# Patent

## Title
Methods and compositions for genetic and retinal disease

## Abstract

An inventive method for treatment or prevention of vascular diseases of the retina is provided. A Norrin compound is optionally administered to a subject either directly and/or as expressed by a cell. The presence of the compound is either protective of or therapeutic for a pathological condition of the retina. Preferred pathological conditions are those linked to the absence of or mutation of norrin protein and are preferably Norrie disease, FEVR, or macular degeneration.

## Background
FIELD OF THE INVENTION
The subject invention relates generally to methods and therapies for the treatment of ocular diseases due to acquired retinal or vascular degeneration or genetic abnormality. More specifically, the subject invention relates to treatments and therapeutics to promote vascular and neuronal growth or differentiation in the retinal bed. Most specifically, the subject invention relates to methods and compositions for treatment of Norrie disease, familial exudative vitreoretinopathy, or other related genetic and acquired vitreoretinal and vascular developmental diseases.
BACKGROUND OF THE INVENTION
Proper vascular modeling in the retina is essential for ocular development and visual acuity. Abnormal vessel growth during development or in adulthood produces several relatively common diseases such as retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration. Normal retinal development occurs through vessels forming at the optic nerve head and spreading over the retina to form a dense network. Connolly, S E, et al, Microvasc Res, 1988; 36:275-290; Provis, J M, Prog Retin Eye Res, 2001; 20:799-821; Fruttiger, M, Invest Ophthalmol Vis Sci, 2002; 43:522-527. Development proceeds through formation of primary vessels along the surface of the developing retina from which divergent vessels begin to extend into the capillary beds that form the outer and inner plexiform layers of the retina. Connelly, 1988; Provis, 2001, Fruttiger, 2002. Vascular development is mediated by a series of growth factors that direct formation and extension of new vessels. Retinal development is unique in the concentration and types of signaling mediators employed to promote angiogenic sprouting from the primary vascular network and the formation of the final capillary architecture. Ohlmann, A, et al, J Neurosci, 2005; 25:1701-1710. One factor hypothesized to be involved in formation of primary retinal vasculature and retinal capillaries is the protein Norrin. Norrin, is a 131 amino acid long protein that is secreted into the extracellular space. Meitinger, T, et al, Nat Genet, 1993; 5:376-380; Berger, W, et al, Hum Mol Genet, 1996; 5:51-59. Two primary domains define the general Norrin protein structure: a signal peptide directs localization of the molecule; and a cysteine-knot motif provides the tertiary confirmation required for receptor binding and activation of signal transduction.
The importance of the cysteine knot-motif is highlighted by computer modeling that demonstrates the requirement of disulfide bonds between the cysteine residues in forming the structural confirmation of Norrin. Mutation(s) of the cysteine residues reduces the affinity of Norrin for its receptor and prevents activation of subsequent signaling pathways. Mutations in these residues also result in severe retinal dysgenesis and Norrie disease. However, mutations in regions other than the cysteine knot-motif produce incomplete protein folding and result in familial exudative vitreoretinopathy (FEVR) and related vitreoretinopathies (Retinopathy of Prematurity, persistent fetal vasculature).
Norrin is a ligand for the Frizzled receptor subtype 4 (Fz4). Norrin binds Fz4 with nanomolar affinity and stimulates a Wnt receptor:β-catenin signal transduction pathway that regulates retinal development and is necessary for regression of hyaloid vessels in the eye. Xu, Q, et al, Cell, 2004; 116:883-895; Clevers, H, Curr Biol, 2004; 14:R436-437; Nichrs, C, Dev Cell, 2004; 6:453-454. Norrin interaction with Fz4 is dependent on the cell surface receptor LRP5. Xu, 2004. Frizzled receptors are coupled to the β-catenin canonical signaling pathway that functions by the activation of Wnt target genes. Wnt protein binding to Frizzled and LRP5 inactivates glycogen synthase kinase (GSK) 3β and Axin. The inactivation of these proteins stabilizes β-catenin, which subsequently accumulates in the cell nucleus and activates the transduction of target genes that are crucial in the G1-S-phase transition, such as cyclin D1 or c-Myc. Willert K, and Nusse R, Curr Opin Genet Dev, 1998; 8:95-102. These pathways promote stimulation and proliferation of retinal stem cells. Inoue, T, et al, Stem Cells, 2006; 24:95-104.
Norrin is encoded by the NDP gene present on chromosome X at position 11.4. The importance of this gene product is highlighted by observations that inactivating mutations lead to Norrie disease which is characterized by ocular and cochlear vascular defects. Rhem, H L, et al, J Neurosci, 2002; 22:4286-4292; Black, G C, et al, Hum Mol Genet, 1999; 8:2031-2035. Silencing of the NDP gene produces incomplete regression of the primary hyaloid system and abnormal retinal maturation.
Observations that abnormalities in the Fz4 and LRP5 receptors that result in the phenotypically similar condition, FEVR underscore the importance of Norrin signaling. Robitaille, J, et al, Nature Genet, 2002; 32:326-330; Kondo, H, et al, Br J Opthalmol, 2003; 87:1291-1295; Toomes, C, et al, Am J Hum Genet, 2004; 74:721-730. The close association between the phenotypes produced by Norrin mutations and mutations in the Fz4 and LRP5 receptors bolsters the hypothesis that these molecules form a functional signaling group. Planutis, K, et al, BMC Cell Biology, 2007; 8:12.
While defects in the NDP gene and diseases due to incomplete or immature vascularization have been studied and correlated with disease, therapies presently available for Norrie disease, FEVR, or other retinal diseases are only modestly effective. Thus, there exists a need for improved therapeutics and methods of treatment for vitreoretinal disease and vascular disease in the retina.
SUMMARY OF THE INVENTION
The present invention provides a method of altering or maintaining physiological activity that involves administering a Norrin compound to a subject and measuring at least one parameter indicative of physiological activity in said subject. The physiological activity is optionally vascularization, cell proliferation, cellular interaction, neuroprotection, growth, vascular regression, b-wave response, cell viability, or substantial oscillatory potential.
The inventive process optionally includes administering a cell to the subject. The cell is optionally transfected with a nucleotide sequence encoding a Norrin compound, and administering the transfected cell to the subject. The cell is optionally a stem cell.
Numerous methods of administration are operable in the inventive methods illustratively including: systemic administration, local administration, injection, topical administration, intraocular, and iontophoretic delivery.
The inventive methods illustratively include administration of the compound to a subject. A subject is illustratively a mammal, human, cow, horse, sheep, pig, goat, chicken, cat, dog, mouse, guinea pig, hamster, rabbit, rat, and a cell.
The inventive method is preferably used to treat a subject with a pathological condition of the retina or is at risk of developing a pathological condition or the retina. The pathological condition is preferably caused by lacking a protein or a mutant protein, or by an acquired degeneration or disease of the retina requiring proliferation of progenitor cells. The pathological condition is optionally vitreoretinopathy, retinopathy of prematurity, familial exudative vitreoretinopathy, Norrie disease, persistent fetal vasculature, and macular degeneration.
The compound of the subject inventive methods is optionally recombinant. The compound further optionally has a marker. The marker is optionally green fluorescent protein, luciferase, and/or β-galactosidase.



BRIEF DESCRIPTION OF THE DRAWINGS
The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawings will be provided by the Office upon request and payment of the necessary fee.
FIG. 1 depicts protection against retinal damage by NDMA in vivo;
FIG. 2 depicts growth and differentiation of neural progenitor cells in in vivo retinas following administration of Norrin;
FIG. 3 depicts early development of vascular channels during development of stem cells into embroyid bodies due to the presence of Norrin;
FIG. 4 depicts in vivo retinal cell differentiation and protection from NDMA damage by activation of the Wnt pathways;
FIG. 5 depicts subsequent art illustrating protection of RGC5 cell viability from staurosporine damage by various concentrations of Norrin. Lin, S, et al, Molecular Vision 2009; 15:26-37, the entire contents of which are incorporated herein by reference.



DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
It is to be understood that the present invention is not limited to particular embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting.
A method for treatment of degenerative or inherited ocular diseases is provided. Also provided are therapeutics for the treatment of vascular diseases. Thus, the subject invention has utility for the prevention, reversal, or treatment of vitreoretinal and vascular disease.
As used herein, the term subject illustratively includes a mammal, human, cow, horse, sheep, pig, goat, chicken, cat, dog, mouse, guinea pig, hamster, rabbit, rat, a cell, tissue, organ, organ system, or combinations thereof. It is appreciated that the term subject is optionally a patient.
As used herein, the terms pathological condition or disease illustratively include vitreoretinopathy, retinopathy of prematurity (retrolental fibroplasias), Familial Exudative Vitreoretinopathy (FEVR), Norrie disease, Persistent Fetal Vasculature Syndrome (persistent hyperplastic primary vitreous), Coats disease, Macular Degeneration, Macular Dystrophy, inherited dystrophy, cancer, growth of abnormal cells, Osteoporosis-Pseudoglioma Syndrome, Non-Exudative Age Related Macular Degeneration (ARMD), Exudative Age Related Macular Degeneration (ARMD), Choroidal Neovascularization, Diabetic Retinopathy, Retinal Vein Occlussion, Retinal Artery Occlussion, Acute Macular Neuroretinopathy, Central Serous Chorioretinopathy, Cystoid Macular Edema, Diabetic Macular Edema, Acute Multifocal Placoid Pigment Epitheliopathy, Behcet's Disease, Birdshot Retinochoroidopathy, Infectious (Syphilis, Lyme, Tuberculosis, Toxoplasmosis), Intermediate Uveitis (Pars Planitis), Multifocal Choroiditis, Multiple Evanescent White Dot Syndrome (MEWDS), Ocular Sarcoidosis, Posterior Scleritis, Serpignous Choroiditis, Subretinal Fibrosis and Uveitis Syndrome, Vogt-Koyanagi-Harada Syndrome, Parafoveal Telangiectasis, Papillophlebitis, Frosted Branch Angitis, Sickle Cell Retinopathy and other Hemoglobinopathies, Angioid Streaks, Sympathetic Ophthalmia, Uveitic Retinal Disease, Retinal Detachment, Trauma, Laser, PDT, Photocoagulation, Hypoperfusion During Surgery, Radiation Retinopathy, Bone Marrow Transplant Retinopathy, Proliferative Vitreal Retinopathy and Epiretinal Membranes, Proliferative Diabetic Retinopathy, Ocular Histoplasmosis, Ocular Toxocariasis, Presumed Ocular Histoplasmosis Syndrome (POHS), Endophthalmitis, Toxoplasmosis, Retinal Diseases Associated with HIV Infection, Choroidal Disease Associated with HIV Infection, Uveitic Disease associated with HIV Infection, Viral Retinitis, Acute Retinal Necrosis, Progressive Outer Retinal Necrosis, Fungal Retinal Diseases, Ocular Syphilis, Ocular Tuberculosis, Diffuse Unilateral Subacute Neuroretinitis, Myiasis, Systemic Disorders with Associated Retinal Dystrophies, Congenital Stationary Night Blindness, Cone Dystrophies, Fundus Flavimaculatus, Best's Disease, Pattern Dystrophy of the Retinal Pigmented Epithelium, X-Linked Retinoschisis, Sorsby's Fundus Dystrophy, Benign Concentric Maculopathy, Bietti's Crystalline Dystrophy, pseudoxanthoma elasticum, Osler Weber syndrome, Retinal Detachment, Macular Hole, Giant Retinal Tear, Retinal Disease Associated with Tumors, Solid Tumors, Tumor Metastasis, Benign Tumors, for example, hemangiomas, neurofibromas, trachomas, and pyogenic granulomas, Congenital Hypertrophy of the RPE, Posterior Uveal Melanoma, Choroidal Hemangioma, Choroidal Osteoma, Choroidal Metastasis, Combined Hamartoma of the Retina and Retinal Pigmented Epithelium, Retinoblastoma, Vasoproliferative Tumors of the Ocular Fundus, Retinal Astrocytoma, Intraocular Lymphoid Tumors, Punctate Inner Choroidopathy, Acute Posterior Multifocal Placoid Pigment Epitheliopathy, Myopic Retinal Degeneration, Acute Retinal Pigment Epithelitis, Ocular inflammatory and immune disorders, ocular vascular malfunctions, Corneal Graft Rejection, Neovascular Glaucoma, and other diseases of ocular vascular development.
As used herein, the term physiological activity illustratively includes vascularization, cell proliferation, cellular interaction, cellular differentiation, reduction in apoptosis, reduction in necrosis, neuroprotection, growth, vascular regression, CAMKII phosphorylation, protein kinase C (PKC) activation, protein kinase A activation, activation of the MAPK pathway (illustratively, MAPK8 or JNK), downstream gene activation, activation of the β-catenin pathway, cellular viability, proteolytic activity, phosphorylation, dephosphorylation, receptor activation, receptor inactivation, other activities illustratively describe by Lin, S, et al, Molecular Vision 2009; 15:26-37, or combinations thereof.
As used herein, the term cell illustratively includes a somatic cell, a germ cell, a progenitor cell, a cultured cell, a stem cell, a transfected cell, or combinations thereof.
As used herein, the term administering illustratively includes delivery of a molecule or a cell to a subject by a route illustratively including systemic administration, local administration, injection, intravitreal injection, subconjuctival injection, sub-tenon injection, retrobulbar injection, suprachoroidal injection, surgical implantation, topical administration, iontophoretic delivery, oral, rectal, parenteral, intravenous, intramuscular, subcutaneous, intracisternal, intravaginal, intraperitoneal, intravesical, intraventricular, intracranial, intratumoral, local, transdermal, intrabuccal, intranasal, intrathecal, modifications thereof, or combinations thereof.
As used herein a compound is illustratively a protein, DNA, RNA, lipid, steroid, growth factor, antibody, antibody fragment, Fab′, F(ab)2, Fabc, Fv fragment, organic molecule, a cell, fragments thereof, mutations thereof, or mimics thereof. A compound is optionally recombinant. Most preferably, a compound encodes Norrin such as a Norrin compound.
As used herein, the term stem cell is illustratively a cell possessing self-replicating potential and the ability to give rise to terminally differentiated cells of single or multiple lineages. Stem cells are capable of generating identical progeny through unlimited numbers of cell divisions while retaining the ability to respond to physiological demands by producing daughters committed to differentiate.
Antibodies useful in the present systems include antibody fragments, such as Fab′, F(ab)2, Fabc, and Fv fragments. Antibody fragments are optionally produced by modification of whole antibodies or synthesized de novo using recombinant DNA methodologies, and further include “humanized” antibodies made by conventional or nonconventional techniques.
A compound administered herein is optionally supplemented with one or more agents effective in reducing inflammation, reducing pain, reducing or preventing tumor growth, reducing intraocular pressure, protecting cells, such as retinal neurons, reducing excitotoxicity, reducing infection, and reducing hemorrhage. A co-administered agent is optionally cytotoxic depending on the condition being treated. In addition, a co-administered agent optionally comprises a neurotoxic macromolecule, such as a botulinum neurotoxin, in combination with the non-neurotoxic macromolecule. A co-administered agent optionally comprises a small chemical compound in combination with the present macromolecules. Examples of chemical compounds operable herein illustratively include a small chemical compound, such as anecortave acetate, ketorlac tromethamine (such as Acular), gatifloxacin, ofloxacin, epinastine, and the like.
Optionally, a compound is delivered to a subject conjugated to a magnetic particle as described in U.S. Patent Application Publication 2004/0086572 which is incorporated herein.
A Norrin compound is illustratively a nucleotide sequence or a protein sequence encoding a Norrin protein, a fragment thereof, or a mimetic thereof. A Norrin compound is illustratively SEQ ID NOs: 1-6. A Norrin compound is optionally purified.
In a preferred embodiment Norrin protein is administered to a subject. Norrin is optionally purified from a subject or expressed in a recombinant cell system and subsequently purified. Purification is not absolutely required but is preferred. Norrin protein sequence operable herein illustratively includes that derived from human, mouse, rat, dog, cat, or other suitable organism. SEQ ID NO: 1 represents the Norrin sequence from homo sapiens. SEQ ID NO: 2 represents the Norrin sequence from Mus musclus. SEQ ID NO: 3 represents the Norrin sequence from Rattus norvegicus.
Norrin protein is optionally administered as an oligomeric complex. See Perez-Vilar, J and Hill, R L, J Biol Chem, 1997; 272: 33410-33415. Oligomers operable herein are optionally dimers, trimers, quadramers, pentamers, hexamers, octamers, or higher order multimers. Oligomeric complexes are optionally homomultimeric or heteromultimeric. The range of oligomeric association is preferably between monomers and 30-mers. More preferably, the oligomeric association is between dimers and 20-mers. Most preferably, the oligomeric association is monomers or dimers.
Norrin is optionally administered to a subject with a cofactor. A cofactor is illustratively a polyanion. More preferably a cofactor is heparin or heparin sulfate. It is appreciated that other polyanions or modifications thereof are similarly operable.
Norrin protein is preferably administered to a subject at a concentration suitable to alter or maintain a physiological activity. The total quantity or concentration of Norrin protein delivered is optionally dependent on the age or size of the subject as appreciated by one of skill in the art.
In a preferred embodiment a compound is a biologically active polypeptide fragment of Norrin protein which is administered to a subject. A biologically active polypeptide fragment illustratively includes residues 20-133 of SEQ ID NO: 1, Residues 30-133 of SEQ ID NO: 1, or any other truncation N-terminal to cysteine 39 of SEQ ID NO: 1 and extending toward the C-terminus of Norrin protein. It is appreciated that other polypeptide regions of the Norrin protein or nucleotide sequence will be similarly operable.
A biologically active peptide optionally is a mutant form of Norrin. Norrin mutants operable herein illustratively include amino acid substitutions relative to SEQ ID NO: 1 of R64E. Optionally the biologically active peptide is a multiple mutant relative to SEQ ID NO: 1: T27A, S28A, S29A; P36A, R37A, R38A; Y120A, R121A, Y122A; or H127A, E129A, E130A; or combinations thereof. Any amino acid mutated in a multiple mutation is operable as a single mutation. Other sequence mutations operative herein are illustrated in FIG. 6A of Smallwood, P M, et al, J Biol Chem, 2007: 282:4057-4068. It is appreciated that other mutations at different amino acid sites are similarly operable. It is further appreciated that mutation of the conserved amino acid at any particular site is preferably mutatated to glycine or alanine. It is further appreciated that mutation to any neutrally charged, charged, hydrophobic, hydrophilic, synthetic, non-natural, non-human, or other amino acid is similarly operable.
Modifications and changes are optionally made in the structure (primary, secondary, or tertiary) of the Norrin protein which are encompassed within the inventive compound that may or may not result in a molecule having similar characteristics to the exemplary polypeptides disclosed herein. It is appreciated that changes in conserved amino acid bases are most likely to impact the activity of the resultant protein. However, it is further appreciated that changes in amino acids operable for receptor interaction, resistance or promotion of protein degradation, intracellular or extracellular trafficking, secretion, protein-protein interaction, post-translational modification such as glycosylation, phosphorylation, sulfation, and the like, may result in increased or decreased activity of an inventive compound while retaining some ability to alter or maintain a physiological activity. Certain amino acid substitutions for other amino acids in a sequence are known to occur without appreciable loss of activity.
In making such changes, the hydropathic index of amino acids are considered. According to the present invention, certain amino acids can be substituted for other amino acids having a similar hydropathic index and still result in a polypeptide with similar biological activity. Each amino acid is assigned a hydropathic index on the basis of its hydrophobicity and charge characteristics. Those indices are: isoleucine (+4.5); valine (+4.2); leucine (+3.8); phenylalanine (+2.8); cysteine/cysteine (+2.5); methionine (+1.9); alanine (+1.8); glycine (−0.4); threonine (−0.7); serine (−0.8); tryptophan (−0.9); tyrosine (−1.3); proline (−1.6); histidine (−3.2); glutamate (−3.5); glutamine (−3.5); aspartate (−3.5); asparagine (−3.5); lysine (−3.9); and arginine (−4.5).
Without intending to be limited to a particular theory, it is believed that the relative hydropathic character of the amino acid determines the secondary structure of the resultant polypeptide, which in turn defines the interaction of the polypeptide with other molecules. It is known in the art that an amino acid can be substituted by another amino acid having a similar hydropathic index and still obtain a functionally equivalent polypeptide. In such changes, the substitution of amino acids whose hydropathic indices are within ±2 is preferred, those within ±1 are particularly preferred, and those within ±0.5 are even more particularly preferred.
As outlined above, amino acid substitutions are generally based on the relative similarity of the amino acid side-chain substituents, for example, their hydrophobicity, hydrophilicity, charge, size, and the like. Exemplary substitutions that take various of the foregoing characteristics into consideration are well known to those of skill in the art and include (original residue: exemplary substitution): (Ala: Gly, Ser), (Arg: Lys), (Asn: Gln, His), (Asp: Glu, Cys, Ser), (Gln: Asn), (Glu: Asp), (Gly: Ala), (His: Asn, Gln), (Ile: Leu, Val), (Leu: Ile, Val), (Lys: Arg), (Met: Leu, Tyr), (Ser: Thr), (Thr: Ser), (Tip: Tyr), (Tyr: Trp, Phe), and (Val: Ile, Leu). Embodiments of this disclosure thus contemplate functional or biological equivalents of a polypeptide as set forth above. In particular, embodiments of the polypeptides can include variants having about 50%, 60%, 70%, 80%, 90%, and 95% sequence identity to the polypeptide of interest.
In a preferred embodiment a compound is a Norrin mimetic. A Norrin mimetic is illustratively a polypeptide, lipid, DNA structure, RNA structure, small molecule, other molecule optionally capable of interacting with a Fz receptor, fragments thereof, synthetic analogous thereof, or combinations thereof. Preferably a Norrin mimetic is a molecule capable of stimulating signaling via the Fz4 receptor. Norrin mimetics operable herein are illustratively a WNT protein, a mutation of a WNT protein, antibodies, antibody fragments, or combinations thereof. It is appreciated that other molecules known in the art to stimulate signaling via Fz4 are similarly operable.
Multiple physiological activities are altered or maintained in the present inventive method. Physiological activities illustratively include vascularization, cell proliferation, cellular interaction, neuroprotection, growth, vascular regression, b-wave response, substantial oscillatory potential, or combinations thereof.
In a preferred embodiment Norrin is administered to a subject as a factor suitable for expression within the eye or within a cell located in the eye. An exemplary system for the expression of protein is described in U.S. Patent Application Publication 2003/0129164, which is incorporated herein by reference with particularity for disclosure of diseases, gene delivery methods, and gene expression methods. Any of a variety of vectors adapted for expression of Norrin in a cell of the eye, preferably within a retinal cell, are within the scope of the present invention. Gene delivery vectors are optionally viral (e.g., derived from or containing sequences of viral DNA or RNA, preferably packaged within a viral particle), or non-viral (e.g., not packaged within a viral particle, including “naked” polynucleotides, nucleic acid associated with a carrier particle such as a liposome or targeting molecule, and the like).
The viral factor operable herein is illustratively a recombinant adeno-associated viral (rAAV) vector. It is appreciated the other suitable vectors known in the art are similarly operative. Additional illustrative vectors optionally include adenoviral vectors, alphaviral vectors, viruses illustratively including pox viruses—illustratively canary pox virus or vaccinia virus, SV40, influenza virus, HIV, herpes, measles, Semliki Forest Virus, and coronavirus, as well as other viral systems. In addition, viral carriers are optionally homologous, non-pathogenic(defective), replication competent virus.
A particularly preferred gene delivery vector is a rAAV vector. A variety of rAAV vectors are optionally utilized to direct the expression of a neurotrophic factor such as Norrin. An operable rAAV is generally comprised of, in order of 5′ to 3′, a 5′ adeno-associated virus inverted terminal repeat, a coding sequence for the desired gene product (e.g., Norrin) operatively linked to a sequence which regulates its expression in a cell (e.g., a promoter sequence), and a 3′ adeno-associated virus inverted terminal repeat. A promoter sequence is preferably a cell specific promoter sequence. In addition, the rAAV vector preferably has a polyadenylation sequence. The promoter is illustratively a constitutive promoter, a cell specific promoter, a selective molecule responsive promoter, or combinations thereof. Preferably a promoter is a cell specific promoter. More preferably, a promoter is a constitutive promoter that is cell type specific. Promoter sequences operative herein illustratively include the GFAP promoter, a retinal pigment cell specific promoter, a Muller cell specific promoter, promoters described in WO/2000/015822, which is incorporated herein by reference, a Cdc6 promoter, human ICAM-2 promoter, promoters and vectors described by Dai, C, et al, J Virology, 2004; 78:6209-6221, or other promoter known in the art.
Norrin is optionally delivered to the eye by one or multiple routes illustratively including intraocularly, by topical application to the eye or by intraocular injection illustratively into the vitreous or subretinal (interphotoreceptor) space. Alternatively, delivery is local by insertion or injection into the tissue surrounding the eye, systemically through an oral route, or by subcutaneous, intravenous or intramuscular injection. Alternatively, delivery is by a catheter or by means of an implant, wherein such an implant is made of a porous, non-porous or gelatinous material, including membranes such as silastic membranes or fibers, biodegradable polymers, or proteinaceous material. A compound is illustratively administered prior to the onset of a pathological condition to prevent its occurrence, for example, during or prior to surgery on the eye, or immediately after the onset of the pathological condition or during the occurrence of an acute or protracted disease.
In a preferred embodiment, a compound is administered to the eye, preferably intraocularly to a variety of locations within the eye depending on the type of disease to be treated, prevented, or, inhibited, and the extent of disease. Examples of suitable locations include the retina (e.g., for retinal diseases), the vitreous, or other locations in or adjacent the retina or in or adjacent to the eye.
In a preferred embodiment a cell is transfected with a nucleotide sequence encoding a Norrin protein, a biologically active fragment of a Norrin protein, or a Norrin mimetic. Preferably, a nucleotide sequence is cloned into an expression vector with a promoter. The promoter is illustratively a constitutive promoter, strong promoter (e.g., CMV promoters), inducible promoter, tissue-specific promoter, a cell specific promoter, a selective molecule responsive promoter, or combinations thereof. Preferably a promoter is a cell specific promoter. More preferably, a promoter is a constitutive promoter that is cell type specific. Promoter sequences operative herein illustratively include the GFAP promoter, a retinal pigment cell specific promoter, a Muller cell specific promoter, promoters described in WO/2000/015822, which is incorporated herein by reference, a Cdc6 promoter, human ICAM-2 promoter, promoters and vectors described by Dai, C, et al, J Virology, 2004; 78:6209-6221, or other promoter known in the art. In a preferred embodiment a tetracycline responsive promoter is used to limit expression to instances when tetracycline is present in the system.
Numerous enhancers are operable to stimulate expression of Norrin in a transfected cell. Illustratively an endothelial enhancer such as that described by Shaw, L C, et al, Gene Therapy, 2006; 13:752-760 is operative herein.
A cell is preferably a mammalian cell. A cell is optionally an endothelial cell, vascular cell, stem cell, immortalized cell, or combinations thereof. Preferably, a cell is a stem cell. It is appreciated that a stem cell illustratively includes a primary stem cells and lineage cells.
In a preferred embodiment, the cell is a stem cell. A stem cell operable herein and its method of isolation and preparation is illustratively described in U.S. Patent Application Publication 2007/0154465 A1, which is incorporated herein by reference. Stem cells are illustratively transfected with a vector encoding and inventive compound. Suitable vectors and methods of administration to a stem cell are also illustrated in U.S. Patent Application Publication 2007/0154465 A1. Stem cells are optionally transiently transfected or transfected with a vector that provides incorporation into the host genome and constitutive expression.
In a preferred embodiment, a cell is transfected with an expression vector encoding a Norrin protein, a biologically active peptide fragment of a Norrin protein, or a Norrin mimetic and the transfected cell is administered to a subject. An advantage to this embodiment is that possible barriers to optimal protein expression from host cells are overcome by capitalizing on known techniques of in vitro cell transfection. As such, delivery of Norrin protein to the retina of a subject is greatly simplified and expression is improved or maximized. Further, when endothelial cell, stem cell capable of differentiating into an endothelial cell, or other suitable cell type is used as the transfected cell, its subsequent administration to the eye of a subject provides suitable endogenous growth mediators such that cell survival is optimal and duration of successful delivery of a compound is maximized in concentration and time.
Optionally, a cell is derived from a patient. Illustratively, a stem cell is obtained from the patient, transfected, and administered to the patient as a Norrin expressing cell. In a preferred embodiment a retinal cell is obtained from a subject, is transfected with an expression vector expressing an inventive compound, and the transfected cell is administered to the subject.
Administration to the ocular environment in a subject is most preferably by injection into the vitreous. While patients who suffer from a pathological condition of the retina are amenable to multiple injections over the course of time, the use of transfected cells expressing a compound will preferably reduce the number of injections a subject must endure. Illustratively, a single injection of endothelial cells that have been transfected with a vector expressing an inventive compound onto the retina of a subject provides a long-term delivery of the inventive compound to the subject's retina. As such, a single therapeutic delivery will produce a clinical benefit.
In a most preferred embodiment the instant inventive method is employed with a subject that has a pathological condition. Pathological conditions are preferably vitreoretinopathy, retinopathy of prematurity, familial exudative vitreoretinopathy, Norrie disease, persistent fetal vasculature syndrome, Coats disease, macular degeneration, macular dystrophy, inherited dystrophy, cancer, growth of abnormal cells, osteoporosis-pseudoglioma syndrome, and other diseases of ocular vascular and retinal development.
Preferably, a pathological condition results from, is caused by, is related to, or otherwise is associated with a mutation in the NDP gene, alteration in transcription to mRNA, mRNA survival, mRNA degradation, alternative mRNA splicing, protein translation, protein survival, protein degradation, protein trafficking, expression of protein on a cell membrane, protein secretion, or other abnormality in production of a functional Norrin protein. This includes decreased production of Norrin secondary to alternate gene expression or suppressed gene activation, seen in mature tissues. Most preferably, a pathological condition is associated with a mutation in the Norrin protein. In a most preferred embodiment a pathological condition is a pathological condition of the retina.
In a most preferred embodiment a compound is administered to a subject with a pathological condition and the presence of the compound alters or maintains at least one physiological activity. A physiological activity is preferably observed in the retina of a subject. This embodiment has the greatest efficacy in patients suffering from diseases that manifest themselves during development and childhood such as FEVR or Norrie disease. Further, patients illustratively presenting with age related macular degeneration or young patients presenting with early stage disease will benefit from maintenance of retinal vascularization, oxygenation, or visual acuity. The instant inventive method is operable to reduce the rate of visual or other vascular related degeneration relative to subjects not receiving treatment.
A function of the retina is illustratively vascularization, cell proliferation, cellular interaction, neuroprotection, growth, vascular regression, b-wave response, substantial oscillatory potential, Wnt signaling, Fz signaling, CAMKII autophosphorylation, PKC activation, protein kinase A activation, activation of the MAPK pathway, stimulation of gene transcription, activation of intracellular signaling pathways illustratively including the PI3K/Akt pathway, preventing nuclear translocation of c-Jun N-terminal protein (JNK), or regulating caspase activation, stimulation of marker signaling, inhibition of marker signaling, maintenance of marker signaling, or combinations thereof. In a preferred embodiment retinal vascularization is increased. Most preferably, retinal vascularization approaches that observed in subjects that do not present with a pathological condition of the retina. It is appreciated that other markers of proper vascularization are also a function of the retina. These illustratively include development or differentiation of neuronal cells, or activity of neuronal cells.
A marker is illustratively a component of a compound. Illustratively, a cell is transfected with an expression vector that encodes a marker as well as a vector that encodes a compound. The administration of a marker provides the advantage of monitoring the function of the inventive method in cells or in a subject to whom a compound is administered. Markers operable herein are illustratively green fluorescent protein, luciferase, and β-galactosidase. It is appreciated that other suitable markers known in the art are similarly operable. A marker is optionally radioactive, luminescent, biologically active, or otherwise amenable to detection by methods known in the art.
Methods involving conventional biological techniques are described herein. Such techniques are generally known in the art and are described in detail in methodology treatises such as Molecular Cloning: A Laboratory Manual, 2nd ed., vol. 1-3, ed. Sambrook et al., Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y., 1989; and Current Protocols in Molecular Biology, ed. Ausubel et al., Greene Publishing and Wiley-Interscience, New York, 1992 (with periodic updates). Immunological methods (e.g., preparation of antigen-specific antibodies, immunoprecipitation, and immunoblotting) are described, e.g., in Current Protocols in Immunology, ed. Coligan et al., John Wiley & Sons, New York, 1991; and Methods of Immunological Analysis, ed. Masseyeff et al., John Wiley & Sons, New York, 1992.
Various aspects of the present invention are illustrated by the following non-limiting examples. The examples are for illustrative purposes and are not a limitation on any practice of the present invention. It will be understood that variations and modifications can be made without departing from the spirit and scope of the invention. While the examples are generally directed to mammalian tissue, specifically, analyses of murine tissue, a person having ordinary skill in the art recognizes that similar techniques and other techniques known in the art readily translate the examples to other organisms such as humans. Reagents illustrated herein are commonly cross reactive between mammalian species or alternative reagents with similar properties are commercially available, and a person of ordinary skill in the art readily understands where such reagents may be obtained.
EXAMPLE 1
Preparation of Norrin containing microspheres. Norrin purchased from R&D Systems, Minneapolis, Minn., or cloned, expressed and purified is loaded into biodegradable microspheres substantially as described by Jiang, C, et al, Mol Vis, 2007; 13:1783-92 using the spontaneous emulsification technique of Fu, K, et al, J Pharm Sci, 2003; 92:1582-91. Microspheres are synthesized and loaded by dissolving 200 mg of 50:50 PLGA (DURECT Corp., Birmingham, Ala.) in 5 ml of 4:1 volume ratio trifluoroethanol:dichloromethane supplemented with 8 mg magnesium hydroxide to minimize protein aggregation during encapsulation. 10 μg Norrin is reconstituted in 300 μl 7 mg bovine serum albumin (BSA) and 100 mg docusate sodium (Sigma-Aldrich, St. Louis, Mo.) dissolved in 3 ml PBS. The solution is vortexed and poured into 200 ml of 1% (w/v) polyvinyl alcohol (PVA, 88% hydrolyzed) with gentle stirring. Microspheres are hardened by stirring for three hours, collected by centrifugation, and washed three times to remove residual PVA. If the microspheres are not to be immediately injected they are rapidly frozen in liquid nitrogen, lyophilized for 72 h, and stored in a dessicator at −20° C. Norrin containing microspheres exhibit average diameters of 8 μm as determined by a particle size.
EXAMPLE 2
Intravitreal injection of Norrin. Norrin in solution, packaged into microspheres as described in Example 1, or expressed in cells, or in purified form in solution is exposed to the retina by intravitreal injection substantially as described by Jiang, 2007. Intravitreal injection is performed under general anesthesia using an ophthalmic operating microscope (Möller-Wedel GmbH, Wedel, Germany) using beveled glass micro-needles with an outer diameter of approximately 100 μm. Microsphere suspensions are prepared in PBS at 2 and 10% (w/v) and briefly vortexed immediately before injection to ensure a uniform dispersion. A 30-gauge hypodermic needle is used to perforate the sclera 1.5 mm behind the limbus. Five μl of test sample is optionally injected by way of this passage into the vitreous using a 50 μl Hamilton Syringe (Hamilton Co, Reno, Nev.). To ensure adequate delivery and prevent shock the needle is held in place for one min after the injection is completed and subsequently withdrawn slowly. In addition, paracentesis is simultaneously performed to relieve pressure and thereby prevent reflux.
EXAMPLE 3
Delivery of Norrin to the retina by a controlled release delivery system. An implantable controlled release delivery system is described in U.S. Patent Application Publication 2005/0281861 A1 which is incorporated herein by reference for its entire disclosure, figures, examples, and methods. Norrin is packaged into such as system at 100 μg per final formulated capsule. The Norrin containing drug delivery systems are placed in the eye using forceps or a trocar after making a 2-3 mm incision in the sclera. Alternatively, no incision is made and the system is placed in an eye by inserting a trocar or other delivery device directly through the eye. The removal of the device after the placement of the system in the eye can result in a self-sealing opening. One example of a device that is used to insert the implants into an eye is disclosed in U.S. Patent Application Publication No. 2004/0054374 which is incorporated herein by reference. The location of the system may influence the concentration gradients of therapeutic component or drug surrounding the element, and thus influence the release rates (e.g., an element placed closer to the edge of the vitreous may result in a slower release rate). Thus, it is preferred if the system is placed near the retinal surface or in the posterior portion of the vitreous.
EXAMPLE 4
Treatment of retinal explants with Norrin. Retinal explants from rats or mice are obtained and cultured as described. Nakhai, H, et al, Development, 2007; 134:1151-1160. Eyes are isolated from E18.5 embryos. Explants of the neural retina are dissected and placed into a Millicell CM chamber (Millipore) with the ganglion cell layer upward and cultured in 50% DMEM (Gibco) supplemented with HEPES, 25% Hank's solution, 25% heat-inactivated horse serum, 200 μM L-glutamine and 6.75 mg/ml glucose at 34° C. in a 5% CO2 incubator.
EXAMPLE 5
Administered Norrin is protective of NDMA induced retinal damage. Eighteen adult male ddY mice weighing 36 to 43 g each are anesthetized with 3.0% isoflurane and maintained with 1.5% isoflurane in 70% N2O and 30% O2. Body temperatures are maintained between 37.0° C. and 37.5° C. with the aid of a heating pad and a heating lamp. One eye of each animal is designated a control eye with the other eye used as a test eye. At day 0 all test eyes and 1⁄2 of control eyes are injected into the vitreous body with n-methyl D-aspartate (NMDA) (Sigma-Aldrich) at 200 nM per eye dissolved in 0.01 M phosphate-buffered saline (PBS) to induce retinal damage. The remaining control eyes are injected with an equal volume of PBS. At day 1, test eyes are injected with either Wnt3 or Norrin as prepared in example 1 at concentrations of 0.1, 1, or 10 ng per eye. One drop of levofloxacin ophthalmic solution (Santen Pharmaceuticals Co. Ltd., Osaka, Japan) is applied topically to each eye after intravitreous injection. Animals are returned to cages and maintained until day 6 at which time they are sacrificed and all eyes are enucleated for retinal tissue fixation and immunohistochemistry. Eyes are enucleated, fixed in 4% paraformaldehyde overnight at 4° C., immersed in 20% sucrose for 48 hours at 4° C., and embedded in optimum cutting temperature (OCT) compound (Sakura Finetechnical Co., Ltd., Tokyo, Japan). Transverse, 10-μm-thick cryostat sections are cut and placed onto slides (Mas Coat). Sections are subsequently processed for immunocytochemistry following staining for Glutamine synthatase and staining for DNA using DAPI.
NMDA treated eyes develop numerous lesions indicative of neuronal damage (FIG. 1B). Treatment with positive control Wnt3 illustrates much less retinal damage (FIG. 1C). Treatment of mouse eyes with norrin is protective of damage as illustrated by nearly complete protection against NMDA damage as compared to control eyes (FIG. 1D).
EXAMPLE 6
Norrin promotes retinal progenitor cell differentiation in NMDA damages eyes. Mouse eyes are treated with PBS, NMDA, or NMDA plus Norrin as described in example 5. Retinal samples are stained with either Chx10 or Pax6. Costaining with both Chx10 (red) and Pax6 (green) is indicative of the presence of retinal progenitor cells. Norrin treatment (FIG. 2B) results in increased numbers of retinal progenitor cells as compared to control non-norrin treated eyes (FIG. 2A).
EXAMPLE 7
Norrin produces earlier development of vascular channels in developing stem cells.
Endothelial stem cells (EC cells) are differentiated and analyzed essentially as described by Ng, Y, et al. Laboratory Investigation, 2004; 84:1209-1218. Briefly, trypsinized ES cells are suspended in culture medium including high-glucose Dulbecco's modified Eagle's medium (DMEM, GIBCO BRL, Grand Island, N.Y., USA) with 15% fetal bovine serum (Hyclone, Utah, USA), sodium pyruvate (GIBCO, stock solution diluted 1:100), nonessential amino acids (GIBCO, stock solution diluted 1:100), β-mercaptoethanol (GIBCO, final concentration 30 μM), 190 μg/ml of L-glutamine, 60 U/ml of penicillin G, 60 μg/ml of streptomycin (glutamine pen-strep mix, Irvine Scientific, Santa Ana, Calif., USA), supplemented with media (1:300 dilution) conditioned by Chinese hamster ovary cells overexpressing LIF (provided by Genetics Institute, Cambridge, Mass., USA) as a source of LIF to maintain the ES cells in an undifferentiated state in a humidified tissue culture incubator at 10% CO2 and 37° C., and passaged every 2-3 days. Cells are either cultured in the presence or absence of Norrin.
ES cells are differentiated into embroyid bodies A total of 60 aliquots (30 μl) of ES cell suspension containing 2.5×103 cells are plated as individual drops onto 100 mm2 bacteriological dishes (Valmark Inc., Canada). The plates are then gently inverted into hanging drops and the cells incubated. The CEB are cultivated for 40-45 h, and then the dishes are turned right side up and flooded with 10 ml of ES culture media without LIF. The culture media is replaced every three days. The attached cultures of CEB are transferred at day 4 or day 5 to gelatin-coated tissue culture plates or gelatin-coated cover glasses, onto which the CEB attaches, flattens and spreads. Cells are fixed and stained for PECAM-1 expression as described by Ng, Y, et al.
PECAM-1 staining (red) reveals that Norrin induces earlier vascular channel development than non-norrin treated cells with vascular channels appearing at week 2 in Norrin treated groups and not readily apparent in untreated until week 4 (FIG. 3).
EXAMPLE 8
Treatment of Norrie disease eyes with recombinant Norrin promotes improved retinal response. Subjects who have been diagnosed with Norrie disease or are at risk for Norrie disease are exposed to norrin prepared essentially as described in example 1 and administered as described in examples 2 or 3. Administration is performed either a single time, or repeated weekly depending on the delivery mechanism used. At weeks 1, 2, 4, and 20 subjects are analyzed for improved retinal physiological activity using electroretinograms by methods known in the art or illustratively as described by Wu, W, et al., Molecular Vision, 2004; 10:93-102. Subjects treated with Norrin demonstrate improved a- and b-wave measurements at all time points tested.
Various modifications of the present invention, in addition to those shown and described herein, will be apparent to those skilled in the art of the above description. Such modifications are also intended to fall within the scope of the appended claims.
Patents and publications mentioned in the specification are indicative of the levels of those skilled in the art to which the invention pertains. These patents and publications are incorporated herein by reference to the same extent as if each individual application or publication was specifically and individually incorporated herein by reference.
The foregoing description is illustrative of particular embodiments of the invention, but is not meant to be a limitation upon the practice thereof. The following claims, including all equivalents thereof, are intended to define the scope of the invention.
The following references are each incorporated herein by reference for the entirety of their contents as if each reference were fully and explicitly included.
REFERENCE LIST


    
    
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## Claims

1. A process of treating a pathological condition of the retina in a subject comprising:
identifying a subject with the pathological condition of the retina of Norrie disease,
administering a Norrin protein in an amount of 1-10 ng per eye to said subject, said Norrin protein selected from the group consisting of: one of SEQ ID Nos. 1-3, an N-terminal truncate fragment thereof, and a mutant thereof, said mutant being a SEQ ID. No. 1 mutation of one of: T27A, S28A, S29A; P36A, R37A, R38A; Y120A, R121A, Y122A; H127A, E129A, E130A or combinations thereof; and said Norrin protein binds and stimulates signaling via a frizzled-4 cellular receptor.

2. The process of claim 1 wherein said administering is by a route selected from the group consisting of: systemic administration, local administration, injection, topical administration, intraocular, and iontophoretic delivery.

3. The process of claim 1 wherein said subject is selected from the group consisting of: human, cow, horse, sheep, pig, goat, chicken, cat, dog, mouse, guinea pig, hamster, rabbit, and rat.

4. The process of claim 1 wherein said Norrin protein is recombinant.

5. The process of claim 1 said Norrin protein further comprises further comprising a marker for monitoring function of the said Norrin protein in the subject to whom said Norrin protein has been administered.

6. The process of claim 5 wherein said marker is selected from the group consisting of: green fluorescent protein, luciferase, and β-galactosidase.

7. A process of treating a pathological condition of the retina in a subject comprising:
identifying a subject with a pathological condition of the retina,
administering a Norrin protein packaged into microspheres of one of SEQ ID Nos. 1-3 to said subject in an amount of 1-10 ng per eye, wherein said pathological condition Norrie disease.

8. The process of claim 7 wherein said administering is by a route selected from the group consisting of: systemic administration, local administration, injection, topical administration, intraocular, and iontophoretic delivery.

9. The process of claim 7 wherein said subject is selected from the group consisting of: human, cow, horse, sheep, pig, goat, chicken, cat, dog, mouse, guinea pig, hamster, rabbit, and rat.

10. The process of claim 7 wherein said Norrin protein is recombinant.

11. The process of claim 1 wherein said Norrin protein is packaged into microspheres.