U.S. patent application number 16/430079 was filed with the patent office on 2019-10-17 for treatment of hormonal disorders of growth.
This patent application is currently assigned to The United States of America, as represented by the Secretary, Department of Health and Human Servic. The applicant listed for this patent is CENTRE HOSPITALIER UNIVERSITAIRE DE LIEGE, The United States of America, as represented by the Secretary, Department of Health and Human Servic, The United States of America, as represented by the Secretary, Department of Health and Human Servic, UNIVERSITE DE LIEGE. Invention is credited to Albert Beckers, Adrian Francis Daly, Fabio Rueda Faucz, Constantine A. Stratakis, Giampaolo Trivellin.
Application Number | 20190314459 16/430079 |
Document ID | / |
Family ID | 54695855 |
Filed Date | 2019-10-17 |
United States Patent
Application |
20190314459 |
Kind Code |
A1 |
Beckers; Albert ; et
al. |
October 17, 2019 |
TREATMENT OF HORMONAL DISORDERS OF GROWTH
Abstract
The present invention refers to a GPR101 inhibitor, antagonist
or inverse agonist or inverse agonist for use in preventive and/or
therapeutic treatment of diseases selected from the group
consisting of acromegaly and gigantism and to methods for
preventive and/or therapeutic treatment of diseases selected from
the group consisting of acromegaly and gigantism. Further, the
present invention provides a GPR101 agonist for use in preventive
and/or therapeutic treatment of disorders selected from the group
consisting of dwarfism, short stature, hypopituitarism and a
disease of low levels of pituitary hormone secretion and to methods
for preventive and/or therapeutic treatment of diseases selected
from the group consisting of dwarfism, short stature,
hypopituitarism and a disease of low levels of pituitary hormone
secretion wherein to a subject GPR101 agonist is administered.
Inventors: |
Beckers; Albert; (Pepinster,
BE) ; Daly; Adrian Francis; (Gijon, ES) ;
Faucz; Fabio Rueda; (Bethesda, MD) ; Stratakis;
Constantine A.; (Bethesda, MD) ; Trivellin;
Giampaolo; (Bethesda, MD) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
The United States of America, as represented by the Secretary,
Department of Health and Human Servic
UNIVERSITE DE LIEGE
CENTRE HOSPITALIER UNIVERSITAIRE DE LIEGE |
Bethesda
Angleur
Liege |
MD |
US
BE
BE |
|
|
Assignee: |
The United States of America, as
represented by the Secretary, Department of Health and Human
Servic
Bethesda
MD
UNIVERSITE DE LIEGE
Angleur
CENTRE HOSPITALIER UNIVERSITAIRE DE LIEGE
Liege
|
Family ID: |
54695855 |
Appl. No.: |
16/430079 |
Filed: |
June 3, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
15525928 |
May 10, 2017 |
10350273 |
|
|
PCT/US2015/060442 |
Nov 12, 2015 |
|
|
|
16430079 |
|
|
|
|
62078517 |
Nov 12, 2014 |
|
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|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
C12N 15/1138 20130101;
C12N 2310/14 20130101; A61K 47/60 20170801; C07K 16/28 20130101;
C07K 14/705 20130101; A61K 31/352 20130101; A61K 31/473 20130101;
A61K 38/12 20130101; A61P 5/06 20180101; A61K 38/27 20130101; C12N
2310/11 20130101; A61K 38/1709 20130101; A61K 31/48 20130101; A61K
31/713 20130101; C07K 14/723 20130101; A61K 38/31 20130101; A61K
31/437 20130101; A61P 35/00 20180101 |
International
Class: |
A61K 38/31 20060101
A61K038/31; A61K 31/48 20060101 A61K031/48; A61K 38/17 20060101
A61K038/17; A61K 47/60 20060101 A61K047/60; A61K 31/713 20060101
A61K031/713; A61K 31/437 20060101 A61K031/437; C07K 16/28 20060101
C07K016/28; A61K 31/352 20060101 A61K031/352; A61K 38/27 20060101
A61K038/27; A61K 38/12 20060101 A61K038/12; C12N 15/113 20060101
C12N015/113; C07K 14/705 20060101 C07K014/705; A61K 31/473 20060101
A61K031/473 |
Claims
1. A non-human transgenic animal, comprising an expressed transgene
encoding GPR101.
2. The non-human transgenic animal according to claim 1, wherein
the transgene comprises the nucleic acid sequence shown in SEQ ID
NO: 1, or encodes a protein having the amino acid sequence shown in
SEQ ID NO: 2.
3. The non-human transgenic animal according to claim 1, wherein
the transgenic animal is a transgenic mammal.
4. The non-human transgenic animal according to claim 1, wherein
the animal is a chicken
5. The non-human transgenic animal according to claim 1, wherein
the animal is a cow or a pig.
6. The non-human transgenic animal of claim 1, wherein the animal
has increased body ma
7. A method of increasing body mass and/or body size of a livestock
comprising: administering to the livestock an effective amount of
GPR101 agonist, or a GPR01 protein, thereby increasing body mass
and/or body size of the livestock.
8. The method according to claim 7, wherein the livestock is a
chicken, a goose, a duck, a turkey, a pheasant, a pig, a cow, a
sheep, or a goat.
9. The method of claim 7, wherein the method increases body mass of
the livestock.
10. The method of claim 7, wherein the method increases body size
of the livestock.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This is a continuation of U.S. patent application Ser. No.
15/525,928, filed May 10, 2017, which is a .sctn. 371 U.S. national
stage of International Application No. PCT/US2015/060442, filed
Nov. 12, 2015, which was published in English under PCT Article
21(2), which claims the benefit of U.S. Provisional Application No.
62/078,517, filed Nov. 12, 2014. The prior applications are
incorporated herein by reference in their entirety.
FIELD
[0002] This relates to a method for treatment of hormonal disorders
of growth and to the use of agents for treatment of hormonal
disorders of growth, such as, but not limited to, acromegaly,
gigantism, dwarfism, short stature, hypopituitarism and a disease
of low levels of pituitary hormone secretion.
BACKGROUND
[0003] Secretion of hormones by glands of the endocrine system is
responsible for regulating many important physiological processes
in the body. The primary central regions that are responsible for
controlling hormonal networks are the hypothalamus and the
pituitary gland. Factors released by neurons in certain nuclei of
the hypothalamus have stimulatory or inhibitory actions on the
anterior pituitary gland cells. These anterior pituitary gland
cells release hormones into the circulation, such as growth hormone
(GH) and thyroid stimulating hormone, that, in turn, have potent
erects on the production of growth factors and other hormones at
the level of the liver, thyroid gland etc. Control of these systems
is crucial to normal development across multiple animal species
including humans. For instance, human GH secretion has a pattern
that is pulsatile and diurnal: peaks of GH occur every two to four
hours, usually at night. GH secretion is regulated by hormonal and
biochemical factors. GH releasing hormone (GHRH) and somatostatin
play opposite roles in modulating GH secretion: GHRH is a
stimulator and somatostatin is an inhibitor. GHRH is released by
neurons in the median eminence and the infudibular nucleus of the
hypothalamus and this pulsatile release of GHRH is a potent
stimulator of GH secretion from the anterior pituitary. GH
stimulates IGF-I release from the liver and other tissues, which
then feeds back to stimulate somatostatin and inhibit GHRH under
normal circumstances.
[0004] Regulation of GHRH receptor (GHRH-R) and somatostatin
receptor (SSTR) concentrations in the pituitary gland play an
important role in the fine control of this system, as do the
actions of other hormones such as estrogen and testosterone.
However much remains to be learned about integration of systems of
control at the hypothalamic level, where signals regarding body
growth, energy utilization and sexual maturation need to be
orchestrated so as to occur at the appropriate time. Other networks
of hormone function controlled by the hypothalamus and pituitary,
such as gonadotrope regulation of sexual development and fertility,
corticotrope regulation of adrenal corticosteroid activity and
thyrotrope regulation of thyroid hormone activity have similar
processes of integrating peripheral feedback.
[0005] Dysfunction of the hypothalamus and the pituitary can,
therefore, lead to profound disturbances in hormonal control of
normal physiology. Underactivity of hypothalamic and pituitary
hormone secretion leads to syndromes of hypopituitarism, which vary
in severity depending on the variety of hormone axes affected. For
example, deficiency in hypothalamic and pituitary signals governing
MIRE and GH release caused by genetic mutations can lead to forms
of short stature or dwarfism. Replacement therapy is required in
these conditions depending on the deficient hormones; individuals
with short stature or dwarfism due to OH deficiency in childhood
can be treated with GH to increase final adult height.
[0006] When tumors occur in endocrine cells, this can lead to
disruption of normal hormonal secretion, either by destruction of
the gland by non-hormone secreting tumor cells and concomitant
undersecretion of hormones, or by overgrowth of hormone secreting
cells in the tumor, leading to hyper-secretion of hormones. In the
latter situation, the subject suffering from an endocrine tumor can
suffer symptoms caused by growth of the tumor itself, combined with
the effects of hormone over-secretion. In humans and other mammals,
for example, a tumor of the pituitary gland may over-secrete active
hormones GH or adrenocorticotropic hormone (ACTH), among others,
leading to well-known diseases such as acromegaly-gigantism and
Cushing disease, respectively. Endocrine gland tumors are
associated with significant morbidity and increased mortality when
not controlled by available therapies. For tumors of the pituitary
gland, medical, surgical and radiotherapies are used, either alone
or in combination, to control disease.
[0007] For example, GH hypersecretion by a pituitary tumor in a
subject that has not finished pubertal growth (i.e. bone growth
plates have not yet fused) can cause physical overgrowth, including
increased height, leading to a disease called gigantism. In adults,
similar GH secreting pituitary tumors cause a disease called
acromegaly in which an overgrowth deformation of the face and
extremities is accompanied by important morbidities of the
metabolic system and cardiovascular system, among others. Diseases
of the pituitary gland like acromegaly can be treated medically
using a somatostatin analog, such as, octreotide or lanreotide.
Neurosurgical resection of the tumor can be performed; either as a
complete or partial resection (called "debulking"), and
radiotherapy (conventional or targeted gamma-knife methods) is
usually reserved for cases that do not respond to medical and
surgical therapies. Somatostatin analogs are used in a number of
settings for endocrine and neuroendocrine tumor control. They are
used as a treatment for GH secreting tumors causing acromegaly and
gigantism. When these therapies are ineffective, tumor growth and
elevated hormone levels can lead to serious disease effects and can
increase mortality. Other alternate therapies for acromegaly,
gigantism and other disorders of pituitary hormone hypersecretion
could be medically useful.
SUMMARY
[0008] In some embodiments, the use of a GPR101 inhibitor,
antagonist or inverse agonist for preventive and/or therapeutic
treatment of diseases selected from the group consisting of
acromegaly and gigantism is disclosed.
[0009] In additional embodiments, the use of GPR101 agonist for use
in preventive and/or therapeutic treatment of disorders selected
from the group consisting of dwarfism, short stature,
hypopituitarism and a disease of low levels of pituitary hormone
secretion is disclosed.
[0010] In some embodiments, methods are disclosed for reducing
hormone secretion from the hypothalamus and pituitary gland in a
subject by administering a GPR101 antagonist.
[0011] In yet other embodiments, methods are disclosed for reducing
hormone production by a pituitary tumor or hyperplasia in a subject
by administering a GPR101 antagonist.
[0012] In additional embodiments methods are disclosed for reducing
the growth velocity of a subject with a pituitary tumor or
hyperplasia where said tumor or hyperplasia causes growth hormone
over-secretion and increased height (the clinical disease of
gigantism) by administering a GPR101 antagonist.
[0013] In other embodiments, methods are disclosed for reducing
hormone production by a pituitary tumor or hyperplasia where said
tumor or hyperplasia over-secretes growth hormone over-secretion
and leads to the clinical disease of acromegaly by administering a
GPR101 antagonist.
[0014] In some embodiments, methods are disclosed for reducing
hormone production by a pituitary tumor or hyperplasia where the
tumor or hyperplasia over-secretes prolactin (prolactinoma), causes
Cushing's disease due to an adrenocorticotropic hormone (ACTH)
secreting pituitary tumor, or a thyroid stimulating hormone (TSH)
secreting pituitary adenoma, or pituitary tumors secreting a
variety of different hormones by administering a GPR101
antagonist.
[0015] In additional embodiments, methods are disclosed for
controlling the growth of a pituitary tumor where the tumor
secretes functional hormone or no functional hormones (a
non-functioning pituitary adenoma) by administering a GPR101
antagonist.
[0016] In further embodiments, methods are disclosed for increasing
hormone production from the hypothalamus and pituitary gland in a
subject by stimulating hormone production by administering a GPR101
agonist.
[0017] In yet other embodiments, methods are disclosed for
increasing hormone production by the hypothalamus and pituitary in
a subject where said subject has the disease of hypopituitarism and
low levels of pituitary hormone secretion by stimulating hormone
production by administering a GPR101 agonist.
[0018] In some embodiments, methods are disclosed for increasing
hormone production by the hypothalamus and pituitary in a subject
where said subject has the disease of dwarfism or short stature due
to growth hormone deficiency by stimulating growth hormone
production by administering a GPR101 agonist.
[0019] In additional embodiments, methods are disclosed for
increasing the growth rate of a subject where said subject has the
disease of dwarfism or short stature due to growth hormone
deficiency by stimulating growth by administering a GPR101
agonist.
[0020] In further embodiments, disclosed is a GHRH inhibitor,
antagonist or inverse agonist for use in the therapeutic treatment
of X-linked acrogigantism (X-LAG syndrome).
[0021] In yet other embodiments, disclosed is a GH antagonist for
use in the therapeutic treatment of X-linked acrogigantism (X-LAG
syndrome).
[0022] In some embodiments, methods are disclosed for increasing
body mass and/or body size of lifestock comprising administering to
livestock an effective amount of a GPR101 agonist.
[0023] In addition, a non-human transgenic animal is disclosed,
wherein cells in the transgenic animal express a transgene encoding
GPR101 or overexpressing an endogenous GPR101 gene.
[0024] The foregoing and other features and advantages will become
more apparent from the following detailed description of several
embodiments, which proceeds with reference to the accompanying
figures.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] FIGS. 1A-1F shows the results relating to the expression of
GPR101 in Pituitary Tissue from Children with Xq26.3
Microduplications. The expression of GPR101 in pituitary tissue
from children carrying Xq26.3 microduplications was increased by a
factor as high as 1000, as compared with the expression in
unaffected pituitary tissue (in five samples [NP1 through NP5]
obtained on autopsy) and in pituitary tumors from two patients with
sporadic acromegaly (GH1 and GH2) who tested negative for the
microduplication (Panel A). These findings, which were obtained on
quantitative reverse-transcriptase-polymerase-chain-reaction
(qRT-PCR) assay and normalized by a housekeeping gene, contrast
with those for two other genes, ARHGEF6 (Panel B) and RBMX (Panel
C), in the duplicated stretch of DNA; neither of these two genes
showed up-regulated expression. Also shown are cell proliferation
(Panel D), growth hormone secretion (Panel E), and activation of
DNA sequences called cyclic AMP response elements (CRE) (Panel F)
in rat GH3 cells transfected with mutant (p.E308D and p.A397K) and
nonmutant GPR101 constructs. Values for cells transfected with
empty (control) vector were set at 1. Also shown are values for
untreated cells (vehicle) and forskolin (which increases CRE
activation). Data are expressed as the mean results of three to
five independent experiments, each of which was performed in
triplicate. The T bars indicate standard deviations. One asterisk
denotes P<0.05, two asterisks P<0.01, and three asterisks
P<0.001.
[0026] FIGS. 2A-2C show dynamic and pulsatility testing. Elevated
growth hormone (GH), prolactin (PRL) and GHRH levels were seen
throughout an extended testing period of 180 minutes (Panel A). GH
levels are seen to peak at 150 min after an earlier GHRH rise
between 105 min and 135 min. A TRH test induced an immediate and
marked increase in GH levels and GHRH remained largely unchanged
(Panel B). GnRH administration led to suppression of GH levels at
30 mins, whereas GHRH levels remained unaltered and prolactin rose
mildly (Panel C).
[0027] FIGS. 3A-3D shows the in vitro dose-effect on GH (A, C) and
PRL (B, D) secretion in somatotroph cells after overnight
incubation with (A,B) GHRH, GnRH1-5, (C,D) octreotide (OCT)
cabergoline (CAB) or pasireotide (PAS). The results are expressed
as the mean percentage of PRL or GH change compared to the values
of control wells (ctrl). *: p<0.05.
[0028] FIGS. 4A-4B show the in vitro dose-effect on GH (A) and PRL
(B) secretion in somatotroph cells after overnight incubation with
GHSR agonist (MK-0677) or GHSR-inverse agonist (MSP). The results
are expressed as the mean percentage of PRL or GH change compared
to the values of control wells (ctrl). *: p<0.05.
[0029] FIGS. 5A-5B show the in vitro dose-effect on GH (A) and PRL
(B) secretion in somatotroph cells after overnight incubation with
GHRH-R antagonist, with or without GHRH at 10.sup.-10 M. The
results are expressed as the mean percentage of PRL or GH change
compared to the values of control wells (ctrl). *: p<0.05.
SEQUENCE LISTING
[0030] The nucleic and amino acid sequences listed in the
accompanying sequence listing are shown using standard letter
abbreviations for nucleotide bases, and three letter code for amino
acids, as defined in 37 C.F.R. 1.822. Only one strand of each
nucleic acid sequence is shown, but the complementary strand is
understood as included by any reference to the displayed strand.
The Sequence Listing is submitted as an ASCII text file
Sequence_Listing.txt, May 29, 2019, 8,712 bytes, which is
incorporated by reference herein.
[0031] Unless otherwise explained, all technical and scientific
terms used herein have the same meaning as commonly understood by
one of ordinary skill in the art to which this disclosure belongs.
The singular terms "a," "an," and "the" include plural referents
unless context clearly indicates otherwise. Unless context
indicates otherwise, a reference to "A or B" encompasses A, B, and
both "A and B." It is further to be understood that all base sizes
or amino acid sizes, and all molecular weight or molecular mass
values, given for nucleic acids or polypeptides are approximate,
and are provided for description. Although methods and materials
similar or equivalent to those described herein can be used in the
practice or testing of this disclosure, suitable methods and
materials are described below. The term "comprises" means
"includes." All publications, patent applications, patents, and
other references mentioned herein are incorporated by reference in
their entirety. In case of conflict, the present specification,
including explanations of terms, will control. Reference to the
"invention" is descriptive of particular embodiments and is not
meant to imply that any particular limitation is critical or
essential for operation. In addition, the materials, methods, and
examples are illustrative only and not intended to be limiting.
DETAILED DESCRIPTION
[0032] Methods are disclosed for treatment of hormonal disorders of
growth and to the use of agents for treatment of hormonal disorders
of growth, such as, but not limited to, acromegaly, gigantism,
dwarfism, short stature, hypopituitarism and a disease of low
levels of pituitary hormone secretion. Medicaments and therapies
are disclosed for treatment of acromegaly, gigantism and other
disorders of pituitary hormone hypersecretion.
[0033] When carrying out the studies for the present invention the
present inventors have discovered a microduplication of a series of
genes on chromosome Xq26.3 in human patients with gigantism due to
GH and prolactin over-secreting pituitary adenomas occurring as
children and in certain families with familial isolated pituitary
adenomas. Among those genes, the only duplicated gene that was seen
at increased levels in mRNA and immunohistochemical staining
studies of pituitary tissues was GPR101 This increased expression
of GPR101 and increased levels in tumor tissue was accompanied by
an increase in numbers of GHRH receptors (GHRH-R), indicating that
this gene duplication of GPR101 was having a direct effect on the
pituitary tissue to increase the responsiveness to stimulatory
signals from GHRH via activation of its receptor. Despite very high
circulating GH and IGF-1 levels, the level of circulating GURU was
not inhibited as would be expected. Indeed the studies according to
the present invention showed that in cases of microduplications
involving GPR101 that increased circulating levels of GHRH are
seen. In particular, it was subsequently demonstrated that such
cases can have chronically elevated GHRH levels in the blood.
Studies on the tumor of one such case demonstrated responsiveness
in terms of GH and prolactin secretion to GHRH stimulation. This
effect in the tumor could be blocked by a GHRH inhibitor. This
further indicates an important dysregulation of pituitary
growth-promoting signals due to the GPR101 duplication. The disease
severity of these patients with duplicated GPR101 was also very
remarkable, having pituitary tumors and hyperplasia at a very young
age (<3 years), and the management of these cases was
complicated by poor treatment responses. These data indicate that
GPR101 duplication has a previously unrecognized role in the
modulation of growth. Previous studies on GPR101 have not
demonstrated that it plays a role in growth of the body or in
increased secretion of GHRH, increased expression of GHRH-R or
higher circulating levels of GH, IGF-1 and prolactin. Similarly
this is the first data to note that GPR101 can play a role in the
generation of pituitary tumors and can cause severe growth
disorders.
[0034] Treatment of pituitary tumors such as those that cause
gigantism and acromegaly is complex and multi-modal in many cases.
Medical therapy with somatostatin analogs is associated with
incomplete control in over 40% of cases. Other treatment options
such as neurosurgery or radiotherapy are not suitable for all
patients and can have significant side effects. Tumors of patients
with gigantism due to pituitary tumors caused by microduplications
involving the GPR101 gene can have increased GPR101 and GHRH-R
levels in their tumors. Similarly these cases can have elevated
circulating GHRH levels, indicating a hypothalamic disorder as this
is the site of GHRH generation. GPR101 has been shown to be mainly
present in regions of the hypothalamus and linked to the
hypothalamus. Inhibition of GPR101 by an antagonist or
downregulation of GPR101 by other means (e.g. small interfering
RNA, anti GPR101 antibodies) can reduce tumor growth, decrease
GHRH-R levels and normalize circulating GH, IGF-1 and prolactin
levels. This has the effect of improving the health of the treated
patient by decreasing the effects of over-secreted hormones on the
patient. In contrast, stimulation of GPR101 by an agonist or
upregulation of GPR101 levels in patients with low endogenous
pituitary hormone secretion (hypopituitarism) could increase
circulating hormone production (e.g. GH) and reduce disease
severity (e.g. increase vertical growth). This has the effect of
improving the health of the treated patient by increasing the
deficient hormone levels and reducing the effect of pituitary
hormone deficiency on the patient.
[0035] In a first aspect, this invention relates to a method for
reducing the effects of hormones secreted by tumors with increased
levels of GPR101 in a human or a non-human subject, in whom this
effect of reducing hormonal levels is to improve the health of the
subject and such a method involves the administration of an
antagonist or inverse agonist of GPR101.
[0036] In a first embodiment of said first aspect said subject is a
mammal. It is preferable that said mammal is a human. It is more
preferable that the subject is a human with a tumors growth causing
elevated levels of hormones in the blood that are deleterious to
the health of the subject. More preferably still, the subject is a
human with a tumor of the pituitary gland that secretes elevated
levels of growth hormone causing gigantism or acromegaly. Again
more preferably the subject with gigantism or acromegaly is treated
with an antagonist of GPR101 to reduce the secretion of growth
hormone to levels compatible with normal health.
[0037] In a second aspect, the invention relates to a method for
normalizing serum prolactin concentration in a human or non-human
subject in whom such normalization is desirable. This method
comprises administering to said subject an antagonist of
GPR101.
[0038] In a first embodiment of this second aspect said subject is
a mammal. Preferably said mammal is a human, more preferably a
human whose blood plasma level of prolactin is higher than desired,
and again more preferably still a human who is suffering from
acromegaly or who is at risk of developing acromegaly or symptoms
thereof. More preferably still the subject with elevated levels of
prolactin is treated with an antagonist of GPR101 to reduce the
secretion of prolactin to levels compatible with normal health.
[0039] In a third aspect, the invention relates to a method for
normalizing serum insulin-like growth factor 1 (IGF-1)
concentration in a human or non-human subject in whom such
normalization is desirable. This method comprises administering to
said subject an antagonist or inverse agonist of GPR101.
[0040] In a first embodiment of this third aspect said subject is a
mammal. Preferably said mammal is a human, more preferably a human
whose blood plasma level of IGF-1 is higher than desired, more
preferably still a human who is suffering from gigantism or
acromegaly. More preferably still the subject with elevated levels
of IGF-1 is treated with an antagonist or inverse agonist of GPR101
to reduce the secretion of IGF-1 to levels compatible with normal
health.
[0041] In a fourth aspect, the invention relates to a method for
normalizing serum adrenocorticotropic hormone (ACTH) concentration
in a human or non-human subject in whom such normalization is
desirable. This method comprises administering to said subject an
antagonist of GPR101.
[0042] In a first embodiment of this fourth aspect said subject is
a mammal. Preferably said mammal is a human, more preferably a
human whose blood plasma level of ACTH is higher than desired, more
preferably still a human who is suffering from Cushing's disease.
More preferably still the subject with elevated levels of ACTH is
treated with an antagonist of GPR101 to reduce the secretion of
ACTH to levels compatible with normal health.
[0043] In a fifth aspect, the invention relates to a method for
normalizing serum cortisol concentration in a human or non-human
subject in whom such normalization is desirable. This method
comprises administering to said subject an antagonist of
GPR101.
[0044] In a first embodiment of this fifth aspect said subject is a
mammal. Preferably said mammal is a human, more preferably a human
whose blood plasma level of cortisol is higher than desired, more
preferably still a human who is suffering from Cushing's disease.
More preferably still the subject with elevated levels of cortisol
is treated with an antagonist or inverse agonist of GPR101 to
reduce the secretion of cortisol to levels compatible with normal
health.
[0045] In a sixth aspect, this invention relates to a method for
increasing the secretion of hormones in a human or a non-human
subject, in whom this effect of increasing hormonal levels is to
improve the health of the subject and such a method involves the
administration of an agonist of GPR101.
[0046] In a first embodiment of said sixth aspect said subject is a
mammal. It is preferable that said mammal is a human. It is more
preferable that the subject is a human with abnormally decreased
levels of hormones in the blood that is deleterious to the health
of said subject. More preferably still, the subject is a human with
a deficiency of pituitary gland hormone secretion causing
hypopituitarism. Again more preferably the subject is a human with
a deficiency of pituitary gland hormone secretion that includes
deficient growth hormone secretion leading to growth hormone
deficiency and more preferably the subject is treated with an
agonist of GPR101 to increase the secretion of growth hormone to
levels compatible with normal health.
[0047] In a seventh aspect, this invention relates to a method for
increasing the secretion of IGF-1 in a human or a non-human
subject, in whom this effect of increasing hormonal levels is to
improve the health of the subject and such a method involves the
administration of an agonist of GPR101.
[0048] In a first embodiment of said seventh aspect said subject is
a mammal. It is preferable that said mammal is a human. It is more
preferable that the subject is a human with abnormally decreased
levels of hormones in the blood that is deleterious to the health
of said subject. More preferably still, the subject is a human with
a deficiency of IGF-1 secretion leading to IGF-1 deficiency and
more preferably the subject is treated with an agonist of GPR101 to
increase the secretion of IGF-1 to levels compatible with normal
health.
[0049] In a eighth aspect, this invention relates to a method for
increasing the secretion of ACTH in a human or a non-human subject,
in whom this effect of increasing hormonal levels is to improve the
health of the subject and such a method involves the administration
of an agonist of GPR101.
[0050] In a first embodiment of said eighth aspect said subject is
a mammal. It is preferable that said mammal is a human. It is more
preferable that the subject is a human with abnormally decreased
levels of hormones in the blood that is deleterious to the health
of said subject. More preferably still, the subject is a human with
a deficiency of pituitary gland hormone secretion causing
hypopituitarism. Again more preferably, the subject is a human with
a deficiency of ACTH secretion leading to ACTH deficiency and more
preferably the subject is treated with an agonist of GPR101 to
increase the secretion of ACTH to levels compatible with normal
health.
[0051] In a ninth aspect, this invention relates to a method for
increasing the secretion of cortisol in a human or a non-human
subject, in whom this effect of increasing hormonal levels is to
improve the health of the subject and such a method involves the
administration of an agonist of GPR101.
[0052] In a first embodiment of said ninth aspect said subject is a
mammal. It is preferable that said mammal is a human. It is more
preferable that the subject is a human with abnormally decreased
levels of hormones in the blood that is deleterious to the health
of said subject. More preferably still, the subject is a human with
a deficiency of cortisol secretion leading to cortisol deficiency
and more preferably the subject is treated with an agonist of
GPR101 to increase the secretion of cortisol to levels compatible
with normal health.
[0053] Disclosed are the following, without limitation:
[0054] (1) A GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment of diseases selected
from the group consisting of acromegaly and gigantism.
[0055] (2) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to (1),
wherein said diseases are caused by a pituitary tumor or
hyperplasia.
[0056] (3) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to (1) or
(2), wherein said diseases are caused by over-secretion of growth
hormone by a pituitary tumor or hyperplasia.
[0057] (4) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to (2) or
(3), wherein said tumor or hyperplasia over-secretes prolactin
(prolactinoma), causes Cushing's disease due to an
adrenocorticotropic hormone (ACTH) secreting pituitary tumor, or a
thyroid stimulating hormone (TSH) secreting pituitary adenoma, or
pituitary tumors secreting a variety of different hormones.
[0058] (5) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to any one
of (1) to (4), for use in controlling the growth of a pituitary
tumor wherein the tumor secretes functional hormone or no
functional hormones.
[0059] (6) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to (1),
for reducing hormone secretion from the hypothalamus and pituitary
gland.
[0060] (7) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to (1),
for reducing hormone production by a pituitary tumor or
hyperplasia.
[0061] (8) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to any one
of (1) to (7), wherein the GPR101 inhibitor is selected from the
group consisting of a monoclonal or polyclonal antibody
specifically binding to GPR101, an antisense nucleic acid, small
interfering RNA or chemical analogue of antisense nucleic acid or
small interfering RNA specifically hybridizing to GPR101 mRNA or a
chemical compound specifically inhibiting GPR101 activity,
preferably the GPR101 inhibitor is a small interfering RNA or an
anti-GPR101 antibody.
[0062] (9) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to any one
of (1) to (8), wherein the GPR101 inhibitor is a small interfering
RNA complementary to a target sequence comprised within the nucleic
acid having the nucleotide sequence shown in SEQ ID NO: 1 or a
fragment thereof.
[0063] (10) The GPR101 inhibitor, antagonist or inverse agonist for
use in preventive and/or therapeutic treatment according to any one
of (1) to (8), wherein the GPR101 inhibitor is an anti-GPR101
antibody specifically binding to GPR101 protein or to a protein
consisting of or comprising the amino acid sequence shown in SEQ ID
NO: 2 or a fragment thereof.
[0064] (11) A GPR101 agonist for use in preventive and/or
therapeutic treatment of disorders selected from the group
consisting of dwarfism, short stature, hypopituitarism and a
disease of low levels of pituitary hormone secretion.
[0065] (12) The GPR101 agonist for use in preventive and/or
therapeutic treatment according to (11), wherein the disease is due
to growth hormone deficiency.
[0066] (13) The GPR101 agonist for use in preventive and/or
therapeutic treatment according to (11) or (12), wherein the GPR101
agonist is GPR101 protein or a fragment thereof.
[0067] (14) The GPR101 agonist for use in preventive and/or
therapeutic treatment according to (13), wherein the GPR101 agonist
is GPR101 protein consisting of or comprising the amino acid
sequence shown in SEQ ID NO: 2 or a fragment thereof.
[0068] (15) A method for reducing hormone secretion from the
hypothalamus and pituitary gland in a subject by administering a
GPR101 antagonist.
[0069] (16) A method for reducing hormone production by a pituitary
tumor or hyperplasia in a subject by administering a GPR101
antagonist.
[0070] (17) A method for reducing the growth velocity of a subject
with a pituitary tumor or hyperplasia where said tumor or
hyperplasia causes growth hormone over-secretion and increased
height (the clinical disease of gigantism) by administering a
GPR101 antagonist.
[0071] (18) A method for reducing hormone production by a pituitary
tumor or hyperplasia where said tumor or hyperplasia over-secretes
growth hormone over-secretion and leads to the clinical disease of
acromegaly by administering a GPR101 antagonist.
[0072] (19) A method for reducing hormone production by a pituitary
tumor or hyperplasia where said tumor or hyperplasia over-secretes
prolactin (prolactinoma), causes Cushing's disease due to an
adrenocorticotropic hormone (ACTH) secreting pituitary tumor, or a
thyroid stimulating hormone (TSH) secreting pituitary adenoma, or
pituitary tumors secreting a variety of different hormones by
administering a GPR101 antagonist.
[0073] (20) A method for controlling the growth of a pituitary
tumor where the tumor secretes functional hormone or no functional
hormones (a non-functioning pituitary adenoma) by administering a
GPR101 antagonist.
[0074] (21) A method for increasing hormone production from the
hypothalamus and pituitary gland in a subject by stimulating
hormone production by administering a GPR101 agonist.
[0075] (22) A method for increasing hormone production by the
hypothalamus and pituitary in a subject where said subject has the
disease of hypopituitarism and low levels of pituitary hormone
secretion by stimulating hormone production by administering a
GPR101 agonist.
[0076] (23) A method for increasing hormone production by the
hypothalamus and pituitary in a subject where said subject has the
disease of dwarfism or short stature due to growth hormone
deficiency by stimulating growth hormone production by
administering a GPR101 agonist.
[0077] (24) A method for increasing the growth velocity of a
subject where said subject has the disease of dwarfism or short
stature due to growth hormone deficiency by stimulating growth by
administering a GPR101 agonist.
[0078] (25) The method according to any one of (15) to (24), where
the said subject is a human.
[0079] (26) The method according to any one of (15) to (24), where
the said subject is a non-human animal.
[0080] (27) GHRH inhibitor, antagonist or inverse agonist for use
in the therapeutic treatment of X-linked acrogigantism (X-LAG
syndrome).
[0081] (28) GHRH inhibitor, antagonist or inverse agonist for use
in the therapeutic treatment of X-linked acrogigantism according to
(27), wherein the X-linked acrogigantism is characterized by
gigantism occurring during infancy and a microduplication in
chromosome Xq26.3 that includes the orphan G-protein coupled
receptor (GPCR) gene, GPR101.
[0082] (29) GHRH inhibitor, antagonist or inverse agonist for use
in the therapeutic treatment of X-linked acrogigantism according to
(27) or (28), wherein the GHRH inhibitor, antagonist or inverse
agonist is selected from the group consisting of pasireotide,
octreotide, lanreotide, cabergoline and hGHRH peptide
antagonist.
[0083] (30) GH antagonist for use in the therapeutic treatment of
X-linked acrogigantism (X-LAG syndrome).
[0084] (31) GH antagonist for use in the therapeutic treatment of
X-linked acrogigantism according to (30), wherein the X-linked
acrogigantism is characterized by gigantism occurring during
infancy and a microduplication in chromosome Xq26.3 that includes
the orphan G-protein coupled receptor (GPCR) gene, GPR101.
[0085] (32) GH antagonist for use in the therapeutic treatment of
X-linked acrogigantism according to (30) or (31), wherein the GH
antagonist is pegvisomant.
[0086] (33) A method of increasing body mass and/or body size of
lifestock comprising administering to livestock an effective amount
of GPR101 agonist.
[0087] (34) The method of (33), wherein the livestock is selected
from the group consisting of poultry, including chickens, goose,
duck, turkey, pheasant, swine, cattle, sheep, and goat.
[0088] (35) A non-human transgenic animal, comprising as expressed
transgene a gene encoding GPR101 or overexpressing endogenous
GPR101 gene.
[0089] (36) The non-human transgenic animal according to (35),
wherein the transgene comprises the nucleic acid sequence shown in
SEQ ID NO: 1, or encodes a protein having the amino acid sequence
shown in SEQ ID NO: 2.
[0090] (37) The non-human transgenic animal according to (35) or
(36), being a non-human mammalian transgenic animal.
[0091] (38) The non-human transgenic animal according to (35) or
(36), wherein the animal is selected from the taxononic groups of
Gallus sp. (chicken), Maleagris sp. (turkey), Anatidae (duck,
goose), Bovidae, in particular Bos, Bubalus, Ovis; Sus sp.
(pig).
[0092] The present invention refers to medicaments and methods for
treating growth disorders in a human or non-human subject. An
inhibitor, antagonist or inverse agonist of GPR101, an orphan
G-protein coupled receptor (GPCR), is used as medicament and is
administrated to a subject for the purposes of reducing the
secretion of hormones by the hypothalamus or pituitary gland or
both. Said subjects will be individuals with tumors that have high
levels of GPR101 expression due to an activating mutation of the
GPR101 gene or a gene duplication or due to overexpression of the
GPR101 protein. Preferred embodiments of the method include
subjects with acromegaly or gigantism and high levels of GPR101 in
pituitary or hypothalamic tissue, leading to stimulation of tumor
growth and growth hormone and/or prolactin over-secretion by the
pituitary gland in whom administration of a GPR101 inhibitor,
antagonist or inverse agonist lowers hormone levels and reduces
severity of acromegaly or gigantism.
[0093] The present invention also refers to GPR101 agonists for
administration to individuals with inadequate secretion of hormones
from the hypothalamus or pituitary gland or both. Said subjects
will be individuals with low GPR101 activity due to an inactivating
mutation of the GPR101 gene, or a deletion of the GPR101 gene or
decreased expression of the GPR101 gene. Preferred embodiments
include subjects with hypopituitarism leading to abnormally growth
hormone secretion and short stature/dwarfism in whom administration
of a GPR101 agonist leads to stimulation of hypothalamic and/or
pituitary hormone secretion leading to increased circulating growth
hormone and increased or normalized height.
[0094] The present invention also provides GHRH inhibitors,
antagonists or inverse agonists and GH antagonists for use in the
therapeutic treatment of X-linked acrogigantism (X-LAG syndrome).
In particular, the X-LAG syndrome is characterized by gigantism
occurring during infancy and a microduplication in chromosome
Xq26.3 that includes the orphan G-protein coupled receptor (GPCR)
gene, GPR101. Preferably, the GHRH inhibitor, antagonist or inverse
agonist is selected from the group consisting of somatostatin
analogs, in particular pasireotide, octreotide and lanreotide,
dopamine agonists, in particular cabergoline, and hGHRH peptide
antagonists. Further preferred, the GH antagonist is
pegvisomant.
[0095] In addition, the present invention refers to a method of
increasing body mass and/or body size of lifestock comprising
administering to livestock an effective amount of GPR101 agonist.
By stimulating the GPR101 activity using an GPR101 agonist it is
expected that secretion of growth hormones increases which in turn
leads to increased body mass and/or body size and consequently to a
higher meat production by the livestock.
[0096] Further, the present invention is directed to a non-human
transgenic animal, comprising as expressed transgene a gene
encoding GPR101 or overexpressing endogenous GPR101 gene. Both
approaches, i) expressing as transgene a gene encoding GPR101, ii)
overexpressing endogenous GPR101 gene, will lead to an increase in
growth hormone secretion and to increased body mass and/or body
size, which in turn results in a higher meat production by the
livestock.
DESCRIPTION OF SEVERAL EMBODIMENTS
[0097] In particular, the present invention refers to agents for
treatment of diseases selected from the group consisting of
acromegaly and gigantism and to agents for treatment of diseases
selected from the group consisting of dwarfism, short stature,
hypopituitarism and a disease of low levels of pituitary hormone
secretion. The present invention further provides a method of
increasing body mass and/or body size of lifestock and a non-human
transgenic animal.
[0098] The present invention relates to a method useful for the
treatment of subjects with diseases of glands of the endocrine
system that may lead to increased or decreased levels of hormones
in the circulating blood. In particular this invention relates to
the control of hormone secretion and tumor growth in subjects with
increased levels of the orphan G Protein Coupled Receptor (GPCR),
GPR101, in their pituitary and brain (e.g. hypothalamus) due to
up-regulation or over-activity of the GPR101 gene. The invention
relates also to stimulating hormone secretion in subjects with
decreased levels of GPR101 in their pituitary and brain (e.g.
hypothalamus) due to down-regulation or lack of function of the
GPR101 gene. More particularly this invention relates to the
inhibition of excessive pituitary hormone secretion and improvement
in associated clinical symptoms (e.g. gigantism) from a pituitary
tumor using a GPR101 inhibitor, antagonist or inverse agonist, or
the stimulation of abnormally decreased pituitary hormone secretion
and improvement in associated clinical symptoms (e.g. dwarfism)
using a GPR101 agonist.
[0099] The present invention refers to a GPR101 inhibitor,
antagonist or inverse agonist for use in preventive and/or
therapeutic treatment of diseases selected from the group
consisting of acromegaly and gigantism and to methods for
preventive and/or therapeutic treatment of diseases selected from
the group consisting of acromegaly and gigantism wherein to a
subject GPR101 inhibitor, antagonist or inverse agonist is
administered.
[0100] Further, the present invention provides a GPR101 agonist for
use in preventive and/or therapeutic treatment of disorders
selected from the group consisting of dwarfism, short stature,
hypopituitarism and a disease of low levels of pituitary hormone
secretion and to methods for preventive and/or therapeutic
treatment of diseases selected from the group consisting of
dwarfism, short stature, hypopituitarism and a disease of low
levels of pituitary hormone secretion wherein to a subject GPR101
agonist is administered.
[0101] Moreover, the present invention provides GHRH inhibitors,
antagonists or inverse agonists and GH antagonists for use in the
therapeutic treatment of X-linked acrogigantism (X-LAG syndrome)
and methods for therapeutic treatment of X-LAG syndrome, wherein to
a subject GHRH inhibitor, antagonist or inverse agonist and/or GH
antagonist is administered.
[0102] X-linked acrogigantism (X-LAG) syndrome is a form of
inheritable pituitary gigantism that begins in early childhood and
is usually associated with very elevated growth hormone (GH) and
prolactin secretion by mixed pituitary adenomas. Microduplications
on chromosome Xq26.3 that include the gene GPR101 underlie the
genetic etiology of X-LAG syndrome.
[0103] Pituitary gigantism is a very recognizable but rare
disorder. Patients with pituitary gigantism develop growth hormone
(GH) excess from a pituitary tumor before closure of epiphyseal
growth plates. The etiology of pediatric or adolescent pituitary
tumors in general, and pituitary gigantism in particular, remains
relatively obscure, with about 50% of cases of the latter having no
known genetic cause. The most frequent known genetic cause is aryl
hydrocarbon receptor interacting protein gene (AIP) mutations.
During the studies according to the present invention a new
condition, termed X-linked acrogigantism, (X-LAG) syndrome, was
found. X-LAG syndrome is characterized by gigantism occurring
during infancy. X-LAG syndrome patients develop pituitary
adenomas/hyperplasia and greatly elevated growth hormone (GH) and
insulin-like growth factor 1 (IGF-1) levels that are usually
accompanied by hyperprolactinemia. Unlike other forms of pituitary
gigantism due to single gene mutations/deletions, the underlying
abnormality in X-LAG syndrome is a microduplication in chromosome
Xq26.3 that includes the orphan G-protein coupled receptor (GPCR)
gene, GPR101.
[0104] Patients with X-LAG syndrome usually develop pituitary
macroadenomas, while a few have hyperplasia alone or in conjunction
with adenoma. The elevated GH/IGF-1 levels are poorly responsive to
somatostatin analogs despite the presence of ample somatostatin
receptors. Control of growth and hormonal hypersecretion can be
achieved by radical resection of the anterior pituitary. Residual
tumor is capable of maintaining IGF-1 levels in the acromegalic
range for many years, necessitating multimodal therapy. According
to the present invention it was also found that the GH receptor
antagonist pegvisomant represents a useful option for IGF-1 and
growth control.
[0105] The terms GPR101, GPR101 protein and GPCR (orphan G Protein
Coupled Receptor) as used herein are synonyms. GPR101 is highly
expressed in hypothalamus and is predicted to couple to G.sub.s, a
potent activator of adenylyl cyclase. GPR101 protein is encoded by
the gene GPR101. The amino acid sequence of GPR101 is shown in SEQ
ID NO: 2. The nucleic acid sequence of the GPR101 mRNA is shown in
SEQ ID NO: 1.
[0106] As used herein "inhibitor of GPR101" generally refers to an
active agent, which selectively decreases or blocks the activity,
the bioavailability and biological effects of GPR101. Preferably,
the inhibitor of GPR101 is an active agent having one or more of
the following activities: i) selectively decreasing or blocking
binding of ligand to GPR101 protein, ii) selectively decreasing or
blocking binding of a fragment of gonadotropin-releasing hormone,
namely GnRH-(1-5), to GPR101 protein, iii) reducing or blocking
cAMP pathway activation by GPR101, iv) downregulate GPR101 mRNA,
protein and/or activity. Therefore, such inhibitor also may
generally downregulate GPR101 mRNA, protein and/or activity, which
includes reducing or blocking GPR101 mRNA transcription,
translation, transport, GPR101 protein transport, folding,
modification. As used herein the term "inhibitor" of GPR101 also
comprises "antagonists" and "inverse agonists" of GPR101.
[0107] As used herein an antagonist of GPR101 is an active agent,
which selectively decreases or blocks the activity, the
bioavailability and biological effects of GPR101. Preferably, the
antagonist of GPR101 is an active agent having one or more of the
following activities: i) selectively decreasing or blocking binding
of ligand to GPR101 protein, ii) selectively decreasing or blocking
binding of a fragment of gonadotropin-releasing hormone, namely
GnRH-(1-5), to GPR101 protein, iii) reducing or blocking cAMP
pathway activation by GPR101.
[0108] The present invention also refers to inverse agonists of
GPR101 Many GPCRs show spontaneous intrinsic constitutive
activation when they are on the membrane surface. Therefore, if
such GPCR is present it is "on" and do not require a ligand to
activate the respective GPCR type. This GPCR type requires a
different type of compound that would bind the receptor to switch
it off, which then is termed an "inverse agonist".
[0109] Said inhibitor of GPR101 may be a monoclonal or polyclonal
antibody specifically binding to GPR101, an antisense nucleic acid,
small interfering RNA or chemical analogue of antisense nucleic
acid or small interfering RNA specifically hybridizing to GPR101
mRNA or a chemical compound specifically inhibiting GPR101
activity. Preferably, the GPR101 inhibitor is small interfering RNA
or anti-GPR101 antibody.
[0110] In another embodiment the GPR101 inhibitor is an antisense
nucleic acid. Said antisense nucleic acid hybridises with GPR101
mRNA, which preferably has or comprises the nucleic acid sequence
shown in SEQ ID NO: 1.
[0111] More preferred, the GPR101 inhibitor is an antisense nucleic
acid or small interfering RNA complementary to a target sequence
comprised within the nucleic acid having the nucleotide sequence
shown in SEQ ID NO: 1 or a fragment thereof. Said small interfering
RNA is used for silencing GPR101. Said antisense nucleic acid is
for GPR101 knockdown. In a particularly preferred embodiment, the
GPR101 inhibitor is an antisense nucleic acid molecule or small
interfering RNA molecule that binds specifically to a complementary
target sequence of GPR101 RNA. The GPR101 target sequence which is
targeted by the siRNA is comprised within the nucleotide sequence
shown in SEQ ID NO: 1. Silencing of GPR101 by small interfering RNA
(siRNA) and GPR101 knockdown by antisense oligonucleotides has
successfully been carried out in human endometrial cells by
Cho-Clark et al. (Mol. Endocrinol., 28 (1), 80-98 (2014).
[0112] In another preferred embodiment the GPR101 inhibitor is an
anti-GPR101 antibody specifically binding to GPR101 protein or to a
protein consisting of or comprising the amino acid sequence shown
in SEQ ID NO: 2 or a fragment thereof.
[0113] Still further preferred, the GPR101 inhibitor is an
anti-GPR101 antibody specifically binding to GPR101 protein or to a
protein comprising one or more epitopes of GPR101 protein or one or
more epitopes comprised within the amino acid sequence shown in SEQ
ID NO: 2. Anti-GPR101 antibodies have already been described in the
prior art (for example in U.S. Pat. No. 8,142,762 B2, Example 13:
here rabbit polyclonal anti-GPR101 antibodies specific for the
carboxy terminus of rat, mouse and human GPR101).
[0114] In one embodiment the GPR101 inhibitor is an antibody which
may be a common antibody (which is composed of two heavy protein
chains and two light chains), Fab fragments of a common antibody,
single-chain variable fragments (scFV) or single-domain antibody
(sdAb). Said antibody specifically binds to GPR101, which
preferably has an amino acid sequence shown in SEQ ID NO: 2.
[0115] In yet another embodiment the GPR101 inhibitor is a fragment
of GPR101, preferably a fragment of GPR101 which interferes with
signaling. Said fragment of GPR101 is at least 8 consecutive amino
acid residues and up to 10, 12, 15, 18, 20, 30, 50, 80, 100, 150,
200, 250, 300, 350, 400, 450, 500, consecutive amino acids in
length of the amino acid sequence shown in SEQ ID NO: 2. The amino
acid sequence of said fragment may have further deletions,
additions and replacements of 1 to 20 amino acid residue
positions.
[0116] The present invention also relates to GHRH inhibitors,
antagonists or inverse agonists for use in the therapeutic
treatment of X-linked acrogigantism (X-LAG syndrome). Preferably,
the GHRH inhibitor, antagonist or inverse agonist is selected from
the group consisting of somatostatin analogs, in particular
pasireotide, octreotide and lanreotide, dopamine agonists, in
particular cabergoline, and hGHRH peptide antagonists. Further
preferred, the GH antagonist is pegvisomant.
[0117] Growth hormone releasing hormone (GHRH) is a peptide
belonging to the secretin glucagon family of neuroendocrine and
gastrointestinal hormones. Human GHRH (hGHRH) peptide is comprised
of 44 amino acid residues. The best known site of production of
GHRH is the hypothalamus. hGHRH is also produced by human malignant
tissues (cancers) of diverse origin. Hypothalamic GHRH is an
endocrine releasing hormone that, acting through specific GHRH
receptors on the pituitary, which regulates the secretion of
pituitary growth hormone (GH).
[0118] hGHRH peptide antagonists, also referred herein as "GHRH
receptor antagonist", have been implicated in treating various
disorders. GHRH peptide antagonists inhibit the proliferation of
malignancies by indirect endocrine mechanisms based on the
inhibition of pituitary GH release and resulting in the decrease of
serum levels of GH and IGF-1, as well as by direct effects on the
tumor tissue. Antagonistic analogs of GHRH can inhibit the
stimulatory activity of GHRH and exert direct antiproliferative
effects in vitro on cancer cells, and in vivo on tumors.
[0119] Various modifications of GHRH peptides confer antagonistic
properties. The GHRH fragment comprising residues 1 to 29, or
GHRH(1-29), is the minimum sequence necessary for biological
activity on the pituitary. This fragment retains 50% or more of the
potency of native GHRH. Many synthetic analogs of GHRH, based on
the structure of hGHRH(1-29)NH.sub.2 peptide have been prepared and
were described in WO95/16707, WO97/42223, WO00/31336, U.S. Pat.
Nos. 5,550,212, 5,942,489, 6,057,422, WO2014/004934 and US
2015/0166617, the disclosure of all of which is herein incorporated
by reference in its entirety. The peptide hGHRH(1-29)NH.sub.2 has
the following amino acid sequence:
Tyr-Ala-Asp-Ala-Ile-Phe-Thr-Asn-Ser-Tyr-Arg-Lys-Val-Leu-Gly-Gln-Leu-Ser-A-
la-Arg-Lys-Leu-Leu-Gln-Asp-Ile-Met-Ser-Arg-NH.sub.2 (SEQ ID NO: 3).
hGHRH(1-30)NH.sub.2 has the following amino acid sequence:
Tyr-Ala-Asp-Ala-Ile-Phe-Thr-Asn-Ser-Tyr-Arg-Lys-Val-Leu-Gly-Gln-Leu-Ser-A-
la-Arg-Lys-Leu-Leu-Gln-Asp-Ile-Met-Ser-Arg-Gln-NH.sub.2 (SEQ ID NO:
4). hGHRH(1-31)NH.sub.2 has the following amino acid sequence:
Tyr-Ala-Asp-Ala-Ile-Phe-Thr-Asn-Ser-Tyr-Arg-Lys-Val-Leu-Gly-Gln-Leu-Ser-A-
la-Arg-Lys-Leu-Leu-Gln-Asp-Ile-Met-Ser-Arg-Gln-Gln-NH.sub.2 (SEQ ID
NO: 5). Preferably, the hGHRH peptide antagonists comprises a GHRH
peptide sequence to which amino acid deletions, insertions, and/or
substitutions have been made. Further preferred, the hGHRH peptide
antagonists is a fragment or modified fragment of hGHRH having the
capability to bind to the hGHRH receptor and to inhibit or to
reduce the release of growth hormone. These antagonistic properties
are believed to result from replacement of various amino acids and
acylation with aromatic or nonpolar acids at the N-terminus of
hGHRH(1-29)NH.sub.2, hGHRH(1-30)NH.sub.2 and hGHRH(1-31)NH.sub.2,
respectively.
[0120] Therefore, particularly preferred hGHRH peptide antagonists
for use in the therapeutic treatment of X-linked acrogigantism
(X-LAG syndrome) are hGHRH peptide antagonists described in
WO95/16707, WO97/42223, WO00/31336, U.S. Pat. Nos. 5,550,212,
5,942,489, 6,057,422 or WO2014/004934. In particular, the hGHRH
peptide antagonist is a modified fragment of hGHRH, in particular
hGHRH(1-29)NH.sub.2, hGHRH(1-30)NH.sub.2 or hGHRH(1-31)NH.sub.2,
wherein one or more amino acids are replaced and/or the N-terminus
is acylated with aromatic or nonpolar carboxylic acids. More
preferred, hGHRH peptide antagonists are selected from the group
consisting of MIA-602, MIA-604, MIA-606, MIA-610, MIA-640 and
MIA-690 described in WO2014/004934 WO2014/004934 and US
2015/0166617. The structure of MIA-602 is
[(PhAc-Ada).sup.0-Tyr.sup.1, D-Arg.sup.2, Fpa.sub.5.sup.6,
Ala.sup.8, Har.sup.9, Tyr(Me).sup.10, His.sup.11, Orn.sup.12,
Abu.sup.15, His.sup.20, Orm.sup.21, Nle.sup.27, D-Arg.sup.28,
Har.sup.29]hGHRH(1-29)NH.sub.2, wherein PhAc is phenylacetyl, Ada
is 12-aminododecanoyl, Fpa is mono- or poly-fluorinated Phe
(fluorine substitutions on the aromatic ring). Fpa.sub.5 is
penta-fluorinated Phe (fluorine substitutions on the aromatic
ring), Har is homoarginine, Me is methyl, Orn is ornithine, Abu is
alpha-aminobutyric acid and Nle is norleucine. The remaining amino
acid positions are as defined by the original sequence
Tyr.sup.1-Ala.sup.2-Asp.sup.3-Ala.sup.4-Ile.sup.5-Phe.sup.6-Thr.sup.7-Asn-
.sup.8-Ser.sup.9-Tyr.sup.10-Arg.sup.11-Lys.sup.12-Val.sup.13-Leu.sup.14-Gl-
y.sup.15-Gln.sup.16-Leu.sup.17-Ser.sup.18-Ala.sup.19-Arg.sup.20-Lys.sup.21-
-Leu.sup.22-Leu.sup.23-Gln.sup.24-Asp.sup.25-Ile.sup.26-Met.sup.27-Ser.sup-
.28-Arg.sup.29-NH.sub.2 (SEQ ID NO: 3). It is noted that the amino
acid residues from 30 through 44 of the native GHRH molecule do not
appear to be essential to activity; nor does their identity appear
to be critical. Therefore, it appears that the addition of some or
all of these further amino acid residues to the C-terminus of the
hGHRH(1-29)NH.sub.2, hGHRH(1-30)NH.sub.2 and hGHRH(1-31)NH.sub.2
analogs will not affect the efficacy of these analogs as GHRH
antagonists. If some or all of these amino acids were added to the
C-terminus of the hGHRH(1-29)NH.sub.2, hGHRH(1-30)NH.sub.2 and
hGHRH(1-31)NH.sub.2 analogs, the added amino acid residues could be
the same as residues 30 through 44 in the native hGHRH sequence
(SEQ ID NO: 6) or reasonable equivalents.
[0121] The amino acid sequences of the synthetic peptides are
numbered in correspondence with the amino acid residues in
hGHRH(1-29) (SEQ ID NO: 3), hGHRH(1-30)NH.sub.2 (SEQ ID NO: 4) and
hGHRH(1-31)NH.sub.2, (SEQ ID NO: 5), respectively. Thus, for
example, the Ala.sup.4 in the synthetic peptides occupy the same
position in the sequence as the Ala.sup.4 residue in hGHRH(1-29).
The convention under which the N-terminal of a peptide is placed to
the left, and the C-terminal to the right is also followed
herein.
[0122] The present invention also relates to GH antagonists for use
in the therapeutic treatment of X-linked acrogigantism (X-LAG
syndrome). A preferred GH antagonist is pegvisomant. Pegvisomant
(Somavert.RTM.) is a growth hormone receptor antagonist and is a
pegylated and in terms of the amino acid sequence modified human
growth hormone containing 191 amino acid residues. In the prior art
pegvisomant is used in the treatment of acromegaly, in particular
if the tumor of the pituitary gland causing the acromegaly cannot
be controlled with surgery or radiation, and the use of
somatostatin analogues is not successful. Pegvisomant blocks the
action of growth hormone at the growth hormone receptor to reduce
the production of IGF-1.
[0123] The present invention refers to a method of increasing body
mass and/or body size of lifestock comprising administering to
livestock an effective amount of GPR101 agonist. Administration of
GPR101 agonist will increase GPR101 activity and hormone secretion.
This will lead to increased body mass and/or body size and to a
higher meat production by the livestock.
[0124] The term "livestock" refers to any livestock, or offspring
of livestock, who is receiving treatment, is in need of treatment,
is taking or receiving treatment for prevention purposes, and/or is
being administered the composition.
[0125] The term "offspring" refers to progeny or descendants of
livestock, and includes born progeny, fetuses and embryos.
"Livestock" shall include poultry, including chickens, goose, duck,
turkey, pheasant, swine, cattle, which includes beef and dairy
production, sheep, and goat.
[0126] The term "administering" or "administration" includes any
means for introducing the GPR101 agonist and other therapeutic
agents, into the body, preferably into the systemic circulation.
Examples include but are not limited to oral, including feed and/or
drinking water, buccal, sublingual, pulmonary, ophthalmic,
transdermal, transmucosal, as well as subcutaneous,
intraperitoneal, intravenous, intramuscular injection,
transplacental transfer and lactation. A "therapeutically effective
amount" is an amount of an agent, such as a GPR101 agonist or
antagonist, that is sufficient cause the desired effect, such as to
treat a condition of interest.
[0127] The present invention is also directed to a non-human
transgenic animal, comprising as expressed transgene a gene
encoding GPR101 or overexpressing endogenous GPR101 gene. The
GPR101 gene expressed as transgene in said non-human transgenic
animal may be any animal, preferably mammalian GPR101 gene, for
example human GPR101 gene. In an alternative approach the non-human
transgenic animal is altered by genetic engineering, wherein the
regulation of the expression of the respective endogenous GPR101
gene(s) is modified in that way that the endogenous gene is
expressed at a higher rate compared to the wild-type or unmodified
gene. Either of these modifications will lead to an increase in
growth hormone secretion and to increased body mass and/or body
size, resulting in a higher meat production by the livestock.
[0128] Somatic growth is orchestrated by a complex hormonal
crosstalk involving the hypothalamus, pituitary, and peripheral
tissues. Genetic disorders that affect this network can lead to
increased secretion of growth hormone, which results in acromegaly.
If the excess in growth hormone occurs before epiphyseal fusion,
the result can be gigantism. Nonsyndromic gigantism is most
frequently caused by pituitary adenomas occurring as familial
isolated pituitary adenomas or sporadically, usually as a result of
mutations in the gene encoding aryl hydrocarbon
receptor-interacting protein (AIP). Other monogenic diseases can
cause gigantism, but most of these conditions develop in adulthood
in association with other tumors. In young children, somatic
overgrowth that is due to an excess of growth hormone is rare, and
the cause is unknown. Other syndromic genetic overgrowth conditions
in children, such as the Sotos syndrome and the
Simpson-Golabi-Behmel syndrome, are not associated with pituitary
abnormalities.
[0129] During the studies carried out for the present invention a
striking phenotype of gigantism has been found that has an onset in
early childhood and that is caused by an excess of growth hormone.
The disorder is associated with heritable microduplications on
chromosome Xq26.3. There are four genes in the duplicated stretch
of DNA; one of these, GPR101, encodes an orphan G-protein-coupled
receptor and is very likely the gene that drives the phenotype in
young children and the growth of sporadic growth hormone-producing
adenomas in some patients with acromegaly.
[0130] Several lines of evidence support the identification this
new pituitary gigantism syndrome in young children carrying
microduplications on chromosome Xq26.3. This disorder caused by
GPR101 overexpression herein may be further referred to X-linked
acrogigantism (X-LAG). First, no disruption of Xq26.3 was found in
patients with later-onset gigantism. Second, the finding that
patients with other conditions had different duplications within
the same region narrowed the focus to the smallest region of
overlap. A duplication encompassing CD40LG and ARHGEF6 but not RBMX
and GPR101 occurred in a family with low birth weight, intellectual
disability, and craniofacial abnormalities, which suggests that
duplications with the exclusion of RBMX and GPR101 do not lead to
gigantism. Third, short stature has been reported in several
patients with deletions in this region, which suggests that the
absence of these genes may lead to the opposite phenotype. Other
investigators have described at least 15 additional patients with
the same phenotype of early-onset growth who may be good candidates
for a diagnosis of X-LAG.
[0131] The breakpoint features of Xq26.3 duplications suggest that
they were generated by means of a replication-based mechanism that
underlies the genesis of other copy-number variants (CNVs) and the
pathogenesis of other genomic disorders.
[0132] The cytogenetic data narrowed the smallest region of overlap
to a segment spanning CD40LG, ARHGEF6, RBMX, GPR101, one microRNA
(miR-934), and a small nucleolar RNA (SNORD61) of unknown function.
Expression of CD40LG in the pituitary tissues of the patients
analyzed in these studies was not detected (FIG. 1). Messenger RNA
for ARHGEF6 and RBMX was expressed to a similar degree in affected
and unaffected tissues from duplication carriers. Of all the genes
and the noncoding RNAs in the duplicated segment, only GPR101 had
markedly increased expression in the pituitary tumors from the
duplication carriers (FIG. 1). FIG. 1A shows that the expression of
GPR101 in pituitary tissue from children carrying Xq26.3
microduplications was increased by a factor as high as 1000, as
compared with the expression in unaffected pituitary tissue (NP1
through NP5) and in pituitary tumors from two patients with
sporadic acromegaly (GH1 and GH2) who tested negative for the
microduplication.
[0133] GPR101 is an orphan G-protein-coupled receptor that is
strongly expressed in the hypothalamus in rodents. It was recently
shown that a fragment of the gonadotropin-releasing hormone (namely
GnRH-(1-5)) could be a ligand for this receptor. The effect of a
mutation (p.A397K) that is predicted to activate GPR101 when tested
in vitro and in mice supports such a role. The pituitary-specific
overexpression of GPR101 may be due to a gene-dose effect (as
described in many genomic disorders) or to an unknown promoter
sequence created by the chromosomal rearrangement or to perturbed
chromatin regulation due to the genomic structural alteration from
duplication CNVs.
[0134] Unlike GPR101, neither ARHGEF6 nor RBMX was overexpressed in
the pituitary tumors from children with microduplications.
[0135] The studies of sporadic acromegaly carried out for the
present invention provide further support for a role of GPR101 in
X-LAG. A recurrent GPR101 mutation was found, p.E308D, in 4.4% of
DNA in tumor samples and in 1.9% of DNA in PBMC samples obtained
from patients with isolated acromegaly. In at least one patient,
the mutation was present only in the tumor DNA. GPR101 mutations in
families with familial isolated pituitary adenomas were not
identified. Transfection of a construct expressing GPR101
containing the p.E308D mutation increased proliferation and growth
hormone secretion in a rat pituitary cell line. Moreover, it was
shown that GPR101 can strongly activate the cAMP pathway, for which
the mitogenic effects in pituitary somatotropes are well
established. These data further support a role for variant GPR101
in sporadic acromegaly.
[0136] The mechanism by which mutant GPR101 contributes to
increased growth hormone secretion is unclear. Some of the patients
with early onset gigantism whom were evaluated in the studies of
the present invention had normal or mildly elevated levels of
circulating GHRH (but below the threshold required for ectopic
tumoral secretion of this hormone). The tumor tissue showed strong
expression of the growth hormone-releasing hormone receptor, in
contrast to its expression of growth hormone-releasing hormone,
which was low or absent.
[0137] In conclusion, the results of the studies of the present
invention show that Xq26.3 microduplication is associated with a
clinical syndrome of early-onset gigantism. An increased dose of
GPR101 on chromosome Xq26.3 probably causes the disease, and its
activation by mutation occurs in patients with sporadic acromegaly.
Xq26.3 microduplications may explain other historical cases of
gigantism with features that closely resemble those of X-LAG.
[0138] As mentioned above, during the studies for the present
invention an Xq26.3 microduplication in the early-childhood form of
gigantism was detected. Nine of the thirteen patients with the
Xq26.3 microduplication and the one probable carrier (an affected
mother with gigantism) were female and were of normal size at
birth. They grew rapidly during infancy, attaining a median height
score of +3.8 SD at diagnosis (median age: 36 months), at which
point they showed marked overall somatic growth with elevated
weight and enlarged head circumference (median: 51.2 cm). The onset
of accelerated growth and the onset of accelerated weight gain
usually coincided, but were not always synchronous. Compared with
those who lacked the Xq26.3 microduplication, those with the
microduplication had an earlier median age of abnormal growth onset
(12 months vs. 16 years), increased height acceleration and
elevated levels of IGF-1 and prolactin. Precocious puberty in the
microduplication carriers was not detected. Levels of peripheral
growth hormone releasing hormone (GHRH) did not suggest ectopic
GHRH secretion, and nuclear imaging scans were negative. All
patients who underwent surgery had pituitary macroadenomas alone
(median maximum diameter: 16 mm), and three had pituitary
hyperplasia with or without an identified adenoma. Hormonal control
was not achieved with medical therapy alone; radical/repeated
neurosurgery alone (n=4) or in combination with pegvisomant (n=3)
or radiotherapy (n=2) was required. Seven patients had permanent
hypopituitarism at the time of carrying out the studies for the
present patent application.
[0139] The common duplicated genomic segment was approximately 500
Kb in length, from position 135,627,637 to 136,118,269
(GRCh37/hg19). One patient had a complex genomic rearrangement,
with two duplicated segments, and separated by a short region of
normal genomic sequence. No other patterns of duplication/deletion
or homozygosity were shared among affected cases. One FIPA family
included an affected mother and two affected sons with the same
Xq26.3 microduplication; the unaffected father did not have the
duplication. In another FIPA family the mother had childhood-onset
gigantism and a histologically-confirmed pituitary macroadenoma but
had died of complications of hypopituitarism. She had two children:
the son carried the Xq26.3 microduplication and had childhood-onset
gigantism (patient F2A), and the healthy daughter did not have the
duplication. The most parsimonious explanation is that the son
inherited the X-linked disease from his carrier mother. Hence, the
Xq26.3 microduplication can be considered a new pathogenic
explanation in certain AIP mutation-negative FIPA acrogigantism
kindreds with familial isolated pituitary adenomas that have
acrogigantism without AIP mutations.
Further Characterization of the Xq26.3 Microduplication
[0140] Using high-definition analysis of the critical duplicated
region, 10 genomic duplications in the 13 genetically studied
patients were analyzed, including four of the familial and eight
sporadic cases. On aCGH these appeared to be simple duplications;
however, high-resolution aCGH, long-range PCR and Sanger sequencing
of the breakpoints revealed various underlying genomic
complexities. All sporadic Xq26.3 duplications were non-recurrent;
the boundaries of the duplicated segment where unique to each
person. Both aCGH and assay by PCR yielded negative results for
normal parents/siblings of sporadic cases. The same duplication was
transmitted from F1A (affected mother) to her affected offspring,
F1B and F1C. The two smallest regions of overlap (SRO), SRO1 and
SRO2, were shared by the duplications: SRO1 (ChrX:
135627637-135986830, hg19) encompassed three OMIM genes, CD40LG
(MIM#300386), ARHGEF6 (MIM#300267), and RBMX (MIM#300199), while
SRO2 (ChrX: 136045310-136118269, hg19) included GPR101
(MIM#300393). (An SRO is the genomic region that is (in this study)
duplicated and shared by all affected persons.)
Investigation of Candidate Genes
[0141] Sequencing each of the four genes in the 43 patients with
gigantism did not reveal any single nucleotide variants of likely
pathogenicity.
[0142] RT-qPCR of pituitary tumor RNA from two Xq26.3
microduplication patients suggested that CD40LG was not expressed
in the pituitary tumors. Neither ARHGEF6 nor RBMX showed
upregulated expression in the pituitary tumors of two patients with
the duplication (FIG. 1). In contrast, the expression of GPR101 in
the pituitaries of the children carrying a Xq26.3 duplication was
up to 1000-fold higher than in unaffected pituitary tissue, and in
pituitary tumors from persons who tested negative for the
microduplication (FIG. 1A). This result was confirmed at the
protein level by increased immunostaining for GPR101 in pituitary
tumor from Xq26.3 duplicated cases. Experimental over-expression of
ARHGEF6, RBMX, and GPR101 genes alone in the rat pituitary cell GH3
cell line did not significantly increase GH secretion or cell
proliferation (FIGS. 1B and 1C); non-mutated GPR101 in combination
with ARHGEF6 and/or RBMX modestly increased cell proliferation, but
not GH secretion.
GPR101 as a Candidate Gene; Identification of the p.E308D
Mutation
[0143] In a series of 248 patients with sporadic acromegaly, none
carried a microduplication at Xq26.3. However, 11 of them carried a
c.924G>C substitution (p.E308D) in GPR101, which was not found
in 7600 controls from public databases. Of the 11 mutation
carriers, three appeared to carry a constitutive mutation, which
was detected in DNA from their PBMCs; the mutation was detected in
the tumor DNA in the remaining eight cases. In one case, it was
determined that the mutation was somatic (i.e., GPR101 sequence of
DNA from PBMCs did not carry the mutation, whereas that of the
tumor did. None of the 13 FIPA families with acromegaly carried the
p.E308D GPR101 change.
[0144] GPR101 encodes an orphan GPCR that is highly expressed in
rodent hypothalamus and is predicted to couple to G.sub.s, a potent
activator of adenylyl cyclase. Over-expression of the p.E308D and
p.A397K mutants, but not non-mutated GPR101, significantly
increased cell proliferation and GH secretion in rat GH3 cells
(FIGS. 1D and 1E). Like the construct containing the non-mutant
receptor, the two mutant constructs resulted in increased cAMP
signaling in GH3 cells in an in vitro reporter assay, both at
baseline and in the presence of forskolin (10 .mu.M), a direct
stimulator of adenylyl cyclase (FIG. 1F).
Clinical Observations and Results
[0145] A patient diagnosed to have X-LAG syndrome and elevated GHRH
levels underwent surgery. In the studies for the present invention
increased GHRH levels at all time points, ranging between 100-200
pg/ml, were found. These levels were seen against a backdrop of
markedly elevated circulating GH and prolactin concentrations in
excess of 200 ng/ml and 500 ng/ml at baseline. A pulsatility study
showed elevations in GHRH, GH and prolactin throughout the 180 mins
of the study. One peak of GHRH secretion was captured and was
seemingly accompanied by a concomitant peak in GH but not prolactin
secretion. The elevated GHRH was not markedly altered by TRH or
GnRH administration. As no peripheral source of GHRH was found,
these results indicate that GHRH hypersecretion is an intrinsic
part of the etiology of X-LAG syndrome in some patients.
Interestingly the pathology of pituitary disease in X-LAG syndrome
bears strong resemblance to that seen in other cases of GHRH
excess. It is known that central GHRH hypersecretion from
hypothalamic gangliocytomas leads to pituitary adenoma and
acromegaly. It was also known that hypersecretion of GHRH in mice
transgenic for the human GHRH gene leads to the development of
early and massive pituitary (somatotrope, mammotrope and
somatomammotrope) hyperplasia. It was previously reported that in
older transgenic mice, chronic GHRH hypersecretion leads to
pituitary adenoma formation, predominantly with GH and prolactin
staining. Further, it was known that peripheral GHRH hypersecretion
from neuroendocrine tumors is accompanied by either pituitary
somatotrope hyperplasia or mixed GH and prolactin secreting
adenomas. Taken together, the sum effect of chronic GHRH
hypersecretion on the pituitary is somatotrope, mammotrope and
somatomammotrope hyperplasia and/or mixed GH and prolactin
secreting adenomas. The fact that GHRH hypersecretion was found in
combination with a similar pattern of pituitary histological
changes suggests that X-LAG syndrome is a form of
hypothalamic-onset pituitary tumorigenesis.
[0146] Further support for a role for GHRH hypersecretion in X-LAG
syndrome comes from the in vitro pituitary culture data obtained
during the studies for the present invention, which are the first
results to be reported in a tumor from a known case of X-LAG
syndrome. These results confirm basal GH and prolactin
hypersecretion, which was further stimulated by GHRH co-incubation.
Crucially, the addition of the GHRH antagonist
acetyl-(D-Arg.sup.2)-GHRH(1-29) was able to reduce basal and
stimulated GH and prolactin secretion in a dose dependent manner.
Co-incubation of acetyl-(D-Arg.sup.2)-GHRH(1-29) with GHRH
abolished the stimulatory effect of GHRH itself. This combination
of findings suggests that clinical benefit could be yielded from
pharmacological treatment with GHRH antagonists in X-LAG
syndrome.
[0147] During the studies for the present invention a number of
other stimulatory and inhibitory factors were investigated. Use of
somatostatin analogs (SSA) such as octreotide did not lead to
hormonal or growth control in X-LAG patients. These poor clinical
responses to somatostatin receptor 2 (SSTR2)-specific somatostatin
analogs in X-LAG syndrome were observed, despite strong
immunohistochemical staining for SSTR2 in tumor samples. According
to the studies, octreotide had no inhibitory effect on GH or
prolactin in the X-LAG syndrome pituitary cell culture. Pasireotide
had a small inhibitory effect on GH secretion, which suggests that
some clinical benefit might be obtained in X-LAG syndrome via its
binding at SSTR5 and SSTR3, as these receptor types are expressed
in X-LAG syndrome tumor tissue (data not shown).
[0148] As some patients with X-LAG syndrome exhibit increased
appetite in conjunction with their gigantism, the effects of
ghrelin in the tumor tissue were studied. Ghrelin itself had a
minor stimulatory effect on GH secretion, while a ghrelin receptor
antagonist inhibited GH secretion at 10.sup.-8 and 10.sup.-7 M.
These results suggest that patients with X-LAG syndrome may have GH
dysregulation across various control pathways, although specific
studies are needed.
[0149] According to further studies it was observed that in X-LAG
patients postoperative use of pegvisomant resulted in control of
IGF1 in all five X-LAG patients, where it was employed. Addition of
pegvisomant permitted control of IGF1 and excessive growth in three
patients who had previously undergone surgery and who also had
developed multiple pituitary axis deficiencies. Among the nine
patients who underwent primary surgical resection, three had
immediate GH/PRL control and excessive growth was halted. For those
patients in whom growth and GH secretion were not controlled by
their initial surgery, the subsequent management was complex. Use
of somatostatin analogs (SSA) (octreotide, lanreotide) and dopamine
postoperatively did not lead to hormonal or growth control, which
was only achieved with combinations of radiotherapy, repeated
surgery, SSA, and finally pegvisomant. Therefore, it can be
concluded that the GH receptor antagonist pegvisomant represents a
useful option for IGF-1 and growth control.
[0150] In conclusion, the studies according to the present
invention provide new evidence that GHRH dysregulation plays a role
in the pituitary pathology and gigantism seen in X-LAG syndrome.
Chronic GHRH hypersecretion in X-LAG syndrome leads to pituitary
pathology that is similar to that seen in other experimental and
clinical settings with GHRH excess. Inhibition of GH and prolactin
secretion from tumor cell culture in X-LAG syndrome using a GHRH
antagonist suggests that the challenging clinical management of
X-LAG syndrome could be improved by targeting GHRH inhibition and
GH receptor inhibition.
Treatment Protocols
[0151] The method for treatment of acromegaly and gigantism
comprises administering to a patient an effective amount of the
compound of the present invention.
[0152] Typically, the compounds of the present invention are
administered in an amount of about 5 .mu.g/kg per day to 3,000
.mu.g/kg per day, and more preferably about 20 to 1,500 .mu.g/kg
per day preferably once or twice daily. However, other amounts,
including substantially lower or higher amounts, may also be
administered. The compounds of the invention are administered to a
human subject in need of treatment by oral, intravenous,
intraperitoneal, intramuscular, transdermal, nasal, iontophoretic,
subcutaneous, intratumoral, administration or by any other
acceptable route of administration.
[0153] Different amounts of the compounds of the present invention
may also be administered as seen suitable by a practitioner for
specific cases. For this or any other application the compounds of
this invention may be administered in an amount of about 10 to
3,750 .mu.g/kg, and more preferably about 15 to 1,600 .mu.g/kg. Any
means of administration is suitable. The foregoing ranges are,
however, suggestive, as the number of variables in regard to an
individual treatment regime is large, and considerable excursions
from these recommended values are expected.
Formulations and Pharmaceutical Compositions
[0154] The following description refers to pharmaceutical
compositions, which may contain the active agent of the present
invention.
[0155] The compositions of the invention will be formulated for
administration through ways known in the art and acceptable for
administration to a mammalian subject, preferably a human. In some
embodiments of the invention, the compositions of the invention can
be administered by oral, intravenous, intraperitoneal,
intramuscular, transdermal, nasal, iontophoretic, subcutaneous,
intratumoral, administration or by any other acceptable route of
administration. In further embodiments of the invention the
compositions of the invention are administered "locoregionally",
i.e., intravesically, intralesionally, and/or topically. In
preferred embodiments of the invention, the compositions of the
invention are administered systemically by injection, inhalation,
suppository, transdermal delivery, etc. In further embodiments of
the invention, the compositions are administered through catheters
or other devices to allow access to a remote tissue of interest,
such as an internal organ. The compositions of the invention can
also be administered in depot type devices, implants, or
encapsulated formulations to allow slow or sustained release of the
compositions.
[0156] In order to administer therapeutic agents based on, or
derived from, the present invention, it will be appreciated that
suitable carriers, excipients, and other agents may be incorporated
into the formulations to provide improved transfer, delivery,
tolerance, and the like.
[0157] A multitude of appropriate formulations can be found in the
formulary known to all pharmaceutical chemists: Remington's
Pharmaceutical Sciences, (15th Edition, Mack Publishing Company,
Easton, Pa. (1975)), particularly Chapter 87, by Blaug, Seymour,
therein. These formulations include for example, powders, pastes,
ointments, jelly, waxes, oils, lipids, anhydrous absorption bases,
oil-in-water or water-in-oil emulsions, emulsions carbowax
(polyethylene glycols of a variety of molecular weights),
semi-solid gels, and semi-solid mixtures containing carbowax.
[0158] Any of the foregoing formulations may be appropriate in
treatments and therapies in accordance with the present invention,
provided that the active agent in the formulation is not
inactivated by the formulation and the formulation is
physiologically compatible.
[0159] The quantities of active ingredient necessary for effective
therapy will depend on many different factors, including means of
administration, target site, physiological state of the patient,
and other medicaments administered. Thus, treatment dosages should
be titrated to optimize safety and efficacy. Typically, dosages
used in vitro may provide useful guidance in the amounts useful for
in situ administration of the active ingredients. Animal testing of
effective doses for treatment of particular disorders will provide
further predictive indication of human dosage. Various
considerations are described, for example, in Goodman and Gilman's
the Pharmacological Basis of Therapeutics, 7th Edition (1985),
MacMillan Publishing Company, New York, and Remington's
Pharmaceutical Sciences 18th Edition, (1990) Mack Publishing Co,
Easton Pa. Methods for administration are discussed therein,
including oral, intravenous, intraperitoneal, intramuscular,
transdermal, nasal, iontophoretic administration, and the like.
[0160] The compositions of the invention may be administered in a
variety of unit dosage forms depending on the method of
administration. For example, unit dosage forms suitable for oral
administration include solid dosage forms such as powder, tablets,
pills, capsules, and dragees, and liquid dosage forms, such as
elixirs, syrups, and suspensions. The active ingredients may also
be administered parenterally in sterile liquid dosage forms.
Gelatin capsules contain the active ingredient and as inactive
ingredients powdered carriers, such as glucose, lactose, sucrose,
mannitol, starch, cellulose or cellulose derivatives, magnesium
stearate, stearic acid, sodium saccharin, talcum, magnesium
carbonate and the like. Examples of additional inactive ingredients
that may be added to provide desirable color, taste, stability,
buffering capacity, dispersion or other known desirable features
are red iron oxide, silica gel, sodium lauryl sulfate, titanium
dioxide, edible white ink and the like. Similar diluents can be
used to make compressed tablets. Both tablets and capsules can be
manufactured as sustained release products to provide for
continuous release of medication over a period of hours. Compressed
tablets can be sugar-coated or film-coated to mask any unpleasant
taste and protect the tablet from the atmosphere, or enteric-coated
for selective disintegration in the gastrointestinal tract. Liquid
dosage forms for oral administration can contain coloring and
flavoring to increase patient acceptance.
[0161] The concentration of the compositions of the invention in
the pharmaceutical formulations can vary widely, i.e., from less
than about 0.1%, usually at or at least about 2% to as much as 20%
to 50% or more by weight, and will be selected primarily by fluid
volumes, viscosities, etc., in accordance with the particular mode
of administration selected.
[0162] The compositions of the invention may be administered by use
of solid compositions. For solid compositions, conventional
nontoxic solid carriers may be used which include, for example,
pharmaceutical grades of mannitol, lactose, starch, magnesium
stearate, sodium saccharin, talcum, cellulose, glucose, sucrose,
magnesium carbonate, and the like. For oral administration, a
pharmaceutically acceptable nontoxic composition is formed by
incorporating any of the normally employed excipients, such as
those carriers previously listed, and generally 10-95% of active
ingredient, that is, one or more compositions of the invention, and
more preferably at a concentration of 25%-75%.
[0163] For aerosol administration, the compositions of the
invention are preferably supplied in finely divided form along with
a surfactant and propellant. Typical percentages of compositions of
the invention are 0.01%-20% by weight, preferably 1%-10%. The
surfactant must, of course, be nontoxic, and preferably soluble in
the propellant. Representative of such agents are the esters or
partial esters of fatty acids containing from 6 to 22 carbon atoms,
such as caproic, octanoic, lauric, palmitic, stearic, linoleic,
linolenic, olesteric and oleic acids with an aliphatic polyhydric
alcohol or its cyclic anhydride. Mixed esters, such as mixed or
natural glycerides may be employed. The surfactant may constitute
0.1%-20% by weight of the composition, preferably 0.25%-5%. The
balance of the composition is ordinarily propellant. A carrier can
also be included, as desired, as with, e.g., lecithin for
intranasal delivery.
[0164] The compositions of the invention can additionally be
delivered in a depot-type system, an encapsulated form, or an
implant by techniques well known in the art. Similarly, the
compositions can be delivered via a pump to a tissue of
interest.
[0165] The composition of the invention may also be provided in a
kit as a slow-release composition such as a daily, weekly, monthly
unit provided as a sponge, dermal patch, subcutaneous implant and
the like in a wrapping or container. In this case, the patient may
release a unit of the composition from the container and applies it
as indicated in the kit instructions. The composition may then be
replaced at the end of the specified period by a fresh unit, and so
on.
[0166] The compound(s) of the present invention may be administered
in a composition that also comprises one or more further drugs. The
proportion of compounds of the present invention to the other
drug(s) and carrier may be adjusted accordingly.
Antibodies
[0167] The present invention also refers to anti-GPR101 antibodies
as GPR101 inhibitors directed to GPR101 protein which will
partially or completely reduce the activity of this GPR101 protein.
The present invention further provides compositions comprising
antibodies that specifically bind to GPR101. In a preferred
embodiment the protein GPR101 is having the amino acid sequence SEQ
ID NO: 2. The antibodies may be monoclonal antibodies, polyclonal
antibodies, antibody fragments or any combination thereof. In
particular, said antibody may be a common antibody (which is
composed of two heavy protein chains and two light chains), Fab
fragments of a common antibody, single-chain variable fragments or
single-domain antibody (sdAb). The antibodies may be formulated
with a pharmaceutically acceptable carrier. In a preferred
embodiment the antibodies specifically recognize and bind to GPR101
having the amino acid sequence SEQ ID NO: 2. Further preferred the
antibodies specifically recognize an epitope (a stretch of 5 or
more consecutive amino acid residues within the amino acid sequence
shown in SEQ ID NO: 2).
[0168] The term "antibody," as used herein, refers to a full-length
(i.e., naturally occurring or formed by normal immunoglobulin gene
fragment recombinatorial processes) immunoglobulin molecule (e.g.,
an IgG antibody) or an immunologically active (i.e., specifically
binding) portion of an immunoglobulin molecule, including an
antibody fragment. "Antibody" and "immunoglobulin" are used
synonymously herein. An antibody fragment is a portion of an
antibody such as F(ab')2, F(ab)2, Fab', Fab, Fv, scFv, Nanobodies
and the like. Nanobodies (or single-domain antibodies (sdAb)) are
antibody-derived therapeutic proteins that contain the unique
structural and functional properties of naturally-occurring
heavy-chain antibodies. The Nanobody technology was originally
developed following the discovery that camelidae (camels and lamas)
possess fully functional antibodies that lack light chains. These
heavy-chain antibodies contain a single variable domain (VHH) and
two constant domains (C.sub.H2 and C.sub.H3). Importantly, the
cloned and isolated VHH domain is a perfectly stable polypeptide
harbouring the full antigen-binding capacity of the original
heavy-chain antibody. The antibodies could be obtained using
immunization in human and animals (mouse, rabbit, camel, lama, hen,
goat).
[0169] Regardless of structure, an antibody fragment binds with the
same antigen that is recognized by the full-length antibody, and,
in the context of the present invention. Methods of making and
screening antibody fragments are well-known in the art.
[0170] An anti-GPR101 antibody according to the present invention
may be prepared by a number of different methods. For example, the
antibodies may be obtained from subjects administered the
recombinant polypeptide according to the present invention. In some
embodiments, the antibodies may be made by recombinant methods.
Techniques for making recombinant monoclonal antibodies are
well-known in the art. Recombinant polyclonal antibodies can be
produced by methods analogous to those described in U.S. Patent
Application 2002/0009453, using the recombinant polypeptide
according to the present invention as the immunogen(s). Said
antibody obtained in accordance with the invention may be a murine,
human or humanized antibody. A humanized antibody is a recombinant
protein in which the CDRs of an antibody from one species; e.g., a
rodent, rabbit, dog, goat, horse, camel, lama or chicken antibody
(or any other suitable animal antibody), are transferred from the
heavy and light variable chains of the rodent antibody into human
heavy and light variable domains. The constant domains of the
antibody molecule are derived from those of a human antibody.
Methods for making humanized antibodies are well known in the art.
More recently, it was reported that it is possible to generate
hybridomas directly from human B-cells. Consequently, the
recombinant polypeptide according to the present invention could be
used to stimulate proliferation of human B-cell before to proceed
to the generation of hybridomas.
[0171] The above-described antibodies can be obtained by
conventional methods. For example, the recombinant polypeptide
according to the present invention can be administered to a subject
and the resulting IgGs can be purified from plasma harvested from
the subject by standard methodology.
Antibody Compositions
[0172] The invention also refers to the preparation of antibodies
and antibody compositions suitable for administration, such as
compositions comprising an antibody and a pharmaceutically
acceptable carrier. The antibody compositions may be formulated for
any route of administration, including intravenous, intramuscular,
subcutaneous and percutaneous, by methods that are known in the
art. In one embodiment, the antibody composition provides a
therapeutically effective amount of antibody, i.e., an amount
sufficient to achieve a therapeutically beneficial effect.
[0173] In one embodiment, the antibody composition is an IVIG
composition. As used herein, "IVIG" refers to an immunoglobulin
composition suitable for intravenous administration. IVIG
compositions may contain, in addition to immunoglobulin, a
pharmaceutically acceptable carrier. The IVIG compositions may be
"specific IVIG," meaning that the IVIG contains immunoglobulins
that specifically bind to the antigen(s) represented by the
recombinant polypeptide according to the present invention.
Treatment of Hormonal Disorders of Growth with Antibody
Compositions
[0174] The present invention also refers to a method of treating
hormonal disorders of growth by administering the above-described
antibody compositions, such as the above-described IVIG
compositions, to a subject in need thereof. A target patient
population for the treatment of hormonal disorders of growth
includes mammals, such as humans, who suffer from hormonal
disorders of growth.
[0175] In accordance with one embodiment, the invention provides a
method for treating hormonal disorders of growth using compositions
comprising an antibody or antibodies directed to GPR101 according
to the present invention, and a pharmaceutically acceptable
carrier. In yet another embodiment, the antibodies are monoclonal
antibodies.
[0176] A therapeutically effective amount of the antibody
compositions can be determined by methods that are routine in the
art. Skilled artisans will recognize that the amount may vary
according to the particular antibodies within the composition, the
concentration of antibodies in the composition, the frequency of
administration, the severity of disease to be treated, and subject
details, such as age, weight and immune condition. In some
embodiments, the dosage will be at least 50 mg IVIG composition per
kilogram of body weight (mg/kg), including at least 100 mg/kg, at
least 150 mg/kg, at least 200 mg/kg, at least 250 mg/kg, at least
500 mg/kg, at least 750 mg/kg and at least 1000 mg/kg. Dosages for
monoclonal antibody compositions typically may be lower, such as
1/10 of the dosage of an IVIG composition, such as at least about 5
mg/kg, at least about 10 mg/kg, at least about 15 mg/kg, at least
about 20 mg/kg, or at least about 25 mg/kg. The route of
administration may be any of those appropriate for a passive
vaccine. Thus, intravenous, subcutaneous, intramuscular,
intraperitoneal, intratumorally and other routes of administration
are envisioned. As noted above, a therapeutically effective amount
of antibody is an amount sufficient to achieve a therapeutically
beneficial effect.
Antisense Oligonucleotides
[0177] The GPR101 inhibitor may be an antisense oligonucleotide,
e.g. a small interfering RNA, being at least 8 nucleotides in
length, preferably 8 to 1527, further preferred 8 to 500, still
further preferred 8 to 200, even further preferred 8 to 80
nucleotides and particularly preferred 12 to 50, 13 to 40 and 15 to
30 nucleotides in length, which specifically hybridises with a
nucleic acid molecule encoding GPR101, or which specifically
hybridises to a nucleic acid having the nucleotide sequence shown
in SEQ ID NO: 1, and is capable of inhibiting GPR101
expression.
[0178] In one embodiment the antisense oligonucleotide is 100%
complementary to the nucleic acid molecule encoding GPR101.
[0179] The relationship between an antisense compound such as an
oligonucleotide and its reverse complementary nucleic acid target,
to which it hybridizes, is commonly referred to as "antisense".
"Targeting" an oligonucleotide to a chosen nucleic acid target, in
the context of this invention, is a multistep process. The process
usually begins with identifying a nucleic acid sequence whose
function is to be modulated. This may be, as examples, a cellular
gene (or mRNA made from the gene) whose expression is associated
with a particular disease state, or a foreign nucleic acid from an
infectious agent.
[0180] In the present invention, the targets are nucleic acids
encoding GPR101; in other words, a gene encoding GPR101, or mRNA
expressed from the GPR101 gene. mRNA which encodes GPR101 is
presently the preferred target. The targeting process also includes
determination of a site or sites within the nucleic acid sequence
for the antisense interaction to occur such that modulation of gene
expression will result.
[0181] In accordance with this invention, persons of ordinary skill
in the art will understand that messenger RNA includes not only the
information to encode a protein using the three letter genetic
code, but also associated ribonucleotides which form a region known
to such persons as the 5'-untranslated region, the 3'-untranslated
region, the 5' cap region and intron/exon junction ribonucleotides.
Thus, oligonucleotides may be formulated in accordance with this
invention which are targeted wholly or in part to these associated
ribonucleotides as well as to the informational ribonucleotides.
The oligonucleotide may therefore be specifically hybridizable with
a transcription initiation site region, a translation initiation
codon region, a 5' cap region, an intron/exon junction, coding
sequences, a translation termination codon region or sequences in
the 5'- or 3'-untranslated region. Since, as is known in the art,
the translation initiation codon is typically 5'-AUG (in
transcribed mRNA molecules; 5'-ATG in the corresponding DNA
molecule), the translation initiation codon is also referred to as
the "AUG codon," the "start codon" or the "AUG start codon." A
minority of genes have a translation initiation codon having the
RNA sequence 5'-GUG, 5'-UUG or 5'-CUG, and 5'-AUA, 5'-ACG and
5'-CUG have been shown to function in vivo. Thus, the terms
"translation initiation codon" and "start codon" can encompass many
codon sequences, even though the initiator amino acid in each
instance is typically methionine (in eukaryotes) or
formylmethionine (prokaryotes). It is also known in the art that
eukaryotic and prokaryotic genes may have two or more alternative
start codons, any one of which may be preferentially utilized for
translation initiation in a particular cell type or tissue, or
under a particular set of conditions. In the context of the
invention, "start codon" and "translation initiation codon" refer
to the codon or codons that are used in vivo to initiate
translation of an mRNA molecule transcribed from a gene encoding
GPR101, regardless of the sequence(s) of such codons. It is also
known in the art that a translation termination codon (or "stop
codon") of a gene may have one of three sequences, i.e., 5'-UAA,
5'-UAG and 5'-UGA (the corresponding DNA sequences are 5'-TAA,
5'-TAG and 5'-TGA, respectively). The terms "start codon region,"
"AUG region" and "translation initiation codon region" refer to a
portion of such an mRNA or gene that encompasses from about 25 to
about 50 contiguous nucleotides in either direction (i.e., 5' or
3') from a translation initiation codon. This region is a preferred
target region. Similarly, the terms "stop codon region" and
"translation termination codon region" refer to a portion of such
an mRNA or gene that encompasses from about 25 to about 50
contiguous nucleotides in either direction (i.e., 5' or 3') from a
translation termination codon. This region is a preferred target
region. The open reading frame (ORF) or "coding region," which is
known in the art to refer to the region between the translation
initiation codon and the translation termination codon, is also a
region which may be targeted effectively. Other preferred target
regions include the 5' untranslated region (5'UTR), known in the
art to refer to the portion of an mRNA in the 5' direction from the
translation initiation codon, and thus including nucleotides
between the 5' cap site and the translation initiation codon of an
mRNA or corresponding nucleotides on the gene and the 3'
untranslated region (3'UTR), known in the art to refer to the
portion of an mRNA in the 3' direction from the translation
termination codon, and thus including nucleotides between the
translation termination codon and 3' end of an mRNA or
corresponding nucleotides on the gene. The 5' cap of an mRNA
comprises an N7-methylated guanosine residue joined to the 5'-most
residue of the mRNA via a 5'-5' triphosphate linkage. The 5' cap
region of an mRNA is considered to include the 5' cap structure
itself as well as the first 50 nucleotides adjacent to the cap. The
5' cap region may also be a preferred target region.
[0182] Although some eukaryotic mRNA transcripts are directly
translated, many contain one or more regions, known as "introns",
which are excised from a pre-mRNA transcript to yield one or more
mature mRNA. The remaining (and therefore translated) regions are
known as "exons" and are spliced together to form a continuous mRNA
sequence. mRNA splice sites, i.e., exon-exon or intron-exon
junctions, may also be preferred target regions, and are
particularly useful in situations where aberrant splicing is
implicated in disease, or where an overproduction of a particular
mRNA splice product is implicated in disease. Aberrant fusion
junctions due to rearrangements or deletions are also preferred
targets. Targeting particular exons in alternatively spliced mRNAs
may also be preferred. It has also been found that introns can also
be effective, and therefore preferred, target regions for antisense
compounds targeted, for example, to DNA or pre-mRNA.
[0183] Once the target site or sites have been identified,
oligonucleotides are chosen which are sufficiently complementary to
the target, i.e., hybridize sufficiently well and with sufficient
specificity, to give the desired modulation.
[0184] "Hybridization", in the context of this invention, means
hydrogen bonding, also known as Watson-Crick base pairing, between
complementary bases, usually on opposite nucleic acid strands or
two regions of a nucleic acid strand. Guanine and cytosine are
examples of complementary bases which are known to form three
hydrogen bonds between them. Adenine and thymine are examples of
complementary bases which form two hydrogen bonds between them.
[0185] "Specifically hybridizable" and "complementary" are terms
which are used to indicate a sufficient degree of complementarity
such that stable and specific binding occurs between the DNA or RNA
target and the oligonucleotide.
[0186] It is understood that an oligonucleotide need not be 100%
complementary to its target nucleic acid sequence to be
specifically hybridizable. An oligonucleotide is specifically
hybridizable when binding of the oligonucleotide to the target
interferes with the normal role of the target molecule to cause a
loss of function or activity, and there is a sufficient degree of
complementarity to avoid non-specific binding of the
oligonucleotide to non-target sequences under conditions in which
specific binding is desired, i.e., under physiological conditions
in the case of in vivo assays or therapeutic treatment or, in the
case of in vitro assays, under conditions in which the assays are
conducted.
[0187] Hybridization of antisense oligonucleotides with mRNA
interferes with one or more of the normal functions of mRNA. The
functions of mRNA to be interfered with include any vital functions
such as, for example, translocation of the RNA to the site of
protein translation, translation of protein from the RNA, splicing
of the RNA to yield one or more mRNA species, and catalytic
activity which may be engaged in by the RNA. Binding of specific
protein(s) to the RNA may also be interfered with by antisense
oligonucleotide hybridization to the RNA.
[0188] The locations on the target nucleic acid to which the
preferred antisense compounds hybridize are herein below referred
to as "target segments." As used herein the term "target segment"
is defined as at least an 8-nucleotide portion of a target region
to which an active antisense compound is targeted. While not
wishing to be bound by theory, it is presently believed that these
target segments represent portions of the target nucleic acid which
are accessible for hybridization.
[0189] While the specific sequences of certain target segments are
set forth herein, one of skill in the art will recognize that these
serve to illustrate and describe particular embodiments within the
scope of the present invention. Additional target segments may be
identified by one having ordinary skill.
[0190] Target segments 8-80 nucleotides in length comprising a
stretch of at least eight consecutive nucleotides selected from
within the illustrative preferred target segments are considered to
be suitable for targeting as well.
[0191] Target segments can include DNA or RNA sequences that
comprise at least the 8 consecutive nucleotides from the
5'-terminus of one of the illustrative target segments (the
remaining nucleotides being a consecutive stretch of the same DNA
or RNA beginning immediately upstream of the 5'-terminus of the
target segment and continuing until the DNA or RNA contains about 8
to about 80 nucleotides). Similarly target segments are represented
by DNA or RNA sequences that comprise at least the 8 consecutive
nucleotides from the 3'-terminus of one of the illustrative
preferred target segments (the remaining nucleotides being a
consecutive stretch of the same DNA or RNA beginning immediately
downstream of the 3'-terminus of the target segment and continuing
until the DNA or RNA contains about 8 to about 80 nucleotides). It
is also understood that antisense target segments may be
represented by DNA or RNA sequences that comprise at least 8
consecutive nucleotides from an internal portion of the sequence of
an illustrative preferred target segment, and may extend in either
or both directions until the oligonucleotide contains about 8 to
about 80 nucleotides.
[0192] One having skill in the art armed with the target segments
illustrated herein will be able, without undue experimentation, to
identify further preferred target segments.
[0193] Once one or more target regions, segments or sites have been
identified, antisense compounds are chosen which are sufficiently
complementary to the target, i.e., hybridize sufficiently well and
with sufficient specificity, to give the desired effect.
[0194] The overall effect of interference with mRNA function is
decrease of the expression of GPR101. This decrease can be measured
in ways which are routine in the art, for example by Northern blot
assay of mRNA expression, or reverse transcriptase PCR, as taught
in the examples of the instant application or by Western blot or
ELISA assay of protein expression, or by an immunoprecipitation
assay of protein expression.
[0195] In the context of this invention, the term "oligonucleotide"
refers to an oligomer or polymer of ribonucleic acid or
deoxyribonucleic acid. This term includes oligonucleotides composed
of naturally-occurring nucleobases, sugars and covalent intersugar
(backbone) linkages as well as oligonucleotides having
non-naturally-occurring portions which function similarly. Such
modified or substituted oligonucleotides are often preferred over
native forms because of desirable properties such as, for example,
enhanced cellular uptake, enhanced binding to target and increased
stability in the presence of nucleases.
[0196] As used herein the term "oligomeric compound" is defined as
a polymeric compound substantially comprising nucleic acid based
monomer subunits. Oligomeric compounds include oligonucleotides and
their analogs, mimics or mimetics.
Oligomer and Monomer Modifications
[0197] As is known in the art, a nucleoside is a base-sugar
combination. The base portion of the nucleoside is normally a
heterocyclic base. The two most common classes of such heterocyclic
bases are the purines and the pyrimidines. Nucleotides are
nucleosides that further include a phosphate group covalently
linked to the sugar portion of the nucleoside. For those
nucleosides that include a pentofuranosyl sugar, the phosphate
group can be linked to either the 2', 3' or 5' hydroxyl moiety of
the sugar. In forming oligonucleotides, the phosphate groups
covalently link adjacent nucleosides to one another to form a
linear polymeric compound. Within oligonucleotides, the phosphate
groups are commonly referred to as forming the internucleoside
linkage or in conjunction with the sugar ring the backbone of the
oligonucleotide. The normal internucleoside linkage that makes up
the backbone of RNA and DNA is a 3' to 5' phosphodiester
linkage.
Modified Internucleoside Linkages
[0198] Specific examples of preferred antisense oligomeric
compounds useful in this invention include oligonucleotides
containing modified e.g. non-naturally occurring internucleoside
linkages. As defined in this specification, oligonucleotides having
modified internucleoside linkages include internucleoside linkages
that retain a phosphorus atom and internucleoside linkages that do
not have a phosphorus atom. For the purposes of this specification,
and as sometimes referenced in the art, modified oligonucleotides
that do not have a phosphorus atom in their internucleoside
backbone can also be considered to be oligonucleosides.
[0199] Certain preferred oligomeric compounds of the invention can
have one or more modified internucleoside linkages. A preferred
phosphorus containing modified internucleoside linkage is the
phosphorothioate internucleoside linkage.
[0200] Preferred modified oligonucleotide backbones containing a
phosphorus atom therein include, for example, phosphorothioates,
chiral phosphorothioates, phosphorodithioates, phosphotriesters,
aminoalkylphosphotriesters, methyl and other alkyl phosphonates
including 3'-alkylene phosphonates, 5'-alkylene phosphonates and
chiral phosphonates, phosphinates, phosphoramidates including
3'-amino phosphoramidate and aminoalkylphosphoramidates,
thionophosphoramidates, thionoalkylphosphonates,
thionoalkylphosphotriesters, selenophosphates and boranophosphates
having normal 3'-5' linkages, 2'-5' linked analogs of these, and
those having inverted polarity wherein one or more internucleotide
linkages is a 3' to 3', 5' to 5' or 2' to 2' linkage.
Oligonucleotide Mimetics
[0201] Another group of compounds of the present invention includes
oligonucleotide mimetics. The term mimetic as it is applied to
oligonucleotides is intended to include oligomeric compounds
wherein only the furanose ring or both the furanose ring and the
internucleotide linkage are replaced with novel groups, replacement
of only the furanose ring is also referred to in the art as being a
sugar surrogate. The heterocyclic base moiety or a modified
heterocyclic base moiety is maintained for hybridization with an
appropriate target nucleic acid. One such oligomeric compound, an
oligonucleotide mimetic that has been shown to have excellent
hybridization properties, is referred to as a peptide nucleic acid
(PNA). In PNA oligomeric compounds, the sugar-backbone of an
oligonucleotide is replaced with an amide containing backbone, in
particular an aminoethylglycine backbone. The nucleobases are
retained and are bound directly or indirectly to aza nitrogen atoms
of the amide portion of the backbone.
Modified Nucleobases/Naturally Occurring Nucleobases
[0202] Oligomeric compounds may also include nucleobase (often
referred to in the art simply as "base" or "heterocyclic base
moiety") modifications or substitutions. As used herein,
"unmodified" or "natural" nucleobases include the purine bases
adenine (A) and guanine (G), and the pyrimidine bases thymine (T),
cytosine (C) and uracil (U). Modified nucleobases also referred
herein as heterocyclic base moieties include other synthetic and
natural nucleobases such as 5-methylcytosine (5-me-C),
5-hydroxymethyl cytosine, xanthine, hypoxanthine, 2-aminoadenine,
6-methyl and other alkyl derivatives of adenine and guanine,
2-propyl and other alkyl derivatives of adenine and guanine,
2-thiouracil, 2-thiothymine and 2-thiocytosine, 5-halouracil and
cytosine, 5-propynyl uracil and cytosine and other alkynyl
derivatives of pyrimidine bases, 6-azo uracil, cytosine and
thymine, 5-uracil (pseudouracil), 4-thiouracil, 8-halo, 8-amino,
8-thiol, 8-thioalkyl, 8-hydroxyl and other 8-substituted adenines
and guanines, 5-halo particularly 5-bromo, 5-trifluoromethyl and
other 5-substituted uracils and cytosines, 7-methylguanine and
7-methyladenine, 2-F-adenine, 2-amino-adenine, 8-azaguanine and
8-azaadenine, 7-deazaguanine and 7-deazaadenine and 3-deazaguanine
and 3-deazaadenine.
[0203] Heterocyclic base moieties may also include those in which
the purine or pyrimidine base is replaced with other heterocycles,
for example 7-deaza-adenine, 7-deazaguanosine, 2-aminopyridine and
2-pyridone.
[0204] Oligomeric compounds used in the compositions of the present
invention can also be modified to have one or more stabilizing
groups that are generally attached to one or both termini of
oligomeric compounds to enhance properties such as for example
nuclease stability. Included in stabilizing groups are cap
structures. By "cap structure or terminal cap moiety" is meant
chemical modifications, which have been incorporated at either
terminus of oligonucleotides. These terminal modifications protect
the oligomeric compounds having terminal nucleic acid molecules
from exonuclease degradation, and can help in delivery and/or
localization within a cell. The cap can be present at the
5'-terminus (5'-cap) or at the 3'-terminus (3'-cap) or can be
present on both termini.
[0205] In the case of antisense, effective inhibition of the mRNA
requires that the antisense DNA have a very high binding affinity
with the mRNA. Otherwise the desired interaction between the
synthetic oligonucleotide strand and target mRNA strand will occur
infrequently, resulting in decreased efficacy.
Antisense Compositions and Formulations
[0206] The compounds of the invention may also be admixed,
encapsulated, conjugated or otherwise associated with other
molecules, molecule structures or mixtures of compounds, as for
example, liposomes, receptor targeted molecules, oral, rectal,
topical or other formulations, for assisting in uptake,
distribution and/or absorption.
[0207] The antisense compounds of the invention encompass any
pharmaceutically acceptable salts, esters, or salts of such esters,
or any other compound which, upon administration to an animal
including a human, is capable of providing (directly or indirectly)
the biologically active metabolite or residue thereof. Accordingly,
for example, the disclosure is also drawn to prodrugs and
pharmaceutically acceptable salts of the compounds of the
invention, pharmaceutically acceptable salts of such prodrugs, and
other bioequivalents.
[0208] The term "prodrug" indicates a therapeutic agent that is
prepared in an inactive form that is converted to an active form
(i.e., drug) within the body or cells thereof by the action of
endogenous enzymes or other chemicals and/or conditions.
[0209] The term "pharmaceutically acceptable salts" refers to
physiologically and pharmaceutically acceptable salts of the
compounds of the invention: i.e., salts that retain the desired
biological activity of the parent compound and do not impart
undesired toxicological effects thereto. Pharmaceutically
acceptable base addition salts are formed with metals or amines,
such as alkali and alkaline earth metals or organic amines.
Examples of metals used as cations are sodium, potassium,
magnesium, calcium, and the like. Examples of suitable amines are
N,N'-dibenzylethylenediamine, chloroprocaine, choline,
diethanolamine, dicyclohexylamine, ethylenediamine,
N-methylglucamine, and procaine.
[0210] For oligonucleotides, preferred examples of pharmaceutically
acceptable salts include but are not limited to (a) salts formed
with cations such as sodium, potassium, ammonium, magnesium,
calcium, polyamines such as spermine and spermidine, etc.; (b) acid
addition salts formed with inorganic acids, for example
hydrochloric acid, hydrobromic acid, sulfuric acid, phosphoric
acid, nitric acid and the like; (c) salts formed with organic acids
such as, for example, acetic acid, oxalic acid, tartaric acid,
succinic acid, maleic acid, fumaric acid, gluconic acid, citric
acid, malic acid, ascorbic acid, benzoic acid, tannic acid,
palmitic acid, alginic acid, polyglutamic acid, naphthalenesulfonic
acid, methanesulfonic acid, p-toluenesulfonic acid,
naphthalenedisulfonic acid, polygalacturonic acid, and the like;
and (d) salts formed from elemental anions such as chlorine,
bromine, and iodine.
Pharmaceutical Compositions and Routes of Administration
[0211] The pharmaceutical compositions of the present invention may
be administered in a number of ways depending upon whether local or
systemic treatment is desired and upon the area to be treated.
Administration may be topical (including ophthalmic and to mucous
membranes including vaginal and rectal delivery), pulmonary, e.g.,
by inhalation or insufflation of powders or aerosols, including by
nebulizer; intratracheal, intranasal, epidermal and transdermal),
oral or parenteral. Parenteral administration includes intravenous,
intraarterial, subcutaneous, intraperitoneal or intramuscular
injection or infusion; or intracranial, e.g., intrathecal or
intraventricular, administration. Oligonucleotides with at least
one 2'-O-methoxyethyl modification are believed to be particularly
useful for oral administration.
[0212] Pharmaceutical compositions and formulations for topical
administration may include transdermal patches, ointments, lotions,
creams, gels, drops, suppositories, sprays, liquids and powders.
Conventional pharmaceutical carriers, aqueous, powder or oily
bases, thickeners and the like may be necessary or desirable.
[0213] In some embodiments, an oligonucleotide may be administered
to a subject via an oral route of administration. In some
embodiments, non-parenteral (e.g. oral) oligonucleotide
formulations according to the present invention result in enhanced
bioavailability of the oligonucleotide. In this context, the term
"bioavailability" refers to a measurement of that portion of an
administered drug which reaches the circulatory system (e.g. blood,
especially blood plasma) when a particular mode of administration
is used to deliver the drug. Enhanced bioavailability refers to a
particular mode of administration's ability to deliver
oligonucleotide to the peripheral blood plasma of a subject
relative to another mode of administration.
[0214] Oligonucleotide compositions may be formulated in various
dosage forms such as, but not limited to, tablets, capsules, liquid
syrups, soft gels, suppositories, and enemas. The term "alimentary
delivery" encompasses e.g. oral, rectal, endoscopic and
sublingual/buccal administration. A common requirement for these
modes of administration is absorption over some portion or all of
the alimentary tract and a need for efficient mucosal penetration
of the oligonucleotides or mimetics thereof so administered.
[0215] A "pharmaceutical carrier" or "excipient" may be a
pharmaceutically acceptable solvent, suspending agent or any other
pharmacologically inert vehicle for delivering one or more nucleic
acids to an animal. The excipient may be liquid or solid and is
selected, with the planned manner of administration in mind, so as
to provide for the desired bulk, consistency, etc., when combined
with an oligonucleotide and the other components of a given
pharmaceutical composition. Typical pharmaceutical carriers
include, but are not limited to, binding agents (e.g.,
pregelatinised maize starch, polyvinylpyrrolidone or hydroxypropyl
methylcellulose, etc.); fillers (e.g., lactose and other sugars,
microcrystalline cellulose, pectin, gelatin, calcium sulfate, ethyl
cellulose, polyacrylates or calcium hydrogen phosphate, etc.);
lubricants (e.g., magnesium stearate, talc, silica, colloidal
silicon dioxide, stearic acid, metallic stearates, hydrogenated
vegetable oils, corn starch, polyethylene glycols, sodium benzoate,
sodium acetate, etc.); disintegrants (e.g., starch, sodium starch
glycolate, EXPLOTAB); and wetting agents (e.g., sodium lauryl
sulphate, etc.).
RNA Interference (RNAi) and siRNAs
[0216] RNA interference (RNAi) is a phenomenon that has developed
into a new approach for elucidating and modulating gene function.
RNAi is a sequence-specific, post-transcriptional, gene-silencing
mechanism that is effected through RNA molecules, usually double
stranded (dsRNA) that are homologous to a sequence of the target
gene. Fragments of the dsRNA called "small interfering" RNAs
(siRNAs) can rapidly induce loss of function, and only a few
molecules are required in a cell to produce the effect through
hybrid formation between a homologous siRNA and mRNA. A member of
the RNase III family of nucleases named dicer has been identified
as being involved in processing. DNA vector-mediated RNAi
technology has made it possible to develop therapeutic applications
for use in mammalian cells.
[0217] siRNA suppression or silencing of gene expression through a
highly regulated enzyme-mediated process of RNAi involves multiple
RNA-protein interactions characterized by four major steps:
assembly of siRNA with the RNA-induced silencing complex (RISC),
activation of the RISC, target recognition and target cleavage.
These interactions may bias strand selection during siRNA-RISC
assembly and activation, and contribute to the overall efficiency
of RNAi.
[0218] Preferably, the inhibitory nucleic acid molecule is a double
stranded nucleic acid, preferably an RNA, most preferably an siRNA
used in a method of RNAi that results in sequence-specific
silencing, e.g. via sequence-specific degradation of homologues in
an mRNA. As used herein, the term siNA (small, or short,
interfering nucleic acid) is meant to be equivalent to other terms
used to describe nucleic acid molecules that are capable of
mediating sequence specific RNAi (RNA interference), for example
short (or small) interfering RNA (siRNA), double-stranded RNA
(dsRNA), micro-RNA (miRNA), short hairpin RNA (shRNA), short
interfering oligonucleotide, short interfering nucleic acid, short
interfering modified oligonucleotide, chemically-modified siRNA,
post-transcriptional gene silencing RNA (ptgsRNA), translational
silencing, and others. Longer ds RNAi's, such a miRNAs, appear to
tolerate mismatches more readily than do shorter dsRNAs. In
addition, as used herein, the term RNAi is meant to be equivalent
to other terms used to describe sequence specific RNA interference,
such as post transcriptional gene silencing, or an epigenetic
phenomenon. For example, siNA molecules of this are used to
epigenetic ally silence genes at both the pre-transcriptional and,
more commonly, the post-transcriptional level.
[0219] An siNA can be designed to target any region of the coding
or non-coding sequence of an mRNA, preferably the coding sequence.
The siRNA's exemplified herein are "targeted to" (which is
synonymous with "specific for" or are "complementary to" or
"hybridize with" or "hybridize to.") coding sequences. A siNA or
siRNA is preferably a double-stranded polynucleotide molecule
comprising self-complementary sense and antisense regions, wherein
the antisense region comprises a nucleotide sequence that is
complementary to the nucleotide sequence in a target nucleic acid
molecule or a portion thereof and the sense region has a nucleotide
sequence corresponding to the target nucleic acid sequence or a
portion thereof. The siNA can be assembled from two separate
oligonucleotides, where one strand is the sense strand and the
other is the antisense strand and wherein the antisense and sense
strands are self-complementary. The siNA can also be assembled from
a single oligonucleotide, where the self-complementary sense and
antisense regions of the siNA are linked by means of a nucleic acid
linker or a non-nucleic acid-based linker. The siNA can be a
polynucleotide with a hairpin secondary structure, having
self-complementary sense and antisense regions that create the
hairpin. The siNA can be a circular single-stranded polynucleotide
having two or more loop structures and a stem comprising
self-complementary sense and antisense regions which circular
polynucleotide can be processed either in vivo or in vitro to
generate an active siNA molecule capable of mediating RNAi. The
siNA can also comprise a single stranded oligo- or poly-nucleotide
having nucleotide sequence complementary to a target nucleotide
sequence in a target nucleic acid molecule or a portion thereof,
wherein the single stranded oligo- or polynucleotide can further
comprise a terminal phosphate group, such as a 5'-phosphate or
5',3'-diphosphate. In certain embodiments, the siNA molecule of the
invention comprises separate sense and antisense sequences or
regions, wherein the sense and antisense regions are covalently
linked by nucleotide or non-nucleotide linkers as is known in the
art, or are alternately non-covalently linked by ionic
interactions, hydrogen bonding, Van der Waal's interactions,
hydrophobic interactions, and/or stacking interactions.
[0220] As used herein, siNA molecules need not be limited to those
molecules containing only RNA, but further encompasses
chemically-modified nucleotides and non-nucleotides. In certain
embodiments, the siNA molecules lack 2'-OH-containing nucleotides.
In certain embodiments, siNA's do not require the presence of
nucleotides having a 2'-OH group, and as such, siNA molecules may
optionally not include any "ribonucleotides" (e.g., those
nucleotides that have a 2'-OH group); these molecules can however
have an attached linker or linkers or other attached or associated
groups, moieties, or chains containing one or more nucleotides with
2'-OH groups. Optionally, siNA molecules can comprise
ribonucleotides at about 5, 10, 20, 30, 40, or 50% of the
nucleotide positions. Such modified siNA molecules have also been
referred to as short interfering modified oligonucleotides (siMON).
Other chemical modifications, e.g., as described in WO 2003/070918
and WO2003074654 can be applied to any siNA sequence of the
invention. In one embodiment, the molecule mediating RNAi has a 2
nucleotide 3' overhang. If the RNAi molecule is expressed in a cell
from a construct, for example from a hairpin molecule or from an
inverted repeat of the desired sequence, then the endogenous
cellular machinery creates the overhangs.
[0221] Methods of making siRNAs are conventional. In vitro methods
include processing the polyribonucleotide sequence in a cell-free
system (e.g. digesting long dsRNAs with RNAse III or Dicer),
transcribing recombinant double stranded DNA in vitro, and,
preferably, chemical synthesis of nucleotide sequences homologous
to GPR101 sequence.
[0222] Ribozymes and siNAs can take any of the forms, including
modified versions, described for antisense nucleic acid molecules;
and they can be delivered to cells and introduced into cells as
oligonucleotides (single or double stranded) or in the form of an
expression vector.
[0223] In a preferred embodiment, an antisense nucleic acid, siNA,
preferably an siRNA comprises a single stranded polynucleotide
comprising a sequence that is at least about 90% or at least about
91%, 92%, 93%, 94%, 95%, 96%, 97%, 98% or 99% identical to or
complementary to a segment of the human GPR101 mRNA or coding DNA
sequence (SEQ ID NO: 1). As used herein, a DNA and an RNA encoded
by it are said to contain the same "sequence", taking into account
that the thymine bases in DNA are replaced by uracil bases in
RNA.
[0224] Active variants (e.g. length variants, including fragments;
and sequence variants) of the nucleic acid-based inhibitors,
preferably siRNAs, discussed herein are included. An "active"
variant is one that retains the activity of the inhibitor from
which it is derived (preferably the ability to inhibit GPR101 gene
expression). It is routine to test a variant to determine its
activity using conventional procedures.
[0225] As for length variants, an antisense nucleic acid or siRNA
may be of any length that is effective for inhibition of the GPR101
gene/coding sequence. Typically, an antisense nucleic acid is from
6 to 50 nucleotides (e.g. at least 12, 15, 20, 25, 30, 35, 40, 45
or 50 nt), and may be as long as about 100 to about 200 nucleotides
or more. Antisense nucleic acids may have the same length as the
coding sequence to be inhibited. When referring to length, the
terms "bases" and "base pairs" (bp) are used interchangeably, and
will be understood to correspond to single stranded (ss) and double
stranded (ds) nucleic acids.
[0226] The length of an effective siNA is generally from 15 bp to
29 bp, preferably from 19 to 29 bp, e.g. 15, 16, 17, 18, 19, 20,
21, 22, 23, 24, 25, 26, 27, 18 or 29 bp, with shorter and longer
sequences being acceptable.
[0227] As for sequence variants, it is generally preferred that an
inhibitory nucleic acid, whether an antisense nucleic acid, a
ribozyme (the recognition sequences), a siNA, preferably a siRNA
comprise a strand that is completely complementary to (or identical
to the complement of) a sequence of the target sequence of a target
nucleic acid that it is designed to inhibit. However, 100%
complementarity/sequence identity is not required for the siRNA to
function and thus be included within the scope of this invention.
Thus, the siRNA of the present invention has the advantage of being
able to tolerate and accommodate naturally occurring sequence
variations, for example, in human GPR101 that might be expected due
to genetic mutation, polymorphism, or evolutionary divergence and
to encompass all known or yet unknown allelic variants thereof.
[0228] The degree of sequence identity may be optimized by sequence
comparison and alignment algorithms well-known in the art. At least
about 90% sequence identity is preferred (more preferably at least
about 92%, 93%, 94%, 95%, 96%. 97%, 98% or 99%) between the
inhibitory nucleic acid, preferably a siRNA, and the targeted
nucleotide sequence of GPR101. Defined alternatively, an active
variant of an inhibitory nucleic acid, preferably of a siRNA, of
this invention is one that hybridizes to the sequence it is
intended to inhibit under conditions of high stringency. For
example, the duplex region of an siRNA may be defined functionally
as a nucleotide sequence that is capable of hybridizing with a
portion of the target gene transcript in vitro under high
stringency conditions (e.g. 400 mM NaCl, 40 mM PIPES pH 6.4, 1 mM
EDTA, 50.degree. C. or 70.degree. C., hybridization for 12-16
hours), followed generally by washing.
[0229] The disclosure is illustrated by the following non-limiting
Examples.
EXAMPLES
Example 1: Array Comparative Genomic Hybridization (aCGH)
[0230] Samples were analyzed obtained from 43 patients with
gigantism who had hypersecretion of growth hormone, evidence of an
anterior pituitary lesion on magnetic resonance imaging, a height
on country-specific growth charts of either more than the 97th
percentile or more than 2 SD above the mean height for age, and
negative test results for mutations or deletions in genes
associated with pituitary adenomas. Genetic analyses delineated two
phenotypes: an early-childhood form of gigantism with a typical
onset in late infancy and a second form with a typical onset in
adolescence.
[0231] In the gigantism population, all 43 patients underwent aCGH.
DNA extracted from peripheral blood leukocytes underwent aCGH
analysis using the following commercial arrays: 8.times.60K
(G4827A-031746), and 4.times.180K (G4890A-029830) (Agilent
Technologies, Santa Clara, Calif., USA) according to the
manufacturer's instructions. The arrays were scanned with a G2565CA
microarray scanner (Agilent Technologies, Santa Clara, Calif., USA)
and the images were extracted and analyzed with CytoGenomics
software v2.0 (Agilent Technologies, Santa Clara, Calif., USA). An
ADM-2 algorithm (cut-off 6.0), followed by a filter to select
regions with three or more adjacent probes and a minimum average
log 2 ratio.+-.0.25, was used to detect copy number changes. The
quality of each experiment was assessed by the measurement of the
derivative log ratio spread with CytoGenomics software v2.0.
Genomic positions were based on the UCSC February 2009 human
reference sequence (hg19) (NCBI build 37 reference sequence
assembly). Filtering of copy number changes was carried out using
the BENCHlab CNV software (Cartagenia, Leuven, Belgium).
[0232] In order to precisely determine the sizes, genomic
boundaries and contents of the rearrangements in each individual,
an 8.times.60K format aCGH (Agilent Technologies) was designed with
high-density probes tiling the critical region inside Xq26.3 (ChrX:
135001882-136499429, hg19). The probe density averaged five
oligonucleotides/Kb for the critical region with copy number
changes. It also interrogates the flanking genomic regions of up to
2 Mb in size with probe density of 1-2 per Kb. The experimental
procedures of aCGH, including DNA fragmentation, labeling and
hybridization, are performed by following the protocols described
previously with minor modifications.
Results
[0233] The critical region with genomic gains shared amongst the
unrelated patients was previously identified by low-resolution
whole-genome aCGH. Custom designed HD-aCGH interrogating the
critical region delineated 10 different genomic duplications in 12
patients, including four familial and eight sporadic cases. The DNA
of patient S3 was not of sufficient quality to be analyzed by
HD-aCGH. The remaining 29 patients that did not shown any
duplication in the Xq26.3 region by low-resolution whole-genome
aCGH were also investigated in order to exclude an undetectable
microduplication. HD-aCGH confirmed that these patients do not
harbor any duplication in the studied region.
[0234] In the patients S1, S6, S7, S8, and S9, various sized
microhomologies were observed at the breakpoint junctions,
suggesting the FoSTeS/MMBIR (Fork Stalling and Template
Switching/Microhomology-Mediated Break-Induced Replication) as the
potential mechanism for the formation of this tandem duplications.
Interestingly, one base-pair mismatch (C/G) was observed in the
microhomology of S9, reflecting the possibility that a perfect
match may not be always required for the microhomology to mediate
FoSTeS/MMBIR mechanism. For case S5, a 5 bp insertion was observed.
The FoSTeS/MMBIR may act as the mechanism for generating such
complexity by switching the template twice. In the duplication of
case S2, a 5 bp microhomology was observed at the breakpoint of the
tandem duplication, while further sequencing revealed a 149 bp
insertion that possibly arose from a copy of a template positioned
on the reverse strand 122 Mb away (ChrX: 12865862-12866010, hg19).
Flanking that 149 bp insertion were two 1 bp micro-homologies (G
and A). A similar level of complexity was apparent for the
rearrangement in patient F2A. A 2 bp microhomology was observed at
the breakpoint of the tandem duplication, with a 105 bp deletion
and then a 1 bp insertion at the same place of the deletion.
Non-homologous end-joining (NHEJ) or FoSTeS/MMBIR may act as the
deletion/insertion mechanism.
[0235] More complex abnormalities were seen in the duplication of
patient S4: HD-aCGH detected proximal and distal duplicated
segments separated by a normal segment (this complexity was not
seen on the whole genome low density array which simply showed a
single duplicated region). Two major breakpoint junction clusters,
S4-1 and S4-2, were revealed. A 3 bp insertion was observed at S4-1
and an insertion of 86 bp at the proximal S4-2, which could
partially derive from mismatches in the vicinity (e.g. a 7 bp
insertion and a 9 bp insertion). This 86 bp insertion also may
provide the 7 bp microhomology for priming the replication to the
distal end of S4-2.
[0236] PCRs of the breakpoint junctions specific for the patients
were performed to confirm the inheritance pattern of the genomic
gains. Breakpoint junction PCRs for the families of S2, S4 and S6
suggested the gains to be de novo events. The paternal sample was
not available for S5. The breakpoint junction PCRs were negative in
the mother and the unaffected brother. Breakpoint junction PCRs for
the familial cases F1A, F1B and F1C revealed that the duplications
in F1B and F1C were identical and inherited from the mother F1A.
PCR was negative in the paternal DNA. For the other familial case
F2A, the breakpoint junction PCR was negative for the unaffected
sister of the proband.
[0237] In total, 21 potential template-switching events occurred in
all the genomic gains, and microhomologies were involved in nine of
them. Further, six small insertions (<10 bp) were observed,
which may account for up to 12 template switches (2 template
switches being required for each small insertion). Although the
small insertions (less than 10 bp) were too small to be uniquely
located in the genome, it is possible that there were
microhomologies flanking the insertions, mimicking the mechanism of
the insertion observed in S2. The small insertions could have also
been de novo synthesized, rather than being template events. Five
out of ten genomic gains showed multiple template switches, which
introduced small-scale complexities near the large genomic gain
breakpoints, reflecting the potential low-processivity replication
repair and iterative template switches after the collapse of the
replication forks.
Example 2: Copy Number Variation (CNV) Analysis
[0238] Individual CNV assays were performed by duplex TaqMan
real-time PCR assays in order to confirm the array-CGH results in
the giant patients and to extend the analysis in a cohort of 47
patients with sporadic pituitary tumors for which
sufficient-quality DNA was available. CNV assays for CD40LG,
ARHGEF6, RBMX, and GPR101, consisting in a pair of unlabeled
primers and a FAM-labeled MGB probe, were supplied from Life
Technologies (Assay ID: Hs02425845_cn, Hs01655699_cn,
Hs01064297_cn, Hs01730605_cn, respectively). RNase P (Life
Technologies, #4403328) with a VIC-labeled TAMRA probe was used as
reference gene. TaqMan CMV assays were performed according to
manufacturer's protocol (Life Technologies, Carlsbad, Calif., USA).
Briefly, experiments were prepared in 96 microwell plates and
consisted of 20 .mu.l reactions containing 20 ng of genomic DNA, 10
.mu.l TaqMan Genotyping Master Mix (Life Technologies, catalog
number 4371355) and 1 .mu.l each of one target gene and reference
CNV assay mixes. All reactions were run in triplicate on a ViiA 7
Real-Time PCR System (Life Technologies) and thermal cycling
conditions were 95.degree. C., 10 min followed by 40 cycles of
95.degree. C. for 15 s and 60.degree. C. for 1 min. All data were
analyzed using the CopyCaller software version 2.0 (Life
Technologies). The copy number was determined by the relative
relationship between the quantity of the target gene and the
reference gene, using a female calibrator sample known to have two
copies of each gene as the basis for comparison.
Results
[0239] Six patients harboring an Xq26.3 microduplications and 47
patients with sporadic acromegaly and pediatric pituitary tumors
were analyzed for CNV by duplex TaqMan real-time PCR assays for
CD40LG, ARHGEF6, RBMX, and GPR101. CNV assays confirmed the aCGH
results in the patients with the duplication, whereas no gain or
loss of genetic material was found in any gene in any sporadic
acromegaly and pediatric patients. CNV analysis in the tumor DNA of
two patients harboring the Xq26.3 duplication confirmed the
duplication of all 4 genes in the pituitary tumor tissue.
Example 3: Whole Exome Analysis (WES)
[0240] Thirteen FIPA kindreds with homogeneous acromegaly (2-3
affected patients per kindred) were selected for WES and one
affected individual per kindred was studied. Five patients from the
gigantism population also underwent WES. Genomic DNA was extracted
from 400 .mu.l whole blood using the BioRobot M48 (Qiagen). Exome
libraries were prepared from high quality DNA following vendors'
protocols (TruSeq and Nextera exome capturing kits, Illumina with,
respectively, 1 .mu.g and 50 ng DNA). Exome libraries were
multiplexed by 24 and paired-end sequenced on two lanes of an
Illumina HiSeq reaching a mean 30.times. coverage depth. For each
sample, reads were mapped and variants were called following the
GATK Best Practices (GATK v3.1). Unless stated otherwise, steps
were performed with GATK tools (v3.1). Briefly, paired-end reads
were mapped to the reference human genome (UCSC hg19) with bwa-mem
(0.7.7). Duplicate reads were marked with Picard (1.73) and locally
realigned with MarkDuplicates. Base quality scores were
recalibrated with BaseRecalibrator. Variants were called on each
processed sample with the HaplotypeCaller in gVCF mode followed by
a joint GenotypeGVCFs step including 1000Genomes control samples.
Variant quality scores were recalibrated with VariantRecalibrator
and annotated with Variant Effect Predictor (Ensembl, release 75).
Variants falling in a 99% truth sensitivity level were
retained.
Example 4: Fluorescent In Situ Hybridization (FISH) Analysis
[0241] FISH analysis was performed for confirmation of the array
data. Commercially available probes covering the region of
chromosome X provided insufficient coverage and hence new
fluorescent probes were designed in collaboration with the
commercial partner (Agilent). The red and green probes were
designed based on the continuous Xq26.3 duplication intervals of
two of the sporadic cases, 51 and S2 (chrx:135620070-136173879,
chrx:135617178-136250554) and the two separate duplicated intervals
of case S4 (chrx:135624323-135985727; chrx:136 045 379-136 268
105). This provided coverage of the two SROs identified in the
Xq26.3 duplicated cases. The nuclei preparation was performed as
described previously. Analysis was performed with a BX51
epifluorescence microscope (Olympus) equipped with a CV-M4+CL
camera (JAI) and images were captured using the platform CYTOVISION
version 7.3.1 (Leica Microsystems).
[0242] The specially designed fluorescent probes covering regions
within SRO1 (green) and SRO2 (red) were applied to cultured
leukocytes from four of the sporadic cases 51, S2, S4 and S9 (3
females and 1 male). In all four cases a duplication of the two
probe signals was seen; a normal single copy of each probe signal
was seen in the non-involved X chromosome of the 3 female
cases.
Example 5: DNA Preparation and Sequencing Analysis
[0243] All patients with Xq26.3 microduplication, 37 pediatric
sporadic patients from the NIH (32 ACTH-secreting and 5
GH-secreting adenomas without a history of FIPA or other inherited
pituitary adenoma conditions), and 96 sporadic acromegaly patients
(55% males; median age at diagnosis: 38.5 years) from the
University of Liege (n=88) and the NIH (n=8) were sequenced for the
four protein-coding genes (CD40LG, ARHGEF6, RBMX, and GPR101), the
small nucleolar RNA, SNORD61, and the microRNA, miR-934, located in
the duplicated Xq26.3 region. In addition, the GPR101 gene was
sequenced in a large international cohort of sporadic acromegaly
patients and somatic somatotropinoma samples from the NIH, European
centers, and a group of samples of varied geographic origin. Among
these sporadic acromegaly cases, 11 patients had paired genomic and
somatic DNA available.
[0244] DNA was extracted from peripheral EDTA blood and pituitary
tumor samples using the QIAamp DNA Mini Kit (Qiagen, Valencia,
Calif.) according to the manufacturer's protocols. The whole coding
region, intron-exon boundaries, and 5'- and 3'-UTRs of all five
target genes were PCR amplified and directly sequenced. Primers
sequences and PCR conditions are available upon request. DNA
sequencing was performed using the BigDye 3.1 Termination Chemistry
(Life Technologies) on a Genetic Sequencer ABI3100 apparatus (Life
Technologies). Sequences were visualized and aligned to the
corresponding wt reference sequence using the SeqMan Pro software
(DNAStar, Madison, Wis.). All variants have been annotated
according to Human Genome Variation Society (HGVS) recommendations
(www.hgvs.org/mumomen). The following reference sequences were
used: NM_016267.3 for miR-934 (VGLL1), NM_000074.2 for CD40LG,
NM_004840.2 for ARHGEF6, NM_002139.3 for RBMX, NR_002735.1 for
SNORD61, and NM_054021.1 for GPR101.
Example 6: Immunostaining
[0245] The surgical samples were fixed in formalin and embedded in
paraffin. Five-.mu.m-thick sections were stained with
haematoxylin-eosin (H&E) and reticulin for light microscopy.
Immunohistochemistry for pituitary hormones was performed following
previously described protocols using the following primary
antibodies: anti-Prolactin (PRL) AM031-5M Biogenex.RTM.,
Fremont-CA, monoclonal mouse, ready to use; anti-Human Growth
Hormone (GH) A0570 Dako Cytomation.RTM., Carpinteria-CA, polyclonal
rabbit, working dilution 1:2000; anti-Adrenocorticotropin (ACTH)
Clone 02A3 Dako Cytomation, Carpinteria-CA, monoclonal mouse,
working dilution 1:2000; anti-Follicle Stimulating Hormone (FSH),
AM026-5M Biogenex, Fremont-CA, monoclonal mouse, ready to use;
anti-Luteinizing hormone (LH) AM030-5M Biogenex, Fremont-CA,
monoclonal mouse, ready to use; anti-Thyroid stimulating hormone
(TSH) AM033-5M Biogenex, Fremont-CA, monoclonal mouse, ready to
use; anti-alpha-subunit (alpha-hCG) AM037-5M Biogenex, Fremont-CA,
monoclonal mouse, ready to use.
[0246] GHRH-R, ab150575, Abcam.RTM., Cambridge-MA, primary antibody
is a rabbit polyclonal antibody mapping to the C-terminal
transmembrane domain of GHRH-R. Immunohistochemistry was performed
by Ventana.RTM. BenchMarkXT Automated IHC/ISH slide staining
system. The histological samples were incubated for 90 min at
37.degree. with this primary antibody diluted at 1:50, after
pre-treatment with a pH9 buffer for 60 min. The Ventana.RTM.
ultraView Universal DAB Detection Kit was used for the detection.
GHRH, GTX81311, Genetex.RTM., Irvine Calif., primary antibody is a
rabbit polyclonal antibody mapping to the N-terminal region of
GHRH. Immunohistochemistry was performed by Ventana.RTM.
BenchMarkXT Automated IHC/ISH slide staining system. The
histological samples were incubated.times.120' at 37.degree. with
this primary antibody diluted at 1:10, without pre-treatment. The
Ventana.RTM. ultraView Universal DAB Detection Kit was used for
detection. Cytokeratin staining was performed with CAM5.2. Normal
pituitary, pancreatic, and gonadal tissues were used as positive
controls.
[0247] Negative control reactions were obtained in each test series
by omission of the primary antibody. Images from haematoxylin-eosin
and reticulin stain for light microscopy and immunohistochemistry
were performed with BX41 Olympus Microscope, Axiocam ICc 1 camera
and Axiovision 4 software from Zeiss at 100.times. and 200.times.
magnifications.
[0248] For GPR101 immunofluorescence evaluation, a subset of five
human pituitary tumor tissues, a human normal pituitary tissue, and
five human normal hypothalami, was used. All paraffin embedded
slides were submitted to de-parafinization, rehydration and antigen
retrieval for 30 min in citrate buffer solution (pH 6.0). All
slides were incubated with 10% normal donkey serum (NDS) for one
hour for blocking, and they were incubated with the following
primary antibodies: rabbit anti-GPR101 (dilution 1:500; SAB4503289,
Sigma-Aldrich, St. Louis, Mo., USA), rabbit anti-GPR101 (dilution
1:500; HPA001084, Sigma-Aldrich), goat anti-GH (dilution 1:100,
sc-10364; Santa Cruz Biotechnology, Santa Cruz, Calif.) overnight
at 4.degree. C. Both anti-GPR101 antibodies react with the human
and rodent homologues of GPR101. All slides were incubated for 1-2
hours with the following secondary antibodies: donkey anti-rabbit
555 (A-31572, Life Technologies, Foster City, Calif.) and donkey
anti-goat 488 (A-11055, Life Technologies), both at 1:500 dilution.
Prolong gold mounting media with DAPI (P36934, Life Technologies)
was used to set the slides. As negative control, a section of the
same specimen was incubated under identical conditions with no
primary antibody. Fluorescence was analyzed with a Leica AF6000
microscope (Leica, Allendale, N.J.) at 63.times. magnification with
fixed time of exposure for all samples. Subsequently, images were
deconvoluted with the supplied Leica image processing software
(Leica). The same linear adjustments for brightness, contrast and
color balance have been applied with Adobe Photoshop CS6 to each
entire image.
[0249] 75,000 GH3 cells were seeded onto Lab-Tek II chamber slides
(Nunc, Rochester, N.Y.), left overnight and transiently transfected
with WT and mutant GPR101 vectors. 24 h after transfection cells
were washed 2.times. in PBS and fixed in 4% paraformaldehyde in PBS
for 15 min, followed by rehydration and permeabilization in PBS
containing 0.01% Tween-20. Slides were blocked in 10% goat serum
(Jackson ImmunoResearch, West Grove, Pa.) for 1 h. Two primary
antibodies against GPR101 (SAB4503289, dilution 1:500, and
HPA001084, dilution 1:1000, Sigma-Aldrich) in 10% goat serum were
applied to the slides at 4.degree. C. overnight alongside negative
controls without primary antibody. Slides were washed in PBS-T and
secondary Alexa Fluor 488 goat anti-rabbit (dilution 1:1000, Life
Technologies) was applied for 1 h. Slides were washed, mounted
using Prolong Gold containing DAPI (Life Technologies) and covered.
Cells were visualized at 40.times. magnification with a Zeiss
AxioCam MRm microscope camera using the ZEN software.
[0250] Five-.mu.m-thick coronal sections of the mouse brain tissues
were deparaffinized and the heat induced antigen retrieval was done
in a microwave for 5 min with buffer containing 10 mM Tris, 1 mM
EDTA, and 0.05% Tween 20, pH 9. The rabbit polyclonal anti-GPR101
antibody (SAB4503289, Sigma-Aldrich) was applied in 2 .mu.g/ml
dilution overnight at 4.degree. C. Immunofluorescence staining was
performed using a Tyramide signal amplification kit (T20922, Life
Technologies) with horseradish peroxidase-goat anti-rabbit IgG and
Alexa fluor 488 tyramide, according to the manufacturer's
instructions. The sections were mounted in Mowiol and visualized
under an inverted confocal microscope (Zeiss LSM 510). Brightness
and contrast were adjusted in each entire image in Adobe Photoshop
CS4.
Results
[0251] Immunostaining for GPR101 (red) and GH (green) was performed
in five patients with the Xq26.3 microduplication and in controls
(an age-matched control somatotropinoma without the duplication and
a normal pituitary). A higher GPR101 expression was observed in
patients harboring the Xq26.3 duplication compared to both
controls.
[0252] Immunostaining for GPR101 was also performed in the mouse
and human normal brain. GPR101 expression was observed in the mouse
hypothalamic area around the third ventricle (3V), including the
arcuate nucleus (ARH). In both the mouse and human ARH, GPR101 was
detected on neuronal cell bodies and axons.
[0253] Haematoxylin-eosin (H&E) and reticulin staining were
performed in all cases. In general, cases were of the mixed-type of
GH and prolactin secreting adenoma (WHO 2004 Classification). Tumor
cells showed eosinophilia and were organized in solid pattern with
some cystic structures and psammomas. The tissue architecture was
characterized by expended hyperplastic acini with intact reticulin
fiber network compared to normal adenohypophysis. Some areas with
enlarged, hyperplastic acini showed an initial breakdown of some
reticulin fibers, resulting in confluent acini (transformation
areas). Other zones presented clearly a partial or total disruption
of reticulin fiber network with pseudo-nodular formations
(microadenoma). In patient F1C the normal pituitary tissue was
extensively substituted by mammosomatotroph hyperplasia with
nodular pattern. There were small foci where the enlarged acini of
the hyperplasia become confluent. GHRH-R was expressed in
GH-secreting cells in normal adenohypophysis, but at low intensity.
In contrast, GHRH-R immunostaining was positive in hyperplastic
areas and in adenomas with intensity stronger than normal
adenohypophysis. GHRH staining was performed and was low/absent in
tumor or hyperplasia from patients with duplication, similar to
that of normal pituitary tissue.
Example 7: RNA Isolation, Reverse Transcription and mRNA Expression
Analysis
[0254] Total RNA was isolated from PHA stimulated blood cells using
the RNeasy Mini Kit (Qiagen, Germantown, Md.). Prior to RNA
extraction, in order to reduce nonsense-mediated mRNA decay, cells
were incubated with 100 .mu.g/ml cycloheximide (Sigma-Aldrich) for
2 h at 37.degree. C. Total RNA was isolated from human and mouse
pituitary tissues using TRIzol reagent (Life Technologies). 1 .mu.g
of RNA was treated with DNase I (Life Technologies) to remove
genomic DNA contamination and then reverse transcribed to cDNA
using the Superscript III Kit (Life Technologies) according to the
manufacturer's protocols. Total RNA was isolated from GH3 cells
transiently transfected with human WT and mutant GPR101 vectors
(see below) using the RNeasy Mini Kit (Qiagen) according to the
manufacturer's protocols, and reverse transcribed as described
above. Total RNA from mouse hypothalamus and Poly A+ RNA from human
hypothalamus were purchased from Clontech (catalog number 636664,
636144, respectively) and reverse transcribed as described
above.
mRNA Expression Analysis
[0255] The expression levels of the four duplicated genes and GHRH
were measured by RT-qPCR with the TaqMan system using ready-made
probe-primer kits supplied from Life Technologies (Assay ID:
CD40LG, Hs00163934_m1; ARHGEF6, Hs00374462_m1; RBMX, Hs00953944_g1;
GPR101, Hs00369662_s1; GHRH, Hs00184139_m1). Reactions were
performed in triplicate and GAPDH (glyceraldehyde-3-phosphate
dehydrogenase, Life Technologies, Hs99999905_m1) was used as
endogenous control. In GH3-transfected cells beta-actin (Actb) was
used as endogenous control (Rn00667869_m1, Life Technologies). In
mouse tissues Gpr101 expression was measured with TaqMan assay ID
Mm01296083_m1 (Life Technologies) and normalized on beta-actin
expression (Actb, Mm00607939_s1, Life Technologies). TaqMan assays
were performed according to the manufacturer's protocol (Life
Technologies). Briefly, experiments were prepared in 96 microwell
plates and consisted of 20 .mu.l reactions containing 20 ng of
cDNA, 10 .mu.l TaqMan Gene Expression Master Mix (Life
Technologies, catalog number 4369016) and 1 .mu.l each of one
target gene and endogenous control assay mixes. All reactions were
run on a ViiA 7 Real-Time PCR System (Life Technologies) and
thermal cycling conditions were 95.degree. C., 10 min followed by
40 cycles of 95.degree. C. for 15 s and 60.degree. C. for 1 min.
Relative gene expression data were analyzed using a relative
standard curve using qPCR human reference cDNA, random-primed (50
ng/.mu.l, 639654, Clontech). Data analysis was performed using the
ViiA 7 software (Life Technologies).
[0256] Results
[0257] The transcriptional levels of CD40LG, ARHGEF6, RBMX, and
GPR101 were evaluated on peripheral RNA obtained from two patients
with Xq26.3 micro duplications and compared with three normal
subjects. CD40LG levels do not differ between patients and
controls, whereas the mRNA levels of ARHGEF6, RBMX, and GPR101 are
lower in peripheral RNA in the patients; this was particularly
evident for GPR101. The transcriptional levels of GHRH were
evaluated in two patients with the Xq26.3 duplication and compared
with two normal pituitaries and two sporadic GH secreting adenomas.
None of the analyzed samples showed expression of GHRH.
Example 8: Protein Extraction and Western Blot Analysis
[0258] Proteins were extracted from GH3 cells transiently
transfected with WT and mutant GPR101 vectors. 24 h after
transfection cells were washed with PBS, lysed with 100 .mu.l of
lysis buffer (50 mM Tris-HCl, 50 mM NaCl, 10 mM EGTA, 10 mM EDTA,
80 M sodium molybdate, 5 mM sodium pyrophosphate, 1 mM sodium
orthovanadate, 1 mM PMSF, 4 mM pNPP, 1% Triton; Sigma-Aldrich),
sonicated, and centrifuged at 20,000 g for 15 min at 4 C. The
supernatant was subsequently measured for protein content using the
BCA Protein Assay Kit (Pierce Biotechnology, Rockford, Ill.).
[0259] Proteins were also isolated from two post-mortem samples of
normal human pituitary using 350 .mu.l of lysis buffer (see above),
sonicated, and centrifuged at 20,000 g for 15 min at 4 C. Pools of
tissue-specific total proteins isolated from different human brain
regions (amygdala, hippocampus, hypothalamus) were purchased from
Clontech (catalog number 635317, 635319, 635320, respectively).
[0260] Under denaturing conditions, 15-30 .mu.g of protein lysates
were loaded onto Bolt 10% Bis-Tris Plus gels (Life Technologies)
and electroblotted onto Whatman Protran nitrocellulose membranes
(Sigma-Aldrich). Blots were blocked for 30 min in 5% non-fat dry
milk in TBST 0.1% and incubated overnight with primary antibodies
(GPR101 (SAB4503289, dilution 1:500, Sigma-Aldrich), and GAPDH
(sc-137179, dilution 1:400, Santa Cruz)). Subsequently, blots were
washed with TBST 0.1% (3.times.15 min) and incubated in goat
anti-rabbit IgG horseradish peroxidase-conjugated secondary
antibody (dilution 1:2000, Jackson ImmunoResearch) for 1 h at room
temperature. Immunoblots were visualized using the Supersignal West
Pico Chemiluminescent substrate (Thermo Scientific, Waltham, Mass.)
on a ChemiDoc MP imaging system (Bio-Rad, Hercules, Calif.), and
quantified using the Image Lab software (Bio-Rad). Expression was
normalized to GAPDH.
Results
[0261] GPR101 protein expression in normal human pituitary,
amygdala, hippocampus, and hypothalamus was analyzed by Western
Blot. GPR101 expression was detected in all the three brain regions
analyzed, whereas only one out of two normal pituitary samples
showed low expression levels.
Example 9: Cell Culture, GH Secretion after ARHGEF6, RBMX, and
GPR101 Over-Expression
[0262] The rat pituitary somatomammotroph GH3 cell line was grown
in Dulbecco's modified Eagle's medium (DMEM, high glucose,
pyruvate, no glutamine; 10313, Life Technologies) supplemented with
10% fetal bovine serum (100-106, Gemini Bio-Products), and 1%
antibiotic-antimycotic (15240-062, Life Technologies) in a
humidified atmosphere at 37.degree. C. with 5% CO.sub.2.
[0263] GH3 cells were seeded in 12-well plates at a density of
2.times.10.sup.5 cells/well. After 24 h, cells were starved with
DMEM without serum for 16 h and then transfected with
LIPOFECTAMINE.RTM. 2000 (11668030, Life Technologies) according to
the manufacturer's protocol, using OPTI-MEM.RTM. I Reduced Serum
Medium (31985-070, Life Technologies) and 1 .mu.g of each vector,
alone or in combination. The human GPR101 wt (NM_054021.1) and
ARHGEF6 wt (NM_004840) coding sequences cloned into the pCMV-XL5
vector were purchased from Origene (SC120214 and SC100230,
respectively), while the human wt RBMX coding sequence (NM_002139)
cloned into the pcDNA3.1/V5-His TOPO vector (Life Technologies) was
a kind gift of Dr SJ Levine (NIH, Bethesda, USA). The p.E308D and
p.A397K variants were introduced into the human GPR101 wt template
using the QuikChange Lightning site-directed mutagenesis kit
(210518-5, Agilent Technologies), following the manufacturer's
protocol. The empty pCMV-XL5 and pcDNA3.1/V5-His TOPO vectors were
used as negative controls, accordingly. 24 h after transfection
supernatants were collected and GH secretion was measured using the
Rat/Mouse Growth Hormone ELISA kit (EZRMGH-45K, EMD Millipore)
following the manufacturer's protocol. Absorbance was read at 450
nm and 590 nm using a FLUOSTAR.RTM. Omega microplate reader (BMG
LABTECH). GH secretion values (expressed in ng/ml) were normalized
either on protein content or on O.D. values obtained for the same
samples from cell proliferation experiments (see section
below).
Cell Proliferation after ARHGEF6, RBMX, and GPR101
Over-Expression
[0264] GH3 cells were seeded in 96-well plates at a density of
2.times.10.sup.4 cells/well. After 24 h, cells were starved with
DMEM without serum for 16 h and then transfected with
LIPOFECTAMINE.RTM. 2000 (Life Technologies) according to the
manufacturer's protocol, using OPTI-MEM.RTM. I Reduced Serum Medium
(Life Technologies) and 125 ng of each vector (human WT ARHGEF6, WT
RBMX, WT GPR101, p.E308D GPR101, and p.A397K GPR101), alone or in
combination. The empty pCMV-XL5 and pcDNA3.1/V5-His TOPO vectors
were used as negative controls. 24 h after transfection cell
viability was assessed with the VYBRANT.RTM. MTT cell proliferation
assay (Life Technologies) following the manufacturer's protocol.
Briefly, cells were incubated for 4 h at 37.degree. C. with MTT
solution and were then lysed with Dimethyl sulfoxide (DMSO).
Absorbance was read at 540 nm using a FLUOSTAR.RTM. Omega
microplate reader (BMG LABTECH).
Results
[0265] The three human genes that were expressed in the pituitary
tumors (ARHGEF6, RBMX, and GPR101) were transiently over-expressed
in the GH3 mammosomatotroph cell line. None of the over-expressed
human WT proteins significantly affected cell proliferation or GH
secretion when singularly transfected compared to cells transfected
with the corresponding empty vector. When human GPR101 was
overexpressed together with either or both human ARHGEF6 and human
RBMX, a synergistic effect was shown on cell proliferation but not
on GH secretion.
GPR101 Over-Expression Analysis in Transfected GH3 Cells
[0266] GH3 cells transiently transfected with the human WT and
mutant GPR101 were analyzed both at the mRNA and protein level for
the achieved levels of expression of the receptor. Human GPR101
expression levels are comparable to those observed in the patients
with Xq26.3 microduplications.
Example 10: Use of a Reporter Assay to Monitor cAMP Levels after
Over-Expression of WT and Mutant GPR101 Constructs
[0267] GH3 cells were seeded in 12-well plates at a density of
2.times.10.sup.5 cells/well. After 24 h, cells were starved with
DMEM without serum for 16 h and then transfected with
LIPOFECTAMINE.RTM. 2000 (11668030, Life Technologies) according to
the manufacturer's protocol, using OPTI-MEM.RTM. I Reduced Serum
Medium (31985-070, Life Technologies), 1 .mu.g of each GPR101
vector (human WT GPR101, p.E308D GPR101, and p.A397K GPR101), 800
ng of pGL4.29[luc2P/CRE/Hygro] vector containing a cAMP response
element (CRE) that drives the transcription of the luciferase
reporter gene (Promega), and 40 ng of the Renilla vector (pRL-SV40,
Promega). The empty pCMV-XL5 vector was used as negative control.
24 h after transfection, a subset of cells was treated with 10
.mu.M forskolin (F6886, Sigma-Aldrich) for 1 h and then lysed.
Firefly and Renilla luciferase activities were measured
consecutively in the same sample using the DUAL-LUCIFERASE.RTM.
Reporter Assay System (E1910, Promega) following the manufacturer's
protocol. Ratios of Firefly vs. Renilla luminescence signals,
serving as a measure for reporter activity normalized for
transfection efficiency, were measured using a FLUOSTAR.RTM. Omega
microplate reader (BMG LABTECH). The results are summarized in FIG.
1F. The figure shows activation of DNA sequences called cyclic AMP
response elements (CRE) in rat GH3 cells transfected with mutant
(p.E308D and p.A397K) and nonmutant GPR101 constructs. Values for
cells transfected with empty (control) vector were set at 1. Also
shown are values for untreated cells (vehicle) and forskolin (which
increases CRE activation). Like the construct containing the
non-mutant receptor, the two mutant constructs resulted in
increased cAMP signaling in GH3 cells in an in vitro reporter
assay, both at baseline and in the presence of forskolin (10
.mu.M), a direct stimulator of adenylyl cyclase.
Statistical Analysis
[0268] Statistical analysis was performed with StatsDirect software
(Addison-Wesley-Longman, Cambridge, UK).
[0269] Data are presented as the mean.+-.standard deviation (SD) of
two to five independent experiments, each performed at least in
triplicate. Comparisons were calculated using a two-tailed
Student's t test for unpaired data and the Kruskal-Wallis test
followed by the Conover-Inman test, as appropriate. A Chi-square
test was used to compare the allelic frequencies of the different
genes in patients and controls. The data were considered to be
significant when P<0.05.
Example 11: Case Report of a Female Sporadic X-LAG Patient
[0270] X-linked acrogigantism (X-LAG) syndrome is a of inheritable
pituitary gigantism that begins in early childhood and is usually
associated with very elevated growth hormone (GH) and prolactin
secretion by mixed pituitary adenomas. Microduplications on
chromosome Xq26.3 that include the gene GPR101 underlie the genetic
etiology of X-LAG syndrome. In individual cases random GH-releasing
hormone (GHRH) levels have been elevated.
[0271] A series of hormonal profiles were performed in a young
female sporadic X-LAG patient and subsequently undertook in vitro
studies of primary pituitary tumor culture following a
neurosurgical resection.
[0272] The patient was a 2-year-old female with no family history
of growth disorders. The patient was born at 35.5 weeks gestation
and had a birth weight of 2306 g and a birth length of 44.5 cm,
which were both below the 3rd percentile. Beginning from 2 months
of age the patient began to grow excessively in terms of length and
weight, exceeding the 97.sup.th percentile of her growth charts by
the ages of 12 and 14 months, respectively. The patient was
diagnosed with marked GH, IGF-1 and prolactin excess and a
pituitary MRI demonstrated a large, uniform sellar lesion
(17.times.8.times.8 mm) with suprasellar extension. A random level
of GHRH was raised, although no potential ectopic sources were
identified. Treatment with octreotide (150 mcg sc t.i.d.) and
cabergoline (0.5 mg/week) was initiated, but IGF-1 levels remained
consistently elevated. The patient was diagnosed with X-LAG
syndrome based on an array CGH study that showed a microduplication
on chromosome Xq26.3 that was confirmed by fluorescent in situ
hybridization studies. As chronic treatment with somatostatin
analogs and dopamine agonists for 12 months had no effect on the
patient's excessive growth and her pituitary lesion began impinging
on the optic chiasm, the patient was referred for neurosurgical
treatment.
[0273] At transsphenoidal surgery, a gross total resection of the
anterior pituitary was performed. Histology revealed a densely
cellular tissue specimen comprised of cords of polymorphic cells
with abundant cytoplasm (some acidophilic, some chromophobic) and
rounded nuclei. Some nuclear atypia was seen and some mitotic
figures were seen. Small calcifications were identified but no
necrotic foci were seen. Silver staining demonstrated pituitary
hyperplasia with widening of the pituitary acini, which was
accompanied by focal loss of acinar structure. Immunohistochemistry
revealed widespread positivity for GH and prolactin throughout the
lesion. Staining for ACTH and TSH was limited to the periphery of
the resected tissue and rare cells disseminated within the lesion
(LH staining was very rare and FSH staining was absent). Nuclear
positivity for p53 was focally highly intense in some cells within
the lesion and the Ki67 index was elevated at 5%. CAM 5.2 staining
revealed cytoplasmic peri-nuclear and dot-like positivity patterns.
The overall pathological result was determined to be an atypical
mixed GH/prolactin adenoma associated with anterior
hyperplasia.
[0274] Postoperatively the patient had cortisol and thyroid
deficiencies and diabetes insipidus, which all replaced.
Post-operative hormonal levels revealed that GH, IGF-1 and
prolactin were in the normal range, and remained so after 6 months'
follow-up. The increased growth of the patient has halted.
Example 12: Dynamic Hormone Profiles
[0275] In respect to the case report described in Example 11
pre-operatively a series of dynamic pituitary hormone tests were
performed, including a 180 minute test for GH, prolactin and GHRH
pulsatility, a GnRH test (25 .mu.g IV GnRH (HRF-AYERST) to study
prolactin, GH and GHRH (0, 15, 30 and 90 minutes) and a TRH test
(125 .mu.g IV) with measurements of prolactin, GH and GHRH (0, 15,
30 and 90 minutes). These were all performed in the immediate
preoperative period after washout of octreotide (48 hrs.) and
cabergoline (24 hrs.). The pulsatility study (FIG. 2A) demonstrated
markedly raised levels of GH and PRL throughout and all GHRH levels
were elevated at all study time points. Fluctuations in elevated
GHRH levels also occurred, and these were partially but not
completely in phase with alterations in GH. While the elevated
prolactin levels varied by less than .+-.7% from baseline
throughout the study, changes in GH levels were more marked (-23.6%
to +61.5%).
[0276] A TRH test (FIG. 2B) led to a paradoxical rise in GH that
was accompanied by the expected rise in prolactin. Following GnRH
administration (FIG. 2C), the grossly elevated baseline level of GH
(212 ng/mL) decreased to 50 ng/mL. Again, the GHRH level was also
elevated at baseline (138 pg/mL) and remained elevated
throughout.
Example 13: Cell Culture
[0277] A surgical sample of the human pituitary adenoma of the
patient mentioned in example 11 in Dulbecco's modified Eagle's
medium (DMEM) was dissociated mechanically and enzymatically as
described by Jaquet et al. (Hormonal regulation of prolactin
release by human prolactinoma cells cultured in serum-free
conditions. Horm Res 22 153-163, 1985). A sample of the medium in
the postoperative sample was retained before further preparation. A
total of 50,000 tumor cells per well were plated in 24 well plates
coated with extracellular matrix from bovine endothelial corneal
cells required for cell adhesion. The cells were cultured in DMEM
depleted of L-Valine (D-Valine-DMEM) to block fibroblast
proliferation, supplemented with 10% fetal calf serum, penicillin
(100 U/ml), streptomycin (100 .mu.g/ml), and glutamine (100 U/ml)
at 37.degree. C. in a water-saturated atmosphere containing 7%
CO.sub.2. After 48 h, culture medium was changed to D-Valine DMEM
containing 1% ITS (Insulin Transferin Selenium) and 1% fetal calf
serum for another 48 h. Cells were incubated with drugs at a range
of concentrations (10.sup.-12-10.sup.-7 mol/L) for 16 h
(overnight). All the experiments were performed in triplicate. The
medium was collected and stored frozen for GH and PRL
measurements.
Pharmacological Compounds
[0278] The somatostatin analogs (SSAs), octreotide and pasireotide
were purchased from Novartis (Basel, Switzerland), Forskolin was
obtained from Sigma-Aldrich (St. Quentin Fallavier, France),
Cabergoline was obtained from Pfizer (Pharmacia & Upjohn
Kalamazoo, USA), MK-0677 (ghrelin analog) was obtained from
Europeptide, Argenteuil France, and MSP (ghrelin receptor-GHS-R
inverse agonist) came from Polypeptide Laboratories (Strasbourg,
France). The GHRH receptor antagonist,
acetyl-(D-Arg.sup.2)-GHRH(1-29) amide, and GnRH.sub.1-5 were
obtained from Bachem, Europe.
Hormonal Assays
[0279] GH secretion by the primary culture cells was quantified
using the ALPHALISA.RTM. human growth hormone GH kit (Perkin Elmer
USA). Prolactin levels were measured in culture medium using a
commercial IRMA kit (PRL IRMA Kit-Beckman Coulter Immunotech,
Marseille, France). Human GHRH concentrations in plasma were
measured using an in-house double-antibody radio-immunoassay as
described previously and using a standard solution of Stimu-GH 50
.mu.g (Ferring) and the matrix was non-used culture medium (Girard
et al.; Eur. J. Chu. Pharmacol., 32, 507-513, 1987).
Cell Culture Experiments
[0280] Following 96 h (day 4) of culture of the pituitary surgical
sample in FCS and before pharmacological incubation studies, the
GHRH concentration was 0.3 ng/50,000 cells. In 1% FCS and ITS, the
24 h secretion for 50,000 cells was 40 ng/ml for GH and 300 ng/ml
for prolactin indicating that the tumor cells were actively
producing hormone. The GHRH concentration was below the lower limit
of the assay (<62 pg/mL) under these same experimental
conditions.
[0281] As shown in FIG. 3, basal GH secretion was further
stimulated by incubation with GHRH reaching a peak at a GHRH
concentration of 10.sup.-10 M (+41.+-.0.4%). In contrast, the
putative GPR101 agonist, GnRH1-5, had little effect on GH across
the dose range studied (+15.+-.1.5% at 10.sup.-10 M). Prolactin
secretion was slightly stimulated by GHRH, (+11.+-.0.4% at
10.sup.-8M). GnRH1-5 did not stimulate prolactin release.
[0282] Then the effect of a GHRH receptor antagonist,
acetyl-(D-Arg.sup.2)-GHRH (1-29) amide on GH and prolactin
secretion was studied. There was an initial stimulatory effect of
the GHRH-receptor antagonist on GH secretion at 10.sup.-13 M to
10.sup.-11M (+18.+-.0.8% and +13.+-.1.9% respectively). This was
followed by a dose dependent inhibition of GH secretion, reducing
GH secretion to approximately -34.+-.1.9% of controls at the
highest GHRH-receptor antagonist dose studied. Interestingly,
incubation with the GHRH receptor antagonist also markedly
decreased prolactin secretion, -73.+-.0.1%. at a concentration of
10.sup.-8M. Co-incubation of GHRH (10.sup.-1.degree. M) with the
GHRH antagonist led to complete abolition of the GH and PRL
responses to GHRH antagonist. The results are summarized in FIG. 5
which shows the in vitro dose-effect on GH (A) and PRL (B)
secretion in somatotroph cells after overnight incubation with
GHRH-R antagonist (acetyl-(D-Arg.sup.2)-GHRH (1-29) amide), with or
without GHRH at 10.sup.-10 M. The results are expressed as the mean
percentage of PRL or GH change compared to the values of control
wells (ctrl).
[0283] When tumor cells were incubated with the SSTR2-specific
somatostatin analog, octreotide, no inhibition in GH secretion was
seen, while the prolactin decrease was -26.+-.0.03% at 10.sup.-9M.
In contrast, following incubation with pasireotide, a
multi-somatostatin receptor agonist, a decrease in GH secretion was
seen, reaching a maximum inhibition at 10.sup.-8M (-18.+-.0.6%)
(pasireotide had no effect on prolactin secretion in these tumor
cells). The D2-receptor agonist, cabergoline, displayed stronger
inhibition than either somatostatin analog on GH secretion
(-32.+-.0.8% at 10.sup.-8M), but the inhibition of prolactin was
less (-15.+-.0.04%). The results are summarized in FIG. 3 which
shows the in vitro dose-effect on GH (A, C) and PRL (B, D)
secretion in somatotroph cells after overnight incubation with
(A,B) GHRH, GnRH1-5, (C,D) octreotide (OCT) cabergoline (CAB) or
pasireotide (PAS). The results are expressed as the mean percentage
of PRL or GH change compared to the values of control wells
(ctrl).
[0284] FIG. 4 shows the effects of incubation with a ghrelin
analog, MK-0677, and the inverse agonist of the ghrelin receptor,
MSP. MK-0677 had a minor stimulatory effect on GH secretion as
compared with control (+15.+-.0.5%), while no effect on prolactin
secretion occurred. MSP did however decrease GH and PRL secretion
by -24%.+-.0.3% and -12.+-.0.08%, respectively, as compared with
controls.
Example 14: cAMP Assay
[0285] Following the pharmacological co-incubation studies
described in Example 13 the response of the tumor cells in terms of
cAMP production was assessed. The cells from tumor were seeded into
24-well plates (4.times.10.sup.4 cells/well). After 24 h in
culture, the cAMP concentration was determined using the HTRF-cAMP
Femto Kit (CisBio International, Bagnols-sur-Ceze, France), as
described previously Cuny et al. (Mol Cell Endocrinol 355, 106-113,
2012). According to the manufacturer's protocol, the cells were
detached using trypsin, seeded onto 96-well plates in suspension,
and incubated at 37.degree. C. for 3 h in the presence of
forskolin. The HTRF assay reagents were then added directly into
the 96-well plates. As compared with controls, forskolin-treated
(10.sup.-6M) cells exhibited a strong (+396.+-.1.9%) rise in cAMP
production.
Statistical Analysis
[0286] Data are expressed as mean.+-.SEM. The statistical tests
used were the non-parametric paired Wilcoxon and non-paired
Mann-Whitney tests. Significance was set at p.ltoreq.0.05.
[0287] It will be apparent that the precise details of the methods
or compositions described may be varied or modified without
departing from the spirit of the described invention. We claim all
such modifications and variations that fall within the scope and
spirit of the claims below.
Sequence CWU 1
1
611527DNAHomo sapiens 1atgacgtcca cctgcaccaa cagcacgcgc gagagtaaca
gcagccacac gtgcatgccc 60ctctccaaaa tgcccatcag cctggcccac ggcatcatcc
gctcaaccgt gctggttatc 120ttcctcgccg cctctttcgt cggcaacata
gtgctggcgc tagtgttgca gcgcaagccg 180cagctgctgc aggtgaccaa
ccgttttatc tttaacctcc tcgtcaccga cctgctgcag 240atttcgctcg
tggccccctg ggtggtggcc acctctgtgc ctctcttctg gcccctcaac
300agccacttct gcacggccct ggttagcctc acccacctgt tcgccttcgc
cagcgtcaac 360accattgtcg tggtgtcagt ggatcgctac ttgtccatca
tccaccctct ctcctacccg 420tccaagatga cccagcgccg cggttacctg
ctcctctatg gcacctggat tgtggccatc 480ctgcagagca ctcctccact
ctacggctgg ggccaggctg cctttgatga gcgcaatgct 540ctctgctcca
tgatctgggg ggccagcccc agctacacta ttctcagcgt ggtgtccttc
600atcgtcattc cactgattgt catgattgcc tgctactccg tggtgttctg
tgcagcccgg 660aggcagcatg ctctgctgta caatgtcaag agacacagct
tggaagtgcg agtcaaggac 720tgtgtggaga atgaggatga agagggagca
gagaagaagg aggagttcca ggatgagagt 780gagtttcgcc gccagcatga
aggtgaggtc aaggccaagg agggcagaat ggaagccaag 840gacggcagcc
tgaaggccaa ggaaggaagc acggggacca gtgagagtag tgtagaggcc
900aggggcagcg aggaggtcag agagagcagc acggtggcca gcgacggcag
catggagggt 960aaggaaggca gcaccaaagt tgaggagaac agcatgaagg
cagacaaggg tcgcacagag 1020gtcaaccagt gcagcattga cttgggtgaa
gatgacatgg agtttggtga agacgacatc 1080aatttcagtg aggatgacgt
cgaggcagtg aacatcccgg agagcctccc acccagtcgt 1140cgtaacagca
acagcaaccc tcctctgccc aggtgctacc agtgcaaagc tgctaaagtg
1200atcttcatca tcattttctc ctatgtgcta tccctggggc cctactgctt
tttagcagtc 1260ctggccgtgt gggtggatgt cgaaacccag gtaccccagt
gggtgatcac cataatcatc 1320tggcttttct tcctgcagtg ctgcatccac
ccctatgtct atggctacat gcacaagacc 1380attaagaagg aaatccagga
catgctgaag aagttcttct gcaaggaaaa gcccccgaaa 1440gaagatagcc
acccagacct gcccggaaca gagggtggga ctgaaggcaa gattgtccct
1500tcctacgatt ctgctacttt tccttga 15272508PRTHomo sapiens 2Met Thr
Ser Thr Cys Thr Asn Ser Thr Arg Glu Ser Asn Ser Ser His1 5 10 15Thr
Cys Met Pro Leu Ser Lys Met Pro Ile Ser Leu Ala His Gly Ile 20 25
30Ile Arg Ser Thr Val Leu Val Ile Phe Leu Ala Ala Ser Phe Val Gly
35 40 45Asn Ile Val Leu Ala Leu Val Leu Gln Arg Lys Pro Gln Leu Leu
Gln 50 55 60Val Thr Asn Arg Phe Ile Phe Asn Leu Leu Val Thr Asp Leu
Leu Gln65 70 75 80Ile Ser Leu Val Ala Pro Trp Val Val Ala Thr Ser
Val Pro Leu Phe 85 90 95Trp Pro Leu Asn Ser His Phe Cys Thr Ala Leu
Val Ser Leu Thr His 100 105 110Leu Phe Ala Phe Ala Ser Val Asn Thr
Ile Val Val Val Ser Val Asp 115 120 125Arg Tyr Leu Ser Ile Ile His
Pro Leu Ser Tyr Pro Ser Lys Met Thr 130 135 140Gln Arg Arg Gly Tyr
Leu Leu Leu Tyr Gly Thr Trp Ile Val Ala Ile145 150 155 160Leu Gln
Ser Thr Pro Pro Leu Tyr Gly Trp Gly Gln Ala Ala Phe Asp 165 170
175Glu Arg Asn Ala Leu Cys Ser Met Ile Trp Gly Ala Ser Pro Ser Tyr
180 185 190Thr Ile Leu Ser Val Val Ser Phe Ile Val Ile Pro Leu Ile
Val Met 195 200 205Ile Ala Cys Tyr Ser Val Val Phe Cys Ala Ala Arg
Arg Gln His Ala 210 215 220Leu Leu Tyr Asn Val Lys Arg His Ser Leu
Glu Val Arg Val Lys Asp225 230 235 240Cys Val Glu Asn Glu Asp Glu
Glu Gly Ala Glu Lys Lys Glu Glu Phe 245 250 255Gln Asp Glu Ser Glu
Phe Arg Arg Gln His Glu Gly Glu Val Lys Ala 260 265 270Lys Glu Gly
Arg Met Glu Ala Lys Asp Gly Ser Leu Lys Ala Lys Glu 275 280 285Gly
Ser Thr Gly Thr Ser Glu Ser Ser Val Glu Ala Arg Gly Ser Glu 290 295
300Glu Val Arg Glu Ser Ser Thr Val Ala Ser Asp Gly Ser Met Glu
Gly305 310 315 320Lys Glu Gly Ser Thr Lys Val Glu Glu Asn Ser Met
Lys Ala Asp Lys 325 330 335Gly Arg Thr Glu Val Asn Gln Cys Ser Ile
Asp Leu Gly Glu Asp Asp 340 345 350Met Glu Phe Gly Glu Asp Asp Ile
Asn Phe Ser Glu Asp Asp Val Glu 355 360 365Ala Val Asn Ile Pro Glu
Ser Leu Pro Pro Ser Arg Arg Asn Ser Asn 370 375 380Ser Asn Pro Pro
Leu Pro Arg Cys Tyr Gln Cys Lys Ala Ala Lys Val385 390 395 400Ile
Phe Ile Ile Ile Phe Ser Tyr Val Leu Ser Leu Gly Pro Tyr Cys 405 410
415Phe Leu Ala Val Leu Ala Val Trp Val Asp Val Glu Thr Gln Val Pro
420 425 430Gln Trp Val Ile Thr Ile Ile Ile Trp Leu Phe Phe Leu Gln
Cys Cys 435 440 445Ile His Pro Tyr Val Tyr Gly Tyr Met His Lys Thr
Ile Lys Lys Glu 450 455 460Ile Gln Asp Met Leu Lys Lys Phe Phe Cys
Lys Glu Lys Pro Pro Lys465 470 475 480Glu Asp Ser His Pro Asp Leu
Pro Gly Thr Glu Gly Gly Thr Glu Gly 485 490 495Lys Ile Val Pro Ser
Tyr Asp Ser Ala Thr Phe Pro 500 505329PRTArtificial
Sequencesynthetic peptide 3Tyr Ala Asp Ala Ile Phe Thr Asn Ser Tyr
Arg Lys Val Leu Gly Gln1 5 10 15Leu Ser Ala Arg Lys Leu Leu Gln Asp
Ile Met Ser Arg 20 25430PRTArtificial Sequencesynthetic peptide
4Tyr Ala Asp Ala Ile Phe Thr Asn Ser Tyr Arg Lys Val Leu Gly Gln1 5
10 15Leu Ser Ala Arg Lys Leu Leu Gln Asp Ile Met Ser Arg Gln 20 25
30531PRTArtificial Sequencesynthetic peptide 5Tyr Ala Asp Ala Ile
Phe Thr Asn Ser Tyr Arg Lys Val Leu Gly Gln1 5 10 15Leu Ser Ala Arg
Lys Leu Leu Gln Asp Ile Met Ser Arg Gln Gln 20 25
30644PRTArtificial Sequencesynthetic peptide 6Tyr Ala Asp Ala Ile
Phe Thr Asn Ser Tyr Arg Lys Val Leu Gly Gln1 5 10 15Leu Ser Ala Arg
Lys Leu Leu Gln Asp Ile Met Ser Arg Gln Gln Gly 20 25 30Glu Ser Asn
Gln Glu Arg Gly Ala Arg Ala Arg Leu 35 40
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