# Patent

## Title
Dendritic cell tumor injection (DCTI) therapy

## Abstract

The invention relates to a method of treating tumor cells within a patient wherein immature dendritic cells developed from the patient's monocyte cells and a lymphocyte cultured medium (LCM) adjuvant are introduced into the patient directly into the patient's tumor cells. The immature dendritic cells and LCM adjuvant combine with the antigens in the tumor cells to form a cancer vaccine, thereby immediately treating the tumor cells of the patient. The invention also provides a precursor treatment step of treating the patient with radiation therapy or a chemotherapy regimen.

## Background
CROSS REFERENCE TO RELATED APPLICATION
The present application is a continuation-in-part application to U.S. patent application Ser. No. 11/227,374, filed Sep. 15, 2005, now abandoned, which claims priority to U.S. Provisional Patent Application 60/610,822 filed Sep. 17, 2004, both of which are incorporated herein by reference.
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to a tumor therapy that includes the injection of immature dendritic cells and adjuvant directly into the patient's (a human or an animal) tumor tissue, which presents antigenicity as a vaccine antigen at the injection sight. Conjugation of these elements within the tumor tissue rapidly induce and activate the patient's immune system to dramatically reduce and/or eliminate tumor cells. Most adjuvants, which augment the immune response, can be directly injected with immature dendritic cells to the tumor tissue to achieve the reduction or elimination of tumor tissues.
2. Description of the Prior Art
Immunological adjuvants are used in combination with vaccines to augment the immune response to the antigen. One way in which immunological adjuvants function is by attracting macrophages to the antigen, so that the macrophages can present the antigen to the regional lymph nodes and initiate an effective antigenic response. Adjuvants may also act as carriers themselves for the antigen, or may influence the immune response by other mechanisms such as depot effect, cytokine induction, complement activation, recruiting of different cell populations of the immunological system, antigen delivery to different antigen presenting cells, regulation of the expression of HLA class I or class II molecules and the stimulation to produce different antibody subtypes. Many of the newer vaccines are only weakly immunogenic and thus require the presence of adjuvants.
Materials having adjuvant activity are well known. Alum (Al(OH)3), and similar aluminum gels are adjuvants licensed for human use. The adjuvant activity of alum was first discovered in 1926 by Glenny (Chemistry and Industry, Jun. 15, 1926; J. Path. Bacteriol, 34, 267). Aluminum hydroxide and aluminum phosphate (collectively commonly referred to as alum) are routinely used as adjuvants in human and veterinary vaccines. The efficacy of alum in increasing antibody responses to diphtheria and tetanus toxoids is well established and, more recently, a HBsAg vaccine has been adjuvanted with alum.
One line of research in the development of adjuvants has been directed to the study of dendritic cells. Dendritic cells (DC) are professional antigen presenting cells (APC) that have the unique capacity to initiate primary immune responses in vivo and in vitro. They are derived from myeloid (DC1) or lymphoid (DC2) precursors and are distributed in their immature form throughout the body in tissues that commonly encounter environmental pathogens (skin, mucus membranes, gut epithelia, etc.). Whereas DC1 and DC2 comprise a small percentage of the total number of mononuclear cells in the peripheral circulation, DC1 precursors in the form of CD14+/CD11c+/HLA-DR+ monocytes are relatively abundant, constituting about 10% to 15% of mononuclear blood cells.
Immature DC express a host of surface structures that are involved in antigen acquisition, DC activation/maturation, and antigen presentation. Once DC encounter antigen, they undergo a maturation process characterized by the up-regulation of HLA class I and II molecules as well as co-stimulatory molecules and interact with cognate receptors on T and B lymphocytes, resulting in the generation of antigen specific cellular and humoral immune responses.
DC are considered to be the primary APC in the immune system. The ability to isolate these cells and/or their precursors and to study them in vitro has added considerable dimension to knowledge of their role in innate and acquired immunity. The classic means of generating human DC in vitro is to isolate and enrich CD14+-monocytes from peripheral blood and culture them for various periods of time in GM-CSF and IL-4 followed by final maturation with a number of cytokines, including IL-2, IL-6, IL-7, IL-13, IL-15, TNFα, IL-10, or with various other agents including lipopolysaccharides, PGE2, type 1 interferons, or double-stranded RNA.
Numerous investigators have shown that these in vitro generated monocyte-derived DC are potent antigen presenting cells (APC) capable of initiating primary and recall antigen-specific CD4+ and CD8+ T cell responses. Recent in vitro studies have generated a rather extensive body of information regarding the biology of DC1 and shed light on the processes whereby antigen specific immune responses are generated in vivo. In the peripheral tissues, immature DC acquire antigenic materials in the context of danger signals initiating a complex cytokine/chemokine milieu that is generated by DC and other cell types in the vicinity.
Soluble mediators produced by DC may act in an autocrine or paracrine fashion. T cells produce additional cytokines and chemokines following interaction with antigen armed DC, as do other immune cells that are activated by the cytokines released. This complex network of interactions may in turn create an environment that promotes the generation of DC from their monocyte precursors.
It is thought that those adjuvants which promote that maturation of dendritic cells, when administered in combination with a vaccine antigen, will result in more antigen presenting cells presenting the vaccine antigen to T lymphocytes and B cells, thus bolstering the immune response to the vaccine antigen. However, isolation of the most effective vaccine antigen has been extremely difficult since antigenicity of APC has always been subject to its evolution with antigenic drift and/or shift, and therefore many of the newer vaccines are only weakly immunogenic even though dendritic cells and adjuvant are present. The most effective vaccine antigen against the live tumor cells should be used with dendritic cells and adjuvant during a course of treatment to promote and to induce a rather strong immunogenicity.
SUMMARY OF THE INVENTION
The present invention solves the above need by providing the most effective antigenic vaccine antigen with dendritic cells and adjuvant to increase the amount and quality of the immune response against tumor cells.
In an aspect of the present invention, there is provided a method of reduction of tumor cells in tumor tissue of a patient, comprising collecting monocyte cells from the patient, culturing the monocyte cells with IL-4 and GM-CFS to form immature dendritic cells from the monocyte cells, and administering a therapeutically effective amount of the immature dendritic cells with a leukocyte cultured medium (LCM) adjuvant to the patient. The LCM adjuvant comprises at least three, preferably at least six and more preferably at least ten cytokines selected from eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, ILβ, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα and VEGF.
The immature dendritic cells and LCM adjuvant are administered intratumorally, i.e., directly into the site of the tumor.
Optionally, this method provides treating the patient with chemotherapy, radiation or anti T-cell antibodies prior to the administration of the immature dendritic cells and LCM adjuvant.
In another aspect of the present invention, there is provided a method of reduction of tumor cells in tumor tissue comprising treating a tumor of a patient, with a chemotherapy regimen, collecting monocyte cells from the patient, culturing the monocyte cells with IL-4 and GM-CFS to form immature dendritic cells from the monocyte cells and administering a therapeutically effective amount of the immature dendritic cells with a leukocyte cultured medium (LCM) adjuvant to the patient. The LCM adjuvant comprises at least three, preferably at least six and more preferably at least ten cytokines selected from eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF.
Optionally, this method provides treating the patient with radiation prior to the administration of the immature dendritic cells and LCM adjuvant.
In a further aspect of the present invention, there is provided a method of reduction of tumor cells in tumor tissue comprising treating a tumor of a patient with a radiation therapy regimen, collecting monocyte cells from the patient, culturing the monocyte cells with IL-4 and GM-CFS to form immature dendritic cells from the monocyte cells, and administering a therapeutically effective amount of the immature dendritic cells with a leukocyte cultured medium (LCM) adjuvant into the tumor tissue of the patient. The LCM adjuvant comprises at least three, preferably at least six and more preferably at least ten cytokines selected from eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF.
Optionally, this method provides treating the patient with chemotherapy prior to the administration of the immature dendritic cells and LCM adjuvant.



BRIEF DESCRIPTION OF THE DRAWINGS
A full understanding of the invention can be gained from the following description of the preferred embodiments when read in conjunction with the accompanying drawings in which:
FIG. 1 shows two protocols for treating patients with tumors according to the methods of the present invention;
FIG. 2 shows a computerized tomography (CT) image of a patient with gastric cancer and liver metastasis before and after treatment according to the methods of the present invention;
FIG. 3 shows a CT image of a patient with upper pharyngeal cancer before and after treatment according to the methods of the present invention;
FIG. 4 shows a CT image of a patient with sigmoid cancer and liver metastasis before and after treatment according to the methods of the present invention;
FIG. 5 shows a CT image of a patient with rectal cancer and lung, pelvic and left cervical metastasis before and after treatment according to the methods of the present invention;
FIG. 6 shows a CT image of a patient with right breast cancer and left chest wall and mediastinal metastasis before and after treatment according to the methods of the present invention;
FIG. 7 shows the effect of LCM on surface marker expression, in which monocytes in PBMCs differentiate to a DC-like phenotype following exposure to LCM;
FIG. 8 shows the effect of LCM on surface marker expression, in which immature monocyte-derived DCs differentiate to a mature-phenotype following exposure to LCM;
FIG. 9 shows that LCM augments CpG-induced maturation and IFNα production by CpG treated plasmacytoid DCs (pDCs);
FIG. 10 shows the effect of LCM treatment on T cell responses in vitro;
FIG. 11 shows T cell responses to vaccines are enhanced following treatment with LCM (ELISPOT);
FIG. 12 shows antibody responses to vaccines are enhanced following treatment with LCM (ELISA);
FIG. 13 provides an outline of an elutriation study;
FIG. 14 shows percent viability following incubation with LCM;
FIGS. 15 A, B provides recall responses and shows that LCM augments response to antigens (CMV, n=2); A: Aph082305 and Aph011006; B: Aph082305 and Aph011006;
FIGS. 16 A, B shows tumor cell lysates (n=2); A: Aph062805; B: Aph011006;
FIGS. 17 A, B shows responses of LCM-treated ‘naïve IL7-IL15-treated’ cells (N=2); A: Aph062805; B: Aph01106; and
FIG. 18 shows a proposed culture system for lymphocytes.



DESCRIPTION OF THE PREFERRED EMBODIMENTS
As used herein, the term “leukocyte cultured medium (LCM)” is synonymous and interchangeable with the term “activated leukocyte medium (ALM).”
As used herein, “patients” in clude mammals, which include humans.
As used herein, the term “therapeutically effective amount” refers to that amount of immature dendritic cells and lymphocyte cultured medium (LCM) adjuvant required to bring about a desired effect in a human or other mammal. In all instances, at its most basic level, the desired effect is a reduction of tumor cells in tumor tissue of the patient when compared to the tumor cells in the tumor tissue of the patient prior to employing the methods of the present invention.
The present invention provides treatment tumor tissue using full antigenic elements, which include antigenicity of both known and unknown antigen presenting cells, by locating them within the live tumor tissue in the human body (or alternatively, the body of an animal). This is in contrast to prior art cultured antigens obtained from tumor cell lines or any process added antigen, which have limited antigencity and outdated antigenic data or potency as a vaccine antigen for the patient's tumor cells. In particular, the present invention relates to a therapy that includes the injection of immature dendritic cells and adjuvant directly into the patient's tumor tissue, which presents antigenic elements as the vaccine antigen at the injection sight. The conjugation of these elements within the tumor tissue rapidly induce and activate the patient's immune system to dramatically reduce and/or eliminate tumor cells. Most adjuvants, which augment the immune response, can be directly injected with immature dendritic cells into the tumor tissue to achieve the reduction or elimination of tumor cells. Such adjuvants may include, without limitation, lipid-based, protein-based and polysaccharides-based adjuvants, such as lymphocyte cultured medium, Marignase, Agaricus, OK432, BCG, Lentinan (shiitake), Reishi, Sarunokoshikake, TNF Meshimakobu, Froint's complete or incomplete adjuvant, LPS, fatty acids, phospholipids, cytokines or a virus.
The present invention provides rapid reduction and/or elimination of tumor cells, which can be visually detected by MRI and/or CT and/or Echo scan within two weeks after the injection. The therapy according to a preferred embodiment of the invention includes the following steps: Step 1: Collecting peripheral blood monocyte cells (PBMC) from a patient; Step 2: Culturing these PBMC with GM-CFS and IL-4 to immature dendritic cells; Step 3: Injecting the cultured immature dendritic cells and an adjuvant into the tumor; and Step 4: Evaluating the tumor in two weeks.
In one particular embodiment, the effectiveness (immuno-response) of this method of treatment can be enhanced by pre-treating the tumor cells using known chemotherapy and/or radiation therapy techniques, which diminish the existing immune system, prior to steps 1-4 described above. In addition, the effectiveness (immuno-response) of this method of treatment can also be enhanced by injecting the tumors cells with an anti T-cell monoclonal antibody prior to steps 1-4 described above (either alone or in addition to the chemotherapy and/or radiation therapy described above).
EXAMPLES
The present invention is more particularly described in the following non-limiting examples, which are intended to be illustrative only, as numerous modifications and variations therein will be apparent to those skilled in the art.
Example 1
Treatment with Immature Dendritic Cells and Lymphocyte Cultured Medium Adjuvant
Six patients, four with stomach cancer and two with colon cancer, were used in this clinical investigation to assess the effect of intratumoral administration of immature dendritic cells (imDCs) with a lymphocyte cultured medium adjuvant (LCMadj). All patients were self-referred, had advanced cancers and progressive disease that had not responded to conventional standard therapies.
1. Methods
Four weeks prior to administration of the imDC and LCMadj, leukapheresis was performed on each patient to collect monocyte cells from the patient. The monocyte cells were cultured with IL4 and GM-CFS. This resulted in the production of imDCs. Four weeks later, a cocktail was prepared containing between about 107 to 108 imDCs and between about 1.0 to 2.0 mg of LCMadj to make up a 10% concentration in normal saline. Depending on the size of the tumor, between 2.0 to 50 cc of normal saline was injected into the tumor site of each patient. Four weeks after injection of the cocktail, the patients were evaluated by CT image analysis and measurement of serum tumor markers.
2. Results
Of the six patients in this clinical study, three of the tumors of the patients showed stable disease (SD); defined as showing less than a 20% increase in tumor size and less than a 30% reduction in tumor size, with no increase in serum tumor markers. The tumors of the other three patients showed progressive disease (PD); defined as a 20% or greater increase in tumor size, new metastatic lesions and an increase in serum markers.
Example 2
Pretreatment with Chemotherapy Prior to Injection of Immature Dendritic Cells and Lymphocyte Cultured Medium Adjuvant
Four patients, three with rectal cancer and one with colon cancer, were used in this clinical investigation to assess the effect of chemotherapy prior to intratumoral administration of imDCs with a LCMadj. All patients were self-referred, had advanced cancers and progressive disease that had not responded to conventional standard therapies.
1. Methods
As shown in FIG. 1, Four weeks prior to administration of the imDC and LCMadj, leukapheresis was performed on each patient to collect monocyte cells from the patient. The monocyte cells were cultured with IL4 and GM-CFS. This resulted in the production of imDCs. Three weeks later, all patients were administered cytoxan intratumorally. One week later, a cocktail was prepared containing between about 107 to 108 imDCs and between about 1.0 to 2.0 mg of LCMadj to make up a 10% concentration in normal saline. Depending on the size of the tumor, between 2.0 to 50 cc of normal saline was injected into the tumor site of each patient. Four weeks after injection of the cocktail, the patients were evaluated by CT image analysis and measurement of serum tumor markers.
2. Results
Of the four patients in this clinical study, two of the tumors of the patients showed a partial response (PR); defined as a 30% reduction in the size of the injected tumor, decline in serum markers, no increase in tumor size at other metastatic sites or appearance of new metastasis. The tumor from the third patient showed stable disease (SD), as defined above; and the tumor from the fourth patient showed progressive disease (PD), as defined above.
Example 3
Injection of Immature Dendritic Cells and Lymphocyte Cultured Medium Adjuvant or Pretreatment with Chemotherapy or Radiation Therapy Prior to Injection of Immature Dendritic Cells and Lymphocyte Cultured Medium Adjuvant
Twenty patients with advanced malignancies of different types were used in this clinical study to assess the effect of intratumoral administration of imDCs with an LCMadj, chemotherapy prior to imDCs and LCMadj administration or radiation therapy prior to imDCs and LCMadj administration. All patients were self-referred, had advanced cancers and progressive disease that had not responded to conventional standard therapies. 1.
Methods
Four weeks prior to administration of the imDC and LCMadj, leukapheresis was performed on each patient to collect monocyte cells from the patient. The monocyte cells were cultured with IL4 and GM-CFS. This resulted in the production of imDCs. Three weeks later, three patients received radiation therapy and 11 patients were given chemotherapy (see Table 1) by administering the chemotherapeutic agent intratumorally. One week later, a cocktail was prepared containing between about 107 to 108 imDCs and between about 1.0 to 2.0 mg of LCMadj to make up a 10% concentration in normal saline. Depending on the size of the tumor, between 2.0 to 50 cc of normal saline was injected into the tumor site of each patient. Four weeks after injection of the cocktail, the patients were evaluated by CT image analysis and measurement of serum tumor markers.
2. Results
As shown in Table 1, of the six patients that did not receive any prior treatment before administration of the imDCs and LCMadj cocktail, the tumors of two patients showed a partial response (PR) (see, for example, FIG. 2); the tumors of two other patients showed no change (NC) from their previous condition (see, for example, FIG. 3); and the tumors from two other patients showed progressive disease (PD) (see, for example, FIG. 4). Of the three patients that had radiation therapy prior to administration of the imDCs and LCMadj cocktail, the tumor from one patient showed no change (NC) from its previous status. The other patient dropped out before they could be evaluated. Of the eleven patients that received chemotherapy prior to administration of the imDCs and LCMadj cocktail, the tumors from three of the patients showed a partial response (PR) (see for example FIG. 5); the tumors from six of the patients showed no change (NC) from their previous condition (see, for example, FIG. 6); and the tumors from two patients showed progressive disease (PD). FIGS. 2-7 show CT images of various cancers and their response to the treatment protocol.












TABLE 1









Pre-
Eval-


Sex
ID
Diagnosis
Stage
treatment
uation







F
030593
Gastric Ca Op
Rec
No
PR




Liver Meta





M
011077
Epi pharyngeal Ca Op
Rec
No
NC


M
040231
Sigmoid Ca Op Liver,
Rec
No
PD




Lung & Urinary Bladder







Meta





M
040265
Gastric Ca Op Peritoneal
Rec
No
NC




Meta





M
051585
Gastric Ca Op Mult,
Rec
No
PR




Lever Meta





M
040402
Rt. Lung Ca Op Rt Chest
Rec
Radiation
Drop




Wall Meta


Out


M
040465
Gastric Ca Op Liver
Rec
Radiation
NC




Meta





F
040865
Malig. Melanoma of
Rec
Endoxan
PR




Gingiva Op Cervical LN







Meta





F
031180
Rectal Ca Op., Lung
Rec
Endoxan
PR




Meta Pelvic & Lt.







Cervical LN Meta





F
040764
Sigmoid Ca Op Mult.
Rec
Chemo
NC




Liver Meta

(TAI)



F
010863
Rec. of Rectal & Caecal
Rec
None
PD




Cancer Op., Lt. Cervical







LN Meta





F
041095
Rectal Ca Op. Lung Meta
Rec
Radiation
NC




Pelvic LN Meta





F
040924
Breast Ca Op Skin Meta
Rec
Endoxan
PR


F
040520
Breast Ca Op Skin Meta
Rec
Endoxan
NC


F
031119
Lt. Pylvic Tumor Op. Lt.
Rec
Endoxan
PD




Cervical & Axilla LN







Meta





F
040558
Rec. of Rt. Breast Cancer
Rec.
CDDP
NC




Op., Liver Metastasis





M
040325
Malig. Mesothelioma
IV
Endoxan
NC


M
041266
Rectal Ca Op Liver
Rec
Endoxan
PD




Metastasis





F
900182
Rt. Breast Ca Op., Lt.
Rec
CDDP
NC




Chest Wall & Medistinal







LN Meta





F
041264
Rec. of Endometrial
Rec
CDDP
NC




Cancer op., Pelvic LN







Metastasis









3. Discussion

Approximately 80% of the patients showed some degree of tumor regression. Moreover, none of the patients had any adverse reaction to the treatment protocol they were given. In those patients showing tumor regression, this was evident within one month after completion of the treatment protocol and effectiveness of the treatment was observed after over 3 months. The number of cases and percentage effectiveness of the treatment protocols were as follows:
Complete response (CR); defined as a decrease in serum markers to normal levels, complete disappearance of all measurable lesions: 0 (0%)















PR
5 (26%)



NC
10 (53%) 



PD
4 (21%)









Example 4
Preparation of Lymphocyte Cultured Medium (LCM) for Clinical Application
Objective
To develop a clinically acceptable method for the production of LCM from elutriated cell fractions obtained from mononuclear cells (MNC) and generate preliminary data in support of a potential ND submission.
BACKGROUND
A variety of cytokines are known to induce the differentiation and maturation of monocyte-derived dendritic cells (DC). Soluble factors found in cell-free supernatants from monocyte and anti-CD3-activated T cells have been found to increase the expression of activation and maturation markers. In this laboratory, earlier studies showed that activation of ficolled PBMC with anti-CD3/CD28 beads results in a product that could mature APCs and augment T cell responses. The activated lymphocyte medium contained a mix of cytokines and chemokines known to be important for the development and migration of DC including GM-CSF, TNFα, IFNγ, IL8, MCP-1 and MIP1. When cultured in LCM, purified monocytes and monocytes in whole PBMC preparations developed a DC-like phenotype characterized by the loss of CD14 and upregulation of costimulatory molecules. Immature DC exposed to LCM underwent maturation within 48 h marked by an increase in surface expression of CD40, CD80, CD86, CD83 and HLADR. LCM-treated DC stimulated potent allogeneic PBMC responses and boosted antigen-specific T cell responses to antigens. Enhanced T cell and antibody responses were observed when LCM was co-administered with a variety of vaccines in macaques. LCM represents a potential ‘physiologic’ product for the generation of DCs in vitro as well as vaccine adjuvant; providing a cytokine milieu for DC generation and immune activation in vivo. Data using activated PBMCs as well as activation products developed from elutriated lymphocyte fractions are included in this study.
The cytokine composition of LCM is shown in Table 2.







TABLE 2







Quantities of Cytokines or Chemokines (PBMCs)









Quantity (pg/ml)













GM-CSF
23000



IFNα
0



IFNγ
31000



IL1β
70



IL2
5900



IL3
1000



IL4
280



IL6
2170



IL8
47970



IL10
660



IL12
10



IL15
0



MCP1
110040



M-CSF
8690



MIP1α
127200



MIP1β
157890



PGE2
1540



RANTES
20640



CD40L
1270



SDF1α
0



TGFβ
0



TNFα
6430









FIGS. 7 and 8 show the effect of LCM on surface marker expression. Regarding FIG. 7, monocytes in PBMCs differentiated to a DC-like phenotype following exposure to LCM. Expression of CD14, HLA-DR, CD40, CD80, and CD86 was analyzed at 0, 3 and 5 days following exposure to LCM. Data represent mean±SEM of 11 experiments and ** indicates p<0.005. Regarding FIG. 8, immature monocyte-derived DCs differentiated to a mature-phenotype following exposure to LCM. Elutriated monocytes were cultured with GM-CSF/IL-4 for 3-4 days followed by addition of media alone, LCM or Maturation Cocktail for 48 hours. Monocytes cultured in cRPMI only were used as a negative control. CD11c+DCs were examined for surface expression of CD14, HLA-DR, CD40, CD83, CD80, and CD86 by flow cytometry. Open histograms represent staining of DC with isotype control mAb, and shaded histograms represent staining of DC with specific mAb.
FIG. 9 shows that LCM augments CpG-induced maturation and IFNα production by CpG treated plasmacytoid DCs (pDCs). Human pDCs (91-96% purity assessed by surface expression of CD123) were isolated using positive BDCA-4 immunomagnetic selection (Miltenyi Biotech, Auburn, Calif.). Typically, 1×108 monocytes yielded 3-4×105 pDCs. The pDCs were adjusted to 0.5×106 cells/ml in DMEM (Life Technologies, Rockville, Md.) containing 10% fetal bovine serum (BioWhittaker, Walkersville, Md.) and cultured at 1×105 cells per well in 96 well round bottom plates. Freshly isolated pDCs expressed an immature phenotype (CD83−, low MHC and co-stimulatory molecules). pDCs were matured with CpG2006 (20 μg/ml) for 24 to 48 h. LCM was added at a 25% dilution.
FIG. 10 shows the effect of LCM treatment on T cell responses in vitro. PBMCs were cultured for 24 h with or without antigen and/or LCM (25%), washed to remove LCM and plated for: (A) Recall Responses (re-plated on ELISPOT for 24 hours; (B) Primary Responses (culture for 7 days with media containing IL7 and IL15, cells washed, then replated on ELISPOT with antigen for 24 hours). CMV=cytomegalovirus lysate; cancer cell lines: K=gastric cancer, P=pancreatic cancer, N=renal cell carcinoma, col=colon cancer.
Effect of LCM Immunization with Vaccines on T Cell and Antibody Responses-In Vivo.
Total solubilized protein was measured in pooled LCM samples (BioRad protein assay based on the method of Bradford, absorbance at 595 nm). To determine adjuvant activity of LCM in vivo, 0.3 ml LCM (97.5 ng) was mixed with individual vaccines (hepatitis A=HepA; tetanus diphtheria toxoid=TDT; rabies or prostate specific antigen=PSA) and each vaccine/LCM mixture was injected IM in macaques at four separate sites (right and left arms and thighs). Selected cytokine levels are calculated in Table 3.







TABLE 3







Cytokine/Chemokine Concentrations of Pooled LCM Injected into


Macaques













ng/ml
ng/injection site
total ng/injection















GM-CSF
310
93
372



IL-4
2.5
0.75
3



IL-5
1.5
0.45
1.8



IL-8
4.3
1.29
5.2



IL-10
3.2
0.96
3.8



MCP-1
3.7
1.11
4.4



IL-1α
0.228
0.07
0.274



IL-1β
0.364
0.11
0.437



IL-12p40
0.313
0.09
0.376









Animals were injected with vaccines alone or vaccines plus LCM and cell and serum samples removed for testing according to the following timeline, shown in Table 4.







TABLE 4







Treatment timeline for 


animals receiving vaccine or vaccine plus LCM
















Treatment
0
7
14
21
28
35
42
49
56












Days of injection

















Vaccine
HepA
+
+
+








alone
TDT
+
+
+









Rabies
+
+
+









PSA
+
+
+















Days samples collected for testing


















Cells (ELISPOT)
+




+
+
+
+



Serum (ELISA: IgG
+




+
+
+
+



antibodies to HLA 












class I and HLA 












class II antigens and 












vaccines)











Vaccine + 
HepA
+
+
+








LCM
TDT
+
+
+









Rabies
+
+
+









PSA
+

+









Cells (ELISPOT)
+
+
+
+
+
+
+
+
+



Serum (ELISA: IgG
+
+
+
+
+
+
+
+
+



antibodies to HLA 












class I and HLA 












class II antigens and 












vaccines)





+ = procedure done on indicated day






FIG. 11 shows that T cell responses to vaccines were enhanced following treatment with LCM (ELISPOT). FIG. 12 shows that antibody responses to vaccines were enhanced following treatment with LCM (ELISA).
Table 5 shows detection of HLA Ab in Macaque serum using solid phase ELISA.









TABLE 5








Class I
Class II








Monkey ID
Day of serum collection

























code
0
7
14
21
28
35
42
49
56
0
7
14
21
28
35
42
49
56










Vaccine only

























CC8A
−




−
−
−
−
−




−
−
−
−


CG33
−




−
−
−
−
−




−
−
−
−


98021
−




−
−
−
−
−




−
−
−
−


99E030
−




−
−
−
−
−




−
−
−
−


99061
−




−
−
−
−
−




−
−
−
−







Vaccine and LCM

























LCM-98023
−
−
−
−
+
+
+
+
+
−
−
−
−
−
−
−
−
−


LCM-99E145
−
−
−
−
−
−
−
−
−
−
−
−
−
−
−
−
−
−


LCM-99E107
−
−
+
+
+
+
+
+
+
−
−
−
−
−
−
−
−
−





*GTI, Waukesha, WI;


+ = positive detection,


− not detected






Summary: Media from Anti-CD3/CD28 Activated PBMCs:

Contain cytokines and chemokines that are known to influence the generation of immune responses; induces maturation and differentiation of monocyte-derived DCs and pDCs; augments primary and recall antigen specific T cell responses in vitro; and augments antibody and T cell responses to vaccines in non-human primates.
Data Generated from ‘Purified’ Elutriated Lymphocyte-Derived LCM
To determine if LCM production could be adapted to a larger scale process potentially better defined and more easily amenable to FDA guidelines than the use of ficolled whole blood PBMCs, a study on apheresed cells with autologous testing was initiated. MNC were fractionated into different cell types from healthy individuals utilizing a programmable semi-closed cell separation device (Elutra, Gambro BCT) that allows the collection of cells based primarily on size. This system offers obvious advantages including the automated removal of platelets and red blood cells, collection of a large number of enriched cell populations for autologous treatment including monocytes for generation of DCs, and lymphocytes for activation of T cells and LCM. Using a program developed for monocyte collection; we were able to collect upstream fractionated products containing predominantly lymphocytes. Designated as Fractions 2 and 3, these cells were cryopreserved for LCM preparation and testing. Cell profiles of each fraction of each donor were generated by flow cytometry. Cells were activated with either anti-CD3 antibody+ionomycin or anti-CD3/CD28 beads. The media was tested for cytokine composition and its capacity to ‘mature’ dendritic cells (DCs) and augment T cell responses.
Because this study involved the injection to humans of activated cell products, prior to any laboratory studies, the acceptability of culture materials was first determined by enquiry with FDA. It was recommended that GMP-produced serum-free media filed in previous IND's be used; and all media ‘components’ (including cytokines) be well-defined.
Data: Characterization of Apheresis Products Pre- and Post-Elutriation.
The cell number in healthy donor leukapheresis products and lymphocyte recoveries is shown in Table 6.








TABLE 6






mean ± SD*







Pre-elutriation



Total MNC in product (×109)
7.2 ± 3  


Total RBC in product (×1010)
4.3 ± 1.1


Total lymphocytes in product (×109)
5.6 ± 2.2


Total monocytes in product (×109)
 1.2 ± 0.38


HCT (%)
2.2 ± 0.5


Total PLT in product (×1011)
2.7 ± 0.9


Percentage of lymphocytes in product
79.3 ± 2.9 


Post-elutriation



Cell recovery in lymphocyte-rich fractiona
Fraction 2: ~63%; Fraction 3:



~42%


Lymphocyte purityb
81-86 ± 3% 





*n = 9;


aPercentage of cells recovered in lymphocyte-rich fractions 2 and 3 with respect to cell counts in starting material (manual count)


bPercentage of lymphocytes in lymphocyte-rich fraction determined by CD3+ labling






Phenotype of Fraction 2 and 3 Cells

To verify that the majority of cells in fractions 2 and 3 were lymphocytes, fresh and cryopreserved fractionated cells were phenotyped by labeling with fluorochrome-conjugated monoclonal antibodies against leukocyte cell surface markers. Profiles of cryopreserved cells are shown in Table 7 as in practice stored cells will be used to generate the batches of clinical product.







TABLE 7







Phenotype of Thawed elutriated fractions












Fraction 2*
Fraction 3**














AVE
SD
AVE
SD

















Viability
87
7
88
15



CD45+
97
2
97
3



CD3+
86
3
81
3



CD4+
41
5
48
10



CD8+
29
6
21.8
7



CD4+DR+
8
2
10
2



CD4+CD25+
5
0.5
6
1



CD25+
7
1
9
3



CD3+CD56+
16
6
19
9



CD3−CD56+
7
5
8
5



CD56+
23
10
24
16



CD19+
3
1
4
2







FACScan analysis,



*n = 87 (storage time 9-547 days);



**n = 45 (storage time = 9-399 days)






Cytokine Composition of LCM Derived from Fractions 2 and 3

Culture conditions based on historical data in flasks and plates (Table 8) were tested with fractions 2 and 3 to select the ‘best’ conditions for further clinical process development.







TABLE 8







Culture conditions tested (37° C., humidified, 5% CO2)


Table 6:


Culture












Fraction 2
Fraction 3











incubation time














48 h
72 h
48 h
72 h







CD3-CD28 beads
X
X
X
X



No beads
X
—
X
—



CD3-CD28 beads +
—
X
—
X



IL2







No beads + IL2
—
X
—
—



Anti-CD3 coating
—
X
—
—










LCM supernatants were collected by centrifugation and stored at 4° C. until assayed. Cytokines were assessed within a single assay for direct comparison using flow cytometry-based technology (BioRad, BD Biosciences) (see Table 7).
Comment: Data suggest that anti-CD3/CD28 stimulation provide a ‘manufacturing’ system which is easy to execute and yields fairly consistent cytokine patterns. The use of beads compared to flask/bag surface coating with antibody may be preferred as beads can be systematically measured, their use subject to less operator error, and ‘generally’ similar cytokine patterns are observed.
Tables 9A and 9B show survey assay on cultures in traditional polystyrene plates or flasks.







TABLE 9A







Activation of FRACTION 2 cells


Cytokines Produced from Cells Stimulated under Different Conditions (27-Bioplex)


(pg/ml)


















No
Anti-CD3



CD3-CD28
No
CD3-CD28
CD3-CD28
beads +
Ab



beads
beads
beads
beads + IL2
IL2
coating










48 h stimulation (n = 2)
72 h stimulation (n = 2)
















Eotaxin
145 ± 22 
 7 ± 10
138 ± 60 
487 ± 260
18 ± 24
147 ± 94 


FGF
39 ± 2 
0 ± 0
76 ± 43
162 ± 132
0 ± 0
23 ± 32


G-CSF
16.7 ± 3  
0 ± 0
27 ± 11
89 ± 51
1 ± 1
26 ± 16


GM-CSF
1124 ± 140 
20 ± 23
3551 ± 2115
5944 ± 2657
60 ± 52
1373 ± 961 


IFNγ
42512 ± 13867
0 ± 0
50335 ± 56228
42997 ± 24322
227 ± 60 
55600 ± 49000


IP10
86034 ± 39358
254 ± 360
170543 ± 400405
13066 ± 2666 
694 ± 327
1183 ± 1006


IL1β
24 ± 2 
0.6 ± 0.1
21 ± 15
130 ± 81 
14 ± 24
34 ± 10


IL1ra
164 ± 109
 92 ± 118
232 ± 195
320 ± 143
140 ± 76. 
45.5 ± 10  


IL2
7944 ± 1549
0 ± 0
6750 ± 4760
24724 ± 9572 
10867 ± 1961 
5836 ± 3686


IL4
155 ± 39 
0 ± 0
292 ± 320
251 ± 123
 8.2 ± 11.3
61 ± 47


IL5
236 ± 225
0 ± 0
423 ± 403
493 ± 188
1.5 ± 0.6
183 ± 103


IL6
1646 ± 526 
12.9 ± 18.2
2797 ± 3566
2032 ± 670 
18 ± 21
226 ± 155


IL7
0.8 ± 0.8
0.0 ± 0  
4.20 ± 2.8 
5.00 ± 4.8 
0 ± 0
0.50 ± 0.7 


IL8
2205 ± 1700
283 ± 350
4892 ± 8372
2197 ± 561 
815 ± 37 
1408 ± 1092


IL9
1590 ± 1601
15 ± 18
1918 ± 2235
2523 ± 1007
0 ± 0
118 ± 167


IL10
7298 ± 2236
0 ± 0
2122 ± 2349
2289 ± 629 
0 ± 0
1385 ± 1033


IL12
3 ± 1
0 ± 0
16 ± 14
0 ± 0
0 ± 0
0 ± 0


IL13
874 ± 534
0 ± 0
1479 ± 772 
1574 ± 370 
3 ± 3
530 ± 160


IL15
  3 ± 0.4
  2 ± 0.1
3 ± 2
10 ± 21
1.5 ± 3  
0 ± 0


IL17
481 ± 70 
0 ± 0
1087 ± 1860
386 ± 293
0 ± 0
25 ± 35


MCP1
36 ± 36
26 ± 37
69 ± 74
70 ± 80
0 ± 0
6 ± 8


MIP1α
21945 ± 0  
15 ± 15
17781 ± 6324 
19153 ± 0  
413 ± 98 
6146 ± 6832


MIP1β
13684 ± 13363
812 ± 646
18277 ± 7656 
48070 ± 49740
7079 ± 2396
17893 ± 7504 


PDGFbb
267 ± 41 
0 ± 0
189 ± 169
779 ± 586
28 ± 33
122 ± 172


RANTES
15101 ± 182 
322 ± 82 
34432 ± 29650
 7969 ± 11890
781 ± 33 
1338 ± 709 


TNFα
3457 ± 1540
0 ± 0
7540 ± 8717
7142 ± 2016
0 ± 0
2631 ± 1052


VEGF
136 ± 81 
0 ± 0
242 ± 173
582 ± 478
22 ± 0 
117 ± 132
















TABLE 9B







Activation of FRACTION 3 cells


Cytokines Produced under Different Culture Conditions


(pg/ml)















CD3-CD28



CD3-CD28
No
CD3-CD28
beads +



beads
beads
beads
IL2










48 h stimulation
72 h stimulation



(n = 2)
(n = 2)














Eotaxin
173 ± 21 
12 ± 17
225 ± 9 
0 ± 0


FGF
38 ± 1 
3 ± 4
56 ± 15
0 ± 0


G-CSF
  22 ± 0.52
0 ± 0
33 ± 5 
0 ± 0


GM-CSF
2279 ± 746 
22 ± 1 
5577 ± 1278
4 ± 6


IFNγ
223663 ± 20006 
14 ± 21
327345 ± 41111 
0 ± 0


IP10
21221 ± 5076 
884 ± 459
31794 ± 684 
1680 ± 1073


IL1β
45 ± 3 
  1 ± 0.97
67 ± 24
  1 ± 0.94


IL1ra
1969 ± 180 
1397 ± 172 
2715 ± 1086
1545 ± 495 


IL2
5518 ± 1387
0 ± 0
2655 ± 1569
0 ± 0


IL4
267 ± 124
0 ± 0
252 ± 50 
0 ± 0


IL5
411 ± 322
0 ± 0
542 ± 273
0 ± 0


IL6
1840 ± 394 
40 ± 50
2378 ± 75 
35 ± 45


IL7
0.9 ± 0.9
0.05 ± 0.07
  2 ± 0.08
0 ± 0


IL8
26859 ± 13919
9081 ± 883 
36702 ± 0  
17269 ± 11218


IL9
3437 ± 2136
43 ± 3 
9363 ± 4575
43 ± 25


IL10
8554 ± 973 
0 ± 0
10940 ± 2529 
0 ± 0


IL12
27 ± 11
0 ± 0
23 ± 5 
0 ± 0


IL13
977 ± 574
0 ± 0
1938 ± 697 
0 ± 0


IL15
  4 ± 0.8
  2 ± 0.2
  6 ± 0.9
  2 ± 0.01


IL17
 1928 ± 200.8
0 ± 0
2860 ± 1255
0 ± 0


MCP1
 689 ± 94.6
243 ± 87 
936 ± 308
222 ± 177


MIP1α
12242 ± 13722
48 ± 65
21945 ± 0  
3 ± 4


MIP1β
13922 ± 16298
822 ± 583
15449 ± 14138
501 ± 443


PDGFbb
 227 ± 14.6
0 ± 0
581 ± 96 
0 ± 0


RANTES
8405 ± 944 
111 ± 22 
34085 ± 14533
 93 ± 2.4


TNFα
7015 ± 770 
0 ± 0
18531 ± 6916 
0 ± 0


VEGF
 176 ± 90.2
0 ± 0
277 ± 40 
0 ± 0









Development of LCM Closed ‘Manufacturing’ Process

There appeared to be no large differences in cellular composition between fractions 2 and 3; however, cell recovery was highest in fraction 2. Fraction 2 cells were selected for further analysis and development in a closed system. A 3-day culture period using anti-CD3-CD28 bead stimulation was selected. Closed FEP VueLife® bags (2 PF-0025, American Fluoroseal Corporation, Gaithersburg, Md.) were used (in part based on our previous DC culture IND work) as they: reduce risk of contamination while allowing easy access to cells; are transparent so cells can be easily monitored; are non-reactive, i.e., no plasticizers, leachables or extractables to affect cell culture; are manufactured to meet FDA approval; allow O2, CO2, and N2 gas transfer. FEP is impermeable to water and allows incubation without water loss; and therefore, there is no need to use humidified chambers which often is a source of contamination;
Five different aphereses from different donors were used to make LCM in a bag system. Cells were cultured in serum-free, phenol-red free XVIVO10 (BioWhittaker) media using syringe loading at 1×106 cells/ml in 15 ml media plus CD3-CD28 beads (Dynabeads, Dynal) at 3 beads to 1 cell. Bags were placed atop wire racks to ensure proper gas exchange and even cell distribution then incubated for 3 days at 37° C.
Following culture, cells and LCM from individual units were collected by removing beads with a Dynal magnet followed by centrifugation (10 min at 400×g). Cells were phenotyped (Table 10) and collected supernatants were assayed for cytokines using 27 Bioplex flow-based analyses (Table 11 A, B).
Characterization of Activation Products Produced in Closed System







TABLE 10







Phenotype of elutriated cells following activation*










CD3-CD28
Non-activated



activated
(i.e., no beads but cells in culture)












AVE
SD
AVE
SD














Viability
80
4
91
6


CD3+
76
7
73
6


CD4+
42
6
36
9


CD8+
39
18
32
9


HLA-DR+
20
16
14
5


CD25+
71
9
1
1


CD19+
7
7
10
4









Cytokines Released from Activated Cells








TABLE 11A







Cytokines found in supernatants from lymphocyte cultures


in ‘bag’ system*


CD3-CD28 bead activation










Apheresis unit (pg/ml)
N = 5














APH062805
APH082305
APH112905
APH011006
APH112706
Ave ± SD
















Eotaxin
78
86
132
160
117
115 ± 34 


FGF
79
95
117
134
115
108 ± 21 


G-CSF
18
21
31
41
31
29 ± 9 


GM-CSF
3409
3619
3595
8189
3446
4452 ± 2091


IFNγ
5240
7474
27957
188081
54453
56641 ± 76098


IP10
6158
9415
54621
87794
1234754
278548 ± 535605


IL1β
7
6
9
18
19
12 ± 6 


IL1ra
115
117
160
659
396
289 ± 237


IL2
3161
4510
14896
14896
6676
8828 ± 5680


IL4
241
247
351
1108
254
440 ± 376


IL5
425
358
328
1431
247
558 ± 492


IL6
977
955
3207
11942
2852
3986 ± 4567


IL7
5
6
8
7
6
6 ± 1


IL8
973
759
1216
7404
26397
 7350 ± 11006


IL9
531
132
2040
6364
1397
2093 ± 2501


IL10
469
302
591
2625
1424
1082 ± 965 


IL12
29
46
12
26
20
27 ± 12


IL13
1804
2718
737
2309
1148
1743 ± 813 


IL15
3
3
5
7
5
5 ± 2


IL17
102
118
1855
5808
805
1738 ± 2385


MCP1
37
24
44
138
242
97 ± 93


MIP1α
19153
19153
19153
19153
19153
19153 ± 0  


MIP1β
23200
23200
23200
23200
9465
20453 ± 6143 


PDGFbb
57
65
70
127
165
97 ± 47


RANTES
76360
73239
15223
64659
37225
53341 ± 26299


TNFα
2026
1801
7344
29476
9507
10031 ± 11373


VEGF
266
577
97
133
108
236 ± 202





*72 h incubation













TABLE 11B







Cytokines found in supernatants from lymphocyte cultures


in ‘bag’ system*


No Beads










Apheresis unit (pg/ml)
N = 5














APH062805
APH082305
APH112905
APH011006
APH112706
Ave ± SD
















Eotaxin
78
86
132
160
117
115 ± 34 


FGF
79
95
117
134
115
108 ± 21 


G-CSF
18
21
31
41
31
29 ± 9 


GM-CSF
3409
3619
3595
8189
3446
4452 ± 2091


IFNγ
5240
7474
27957
188081
54453
56641 ± 76098


IP10
6158
9415
54621
87794
1234754
278548 ± 535605


IL1β
7
6
9
18
19
12 ± 6 


IL1ra
115
117
160
659
396
289 ± 237


IL2
3161
4510
14896
14896
6676
8828 ± 5680


IL4
241
247
351
1108
254
440 ± 376


IL5
425
358
328
1431
247
558 ± 492


IL6
977
955
3207
11942
2852
3986 ± 4567


IL7
5
6
8
7
6
6 ± 1


IL8
973
759
1216
7404
26397
 7350 ± 11006


IL9
531
132
2040
6364
1397
2093 ± 2501


IL10
469
302
591
2625
1424
1082 ± 965 


IL12
29
46
12
26
20
27 ± 12


IL13
1804
2718
737
2309
1148
1743 ± 813 


IL15
3
3
5
7
5
5 ± 2


IL17
102
118
1855
5808
805
1738 ± 2385


MCP1
37
24
44
138
242
97 ± 93


MIP1α
19153
19153
19153
19153
19153
19153 ± 0  


MIP1β
23200
23200
23200
23200
9465
20453 ± 6143 


PDGFbb
57
65
70
127
165
97 ± 47


RANTES
76360
73239
15223
64659
37225
53341 ± 26299


TNFα
2026
1801
7344
29476
9507
10031 ± 11373


VEGF
266
577
97
133
108
236 ± 202





*72 h incubation






Comment: Particularly IFNγ, IP10, IL6, IL9, IL10, TNFα and the chemoattractants appear to be produced at the highest concentrations following stimulation with some variability between units. Though fraction 2 is relatively pure, variation could be possibly due to cell types (e.g., NK cells) and their proportion in each fraction.
A summary of the function of these cytokines for reference is given in Table 12. Awareness of the cytokine concentrations prior to experiments may be used to calculate actual cytokine amount in dilutions, enable matched comparisons between donors, and establish a dosing level for LCM application.







TABLE 12







Selected Cytokines and Their Activities*









Cytokine
Producing Cell
Function





GM-CSF
Th cells
growth and differentiation of monocytes




and DC


IFNγ
T cells, NK cells
antiviral, anti-tumor activity,




immunoregulation; activates APCs,




promotes Th1


IP10 (IFNγ 
activated T cells
mediates Ca+ mobilization, chemotaxis


inducible 




protein)




IL-2
Th1 cells
growth, proliferation, activation


IL-4
Th2 cells
proliferation and differentiation




MHC Class II




proliferation


IL-5
Th2 cells
proliferation and differentiation


IL-6
monocytes,
differentiation into plasma cells



macrophages,
antibody secretion



Th2 cells
differentiation


IL-8
macrophages,
chemotaxis



endothelial cells



IL-10
Th2 cells
cytokine production




activation


IL-12
macrophages, B
differentiation into CTL (with IL-2)



cells
activation




MHC expression




proliferation




pathogen elimination


MIP-1α
macrophages,
chemotaxis



activated NK,




CD8+T, CD4+T



MIP-1β
activated NK,
chemotaxis



CD8+T, CD4+T



RANTES
activated NK,
chemotaxis


(regulated on 
CD8+T, CD4+T



activation




normal T cell 




expressed




and secreted)




TNFα
macrophages,
CAM and cytokine expression, cellular



mast cells, NK
proliferation, differentiation,



cells
inflammation,




cell death





*derived from sources in the literature






The Effects of LCM Produced in Closed System on Autologous Monocytes/DCs

To assess their properties LCM, or activated T (AT) cells, were added to autologous DCs (for 2-3 days or overnight, respectively). The autologous setting was first tested as this would be the likely protocol ‘type’ for immunotherapeutic approval. Treated cells were examined for: (a) viability following culture measured by trypan blue exclusion (FIG. 14); (b) changes in surface marker expression (e.g., CD14, CD40, CD80, CD83, CD86) measured by flow cytometry (Tables 13, 14); (c) effects on T cell responses measured in IFNγ ELISPOT following exposure to CMV and tumor lysates before and after IL7+IL15 expansion (FIGS. 15, 16).
Cell surface marker expression on DCs following exposure to autologous LCM is shown in Table 13.








TABLE 13








% expression













CD14
CD40
CD80
CD86
CD83











pre-LCM exposure
Day 0















DC (thawed, no 
20
77
74
86
2


additional







cytokines added)











post-LCM exposure
Day 2→Day 3















DC alone
20→7
55→31
58→22
73→51
 4→5


DC + LCM (50%)
 9→23
47→54
42→30
54→70
11→16


DC + LCM (25%)
21→22
64→60
63→39
67→70
12→13


DC + LCM (10%)
22→ND
52→ND
49→ND
49→ND
13→ND


DC + non-activated
 4→40
42→44
35→36
19→51
 6→5


(i.e., no bead)







medium







DC + maturation 
43→56
64→54
56→52
66→63
27→15


cocktail (IL1β,







IL6, TNFα, PGE2)





n = 3 units;


ND = not determined






Table 14 shows cell surface marker expression on DCs* following overnight exposure to autologous activated T cells.








TABLE 14







Culture
Marker (% expression)














Condition
Donor
Viability
CD14
CD40
CD80
CD83
CD86





DCs
APH112706
93
38
79
86
1
98


pre-
APH082305
98
2
70
80
0
42


coculture









DCs +
APH112706
57
31
92
92
78
65


non-
APH082305
84
12
98
94
95
94


activated









T cells









DCs +
APH112706
63
5
27
12
4
43


activated
APH082305
85
0
83
94
77
94


T cells










*Gating set on DCs


Refer to cytokine profiles for activation of T cells from these units (Table 9). 


High IFNγ production was measured following stimulation of APH112706.


NOTE: Cytokine release assessed following coculture of DC and non-


activated T cells or AT cells** showed the following









Culture Condition












DC

DC + non-




alone
DC + AT cells
activated T cells
T cells alone





Eotaxin
36
63
0
1


FGF
38
123
41
10


G-CSF
0
19
0
0


GM-CSF
608
536
250
0


IFNγ
23
241
16
0


IP10
70
54621
5256
71


IL1β
1
18
3
1


IL1ra
386
16394
730
0


IL2
0
12
1
0


IL4
56
45
31
0


IL5
1
10
1
1


IL6
25
421
152
45


IL7
4
15
0
0


IL8
248
18225
2542
137


IL9
5
58
6
0


IL10
2
11
2
0


IL12
5
4
0
0


IL13
0
329
0
0


IL15
1
2
1
0


IL17
20
82
31
23


MCP1
8
288
44
0


MIP1α
4
39
9
16


MIP1β
69
821
507
261


PDGFbb
29
849
122
34


RANTES
9
1125
319
673


TNFα
16
243
23
14


VEGF
85
87
20
13





**APH082305; sups from other cocultures have been stored and are available to assay






Comment: DCs incubated with LCM (for 2 or 3 days) demonstrate some upregulation in the maturation marker CD83, as well as changes in costimulatory molecule expression. When autologous activated or non-activated T cells are added (overnight) to DCs in another set of wells, as expected, upregulation of costimulatory markers is observed in both cell populations-except with AT cells from donor APH112706, which showed a negative change in costimulatory molecules. Though difficult to make sweeping statements with such low sample sizes, these changes could be attributable to a number of factors including level of stimulation, receptor activation on T cells, cytokines and or viable status. Viability may not be the issue here as non-activated T cell-DC samples demonstrated equal viability with maintained high DC marker expression. The ‘stimulatability’ of T cells from donor APH112706 shows that CD3-CD28-activation can produce high levels of IFNγ (see Table 9a) which is APC activating and our observation could be due to high activation and ‘spent’ status which occurred prior to our measurement point.
Cytokines released from DC-T cell cocultures underscore the importance of activation levels (IFNγ and chemotactic cytokines). With the addition of antigen and expanded observation points, these measures may prove useful to further characterize and screen individual cells for activation status and potential clinical efficacy, particularly if indicative of differences between induction of immunity or tolerance.
Recall and Primary T Cell Responses-ELISPOT
Description

    
    
        1. Supernatants and antigen were added to monocytes and DCs (designated as APC):
        
            i. Source of DCs: cryopreserved/cultured from monocytes (3 days, serum-free DC medium (CellGenix, Germany) GM-CSF (800 IU/ml)+IL4 (500 IU/ml) (CellGenix);
            ii. Source of monocytes: cryopreserved elutriated rotor-off fraction;
            iii. Cell supernatants tested: 50%, 25% and 10% of original strength from CD3-CD28 bead-activated or non-activated cells;
        
        
        2. Cultures were incubated for 2 days at 37° C. and washed free or LCM or non-activated supernatants then placed in IFNγ ELISPOT assay (see schematic below):
        
            a. For recall responses:
            
                i. cells were counted; autologous lymphocytes (fraction 2) were added at 10 lymphocytes: 1 APC (total 1.5×105 cells/well) then
                ii. plated on IFNγ antibody-coated ELISPOT plates, incubated for 3 days at 37° C. then plates developed and enumerated
            
            
            b. For primary responses:
            
                i. Washed cells were cultured in IL7+IL15 (5 ng/ml each) for 7 days, then washed and plated on coated ELISPOT plates and developed as above.
            
            
        
        
    
    


Table 15 is a schematic of the assay.







TABLE 15







Schematic of Assay















Culture Conditions


Day 0
Day 2
Day 8
Day 9
DCs and monocytes





Culture DCs
Harvest APCs,
Restimulate
Harvest
alone


and
wash and add T
cells with
cells and
+GM-IL4


monocytes:
cells:
antigen or
assay in
+25% LCM


±LCM
RECALL:
Add
ELISPOT
+10% LCM


±tumor
Assay
antigen to
IFNγ
+no bead sup


(myeloma
portion
antigen-

+tumor lysate (d0 + d8


8226)(3 × 104
cells in
naïve cells

or d8)


cell
ELISPOT
overnight

+GM-IL4 + tumor


equivalent
PRIMARY:


lysate (d0 + d8 or d8)


lysate per
Expand


+25% LCM + tumor


well or
portion of


lysate (d0 + d8 or d8)


CMV
cells in IL7 +


+10% LCM + tumor


lysate
IL15 for 7


lysate (d0 + d8 or d8)


(0.01 mg/well)
days


+no bead sup + tumor






lysate (d0 + d8 or d8)









Results

FIGS. 15 A, B provides recall responses and shows that LCM augments response to antigens (CMV, n=2).
FIGS. 16 A, B shows tumor cell lysates (n=2), in which FIG. A is Aph062805 and FIG. B is Aph-11006.
Comment: Cocultures of either DC preparation with LCM and tumor cells show enhanced T cell responses; however, the response is larger in cultures from donor APH011006 compared to donor APH062805. It is interesting to refer to the cytokine table (Table 9) and compare the differences in the degree of the capacity for IFNγ production following activation between the donors. Though different levels in the number of spots in this type of assay are expected, in vivo potential may be predictable by determining a stimulation index for a particular cytokine. Such an index would prove useful for screening potential positive activity; however, to determine if this is a real response, a larger sample evaluation to include appropriate controls will be necessary. Interestingly, the monocyte-antigen cocultures in donor APH011006 also show a larger response than those in the APH062805 donor (FIG. 16B) possibly due to the capacity for detection of IFNγ in this donor or activity of other cytokines such as TNFγ. Higher TNFγ levels were also present in the LCM of this donor which could ‘push’ the monocyte to a DC. Unfortunately, the phenotype of these cells was not determined due to limited amount of material.
These data warrant future study to determine the cell (maturation) status and how the cytokine levels should be manipulated to control and potentially predict function.
Primary Responses: IL7-IL15 T Cell Expansion
FIG. 17 shows responses of LCM-treated ‘naïve IL7-IL15-treated’ cells (i.e., cells first exposed to tumor on day 8) were enhanced compared to cells exposed to antigen on days 0 and 8.
Comment: LCM added to DCs and monocytes enhanced tumor antigen presentation to antigen-naïve T cells cultured in IL7 and IL15 for 7 days prior to antigen stimulation. The higher response levels compared to short recall responses (FIG. 15) could be due to the cytokines that help to maintain viability of T or APCs (cell viability 78-100%). When IL7 and IL15 antigen-treated expanded cultures were restimulated with antigen, that is, pulsed with antigen both on days 0 and 8, there was a response in LCM-treated APCs above non-treated; however, the responses were lower than that of APCs that had been treated with GM-IL4. The LCM data may indicate the presence of suppressive factors or optimal levels of cytokine were present-absent and should be adjusted. This data is reported from two different donors. Expanded studies would be valuable to better characterize the responding cells functionally and phenotypically.
Though it may appear that using a few cytokines would be ‘easiest’ to generate a desired immune response, it may be that the mix of cytokines found in LCM will be the most potent; mimicking a true physiological response and demonstrating that cytokine interactions are essential in optimizing functional activity.
SUMMARY
In this protocol, elutriated fractions 2 or 3 may be used for activation. The greatest number of lymphocytes were collected in fraction 2 (Table 6). There were fairly consistent results between the two fractions (Table 9); however, purity in fraction 3 may be an issue if cell levels in the starting units do not meet optimal elutriation criteria. That is, if the starting total cell number (i.e., ≧5×109 cells) or monocyte count (i.e., ≧1×109) falls below the recommended level for the cell separator, cell fractionation patterns can shift and result in heterogeneous cell distribution in later fractions.
Fractionated or lymphocyte-enriched cell populations permit ‘controlled’ activation as measured by the composition of cell products in the LCM. Cytokines, particularly GM-CSF, IFNγ, IP10, IL2, IL6, IL8, IL9, IL10, IL13, MIP1α, MIP1β, RANTES, TNFα, were most highly induced at fairly even distributions (Table 13); however, more samples should be evaluated for presentation to FDA.
LCM enhanced the expression levels of costimulatory molecules (e.g., CD40, CD80, CD86, and CD83) on DCs, an indication of the maturation process important to antigen presentation (Table 13).
LCM promoted an ‘adjuvant-like’ effect on DC function. DCs treated in vitro with 50-25% of the original LCM solution were able to stimulate responses to CMV and tumor antigens in recall assays (FIG. 15).
LCM may help APC function and expand antigen-specific T cells (FIG. 16); however, optimal levels of cytokine are currently undefined (Note: compare to cells incubated with the ‘standard’ GM-CSF+IL4 formulation).
Based on preliminary results, elutriated cells appear to be a good source for the preparation of LCM in the autologous setting. Note PBMC preparations and elutriated fractions were not directly compared from the same donors in “side-by-side” studies. Stimulated PBMCs, presumably due to the presence of monocytes or possibly platelets, do appear to express some cytokines (e.g., MCP1) not seen at high levels in the elutriated cells which could endow a more robust adjuvant effect.
Further development of the production of LCM or cells is warranted, in which a closed system design illustrated in FIG. 17 could be applied to clinical use.
FIG. 18 shows a proposed culture system for lymphocytes.
It will be appreciated by those skilled in the art that changes could be made to the embodiments described above without departing from the broad inventive concept thereof. It is understood, therefore, that this invention is not limited to the particular embodiments disclosed, but it is intended to cover modifications that are within the spirit and scope of the invention, as defined by the appended claims.

## Claims

1. A method of stabilizing or regressing a tumor in a patient comprising the steps of:
collecting monocyte cells from the patient afflicted with the tumor, said tumor selected from the group consisting of gastric carcinoma, epipharyngial carcinoma, sigmoid carcinoma, melanoma, rectal carcinoma, breast carcinoma, pelvic carcinoma, endometrial carcinoma, and mesothelioma;
culturing the monocyte cells with IL-4 and GM-CFS to form immature dendritic cells from the monocyte cells;
combining the immature dendritic cells and a leukocyte cultured medium adjuvant to form a composition, said leukocyte cultured medium adjuvant comprising at least three cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF; and
administering intratumorally a therapeutically effective amount of the composition to the patient.

2. The method according to claim 1, wherein said LCM adjuvant comprises at least six cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF.

3. The method according to claim 2, wherein said LCM adjuvant comprises at least ten cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF.

4. The method of claim 1, wherein the patient is a human.

5. The method of claim 1, further comprising the step of treating the patient with chemotherapy prior to the administration of the immature dendritic cells and LCM adjuvant.

6. The method of claim 1, further comprising the step of treating the patient with radiation therapy prior to administration of the immature dendritic cells and LCM adjuvant.

7. A method of stabilizing or regressing a tumor in a patient comprising the steps of:
collecting monocyte cells from the patient afflicted with the tumor, said tumor selected from the group consisting of gastric carcinoma, epipharyngial carcinoma, sigmoid carcinoma, endometrial carcinoma, pelvic carcinoma, mesothelioma, melanoma, rectal carcinoma, and breast carcinoma;
culturing the monocyte cells with IL-4 and GM-CFS to form immature dendritic cells from the monocyte cells;
combining the immature dendritic cells and a leukocyte cultured medium adjuvant to form a composition, said leukocyte cultured medium adjuvant comprising at least three cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF;
administering chemotherapy to the patient; and
administering intratumorally a therapeutically effective amount of the composition to the patient.

8. The method according to claim 7, wherein said LCM adjuvant comprises at least six cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF.

9. The method according to claim 8, wherein said LCM adjuvant comprises at least ten cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF.

10. The method of claim 7, wherein the patient is a human.

11. The method of claim 7, further comprising the step of treating the patient with radiation therapy prior to the administration of the immature dendritic cells and LCM adjuvant.

12. A method of stabilizing or regressing a tumor in a patient comprising the steps of:
collecting monocyte cells from the patient afflicted with the tumor, said tumor selected from the group consisting of gastric carcinoma, rectal carcinoma, epipharyngial carcinoma, sigmoid carcinoma, endometrial carcinoma, pelvic carcinoma, mesothelioma, melanoma, and breast carcinoma;
culturing the monocyte cells with IL-4 and GM-CFS to form immature dendritic cells from the monocyte cells;
combining the immature dendritic cells and a leukocyte cultured medium adjuvant to form a composition, said leukocyte cultured medium adjuvant comprising at least three cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF;
administering radiation therapy to the patient; and
administering intratumorally a therapeutically effective amount of the composition to the patient.

13. The method according to claim 12, wherein said LCM adjuvant comprises at least six cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF.

14. The method according to claim 13, wherein said LCM adjuvant comprises at least ten cytokines selected from the group consisting of eotaxin, FGF, G-CSF, GM-CSF, IFNγ, IP10, IL1β, IL1ra, IL2, IL4, IL5, IL6, IL7, IL8, IL9, IL10, IL12, IL13, IL15, IL17, MCP1, MIP1α, MIP1β, PDGFbb, RANTES, TNFα, and VEGF.

15. The method of claim 13, wherein the patient is a human.

16. The method of claim 13, further comprising the step of treating the patient with chemotherapy at a time prior to introducing the immature dendritic cells and LCM adjuvant into the tumor tissue.