ALLELE SPECIFIC IMMUNOTHERAPEUTIC METHOD AND DOSAGE FORM

Abstract: Diseases associated with one or more particular alleles of MHC-linked immune response genes are controlled through selective immunosuppression of the immune response(s) con­ trolled by the allele(s) by administering monoclonal antibodies directed specifically against the gene product(s) of the al­ lele(s) to individuals who are heterozygous for the gene(s).

Description: ALLELE SPECIFIC IMMUNOTHERAPEUTIC MET1OD AND DOSAGE FORM The United States Government has rights to this invention pursuant to Grant No AI07757 awarded by National Institutes of Health. The invention is in the field of immunotherapy. ore specifically it relates to controlling diseases associated with a particular allele of certain regions the major histocompatibility complex (MHC), such as the HLA-D region in humans, by selectively suppressing the immune response(s) controlled by the allele with an allele-specific monoclonal antibody. Immunosuppression is commonly achieved through treatment with a means and/or agent such as radiation, antimitotics, heterologous antilymphocyte sera, heterologous anti-T cell antibody, adrenal steroids, and cytotoxic chemicals. Such treatment is nonspecific in the sense that it suppresses the entire immune system rather than a single immune response. The major side effect of nonspecific or general immunosuppression is immunodeficiency which leaves the treated individual highly susceptible to bacterial, viral, and fungal infections that would otherwise be manageable but under the circumstances are potentially life-threatening. Antibodies are the most inherently specific natural immunosuppressive agents. Antibody regulation of the mouse immune system has been reported by Greene, et al, PNAS 74:5118-5121, 1977 and Meruelo, et al, PNAS 77:2178, 1980. Their experiments indicated that different anti-Ia sera could both increase and decrease tumor growth in vivo. This correlated with suppression or enhancement of the specific immune response. Antibody immunosuppressive therapy is used in certain instances in humans, such as for preventing Rh-related erythrbblastosis fetalis. This mode of treatment, however, is limited to diseases in which the offending antigen is known and a specific human antiserum is available. Murine monoclonal antibodies have been developed against various antigens, including H-2 antigens. See, for instance Galfre, et al, Antihodies to major histocompatibility antigens produced by hybrid cell lines, Nature, Vol 266, 7 April 1977. Although these antibodies have been directed against a particular histocompatability antigen, they are species specific only, and have not been specific enough to be effective in treating allele specific autoimmune diseases. In summary, current immunotherapy practice does not include a technique for treating genetically controlled, MHC associated autoimmune diseases via selective immunosuppression. The prime objective of the present invention is to provide such technique. One aspect of the invention is an immunotherapeutic method for treating an individual to control a disease associated with an MHC-linked immune response gene allele of the individual, the individual being heterozygous for the gene, comprising administering a disease-controlling amount of a monoclonal antibody against the product of the allele to the individual, whereby the immune response controlled by the allele is selectively suppressed. Another aspect of the invention is a unit dosage form for treating an individual to control a disease associated with an MHC-linked immune response gene allele of the individual the individual being heterozygous for the gene, comprising a monoclonal antibody against the product of the allele combined with a pharmaceutically acceptable vehicle, the amount of the monoclonal antibody in the dosage form being sufficient to substantially and selectively suppress the immune response controlled by the allele. The term "control" and conjugates thereof that are used herein to describe the purpose and/or result of the treatment is intended to mean prophylaxis and/or therapy. Accordingly the invention ma be used to prevent or alleviate a disease associated with a particular immune response allele of the MHC of the individual being treated. It is known that all mammals and probably all vertebrates possess basically equivalent MHC systems and that immune response genes are linked to the MHC. The invention may, therefore, be used to control immune response allele associated diseases in heterozy gous vertebrate animals, particularly in mammals. It is expected that the immunotherapeutic method of the invention will be used primarily in humans, as well as in domestic, pet, and sport animals. Associations between the human MHC, denoted the HLA, and susceptibility to diseases are reported on the HLA and Disease Registry which is kept and published in Copenhagen hy Ryder and Svejgaard. Such associations are determined by comparing the HLA types of a diseased population with the HLA types of a healthy population. Many diseases are associated with more than one HLA specificity. Most associations have involved the D region of the HLA. Some are race specific. The association of a particular HLA allele with susceptibility to a disease is dominant. Studies to date have shown associations with an enormous variety of diseases, including most autoimmune diseases, some of which are listed below. Antigen Frequency HLA Rela Gene Pa- Con- tive Racial Group Type tients trols Risk Joint Disease Ankylosing spondylitis Caucasian B27 89.8 8.0 87.8 Japanese B27 66.7 0.0 305.7 Reiter's disease Caucasian B27 78.2 8.4 35.9 Yersinia arthritis Caucasian B27 79.4 9.4 24.3 Salmonella arthritis Caucasian B27 66.7 8.6 17.6 Psoriatic arthritis Caucasian B13 19.8 5.5 4.8 Central Jones B27 40.2 8.7 8.6 Juvenile rheumatoid arthritis Caucasian B27 26.4 8.5 4.7 Rheumatoid arthritis Caucasian Dw4 42.2 15.7 3.0 Caucasian Dw3 30.0 17.0 2.7 Sjogren's syndrome Caucasian B8 50.6 24.0 3.2 Dw3 53.5 17.0 5.2 Antigen Frequency HLA Rela Gene Pa- Con- tive Racial Group Type tients trols Risk Neurological disease Multiple sclerosis Caucasian Dw2 60.0 15.0 8.5 Myasthenia gravid Caucasian Al 44.6 26.3 2.45 Caucasian B8 57.7 22.9 4.40 Caucasian Dw3 43.0 17.0 3.5 Paralytic poliomyelitis Caucasain B7 37.8 19.0 2.6 EIHocrine glands Graves' disease Caucasian B8 36.7 21.7 2.13 Thyroid Dw3 50.0 21.7 4.0 Japanese Bw35 56.8 20.5 4.97 deQuervain's thyroiditis Caucasian Bw35 76.9 12.5 22.2 Adrenal Addison's disease Caucasian B8 50.0 22.7 3.9 Dw3 - 70.0 21.7 10.5 Pancreas Diabetes Caucasian B8 36.7 21.8 2.1 Juvenile onset diabetes Bw15 22.8 14.9 2.1 Dw3 50.0 4.7 4.5 Gastrointestinal tract Chronic active hepatitis Caucasian Al 41.6 28.4 1.8 B8 44.2 20.3 3.0 Dw3 60.0 21.7 7.2 Celiac disease Caucasian Al 63.7 29.5 4.2 (gluten entero pathy) 138 71.2 23.1 8.8 Dw3 98.0 15.0 278. Hemochromatosis Caucasian A3 78.4 27.0 9.5 B14 25.5 3.4 9.23 Ulcerative colitis Japanese B5 80.0 30.8 9.3 Pernicious anemia Caucasian B7 35.8 22.1 2.2 Skin Psoriasis Caucasian B13 19.7 4.5 4.65 Bw17 26.2 7.8 4.7 Bw37 7.7 1.4 5.4 D-LD MA 36.0 5.0 10.2 Antigen Frequency HLA Rela Gene Pa- Con- tive Racial Group Type tients trols Risk Dermatitis herpetiformis Caucasian Al 69.0 30.1 4.4 B8 77.0 24.7 9.2 Pemphigus vulgaris Caucasian AlO 39.3 12.7 3.1 Behcet's disease Caucasian B5 35.1 11.1 4.3 Japanese B5 75.0 30.8 6.5 Herpes labialis Caucasian Al 55.6 25.1 3.7 B8 33.3 16.8 2.5 CEye disease Anterior uvetis Caucasian B27 56.8 7.7 15.4 Vogt-Koyanagi-Harada disease Japanese B22J 42.9 13.2 4.5 D-LD <RTI ID=6.6> Yet66.6 16.0 11.2 Conqenlal malformation Congengìal heart disease Caucasian A2 80.n 43.9 4.9 Preferably the invention is used to control diseases having a high degree of association with one or more particular HLA gene types. Examples of such associations are: B27 - ankylosing spondylitis; Dwd - rheumatoid arthritis and juvenile onset diabetes; Dw3 Sjogrenls syndrome, myasthenia gravis, Addison's disease, juvenile onset diabetes, chronic active hepatitis, and celiac disease; and Dw2 - multiple sclerosis. In order for immunotherapy to be specifically directed against the immune response controlled by the allele associated with the disease, the individual riust be heterozyqous for the allele. Otherwise the response of the other (identical) allele at the locus would quite likely he suppressed as well. The heterozyqosity of an individual for a particular allele may be established by standard HLA typing methods such as typing by cytotoxicity using pregnancy sera or by mixed pho- cyte reaction (HLA-D) using cells from individuals that are homozygous for the HLA region involved. Most individuals (80% - 90%) are heterozygous for HLA-A,R,C, and D. According to the invention, diseases are controlled by selective immunosuppression using monoclonal antibodies having a specific affinity for the product of the particular respond allele associated with the disease. In instances in which the disease is associated in different populations with more than one allele, it may be desirable to administer monoclonal antibodies against each of the associated allele products concurrently or sequentially. Recent evidence indicates that immune response gene products are "Ia" molecules--surface glycoproteins composed of o & and chains. Monoclonal antibodies directed against such products nay he made from antibody expressing hybridomas by well known procedures such as those described by Kohler, G. and Milstein, C. (1975) Nature 356: 497-7; Levy, R. and Dilley, I. (1978) PNAS USA 75: 4211-4215; àlfre et al, supra; and Ollson, C. and Kaplan, H. (1980) PNAS USA 77: 5429-5431. Briefly, these processes involve fusing myeloma cells and lymphocytes in a nonionic detergent medium, typically polyethylene glycol. The fused cells or hybridomas are then expand- ed in a nutrient medium and then selected by incubation in a selective mediurn such as HAT medium. The cells surviving the incubation are assayed for production of the desired antibody and positive cells are sorted and cloned by known techniques. The monoclonal- antibodies expressed by the clones may be harvested and purl flea by known techniques. Myeloma cell lines that may be used in the process are known and available. The lymphocytes, typically either spleen cells or B-cells, are obtained from immunized individuals known to have a high titer of the desired anti-MHC antibody. Pregnancy sera is a good source for such B-cells. In tis manner monoclonal antibodies that are directed specifically against the product of the particular allele associated with the disease to be treated may be prepared. Exapples of antibodies that may be made and used in the invention are anti-HLA-B27 monoclonal antibody, anti HLA-Dw2 monoclonal antibody, anti-HLA-Dw3 monoclonal antibody, and anti-Dw4 monoclonal antibody Although xenogeneic antibodies may be used in the invention, it is-preferable to use allogeneic antibodies to reduce the likelihood of the antibodies themselves inducing an immune response from the host. An allogeneic monoclonal antibody is one that is expressed by a hybridoma made by fusing cells from the same animal species as the host. The antibodies may be from one or more immunoglobulin classes (IgM, IgG, IgA, IgD, or IgE) depending upon the particular disease and individual involved. Antigen binding fragments (F(ab1)2, Fab, Fab') of IgG monoclonal antibodies may also be used in appropriate situations, for instance, where it is desired to reduce the likelihood of complement fixation. As used herein, the term "monoclonal antibody" is intended to include such fragments as well as whole immunoglobulins. The anti-MHC allele monoclonal antibodies are preferably administered to the individuals in a manner that will maximize the likelihood of the antibody reaching the products of the disease associated allele, binding to those products, and thereby blocking the immune response that leads to or perpetuates the disease. Being proteins, the antibodies will normally be administered parenterally, preferably intravenously. Since they may react with white blood cells, they will preferably be administered slowly either from a conventional IV administration set or from a subcutaneous depot. marine tests indicate that the amount of antibody required to suppress an immune response will typically be in the range of 1 to 3 g/l of blood volume, more usually 1.5 to 2.5 q/l of blood volume. This dosing may have to be repeated periodically depending upon the particular disease. When used as a prophylaxis it may be possible to administer the antibody or antibodies semiannually or annually. In treating an esting disease it is expected that the antibody or antibodies will be administered more frequently as needed. For autoimmune diseases that are known to be triggered or aggravated by particular environmental factors, the dosage regimen will be scheduled accordingly. When administered parenterally the antibodies will be formulated in a unit dosage injectable form (solution, suspension, emulsion) in association with a pharmaceutically acceptable parenteral vehicle. Such vehicles are inherently nontoxic and nontherapeutic. Examples of such vehicles are water, saline, Ringer's solution, dextrose solution, and Hank's solution. Nonaqueous vehicles such as fixed oils and ethyl oleate may also be used. A preferred vehicle is 5w% dextrose/saline. The vehicle may contain minor amounts of additives such as substances that enhance isotonicity and chemical stability, e.g. buffers and preservatives. The antibody is preferably formulated in purifled form substantially free of aggregates and other proteins at concentrations of ahout 5 to 30 mg/ml, preferably 10 to 20 mg/ml. The following examples further illustrate the invention. These examples are not intended to limit the invention in any manner. EXAMPLE 1 H2k/b mice are heterozygous for the H-2k (I-Ak) and H-2b (I-A5) alleles. H-2k mice respond to (n,G)-A--L but not to (T,G)-A--L. -2b mice respond to (T,G)-A--L but not (H,G)-A--L. The H-2k/bF heterozygote responds to both antigens. Treating these F1 mice with two ml of a 5-10 mg/ml solution of an anti I-Ak monoclonal antibody, suppresses the immune response to two aqueous injections of (H,G)-A--L but not to (T,G)-A--L. This is thus allele specific immunosuppression for an antigen for which the high responder is I-Ak and not I-Ab. EXAMPLE 2 One mouse autoimmune disease, EAE, has been suppressed in the homozygous H-2S/s mouse using monoclonal anti-I -AS. In view of the known correlations between the chemistry and function of the murine H-2 system and its gene products and the human HLA system and its gene products, persons of skill in immunology will find the murine responses to anti-H-2 allele monoclonal antibodies reported above convincing evidence that humans will respond similarly to anti-HLA allele monoclonal antibodies. EXAMPLE 3 This Example provides a hypothetical protocol for confirming the efficacy of the invention process in controlling multiple sclerosis in humans. The patient population is 50-100 adult D type heterozygous persons who are HLA-Dw2 positive and have rapidly progressive or nonremitting multiple sclerosis. One half of this population is treated with human anti-HLA-Dw2 monoclonal antibody at a dose of 2 g/l of blood volume admin isRered intravenously over several hours. This treatment is repeated weekly for four months, The other half of the population is treated in the same manner but with an innocuous comparable control monoclonal antibody that is not directed against the patients' D type. A comparison of the efficacy of this treatment against the control based on evaluation of the patients' neurological lesions shows the efficacy of the anti-HLA-Dw2 monoclonal antibody treatment in controlling multpile sclerosis. Modifications of the above modes for carrying out the invention that are obvious to those of skill in related arts, eg molecular biology, biochemistry, immunology, and medicine, are intended to be within the scope of the following claims.

Claims: CLAIMS 1. A unit dosage form for treating an in dividual to control a disease associated with an MHClinked immune response gene allele of the individual, the individual being heterozygous for the gene, comprising a monoclonal antibody against the product of the allele combined with a pharmaceutically acceptable vehicle, the amount of the monoclonal antibody in the dosage form being sufficient to substantially and selectively suppress the immune responses controlled by the allele. 2. The unit dosage form of Claim 1 wherein the monoclonal antibody is an allogeneic monoclonal antibody. The unit dosage form of Claim I or 2 wherein the individual is a human, the disease is multiple sclerosis,- the allele is HLA-Dw2 and the monoclonal antibody is anti-HLA-Dw2. 4. The unit dosage form of Claim 1 or 2 wherein the individual is a human, the disease is r.iyasthenia gravis, the allele is HLA-Dw3, and the monoclonal antibody is anti-HLA-Dw3. 5. The unit dosage form of Claim 1 or 2 wherein the individual is a human, the disease is rheumatoid arthritis, the allele is at least one of HLA-Dw4 and HLA-Dw3, and the monoclonal antibody is correspondingly at least one of anti-HLA-Dw4 and anti-HLA-Dw3 The unit dosage form of Claim 1 or 2 wherein the individual is human, the disease is juvenile onset diabetes, the allele is at least one of HLA-Dw4 and HLA-Dw3, and the monoclonal antibody is correspondingly at least one of anti-HLA-Dw4 and anti-HLA-Dw3. 7. The unit dosage form of Claim l.or 2 herein the dosage form is a parenteral dosage form. 8. The unit dosage form of Claim low 2 wherein the dosage form is an intravenous dosage form, the vehicle is a solvent for the antibody, and the concentration of the antibody in the dosage form is about 5 to 30 mg/ml. 9. The unit dosage form of Claim 7 or 8 wherein said amount of monoclonal antibody is in the range of 1 to 3 grams per liter of blood volume of the individual. 10. Monoclonal antibody anti-HLA-DW2 for use in the treatment of multiple sclerosis in individuals with a gene heterozygous for the relevant immune response. 11. Monoclonal antibody anti-HLA-DW3 for use in the treatment of myasthenia in individuals with a gene heterozygous for the relevant immune response. 12. Monoclonal antibody anti-HLA-DW4 or anti-IILA-0W3 for use in the treatment of rheumatoid arthritis in individuals with a gene heterozygous for the relevant immune response. 13. Monoclonal antibody anti-HLA-D}z4 or anti-HLA-DXig for use in the treatment of juvenile onset diabetes in individuals with a gene heterozygous for the relevant immune response.

Inventors: MCDEVITT, HUGH O.
Applicants: THE BOARD OF TRUSTEES OF THE LELAND STANFORD JUNIOR UNIVERSITY
Application year: 1982
Main classification: A61K39
IPC codes: C07K16, A61K39, C12N15, A61K38, C12P21