COMPOSITIONS FOR THE ALLEVATION, TREATMENT AND DIAGNOSIS OF ARTHRITIC DISEASE AND RELATED CONDITIONS

Abstract: The invention provides pharmaceutical compositions for the alleviation of arthritic diseases. These contain as active ingredient mycobacteria or fractions of these, e.g. obtained by fractionation in certain solvents. The compositions can also be used for vaccinations. There is also provided an assay for the diagnosis of arthritic diseases, and a kit for carrying such an assay.

Description: COMPOSITIONS FOR THE ALLEVIATION, TREATMENT AND DIAGNOSIS OF ARTHRITIC DISEASE AND RELATED CONDITIONS The invention relates to preparations for - - ' ' preventing various arthritic afflictions, for alleviating symptoms of arthritic diseases and of other autoimmune diseases, and for their diagnosis. The novel preparations are based on certain mycobacteria or on certain fractions obtained from mycobacteria . There were also developed certain clones of T-lymphocytes which can be used for diagnostic and therapeutic purposes. Background of the Invention; Millions of persons are afflicted with chronic forms of arthritis which are thought to involve autoimmunity to constituents of the joints or connecting tissues of the body. These conditions .include rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome. and other forms of reactive arthritis. The etiology of these diseases- is- not known, but previous infection with various microbes seems ' to act as an inciting circumstance in genetically susceptible individuals. For example, patients with rheumatoid arthritis may show unusual immune reactivity to mycobacterial antigens and immunization with the BCG strain of mycobacteria was found to lead to arthritis in 15 of 150 individuals. Ankylosing spondylitis has been associated with infection by Klebsiella or Yersinia species of bacteria and other cases of arthritis by Salmonella, Snigella, etc. There is no evidence of active infection of joints by these microbes in the vast majority of cases and it has been postulated that microbial infection may trigger an aberrant, , autoimmune response of the individual against his own antigens present in the joints. Adjuvant arthritis (AA) is an experimental model of arthritis inducible by immunizing susceptible strains of rats to Mycobacteria. The disease which develops about 12 days after immunization has many of the features of rheumatiod arthritis and AA has been considered to De a model of rheumatoio arthritis. Summary of the Invention There are provided pnarmaceuticai preparations for the diagnosis, for the vaccination against, and for the treatment of various autoimmune Diseases and especially of arthritic conαitions. There exists a family of cnronic artnritic conditions such as rheumatoid arthritis, ankylosing spondylitis or Reiter's syndrome which are thought to arise from autoimmune processes in which the joints and other tissues are damaged by the immune system of the patient. The triggering factors are unknown but it is believed that the infection with certain microDial agents may be important. Adjuvant arthritis is considered to be an experimental mooel of autoimmune arthritis inducible in strains of rats oy immunizing tnem to mycobacterial antigens. According to the present invention there are proviαeα pharmaceutical preparations based on certain mycobacteria and on fractions derived from such mycobacteria. We have found that various types of mycobacteria, such as Mycobacteria H-37 RA, M. kansasii, M. vaccae, and similar strains may be used as such or fractionated by the use of certain solvents to give a precipitate and a water soluble fraction, which latter is suitable for various vaccinations and curative purposes. Mycobacteria H-37 can be fractionated by the use of an aqueous solution of acetone (66% acetone in water). There is obtained a precipitate (AP) fraction ana an acetone soluDle (AS) fraction. The immune response to the AS fraction leads to resistance to adjuvant arthritis; clones of lymphocytes that respond to AS, upon inoculation into naive rats, protect these against suosequent induction of adjuvant arthritis. Inoculation of such clones of lymphocytes into rats suffering from adjuvant artnritis markedly hastens tneir recovery from tne arthritis. - - It has been founα that clones of T-lympnocytes wnicn cause adjuvant arthritis respond (proliferate) to the AP fraction, but not to the AS fraction. The SP ana tne AS fractions are immunoiogicaliy cross-reactive with proteoglycans of normal joint cartilage, ana therefore adjuvant arthritis can be explained as a noxious autoimmune response to AP cross-reactive antigens of proteoglycans. Protection against adjuvant arthritis can be associated with a protective, or disease suppressive response to the AS cross-reactive antigens of proteoglycans. Diagnostic tests for autoimmune artnritis and similar autoimmune diseases can be based on tne different immune reactivity of the tested persons to be AS and the AP fractions of mycobacteria ana other " bacteria associated with arthritis, or to the AS and AP cross-reactive antigens of proteoglycans. Immunization of patients to AS fractions of mycobacteria and other bacteria associated with arthritic conditions, or to AS cross-reactive antigens or proteoglycans can De used for the prevention of autoimmune artnritis and for the treatment of arthritic diseases. It nas been discovered tnat certain lines ana clones of T-lymphocytes selected for their reactivity to mycobacteria can be used for producing arthritis upon inoculation into irraαiated rats. One line, designated as A2 was founα to inαuce artnritis upon intravenous injection into irradiated rats. The same line, A2 is effective in vaccinating unirradiated rats against subsequent AA induced by active immunization to Mycooacteria. Cell line A2 has been cloned and there were obtained two distinct clones, designated as A2D ana A2c, respectively. A2b causes arthritis but does not vaccinate against it; clone A2c does not cause arthritis but vaccinates against it (see Table 1). In addition to preventing arthritis, clone A2 can be used to treat AA. Figure 1 snows the result of an experiment in wnicn rats suffering from AA were inoculated twice (on days 16 and 17 after the induction of disease) with clone A2c, or with a central, irrelevant clone of T-lymphocyte. Tne rats inoculated with clone A2c went into rapid remission. Six montns later the A2c treated rats had normal joints wnile tne control rats had ankylosis and deformities of the paws. Thus, clones A2D and A2c can De used to identify antigens associated with artnritogenicity or with suppression of artnritogenicity. Botn clones respond to whole mycooacteria. Clone A2d responds to the AP fraction but not to the AS fraction defined above; protective clone A2c responds to AS and only slig tly tp AP. Both A2D and A2c respond to cartilage proteoglycan, see Taoie 2. Results presented in Table 3 demonstrate tnat anti-AP and anti-AS antisera recognize cross-reactive antigens in cartilage. AP and AS induce different classes of antiDodies, IgG aπα IgM, respectively, wnicn indicates that these fractions induce functionally different responses. IgG is associated with AP and artnritogenicity while IgM is associated with AS and suppression of artnritogenicity. Rats were immunized witn Mycooacteria, witn water, and with AS in oil, see Taole 4. The mycobacteria inocculated rats developed AA as expected, while the water and AS inoculateα rats did not. After 35 days the rats were challenged with mycooacteria in oil to induce active AA. Rats that had suffered primary AA were resistant to a second bout; those inoculated with water only were susceptible to AA, whereas the AS inoculated rats were _ totally resistant to AA. Thus, the As fraction is arthritis suppressive, while not being arthritogenic. Moreover, AS can be used to activate cells of the A2 line to provide treatment of AA after ' its onset. (Figure 2). The effective dosage varies, it is generally about 1 to 20 mg/kg, preferably about 2 to 10 mg/kg. This demonstrates that when AA was induced in rats by Mycobacteria, after 16 days, when arthritis had developed, some of the rats were inoculated intravenously with line A2 that had been activated with Mycobacteria or with the As fraction. The Mycobacteria treated A2 cells arrested the arthritis, while the AS treated A2 cells induced a full remission of the disease. Table 5 demonstrates the proliferative responses of peripheral blood mononuclear cells of rheumatoid arthritis (RA) patients and controls, to mycobacterial antigens. Several different species of mycobacteria were tested * as to whether clones A2b and A2c recognized their differences. One of these, mycobacteria, M. vaccae was recognized in an in vitro proliferation test by the protective clone A2c but not by the arthritogenic clone A2b (Table 6). This finding indicated that M. vaccae was relatively rich in protective antigens and poor in arthritogenic antigens. Accordingly tests were carried out to evaluate the effect of M. vaccae on adjuvant arthritis (Table 7). The strain of M. vaccae used was that deposited at the National Collection of Type Cultures (NCTC) Central Public Health Laboratory, Colindale Avenue, London NW9 5HT on February 13th 1984 under the number NCTC 11659. In the first experiments, rats were inoculated with M. vaccae and then a week later adjuvant arthritis was induced by inmunizing the rats with M. tuberculosis. It was found that prior inoculation with . vaccae prevented the development of arthritis. Thus M. vaccae is effective as a prophylactic vaccine against adjuvant arthritis. In the second series of experiments, adjuvant arthritis was first induced by immunization witn M. tuberculosis ana 3 weeks later, when all the rats were suffering from artnritis, some rats were inoculated with M. vaccae in oil, or with oil alone. Tnose receiving M. vaccae in oil nad a remission in artnritis in several days while the control group of rats continued to suffer from severe arthritis (Figure 3). We have eviαence that rheumatoid artnritis patients have T-lymphocytes that respond to tne arthritogenic fraction of M^ tuoerculosis (Taole 5), indicating that similar immunologic processes may occur in ootn adjuvant artnritis in rheumatoid arthritis. According to the invention tnere are also provided compositions for the diagnosis of arthritic diseases and an assay for this purpose, based on the use of whole mycobacteria or on the use of certain fractions thereof, obtained by the separation of mycooacteria. Sucn separation can be effected in a suitable solvent system, wnereby there is obtained a soluDle fraction and an insoluble one (precipitate). Each of these can be futher fractionated and purified, until specifically active substances are obtained. Sucn fractions can be used for various types of assays for the above purpose, such as: a 1. a lympnocyte proliferation test, or determination of any entity indicative of sucn proliferation; a 2. indicative of the measure of lymphocyte activation are also cnanges which can be assayed by standard means so as to establish the presence and degree of lympnocyte activation: amongst these there may De mentioneα: a.proαuction of lympnoKines (such as interieuκin-2 (1L-2); D. gamma interferon; c. migration inhibition factor (MIF); d. expression of memorane markers, sucn as 1L-2 receptor; peanut agglutination receptor. e. expression of enzymes such as heparanase; " b. determination of antibody titer in aDsolute terms or as a ratio of the values obtained by different fractions, said values or ratios being indicative of the presence or aosence of the disease. Quantitative values ootained are of use in estaDlisning the severity of the disease. For carrying out sucn assays, there can be provided means in Kit form, comprising one or more of the above defined fractions with suitable adjuvants and auxiliary components. Standardized kits with reference and calibration means are of value in the rapid and convenient determination of arthritic disease ana its stage and/or severity. Legend to the figures; Figure 1 : Treatment of Adjuvant Arthritis (AA) Using Clone A2c; AA was induced in Lewis strain rats by inoculation of M . Sixteen and seventeen days later groups of 10 rats each were injected intraperitoneally with 2 x 10 cells of clone A2c (open circles) or central clone Cla (closed circles). The rats were observed for the severity of arthritis on a clinical scale of 1 to 16. Upon examination 6 months later, recipients of clone A2c were free of disease while recipients of Cla had severe ankylosis of the paws. Figure 2: Treatment of Adjuvant Arthritis by Injection of A2 Line Cells; Adjuvant arthritis was induced in 30 Lewis rats by active immunization with complete Freund's adjuvant on day 0. On day 16, after arthritis had developed in all rats, they were divided into three groups. A control groups of 10 rats (solid circles) was not treated. A second group of 10 rats was. treated' by a single intravenous inoculation of 2 x 10 A2 line cells that had been activated using whole myco- bacterial organisms (o). The third group of 10 rats was inoculated with A2 line cells that had been activated with the AS fraction (triangles). Severity of arthritis was assessed on a clinical scale of 1 to 16. Figure 3: Treatment of Adjuvant Arthritis by Injection of M. vaccae Cell AA was induced in Lewis strain rats by immunization with M. tuberculosis and 2 and 4 weeks later, when all the rats were suffering from arthritis, some rats were inoculated with M. vaccae (1 g. ) in oil (incomplete Freund's adjuvant) (open circles) or with the oil alone (solid circles). Severity of arthritis was assessed on a clinical scale of 1 to 16. TABLE 1J.Production anα/or prevention of adjuvant artnritis (AA) by T-iympnocyte line A2 ana clones A2o ana A2c T-lympnocytes Recipient Line-mediated AA induceα by MT 35 days after transferred rats artnritis line transfer (2xl0 7 ) Irradiated (750R) % Incidence Mean day Duration Clinical (no.rats) of onset (days) Arthritis None * No No 89 (76) 12.9 56 Severe Yes No til (42) 13.6 55 Severe I A2 No No 0 (69) - - None I Yes Yes 0 (38) - - None A2D No No 91 (22) 13.7 53 Severe Yes Yes 93 (14) 13.9 54 Severe A2c No No 0 (15) - - None Yes No U (15) - - None Irradiated (750R) or non-irraoiated Lewis rats were injected intravenously witn 2x10 ceils of line A2 or cioneα suDlines A2u or A2c-iϋ. 35 αays later active AA was induceα by an intradermal injection of killed Mycooacterium tuoerculosii organisms in oil (MT). Control groups consisting of irradiated or non-irradiated rats were injected with MT 35 days after irradiation. TABLE:2 Responses of clones A2b and A2c to antigens Clone In vivo effect Response to antigens Whole AP AS Cartilage mycobacteria proteoglycan A2b arthritogenic + + - + A2c protective, + + + + therapeutic o I TABLE 3: Raobit antibodies to AP or AS recognize joint cartilage TABLE 4: Active Immunization to AS Protects Rats against AA Primary Immunization Secondary challenge with mycobacteria in oil (MT) Inoculum in oil % incidence of 1 g arthritis % incidence of arthritis Mycobacteria 100 0 Water 0 100 AS 0 0 TABLE 5: Proliferative responses of peripheral blood mononuciear cells of rheumatoid arthritis (RA) patients and controls to mycobacterial antigens No. Mean stimulation index Significant response to* Ratio of of PPD AP AS AP AS responses patients AP:AS Group RA 17 18.4 13.6 1.2 14/17 0/17 11 h Osteoarthritis 12 15.0 5.6 7.0 7/12 8/12 0.6 Normal 8 13.2 3.9 4.9 4/8 5/8 0.8 controls • *Stimulation index> 2.0 TABLE 6: Therapeutic clone A2c recognizes M. vaccae, arthritogenic clone A2b does not. Clone In vitro proliferation response " } —3 (H -thymidine incorporation, cpm x 10 ) No antigen M. tuberculosis M. vaccae A2b 2+1 6+5 4+1 A2c 1+1 62+6 60+9 Clones A2D and A2c were assayed for their in vitro proliferative responses to I M. tuberculosis or M. vaccae organisms in a stanαard test (2.5x10 clone cells, 2x10 irradiated accessory cells and 2 ug of mycobacteria extract per well, IT-thymidine incorporation for 18 h, after 24 h of incubation). Results are expressed as cpm. TABLE 7: Treatment with M. vaccae induces resistance to adjuvant arthritis. Treatment Arthritis induced by M. tuberculosis 3 months later Incidence Clinical grade Oil (control) 1005- Severe M. vaccae in oil α_ 0 Groups of 13 Lewis rats were treated by intracutaneous inoculation of M. vaccae (1 mg) in oil (incomplete Freund's adjuvant) or by oil alone (control). Three months later, susceptibility to induction of adjuvant I arthritis was tested by inoculating the rats with M. tuberculosis (1 mg) in oil.

Claims: CLAIMS 1. A composition for alleviation of the symptoms of and for the treatment or diagnosis of arthritic diseases which comprises, as active ingredient,,a mycobacterium or a fraction or secretion thereof. 2. A composition according to claim 1, wherein the mycobacterium is M. vaccae. 3. A composition according to claim 1 or 2 comprising a portion obtained by fractionation of such mycobacteria in a suitable solvent system, and separating therefrom a soluble fraction used as active component, or a secretion of such mycobacteria into a culture medium. 4. A composition according to claim 3, wherein the solvent system for fractionation is an acetone/water mixture. 5. A composition according to claim 4, wherein the solvent system used for fractionation is an acetone/water mixture of about 2/1 by volume. 6. A composition according to claim 2, wherein the active ingredient is the whole organism of M. vaccae. 7. A composition according to any of claims 1 to 6, in the form of an injectable preparation, as oral dosage form-, or as dosage form applicable to any body cavity. 8. A composition according to any of claims 1 to 7, wherein the active ingredient is present together with an adjuvant. 9. A composition according to any of claims 1 to 8, wherein the active ingredient is in unit dosage form, containing from about 2 mg to about 10 mg/kg weight of the patient. 10. A composition according to any of claims 1 to 9, for use in therapy for the immunization against, and for the treatment of, arthritis. 11. A composition according to any of claims 1 to 9, for use in therapy for the diagnosis of arthritic diseases by determination of lymphocyte proliferation; determination of any entity indicative of such proliferation; or determination of antibody titre. 12. A composition according to claim 11, comprising a soluble and/t.r non-soluble fraction of a mycobacterium, which may be further separated or purified. 13. A composition according to claim 11 or 12, wherein the determination is effected by measuring absolute values or the ratio of values obtained by the use of different fractions. 14. A composition according to claim 11, 12 or 13, for the determination of the presence or absence of an arthritic disease, and/or its severity, in kit form, comprising such fraction or fractions with required adjuvants and auxiliaries and with calibration means. 15. A method for the alleviation or treatment of arthritic disease or a related condition which comprises administering to a patient suffering therefrom or subject thereto an effective amount of a composition as claimed ih claim 1. " 16. A method of the diagnosis of arthritic disease or a related condition which comprises determining lymphocyte proliferation or any entity indicative of each proliferation or determining antibody titre, using in such determination a composition as claimed in claim 1. 17. A method as claimed in claim 15 or 16, wherein the composition is as claimed in any one of claims 2 to 14.

Inventors: COHEN IRUN ROBERT, FRENKEL AYALA, HOLOSHITZ JOSEPH, ROOK GRAHAM ARTHUR WILLIAM, STANFORD JOHN LAWSON, VAN EDEN WILLEM, COHEN, IRUN, ROBERT, FRENKEL, AYALA, HOLOSHITZ, JOSEPH, ROOK, GRAHAM, ARTHUR, WILLIAM, STANFORD, JOHN, LAWSON, VAN EDEN, WILLEM
Applicants: UNIV LONDON, YEDA RES & DEV, UNIVERSITY COLLEGE LONDON, YEDA RESEARCH AND DEVELOPMENT CO. LTD.
Application year: 1985
Main classification: A61K35
IPC codes: A61K35, A61K39