METHOD TO INDUCE THE TH1 IMMUNE RESPONSE

Abstract: The present invention relates to a method to induce the CD4+ Th1 immune response, eventually combined with a repression of the Th2 mediated activities, comprising the administration of an IgG isotype antibody which is not an IgG1 isotype antibody. Preferentially said antibody is an IgG2a and/or IgG2b isotype anti-allergen antibody. The shift from a Th2 response towards a mixed Th1/Th2 response is particularly useful in the treatment of diseases such as asthma.Because the method described corrects the immuno-pathological cause of the disease, this is the polarised Th2 response against allergen, rather than its consequences, a sustained cure from asthma can be achieved instead of a transient reduction of symptoms.

Description: Method to induce the Th1 immune response The present invention relates to a method to induce the CD4 + Th1 immune response, possibly combined with a repression of the Th2 mediated activities, comprising the administration of an IgG isotype antibody which is not an lgG1 isotype antibody. The present invention also relates to a method to reduce eosinophilic inflammation of the airways, comprising the administration of said antibody. Upon T-Cell Receptor (TCR) - ligation, ThO cells differentiate into distinct subsets characterised by their functions and cytokine production profiles (Mosmann and Coffman, 1989). Thus Th1 lymphocytes, characterised by the production of IL-2, IFN-γ and TNF-β, contribute to cellular immunity whereas Th2 lymphocytes, mainly involved in humoral immunity, produce IL-4, IL-5 and IL-10. Numerous examples of the consequences on disease outcome of skewed Th1 to Th2 ratios have been reported. Polarised Th2 responses have been implicated in pathological situations, such as Leishmania major (Heinzel et al., 1991 ; Nabors et al., 1995), TBC (de Jong et a/., 1997) human leprosy (Yamamura et al., 1991), and mycotic infections (Murphy et al., 1994). The contribution of Th1 cells relative to Th2 cells to the developing autoimmune response determines for a large part whether or not this response leads to clinical disease (Racke et al., 1994; Racke et al., 1995; Leonard et al., 1995). The chronic autoimmune graft-versus-host disease, which develops after the administration of mismatched lymphoid cells, can be prevented by switching a Th2 to a Th1 response through administration of IFN-γ at the time of cellular transfer (Donckier et al., 1994). Roussel et al. (1996) describe that the inefficiency of the immune response against a human glioma is caused by the presence of activated tumour-infiltrating lymphocytes, characterised by a predominant type 2 lymphokine production. These cytokines do not promote a tumouricidal immune response and therefore do not counteract the growth of the tumour. In allergic asthma, also a predominant Th2 response has been noted (Vogel, 1997). Asthma describes a heterogeneous collection of clinical symptoms such as reversible airway narrowing, airway hyper reactivity, and eosinophilic inflammation of the airways. Due to the chronic nature of asthma, structural and functional changes in the organ will occur on the long-term, resulting in airway remodelling and a further amplification of the syndrome. Clearly, sensitisation to airborne environmental allergens, leading to atopy, is a major risk factor for asthma (reviewed in Holt et al., 1999). In sensitised individuals, exposure to the aeroallergen will trigger within minutes an acute response, resulting in airway constriction and difficult breathing. Interaction of the allergen with allergen-specific IgE antibodies bound to various effector cells through the Fcε receptor I, provides the trigger for this acute reaction. The secreted inflammatory mediators in addition recruit eosinophils, mast cells, T lymphocytes and other circulating leukocytes to the site(s) of allergen challenge. Besides causing a recurrence of symptoms, this cellular infiltration by effector cells will persist upon chronic exposure to allergen, thus leading to chronic eosinophilic inflammation of the airways, characteristic for asthma (reviewed in Wills-Karp, 1999 and Galli, 2000). Specific cytokines, various inflammatory mediators and allergen-specific IgE antibodies all contribute to the complex pathogenesis of asthma. However, increasing evidence indicates that Th2 cell-derived cytokines are pivotal in the generation and persistence of the disorder. Thus, IL-4 and IL-13 are critical in switching B lymphocytes to produce of allergen-specific IgE. IL-3 controls the induction of mast cell proliferation and recruitment of lymphocytes, mast cells, and basophils. IL-5 is involved in growth and differentiation of eosinophils and B lymphocytes, while IL-9 promotes growth and differentiation of mast cells. Finally, IL-10 inhibits IFN-γ production and classical activation of macrophages (reviewed in Corny and Kheradmand, 1999). Accordingly, these Th2-derived cytokines, along with IgE-mediated activities, represent important therapeutic targets, and strategies aimed at eliminating or neutralizing these activities are actively pursued by several researchers. These strategies involve the administration of neutralising or antagonistic anti-cytokine or anti-lgE antibodies, administration of soluble cytokine receptors or peptido-mimetics of cytokine receptors. WO9004979 e.g. describes a method of preventing or reducing eosinophilia comprising administering an antagonist to human IL-5, such as a monoclonal antibody against IL-5. However, none of these methods is antigen specific. As a result, these methods will affect the targeted allergic immune response as well as immune responses against unrelated antigens. Alternative strategies for treatment of allergic diseases comprise selective suppression of the anti-allergen immune response. These approaches are all based on some form of active vaccination using injection of crude or purified allergen preparations and resulting in hyposensitisation. Classically, the subcutaneous route of administration is used for this type of immunotherapy. A more recent approach for immunotherapy, the so-called Saint-Remy technique (EP0178085 and EP0287361) uses autologous IgG antibodies complexed in vitro to the relevant allergen(s). This approach generates fewer side effects due to the feasibility to apply smaller amounts of allergen. Hyposensitisation has proven to be moderately effective in treating allergic diseases among which allergic rhinitis and asthma. However, there are numerous difficulties with this form of treatment. Treatment schedules are cumbersome and prolonged courses of treatment are necessary, resulting in low patient compliance. Since the precise immune mechanism is not known, the cause of therapeutic failure usually cannot be established. Various improvements on the vaccination approach have been described to render hyposensitisation more effective. These comprise among others encapsulation in or covalent attachment to liposomes of the allergen (US5049390), covalent attachment to the allergen of a saccharide (US5073628), and application of adjuvans that suppress formation of IgE antibodies and promote formation of IgM and IgG antibodies. Examples of the latter are a glycolipid extracted from maize tissue (US4871540) and preparations containing life or heat-killed mycobacteria such as Mycobacterium bovis Bacillus Calmette-Guerin or mycobacterial cell wall products (Azuma et al., 1976; Yang et al., 2000). All these methods as well as methods whereby the allergen is first modified by coupling to various bridging molecules such as antibodies and subsequently is administered to the recipient, as described for instance in WO9707218, have the important drawback that they encompass administration of an allergen-containing composition to individuals that exhibit various degrees of atopy and/or anaphylaxis, and therefore are at risk of developing immediate hyperresponsiveness and/or anaphylactic shock in response to the treatment. Yamauchi et al. (1983) describe that, in a model of allergic asthma, intravenous administration of specific lgG2 antibody prior to challenge with antigen inhibited the IgE induced bronchial response. The authors suggested that a direct competition between lgG2 and IgE for the antigen is responsible for the inhibition of the IgE induced bronchial response by blocking the trigger for the acute reaction. This treatment would therefore rather be a symptomatic treatment and not result in a cure for the allergic asthma. The present invention describes an approach for treatment of allergic diseases based on the conversion of the anti-allergen pathogenic response to a benign and persistent immune response. Indeed, surprisingly we found that an anti-allergen antibody of the IgG isotype, which is not an lgG1 isotype, said antibody being substantially free of allergen, can induce the Th1 response in combination with a repression of the Th2 related activities. This implies a conversion of the polarised Th2 cell response, characteristic for allergic asthma, to a mixed Th1 / Th2 response or a predominant Th1 response. Due to the pivotal role of Th2-cell derived cytokines in allergic asthma, this conversion reduces allergic asthma due to the diminished production of the causative Th2 cytokines and the mutual antagonistic activity of Th1 and Th2 cytokines. This approach not only has the advantage of antigen specificity so that it does not abrogate ongoing beneficial Th2 responses against unrelated antigens, but in addition promises a substantial cure from asthma rather than a symptomatic treatment as a result of the elimination of the fundamental cause of the disease, namely the anti-allergen Th2-poIarized immune response. Furthermore, because the treatment does not require administration of allergen, either in it native form or modified, the disadvantages and health risks intrinsic to active vaccination strategies are avoided. It is a first aspect of the invention to provide a method to induce the CD4 + Th1 immune response, comprising the administration of a compound that can bind allergen and direct said allergen to an antigen-presenting cell (APC) that induces and/or supports a Th1 response and counteracts a Th2 response. Preferentially, said administration is intranasal. Said compound allows spontaneously inhaled environmental allergen to be directed to the antigen presenting cells that preferentially induce and/or support Th1 responses, and counteracts a Th2 response. As a result, the pathological Th2 response is converted in a beneficial mixed Th1 Th2 response or predominant Th1 response without requirement for enforced exposure of the asthmatic individual to an increased allergen load. This abolishes the risk of treatment-induced anaphylaxis while generating an antigen-specific and sustained suppression of asthma. Moreover, the shift is persistent in time and allows a cure of the allergic reaction, rather than being a symptomatic treatment. Different types of APCs may steer differentiation of the CD4 + T cell into either Th1 , Th2, or Th1 and Th2 effectors. Dendritic cells induce the development of Th1 or Th2 cells dependent on their state of differentiation and/or the presence in the microenvironment of factors such as IFN-γ or prostaglandin E2 (Macatonia et al., 1995; Ronchese et al., 1994; Kalinski et al., 1999). B cells on the other hand seem to support the induction and expansion of Th2 cells (Gajewski et al., 1991). The involvement of macrophages in initiating cognate immunity has long remained elusive. Although macrophages are dedicated APCs in vitro, they exert this activity only after treatment with IFN-γ and appear to be mainly involved in non-specific inflammatory responses. However, macrophages are an important source of IL-12 and might therefore favour the development of Th1 cells. This is supported by the observation that macrophage depletion in mice shifts an expected Th1 response to a Th2 response (Brewer et al., 1994). Moreover, WO9921968 describes that ex vivo loaded antigen-presenting macrophages may be used to influence the CD4 + Th1 / CD4 + Th2 balance towards Th1 reactivity. A first embodiment is a method to induce the CD4 + Th1 immune response, comprising the administration of a compound that can bind an allergen and direct said allergen to an antigen-presenting cell that induces and/or supports a Th1 response and counteracts a Th2 response, whereby said antigen-presenting cell is a macrophage, preferably an IFN-γ activated macrophage. A second embodiment is a method to induce the CD4 + Th1 immune response, comprising the administration of a compound that can bind an allergen and direct said allergen to an antigen-presenting cell that induces and/or supports a Th1 response and counteracts of a Th2 response, whereby said compound is an IgG isotype antibody, said antibody being substantially free of allergen and whereby said IgG isotype antibody is not an lgG1 isotype antibody. Preferably, said antibody is an anti-allergen antibody. One specific embodiment is a method to induce the CD4 + Th1 immune response, comprising the administration of a compound that can bind an allergen and direct said allergen to an antigen presenting cell that induces and/or supports a Th1 response and counteracts a Th2 response, whereby said compound it an lgG2 isotype antibody. Still another embodiment is a method to induce the CD4 + Th1 immune response, comprising the administration of a compound that can bind an allergen and direct said allergen to an antigen presenting cell that induces and/or supports a Th1 response and counteracts a Th2 response, whereby said compound is a bispecific or multispecific antibody, whereby at least one specificity is directed against said allergen and at least another specificity is directed against said antigen presenting cell, whereby said antigen-presenting cell is preferably a macrophage, more preferably an IFN-γ activated macrophage, even more preferably whereby said antigen is directed against the low affinity receptor Fcγ receptor II or against CD14 on the macrophage. Methods to produce bispecific or multispecific antibodies are know to the person skilled in the art and have been described, as a non limiting example, in WO9937791 and by Merchant et al. (1998) A second aspect of the invention is a method to reduce aeroallergen-induced inflammatory responses in the airways, comprising the administration of a compound that can bind allergen and direct said allergen to an antigen-presenting cell that induces and/or supports a Th1 response and counteracts a Th2 response. Preferably, said reduction of aeroallergen-induced inflammatory responses is persistent Preferably, said administration is intranasal and/or said antigen presenting cell is a macrophage. Even more preferably, said compound is an IgG isotype antibody, said antibody being substantially free of allergen and whereby said IgG isotype antibody is not an lgG1 isotype antibody. Most preferably, said IgG isotype antibody is an anti- allergen antibody. One specific embodiment is a method to reduce aeroallergen- induced inflammatory responses in the airways, comprising the administration of a compound that can bind an allergen and direct said allergen to an antigen-presenting cell that induces and/or supports a Th1 response and counteracts a Th2 response, whereby said compound is an lgG2 isotype antibody. It is another aspect of the invention to provide a pharmaceutical composition for the treatment of a disease in which the natural CD4 + Th1 / CD4 + Th2 balance is biased towards a Th2 response and/or which can be treated by shifting said balance towards a Th1 response, comprising one or more IgG isotype antibodies, substantially free from other isotype antibodies and substantially free from allergen, whereby said IgG isotype antibody is not an lgG1 isotype. Such diseases are known to the person skilled in the art and include, but are not limited to allergic asthma, allergic rhinitis, airway hyperreactivity and eosinophilic airway inflammation. Preferentially, said antibody is an anti-allergen antibody and/or said pharmaceutical composition is intended for intranasal administration. Still another aspect of the invention is the use of an IgG isotype antibody for the manufacturing of a medicament for the treatment of a disease in which the natural CD4 + Th1 / CD4 + Th2 balance is biased towards a Th2 response and/or which can be treated by shifting said balance towards a Th1 response, whereby said IgG isotype antibody is not an lgG1 isotype. Preferably, said antibody is an anti-allergen antibody, more preferably said antibody is directed against antigenic structures of the causative agents. A preferred embodiment is the use of an IgG isotype according to the invention, whereby said disease is allergic asthma, allergic rhinitis, airway hyperreactivity or eosinophilic airway inflammation. Definitions The following definitions are set forth to illustrate and define the meaning and scope of various terms used to describe the invention herein. lgG2 isotype antibody as used herein means an isotype antibody, derived either from a polyclonal or, preferentially, a monoclonal preparation and, if necessary, purified to a degree that it is free from immunological active amounts of antibodies of another isotype or of other immunological active compounds. Substantially free of allergen means that the ratio of number of antibodies to the number of antibody-binding epitopes binding to said antibodies, as measured in vitro, before administration is at least 10/1 , preferably 100/1 , more preferably 1000/1. One or more IgG isotype antibodies, substantially free of other isotype antibodies means that the ratio of the total number of IgG isotype antibodies to the total number of non-lgG isotype antibodies, as determined in vitro, before administration is at least 10/1, preferably 100/1 , more preferably 1000/1. Environmental allergen as used here means any allergen to which an animal, including a human is exposed by external contact, such as inhalation. Aeroallergens include, but are no limited to pollen, including pollen from gymnosperms, dicotyledonous angiosperms and monocotyledonous angiosperms, dust mite antigens and mould antigens such as Alternaria antigens A persistent reduction of aeroallergen-induced inflammatory response is a reduction whereby, after a contact with the allergen, a significant decrease in inflammatory response is noticed, even after stopping the treatment for at least four days, preferably after stopping of the treatment for at least six days. The significance of the decrease may be evaluated by comparing the treatment, supposed to result in a persistent reduction of aeroallergen-induced inflammatory response with a placebo treatment. Brief description of the figures Figure 1. Increment of Ovalbumine (OVA) -specific IgE titres by aerosol challenge of BALB/c mice, sensitised by repetitive OVA injections. Figure 2. Bronchial Alveolar Lavage (BAL) cellular content from mice sensitised and challenged with OVA (OVA/OVA). Controls for induction of hyperresponsiveness are placebo treated mice (PBS/PBS) and mice that were sensitised but not challenged with OVA (OVA PBS). Mean values of the respective experimental groups are shown (n=3) Figure 3. Recovery of anti-hCat IgG from lungs after administration by aerosol or intranasal instillation. Figure 4. Clearing from lungs of anti-OVA IgG, instilled by intranasal route Figure 5. Detection of cell-bound anti-OVA IgG in BAL cells of C57BL/6 mice. Fluorescent-labelled antibody was administered by intranasal route and the presence of cell-bound Ig analysed by flow cytometry (line). Filled histograms represent autofluorescence of non-labelled cells. Figure 6. OVA-sensitised mice were treated twice with the indicated amounts of anti- OVA IgG, administered by intranasal route. Time of treatment was 2h before the first and the fifth aerosol. The number of BAL eosinophils is expressed as % relative to control mice that received PBS. Bars represent individual mice. Figure 7. OVA-sensitised mice received by intranasal or intravenous route a single administration of 100μg anti-OVA IgG, 2h before the first aerosol exposure. The number of BAL eosinophils is expressed as % relative to control mice that received PBS. Bars represent individual mice. Figure 8. Total cells and eosinophils in BAL of mice, after single OVA-alum sensitisation (experiment 1) or double OVA-alum sensitisation (experiment 2). The amount of anti-OVA IgG used is indicated in the figure. Figure 9. Anti-OVA IgG titres in serum, after a second round of aerosol challenge. Mice were triple sentisised with OVA-alum, treated twice with 50 μg IgG, with a first tound of antigen aerosol challenge 2 hours after each treatment, and a second round 6 days after the IgG treatment. The experimental outline is shown in Figure 11 Figure 10. Evidence for persistence of the anti-inflammatory effect upon aerosol challenge, after stopping the treatment: short term protection. Total cells and eosinophils in BAL of mice, after triple OVA-alum sensitisation, and intemasal treatment with 2 x 50 μg IgG, followed by aerosol antigen exposure 2 hrs after each IgG treatment. BAL is harvested 2 days after the last IgG treatment. OVA-alum: OVA- alum sensitisation; Ab: IgG treatment; aerosol: antigen challenge; BAL: BAL harvest. Figure 11. Evidence for persistence of the anti-inflammatory effect upon aerosol challenge, after stopping the treatment: persistent protection. Total cells and eosinophils in BAL of mice, after triple OVA-alum sensitisation, and intemasal treatment with 2 x 50 μg IgG, followed by aerosol antigen exposure 2 hrs after each IgG treatment. An additional aerosol antigen exposure is given 6 days after the last IgG treatment. BAL is harvested 8 days after the last IgG treatment. Abbreviations as in figure 10. Examples Methods used in the examples Mouse strains: In all experiments, except otherwise indicated, BALB/c mice were used Aeroallergen: Ovalbumin (OVA); Induction protocol: Sensitisation by repeated injection of OVA. Alternatively, mice were sensitised by injection of 10 μg OVA, adsorbed with 1 mg AI(OH) 3 (OVA-Alum). Dependent on the experiment and degree of sensitisation desired, mice were injected with OVA-Alum once on day 0, or received an additional injection on day 7 and day 14. Challenge was by 8 consecutive exposures to nebulised OVA over 8 days, unless otherwise indicated. Parameters monitored: Number of BAL cells in individual animals; composition of BAL regarding numbers of eosinophils, macrophages, CD4 + T cells and CD8 + T cells; number of cytokine-positive CD4 + T cells from BAL following in vitro activation with anti-CD3 and anti-CD28 monoclonal antibody; cytokine concentration in the supernatant of the above described T cell cultures, collected after 24 hrs; serum titres of OVA-specific IgE, lgG1, lgG2a and lgG2b antibodies (OVA-specific Elisa). Anti-OVA antibodies: Mouse monoclonal anti-OVA antibodies of the isotypes IgE, lgG1, lgG2a and lgG2b were isolated in the laboratory. Anti-OVA IgE-containing crude hybridoma culture supernatant was exclusively used as internal standard for OVA- specific IgE Elisa. The various anti-OVA IgG monoclonal antibodies were similarly used as internal standard for specific Elisa. In addition, cultures of the corresponding hybridomas were expanded for large-scale antibody production followed by purification of the monoclonal antibody. All preparations were found to be free of endotoxin; Route of administration of anti-OVA antibody: Antibodies were administered either by intravenous (i.v.) injection or by intranasal instillation. Example 1 : Murine experimental model for persistent atopic asthma in humans A well-established experimental model for allergic asthma consists of sensitisation of BALB/C mice to the protein antigen OVA, followed by challenging the sensitised mice by repeated exposure to nebulised OVA (Hofstra et al., 1998). Sensitisation was achieved by 7 intraperitoneal injections of 10 μg OVA in PBS, given on alternate days. Exposure of treated mice, 3 weeks after the last injection, to inhaled OVA resulted in induction of atopy, apparent from strongly increased serum titres of anti-OVA IgE (Fig. 1). This IgE response was accompanied by a strong increment of cellular infiltration in the lungs. The cell infiltrate consisted of mainly eosinophils as well as CD4 + and CD8 + T lymphocytes, and macrophages (Fig. 2). Both responses to inhaled allergen, namely induction of atopy and eosinophilic airway inflammation, are characteristic of allergen- induced asthma and as a consequence represent a valid experimental model for the human disease. Example 2: Advantages of intranasal administration of IgG antibody. An essential feature of the postulated approach relates to the spontaneous formation of antibody-allergen immune complexes as soon as inhaled allergen reaches the airways. Therefore, administration of antibody specifically to the airways is expected to be crucial. As a consequence, the feasibility of introducing antibodies to the lungs by aerosol or by intranasal instillation was first investigated. To this end, the presence of functional anti-human catalase IgG antibody (anti-hCat) in the BAL was measured by specific Elisa after administration of the antibody by either aerosol or intranasal instillation. As shown in figure 3, administration by aerosol merely allowed recovery of functional antibody, whereas intranasal instillation allowed near 40% recovery of functional antibody. Control experiments showed that the dramatic loss of functional antibody in the BAL after aerosol administration reflected loss of function of the antibody rather then inadequate inhalation. Altering the pressure used for aerosol and/or the concentration of the antibody did not lead to significant gains in antibody stability. As a consequence, intranasal instillation was chosen as most effective administration method for antibody delivery to the upper airways. A second important parameter to be established, concerned the time of retention of antibody in the lungs, critical for defining the time range wherewith the administered antibody may exert its presumed effects. OVA-specific Elisa on BAL fluid of mice that received anti-OVA IgG by intranasal route showed a slow clearance of free antibody, with significant titres still detectable after 24h (Figure 4). However, after 48h most of the antibody seemed to be cleared from the lungs. To verify whether also cell-bound antibody exhibited a similar clearance rate, fluorescent-labelled antibody was administered and the presence of cell-bound fluorescence was measured on BAL cells by flow cytometry. In C57BL/6 mice, cell-bound antibody became detectable within 1h after intranasal instillation and reached maximal intensity after 6h (Figure 5). However, contrarily to free antibody, cell-bound antibody remained detectable 48h after administration. A similar result was obtained with BALB/c mice. From these results we conclude that intranasal administered antibody may exert its local effects in the airways within a time span of 24h to 48h. Example 3: Reduction of allergen-induced airway inflammation is lgG2 dependent In a next set of experiments, it was verified whether administration of anti-allergen IgG antibodies to sensitised mice, 2 hrs before challenge with aerosol, affects the airway inflammatory response. Preliminary experiments indicated that an antibody dose range of 50 to 200μg IgG antibody was suited (Figure 6). As a consequence, we choose in the subsequent experiments for an antibody dose of 100μg, and the following experimental parameters were varied: • The IgG isotype administered, either lgG1 , lgG2a, or lgG2b; • The number of administrations, either once (2h before the first exposure to aerosol) or twice (an additional administration of antibody 2h before the 5 th aerosol exposure); • The route of administration, either intravenous or intranasal; Analysis of the extent of eosinophilia in the BAL, the major indicator of allergen- induced airway inflammation, revealed a pronounced reduction in those conditions where lgG2 antibodies were administered to the lungs by intranasal instillation (Figure 7, upper panel). Especially, lgG2a seems to be the most potent lgG2 isotype in generating this protective effect. In contrast, intranasal administration of lgG1 had no protective effect. Administration of the same antibodies by intravenous route had no or only marginal effects on the degree of eosinophilia (Figure 7, lower panel). A comparison, in two separate experiments, between the same lgG2a antibody dose (100μg), either given in a single administration or divided over two separate administrations of 50μg each revealed a diminished eosinophilia and diminished cell infiltration in the airways with both treatment schedules (Figure 8). However, two separate administrations of 50 μg lgG2a each produced a more pronounced reduction in both independent experiments of allergen-induced airway inflammation compared to a single administration of 100μg lgG2a antibody. Example 4: Analysis of the serum titres induced by a first round of aerosol challenge Analysis of the serum titres of OVA-specific IgE, lgG1 , lgG2a and lgG2b induced by the challenge with OVA aerosol revealed no significant changes between the various experimental groups (Table I). Thus, despite the presence in the airways of OVA- specific IgG antibodies, a challenge with inhaled antigen induced a secondary antibody response similar to the one induced in placebo-treated mice. This result indicates that the reduced airway inflammation observed in the lgG2-treated mice did not result from molecular avoidance or immune exclusion of the aeroallergen by the administered allergen-specific antibodies as was previously reported for allergen- specific IgA (Schwarze et al., 1998). Table I Anti-OVA Ig-serum titres induced by OVA aerosol challenge of treated and untreated sensitised mice. ND: not determined, i.n.: intranasal administration; IgE, lgG1 , lgG2a, lgG2b: anti-OVA Ig-serum titre of the indicated antibody type. As a consequence, an active process involving a modulation of the allergen-induced immune response by the administered lgG2 antibodies is responsible for the attenuation of the airway inflammatory response to allergen. Also, the recurrent response pattern observed in example 3 with various administration schedules of allergen-specific IgG antibodies, indicates an alternative modulation of the anti-allergen immune response. Thus, all treatments involving intranasal instillation of lgG2, but not IgGI , antibodies consistently resulted in a diminished airway inflammatory response to inhaled allergen whereas the intravenous route of administration did not produce this consistent response pattern. This discrepancy betwee'n both administration routes clearly indicates that the protective effect of the allergen-specific lgG2 antibodies requires interaction of the antibody with the allergen at the site of allergen entry. As this protection is clearly not the result of shielding of the immune system from the allergen by the administered antibody, an active instead of a passive mechanism must be responsible for the observed reduction in inflammation. Both observations therefore, specifically the dependence of the protective effect on intranasal instillation and its occurrence despite contact of the immune system with the allergen, indicate that this method modifies the nature of the anti-allergen immune response and therefore is valid for obtaining a sustained cure for asthma, rather than a symptomatic treatment. Example 5: Analysis of the serum titres induced by a second round of aerosol challenge The absence of decreased IgE and IgG antibody responses in the treated animals, despite a marked reduction of the inflammatory airway response, can be explained as follows. The antibody titres observed reflect the activation by allergen of antibody- producing memory B lymphocytes generated during the preceding sensitisation. Antibodies derived from newly generated antibody-producing B cells only marginally contribute to this antibody response due to the short period (7 days) between the aerosol challenge and the serum collection. However, upon renewed challenge with allergen, memory B cells derived from those newly generated antibody-producing B cells will significantly contribute to the antibody response. To verify whether the treatment with antibody affected the generation of new antibody-producing B cells and subsequently of new memory B cells, lgG2a treated mice were exposed to a second round of aerosol after a 2 week rest period. A marked increase of the Th1-dependent lgG2a and especially lgG2b isotypes was observed in the treated mice (Figure 9). Opposed to this, the Th2-dependent isotypes remained at the same level (IgGI) or showed a slight decrease (IgE). Thus, although the mice did not receive an intermittent treatment with antibody, their memory IgE response (Th2 dependent) was reduced whereas their memory lgG2 response (Th1 dependent) was enhanced. Accordingly, the treatment with anti-allergen lgG2 at the time of the first challenge not only reduced the airway inflammatory response to aeroallergen, but also selectively affected the formation of Th1 versus Th2-dependent memory B cells. Example 6: Persistence of the reduced airway inflammatory response to aeroallergen during a second round of aerosol challenge The previous indications that locally administered anti-allergen lgG2 protects against allergen-induced airway inflammation through an active instead of passive mechanism (see examples 3 - 5), imply a modification of the nature of the anti-allergen immune response that drives the airway eosinophilic inflammation. If true, a likely consequence would be that the immune response retains a memory of this altered nature, thus causing a persistence of the therapeutical effect. To verify this possibility, sensitized mice received a first challenge with OVA by exposure to aerosol during two consecutive days, along with two separate administrations of 50 μg anti-OVA lgG2a given 2h before each aerosol (Figure 10). Again this treatment with antibody resulted in a pronounced reduction of bronchial alveolar cell infiltration and eosinophilia, measured 48h after the last OVA aerosol (Figure 10). Next, the persistence of this protective effect was verified by exposing the thus treated mice to a second round of aerosol challenge, 6 days after the first (Figure 11). However, in this case the mice did not receive an additional treatment with anti-OVA lgG2a, thus allowing analysis of the endurance of the protective effect during a new allergen exposure. As shown in figure 11 , the mice indeed retained a memory of their first treatment as apparent from the significantly lower airway inflammation and eosinophilia induced by this second round of allergen challenge. This result confirms the active nature of the treatment method and its capacity to generate as a consequence a sustained cure for asthma rather then to provide a symptomatic treatment. Example 7: conversion of the anti-allergen CD4 + T cell response from a Th2 polarised response to a Th1 and Th2 mixed response The reduced airway inflammatory response, the persistent nature of this reduction, and the increased formation of Th1 -dependent memory B-cells but not of Th2-dependent memory B-cells after intranasal administration of anti-allergen lgG2, indicate that an increased participation of Th1 cells represents the actual modification of the anti- allergen immune response that is responsible for the reduced asthmatic phenotype. To verify this possibility, the number of OVA-responsive Th1 and Th2 cells in the BAL were determined. BAL cells were stimulated in vitro with anti-CD3 antibody in the presence of anti-CD28 antibody (maximisation of T cell costimulation) and the number of IFN-γ, IL-4 and IL-5-secreting CD4* T cells were determined by cytoplasmic cytokine staining and 2-colour flowcytometry (Table 2). CD4 + T cells from the BAL of sensitized mice, challenged with OVA and treated with placebo produced predominantly the Th2 cytokine IL-4, whereas only a smaller fraction of the cells produced the Th1 cytokine IFN-γ. This prevailing Th2 nature of the bronchial alveolar CD4 + T cells is in agreement with the well-established Th2 nature of the airway inflammatory response. Significantly, treatment with anti-OVA lgG2a reversed the immune response to a prevailing Th1 response as apparent from the reduced number of IL-4-secreting Th2 cells, the doubling of IFN-γ-secreting Th1 cells, and the resulting shift in Th1/Th2 ratio from 0.5 to 1.9. From this result we conclude that the anti-OVA lgG2a exerts its protective and sustained effect on allergen-induced airway eosinophilia by altering the Th1/Th2 ratio of the immune response, thus shifting the response pattern from a pathological Th2 response towards a benign Th1 response. We conclude that intranasal administration, prior to aeroallergen exposure, of a compound that binds inhaled allergen and hereby allows it to be directed to antigen- presenting cells that preferentially induce and/or support Th1 cell responses and counteract Th2 responses, in casu lgG2 and macrophages (preferentially IFN-γ activated macrophages) respectively, acts inhibitory on aeroallergen-induced eosinophilic airway inflammation in sensitized mice by modifying the CD4 + T cell response from a predominant Th2 response to a predominant Th1 response. Table 2 % Cytokine-positive CD4 + T cells from BAL Example 8: Cross-protection to unrelated allergens To verify whether the generation of a prevailing Th1 environment by local treatment with anti-allergen lgG2 also promotes the generation of a prevailing Th1 response against unrelated aeroallergens, mice were rendered sensitive simultaneously to two inhaled antigens namely OVA and human catalase (hCat). Occurrence of cross- protection is analysed by intranasal administration of lgG2a antibodies against either allergen, followed 2h and 26h later by intratracheal instillation of both antigens. Analysis of the BAL 2 days later reveals again a clear reduction in airway inflammation, as apparent from the reduced cell infiltration and degree of eosinophilia. This reduction is not observed in mice treated with the mismatched antibody, thus confirming the requirement for a high-affinity interaction between the administered lgG2a antibody and the allergen. 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Claims: Claims 1. A method to induce the CD4 + Th1 immune response, comprising the administration of a compound that can bind allergen and direct said allergen to an antigen-presenting cell that induces and/or supports a Th1 response and counteracts a Th2 response. 2. A method to reduce aeroallergen-induced airway hyperreactivity, comprising the administration of a compound that can bind allergen and direct said allergen to an antigen-presenting cell that induces and/or supports a Th1 response and counteracts a Th2 response. 3. The method according to claim 2, whereby said reduction of aeroallergen- induced airway hyperreactivity is persistent. 4. The method according to any of the claims 1 - 3, whereby said antigen-presenting cell is a macrophage. 5. The method according to any of the claims 1-4, whereby said compound is an IgG isotype antibody, whereby said IgG isotype antibody is not an IgGI isotype. 6. The method according to claim 5, whereby said compound is an lgG2 isotype antibody 7. The method according to claim 5 - 6, whereby said antibody is an anti-allergen antibody. 8. Method according to any of the previous claims whereby said administration is intranasal. 9. Pharmaceutical composition for the treatment of a disease in which the natural CD4 + Th1 / CD4 + Th2 balance is biased towards a Th2 response and/or which can be treated by shifting said balance towards a Th1 response, comprising one or more IgG isotype antibodies, substantially free from other isotype antibodies, whereby said IgG isotype antibody is not an IgGI isotype. 10. Pharmaceutical composition according to claim 8 whereby at least one of said antibodies is an anti-allergen antibody. 11. The use of an IgG isotype antibody for the manufacturing of a medicament for the treatment of a disease in which the natural CD4 + Th1 / CD4 + Th2 balance is biased towards a Th2 response and/or which can be treated by shifting said balance towards a Th1 response, whereby said IgG isotype antibody is not an IgGI isotype. 12. The use according to claim 11 in which said disease is allergic asthma. 13. The use according to claim 11 in which said disease is allergic rhinitis. 14. The use according to claim 11 in which said disease is airway hyperreactivity and/or eosinophilic airway inflammation. 15. The use according to any of the claims 11-14 whereby said antibody is an anti- allergen antibody.

Inventors: GROOTEN JOHAN, SEHRA SARITA, GROOTEN, JOHAN, SEHRA, SARITA
Applicants: GROOTEN JOHAN, SEHRA SARITA, VLAAMS INTERUNIV INST BIOTECH, GROOTEN, JOHAN, SEHRA, SARITA, VLAAMS INTERUNIVERSITAIR INSTITUUT VOOR BIOTECHNOLOGIE VZW
Application year: 2001
Main classification: C07K16
IPC codes: C07K16