and at
its C-terminus to at least one additional copy of the N-terminal
segment. In some methods the heterologous polypeptide induces a
T-cell response against the heterologous polypeptide and thereby a
B-cell response against AA. In some methods the polypeptide further
comprises at least one additional copy of AA. Optionally, the
polypeptide comprises from N-terminus to C-terminus, AA, a
plurality of additional copies of AA, and the heterologous amino
acid segment.
[0099] In some treatment methods the polypeptide is administered
with an adjuvant that enhances an immune response to the N-terminal
segment. Optionally, the adjuvant and the polypeptide are
administered together as a composition. Optionally, the adjuvant is
administered before the polypeptide. Optionally, the adjuvant is
administered after the polypeptide. In some methods the adjuvant is
alum. In some methods the adjuvant is MPL. In some methods the
adjuvant is QS-21. In some methods the adjuvant is incomplete
Freund's adjuvant. In some methods the immune response comprises
T-cells that bind to the AA peptide as a component of an MHC I or
MHC II complex.
[0100] The invention provides methods of effecting prophylaxis of
AA amyloidosis in a patient. The methods comprise administering an
agent that induces an immune response to AA70-76 in a regime
effective to induce an immune response comprising antibodies
against AA70-76 in a regime effective to induce an immune response
comprising antibodies against AA70-76. In some methods the patient
is human. In some methods the patient is asymptomatic. In some
methods the patient suffers from an underlying amyloid disease
selected from the group consisting of rheumatoid arthritis,
juvenile chronic arthritis, ankylosing spondylitis, psoriasis,
psoriatic arthropathy, Reiter's syndrome, Adult Still's disease,
Behcet's syndrome, Crohn's disease, leprosy, tuberculosis,
bronchiectasis, decubitus ulcers, chronic pyelonephritis,
osteomyelitis, Whipple's disease, Hodgkin's lymphoma, renal
carcinoma, carcinomas of gut, lung and urogenital tract, basal cell
carcinoma, hairy cell leukemia, Familial Mediterranean Fever, and
Castleman's Disease.
[0101] In some methods of effecting prohylaxis, the agent comprises
AA70-76 or a subfragment of at least 3 contiguous residues thereof
and has fewer than 20 contiguous amino acids from an AA peptide.
Optionally, the agent is a peptide having a sequence selected from
the group consisting of SEQ ID NOS 4, 5, 6, 7, 8, 9, 10 and 11. and
subfragments of at least 3 contiguous residues thereof and has
fewer than 20 amino acids from an AA peptide. Optionally, the agent
is linked at its N and C termini to first and second heterologous
polypeptides. Optionally, the agent is linked at its N terminus to
a heterologous polypeptide, and at its C-terminus to at least one
additional copy of the N-terminal segment. In some methods the
heterologous polypeptide induces a T-cell response against the
heterologous polypeptide and thereby a B-cell response against AA.
In some methods the polypeptide further comprises at least one
additional copy of AA. Optionally, the polypeptide comprises from
N-terminus to C-terminus, AA, a plurality of additional copies of
AA, and the heterologous amino acid segment.
[0102] The invention further provides pharmaceutical compositions.
The pharmaceutical compositions comprise an AA fragment consisting
of residues beginning at residue 70 of AA and ending at residue 76
of AA. Optionally, the AA fragment is linked at its C-terminus to a
heterologous polypeptide. Optionally, the AA fragment is linked at
its N-terminus to a heterologous polypeptide. Optionally, the AA
fragment is linked at its N and C termini to first and second
heterologous polypeptides. Optionally, the AA fragment is linked at
its N terminus to a heterologous polypeptide, and at its C-terminus
to at least one additional copy of the N-terminal segment.
Optionally, the polypeptide further comprises at least one
additional copy of the N-terminal segment. Optionally, the
polypeptide comprises from N-terminus to C-terminus, AA, a
plurality of additional copies of the N-terminal segment, and the
heterologous amino acid segment. In some pharmaceutical
compositions the heterologous polypeptide induces a T-cell response
against the heterologous polypeptide and thereby a B-cell response
against the N-terminal segment.
[0103] Some pharmaceutical compositions further comprise an
adjuvant that enhances an immune response to AA. Optionally, the
adjuvant is alum. Optionally, the adjuvant is MPL. Optionally, the
adjuvant is QS-21. Optionally, the adjuvant is incomplete Freund's
adjuvant. Optionally, the adjuvant further comprises GM-CSF.
Optionally, the adjuvant is M-CSF. Optionally, the composition
comprises greater than 10 micrograms of the polypeptide.
[0104] The invention provides methods of treating AA amyloidosis in
a patient. The methods comprise administering an agent effective to
induce an immune response against a peptide component of an amyloid
deposit in the patient and a different agent that treats an
underlying disease, and thereby treating AA amyloidosis in the
patient. In some methods the underlying disease is selected from
the group consisting of rheumatoid arthritis, juvenile chronic
arthritis, ankylosing spondylitis, psoriasis, psoriatic
arthropathy, Reiter's syndrome, Adult Still's disease, Behcet's
syndrome, Crohn's disease, leprosy, tuberculosis, bronchiectasis,
decubitus ulcers, chronic pyelonephritis, osteomyelitis, Whipple's
disease, Hodgkin's lymphoma, renal carcinoma, carcinomas of gut,
lung and urogenital tract, basal cell carcinoma, hairy cell
leukemia, Familial Mediterranean Fever, and Castleman's
Disease.
[0105] The invention provides methods of effecting prophylaxis of
AA amyloidosis in a patient. The methods comprise administering an
agent effective to induce an immune response against a peptide
component of an amyloid deposit in the patient and a different
agent that treats an underlying disease, and thereby treating AA
amyloidosis in the patient. In some methods the underlying disease
is selected from the group consisting of rheumatoid arthritis,
juvenile chronic arthritis, ankylosing spondylitis, psoriasis,
psoriatic arthropathy, Reiter's syndrome, Adult Still's disease,
Behcet's syndrome, Crohn's disease, leprosy, tuberculosis,
bronchiectasis, decubitus ulcers, chronic pyelonephritis,
osteomyelitis, Whipple's disease, Hodgkin's lymphoma, renal
carcinoma, carcinomas of gut, lung and urogenital tract, basal cell
carcinoma, hairy cell leukemia, Familial Mediterranean Fever, and
Castleman's Disease.
[0106] The invention provides methods of screening an antibody for
activity in treating a patient having AA amyloidosis. The methods
comprise contacting the antibody with AA peptide and determining
whether the antibody specifically binds to AA, specific binding
providing an indication that the antibody has activity in treating
AA amyloidosis.
[0107] The invention provides methods of screening an antibody for
activity in clearing a biological entity physically associated with
an antigen. The methods comprise combining the antigen-associated
biological entity, the antibody and phagocytic cells bearing Fc
receptors in a medium; and monitoring the amount of the
antigen-associated biological entity remaining in the medium, a
reduction in amount of the antigen-associated biological entity
indicating the antibody has clearing activity against the antigen.
In some methods the monitoring step monitors the amount of the
antigen remaining in the medium. In some methods the combining
comprises adding antigen-associated biological entity to the
medium, and contacting the medium with the phagocytic cells bearing
Fc receptors. In some methods the antigen-associated biological
entity is provided as a tissue sample. In some methods the antigen
is the biological entity. In some methods the tissue sample
comprises an amyloid deposit. Optionally, the tissue sample is from
the patient or a mammal having AA Amyloidosis pathology. In some
methods, the antigen is AA. In some methods the phagocytic cells
are microglial cells. In some methods the tissue sample is selected
from the group consisting of a cancerous tissue sample, a virally
infected tissue sample, a tissue sample comprising inflammatory
cells, a nonmalignant abnormal cell growth, and a tissue sample
comprising an abnormal extracellular matrix.
[0108] The invention provides methods of detecting an amyloid
deposit in a patient. The methods comprise administering to the
patient an antibody that specifically binds to an epitope within
amino acids 70-76 of AA and detecting presence of the antibody in
the patient. Optionally, the antibody is labeled. Optionally, the
antibody is labeled with a paramagnetic label. Optionally, the
labeled antibody is detected by nuclear magnetic resonance.
Optionally, the labeled antibody is detected with SPECT/CT imaging.
In some methods, the antibody lacks capacity to induce a clearance
response on binding to an amyloid deposit in the patient.
[0109] The invention provides diagnostic kits. The kits comprise an
antibody that specifically binds to an epitope with residues 70-76
of AA. Some kits further comprise labeling describing use of the
antibody for in vivo diagnosis or monitoring of a disease
associated with amyloid deposits of AA in a patient. In some
embodiments, the kits include instructions for use of the antibody
or antigen-binding fragment thereof in detecting AA.
[0110] The invention further provides a method of diagnosing
amyloidosis in a subject comprising: (a) administering to the
subject an antibody or antigen-binding fragment thereof that is
bound to a detectable label, wherein the antibody or fragment
thereof specifically binds to an epitope comprising
X.sub.1EDX.sub.2 in an aggregated amyloid protein, wherein X.sub.1
and X.sub.2 are any amino acid; and (b) detecting the presence or
absence of the bound antibody or fragment thereof, wherein the
presence of the bound antibody or fragment indicates a diagnosis of
AA amyloidosis.
[0111] Further provided herein is a method of treatment or
prophylaxis of amyloidosis using an antibody or antigen-binding
fragment thereof, which specifically binds to an epitope comprising
X.sub.1EDX.sub.2 in an aggregated amyloid protein, wherein X.sub.1
and X.sub.2 are any amino acid.
[0112] The present invention provides an antibody or
antigen-binding fragment thereof that binds specifically to an
epitope comprising X.sub.1EDX.sub.2, in an aggregated amyloid
protein, wherein X.sub.1 and X.sub.2 are any amino acid. For
example, X.sub.1 includes H, T, F, S, P, A, L, C, Q, R, E, K, D, G,
V, Y, I or W, such as H, T, F, S, P, or A, or such as H, T, F, or
A. X.sub.2 includes T, S, E, R, I, V, F, D, A, G, M, L, N, P, C, K,
Y, or Q, such as T, S, E, R, I, V, F, D, or A, or such as T, S, E,
D, or A. In other examples, X.sub.1 is H, T, or A and X.sub.2 is T,
S, E, or A, such as X.sub.1 is H or A and X.sub.2 is T, S, or A. In
yet additional examples, X.sub.1 is H and H.sub.2 is T or A; or
X.sub.1 is A and X.sub.2 is S, T, E, or V, such as X.sub.1 is A and
X.sub.2 is S, T, or E, or X.sub.1 is T and X.sub.2 is E, or X.sub.1
is F and X.sub.2 is D, or X.sub.1 is S and X.sub.2 is E, F, or A;
or X.sub.1 is P and X.sub.2 is E, I, or F.
[0113] In particular, the epitopes include amino acid sequences
such as those set forth in SEQ ID NO: 3 through to SEQ ID NO: 25,
such as SEQ ID NOS: 3, 12, 13, 14, 15, and 16. Additional examples
include SEQ ID NOS: 4, 5, 7, 8, and 9, such as SEQ ID NO: 4.
Antibodies of the invention that bind to the epitopes, such as to
SEQ ID NO: 3, include the 2A4, 7D8, and 8G9 antibodies.
[0114] The aggregated amyloid proteins to which antibodies of the
invention bind are non-monomeric proteins. Such aggregated amyloid
proteins include serum amyloid A protein (SAA), immunoglobulin
light chain protein, human islet amyloid precursor polypeptide
(IAPP), beta amyloid peptide, transthyretin (TTR), and ApoA1, such
as SAA.
[0115] The invention further provides antibodies or antigen-binding
fragments thereof that (a) compete for binding to an epitope that
includes X.sub.1EDX.sub.2 with a 2A4, 7D8, or 8G9 antibody; (b)
bind to the same epitope that includes X.sub.1EDX.sub.2 as a 2A4,
7D8, or 8G9 antibody; (c) have an antigen-binding domain of a 2A4,
7D8, or 8G9 antibody; or (d) include the six complementarity
determining regions (CDRs) of a 2A4, 7D8, or 8G9 antibody. The
invention also provides chimeric or humanized versions of a 2A4,
7D8, or 8G9 antibody.
[0116] Representative antibodies, which specifically bind to an
epitope that includes X.sub.1EDX.sub.2, also include antibodies
having at least one, two, or three of the complementarity
determining regions (CDRs) of a light chain of a 2A4, 7D8 or 8G9
antibody. Antibodies of the invention, which specifically bind to
an epitope that includes X.sub.1EDX.sub.2, also include antibodies
having at least one, two, or three of the CDRs of a heavy chain of
a 2A4, 7D8, or 8G9 antibody.
[0117] CDRs can be identified according to methods known in the
art. For example, numbering systems for identifying CDRs are in
common use. The Kabat definition is based on sequence variability,
and the Chothia definition is based on the location of the
structural loop regions. The AbM definition is a compromise between
the Kabat and Chothia approaches. The CDRs of the light chain
variable region are bounded by the residues at positions 24 and 34
(CDR1-L), 50 and 56 (CDR2-L), and 89 and 97 (CDR3-L) according to
the Kabat, Chothia, or AbM algorithm. According to the Kabat
definition, the CDRs of the heavy chain variable region are bounded
by the residues at positions 31 and 35B (CDR1-H), 50 and 65
(CDR2-H), and 95 and 102 (CDR3-H) (numbering according to Kabat).
According to the Chothia definition, the CDRs of the heavy chain
variable region are bounded by the residues at positions 26 and 32
(CDR1-H), 52 and 56 (CDR2-H), and 95 and 102 (CDR3-H) (numbering
according to Chothia). According to the AbM definition, the CDRs of
the heavy chain variable region are bounded by the residues at
positions 26 and 35B (CDR1-H), 50 and 58 (CDR2-H), and 95 and 102
(CDR3-H) (numbering according to Kabat). See Martin et al. (1989)
Proc. Natl. Acad. Sci. USA 86: 9268-9272; Martin et al. (1991)
Methods Enzymol. 203: 121-153; Pedersen et al. (1992) Immunomethods
1: 126; and Rees et al. (1996) In Sternberg M. J. E. (ed.), Protein
Structure Prediction, Oxford University Press, Oxford, pp.
141-172.
[0118] The antibodies of the invention further include an antibody
that binds specifically to an epitope comprising X.sub.1EDX.sub.2,
in an aggregated amyloid protein, wherein X.sub.1 and X.sub.2 are
any amino acid, having variable regions derived from variable
regions of a 2A4, 7D8, or 8G9 antibody. Antibodies having variable
regions of 2A4, 7D8, or 8G9 antibodies are also included.
[0119] The antibodies of the invention further include chimeric
antibodies, human antibodies, humanized antibodies, single chain
antibodies, tetrameric antibodies, tetravalent antibodies,
multispecific antibodies domain-specific antibodies, domain-deleted
antibodies or fusion proteins.
[0120] Fragments of the antibodies of the invention are also
provided. The fragments of the invention may be Fab fragments, Fab'
fragment, F(ab').sub.2 fragments, Fv fragments or ScFv fragments.
Such antibodies or fragments thereof can be coupled with a
cytotoxic agent, a radiotherapeutic agent, or a detectable
label.
[0121] The invention also provides an isolated antibody variable
region comprising (a) a light chain variable region derived from a
7D8, 2A4, or 8G9 antibody light chain variable region, or (b) a
heavy chain variable region derived from a 7D8, 2A4, or 8G9
antibody light chain variable region. Isolated variable regions are
also provided having a light chain or heavy chain variable region
of a 7D8, 2A4, or 8G9 antibody. The isolated antibody variable
regions are useful in antibody production.
[0122] The invention also provides isolated nucleic acids encoding
an antibody light chain variable region or a heavy chain variable
region having (a) a nucleotide sequence that encodes a light chain
or heavy chain variable region of a 7D8, 2A4, or 8G9 antibody; (b)
a nucleotide sequence that is identical to a nucleotide sequence of
a 7D8, a 2A4, or an 8G9 antibody that encodes a light or heavy
chain variable region; or (c) a nucleotide sequence that is
substantially identical, i.e., at least 50%, 55%, 60%, 65%, 70%,
75%, 80%, 85%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%,
97%, 98%, 99%, 99.5%, or 99% to a nucleotide sequence of (a) or
(b); or (d) a nucleic acid that specifically hybridizes to a
nucleic acid having a nucleotide sequence that is the complement of
a nucleotide sequence of (a) or (b) under stringent hybridization
conditions, for example, final wash conditions of 0.1.times.SSC at
65.degree. C.
[0123] The present invention further provides cells and cell lines
expressing the antibodies or nucleic acids of the invention.
Representative host cells include mammalian and human cells, such
as CHO cells, HEK-293 cells, HeLa cells, CV-1 cells, and COS cells.
Methods for generating a stable cell line following transformation
of a heterologous construct into a host cell are known in the art.
Representative non-mammalian host cells include insect cells
(Potter et al. (1993) Int. Rev. Immunol. 10(2-3):103-112).
Antibodies may also be produced in transgenic animals (Houdebine
(2002) Curr. Opin. Biotechnol. 13(6):625-629) and transgenic plants
(Schillberg et al. (2003) Cell Mol. Life. Sci. 60(3):433-45).
[0124] The invention also provides methods of treating or effecting
prophylaxis of amyloidosis associated using immunogenic fragments
of an amyloid protein comprising X.sub.1EDX.sub.2, wherein X.sub.1
is H, T, F, S, P, A or any other amino acid residue immediately
preceding ED in such amyloid protein; and wherein X.sub.2 is T, S,
E, R, I, V, F, A or any other amino acid residue immediately
following ED in such amyloid protein. Without wishing to be bound
by a particular theory, it is believed that an epitope comprising
X.sub.1EDX.sub.2 can become exposed when an amyloid protein
aggregates, or undergoes fibrillogenesis or otherwise enters a
fibrillar structure, whether by cleavage from a larger precursor
protein or by conformational change. For example, representative
methods of treatment or prophylaxis of AA amyloidosis include
administration of AA 70-76 fragments or immunogenic fragments
thereof. The invention also provides methods of treating or
effecting prophylaxis of amyloidosis associated with deposition of
amyloid protein using antibodies reactive with X.sub.1EDX.sub.2 in
an aggregated amyloid protein, wherein X.sub.1 is H, T, F, S, P, A
or any other amino acid residue immediately preceding ED in such
aggregated amyloid protein; and wherein X.sub.2 is T, S, E, R, I,
V, F, A or any other amino acid residue immediately following ED in
such aggregated amyloid protein. Preferably, such antibodies are
preferentially reactive with aggregated amyloid protein relative to
non-pathological amyloid protein. For example, methods of treatment
or prophylaxis of AA amyloidosis associated with AA fibrils may
include administration of antibodies specific for C-terminal region
of AA fibrils (.about.residues 70-76 of AA). The antibodies can
inhibit formation of AA aggregates (e.g., fibrils) or result in
their disaggregation and clearance, thus treating or effecting
prophylaxis of AA amyloidosis.
I. DEFINITIONS
[0125] The term "substantial identity" means that two peptide
sequences, when optimally aligned, such as by the programs GAP or
BESTFIT using default gap weights, share at least 65 percent
sequence identity, preferably at least 80 or 90 percent sequence
identity, more preferably at least 95 percent sequence identity or
more (e.g., 99 percent sequence identity or higher). Preferably,
residue positions, which are not identical differ by conservative
amino acid substitutions.
[0126] For sequence comparison, typically one sequence acts as a
reference sequence, to which test sequences are compared. When
using a sequence comparison algorithm, test and reference sequences
are input into a computer, subsequence coordinates are designated,
if necessary, and sequence algorithm program parameters are
designated. The sequence comparison algorithm then calculates the
percent sequence identity for the test sequence(s) relative to the
reference sequence, based on the designated program parameters.
[0127] Optimal alignment of sequences for comparison can be
conducted, e.g., by the local homology algorithm of Smith &
Waterman, Adv. Appl. Math. 2:482 (1981), by the homology alignment
algorithm of Needleman & Wunsch, J. Mol. Biol. 48:443 (1970),
by the search for similarity method of Pearson & Lipman, Proc.
Nat'l. Acad. Sci. USA 85:2444 (1988), by computerized
implementations of these algorithms (GAP, BESTFIT, FASTA, and
TFASTA in the Wisconsin Genetics Software Package, Genetics
Computer Group, 575 Science Dr., Madison, Wis.), or by visual
inspection (see generally Ausubel et al., supra). One example of
algorithm that is suitable for determining percent sequence
identity and sequence similarity is the BLAST algorithm, which is
described in Altschul et al., J. Mol. Biol. 215:403-410 (1990).
Software for performing BLAST analyses is publicly available
through the National Center for Biotechnology Information
(http://www.ncbi.nlm.nih.gov/). Typically, default program
parameters can be used to perform the sequence comparison, although
customized parameters can also be used. For amino acid sequences,
the BLASTP program uses as defaults a wordlength (W) of 3, an
expectation (E) of 10, and the BLOSUM62 scoring matrix (see
Henikoff & Henikoff, Proc. Natl. Acad. Sci. USA 89, 10915
(1989))
[0128] For purposes of classifying amino acids substitutions as
conservative or nonconservative, amino acids are grouped as
follows: Group I (hydrophobic sidechains): norleucine, met, ala,
val, leu, ile; Group II (neutral hydrophilic side chains): cys,
ser, thr; Group III (acidic side chains): asp, glu; Group IV (basic
side chains): asn, gln, his, lys, arg; Group V (residues
influencing chain orientation): gly, pro; and Group VI (aromatic
side chains): trp, tyr, phe. Conservative substitutions involve
substitutions between amino acids in the same class.
Non-conservative substitutions constitute exchanging a member of
one of these classes for a member of another.
[0129] The term "all-D" refers to peptides having .gtoreq.75%,
.gtoreq.80%, .gtoreq.85%, .gtoreq.90%, .gtoreq.95%, and 100%
D-configuration amino acids.
[0130] The term "agent" is used to describe a compound that has or
may have a pharmacological activity. Agents include compounds that
are known drugs, compounds for which pharmacological activity has
been identified but which are undergoing further therapeutic
evaluation, and compounds that are members of collections and
libraries that are to be screened for a pharmacological
activity.
[0131] "Amyloid disease" or "amyloidosis" refers to any number of
disorders which have as a symptom or as part of its pathology the
accumulation or formation of amyloid plaques.
An "amyloid plaque" is an extracellular deposit composed mainly of
proteinaceous fibrils. Generally, the fibrils are composed of a
dominant protein or peptide; however, the plaque may also include
additional components that are peptide or non-peptide molecules, as
described herein.
[0132] An "amyloid protein" or "amyloid peptide" is a protein or
peptide capable of undergoing cleavage, conformational change,
aggregation or fibrillogenesis, resulting in the formation of
pathological oligomers, amyloid fibrils, amyloid plaques and/or
amyloid components.
[0133] An "amyloid component" is any molecular entity that is
present in an amyloid plaque including antigenic portions of such
molecules. Amyloid components include but are not limited to
proteins, peptides, proteoglycans, and carbohydrates.
[0134] An "anti-amyloid agent" is an agent which is capable of
producing an immune response against an amyloid plaque component in
a vertebrate subject, when administered by active or passive
immunization techniques.
[0135] An "AA protein" or "AA peptide" refers to the form of
amyloid protein A protein or peptide formed by proteolytic cleavage
of serum amyloid A protein (SAA), whether monomeric or aggregated,
soluble or insoluble.
[0136] An "aggregated amyloid protein" or "aggregated amyloid
peptide" or "amyloid aggregate" refers to a pathological,
non-monomeric, aggregated form of an amyloid protein or amyloid
peptide. Aggregated amyloid proteins and amyloid peptides can be
soluble or insoluble. Some aggregated amyloid proteins and
aggregated amyloid peptides can form oligomers, fibrils and/or
amyloid plaques. Examples of such aggregated amyloid proteins and
amyloid peptides, including fibril peptides and proteins are
provided herein.
[0137] An "AA aggregate" refers to an aggregated form of AA.
[0138] Therapeutic agents of the invention are typically
substantially pure from undesired contaminant. This means that an
agent is typically at least about 50% w/w (weight/weight) purity,
as well as being substantially free from interfering proteins and
contaminants. Sometimes the agents are at least about 80% w/w and,
more preferably at least 90 or about 95% w/w purity. However, using
conventional protein purification techniques, homogeneous peptides
of at least 99% w/w can be obtained. Therapeutic agents of the
invention may prevent, effect prophylaxis of, or treat a disease
associated with amyloid deposits.
[0139] Specific binding between two entities means the entities
have a mutual affinity for each other that is at least 10-, 100- or
100-fold greater than the affinity of either entity for a control,
such as unrelated antigen or antibody to a different antigen. The
mutual affinity of the two entities for each other is usually at
least 10.sup.7 M.sup.-1, 10.sup.8 M.sup.-1, 10.sup.9 M.sup.-1, or
10.sup.10 M.sup.-1. Affinities greater than 10.sup.8 M.sup.-1 are
preferred.
[0140] The term "immunoglobulin" or "antibody" (used
interchangeably herein) refers to an antigen-binding protein having
a basic four-polypeptide chain structure consisting of two heavy
and two light chains, said chains being stabilized, for example, by
interchain disulfide bonds, which has the ability to specifically
bind antigen. Both heavy and light chains are folded into domains.
The term "domain" refers to a globular region of a heavy or light
chain polypeptide comprising peptide loops (e.g., comprising 3 to 4
peptide loops) stabilized, for example, by 13-pleated sheet and/or
intrachain disulfide bond. Domains are further referred to herein
as "constant" or "variable", based on the relative lack of sequence
variation within the domains of various class members in the case
of a "constant" domain, or the significant variation within the
domains of various class members in the case of a "variable"
domain. "Constant" domains on the light chain are referred to
interchangeably as "light chain constant regions", "light chain
constant domains", "CL" regions or "CL" domains. "Constant" domains
on the heavy chain are referred to interchangeably as "heavy chain
constant regions", "heavy chain constant domains", "CH" regions or
"CH" domains. "Variable" domains on the light chain are referred to
interchangeably as "light chain variable regions", "light chain
variable domains", "VL" regions or "VL" domains. "Variable" domains
on the heavy chain are referred to interchangeably as "heavy chain
constant regions", "heavy chain constant domains", "CH" regions or
"CH" domains.
[0141] The term "region" refers to a part or portion of an antibody
chain and includes constant or variable domains as defined herein,
as well as more discrete parts or portions of said domains. For
example, light chain variable domains or regions include
"complementarity determining regions" or "CDRs" interspersed among
"framework regions" or "FRs", as defined herein.
[0142] Immunoglobulins or antibodies can exist in monomeric or
polymeric form. The term "antigen-binding fragment" refers to a
polypeptide fragment of an immunoglobulin or antibody binds antigen
or competes with intact antibody (i.e., with the intact antibody
from which they were derived) for antigen binding (i.e., specific
binding). The term "conformation" refers to the tertiary structure
of a protein or polypeptide (e.g., an antibody, antibody chain,
domain or region thereof). For example, the phrase "light (or
heavy) chain conformation" refers to the tertiary structure of a
light (or heavy) chain variable region, and the phrase "antibody
conformation" or "antibody fragment conformation" refers to the
tertiary structure of an antibody or fragment thereof.
[0143] "Specific binding" of an antibody mean that the antibody
exhibits appreciable affinity for antigen or a preferred epitope
and, preferably, does not exhibit significant crossreactivity.
"Appreciable" or preferred binding include binding with an affinity
of at least 10.sup.6, 10.sup.7, 10.sup.8, 10.sup.9 M.sup.-1, or
10.sup.10 M.sup.-1. Affinities greater than 10.sup.7 M.sup.-1,
preferably greater than 10.sup.8 M.sup.-1 are more preferred.
Values intermediate of those set forth herein are also intended to
be within the scope of the present invention and a preferred
binding affinity can be indicated as a range of affinities, for
example, 10.sup.6 to 10.sup.10 M.sup.-1, preferably 10.sup.7 to
10.sup.10 M.sup.-1, more preferably 10.sup.8 to 10.sup.10 M.sup.-1.
An antibody that "does not exhibit significant crossreactivity" is
one that will not appreciably bind to an undesirable entity (e.g.,
an undesirable proteinaceous entity). For example, an antibody that
specifically binds to AA will appreciably bind AA but will not
significantly react with non-AA proteins or peptides (e.g., non-AA
proteins or peptides included in plaques). An antibody specific for
a preferred epitope will, for example, not significantly crossreact
with remote epitopes on the same protein or peptide. Specific
binding can be determined according to any art-recognized means for
determining such binding. Preferably, specific binding is
determined according to Scatchard analysis and/or competitive
binding assays.
[0144] Antigen-binding antibody fragments are produced by
recombinant DNA techniques, or by enzymatic or chemical cleavage of
intact immunoglobulins. Binding fragments include Fab, Fab',
F(ab').sub.2, Fabc, Fv, single chains, and single-chain antibodies.
Additional antibody fragments and effector function variants are
discussed herein in the section entitled "Antibodies". Other than
"bispecific" or "bifunctional" immunoglobulins or antibodies, an
immunoglobulin or antibody is understood to have each of its
binding sites identical. A "bispecific" or "bifunctional antibody"
is an artificial hybrid antibody having two different heavy/light
chain pairs and two different binding sites. Bispecific antibodies
can be produced by a variety of methods including fusion of
hybridomas or linking of Fab' fragments. See, e.g., Songsivilai
& Lachmann, Clin. Exp. Immunol. 79:315-321 (1990); Kostelny et
al., J. Immunol. 148, 1547-1553 (1992).
[0145] The term "humanized immunoglobulin" or "humanized antibody"
refers to an immunoglobulin or antibody that includes at least one
humanized immunoglobulin or antibody chain (i.e., at least one
humanized light or heavy chain). The term "humanized immunoglobulin
chain" or "humanized antibody chain" (i.e., a "humanized
immunoglobulin light chain" or "humanized immunoglobulin heavy
chain") refers to an immunoglobulin or antibody chain (i.e., a
light or heavy chain, respectively) having a variable region that
includes a variable framework region substantially from a human
immunoglobulin or antibody and complementarity determining regions
(CDRs) (e.g., at least one CDR, preferably two CDRs, more
preferably three CDRs) substantially from a non-human
immunoglobulin or antibody, and further includes constant regions
(e.g., at least one constant region or portion thereof, in the case
of a light chain, and preferably three constant regions in the case
of a heavy chain). The term "humanized variable region" (e.g.,
"humanized light chain variable region" or "humanized heavy chain
variable region") refers to a variable region that includes a
variable framework region substantially from a human immunoglobulin
or antibody and complementarity determining regions (CDRs)
substantially from a non-human immunoglobulin or antibody.
[0146] The phrase "substantially from a human immunoglobulin or
antibody" or "substantially human" means that, when aligned to a
human immunoglobulin or antibody amino sequence for comparison
purposes, the region shares at least 80-90%, preferably 90-95%,
more preferably 95-99% identity (i.e., local sequence identity)
with the human framework or constant region sequence, allowing, for
example, for conservative substitutions, consensus sequence
substitutions, germline substitutions, backmutations, and the like.
The introduction of conservative substitutions, consensus sequence
substitutions, germline substitutions, backmutations, and the like,
is often referred to as "optimization" of a humanized antibody or
chain. The phrase "substantially from a non-human immunoglobulin or
antibody" or "substantially non-human" means having an
immunoglobulin or antibody sequence at least 80-95%, preferably
90-95%, more preferably, 96%, 97%, 98%, or 99% identical to that of
a non-human organism, e.g., a non-human mammal.
[0147] Accordingly, all regions or residues of a humanized
immunoglobulin or antibody, or of a humanized immunoglobulin or
antibody chain, except possibly the CDRs, are substantially
identical to the corresponding regions or residues of one or more
native human immunoglobulin sequences. The term "corresponding
region" or "corresponding residue" refers to a region or residue on
a second amino acid or nucleotide sequence which occupies the same
(i.e., equivalent) position as a region or residue on a first amino
acid or nucleotide sequence, when the first and second sequences
are optimally aligned for comparison purposes.
[0148] The terms "humanized immunoglobulin" or "humanized antibody"
are not intended to encompass chimeric immunoglobulins or
antibodies, as defined infra. Although humanized immunoglobulins or
antibodies are chimeric in their construction (i.e., comprise
regions from more than one species of protein), they include
additional features (i.e., variable regions comprising donor CDR
residues and acceptor framework residues) not found in chimeric
immunoglobulins or antibodies, as defined herein.
[0149] The term "chimeric immunoglobulin" or antibody refers to an
immunoglobulin or antibody whose variable regions derive from a
first species and whose constant regions derive from a second
species. Chimeric immunoglobulins or antibodies can be constructed,
for example by genetic engineering, from immunoglobulin gene
segments belonging to different species.
[0150] An "antigen" is an entity (e.g., a protenaceous entity or
peptide) to which an antibody specifically binds.
[0151] The term "epitope" or "antigenic determinant" refers to a
site on an antigen to which an immunoglobulin or antibody (or
antigen binding fragment thereof) specifically binds. Epitopes can
be formed both from contiguous amino acids or noncontiguous amino
acids juxtaposed by tertiary folding of a protein. Epitopes formed
from contiguous amino acids are typically retained on exposure to
denaturing solvents whereas epitopes formed by tertiary folding are
typically lost on treatment with denaturing solvents. An epitope
typically includes at least 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14
or 15 amino acids in a unique spatial conformation. Methods of
determining spatial conformation of epitopes include, for example,
x-ray crystallography and 2-dimensional nuclear magnetic resonance.
See, e.g., Epitope Mapping Protocols in Methods in Molecular
Biology, Vol. 66, G. E. Morris, Ed. (1996).
[0152] Representative antibodies of the invention include an
antibody or fragment thereof that specifically binds to an epitope
that includes X.sub.1EDX.sub.2 in an aggregated amyloid protein,
which binds to the epitope including X.sub.1EDX.sub.2 that is also
bound by e.g. a 2A4, 7D8, or 8G9 antibody. Antibodies that
recognize the same epitope can be identified in a simple
immunoassay showing the ability of one antibody to block the
binding of another antibody to a target antigen, i.e., a
competitive binding assay. Competitive binding is determined in an
assay in which the immunoglobulin under test inhibits specific
binding of a reference antibody to a common antigen, such as A13.
Numerous types of competitive binding assays are known, for
example: solid phase direct or indirect radioimmunoassay (RIA),
solid phase direct or indirect enzyme immunoassay (EIA), sandwich
competition assay (see Stahli et al., Methods in Enzymology 9:242
(1983)); solid phase direct biotin-avidin EIA (see Kirkland et al.,
J. Immunol. 137:3614 (1986)); solid phase direct labeled assay,
solid phase direct labeled sandwich assay (see Harlow and Lane,
Antibodies: A Laboratory Manual, Cold Spring Harbor Press (1988));
solid phase direct label RIA using 1-125 label (see Morel et al.,
Mol. Immunol. 25(1):7 (1988)); solid phase direct biotin-avidin EIA
(Cheung et al., Virology 176:546 (1990)); and direct labeled RIA.
(Moldenhauer et al., Scand. J. Immunol. 32:77 (1990)). Typically,
such an assay involves the use of purified antigen bound to a solid
surface or cells bearing either of these, an unlabeled test
immunoglobulin and a labeled reference immunoglobulin. Competitive
inhibition is measured by determining the amount of label bound to
the solid surface or cells in the presence of the test
immunoglobulin. Usually the test immunoglobulin is present in
excess. Usually, when a competing antibody is present in excess, it
will inhibit specific binding of a reference antibody to a common
antigen by at least 50-55%, 55-60%, 60-65%, 65-70% 70-75% or
more.
[0153] An epitope is also recognized by immunologic cells, for
example, B cells and/or T cells. Cellular recognition of an epitope
can be determined by in vitro assays that measure antigen-dependent
proliferation, as determined by .sup.3H-thymidine incorporation, by
cytokine secretion, by antibody secretion, or by antigen-dependent
killing (cytotoxic T lymphocyte assay).
[0154] The term "neoepitope" refers to a new and/or unique site on
an antigen to which B and/or T cells respond.
[0155] The term "neoepitope antibodies" refer to antibodies that
specifically recognize a new N- or C-terminal amino acid sequence
exposed by proteolytic cleavage of a molecule, but does not bind to
such an epitope on the native (uncleaved) molecule. The term
"neoepitope antibodies" may refer to antibodies that specifically
recognize a new N- or C-terminal amino acid sequence exposed by
proteolytic cleavage of SAA, but do not bind to such an epitope on
the native (uncleaved) SAA molecule. Some neoepitope antibodies
bind to either soluble or insoluble AA and result in dissociation
of AA aggregates, including AA fibrils. A "neoepitope antibody" may
also be an antibody that specifically recognizes a new epitope that
is only available to bind to an antibody after a protein undergoes
a conformation change, for example, as in the case of AL
amyloidosis and light chain, when only the light chain is expressed
and forms amyloid.
[0156] The term "immunological" or "immune" response is the
development of a beneficial humoral (antibody mediated) and/or a
cellular (mediated by antigen-specific T cells or their secretion
products) response directed against an amyloid peptide in a
recipient patient. Such a response can be an active response
induced by administration of immunogen or a passive response
induced by administration of antibody or primed T-cells. A cellular
immune response is elicited by the presentation of polypeptide
epitopes in association with Class I or Class II MHC molecules to
activate antigen-specific CD4.sup.+ T helper cells and/or CD8.sup.+
cytotoxic T cells. The response may also involve activation of
monocytes, macrophages, NK cells, basophils, dendritic cells,
astrocytes, microglia cells, eosinophils or other components of
innate immunity. The presence of a cell-mediated immunological
response can be determined by proliferation assays (CD4.sup.+ T
cells) or CTL (cytotoxic T lymphocyte) assays (see Burke, supra;
Tigges, supra). The relative contributions of humoral and cellular
responses to the protective or therapeutic effect of an immunogen
can be distinguished by separately isolating antibodies and T-cells
from an immunized syngeneic animal and measuring protective or
therapeutic effect in a second subject.
[0157] An "immunogenic agent" or "immunogen" is capable of inducing
an immunological response against itself on administration to a
mammal, optionally in conjunction with an adjuvant.
[0158] The term "naked polynucleotide" refers to a polynucleotide
not complexed with colloidal materials. Naked polynucleotides are
sometimes cloned in a plasmid vector.
[0159] The term "adjuvant" refers to a compound that when
administered in conjunction with an antigen augments the immune
response to the antigen, but when administered alone does not
generate an immune response to the antigen. Adjuvants can augment
an immune response by several mechanisms including lymphocyte
recruitment, stimulation of B and/or T cells, and stimulation of
macrophages.
[0160] The term "effective dose" or "effective dosage" is defined
as an amount sufficient to achieve or at least partially achieve
the desired effect. The term "therapeutically effective dose" is
defined as an amount sufficient to cure or at least partially
arrest the disease and its complications in a patient already
suffering from the disease. Amounts effective for this use will
depend upon the severity of the infection and the general state of
the patient's own immune system.
[0161] The term "patient" includes human and other mammalian
subjects that receive either prophylactic or therapeutic
treatment.
[0162] The invention provides antibodies or antigen-binding
fragments thereof that specifically bind to an epitope that
includes X.sub.1EDX.sub.2 in an aggregated amyloid protein, and
which competes for binding to the epitope comprising
X.sub.1EDX.sub.2 with e.g., a 2A4, 7D8, or 8G9 antibody.
Competition between antibodies is determined by an assay in which
the immunoglobulin under test inhibits specific binding of a
reference antibody to a common antigen, such as AA. Numerous types
of competitive binding assays are known, for example: solid phase
direct or indirect radioimmunoassay (RIA), solid phase direct or
indirect enzyme immunoassay (EIA), sandwich competition assay (see
Stahli et al., Methods in Enzymology, 9:242-253 (1983)); solid
phase direct biotin-avidin EIA (see Kirkland et al., J. Immunol.
137:3614-3619 (1986)); solid phase direct labeled assay, solid
phase direct labeled sandwich assay (see Harlow and Lane,
"Antibodies, A Laboratory Manual," Cold Spring Harbor Press
(1988)); solid phase direct label RIA using 1-125 label (see Morel
et al., Molec. Immunol. 25(1):7-15 (1988)); solid phase direct
biotin-avidin EIA (Cheung et al., Virology, 176:546-552 (1990));
and direct labeled RIA (Moldenhauer et al., Scand. J. Immunol.,
32:77-82 (1990)). Typically, such an assay involves the use of
purified antigen bound to a solid surface or cells expressing the
antigen, an unlabeled test immunoglobulin and a labeled reference
immunoglobulin. Competitive inhibition is measured by determining
the amount of label bound to the solid surface or cells in the
presence of the test immunoglobulin. Usually the test
immunoglobulin is present in excess. Antibodies identified by
competition assay (competing antibodies) include antibodies binding
to the same epitope as the reference antibody and antibodies
binding to an adjacent epitope sufficiently proximal to the epitope
bound by the reference antibody for steric hindrance to occur.
Usually, when a competing antibody is present in excess, it will
inhibit specific binding of a reference antibody to a common
antigen by at least 50% to 75%.
[0163] An antibody that specifically binds to an amyloid protein
means an antibody that binds to the amyloid protein with an
affinity of at least 10.sup.7 M.sup.-1. Some antibodies bind to the
amyloid protein with affinities between 10.sup.8 M.sup.-1 and
10.sup.11 M.sup.-1.
[0164] An antibody that specifically binds to aggregated amyloid
protein such as aggregated AA without specifically binding to
monomeric amyloid protein means an antibody that binds to
aggregated amyloid protein, such as, for example fibrils (e.g., AA
in aggregated .beta.-pleated sheet form such as from a cadaver of a
former AA Amyloidosis patient or a transgenic animal model) as
described above and has at least a ten fold and usually at least
100-fold lower specific binding affinity for monomeric forms of the
amyloid protein. For example, such an antibody might bind to
soluble AA with an affinity of 10.sup.9 M.sup.-1 and to plaques
with an affinity less than 10.sup.7 M.sup.-1. The affinity of such
antibodies for plaques is usually less than 10.sup.7 or 10.sup.6
M.sup.-1. Such antibodies are additionally or alternatively defined
by fluorescence intensity relative to an irrelevant control
antibody (e.g., an antibody or mixture of polyclonal antibodies to
a reversemer AA peptide) when the antibodies are contacted with
fibrils and binding assessed by fluorescently labeling. The
fluorescence intensity of antibodies that bind to soluble AA
peptide without binding to plaques is within a factor of five,
sometimes within a factor of two and sometimes indistinguishable
within experimental error from that of the control antibody.
[0165] Compositions or methods "comprising" one or more recited
elements may include other elements not specifically recited. For
example, a composition that comprises AA peptide encompasses both
an isolated AA peptide and AA peptide as a component of a larger
polypeptide sequence.
II. AMYLOID DISEASES
1. Overview and Pathogenesis
[0166] Amyloid diseases or amyloidoses include a number of disease
states having a wide variety of outward symptoms. These disorders
have in common the presence of abnormal extracellular deposits of
protein fibrils, known as "amyloid deposits" or "amyloid plaques"
that are usually about 10-100 .mu.m in diameter and are localized
to specific organs or tissue regions. Such plaques are composed
primarily of a naturally occurring soluble protein or peptide.
These insoluble deposits are composed of generally lateral
aggregates of fibrils that are approximately 10-15 nm in diameter.
Amyloid fibrils produce a characteristic apple green birefringence
in polarized light, when stained with Congo Red dye. The disorders
are classified on the basis of the major fibril components forming
the plaque deposits, as discussed below.
[0167] The peptides or proteins forming the plaque deposits are
often produced from a larger precursor protein. More specifically,
the pathogenesis of amyloid fibril deposits generally involves
proteolytic cleavage of an "abnormal" precursor protein into
fragments. These fragments generally aggregate into anti-parallel
.beta. pleated sheets; however, certain undegraded forms of
precursor protein have been reported to aggregate and form fibrils
in familial amyloid polyneuropathy (variant transthyretin fibrils)
and dialysis-related amyloidosis (.beta..sub.2 microglobulin
fibrils) (Tan, et al., 1994, supra).
2. Clinical Syndromes
[0168] This section provides descriptions of major types of
amyloidoses, including their characteristic plaque fibril
compositions. It is a general discovery of the present invention
that amyloid diseases can be treated by administering agents that
serve to stimulate an immune response against a component or
components of the various disease-specific amyloid deposits. As
discussed in more detail in Section C below, such components are
preferably constituents of the fibrils that form the plaques. The
sections below serve to exemplify major forms of amyloidosis and
are not intended to limit the invention.
[0169] a. AL Amyloidoses
[0170] AL amyloid deposition is generally associated with almost
any dyscrasia of the B lymphocyte lineage, ranging from malignancy
of plasma cells (multiple myeloma) to benign monoclonal gammopathy.
At times, the presence of amyloid deposits may be a primary
indicator of the underlying dyscrasia.
[0171] Fibrils of AL amyloid deposits are composed of monoclonal
immunoglobulin light chains or fragments thereof. More
specifically, the fragments are derived from the N-terminal region
of the light chain (kappa or lambda) and contain all or part of the
variable (V.sub.L) domain thereof. Deposits generally occur in the
mesenchymal tissues, causing peripheral and autonomic neuropathy,
carpal tunnel syndrome, macroglossia, restrictive cardiomyopathy,
arthropathy of large joints, immune dyscrasias, myelomas, as well
as occult dyscrasias. However, it should be noted that almost any
tissue, particularly visceral organs such as the heart, may be
involved.
[0172] b. Hereditary Systemic Amyloidoses
[0173] There are many forms of hereditary systemic amyloidoses.
Although they are relatively rare conditions, adult onset of
symptoms and their inheritance patterns (usually autosomal
dominant) lead to persistence of such disorders in the general
population. Generally, the syndromes are attributable to point
mutations in the precursor protein leading to production of variant
amyloidogenic peptides or proteins. Table 2 summarizes the fibril
composition of exemplary forms of these disorders.
TABLE-US-00002 TABLE 2 Hereditary Amyloidoses.sup.a Fibril
Peptide/Protein Genetic variant Clinical Syndrome Transthyretin and
Met30, Familial amyloid fragments many polyneuropathy (FAP), (ATTR)
others (mainly peripheral nerves) Transthyretin and Thr45, Cardiac
involvement fragments, Ala60, predominant (ATTR) Ser84, without
Met111, neuropathy Ile122 N-terminal Arg 26 Familial amyloid
fragment of polyneuropathy (FAP), Apolipoprotein (mainly A1(apoAI)
peripheral nerves) N-terminal Arg26, Ostertag-type, fragment of
Arg50, non-neuropathic Apolipoprotein A1 Arg 60, (predominantly
visceral (AapoAI) others involvement) Lysozyme (Alys) Thr56,
Ostertag-type, His67 non-neuropathic (predominantly visceral
involvement) Fibrogen .alpha. chain Leu554, Ostertag-type, fragment
Val 526 non-neuropathic (predominantly visceral involvement)
Gelsolin fragment Asn187, Cranial neuropathy (Agel) Tyr187 with
lattice corneal dystrophy Cystatin C Glu68 Hereditary cerebral
fragment hemorrhage (cerebral amyloid angiopathy)-Icelandic type
.beta.-amyloid protein (A.beta.) Gln693 Hereditary cerebral derived
from Amyloid hemorrhage Precursor Protein (cerebral amyloid (APP)
angiopathy)-Dutch type .beta.-amyloid protein (A.beta.) Ile717,
Familial Alzheimer`s derived from Amyloid Phe717, Disease Precursor
Protein (APP) Gly717 .beta.-amyloid protein (A.beta.) Asn670,
Familial Dementia-probable derived from Amyloid Leu671 Alzheimer`s
Disease Precursor Protein (APP) Prion Protein (PrP) Leu102, Familal
Creutzfeldt-Jakob derived from PrP Val167, disease; Gerstmann-
precursor protein Asn178, Straussler- 51-91 insert Lys200 Scheinker
syndrome (hereditary spongiform encephalopathies, prion diseases)
AA derived from Serum Familal Mediterranean amyloid A protein
fever, predominant renal (ApoSSA) involvement (autosomal recessive)
AA derived from Serum Muckle-Well's syndrome, amyloid A protein
nephropathy, deafness, (ApoSSA) urticaria, limb pain Unknown
Cardiomyopathy with persistent atrial standstill Unknown Cutaneous
deposits (bullous, papular, pustulodermal) .sup.aData derived from
Tan & Pepys, 1994, supra.
[0174] The data provided in Table 2 are exemplary and are not
intended to limit the scope of the invention. For example, more
than 40 separate point mutations in the transthyretin gene have
been described, all of which give rise to clinically similar forms
of familial amyloid polyneuropathy.
[0175] Transthyretin (TTR) is a 14 kilodalton protein that is also
sometimes referred to as prealbumin. It is produced by the liver
and choroid plexus, and it functions in transporting thyroid
hormones and vitamin A. At least 50 variant forms of the protein,
each characterized by a single amino acid change, are responsible
for various forms of familial amyloid polyneuropathy. For example,
substitution of proline for leucine at position 55 results in a
particularly progressive form of neuropathy; substitution of
methionine for leucine at position 111 resulted in a severe
cardiopathy in Danish patients. Amyloid deposits isolated from
heart tissue of patients with systemic amyloidosis have revealed
that the deposits are composed of a heterogeneous mixture of TTR
and fragments thereof, collectively referred to as ATTR, the full
length sequences of which have been characterized. ATTR fibril
components can be extracted from such plaques and their structure
and sequence determined according to the methods known in the art
(e.g., Gustaysson, A., et al., Laboratory Invest. 73: 703-708,
1995; Kametani, F., et al., Biochem. Biophys. Res. Commun. 125:
622-628, 1984; Pras, M., et al., PNAS 80: 539-42, 1983).
[0176] Persons having point mutations in the molecule
apolipoprotein AI (e.g., Gly.fwdarw.Arg26; Trp.fwdarw.Arg50;
Leu.fwdarw.Arg60) exhibit a form of amyloidosis ("Ostertag type")
characterized by deposits of the protein apolipoprotein AI or
fragments thereof (AApoAI). These patients have low levels of high
density lipoprotein (HDL) and present with a peripheral neuropathy
or renal failure.
[0177] A mutation in the alpha chain of the enzyme lysozyme (e.g.,
Ile.fwdarw.Thr56 or Asp.fwdarw.His57) is the basis of another form
of Ostertag-type non-neuropathic hereditary amyloid reported in
English families. Here, fibrils of the mutant lysozyme protein
(Alys) are deposited, and patients generally exhibit impaired renal
function. This protein, unlike most of the fibril-forming proteins
described herein, is usually present in whole (unfragmented) form
(Benson, M. D., et al. CIBA Fdn. Symp. 199: 104-131, 1996).
[0178] .beta.-amyloid peptide (A.beta.) is a 39-43 amino acid
peptide derived by proteolysis from a large protein known as beta
amyloid precursor protein (.beta.APP). Mutations in .beta.APP
result in familial forms of Alzheimer's disease, Down's syndrome
and/or senile dementia, characterized by cerebral deposition of
plaques composed of A.beta. fibrils and other components, which are
described in further detail below. Known mutations in APP
associated with Alzheimer's disease occur proximate to the cleavage
sites of .beta. or .gamma. secretase, or within A.beta.. For
example, position 717 is proximate to the site of .gamma.-secretase
cleavage of APP in its processing to A.beta., and positions 670/671
are proximate to the site of .beta.-secretase cleavage. Mutations
at any of these residues may result in Alzheimer's disease,
presumably by causing an increase the amount of the 42/43 amino
acid form of A.beta. generated from APP. The structure and sequence
of A.beta. peptides of various lengths are well known in the art.
Such peptides can be made according to methods known in the art
(e.g., Glenner and Wong, Biochem Biophys. Res. Comm. 129: 885-890,
1984; Glenner and Wong, Biochem Biophys. Res. Comm. 122: 1131-1135,
1984). In addition, various forms of the peptides are commercially
available.
[0179] Synuclein is a synapse-associated protein that resembles an
alipoprotein and is abundant in neuronal cytosol and presynaptic
terminals. A peptide fragment derived from .alpha.-synuclein,
termed NAC, is also a component of amyloid plaques of Alzheimer's
disease. (Clayton, et al., 1998). This component also serves as a
target for immunologically-based treatments of the present
invention, as detailed below.
[0180] Gelsolin is a calcium binding protein that binds to and
fragments actin filaments. Mutations at position 187 (e.g.,
Asp.fwdarw.Asn; Asp.fwdarw.Tyr) of the protein result in a form of
hereditary systemic amyloidosis, usually found in patients from
Finland, as well as persons of Dutch or Japanese origin. In
afflicted individuals, fibrils formed from gelsolin fragments
(Agel), usually consist of amino acids 173-243 (68 kDa
carboxyterminal fragment) and are deposited in blood vessels and
basement membranes, resulting in corneal dystrophy and cranial
neuropathy which progresses to peripheral neuropathy, dystrophic
skin changes and deposition in other organs. (Kangas, H., et al.
Human Mol. Genet. 5(9): 1237-1243, 1996).
[0181] Other mutated proteins, such as mutant alpha chain of
fibrinogen (AfibA) and mutant cystatin C (Acys) also form fibrils
and produce characteristic hereditary disorders. AfibA fibrils form
deposits characteristic of a nonneuropathic hereditary amyloid with
renal disease; Acys deposits are characteristic of a hereditary
cerebral amyloid angiopathy reported in Iceland. (Isselbacher, et
al., Harrison's Principles of Internal Medicine, McGraw-Hill, San
Francisco, 1995; Benson, et al., supra.). In at least some cases,
patients with cerebral amyloid angiopathy (CAA) have been shown to
have amyloid fibrils containing a non-mutant form of cystatin C in
conjunction with beta protein. (Nagai, A., et al. Molec. Chem.
Neuropathol. 33: 63-78, 1998).
[0182] Certain forms of prion disease are now considered to be
heritable, accounting for up to 15% of cases, which were previously
thought to be predominantly infectious in nature. (Baldwin, et al.,
in Research Advances in Alzheimer's Disease and Related Disorders,
John Wiley and Sons, New York, 1995). In such prion disorders,
patients develop plaques composed of abnormal isoforms of the
normal prion protein (PrP.sup.c). A predominant mutant isoform,
PrP.sup.Sc, also referred to as AScr, differs from the normal
cellular protein in its resistance to protease degradation,
insolubility after detergent extraction, deposition in secondary
lysosomes, post-translational synthesis, and high .beta.-pleated
sheet content. Genetic linkage has been established for at least
five mutations resulting in Creutzfeldt-Jacob disease (CJD),
Gerstmann-Straussler-Scheinker syndrome (GSS), and fatal familial
insomnia (FFI). (Baldwin) Methods for extracting fibril peptides
from scrapie fibrils, determining sequences and making such
peptides are known in the art. (e.g., Beekes, M., et al. J. Gen.
Virol. 76: 2567-76, 1995).
[0183] For example, one form of GSS has been linked to a PrP
mutation at codon 102, while telencephalic GSS segregates with a
mutation at codon 117. Mutations at codons 198 and 217 result in a
form of GSS in which neuritic plaques characteristic of Alzheimer's
disease contain PrP instead of A.beta. peptide. Certain forms of
familial CJD have been associated with mutations at codons 200 and
210; mutations at codons 129 and 178 have been found in both
familial CJD and FFI. (Baldwin, supra).
[0184] c. Senile Systemic Amyloidosis
[0185] Amyloid deposition, either systemic or focal, increases with
age. For example, fibrils of wild type transthyretin (TTR) are
commonly found in the heart tissue of elderly individuals. These
may be asymptomatic, clinically silent, or may result in heart
failure. Asymptomatic fibrillar focal deposits may also occur in
the brain (A.beta.), corpora amylacea of the prostate
(A.beta..sub.2 microglobulin), joints and seminal vesicles.
[0186] d. Cerebral Amyloidosis
[0187] Local deposition of amyloid is common in the brain,
particularly in elderly individuals. The most frequent type of
amyloid in the brain is composed primarily of A.beta. peptide
fibrils, resulting in dementia or sporadic (non-hereditary)
Alzheimer's disease. In fact, the incidence of sporadic Alzheimer's
disease greatly exceeds forms shown to be hereditary. Fibril
peptides forming these plaques are very similar to those described
above, with reference to hereditary forms of Alzheimer's disease
(AD).
[0188] e. Dialysis-related Amyloidosis
[0189] Plaques composed of .beta..sub.2 microglobulin
(A.beta..sub.2M) fibrils commonly develop in patients receiving
long term hemodialysis or peritoneal dialysis. .beta..sub.2
microglobulin is a 11.8 kilodalton polypeptide and is the light
chain of Class I MHC antigens, which are present on all nucleated
cells. Under normal circumstances, it is continuously shed from
cell membranes and is normally filtered by the kidney. Failure of
clearance, such as in the case of impaired renal function, leads to
deposition in the kidney and other sites (primarily in
collagen-rich tissues of the joints). Unlike other fibril proteins,
A.beta..sub.2M molecules are generally present in unfragmented form
in the fibrils. (Benson, supra).
[0190] f. Hormone-Derived Amyloidoses
[0191] Endocrine organs may harbor amyloid deposits, particularly
in aged individuals. Hormone-secreting tumors may also contain
hormone-derived amyloid plaques, the fibrils of which are made up
of polypeptide hormones such as calcitonin (medullary carcinoma of
the thyroid), islet amyloid polypeptide (amylin; occurring in most
patients with Type II diabetes), and atrial natriuretic peptide
(isolated atrial amyloidosis). sequences and structures of these
proteins are well known in the art.
[0192] g. Miscellaneous Amyloidoses
[0193] There are a variety of other forms of amyloid disease that
are normally manifest as localized deposits of amyloid. In general,
these diseases are probably the result of the localized production
and/or lack of catabolism of specific fibril precursors or a
predisposition of a particular tissue (such as the joint) for
fibril deposition. Examples of such idiopathic deposition include
nodular AL amyloid, cutaneous amyloid, endocrine amyloid, and
tumor-related amyloid.
III. AA AMYLOID DISEASES
[0194] AA amyloidosis, formerly called secondary or reactive
amyloidosis because it develops secondary to a preexisting or
coexisting disease. Such diseases include, but are not limited to
inflammatory diseases, such as rheumatoid arthritis, juvenile
chronic arthritis, ankylosing spondylitis, psoriasis, psoriatic
arthropathy, Reiter's syndrome, Adult Still's disease, Behcet's
syndrome, and Crohn's disease. AA deposits are also produced as a
result of chronic microbial infections, such as leprosy,
tuberculosis, bronchiectasis, decubitus ulcers, chronic
pyelonephritis, osteomyelitis, and Whipple's disease. Certain
malignant neoplasms can also result in AA fibril amyloid deposits.
These include such conditions as Hodgkin's lymphoma, renal
carcinoma, carcinomas of gut, lung and urogenital tract, basal cell
carcinoma, and hairy cell leukemia. AA amyloid disease may also
result from inherited inflammatory diseases such as Familial
Mediterranean Fever. Additionally, AA amyloid disease may result
from lymphoproliferative disorders such as Castleman's Disease.
1. Inflammatory Diseases Associated with AA Amyloidosis
[0195] Rheumatoid arthritis is a chronic systemic disease primarily
of the joints. The symptoms of rheumatoid arthritis are marked by
inflammatory changes in the synovial membranes and articular
structures (joints) and by atrophy and rarefaction (bone density
decreases) of the bones. In late stages of rheumatoid arthritis,
deformity and ankylosis (immobility of the joint) develop. A model
of rheumatoid arthritis can be induced in mice or rats by
administering type II collagen in complete Freund's adjuvant.
[0196] Juvenile chronic arthritis comes in many forms; the most
common being juvenile rheumatoid arthritis. It can occur in
children at any age, but first appears more commonly between the
ages of 2 and 6 years. There are 3 main types of juvenile
rheumatoid arthritis, namely, pauci-articular arthritis,
polyarticular arthritis, and systemic arthritis (also known as
Still's disease). Pauci-articular arthritis typically affects 4 or
fewer joints, usually the larger ones such as the knees. It can be
accompanied by stiffness, causing the child to limp. Polyarticular
arthritis is characterized by 5 or more joints being affected, most
commonly the smaller joints in the hands and feet. Children with
polyarticular arthritis often have a more severe form of the
disease. Systemic arthritis is characterized by joint swelling in
combination with fever and a pink rash. The joints may not start to
swell until some months or years after the fevers begin. It may
also affect internal organs such as the liver, heart, spleen and
lymph nodes, and anemia is common. While systemic arthritis tends
to abate of its own accord, a small percentage of these children
can have severe arthritis that continues into adulthood.
[0197] Ankylosing spondylitis is a rheumatic disease that causes
arthritis of the spine and sacroiliac joints and can cause
inflammation of the eyes, lungs, and heart valves. It varies from
intermittent episodes of back pain that occur throughout life to a
severe chronic disease that attacks the spine, peripheral joints
and other body organs, resulting in severe joint and back
stiffness, loss of motion and deformity as life progresses.
[0198] Psoriasis is a common chronic, squamous dermatosis, marked
by exacerbation and remissions and having a polygenic inheritance
pattern. The symptoms of psoriasis are marked by the presence of
rounded, dry scaling patches of various sizes, covered by a grayish
white or silvery white scales that have a predilection for the
extensor surfaces, nails, scalp, genitalia and the lumbosacral
region.
[0199] Psoriatic arthropathy is a disorder in which psoriasis is
linked to the development of arthritis. The disorder can be
exhibited in a variety of ways. The arthritis is generally mild and
involves only a few joints. In a few patients, the disease is
severe and usually affects the fingers and the spine. When the
spine is affected, the symptoms are very much like those of
ankylosing spondylitis.
[0200] Reiter's syndrome is a group of symptoms consisting of
arthritis, urethritis (inflammation of the urogenital tract),
conjunctivitis (inflammation of the lining of the eye), and lesions
of the skin and mucous membranes. Reiter's syndrome is also
referred to as reactive arthritis, which means that the arthritis
occurs as a "reaction" to an infection that started elsewhere in
the body. Chlamydia trachomatis is the bacteria most often
associated with Reiter's syndrome acquired through sexual contact.
Several different bacteria are associated with Reiter's syndrome
acquired through the digestive tract, including Salmonella,
Shigella, Yersinia, and Campylobacter.
[0201] Adult Still's disease, also called Adult Onset Still's
Disease is a rare inflammatory condition that attacks internal
organs, joints and other parts of the body. It can appear and
disappear suddenly. In very severe cases, adult Still's disease
becomes chronic and extremely debilitating, causing terrible pain
and stiffness. After many years, the disease cripples vital organs
such as the heart and lungs.
[0202] Behcet's syndrome is a multisystem disorder presenting with
recurrent oral and/or genital ulcerations, chronic relapsing
uveitis that may cause blindness and neurologic impairments. It is
characterized by 4 major symptoms: oral aphthous ulcers, skin
lesions, ocular symptoms, and genital ulcerations, and occasionally
by inflammation in tissues and organs throughout the body,
including the gastrointestinal tract, central nervous system,
vascular system, lungs, and kidneys. The arthritis of Behcet's
syndrome is usually intermittent, self-limited, not deforming and
localized to the knees and ankles.
[0203] Crohn's disease is a chronic granulomatous (small grain-like
body or growth) inflammatory disease involving any part of the
gastrointestinal tract from the mouth to anus; but commonly
involving the ileum (lower three-fifths of the small intestines)
with scarring and thickening of the bowel wall. The symptoms of
Crohn's disease include the presence of chronic diarrhea, increased
bowel sounds, cramping, possibly evidenced by weight loss and
aversion to eating.
2. Chronic Microbial Infection Diseases Associated with AA
Amyloidosis
[0204] Leprosy is an infectious disease characterized by
disfiguring skin sores, peripheral nerve damage, and progressive
debilitation. Leprosy is caused by the organism Mycobacterium
leprae, which is not very contagious and has a long incubation
period. Leprosy has two common forms, tuberculoid and lepromatous.
Both forms produce sores on the skin, but the lepromatous form is
most severe, producing large, disfiguring nodules (lumps and
bumps). Leptosy eventually causes peripheral neurological damage.
Patients with long-term leprosy may lose the use of their hands or
feet due to repeated injury resulting from lack of sensation.
[0205] Tuberculosis is a contagious bacterial infection caused by
Mycobacterium tuberculosis. The disease is characterized by the
development of granulomas (granular tumors) in the infected
tissues. The lungs are primarily involved, but the infection can
spread to other organs.
[0206] Bronchiectasis is an abnormal destruction and dilation of
the large airways. Bronchiectasis is often caused by recurrent
inflammation or infection of the airways. A classic bacterium that
is seen in patients with bronchiectasis is Pseudomonas aeruginosa,
which is notoriously hard to eradicate. Repeated infections of the
airways by this bacterium can lead to colonization of the bronchi
by this organism which predisposes such people to Pseudomonal
pneumonias, which requires special antibiotics to treat.
[0207] Decubitus ulcer also known as pressure ulcer or bedsore is
an ulceration of the skin and underlying tissues caused by
prolonged pressure over the affected area. They start as reddened
skin but gets progressively worse, forming a blister, then an open
sore, and finally a crater. These ulcerations usually occur over
bony prominences such as heels, coccyx area of the buttock and the
back of the head.
[0208] Chronic pyelonephritis is an infection of the kidney and the
ureters (ducts that carry urine away from the kidney).
Pyelonephritis most often occurs as a result of urinary tract
infection, particularly in the presence of occasional or persistent
backflow of urine from the bladder into the ureters or kidney
pelvis.
[0209] Osteomyelitis is an acute or chronic bone infection, usually
caused by bacteria. Often the infection initiates in another part
of the body and spreads to the bone via the blood. When the bone is
infected, pus is produced within the bone, which may result in an
abscess. The abscess then deprives the bone of its blood supply.
Chronic osteomyelitis results when bone tissue dies as a result of
the lost blood supply. Chronic infection can persist intermittently
for years.
[0210] Whipple's disease is a rare condition that causes inadequate
absorption of nutrients from the intestinal tract due to infection
of the intestine. It is caused by the bacteria, Tropheryma
whippelii. Symptoms include diarrhea, intestinal bleeding,
abdominal pain, loss of appetite, weight loss, fatigue, and
weakness. Arthritis and fever often occur several years before
intestinal symptoms develop. Patients may experience neurological
symptoms as well. Diagnosis is based on symptoms and the results of
a biopsy of tissue from the small intestine or other organs that
are affected. When recognized and treated, Whipple's disease can
usually be cured. Without treatment, the condition is usually
fatal.
3. Malignant Neoplasms Associated with AA Amyloidosis
[0211] Hodgkin's lymphoma is a cancer of lymphatic tissue found in
the lymph nodes, spleen, liver, and bone marrow. The first sign of
this cancer is often an enlarged lymph node. The disease can spread
to nearby lymph nodes and later may spread to the lungs, liver, or
bone marrow.
[0212] Renal carcinoma is cancer of the kidney. The cancerous cells
are found in the lining of tubules in the kidney. The first symptom
is usually blood in the urine. Sometimes both kidneys are involved.
The cancer spreads easily, most often to the lungs and other
organs. Renal cell carcinoma is the most common type of kidney
cancer followed by papillary renal cell carcinoma, chromophobe
renal carcinoma and collecting duct renal carcinoma. About 5% of
renal carcinoma are unclassified because their appearance doesn't
fit into any of the other categories.
[0213] Carcinomas of the gut include gastrointestinal cancers such
as colorectal, pancreatic, stomach and esophageal. Colorectal
cancer is cancer that starts in the large intestine or the rectum.
Almost all colorectal cancers begin as benign polyps which, over a
period of many years, develop into cancers. Most cases of
colorectal cancer have no symptoms. Pancreatic cancer is a
malignancy of the pancreas. Symptoms include abdominal pain, loss
of appetite, significant weight loss and painless jaundice. Stomach
cancer, also called gastric cancer, can develop in any part of the
stomach and may spread throughout the stomach and to other organs;
particularly the esophagus and the small intestine. It may also
spread, through the stomach wall, to nearby lymph nodes and organs
such as the liver, pancreas, and the lungs, or to distant organs
such as the lymph nodes above the collar bone, the colon, and the
ovaries. Stomach cancer is often asymptomatic. Esophageal cancer is
malignancy of the esophagus. Symptoms include dysphagia (difficulty
swallowing), pain and substantial weight loss.
[0214] Carcinomas of the lung are a cancer of the lungs
characterized by the presence of malignant tumours. There are two
main types of lung cancer: non-small cell lung cancer and small
cell lung cancer. Symptoms depend on the specific type of cancer,
but may include chronic cough, coughing up blood, shortness of
breath, wheezing, chest pain, loss of appetite, weight loss and
fatigue.
[0215] Carcinomas of the urogenital tract include but are not
limited to prostate cancer, bladder cancer, endometrial cancer,
cervical cancer and ovarian cancer. Prostate cancer involves a
malignant tumor growth within the prostate gland. Symptoms may
include frequent urination, difficulty starting and maintaining a
steady stream of urine, blood in the urine, painful urination,
difficulty achieving erection or painful ejaculation. Bladder
cancer refers to any of several types of malignant growths of the
urinary bladder. Symptoms include blood in the urine, frequent
urination, painful urination, and urinary urgency. Endometrial
cancer involves cancerous growth of the endometrium (lining of the
uterus). It mainly occurs after menopause, and presents with
vaginal bleeding. Cervical cancer is a malignancy of the cervix.
The early stages of cervical cancer may be completely asymptomatic.
Vaginal bleeding may indicate the presence of malignancy. In
advanced stages, metastases may be present in the abdomen, lungs or
elsewhere. Ovarian cancer is a malignant neoplansm of the ovaries.
Ovarian cancer symptoms are often vague and non-specific, which
include vague lower abdominal discomfort, sense of pelvic
heaviness, abnormal menstrual cycle, vaginal bleeding, weight gain
or loss, nonspecific gastrointestinal symptoms. Ovarian cancers
shed cancer cells that often implant on the uterus, bladder, bowel,
and lining of the bowel wall. These cancer cells can begin forming
new tumor growths before cancer is even suspected.
[0216] Basal cell carcinoma is a slow-growing skin tumor involving
cancerous changes in basal skin cells. Symptoms include skin
lesions located on the face, ear, neck, chest, back, or scalp;
visible blood vessels in the lesion or adjacent skin; and
persistent, non-healing sores. This cancer usually remains local
and almost never spreads to distant parts of the body, but it may
continue to grow and invade nearby tissues and structures,
including the nerves, bones, and brain.
[0217] Hairy cell leukemia is a cancer of lymphocytes (B cells)
that leads to low blood counts. The disease is caused by the
abnormally shaped B cells with hair-like projections. Symptoms are
often vague. The low blood counts caused by hairy cell leukemia can
lead to infections, fatigue, and excessive bleeding.
4. Inherited Inflammatory Disease Associated with AA
[0218] Familial Mediterranean Fever is an inherited disorder
characterized by recurrent fever and inflammation, often involving
the abdomen or the lung. Symptoms include inflammation in the
lining of the abdominal cavity, chest cavity, skin, or joints
occurs, along with high fevers that usually peak in 12 to 24 hours.
Attacks may vary in severity of symptoms, and people are usually
symptom free between attacks. This disease is very rare. Risk
factors include a family history of familial Mediterranean Fever or
having Mediterranean ancestry.
5. Lymphoproliferative Disorders Associated with AA Amyloidosis
[0219] Castleman's Disease is a form of lympoproliferative disorder
characterized pathologicaly by the presence of giant lymp node
hyperplasia with plasma cell infiltration. Patients with
Castleman's Disease commonly have fever, anemia,
hypergammaglobulinaemia, and an increase in the serum
concentrations of acute phase reactant proteins, all of which are
ascribed to the large amount of IL-6 produced in the lymph
nodes.
IV. SERUM AMYLOID A
1. Human Serum Amyloid A
[0220] Serum amyloid A (SAA) is the circulating precursor of
amyloid A protein, the fibrillar component of amyloid deposits. The
structural studies showed that the human SAA is heterogeneous and
represents a family of polymorphic SAA genes and protein products.
The SAA gene superfamily comprises a cluster of closely linked
genes localized to 11p15.1. See Sellar, G C et al. Genomics 19:
221-227 (1994). Four SAA genes have been described in humans.
Representative amino acid sequences of proteins encoded by the four
SAA genes are illustrated by FIG. 1. Two genes (SAA1 and SAA2)
encode acute-phase serum amyloid A (A-SAA) and are coordinately
induced in response to inflammation. SAA1 and SAA2 share 95%
sequence identity in both coding and noncoding regions. There are
alpha, beta and gamma isoforms of human SAA1 and alpha and beta
isoforms of human SAA2 as illustrated by FIGS. 18 and 19. SAA3 is a
pseudogene. SAA4 encodes constitutive SAA and is minimally
inducible. See Cunnane G. Bailliere's Clin. Rheumatol. 13(4):
615-628. All human SAA/AA molecules contains a theoretical
calcium-binding tetrapeptide sequence, Gly-Pro-Gly-Gly, of possible
importance for self aggregation and with extrafibrillar moieties of
amyloid in fibrillogenesis. See Fykse, E. M. et al. Biochem. J.
256:973-980 (1988) and Turnell et al. Mol. Biol. Med. 3:387-407
(1986). The N terminal portion of SAA/AA is strongly hydrophobic,
probably of importance for self aggregation and other components in
amyloid deposits. See Husby et al. Clin. Immunol. Immunopathol.
70(1):2-9 (1994). The sequence of each isoform of AA and its
relationship to its corresponding SAA isoform is illustrated by
FIGS. 2-5. For example, human SAA1 alpha isoform has the
sequence:
TABLE-US-00003 (SEQ ID NO: 1)
H.sub.2N-Met-Lys-Leu-Leu-Thr-Gly-Leu-Val-Phe-Cys-Ser-
Leu-Val-Leu-Gly-Val-Ser-Ser-Arg-Ser-Phe-Phe-Ser-
Phe-Leu-Gly-Glu-Ala-Phe-Asp-Gly-Ala-Arg-Asp-Met-
Try-Arg-Ala-Tyr-Ser-Asp-Met-Arg-Glu-Ala-Asn-Tyr-
Ile-Gly-Ser-Asp-Lys-Tyr-Phe-His-Ala-Arg-Gly-Asn-
Tyr-Asp-Ala-Ala-Lys-Arg-Gly-Pro-Gly-Gly-Ala-Try-
Ala-Ala-Glu-Val-Ile-Ser-Asp-Ala-Arg-Glu-Asn-Ile-
Gln-Arg-Phe-Phe-Gly-His-Gly-Ala-Glu-Asp-Ser-Leu-
Ala-Asp-Gln-Ala-Ala-Asn-Glu-Try-Gly-Arg-Ser-Gly-
Lys-Asp-Pro-Asn-His-Phe-Arg-Pro-Ala-Gly-Leu-Pro-
Glu-Lys-Tyr-OH.
[0221] AA, which is a proteolytic fragment of SAA, is also
heterogeneous. The predominant human AA peptide consists of 76
amino acids. An example of AA has the sequence:
TABLE-US-00004 (SEQ ID NO: 2)
H.sub.2N-Arg-Ser-Phe-Phe-Ser-Phe-Leu-Gly-Glu-Ala-Phe-
Asp-Gly-Ala-Arg-Asp-Met-Try-Arg-Ala-Tyr-Ser-Asp-
Met-Arg-Glu-Ala-Asn-Tyr-Ile-Gly-Ser-Asp-Lys-Tyr-
Phe-His-Ala-Arg-Gly-Asn-Tyr-Asp-Ala-Ala-Lys-Arg-
Gly-Pro-Gly-Gly-Ala-Try-Ala-Ala-Glu-Val-Ile-Ser-
Asp-Ala-Arg-Glu-Asn-Ile-Gln-Arg-Phe-Phe-Gly-His-
Gly-Ala-Glu-Asp-Ser-OH.
[0222] AA70-76 refers to an AA fragment beginning at residue 70 and
ending at residue 76 of (SEQ ID NO:2) consisting of the sequence
GHGAEDS, (SEQ ID NO: 4), or corresponding segment from another
naturally occurring AA protein from a human or other species when
the sequence of that protein is maximally aligned with SEQ ID
NO:2.
2. Murine Serum Amyloid A
[0223] In the mouse, four SAA genes have been described.
Representative amino acid sequences of proteins encoded by the four
murine SAA genes are illustrated by FIG. 8. Mouse SAA gene family
comprises four members that are closely linked in the chromosome 7.
Two of these genes encoding major mouse SAA isotypes (SAA1 and
SAA2) share high sequence identity not only in exons but also in
introns and flanking regions and are induced in approximately equal
quantities in response to amyloid induction models. These two
isotypes differ in only 9 of 103 amino acid residues; however, only
SAA2 is selectively deposited into amyloid fibrils. See de Beer M.
C. Biochem J. 1991 280(Pt 1): 45-49 (1991); Hoffman J. S. et al. J
Exp Med. 159:641-646 (1984); Shiroo M et al. Scand J. Immunol.
26:709-716 (1987). SAA3 is a minor HDL apolipoprotein and
peripherally produced acute phase. SAA4 is a constitutive subfamily
that is a minor normal HDL apolipoprotein comprising more than 90%
of the SAA during homeostasis. See Stearman R. S. et al. Nucleic
Acids Research, 14(2)797-809 (1986) and de Beer M. C. Genomics,
34(1):139-42 (1996).
[0224] Murine AA which is a proteolytic fragment of SAA is also
heterogeneous. The sequence of each murine isoform of AA and its
relationship to its corresponding SAA isoform is illustrated by
FIGS. 9-12. A sequence alignment of murine AA1, AA2, AA3 and AA4 is
illustrated by FIG. 13.
[0225] Murine AA1 is the murine equivalent of human AA1. See FIG.
16. In particular, residues 69-75 of murine AA1 (GRGHEDT, SEQ ID
NO: 9) are maximally aligned with residues 70-76 of human AA1
(GHGAEDS, SEQ ID NO: 4). See also FIG. 17.
3. Shar Pei Serum Amyloid A
[0226] The Shar Pei sequence is indicated in FIG. 20.
Interestingly, the homologous region in the human SAA protein
-AEDS, (SEQ ID NO: 13) contains a conserved Thr to Ser substitution
at position 76, as well as significantly different side chain of
the residue at position 73 (His to Ala; FIG. 1). The -AEDS, (SEQ ID
NO: 13), sequence is also observed in the Shar Pei species of dog,
a breed that is particularly susceptible to AA-amyloidosis and
could provide a naturally occurring model of systemic AA in which
to evaluate novel diagnostic and therapeutic applications of AA
amyloid-specific antibodies and other compounds.
4. The N-Terminal Segment of AA Protein Determines its
Fibrillogenic Property
[0227] The amyloid fibril protein AA consists of a varying long
N-terminal part of the precursor protein serum AA. Evidence shows
that the amyloidogenic part of the molecule is the N-terminal 10-15
amino acid long segment. Amino acid substitutions in this part of
the molecule may explain why only one of the two mouse SAA isoforms
is amyloidogenic. See Westermark G. T. Biochem Biophys Res Commun.
182(1):27-33 (1992).
V. OTHER HUMAN AMYLOIDOGENIC PROTEINS
[0228] The Genbank Accession Numbers and X.sub.1EDX.sub.2 sequences
are provided below in Table 3 for several human amyloidogenic
proteins, including some of those listed above in Table 2.
TABLE-US-00005 TABLE 3 Human Amyloidogenic Proteins Human GenBank
amyloidogenic Consensus Accession protein sequence Number SAA1
AEDS, (SEQ ID NO: 13) SAA2 AEDS, (SEQ ID NO: 13) SAA3 AEDS, (SEQ ID
NO: 13) SAA4 AEDS, (SEQ ID NO: 13) anti-Sm immunoglobulin kappa
light chain V AEDV, (SEQ ID NO: 23) AAB26897 region; monoclonal
antibody 4B4 kappa chain immunoglobulin variable region used by the
PEDS, (SEQ ID NO: 26) AAC61608 ITC52 kappa light chain (subgroup V
kappa II) immunoglobulin variable region used by the AEDV, (SEQ ID
NO: 23) AAC61606 ITC48 kappa light chain (subgroup V kappa IV)
anti-RhD monoclonal T125 kappa light SEDF, (SEQ ID NO: 24) AAW82027
chain precursor immunoglobulin kappa light chain precursor AEDV,
(SEQ ID NO: 23) CAA45496 immunoglobulin kappa light chain PEDF,
(SEQ ID NO: 22) AAT44350 variable region immunoglobulin kappa light
PEDF, (SEQ ID NO: 22) AAT44349 chain variable region immunoglobulin
kappa light PEDF, (SEQ ID NO: 22) AAT44348 chain variable region
immunoglobulin kappa light chain PEDF, (SEQ ID NO: 22) CAA09185
immunoglobulin kappa light chain SEDF, (SEQ ID NO: 24) CAA09181
immunoglobulin kappa light chain SEDF, (SEQ ID NO: 24) AAU14891
variable region anti-rabies SOJA immunoglobulin PEDF, (SEQ ID NO:
22) AAO17825 kappa light chain anti- streptococcal/anti-myosin
SEDF, (SEQ ID NO: 24) AAB68786 immunoglobulin kappa light chain
variable region anti- streptococcal/anti-myosin PEDF, (SEQ ID NO:
22) AAB68785 immunoglobulin kappa light chain variable region
anti-HLA-A2/anti-HLA-A28 PEDF, (SEQ ID NO: 22) AAC99644
immunoglobulin kappa light chain variable region immunoglobulin
kappa light chain V region; PEDF, (SEQ ID NO: 22) AAB62946 anti-DNA
antibody 18/2 immunoglobulin kappa light chain PEDF, (SEQ ID NO:
22) BAF75949 anti-HIV-1 gp120 immunoglobulin 48d PEDF, (SEQ ID NO:
22) AAR88370 kappa light chain immunoglobulin kappa light chain
PEDL, (SEQ ID NO: 27) BAA97671 anti-Entamoeba histolytica
immunoglobulin PEDF, (SEQ ID NO: 22) BAA82105 kappa light chain
anti-Entamoeba histolytica immunoglobulin TEDV, (SEQ ID NO: 28)
BAA82102 kappa light chain immunoglobulin kappa light chain PEDF,
(SEQ ID NO: 22) AAC41705 anti-GM2 glanglioside IgM monoclonal AEDV,
(SEQ ID NO: 23) AAC26480 kappa light chain variable region
anti-SARS-CoV immunoglobulin PEDV, (SEQ ID NO: 151) AAT51719 kappa
light chain variable region anti-SARS-CoV immunoglobulin PEDF, (SEQ
ID NO: 22) AAT51718 kappa light chain variable region
immunoglobulin kappa light chain PEDF, (SEQ ID NO: 22) BAD27502 VLJ
region immunoglobulin kappa light chain SEDF, (SEQ ID NO: 24)
BAD27497 VLJ region anti-HIV-1 gp120 immunoglobulin PEDF, (SEQ ID
NO: 22) AAR88378 47e kappa light chain anti-HIV-1 gp120
immunoglobulin PEDF, (SEQ ID NO: 22) AAR88374 16c kappa light chain
anti-HIV-1 gp120 immunoglobulin 411g SEDF, (SEQ ID NO: 24) AAR88372
kappa light chain immunoglobulin kappa light PEDF, (SEQ ID NO: 22)
AAF14212 chain variable region immunoglobulin kappa light PEDF,
(SEQ ID NO: 22) AAF14211 chain variable region immunoglobulin kappa
light chain PEDF, (SEQ ID NO: 22) AAF14210 variable region
immunoglobulin kappa light chain PEDF, (SEQ ID NO: 22) AAF14209
variable region immunoglobulin V-region kappa light chain PEDI,
(SEQ ID NO: 21) AAR02415 immunoglobulin kappa light chain PEDF,
(SEQ ID NO: 22) AAM46647 immunoglobulin kappa light chain AEDV,
(SEQ ID NO: 23) AAM46643 anti-Entamoeba histolytica immunoglobulin
PEDF, (SEQ ID NO: 22) BAA82103 kappa light chain immunoglobulin
light chain AEDV, (SEQ ID NO: 23) AAL65723 kappa variable region
immunoglobulin light chain PEDF, (SEQ ID NO: 22) AAL65718 kappa
variable region immunoglobulin light chain SEDF, (SEQ ID NO: 24)
AAL65717 kappa variable region immunoglobulin light chain SEDF,
(SEQ ID NO: 24) AAL65716 kappa variable region immunoglobulin light
chain PEDF, (SEQ ID NO: 22) AAL65714 kappa variable region
immunoglobulin light chain PEDF, (SEQ ID NO: 22) AAL65713 kappa
variable region immunoglobulin light chain PEDF, (SEQ ID NO: 22)
AAL65712 kappa variable region immunoglobulin light chain PEDF,
(SEQ ID NO: 22) AAL65711 kappa variable region immunoglobulin light
chain PEDF, (SEQ ID NO: 22) AAL65710 kappa variable region
immunoglobulin light chain LEDG, (SEQ ID NO: 31) AAL65709 kappa
variable region PEDF, (SEQ ID NO: 22) immunoglobulin light chain
LEDG, (SEQ ID NO: 31) AAL65708 kappa variable region PEDF, (SEQ ID
NO: 22) immunoglobulin light chain PEDF, (SEQ ID NO: 22) AAL65707
kappa variable region immunoglobulin light chain PEDF, (SEQ ID NO:
22) AAL65706 kappa variable region immunoglobulin light chain PEDF,
(SEQ ID NO: 22) AAL65705 kappa variable region immunoglobulin light
chain PEDF, (SEQ ID NO: 22) AAL65704 kappa variable region
immunoglobulin light chain PEDF, (SEQ ID NO: 22) AAL65703 kappa
variable region immunoglobulin kappa light SEDF, (SEQ ID NO: 24)
AAC64146 chain variable region immunoglobulin kappa light SEDF,
(SEQ ID NO: 24) AAC64144 chain variable region immunoglobulin kappa
light PEDF, (SEQ ID NO: 22) ABI64139 chain variable region
anti-pneumococcal capsular polysaccharide AEDV, (SEQ ID NO: 23)
AAL04535 immunoglobulin kappa light chain immunoglobulin light
chain AEDV, (SEQ ID NO: 23) AAL65722 kappa variable region
immunoglobulin light chain AEDV, (SEQ ID NO: 23) AAL65720 kappa
variable region immunoglobulin light chain V-J region PEDF, (SEQ ID
NO: 22) BAA19563 immunoglobulin light chain V-J region AEDE, (SEQ
ID NO: 19) BAA19562 immunoglobulin light chain V-J region AEDE,
(SEQ ID NO: 19) BAA19561 immunoglobulin light chain V-J region
PEDF, (SEQ ID NO: 22) BAA19560 immunoglobulin light chain V-J
region PEDF, (SEQ ID NO: 22) BAA19559 immunoglobulin light chain
V-J region AEDV, (SEQ ID NO: 23) BAA19558 immunoglobulin light
chain V-J region PEDI, (SEQ ID NO: 21) BAA19556 immunoglobulin
kappa light PEDF, (SEQ ID NO: 22) AAA71907 chain variable region
immunoglobulin kappa light AEDV, (SEQ ID NO: 23) AAA71905 chain
variable region immunoglobulin G1 Fab light AEDV, (SEQ ID NO: 23)
BAF49281 chain variable region immunoglobulin G1 Fab light PEDF,
(SEQ ID NO: 22) BAF48998 chain variable region immunoglobulin G1
Fab light PEDF, (SEQ ID NO: 22) BAF48996 chain variable region
kappa light chain V-region AEDM, (SEQ ID NO: 32) CAA37675
immunogloburin G1 Fab light SEDF, (SEQ ID NO: 24) BAF48994 chain
variable region immunogloburin G1 Fab light PEDF, (SEQ ID NO: 22)
BAF48992 chain variable region Ig kappa chain precursor V-J-C
region AEDV, (SEQ ID NO: 23) A53261 Ig kappa chain precursor V
region AEDV, (SEQ ID NO: 23) A49137 Ig kappa chain precursor V-I
region SEDI, (SEQ ID NO: 29) PN0445 Ig kappa chain precursor V-
PEDF, (SEQ ID NO: 22) A32274 III region (EVI-15) Ig kappa chain
V-IV region (Dep) AEDV, (SEQ ID NO: 23) A34153 Ig kappa chain V-IV
region (Fue) AEDV, (SEQ ID NO: 23) B34153 Ig kappa chain V-II
region (Pec) AEDV, (SEQ ID NO: 23) C34153 Chain L, Igg Fab Fragment
(Cd25-Binding). AEDA, (SEQ ID NO: 62) 1MIM_L Chain H, Igg Fab
Fragment (Cd25-Binding). HEDS, (SEQ ID NO: 33) 1MIM_H Ig mu chain C
region, secreted splice form CEDD, (SEQ ID NO: 34) MHHU
immunoglobulin kappa-chain VJ region AEDV, (SEQ ID NO: 23) AAA58923
recombinant monoclonal antibody IgM 12 PEDF, (SEQ ID NO: 22)
ABA41551 kappa light chain variable region immunoglobulin light
chain AEDE, (SEQ ID NO: 19) CAA65054 immunoglobulin light chain
AEDE, (SEQ ID NO: 19) AAL65769 lambda variable region
immunoglobulin light chain AEDE, (SEQ ID NO: 19) AAL65767 lambda
variable region immunoglobulin light chain AEDE, (SEQ ID NO: 19)
AAL65765 lambda variable region immunoglobulin light chain TEDE,
(SEQ ID NO: 16) AAL65764 lambda variable region immunoglobulin
light chain AEDE, (SEQ ID NO: 19) AAL65763 lambda variable region
immunoglobulin light chain SEDE, (SEQ ID NO: 18) AAL65762 lambda
variable region immunoglobulin light chain SEDE, (SEQ ID NO: 18)
AAL65761 lambda variable region immunoglobulin light chain SEDE,
(SEQ ID NO: 18) AAL65760 lambda variable region immunoglobulin
light chain AEDE, (SEQ ID NO: 19) AAL65759 lambda variable region
immunoglobulin light chain AEDE, (SEQ ID NO: 19) AAL65758 lambda
variable region immunoglobulin light chain V-J region PEDF, (SEQ ID
NO: 22) BAA19563 immunoglobulin light chain V-J region AEDE, (SEQ
ID NO: 19) BAA19562 immunoglobulin light chain V-J region AEDE,
(SEQ ID NO: 19) BAA19561 immunoglobulin light chain V-J region
PEDF, (SEQ ID NO: 22) BAA19560 immunoglobulin light chain V-J
region PEDF, (SEQ ID NO: 22) BAA19559 immunoglobulin light chain
V-J region AEDV, (SEQ ID NO: 23) BAA19558 immunoglobulin light
chain V-J region PEDI, (SEQ ID NO: 21) BAA19556 30-lambda
immunoglobulin AEDE, (SEQ ID NO: 19) AAK95335 light chain variable
region PREDICTED: similar to Low affinity QEDS, (SEQ ID NO: 35)
XP_001129584 immunoglobulin gamma Fc region receptor II-a precursor
(Fc-gamma RII-a) (FcRII-a) (IgG Fc receptor II-a) (Fc-gamma-RIIa)
(CD32 antigen) (CDw32) Fc fragment of IgG, high affinity Ia, REDS,
(SEQ ID NO: 36) NP_000557 receptor (CD64) TEDG, (SEQ ID NO: 37)
QEDR, (SEQ ID NO: 38) Fc fragment of IgG, low affinity IIb, QEDS,
(SEQ ID NO: 35) NP_001002273 receptor for (CD32) isoform 2
XP_943944 Fc fragment of IgG, low affinity IIb, QEDS, (SEQ ID NO:
35) NP_003992 receptor for (CD32) isoform 1 Fc fragment of IgG, low
affinity IIb, QEDS, (SEQ ID NO: 35) NP_001002275 receptor for
(CD32) isoform 4 Fc fragment of IgG, low affinity IIb, QEDS, (SEQ
ID NO: 35) NP_001002274 receptor for (CD32) isoform 3 XP_001129592
Fc fragment of IgG, high affinity Ib, QEDR, (SEQ ID NO: 38)
NP_001017986 receptor (CD64) isoform a Fc fragment of IgG, high
affinity Ib, QEDR, (SEQ ID NO: 38) NP_001004340 receptor (CD64)
isoform b XP_496386 Fc fragment of IgG, low affinity IIa, QEDS,
(SEQ ID NO: 35) NP_067674 receptor (CD32) XP_943942 low affinity
immunoglobulin TEDL, (SEQ ID NO: 39) NP_000561 gamma Fc region
receptor PEDN, (SEQ ID NO: 40) III-B precursor EEDP, (SEQ ID NO:
41) Fc fragment of IgG, low affinity Ma, TEDL, (SEQ ID NO: 39)
NP_000560 receptor for (CD16) PEDN, (SEQ ID NO: 40) XP_001133750
EEDP, (SEQ ID NO: 41) Low affinity immunoglobulin gamma Fc QEDS,
(SEQ ID NO: 35) P12318 region receptor II-a precursor (Fc-gamma
RII-a) (FcRII-a) (IgG Fc receptor II-a) (Fc- gamma-RIIa) (CD32
antigen) (CDw32) Low affinity immunoglobulin gamma Fc TEDL, (SEQ ID
NO: 39) O75015 region receptor III-B precursor (IgG Fc PEDN, (SEQ
ID NO: 40) receptor III-1) (Fc-gamma RIII-beta) (Fc- EEDP, (SEQ ID
NO: 41) gamma RIIIb) (FcRIIIb) (Fc-gamma RIII) (FcRIII) (FcR-10)
(CD16b antigen) Low affinity immunoglobulin gamma Fc TEDL, (SEQ ID
NO: 39) P08637 region receptor III-A precursor (IgG Fc PEDN, (SEQ
ID NO: 40) receptor III-2) (Fc-gamma RIII-alpha) (Fc- EEDP, (SEQ ID
NO: 41) gamma RIIIa) (FcRIIIa) (Fc-gamma RIII) (FcRIII) (FcR-10)
(CD16a antigen) High affinity immunoglobulin gamma Fc REDS, (SEQ ID
NO: 36) P12314 receptor I precursor (Fc-gamma RI) (FcRI) TEDG, (SEQ
ID NO: 37) (IgG Fc receptor I) (CD64 antigen). QEDR, (SEQ ID NO:
38) IGHG1 immunoglobulin heavy constant AEDT, (SEQ ID NO: 14)
Q6PJA4 gamma 1 (G1m marker) apoAI [Homo sapiens] LEDL, (SEQ ID NO:
42) CAA01253 apolipoprotein C-III precursor AEDA, (SEQ ID NO: 62)
NP_000031 [Homo sapiens] apolipoprotein A-IV precursor AEDV, (SEQ
ID NO: 23) NP_000473 [Homo sapiens].
gelsolin (amyloidosis, Finnish type) TEDT, (SEQ ID NO: 30) CAM20459
[Homo sapiens] KEDA, (SEQ ID NO: 43) SEDC, (SEQ ID NO: 44) QEDL,
(SEQ ID NO: 63) gelsolin (amyloidosis, Finnish type) TEDT, (SEQ ID
NO: 30) CAI14413 [Homo sapiens] KEDA, (SEQ ID NO: 43) SEDC, (SEQ ID
NO: 44) QEDL, (SEQ ID NO: 63) gelsolin (amyloidosis, Finnish type),
TEDT, (SEQ ID NO: 30) EAW87491 isoform CRA_c KEDA, (SEQ ID NO: 43)
[Homo sapiens]. SEDC, (SEQ ID NO: 44) QEDL, (SEQ ID NO: 63)
gelsolin (amyloidosis, Finnish type), TEDT, (SEQ ID NO: 30)
EAW87490 [Homo sapiens] KEDA, (SEQ ID NO: 43) SEDC, (SEQ ID NO: 44)
QEDL, (SEQ ID NO: 63) gelsolin (amyloidosis, Finnish type), TEDT,
(SEQ ID NO: 30) EAW87489 [Homo sapiens] KEDA, (SEQ ID NO: 43) SEDC,
(SEQ ID NO: 44) QEDL, (SEQ ID NO: 63) amyloid precursor protein;
APP AEDV, (SEQ ID NO: 23) AAB23646 [Homo sapiens]. amyloid
precursor protein; APP AEDV, (SEQ ID NO: 23) AAB19991 [Homo
sapiens]. amyloid peptide AEDV, (SEQ ID NO: 23) AAA51768 Amyloid
beta A4 protein precursor (APP) EEDD, (SEQ ID NO: 45) P05067 (ABPP)
(Alzheimer disease amyloid protein) SEDK, (SEQ ID NO: 46) (Cerebral
vascular amyloid peptide) (CVAP) DEDD, (SEQ ID NO: 47) (Protease
nexin-II) (PN-II) (APPI) (PreA4) DEDG, (SEQ ID NO: 48) [Contains:
Soluble APP-alpha (S-APP- AEDV, (SEQ ID NO: 23) alpha); Soluble
APP-beta (S-APP-beta); C99; Beta-amyloid protein 42 (Beta-APP42);
Beta-amyloid protein 40 (Beta-APP40); C83; P3(42); P3 (40);
Gamma-CTF (59) (Gamma- secretase C-terminal fragment 59) (Amyloid
intracellular domain 59) (AID (59)) (AICD- 59); Gamma-CTF (57)
(Gamma-secretase C- terminal fragment 57) (Amyloid intracellular
domain 57) (AID (57)) (AICD-57); Gamma- CTF (50) (Gamma-secretase
C-terminal fragment 50) (Amyloid intracellular domain 50) (AID
(50)) (AICD-50); C31]. APP protein [Homo sapiens]. EEDD, (SEQ ID
NO: 45) AAH65523 SEDK, (SEQ ID NO: 46) DEDD, (SEQ ID NO: 47) DEDG,
(SEQ ID NO: 48) APP protein [Homo sapiens]. EEDD, (SEQ ID NO: 45)
AAH04369 SEDK, (SEQ ID NO: 46) DEDD, (SEQ ID NO: 47) DEDG, (SEQ ID
NO: 48) amyloid beta (A4) precursor protein EEDD, (SEQ ID NO: 45)
AAW82435 (protease nexin-II, Alzheimer disease) SEDK, (SEQ ID NO:
46) [Homo sapiens]. DEDD, (SEQ ID NO: 47) DEDG, (SEQ ID NO: 48)
AEDV, (SEQ ID NO: 23) Calcitonin SEDE, (SEQ ID NO: 18) AAA58403
calcitonin precursor SEDE, (SEQ ID NO: 18) AAA35501
preprocalcitonin [Homo sapiens] SEDE, (SEQ ID NO: 18) CAA25103
Preprocalcitonin SEDE, (SEQ ID NO: 18) AAA51913 Calcitonin
precursor [Contains: Calcitonin; SEDE, (SEQ ID NO: 18) P01258
Katacalcin (Calcitonin carboxyl-terminal peptide) (CCP) (PDN-21)]
calcitonin isoform CALCA SEDE, (SEQ ID NO: 18) NP_001029124
preproprotein [Homo sapiens]. calcitonin isoform CALCA SEDE, (SEQ
ID NO: 18) NP_001732 preproprotein [Homo sapiens]. calcitonin
isoform CGRP preproprotein SEDE, (SEQ ID NO: 18) NP_001029125 [Homo
sapiens]. Calcitonin gene-related peptide 1 precursor SEDE, (SEQ ID
NO: 18) P06881 (Calcitonin gene-related peptide I) (CGRP-I)
(Alpha-type CGRP). atrial natriuretic factor LEDE, (SEQ ID NO: 49)
AAA35528 atrial natriuretic factor propeptide LEDE, (SEQ ID NO: 49)
CAA25700 [Homo sapiens]. atrial natriuretic factor LEDE, (SEQ ID
NO: 49) 1101403A Atrial natriuretic factor precursor (ANF) LEDE,
(SEQ ID NO: 49) P01160 (Atrial natriuretic peptide) (ANP)
(Prepronatriodilatin) (CDD-ANF) [Contains: Cardiodilatin-related
peptide (CDP)]. atrial natriuretic peptide LEDE, (SEQ ID NO: 49)
AAA35529 keratin [Homo sapiens] GEDA, (SEQ ID NO: 50) AAB30058
keratin [Homo sapiens]. VEDF, (SEQ ID NO: 51) CAA31695 YEDE, (SEQ
ID NO: 52) Keratin IEDL, (SEQ ID NO: 53) AAB59562 GEDA, (SEQ ID NO:
50) Keratin, type II cytoskeletal 6C (Cytokeratin- VEDL, (SEQ ID
NO: 64) P48668 6C) (CK 6C) (K6c keratin) (Cytokeratin-6E) YEDE,
(SEQ ID NO: 52) (CK 6E) (Keratin K6h). LEDA, (SEQ ID NO: 65)
fibrinogen[Homo sapiens] WEDY, (SEQ ID NO: 54) CAA50740 fibrinogen
alpha subunit precursor DEDW, (SEQ ID NO: 55) AAC97142 [Homo
sapiens]. SEDL, (SEQ ID NO: 56) YEDQ, (SEQ ID NO: 57) SEDG, (SEQ ID
NO: 66) LEDW, (SEQ ID NO: 58) Fibrinogen alpha chain DEDW, (SEQ ID
NO: 55) AAI01936 [Homo sapiens] SEDL, (SEQ ID NO: 56) YEDQ, (SEQ ID
NO: 57) SEDG, (SEQ ID NO: 66) Fibrinogen alpha chain DEDW, (SEQ ID
NO: 55) AAH98280 [Homo sapiens] SEDL, (SEQ ID NO: 56) YEDQ, (SEQ ID
NO: 57) SEDG, (SEQ ID NO: 66) fibrinogen alpha chain, isoform CRA_b
DEDW, (SEQ ID NO: 55) EAX04926 [Homo sapiens]. SEDL, (SEQ ID NO:
56) YEDQ, (SEQ ID NO: 57) SEDG, (SEQ ID NO: 66) LEDW, (SEQ ID NO:
58) fibrinogen alpha chain, isoform CRA_c DEDW, (SEQ ID NO: 55)
EAX04928 [Homo sapiens]. SEDL, (SEQ ID NO: 56) YEDQ, (SEQ ID NO:
57) SEDG, (SEQ ID NO: 66) fibrinogen alpha chain, isoform CRA_a
DEDW, (SEQ ID NO: 55) EAX04924 [Homo sapiens] SEDL, (SEQ ID NO: 56)
prion protein precursor; PRNP YEDR, (SEQ ID NO: 59) AAC62750 [Homo
sapiens] Major prion protein precursor (PrP) (PrP27- YEDR, (SEQ ID
NO: 59) P04156 30) (PrP33-35C) (ASCR) (CD230 antigen) prion protein
preproprotein [Homo sapiens]. YEDR, (SEQ ID NO: 59) NP_000302
prolactin [Homo sapiens] PEDK, (SEQ ID NO: 60) CAA38264 Prolactin
[Homo sapiens]. PEDK, (SEQ ID NO: 60) AAH88370
VI. AMYLOID PEPTIDES FOR ACTIVE IMMUNIZATION
[0229] Therapeutic agents for use in the methods of the invention
are immunogenic peptides, such as AA peptides and AL peptides, that
on administration to a patient generate antibodies that
specifically bind to one or more epitopes comprising
X.sub.1EDX.sub.2, such as, for example, epitopes between residues
70-76 of AA ("AA agents"). Additional examples of agents include
immunogenic peptides that comprise a fragment consisting of
X.sub.1EDX.sub.2 derived from other amyloid proteins
("X.sub.1EDX.sub.2 fragments"), such as AL V.kappa. fragments
consisting of the amino acid sequence PEDI, (SEQ ID NO: 21), PEDF,
(SEQ ID NO: 22), AEDV, (SEQ ID NO: 23), SEDF, (SEQ ID NO: 24), or
SEDA, (SEQ ID NO: 25), and AL VX fragments consisting of the amino
acid sequence SEDE, (SEQ ID NO: 18), AEDE, (SEQ ID NO: 19), TEDE,
(SEQ ID NO: 16) or PEDE, (SEQ ID NO: 20). An AL VX fragment
consisting of the amino acid sequence FEDD, (SEQ ID NO: 17) may
also be used. Some suitable amyloid proteins include Serum amyloid
A protein, immunoglobulin light chain protein, human islet amyloid
precursor polypeptide (IAPP), beta amyloid peptide, transthyretin
(TTR), ApoA1 and other amyloid proteins listed in Table 1 and which
comprise the sequence X.sub.1EDX.sub.2. In some agents X.sub.1 is
H, T, F, S, P, A or any other amino acid residue immediately
preceding ED in an amyloid protein; and X.sub.2 is T, S, E, R, I,
V, F, D, A or any other amino acid residue immediately following ED
in such amyloid protein. In some agents, X.sub.1 is H, T, F, S, P,
or A and X.sub.2 is T, S, E, D, R, I, V, F or A. In some such
agents, when X.sub.1 is H, X.sub.2 is T or A; when X.sub.1 is A,
X.sub.2 is S, T, E or V; when X.sub.1 is T, X.sub.2 is E; when
X.sub.1 is F, X.sub.2 is D; when X.sub.1 is S, X.sub.2 is E, F or
A; and when X.sub.1 is P, X.sub.2 is E, I or F. In some agents,
X.sub.1 is H, T, F, S, P, or A and X.sub.2 is T, S, E, D, R, I, V,
F or A, with the proviso that if X.sub.1 is A, X.sub.2 is not V. In
some agents, when X.sub.1 is A, X.sub.2 is S, T or E.
[0230] Some agents comprise the amino acid sequence GHEDT, (SEQ ID
NO: 3), HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO: 13), AEDT, (SEQ ID
NO: 14), HEDA, (SEQ ID NO: 15), TEDE, (SEQ ID NO: 16), FEDD, (SEQ
ID NO: 17), SEDE, (SEQ ID NO: 18), AEDE, (SEQ ID NO: 19), PEDE,
(SEQ ID NO: 20), PEDI, (SEQ ID NO: 21), PEDF, (SEQ ID NO: 22),
AEDV, (SEQ ID NO: 23), SEDF, (SEQ ID NO: 24) or SEDA, (SEQ ID NO:
25). Some agents consist of an amino acid sequence selected from
the group consisting of GHEDT, (SEQ ID NO: 3, HEDT, (SEQ ID NO:
12), AEDS, (SEQ ID NO: 13), AEDT, (SEQ ID NO: 14), HEDA, (SEQ ID
NO: 15), TEDE, (SEQ ID NO: 16), FEDD, (SEQ ID NO: 17), SEDE, (SEQ
ID NO: 18), AEDE, (SEQ ID NO: 19), PEDE, (SEQ ID NO: 20), PEDI,
(SEQ ID NO: 21), PEDF, (SEQ ID NO: 22), AEDV, (SEQ ID NO: 23),
SEDF, (SEQ ID NO: 24), or SEDA, (SEQ ID NO: 25), linked to a
carrier to form a conjugate. Some agents comprise the amino acid
sequence GHEDT, (SEQ ID NO: 3, HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID
NO: 13), AEDT, (SEQ ID NO: 14), HEDA, (SEQ ID NO: 15), TEDE, (SEQ
ID NO: 16), FEDD, (SEQ ID NO: 17), SEDE, (SEQ ID NO: 18), AEDE,
(SEQ ID NO: 19), PEDE, (SEQ ID NO: 20), PEDI, (SEQ ID NO: 21),
PEDF, (SEQ ID NO: 22), AEDV, (SEQ ID NO: 23), SEDF, (SEQ ID NO:
24), or SEDA, (SEQ ID NO: 25). Some agents consist of an amino acid
sequence selected from the group consisting of GHEDT, (SEQ ID NO:
3, HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO: 13), AEDT, (SEQ ID NO:
14), HEDA, (SEQ ID NO: 15), TEDE, (SEQ ID NO: 16), FEDD, (SEQ ID
NO: 17), SEDE, (SEQ ID NO: 18), AEDE, (SEQ ID NO: 19), PEDE, (SEQ
ID NO: 20), PEDI, (SEQ ID NO: 21), PEDF, (SEQ ID NO: 22), SEDF,
(SEQ ID NO: 24) and SEDA, (SEQ ID NO: 25), linked to a carrier to
form a conjugate. Some agents comprise an amino acid sequence
selected from the group consisting of GHEDT, (SEQ ID NO: 3, HEDT,
(SEQ ID NO: 12), AEDS, (SEQ ID NO: 13), AEDT, (SEQ ID NO: 14),
HEDA, (SEQ ID NO: 15) and TEDE, (SEQ ID NO: 16).
[0231] Preferred AA fragments are human AA1 (HAA1) alpha isoform
residues 70-76 (GHGAEDS, SEQ ID NO:4), HAA1 beta isoform residues
70-76 (GHDAEDS, SEQ ID NO:5), HAA1 gamma isoform residues 70-76
(GHDAEDS, SEQ ID NO: 5), HAA2 alpha and beta isoforms residues
70-76 (GHGAEDS, SEQ ID NO: 4), HAA3 residues 70-76 (GDHAEDS, SEQ ID
NO:7), HAA4 residues 78-84 (STVIEDS, SEQ ID NO:8), mouse AA1 (MAA1)
residues 69-75 (GRGHEDT, SEQ ID NO:9), MAA2 residues 69-75
(GRGHEDT, SEQ ID NO: 9), MAA3 residues 62-68 (GHGAEDS, SEQ ID
NO:10), and MAA4 residues 76-82 (NHGLETL, SEQ ID NO:11) or
subfragments of at least three contiguous amino acids of any of
these. Some AA fragments contain no residues of an AA amyloidosis
peptide other than the segment designated above. Other AA fragments
contain additional flanking residues from an AA amyloidosis peptide
but contain no more than 20 or preferably no more than 10
contiguous residues in total from an AA amyloidosis peptide.
Additional preferred X.sub.1EDX.sub.2 and AL fragments include
GHEDT, (SEQ ID NO: 3), HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO:
13), AEDT, (SEQ ID NO: 14), HEDA, (SEQ ID NO: 15), and TEDE, (SEQ
ID NO: 16).
[0232] Therapeutic agents for use in the methods of the invention
also include immunogenic AA peptides that on administration to a
patient generate antibodies that specifically bind to N-terminal
epitopes of AA. Preferred agents induce an immunogenic response
directed to an epitope within residues 1-15 of human AA.
[0233] Preferably, the fragment of AA or AL or other agents such as
X.sub.1EDX.sub.2 fragments administered lack an epitope that would
generate a T-cell response to the fragment. Generally, T-cell
epitopes are greater than 10 contiguous amino acids. Therefore,
preferred fragments of amyloid proteins such as AA or
X.sub.1EDX.sub.2 fragments are of size 4-10 or preferably 7-10
contiguous amino acids; i.e., sufficient length to generate an
antibody response without generating a T-cell response. Absence of
T-cell epitopes is preferred because these epitopes are not needed
for immunogenic activity of fragments, and may cause an undesired
inflammatory response in a subset of patients (Anderson et al.,
(2002) J. Immunol. 168, 3697-3701; Senior (2002) Lancet Neurol. 1,
3).
[0234] Preferred AA fragments are human AA1 (HAA1) alpha isoform
residues 70-76 (GHGAEDS) (SEQ ID NO: 4), HAA1 beta isoform residues
70-76 (GHDAEDS) (SEQ ID NO:5), HAA1 gamma isoform residues 70-76
(GHDAEDS, SEQ ID NO: 5), HAA2 alpha and beta isoforms residues
70-76 (GHGAEDS, SEQ ID NO: 4), HAA3 residues 70-76 (GDHAEDS) (SEQ
ID NO:7), HAA4 residues 78-84 (STVIEDS) (SEQ ID NO:8), mouse AA1
(MAA1) residues 69-75 (GRGHEDT) (SEQ ID NO:9), MAA2 residues 69-75
(GRGHEDT, SEQ ID NO: 9), MAA3 residues 62-68 (GHGAEDS) (SEQ ID
NO:10), and MAA4 residues 76-82 (NHGLETL) (SEQ ID NO:11) or
subfragments of at least three contiguous amino acids of any of
these. Some AA fragments contain no residues of an AA amyloidosis
peptide other than the segment designated above. Other AA fragments
contain additional flanking residues from an AA amyloidosis peptide
but contain no more than 20 or preferably no more than 10
contiguous residues in total from an AA amyloidosis peptide.
Additional preferred X.sub.1EDX.sub.2 and AL fragments include
GHEDT, (SEQ ID NO: 3), HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO:
13), AEDT, (SEQ ID NO: 14), HEDA, (SEQ ID NO: 15), and TEDE, (SEQ
ID NO: 16).
[0235] Analogs of the natural AA amyloidosis, AL amyloidosis, and
other amyloidosis peptides can also be used to induce an immune
response in the methods and compositions of the invention. Analogs
including allelic, species and induced variants. Analogs of AA
induce antibodies that specifically bind with a natural AA 70-76
peptide. Some such analogs fail to induce antibodies that
specifically binds to epitopes outside AA70-76. Analogs of AA
typically differ from naturally occurring peptides at up to 30% of
amino acid positions by up to 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10
position changes. Each deletion or substitution of a natural amino
acid residue is considered a position change as is the insertion of
a residue without substitution. Amino acids substitutions are often
conservative substitutions.
[0236] Some analogs of AA or AA fragments or AL or AL fragments or
other amyloid protein fragments such as X.sub.1EDX.sub.2 fragments
also include unnatural amino acids or modifications of N or C
terminal amino acids at one, two, five, ten or even all positions.
For example, the natural aspartic acid residue can be replaced with
iso-aspartic acid. Examples of unnatural amino acids are D, alpha,
alpha-disubstituted amino acids, N-alkyl amino acids, lactic acid,
4-hydroxyproline, gamma-carboxyglutamate,
epsilon-N,N,N-trimethyllysine, epsilon-N-acetyllysine,
O-phosphoserine, N-acetylserine, N-formylmethionine,
3-methylhistidine, 5-hydroxylysine, omega-N-methylarginine,
.beta.-alanine, ornithine, norleucine, norvaline, hydroxproline,
thyroxine, gamma-amino butyric acid, homoserine, citrulline, and
isoaspartic acid. Some therapeutic agents of the invention are
all-D peptides, e.g., all-D AA or all-D AA fragments, and all-D
peptide analogs. Some therapeutic agents of the invention are 90%
all-D peptides, e.g., 90% all-D AA or 90% all-D AA fragments, and
90% all-D peptide analogs. Some therapeutic agents of the invention
are 80% all-D peptides, e.g., 80% all-D AA or 80% all-D AA
fragments, and 80% all-D peptide analogs. Fragments and analogs can
be screened for prophylactic or therapeutic efficacy in transgenic
animal models in comparison with untreated or placebo controls as
described below.
[0237] AA, AL, their fragments, and analogs and X.sub.1EDX.sub.2
fragments and their analogs can be synthesized by solid phase
peptide synthesis or recombinant expression, or can be obtained
from natural sources. Automatic peptide synthesizers are
commercially available from numerous suppliers, such as Applied
Biosystems, Foster City, Calif. Recombinant expression can be in
bacteria, such as E. coli, yeast, insect cells or mammalian cells.
Procedures for recombinant expression are described by Sambrook et
al., Molecular Cloning: A Laboratory Manual (C.S.H.P. Press, NY 2d
ed., 1989.)
[0238] Therapeutic agents also include longer polypeptides that
include, for example, an immunogenic fragment of AA peptide, AL
peptide or an X.sub.1EDX.sub.2 fragment, together with one or more
other amino acids flanking the AA peptide, AL peptide or
X.sub.1EDX.sub.2 fragment on one or one or both sides. For example,
preferred agents include fusion proteins comprising a segment of
AA, AL or X.sub.1EDX.sub.2 fragment fused to a heterologous amino
acid sequence that induces a helper T-cell response against the
heterologous amino acid sequence and thereby a B-cell response
against the AA segment, AL segment or X.sub.1EDX.sub.2 fragment.
One or more flanking heterologous amino acids can also be used to
cap an AA or AL peptide or X.sub.1EDX.sub.2 fragment to protect it
from degradation in manufacture, storage or use. Such polypeptides
can be screened for prophylactic or therapeutic efficacy in animal
models in comparison with untreated or placebo controls as
described below. Therapeutic agents of the invention include an
immunogenic fragment of AA or AL or X.sub.1EDX.sub.2 fragment
flanked by polylysine sequences. The polylysine sequences can be
fused to the N-terminus, the C terminus, or both the N- and
C-terminus of AA or AL or an immunogenic fragment of AA or AL or
X.sub.1EDX.sub.2 fragment. The AA or AL peptide, X.sub.1EDX.sub.2
fragment, analog, active fragment of AA or other polypeptide can be
administered in associated or multimeric form or in dissociated
form. Therapeutic agents also include multimers of monomeric
immunogenic agents.
[0239] In a further variation, an immunogenic fragment of AA or AL
or X.sub.1EDX.sub.2 fragment can be presented by a virus or a
bacterium as part of an immunogenic composition. A nucleic acid
encoding the immunogenic peptide is incorporated into a genome or
episome of the virus or bacteria. Optionally, the nucleic acid is
incorporated in such a manner that the immunogenic peptide is
expressed as a secreted protein or as a fusion protein with an
outer surface protein of a virus or a transmembrane protein of a
bacterium so that the peptide is displayed. Viruses or bacteria
used in such methods should be nonpathogenic or attenuated.
Suitable viruses include adenovirus, HSV, Venezuelan equine
encephalitis virus and other alpha viruses, vesicular stomatitis
virus, and other rhabdo viruses, vaccinia and fowl pox. Suitable
bacteria include Salmonella and Shigella. Fusion of an immunogenic
peptide to HBsAg of HBV is particularly suitable.
[0240] Therapeutic agents also include peptides and other compounds
that do not necessarily have a significant amino acid sequence
similarity with AA or AL or X.sub.1EDX.sub.2 fragment but
nevertheless serve as mimetics of AA or AL or X.sub.1EDX.sub.2
fragment and induce a similar immune response. For example, any
peptides and proteins forming .beta.-pleated sheets can be screened
for suitability. Anti-idiotypic antibodies against monoclonal
antibodies to AA or AL or other amyloidogenic peptides such as or
X.sub.1EDX.sub.2 fragments can also be used. Such anti-Id
antibodies mimic the antigen and generate an immune response to it
(see Essential Immunology (Roit ed., Blackwell Scientific
Publications, Palo Alto, 6th ed.), p. 181). Agents other than AA
peptides should induce an immunogenic response against one or more
of the preferred segments of AA listed above (e.g., AA70-76 or
GHEDT, (SEQ ID NO: 3) or an AL or X.sub.1EDX.sub.2 fragment listed
above, such as, for example, HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID
NO: 13), AEDT, (SEQ ID NO: 14), HEDA, (SEQ ID NO: 15) and TEDE,
(SEQ ID NO: 16).
[0241] Preferably, such agents induce an immunogenic response that
is specifically directed to one of these segments without being
directed to other segments of AA or AL or amyloid protein from
which the X.sub.1EDX.sub.2 fragment was derived.
[0242] Random libraries of peptides or other compounds can also be
screened for suitability. Combinatorial libraries can be produced
for many types of compounds that can be synthesized in a
step-by-step fashion. Such compounds include polypeptides,
beta-turn mimetics, polysaccharides, phospholipids, hormones,
prostaglandins, steroids, aromatic compounds, heterocyclic
compounds, benzodiazepines, oligomeric N-substituted glycines and
oligocarbamates. Large combinatorial libraries of the compounds can
be constructed by the encoded synthetic libraries (ESL) method
described in Affymax, WO 95/12608, Affymax, WO 93/06121, Columbia
University, WO 94/08051, Pharmacopeia, WO 95/35503 and Scripps, WO
95/30642 (each of which is incorporated by reference for all
purposes). Peptide libraries can also be generated by phage display
methods. See, e.g., Devlin, WO 91/18980.
[0243] Combinatorial libraries and other compounds are initially
screened for suitability by determining their capacity to
specifically bind to antibodies or lymphocytes (B or T) known to be
specific for AA or other amyloidogenic peptides. For example,
initial screens can be performed with any polyclonal sera or
monoclonal antibody to AA or AL or a fragment thereof or to an
X.sub.1EDX.sub.2 fragment. Compounds can then be screened for
specifically binding to a specific epitope within AA (e.g., AA70-76
or GHEDT, (SEQ ID NO: 3) or AL or to an X.sub.1EDX.sub.2 fragment
listed above, such as, for example, HEDT, (SEQ ID NO: 12), AEDS,
(SEQ ID NO: 13), AEDT, (SEQ ID NO: 14), HEDA, (SEQ ID NO: 15) and
TEDE, (SEQ ID NO: 16).
[0244] Compounds can be tested by the same procedures described for
mapping antibody epitope specificities. Compounds identified by
such screens are then further analyzed for capacity to induce
antibodies or reactive lymphocytes to AA or AL or fragments thereof
or to an X.sub.1EDX.sub.2 fragment. For example, multiple dilutions
of sera can be tested on microtiter plates that have been precoated
with AA or AL or a fragment thereof or an X.sub.1EDX.sub.2 fragment
and a standard ELISA can be performed to test for reactive
antibodies to AA or AL or the fragment or to the X.sub.1EDX.sub.2
fragment. Compounds can then be tested for prophylactic and
therapeutic efficacy in transgenic animals predisposed to
amyloidosis, such as, for example, AA Amyloidosis or AL
amyloidosis. The same screening approach can be used on other
potential agents, analogs of AA, analogs of AL and longer peptides,
including fragments of AA, AL and X.sub.1EDX.sub.2 fragments,
described above.
VII. CONJUGATES
[0245] Some agents for inducing an immune response contain the
appropriate epitope for inducing an immune response against AA but
are too small to be immunogenic. In this situation, a peptide
immunogen can be linked to a suitable carrier molecule to form a
conjugate which helps elicit an immune response. A single agent can
be linked to a single carrier, multiple copies of an agent can be
linked to multiple copies of a carrier, which are in turn linked to
each other, multiple copies of an agent can be linked to a single
copy of a carrier, or a single copy of an agent can be linked to
multiple copies of a carrier, or different carriers. Suitable
carriers include serum albumins, keyhole limpet hemocyanin,
immunoglobulin molecules, thyroglobulin, ovalbumin, tetanus toxoid,
or a toxoid from other pathogenic bacteria, such as diphtheria, E.
coli, cholera, or H. pylori, or an attenuated toxin derivative. T
cell epitopes are also suitable carrier molecules. Some conjugates
can be formed by linking agents of the invention to an
immunostimulatory polymer molecule (e.g., tripalmitoyl-S-glycerine
cysteine (Pam.sub.3Cys), mannan (a manose polymer), or glucan (a
beta 1.fwdarw.2 polymer)), cytokines (e.g., IL-1, IL-1 alpha and
beta peptides, IL-2, gamma-INF, IL-10, GM-CSF), and chemokines
(e.g., MIP1alpha and beta, and RANTES). Immunogenic agents can also
be linked to peptides that enhance transport across tissues, as
described in O'Mahony, WO 97/17613 and WO 97/17614. Immunogens may
be linked to the carries with or with out spacers amino acids
(e.g., gly-gly).
[0246] Some conjugates can be formed by linking agents of the
invention to at least one T cell epitope. Some T cell epitopes are
promiscuous while other T cell epitopes are universal. Promiscuous
T cell epitopes are capable of enhancing the induction of T cell
immunity in a wide variety of subjects displaying various HLA
types. In contrast to promiscuous T cell epitopes, universal T cell
epitopes are capable of enhancing the induction of T cell immunity
in a large percentage, e.g., at least 75%, of subjects displaying
various HLA molecules encoded by different HLA-DR alleles.
[0247] A large number of naturally occurring T-cell epitopes exist,
such as, tetanus toxoid (e.g., the P2 and P30 epitopes), Hepatitis
B surface antigen, pertussis, toxoid, measles virus F protein,
Chlamydia trachomitis major outer membrane protein, diphtheria
toxoid (e.g., CRM197), Plasmodium falciparum circumsporozite T,
Plasmodium falciparum CS antigen, Schistosoma mansoni triose
phosphate isomersae, Escherichia coli TraT, and Influenza virus
hemagluttinin (HA). The immunogenic peptides of the invention can
also be conjugated to the T-cell epitopes described in Sinigaglia
F. et al., Nature, 336:778-780 (1988); Chicz R. M. et al., J. Exp.
Med., 178:27-47 (1993); Hammer J. et al., Cell 74:197-203 (1993);
Falk K. et al., Immunogenetics, 39:230-242 (1994); WO 98/23635;
Southwood S. et al. J. Immunology; 160:3363-3373 (1998); and,
Giannini, G. et al. Nucleic Acids Res. 12: 4063-4069 (1984), (each
of which is incorporated herein by reference for all purposes).
Further examples include:
TABLE-US-00006 Influenza Hemagluttinin: HA.sub.307-319 Malaria CS:
(SEQ ID NO: 67). T3 epitope EKKIAKMEKASSVFNV, Hepatitis B surface
antigen: (SEQ ID NO: 68). HBsAg.sub.19-28 FFLLTRILTI, Heat Shock
Protein 65: (SEQ ID NO: 69). hsp65.sub.153-171 DQSIGDLIAEAMDKVGNEG,
bacille Calmette-Guerin (SEQ ID NO: 70). QVHFQPLPPAVVKL, Tetanus
toxoid: (SEQ ID NO: 71). TT.sub.830-844 QYIKANSKFIGITEL, Tetanus
toxoid: (SEQ ID NO: 72). TT.sub.947-967 FNNFTVSFWLRVPKVSASHLE, HIV
gp120 T1: (SEQ ID NO: 73). KQIINMWQEVGKAMYA, Tetanus toxoid:
TT.sub.947-967 FNNFTVSFWLRVPKVSASHLE HIV gp120 T1:
KQIINMWQEVGKAMYA.
[0248] Alternatively, the conjugates can be formed by linking
agents of the invention to at least one artificial T-cell epitope
capable of binding a large proportion of MHC Class II molecules.,
such as the pan DR epitope ("PADRE"). PADRE is described in U.S.
Pat. No. 5,736,141, WO 95/07707, and Alexander J et al., Immunity,
1:751-761 (1994) (each of which is incorporated herein by reference
for all purposes). A preferred PADRE peptide is AKXVAAWTLKAAA, (SEQ
ID NO: 74), (common residues bolded) wherein X is preferably
cyclohexylalanine tyrosine or phenylalanine, with cyclohexylalanine
being most preferred.
[0249] Immunogenic agents can be linked to carriers by chemical
crosslinking. Techniques for linking an immunogen to a carrier
include the formation of disulfide linkages using
N-succinimidyl-3-(2-pyridyl-thio) propionate (SPDP) and
succinimidyl 4-(N-maleimidomethyl)cyclohexane-1-carboxylate (SMCC)
(if the peptide lacks a sulfhydryl group, this can be provided by
addition of a cysteine residue). These reagents create a disulfide
linkage between themselves and peptide cysteine resides on one
protein and an amide linkage through the epsilon-amino on a lysine,
or other free amino group in other amino acids. A variety of such
disulfide/amide-forming agents are described by Immun. Rev. 62, 185
(1982). Other bifunctional coupling agents form a thioether rather
than a disulfide linkage. Many of these thio-ether-forming agents
are commercially available and include reactive esters of
6-maleimidocaproic acid, 2-bromoacetic acid, and 2-iodoacetic acid,
4-(N-maleimido-methyl)cyclohexane-1-carboxylic acid. The carboxyl
groups can be activated by combining them with succinimide or
1-hydroxyl-2-nitro-4-sulfonic acid, sodium salt.
[0250] Immunogenicity can be improved through the addition of
spacer residues (e.g., Gly-Gly) between the T.sub.h epitope and the
peptide immunogen of the invention. In addition to physically
separating the T.sub.h epitope from the B cell epitope (i.e., the
peptide immunogen), the glycine residues can disrupt any artificial
secondary structures created by the joining of the T.sub.h epitope
with the peptide immunogen, and thereby eliminate interference
between the T and/or B cell responses. The conformational
separation between the helper epitope and the antibody eliciting
domain thus permits more efficient interactions between the
presented immunogen and the appropriate T.sub.h and B cells.
[0251] To enhance the induction of T cell immunity in a large
percentage of subjects displaying various HLA types to an agent of
the present invention, a mixture of conjugates with different
T.sub.h cell epitopes can be prepared. The mixture may contain a
mixture of at least two conjugates with different T.sub.h cell
epitopes, a mixture of at least three conjugates with different
T.sub.h cell epitopes, or a mixture of at least four conjugates
with different T.sub.h cell epitopes. The mixture may be
administered with an adjuvant.
[0252] Immunogenic peptides can also be expressed as fusion
proteins with carriers (i.e., heterologous peptides). The
immunogenic peptide can be linked at its amino terminus, its
carboxyl terminus, or both to a carrier. Optionally, multiple
repeats of the immunogenic peptide can be present in the fusion
protein. Optionally, an immunogenic peptide can be linked to
multiple copies of a heterologous peptide, for example, at both the
N and C termini of the peptide. Optionally, multiple copies of an
immunogenic peptide can be linked to multiple copies of a
heterologous peptide. which are linked to each other. Some carrier
peptides serve to induce a helper T-cell response against the
carrier peptide. The induced helper T-cells in turn induce a B-cell
response against the immunogenic peptide linked to the carrier.
[0253] Some examples of fusion proteins suitable for use in the
invention are shown below. Some of these fusion proteins comprise
segments of AA linked to tetanus toxoid epitopes such as described
in U.S. Pat. No. 5,196,512, EP 378,881 and EP 427,347. Some fusion
proteins comprise segments of AA linked to at least one PADRE
peptide described in U.S. Pat. No. 5,736,142. Some heterologous
peptides are promiscuous T-cell epitopes, while other heterologous
peptides are universal T-cell epitopes. In some methods, the agent
for administration is simply a single fusion protein with an AA
segment linked to a heterologous segment in linear configuration.
The therapeutic agents of the invention can be represented using a
formula. For example, in some methods, the agent is multimer of
fusion proteins represented by the formula 2.sup.x, in which x is
an integer from 1-5. Preferably x is 1, 2 or 3, with 2 being most
preferred. When x is two, such a multimer has four fusion proteins
linked in a preferred configuration referred to as MAP4 (see U.S.
Pat. No. 5,229,490).
[0254] The MAP4 configuration is shown below, where branched
structures are produced by initiating peptide synthesis at both the
N terminal and side chain amines of lysine. Depending upon the
number of times lysine is incorporated into the sequence and
allowed to branch, the resulting structure will present multiple N
termini. In this example, four identical N termini have been
produced on the branched lysine-containing core. Such multiplicity
greatly enhances the responsiveness of cognate B cells. In the
examples below, Z refers to an immunogenic fragment of AA, AL or an
X.sub.1EDX.sub.2 fragment, and Z1-4 refer to immunogenic
fragment(s) of AA, AL or an X.sub.1EDX.sub.2 fragment. The
fragments can be the same as each other or different.
##STR00001##
[0255] Other examples of fusion proteins include: [0256] Z-Tetanus
toxoid 830-844 in a MAP4 configuration:
TABLE-US-00007 [0256] (SEQ ID NO: 71) Z-QYIKANSKFIGITEL,
[0257] Z-Tetanus toxoid 947-967 in a MAP4 configuration:
TABLE-US-00008 [0257] (SEQ ID NO: 72) Z-FNNFTVSFWLRVPKVSASHLE,
[0258] Z-Tetanus toxoid 830-844 in a MAP4 configuration:
TABLE-US-00009 [0258] (SEQ ID NO: 71) Z-QYIKANSKFIGITEL,
[0259] Z-Tetanus toxoid 830-844+947-967 in a linear
configuration:
TABLE-US-00010 [0259] (SEQ ID NO: 75).
Z-QYIKANSKFIGITELFNNFTVSFWLRVPKVSASHLE,
[0260] PADRE peptide (all in linear configurations), wherein X is
preferably cyclohexylalanine, tyrosine or phenylalanine, with
cyclohexylalanine being most preferred-Z:
TABLE-US-00011 [0260] (SEQ ID NO: 74). AKXVAAWTLKAAA-Z,
[0261] Z.times.3-PADRE peptide:
TABLE-US-00012 [0261] (SEQ ID NO: 74). Z-Z-Z-AKXVAAWTLKAAA,
[0262] Z--ovalbumin 323-339 in a linear configuration:
TABLE-US-00013 (SEQ ID NO: 76). Z-ISQAVHAAHAEINEAGR,
[0263] Further examples of fusion proteins include:
TABLE-US-00014 (SEQ ID NO: 74). AKXVAAWTLKAAA-Z-Z-Z-Z, (Z-(SEQ ID
NO: 74). Z-AKXVAAWTLKAAA, (SEQ ID NO: 77). PKYVKQNTLKLAT-Z-Z-Z,
(SEQ ID NO: 77). Z-PKYVKQNTLKLAT-Z, (SEQ ID NO: 77).
Z-Z-Z-PKYVKQNTLKLAT, (SEQ ID NO: 77) Z-Z-PKYVKQNTLKLAT, (Z-Z- (SEQ
ID NO: 78) Z-PKYVKQNTLKLAT-EKKIAKMEKASSVFNV-QYIKANSKFIGITEL-
FNNFTVSFWLRVPKVSASHLE- (SEQ ID NO: 79).
Z-Z-Z-QYIKANSKFIGITEL-FNNFTVSFWLRVPKVSASHLE, (SEQ ID NO: 79).
Z-QYIKANSKFIGITELCFNNFTVSFWLRVPKVSASHLE-Z, (SEQ ID NO: 79)
QYIKANSKFIGITELCFNNFTVSFWLRVPKVSASHLE-Z, (SEQ ID NO: 71)
Z-QYIKANSKFIGITEL,
on a 2 branched resin: fragments can be the same as each other or
different.
##STR00002##
[0264] The same or similar carrier proteins and methods of linkage
can be used for generating immunogens to be used in generation of
antibodies against AA or an immunogenic fragment of
[0265] AA, AL or an X.sub.1EDX.sub.2 fragment. For example, AA or
an immunogenic fragment of AA, AL or an X.sub.1EDX.sub.2 fragment
linked to a carrier can be administered to a laboratory animal in
the production of monoclonal antibodies to AA or an immunogenic
fragment of AA, AL or an X.sub.1EDX.sub.2 fragment.
VIII. NUCLEIC ACID ENCODING THERAPEUTIC AGENTS
[0266] Therapeutic agents of the invention also include nucleic
acids. Immune responses against amyloid deposits can also be
induced by administration of nucleic acids encoding segments of AA
peptide, and fragments thereof, other peptide immunogens such as
X.sub.1EDX.sub.2 fragments, or antibodies and their component
chains, such as antibodies 2A4, 8G9 and 7D8, used for passive
immunization. Such agents for use in the methods of the invention
include nucleic acids encoding AA peptides that on administration
to a patient generate antibodies that specifically bind to one or
more epitopes between residues 70-76 of AA, AL or nucleic acids
encoding peptides comprising X.sub.1EDX.sub.2 fragments. Such
agents for use in the methods of the invention also include nucleic
acids encoding antibodies that specially bind to a C-terminal
neoepitope of AA or to X.sub.1EDX.sub.2. In particular, such
nucleic acids encode antibodies that specifically bind to HAA1
alpha isoform within residues 70-76 (GHGAEDS, (SEQ ID NO: 4), HAA1
beta isoform within residues 70-76 (GHDAEDS, (SEQ ID NO: 5), HAA1
gamma isoform within residues 70-76 (GHDAEDS, (SEQ ID NO: 5), HAA2
alpha and beta isoforms within residues 70-76 (GHGAEDS, (SEQ ID NO:
4), HAA3 within residues 70-76 (GDHAEDS, (SEQ ID NO: 7), HAA4
within residues 78-84 (STVIEDS, (SEQ ID NO: 8), mouse AA1 (MAA1)
within residues 69-75 (GRGHEDT, (SEQ ID NO: 9), MAA2 within
residues 69-75 (GRGHEDT, (SEQ ID NO: 9), MAA3 within residues 62-68
(GHGAEDS, (SEQ ID NO: 4), and MAA4 within residues 76-82 (NHGLETL,
(SEQ ID NO: 11). Such nucleic acids can be DNA or RNA. Additional
preferred nucleic acids encode antibodies that specifically bind to
HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO: 13), AEDT, (SEQ ID NO:
14), HEDA, (SEQ ID NO: 15) or TEDE, (SEQ ID NO: 16) or other
X.sub.1EDX.sub.2 peptides listed above. A nucleic acid segment
encoding an immunogen is typically linked to regulatory elements,
such as a promoter and enhancer, that allow expression of the DNA
segment in the intended target cells of a patient. For expression
in blood cells, as is desirable for induction of an immune
response, promoter and enhancer elements from light or heavy chain
immunoglobulin genes or the CMV major intermediate early promoter
and enhancer are suitable to direct expression. The linked
regulatory elements and coding sequences are often cloned into a
vector. For administration of double-chain antibodies, the two
chains can be cloned in the same or separate vectors. The nucleic
acids encoding therapeutic agents of the invention can also encode
at least one T cell epitope. The disclosures herein which relate to
the use of adjuvants and the use of carriers apply mutatis mutandis
to their use with the nucleic acids encoding the therapeutic agents
of the present invention.
[0267] A number of viral vector systems are available including
retroviral systems (see, e.g., Lawrie and Tumin, Cur. Opin. Genet.
Develop. 3, 102-109 (1993)); adenoviral vectors (see, e.g., Bett et
al., J. Virol. 67, 5911 (1993)); adeno-associated virus vectors
(see, e.g., Zhou et al., J. Exp. Med. 179, 1867 (1994)), viral
vectors from the pox family including vaccinia virus and the avian
pox viruses, viral vectors from the alpha virus genus such as those
derived from Sindbis and Semliki Forest Viruses (see, e.g.,
Dubensky et al., J. Virol. 70, 508-519 (1996)), Venezuelan equine
encephalitis virus (see U.S. Pat. No. 5,643,576) and rhabdoviruses,
such as vesicular stomatitis virus (see WO 96/34625) and
papillomaviruses (Ohe et al., Human Gene Therapy 6, 325-333 (1995);
Woo et al., WO 94/12629 and Xiao & Brandsma, Nucleic Acids.
Res. 24, 2630-2622 (1996)).
[0268] DNA encoding an immunogen, or a vector containing the same,
can be packaged into liposomes. Suitable lipids and related analogs
are described by U.S. Pat. Nos. 5,208,036, 5,264,618, 5,279,833 and
5,283,185. Vectors and DNA encoding an immunogen can also be
adsorbed to or associated with particulate carriers, examples of
which include polymethyl methacrylate polymers and polylactides and
poly(lactide-co-glycolides), see, e.g., McGee et al., J. Micro
Encap. (1996).
[0269] Gene therapy vectors or naked DNA can be delivered in vivo
by administration to an individual patient, typically by systemic
administration (e.g., intravenous, intraperitoneal, nasal, gastric,
intradermal, intramuscular, subdermal, or intracranial infusion) or
topical application (see e.g., U.S. Pat. No. 5,399,346). Such
vectors can further include facilitating agents such as bupivacine
(U.S. Pat. No. 5,593,970). DNA can also be administered using a
gene gun. (See Xiao & Brandsma, supra.) The DNA encoding an
immunogen is precipitated onto the surface of microscopic metal
beads. The microprojectiles are accelerated with a shock wave or
expanding helium gas, and penetrate tissues to a depth of several
cell layers. For example, The Accel.TM. Gene Delivery Device
manufactured by Agacetus, Inc. Middleton Wis. is suitable.
Alternatively, naked DNA can pass through skin into the blood
stream simply by spotting the DNA onto skin with chemical or
mechanical irritation (see WO 95/05853).
[0270] In a further variation, vectors encoding immunogens can be
delivered to cells ex vivo, such as cells explanted from an
individual patient (e.g., lymphocytes, bone marrow aspirates,
tissue biopsy) or universal donor hematopoietic stem cells,
followed by reimplantation of the cells into a patient, usually
after selection for cells which have incorporated the vector.
IX. ADJUVANTS
[0271] Immunogenic agents of the invention, such as peptides, are
sometimes administered in combination with an adjuvant. The
adjuvant increases the titer of induced antibodies and/or the
binding affinity of induced antibodies relative to the situation if
the peptide were used alone. A variety of adjuvants can be used in
combination with an immunogenic fragment of AA, to elicit an immune
response. Preferred adjuvants augment the intrinsic response to an
immunogen without causing conformational changes in the immunogen
that affect the qualitative form of the response. Preferred
adjuvants include aluminum hydroxide and aluminum phosphate, 3
De-O-acylated monophosphoryl lipid A (MPL) (see GB 2220211 (RIBI
ImmunoChem Research Inc., Hamilton, Mont., now part of Corixa),
RC-529 (Corixa, Hamilton, Mont.). STIMULON.TM. QS-21 is a
triterpene glycoside or saponin isolated from the bark of the
Quillaja Saponaria Molina tree found in South America (see Kensil
et al., in Vaccine Design: The Subunit and Adjuvant Approach (eds.
Powell & Newman, Plenum Press, NY, 1995); U.S. Pat. No.
5,057,540), (Aquila BioPharmaceuticals, Framingham, Mass.). Other
adjuvants are oil in water emulsions (such as squalene or peanut
oil), optionally in combination with immune stimulants, such as
monophosphoryl lipid A (see Stoute et al., N. Engl. J. Med. 336,
86-91 (1997)), pluronic polymers, and killed mycobacteria. Another
adjuvant is CpG (WO 98/40100). Adjuvants can be administered as a
component of a therapeutic composition with an active agent or can
be administered separately, before, concurrently with, or after
administration of the therapeutic agent.
[0272] A preferred class of adjuvants is aluminum salts (alum),
such as alum hydroxide, alum phosphate, alum sulfate. Such
adjuvants can be used with or without other specific
immunostimulating agents such as MPL or 3-DMP, QS-21, polymeric or
monomeric amino acids such as polyglutamic acid or polylysine.
Another class of adjuvants is oil-in-water emulsion formulations.
Such adjuvants can be used with or without other specific
immunostimulating agents such as muramyl peptides (e.g.,
N-acetylmuramyl-L-threonyl-D-isoglutamine (thr-MDP),
N-acetyl-normuramyl-L-alanyl-D-isoglutamine (nor-MDP),
N-acetylmuramyl-L-alanyl-D-isoglutaminyl-L-alanine-2-(1'-2'dipalmitoyl-sn-
-glycero-3-hydroxyphosphoryloxy)-ethylamine (MTP-PE),
N-acetylglucsaminyl-N-acetylmuramyl-L-Al-D-isoglu-L-Ala-dipalmitoxy
propylamide (DTP-DPP) THERAMIDE), or other bacterial cell wall
components. Oil-in-water emulsions include (a) MF59 (WO 90/14837),
containing 5% Squalene, 0.5% Tween 80, and 0.5% Span 85 (optionally
containing various amounts of MTP-PE) formulated into submicron
particles using a microfluidizer such as Model 110Y microfluidizer
(Microfluidics, Newton Mass.), (b) SAF, containing 10% Squalene,
0.4% Tween 80, 5% pluronic-blocked polymer L121, and thr-MDP,
either microfluidized into a submicron emulsion or vortexed to
generate a larger particle size emulsion, and (c) RIBI.TM. adjuvant
system (RAS), (Ribi ImmunoChem, Hamilton, Mont.) containing 2%
squalene, 0.2% Tween 80, and one or more bacterial cell wall
components from the group consisting of monophosphoryllipid A
(MPL), trehalose dimycolate (TDM), and cell wall skeleton (CWS),
preferably MPL+CWS (DETOX.TM.).
[0273] Another class of preferred adjuvants is saponin adjuvants,
such as STIMULON.TM. (QS-21, Aquila, Framingham, Mass.) or
particles generated therefrom such as ISCOMs (immunostimulating
complexes) and ISCOMATRIX. Other adjuvants include RC-529, GM-CSF
and Complete Freund's Adjuvant (CFA) and Incomplete Freund's
Adjuvant (IFA). Other adjuvants include cytokines, such as
interleukins (e.g., IL-1 cc and 13 peptides, IL-2, IL-4, IL-6,
IL-12, IL13, and IL-15), macrophage colony stimulating factor
(M-CSF), granulocyte-macrophage colony stimulating factor (GM-CSF),
tumor necrosis factor (TNF), chemokines, such as MIP1.alpha. and
.beta. and RANTES. Another class of adjuvants is glycolipid
analogues including N-glycosylamides, N-glycosylureas and
N-glycosylcarbamates, each of which is substituted in the sugar
residue by an amino acid, as immuno-modulators or adjuvants (see
U.S. Pat. No. 4,855,283). Heat shock proteins, e.g., HSP70 and
HSP90, may also be used as adjuvants.
[0274] An adjuvant can be administered with an immunogen as a
single composition, or can be administered before, concurrent with,
or after administration of the immunogen. Immunogen and adjuvant
can be packaged and supplied in the same vial or can be packaged in
separate vials and mixed before use. Immunogen and adjuvant are
typically packaged with a label indicating the intended therapeutic
application. If immunogen and adjuvant are packaged separately, the
packaging typically includes instructions for mixing before use.
The choice of an adjuvant and/or carrier depends on the stability
of the immunogenic formulation containing the adjuvant, the route
of administration, the dosing schedule, the efficacy of the
adjuvant for the species being vaccinated, and, in humans, a
pharmaceutically acceptable adjuvant is one that has been approved
or is approvable for human administration by pertinent regulatory
bodies. For example, Complete Freund's adjuvant is not suitable for
human administration. Alum, MPL and QS-21 are preferred.
Optionally, two or more different adjuvants can be used
simultaneously. Preferred combinations include alum with MPL, alum
with QS-21, MPL with QS-21, MPL or RC-529 with GM-CSF, and alum,
QS-21 and MPL together. Also, Incomplete Freund's adjuvant can be
used (Chang et al., Advanced Drug Delivery Reviews 32, 173-186
(1998)), optionally in combination with any of alum, QS-21, and MPL
and all combinations thereof.
X. PASSIVE ADMINISTRATION OF ANTIBODIES
[0275] Therapeutic agents of the present invention include
antibodies that specifically bind to to an epitope comprising
X.sub.1EDX.sub.2 in an aggregated amyloid protein, wherein X.sub.1
is H, T, F, S, P, A or any other amino acid residue immediately
preceding ED in such aggregated amyloid protein; and wherein
X.sub.2 is T, S, E, R, I, V, F, A or any other amino acid residue
immediately following ED in such aggregated amyloid protein,
including epitopes within amyloid peptides such as AA. The
antibodies used for passive administration can be antibodies that
bind to C-terminal or N-terminal epitopes of AA. Other amyloid
proteins in addition to Serum amyloid A protein include serum
amyloid A protein, immunoglobulin light chain protein, such as, for
example, V.lamda.6 Wil or V.kappa., human islet amyloid precursor
polypeptide (IAPP), beta amyloid peptide, transthyretin (TTR) and
ApoA1, as well as others listed in Table 1 above.
[0276] AA is formed by proteolytic cleavage of SAA. Preferred
antibodies specifically bind to neoepitopes of AA which form upon
proteolytic cleavage of SAA. Preferred antibodies specially bind to
a C-terminal neoepitope of AA, especially, such antibodies
specifically bind to HAA1 alpha isoform within residues 70-76
(GHGAEDS, SEQ ID NO:4), HAA1 beta isoform within residues 70-76
(GHDAEDS, SEQ ID NO:5), HAA1 gamma isoform within residues 70-76
(GHDAEDS, SEQ ID NO: 5), HAA2 alpha and beta isoforms within
residues 70-76 (GHGAEDS, SEQ ID NO: 10), HAA3 within residues 70-76
(GDHAEDS, SEQ ID NO:7), HAA4 within residues 78-84 (STVIEDS, SEQ ID
NO:8), mouse AA1 (MAA1) within residues 69-75 (GRGHEDT, SEQ ID
NO:9), MAA2 within residues 69-75 (GRGHEDT, SEQ ID NO: 9), MAA3
within residues 62-68 (GHGAEDS, SEQ ID NO:10), and MAA4 within
residues 76-82 (NHGLETL, SEQ ID NO:11). Some antibodies only bind
to an epitope within one of these peptides. Other antibodies bind
to epitopes within more than one of these peptides. For example,
some antibodies specifically bind to a GHGAEDS, (SEQ ID NO: 4)
peptide and a GHDAEDS, SEQ ID NO: 5) peptide. Some antibodies bind
to a GHGAEDS, SEQ ID NO: 4) peptide without specifically binding to
a GHDAEDS, SEQ ID NO: 5) peptide. Binding to at least one of the
human AA peptides is preferable. Binding to at least one of the
human AA peptides and a corresponding mouse peptide is useful in
that the same antibody can be tested in a mouse model and
subsequently used in humans. Some preferred antibodies specifically
bind to epitopes within HAA1 alpha isoform residues 71-76, 72-76,
73-76, 74-76, 70-75, 70-74, 70-73, 70-72, 71-75, 72-75, 73-75,
71-74, 71-73, 72-74, or MAA1 residues 70-75, 71-75, 72-75, 73-75,
69-74, 69-73, 69-72, 69-71, 70-74, 71-74, 72-74, 70-73, 70-72. Such
antibodies typically specifically bind to amyloid deposits but may
or may not bind to soluble AA. When an antibody is said to
specifically bind to an epitope within specified residues, such as
HAA1 alpha isoform residues 70-76 of for example, what is meant is
that the antibody specifically binds to a polypeptide containing
the specified residues (i.e., residues 70-76 of HAA1 alpha isoform
in this an example). Such an antibody does not necessarily contact
every residue within residues 70-76 of HAA1 alpha isoform. Nor does
every single amino acid substitution or deletion with in residues
70-76 of HAA1 alpha isoform necessarily significantly affect
binding affinity. Such neoepitope antibodies bind to AA but not to
SAA. Epitope specificity of an antibody can be determined, for
example, as described by WO 00/72880.
[0277] The antibodies used for passive administration can be
antibodies to N-terminal epitopes of AA. Preferred antibodies
specifically bind to a N-terminal neoepitope of AA, especially,
such antibodies specifically bind to HAA1 residues 1-15
(RSFFSFLGEAFDGAR, SEQ ID NO. 80), HAA2 residues 1-15
(RSFFSFLGEAFDGAR, SEQ ID NO. 80), HAA3 residues 1-15
(QGWLTFLKAAGQGAK, SEQ ID NO: 81), HAA4 residues 1-15 (ESWRSFFKEA,
(SEQ ID NO: 82), MAA1 residues 1-15 (GFFSFVHEAFQGAGD, SEQ ID NO:
83), MAA2 residues 1-15 (GFFSFVHEAFQGAGD, SEQ ID NO: 83), MAA3
residues 1-9 (EAGQGSRD, (SEQ ID NO: 84), and residues 1-14 MAA4
(WYSFFREAVQGTWD, SEQ ID NO: 85). Some antibodies only bind to an
epitope within one of these peptides. Other antibodies bind to
epitopes within more than one of these peptides. For example, some
antibodies specifically bind to a RSFFSFLGEAFDGAR, SEQ ID NO: 80)
peptide and a QGWLTFLKAAGQGAK, SEQ ID NO: 81) peptide. Some
antibodies bind to a RSFFSFLGEAFDGAR, SEQ ID NO: 80) peptide
without specifically binding to a QGWLTFLKAAGQGAK, SEQ ID NO: 81)
peptide. Binding to at least one of the human AA peptides is
preferable. Binding to at least one of the human AA peptides and a
corresponding mouse peptide is useful in that the same antibody can
be tested in a mouse model and subsequently used in humans.
[0278] Some antibodies specifically bind to an epitope consisting
of such X.sub.1EDX.sub.2 Preferably such antibodies specifically
bind to such epitope in an aggregated amyloid protein. Some of such
antibodies preferentially specifically bind to an aggregated
amyloid protein relative to the monomeric form of such amyloid
protein. In some antibodies, X.sub.1 is H, T, F, S, P, or A and
X.sub.2 is T, S, E, D, R, I, V, F or A. In some such antibodies,
when X.sub.1 is H, X.sub.2 is T or A; when X.sub.1 is A, X.sub.2 is
S, T, E or V; when X.sub.1 is T, X.sub.2 is E; when X.sub.1 is F,
X.sub.2 is D; when X.sub.1 is S, X.sub.2 is E, F or A; and when
X.sub.1 is P, X.sub.2 is E, I or F. In some antibodies, X.sub.1 is
H, T, F, S, P, or A and X.sub.2 is T, S, E, D, R, I, V, F or A,
with the proviso that if X.sub.1 is A, X.sub.2 is not V. In some
antibodies, when X.sub.1 is A, X.sub.2 is S, T or E.
[0279] Some antibodies specifically bind an epitope comprising the
amino acid sequence GHEDT, (SEQ ID NO 3), HEDT, (SEQ ID NO: 12),
AEDS, (SEQ ID NO: 13), AEDT, (SEQ ID NO: 14), HEDA, (SEQ ID NO:
15), TEDE, (SEQ ID NO: 16), FEDD, (SEQ ID NO: 17), SEDE, (SEQ ID
NO: 18), AEDE, (SEQ ID NO: 19), PEDE, (SEQ ID NO: 20), PEDI, (SEQ
ID NO: 21), PEDF, (SEQ ID NO: 22), AEDV, (SEQ ID NO: 23), SEDF,
(SEQ ID NO: 24) or SEDA, (SEQ ID NO: 25).
[0280] Some antibodies specifically bind to a peptide comprising an
amino acid sequence selected from the group consisting of GHEDT,
(SEQ ID NO: 3), HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO: 13), AEDT,
(SEQ ID NO: 14), HEDA, (SEQ ID NO: 15), TEDE, (SEQ ID NO: 16),
FEDD, (SEQ ID NO: 17), SEDE, (SEQ ID NO: 18), AEDE, (SEQ ID NO:
19), PEDE, (SEQ ID NO: 20), PEDI, (SEQ ID NO: 21), PEDF, (SEQ ID
NO: 22), SEDF, (SEQ ID NO: 24) and SEDA, (SEQ ID NO: 25). Some
antibodies specifically bind to a peptide comprising an amino acid
sequence selected from the group consisting of GHEDT, (SEQ ID NO:
3), HEDT, (SEQ ID NO: 12), AEDS, (SEQ ID NO: 13), AEDT, (SEQ ID NO:
14), HEDA, (SEQ ID NO: 15) and TEDE, (SEQ ID NO: 16).
[0281] Some antibodies are raised to a peptide comprising GHEDT,
(SEQ ID NO: 3), such as, for example, 2A4, 7D8 and 8G9, or are
humanized or chimeric versions thereof.
[0282] Antibodies can be polyclonal or monoclonal. Polyclonal sera
typically contain mixed populations of antibodies specifically
binding to several epitopes along the length of AA. However,
polyclonal sera can be specific to a particular segment of AA, such
as residues 70-76 of HAA1 alpha isoform. Preferred antibodies are
chimeric, or humanized (see Queen et al., Proc. Natl. Acad. Sci.
USA 86:10029-10033 (1989) and WO 90/07861, U.S. Pat. No. 5,693,762,
U.S. Pat. No. 5,693,761, U.S. Pat. No. 5,585,089, U.S. Pat. No.
5,530,101 and Winter, U.S. Pat. No. 5,225,539), or human (Lonberg
et al., WO93/12227 (1993); U.S. Pat. No. 5,877,397, U.S. Pat. No.
5,874,299, U.S. Pat. No. 5,814,318, U.S. Pat. No. 5,789,650, U.S.
Pat. No. 5,770,429, U.S. Pat. No. 5,661,016, U.S. Pat. No.
5,633,425, U.S. Pat. No. 5,625,126, U.S. Pat. No. 5,569,825, U.S.
Pat. No. 5,545,806, Nature 148, 1547-1553 (1994), Nature
Biotechnology 14, 826 (1996), Kucherlapati, WO 91/10741 (1991)). An
alternative approach for humanizing an antibody, also known as
veneering, is described in U.S. Pat. No. 6,797,492. Several mouse
antibodies of different binding specificities are available as
starting materials for making humanized antibodies.
[0283] Representative humanized antibodies are humanized version
7D8 antibody (ATCC Accession Number PTA-9468), humanized version
7D29 antibody, humanized version 7D19 antibody, humanized version
7D47 antibody, humanized version 7D39 antibody, humanized version
7D66 antibody, humanized version 8G9 antibody, humanized version
8G3 antibody, humanized version 8G4 antibody, humanized version
8G51 antibody, humanized version 8G22 antibody, humanized version
8G30 antibody, humanized version 8G46 antibody, humanized version
2A4 antibody (ATCC Accession Number PTA-9662), humanized version
2A20 antibody, humanized version 2A44 antibody, humanized version
2A77 antibody, humanized version 2A13 antibody, and humanized
version 2A14 antibody. Hybridomas that produce the 7D8 antibody
(JH80 7D8.29.19.47) and the 2A4 antibody (JH80 2A4.20.44077) were
deposited on Sep. 4, 2008, and on Dec. 17, 2008, respectively, with
the American Type Culture Collection (ATCC), currently located at
10801 University Boulevard, Manassas, Va. 20110-2209, under the
provisions of the Budapest Treaty for the International Recognition
of the Deposit of Microorganisms for the Purpose of Patent
Procedure ("Budapest Treaty"). The ATCC has assigned the hybridoma
producing 7D8 ATCC Accession No. PTA-9468, and the hybridoma
producing 2A4 ATCC Accession No. PTA-9662.
[0284] Human isotype IgG1 is preferred for antibodies to the C
terminal region of AA because of it having highest affinity of
human isotypes for the FcRI receptor on phagocytic cells. Some
antibodies specifically bind to AA with a binding affinity greater
than or equal to about 10.sup.7, 10.sup.8, 10.sup.9, or 10.sup.10
M.sup.-1.
[0285] Active immunization with fragments of AA can be combined
with passive administration of antibodies. Examples of specific
combinations include AA fragments comprising HAA1 alpha isoform
residues 70-76 with antibodies that specifically bind to epitope
within HAA1 alpha isoform residues 70-76; AA fragments comprising
HAA1 alpha isoform residues 70-76 with antibodies that specifically
bind to epitope within HAA1 alpha isoform residues 71-76; AA
fragments comprising HAA1 alpha isoform residues 70-76 with
antibodies that specifically bind to epitope within HAA1 alpha
isoform residues 72-76; AA fragments comprising HAA1 alpha isoform
residues 70-76 with antibodies that specifically bind to epitope
within HAA1 alpha isoform residues 73-76; AA fragments comprising
HAA1 alpha isoform residues 70-76 with antibodies that specifically
bind to epitope within HAA1 alpha isoform residues 74-76; AA
fragments comprising HAA1 alpha isoform residues 70-76 with
antibodies that specifically bind to epitope within HAA1 alpha
isoform residues 70-75; AA fragments comprising HAA1 alpha isoform
residues 70-76 with antibodies that specifically bind to epitope
within HAA1 alpha isoform residues 70-74; AA fragments comprising
HAA1 alpha isoform residues 70-76 with antibodies that specifically
bind to epitope within HAA1 alpha isoform residues 70-73; AA
fragments comprising HAA1 alpha isoform residues 70-76 with
antibodies that specifically bind to epitope within HAA1 alpha
isoform residues 70-72; AA fragments comprising HAA1 alpha isoform
residues 70-76 with antibodies that specifically bind to epitope
within HAA1 alpha isoform residues 71-75; AA fragments comprising
HAA1 alpha isoform residues 70-76 with antibodies that specifically
bind to epitope within HAA1 alpha isoform residues 72-75; AA
fragments comprising HAA1 alpha isoform residues 70-76 with
antibodies that specifically bind to epitope within HAA1 alpha
isoform residues 73-75; AA fragments comprising HAA1 alpha isoform
residues 70-76 with antibodies that specifically bind to epitope
within HAA1 alpha isoform residues 73-75; AA fragments comprising
HAA1 alpha isoform residues 70-76 with antibodies that specifically
bind to epitope within HAA1 alpha isoform residues 71-74; AA
fragments comprising HAA1 alpha isoform residues 70-76 with
antibodies that specifically bind to epitope within HAA1 alpha
isoform residues 71-73; AA fragments comprising HAA1 alpha isoform
residues 70-76 with antibodies that specifically bind to epitope
within HAA1 alpha isoform residues 72-74. Additionally, AA
fragments comprising HAA1 alpha isoform residues 71-76, 72-76,
73-76, 74-76, 70-75, 70-74, 70-73, 70-72, 71-75, 72-75, 73-75,
71-74, 71-73, 72-74 may be combined with antibodies that
specifically bind to an epitope within HAA1 alpha isoform residues
71-76, 72-76, 73-76, 74-76, 70-75, 70-74, 70-73, 70-72, 71-75,
72-75, 73-75, 71-74, 71-73, 72-74. AA fragments comprising HAA1
alpha isoform residues 70-76, HAA1 beta isoform residues 70-76,
HAA1 gamma isoform residue 70-76, HAA2 alpha and beta isoforms
residues 70-76, MAA1 residues 69-75, MAA2 residues 69-75, or MAA3
residues 62-68 may be combined with antibodies that specifically
bind to an epitope within HAA1 alpha isoform residues 70-76, HAA1
beta isoform residues 70-76, HAA1 gamma isoform residue 70-76, HAA2
alpha and beta isoforms residues 70-76, MAA1 residues 69-75, MAA2
residues 69-75, or MAA3 residues 62-68.
[0286] Some of the antibodies described above do not specifically
bind the monomeric or precursor form of the amyloid protein. Some
of such antibodies specifically bind to a neoepitope generated upon
cleavage of a precursor protein resulting in an amyloid protein.
For example, some antibodies specifically bind to the C-terminal
residues of mouse AA fibrils -HEDT, (SEQ ID NO: 12), but do not
specifically bind to a peptide that extends into the non-amyloid
portion of SAA (GHEDTMADQE, SEQ ID NO: 61). Some antibodies
specifically bind to a conformational epitope. Some of such
conformational epitopes are linear. Some of such conformational
epitopes are exposed when an amyloid protein enters an aggregated
(e.g., fibrillar) structure or becomes partially denatured.
Examples of such antibodies include murine monoclonal antibodies
2A4 (ATCC Accession Number PTA-9662) and 7D8 (ATCC Accession Number
PTA-9468), human, humanized and chimeric forms thereof, other
antibodies that specifically bind to the same epitope as 2A4, 8G9
or 7D8, and antigen-binding fragments of any such antibodies. Some
antibodies specifically bind to an amyloid protein comprising the
amino acid sequence ED. Some antibodies specifically bind to an
amyloid protein selected from the group consisting of
immunoglobulin light chain protein, human islet amyloid precursor
polypeptide (IAPP), beta amyloid peptide, transthyretin (TTR) and
ApoA1.
[0287] The basic antibody structural unit is known to comprise a
tetramer of subunits. Each tetramer is composed of two identical
pairs of polypeptide chains, each pair having one "light" (about 25
kDa) and one "heavy" chain (about 50-70 kDa). The amino-terminal
portion of each chain includes a variable region of about 100 to
110 or more amino acids primarily responsible for antigen
recognition. The carboxy-terminal portion of each chain defines a
constant region primarily responsible for effector function.
1. Antibodies
[0288] The invention includes intact antibodies and antigen-binding
antibody fragments, as well as pegylated antibodies and antibody
fragments, as well as antibodies with altered (e.g., reduced or
eliminated) effector function, for example, antibodies comprising
mutations or substituted residues in the Fc region. Examples of
immunologically active portions of immunoglobulin molecules include
F(ab) and F(ab')2 tri-Fab', Fab', Fv, scFv, di-Fab' fragments which
can be generated by treating the antibody with an enzyme such as
pepsin or produced by art-recognized recombinant engineering
techniques. Additional antigen-binding fragments of antibodies of
the invention include therapeutic antibody fragments, including
pegylated antibody fragments, such as PEGylated Fab' and PEGylated
di-Fab'. Examples of effector function mutants are described in
U.S. Pat. No. 5,624,821, which is incorporated by reference herein
in its entirety. Some antibodies have reduced binding affinity for
Fc gamma RI receptor. Effector function mutant antibodies include
antibodies comprising mutations in the hinge region. Some mutant
IgG antibodies comprise a mutation in the heavy chain constant
region at one or more of positions 234, 235, 236, 237, 297, 318,
320 and 322. In some antibodies one or more of residues 234, 236
and 237 are substituted with alanine. In some antibodies, residue
235 is substituted with glutamine. In some antibodies, residue 297
is substituted with alanine. In some antibodies, residues 318, 320
and 322 are substituted with alanine. In some antibodies, residue
318 is substituted with valine. In some antibodies, residue 322 is
substituted with glutamine. Antibodies with enhanced effector
function include antibodies single S239D and 1332E and the double
and triple mutants S239D/I332E and S239D/I332E/A330L (Kabat
numbering).
2. Polyclonal Antibodies
[0289] Polyclonal antibodies can be prepared as described above by
immunizing a suitable subject with an immunogen. The antibody titer
in the immunized subject can be monitored over time by standard
techniques, such as with an enzyme linked immunosorbent assay
(ELISA) using immobilized target antigen. If desired, the antibody
molecules directed against the target antigen can be isolated from
the mammal (e.g., from the blood) and further purified by well
known techniques, such as protein A Sepharose chromatography to
obtain the antibody, e.g., IgG, fraction. At an appropriate time
after immunization, e.g., when the anti-antigen antibody titers are
highest, antibody-producing cells can be obtained from the subject
and used to prepare monoclonal antibodies by standard techniques,
such as the hybridoma technique originally described by Kohler and
Milstein (1975) Nature 256:495-497) (see also, Brown et al. (1981)
J. Immunol. 127:539-46; Brown et al. (1980) J. Biol. Chem
255:4980-83; Yeh et al. (1976) Proc. Natl. Acad. Sci. USA
76:2927-31; and Yeh et al. (1982) Int. J. Cancer 29:269-75). For
the preparation of chimeric polyclonal antibodies, see Buechler et
al. U.S. Pat. No. 6,420,113.
3. Monoclonal Antibodies
[0290] Any of the many well known protocols used for fusing
lymphocytes and immortalized cell lines can be applied for the
purpose of generating a monoclonal antibody (see, e.g., G. Galfre
et al. (1977) Nature 266:55052; Gefter et al. Somatic Cell Genet.,
cited supra; Lerner, Yale J. Biol. Med., cited supra; Kenneth,
Monoclonal Antibodies, cited supra). Moreover, the ordinarily
skilled worker will appreciate that there are many variations of
such methods which also would be useful. Typically, the immortal
cell line (e.g., a myeloma cell line) is derived from the same
mammalian species as the lymphocytes. For example, murine
hybridomas can be made by fusing lymphocytes from a mouse immunized
with an immunogenic preparation of the present invention with an
immortalized mouse cell line. Preferred immortal cell lines are
mouse myeloma cell lines that are sensitive to culture medium
containing hypoxanthine, aminopterin and thymidine ("HAT medium").
Any of a number of myeloma cell lines can be used as a fusion
partner according to standard techniques, e.g., the P3-NS1/1-Ag4-1,
P3-x63-Ag8.653 or Sp2/O-Ag14 myeloma lines. These myeloma lines are
available from ATCC. Typically, HAT-sensitive mouse myeloma cells
are fused to mouse splenocytes using polyethylene glycol ("PEG").
Hybridoma cells resulting from the fusion are then selected using
HAT medium, which kills unfused and unproductively fused myeloma
cells (unfused splenocytes die after several days because they are
not transformed). Hybridoma cells producing a monoclonal antibody
of the invention are detected by screening the hybridoma culture
supernatants for antibodies that bind a target antigen, e.g.,
A.beta., using a standard ELISA assay.
4. Recombinant Antibodies
[0291] Alternative to preparing monoclonal antibody-secreting
hybridomas, a monoclonal antibody can be identified and isolated by
screening a recombinant combinatorial immunoglobulin library (e.g.,
an antibody phage display library) with a target antigen to thereby
isolate immunoglobulin library members that bind the target
antigen. Kits for generating and screening phage display libraries
are commercially available (e.g., the Pharmacia Recombinant Phage
Antibody System, Catalog No. 27-9400-01; and the Stratagene
SurfZAP.TM. Phage Display Kit, Catalog No. 240612). Additionally,
examples of methods and reagents particularly amenable for use in
generating and screening antibody display library can be found in,
for example, Ladner et al. U.S. Pat. No. 5,223,409; Kang et al. PCT
International Publication No. WO 92/18619; Dower et al. PCT
International Publication No. WO 91/17271; Winter et al. PCT
International Publication WO 92/20791; Markland et al. PCT
International Publication No. WO 92/15679; Breitling et al. PCT
International Publication WO 93/01288; McCafferty et al. PCT
International Publication No. WO 92/01047; Garrard et al. PCT
International Publication No. WO 92/09690; Ladner et al. PCT
International Publication No. WO 90/02809; Fuchs et al. (1991)
Bio/Technology 9:1370-1372; Hay et al. (1992) Hum. Antibod.
Hybridomas 3:81-85; Huse et al. (1989) Science 246:1275-1281;
Griffiths et al. (1993) EMBO J 12:725-734; Hawkins et al. (1992) J.
Mol. Biol. 226:889-896; Clarkson et al. (1991) Nature 352:624-628;
Gram et al. (1992) Proc. Natl. Acad. Sci. USA 89:3576-3580; Garrad
et al. (1991) Bio/Technology 9:1373-1377; Hoogenboom et al. (1991)
Nuc. Acid Res. 19:4133-4137; Barbas et al. (1991) Proc. Natl. Acad.
Sci. USA 88:7978-7982; and McCafferty et al. Nature (1990)
348:552-554.
5. Chimeric and Humanized Antibodies
[0292] Additionally, recombinant antibodies, such as chimeric and
humanized monoclonal antibodies, comprising both human and
non-human portions, which can be made using standard recombinant
DNA techniques, are within the scope of the invention.
[0293] The term "humanized immunoglobulin" or "humanized antibody"
refers to an immunoglobulin or antibody that includes at least one
humanized immunoglobulin or antibody chain (i.e., at least one
humanized light or heavy chain). The term "humanized immunoglobulin
chain" or "humanized antibody chain" (i.e., a "humanized
immunoglobulin light chain" or "humanized immunoglobulin heavy
chain") refers to an immunoglobulin or antibody chain (i.e., a
light or heavy chain, respectively) having a variable region that
includes a variable framework region substantially from a human
immunoglobulin or antibody and complementarity determining regions
(CDRs) (e.g., at least one CDR, preferably two CDRs, more
preferably three CDRs) substantially from a non-human
immunoglobulin or antibody, and further includes constant regions
(e.g., at least one constant region or portion thereof, in the case
of a light chain, and three constant regions in the case of a heavy
chain). The term "humanized variable region" (e.g., "humanized
light chain variable region" or "humanized heavy chain variable
region") refers to a variable region that includes a variable
framework region substantially from a human immunoglobulin or
antibody and complementarity determining regions (CDRs)
substantially from a non-human immunoglobulin or antibody.
[0294] The phrase "substantially from a human immunoglobulin or
antibody" or "substantially human" means that, when aligned to a
human immunoglobulin or antibody amino sequence for comparison
purposes, the region shares at least 80-90%, 90-95%, or 95-99%
identity (i.e., local sequence identity) with the human framework
or constant region sequence, allowing, for example, for
conservative substitutions, consensus sequence substitutions,
germline substitutions, backmutations, and the like. The
introduction of conservative substitutions, consensus sequence
substitutions, germline substitutions, backmutations, and the like,
is often referred to as "optimization" of a humanized antibody or
chain. The phrase "substantially from a non-human immunoglobulin or
antibody" or "substantially non-human" means having an
immunoglobulin or antibody sequence at least 80-95%, preferably at
least 90-95%, more preferably, 96%, 97%, 98%, or 99% identical to
that of a non-human organism, e.g., a non-human mammal.
[0295] Accordingly, all regions or residues of a humanized
immunoglobulin or antibody, or of a humanized immunoglobulin or
antibody chain, except the CDRs, are substantially identical to the
corresponding regions or residues of one or more native human
immunoglobulin sequences. The term "corresponding region" or
"corresponding residue" refers to a region or residue on a second
amino acid or nucleotide sequence which occupies the same (i.e.,
equivalent) position as a region or residue on a first amino acid
or nucleotide sequence, when the first and second sequences are
optimally aligned for comparison purposes.
[0296] The term "significant identity" means that two polypeptide
sequences, when optimally aligned, such as by the programs GAP or
BESTFIT using default gap weights, share at least 50-60% sequence
identity, preferably at least 60-70% sequence identity, more
preferably at least 70-80% sequence identity, more preferably at
least 80-90% sequence identity, even more preferably at least
90-95% sequence identity, and even more preferably at least 95%
sequence identity or more (e.g., 99% sequence identity or more).
The term "substantial identity" means that two polypeptide
sequences, when optimally aligned, such as by the programs GAP or
BESTFIT using default gap weights, share at least 80-90% sequence
identity, preferably at least 90-95% sequence identity, and more
preferably at least 95% sequence identity or more (e.g., 99%
sequence identity or more). For sequence comparison, typically one
sequence acts as a reference sequence, to which test sequences are
compared. When using a sequence comparison algorithm, test and
reference sequences are input into a computer, subsequence
coordinates are designated, if necessary, and sequence algorithm
program parameters are designated. The sequence comparison
algorithm then calculates the percent sequence identity for the
test sequence(s) relative to the reference sequence, based on the
designated program parameters.
[0297] Optimal alignment of sequences for comparison can be
conducted, e.g., by the local homology algorithm of Smith &
Waterman, Adv. Appl. Math. 2:482 (1981), by the homology alignment
algorithm of Needleman & Wunsch, J. Mol. Biol. 48:443 (1970),
by the search for similarity method of Pearson & Lipman, Proc.
Nat'l. Acad. Sci. USA 85:2444 (1988), by computerized
implementations of these algorithms (GAP, BESTFIT, FASTA, and
TFASTA in the Wisconsin Genetics Software Package, Genetics
Computer Group, 575 Science Dr., Madison, Wis.), or by visual
inspection (see generally Ausubel et al., Current Protocols in
Molecular Biology). One example of algorithm that is suitable for
determining percent sequence identity and sequence similarity is
the BLAST algorithm, which is described in Altschul et al., J. Mol.
Biol. 215:403 (1990). Software for performing BLAST analyses is
publicly available through the National Center for Biotechnology
Information (publicly accessible through the National Institutes of
Health NCBI internet server). Typically, default program parameters
can be used to perform the sequence comparison, although customized
parameters can also be used. For amino acid sequences, the BLASTP
program uses as defaults a wordlength (W) of 3, an expectation (E)
of 10, and the BLOSUM62 scoring matrix (see Henikoff &
Henikoff, Proc. Natl. Acad. Sci. USA 89:10915 (1989)).
[0298] Preferably, residue positions which are not identical differ
by conservative amino acid substitutions. For purposes of
classifying amino acids substitutions as conservative or
nonconservative, amino acids are grouped as follows: Group I
(hydrophobic sidechains): leu, met, ala, val, leu, ile; Group II
(neutral hydrophilic side chains): cys, ser, thr; Group III (acidic
side chains): asp, glu; Group IV (basic side chains): asn, gln,
his, lys, arg; Group V (residues influencing chain orientation):
gly, pro; and Group VI (aromatic side chains): trp, tyr, phe.
Conservative substitutions involve substitutions between amino
acids in the same class. Non-conservative substitutions constitute
exchanging a member of one of these classes for a member of
another.
[0299] Preferably, humanized immunoglobulins or antibodies bind
antigen with an affinity that is within a factor of three, four, or
five of that of the corresponding non-humanized antibody. For
example, if the nonhumanized antibody has a binding affinity of
10.sup.-9 M, humanized antibodies will have a binding affinity of
at least 3.times.10.sup.-8 M, 4.times.10.sup.-8 M,
5.times.10.sup.-8 M, or 10.sup.-9 M. When describing the binding
properties of an immunoglobulin or antibody chain, the chain can be
described based on its ability to "direct antigen (e.g., A13)
binding". A chain is said to "direct antigen binding" when it
confers upon an intact immunoglobulin or antibody (or antigen
binding fragment thereof) a specific binding property or binding
affinity. A mutation (e.g., a backmutation) is said to
substantially affect the ability of a heavy or light chain to
direct antigen binding if it affects (e.g., decreases) the binding
affinity of an intact immunoglobulin or antibody (or antigen
binding fragment thereof) comprising said chain by at least an
order of magnitude compared to that of the antibody (or antigen
binding fragment thereof) comprising an equivalent chain lacking
said mutation. A mutation "does not substantially affect (e.g.,
decrease) the ability of a chain to direct antigen binding" if it
affects (e.g., decreases) the binding affinity of an intact
immunoglobulin or antibody (or antigen binding fragment thereof)
comprising said chain by only a factor of two, three, or four of
that of the antibody (or antigen binding fragment thereof)
comprising an equivalent chain lacking said mutation.
[0300] The term "chimeric immunoglobulin" or antibody refers to an
immunoglobulin or antibody whose variable regions derive from a
first species and whose constant regions derive from a second
species. Chimeric immunoglobulins or antibodies can be constructed,
for example by genetic engineering, from immunoglobulin gene
segments belonging to different species. The terms "humanized
immunoglobulin" or "humanized antibody" are not intended to
encompass chimeric immunoglobulins or antibodies, as defined infra.
Although humanized immunoglobulins or antibodies are chimeric in
their construction (i.e., comprise regions from more than one
species of protein), they include additional features (i.e.,
variable regions comprising donor CDR residues and acceptor
framework residues) not found in chimeric immunoglobulins or
antibodies, as defined herein.
[0301] Such chimeric and humanized monoclonal antibodies can be
produced by recombinant DNA techniques known in the art, for
example using methods described in Robinson et al. International
Application No. PCT/US86/02269; Akira, et al. European Patent
Application 184,187; Taniguchi, M., European Patent Application
171,496; Morrison et al. European Patent Application 173,494;
Neuberger et al. PCT International Publication No. WO 86/01533;
Cabilly et al. U.S. Pat. No. 4,816,567; Cabilly et al. European
Patent Application 125,023; Better et al. (1988) Science
240:1041-1043; Liu et al. (1987) Proc. Natl. Acad. Sci. USA
84:3439-3443; Liu et al. (1987) J. Immunol. 139:3521-3526; Sun et
al. (1987) Proc. Natl. Acad. Sci. USA 84:214-218; Nishimura et al.
(1987) Canc. Res. 47:999-1005; Wood et al. (1985) Nature
314:446-449; and Shaw et al. (1988) J. Natl. Cancer Inst.
80:1553-1559); Morrison, S. L. (1985) Science 229:1202-1207; Oi et
al. (1986) BioTechniques 4:214; Winter U.S. Pat. No. 5,225,539;
Jones et al. (1986) Nature 321:552-525; Verhoeyan et al. (1988)
Science 239:1534; and Beidler et al. (1988) J. Immunol.
141:4053-4060. Therapeutic agents also include antibody mimetics
such as complementarity determining region (CDR) mimetics.
6. Human Antibodies from Transgenic Animals and Phage Display
[0302] Alternatively, it is now possible to produce transgenic
animals (e.g., mice) that are capable, upon immunization, of
producing a full repertoire of human antibodies in the absence of
endogenous immunoglobulin production. For example, it has been
described that the homozygous deletion of the antibody heavy-chain
joining region (J.sub.H) gene in chimeric and germ-line mutant mice
results in complete inhibition of endogenous antibody production.
Transfer of the human germ-line immunoglobulin gene array in such
germ-line mutant mice results in the production of human antibodies
upon antigen challenge. See, e.g., U.S. Pat. Nos. 6,150,584;
6,114,598; and 5,770,429.
[0303] Fully human antibodies can also be derived from
phage-display libraries (Hoogenboom et al., J. Mol. Biol., 227:381
(1991); Marks et al., J. Mol. Biol., 222:581-597 (1991)). Chimeric
polyclonal antibodies can also be obtained from phage display
libraries (Buechler et al. U.S. Pat. No. 6,420,113).
7. Bispecific Antibodies, Antibody Fusion Polypeptides, and
Single-Chain Antibodies
[0304] Bispecific antibodies (BsAbs) are antibodies that have
binding specificities for at least two different epitopes. Such
antibodies can be derived from full length antibodies or antibody
fragments (e.g. F(ab)'2 bispecific antibodies). Methods for making
bispecific antibodies are known in the art. Traditional production
of full length bispecific antibodies is based on the coexpression
of two immunoglobulin heavy chain-light chain pairs, where the two
chains have different specificities (Millstein et al., Nature,
305:537-539 (1983)). Because of the random assortment of
immunoglobulin heavy and light chains, these hybridomas (quadromas)
produce a potential mixture of different antibody molecules (see,
WO 93/08829 and in Traunecker et al., EMBO J., 10:3655-3659
(1991)).
[0305] Bispecific antibodies also include cross-linked or
"heteroconjugate" antibodies. For example, one of the antibodies in
the heteroconjugate can be coupled to avidin, the other to biotin
or other payload. Heteroconjugate antibodies may be made using any
convenient cross-linking methods. Suitable cross-linking agents are
well known in the art, and are disclosed in U.S. Pat. No.
4,676,980, along with a number of cross-linking techniques.
[0306] In yet another aspect, the antibody can be fused, chemically
or genetically, to a payload such as a reactive, detectable, or
functional moiety, for example, an immunotoxin to produce an
antibody fusion polypeptide. Such payloads include, for example,
immunotoxins, chemotherapeutics, and radioisotopes, all of which
are well-known in the art.
[0307] Single chain antibodies are also suitable for stabilization
according to the invention. The fragments comprise a heavy-chain
variable domain (VH) connected to a light-chain variable domain
(VL) with a linker, which allows each variable region to interface
with each other and recreate the antigen binding pocket of the
parent antibody from which the VL and VH regions are derived. See
Gruber et al., J. Immunol., 152:5368 (1994).
[0308] It is understood that any of the foregoing polypeptide
molecules, alone or in combination, are suitable for preparation as
stabilized formulations according to the invention.
XI. SUBJECTS AMENABLE TO TREATMENT
[0309] Subjects or patients amenable to treatment include
individuals at risk of disease but not showing symptoms, as well as
patients presently showing symptoms. Therefore, the present methods
can be administered prophylactically to the general population
without the need for any assessment of the risk of the subject
patient. The present methods are especially useful for individuals
who do have a known genetic risk autoimmune disorders. Such
individuals include those having relatives who have experienced
this disease and those whose risk is determined by analysis of
genetic or biochemical markers.
[0310] Patients suffering from AA amyloidosis can be asymptomatic
for a prolonged period of time. Therefore, clinical diagnosis of AA
amyloidosis is often delayed or missed until the amyloid deposits
are extensive. For those patients who are symptomatic, it is
estimated that only 53% of the cases are diagnosed. See L.E.K.
Consulting, Independent Market Research (2003).
[0311] The invention provides methods useful to treat or effect
prophylaxis of a disease characterized by the deposition of an
amyloid protein, such as, for example, the diseases described
above, including those listed in Table 1. Some methods are useful
to treat or effect prophylaxis of a disease characterized by the
deposition of an amyloid protein comprising the amino acid sequence
ED. In some methods, if the amyloid protein comprises the amino
acid sequence AEDV, then the antibody is not administered to treat
or effect prophylaxis of Alzheimer's disease or Mild Cognitive
Impairment. The amyloid protein can be any of the amyloid proteins
described above, including those listed in Table 1, such as, for
example, serum amyloid A protein, immunoglobulin light chain
protein, such as, for example, V.lamda.6 Wil or V.kappa., human
islet amyloid precursor polypeptide (IAPP), beta amyloid peptide,
transthyretin (TTR) or ApoA1.
[0312] The present methods are especially useful for individuals
who do have a known risk of, are suspected to have, or have been
diagnosed with AA amyloidosis or AL amyloidosis. Such individuals
include but are not limited to those having chronic inflammatory
diseases, inherited inflammatory diseases, and chronic microbial
infections, such as rheumatoid arthritis, juvenile chronic
arthritis, ankylosing spondylitis, psoriasis, psoriatic
arthropathy, Reiter's syndrome, Adult Still's disease, Behcet's
syndrome, Crohn's disease, Familial Mediterranean Fever, leprosy,
tuberculosis, bronchiectasis, decubitus ulcers, chronic
pyelonephritis, osteomyelitis, Whipple's disease, myeloma,
macroglobulinemia, immunocyte dyscrasia, monoclonal gammopathy,
occult dyscrasia. Chronic inflammatory and infectious conditions
are prerequisite to the development of AA amyloidosis and AL
amyloidosis manifested by local nodular amyloidosis can be
associated with chronic inflammatory diseases. Individuals who do
have known risk of AA amyloidosis also include but are not limited
to those having malignant neoplasms as Hodgkin's lymphoma, renal
carcinoma, carcinomas of gut, lung and urogenital tract, basal cell
carcinoma, andhairy cell leukemia. Additionally, individuals who do
have known risk of AA amyloidosis also include but are not limited
to those having lymphoproliferative disorders such as Castleman's
Disease.
[0313] In both asymptomatic and symptomatic patients, treatment can
begin at any time before or after the diagnosis of the underlying
AA or AL amyloid diseases. Treatment typically entails multiple
dosages over a period of time. Treatment can be monitored by
assaying antibody, activated T-cell (a side effect) or B-cell
responses to the therapeutic agent (e.g., AA peptide), or employing
radiolabeled SAP Scintigraphy over time. If the response falls, a
booster dosage is indicated.
XII. TREATMENT REGIMES
[0314] In general, treatment regimes involve administering an agent
effective to induce an immunogenic response to an amyloid protein,
and preferably to an aggregated form of such amyloid protein, such
as, for example, AA or AL. Preferably an immunogenic fragment of AA
or AL or an X.sub.1EDX.sub.2 fragment is administered to a patient.
In prophylactic applications, pharmaceutical compositions or
medicaments are administered to a patient susceptible to, or
otherwise at risk of, amyloidosis such as AA Amyloidosis or AL
amyloidosis, in an amount sufficient to eliminate or reduce the
risk, lessen the severity, or delay the onset of the disease,
including physiological, biochemical, histologic and/or behavioral
symptoms of the disease, its complications and intermediate
pathological phenotypes presenting during development of the
disease. In therapeutic applications, an agent is administered to a
patient suspected of, or already suffering from such a disease in a
regime comprising an amount and frequency of administration of the
agent sufficient to cure, or at least partially arrest, or inhibit
deterioration of the symptoms of the disease (physiological,
biochemical, histologic and/or behavioral), including its
complications and intermediate pathological phenotypes in
development of the disease. In some methods, administration of
agent reduces or eliminates early symptomology in patients that
have not yet developed characteristic AA or AL Amyloidosis
pathology. An amount adequate to accomplish therapeutic or
prophylactic treatment is defined as a therapeutically- or
prophylactically-effective dose. A combination of amount and dosage
frequency adequate to accomplish the therapeutic or prophylactic
treatment is defined as a therapeutically- or
prophylactically-effective regime. In both prophylactic and
therapeutic regimes, agents are usually administered in several
dosages until a sufficient immune response has been achieved. A
dosage and frequency of administrations adequate to accomplish
therapeutic or prophylactic treatment is defined as a
therapeutically- or prophylactically-effective regime. Typically,
the patient's immune response is monitored and repeated dosages are
given if the immune response starts to wane. The immune response
can be monitored by detecting antibodies, for example, to AA or AL
in the blood in the patient or detecting levels of, for example, AA
or AL.
[0315] Effective doses of the agents and compositions of the
present invention, for the treatment of the above described
conditions vary depending upon many different factors, including
means of administration, target site, physiological state of the
patient, whether the patient is human or an animal, other
medications administered, and whether treatment is prophylactic or
therapeutic. Usually, the patient is a human but nonhuman mammals
including transgenic mammals can also be treated. Treatment dosages
need to be titrated to optimize safety and efficacy. The amount of
immunogen depends on whether adjuvant is also administered, with
higher dosages being required in the absence of adjuvant. The
amount of an immunogen for administration sometimes varies from
1-500 .mu.g per patient and more usually from 5-500 .mu.g per
injection for human administration. Occasionally, a higher dose of
1-2 mg per injection is used. Typically at least 10, 20, 50 or 100
.mu.g is used for each human injection. The mass of immunogen also
depends on the mass ratio of immunogenic epitope within the
immunogen to the mass of immunogen as a whole. Typically, 10.sup.-3
to 10.sup.-5 micromoles of immunogenic epitope are used for
microgram of immunogen. The timing of injections can vary
significantly from once a day, to once a year, to once a decade. On
any given day that a dosage of immunogen is given, the dosage is
greater than 1 .mu.g/patient and usually greater than 10
.mu.g/patient if adjuvant is also administered, and greater than 10
.mu.g/patient and usually greater than 100 .mu.g/patient in the
absence of adjuvant. A typical regimen consists of an immunization
followed by booster injections at time intervals, such as 6 week
intervals. Another regimen consists of an immunization followed by
booster injections 1, 2 and 12 months later. Another regimen
entails an injection every two months for life. Alternatively,
booster injections can be on an irregular basis as indicated by
monitoring of immune response.
[0316] Doses for nucleic acids encoding immunogens range from about
10 ng to 1 g, 100 ng to 100 mg, 1 .mu.g to 10 mg, or 30-300 .mu.g
DNA per patient. Doses for infectious viral vectors vary from
10-100, or more, virions per dose.
[0317] For passive immunization with an antibody (in combination
therapies), the dosage ranges from about 0.0001 to 100 mg/kg, 0.5
to less than 5 mg/kg, and more usually 0.01 to 5 mg/kg, 0.5 to 3
mg/kg, of the host body weight. For example dosages can be 1 mg/kg
body weight or 10 mg/kg body weight or within the range of 1-10
mg/kg or in other words, 70 mg or 700 mg or within the range of
70-700 mg, respectively, for a 70 kg patient. As an additional
example, dosages can be less than 5 mg/kg body weight or 1.5 mg/kg
body weight or within the range of 0.5 to 1.5 mg/kg, preferably at
least 1.5 mg/kg. An exemplary treatment regime entails
administration once per every two weeks or once a month or once
every 3 to 6 months. In some methods, two or more monoclonal
antibodies with different binding specificities are administered
simultaneously, in which case the dosage of each antibody
administered falls within the ranges indicated. Antibody is usually
administered on multiple occasions. Intervals between single
dosages can be weekly, monthly or yearly. Intervals can also be
irregular as indicated by measuring blood levels of antibody to AA
in the patient. In some methods, dosage is adjusted to achieve a
plasma antibody concentration of 1-1000 .mu.g/ml and in some
methods 25-300 .mu.g/ml. Alternatively, antibody can be
administered as a sustained release formulation, in which case less
frequent administration is required. Dosage and frequency vary
depending on the half-life of the antibody in the patient. In
general, human antibodies show the longest half life, followed by
humanized antibodies, chimeric antibodies, and nonhuman antibodies.
The dosage and frequency of administration can vary depending on
whether the treatment is prophylactic or therapeutic. In
prophylactic applications, a relatively low dosage is administered
at relatively infrequent intervals over a long period of time. Some
patients continue to receive treatment for the rest of their lives.
In therapeutic applications, a relatively high dosage at relatively
short intervals is sometimes required until progression of the
disease is reduced or terminated, and preferably until the patient
shows partial or complete amelioration of symptoms of disease.
Thereafter, the patent can be administered a prophylactic
regime.
[0318] Agents for inducing an immune response can be administered
by parenteral, topical, intravenous, oral, subcutaneous,
intraarterial, intracranial, intraperitoneal, intranasal or
intramuscular means for prophylactic and/or therapeutic treatment.
The most typical route of administration of an immunogenic agent is
subcutaneous although other routes can be equally effective. The
next most common route is intramuscular injection. This type of
injection is most typically performed in the arm or leg muscles. In
some methods, agents are injected directly into a particular tissue
where deposits have accumulated, e.g., intracranial injection.
Intramuscular injection or intravenous infusion is preferred for
administration of antibody (in combination therapies). In some
methods, particular therapeutic antibodies are injected directly
into the cranium. In some methods, antibodies are administered as a
sustained release composition or device, such as a MEDIPAD.TM.
device.
[0319] Agents of the invention are often administered as
pharmaceutical compositions comprising an active therapeutic agent,
i.e., and a variety of other pharmaceutically acceptable
components. See Remington's Pharmaceutical Science (15th ed., Mack
Publishing Company, Easton, Pa., 1980). The preferred form depends
on the intended mode of administration and therapeutic application.
The compositions can also include, depending on the formulation
desired, pharmaceutically-acceptable, non-toxic carriers or
diluents, which are defined as vehicles commonly used to formulate
pharmaceutical compositions for animal or human administration. The
diluent is selected so as not to affect the biological activity of
the combination. Examples of such diluents are distilled water,
physiological phosphate-buffered saline, Ringer's solutions,
dextrose solution, and Hank's solution. In addition, the
pharmaceutical composition or formulation may also include other
carriers, adjuvants, or nontoxic, nontherapeutic, nonimmunogenic
stabilizers and the like.
[0320] Pharmaceutical compositions can also include large, slowly
metabolized macromolecules such as proteins, polysaccharides such
as chitosan, polylactic acids, polyglycolic acids and copolymers
(such as latex functionalized SEPHAROSE.TM., agarose, cellulose,
and the like), polymeric amino acids, amino acid copolymers, and
lipid aggregates (such as oil droplets or liposomes). Additionally,
these carriers can function as immunostimulating agents (i.e.,
adjuvants).
[0321] For parenteral administration, agents of the invention can
be administered as injectable dosages of a solution or suspension
of the substance in a physiologically acceptable diluent with a
pharmaceutical carrier that can be a sterile liquid such as water
oils, saline, glycerol, or ethanol. Additionally, auxiliary
substances, such as wetting or emulsifying agents, surfactants, pH
buffering substances and the like can be present in compositions.
Other components of pharmaceutical compositions are those of
petroleum, animal, vegetable, or synthetic origin, for example,
peanut oil, soybean oil, and mineral oil. In general, glycols such
as propylene glycol or polyethylene glycol are preferred liquid
carriers, particularly for injectable solutions. Antibodies can be
administered in the form of a depot injection or implant
preparation which can be formulated in such a manner as to permit a
sustained release of the active ingredient. An exemplary
composition comprises monoclonal antibody at 5 mg/mL, formulated in
aqueous buffer consisting of 50 mM L-histidine, 150 mM NaCl,
adjusted to pH 6.0 with HCl. Compositions for parenteral
administration are typically substantially sterile, isotonic and
manufactured under GMP conditions of the FDA or similar body.
[0322] Typically, compositions are prepared as injectables, either
as liquid solutions or suspensions; solid forms suitable for
solution in, or suspension in, liquid vehicles prior to injection
can also be prepared. The preparation also can be emulsified or
encapsulated in liposomes or micro particles such as polylactide,
polyglycolide, or copolymer for enhanced adjuvant effect, as
discussed above (see Langer, Science 249, 1527 (1990) and Hanes,
Advanced Drug Delivery Reviews 28, 97-119 (1997). The agents of
this invention can be administered in the form of a depot injection
or implant preparation which can be formulated in such a manner as
to permit a sustained or pulsatile release of the active
ingredient.
[0323] Additional formulations suitable for other modes of
administration include oral, intranasal, and pulmonary
formulations, suppositories, and transdermal applications.
[0324] For suppositories, binders and carriers include, for
example, polyalkylene glycols or triglycerides; such suppositories
can be formed from mixtures containing the active ingredient in the
range of 0.5% to 10%, preferably 1%-2%. Oral formulations include
excipients, such as pharmaceutical grades of mannitol, lactose,
starch, magnesium stearate, sodium saccharine, cellulose, and
magnesium carbonate. These compositions take the form of solutions,
suspensions, tablets, pills, capsules, sustained release
formulations or powders and contain 10%-95% of active ingredient,
preferably 25%-70%.
[0325] Topical application can result in transdermal or intradermal
delivery. Topical administration can be facilitated by
co-administration of the agent with cholera toxin or detoxified
derivatives or subunits thereof or other similar bacterial toxins
(See Glenn et al., Nature 391, 851 (1998)). Co-administration can
be achieved by using the components as a mixture or as linked
molecules obtained by chemical crosslinking or expression as a
fusion protein.
[0326] Alternatively, transdermal delivery can be achieved using a
skin path or using transferosomes (Paul et al., Eur. J. Immunol.
25, 3521-24 (1995); Cevc et al., Biochem. Biophys. Acta 1368,
201-15 (1998)).
XIII. COMBINATIONAL DRUG THERAPY TREATMENT REGIMES
[0327] Combination therapy according to the invention may be
performed alone or in conjunction with another therapy to treat or
effect prophylaxis of AA amyloidosis. Combination therapy according
to the invention may also be performed in conjunction with another
therapy which treats or effects prophylaxis of an underlying
amyloid disease such as inflammatory diseases, chronic microbial
infections, malignant neoplasms, inherited inflammatory diseases,
and lymphoproliferative disorders. There are large numbers of
treatments available in commercial use, in clinical evaluation and
in pre-clinical development, which could be selected for use with
the presently disclosed invention for effecting prophylaxis and
treatment of AA amyloidosis by combination drug therapy. Such
treatments can be one or more compounds selected from, but not
limited to several major categories, namely, (i) non-steroidal
anti-inflammatory drugs (NSAIDs; e.g., detoprofen, diclofenac,
diflunisal, etodolac, fenoprofen, flurbiprofen, ibuprofen,
indomethacin, ketoprofen, meclofenameate, mefenamic acid,
meloxicam, nabumeone, naproxen sodium, oxaprozin, piroxicam,
sulindac, tolmetin, celecoxib, rofecoxib, aspirin, choline
salicylate, salsalte, and sodium and magnesium salicylate); (ii)
steroids (e.g., cortisone, dexamethasone, hydrocortisone,
methylprednisolone, prednisolone, prednisone, triamcinolone); (iii)
DMARDs, i.e., disease modifying antirheumatic drugs (e.g.,
cyclosporine, azathioprine, methotrexate, leflunomide,
cyclophosphamide, hydroxychloroquine, sulfasalazine,
D-penicillamine, minocycline, and gold); or (iv) recombinant
proteins (e.g., ENBREL.RTM. (etanercept, a soluble TNF receptor)
and REMICADE.RTM. (infliximab) a chimeric monoclonal anti-TNF
antibody).
[0328] The duration of the combination therapy depends on the type
of underlying disease being treated, the age and condition of the
patient, the stage and type of the patient's disease, and how the
patient responds to the treatment. The doctor can observe the
therapy's effects closely and make any adjustments that are needed.
Additionally, a person having a greater risk of developing AA
Amyloidosis (e.g., a person who is genetically predisposed or
previously had an inflammatory disorder or other underlying
diseases) or AL amyloidosis may receive prophylactic treatment to
inhibit or delay the development of AA AL aggregates such as
fibrils.
[0329] The dosage, frequency and mode of administration of each
component of the combination can be controlled independently. For
example, one compound may be administered orally three times per
day, while the second compound may be administered intramuscularly
once per day. Combination therapy may be given in on-and-off cycles
that include rest periods. The compounds may also be formulated
together such that one administration delivers both compounds. The
combination of the invention can also be provided as components of
a pharmaceutical pack. The drugs can be formulated together or
separately and in individual dosage amounts. Each compound is
admixed with a suitable carrier substance, and is generally present
in an amount of 1-95% by weight of the total weight of the
composition.
[0330] The composition may be provided in a dosage form that is
suitable for oral, parenteral (e.g., intravenous, intramuscular,
subcutaneous), rectal, transdermal, nasal, vaginal, inhalant, or
ocular administration. Thus, the composition may be in form of,
e.g., tablets, capsules, pills, powders, granulates, suspensions,
emulsions, solutions, gels including hydrogels, pastes, ointments,
creams, plasters, drenches, delivery devices, suppositories,
enemas, injectables, implants, sprays, or aerosols. The
pharmaceutical compositions may be formulated according to
conventional pharmaceutical practice (see, e.g., Remington: The
Science and Practice of Pharmacy, (19th ed.) ed. A. R. Gennaro,
1995, Mack Publishing Company, Easton, Pa. and Encyclopedia of
Pharmaceutical Technology, eds. J. Swarbrick and J. C. Boylan,
1988-1999, Marcel Dekker, N.Y.
XIV. METHODS OF MONITORING OR DIAGNOSING AA OR AL AMYLOIDOSIS
[0331] Methods of monitoring or diagnosing AA or AL amyloidosis
include measuring the plasma concentrations of SAA and C-reactive
protein, performing tissue biopsy (renal, rectal, gastric,
gingival, fat, salivary, labial glands) and histology with congo
red staining and/or immunostaining with specific antibodies
directed against AA or AL aggregates such as fibrils. The invention
provides methods of detecting an antibody response against AA
peptide in a patient suffering from or susceptible to AA
Amyloidosis. The methods are particularly useful for monitoring a
course of treatment being administered to a patient. The methods
can be used to monitor both therapeutic treatment on symptomatic
patients and prophylactic treatment on asymptomatic patients. Some
methods entail determining a baseline value of an antibody response
in a patient before administering a dosage of an immunogenic agent,
and comparing this with a value for the immune response after
treatment. A significant increase (i.e., greater than the typical
margin of experimental error in repeat measurements of the same
sample, expressed as one standard deviation from the mean of such
measurements) in value of the antibody response signals a positive
treatment outcome (i.e., that administration of the agent has
achieved or augmented an immune response). If the value for the
antibody response does not change significantly, or decreases, a
negative treatment outcome is indicated. In general, patients
undergoing an initial course of treatment with an immunogenic agent
are expected to show an increase in antibody response with
successive dosages, which eventually reaches a plateau.
Administration of agent is generally continued while the antibody
response is increasing. Attainment of the plateau is an indicator
that the administered of treatment can be discontinued or reduced
in dosage or frequency.
[0332] In other methods, a control value (i.e., a mean and standard
deviation) of an antibody response is determined for a control
population. Typically the individuals in the control population
have not received prior treatment. Measured values of the antibody
response in a patient after administering a therapeutic agent are
then compared with the control value. A significant increase
relative to the control value (e.g., greater than one standard
deviation from the mean) signals a positive treatment outcome. A
lack of significant increase or a decrease signals a negative
treatment outcome. Administration of agent is generally continued
while the antibody response is increasing relative to the control
value. As before, attainment of a plateau relative to control
values in an indicator that the administration of treatment can be
discontinued or reduced in dosage or frequency.
[0333] In other methods, a control value of antibody response
(e.g., a mean and standard deviation) is determined from a control
population of individuals who have undergone treatment with a
therapeutic agent and whose antibody responses have reached a
plateau in response to treatment. Measured values of antibody
response in a patient are compared with the control value. If the
measured level in a patient is not significantly different (e.g.,
more than one standard deviation) from the control value, treatment
can be discontinued. If the level in a patient is significantly
below the control value, continued administration of agent is
warranted. If the level in the patient persists below the control
value, then a change in treatment regime, for example, use of a
different adjuvant, fragment or switch to passive administration
may be indicated.
[0334] In other methods, a patient who is not presently receiving
treatment but has undergone a previous course of treatment is
monitored for antibody response to determine whether a resumption
of treatment is required. The measured value of antibody response
in the patient can be compared with a value of antibody response
previously achieved in the patient after a previous course of
treatment. A significant decrease relative to the previous
measurement (i.e., greater than a typical margin of error in repeat
measurements of the same sample) is an indication that treatment
can be resumed. Alternatively, the value measured in a patient can
be compared with a control value (mean plus standard deviation)
determined in a population of patients after undergoing a course of
treatment. Alternatively, the measured value in a patient can be
compared with a control value in populations of prophylactically
treated patients who remain free of symptoms of disease, or
populations of therapeutically treated patients who show
amelioration of disease characteristics. In all of these cases, a
significant decrease relative to the control level (i.e., more than
a standard deviation) is an indicator that treatment should be
resumed in a patient.
[0335] Some methods employ iodine-123-labeled or iodine-125-labeled
serum amyloid P component (.sup.123I-SAP or .sup.125I-SAP)
Scintigraphy. .sup.123I-SAP or .sup.125I-SAP is intravenously
injected into patients and viewed with gamma camera. Radiolabeled
SAP Scintigraphy is a useful method to monitor the progression of
amyloidosis in patients and evaluate treatments. It is specific for
amyloid and can be used to quantitatively monitor the location and
amount of amyloid deposits in patients. .sup.123I-SAP and
.sup.125I-SAP do not accumulate in healthy subjects or in
non-amyloid patients. Radiolabeled SAP scintigraphy can be used to
monitor dynamic turnover of amyloid, and can assess the efficacy of
treatments aimed at regressing amyloid deposits. Further,
radiolabeled SAP Scintigraphy is non-invasive and provides whole
body scan. Methods of the invention entail determining a baseline
value of an antibody response in a patient before administering a
dosage of an agent, and comparing this with a value for the immune
response after treatment in a patient. A significant increase
(i.e., greater than the typical margin of experimental error in
repeat measurements of the same sample, expressed as one standard
deviation from the mean of such measurements) in value of the
antibody response signals a positive treatment outcome (i.e., that
administration of the agent has achieved or augmented an immune
response). If the value for the antibody response does not change
significantly, or decreases, a negative treatment outcome is
indicated. In general, patients undergoing an initial course of
treatment with an immunogenic agent are expected to show an
increase in antibody response with successive dosages, which
eventually reaches a plateau. Administration of agent is generally
continued while the antibody response is increasing. Attainment of
the plateau is an indicator that the administered of treatment can
be discontinued or reduced in dosage or frequency.
[0336] The tissue sample for analysis is typically blood, plasma,
serum, mucous or cerebrospinal fluid from the patient. The sample
is analyzed for indication of an immune response to any form of AA
or AL peptide. The immune response can be determined from the
presence of antibodies that specifically bind to AA or AL peptide.
Antibodies can be detected in a binding assay to a ligand that
specifically binds to the antibodies. Typically the ligand is
immobilized. Binding can be detected using a labeled anti-idiotypic
antibody.
[0337] In combination regimes employing both active and passive
administration, analogous approaches can be used to monitor levels
of antibody resulting from passive administration.
[0338] Methods of diagnosing amyloidosis can also be employed by,
e.g., administering to a subject an antibody or antigen-binding
fragment thereof, that is bound to a detectable label, wherein the
antibody or fragment thereof specifically binds to an epitope
including X.sub.1EDX.sub.2 in an aggregated amyloid protein,
wherein X.sub.1 and X.sub.2 are any amino acids, and detecting the
presence or absence of the bound antibody or fragment thereof.
Detection of the bound antibody or fragment supports a diagnosis of
amyloidosis. Antibodies and fragments useful in the diagnosis of
amyloidosis include the disclosed antibodies of the invention.
[0339] The diagnostic antibodies or fragments of the invention can
be administered, by e.g., intravenous injection into the body of a
patient, or directly into the brain by intracranial injection. The
antibody dosage is readily determined by one skilled in the art.
Typically, the antibody is labeled, although in some methods, the
antibody is unlabeled and a secondary labeling agent is used to
bind to the antibody. The choice of label depends on the means of
detection. For example, a fluorescent label is suitable for optical
detection. Use of paramagnetic labels is suitable for tomographic
detection without surgical intervention. Radiolabels may be used
including .sup.211At, .sup.212Bi, .sup.67Cu, .sup.125 I, .sup.131I,
.sup.111In, .sup.32P, .sup.212Pb, .sup.186Re, .sup.188Re,
.sup.153Sm, .sup.99mTc, or .sup.90Y. Such labels may be detected
using PET or SPECT or other suitable technique.
[0340] Diagnosis may also be performed by comparing the number,
size, and/or intensity of labeled loci, to corresponding baseline
values. The base line values can represent the mean levels in a
population of undiseased individuals. Baseline values can also
represent previous levels determined in the same patient. For
example, baseline values can be determined in a patient, and
measured values thereafter compared with the baseline values. An
increase in values relative to baseline signals supports a
diagnosis of AA amyloidosis.
[0341] The diagnostic methods of the invention may be used to
diagnose amyloidosis diseases including AA amyloidosis, AL
amyloidosis, Alzheimer's disease, Mild Cognitive Impairment,
amyloid polyneuropathy, Mediterranean fever, Muckle-Wells syndrome,
reactive systemic amyloidosis associated with systemic inflammatory
diseases, myeloma or macroglobulinemia associated amyloidosis,
amyloidosis associated with immunocyte dyscrasia, monoclonal
gammopathy, occult dyscrasia, or local nodular amyloidosis
associated with chronic inflammatory diseases.
XV. ANIMAL MODELS OF AA AMYLOIDOSIS
[0342] AA amyloidosis can be induced experimentally in mice in
which SAA concentrations are markedly increased by injection of
silver nitrate, casein, or lipopolysaccharide. These agents
stimulate the production of cytokines. See Skinner et al. Lab
Invest. 36:420-427 (1997) and Kisilevsky et al. Bailliere's Clin.
Immunol. Immunopathol. 8(3) 613-626 (1994). Within 2 or 3 weeks
after the inflammatory stimulus, animals develop systemic AA
deposits, as found in patients with AA Amyloidosis. This lag phase
is dramatically shortened when mice are given, concomitantly, an
intravenous injection of protein extracted from AA amyloid-laden
mouse spleen or liver. See Axelrad et al. Lab Invest. 47(2):139-46
(1982). The amyloidogenic accelerating activity of such
preparations was termed "amyloid enhancing factor" (AEF). Lundmark
et al. reports that the active principle of AEF is unequivocally
the AA fiber itself. Further, they demonstrated that this material
is extremely potent, being active in doses less than 1 ng, and that
it retained its biologic activity over a considerable length of
time. Notably, the AEF was also effective when administered orally.
They concluded that AA and perhaps other forms of amyloidosis are
transmissible diseases, akin to the prion-associated disorders. See
Lundmark et al. Proc. Nat. Acad. Sci. 99: 6979-6984 (2002).
[0343] AA amyloid can also be induced in transgenic strains of mice
carrying the human interleukin 6 gene under the control of the
metallothionein-I promoter resulting in markedly increased
concentrations of SAA and developing amyloid in the spleen, liver
and kidneys by 3 months of age. At the time of death at about 8-9
months, organs from these transgenic mice have extensive amyloid
deposits. See Solomon et al., Am. J. Pathol. 154(4):1267-1272
(1999).
[0344] The Transgenic Rapidly Induced Amyloid Disease (TRIAD)
transgenic mouse model is an improvement to the above described
transgenic mouse model. TRIAD mice carry the human interleukin 6
gene under the control of the H-2L.sup.D histocompatibility
promoter. Adminstration of AEF to 8-week old TRIAD mice results in
prominent spenic and hepatic AA amyloid deposits within 3 to 4
weeks. Subsequently, this process progresses to other organs,
leading to death 4-6 weeks later. The development of the systemic
amyloidosis is accelerated compared to the above-described
transgenic mouse model. See University of Tennessee Research
Corporation, WO 01/77167, Pharmacopeia, WO 95/35503 and Scripps, WO
95/30642 Wall et al. Amyloid 12(3): 149-156 (2005) (each of which
is incorporated by reference for all purposes).
[0345] The common marmoset (Callithrix jacchus) is a small New
World primate native to Brazil that has been used extensively in
biomedical research. Ludlage et al. reports that common marmoset
were found to have amyloid deposits in one or more organs,
including the liver, adrenal glands, kidneys, and intestine. The
authors posit that hereditary factors might be responsible for the
development of AA amyloidosis in this primate. In this regard, the
common marmoset could serve as a unique experimental model for
study of the pathogenesis and therapy of AA and other systemic
amyloid disorders. See Ludlage et al. Vet Pathol 42:117-124
(2005).
[0346] The Shar Pei species of dog, a breed having an AA sequence
with the -AEDS motif and that is particularly susceptible to
AA-amyloidosis, provides a naturally occurring model of systemic AA
in which to evaluate novel diagnostic and therapeutic applications
of AA amyloid-specific antibodies and other compounds.
EXAMPLES
Example I
AA Fragments
[0347] Peptides corresponding to amino acids 71-75--GHEDT, as
described by Yamamoto and Migita Proc. Natl. Acad. Sci. USA
82:2915-2919 were synthesized by AnaSpec, San Jose, Calif., USA.
Polyclonal antibodies (Pab) AA were raised and the immunoglobulin
fraction isolated, as previously described by Bard, F. et al.,
(2000) Nat. Med. 6, 916-919.
Example II
Immunogen for Preparation of Murine Antibodies
[0348] The epitope used was GHEDT, (SEQ ID NO: 3) with a CG linker
at its N terminus. The peptide EPRB-39 which contains the epitope
is coupled to sheep anti mouse antibody. EPRB-39 is obtained from
Anasec, San Jose, Calif. The antibodies produced appear to be
neoepitope specific because they don't specifically bind to a
peptide that spans the region GHEDTIADQE, (SEQ ID NO: 89).
Example III
Immunization Procedures
[0349] Six-week-old An mice were intraperitoneal injected with 50
ug EPRB-39/sheep anti-mouse IgG with Complete Freund's Adjuvant
(CFA) followed by Incomplete Freund's adjuvant (IFA) once every
other week for a total of three injections. Three days before
fusion, the tail vein was injected with 50 ug EPRB-39 SAM IgG in 90
ul PBS. The titer was estimated at 1/10000 from ELISA with high
background
[0350] JH80 is the fusion number for EPRB-39. The following is a
list of the clones and limiting dilution clones that are
active:
TABLE-US-00015 7D8.29.19.47*, 39, 66 IgG2b k 8G9.3.4.51.22*, 30, 46
IgG2b k 2A4.20.44.77*, 13, 14 IgG2b k
[0351] 7D47, 8G9 and 2A77 indicate preferred subclones. The
antibodies produced appear to be neoepitope specific because they
don't react with a peptide that spans the C-terminus cleavage site
of SAA.
Example IV
Antibody Binding to Aggregated and Soluble AA
[0352] Serum titers (determined by serial dilution) and monoclonal
antibody binding to aggregated AA were performed by ELISA as
previously described by Schenk D. et al., (1999) Nature 400,
173-177. Soluble AA refers to the AA fibrils sonicated in dimethyl
sulfoxide. Serial dilutions of antibody were incubated with 50,000
cpm of .sup.125I-AA overnight at room temperature. 50 .mu.l of a
slurry containing 75 mg/ml protein A sepharose (Amersham
Biosciences, Uppsala, Sweden)/200 .mu.g rabbit anti-mouse IgG (H+L)
(Jackson ImmunoResearch, West Grove, Pa., USA) was incubated with
the diluted antibodies for 1 hr at room temperature, washed twice,
and counted on a Wallac gamma counter (PerkinElmer Life Science,
Grove, IL, USA). All steps were performed in radioimmunoassay
buffer consisting of 10 mM Tris, 0.5 M NaCl, 1 mg/ml gelatin, and
0.5% Nonidet P-40, pH 8.0.
Example V
Analysis of V.lamda.6 Wil Structure
[0353] The sequences of the expressed human V.kappa. and V.lamda.
immunoglobulin light chain germline genes are as illustrated in
FIGS. 21 and 22. With exception of the .kappa.1a, .lamda.1a,
.lamda.3a, and .lamda.3c subgroups there is a Glu-Asp residue
pairing at positions 81 and 82 in all, V.kappa. and V.lamda.
germline gene sequences (FIGS. 21 and 22). In addition, a second
germline encoded Glu-Asp pairing at positions 50 and 51 is unique
to V.lamda.6 germline gene. Thus, V.lamda.6 Wil contains both the
50-51 and 81-82 Glu-Asp pairs. The side chains of residues 50 and
51 are both accessible on the surface of V.lamda.6 Wil, as shown by
x-ray crystallography (FIG. 24). In contrast, only the Glu81 side
chain is surface exposed and the Asp82 side chain is partially
buried and appears to interact (either by electrostatic
interactions or H-bonding) with the side chains of Lys79 and Arg61
(FIG. 25).
[0354] Based on these analyses of the x-ray crystal structure and
the relative availability of the Glu-Asp side chains Applicants
conclude that the buried Glu81 becomes accessible as the domain
enters an aggregated (e.g., fibrillar) structure (or becomes
partially denatured), thus exposing what is otherwise a hidden,
cryptic epitope.
Example VI
Analysis of Anti-AA Monoclonal Antibody Binding To V.lamda.6
[0355] A. Surface Plasmon Resonance
[0356] Surface plasmon resonance was used to establish the binding
kinetics of several monoclonal antibodies with V.lamda.6 Wil
fibrils and monomer. At a concentration of 6.6 nM all 3 antibodies
bound to the immobilized synthetic V.lamda.6 Wil fibrils with a KD
of .about.1 nM--a value comparable to that found for their
reactivity with murine AA fibrils (FIG. 26). The deflection
(expressed in RU) during the binding phase was similar for mAbs 7D8
and 2A4 but was 50% lower for 8G9. This suggests that the density
of this antibody on the fibrils was lower than the other 2
reagents, as the calculated affinities were similar for all 3
antibodies. An IgG1 mAb served as a control and exhibited no
binding to V.lamda.6 Wil fibrils.
[0357] Titration of the mAb 7D8 over the range of 6.6 nM to 33.3 nM
produced the expected decrease in the maximal deflection associated
with kon (FIG. 27). In general, the binding kinetics were similar
at each concentration, although in these pilot experiments the KD
value for 7D8 at 26.6 nM did differ from that obtained at the other
concentrations.
[0358] To assess the specificity of the reaction and ensure that
the binding of the mAbs with the fibrils occurred via the classic
F(ab)-antigen interaction (as opposed to Fc-mediated binding or
non-specific adsorption), binding data were acquired in the
presence of the immunogen peptide (p39) at 20 and 1 .mu.g/mL (FIG.
8). Peptide p41 which does not bind the mAb 7D8 at low
concentrations, served as a control. In the presence of 20 .mu.g/mL
p41 peptide, the binding kinetics for mAb 7D8 with V.lamda.6 Wil
fibrils were identical to 7D8 alone. In contrast, the immunogen
peptide p39 at 1 .mu.g/mL caused a >2-fold decrease in the
extent of binding as judged by the deflection of the measured
signal (FIG. 28). Inhibition of fibril binding by 7D8 was almost
completely inhibited when 20 .mu.g/mL of p39 peptide was used.
These data indicated that mAb 7D8 bound fibrils via the F(ab)
region of the molecule inasmuch as this interaction could be
completely inhibited by the immunogen peptide.
[0359] The reactivity of the mAb 7D8 with V.lamda.6 monomer
immobilized on a chip was examined using the BIAcore. The antibody
did not react with the monomeric protein. These data indicate that
the binding site recognized by the mAb 7D8 is present on fibrils,
but not on the soluble precursor protein, implying that the antigen
is conformational or cryptic in nature.
[0360] B. Immunohistochemistry
[0361] Immunohistochemistry was performed as follows: 6 .mu.m-thick
sections, cut from formalin-fixed, paraffin embedded blocks, were
subjected to and antigen retrieval by incubation with CitraPlus
(BioGenex, San Ramon, Calif.) for 30 min at 90.degree. C. Tissues
were immunostained with a 3 .mu.g/mL solution of mAbs 2A4, 7D8, or
8G9. The IgG2a mAb TY11 served as a control. A HRPO-conjugated
horse anti-mouse Ig antibody (ImmPRESS Universal Reagent, Vector
Labs, Burlingame, Calif.) was used as the secondary reagent. Slides
were developed using 3,3'-diaminobezidene (Vector Labs) and
examined using a Leica DM500 microscope. The interaction of the
monoclonal antibodies with AL.kappa. and AL.lamda. amyloid tissues
deposits was also studied using immunohistochemistry. As
illustrated in FIG. 29, amyloid deposits in a patient's thyroid
gland which were composed of .lamda.2 fragments were immunostained
by 7D8, 2A4 and 8G9. The areas of reactivity correlated with the
amyloid deposits, indicated by the green-gold birefringence seen in
the Congo red-stained tissue section. The most impressive
reactivity was achieved with mAbs 7D8 and 2A4 mAbs while 8G9,
although positive, was considerably weaker. These qualitative data
correspond well with the BIAcore analyses in which 8G9 bound less
to the V.lamda.6 Wil fibrils than the other 2 reagents (FIG. 26).
The isotype matched mAb TY11 that served as a control exhibited no
amyloid immunoreactivity.
[0362] The amino acid sequence of this .lamda.2 protein (SEQ ID NO:
86) (shown below) contains the germline encoded Glu and Asp
residues at position 81 and 82, respectively.
TABLE-US-00016 1 11 21 27d GSVVTQPPS VSGAPRQTVA ISCSGSSSNI GNNAVN
35 45 55 65 WYQQLPGKAP KVLIYYDDLL PAGVSDRFSG SKSGTSAS 73 83 93
LAIRGLQSED EGDYYCAAWD DSLSAL
[0363] Examination of an AL.kappa. amyloid tissue deposit revealed
2A4, and to a lesser degree the 7D8 and 8G9, to have positive
reactivity. Again there was concordance between the immunostaining
and birefringent, congophilic amyloid regions. The TY11 mAb was
unreactive.
[0364] C. Radioimaging of AL Amyloidoma Using .sup.125I-Labeled
7D8
[0365] The experimental in vivo model of AL amyloidoma was used to
study if radiolabeled mAb 7D8 would image human AL amyloid. The
radiolabelling efficiency of 7D8, as determined by SDS-PAGE,
revealed that both the IgH and IgL chains incorporated the 1-125
label, and no evidence of bands associated with fragmentation or
aggregation were observed. SPECT/CT imaging of a mouse bearing an
induced AL amyloidoma revealed that the .sup.125I-labeled antibody
localized to the induced, dorsally-located amyloid mass, as
evidenced by accumulation of the radiolabeled antibodies in the
amyloid, relative to amyloid-free tissues (e.g., liver, heart,
spleen, and kidneys). Radioloabeled irrelevant IgG mAb did not
accumulate in the mass; however free radioiodide was observed
accumulating in the thyroid, indicative of the catabolism and
dehalogention of the IgG antibody. The distribution of the
.sup.125I-7D8 mAb in the amyloidoma-bearing mice was quantified by
measuring the activity associated with the amyloid mass as compared
to that of the liver, spleen, kidney, stomach, heart, and lung.
These data confirmed the SPETC/CT imaging study. At 72-h post
injection (at which time the images were acquired and the tissues
harvested), the amyloidoma contained .about.8% ID which is
.about.4-fold higher than that seen in the liver--the site of mAb
catabolism- and the heart where residual blood-pool activity would
expected to be high. The activity shown in the lung was due to the
mode of euthanasia (data not shown).
[0366] To confirm the biodistribution data, the amyloidoma as well
as the liver, spleen, heart, and kidneys were harvested and tissue
sections prepared for autoradiographic analysis. Radiolabelling was
performed as follows: The 7D8 antibody was labeled with 2 mCi of
reductant-free .sup.125I (Perkin Elmer) using limiting amounts of
Chloramine T and suspended in PBS containing 5 mg/ml of bovine
serum albumin (BSA/PBS). Unbound isotope and protein aggregates
were removed by size-exclusion liquid chromatography through an
Ultrogel AcA34 column (Amersham Pharmacia). Fractions containing
IgG monomer were pooled for imaging experiments. The radiochemical
yield was .about.50%, providing a specific activity of .about.25
.mu.Ci/.mu.g. .sup.125I-labeled mAb was subjected to SDS/PAGE (10%
gels) in the presence or absence of a reducing agent and analyzed
with a Cyclone phosphor-imager. In accordance with the SPECT
imaging and biodistribution measurements, the autoradiographs
confirmed significant accumulation of .sup.125I-7D8 in the
amyloidoma, relative to the liver. There was no evidence of uptake
of radiolabeled antibody .sup.125I-7D8 in any other organs (other
than the expected hepatic activity associate with catabolism of the
antibody). Although mAb 7D8 was relatively uniformly distributed
throughout the bulk of the amyloid mass, a moderately higher
density was observed in the peripheral areas at the abdomen-amyloid
boundary. There was no uptake of the radiolabeled control IgG in
any organs.
[0367] D. Summary and Conclusions
[0368] Surface plasmon resonance, immunohistochemistry and in vivo
radioimaging establish that AA-reactive antibodies 2A4, 7D8, and
8G9 bind AL amyloid and fibrils (Kd .about.I nM) derived from
immunoglobulin light chains. This interaction likely occurs at the
highly-conserved Glu and Asp amino acids at position 81 and 82,
respectively, which form a cryptic linear epitope that becomes
exposed only when the amyloidogenic light chain is incorporated
into fibrils.
Example VII
ELISA Analysis Demonstrates Antibody Binding to X.sub.1EDX.sub.2
Peptides
[0369] BIAcore analysis was performed to evaluate binding of
antibodies 2A4, 7D8 and 8G4 on peptides of various sequences. As
shown below in Table 4, the antibodies were found to react with
peptides having the sequence X.sub.1EDX.sub.2. Interestingly, the
antibodies did not react with peptides having additional C-terminal
residues. This suggests that the antibodies specifically bind to a
neoepitope generated cleavage of SAA to generate a free C-terminal
end However, as demonstrated in Example V, the free end is not
essential for binding of these antibodies to V.lamda.6 Wil, but
rather the X.sub.1EDX.sub.2 domain adopts a conformation favorable
to binding to the antibodies as it enters an aggregated (e.g.,
fibrillar) structure (or becomes partially denatured), exposing an
otherwise hidden, cryptic epitope.
TABLE-US-00017 TABLE 4 Antibody Peptide pos/neg 2A4(39) CGGHEDT,
POS (SEQ ID NO: 87) 40 CGGAEDS, pos (SEQ ID NO: 88) 41 GHEDTIADQE,
NEG (SEQ ID NO: 89) 64 CGGAEDT, POS (SEQ ID NO: 90) 65 CGGHADT,
WEAK (SEQ ID NO: 91) 66 CGGHEAT, NEG (SEQ ID NO: 92) 67 CGGHEDA,
POS (SEQ ID NO: 93) 68 CGGHEDTM, NEG (SEQ ID NO: 94) 69 CGGHEDTMA,
NEG (SEQ ID NO: 95) 70 CGGHEDTMAD, NEG (SEQ ID NO: 96) 71 CGGHED,
FALSE POS? (SEQ ID NO: 97) 7d8 (39) CGGHEDT, POS (SEQ ID NO: 87) 40
CGGAEDS, POS (SEQ ID NO: 88) 41 GHEDTIADQE, NEG (SEQ ID NO: 89) 64
CGGAEDT, POS (SEQ ID NO: 90) 65 CGGHADT, NEG (SEQ ID NO: 91) 66
CGGHEAT, NEG (SEQ ID NO: 92) 67 CGGHEDA, POS (SEQ ID NO: 93) 68
CGGHEDTM, NEG (SEQ ID NO: 94) 69 CGGHEDTMA, NEG (SEQ ID NO: 95) 70
CGGHEDTMAD, NEG (SEQ ID NO: 96) 71 CGGHED, NEG (SEQ ID NO: 97) 8g4
(39) CGGHEDT, POS (SEQ ID NO: 87) 40 CGGAEDS, POS (SEQ ID NO: 88)
41 GHEDTIADQE, NEG (SEQ ID NO: 89) 64 CGGAEDT, POS (SEQ ID NO: 90)
65 CGGHADT, NEG (SEQ ID NO: 91) 66 CGGHEAT, NEG (SEQ ID NO: 92) 67
CGGHEDA, WEAK (SEQ ID NO: 93) 68 CGGHEDTM, FALSE +? (SEQ ID NO: 94)
69 CGGHEDTMA, FALSE +? (SEQ ID NO: 95) 70 CGGHEDTMAD, NEG (SEQ ID
NO: 96) 71 CGGHED, NEG (SEQ ID NO: 97)
Example VIII
Immunohistochemical Analysis of Mouse AA
[0370] The reactivity of supernatants from hybridomas expressing
antibodies 2A4, 8G9 and 7D8 to murine AA splenic and hepatic
amyloid deposits (the principal sites of amyloid deposition) was
documented immunohistochemically. For these studies, sections of
tissue harvested from a TRIAD mouse with extensive AA amyloid in
the liver and spleen (as evidenced by green birefringent
Congophilic deposits) were stained with the mAb-containing
supernatants. All 3 bound to the hepatic and splenic amyloid. In
contrast, there was no reactivity with culture supernatants derived
from irrelevant hybridomas. The capability of the amyloid using
2A4, 8G9 and 7D8 to immunostain amyloid in fresh (unfixed),
OCT-embedded murine liver and spleen was tested. There was evidence
that the mAbs retained their ability to bind AA amyloid in the
hepatic sinusoid. In addition, the antibody reactivity with splenic
tissue was easier to interpret, and the perifollicular amyloid was
intensely immunostained. To demonstrate that the mAbs was
specifically bound AA amyloid, the mAb supernatants at a 1:25
dilution were preincubated with 50 .mu.g/mL of either peptide #39
(p#39) or #41 (p#41) for 1 h at room temperature. With
formalin-fixed tissue as a substrate, the p#39 peptide (50
.mu.g/mL) significantly inhibited the amyloid reactivity of both
2A4 and 7D8 mAbs (the results with 8G9 are pending). In contrast,
the p#41 peptide was ineffective. Comparable results were obtained
with fresh tissues.
Example IX
Immunohistochemical Analysis Of Human AA
[0371] Comparison of the amino acid sequence of mouse and human SAA
from position 73-76 reveals 2 identical residues, a conserved Ser
to Thr substitution, and a non-conserved Ala to His exchange. To
test if the 2A4, 8G9 and 7D8 mAbs would cross-react with human AA
amyloid deposits, we tested their reactivity to human AA-containing
kidney, adrenal, ovary and liver. In all cases, the mAb
supernatants immunostained the amyloid deposits. In ovarian tissue,
the p#39 peptide effectively blocked the binding of the mAbs to the
perivascular AA amyloid, whereas the p#41 peptide did not inhibit
this reaction.
Example X
Interaction Of Anti-AA Of Culture Supernatants With Murine-Derived
AA Fibrils
[0372] The interaction of 2A4, 8G9 and 7D8 mAbs with AA amyloid was
initially tested by ELISA and the data, given in FIG. 31, analyzed
using SigmaPlot (SPSS Inc.). Each point represents the mean.+-.SE
(n=3). A culture supernatant from an irrelevant hybridoma was used
as a control (Ctrl Culture Sup). There was an extremely low
signal-noise ratio and the results showed that the first harvest
contained more mAb relative to the second, as evidenced by the
greater absorbance signal relative to the control supernatant. (In
addition, the immunohistochemical reactivity of the day 1 material
was greater than the day 2 samples). Although the SE values were
large, it appeared from these data that the binding affinity of
2A4, 8G9 and 7D8 was approximately equivalent with reactivity
absent after .about.1:64 dilution. The binding data also suggest
that the capacity, i.e., the amount of mAb bound, varied with
7D8>8G9>2A4; however, these data were not corrected for mAb
concentration and in subsequent studies this trend was not
observed. Because of the low signal and high variability found with
the culture supernatants and to determine more accurately the
relative binding affinity of the mAbs for murine and human AA
amyloid fibrils (as well as to provide material for in vivo
biodistribution studies) it was necessary to isolate the mAbs by
protein A affinity chromatography. The purity of the isolated mAbs
was established SDS-PAGE using 10% acrylamide gels under reducing
and non-reducing conditions (FIG. 32). Samples in lanes 1-4 treated
with mercaptoethanol, lanes 5-9 without. Gel was stained with
Coomassie blue: mAb 8G9, lanes 1 and 6; mAb 2A4, lanes 2 and 7; mAb
7D8, lanes 3 and 8; SP2/0 control supernatant, lanes 4 and 9;
blank, lane 5. Protein Mr markers (Std) are, form top to bottom:
176, 119, 75, 49, 39, 25 and 19 kDa. The interaction of the
purified mAbs with immunizing peptide p#39, control peptide (p#41),
murine and human AA extracts were determined by ELISA as described
above. These data were analyzed by fitting a sigmoidal curve using
the SigmaPlot software and the mAb concentration at 50% saturation
(EC50), determined (Table 5).
TABLE-US-00018 TABLE 5 EC.sub.50 values for purified mAb binding
Substrate Human Mouse Peptide Peptide mAb AA AA (AEF) 39 41 8G9
31.7 nM 5.64 nM 4.0 nM >>100 nM 2A4 26.4 nM 4.09 nM 3.4 nM
>>100 nM 7D8 13.3 nM 1.84 nM 2.3 nM >>100 nM
[0373] The interaction of the 3 mAbs with peptide p#39 exhibited
saturable binding with EC50 values in the low nanomolar range (see
above Table 5). In contrast, even at the highest concentration of
mAb used (100 nM) there was little detectable binding to the p#41
peptide (FIG. 33--Each point represents the mean.+-.SE, (n=3 at
each concentration)). These data confirmed the immunohistochemical
results described above, i.e., that peptide p#39 was capable of
completely blocking the binding of the mAbs to AA amyloid laden
tissues. The calculated EC50s for the binding of each mAb with p#39
peptide were essentially identical as was the case when a murine AA
amyloid extract was used as the substrate (FIG. 34--Each point
represents the mean.+-.SE (n=3 at each concentration)). The
calculated EC50 values for the mAbs binding to mouse AA extract
were essentially identical to those obtained when the p#39 peptide
was used as the substrate (FIG. 34; Table 5). In contrast, when
human AA amyloid extract was dried onto the wells of the
microplate, the EC50 values were between 5 and 7.times. lower than
that observed for mouse AA and peptide p#39 (FIG. 35--Each point
represents the mean.+-.SE (n=3 at each concentration); Table 5).
Because the EC50 value for 7D8 mAb binding was the lowest of the 3
antibodies tested, Applicants selected this reagent for in vivo
co-localization and imaging studies. The 2 amino acid substitutions
in the human SAA sequence with respect to the murine protein
affected the EC50 values. While not wishing to be bound by a
particular theory, Applicants attribute the higher EC50 for the
human AA to a poorer "fit" of the amino acid side chains in the
antigen binding site. however, this effect corresponds to only a
5-fold decrease in the relative affinity when the amyloid extracts
are surface adsorbed, as in the ELISA. Furthermore, these data
support the observation that all 3 mAbs bound to both murine and
human tissue AA amyloid deposits.
Example XI
Competitive Binding of Mabs to Mouse and Human AA Amyloid
[0374] To determine the effect, if any, of potential denaturation
when adsorbed to the surface of the microtiter well, the reactivity
of the 2A4, 8G9 and 7D4 was evaluated using a competition ELISA in
which murine or human AA amyloid extract was used as a soluble
competitor for the interaction of the mAbs with surface-bound AA
extract.
[0375] In all cases, soluble (non-adsorbed) AA amyloid fibrils of
both human and mouse origin were capable of competing for the 3
mAbs, indicating that the epitope recognized by the reagents is not
dependent upon the partial denaturation that results from surface
adsorption. In general, the murine AA (AEF) extract was a better
competitor than the human AA (Table 6).
TABLE-US-00019 TABLE 6 IC.sub.50 values (.mu.g/mL) for mAb binding
to AA amyloid mAb Human AA.sup..dagger. Mouse AA
(AEF).sup..dagger-dbl. 8G9 >119.5 17.3 2A4 >211.7 14.7 7D8
>881.1 26.8 .sup..dagger.Human AA amyloid in solution competing
for adsorbed mouse AA (AEF); .sup..dagger-dbl.Mouse AA (AEF) in
solution competing for adsorbed human AA amyloid extract on
plate.
[0376] The IC50 values (concentration of AA (by weight) that
reduced the mAb binding by 50%) for murine AEF in solution were
.about.20 .mu.g/mL, whereas for human AA the values were 6- to
44-fold greater (in contrast, the EC50s for human AA were only
7-fold lower than those for mouse AA). This may reflect the fact
that, when in solution, the epitope on the amyloid fibrils is less
accessible in human AA preparations as compared to murine AA.
[0377] As expected, the 7D8 mAb that exhibited the highest relative
affinity for the human and murine AA fibrils when they were
surface-adsorbed required the highest concentration of AA amyloid
to achieve competition.
Example XII
Radiolabeled MAb 7D8
[0378] The radiolabeling efficiency of 7D8 was determined by
SDS-PAGE. Reduced and native mAb were analyzed and the proteins
visualized using a phosphor imager. Both the IgH and IgL chains
incorporated the I-125 label, and no evidence of bands associated
with fragmentation or aggregation were observed.
Example XIII
Imaging of AA Amyloid Using .sup.125I-Labeled 7D8
[0379] To study the in vivo localization of radiolabeled mAb 7D8
three groups of mice were used: transgenic IL-6; AgNO.sub.3/AEF
induced, and amyloid-lacking controls (WT). The SPECT/CT imaging
revealed that the .sup.125I-7D8 mAb localized to murine AA amyloid
deposits in the spleen and liver, as evidenced by the accumulation
of the radiolabeled mAb in these tissues relative to the control
mouse, which showed only low blood pool activity in the liver and
free iodide the thyroid gland.
[0380] In contrast to these mice, the AgNO.sub.3-injected mouse
showed thyroid uptake of free iodide, some hepatic activity, but
the major site of .sup.125I-7D8 binding was seen at the site of
s.c. AgNO.sub.3 injection (the lower right dorsal area). The
activity in this area is clearly circumscribed by the
x-ray-attenuating silver solution as seen by CT. The 7D8 mAb has
been shown to bind to AA amyloid deposits in both the liver and
spleen in the presence of circulating sAA in the TRIAD mouse, as
evidenced in the SPECT images.
[0381] A. Biodistribution Of .sup.125I-7D8 In Mice.
[0382] 48 h post-injection of .sup.125I-7D8 there was radioactivity
in the blood pool, which accounted for the relatively high uptake
In the lung (which fill with blood when the mice are sacrificed).
Of note, the hepatosplenic accumulation of mAb in the IL-6 mouse is
indicative of the presence of amyloid. The SPECT/CT images
confirmed the distribution of the mAb in these organs. 72 h
post-injection the blood pool values have changed little as
evidenced by the unchanged activity in the heart and lung relative
to the mice sacrificed at 48 h, due to the relatively long
T.sub.1/2bio for this mAb (.about.60 h). There was significant
accumulation of the radiolabeled mAb in the IL-6 mouse, which
correlated with the SPECT images that were acquired showing
impressive splenic and, to a lesser degree, hepatic uptake. Of the
other organs, most important was the liver (which is the site of
catabolism of IgG and the source of sAA during the acute phase
response). In the WT mice, with no inflammatory challenge or
amyloid, the liver contained <6% ID/g, which is comparable to
the kidney and heart where the blood pool contributes almost
exclusively to the signal.
[0383] B. Autoradiographic and Histochemical Analyses.
[0384] In order to determine if the increased hepatic accumulation
of .sup.125I-7D8 in the IL-6 and AgNO.sub.3 mice resulted from
amyloid uptake, catabolic clearance or binding to newly synthesized
sAA, liver as well as other tissues were subjected to
autoradiographic analysis.
[0385] Based on the SPECT imaging and biodistribution measurements,
it was presumed that the greatest amount of amyloid in the
transgenic IL-6 mice was in the liver and spleen. This supposition
was confirmed in the Congo red-stained sections in which
significant amyloid was observed throughout the red pulp as well as
in the perivascular regions and sinusoids of the liver. Additional,
more discreet birefringent deposits were present in the kidneys and
heart. The distribution of the .sup.125I-7D8 within these tissues
correlated well with the Congo red and AA-reactive material. There
was no accumulation in hepatocytes that were devoid of amyloid.
[0386] Based on the biodistribution data, the AgNO.sub.3-treated
mouse had more uptake of 125I-7D8 in the liver than the spleen,
which was unexpected since this is not the normal pattern of
accumulation of AA in such animals. Congo red-staining revealed
small amounts of amyloid in a single perifollicular region in the
spleen (upper right corner) and extensive hepatic perivascular
deposits both of which were evident in the autoradiographs.
Additionally, the s.c. site of the AgNO.sub.3 injection was seen in
the SPECT images to have a significant concentration of
.sup.125I-7D8 (we also have observed this when radioiodinated SAP
was used as the imaging agent). This site does not contain amyloid
(i.e., Congo red-birefringent material); however, it was
immunostained by anti-AA mAb. Without wishing to be bound to a
particular theory, it is possible that the mAb 7D8 localizes to
sites of inflammation or "pre-amyloid" (as well as mature amyloid
deposits). In contrast to the impressive accumulation of 7D8 in the
organs of the IL-6 mouse, the tissues of the control mice were
found to have little or no tracer in any organ other than the blood
pool. No amyloid was found in Congo red-stained sections of any
organ of these controls.
[0387] C. Pharmacokinetics of .sup.125I-7D8.
[0388] After injection of the radiolabeled 7D8 antibody, the rate
of disappearance of the molecule was determined and the half-life
determinations summarized in Table 7. These results indicated that
the T.sub.1/2bio of 7D8 was .about.60 h, consistent with that of an
IgG2b murine mAb (note, 7D8 is of the IgG2b subclass). The slightly
more rapid clearance of the .sup.125I-7D8 in the IL-6 (TRIAD) mice
was not considered significant. Based on these data, retention of
the mAb by tissue amyloid, as evidenced in the SPECT data, over 72
h does not influence the excretion rate.
TABLE-US-00020 TABLE 7 half-life analyses for .sup.125I-7D8 in mice
Mouse A (S.E.) K (S.E. .times. 10.sup.-4) R.sup.2 t.sub.1/2 bio
t.sub.1/2 eff IL-6, 48 h 191.7 (2.96) 0.0117 (7.0) 0.98 59.2 h 56.2
IL-6, 72 h 175.2 (3.99) 0.012 (8.9) 0.97 57.7 h AgNO.sub.3, 48 h
181.0 (1 99) 0.0106 (4.9) 0.99 65.3 h 61.1 AgNO.sub.3, 72 h 174.1
(2.97) 0.0112 (5.8) 0.98 62.2 h Ctrl, 48 h 185.1 (3.19) 0.0108
(7.6) 0.98 64.3 h 61.3 Ctrl, 72 h 185.1 (3.09) 0.0109 (5.6) 0.98
63.7 h
[0389] 1. Method of Identifying Agents that Prevent or Treat
Amyloidosis Using Transgenic or TRIAD Mouse. Procedures for
preparation of agents are described in Schenk et al. Nature
400:173-177. Agents are emulsified 1:1 (v/v) with complete Freund's
adjuvant for the first immunization of transgenic mice, followed by
a boost in complete Freund's adjuvant at 2 weeks and monthly
thereafter. PBS injections followed the same schedule and mice were
injected with 1:1 mix of PBS/adjuvant for control. The life span of
the transgenic mice is compared to determine whether the agents are
effective in preventing AA Amyloidosis by increasing the life of
the animal.
[0390] 2. Histopathology. For light and polarizing microscopy, 4-
to 6-.mu.m-thick tissue sections were cut and stained with
hematoxylin and eosin (HE) and a freshly prepared alkaline Congo
red solution, respectively. For electron microscopy, sections were
embedded in Epon (Ted Pella, Redding, Calif.), sectioned, and
examined with a JEOL 100S transmission electron microscope. See
Ludlage et al. Vet Pathol 42:117-124 (2005).
[0391] 3. Immunohistochemistry. Paraffin-embedded tissue sections
(6-.mu.m-thick) were cut on a microtome, mounted on
poly-L-lysine-coated slides, dried overnight at room temperature,
and deparaffinized. Immunostaining was performed using the
avidinbiotin complex (ABC-elite) technique as described previously.
The primary antibodies were mouse anti-human amyloid A (Accurate
Chemical and Scientific Corporation, Westbury, N.Y.) and anti-mouse
SAA polyclonal antisera. Affinity-purified horse anti-mouse
immunoglobulin-G (IgG) horseradish peroxidase conjugate (Vector
Laboratories, Burlingame, Calif.) or goat anti-rabbit, -mouse, or
-rat IgG horseradish peroxidase conjugates (BioRad Laboratories,
Richmond, Calif.) were used as the secondary antibodies.
[0392] 4. SAA Quantitation by ELISA. SAA concentrations were
measured by an enzyme-linked immunosorbent assay (ELISA) using the
Multispecies SAA ELISA kit according to directions supplied by the
manufacturer (Biosource, Camarillo, Calif.). Standard curves were
prepared using known amounts of human SAA protein and absorbance
was measured at 405 nm with a model 4450 BioRad plate reader
(Fullerton, Calif.).
[0393] 5. Radiolabeled SAP Scintigraphy Turnover Studies in Mice.
SAP was oxidatively iodinated with .sup.125I (2-5 MBq/mg) by using
N-bromosuccinimide. 6-12 weeks old mice received 2-10 .mu.g of
.sup.125I-SAP in 200 .mu.L intravenously. Precisely measured tail
bleeds (0.01-0.04 g) were taken at specific time intervals and
trichloroacetic acid-precipitable radioactivity was counted in the
same run at the end of each experiment together with standard
aliquots of the injected tracer. Pepys et al. Proc Natl. Acad. Sci.
USA 91:5602-5606 (1994).
[0394] 6. Radiolabeled SAP Scintigraphy Turnover and Imaging
Studies in Man. SAP for use in man was isolated from the plasma of
a single normal accredited donor and was oxidatively iodinated with
.sup.125I (2-5 MBq/mg) or .sup.123I (110 MBq/50 .mu.g of protein)
by using N-bromosuccinimide. After injection of .sup.123I SAP, data
were acquired and processed on an IGE Starcam gamma camera (IGE
Medical Systems, Slough, U.K. Clearance of .sup.125I-labeled SAP
was studied in healthy individuals and patients suffering from AA
amyloidosis. Pepys et al. Proc Natl. Acad. Sci. USA 91:5602-5606
(1994)
[0395] 7. Amyloid Extraction and Purification. The methods used to
extract amyloid from tissue were as described by Pras et al. See
Pras et al. J. Clin. Invest. 47:924-933 (1968) In brief, a portion
of liver or tissues from other organs obtained at necropsy and
maintained at -80 C was homogenized with cold saline in an ice bath
using an Omni-Mixer (Omni International, Waterbury, Conn.). The
extract was centrifuged at 10,000 rpm for 30 minutes at 4 C and the
pellet reextracted twice more with cold saline, once with 0.1 M
sodium citrate Tris-buffered saline, pH 8.0, and then again with
saline until the A280 of the supernatant was <0.10. The
resultant pellet was homogenized with cold distilled water, and the
mixture centrifuged at 35,000 rpm for 3 hours at 4 C. The pellet
obtained from the water extract was then lyophilized.
[0396] 8. Surface Plasmon Resonance. Binding kinetics were measured
on a BIAcore X instrument. Fibrils prepared from the V.sub..lamda.6
Wil were sonicated briefly with a probe sonicator and then coupled
to a CM-5 chip using amine chemistry, as per the BIAcore protocol.
This process utilizes EDC and NHS to activate the carboxyl groups
on the chip for coupling with free amino groups on the fibrils.
Coupling was conducted in a NaOAc buffer, pH 4.0 at a concentration
of 100 .mu.g/mL. The control channel was "mockcoupled" and both
channels were reacted with ethanolamine to saturate unreacted
sites. Approximately 16,000 RU of V.sub..lamda.6 Wil fibrils were
coupled.
[0397] Sensograms were run in HBS-EP buffer from BIAcore at 20
.mu.L/min in the Fc1 (V.sub..lamda.6 Wil fibrils) minus Fc-2
(control) mode. Samples containing mAb or mAb plus peptide
inhibitors were injected (70 .mu.L) and the sensograms collected
using the delayed-wash function for 200 sec. Data were analyzed in
the BIAevalutation software, using the 1:1 Langmuir model with
mass-action correction.
[0398] 9. MicroSPECT/CT. Two cohorts of 3 mice each were injected
s.c. with 50 mg of human AL amyloid extract between the scapulae.
After 7 days, one group of mice received an iv tail vein injection
of .about.300 .mu.Ci of .sup.125I-labeled mAb 7D8. The second group
were administered and equal quantity of murine mAb MOPC 31C as a
control. After 72 hr, the mice were sacrificed by isoflurane
overdose and SPECT/CT images acquired. To provide vascular
contrast-enhancement in the CT images, mice were given a 200-.mu.L
iv dose of Fenestra VC.TM. (Advanced Research Technologies,
Montreal, Canada) 5 min prior to scanning.
[0399] SPECT data were collected with a microCAT II+SPECT dual
modality imaging platform (Siemens Preclinical Solutions,
Knoxville, Tenn.), capable of submillimeter spatial resolution when
equipped with a 0.5 mm-pore diameter pinhole collimator. When
imaging, the 2 detectors (composed of a 50 mm-diameter Hamamatsu
R2486-02 multi-anode photo-multiplier tube coupled to a
1.times.1.times.8 mm CsI (Tl) crystal array arranged on a 1.2
mm.sup.2 grid) were positioned .about.45 mm from the center of
rotation. Each SPECT dataset comprised 45 projections collected
over 360.degree. during the course of .about.50 min. Images were
reconstructed using an implementation of the expectation
maximization-maximum likelihood (EM-ML) algorithm.
[0400] After collection of SPECT data, high-resolution CT images
were obtained. The microCAT II scanner has a circular orbit cone
beam geometry, equipped with a 20-80 kVp microfocus x-ray source,
and captures a 90 mm.times.60 mm field of view using a
2048.times.3072 CCD array detector, optically coupled to a minR
phosphor screen via a fiber-optic bundle. Each CT dataset, composed
of 360 projections at 1.degree. azimuths, was acquired in 8 min.
Images were reconstructed in real-time on isotropic 77-.mu.m voxels
using an implementation of the Feldkamp backprojection
algorithm.
[0401] To facilitate co-registration of the reconstructed SPECT and
CT images, Co-57 sealed sources were placed on the imaging bed. The
microSPECT and CT datasets were visualized and co-registered
manually with a 3-D image analysis software package (Amira, Version
3.1: Mercury Computer Systems).
[0402] 10. Biodistribution. Samples of liver, spleen, kidney,
heart, lung, and implanted amyloid tumors (i.e., amyloidoma) were
harvested from the mice and placed into tared vials, weighed, and
the radioactivity measured. The primary index values were expressed
as % injected dose/g tissue (% ID/g).
[0403] 11. Autoradiography. 6 .mu.m-thick sections cut from
formalin-fixed, paraffin-embedded blocks of tissue obtained from
mice sacrificed 72 h post-injection of .sup.125I-7D8 were placed on
Probond microscope slides (Fisher Scientific), dipped in NTB-2
emulsion (Eastman Kodak), stored in the dark, and developed after a
24-h exposure. The sections were counter-stained with hematoxylin
and eosin (H&E), cover-slipped using Permount (Fisher
Scientific), and examined by light microscopy. In addition,
consecutive slides were stained with alkaline Congo red and viewed
under cross-polarized illumination. Finally, a third slide was
immunostained using as primary reagent our AA-reactive mAb. Digital
camera microscopic images were taken and evaluated using an image
analysis software package (Image Pro Plus, Media, Cybernetics).
Example XIV
Preparation Of Humanized 2A4 And 7D8 Antibodies
[0404] Humanized 2A4, 7D8, and 8G9 antibodies were prepared by
grafting of murine 2A4, 7D8, and 8G9 CDRs onto human acceptor
frameworks according to techniques known in the art. Back mutations
were made to reduce antigenicity while preserving binding affinity.
The light chain and heavy chain variable regions of murine 2A4 are
set forth as residues 20-131 of SEQ ID NO: 152 and as residues
20-138 of SEQ ID NO: 154, respectively. The light chain and heavy
chain variable regions of 7D8 are set forth as residues 20-131 of
SEQ ID NO: 153 and as residues 20-138 of SEQ ID NO: 154,
respectively. The light chain variable regions of murine 2A4 and
8G9 are identical to each other and differ from the light chain
variable region of 7D8 in a single residue in CDR1. The heavy chain
variable regions of each of 2A4, 7D8, and 8G9 are identical.
[0405] The variable kappa (Vk) of 2A4 and 7D8 belong to mouse
subgroup 2, which corresponds to human subgroup 2 and the variable
heavy (Vh) to mouse subgroup 3c which corresponds to human subgroup
3 (Kabat et al. (1991) Sequences of Proteins of Immunological
Interest, Fifth Edition. NIH Publication No. 91-3242). CDR-L1
includes 16 residues and belongs to canonical class 4 in Vk. CDR-L2
includes 7 residues and belongs to class 1 in Vk. CDR-L3 includes 9
residues and belongs to class 1 in Vk. See Martin A C, Thornton J
M. (1996) J Mol Biol. 263, 800-15. The leucine at position 27 in
the 7D8 is rather unusual, and the glutamine in 2A4 is more usual.
A model shows the sidechain is on the surface of the binding site,
and therefore should be important for antigen binding. CDR-H1
includes 5 residues and belongs to class 1, and CDR-H2 includes 19
residues and belongs to class 4 (Martin & Thornton, 1996).
CDR-H3 has no canonical classes, but the 8 residue loop probably
has a kinked base according to the rules of Shirai et al. (1999)
FEBS Lett. 455, 188-97. This is conserved in a model although the
conformation of the apex of CDR-H3 may be different. The residues
at the interface between the Vk and Vh domains are the ones
commonly found for 2A4 Vk, 7D8 Vk and 2A4 Vh.
[0406] A search was made of the PDB database (Deshpande et al.
(2005) Nucleic Acids Res. 33: D233-7) to find structures which
would guide the choice of back mutations. A search of the
non-redundant protein sequence database from NCBI allowed selection
of suitable human frameworks into which to graft the murine CDRs.
For Vk, a human kappa light chain with NCBI accession code BAC01562
(gi:21669075) (SEQ ID NO: 166) was chosen. This has the same length
CDR-L3 and belongs to human germline VKIIA19/A3 and human kappa
subgroup 2. A similar framework which only differed in the J-region
was also found with NCBI accession code BAC01733 (gi:21669417) (SEQ
ID NO: 167). BAC01562 was used as a framework for 2A4 Vk, and
BAC01733 was used as a framework for 7D8 Vk. For Vh, human Ig heavy
chain AAC51024 (gi:1791061) (SEQ ID NO: 165) was used. See Glas et
al. (1997) Clin. Exp. Immunol. 107: 372-380. This belongs to human
germline VH3-72 and human heavy subgroup 3.
[0407] Representative humanized 2A4 light chain variable regions
are set forth as SEQ ID NOs: 155, 156, and 157. Representative
humanized 7D8 light chain variable regions are set forth as SEQ ID
NOs: 158, 159, 160, 174, 175, and 176. Representative humanized
2A4/7D8 heavy chain variable regions are set forth as SEQ ID NOs:
161, 162, and 163. See FIGS. 36A-36E.
[0408] Representative humanized antibodies of the invention include
antibodies having a light chain variable region selected from one
of residues 20-131 of SEQ ID NO: 152, residues 20-131 of SEQ ID NO:
153, and SEQ ID NOs: 155, 156, 157, 157, 159, 160, 174, 175, and
176; and a heavy chain variable region selected from one of
residues 20-138 of SEQ ID NO: 154 and SEQ ID NOs: 161, 162, and
163.
Example XV
Therapeutic Effects of MAb 2A4 in Mice with Severe Systemic AA
Amyloidosis
[0409] The therapeutic efficacy of mAb 2A4 was evaluated in
H2/huIL-6 mice with severe systemic amyloidosis. The transgenic
H2/huIL-6 mice, which constitutively express a human IL-6
transgene, are prove to rapid and irreversible systemic AA
amyloidosis. In a first and second study, mice treated with
isotype-matched mAb TY-11, which has no reported activity in mice,
was used as a control. Before administering the amyloid enhancing
factor to induce AA, H2/huIL-6 mice were sampled and bled via the
retro-orbital sinus, serum prepared, and the sAA concentration
determined using a commercially available ELISA kit. Representative
values were as follows: 2196.7 .mu.g/mL, 823.91 .mu.g/mL, 1415.00
.mu.g/mL, 1673.01 .mu.g/mL, 814.53 .mu.g/mL, 1088.18 .mu.g/mL,
736.34 .mu.g/mL, 1546.35 .mu.g/mL, 953.70 .mu.g/mL, 886.46
.mu.g/mL, mean=1213.4.+-.478 .mu.g/mL.
[0410] At the start of the second study (week 0), H2/huIL-6 mice
were injected iv with 100 .mu.g of amyloid enhancing factor (AEF).
After induction of AA pathology by injecting AEF, the mice were
administered 5 injections of 100 .mu.g subcutaneously in alternate
limbs of mAb 2A4 (13 animals) or TY11 (11 animals). The therapy was
initiated at approximately 1 week post AEF injection. The survival
of animals in each treatment group was plotted and analyzed. The
results are shown in Table 8. Only 45% of the mAb TY11-treated mice
survived to the end of the study. In contrast, none of the
2A4-treated mice were lost over the course of the study. Analysis
of the survival data using standard methods showed a significant
difference in the survival curves (P<0.0025) in both groups. The
median survival of the TY11-treated mice was calculated to be 41
days, comparable to that observed in a prior study (38.5 days).
TABLE-US-00021 TABLE 8 Percentage of animals surviving Days post
TY11- 2A4- injection treated treated 0 100.00 100.00 22 81.82
100.00 33 72.73 100.00 37 63.64 100.00 41 45.45 100.00 42 45.45
100.00
[0411] At week 6, post-AEF, mice were bled and sacrificed, and
their organs harvested for further analysis. For quantification of
amyloid in liver and spleen, Congo red birefringence was visualized
microscopically under cross-polarized illumination and digitally
recorded. The area of birefringent material was determined by
selecting (using a spectral segmentation method) and quantifying
the amyloid-associated pixels. The amyloid burden index (ABI), a
measure of amyloid content, was expressed as the percentage area
occupied by amyloid in each organ. Quantification of amyloid in the
livers and spleens of 2A4 and TY11-treated mice revealed no
significant difference between the two treatments. However, the
TY11-treated mice that survived to day 42 for comparison with
2A4-treated mice were those that did not develop a morbid degree or
distribution of AA amyloid to thereby result in morbidity. The
hepatosplenic amyloid burden is also monitored during the course of
the survival study to assess an increase in amyloid burden that
correlates with morbidity.
[0412] In a third study, mAb 2A4 was compared to the
isotype-matched mAb JH70, which has no reported reactivity in mice.
In addition blood chemistry and other parameters were monitored
throughout the treatment period. Male and female H2/huIL-6 mice
born between 8/1/08 and 9/7/08 were used in this study. Twenty
three female mice and 16 male mice were bled via the retro-orbital
sinus. Whole blood was used for chemical characterization of blood
urea nitrogen (BUN) and alanine aminotransferase (ALT) to measure
renal and hepatic function by using the VetScan VS2 (Abaxis, Union
City, Calif.). The serum concentration of 12 other proteins and
analytes were simultaneously measured. A complete blood count (CBC)
was performed using the VetScan HM5 platform. In addition, each
mouse was administered a low dose (.about.50-60 .mu.Ci) of
radioiodinated human serum amyloid P component (.sup.125I-SAP) in 5
mg/mL bovine serum albumin to assess the amyloid burden of the mice
prior to initiation of the disease process. The percent of
.sup.125I-SAP retained at 24 h post-injection (pi) was measured by
placing each mouse into a dose calibrator. Retention of
.sup.125I-SAP greater than that observed in non-transgenic
(control) mice was indicative of amyloid disease. Finally, serum
was used to measure the concentration of serum amyloid protein A
(sAA) using a commercial ELISA assay. A summary of these
pretreatment data, selected blood chemistry values, and the
treatments given to each mouse are shown below in Tables 9 and
10.
TABLE-US-00022 TABLE 9 Summary Of Pre-Treatment Data And MAb
Therapy For Each Animal sAA .sup.125I-SAP Therapy Mouse conc.
retention (Group # (.mu.g/mL) Sex DOB (%) No.) 3488 360 F Aug. 1,
2008 9 2A4 (1) 3489 996 F Aug. 1, 2008 29 2A4 (1) 3490 472 F Aug.
1, 2008 10 2A4 (1) 3492 2068 M Aug. 1, 2008 13 2A4 (1) 3493 1740 M
Aug. 1, 2008 11 JH70 (1) 3494 1272 M Aug. 1, 2008 10 JH70 (1) 3495
1436 M Aug. 1, 2008 13 JH70 (1) 3496 2080 M Aug. 1, 2008 9 2A4 (1)
3498 268 M Aug. 1, 2008 9 2A4 (1) 3500 700 F Aug. 11, 2008 11 JH70
(1) 3501 ND F Aug. 11, 2008 9 JH70 (1) 3503 1040 F Aug. 11, 2008 11
JH70 (1) 3504 960 F Aug. 11, 2008 10 JH70 (1) 3513.sup.1 4400 M
Aug. 13, 2008 60 2A4 (1) 3514.sup.1 4400 M Aug. 13, 2008 40 2A4 (1)
3515 2800 M Aug. 13, 2008 13 2A4 (1) 3521 1480 M Aug. 18, 2008 11
2A4 (1) 3524 1680 M Aug. 18, 2008 9 2A4 (1) 3549 720 F Sep. 6, 2008
9 2A4 (2) 3550 760 F Sep. 6, 2008 9 2A4 (2) 3552.sup.2 0 F Sep. 6,
2008 11 2A4 (2) 3553 1160 F Sep. 6, 2008 12 2A4 (2) 3558 1660 M
Sep. 6, 2008 9 JH70 (2) 3559 3520 M Sep. 6, 2008 12 JH70 (2) 3562
1312 F Sep. 6, 2008 11 JH70 (2) 3563 1120 M Sep. 6, 2008 9 JH70 (2)
3564 2512 M Sep. 6, 2008 11 2A4 (2) 3565 1960 M Sep. 6, 2008 10 2A4
(2) 3567 1880 F Sep. 6, 2008 12 2A4 (2) 3570 792 F Sep. 7, 2008 13
2A4 (2) 3573 700 F Sep. 7, 2008 8 2A4 (2) 3577.sup.2 0 F Sep. 7,
2008 10 2A4 (2) 3578.sup.2 0 F Sep. 7, 2008 9 2A4 (2) 3579 1120 F
Sep. 7, 2008 10 2A4 (2) 3580.sup.2 0 F Sep. 7, 2008 8 JH70 (2) 3581
700 F Sep. 7, 2008 9 JH70 (2) 3582 1680 F Sep. 7, 2008 9 JH70 (2)
3583 804 F Sep. 7, 2008 9 JH70 (2) 3584 1040 F Sep. 7, 2008 14 JH70
(2) .sup.1homozygous IL-6 animals with high sAA levels and amyloid
disease early in life. .sup.2wild type mice without circulating sAA
and no amyloid disease. .sup.125I-SAP retention in these animals is
considered normal and reflecting no amyloid burden.
TABLE-US-00023 TABLE 10 Normal Values For Blood Chemistry
Parameters In H2/huIL-6 Mice BUN GLU ALT ALB TP GLOB (mg/dL)
(mg/dL) (U/L) (g/dL) (g/dL) (g/dL) F M F M F M F M F M F M Mean
21.1 23.8 144.7 151.2 37.6 42.3 2.5 1.9 5.6 6.2 3.1 4.4 SD 4.0 2.7
14.0 17.6 16.3 24.3 0.3 0.4 0.2 0.6 0.4 0.6 n 18 13 18 13 18 13 18
13 18 13 18 13 High 28.0 30.0 184.0 179.0 79.0 105.0 3.0 2.6 6.0
7.4 3.7 5.8 Low 15.0 20.0 126.0 119.0 21.0 23.0 2.0 1.2 5.1 5.5 2.6
3.4 Median 20.0 24.0 143.0 154.0 32.5 32.0 2.4 1.9 5.6 6.0 3.2 4.3
BUN, blood urea nitrogen; GLU, glucose; ALT, alanine
aminotransferase; ALB, albumin; TP, total serum protein; GLOB,
immunoglobulin; F, female; M, male; SD, standard deviation; n is
the number of mice used to determine the values.
[0413] At the start of the third study (week 0), all of the all the
H2/huIL-6 mice received 100 .mu.g iv of amyloid enhancing factor (1
mg/mL). One week thereafter, therapy began and each mouse was
administered 100 .mu.g of either mAb 2A4 or JH70 sc as outlined in
Table 9. The mAb injections continued weekly for 7 weeks.
[0414] At 2 wk post-AEF, CBC, blood chemistry, and serum sAA
measurements were made using blood collected via the retro-orbital
sinus. At this time also, the mice in group 1 were administered
.about.60 .mu.Ci of .sup.125I-SAP in BSA as before, to assess the
accumulation of amyloid as evidenced by the retention of the
radiolabeled SAP. Several of the animals showed an adverse effect
of extreme distress, and therefore, evaluation of amyloid burden
using .sup.125I-SAP was discontinued. Results of selected blood
chemistry parameters, acquired 2 wk post-AEF are shown in Table
11.
TABLE-US-00024 TABLE 11 BUN GLU ALT ALB TP GLOB (mg/dL) (mg/dL)
(U/L) (g/dL) (g/dL) (g/dL) F M F M F M F M F M F M Mean 31.4 52.1
145.1 129.8 33.9 63.3 2.3 1.8 6.5 8.1 4.2 6.2 SD 24.3 39.1 16.6
25.6 6.9 30.6 0.3 0.5 1.0 1.7 1.1 1.5 n 15 13 15 13 15 13 15 13 15
13 15 12 High 100.0 159.0 177.0 178.0 46.0 134.0 2.7 3.0 8.6 11.7
7.0 9.6 Low 16.0 20.0 104.0 82.0 22.0 32.0 1.7 1.0 5.2 6.0 3.1 4.5
Median 22.0 31.0 150.0 120.0 32.0 54.0 2.3 1.7 6.5 7.5 4.0 6.0 BUN,
blood urea nitrogen; GLU, glucose; ALT, alanine aminotransferase;
ALB, albumin; TP, total serum protein; GLOB, immunoglobulin; F,
female; M, male; SD, standard deviation; n is the number of mice
used to determine the values.
[0415] At 8 weeks post-AEF, the mice were bled a final time and
immediately thereafter were administered .about.200 .mu.Ci of
.sup.125I-SAP using 5% normal mouse serum as carrier. In response
to this treatment, a few animals showed some unusual behavior that
abated within 30 min. Twenty four hours later, the mice were
injected with x-ray CT contrast agent (.about.200 .mu.L iv in the
tail vein) and were then sacrificed by isoflurane overdose. Single
photon emission (SPECT) and x-ray (CT) tomographic images of each
animal were acquired. The organs were harvested and the amount of
radioactivity in each sample was calculated and expressed as %
injected dose per gram of tissue. Additionally, a portion of each
tissue was fixed overnight in buffered formalin in preparation for
sectioning and microscopic analysis.
[0416] During the 7 wk therapy study, 2 mice were found dead and 3
mice were sacrificed because they were deemed unlikely to survive
overnight and had a poor body condition score (<2; associated
with >15% weight loss). Mice that experienced an adverse
reaction to .sup.125I-SAP injection and 1 mouse that was sacrificed
due to complications that arose from a retro-orbital bleed were not
evaluated as part of the survival analysis. The survival of the
mice in each mAb treatment group is shown in Table 12.
TABLE-US-00025 TABLE 12 Percentage of animals surviving Days post
injection TY11-treated 2A4-treated 0 100.00 100.00 41 100.00 42
100.00 53 85.71 100.00 55 71.43 100.00 56 64.29 100.00 57 64.29
100.00
[0417] Approximately 65% of the mAb JH70-treated mice that were
assessable survived to the end of the study. In contrast, none of
the 2A4 mice that were assessable died during the 57 days. Analysis
of the survival data using the standard methods demonstrated a
significant difference in the survival curves (P=0.015 using
Mantel-Cox test and P=0.016 using Grehan-Breslow-Wilcoxon
test).
[0418] The final blood chemistry data were analyzed according to
the therapy that each mouse received. Because of differences in the
mean parameter values associated with male and female H2/huIL-6
mice (at the time of sacrifice, BUN levels in female mice were
higher for both 2A4-treated and JH70-treated mice), only the female
mice that survived are included in Table 13 below.
TABLE-US-00026 TABLE 13 BUN GLU ALT ALB TP GLOB (mg/dL) (mg/dL)
(U/L) (g/dL) (g/dL) (g/dL) 2A4 JH70 2A4 JH70 2A4 JH70 2A4 JH70 2A4
JH70 2A4 JH70 Mean 60.7 73.3 107.8 100.1 45.5 119.7 2.3 2.2 9.2 9.1
7.0 7.1 SD 27.2 25.7 27.0 13.3 6.2 123.1 0.5 0.6 1.5 1.5 2.0 2.1 n
6.0 7.0 6.0 7.0 6.0 7.0 6.0 7.0 6.0 7.0 6.0 7.0 High 95.0 120.0
160.0 123.0 52.0 381.0 2.9 3.0 11.7 11.9 10.1 10.6 Low 17.0 36.0
83.0 83.0 35.0 33.0 1.5 1.2 7.2 7.5 4.3 5.3 Median 66.5 70.0 99.5
98.0 46.5 65.0 2.2 2.1 9.1 8.9 7.1 6.2 BUN, blood urea nitrogen;
GLU, glucose; ALT, alanine aminotransferase; ALB, albumin; TP,
total serum protein; GLOB, immunoglobulin; F, female; M, male; SD,
standard deviation; n is the number of mice used to determine the
values.
[0419] Mice treated with 2A4 showed decreased serum blood urea
nitrogen (BUN) and alanine aminotransferase (ALT) levels when
compared to mice treated with JH70. BUN and ALT are markers of
renal and hepatic function, respectively, and their reduced levels
indicate that organ function may have been better preserved by 2A4
treatment.
Sequence CWU 1
1
1771122PRTHomo sapiens 1Met Lys Leu Leu Thr Gly Leu Val Phe Cys Ser
Leu Val Leu Gly Val 1 5 10 15 Ser Ser Arg Ser Phe Phe Ser Phe Leu
Gly Glu Ala Phe Asp Gly Ala 20 25 30 Arg Asp Met Trp Arg Ala Tyr
Ser Asp Met Arg Glu Ala Asn Tyr Ile 35 40 45 Gly Ser Asp Lys Tyr
Phe His Ala Arg Gly Asn Tyr Asp Ala Ala Lys 50 55 60 Arg Gly Pro
Gly Gly Ala Trp Ala Ala Glu Val Ile Ser Asp Ala Arg 65 70 75 80 Glu
Asn Ile Gln Arg Phe Phe Gly His Gly Ala Glu Asp Ser Leu Ala 85 90
95 Asp Gln Ala Ala Asn Glu Trp Gly Arg Ser Gly Lys Asp Pro Asn His
100 105 110 Phe Arg Pro Ala Gly Leu Pro Glu Lys Tyr 115 120
276PRTHomo sapiensMISC_FEATUREHuman amyloid protein A peptide 2Arg
Ser Phe Phe Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala Arg Asp 1 5 10
15 Met Tyr Arg Ala Tyr Ser Asp Met Arg Glu Ala Asn Tyr Ile Gly Ser
20 25 30 Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala Ala Lys
Arg Gly 35 40 45 Pro Gly Gly Ala Tyr Ala Ala Glu Val Ile Ser Asp
Ala Arg Glu Asn 50 55 60 Ile Gln Arg Phe Phe Gly His Gly Ala Glu
Asp Ser 65 70 75 35PRTArtificial SequenceDerived from amyloidosis
peptide 3Gly His Glu Asp Thr 1 5 47PRTArtificial SequenceDerived
from amyloid A protein 4Gly His Gly Ala Glu Asp Ser 1 5
57PRTArtificial SequenceDerived from amyloid A protein 5Gly His Asp
Ala Glu Asp Ser 1 5 67PRTArtificial SequenceDerived from amyloid
protein 6Gly His Gly Ala Glu Asp Ser 1 5 77PRTArtificial
SequenceDerived from amyloid A protein 7Gly Asp His Ala Glu Asp Ser
1 5 87PRTArtificial SequenceDerived from amyloid A protein 8Ser Thr
Val Ile Glu Asp Ser 1 5 97PRTArtificial SequenceDerived from
amyloid A protein 9Gly Arg Gly His Glu Asp Thr 1 5 107PRTArtificial
SequenceDerived from amyloid A protein 10Gly His Gly Ala Glu Asp
Ser 1 5 117PRTArtificial SequenceDerived from amyloid A protein
11Asn His Gly Leu Glu Thr Leu 1 5 124PRTArtificial SequenceDerived
from amyloidosis peptide 12His Glu Asp Thr 1 134PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 13Ala Glu Asp Ser 1 144PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 14Ala Glu Asp
Thr 1 154PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 15His Glu Asp Ala 1 164PRTArtificial
SequenceAL V lambda fragment from amyloid protein 16Thr Glu Asp Glu
1 174PRTArtificial SequenceAL V lambda fragment from amyloid
protein 17Phe Glu Asp Asp 1 184PRTArtificial SequenceAL V lambda
fragment from amyloid protein 18Ser Glu Asp Glu 1 194PRTArtificial
SequenceAL V lambda fragment from amyloid protein 19Ala Glu Asp Glu
1 204PRTArtificial SequenceAL V lambda fragment from amyloid
protein 20Pro Glu Asp Glu 1 214PRTArtificial SequenceAL V kappa
fragment from amyloid protein 21Pro Glu Asp Ile 1 224PRTArtificial
SequenceAL V kappa fragment from amyloid protein 22Pro Glu Asp Phe
1 234PRTArtificial SequenceAL V kappa fragment from amyloid protein
23Ala Glu Asp Val 1 244PRTArtificial SequenceAL V kappa fragment
from amyloid protein 24Ser Glu Asp Phe 1 254PRTArtificial
SequenceAL V kappa fragment from amyloid protein 25Ser Glu Asp Ala
1 264PRTArtificial SequenceConsensus sequence derived from human
amyloidogenic proteins 26Pro Glu Asp Ser 1 274PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 27Pro Glu Asp Leu 1 284PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 28Thr Glu Asp
Val 1 294PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 29Ser Glu Asp Ile 1 304PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 30Thr Glu Asp Thr 1 314PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 31Leu Glu Asp
Gly 1 324PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 32Ala Glu Asp Met 1 334PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 33His Glu Asp Ser 1 344PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 34Cys Glu Asp
Asp 1 354PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 35Gln Glu Asp Ser 1 364PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 36Arg Glu Asp Ser 1 374PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 37Thr Glu Asp
Gly 1 384PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 38Gln Glu Asp Arg 1 394PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 39Thr Glu Asp Leu 1 404PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 40Pro Glu Asp
Asn 1 414PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 41Glu Glu Asp Pro 1 424PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 42Leu Glu Asp Leu 1 434PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 43Lys Glu Asp
Ala 1 444PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 44Ser Glu Asp Cys 1 454PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 45Glu Glu Asp Asp 1 464PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 46Ser Glu Asp
Lys 1 474PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 47Asp Glu Asp Asp 1 484PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 48Asp Glu Asp Gly 1 494PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 49Leu Glu Asp
Glu 1 504PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 50Gly Glu Asp Ala 1 514PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 51Val Glu Asp Phe 1 524PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 52Tyr Glu Asp
Glu 1 534PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 53Ile Glu Asp Leu 1 544PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 54Trp Glu Asp Tyr 1 554PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 55Asp Glu Asp
Trp 1 564PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 56Ser Glu Asp Leu 1 574PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 57Tyr Glu Asp Gln 1 584PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 58Leu Glu Asp
Trp 1 594PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 59Tyr Glu Asp Arg 1 604PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 60Pro Glu Asp Lys 1 6110PRTArtificial SequenceNon-amyloid
portion of serum amyloid A protein 61Gly His Glu Asp Thr Met Ala
Asp Gln Glu 1 5 10 624PRTArtificial SequenceConsensus sequence
derived from human amyloidogenic proteins 62Ala Glu Asp Ala 1
634PRTArtificial SequenceConsensus sequence derived from human
amyloidogenic proteins 63Gln Glu Asp Leu 1 644PRTArtificial
SequenceConsensus sequence derived from human amyloidogenic
proteins 64Val Glu Asp Leu 1 654PRTArtificial SequenceConsensus
sequence derived from human amyloidogenic proteins 65Leu Glu Asp
Ala 1 664PRTArtificial SequenceConsensus sequence derived from
human amyloidogenic proteins 66Ser Glu Asp Gly 1 6716PRTArtificial
SequenceDerived from Malaria CS 67Glu Lys Lys Ile Ala Lys Met Glu
Lys Ala Ser Ser Val Phe Asn Val 1 5 10 15 6810PRTArtificial
SequenceDerived from Hepititis B surface antigen residues 19-28
68Phe Phe Leu Leu Thr Arg Ile Leu Thr Ile 1 5 10 6919PRTArtificial
SequenceDerived from mycobacterium heat shock protein 65 residues
153-171 69Asp Gln Ser Ile Gly Asp Leu Ile Ala Glu Ala Met Asp Lys
Val Gly 1 5 10 15 Asn Glu Gly 7014PRTMycobacterium
bovisMISC_FEATUREDerived from Bacille Calmette-Guerin vaccine 70Gln
Val His Phe Gln Pro Leu Pro Pro Ala Val Val Lys Leu 1 5 10
7115PRTArtificial SequenceDerived from Tetanus toxoid residues
830-844 71Gln Tyr Ile Lys Ala Asn Ser Lys Phe Ile Gly Ile Thr Glu
Leu 1 5 10 15 7221PRTArtificial SequenceDerived from Tetanus toxoid
residues 947-967 72Phe Asn Asn Phe Thr Val Ser Phe Trp Leu Arg Val
Pro Lys Val Ser 1 5 10 15 Ala Ser His Leu Glu 20 7316PRTHuman
immunodeficiency virusMISC_FEATUREHIV gb120 T1 73Lys Gln Ile Ile
Asn Met Trp Gln Glu Val Gly Lys Ala Met Tyr Ala 1 5 10 15
7413PRTArtificial SequencePan DR epitope 74Ala Lys Xaa Val Ala Ala
Trp Thr Leu Lys Ala Ala Ala 1 5 10 7536PRTArtificial SequenceFusion
protein derived from Tetanus toxoid residues 830-844 and 947-967
75Gln Tyr Ile Lys Ala Asn Ser Lys Phe Ile Gly Ile Thr Glu Leu Phe 1
5 10 15 Asn Asn Phe Thr Val Ser Phe Trp Leu Arg Val Pro Lys Val Ser
Ala 20 25 30 Ser His Leu Glu 35 7617PRTArtificial SequenceDerived
from ovalbumin residues 323-389 76Ile Ser Gln Ala Val His Ala Ala
His Ala Glu Ile Asn Glu Ala Gly 1 5 10 15 Arg
7713PRTArtificialDerived from hemagglutinin influenza A virus 77Pro
Lys Tyr Val Lys Gln Asn Thr Leu Lys Leu Ala Thr 1 5 10
7865PRTArtificial SequenceFusion protein derived from hemagglutinin
influenza A residues 307-319, Malaria CD T3 epitope, tetanus toxoid
residues 830-844 and 947-967 78Pro Lys Tyr Val Lys Gln Asn Thr Leu
Lys Leu Ala Thr Glu Lys Lys 1 5 10 15 Ile Ala Lys Met Glu Lys Ala
Ser Ser Val Phe Asn Val Gln Tyr Ile 20 25 30 Lys Ala Asn Ser Lys
Phe Ile Gly Ile Thr Glu Leu Phe Asn Asn Phe 35 40 45 Thr Val Ser
Phe Trp Leu Arg Val Pro Lys Val Ser Ala Ser His Leu 50 55 60 Glu 65
7937PRTArtificial SequenceFusion protein 79Gln Tyr Ile Lys Ala Asn
Ser Lys Phe Ile Gly Ile Thr Glu Leu Cys 1 5 10 15 Phe Asn Asn Phe
Thr Val Ser Phe Trp Leu Arg Val Pro Lys Val Ser 20 25 30 Ala Ser
His Leu Glu 35 8015PRTArtificial SequenceDerived from human amyloid
A protein 80Arg Ser Phe Phe Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala
Arg 1 5 10 15 8115PRTArtificial SequenceDerived from human amyloid
A protein 81Gln Gly Trp Leu Thr Phe Leu Lys Ala Ala Gly Gln Gly Ala
Lys 1 5 10 15 8210PRTArtificial SequenceDerived from mouse amyloid
A protein 82Glu Ser Trp Arg Ser Phe Phe Lys Glu Ala 1 5 10
8315PRTArtificial SequenceDerived from mouse amyloid A protein
83Gly Phe Phe Ser Phe Val His Glu Ala Phe Gln Gly Ala Gly Asp 1 5
10 15 848PRTArtificial SequenceDerived from mouse amyloid A protein
84Glu Ala Gly Gln Gly Ser Arg Asp 1 5 8514PRTArtificial
SequenceDerived from mouse amyloid A protein 85Trp Tyr Ser Phe Phe
Arg Glu Ala Val Gln Gly Thr Trp Asp 1 5 10 8699PRTHomo
SapiensMISC_FEATURELambda 2 fragments from human amyloid deposits
86Gly Ser Val Val Thr Gln Pro Pro Ser Val Ser Gly Ala Pro Arg Gln 1
5 10 15 Thr Val Ala Ile Ser Cys Ser Gly Ser Ser Ser Asn Ile Gly Asn
Asn 20 25 30 Ala Val Asn Trp Tyr Gln Gln Leu Pro Gly Lys Ala Pro
Lys Val Leu 35 40 45 Ile Tyr Tyr Asp Asp Leu Leu Pro Ala Gly Val
Ser Asp Arg Phe Ser 50 55 60 Gly Ser Lys Ser Gly Thr Ser Ala Ser
Leu Ala Ile Arg Gly Leu Gln 65 70 75 80 Ser Glu Asp Glu Gly Asp Tyr
Tyr Cys Ala Ala Trp Asp Asp Ser Leu 85 90 95 Ser Ala Leu
877PRTArtificial SequenceDerived from serum amyloid A protein 87Cys
Gly Gly His Glu Asp Thr 1 5 887PRTArtificial SequenceDerived from
serum amyloid A protein 88Cys Gly Gly Ala Glu Asp Ser 1 5
8910PRTArtificial SequenceDerived from serum amyloid A protein
89Gly His Glu Asp Thr Ile Ala Asp Gln Glu 1 5 10 907PRTArtificial
SequenceDerived from serum amyloid A protein 90Cys Gly Gly Ala Glu
Asp Thr 1 5 917PRTArtificial SequenceDerived from serum amyloid A
protein 91Cys Gly Gly His Ala Asp Thr 1 5 927PRTArtificial
SequenceDerived from serum amyloid A protein 92Cys Gly Gly His Glu
Ala Thr 1 5 937PRTArtificial SequenceDerived from serum amyloid A
protein 93Cys Gly Gly His Glu Asp Ala 1 5 948PRTArtificial
SequenceDerived from serum amyloid A protein 94Cys Gly Gly His Glu
Asp Thr Met 1 5 959PRTArtificial SequenceDerived from serum amyloid
A protein 95Cys Gly Gly His Glu Asp Thr Met Ala 1 5
9610PRTArtificial SequenceDerived from serum amyloid A protein
96Cys Gly Gly His Glu Asp Thr Met Ala Asp 1 5 10 976PRTArtificial
SequenceDerived from serum amyloid A protein 97Cys Gly Gly His Glu
Asp 1 5 98122PRTHomo sapiensMISC_FEATUREHSAA1 98Met Lys Leu Leu Thr
Gly Leu Val Phe Cys Ser Leu Val Leu Gly Val 1 5 10 15 Ser Ser Arg
Ser Phe Phe Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala 20 25 30 Arg
Asp Met Trp Arg Ala Tyr Ser Asp Met Arg Glu Ala Asn Tyr Ile 35 40
45 Gly Ser Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala Ala Lys
50 55 60 Arg Gly Pro Gly Gly Val Trp Ala Ala Glu Ala Ile Ser Asp
Ala Arg 65 70 75 80 Glu Asn Ile Gln Arg Phe Phe Gly His Gly Ala Glu
Asp Ser Leu Ala 85 90 95 Asp Gln Ala Ala Asn Glu Trp Gly Arg Ser
Gly Lys Asp Pro Asn His 100 105 110 Phe Arg Pro Ala Gly Leu Pro Glu
Lys Tyr 115 120 99122PRTHomo sapiensMISC_FEATUREHSAA2 99Met Lys Leu
Leu Thr Gly Leu Val Phe Cys Ser Leu Val Leu Ser Val 1 5 10 15 Ser
Ser Arg Ser Phe Phe Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala 20 25
30 Arg Asp Met Trp Arg Ala Tyr Ser Asp Met Arg Glu Ala Asn Tyr Ile
35 40 45 Gly Ser Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala
Ala Lys 50 55 60 Arg Gly Pro Gly Gly Ala Trp Ala Ala Glu Val Ile
Ser Asn Ala Arg 65 70 75 80 Glu Asn Ile Gln Arg Leu Thr Gly His Gly
Ala Glu Asp Ser Leu Ala 85 90 95 Asp Gln Ala Ala Asn Lys Trp Gly
Arg Ser Gly Arg Asp Pro Asn His 100 105 110 Phe Arg Pro Ala Gly Leu
Pro Glu Lys Tyr 115 120 100122PRTHomo
sapiensMISC_FEATUREHSAA3 100Met Lys Leu Ser Thr Gly Ile Ile Phe Cys
Ser Leu Val Leu Gly Val 1 5 10 15 Ser Ser Gln Gly Trp Leu Thr Phe
Leu Lys Ala Ala Gly Gln Gly Ala 20 25 30 Lys Asp Met Trp Arg Ala
Tyr Ser Asp Met Lys Glu Ala Asn Tyr Lys 35 40 45 Lys Ser Asp Lys
Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala Val Gln 50 55 60 Arg Gly
Pro Gly Gly Val Trp Ala Thr Glu Val Ile Ser Asp Ala Arg 65 70 75 80
Glu Asn Val Gln Arg Leu Thr Gly Asp His Ala Glu Asp Ser Leu Ala 85
90 95 Gly Gln Ala Thr Asn Lys Trp Gly Gln Ser Gly Lys Asp Pro Asn
His 100 105 110 Phe Arg Pro Ala Gly Leu Pro Glu Lys Tyr 115 120
101130PRTHomo sapiensMISC_FEATUREHSAA4 101Met Arg Leu Phe Thr Gly
Ile Val Phe Cys Ser Leu Val Met Gly Val 1 5 10 15 Thr Ser Glu Ser
Trp Arg Ser Phe Phe Lys Glu Ala Leu Gln Gly Val 20 25 30 Gly Asp
Met Gly Arg Ala Tyr Trp Asp Ile Met Ile Ser Asn His Gln 35 40 45
Asn Ser Asn Arg Tyr Leu Tyr Ala Arg Gly Asn Tyr Asp Ala Ala Gln 50
55 60 Arg Gly Pro Gly Gly Val Trp Ala Ala Lys Leu Ile Ser Arg Ser
Arg 65 70 75 80 Val Tyr Leu Gln Gly Leu Ile Asp Tyr Tyr Leu Phe Gly
Asn Ser Ser 85 90 95 Thr Val Leu Glu Asp Ser Lys Ser Asn Glu Lys
Ala Glu Glu Trp Gly 100 105 110 Arg Ser Gly Lys Asp Pro Asp Arg Phe
Arg Pro Asp Gly Leu Pro Lys 115 120 125 Lys Tyr 130 10276PRTHomo
sapiensMISC_FEATUREHAA1 102Arg Ser Phe Phe Ser Phe Leu Gly Glu Ala
Phe Asp Gly Ala Arg Asp 1 5 10 15 Met Trp Arg Ala Tyr Ser Asp Met
Arg Glu Ala Asn Tyr Ile Gly Ser 20 25 30 Asp Lys Tyr Phe His Ala
Arg Gly Asn Tyr Asp Ala Ala Lys Arg Gly 35 40 45 Pro Gly Gly Val
Trp Ala Ala Glu Ala Ile Ser Asp Ala Arg Glu Asn 50 55 60 Ile Gln
Arg Phe Phe Gly His Gly Ala Glu Asp Ser 65 70 75 10376PRTHomo
sapiensMISC_FEATUREHAA2 103Arg Ser Phe Phe Ser Phe Leu Gly Glu Ala
Phe Asp Gly Ala Arg Asp 1 5 10 15 Met Trp Arg Ala Tyr Ser Asp Met
Arg Glu Ala Asn Tyr Ile Gly Ser 20 25 30 Asp Lys Tyr Phe His Ala
Arg Gly Asn Tyr Asp Ala Ala Lys Arg Gly 35 40 45 Pro Gly Gly Ala
Trp Ala Ala Glu Val Ile Ser Asn Ala Arg Glu Asn 50 55 60 Ile Gln
Arg Leu Thr Gly His Gly Ala Glu Asp Ser 65 70 75 10476PRTHomo
sapiensMISC_FEATUREHAA3 104Gln Gly Trp Leu Thr Phe Leu Lys Ala Ala
Gly Gln Gly Ala Lys Asp 1 5 10 15 Met Trp Arg Ala Tyr Ser Asp Met
Lys Glu Ala Asn Tyr Lys Lys Ser 20 25 30 Asp Lys Tyr Phe His Ala
Arg Gly Asn Tyr Asp Ala Val Gln Arg Gly 35 40 45 Pro Gly Gly Val
Trp Ala Thr Glu Val Ile Ser Asp Ala Arg Glu Asn 50 55 60 Val Gln
Arg Leu Thr Gly Asp His Ala Glu Asp Ser 65 70 75 10584PRTHomo
sapiensMISC_FEATUREHAA4 105Glu Ser Trp Arg Ser Phe Phe Lys Glu Ala
Leu Gln Gly Val Gly Asp 1 5 10 15 Met Gly Arg Ala Tyr Trp Asp Ile
Met Ile Ser Asn His Gln Asn Ser 20 25 30 Asn Arg Tyr Leu Tyr Ala
Arg Gly Asn Tyr Asp Ala Ala Gln Arg Gly 35 40 45 Pro Gly Gly Val
Trp Ala Ala Lys Leu Ile Ser Arg Ser Arg Val Tyr 50 55 60 Leu Gln
Gly Leu Ile Asp Tyr Tyr Leu Phe Gly Asn Ser Ser Thr Val 65 70 75 80
Ile Glu Asp Ser 106117PRTMus musculusMISC_FEATUREMSAA1 106Met Lys
Leu Leu Thr Ser Leu Val Phe Cys Ser Leu Leu Leu Gly Val 1 5 10 15
Cys His Gly Gly Phe Phe Ser Phe Val His Glu Ala Phe Gln Gly Ala 20
25 30 Gly Asp Met Trp Arg Ala Tyr Thr Asp Met Lys Glu Ala Asn Trp
Lys 35 40 45 Asn Ser Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp
Ala Ala Gln 50 55 60 Arg Gly Pro Gly Gly Val Trp Ala Ala Glu Lys
Ile Ser Asp Gly Arg 65 70 75 80 Glu Ala Phe Gln Glu Phe Phe Gly Arg
Ile Ala Asp Gln Glu Ala Asn 85 90 95 Arg His Gly Arg Ser Gly Lys
Asp Pro Asn Tyr Tyr Arg Pro Pro Gly 100 105 110 Leu Pro Asp Lys Tyr
115 107122PRTMus musculusMISC_FEATUREMSAA2 107Met Lys Leu Leu Thr
Ser Leu Val Phe Cys Ser Leu Leu Leu Gly Val 1 5 10 15 Cys His Gly
Gly Phe Phe Ser Phe Ile Gly Glu Ala Phe Gln Gly Ala 20 25 30 Gly
Asp Met Trp Arg Ala Tyr Thr Asp Met Lys Glu Ala Gly Trp Lys 35 40
45 Asp Gly Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala Ala Gln
50 55 60 Arg Gly Pro Gly Gly Val Trp Ala Ala Glu Lys Ile Ser Asp
Ala Arg 65 70 75 80 Glu Ser Phe Gln Glu Phe Phe Gly Arg Gly His Glu
Asp Thr Met Ala 85 90 95 Asp Gln Glu Ala Asn Arg His Gly Arg Ser
Gly Lys Asp Pro Asn Tyr 100 105 110 Tyr Arg Pro Pro Gly Leu Pro Ala
Lys Tyr 115 120 108122PRTMus musculusMISC_FEATUREMSAA3 108Met Lys
Pro Ser Ile Ala Ile Ile Leu Cys Ile Leu Ile Leu Gly Val 1 5 10 15
Asp Ser Gln Arg Trp Val Gln Phe Met Lys Glu Ala Gly Gln Gly Ser 20
25 30 Arg Asp Met Trp Arg Ala Tyr Ser Asp Met Lys Lys Ala Asn Trp
Lys 35 40 45 Asn Ser Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp
Ala Ala Arg 50 55 60 Arg Gly Pro Gly Gly Ala Trp Ala Ala Lys Val
Ile Ser Asp Ala Arg 65 70 75 80 Glu Ala Val Gln Lys Phe Thr Gly His
Gly Ala Glu Asp Ser Arg Ala 85 90 95 Asp Gln Phe Ala Asn Glu Trp
Gly Arg Ser Gly Lys Asp Pro Asn His 100 105 110 Phe Arg Pro Ala Gly
Leu Pro Lys Arg Tyr 115 120 109130PRTMus musculusMISC_FEATUREMSAA4
109Met Arg Leu Ala Thr Val Ile Val Leu Cys Ser Leu Phe Leu Gly Val
1 5 10 15 Ser Gly Asp Gly Trp Tyr Ser Phe Phe Arg Glu Ala Val Gln
Gly Thr 20 25 30 Trp Asp Leu Trp Arg Ala Tyr Arg Asp Asn Leu Glu
Ala Asn Tyr Gln 35 40 45 Asn Ala Asp Gln Tyr Phe Tyr Ala Arg Gly
Asn Tyr Glu Ala Gln Gln 50 55 60 Arg Gly Ser Gly Gly Ile Trp Ala
Ala Lys Ile Ile Ser Thr Ser Arg 65 70 75 80 Lys Tyr Phe Gln Gly Leu
Leu Asn Arg Tyr Tyr Phe Gly Ile Arg Asn 85 90 95 His Gly Leu Glu
Thr Leu Gln Ala Thr Gln Lys Ala Glu Glu Trp Gly 100 105 110 Arg Ser
Gly Lys Asn Pro Asn His Phe Arg Pro Glu Gly Leu Pro Glu 115 120 125
Lys Phe 130 11085PRTMus musculusMISC_FEATUREMAA1 110Gly Phe Phe Ser
Phe Val His Glu Ala Phe Gln Gly Ala Gly Asp Met 1 5 10 15 Trp Arg
Ala Tyr Thr Asp Met Lys Glu Ala Asn Trp Lys Asn Ser His 20 25 30
Glu Asp Thr Ile Ala Asp Gln Glu Ala Asp Lys Tyr Phe His Ala Arg 35
40 45 Gly Asn Tyr Asp Ala Ala Gln Arg Gly Pro Gly Gly Val Trp Ala
Ala 50 55 60 Glu Lys Ile Ser Asp Gly Arg Glu Ala Phe Gln Glu Phe
Phe Gly Arg 65 70 75 80 Gly His Glu Asp Thr 85 11175PRTMus
musculusMISC_FEATUREMAA2 111Gly Phe Phe Ser Phe Ile Gly Glu Ala Phe
Gln Gly Ala Gly Asp Met 1 5 10 15 Trp Arg Ala Tyr Thr Asp Met Lys
Glu Ala Gly Trp Lys Asp Gly Asp 20 25 30 Lys Tyr Phe His Ala Arg
Gly Asn Tyr Asp Ala Ala Gln Arg Gly Pro 35 40 45 Gly Gly Val Trp
Ala Ala Glu Lys Ile Ser Asp Ala Arg Glu Ser Phe 50 55 60 Gln Glu
Phe Phe Gly Arg Gly His Glu Asp Thr 65 70 75 11268PRTMus
musculusMISC_FEATUREMAA3 112Glu Ala Gly Gln Gly Ser Arg Asp Met Trp
Arg Ala Tyr Ser Asp Met 1 5 10 15 Lys Lys Ala Asn Trp Lys Asn Ser
Asp Lys Tyr Phe His Ala Arg Gly 20 25 30 Asn Tyr Asp Ala Ala Arg
Arg Gly Pro Gly Gly Ala Trp Ala Ala Lys 35 40 45 Val Ile Ser Asp
Ala Arg Glu Ala Val Gln Lys Phe Thr Gly His Gly 50 55 60 Ala Glu
Asp Ser 65 11382PRTMus musculusMISC_FEATUREMAA4 113Trp Tyr Ser Phe
Phe Arg Glu Ala Val Gln Gly Thr Trp Asp Leu Trp 1 5 10 15 Arg Ala
Tyr Arg Asp Asn Leu Glu Ala Asn Tyr Gln Asn Ala Asp Gln 20 25 30
Tyr Phe Tyr Ala Arg Gly Asn Tyr Glu Ala Gln Gln Arg Gly Ser Gly 35
40 45 Gly Ile Trp Ala Ala Lys Ile Ile Ser Thr Ser Arg Lys Tyr Phe
Gln 50 55 60 Gly Leu Leu Asn Arg Tyr Tyr Phe Gly Ile Arg Asn His
Gly Leu Glu 65 70 75 80 Thr Leu 114122PRTHomo
sapiensMISC_FEATUREHSAA1 alpha 114Met Lys Leu Leu Thr Gly Leu Val
Phe Cys Ser Leu Val Leu Gly Val 1 5 10 15 Ser Ser Arg Ser Phe Phe
Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala 20 25 30 Arg Asp Met Trp
Arg Ala Tyr Ser Asp Met Arg Glu Ala Asn Tyr Ile 35 40 45 Gly Ser
Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala Ala Lys 50 55 60
Arg Gly Pro Gly Gly Val Trp Ala Ala Glu Ala Ile Ser Asp Ala Arg 65
70 75 80 Glu Asn Ile Gln Arg Phe Phe Gly His Gly Ala Glu Asp Ser
Leu Ala 85 90 95 Asp Gln Ala Ala Asn Glu Trp Gly Arg Ser Gly Lys
Asp Pro Asn His 100 105 110 Phe Arg Pro Ala Gly Leu Pro Glu Lys Tyr
115 120 115122PRTHomo sapiensMISC_FEATUREHSSA1 beta 115Met Lys Leu
Leu Thr Gly Leu Val Phe Cys Ser Leu Val Leu Gly Val 1 5 10 15 Ser
Ser Arg Ser Phe Phe Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala 20 25
30 Arg Asp Met Trp Arg Ala Tyr Ser Asp Met Arg Glu Ala Asn Tyr Ile
35 40 45 Gly Ser Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala
Ala Lys 50 55 60 Arg Gly Pro Gly Gly Ala Trp Ala Ala Glu Val Ile
Ser Asp Ala Arg 65 70 75 80 Glu Asn Ile Gln Arg Phe Phe Gly His Asp
Ala Glu Asp Ser Leu Ala 85 90 95 Asp Gln Ala Ala Asn Glu Trp Gly
Arg Ser Gly Lys Asp Pro Asn His 100 105 110 Phe Arg Pro Ala Gly Leu
Pro Glu Lys Tyr 115 120 116122PRTHomo sapiensMISC_FEATUREHSSA1
gamma 116Met Lys Leu Leu Thr Gly Leu Val Phe Cys Ser Leu Val Leu
Gly Val 1 5 10 15 Ser Ser Arg Ser Phe Phe Ser Phe Leu Gly Glu Ala
Phe Asp Gly Ala 20 25 30 Arg Asp Met Trp Arg Ala Tyr Ser Asp Met
Arg Glu Ala Asn Tyr Ile 35 40 45 Gly Ser Asp Lys Tyr Phe His Ala
Arg Gly Asn Tyr Asp Ala Ala Lys 50 55 60 Arg Gly Pro Gly Gly Val
Trp Ala Ala Glu Ala Ile Ser Asp Ala Arg 65 70 75 80 Glu Asn Ile Gln
Arg Phe Phe Gly His Asp Ala Glu Asp Ser Leu Ala 85 90 95 Asp Gln
Ala Ala Asn Lys Trp Gly Arg Ser Gly Arg Asp Pro Asn His 100 105 110
Phe Arg Pro Ala Gly Leu Pro Glu Lys Tyr 115 120 117122PRTHomo
sapiensMISC_FEATUREHSAA2 alpha 117Met Lys Leu Leu Thr Gly Leu Val
Phe Cys Ser Leu Val Leu Ser Val 1 5 10 15 Ser Ser Arg Ser Phe Phe
Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala 20 25 30 Arg Asp Met Trp
Arg Ala Tyr Ser Asp Met Arg Glu Ala Asn Tyr Ile 35 40 45 Gly Ser
Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala Ala Lys 50 55 60
Arg Gly Pro Gly Gly Ala Trp Ala Ala Glu Val Ile Ser Asn Ala Arg 65
70 75 80 Glu Asn Ile Gln Arg Leu Thr Gly His Gly Ala Glu Asp Ser
Leu Ala 85 90 95 Asp Gln Ala Ala Asn Lys Trp Gly Arg Ser Gly Arg
Asp Pro Asn His 100 105 110 Phe Arg Pro Ala Gly Leu Pro Glu Lys Tyr
115 120 118122PRTHomo sapiensMISC_FEATUREHSAA2 beta 118Met Lys Leu
Leu Thr Gly Leu Val Phe Cys Ser Leu Val Leu Ser Val 1 5 10 15 Ser
Ser Arg Ser Phe Phe Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala 20 25
30 Arg Asp Met Trp Arg Ala Tyr Ser Asp Met Arg Glu Ala Asn Tyr Ile
35 40 45 Gly Ser Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala
Ala Lys 50 55 60 Arg Gly Pro Gly Gly Ala Trp Ala Ala Glu Val Ile
Ser Asn Ala Arg 65 70 75 80 Glu Asn Ile Gln Arg Leu Thr Gly Arg Gly
Ala Glu Asp Ser Leu Ala 85 90 95 Asp Gln Ala Ala Asn Lys Trp Gly
Arg Ser Gly Arg Asp Pro Asn His 100 105 110 Phe Arg Pro Ala Gly Leu
Pro Glu Lys Tyr 115 120 119104PRTHomo sapiensMISC_FEATUREHAA1 beta
isoform 119Arg Ser Phe Phe Ser Phe Leu Gly Glu Ala Phe Asp Gly Ala
Arg Asp 1 5 10 15 Met Trp Arg Ala Tyr Ser Asp Met Arg Glu Ala Asn
Tyr Ile Gly Ser 20 25 30 Asp Lys Tyr Phe His Ala Arg Gly Asn Tyr
Asp Ala Ala Lys Arg Gly 35 40 45 Pro Gly Gly Val Trp Ala Ala Glu
Ala Ile Ser Asp Ala Arg Glu Asn 50 55 60 Ile Gln Arg Phe Phe Gly
His Gly Ala Glu Asp Ser Leu Ala Asp Gln 65 70 75 80 Ala Ala Asn Glu
Trp Gly Arg Ser Gly Lys Asp Pro Asn His Phe Arg 85 90 95 Pro Ala
Gly Leu Pro Glu Lys Tyr 100 120102PRTMus musculusMISC_FEATURESerum
amyloid A protein 120Gly Phe Phe Ser Phe Ile Gly Glu Ala Phe Gln
Gly Ala Gly Asp Met 1 5 10 15 Trp Arg Ala Tyr Thr Asp Met Lys Glu
Ala Gly Trp Lys Asp Gly Asp 20 25 30 Lys Tyr Phe His Ala Arg Gly
Asn Tyr Asp Ala Ala Gln Arg Gly Pro 35 40 45 Gly Gly Val Trp Ala
Ala Glu Lys Ile Ser Asp Ala Arg Glu Ser Gln 50 55 60 Glu Phe Phe
Gly Arg Gly His Glu Asp Thr Met Ala Asp Gln Glu Ala 65 70 75 80 Asn
Arg His Gly Arg Ser Gly Lys Asp Pro Asn Tyr Tyr Arg Pro Pro 85
90
95 Gly Leu Pro Ala Lys Tyr 100 12184PRTCanis
familiarisMISC_FEATURESerum amyloid A protein 121Trp Tyr Ser Phe
Val Gly Glu Ala Ala Gln Gly Ala Trp Asp Met Leu 1 5 10 15 Arg Ala
Tyr Ser Asp Met Arg Glu Ala Asn Tyr Lys Asn Ser Asp Lys 20 25 30
Tyr Phe His Ala Arg Gly Asn Tyr Asp Ala Ala Gln Arg Gly Pro Gly 35
40 45 Gly Ala Trp Ala Ala Lys Val Ile Ser Asp Ala Arg Glu Asn Ser
Gln 50 55 60 Arg Asp Ser Gly His Gly Ala Glu Asp Ser Lys Ala Asp
Gln Ala Ala 65 70 75 80 Asn Glu Trp Gly 1228PRTHomo sapiens 122Ile
Thr Asp Leu Leu Arg Phe Gly 1 5 12395PRTHomo
sapiensMISC_FEATUREkpla 123Asp Ile Gln Met Thr Gln Ser Pro Ser Thr
Leu Ser Ala Ser Val Gly 1 5 10 15 Asp Arg Val Thr Ile Thr Cys Arg
Ala Ser Gln Ser Ile Ser Ser Trp 20 25 30 Leu Ala Trp Tyr Gln Gln
Lys Pro Gly Lys Ala Pro Lys Leu Leu Ile 35 40 45 Tyr Lys Ala Ser
Ser Leu Glu Ser Gly Val Pro Ser Arg Phe Ser Gly 50 55 60 Ser Gly
Ser Gly Thr Glu Phe Thr Leu Thr Ile Ser Ser Leu Gln Pro 65 70 75 80
Asp Asp Phe Ala Thr Tyr Tyr Cys Gln Gln Tyr Asn Ser Tyr Ser 85 90
95 12417PRTHomo sapiensMISC_FEATUREkplb 124Ser Gln Asp Asn Tyr Asn
Asp Asn Thr Asp Phe Glu Ile Asp Asn Leu 1 5 10 15 Pro 12511PRTHomo
sapiensMISC_FEATUREkplc 125Ser Tyr Asn Ala Gln Asp Glu Ser Tyr Thr
Pro 1 5 10 12613PRTHomo sapiensMISC_FEATUREkpld 126Ser Gly Arg Asn
Asp Gly Arg Ala Gln Glu Leu His Pro 1 5 10 12711PRTHomo
sapiensMISC_FEATUREkple 127Ser Gly Asn Tyr Phe Ser Ala Gln Asp Glu
Pro 1 5 10 12811PRTHomo sapiensMISC_FEATUREkplf 128Ala Leu Ser Gly
Ala Asp Asp Glu Phe Asn Pro 1 5 10 12910PRTHomo
sapiensMISC_FEATUREkplg 129Ser Val Gly Ala Gln Asp Glu Ala Phe Pro
1 5 10 13051PRTHomo sapiensMISC_FEATUREkp2a 130Val Thr Leu Ser Pro
Val Thr Pro Glu Pro Ala Ser Ser Ser Leu Leu 1 5 10 15 Asp Ser Asp
Asp Gly Asn Thr Tyr Asp Leu Gln Ser Gln Thr Leu Tyr 20 25 30 Arg
Ala Asp Asp Lys Arg Val Glu Ala Glu Val Gly Val Met Arg Ile 35 40
45 Glu Phe Pro 50 13149PRTHomo sapiensMISC_FEATUREkp2b 131Val Leu
Ser Pro Val Thr Pro Glu Pro Ala Ser Ser Ser Leu Leu His 1 5 10 15
Ser Asn Gly Tyr Asn Tyr Asp Leu Gln Ser Gln Leu Gly Asn Arg Ala 20
25 30 Asp Asp Lys Arg Val Glu Ala Glu Val Gly Val Met Ala Leu Gln
Thr 35 40 45 Pro 13250PRTHomo sapiensMISC_FEATUREkp2c 132Val Thr
Leu Ser Val Thr Pro Gln Pro Ala Ser Ser Lys Ser Leu Leu 1 5 10 15
His Ser Asp Gly Lys Thr Tyr Tyr Leu Gln Pro Gln Glu Val Asn Arg 20
25 30 Phe Asp Asp Lys Arg Val Glu Ala Glu Val Gly Val Met Ser Ile
Gln 35 40 45 Leu Pro 50 13326PRTHomo sapiensMISC_FEATUREkp3a 133Glu
Val Ala Val Pro Glu Ala Leu Ser Val Asn Gln Arg Gly Thr Arg 1 5 10
15 Ala Thr Ile Ala Ser Glu Val Asn Trp Pro 20 25 13429PRTHomo
sapiensMISC_FEATUREkp3b 134Glu Val Leu Gly Leu Pro Glu Ala Leu Ser
Val Ser Tyr Gln Arg Gly 1 5 10 15 Arg Ala Thr Ile Asp Asp Arg Glu
Glu Val Gly Ser Pro 20 25 13531PRTHomo sapiensMISC_FEATUREkp3c
135Glu Val Leu Ala Leu Pro Glu Ala Leu Ser Val Ser Tyr Gln Arg Asp
1 5 10 15 Asn Arg Ala Thr Ile Ala Asp Glu Glu Val Arg Ser Asn Trp
Pro 20 25 30 13635PRTHomo sapiensMISC_FEATUREkp4 136Val Asp Ser Ala
Val Leu Glu Ala Asn Lys Ser Val Leu Tyr Ser Ser 1 5 10 15 Asn Asn
Lys Asn Tyr Gln Pro Trp Thr Arg Asp Asp Ala Glu Val Val 20 25 30
Tyr Thr Pro 35 13749PRTHomo sapiensMISC_FEATUREkp5 137Glu Thr Thr
Leu Ala Phe Met Thr Pro Lys Asn Ser Lys Asp Asp Asp 1 5 10 15 Asp
Met Asn Glu Ala Ile Phe Ile Gln Glu Thr Thr Val Pro Ile Pro 20 25
30 Tyr Asp Asn Asn Ile Glu Ser Glu Ala Tyr Phe Leu His Asp Asn Phe
35 40 45 Pro 13897PRTHomo sapiensMISC_FEATURElmla 138Gln Ser Val
Leu Thr Gln Pro Pro Ser Val Ser Ala Ala Pro Gly Gln 1 5 10 15 Val
Thr Ile Ser Cys Ser Gly Ser Ser Ser Asn Ile Gly Asn Asn Tyr 20 25
30 Val Ser Trp Tyr Gln Gln Leu Pro Gly Thr Ala Pro Lys Leu Leu Ile
35 40 45 Tyr Glu Asn Asn Lys Arg Pro Ser Gly Ile Pro Asp Arg Phe
Ser Gly 50 55 60 Ser Lys Ser Gly Thr Ser Ala Thr Leu Gly Ile Thr
Gly Leu Gln Thr 65 70 75 80 Gly Asp Glu Ala Asp Tyr Tyr Cys Gly Thr
Trp Asp Ser Ser Leu Ser 85 90 95 Ala 13919PRTHomo
sapiensMISC_FEATURElmlb 139Ala Gly Thr Arg Ser Tyr Arg Gln Val Ser
Ala Ser Arg Ser Glu Ala 1 5 10 15 Ala Asp Gly 14021PRTHomo
sapiensMISC_FEATURElmlc 140Val Gly Arg Thr Ala Gly Tyr Asp His Gly
Ser Asn Val Ser Ala Ala 1 5 10 15 Glu Gln Ser Tyr Gly 20
14127PRTHomo sapiensMISC_FEATURElm2a 141Ala Ala Gly Ser Ser Ile Thr
Thr Asp Val Ser Tyr Leu His Lys Met 1 5 10 15 Gly Ser Val Ser Ala
Ala Glu Gln Ser Tyr Gly 20 25 14234PRTHomo sapiensMISC_FEATURElm2b
142Ala Arg Gly Ser Val Ile Thr Thr Asp Val Gly Tyr His Lys Met Asp
1 5 10 15 Val Ser Val Asn Thr Ser Thr Ser Ala Glu Cys Ser Tyr Ala
Gly Tyr 20 25 30 Thr Phe 14341PRTHomo sapiensMISC_FEATURElm3a
143Ser Tyr Val Lys Thr Ala Arg Thr Gly Asn Asn Ile Gly Ser Lys Ser
1 5 10 15 His Lys Gln Val Val Val Asp Asp Ser Asp Glu Asn Asn Thr
Thr Ser 20 25 30 Arg Val Glu Ala Gln Val Ser Asp His 35 40
14438PRTHomo sapiensMISC_FEATURElm3b 144Ser Tyr Glu Val Ser Thr Ala
Arg Thr Asp Ala Leu Pro Lys Gln Ala 1 5 10 15 Tyr Lys Gln Val Val
Lys Asp Ser Glu Glu Ser Thr Val Thr Ser Val 20 25 30 Ala Glu Gln
Ser Ala Gly 35 14539PRTHomo sapiensMISC_FEATURElm3c 145Ser Tyr Glu
Val Ser Thr Ala Ser Thr Asp Lys Leu Gly Asp Lys Ala 1 5 10 15 Cys
Lys Gln Ser Val Val Gln Asp Ser Glu Asn Asn Thr Thr Ser Thr 20 25
30 Ala Met Gln Ala Thr Ala His 35 14623PRTHomo
sapiensMISC_FEATURElm4 146Ser Glu Asp Ala Val Leu Thr Arg Thr Gln
Asp Leu Arg Ser Tyr Ala 1 5 10 15 Lys Gln Val Val Gly Lys Asn 20
14738PRTHomo sapiensMISC_FEATURElm6 147Asn Phe Met His Glu Ser Lys
Thr Thr Arg Gly Ser Ala Ser Gln Arg 1 5 10 15 Ser Ser Thr Thr Val
Asp Gln Val Ile Asp Ser Ser Asn Ser Thr Ser 20 25 30 Lys Glu Gln
Ser Tyr Asn 35 14857PRTHomo sapiensMISC_FEATURElm7 148Thr Val Glu
Leu Thr Val Ser Gly Thr Leu Thr Ala Ser Thr Gly Ala 1 5 10 15 Val
Thr Ser Gly Tyr Pro Asn Phe Lys Gln Arg Ala Ser Thr Ser Asn 20 25
30 Lys His Trp Thr Ala Leu Leu Gly Lys Ala Thr Leu Ser Val Pro Glu
35 40 45 Glu Leu Leu Tyr Tyr Gly Gly Ala Gln 50 55 14950PRTHomo
sapiensMISC_FEATURElm8 149Leu Ser Ala Ser Leu Ala Ser Lys Leu Thr
Thr Leu Gly His Ser Ser 1 5 10 15 Tyr Ala Ile Ala His Gln Glu Lys
Gly Arg Tyr Met Lys Leu Ser Asp 20 25 30 Gly Gly Asp Ser Ala Glu
Arg Tyr Thr Ser Ser Ser Glu Gln Gly Thr 35 40 45 Gly Ile 50
15098PRTHomo sapiensMISC_FEATUREV lambda Wil 150Asn Phe Leu Leu Thr
Gln Pro His Ser Val Ser Glu Ser Pro Gly Lys 1 5 10 15 Thr Val Thr
Ile Ser Cys Thr Arg Ser Ser Gly Ser Ile Ala Asn Asn 20 25 30 Tyr
Val His Trp Tyr Gln Gln Arg Pro Gly Ser Ser Pro Thr Thr Val 35 40
45 Ile Phe Glu Asp Asp His Arg Pro Ser Gly Val Pro Asp Arg Phe Ser
50 55 60 Gly Ser Val Asp Thr Ser Ser Asn Ser Ala Ser Leu Thr Ile
Ser Gly 65 70 75 80 Leu Lys Thr Glu Asp Glu Ala Asp Tyr Tyr Cys Gln
Ser Tyr Asp His 85 90 95 Asn Asn 1514PRTArtificial SequenceAL V
kappa fragment from amyloid protein 151Pro Glu Asp Val 1
152131PRTMus musculusMISC_FEATUREMurine 2A4 and 8G9 v kappa light
chain 152Met Lys Leu Pro Val Arg Leu Leu Val Leu Met Phe Trp Ile
Pro Ala -15 -10 -5 Ser Ser Ser Asp Val Val Met Thr Gln Thr Pro Leu
Ser Leu Pro Val -1 1 5 10 Ser Leu Gly Asp Gln Ala Ser Ile Ser Cys
Arg Ser Ser Gln Ser Leu 15 20 25 Val His Ser Thr Gly Asn Thr Tyr
Leu His Trp Tyr Leu Gln Lys Pro 30 35 40 45 Gly Gln Ser Pro Lys Leu
Leu Ile Tyr Lys Val Ser Asn Arg Phe Ser 50 55 60 Gly Val Pro Asp
Arg Phe Ser Gly Ser Gly Ser Gly Thr Tyr Phe Thr 65 70 75 Leu Lys
Ile Ser Arg Val Glu Ala Glu Asp Leu Gly Val Tyr Phe Cys 80 85 90
Ser Gln Ser Thr His Val Pro Phe Thr Phe Gly Gly Gly Thr Lys Leu 95
100 105 Glu Ile Lys 110 153131PRTMus musculusMISC_FEATUREMurine 7D8
v kappa light chain 153Met Lys Leu Pro Val Arg Leu Leu Val Leu Met
Phe Trp Ile Pro Ala -15 -10 -5 Ser Ser Ser Asp Val Val Met Thr Gln
Thr Pro Leu Ser Leu Pro Val -1 1 5 10 Ser Leu Gly Asp Gln Ala Ser
Ile Ser Cys Arg Ser Ser Leu Ser Leu 15 20 25 Val His Ser Thr Gly
Asn Thr Tyr Leu His Trp Tyr Leu Gln Lys Pro 30 35 40 45 Gly Gln Ser
Pro Lys Leu Leu Ile Tyr Lys Val Ser Asn Arg Phe Ser 50 55 60 Gly
Val Pro Asp Arg Phe Ser Gly Ser Gly Ser Gly Thr Tyr Phe Thr 65 70
75 Leu Lys Ile Ser Arg Val Glu Ala Glu Asp Leu Gly Val Tyr Phe Cys
80 85 90 Ser Gln Ser Thr His Val Pro Phe Thr Phe Gly Gly Gly Thr
Lys Leu 95 100 105 Glu Ile Lys 110 154138PRTMus
musculusMISC_FEATUREMurine 2A4, 8G9 and 7D8 v heavy chain 154Met
Val Leu Gly Leu Lys Trp Val Phe Phe Val Val Phe Tyr Gln Gly -15 -10
-5 Val His Cys Glu Val Gln Leu Val Glu Ser Gly Gly Arg Leu Val Gln
-1 1 5 10 Pro Lys Gly Ser Leu Lys Leu Ser Cys Ala Ala Ser Gly Phe
Thr Phe 15 20 25 Asn Thr Tyr Ala Met Tyr Trp Ile Arg Gln Ala Pro
Gly Lys Gly Leu 30 35 40 45 Glu Trp Val Ala Arg Ile Arg Ser Lys Ser
Asn Asn Tyr Ala Ile Tyr 50 55 60 Tyr Ala Asp Ser Val Lys Asp Arg
Phe Thr Ile Phe Arg Asp Asp Ser 65 70 75 Gln Ser Met Leu Tyr Leu
Gln Met Asn Asn Leu Lys Thr Glu Asp Thr 80 85 90 Ala Met Tyr Tyr
Cys Val Arg Pro Tyr Ser Asp Ser Phe Ala Tyr Trp 95 100 105 Gly Gln
Gly Thr Leu Val Thr Val Ser Ala 110 115 155112PRTArtificial
SequenceHumanized 2A4 and 8G9 v kappa light chain version 1 155Asp
Val Val Met Thr Gln Ser Pro Leu Ser Leu Pro Val Thr Pro Gly 1 5 10
15 Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser Gln Ser Leu Val His Ser
20 25 30 Thr Gly Asn Thr Tyr Leu His Trp Tyr Leu Gln Lys Pro Gly
Gln Ser 35 40 45 Pro Gln Leu Leu Ile Tyr Lys Val Ser Asn Arg Phe
Ser Gly Val Pro 50 55 60 Asp Arg Phe Ser Gly Ser Gly Ser Gly Thr
Tyr Phe Thr Leu Lys Ile 65 70 75 80 Ser Arg Val Glu Ala Glu Asp Val
Gly Val Tyr Phe Cys Ser Gln Ser 85 90 95 Thr His Val Pro Phe Thr
Phe Gly Gly Gly Thr Lys Val Glu Ile Lys 100 105 110
156112PRTArtificial SequenceHumanized 2A4 and 8G9 v kappa light
chain version 2 156Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu Pro
Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser
Gln Ser Leu Val His Ser 20 25 30 Thr Gly Asn Thr Tyr Leu His Trp
Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu Ile Tyr
Lys Val Ser Asn Arg Phe Ser Gly Val Pro 50 55 60 Asp Arg Phe Ser
Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Lys Ile 65 70 75 80 Ser Arg
Val Glu Ala Glu Asp Val Gly Val Tyr Phe Cys Ser Gln Ser 85 90 95
Thr His Val Pro Phe Thr Phe Gly Gly Gly Thr Lys Val Glu Ile Lys 100
105 110 157112PRTArtificial SequenceHumanized 2A4 and 8G9 v kappa
light chain version 3 157Asp Val Val Met Thr Gln Ser Pro Leu Ser
Leu Pro Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg
Ser Ser Gln Ser Leu Val His Ser 20 25 30 Thr Gly Asn Thr Tyr Leu
His Trp Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu
Ile Tyr Lys Val Ser Asn Arg Phe Ser Gly Val Pro 50 55 60 Asp Arg
Phe Ser Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Lys Ile 65 70 75 80
Ser Arg Val Glu Ala Glu Asp Val Gly Val Tyr Tyr Cys Ser Gln Ser 85
90 95 Thr His Val Pro Phe Thr Phe Gly Gly Gly Thr Lys Val Glu Ile
Lys 100 105 110 158112PRTArtificial SequenceHumanized 7D8 v kappa
light chain version 1 158Asp Val Val Met Thr Gln Ser Pro Leu Ser
Leu Pro Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg
Ser Ser Leu Ser Leu Val His Ser 20 25 30 Thr Gly Asn Thr Tyr Leu
His Trp Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu
Ile Tyr Lys Val Ser Asn Arg Phe Ser Gly Val Pro 50 55 60 Asp Arg
Phe Ser Gly Ser Gly Ser Gly Thr Tyr Phe Thr Leu Lys Ile 65 70 75 80
Ser Arg Val Glu Ala Glu Asp Val Gly Val Tyr Phe Cys Ser Gln Ser 85
90 95 Thr His Val Pro Phe Thr Phe Gly Gln Gly Thr Lys Leu Glu Ile
Lys 100 105 110 159112PRTArtificial SequenceHumanized 7D8 v kappa
light chain version 2 159Asp Val Val Met Thr Gln Ser Pro Leu Ser
Leu Pro Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg
Ser
Ser Leu Ser Leu Val His Ser 20 25 30 Thr Gly Asn Thr Tyr Leu His
Trp Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu Ile
Tyr Lys Val Ser Asn Arg Phe Ser Gly Val Pro 50 55 60 Asp Arg Phe
Ser Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Lys Ile 65 70 75 80 Ser
Arg Val Glu Ala Glu Asp Val Gly Val Tyr Phe Cys Ser Gln Ser 85 90
95 Thr His Val Pro Phe Thr Phe Gly Gln Gly Thr Lys Leu Glu Ile Lys
100 105 110 160112PRTArtificial SequenceHumanized 7D8 v kappa light
chain version 3 160Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu Pro
Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser
Leu Ser Leu Val His Ser 20 25 30 Thr Gly Asn Thr Tyr Leu His Trp
Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu Ile Tyr
Lys Val Ser Asn Arg Phe Ser Gly Val Pro 50 55 60 Asp Arg Phe Ser
Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Lys Ile 65 70 75 80 Ser Arg
Val Glu Ala Glu Asp Val Gly Val Tyr Tyr Cys Ser Gln Ser 85 90 95
Thr His Val Pro Phe Thr Phe Gly Gln Gly Thr Lys Leu Glu Ile Lys 100
105 110 161119PRTArtificial SequenceHumanized 2A4, 8G9 and 7D8
heavy chain version 1 161Glu Val Gln Leu Val Glu Ser Gly Gly Gly
Leu Val Gln Pro Gly Gly 1 5 10 15 Ser Leu Arg Leu Ser Cys Ala Ala
Ser Gly Phe Thr Phe Asn Thr Tyr 20 25 30 Ala Met Tyr Trp Ile Arg
Gln Ala Pro Gly Lys Gly Leu Glu Trp Val 35 40 45 Ala Arg Ile Arg
Ser Lys Ser Asn Asn Tyr Ala Ile Tyr Tyr Ala Asp 50 55 60 Ser Val
Lys Asp Arg Phe Thr Ile Phe Arg Asp Asp Ser Lys Asn Ser 65 70 75 80
Leu Tyr Leu Gln Met Asn Ser Leu Lys Thr Glu Asp Thr Ala Val Tyr 85
90 95 Tyr Cys Val Arg Pro Tyr Ser Asp Ser Phe Ala Tyr Trp Gly Gln
Gly 100 105 110 Thr Leu Val Thr Val Ser Ser 115 162119PRTArtificial
SequenceHumanized 2A4, 8G9 and 7D8 heavy chain version 2 162Glu Val
Gln Leu Val Glu Ser Gly Gly Gly Leu Val Gln Pro Gly Gly 1 5 10 15
Ser Leu Arg Leu Ser Cys Ala Ala Ser Gly Phe Thr Phe Asn Thr Tyr 20
25 30 Ala Met Tyr Trp Ile Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp
Val 35 40 45 Ala Arg Ile Arg Ser Lys Ser Asn Asn Tyr Ala Ile Tyr
Tyr Ala Asp 50 55 60 Ser Val Lys Asp Arg Phe Thr Ile Ser Arg Asp
Asp Ser Lys Asn Ser 65 70 75 80 Leu Tyr Leu Gln Met Asn Ser Leu Lys
Thr Glu Asp Thr Ala Val Tyr 85 90 95 Tyr Cys Val Arg Pro Tyr Ser
Asp Ser Phe Ala Tyr Trp Gly Gln Gly 100 105 110 Thr Leu Val Thr Val
Ser Ser 115 163119PRTArtificial SequenceHumanized 2A4, 7D8 and 8g9
heavy chain version 3 163Glu Val Gln Leu Val Glu Ser Gly Gly Gly
Leu Val Gln Pro Gly Gly 1 5 10 15 Ser Leu Arg Leu Ser Cys Ala Ala
Ser Gly Phe Thr Phe Asn Thr Tyr 20 25 30 Ala Met Tyr Trp Ile Arg
Gln Ala Pro Gly Lys Gly Leu Glu Trp Val 35 40 45 Ala Arg Ile Arg
Ser Lys Ser Asn Asn Tyr Ala Ile Tyr Tyr Ala Asp 50 55 60 Ser Val
Lys Asp Arg Phe Thr Ile Ser Arg Asp Asp Ser Lys Asn Ser 65 70 75 80
Leu Tyr Leu Gln Met Asn Ser Leu Lys Thr Glu Asp Thr Ala Val Tyr 85
90 95 Tyr Cys Ala Arg Pro Tyr Ser Asp Ser Phe Ala Tyr Trp Gly Gln
Gly 100 105 110 Thr Leu Val Thr Val Ser Ser 115 164119PRTMus
musculus 164Glu Val Gln Leu Val Glu Ser Gly Gly Arg Leu Val Gln Pro
Lys Gly 1 5 10 15 Ser Leu Lys Leu Ser Cys Ala Ala Ser Gly Phe Thr
Phe Asn Thr Tyr 20 25 30 Ala Met Tyr Trp Ile Arg Gln Ala Pro Gly
Lys Gly Leu Glu Trp Val 35 40 45 Ala Arg Ile Arg Ser Lys Ser Asn
Asn Tyr Ala Ile Tyr Tyr Ala Asp 50 55 60 Ser Val Lys Asp Arg Phe
Thr Ile Phe Arg Asp Asp Ser Gln Ser Met 65 70 75 80 Leu Tyr Leu Gln
Met Asn Asn Leu Lys Thr Glu Asp Thr Ala Met Tyr 85 90 95 Tyr Cys
Val Arg Pro Tyr Ser Asp Ser Phe Ala Tyr Trp Gly Gln Gly 100 105 110
Thr Leu Val Thr Val Ser Ala 115 165120PRTHomo
sapiensMISC_FEATUREHuman heavy chain framework 165Glu Val Gln Leu
Val Glu Ser Gly Gly Gly Leu Val Gln Pro Gly Gly 1 5 10 15 Ser Leu
Arg Leu Ser Cys Ala Ala Ser Gly Phe Thr Phe Ser Asp His 20 25 30
Tyr Met Asp Trp Val Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp Val 35
40 45 Gly Arg Thr Arg Asn Lys Ala Asn Ser Tyr Thr Thr Glu Tyr Ala
Ala 50 55 60 Ser Val Lys Gly Arg Phe Thr Ile Ser Arg Asp Asp Ser
Lys Asn Ser 65 70 75 80 Leu Tyr Leu Gln Met Asn Ser Leu Lys Thr Glu
Asp Thr Ala Val Tyr 85 90 95 Tyr Cys Ala Arg Tyr Val Val Gly Ala
Thr Leu Asp Tyr Trp Gly Gln 100 105 110 Gly Thr Leu Val Thr Val Ser
Ser 115 120 166113PRTHomo sapiensMISC_FEATUREHuman v kappa light
chain framework 166Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu Pro
Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser
Gln Ser Leu Leu His Ser 20 25 30 Asn Gly Tyr Asn Tyr Leu Asp Trp
Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu Ile Tyr
Leu Gly Ser Asn Arg Ala Ser Gly Val Pro 50 55 60 Asp Arg Phe Ser
Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Lys Ile 65 70 75 80 Ser Arg
Val Glu Ala Glu Asp Val Gly Val Tyr Tyr Cys Met Gln Ala 85 90 95
Leu Gln Thr Pro Leu Thr Phe Gly Gly Gly Thr Lys Val Glu Ile Lys 100
105 110 Arg 167276PRTHomo sapiensMISC_FEATUREHuman v kappa light
chain framework 167Met Lys Tyr Leu Leu Pro Thr Ala Ala Ala Gly Leu
Leu Leu Leu Ala 1 5 10 15 Ala Gln Pro Ala Met Ala Asp Val Val Met
Thr Gln Ser Pro Leu Ser 20 25 30 Leu Pro Val Thr Pro Gly Glu Pro
Ala Ser Ile Ser Cys Arg Ser Ser 35 40 45 Gln Ser Leu Leu His Ser
Asn Gly Tyr Asn Tyr Leu Asp Trp Tyr Leu 50 55 60 Gln Lys Pro Gly
Gln Ser Pro Gln Leu Leu Ile Tyr Leu Gly Ser Asn 65 70 75 80 Arg Ala
Ser Gly Val Pro Asp Arg Phe Ser Gly Ser Gly Ser Gly Thr 85 90 95
Asp Phe Thr Leu Lys Ile Ser Arg Val Glu Ala Glu Asp Val Gly Val 100
105 110 Tyr Tyr Cys Met Gln Ala Leu Gln Thr Pro Tyr Thr Phe Gly Gln
Gly 115 120 125 Thr Lys Leu Glu Ile Lys Arg Thr Val Ala Ala Pro Ser
Val Phe Ile 130 135 140 Phe Pro Pro Ser Asp Glu Gln Leu Lys Ser Gly
Thr Ala Ser Val Val 145 150 155 160 Cys Leu Leu Asn Asn Phe Tyr Pro
Arg Glu Ala Lys Val Gln Trp Lys 165 170 175 Val Asp Asn Ala Leu Gln
Ser Gly Asn Ser Gln Glu Ser Val Thr Glu 180 185 190 Gln Asp Ser Lys
Asp Ser Thr Tyr Ser Leu Ser Ser Thr Leu Thr Leu 195 200 205 Ser Lys
Ala Asp Tyr Glu Lys His Lys Val Tyr Ala Cys Glu Val Thr 210 215 220
His Gln Gly Leu Ser Ser Pro Val Thr Lys Ser Phe Asn Arg Gly Glu 225
230 235 240 Cys Ser Ala Arg Gln Ser Thr Pro Phe Val Cys Glu Tyr Gln
Gly Gln 245 250 255 Ser Ser Asp Leu Pro Gln Pro Pro Val Asn Ala Gly
Gly Gly Ser Gly 260 265 270 Gly Gly Ser Gly 275 16816PRTMus
musculusMISC_FEATURE(1)..(16)2A4 VL CDR1 168Arg Ser Ser Gln Ser Leu
Val His Ser Thr Gly Asn Thr Tyr Leu His 1 5 10 15 1697PRTMus
musculusMISC_FEATURE(1)..(7)2A4 VL CDR2 169Lys Val Ser Asn Arg Phe
Ser 1 5 1709PRTMus musculusMISC_FEATURE(1)..(9)2A4 VL CDR3 170Ser
Gln Ser Thr His Val Pro Phe Thr 1 5 17110PRTMus
musculusMISC_FEATURE(1)..(10)2A4 VH CDR1 171Gly Phe Thr Phe Asn Thr
Tyr Ala Met Tyr 1 5 10 17219PRTMus musculusMISC_FEATURE(1)..(19)2A4
VH CDR2 172Arg Ile Arg Ser Lys Ser Asn Asn Tyr Ala Ile Tyr Tyr Ala
Asp Ser 1 5 10 15 Val Lys Asp 1738PRTMus
musculusMISC_FEATURE(1)..(8)2A4 VH CDR3 173Pro Tyr Ser Asp Ser Phe
Ala Tyr 1 5 174112PRTArtificial SequenceHumanized 7D8 v kappa light
chain version 4 174Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu Pro
Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser
Leu Ser Leu Val His Ser 20 25 30 Thr Gly Asn Thr Tyr Leu His Trp
Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu Ile Tyr
Lys Val Ser Asn Arg Phe Ser Gly Val Pro 50 55 60 Asp Arg Phe Ser
Gly Ser Gly Ser Gly Thr Tyr Phe Thr Leu Lys Ile 65 70 75 80 Ser Arg
Val Glu Ala Glu Asp Val Gly Val Tyr Phe Cys Ser Gln Ser 85 90 95
Thr His Val Pro Phe Thr Phe Gly Gly Gly Thr Lys Leu Glu Ile Lys 100
105 110 175112PRTArtificial SequenceHumanized 7D8 v kappa light
chain version 5 175Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu Pro
Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser
Leu Ser Leu Val His Ser 20 25 30 Thr Gly Asn Thr Tyr Leu His Trp
Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu Ile Tyr
Lys Val Ser Asn Arg Phe Ser Gly Val Pro 50 55 60 Asp Arg Phe Ser
Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Lys Ile 65 70 75 80 Ser Arg
Val Glu Ala Glu Asp Val Gly Val Tyr Phe Cys Ser Gln Ser 85 90 95
Thr His Val Pro Phe Thr Phe Gly Gly Gly Thr Lys Leu Glu Ile Lys 100
105 110 176112PRTArtificial SequenceHumanized 7D8 v kappa light
chain version 6 176Asp Val Val Met Thr Gln Ser Pro Leu Ser Leu Pro
Val Thr Pro Gly 1 5 10 15 Glu Pro Ala Ser Ile Ser Cys Arg Ser Ser
Leu Ser Leu Val His Ser 20 25 30 Thr Gly Asn Thr Tyr Leu His Trp
Tyr Leu Gln Lys Pro Gly Gln Ser 35 40 45 Pro Gln Leu Leu Ile Tyr
Lys Val Ser Asn Arg Phe Ser Gly Val Pro 50 55 60 Asp Arg Phe Ser
Gly Ser Gly Ser Gly Thr Asp Phe Thr Leu Lys Ile 65 70 75 80 Ser Arg
Val Glu Ala Glu Asp Val Gly Val Tyr Tyr Cys Ser Gln Ser 85 90 95
Thr His Val Pro Phe Thr Phe Gly Gly Gly Thr Lys Leu Glu Ile Lys 100
105 110 17716PRTMus musculus 177Arg Ser Ser Leu Ser Leu Val His Ser
Thr Gly Asn Thr Tyr Leu His 1 5 10 15
* * * * *
References