# Patent

## Title
Method for treating cervical cancer

## Abstract

Use of Interleukin-20 for treating cervical cancer or cells infected with human papilloma virus. IL-20 can be administered alone or in conjunction with radiation or chemotherapeutic agents or surgical excision of the involved cells or lesions.

## Background
The present application is a divisional of U.S. patent application Ser. No. 10/321,163, filed Dec. 17, 2002, now U.S. Pat. No. 7,582,287, which claims the benefit of U.S. Provisional Patent Application No. 60/341,783, filed on Dec. 17, 2001, both of which are herein incorporated by reference.


BACKGROUND OF THE INVENTION
According to the American Cancer Society, 12,800 new cases of invasive cervical cancer would be diagnosed in the United States in 1999. During the same year, 4800 patients were expected to die of the disease. This represents approximately 1.8% of all cancer deaths in women and 18% of gynecological cancer deaths. However, for women aged 20 to 39 years of age, cervical cancer is the second leading cause of cancer deaths. Molecular and epidemiologic studies have demonstrated a strong relationship between human papillomavirus (HPV), cervical intraepithelial neoplasia, (CIN), and invasive carcinoma of the cervix. Thus, there is a need to develop new therapeutic entities for the treatment of human papillomavirus infection, cervical intraepithelial neoplasia and carcinoma of the cervix.
DESCRIPTION OF THE INVENTION
The present invention fills this need by administering interleukin-20 (IL-20) to a mammalian having cervical cancer. IL-20 can also be used to treat a human papillomavirus infection. The present invention also provides a method for inhibiting the growth of cervical cancer cells by bringing IL-20 into contact with said cancerous cervical cells. Interleukin-20 (formally called Zcyto10) can be produced according to the method described in International Patent Application No. PCT/US98/25228 filed on Nov. 25, 1998. The human IL-20 polypeptide is comprised of a sequence of 176 amino acids with the initial Met as shown in SEQ ID NO:1 and SEQ ID NO:2. It is believed that amino residues 1-24 are signal sequence, and the mature IL-20 polypeptide is represented by the amino acid sequence comprised of residues 25, a leucine, through amino acid residue 176, a glutamic acid residue, also defined by SEQ ID NO:12. Another embodiment of the present invention is defined by the sequences of SEQ ID NO: 3 and SEQ ID NO: 4. The polypeptide of SEQ ID NO: 4 is comprised of 151 amino acid residues wherein amino acids 1-24 comprise a signal sequence and the mature sequence is comprised of amino acid residues 25, a leucine, through amino acid 151 a glutamic acid, also defined by SEQ ID NO:13. Another active variant is comprised of amino acid residues 33, a cysteine, through amino acid residue 176 of SEQ ID NO:2. This variant is also defined by SEQ ID NO:26.
Mouse IL-20 is also a polypeptide comprised of 176 amino acid residues as defined by SEQ ID NOs: 18 and 19. Mouse IL-20 has a signal sequence extending from amino acid residue 1, a methionine, extending to and including amino acid residue 24, a glycine of SEQ ID NO:19. Thus, the mature mouse IL-20 extends from amino acid residue 25, a leucine, to and including amino acid residue 176 a leucine of SEQ ID NO:19, also defined by SEQ ID NO:20. Another active variant is believed to extend from amino acid 33, a cysteine, through amino acid 176, of SEQ ID NO:19. This variant is also defined by SEQ ID NO:25.
A variant of mouse IL-20 is defined by SEQ ID NOs: 33 and 34. This variant is 154 amino acid residues in length and has a signal sequence extending from amino acid residue 1, a methionine, to and including amino acid residue 24, a glycine, of SEQ ID NO:34. Thus, the mature sequence extends from amino acid residue 25, a leucine, to and including amino acid residue 154, a leucine, of SEQ ID NO:34. The mature sequence is also defined by SEQ ID NO:35.
Pathology of Cervical Cancer
Cervical dysplasia cells and cervical intraepithelial neoplasia (CIN) cells develop into invasive cervical cancer over a number of years. CIN grades I, II and III correspond to mild, moderate, and severe cervical dysplasia. CIN III, which includes severe dysplasia and carcinoma in situ, is unlikely to regress spontaneously and, if untreated, may eventually penetrate the basement membrane, becoming invasive carcinoma. Squamous cell carcinoma accounts for 80 to 85% of all cervical cancers; adenocarcinomas account for most of the rest. Invasive cervical cancer usually spreads by direct extension into surrounding tissues and the vagina or via the lymphatics to the pelvic and para-aortic lymph nodes drained by the cervix. Hematologic spread is possible.
Symptoms, Signs and Diagnosis of Cervical Cancer
CIN is usually asymptomatic and discovered because of an abnormal Pap smear. Patients with early-stage cervical cancer usually present with irregular vaginal bleeding, which is most often postcoital, but intermenstrual bleeding or menometrorrhagia may occur. Patients with larger cervical cancers or advanced-stage disease may present with foul-smelling vaginal discharge, abnormal vaginal bleeding, or pelvic pain. Obstructive uropathy, back pain, and leg swelling are manifestations of late-stage disease. Suspicious lesions, generally first detected by a Pap smear are biopsied. If clinical disease is invasive, staging is performed on the basis of the physical examination, with a metastatic survey including cystoscopy, sigmoidoscopy, IV pyelography, chest x-ray, and skeletal x-rays.
Treatment of Cervical Cancer with IL-20
Cervical cancer can be treated by administration of IL-20 to a female mammal, particularly a human female, afflicted with the disease. IL-20 can be administered intralesionally, or intramuscularly for localized disease. For metastatic disease, IL-20 can also be administered by intraperitoneal administration including intravenous administration. IL-20 can be administered alone or in conjunction with standard therapies such as surgery, radiation or other chemotherapeutic agents such as bleomycin, chlorambucil, epirubicin, 5-fluorouracil, ifosfamide, mitomycin, methotrexate, vincristine, cisplatin and vinblastine.
Use of Interleukin-20 to Treat Cells Infected with the Human Papillomavirus/Genital Warts
Cells infected with the human papillomavirus (HPV) can be treated with IL-20 to inhibit the proliferation of the virus. Anogenital warts caused by HPV type 6, 11, 16, 18, 31, 33 and 35 are transmitted sexually and have an incubation period of 1 to 6 months. Endocervical wart infections caused by type 16 or 18 have been implicated as a cause of cervical intraepithelial neoplasia and cervical cancer. HPV types 16 and 18 generally do no not cause external genital warts, which are usually caused by types 6 and 11.
Symptoms, Signs and Diagnosis
Genital warts usually appear as soft, moist, minute pink or gray polyps that enlarge, may become pedunculated, and are usually found in clusters. The surfaces resemble the surface of cauliflower. In men they occur most commonly on warm, moist surfaces in the subpreputial area, on the coronal sulcus, within the urethral meatus, and on the penile shaft. In women, the vulva, the vaginal wall, the cervix, and the perineum may become involved. They are particularly common in the perianal region and rectum in homosexual men. Growth rates vary, but pregnancy, immunosuppression, or maceration of the skin may accelerate both the growth of individual lesions and their spread. Genital warts usually can be identified by their appearance but must be differentiated from the flat-topped condyloma lata of secondary syphilis. Biopsies of atypical or persistent warts may be necessary to exclude carcinoma.
IL-20 can be administered directly into lesions containing cells infected with HPV alone or with standard therapies such as interferon alpha or interferon beta both of which are commercially available. Interferon alpha is available from Schering Corporation of Kenilworth, N.J. and is called INTRON A®. Interferon beta is produced by Biogen of Cambridge, Mass. and is called AVONEX®. IL-20 can also be administered with other standard therapies for treating HPV including antimitotics such as podophyllotoxin, podophyllin, or 5-fluorouracil; caustics such as trichloroacetic acid; or interferon inducers such as imiquimod.
The quantities of IL-20 for effective therapy will depend upon many different factors, including means of administration, target site, physiological state of the patient, and other medications administered. Thus, treatment dosages should be titrated to optimize safety and efficacy. Typically, dosages used in vitro may provide useful guidance in the amounts useful for in vivo administration of these reagents. Animal testing of effective doses for treatment of particular disorders will provide further predictive indication of human dosage. Methods for administration include, intravenous, peritoneal, intramuscular, or intralesional. Pharmaceutically acceptable carriers will include water, saline, buffers to name just a few. Dosage ranges would ordinarily be expected from 1 μg to 1000 μg per kilogram of body weight per day. However, the doses may be higher or lower as can be determined by a medical doctor with ordinary skill in the art. Excipients and stabilizers can possible be added. These include glycine, histidine, glutamate, aspartate, sugars, sucrose, trehalose, galactose sorbitol, arginine, D- and/or L0amino acids, sugar alcohols, lactose, maltose, threonine, lysine, methionine, isoleucine, a surface active agent such as TWEEN 80, TWEEN 20, polyethylene glycol (PEG) (particularly those PEGs having molecular weights between 1000 and 35000 Da), cetyl alcohol, polyvinylpyrrolidone, polyvinyl alcohol, lanolin alcohol and sorbitan. A reducing agent may be included, such as cysteine, N-acetyl-cysteine, and thioglycerol. For a complete discussion of drug formulations and dosage ranges see Remington's Pharmaceutical Sciences, 18th Ed., (Mack Publishing Co., Easton, Pa., 1996), and Goodman and Gilman's: The Pharmacological Bases of Therapeutics, 9th Ed. (Pergamon Press 1996).
IL-20 can also me administered in conjunction with other treatments for cervical cancer such as radiation and chemotherapy. Examples of chemotherapeutic agents include bleomycin, chlorambucil, epirubicin, 5-fluorouracil, ifosfamide, mitomycin, methotrexate, vincristine, cisplatin and vinblastine.


EXAMPLE
We tested IL-20 in a HeLa229 cytotoxicity assay to measure the ability of IL-20 to prevent cells from growing during normal growth conditions. We used MTT reagent (Promega, Madison, WI USA) as our detection and readout for this inhibition assay. Procedure of a cytotoxicity assay:
Day 1—Plate cells out in complete growth media (with serum) at 5000 cells/well in a 96 well format and let them incubate overnight at 37 degrees and 5% CO2.
Day 2—Dump off media and add a dose response of appropriate ligands in complete growth media (IL-20, zmda1, and MDA7 at 10, 100, and 1000 ng/ml.), along with a positive control retinoic acid (100 uM) in complete growth media, while leaving some wells in complete growth media as controls of how the cells normally grow under normal conditions. Put the cells in incubator and let the assay go for 72 hrs.
Day 5—Add 15 ul/well of MTT reagent, let cells inc. for 4 hrs., then add 100 ul of stop solution, let cells inc. for an additional 1 hr., then read the plate on a multilabel counter (Victor2, PerkinElmer Life Sciences Inc., Boston). The MTT protocol will give you two readings, one at a 650 wavelength (background) and one at a 572 wavelength. Subtract the 650 reading from the 572 reading to get your actual output. These numbers are averaged and converted to a % inhibition value.
Results:

    
    
        Retnoic Acid gave a 53% inhibition of growth (positive control)
        IL-20 gave a maximal 20% inhibition of growth

## Claims

1. A method for inhibiting the proliferation of a human papillomavirus (HPV)-infected cervical cancer cell comprising contacting the cell with an interleukin-20 (IL-20) polypeptide.

2. The method according to claim 1 wherein the IL-20 is a first therapeutic agent that is administered in conjunction with a second HPV therapeutic agent.

3. The method according to claim 2 wherein the second HPV therapeutic agent is selected from the group consisting of interferon alpha, interferon beta, podophyllotoxin, podophyllin, 5-fluorouracil, trichloroacetic acid and imiquimod.

4. The method according to claim 1 wherein the IL-20 is administered intralesionally in conjunction with electrocauterization, laser, cryotherapy, or surgical excision of the cell infected with HPV.

5. The method according to claim 1, wherein the IL-20 polypeptide is the sequence as shown in SEQ ID NOs: 2, 4, 12, 13, or 26.

6. The method of claim 1, wherein the HPV-infected cervical cancer cells are treated with radiation in conjunction with the IL-20 polypeptide.

7. The method of claim 1, wherein the HPV-infected cervical cancer cells are treated with one or more chemotherapeutic agents in conjunction with the IL-20 polypeptide.

8. The method of claim 7, wherein the chemotherapeutic agent is selected from the group consisting of bleomycin, chlorambucil, epirubicin, 5-fluorouracil, ifosfamide, mitomycin, methotrexate, vincristine, cisplatin and vinblastine.

9. A method for inhibiting the proliferation of HPV-infected cervical cancer cells comprising bringing a polypeptide comprising amino acid residues 33-176 of SEQ ID NO: 2 into contact with the HPV-infected cervical cancer cells.

10. The method of claim 9, wherein the HPV-infected cervical cancer cells are treated with radiation in conjunction with the polypeptide.

11. The method of claim 9, wherein the HPV-infected cervical cancer cells are treated with one or more chemotherapeutic agents in conjunction with the polypeptide.

12. The method of claim 11, wherein the chemotherapeutic agent is selected from the group consisting of bleomycin, chlorambucil, epirubicin, 5-fluorouracil, ifosfamide, mitomycin, methotrexate, vincristine, cisplatin and vinblastine.

13. The method of claim 9, wherein the polypeptide comprises amino acid residues 25-176 of SEQ ID NO: 2.

14. The method of claim 9, wherein the polypeptide comprises amino acid residues 1-176 of SEQ ID NO: 2.

15. A method for inhibiting the growth and/or proliferation of HPV-infected cervical cancer cells comprising bringing a polypeptide comprising amino acid residues 25-151 of SEQ ID NO: 4 into contact with the HPV-infected cervical cancer cells.

16. The method of claim 15, wherein the HPV-infected cervical cancer cells are treated with radiation in conjunction with the polypeptide.

17. The method of claim 15, wherein the HPV-infected cervical cancer cells are treated with one or more chemotherapeutic agents in conjunction with the polypeptide.

18. The method of claim 17, wherein the chemotherapeutic agent is selected from the group consisting of bleomycin, chlorambucil, epirubicin, 5-fluorouracil, ifosfamide, mitomycin, methotrexate, vincristine, cisplatin and vinblastine.

19. The method of claim 15, wherein the polypeptide comprises amino acid residues 1-151 of SEQ ID NO: 4.