# Patent

## Title
Method for treating glaucoma

## Abstract

A method for reducing intraocular pressure and increasing outflow facility from an eye of a subject having glaucoma includes the step of providing in the trabecular meshwork of the eye an amount of caldesmon effective to reduce intraocular pressure and increase outflow facility.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims the benefit of U.S. Provisional Patent Application Nos. 60/545,722 and 60/545,723, both filed Feb. 18, 2004. Each provisional application is incorporated by reference in its entirety as if set forth herein.


STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
This invention was made with United States Government Support awarded by the following agency:
NIH, Grant Number EY02698.
The United States Government has certain rights in this invention.


BACKGROUND OF THE INVENTION
The present invention relates to treating ocular disorders and more particularly to treating glaucoma. U.S. Pat. Nos. 5,798,380, 6,110,912, and 6,586,425, each of which is incorporated herein by reference as if set forth in its entirety, describe in detail the nature and etiology of glaucoma and various therapeutic approaches for reducing intraocular pressure characteristic of the disorder. The incorporated patents disclose methods for enhancing aqueous humor outflow and reducing intraocular pressure in the eye of a subject by administering at least one non-corneotoxic ophthalmic preparation which can comprise at least one macrolide. Additional therapeutic modalities employing other agents are still sought.
Caldesmon, a protein found in smooth muscle and non-muscle cells, causes secondary degeneration of the actin-microfilament network and thereby interferes with actomyosin contractility and with formation of focal cell adhesions. Helfman, D. M., et al., “Caldesmon inhibits non-muscle cell contractility and interferes with the formation of focal adhesions,” MBC 10:3097 (1999), incorporated herein by reference as if set forth in its entirety. Caldesmon, which contains actin-, myosin-, tropomyosin-, and Ca2+-calmodulin-binding domains, inhibits an ATPase activity of actomyosin, blocks the interaction of actin with myosin, prevents myosin II-dependent cell contractility, and induces a decrease in number and size of tyrosine-phosphorylated focal adhesions. In the absence of calcium-calmodulin, caldesmon binds filamentous actin (“F-actin”). While various activities of caldesmon are known in general, there is no prior indication of advantageous drainage-enhancing and pressure-reducing activities by caldesmon in animal eyes.
A nucleic acid sequence that encodes caldesmon in humans is known and is disclosed at GenBank at Accession Number NM—033138 (variant 1), provided herein at SEQ ID NO:1 with the encoded caldesmon protein (from nucleotides 460–2838) being provided at SEQ ID NO:2. Several known transcription variants employ the same underlying nucleic acid sequence and are accessible at Accession Numbers NM—004342 (variant 2; coding portion from nucleotides 460–2076), NM—033157 (variant 3; coding portion from nucleotides 460–2154), NM—033139 (variant 4; coding portion from nucleotides 214–1890) and NM—033140 (variant 5; coding portion from nucleotides 214–1812). Variants 2–5 are expressed principally in non-muscle tissues, while variant 1 is expressed principally in muscle. The UniGene accession number for human caldesmon is Hs.490203. Other caldesmon-encoding sequences are known. For example, a nucleic acid sequence that encodes caldesmon in rat is known and is disclosed at GenBank at Accession Number NM—013146 (version 2). The sequence of NM—013146 (version 2) is provided herein at SEQ ID NO:3 with the encoded rat caldesmon protein (coding portion from nucleotides 156–1751) being provided at SEQ ID NO:4.
BRIEF SUMMARY OF THE INVENTION
In one embodiment, the present invention describes a method for reducing elevated intraocular pressure or increasing the reduced aqueous humor outflow facility associated with open angle glaucoma in a human or non-human subject having trabecular meshwork cells and having resistance to fluid drainage and intraocular pressure elevated above that considered clinically normal, the method including the step of delivering into the trabecular meshwork cells an ophthalmic preparation that comprises a non-corneotoxic delivery vehicle and a chemical agent, namely caldesmon.
In a related embodiment, the method includes the step of delivering into the trabecular meshwork cells an ophthalmic preparation that comprises an expressible caldesmon-encoding nucleic acid operably linked to a transcriptional promoter active in the trabecular meshwork cells so that expression of the caldesmon protein in the subject is facilitated after administration.
In either embodiment, the methods provide in and in the vicinity of the trabecular meshwork cells an amount of caldesmon sufficient to perturb cellular contractility by inhibiting actin-dependent myosin II ATPase and, perhaps secondarily, cell adhesions, mainly by reducing tension forces generated by the adhesion-associated cytoskeletal structures that are necessary to maintain adhesion. Reduced contractility and/or perturbation of these adhesions reduces resistance of the trabecular meshwork to fluid flow, enhances aqueous humor outflow from the eye and thereby treats the glaucoma by reducing intraocular pressure in a therapeutically useful manner. However, an understanding of the mechanisms (e.g., the specific molecular mechanisms) is not necessary to utilize the present invention. Indeed, it is intended that the present invention not be limited to any particular mechanism(s).
In either embodiment, the preparation can optionally further include one or more additional non-corneotoxic agents for reducing intraocular pressure and increasing outflow facility or for such other purpose as may be convenient in a particular case. The delivery vehicle can be conventional, and can include standard salt solutions and preservatives for topical administration, or aqueous or salt solutions without preservatives for intracameral or intracanicular administration.
The technical methods for delivering the caldesmon to the eye, and more particularly to the cells of the trabecular meshwork of the eye, can be conventional and are within the level of skill in the art. In particular embodiments, the administration method is topical delivery to the trabecular meshwork cells. In other embodiments, the administration method is intracameral delivery. In still further embodiments, the administration route is intracanalicular. In addition, the present invention provides compositions and methods suitable for relaxing actomyosin, the potent contractile machinery that includes actin and myosin filaments.
The present invention provides effective and, in some cases, non-invasive methods for treating glaucoma without causing untoward and unacceptable adverse effects, such as corneal edema.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
Not applicable.


DETAILED DESCRIPTION OF THE INVENTION
The present invention relates to a treatment for glaucoma. While the present invention does not depend on an understanding of the mechanism by which successful treatment is accomplished, it is believed that caldesmon disrupts the system of focal adhesions and actin and myosin II containing stress fibers, in turn causing changes in cell shape that translate into an increase in aqueous humor outflow facility.
It will be understood, that the use of a genetic construct to provide caldesmon to an eye of a subject, is considered a desired but not an essential aspect of the administration method. Vectors that are particularly well suited for introduction into non-dividing cells (of which trabecular meshwork cells are an example) are known and are considered desirable for in vivo expression of caldesmon in vivo in human and non-human animal eyes. A suitable vector can include an adenovirus vector, an adeno-associated virus vector, a herpes simplex virus-based vector, a lentivirus vector, and a plasmid vector. The skilled artisan will appreciate the importance of engineering a vector and its components for efficient use in trabecular meshwork cells. The transduction efficiency of the various delivery systems is known to vary and can depend upon the nature of the vector and its components.
In addition to vectors of the types noted above, non-vector approaches, including direct administration of caldesmon protein, liposomal delivery of caldesmon, and diffusion of caldesmon protein from implanted cells encapsulated in a sealed semipermeable membrane capsule, are contemplated.
The use of adenovirus expression vectors and other vector systems for therapeutic transfer of a nucleic acid construct into target tissue to treat glaucoma is described generally in, e.g., Borras, T. et al., “Gene Therapy for Glaucoma: Treating a Multifaceted, Chronic Disease,” IOVS, 43:2513 (2002) and papers cited therein in references 25–31, each of which is incorporated by reference herein as if set forth in its entirety. Also incorporated herein by reference in its entirety is Hauswirth, W. W. and L. Beaufrere, “Ocular Gene Therapy: Quo Vadis?,” IOVS 41:2821 (2000) which reviews the eye as a gene therapy target and concludes that “ocular gene therapy seems well poised to be among the earliest successful applications” of the technology. The cited papers also provide the skilled artisan with the technical requirements for a suitable expression vector.
The skilled person will appreciate that when a caldesmon-encoding genetic construct is delivered, various aspects can affect expression of caldesmon from the encoding construct. For example, the vector backbone of the genetic contruct should be suited for efficient transfer into the target trabecular meshwork cells, for long-term maintenance of the construct in the cells and for sustained expression of caldesmon in the cells. Expression is sustained, e.g., by providing on the construct a transcriptional promoter that supports transcription in target trabecular meshwork cells. In particular, certain lentivirus vectors, namely certain feline immunodeficiency virus vectors, are efficiently transduced into human and non-human trabecular meshwork cells and provide efficient and long-term stable expression of a protein encoded by a polynucleotide provided on the vector. Suitable vectors, and methods for their production and use, are described in Loewen, N., et al., “Long-Term, Targeted Genetic Modification of the Aqueous Humor Outflow Tract Coupled with Noninvasive Imaging of Gene Expression In Vivo,” IOVS, 45:3091 (2004) and in Loewen, N., et al., “Preservation of Aqueous Outflow Facility after Second-Generation FIV Vector-Mediated Expression of Marker Genes in Anterior Segments of Human Eyes,” IOVS, 43:3686 (2002), each of which is incorporated by reference as if set forth herein in its entirety. Further incorporation by reference is made to the papers cited in the foregoing papers in connection with various starting materials and methods for producing vectors suited for efficient transduction into trabecular meshwork cells. Loewen, N., et al. (2004) provides the skilled person with guidance as to the amount of vector advantageously administered in vivo to cats, a species for which effectiveness of a therapeutic method is generally considered to be a reliable predictor of effectiveness of the method in humans. In cats, amounts in the range of between about 106 and 108 tranducing units (TU) were administered per eye with good results. The skilled person applying only routine skill can adjust these amounts, if appropriate, to deliver IOP-reducing amounts of vectors to anterior portions of the eye of human or other non-human subjects. Production of lentiviral vectors and delivery into non-dividing human eye cells is also described and claimed in U.S. Pat. No. 6,555,107, incorporated herein by reference as if set forth in its entirety.
Using conventional tools of the molecular biologist, the aforementioned vectors and others, can be modified to provide a polynucleotide that encodes caldesmon in the vector downstream from a transcriptional promoter functional in trabecular meshwork cells, such that caldesmon is produced in the TM cells.
In the accompanying working examples, caldesmon was encoded by and expressed from a vector in trabecular meshwork cells grown in culture or maintained in anterior segments mounted on organ perfusion culture dishes. In the examples, caldesmon and a marker, green fluorescent protein (GFP), were expressed upon introduction into the cells of an adenovirus expression vector under transcriptional control of a cytomegalovirus promoter-enhancer. Introduction by injection of genetic material is considered a preferred approach by the inventors, although provision of caldesmon protein to trabecular meshwork cells in a manner known to the art is also suitable.
The skilled artisan will appreciate that in due course further improvements to nucleic acid delivery methods, employing virus- or non-virus based approaches may be developed, and that the invention is sufficiently broad to encompass use of any such methods for providing caldesmon in trabecular meshwork cells, without regard to the specific delivery vector or method. Further, the caldesmon protein need not be obtained from a human or from a rat. As the activities of caldesmon are well understood, the skilled artisan can readily select a caldesmon protein source having the characteristic properties of caldesmon, namely actin-, myosin-, tropomyosin-, and Ca2+-calmodulin-binding domains, or a nucleic acid sequence encoding same, for administration in the methods of the invention. It will also be understood that the ability of caldesmon to function in the methods of the invention may be modulated, particularly enhanced, by introducing one or more changes to amino acid residues of the caldesmon protein. The skilled artisan can introduce such changes at the nucleic acid level and can monitor outflow facility directed by modified proteins such that modified caldesmon proteins that yield great outflow facility (and nucleic acids encoding same) can be selected for use in the methods. The present invention will be more fully understood upon consideration of the following non-limiting examples. The examples demonstrate proof of principle, but the skilled artisan will appreciate that the caldesmon can be administered via any medically acceptable route. The examples are not intended to be limiting on the scope of the invention which embraces all such variations and modifications as fall within the scope of the appended claims.
EXAMPLES
Example One
Construction of a Replication Deficient Adenoviral Vector Encoding Caldesmon
AdGFPCald, a recombinant, replication-deficient adenovirus carrying the linked coding cDNAs of GFP and non-muscle rat caldesmon was obtained by homologous recombination. The expression cassette cDNA of this recombinant virus contains a fusion of a cDNA that encodes GFP (nucleotides 284–1001 of GenBank Accession Number U76561) with the coding region of the rat caldesmon cDNA. The expression cassette of 2,323 nucleotides is flanked by a PmeI site at the 5′ and a BamH1 site at the 3′; it also contains a 6 nucleotide XbaI site between the cDNA that encodes the two proteins.
The expression cassette was obtained by PCR amplification of plasmid pGFPCad [Helfman et al., M. B. C. 10:3097 (1999), incorporated supra] using forward 5′AGCTGTTTAAACCACCATGGTGAGCAAGGGCGAGGAGCT3′ (nucleotides 284–311 of GFP cDNA) (oligo # 243, SEQ ID NO:5) and reverse 5′ATGCGGATCCTCAGACCTTAGTGGGAGAAGT3′ (nucleotides 2318–2299 of rat caldesmon cDNA) (oligo # 244, SEQ ID NO:6) primers. The forward primer contains 4 extra nucleotide in its 5′ plus a Pme I restriction site. The forward primer introduces the GFP natural Kozak sequences into the cassette and allows translation to start at the GFP ATG initiation codon. The reverse primer contains 4 extra nt in its 5′ plus a Bam HI restriction site. The amplified insert was cloned into the pCR 2.1 vector (Invitrogen, San Diego, Calif.) (pJV10). The pJV10 plasmid insert was isolated by digestion of its cDNA with Pme I-Bam HI and subcloned into the pQBI-AdCMV5 shuttle vector (QBIOgene Montreal, Canada) which is under transcriptional control of CMV5, a cytomegalovirus (CMV) promoter-enhancer combination optimized for constitutive recombinant protein expression. The pQBI-AdCMV5 vector contains the β-globin polyadenylation (polyA) sequences. The pQBI-AdCMV5 also contains Ad5 sequences 1–194 (inverted terminal repeat, ITR) that provide the recombinant adenovirus left terminus and Ad5 map units 9.4–15.5 for overlap recombination.
The resulting shuttle plasmid, pAd-GFPCald (pJV1), was linearized with Cla I and co-transfected with an Ad5 viral DNA arm into 293 cells by calcium phosphate/DNA co-precipitation. The viral arm, QBI-viral DNA (QBIOgene, Montreal, Canada), is derived from Adenovirus serotype 5, subtype d1327 with deletions at the E1a and E3 genes. This arm is produced by cutting the DNA from adenovirus Ad5.CMVLacZΔE1/ΔE3 with Cla I and isolation of the 27 kb fragment lacking the left ITR and the LacZ cassette.
DNA precipitates of the pAd-GFPCald and QBI-viral DNA were exposed to the 293 cells for 12 h, washed exhaustively and allowed to recombine for two weeks. After recombination, harvested cells were lysed and their supernatant assayed for plaque purification by agar overlay {Borrás T., et al., “Ocular adenovirus gene transfer varies in efficiency and inflammatory response,” Invest Ophthalmol Vis Sci, 37:1282–1293 (1996); Borrás T., et al., “Gene transfer to the human trabecular meshwork by anterior segment perfusion,” Invest Ophthalmol Vis Sci, 39:1503–1507 (1998); Borrás T., et al., “Adenoviral reporter gene transfer to the human trabecular meshwork does not alter aqueous humor outflow. Relevance for potential gene therapy of glaucoma,” Gene Ther 6: 515–524 (1999), each incorporated herein by reference as if set forth in its entirety).
Three GFP positive viral plaques were amplified and re-plated by agar overlay for second plaque purification. GFP positive plaque #2/#1 was selected to obtain a higher titer viral stock. A purified viral stock of AdGFPCald (plaque #2/#1) was obtained by propagation in 293 cells and was purified by double-banding in CsCl density gradients as described in the incorporated papers. Purified viruses were titered by the agar overlay plaque assay in 293 cells. This viral stock (lot# 010701) had a titer of 2.5×1010 particle forming units (pfu) per ml in a formulation vehicle of 0.01 M Tris pH 8, 0.01 M MgCl2 and 10% glycerol
Absence of contaminant wild-type viruses in lot # 010701 was tested by PCR amplification with E1A primers 5′TCGAAGAGGTACTGGCTGAT3′ (SEQ ID NO:7) and 5′TGACAAGACCTGCAACCGTG3′ (SEQ ID NO:8).
For sequence confirmation of the recombinant AdGFPCald virus, a fragment containing its expression cassette was amplified from the its DNA with oligonucleotides 5′-GCCCTCCCATATGTCCTTCCGAGTGAGAG-3′ (606–634 nt in pQBI-AdCMV5 DNA) (oligo # 165, SEQ ID NO:9) and 5′-GGATTTGATATTCACCTGGCCCGATCTGG-3′ (815–788 nt in pQBI-AdCMV5 DNA) (oligo # 164, SEQ ID NO:10). The ends of the isolated fragment were sequenced with above external oligonucleotides #165 and #164, reading approximately 700 nt each. Internal sequence was obtained with forward oligos 5′-GATCACTCTCGGCATGGACGA-3′(975–995 nt in GFP cDNA) (oligo#245, SEQ ID NO:11), 5′-GATTTACAGAAGTGAAGGCGC-3′ (1397–1415 in Caldesmon cDNA) (oligo#248, SEQ ID NO:12) and reverse oligos 5′-ACTGTTCTGGACATGGGCCTC-3′ (924–904 in Caldesmon cDNA) (oligo# 247, SEQ ID NO:13) and 5′-CCTTTCGATCTCTTCCTTCAACC-3′ (1470–1397 in caldesmon cDNA) (oligo#246, SEQ ID NO:14). No mismatches were found to referred sequences with the exception of a potential change of an Alanine to a Valine at amino acid 68 of the caldesmon protein.
Example Two
Use of Caldesmon to Alter Human Trabecular Meshwork (HTM) Cytoskeleton
Primary HTM cells grown on coverslips were infected with the AdGFPCald adenovirus vector of Example One at different multiplicities of infection, fixed and assayed by immunofluorescence staining of cytoskeletal proteins 24–48 h post-infection. SV40-transformed HTM cells were plated in glass bottom dishes, AdGFPCald infected, and examined by live time-lapse recording with an Axiovert 100 TV microscope.
Caldesmon co-localized with all actin-containing structures. High caldesmon overexpression induced severe changes in the actin cytoskeleton and formation of new type of actin structures such as curvy fiber networks. In these cells, focal adhesions were disrupted. HTM cells containing lower levels of recombinant caldesmon induced different and milder changes with shorter stress fibers and triangular structures. Real-time GFP-caldesmon dynamics showed motile curvy fibers undergoing continuous remodeling (fusion, formation of loops etc). Myosin remained associated with the altered actin structures in the caldesmon-overexpressing cells.
Recombinant caldesmon induced changes in the HTM cytoskeleton in a dose-dependent manner. This result suggests that modulation of caldesmon expression in the human trabecular meshwork can be used therapeutically to increase aqueous humor outflow facility and to reduce intraocular pressure in glaucoma.
Example Three
Use of Caldesmon to Improve Outflow Facility From Organ-Cultured Human and Monkey Anterior Segments
Organ cultures of human and monkey eye anterior segments are widely regarded as a preferred system for evaluating and for establishing utility in vivo of proposed human therapeutic modalities. The details of the culture methods and several underlying literature citations are set forth in incorporated U.S. Pat. No. 6,586,425.
Six human and eight rhesus or cynomolgus monkey paired anterior segments were mounted on organ culture dishes and perfused with DMEM at a constant rate of 2.5 μl/min. For human eyes, baseline OF [flow divided by intraocular pressure (IOP)] was calculated after 24 hours of equilibration. Human anterior segments were injected with a single 107 pfu dose of the AdGFPCald adenoviral vector of Example One to one eye; vehicle to the opposite eye. IOP was monitored continuously for 66 hours and average OF calculated every 6 hours. For monkey segments, baseline OF was determined by two-level constant pressure perfusion for 45–60 min after overnight equilibration. Segments were then injected via the infusion tubing with 20 ul containing 7.5×108 pfu/ml AdGFP to one eye; AdGFPCald to the opposite eye. Post-treatment OF was monitored at days 2, 5–6, and in some cases up to 9 days after injection. Human and monkey segments were embedded in OCT optimum cutting temperature cryoembedding matrix (Miles Scientific) and examined for the presence of fluorescence.
Baseline OF (μl/min/mmHg) was no different between the paired eyes, and averaged (mean±sem): human, 0.20±0.03 (n=11); monkey, 0.41±0.04 (n=16). In humans, the IOP began to decrease in AdGFPCald segments within 10 hours after the injection and continued to decrease for the duration of the 66 hours. The percent change of final OF from baseline was 49.0±24.8% (AdGFPCald) (p<0.09) and 0.6±7.8% (vehicle) (p<0.9). In monkey segments, the OF increase was detected as early as 1 day after the initial injection with the maximum OF increase occurring from 1 to 9 days after injection. When all eyes were considered, the mean maximum OF increase in AdGFPCald vs AdGFP eyes corrected for baseline was 101±19% (p<0.005). 3 of 8 segments appeared to be contaminated by days 5–6, although an increase in OF was noted before the contamination became apparent in 1 of the 3 segments; the other 2 segments were not tested. Fluorescence was present in both paired segments of monkey eyes and in the AdGFPCald segment of human eyes.
Caldesmon gene therapy can increase outflow facility in the human and monkey anterior segments in organ culture and has the potential to be used in vivo to control IOP in humans.
Example Four (Prophetic)
Use of Caldesmon to Improve Outflow Facility From Trabecular Meshwork in an Eye of a Living Subject
An expressible genetic construct encoding caldesmon protein is delivered (or caldesmon protein is administered) to an eye of a human or a non-human subject having reduced outflow facility and elevated intraocular pressure in an amount effective to improve outflow facility and reduce intraocular pressure. Reduced outflow facility and elevated intraocular pressure can be characteristic of glaucoma in a subject. The delivery or administration is achieved in a manner effective to bring caldesmon into contact with the trabecular meshwork of the eye. The amount of material administered in the method can vary depending upon whether the caldesmon is administered as a protein or as a nucleic acid capable of encoding the caldesmon protein. In either case, the amount of caldesmon present in the trabecular meshwork after administration and effective in the method can be in the same order of magnitude as the agents disclosed in incorporated U.S. Pat. No. 6,586,425. Likewise, caldesmon can be administered in amounts comparable to those administered in the cited patent.
Upon administration, outflow facility is increased and intraocular pressure is reduced relative to pre-administration levels.
Example Five (Prophetic)
Use of Caldesmon to Improve Outflow Facility from Trabecular Meshwork in an Eye of a Living Subject
An expressible FIV genetic construct encoding caldesmon protein is delivered in an amount between about 106 and 108 transducing units to trabecular meshwork cells in an eye of a human or a non-human subject having reduced outflow facility and elevated intraocular pressure. Reduced outflow facility and elevated intraocular pressure can be characteristic of glaucoma in a subject. Upon administration, outflow facility is increased and intraocular pressure is reduced relative to pre-administration levels.
The preceding examples are not intended to limit the scope of the invention, which encompasses all such modifications and variations as fall within the scope of the appended claims.

## Claims

1. A method for increasing outflow facility of aqueous humor from an eye having a trabecular meshwork, the method comprising the step of:
providing to the trabecular meshwork of a subject in need of increased outflow facility an amount of caldesmon effective to increase outflow facility.

2. A method as claimed in claim 1, wherein the providing step includes the step of administering a pharmaceutical preparation comprising a non-corneotoxic delivery vehicle and the caldesmon protein to the trabecular meshwork in an amount effective to increase aqueous humor outflow facility from the eye.

3. A method as claimed in claim 1, wherein the caldesmon protein has a sequence selected from the group consisting of SEQ ID NO:2 and SEQ ID NO:4.