# Patent

## Title
Anaplastic lymphoma kinase (ALK) as oncoantigen for lymphoma vaccination

## Abstract

Use of intracytoplasmatic domain of Anaplastic Lymphoma Kinase (ALK) protein and/or a nucleic acid molecule encoding for the intracytoplasmatic domain of Anaplastic Lymphoma Kinase (ALK) protein, of any species, for the preparation of a medicament, preferably a vaccine, for the treatment and/or prevention of a tumor in a subject, preferably a lymphoma.

## Background
CROSS REFERENCE TO RELATED APPLICATION
This application is a continuation of U.S. patent application Ser. No. 12/237,787 filed on Sep. 25, 2008, now issued U.S. Pat. No. 8,980,287, which claims the benefit of U.S. Provisional Application No. 60/960,414 filed on Sep. 28, 2007, the entire contents of each of which are hereby incorporated by reference in this application.


FIELD OF THE INVENTION
The present disclosure concerns tumor vaccines for the treatment and/or prevention of tumors in a human subject.
BACKGROUND OF THE INVENTION
An ideal vaccination strategy against tumors relies on immunogenic specific antigens that are absolutely required for tumor maintenance. So far vaccination with patient-specific immunoglobulin idiotypes has given the most promising results in cancer vaccination.
Vaccines in cancer prevention and in combinational protocols in oncology have provided great promises, although often followed by recurring pessimism. The reasons for this lack of effectiveness rely mainly in the difficult identification of specific tumor antigens essential for tumor growth.
SUMMARY OF THE INVENTION
The need is therefore felt for the identification of an oncoantigen that can be used in the preparation of efficacious tumor vaccine for the treatment and prevention of tumor in a human subject.
The object of the present disclosure is providing such an oncoantigen.
According to the invention, the above object is achieved thanks to the subject matter recalled specifically in the ensuing claims, which are understood as forming an integral part of this disclosure.
An embodiment of the present disclosure provides the use of intracytoplasmatic domain of Anaplastic Lymphoma Kinase (ALK) protein and/or a nucleic acid molecule encoding for the intracytoplasmatic domain of Anaplastic Lymphoma Kinase (ALK) protein, of any species, for the preparation of a medicament, preferably a vaccine, for the treatment and/or prevention of a tumor in a subject, preferably a lymphoma or a carcinoma.
A further embodiment of the present disclosure provides the use of nucleic acid molecule(s) encoding for the intracytoplasmatic domain of Anaplastic Lymphoma Kinase (ALK) protein of any species in combination with a nucleic acid molecule encoding for Granulocyte-Monocytes Colony Stimulating Factor (GM-CSF) for the preparation of a medicament, preferably a vaccine, for the treatment and/or prevention of a tumor in a subject.
A still further embodiment of the present disclosure provides a product containing nucleic acid molecule(s) encoding for the intracytoplasmatic domain of Anaplastic Lymphoma Kinase (ALK) protein of any species and at least one chemotherapeutic agent or at least one (small molecule) kinase inhibitor as a combined preparation for simultaneous, separate or sequential use in the treatment and/or prevention of a tumor in a subject.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1A depicts results of mice vaccinated with pDEST plasmid or with pDEST-ALK (ALK) plasmid.
FIG. 1B depicts results of mice vaccinated with pDEST-ALKt (ALKt).
FIG. 1C depicts results of mice vaccinated with pDEST-ALK and tumor challenged after 7 months.
FIG. 1D depicts sequential histology of NPM-ALK lymphoma cell growth in mock and ALK-vaccinated mice.
FIG. 1E depicts histological examinations (top panels, hematoxilin and eosin stainings) and anti-ALK immunohistochemistry (bottom panels) of subcutaneous lymphomas in mice.
FIG. 2A depicts efficacy of ALK vaccination in preventing disseminated lymphoma growth and in lymphoma therapy.
FIG. 2B depicts autopsies of mock vaccinated and ALK plasmid vaccinated mice.
FIG. 2C depicts tumor growth after increasing amounts of NPM-ALK lymphoma cells were injected s.c. in mice.
FIG. 2D depicts mice injected with lymphoma cells and vaccinated by mock or ALK-expressing plasmids.
FIG. 2E depicts efficacy of ALK vaccination in chemotherapy treated mice.
FIG. 2F depicts efficacy of ALK vaccination on lymphoma growth in mice treated with ALK selective inhibitor.
FIG. 2G depicts efficacy of combination therapy based on ALK selective inhibitor and ALK vaccination.
FIG. 3A depicts spot forming units for IFNγ production in ALK-vaccinated mice.
FIG. 3B depicts percentages of CD4+CSFE+ expressing splenocytes in ALK-vaccinated mice.
FIG. 3C depicts percentages of ALK-directed specific cytotoxicity in ALK-vaccinated mice.
FIG. 3D depicts visualization of in vivo ALK-directed cytotoxicity in ALK-vaccinated mice.
FIG. 4A depicts tumor growth of mice with ALK vaccination.
FIG. 4B depicts in vivo cytotoxicity assays of mice with ALK vaccination.
FIG. 4C depicts tumor growth over time of mice with ALK vaccination depleted of either CD4 or CD8 T cells.
FIG. 5 depicts results of protection from lymphoma growth in mice vaccinated with ALKK210R.
FIG. 6 depicts percentage survival of NPM-ALK lymphoma cells incubated with increasing concentrations of doxorubicin.
FIG. 7 depicts in vivo cytotoxic assay on in ALK-vaccinated mice.
FIG. 8A depicts specific anti-ALK immunoglobulins in mice vaccinated with purified GST-ALK-KHL.
FIG. 8B depicts tumor growth in mice vaccinated with purified GST-ALK-KHL.



DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS
The invention will now be described, by way of example only, with reference to the enclosed figures of drawing, wherein:
FIG. 1. ALK vaccination prevents the growth of NPM-ALK positive lymphoma cells. (a,b) BALB/c mice were vaccinated on day 0 and 7 in both the tibial muscles with 40 μg of pDEST plasmid or with pDEST-ALK (ALK) plasmid coding for the full ALK tyrosine kinase intracytoplasmic domain (a) or with pDEST-ALKt (ALKt) coding for a truncated portion of ALK lacking the part of the tyrosine kinase domain (b). An additional group of mice was vaccinated with the pDEST-ALK or pDEST-ALKt plasmids combined with the same amount of a pcDNA3 plasmid coding for GM-CSF. On day 14, mice were challenged with 1×106 NPM-ALK expressing lymphoma cells derived from NPM-ALK BALB/c Tg mice injected subcutaneously (s.c) in the right flank. (c) BALB/c mice were DNA vaccinated as above with a pDEST-ALK plasmid. After 7 months from vaccination mice were tumor challenged as above. The histograms represent the percentages of mice which were protected from tumor uptake 60 days after the challenge. The total numbers of mice from two to four independent experiments are indicated. (d) Sequential histology of NPM-ALK lymphoma cell growth in mock and ALK-vaccinated BALB/c mice injected in the flank (hematoxylin and eosin stains). Arrows indicate the reactive inguinal lymph node, * indicate tumors (e) Histological examinations (top panels, hematoxilin and eosin stainings) and anti-ALK immunohistochemistry (bottom panels) of subcutaneous lymphomas at day 10 after injection in mock or ALK vaccinated mice. Infiltration of reactive cells, mainly lymphocytes and granulocytes, are evident only in ALK vaccinated mice. Scale bars, 30 μM.
FIG. 2. Efficacy of ALK vaccination in preventing disseminated lymphoma growth and in lymphoma therapy (a,b) Disseminated growth of NPM-ALK lymphoma cells injected in the tail vein in mock or ALK plasmid vaccinated BALB/c mice. (a) All mock vaccinated mice challenged i.v. 7 days after the second vaccination with 1×106 NPM-ALK lymphoma died of lymphoma outgrowth within 50 days after challenge while 70% of ALK vaccinated mice remained alive and well for all the observation period of 180 days. Data are from one of two independent experiments with similar results. * P=0.0061 (b) Autopsies of mock vaccinated mice displayed lymphoma cells disseminated in the kidney, the spleen and the liver. By contrast, ALK plasmid vaccinated mice were tumor free in all the organs. (c) Increasing amounts of NPM-ALK lymphoma cells were injected s.c. in BALB/c mice on day 0. Mice were then vaccinated as described above on days 1 and 8. Tumor growth was followed over time. Data are from one of two independent experiments with at least 7 mice for each group. * P<0.01. (d) BALB/c mice were i.v. injected with 1×106 NPM-ALK lymphoma cells on day 0. On day 7 mice received i.v. 10 mg/kg of doxorubicin (dashed arrow) followed on days 14, 21 and 28 by DNA vaccination with empty (mock) or ALK-expressing plasmids (full arrows). Mice were then followed up to 90 days. Data are collected from two independent experiments showing similar results. * P<0.05. (e) Efficacy of ALK vaccination in chemotherapy treated mice. BALB/c mice were injected i.v. with 10 mg/kg doxorubicin on day 0 and vaccinated with the indicated plasmids on days 7, 14 and 21. 1×106 NPM-ALK expressing lymphoma cells were then injected s.c. 60 days after the last vaccination. Percentages of protected mice are indicated. Data are from one of two independent experiments. (f) Efficacy of ALK vaccination on lymphoma growth in mice treated with ALK selective inhibitor. BALB/c mice were s.c. injected with 1×106 NPM-ALK lymphoma cells on day 0. When tumor reached approx 2 cm in maximum diameter, mice were treated with an oral ALK kinase inhibitor for 15 days (30 or 100 mg/kg bid). Tumor size was measured over time. (g) Efficacy of combination therapy based on ALK selective inhibitor and ALK vaccination. BALB/c mice were s.c. injected with 1×106 NPM-ALK lymphoma cells on day 0. When tumor reached approx 2 cm in maximum diameter, mice were treated with an oral ALK kinase inhibitor for 15 days (30 or 100 mg/kg bid). When tumor size decrease to less than 0.5 cm mice were vaccinated as described above. Percentages of cure mice are indicated.
FIG. 3. Cytotoxic activity and IFNγ production in ALK-vaccinated mice. (a) Spleen cells from BALB/c mice vaccinated as above were cultured with the indicated amounts of recombinant murine ALK protein or with the indicated ratios of NPM-ALK Tg BALB/c splenocytes. Spot forming units for IFNγ production were evaluated by Elispot. * P<0.01 (b,c) In vivo cytotoxicity assay. BALB/c mice vaccinated twice with the indicated plasmids were i.v. injected with 107 wild type mixed with 107 NPM-ALK Tg BALB/c splenocytes labeled with different amounts of CFSE (0.5 μM and 5 μM, respectively). (b) After 72 hours mice were sacrificed and percentages of CD4+CSFE+ expressing splenocytes were analyzed by flow cytometry. (c) Percentages of ALK-directed specific cytotoxicity were calculated by normalizing the numbers of NPM-ALK expressing CD4 T-cells (CSFE high) with the total amount of CD4+CSFE+ T-cells. (d) Visualization of in vivo ALK-directed cytotoxicity. Spleens from vaccinated mice injected with NPM-ALK Tg BALB/c splenocytes as above were immunostained with anti-ALK antibody to detected the transferred cells. Significantly less ALK positive cells were detected in ALK vaccinated mice as compared to controls. Boxed areas in the top panels are magnified in the lower panels. Scale bars, 200 μM
FIG. 4. Protection generated by ALK vaccination requires CD8 T cells and IFNγ production, but not B cells. (a) BALC/c, BALB-Igμ-chain, BALB-IFNγ −/− and BALB-perforin −/− mice were vaccinated with the mock or ALK plasmid twice on days 0 and 7 and then challenged on day 14 with 1×106 NPM-ALK lymphoma cells s.c. Tumor growth was followed over time. Bars represent standard errors. (b) In vivo cytotoxicity assays were performed as described in FIG. 3 with BALC/c, BALB-Igμ-chain, BALB-IFNγ −/− and BALB-perforin −/− mice vaccinated with the pDEST-ALK plasmid. (c) BALB/c mice were vaccinated twice on days 0 and 7, as described above, and depleted of either CD8 or CD4 T cells with two consecutive injections on days 14 and 15. NPM-ALK lymphoma cells (1×106) were then injected s.c. on day 29 and tumor growth was followed at the indicated times. * P<0.001 for CD4 versus CD8 depleted ALK vaccinated mice. Bars represent standard errors.
FIG. 5. DNA-based vaccination with ALKK210R plasmid protects from lymphoma growth. BALB/c mice were DNA vaccinated twice on days 0 and 7 with 40 μg of pDEST empty vector (mock) or pDEST-ALKK210R (ALKK210R) plasmids in which the entire cytoplasmic portion of a kinase dead mutant K210R of the ALK tyrosine kinase was cloned. On day 14, 1×106 NPM-ALK lymphoma cells were injected s.c. Protection is indicated as the percentage of mice which did not show tumor uptake after 60 days. One of two independent experiments is represented.
FIG. 6. NPM-ALK lymphoma cells are sensitive to doxorubicin. NPM-ALK lymphoma cells were incubated in vitro for 24 or 48 hours with increasing concentrations of doxorubicin. Percentages of alive cells were calculated by TMRM staining and flow cytometry analyses.
FIG. 7. Long lasting protection after DNA vaccination. BALB/c mice were vaccinated twice as indicated above with control or ALK-expressing plasmids. Six months after the last vaccination in vivo cytotoxic assay was performed as described in FIG. 3. Mice were sacrificed and percentages of CD4+CSFE+ expressing splenocytes were analysed by flow cytometry (top panels). Percentages of ALK-directed specific cytotoxicity were calculated by normalizing the numbers of NPM-ALK expressing CD4 T-cells (CSFE high) with the total amount of CD4+CSFE+ T-cells (low panel).
FIG. 8. Vaccination with ALK peptide elicits a specific antibody response but does not protect mice against lymphoma growth. (a) BALB/c mice were vaccinated with purified GST-ALK-KHL as described in the Methods section. Specific anti-ALK immunoglobulins were measured by ELISA on the indicated days. (b) Vaccinated mice were challenged after vaccination with 1×106 NPM-ALK expressing lymphoma cells s.c. Tumor growth was measured over time. Bars represent standard errors.
In the following description, numerous specific details are given to provide a thorough understanding of embodiments. The embodiments can be practiced without one or more of the specific details, or with other methods, components, materials, etc. In other instances, well-known structures, materials, or operations are not shown or described in detail to avoid obscuring aspects of the embodiments.
Reference throughout this specification to “one embodiment” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, the appearances of the phrases “in one embodiment” or “in an embodiment” in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.
The headings provided herein are for convenience only and do not interpret the scope or meaning of the embodiments.
The present disclosure demonstrates that the DNA vaccination with plasmids encoding for the cytoplasmic domain of Anaplastic Lymphoma Kinase (ALK), which is translocated in different fusion proteins necessary for the maintenance of Anaplastic Large Cell Lymphoma (ALCL) growth, protects mice from local and systemic lymphoma growth.
The tumor protection after ALK vaccination was potent and long lasting, eliciting an ALK specific, IFNγ and CD8 T-cell mediated cytotoxicity.
Furthermore, a combination of chemotherapy and vaccination significantly enhanced the survival of mice by eradicating NPM-ALK lymphomas.
These findings indicate that ALK represents an ideal tumor antigen for vaccination-based therapies of ALCLs and possibly of other ALK expressing human tumors.
BALB/c mice were vaccinated twice within a week interval with a DNA plasmid coding for the intracytoplasmic domain of ALK alone, or mixed with a second plasmid encoding for the Granulocyte-Monocytes Colony Stimulating Factor (GM-CSF). Alternatively, animals were immunized with plasmids encoding for a truncated portion of the intracytoplasmic domain of ALK (ALKt), lacking part of its catalytic domain, or for the ALKK210R dead mutant, which lacks its tyrosine kinase activity. One week after the second vaccination, the animals were challenged subcutaneously with a lethal dose of syngeneic NPM-ALK expressing lymphoma cells. Two different lymphoma cell lines, established from BALB/c NPM-ALK transgenic (Tg) mice were utilized. A localized lymphoma mass grew by 10-15 days after injection in all control mice and in animals vaccinated with the empty plasmid, while a total protection was observed in mice vaccinated with the complete ALK or with the ALKt plasmid or with the dead mutant ALKK210R construct (FIG. 1a,b and 5).
Thus, DNA vaccination with the intracytoplasmatic domain of ALK plasmid is efficient also when the plasmid codes for a protein with reduced (<20% of the wild type protein) or absent catalytic function.
A similar protection is achieved after vaccination with DNA sequences derived from species with high homology (equal or greater than 80%) to the DNA sequence encoding for the entire intracytoplasmatic portion of human ALK (as shown in SEQ ID No.:7), such as Pan troglodytes, Macaca mulatta, Microcebus murinus, Felis catus, Canis familiaris, Tupaia belangeri, Bos Taurus, Rattus norvegicus, Mus musculus, Monodelphis domestica, or Gallus gallus. 
Identical protection rates were observed against the challenge with a second NPM-ALK expressing lymphoma cell line. Notably, two ALK vaccinations elicited a long lasting immune response, granting a significant tumor protection up to 7 months (FIG. 1c). Sequential histological biopsies showed that in mock vaccinated mice the lymphoma grew progressively overtime in the absence of any significant reactive infiltrate. By contrast, in ALK vaccinated mice, an inflammatory reaction mainly composed of lymphocytes and granulocytes was intermingled with NPM-ALK positive lymphoma cells within the first ten days after the tumor challenge (FIG. 1d) and by day 14 all neoplastic cells were successfully cleared (FIG. 1e).
Since lymphomas are almost invariably systemic diseases, the efficacy of ALK DNA immunization in controlling the disseminated lymphoma growth was studied. Mice were immunized twice, as described above, and subsequently challenged with 1×106 NPM-ALK positive lymphoma cells by tail vein injection. All mock-vaccinated mice died by day 50 because of a massive and systemic disease, involving the central nervous system (the cerebellum and the meningeal spaces), soft tissues, and many other organs, including the heart, the spleen, the liver and the kidney; whereas 70% of the ALK vaccinated mice were protected and were healthy up to 180 days (FIG. 2a, b).
Next, it has been tested whether DNA-based ALK vaccines could be employed as a therapeutic strategy. Mice were first injected s.c. with lymphoma cells and then vaccinated twice at one week interval. Whereas ALK vaccination did not control lymphoma growth when 1×106 or 5×105 lymphoma cells were injected, a significant protection was observed when 1×105 cells were inoculated, indicating a therapeutic potential of the vaccine only in animals with limited tumor burden (FIG. 2c). This limited tumor burden could be compared to non-Hodgkin's lymphomas (NHL) patients with minimal residual disease after chemotherapy.
To mimic more strictly these clinical settings, the efficiency of the vaccination strategy disclosed herein in association with chemotherapy, which remains the standard therapeutic strategy for human Anaplastic Large Cell Lymphomas (ALCL), was tested. Since current ALCL protocols are based on multiple chemotherapeutic agents such as prednisolone, cyclophosphamide, doxorubicin, methotrexate, and vincristine, some of these drugs were tested in vitro and demonstrated that murine NPM-ALK expressing lymphoma cells underwent rapid apoptosis with low doses of doxorubicin (FIG. 6).
Given that chemotherapy can severely compromise the immune system, the present inventors subsequently demonstrated that doxorubicin-treated animals, following ALK DNA vaccination, were efficiently protected once challenged with lymphoma cells (FIG. 2d).
To test the efficiency of the DNA vaccination after a single-drug based regimen, the present inventors injected i.v. 1×106 lymphoma cells and after one week the mice were treated with a single dose of doxorubicin. After 7 more days, animals were vaccinated with either control or ALK vectors for three times at one week interval. Untreated mice died rapidly in less than 35 days, but chemotherapy alone prolonged their survival, with a cure rate of 60%, similarly to those currently achieved in ALCL patients. Remarkably, the combination of chemotherapy with the ALK vaccination significantly increased to 87% the fraction of cured mice (FIG. 2e).
High dose and/or multi-drug combination chemotherapy protocols are associated with significant toxicity and an increased risk of secondary neoplasms, particularly in young cancer patients. Since NPM-ALK lymphoma cells are highly sensitive to small drug ALK inhibitors, mice bearing syngeneic xenograft tumors were treated with an oral ALK kinase inhibitor for 15 days (30 or 100 mg/kg bid). In virtually all animals, this protocol led to a substantial reduction of the neoplastic masses (FIG. 2f) and to a high degree of intra-tumor necrosis.
To test whether the DNA vaccination could synergize with the therapy with anti-ALK inhibitors and improve the overall survival of mice bearing NPM-ALK lymphomas, mice were vaccinated with ALK or mock plasmids after reduction of tumor mass with ALK inhibitors similarly to those depicted in FIG. 2f and followed their rate of relapse, tumor growth and overall survival. As shown in FIG. 2g, ALK DNA vaccination post ALK inhibitor treatment delays tumor growth in relapsing mice and leads to a 30% cure rate.
The mechanisms of tumor protection by vaccines are multiple. Since the majority of the antitumoral immune reactions are associated with IFNγ production, the present inventors first demonstrated that the percentages of splenic lymphocytes releasing IFNγ from ALK vaccinate animals was remarkably expanded as compared to controls after stimulation by an ALK recombinant protein or NPM-ALK expressing BALB/c lymphocytes in vitro (FIG. 3a). Next, DNA vaccinated mice were tested for their ability to generate a specific cytotoxic response against ALK positive cells in vivo. BALB/c wild type and NPM-ALK Tg splenocytes labeled with different doses of CSFE were injected in vaccinated mice. After 3 days, ALK-vaccinated mice exhibited a marked and specific cytotoxic activity only against NPM-ALK but not wild type splenocytes as NPM-ALK expressing splenocytes were selectively decreased in ALK vaccinated mice compared to controls, as detected by flow cytometry or immunohistochemistry (FIG. 3b-d).
To further elucidate the immunological mechanisms necessary for lymphoma protection in the present model, three BALB/c knock-out mouse models, lacking either B cells (Ig μ-chain −/−), IFNγ (IFNγ −/−), or perforin (perforin −/−) mediated responses were employed. Mice were vaccinated twice and then challenged with lymphoma cells s.c., and tumor growth was measured over time. Mice lacking the B lymphocytes (Ig μ-chain −/−) were successfully protected by ALK vaccination and showed an in vivo cytotoxic activity comparable to wild type mice (FIG. 4a, b). Notably, wild type mice vaccinated with the ALK plasmid displayed very low titers of anti-ALK antibodies and vaccinations with purified ALK peptides in combination with GM-CSF stimulated a strong antibody responses with high titers of anti-ALK antibodies but lack detectable anti-tumor responses (FIG. 8). Altogether, these data indicate that B cells or antibody production are dispensable to obtain a significant protection against ALK lymphomas in the present model. These results differ from those obtained with other Tg mice models (such as HER-2 transgenic BALB/c mice) in which antibodies against the extracytoplasmic portion of the oncogenic tyrosine kinase are essential to obtain a significant protection.
In the absence of IFNγ, ALK vaccinated mice were not protected and in perforin −/− mice an intermediate protection and cytotoxic activity, as compared to immunocompetent animals, was found (FIG. 4a, b), indicating that anti-ALK cytotoxic activity requires IFNγ production and, to a lesser extent, perforin but could be mediated by other effector molecules.
Finally, the role of CD4 and CD8 cells was established after depletion with specific anti-CD4 or anti-CD8 antibodies. First, mice were vaccinated and then selectively depleted for CD4 or CD8 T cells before the tumor challenge. The loss of CD4 T cells did not significantly alter the tumor protection after vaccination, meanwhile lymphoma cells grew in a comparable rate to controls in the absence of CD8 cells (FIG. 4c). Moreover, the xenograft tumor growth of vaccinate mice, after depletion of Natural Killer (NK) cells (<5% NK) with rabbit anti-asialo antibodies, was statistically similar to control animals. In addition, NK depleted mice display an efficient and specific cytotoxic response against ALK positive cells in vivo. In summary, these findings demonstrated that ALK vaccination protects mice from lymphoma growth mainly via T-cell-mediate responses, and requires cytotoxic T-cells, as effectors.
Although ALK fusion proteins are expressed in only 2-3% of NHL, the present disclosure demonstrates that ALK is endowed with many of the features of a perfect tumor vaccination antigen, i.e. specificity, strong immunogenicity, and absolute requirement for tumor maintenance. In fact, the physiological expression of ALK is almost completely restricted to the fetal life, whereas in adult mammals it is detected at high levels only in rare neurons within the central nervous system and in the spinal cord. Since these compartments represent immunological sanctuaries, little, if any, autoimmune or severe/adverse reactions should be expected after ALK vaccination. This hypothesis is supported by the present findings, which demonstrated that mice vaccinated with human ALK were perfectly healthy, fertile and did not display noticeable signs or symptoms (up to 18 months of follow-up), although they developed specific lymphocytes against the murine ALK in the absence of detectable histological signs of acute and/or chronic inflammation. Moreover, the pathological expression of human ALK can elicit measurable B- and T-cell responses in patients with ALCL lymphoma without concomitant autoimmune and/or neurological disorders. The sustained signaling of ALK fusion proteins for the maintenance of the ALCL phenotype and survival is well established. This evidence provides a strong rational and a significant advantage in the design of ALK-based vaccines, since the selection and/or the escape of an ALCL neoplastic clone lacking ALK might be very unlikely.
Finally, but not less importantly, ALK lymphomas represent the most common high-grade lymphoma in children. In these patients, a long-term immuno-surveillance induced by an ALK vaccination could be decisive in preventing lymphoma recurrence as well as in assuring a long lasting remission or, in the best of cases, the complete eradication of the disease, which might be achieved by targeting ALK translocated tumor stem cells.
The present data are also in line with previous findings, which demonstrated the absolute need to decrease the tumor burden to have successful vaccination strategies and to reach durative disease-free survival rates or cures. Today, high dose and/or poly-chemotherapeutic approaches are commonly used, however, these approaches are associated with serious constrains including high toxicity, and increased risk of secondary drug-induced neoplasms. These undesired side effects are of particular relevance in young patients. Thus, alternative protocols taking advantage of more specific compounds (kinase inhibitors), less toxic regiments (i.e. chemoprevention protocols, tailored schedules etc.) capable to better preserve the host immunity, or chemotherapeutic compounds favoring necrosis versus apoptosis (which should enhance tumor antigen presentation) should be consider in association with the vaccine protocols. Our data support this avenue and provide the scientific rational for future clinical applications.
The protocols of ALK DNA vaccination used in the present mouse model will be adapted for clinical application in human patients.
ALK DNA vaccination protocols will be designed following the guidelines established for other antigens in human patients, such as in prostate cancer (Miller et A. M. et al. J Immunother. 28, 389-95 (2005); Roos A. K. et al. Methods Mol Biol. 423, 463-72 (2008)). As a starting protocol three different amounts of ALK DNA are used: 100 μg (90 μg intramuscularly [IM]+10 μg intradermally [ID]), 300 μg (270 μg IM+30 μg ID), and 900 μg (810 μg IM+90 μg ID). To optimize vaccination, the following cytokines will be given concomitantly as vaccine adjuvants: GM-CSF (molgramostim, Leucomax, Schering-Plough & Novartis, Sweden) (40 μg/day for 3 days starting 2 days before vaccination) subcutaneously (SC) at the same site as vaccination and IL-2 (aldesleukin, Proleukin, Chiron, Holland) (75 μg/day for 7 days starting the day after vaccination) SC in the same extremity.
Successive modifications and adaptations will be pursued based on the immunological responses of the patients.
Materials and Methods
Plasmids, Cells Lines and Reagents.
The majority of the cytoplasmic domain of ALK (SEQ ID No.:1), that is translocated in NPM-ALK fusion protein, was cloned into the pDEST vector (Invitrogen) to obtain the pDEST-ALK construct. The fragment from by 469 to 1372 of the NPM-ALK cDNA was cloned into the pDEST vector to obtain pDEST-ALKt, which contains a truncated form of ALK lacking part of the tyrosine kinase domain (SEQ ID No.: 2). The pDEST-ALKK210R plasmid (SEQ ID No.:3) was obtained by site-directed mutagenesis as described in Chiarle R. et al. Nat Med 11, 623-629 (2005).
The two cells lines used in this study (ALK-OVA and VAC) were immortalized from primary lymphomas derived from NPM-ALK Tg mice (Chiarle R. et al. Blood 101, 1919-1927 (2003)) backcrossed on the BALB/c background. Doxorubicin was purchased at 2 mg/ml concentration from Pharmacia (Milan, Italy)
Mice, In Vivo Cell Depletion and Tumor Challenge.
BALB/c mice were from Charles River Laboratories Italia S.p.A. Mice knock out (KO) for the Ig μ heavy-chain gene (BALB-Igμ chain −/−; Qin Z. et al. Nat Med 4, 627-630 (1998)) were kindly provided by Thomas Blankenstein (Freie University, Berlin, Germany). The IFNγ gene KO mice (BALB-IFNγ −/−; Clynes R. et al. Proc Natl Acad Sci USA 95, 652-656 (1998)) were from Jackson Laboratories (Bar Harbor, Me., USA). Mice KO for the perforin gene (BALB-perforin −/−; Smyth M J et al. J Immunol. 162, 6658-6662 (1999)) were from the Peter MacCallum Cancer Institute (East Melbourne, Australia). Mice were treated properly and ethically in accordance with European Community guidelines.
When required, on day −15 and −14 days before tumor challenge mice received two intravenous injections of 0.2 ml PBS containing 40 μg of anti-CD8 (Lyt 2, purified Ab, CL168AP Cederlane Laboratories, Canada) or 40 μl of anti-CD4 (L3T4 ascite, CL012A Cederlane Laboratories, Canada) or anti-asialo Ab (Rabbit anti-asialo GM1, 986-10001, Cedarlane Laboratories, Canada). Flow cytometry of residual blood CD4 and CD8 T-cells and Natural Killer cells, collected 7 days after the last injection, showed that targeted cells were selectively decreased below 1% of cells.
Mice were challenged subcutaneously in the right flank with 0.2 ml PBS of a single suspension containing 105 to 106 ALK-OVA and VAC lymphoid cells, as indicated in each experiment. The cages were coded, and the incidence and the growth of tumors were evaluated at the indicated times in a blind fashion. Neoplastic masses were measured with calipers in the two perpendicular diameters.
Vaccinations.
For DNA electroporation, 50 μg of pDEST empty vector or pDEST-ALK (ALK) vector in 20 μl of 0.9% NaCl with 6 mg/ml polyglutamate were injected on days 0 and 7 into both the tibial muscle of anesthetized BALB/c mice. An additional group of mice was vaccinated with the pDEST-ALK plasmid combined with the same amount of a pcDNA3 plasmid coding for GM-CSF (SEQ ID No.:4). Electric pulses were applied by two electrodes placed on the skin and two square-wave 25 ms, 375 V/cm pulses were generated by a T820 electroporator (BTX, San Diego, Calif.). On day 14 and 7 months after the second vaccination mice were challenged with 1×106 NPM-ALK expressing lymphoma cells derived from NPM-ALK BALB/c Tg mice injected subcutaneously (s.c) in the right flank. Protection was evaluated as the percentage of lymphoma-free mice 21 days after challenge.
For peptide vaccination, mice were vaccinated with 50 μg of purified GST-ALK (coding for the entire cytoplasmic domain of the ALK protein—SEQ ID No.:5) conjugated with KLH (Keyhole Limpet Hemocyanin) in combination with 10.000 U of recombinant GM-CSF (SEQ ID No.:6) on days 0, 15 and 29. To measure specific anti-ALK immunoglobulin production, ELISA plates were coated with purified GST-ALK protein.
Chemotherapy Protocols.
A single dose chemotherapy protocols was employed using doxorubicin (10 mg/kg) 7 day prior the i.v. injection of a challenging dose (1×106) of NPM-ALK positive lymphoma cells. On days 14, 21 and 28 mice were then DNA vaccinated with empty (mock) or ALK-expressing plasmids (full arrows), as described above. Anti-ALK responses after chemotherapy were also studied in BALB/c mice, after a single i.v. injection with 10 mg/kg doxorubicin (day 0), followed by DNA vaccination (on days 7, 14 and 21), and then after 60 days by the s.c. injection of 1×106 NPM-ALK expressing lymphoma cells. Finally, to assess the utility of a combination chemotherapy approach, syngeneic mice (BALB/c and C57BL/6) were challenged with NPM-ALK positive lymphoma cells. Mice bearing approx 2 cm tumor masses (in the largest diameter) were then first treated for 12 consecutive days with 30 or 100 mg/day bid CEP-26939 (Cephalon, USA) followed by DNA vaccination. Tumor growth and overall survival were determined, overtime.
Histology and Immunoistochemistry.
For histological evaluation, tissue samples were fixed in 10% neutral buffered formalin, embedded in paraffin, sectioned at 4 μm, and stained with hematoxylin and eosin. For immunohistochemistry, formalin-fixed, paraffin embedded section were incubated with anti ALK antibody (Rabbit anti-ALK, Invitrogen, Carlsbad, Calif., USA, 1:1000). After washing, sections were overlaid with biotinylated goat anti-rabbit secondary antibody and revealed with the DAKO EnVisionTM+ System (Dako, Glostrup, Denmark).
In Vivo Citotoxicity Assays.
BALB/c mice were vaccinated twice with the indicated plasmids and 7 days after the second vaccination they were i.v. injected with 107 wild type splenocytes mixed with 107 NPM-ALK Tg BALB/c splenocytes labelled with different amounts of CFSE (0.5 μM and 5 μM, respectively). After 72 hours, mice were sacrificed and splenocytes were stained with CD4-APC antibody (Pharmingen) and analysed by flow cytometry. Percentages of ALK-directed specific cytotoxicity were calculated by normalizing the numbers of residual NPM-ALK expressing CD4 T-cells (CSFE high) with the total amount of CD4+CSFE+ T-cells in mock and ALK vaccinated mice.
Elispot Assay.
ELISPOT assay was done using the murine IFNγ Elispot kit (Becton-Dickinson) according to the manufacture's instruction. Briefly, splenocytes (1×106) from non-immunized and immunized mice were incubated in triplicates in 96-well plates (Millipore) for 18 hours at 37° C. alone or together with NPM-ALK Tg BALB/c splenocytes or recombinant GST-mALK protein obtained from a vector in which the cytoplasmic portion of murine ALK (mALK) was cloned in frame with GST. Spot were scanned with ImmunoSpot series 3A Analyzer and counted using the ImmunoSpot image analyzer software v3.2 (CTL ImmunoSpot, Cleveland Ohio). Results are expressed as spot forming units (SFU)/1×106 cells.
Statistical Analyses.
A two sample t test was used for statistical analysis of the tumor growth and cytotoxicity. Significant differences in survival of mice with Kaplan-Meier analysis were determined. P values less than 0.05 were considered significant.
Genebank References.
Human ALK: NM_004304.3. and NP_004295.2. Murine ALK: NM007439, NC_000083.5 and MGI:103305
Naturally, while the principle of the invention remains the same, the details of construction and the embodiments may widely vary with respect to what has been described and illustrated purely by way of example, without departing from the scope of the present invention.

## Claims

1. A method of treating or delaying the growth of an Anaplastic Lymphoma Kinase (ALK) protein expressing tumor comprising the step of:
administering to a subject in need thereof a purified intracytoplasmatic domain of an ALK protein,
wherein the intracytoplasmic domain consists of the sequence of SEQ ID NO:5 or consists of an amino acid sequence encoded by the nucleic acid sequence of SEQ ID NO:2 or SEQ ID NO:3,
wherein said purified domain is administered in a therapeutically effective amount to treat or delay tumor growth.

2. The method according to claim 1, wherein the purified intracytoplasmatic domain of ALK protein is free of its catalytic domain.

3. The method according to claim 1, wherein the purified intracytoplasmatic domain of ALK protein presents a reduced or absent catalytic function.

4. The method according to claim 1, wherein the tumor is selected from the group consisting of:
a neuroblastoma;
a glioblastoma;
a soft tissue tumor;
an ALK expressing lymphoma;
an ALK expressing lung carcinoma;
an ALK expressing breast carcinoma;
an ALK expressing colon carcinoma; and
an ALK expressing prostate carcinoma.

5. The method according to claim 1, wherein the method further comprises the step of:
administering to the subject in need thereof at least one chemotherapeutic agent or at least one small molecule kinase inhibitor.

6. The method of claim 5, wherein the two administering steps are performed simultaneously or sequentially.

7. The method according to claim 5, wherein the chemotherapeutic agent is at least one selected from the group consisting of:
prednisolone;
cyclophosphamide;
doxorubicin;
methotrexate; and
vincristine.

8. The method according to claim 5, wherein the small molecule kinase inhibitor is at least one selected from the group consisting of:
a pyridone;
a dialkoxyquinoline;
an aminopyridopyrimidinone;
a diaminopyrimidine;
a pyrrolopyrimidine;
a fused pyrrolocarbazole; and
a derivative thereof.