# Patent

## Title
Treatment of chronic nephropathies using soluble complement receptor type I (sCR1)

## Abstract

A method is disclosed for treating nephropathies involving undesired alternative pathway complement activation by administration of a complement inhibitory protein such as soluble complement receptor type I (sCR1).

## Background
CROSS-REFERENCE TO PRIORITY APPLICATIONS
This application is a division of U.S. Ser. No. 13/233,916 filed Sep. 15, 2011 (in issue) which claims priority to U.S. Provisional Patent Application Ser. No. 61/383,004 filed Sep. 15, 2010, the contents of which are incorporated herein.


GOVERNMENT INTEREST
The invention was made with government support under Grant No. 1R01DK074409 awarded by National Institutes of Health. Accordingly, the United States Government has certain rights in the invention.


FIELD OF THE INVENTION
The present invention relates to pharmaceutical compositions for treatment of diseases associated with dysregulation of the alternative pathway complement activation which ultimately harms kidney function, in particular atypical hemolytic uremic syndrome (aHUS) and dense deposit disease (DDD, also known as membrano-proliferative glomerulonephritis type II or MPGN2), as well as a recently described syndrome referred to as glomerulonephritis with isolated C3 deposits (GN-C3) or C3 glomerulopathy (C3G). Specifically, the invention relates to the use of pharmaceutical compositions comprising a soluble complement receptor type I (sCR1) to treat such diseases.
BACKGROUND OF THE INVENTION
The complement system comprises more than 40 different proteins directly or indirectly mediating attack and elimination of microbes, foreign particles and altered self cells via three different pathways of activation: classical pathway, alternative pathway, and lectin pathway (see, The Complement System, 2nd revised edition, Rother et al. (eds); Springer Verlag, 1998). The complement system is a major component of innate immunity and is a central host defense against infection. Activation of the complement cascade via the classical pathway, involving antigen-antibody complexes, by the lectin pathway, or by the alternative pathway, involving the recognition of certain cell wall polysaccharides, mediates a range of activities including lysis of microorganisms, chemotaxis, opsonization, stimulation of vascular and other smooth muscle cells, degranulation of mast cells, increased permeability of small blood vessels, directed migration of leukocytes, and activation of B lymphocytes and macrophages. The membrane attack complex (MAC) is the final product of the activated complement cascade. It is a lytic multi-protein complex that is lethal to pathogens and, at sublytic levels, causes the release of cytokines and growth factors such as beta-FGF and VEGF from nucleated cells (e.g., smooth muscle cells, endothelial cells).
Several human diseases are characterized by an unwanted activation of the complement cascade via one or more of these activation pathways, which is reflected by elevated levels of typical activation markers such as downstream components of the complement cascade, e.g., cleavage products of the complement system and inhibitor-protease complexes. Proteolytic cleavage of C3 by specific C3 convertases plays a major role in complement activation. C3 convertases generate forms of C3b, which represent a potential component of new C3 convertase molecules, thereby stimulating the cascade.
The protection of self-cells and tissue is normally tightly regulated by specific complement regulatory proteins or inhibitors, existing in the fluid-phase (soluble form) and/or in membrane-bound forms. The membrane-bound complement regulatory proteins include complement receptor type I (CR1 or CD35), which binds C3b and C4b, disassembles C3 convertases and permits C3b/C4b degradation by factor I; decay accelerating factor (DAF or CD55), which binds C3b and disassembles C3/C5 convertase; and membrane co-factor protein (MCP or CD46), which binds C3b and C4b to permit their degradation by factor I). In addition to the membrane-anchored complement regulatory proteins, the soluble regulatory protein Factor H acts as a potent protective factor for cells by attachment to the polyanionic surface of self cells, where it increases complement inhibitory potential (Jozsi et al., Histol. Histopathol., 19:251-8 (2004)). This protective activity of Factor H is mainly achieved by its efficient reduction of the lifetime of the alternative C3 convertase C3bBb by (1) binding to the covalently bound C3b and displacing Bb (decay acceleration), and (2) catalyzing the permanent inactivation of C3b via proteolytic cleavage by the serine proteinase factor I (co-factor activity: generation of, e.g., iC3b, C3c). (The Complement System, 2nd revised edition, Rother et al. (eds); Springer Verlag, 1998; pp. 28, 34-7.) The activity of Factor H as co-factor for factor I in the outer phase of the surface layer (approx. 20-140 nm) is facilitated by binding of Factor H to surface-located proteoglycans by means of the C-terminal short consensus repeat (Jozsi et al. (2004), supra). The protective potential of Factor H limits locally the progression of the complement cascade. This is of particular importance for cells that express a low number of the membrane-anchored complement regulators, or for tissues which completely lack such complement regulatory proteins, such as the kidney glomerular basement membrane (Hogasen et al., J. Clin. Invest., 95:1054-61 (1995)).
A significant reduction or absence of functional Factor H protein, i.e., due to reduced or eliminated Factor H expression, or mutation of the Factor H gene leading to production of mutant Factor H that is non-functional or has reduced functionality, has been demonstrated as one possible cause in diseases such as atypical hemolytic uremic syndrome (aHUS), dense deposit disease (DDD, also known as membranoproliferative glomerulonephritis type II or MPGN2), and glomerulonephritis with isolated C3 deposits (GN-C3, also sometimes referred to as C3 glomerulopathy, or C3G). These diseases ultimately harm kidney function. Since the glomerular membrane lacks endogenous complement regulatory membrane proteins, continuous cleavage of C3 occurs at this site, resulting in deposition of complement activation products, resulting in C3 convertase-mediated damage of the glomerular basement membranes and of epithelial tubules and endothelial cells, membrane thickening via deposition of extracellular matrix and/or components of the complement system (e.g., C3 cleavage products) and of antibodies, and, consequently, in defective filtration (proteinuria).
Dense deposit disease (DDD), also termed membranoproliferative glomerulonephritis type II or MPGN2, is a rare disease which is characterized by complement-containing dense deposits within the basement membrane of the glomerular capillary wall, followed by capillary wall thickening, mesangial cell proliferation and glomerular fibrosis (Ault, Pediatr. Nephrol., 14:1045-53(2000)). Besides DDD, there are two other types of membranoproliferative glomerulonephritis, i.e., types I and III (MPGN1 and MPGN3, respectively). The membranoproliferative glomerulonephritides are diseases of diverse and often obscure etiology that account for 4% and 7% of primary renal causes of nephrotic syndrome in children and adults, respectively (Orth et al., New Engl. J. Med., 338:1202-1211 (1998)). Membranoproliferative glomerulonephritis (MPGN) types I and III are variants of immune complex-mediated disease; MPGN type II, in contrast, has no known association with immune complexes (Appel et al., “Membranoproliferative glomerulonephritis type II (Dense Deposit Disease): an update,” J. Am. Soc. Nephrol., 16:1392-1403 (2005)).
DDD accounts for less than 20% of cases of MPGN in children and only a fractional percentage of cases in adults (Orth et al., 1998, supra; Habib et al., Kidney Int., 7:204-15 (1975); Habib et al., Am. J. Kidney Diseas., 10:198-207 (1987)). Both sexes are affected equally, with the diagnosis usually made in children between the ages of 5-15 years who present with non-specific findings like hematuria, proteinuria, acute nephritic syndrome or nephrotic syndrome (Appel et al., 2005, supra). More than 80% of patients with DDD are also positive for serum C3 nephritic factor (C3NeF), an autoantibody directed against C3bBb, the convertase of the alternative pathway of the complement cascade (Schwertz et al., Pediatr. Allergy Immunol., 12:166-172 (2001)). C3NeF is found in up to one-half of persons with MPGN types I and III and also in healthy individuals, making the electron microscopic demonstration of dense deposits in the glomerular basement membrane (GBM) necessary for a definitive diagnosis of DDD (Appel et al., 2005, supra). This morphological hallmark is characteristic of DDD and is the reason “dense deposit disease” or “DDD” have become the more common terms for this MPGN.
C3NeF autoantibodies persists throughout the disease course in more than 50% of patients with DDD (Schwertz et al., 2001). Its presence is typically associated with evidence of complement activation, such as a reduction in CH50, decrease in C3, increase in C3dg/C3d, and persistently high levels of activation of the alternative pathway of the complement cascade. In DDD, C3NeF binds to C3bBb (or to the assembled convertase) to prolong the half-life of this enzyme, resulting in persistent C3 consumption that overwhelms the normal regulatory mechanisms to control levels of C3bBb and complement activation (Appel et al., 2005, supra). Most DDD patients do not have disease-causing mutations in Factor H, however, several alleles of both Factor H and the complement Factor H-related 5 gene (CFHR5) are preferentially associated with DDD (Abrera-Abeleda, M. A., et al., Journal of Medical Genetics, 43:582-589 (2006)).
Spontaneous remissions of DDD are uncommon (Habib et al., 1975, supra; Habib et al., 1987, supra; Cameron et al., Am. J. Med., 74:175-192 (1983)). The more common outcome is chronic deterioration of renal function leading to end-stage renal disease (ESRD) in about half of patients within 10 years of diagnosis (Barbiano di Belgiojoso et al., Nephron., 19:250-258 (1977)); Swainson et al., J. Pathol., 141:449-468 (1983)). In some patients, rapid fluctuations in proteinuria occur with episodes of acute renal deterioration in the absence of obvious triggering events; in other patients, the disease remains stable for years despite persistent proteinuria.
Atypical hemolytic-uremic syndrome (aHUS) consists of the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. aHUS, although rare, is a severe disease with death rates up to 25% in the acute phase and 50% developing end-stage renal disease (Noris, M., et al., N. Engl. J. Med., 361:1676-1687 (2009)).
Research has linked atypical haemolytic-uremic syndrome to uncontrolled activation of the complement system. Approximately half of the patients with aHUS have mutations in CFH, CFI and MCP, encoding the complement regulatory proteins complement factor H, factor I and membrane cofactor protein, respectively (www.FH-HUS.org) (Noris, M., et al., 2009, supra). Gain-of-function mutations in key proteins of the alternative pathway cascade, complement factor B (CFB) and C3 have also been reported (Goicoechea de Jorge, E., et al., Proc. Natl. Acad. Sci. USA, 104:240-245 (2007); Fremeaux-Bacchi, V. et al., Blood, 112:4948-4952 (2008)). More recently, mutations in the gene encoding thrombomodulin (THBD), a membrane-bound glycoprotein with anticoagulant properties that modulates complement activation on cell surfaces, have also been associated with aHUS (Delvaeye, M., et al., N. Engl. J. Med., 361:345-357 (2009)). Finally, aHUS associated with anti-CFH autoantibodies has been described in sporadic forms mostly in association with deficiency of factor H related proteins 1 and 3 (Moore, I., et al., Blood, 115:379-387 (2009)).
In vitro functional tests with recombinant or plasma-purified CFH, MCP, CFI and THBD all documented that aHUS-associated mutations impair the capacity of regulatory proteins to control the activity of the alternative pathway of complement on endothelial cell surface (Noris, M., et al., 2009, supra). On the other hand, gain of function mutations in CFB and C3 resulted in hyperfunctional components of the C3 convertase that caused complement deposition on cell surface in vitro (Goicoechea de Jorge, E., et al., 2007, supra; Fremeaux-Bacchi, V. et al., 2008, supra). These findings indicate that aHUS is a disease of excessive complement activation on endothelial cells, which eventually results in renal microvascular thrombosis.
Factor H replacement therapy, inter alia, has been proposed for aHUS and DDD patients (see, e.g., US Pat. Publication 2009-0118163), however difficulties arise where the normal levels of a non-functional mutant Factor H are underlying the disease. It was not previously known whether addressing the continuous activation of complement via the alternative pathway would be a viable therapy, and a persistent need for new therapeutic approaches is evident.
SUMMARY OF THE INVENTION
The present invention relates to the use of a soluble complement receptor type I protein for the therapeutic treatment of nephropathies, in particular atypical hemolytic uremic syndrome (aHUS), dense deposit disease (DDD, also known as membranoproliferative glomerulonephritis type II or MPGN2), and glomerulonephritis with isolated C3 deposits (GN-C3, also sometimes referred to as C3 glomerulopathy, or C3G).
Thus, in one aspect, the present invention provides a new pharmaceutical composition for the treatment of aHUS, DDD or GN-C3 comprising an amount of a soluble CR1 protein, effective to inhibit complement and a pharmaceutically acceptable vehicle.
In another aspect, the present invention relates to the use of a soluble complement receptor type I (sCR1) polypeptide in the treatment of a nephropathy characterized by undesired alternative pathway complement activation.
In preferred aspects of the invention, the sCR1 polypeptide used in the methods herein is selected from a fragment of human CR1 comprising at least short consensus repeats 8-11; a fragment of human CR1 comprising at least short consensus repeats 15-18; a soluble CR1 polypeptide comprising human CR1 short consensus repeats 8-11 and 15-18; a fragment of human CR1 comprising long homologous repeat B; a fragment of human CR1 comprising long homologous repeat C; a fragment of human CR1 comprising long homologous repeats B and C; a fragment of human CR1 comprising long homologous repeats B, C and D; a fragment of human CR1 comprising at least long homologous repeats A and B; a fragment of human CR1 comprising long homologous repeats A, B and C; a fragment of human CR1 comprising long homologous repeats A, B, C and D; a fragment of human CR1 comprising the extracellular domain of CR1; a fragment of human CR1 comprising the extracellular domain of CR1 and having the N-terminal LHR A deleted (sCR1[desLHR-A]); a soluble CR1 polypeptide having modified glycosylation to improve serum half-life in vivo; a soluble CR1 polypeptide having glycosylation modified to exhibit sialyl Lewis X moieties (sCR1-sLex); a soluble CR1 construct having two or more CR1 polypeptide moieties linked to a carrier molecule; and combinations thereof.
In another aspect of the invention, the sCR1 polypeptide or fragment thereof used the in the methods disclosed herein exhibits a complement regulatory activity selected from the group consisting of: (i) the ability to bind C3b; (ii) the ability to bind C4b; (iii) the abilities to bind C3b and to bind C4b; (iv) factor I cofactor activity; (v) the ability to inhibit classical C3 convertase activity; (vi) the ability to inhibit alternative C3 convertase activity; (vii) the ability to inhibit classical C5 convertase activity; (viii) the ability to inhibit alternative C5 convertase activity; (ix) the ability to inhibit neutrophil oxidative burst; (x) the ability to inhibit complement-mediated hemolysis; (xi) the ability to inhibit C3a production; and (xii) the ability to inhibit C5a production. In yet another aspect of the invention, the sCR1 polypeptide or fragment thereof exhibits combinations of the above activities.
In another aspect, the sCR1 polypeptide or fragment thereof used the in the methods disclosed herein exhibits ability to inhibit complement activation via both the classical activation pathway and the alternative activation pathway.
Another aspect of the invention relates to the use of a soluble complement receptor type I (sCR1) polypeptide in the treatment of a nephropathy in a mammal, including humans, characterized by undesired alternative pathway complement activation.
In yet another aspect of the invention, the nephropathy characterized by undesired alternative pathway complement activation results in C3 deposition in kidney tissue.
In one aspect of the invention, the use of the sCR1 polypeptide in the treatment of a nephropathy described herein results in a reduction of further C3 deposition in kidney tissue and/or at least partially reverses existing C3 deposition and reduces further C3 deposition in kidney tissue.
In yet another aspect of the invention, the use of a soluble complement receptor type I (sCR1) polypeptide in the treatment of a nephropathy characterized by undesired alternative pathway complement activation reduces kidney damage, reduces further kidney damage, and/or at least partially reverses existing kidney damage.
In another aspect of the invention, the use of a soluble complement receptor type I (sCR1) polypeptide in the treatment of a nephropathy characterized by undesired alternative pathway complement activation reduces deterioration in renal function and/or improves renal function. In one aspect of the invention, the improved renal function is indicated by one or more of i) reduced proteinuria, ii) reduced serum creatinine, and/or iii) improved glomerular filtration rate.
In another aspect of the invention, the use of a soluble complement receptor type I (sCR1) polypeptide in the treatment of a nephropathy characterized by undesired alternative pathway complement activation increases serum levels of C3.
Another aspect of the invention relates to a method for treating DDD comprising administration of an amount of a soluble CR1 protein effective to inhibit alternative pathway complement activation to a mammalian subject suffering from DDD. Another aspect of the invention relates to a method for treating aHUS comprising administration of an amount of a soluble CR1 protein effective to inhibit alternative pathway complement activation to a mammalian subject suffering from aHUS. Another aspect of the invention relates to a method for treating GN-C3 comprising administration of an amount of a soluble CR1 protein effective to inhibit alternative pathway complement activation to a mammalian subject suffering from GN-C3.
Another aspect of the invention relates to a method for treating DDD comprising systemic administration of an amount of a soluble CR1 protein effective to inhibit complement activity to a mammalian subject suffering from DDD. In this aspect, administration of the soluble CR1 protein may be intravenous (IV), subcutaneous (SC), intramuscular (IM), intra-arterial, intraperitoneal (IP), intrathecal, pulmonary, or oral. Another aspect of the invention relates to a method for treating aHUS comprising systemic administration of an amount of a soluble CR1 protein effective to inhibit complement activity to a mammalian subject suffering from aHUS. In this aspect, administration of the soluble CR1 protein may be intravenous (IV), subcutaneous (SC), intramuscular (IM), intra-arterial, intraperitoneal (IP), intrathecal, pulmonary, or oral.
Yet another aspect of the invention relates to a method for treating GN-C3 comprising systemic administration of an amount of a soluble CR1 protein effective to inhibit complement activity to a mammalian subject suffering from GN-C3. In this aspect, administration of the soluble CR1 protein may be intravenous (IV), subcutaneous (SC), intramuscular (IM), intra-arterial, intraperitoneal (IP), intrathecal, pulmonary, or oral.
Pharmaceutical compositions for use in treating DDD, GN-C3 or aHUS comprising a soluble complement receptor type I and a pharmaceutically acceptable diluent, carrier or excipient are also contemplated. Use of a soluble complement receptor type I in the manufacture of a medicament for the treatment of DDD, GN-C3 or aHUS is also contemplated.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a graph showing the dose-dependent inhibition of alternative pathway (AP) complement activation by sCR1.
FIG. 2 is a graph showing the results of in vitro hemolytic assays in a patient with aHUS and a patient with DDD, showing that sCR1 is a potent inhibitor of C3 convertase activity in both patients, and even in the presence of C3NeF in the DDD patient.
FIG. 3 is a graph showing the results of an in vivo study of C3 levels in Cfh−/− mice injected with a single dose of sCR1 at 50 mg/kg. C3 levels in sCR1-injected mice significantly increased after 24 hours.
FIG. 4 are histopathologic slides comparing C3 deposition in the kidneys at 48 hours in a Cfh−/− test animal treated with a single does of sCR1 (Injected-1 and Injected-2) vs. the negative controls (Untreated and PBS).
FIG. 5 is a graph showing the results of an in vivo study of C3 concentrations in Cfh−/−tg-CR1 mice injected with 3 doses of sCR1 at 0, 24, and 48 hours at a dose of 25 mg/kg and 50 mg/kg. C3 concentration was measured at 0, 12, 36, and 60 hours.
FIG. 6 are histopathologic slides comparing C3 deposition in the kidneys in Cfh−/−tg-CR1 mouse test animals treated with a single dose of sCR1 (25 mg/kg and 50 mg/kg) vs. the negative control (0 mg/kg) at 60 hours post-injection.



DETAILED DESCRIPTION
The present invention is based on the important and surprising discovery that administration of a complement inhibitory protein, in particular soluble CR1, is effective in inhibiting alternative pathway complement activity in patients with chronic nephropathies/glomerulopathies, in particular atypical hemolytic uremic syndrome (aHUS), dense dense deposit disease (DDD, also known as membranoproliferative glomerulonephritis type II or MPGN2), and glomerulonephritis with isolated C3 deposits (GN-C3, also sometimes referred to as C3 glomerulopathy or C3G).
In order that the invention may be more fully understood, the following terms are defined.
The term “nephropathy” or “nephrosis” as used herein refers to damage to or disease or disorder of the kidney, including diseases/disorders associated with undesired alternative pathway complement activation and/or deposition of complement activation products in kidney tissue, including atypical hemolytic uremic syndrome (aHUS) and/or dense deposit disease (DDD) and/or glomerulonephritis with isolated C3 deposits (GN-C3).
The term “complement inhibitory protein” as used herein refers to any of the complement regulatory proteins that have a negative regulatory activity on complement activation. Complement inhibitory proteins useful in the present invention include, specifically, soluble complement receptor type I (sCR1), C4-binding protein (C4-BP), decay accelerating factor (DAF), membrane cofactor protein (MCP), and Factor H.
As used herein, the terms “soluble complement receptor type I”, “soluble CR1 polypeptides” or “soluble CR1” or “sCR1” will be used to refer to portions of full-length human CR1 protein which, in contrast to the native CR1 proteins, are not expressed on the cell surface as transmembrane proteins but nevertheless exhibit a complement regulatory activity such as C3b binding, C4b binding, the ability to inhibit the classical complement activation pathway and/or the alternative complement activation pathway, and/or the lectin complement activation pathway, etc. In particular, CR1 polypeptides which substantially lack a transmembrane region, or, preferably, which comprise all or part of the extracellular domain of CR1 and retain a complement regulatory activity, are soluble CR1 polypeptides. In a preferred embodiment, the soluble CR1 polypeptides useful in the present invention are secreted by a cell in which they are expressed. Suitable soluble CR1 polypeptides and preparations are described in detail, e.g., in U.S. Pat. No. 5,981,481; U.S. Pat. No. 5,456,909; and U.S. Pat. No. 6,193,979, which are incorporated herein by reference. Soluble CR1 polypeptides having at least one C3b/C4b binding site intact are preferred, as such molecules have the ability to block complement activation via the classical activation pathway and the alternative activation pathway both. Reference to specific complement inhibitory proteins includes fragments of such proteins produced by truncation or splicing-out of unwanted polypeptide segments, so long as complement regulatory activity is retained. Derivatives made by one or more amino acid substitutions or linking to other structures such as carrier proteins or immunoglobulin constant regions are also contemplated, again so long as complement inhibitory activity is retained. In particular, soluble CR1 polypeptides having at least one of the two C3b/C4b binding sites (specifically, short consensus repeats (SCRs) 8-11 and 15-18) intact are preferred, because such molecules will retain the ability to block complement activation via the alternative complement pathway.
Special mention is made of a soluble CR1 polypeptide having glycosylation modified to exhibit sialyl Lewis X moieties (sCR1-sLex), as described in U.S. Pat. No. 6,193,979; novel glycoform preparations of soluble CR1 having an increased in vivo half-life described in U.S. Pat. No. 5,456,909; and soluble constructs having two or more CR1 moieties linked to a carrier molecule, e.g., an sCR1-F(ab)2 fusion, as described in U.S. Pat. No. 6,458,360. Also contemplated are soluble CR1 polypeptides having at least one of the C3b or C4b binding sites intact covalently linked to lipopeptides to facilitate localization on cell surfaces, as disclosed in U.S. Pat. No. 6,713,606. More preferably, the method of the invention utilizes a polypeptide comprising the extracellular domain of mature human CR1 (SEQ ID NO:1).
As used herein, the terms “treatment” or “treating” refers to any regimen that alleviates one or more symptoms of a disease or disorder, that inhibits progression of a disease or disorder, that arrests progression or reverses progression (causes regression) of a disease or disorder, or that prevents onset of a disease or disorder. Treatment includes prophylaxis and includes but does not require cure of a disease or disorder.
As used herein, the terms “disease” and “disorder” have the meaning generally known and understood in the art and comprise any abnormal condition in the function or well being of a host individual. A diagnosis of a particular disease or disorder, such as atypical hemolytic uremic syndrome (aHUS) and/or dense deposit disease (DDD) and/or glomerulonephritis with isolated C3 deposits (GN-C3) by a healthcare professional may be made by direct examination and/or consideration of results of one or more diagnostic tests.
A composition or method described herein as “comprising” one or more named elements or steps is open-ended, meaning that the named elements or steps are essential, but other elements or steps may be added within the scope of the composition or method. To avoid prolixity, it is also understood that any composition or method described as “comprising” (or “comprises”) one or more named elements or steps also describes the corresponding, more limited, composition or method “consisting essentially of” (or “consists essentially of”) the same named elements or steps, meaning that the composition or method includes the named essential elements or steps and may also include additional elements or steps that do not materially affect the basic and novel characteristic(s) of the composition or method. It is also understood that any composition or method described herein as “comprising” or “consisting essentially of” one or more named elements or steps also describes the corresponding, more limited, and close-ended composition or method “consisting of” (or “consists of”) the named elements or steps to the exclusion of any other unnamed element or step. In any composition or method disclosed herein, known or disclosed equivalents of any named essential element or step may be substituted for that element or step.
The definitions of other terms used herein are those understood and used by persons skilled in the art and/or will be evident to persons skilled in the art from their usage in the text.
The method of this invention can be practiced by using any soluble complement receptor type I polypeptide which is effective to block alternate pathway complement activation. Such complement inhibitory proteins include, for example, soluble complement receptor type I (sCR1) of SEQ ID NO:1, i.e., comprising the extracellular domain of human CR1, or fragments of CR1 that retain complement inhibiting properties, such as the ability to inhibit complement activation, to bind C3b, or to bind both C3b and C4b, or factor I co-factor activity. Preferably, the complement inhibitory protein used in the methods described herein is a soluble (non-membrane-bound) form of human CR1 comprising at least long homologous repeats (LHRs) B and/or C, preferably both LHRs B and C, more preferably long homologous repeats A, B, and C or A, B, C, and D, and most preferably substantially the entire extracellular domain of human CR1 or the molecule sCR1[desLHR-A], which is the extracellular domain of CR1 including the LHRs BCD but omitting the N-terminal LHR A (see, Scesney, S. M. et al, Eur. J. Immunol., 26:1729-35 (1996)). Suitable soluble CR1 polypeptides and preparations are described in detail, e.g., in U.S. Pat. No. 5,981,481; U.S. Pat. No. 5,456,909; and U.S. Pat. No. 6,193,979. Modified sCR1 molecules having, for example, a modified glycosylation, e.g., to improve serum half-life, such as those described in U.S. Pat. No. 5,456,909 may also be used. Soluble CR1 polypeptides having glycosylation modified to exhibit sialyl Lewis X moieties (designated sCR1-sLex), as described in U.S. Pat. No. 6,193,979, may also be used. And soluble constructs having two or more CR1 moieties linked to a carrier molecule, e.g., an sCR1-F(ab)2 fusion, as described in U.S. Pat. No. 6,458,360, may also be used.
As discussed more fully below, it has been demonstrated herein that administration of sCR1 alleviates the effects of undesirable alternative pathway complement activation, in particular in nephropathic diseases such as atypical hemolytic uremic syndrome (aHUS), dense deposit disease (DDD), or glomerulonephritis with isolated C3 deposits (GN-C3). We have thus discovered that administration of a complement inhibitory protein to a subject in a relevant aHUS or MPGN2 model reduces and/or ameliorates the pathogenesis of massive activation of the alternative pathway and terminal complement cascade, with subsequent deposition of complement activation products (iC3b, C3c, C3d, sMAC) in the glomerular basement membrane. The effects of sCR1 in nephropathic diseases has been demonstrated in vivo, which demonstrates an important aspect previously unknown, namely, whether sCR1 could be delivered to affect C3 deposition at particular tissues lacking complement regulatory proteins, such as kidney glomerular basement membrane, whether the regulatory activity of sCR1 could persist for a meaningful period in vivo to alleviate the effects of unregulated complement activation and such outward indicators as C3 deposition in kidney tissues, and whether administration of sCR1 could be effective at a dosage level that would make sCR1 a realistic candidate as a therapeutic.
It has also now been demonstrated that sCR1 can effectively compete with C3Nef autoantibodies and counterbalance C3Nef-mediated complement activation that occurs in about 85% of DDD patients.
The human C3b/C4b receptor, termed complement receptor type I (CR1) or CD35, is naturally present on the membranes of erythrocytes, monocytes/macrophages, granulocytes, B cells, some T cells, splenic follicular dendritic cells, and glomerular podocytes. (Fearon, 1980, J. Exp. Med., 152: 20, Wilson, J. G., et al., 1983, J. Immunol., 131: 684). CR1 specifically binds C3b, C4b, iC3b and iC4b.
CR1 can inhibit the classical and alternative pathway C3/C5 convertases and act as a cofactor for the cleavage of C3b and C4b by factor I, indicating that CR1 also has complement regulatory functions in addition to serving as a receptor. (Fearon, D. T., 1979, Proc. Nalt. Acad. Sci. U.S.A., 76: 5867; Iida, K. I. and Nussenzweig, V., 1981, J. Exp. Med., 153: 1138.) In the alternative pathway of complement activation, the bimolecular complex C3bBb is a C3 protease (convertase). CR1 can bind to C3b thereby promoting the dissociation of fragment Bb from the complex. In the alternative pathway of complement activation, the tri-molecular complex C3bC3bBb is a C5 protease (convertase). CR1 can bind to C3bC3b thereby promoting the dissociation of fragment Bb from the complex. Furthermore, binding of C3b to CR1 renders C3b susceptible to irreversible proteolytic inactivation by factor I, resulting in the production of inactivated derivatives of C3b (namely, iC3b, C3d and C3dg). In the classical pathway of complement activation, the bimolecular complex C4bC2a is the C3 convertase. CR1 binds to C4b thereby promoting the dissociation of C2a from the complex. In the classical pathway of complement activation, the complex C3bC4bC2a is the C5 convertase. CR1 binds to C4b and/or C3b thereby promoting the dissociation of C2a from the complex. The binding renders C4b and/or C3b susceptible to irreversible proteolytic inactivation by factor I. Finally, the lectin pathway (also called the mannose binding lectin or MBL pathway) feeds into the classical pathway upstream of the C3 convertase. Thus, CR1 inhibits lectin pathway activation through its inhibitory activities on the classical pathway at the C3 and C5 activation steps.
Factor H has some of the same properties exhibited by CR1 but is not effective to block both activation pathways. Factor H has decay accelerating activity and factor I co-factor activity in the alternative pathway only. In addition, the activity of Factor H is restricted to non-activating surfaces. This is an important distinction with respect to CR1, which is active both on activating and non-activating surfaces and is therefore more suitable for use under conditions of an ongoing disease. Activating surfaces would include, e.g., the presence of necrotic and inflamed tissue.
Several soluble (non-membrane bound) fragments of CR1 have been generated via recombinant DNA procedures by eliminating the transmembrane and cytoplasmic regions from the DNAs being expressed. See, e.g., Fearon et al., Intl. Patent Publn. WO 89/09220, Oct. 5, 1989. The soluble CR1 fragments are functionally active, i.e., retaining the ability to bind C3b and/or C4b, inhibiting complement activation, and demonstrating factor I co-factor activity, depending upon the native CR1 regions the CR1 fragments contain. Such constructs inhibit in vitro the consequences of complement activation such as neutrophil oxidative burst, complement mediated hemolysis, C3a and C5a production, and the production of C5b-9 (MAC). A soluble construct, sCR1/pBSCR1c, also has demonstrated in vivo activity in a reversed passive Arthus reaction (Yeh et al., 1991, J. Immunol., 146:250), suppressed post-ischemic myocardial inflammation and necrosis (Weisman et al., 1990, Science, 249: 146-151) and extended survival rates following transplantation (Pruitt et al., 1991, J. Surg. Res., 50: 350; Pruitt et al., 1991, Transplantation, 52: 868).
The complete cDNA coding sequence and amino acid sequence of the human CR1 protein is described in U.S. Pat. No. 5,981,481, which is incorporated herein by reference. The isolation of the full-length CR1 gene, expression and purification of the full-length protein and active fragments thereof, and demonstration of activity in the full-length protein and fragments derived from the full-length protein, are described in U.S. Pat. No. 5,981,481.
The complement inhibitory proteins such as sCR1 that are useful in the methods of the present invention are advantageously produced in quantity using recombinant DNA technology to express the protein in a host cell, such as bacterial cells, mammalian cells, or even plant cells. For the complement inhibitory proteins contemplated herein, mammalian host cells, such as Chinese Hamster ovary (CHO) cells, African Green Monkey kidney (COS) cells, or human cells, retina-derived cells (e.g., PER.C6 cells) being preferred. Yeast expression, E. coli expression, baculovirus expression, and plant expression are also contemplated, where non-mammalian glycosylation patterns do not have a significant impact on biological function or pharmacokinetics. Other expression systems for the production of recombinant proteins will also be useful for the production of complement receptor type I polypeptides contemplated herein. The isolated gene encoding the desired protein can be inserted into an appropriate cloning vector. A large number of vector-host systems known in the art may be used. Possible vectors include, but are not limited to, plasmids or modified viruses. The vector system must be compatible with the host cell used. Such vectors include, but are not limited to, bacteriophages such as lambda derivatives, or plasmids such as pBR322, pUC or CDM8 plasmids (Seed, 1987, Nature, 329: 840-842) or derivatives of those well-known vectors. Recombinant molecules can be introduced into host cells via transformation, transfection, infection, electroporation, etc.
Recombinant cells producing a preferred form of sCR1 are deposited with the American Type Culture Collection, Rockville, Md. (accession no. CRL 10052). The deposited cells are a Chinese Hamster ovary cell line DUX B11 carrying plasmid pBSCR1c/pTCSgpt clone 35.6, encoding the extracellular domain of human CR1. Such sCR1 polypeptide in purified form is produced under the product designation TP10 and also by the designation CDX-1135 by Celldex Therapeutics, Inc. (Needham, Mass.).
After expression in a host cell, the soluble CR1 molecules may be isolated and purified by standard methods including chromatography (e.g., ion exchange, affinity, and sizing column chromatography, high pressure liquid chromatography), centrifugation, differential solubility, or by any other standard technique for the purification of proteins. Preferred purification methods are described in U.S. Pat. No. 6,316,604, U.S. Pat. No. 5,252,216, and U.S. Pat. No. 5,840,858, which are incorporated herein by reference.
Soluble CR1 proteins are therapeutically useful in the modulation of complement-mediated diseases, that is, diseases or conditions characterized by inappropriate or undesired complement activation. A soluble CR1 protein or fragment which can bind C3b and/or retains the ability to inhibit the alternative or classical C3 or C5 convertases, and/or retains factor I cofactor activity, can be used in the methods and uses disclosed herein. In the present invention, we have demonstrated that soluble CR1 can be used to ameliorate or inhibit undesirable complement activity in the pathogenesis of nephropathies caused by DDD and/or aHUS.
In the method of the invention, a soluble CR1 polypeptide is administered to a subject who suffers from aHUS, DDD, and/or GN-C3 in order to attenuate complement activation and its role in the pathogenesis in persistent reduction in serum C3 and deposition of complement activation products, resulting in C3 convertase-mediated damage of the glomerular basement membranes and of epithelial tubules and endothelial cells, membrane thickening via deposition of extracellular matrix and/or components of the complement system (e.g., C3 cleavage products) and of antibodies, and, consequently, in defective filtration (proteinuria).
In a method of treating DDD, aHUS, or GN-C3 according to the invention, a therapeutically active amount of a soluble complement receptor type I polypeptide is administered to a mammalian subject in need of such treatment. The preferred subject is a human. The amount administered should be sufficient to inhibit complement activation and/or restore normal alternative pathway regulation. The determination of a therapeutically effective dose is within the capability of practitioners in this art, however, as an example, in embodiments of the method described herein utilizing systemic administration of sCR1 for the treatment of DDD, an effective human dose will be in the range of 0.1-150 mg/kg; preferably 1-100 mg/kg, more preferably 3-75 mg/kg, most preferably 5-60 mg/kg patient body weight (e.g., 5 mg/kg, 10 mg/kg, 25 mg/kg, 50 mg/kg, etc.). The route of administration may affect the recommended dose. Repeated systemic doses are contemplated in order to maintain an effective level, e.g., to attenuate or inhibit complement activation in a patient's system, depending on the mode of administration adopted.
Soluble CR1 may be used in combination or alternating with the administration of other therapeutics prescribed for DDD and/or aHUS and/or GN-C3.
For administration, the sCR1 or other therapeutic protein may be formulated into an appropriate pharmaceutical composition. Such a composition typically contains a therapeutically active amount of the sCR1 or other protein and a pharmaceutically acceptable excipient or carrier such as saline, buffered saline, salt solutions (e.g., BSS®), phosphate buffers, dextrose, or sterile water. Compositions may also comprise specific stabilizing agents such as sugars, including mannose and mannitol.
Various delivery systems are known and can be used for delivery of complement inhibitory proteins such as sCR1 polypeptides in accordance with this invention, e.g., encapsulation in liposomes, microparticles, or microcapsules. Suitable modes of administration include but are not limited to intradermal, intramuscular, intraperitoneal, intravenous, subcutaneous, intrathecal, or epidural injection, and oral or pulmonary delivery.
Pharmaceutical compositions containing one or more complement inhibitory proteins for use in the present invention may be formulated in accordance with routine procedures as a pharmaceutical composition for systemic administration to an individual suffering from DDD and/or aHUS and/or GN-C3. Typically compositions for systemic administration are solutions in sterile aqueous buffer. Where necessary, the composition may also include a solubilizing agent and a local anesthetic such as lidocaine to ease pain at the site of injection. Generally, the ingredients will be supplied either separately or mixed together in unit dosage form, for example, as a dry lyophilized powder or water free concentrate in a hermetically sealed container such as an ampoule or sachette indicating the quantity of active agent in activity units. Where the composition is to be administered by injection, an ampoule of sterile water for injection or saline may be provided so that the ingredients may be mixed prior to administration.
A pharmaceutical pack comprising one or more containers filled with one or more of the ingredients of the pharmaceutical composition is also contemplated.
The following examples illustrate the methods of the present invention. They are provided by way of illustration and not for purposes of limitation.
Example 1
Recombinant soluble complement receptor type I (sCR1) consisting of the extracellular portion of human CR1, produced in CHO cells, was used in the following experiments. The sCR1 was obtained from Celldex Therapeutics, Inc. (Needham, Mass.).
Complement Activity Assay
Alternative pathway (AP) complement activity was evaluated in the fluid phase using the Wieslab complement AP assay kit (Wieslab AB, Lund, Sweden). This method combines principles of the hemolytic assay for complement activation with the use of labeled antibodies specific for a neoantigen produced as a result of complement activation. The amount of neoantigen generated is proportional to the functional activity of the alternative pathway.
Twenty (20) microliters of pooled normal serum (Innovative research, Cat#IPLA-CSER, Novo, Mich.) was diluted in 340 μl of diluents (Wieslab complement AP assay kit; Wieslab AB, Lund, Sweden) containing specific blockers to ensure that only the alternative pathway is activated. Soluble CR1 polypeptide (TP10, Celldex Therapeutics, Inc., Needham, Mass.) was added to a final concentration of 10 μg/ml, 5 μg/ml, 2.5 μg/ml, 1.25 μg/ml, 0.63 μg/ml, 0.31 μg/ml or 0 μg/ml. The mixture was then incubated on ice for 15 minutes; thereafter, each diluted serum was transferred in 100 microliter aliquots to microtiter wells. Activation was initiated during incubation of diluted serum in microtiter wells coated with specific complement activators of the alternative pathway, i.e., LPS (lipopolysaccharides). The wells were washed with the provided buffer and C5b-9 (MAC) was detected using the provided phosphatase-labeled antibody to the neoantigen that is exposed during MAC formation.
Data showed that sCR1 strongly inhibits fluid phase activation of the alternative pathway in a dose-dependent manner (see, FIG. 1).
Hemolytic Assay
The sheep erythrocyte lysis assay measures complement-mediated lysis of sheep erythrocytes secondary to activation of the alternative pathway on a cell surface. Sheep erythrocytes generally act as non-activators of complement-mediated lysis in human serum. A small number of C3b molecules spontaneously generated through alternative pathway tick-over are deposited on the surface of sheep erythrocytes. In normal human serum, factor H binds to C3b molecules through N-terminal domains and to sheep erythrocytes through C-terminal domains. These interactions protect sheep erythrocytes from complement and no lysis is observed.
Hemolysis was observed 30 minutes after mixing 20 microliters of patient A serum (FIG. 2, aHUS, dark blue) and sheep erythrocytes (50 μl, 1×108/ml) in the presence of Mg′/EGTA (AP activation possible) at 37° C. In parallel tests, various amounts of sCR1 (to final concentrations 0 μg/ml, 10 μg/ml, 20 μg/ml, 30 μg/ml, 40 μg/ml) were added to the same amount serum (20 μl) from patient A before adding sheep erythrocytes (50 μl, 1×108/ml) and incubating for 15 minutes on ice. Hemolysis was greatly reduced by the addition of sCR1 (see, FIG. 2).
Patient B has dense deposit disease (DDD) and very strong C3NeF activity, which causes uncontrolled alternative pathway activation with massive C3 consumption. As a consequence, alternative pathway complement factors are totally consumed. To test whether sCR1 can prevent C3NeF from stabilizing C3 convertase, 10 μl of patient B's serum were added to 10 μl of sheep erythrocytes (1×109/ml) coated with pre-formed C3 convertase. Pre-formed C3 convertase was allowed to decay at 30° C. (water bath) for 20 minutes. The pre-formed C3 convertase was made by adding normal human serum to sheep erythrocytes and incubating first at room temperature (water bath) for 8 minutes and then on ice for 40 minutes. Sheep RBCs were lysed in the prolonged presence of C3 convertase. Hemolysis was assayed by adding rat serum (1:5 diluted in GVB-EDTA buffer) as a source of C3-9 (FIG. 2, DDD, light blue). In parallel tests, various amounts of sCR1 (to final concentrations 0 μg/ml, 10 μg/ml, 20 μg/ml, 30 μg/ml, 40 μg/ml) were added to the patient serum before mixing with sheep erythrocytes and incubating on ice for 15 minutes. Data showed that sCR1 suppressed C3NeF activity in a dosage-dependent manner (see, FIG. 2). Repetition of this experiment with sera from ten DDD patients showed similar results.
The results of the in vitro hemolytic assays in a patient with aHUS and the patients with DDD show that sCR1 is a potent inhibitor of C3 convertase activity, even in the presence of C3NeF.
Example 2
Cfh−/− In Vivo Mouse Study
Complement factor H (CFH) deficiencies have been associated with dense deposit disease (DDD) and aHUS (Fakhouri et al., Kidney International, 78:279-286 (2010). Gene-targeted CFH-deficient mice (Cfh−/−) spontaneously develop low plasma C3 levels and deposition of C3 along the murine glomerular basement membrane, analogous to human dense deposit disease (Pickering, M C, et al., Nat. Genet., 31:424-428 (2002)). Accordingly, Cfh−/− mice were selected as an animal model for this experiment.
Five Cfh−/− mice, a gift from Drs. Matthew Pickering and Marina Botto of the Imperial College London, were injected with sCR1 at a dose of 50 mg/kg (tail vein injection). As controls, one littermate was injected with the same amount of PBS and another one littermate was left untreated. Sera were collected by tail bleeding at 0, 24 and 48 hours. Serum C3 levels were measured using the mouse complement C3 kit (Kamiya Biomedical, Seattle, Wash.). C3 levels in sCR1-injected mice dramatically increased at 24 hours (rising close to the low end of normal reference values,  ̃300-1500 mg/L); however, C3 levels dropped to near pre-injection state by 48 hours in all injected mice (see, FIG. 3).
Kidneys were harvested at the time of euthanasia (48 hours) and imbedded in tissue-freezing medium (Triangle Biomedical Sciences, Durham, N.C.). Blocks were cut to a thickness of 5 micron and C3 deposition was assayed with FITC-conjugated C3 antibody (MP Biomedicals, Solon, Ohio).
C3 deposition was decreased in all sCR1-injected mice (see, FIG. 4). C3 immunofluorescence was decreased at 48 hours after a single dose of sCR1. By 48 hours, alternative pathway activation was again robust as evidenced by a decrease in C3 levels (see, FIG. 3). The decrease in C3 immunofluorescence reflects the transient control of C3 convertase activity over the 24 hour period following sCR1 injection.
The experiment was repeated, using Cfh−/−tg-CR1 mice, a gift from Dr. Richard Quigg of the University of Chicago Medical Center (i.e., factor H-knock-out mice transgenic for human CR1). These mice are identical to the Cfh−/− mouse described above however they have been crossed with a mouse transgenic for human CR1 (Repik, A. et al., Clinical and Experimental Immunology, 140:230-240 (2005)). Four mice were injected (intraperitoneally) with sCR1 at 0, 24, and 48 hours (3 injections per mouse) at doses of either 25 mg/kg (2 mice) or 50 mg/kg (2 mice). As controls, two additional mice were injected with the same volume of PBS. C3 levels were measured at 0, 12, 36, and 60 hours. Because the Cfh−/−tg-CR1 mouse expresses human CR1, it does not develop an immune response against sCR1 and is suitable for longer studies that employ multiple doses of sCR1. The results are shown in FIG. 5. C3 levels in sCR1-injected mice showed a dramatic and sustained increase (again, rising close to the low end of normal reference values,  ̃300-1500 mg/L).
Kidneys were harvested at the time of euthanasia (60 hours) and imbedded in tissue-freezing medium (Triangle Biomedical Sciences, Durham, N.C.). Blocks were cut to a thickness of 5 micron and C3 deposition was assayed with FITC-conjugated C3 antibody (MP Biomedicals, Solon, Ohio). The results are shown in FIG. 6.
C3 deposition was decreased in all sCR1-injected Cfh−/−tg-CR1 mice at both concentrations (see, FIG. 5). C3 immunofluorescence was significantly decreased at 60 hours after the three-dose regimen sCR1 at 50 mg/kg. As seen in FIG. 6, the three-dose regimen, leading to sustained levels of sCR1 through the end of the experiment (see, FIG. 5), led to a remarkable decrease in C3 deposition on kidney sections at the end of the experiment. These results indicate that susceptible kidney tissues in DDD can be protected by systemic administration of sCR1.
These data indicate a treatment for the rare complement-mediated diseases of DDD (MPGN2) and/or aHUS and/or GN-C3 to alleviate undesired complement activity in the short term, and to improve or protect renal function in the long term.
Following the foregoing description, additional therapeutic formulations containing other embodiments of the complement regulatory protein sCR1 may readily be tested, prepared and used for the treatment of DDD (MPGN2) and/or aHUS and/or GN-C3. Additional embodiments of the invention and alternative methods adapted to a particular composition and mode of delivery will be evident from studying the foregoing description. All such embodiments and obvious alternatives are intended to be within the scope of this invention, as defined by the claims that follow.
Publications referred to above are hereby incorporated by reference.
A preferred soluble complement receptor type I polypeptide for use according to the present disclosure has the amino acid sequence:







(SEQ ID NO: 1)


Gln Cys Asn Ala Pro Glu Trp Leu Pro Phe Ala Arg


1               5                   10


 


Pro Thr Asn Leu Thr Asp Glu Phe Glu Phe Pro Ile


        15                  20


 


Gly Thr Tyr Leu Asn Tyr Glu Cys Arg Pro Gly Tyr


25                  30                  35


 


Ser Gly Arg Pro Phe Ser Ile Ile Cys Leu Lys Asn


            40                  45


 


Ser Val Trp Thr Gly Ala Lys Asp Arg Cys Arg Arg


    50                  55                  60


 


Lys Ser Cys Arg Asn Pro Pro Asp Pro Val Asn Gly


                65                  70


 


Met Val His Val Ile Lys Gly Ile Gln Phe Gly Ser


        75                  80


 


Gln Ile Lys Tyr Ser Cys Thr Lys Gly Tyr Arg Leu


85                  90                  95


 


Ile Gly Ser Ser Ser Ala Thr Cys Ile Ile Ser Gly


            100                 105


 


Asp Thr Val Ile Trp Asp Asn Glu Thr Pro Ile Cys


    110                 115                 120


 


Asp Arg Ile Pro Cys Gly Leu Pro Pro Thr Ile Thr


                125                 130


 


Asn Gly Asp Phe Ile Ser Thr Asn Arg Glu Asn Phe


        135                 140


 


His Tyr Gly Ser Val Val Thr Tyr Arg Cys Asn Pro


145                 150                 155


 


Gly Ser Gly Gly Arg Lys Val Phe Glu Leu Val Gly


            160                 165


 


Glu Pro Ser Ile Tyr Cys Thr Ser Asn Asp Asp Gln


    170                 175                 180


 


Val Gly Ile Trp Ser Gly Pro Ala Pro Gln Cys Ile


                185                 190


 


Ile Pro Asn Lys Cys Thr Pro Pro Asn Val Glu Asn


        195                 200


 


Gly Ile Leu Val Ser Asp Asn Arg Ser Leu Phe Ser


205                 210                 215


 


Leu Asn Glu Val Val Glu Phe Arg Cys Gln Pro Gly


            220                 225


 


Phe Val Met Lys Gly Pro Arg Arg Val Lys Cys Gln


    230                 235                 240


 


Ala Leu Asn Lys Trp Glu Pro Glu Leu Pro Ser Cys


                245                 250


 


Ser Arg Val Cys Gln Pro Pro Pro Asp Val Leu His


        255                 260


 


Ala Glu Arg Thr Gln Arg Asp Lys Asp Asn Phe Ser


265                 270                 275


 


Pro Gly Gln Glu Val Phe Tyr Ser Cys Glu Pro Gly


            280                 285


 


Tyr Asp Leu Arg Gly Ala Ala Ser Met Arg Cys Thr


    290                 295                 300


 


Pro Gln Gly Asp Trp Ser Pro Ala Ala Pro Thr Cys


                305                 310


 


Glu Val Lys Ser Cys Asp Asp Phe Met Gly Gln Leu


        315                 320


 


Leu Asn Gly Arg Val Leu Phe Pro Val Asn Leu Gln


325                 330                 335


 


Leu Gly Ala Lys Val Asp Phe Val Cys Asp Glu Gly


            340                 345


 


Phe Gln Leu Lys Gly Ser Ser Ala Ser Tyr Cys Val


    350                 355                 360


 


Leu Ala Gly Met Glu Ser Leu Trp Asn Ser Ser Val


                365                 370


 


Pro Val Cys Glu Gln Ile Phe Cys Pro Ser Pro Pro


        375                 380


 


Val Ile Pro Asn Gly Arg His Thr Gly Lys Pro Leu


385                 390                 395


 


Glu Val Phe Pro Phe Gly Lys Ala Val Asn Tyr Thr


            400                 405


 


Cys Asp Pro His Pro Asp Arg Gly Thr Ser Phe Asp


    410                 415                 420


 


Leu Ile Gly Glu Ser Thr Ile Arg Cys Thr Ser Asp


                425                 430


 


Pro Gln Gly Asn Gly Val Trp Ser Ser Pro Ala Pro


        435                 440


 


Arg Cys Gly Ile Leu Gly His Cys Gln Ala Pro Asp


445                 450                 455


 


His Phe Leu Phe Ala Lys Leu Lys Thr Gln Thr Asn


            460                 465


 


Ala Ser Asp Phe Pro Ile Gly Thr Ser Leu Lys Tyr


    470                 475                 480


 


Glu Cys Arg Pro Glu Tyr Tyr Gly Arg Pro Phe Ser


                485                 490


 


Ile Thr Cys Leu Asp Asn Leu Val Trp Ser Ser Pro


        495                 500


 


Lys Asp Val Cys Lys Arg Lys Ser Cys Lys Thr Pro


505                 510                 515


 


Pro Asp Pro Val Asn Gly Met Val His Val Ile Thr


            520                 525


 


Asp Ile Gln Val Gly Ser Arg Ile Asn Tyr Ser Cys


    530                 535                 540


 


Thr Thr Gly His Arg Leu Ile Gly His Ser Ser Ala


                545                 550


 


Glu Cys Ile Leu Ser Gly Asn Ala Ala His Trp Ser


        555                 560


 


Thr Lys Pro Pro Ile Cys Gln Arg Ile Pro Cys Gly


565                 570                 575


 


Leu Pro Pro Thr Ile Ala Asn Gly Asp Phe Ile Ser


            580                 585


 


Thr Asn Arg Glu Asn Phe His Tyr Gly Ser Val Val


    590                 595                 600


 


Thr Tyr Arg Cys Asn Pro Gly Ser Gly Gly Arg Lys


                605                 610


 


Val Phe Glu Leu Val Gly Glu Pro Ser Ile Tyr Cys


        615                 620


 


Thr Ser Asn Asp Asp Gln Val Gly Ile Trp Ser Gly


625                 630                 635


 


Pro Ala Pro Gln Cys Ile Ile Pro Asn Lys Cys Thr


            640                 645


 


Pro Pro Asn Val Glu Asn Gly Ile Leu Val Ser Asp


    650                 655                 660


 


Asn Arg Ser Leu Phe Ser Leu Asn Glu Val Val Glu


                665                 670


 


Phe Arg Cys Gln Pro Gly Phe Val Met Lys Gly Pro


        675                 680


 


Arg Arg Val Lys Cys Gln Ala Leu Asn Lys Trp Glu


685                 690                 695


 


Pro Glu Leu Pro Ser Cys Ser Arg Val Cys Gln Pro


            700                 705


 


Pro Pro Asp Val Leu His Ala Glu Arg Thr Gln Arg


    710                 715                 720


 


Asp Lys Asp Asn Phe Ser Pro Gly Gln Glu Val Phe


                725                 730


 


Tyr Ser Cys Glu Pro Gly Tyr Asp Leu Arg Gly Ala


        735                 740


 


Ala Ser Met Arg Cys Thr Pro Gln Gly Asp Trp Ser


745                 750                 755


 


Pro Ala Ala Pro Thr Cys Glu Val Lys Ser Cys Asp


            760                 765


 


Asp Phe Met Gly Gln Leu Leu Asn Gly Arg Val Leu


    770                 775                 780


 


Phe Pro Val Asn Leu Gln Leu Gly Ala Lys Val Asp


                785                 790


 


Phe Val Cys Asp Glu Gly Phe Gln Leu Lys Gly Ser


        795                 800


 


Ser Ala Ser Tyr Cys Val Leu Ala Gly Met Glu Ser


805                 810                 815


 


Leu Trp Asn Ser Ser Val Pro Val Cys Glu Gln Ile


            820                 825


 


Phe Cys Pro Ser Pro Pro Val Ile Pro Asn Gly Arg


    830                 835                 840


 


His Thr Gly Lys Pro Leu Glu Val Phe Pro Phe Gly


                845                 850


 


Lys Ala Val Asn Tyr Thr Cys Asp Pro His Pro Asp


        855                 860


 


Arg Gly Thr Ser Phe Asp Leu Ile Gly Glu Ser Thr


865                 870                 875


 


Ile Arg Cys Thr Ser Asp Pro Gln Gly Asn Gly Val


            880                 885


 


Trp Ser Ser Pro Ala Pro Arg Cys Gly Ile Leu Gly


    890                 895                 900


 


His Cys Gln Ala Pro Asp His Phe Leu Phe Ala Lys


                905                 910


 


Leu Lys Thr Gln Thr Asn Ala Ser Asp Phe Pro Ile


        915                 920


 


Gly Thr Ser Leu Lys Tyr Glu Cys Arg Pro Glu Tyr


925                 930                 935


 


Tyr Gly Arg Pro Phe Ser Ile Thr Cys Leu Asp Asn


            940                 945


 


Leu Val Trp Ser Ser Pro Lys Asp Val Cys Lys Arg


    950                 955                 960


 


Lys Ser Cys Lys Thr Pro Pro Asp Pro Val Asn Gly


                965                 970


 


Met Val His Val Ile Thr Asp Ile Gln Val Gly Ser


        975                 980


 


Arg Ile Asn Tyr Ser Cys Thr Thr Gly His Arg Leu


985                 990                 995


 


Ile Gly His Ser  Ser Ala Glu Cys Ile  Leu Ser Gly


            1000                 1005


 


Asn Thr  Ala His Trp Ser Thr  Lys Pro Pro Ile Cys


    1010                 1015                 1020


 


Gln Arg Ile Pro Cys  Gly Leu Pro Pro Thr  Ile Ala


                1025                 1030


 


Asn Gly Asp  Phe Ile Ser Thr Asn  Arg Glu Asn Phe


        1035                 1040


 


His  Tyr Gly Ser Val Val  Thr Tyr Arg Cys Asn  Leu


1045                 1050                 1055


 


Gly Ser Arg Gly  Arg Lys Val Phe Glu  Leu Val Gly


            1060                 1065


 


Glu Pro  Ser Ile Tyr Cys Thr  Ser Asn Asp Asp Gln


    1070                 1075                 1080


 


Val Gly Ile Trp Ser  Gly Pro Ala Pro Gln  Cys Ile


                1085                 1090


 


Ile Pro Asn  Lys Cys Thr Pro Pro  Asn Val Glu Asn


        1095                 1100


 


Gly  Ile Leu Val Ser Asp  Asn Arg Ser Leu Phe  Ser


1105                 1110                 1115


 


Leu Asn Glu Val  Val Glu Phe Arg Cys  Gln Pro Gly


            1120                 1125


 


Phe Val  Met Lys Gly Pro Arg  Arg Val Lys Cys Gln


    1130                 1135                 1140


 


Ala Leu Asn Lys Trp  Glu Pro Glu Leu Pro  Ser Cys


                1145                 1150


 


Ser Arg Val  Cys Gln Pro Pro Pro  Glu Ile Leu His


        1155                 1160


 


Gly  Glu His Thr Pro Ser  His Gln Asp Asn Phe Ser


1165                 1170                 1175


 


Pro Gly Gln Glu  Val Phe Tyr Ser Cys  Glu Pro Gly


            1180                 1185


 


Tyr Asp  Leu Arg Gly Ala Ala  Ser Leu His Cys Thr


    1190                 1195                 1200


 


Pro Gln Gly Asp Trp  Ser Pro Glu Ala Pro  Arg Cys


                1205                 1210


 


Ala Val Lys  Ser Cys Asp Asp Phe  Leu Gly Gln Leu


        1215                 1220


 


Pro  His Gly Arg Val Leu  Phe Pro Leu Asn Leu  Gln


1225                 1230                 1235


 


Leu Gly Ala Lys  Val Ser Phe Val Cys  Asp Glu Gly


            1240                 1245


 


Phe Arg  Leu Lys Gly Ser Ser  Val Ser His Cys Val


    1250                 1255                 1260


 


Leu Val Gly Met Arg  Ser Leu Trp Asn Asn  Ser Val


                1265                 1270


 


Pro Val Cys  Glu His Ile Phe Cys  Pro Asn Pro Pro


        1275                 1280


 


Ala  Ile Leu Asn Gly Arg  His Thr Gly Thr Pro  Ser


1285                 1290                 1295


 


Gly Asp Ile Pro  Tyr Gly Lys Glu Ile  Ser Tyr Thr


            1300                 1305


 


Cys Asp  Pro His Pro Asp Arg  Gly Met Thr Phe Asn


    1310                 1315                 1320


 


Leu Ile Gly Glu Ser  Thr Ile Arg Cys Thr  Ser Asp


                1325                 1330


 


Pro His Gly  Asn Gly Val Trp Ser  Ser Pro Ala Pro


        1335                 1340


 


Arg  Cys Glu Leu Ser Val  Arg Ala Gly His Cys  Lys


1345                 1350                 1355


 


Thr Pro Glu Gln  Phe Pro Phe Ala Ser  Pro Thr Ile


            1360                 1365


 


Pro Ile Asn Asp Phe Glu Phe  Pro Val Gly Thr Ser


    1370                1375                 1380


 


Leu Asn Tyr Glu Cys  Arg Pro Gly Tyr Phe  Gly Lys


                1385                 1390


 


Met Phe Ser  Ile Ser Cys Leu Glu  Asn Leu Val Trp


        1395                 1400


 


Ser  Ser Val Glu Asp Asn  Cys Arg Arg Lys Ser  Cys


1405                 1410                 1415


 


Gly Pro Pro Pro  Glu Pro Phe Asn Gly  Met Val His


            1420                 1425


 


Ile Asn  Thr Asp Thr Gln Phe  Gly Ser Thr Val Asn


    1430                 1435                 1440


 


Tyr Ser Cys Asn Glu  Gly Phe Arg Leu Ile  Gly Ser


                1445                 1450


 


Pro Ser Thr  Thr Cys Leu Val Ser  Gly Asn Asn Val


        1455                1460


 


Thr  Trp Asp Lys Lys Ala  Pro Ile Cys Glu Ile  Ile


1465                 1470                 1475


 


Ser Cys Glu Pro  Pro Pro Thr Ile Ser  Asn Gly Asp


            1480                 1485


 


Phe Tyr  Ser Asn Asn Arg Thr  Ser Phe His Asn Gly


    1490                 1495                 1500


 


Thr Val Val Thr Tyr  Gln Cys His Thr Gly  Pro Asp


                1505                 1510


 


Gly Glu Gln  Leu Phe Glu Leu Val  Gly Glu Arg Ser


        1515                 1520


 


Ile  Tyr Cys Thr Ser Lys  Asp Asp Gln Val Gly  Val


1525                 1530                 1535


 


Trp Ser Ser Pro  Pro Pro Arg Cys Ile  Ser Thr Asn


            1540                 1545


 


Lys Cys  Thr Ala Pro Glu Val  Glu Asn Ala Ile Arg


    1550                 1555                 1560


 


Val Pro Gly Asn Arg  Ser Phe Phe Ser Leu  Thr Glu


                1565                 1570


 


Ile Ile Arg  Phe Arg Cys Gln Pro  Gly Phe Val Met


        1575                 1580


 


Val  Gly Ser His Thr Val  Gln Cys Gln Thr Asn  Gly


1585                 1590                 1595


 


Arg Trp Gly Pro  Lys Leu Pro His Cys  Ser Arg Val


            1600                 1605


 


Cys Gln  Pro Pro Pro Glu Ile  Leu His Gly Glu His


    1610                 1615                 1620


 


Thr Leu Ser His Gln  Asp Asn Phe Ser Pro  Gly Gln


                1625                 1630


 


Glu Val Phe  Tyr Ser Cys Glu Pro  Ser Tyr Asp Leu


        1635                 1640


 


Arg  Gly Ala Ala Ser Leu  His Cys Thr Pro Gln  Gly


1645                 1650                 1655


 


Asp Trp Ser Pro  Glu Ala Pro Arg Cys  Thr Val Lys


            1660                 1665


 


Ser Cys  Asp Asp Phe Leu Gly  Gln Leu Pro His Gly


    1670                 1675                 1680


 


Arg Val Leu Leu Pro  Leu Asn Leu Gln Leu  Gly Ala


                1685                 1690


 


Lys Val Ser  Phe Val Cys Asp Glu  Gly Phe Arg Leu


        1695                 1700


 


Lys  Gly Arg Ser Ala Ser  His Cys Val Leu Ala  Gly


1705                 1710                 1715


 


Met Lys Ala Leu  Trp Asn Ser Ser Val  Pro Val Cys


            1720                 1725


 


Glu Gln  Ile Phe Cys Pro Asn  Pro Pro Ala Ile Leu


    1730                 1735                 1740


 


Asn Gly Arg His Thr  Gly Thr Pro Phe Gly  Asp Ile


                1745                 1750


 


Pro Tyr Gly  Lys Glu Ile Ser Tyr  Ala Cys Asp Thr


        1755                 1760


 


His  Pro Asp Arg Gly Met  Thr Phe Asn Leu Ile  Gly


1765                 1770                 1775


 


Glu Ser Ser Ile  Arg Cys Thr Ser Asp  Pro Gln Gly


            1780                 1785


 


Asn Gly  Val Trp Ser Ser Pro  Ala Pro Arg Cys Glu


    1790                 1795                 1800


 


Leu Ser Val Pro Ala  Ala Cys Pro His Pro  Pro Lys


                1805                 1810


 


Ile Gln Asn  Gly His Tyr Ile Gly  Gly His Val Ser


        1815                 1820


 


Leu  Tyr Leu Pro Gly Met  Thr Ile Ser Tyr Ile  Cys


1825                 1830                 1835


 


Asp Pro Gly Tyr  Leu Leu Val Gly Lys  Gly Phe Ile


            1840                 1845


 


Phe Cys  Thr Asp Gln Gly Ile  Trp Ser Gln Leu Asp


    1850                 1855                 1860


 


His Tyr Cys Lys Glu  Val Asn Cys Ser Phe  Pro Leu


                1865                 1870


 


Phe Met Asn  Gly Ile Ser Lys Glu  Leu Glu Met Lys


        1875                 1880


 


Lys  Val Tyr His Tyr Gly  Asp Tyr Val Thr Leu  Lys


1885                 1890                 1895


 


Cys Glu Asp Gly  Tyr Thr Leu Glu Gly  Ser Pro Trp


            1900                 1905


 


Ser Gln  Cys Gln Ala Asp Asp  Arg Trp Asp Pro Pro


    1910                 1915                 1920


 


Leu Ala Lys Cys Thr  Ser Arg Ala His Asp  Ala


                1925                 1930

## Claims

1. A method for treating atypical hemolytic uremic syndrome (aHUS) in a mammalian subject comprising administering to a mammalian subject in need of treatment an effective amount of a soluble complement receptor type I (sCR1) polypeptide.

2. The method according to claim 1, wherein said soluble CR1 polypeptide is selected from the group consisting of:
a fragment of human CR1 comprising at least short consensus repeats 8-11;
a fragment of human CR1 comprising at least short consensus repeats 15-18;
a soluble CR1 polypeptide comprising human CR1 short consensus repeats 8-11 and 15-18;
a fragment of human CR1 comprising long homologous repeat B;
a fragment of human CR1 comprising long homologous repeat C;
a fragment of human CR1 comprising long homologous repeats B and C;
a fragment of human CR1 comprising long homologous repeats B, C and D;
a fragment of human CR1 comprising at least long homologous repeats A and B;
a fragment of human CR1 comprising long homologous repeats A, B and C;
a fragment of human CR1 comprising long homologous repeats A, B, C and D;
a fragment of human CR1 comprising the extracellular domain of CR1;
a fragment of human CR1 comprising the extracellular domain of CR1 and having the N-terminal LHR A deleted (sCR1[desLHR-A]);
a soluble CR1 polypeptide having modified glycosylation to improve serum half-life in vivo;
a soluble CR1 polypeptide having glycosylation modified to exhibit sialyl Lewis X moieties (sCR1-sLex);
a soluble CR1 construct having two or more CR1 polypeptide moieties linked to a carrier molecule; and
combinations thereof.

3. The method according to claim 2, wherein said soluble CR1 polypeptide is selected from the group consisting of:
a fragment of human CR1 comprising the extracellular domain of CR1;
a soluble CR1 polypeptide having modified glycosylation to improve serum half-life in vivo;
a soluble CR1 polypeptide having glycosylation modified to exhibit sialyl Lewis X moieties (sCR1-sLex); and
combinations thereof.

4. The method according to claim 1, wherein said mammalian subject is a human.

5. The method according to claim 1, wherein the administration of said soluble CR1 polypeptide reduces kidney damage.

6. The method according to claim 1, wherein the administration of said soluble CR1 polypeptide improves renal function.

7. The method according to according to claim 1, wherein said polypeptide is administered by an intradermal, intramuscular, intraperitoneal, intravenous, subcutaneous, intrathecal, epidural, oral or pulmonary route.

8. A method for treating atypical hemolytic uremic syndrome (aHUS) in a mammalian subject comprising administering to a mammalian subject in need of treatment an effective amount of a soluble complement receptor type I (sCR1) polypeptide comprising the extracellular domain of mature human CR1 (SEQ ID NO: 1).