# Patent

## Title
Method for treating glaucoma

## Abstract

A method for increasing outflow facility and reducing intraocular pressure from an eye of a subject having glaucoma includes the step of administering to the eye an amount of an ADP ribosyltransferase protein 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 No. 60/545,723, filed Feb. 18, 2004. The 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 No. 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.
Exoenzyme C3 transferase (C3) is an ADP ribosyltransferase that inhibits rho-activated cellular contractility, leading to changes in cell shape and to secondary changes in the actin cytoskeleton and cell adhesion. C3 inactivates Rho by selectively ribosylating Rho proteins on asparagine residue 41. While various activities of exoenzyme C3 are known in general, there is no prior indication of advantageous drainage-enhancing and pressure-reducing activities by C3 in animal eyes. A nucleic acid sequence that encodes C3 from C. botulinum was disclosed by Popoff, M., et al., “DNA Sequence of Exoenzyme C3, an ADP-ribosyltransferase encoded by Clostridium botulinum C and D phages,” N. A. R. 18:1291 (1990) (Genbank Accession Number X51464), incorporated by reference as if set forth herein in its entirety. SEQ ID NO:1 presents the nucleic acid sequence that encodes the C. botulinum C3 exoenzyme; SEQ ID NO:2 presents the encoded amino acid sequence of the C3 enzyme including a short leader sequence at the N-terminus.
Nakamura, Y. et al., “Signaling Mechanism of TGF-Beta1-Induced Collagen Contraction Mediated by Bovine Trabecular Meshwork Cells,” IOVS, mention using C3 to prevent the adverse effects of TGF-Beta1 on the pathophysiology of glaucoma, namely matrix contractility. According to Nakamura et al., TGF-Beta1 induces contractility via activation of Rho and the Ca2+-dependent enzymes PKC and MLCK and that C3 is one way to inhibit the activity of TGF-Beta1. Nakamura et al. make no suggestion that C3 alone can reduce actomyosin contractility, that it can affect outflow facility, or that C3 would be a useful target for treating glaucoma.
BRIEF SUMMARY OF THE INVENTION
In one aspect, the present invention relates to the observation that overexpression of an ADP ribosyltransferase in cultured human trabecular meshwork cells produces changes in cytoskeleton-cell shape and adhesion changes consistent with changes observed using other agents now known to reduce resistance to fluid drainage and intraocular pressure.
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 an ADP ribosyltransferase protein.
In a related embodiment, the method includes the step of delivering into the trabecular meshwork cells an ophthalmic preparation that comprises an expressible ADP ribosyltransferase-encoding nucleic acid operably linked to a transcriptional promoter active in the trabecular meshwork cells so that expression of the protein in the subject is facilitated after administration.
In either embodiment, the ADP ribosyltransferase protein inhibits Rho-activated cellular contractility, leading to changes in cell shape and to secondary changes in the actin cytoskeleton and cell adhesion. When such changes are induced in the cells of the trabecular meshwork of primate (e.g., monkey or human) eyes by other means, the resistance to fluid drainage, and the intraocular pressure, decrease. Reduced fluid drainage and intraocular pressure elevated to a level capable of causing damage to the optic nerve are characteristic of glaucoma. Reduced contractility and/or perturbation of focal adhesions reduces resistance of the trabecular meshwork to fluid flow and thereby reduces 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 ophthalmic preparation can optionally 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.
In certain embodiments, the ADP ribosyltransferase is exoenzyme C3 transferase (“C3”).
The technical methods for delivering the protein 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 route of administration 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 C3 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 C3 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 C3 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 C3 protein, liposomal delivery of C3, and diffusion of C3 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 C3-encoding genetic construct is delivered, various aspects can affect expression of C3 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 C3 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 C3 in the vector downstream from a transcriptional promoter functional in trabecular meshwork cells, such that C3 is produced in the TM cells.
In the accompanying working examples, C3 was encoded by and expressed from a vector provided with the C3 coding sequences in trabecular meshwork cells grown in culture or maintained in anterior segments mounted on organ perfusion culture dishes. In the examples, C3 and a marker, green fluorescent protein (GFP), were expressed upon introduction into the cells by 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 C3 protein to trabecular meshwork cells in a manner known to the art is also suitable.
It is also noted that the protein encoded by the C3 coding sequence includes a short (7 amino acid) leader sequence. This sequence is important to the bacterial source, but is not of interest or use in the present invention and can be removed from the coding sequence without adverse effect on intracellular Rho targeting. It is also noted that other ADP-ribosyltransferase exoenzymes, such as the C. botulinum C2 toxin, having different targets in the actin microfilament network are known and can be employed in place of exoenzyme C3. However, the C2 enzyme can be more toxic than the C3 enzyme and it would be advantageous to introduce substitution mutations into the enzyme (via the C2-encoding polynucleotide) to modulate the toxicity of C2 before use. A polynucleotide that encodes exoenzyme C2 is available at GenBank accession number D88982 and is attached hereto as SEQ ID NO:3. SEQ ID NO:4 and SEQ ID NO:5 are two components encoded by SEQ ID NO:3. SEQ ID NO:4 has ADP-ribosyltransferase activity.
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 C3 in trabecular meshwork cells, without regard to the specific delivery vector or method. Further, the C3 protein need not be obtained from C. botulinum as in the examples. As the activities of C3 are well understood, the skilled artisan can readily select a C3 protein source having the characteristic properties of C3, namely a ADP ribosyltransferase that inhibits rho-activated cellular contractility, or a nucleic acid sequence encoding same, for administration in the methods of the invention. It will also be understood that the ability of C3 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 C3 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 C3 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 C3 can be administered via any medically acceptable route.
In the accompanying working examples, C3 was expressed in trabecular meshwork cells grown in culture. In the examples, C3 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 can increase persistence of the treating agent in the target tissue and is therefore considered a preferred approach by the inventors, although provision of C3 protein to trabecular meshwork cells in a manner known to the art is also suitable. 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 at 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. It will be understood, that the use of a particular adenovirus vector, or an adenovirus vector per se, or, more generally, a genetic construct, to provide C3 to an eye of a subject, is considered a preferred but not an essential administration method. The skilled artisan will appreciate that in due course further improvements to nucleic acid delivery methods, employing virus- or non-virus based approaches will be developed, and that the invention is sufficiently broad to encompass use of any such 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 C3 can be administered via any medically acceptable route.
EXAMPLES
Example One
Preparation of Adenovirus Expression Vector Comprising Gene Encoding Exoenzyme C3
A recombinant adenovirus vector that expressed C3 under the control of a human promoter was constructed using the AdEasy XL Adenoviral Vector system (Stratagene, La Jolla). The C. Botulinum Exonuclease C3 coding sequences were amplified from a vector containing the C3 gene using forward primer (5′ CGG TCG ACA GGC AGG CAT GCA AGC TTA T 3′; SEQ ID NO:6) and reverse primer (5′ CGC TCG AGT TTA GGA TTG TAA GCT GTG C 3′; SEQ ID NO:7). The primers used for amplification introduced a SalI restriction enzyme site upstream and a XhoI site downstream of the coding sequence. The amplified SalI-XhoI fragment was cloned into pShuttle-IRES-hrGFP2 (Stratagene). The resulting shuttle vector with insert was co-transfected with pAdEasy (Stratagene) into competent BJ5183 cells under conditions specified by the manufacturer. Recombinant adenovirus clones containing the C3 coding sequence were isolated, then amplified in XL10-Gold® (Stratagene) cells grown in SOC broth (as opposed to NZY+ broth recommended by the system manufacturer). Recombinant adenovirus DNA was linearized and transfected into HEK293 cells, whereupon recombinant adenovirus was packaged. The viral stock was maintained in elution buffer from Puresyn Adenopure purification kit. The titer of adenovirus stock was determined.
Example Two
Use of C3 to Alter Human Trabecular Meshwork (HTM) Cytoskeleton
To determine the effects of adenovirus-mediated C3 gene expression on cultured human trabecular meshwork (HTM) and ciliary muscle (HCM) cells, in vitro studies were performed using HTM and HCM cells infected with the C3-expressing adenovirus vector of Example One and changes in morphology, actin, vinculin and beta-catenin were detected. Cells treated with medium (untreated cells) and virus vector only were used as controls.
Treatment of both HTM and HCM cells with C3-expressing adenovirus resulted in dose-dependent morphological changes 4 days post-infection. C3-treated cells were either partially retracted, rounded up completely or very elongated and attenuated in appearance compared to untreated cells. Compared to virus-treated control cells, which demonstrated prominent stress fibers, C3-treated cells demonstrated either a disrupted or absent actin cytoskeleton. C3-treated cells of both types demonstrated reduced numbers of vinculin-positive focal adhesions compared to controls. In C3-treated HTM cells, vinculin staining at cell-cell junctions was also partially reduced, and there was a near complete loss of beta-catenin staining even in cells that still exhibited an intact actin cytoskeleton, suggesting that cell-cell junctions may be more sensitive to C3 transferase than actin and cell-matrix contacts. Cells treated with the negative control construct did not round up or retract; however some cells appeared somewhat elongated and irregular compared to untreated cells. In conclusion, transduced C3 is effective in disrupting actin and cellular adhesions in HTM and HCM cells.
Example Three (Prophetic)
Use of C3 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.
The adenoviral vector of Example One can be administered into paired anterior segments of eyes from human or non-human (e.g., rhesus or cynomolgus monkey) animals, the eyes being mounted on organ culture dishes and perfused with DMEM at a constant rate of 2.5 μl/min. For human eyes, following 24 hours of equilibration, baseline OF is calculated as the flow divided by the intraocular pressure (IOP). Human anterior segments are injected with a single dose of 107 pfu of the C3 adenovirus vector to one eye; vehicle to the opposite eye. IOP is monitored continuously for several days and average OF calculated every 6 hours. For monkey segments, baseline OF is determined by two-level constant pressure perfusion for 45–60 min after overnight equilibration. Segments are then injected via the infusion tubing with 80 ul containing 1.5×109 pfu/ml of the control (no C3) vector to one eye; and the C3 vector to the opposite eye. Post-treatment OF is monitored daily beginning two days after injection, continuing for up to 10 days after injection. Human and monkey segments are embedded in optimum cutting temperature cryoembedding matrix (Miles Scientific) and examined for the presence of fluorescence.
Baseline OF (μl/min/mmHg) is similar in the paired eyes. In humans, the IOP begins to decrease in the C3 vector-treated segments after the injection and continues to decrease for the duration of the monitoring. The final OF is increased by at least about 50% in C3-treated segments, while OF of sham-treated segments is substantially unchanged after treatment.
This demonstrates that C3 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 C3 to Improve Outflow Facility from Trabecular Meshwork in an Eye of a Living Subject
An expressible genetic construct encoding C3 protein is delivered (or C3 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 C3 protein into contact with the trabecular meshwork of the eye. The amount of material administered in the method can vary depending upon whether the C3 is administered as a protein or as a nucleic acid capable of encoding the C3 protein. In either case, the amount of C3 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, C3 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 C3 to Improve Outflow Facility from Trabecular Meshwork in an Eye of a Living Subject
An expressible FIV genetic construct encoding C3 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 steps of:
providing to the trabecular meshwork an amount of an ADP ribosyltransferase protein effective to increase outflow facility.

2. A method as claimed in claim 1 wherein the providing step includes the step of delivering into trabecular meshwork cells a pharmaceutical composition that comprises a non-corneotoxic delivery vehicle and an expression vector that encodes the ADP ribosyltransferase such that ADP ribosyltransferase is produced in an amount effective to increase aqueous humor outflow facility from the trabecular meshwork.

3. A method as claimed in claim 2 wherein the expression vector is selected from the group consisting of an adenovirus vector, an adeno-associated virus vector, a herpes simplex virus-based vector, a lentivirus vector, and a plasmid vector.

4. A method as claimed in claim 2 wherein the expression vector is a lentivirus vector.

5. A method as claimed in claim 1 wherein the ADP ribosyltransferase is exoenzyme C3 transferase.

6. A method as claimed in claim 5 wherein the expression vector is a lentivirus vector.

7. 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 an ADP ribosyltransferase protein to the trabecular meshwork in an amount effective to increase aqueous humor outflow facility from the eye.

8. A method as claimed in claim 7 wherein the ADP ribosyltransferase is exoenzyme C3 transferase.