Patent Description:
Various prior art references in the specification are indicated by italicized Arabic numerals in brackets. Full citation corresponding to each reference number is listed at the end of the specification, in order to describe fully and clearly the state of the art to which this invention pertains. <NPL>) discloses folate-decorated poly(lactide-co-glycolide)-vitamin E TPGS nanoparticles for targeted drug delivery. <CIT> discloses anti-EGFR antibodies and antibody drug conjugates.

Unless otherwise specified, all technical terms and phrases used herein conform to standard organic, medicinal, and bioconjugate chemistry nomenclature established by International Union of Pure and Applied Chemistry (IUPAC), American Chemical Society (ACS), and other international professional societies.

Cancer cells also have a remarkable ability to survive, proliferate, and metastasize by evading the cell death pathways. Dysregulation of apoptosis pathway or the loss of apoptotic propensity of cells is the early step of oncogenesis and plays a significant role in nearly all cancers [<NUM>]. The extent of dysregulation, as measured through spontaneous apoptosis level of tumor (referred to as 'apoptotic index, or 'Al', <FIG>) determines the extent to which the tumors respond to therapy, irrespective of the nature of therapy [<NUM>]. Furthermore, it is well established that there is a direct correlation between the apoptotic index of a tumor and its response to therapeutic intervention as shown in <FIG> [<NUM>]. For example, spontaneous apoptosis of hepatocelluar (HCa-<NUM>) and ovarian (OCa-<NUM>) carcinoma is <NUM>% and <NUM>% respectively and consequently, the response of HCa-<NUM> to treatment was minimal or in these tumors despite the fact that the radiation dose to HCa-<NUM> was increased <NUM> fold. Also, the overall <NUM>-year survival rates post treatment for the patients belonging to the group with high Al follows a similar pattern in that those cancer patients exhibiting low apoptotic index has lower survival rate that those having high apoptotic index [<NUM>]. Thus, there is a need to develop effective technologies to treat poorly responsive cancers.

Tumor sensitivity to chemotherapy in vivo is shown to be dependent on spontaneous baseline tumor apoptosis index. In general, the higher the baseline apoptosis index, the better are the responses from chemotherapy and vice versa. Aggressive or incurable cancers show low tumor apoptosis index, high loss of apoptosis capability, and low sensitivity to therapeutic intervention [<NUM>]. Therefore, reactivating cell death pathways back to basal level selectively in tumor cells will enhance the susceptibility of tumor cells thereby evoking a better response from therapeutic intervention. However, ubiquitous activation of apoptosis has been shown to have serious side effects, such as the development of neurodegenerative diseases [<NUM>]. Hence, it is necessary to activate the apoptosis pathway selectively in tumors before application of any therapeutic regimen so that the susceptibility of low-responding tumors to therapy can be substantially increased without affecting the normal cells.

Accordingly, described herein are compositions and methods for selectively delivering apoptosis inducing agents (referred to as 'apoptogens') to the tumor prior to conventional therapeutic treatment protocol. We refer to this technology as 'a priori activation of apoptosis pathways of tumors (AAAPT). ' Specifically, the present invention relates to the use of an ensemble (or 'bioconjugate') comprising of an apoptogen (A) and a tumor targeting group (or vector) (T), wherein the apoptogen is attached through an intervening linker (L), as described schematically in <FIG>, the use being as defined according to claim <NUM>. <CHM>
The apoptogen (A) is defined in claim <NUM> and is a molecule that activates apoptosis pathway and causes cell death. The targeting vector (T) is defined in claim <NUM> and is a that delivers the apoptogen selectively to the tumors. The linker (L) is defined in claim <NUM> and may comprise simple alkylene chain or may contain functional groups that are capable of being cleaved by enzymatic process. As described, the apoptogen may also simultaneously serve as the targeting vector. For example, human beta defensin is known to enter the cell via cell surface receptor mediated endocytosis [<NUM>] and, as we will demonstrate later, deactivates thioredoxin enzyme that is involved in apoptosis [<NUM>]. As described, the enzyme-cleavable linker may also serve as a targeting group. For example, cathepsin B and MMP-<NUM> are overexpressed in many cancers. Thus, the AAAPT bioconjugate bearing a linker capable of being cleaved by these enzymes is expected to induce much higher death of tumor cells compared to the normal cells. As will be demonstrated later, the AAAPT conjugates used in the present invention do induce large synergistic and selective cancer cell death response in combination with therapeutic agents.

The present invention relates to the use of the AAAPT bioconjugate of general Formula <NUM>, as defined in claim <NUM>.

Also described herein (not according to the invention) is the AAAPT bioconjugate of general Formula <NUM>,.

wherein A may be a small molecule such as, α-tocopherol succinate (<NUM>), benzamide riboside (<NUM>), bortezomib (<NUM>), cycloheximide (<NUM>), or hispolone (<NUM>) [<NUM>-<NUM>]; or a macromolecule such as, TRAIL [<NUM>], or AIF1 Flavoprotein [<NUM>]). L may optionally contain acid enzymatically cleavable polypeptide sequences. T is selected from the group comprising somatostatin receptor binding agents, folate receptor binding agents, cathepsin B binding agents, matrix metalloprotein-<NUM> (MMP-<NUM>) binding agents, GRP receptors, estrogen receptors, epidermal growth factor receptors (EGFR), and benzodiazepine.

In an embodiment, the AAAPT bioconjugate isrepresented by Formula <NUM>, wherein A is α-tocopherol; T is cathepsin binding dipeptide, Val-Cit (valine-citrulline); and L is - O(CH<NUM>)f(CH<NUM>CH<NUM>O)g(CH<NUM>)hO-.

Another embodiment has Formula <NUM>, wherein A is α-tocopherol; T is cathepsin binding dipeptide, Val-Cit (valine-citrulline); and L is -HN(CH<NUM>)d-.

Another embodiment has Formula <NUM>, wherein A is α-tocopherol; T is cathepsin binding dipeptide, Val-Cit (valine-citrulline); and L is -HN(CH<NUM>)bCO-.

Another embodiment has Formula <NUM>, wherein A is α-tocopherol; T is cathepsin binding dipeptide, Val-Cit (valine-citrulline); and L is -OC(CH<NUM>)aCO-.

Another embodiment is represented by Formula <NUM>, wherein A is α-tocopherol; T is octreotate; and L is val-cit-HN(CH<NUM>)e-.

Another embodiment is represented by Formula <NUM>, wherein A and T are simultaneously human defensin-<NUM> protein; and L is MMP-<NUM> enzyme cleavable peptide sequence EEEEEP-Cit-GHof-YL.

The compositions of Formula <NUM> can be prepared by conventional synthetic and bioconjugate chemistry known in the art as described by Hermanson et al. The method for determining the extent of apoptosis of cells by fluorescence-activated cell sorter (FACS) analysis is also well known in the art [<NUM>]. Briefly, MDA-MB-<NUM> cells are seeded in <NUM>-well culture plates and grown to <NUM>% confluency, followed by <NUM> treatment with various concentrations of drugs in various combinations; untreated MDA-MB-<NUM> cells are used as control. After the completion of treatment time cells are trypsinized, washed, and analyzed for dead or apoptotic cells by staining with propidium iodide (<NUM>µg/ml) for <NUM>, followed by flow cytometry (FACS Aria III, BD Biosciences, San Jose, CA, USA) at the Stanford FACS Facility. Data are analyzed by Flow Jo FACS analysis software (Tree Star, Ashland, OR, USA). GCV and CB1954 were purchased from Sigma-Aldrich (St Louis, MO, USA).

The compounds represented by Formula I, commonly referred to as 'active pharmaceutical ingredient (API)' or 'drug substance' is typically formulated with pharmaceutically acceptable salts, buffers, diluents, carriers, adjuvants, preservatives, and excipients. The phrase "pharmaceutically acceptable" means those formulations which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of humans and animals without undue toxicity, irritation, allergic response, and are commensurate with a reasonable benefit/risk ratio. Pharmaceutically acceptable salts include, acetate, adipate, citrate, tartarate, benzoate, phosphate, glutamate, gluconate, fumarate, maleate, succinate, oxalate, chloride, bromide, hydrochloride, sodium, potassium, calcium, magnesium, ammonium. The formulation technology for manufacture of the drug product is well-known in the art, and are described in "Remington, The Science and Practice of Pharmacy" [<NUM>].

The final formulated product, commonly referred to as 'drug product,' may be administered enterally, parenterally, or topically. Enteral route includes oral, rectal, topical, buccal, ophthalmic, and vaginal administration. Parenteral route includes intravenous, intramuscular, intraperitoneal, intrasternal, and subcutaneous injection or infusion. The drug product may be delivered in solid, liquid, or vapor forms, or can be delivered through a catheter for local delivery at a target. Also, it may be administered alone or in combination with other drugs if medically necessary.

Formulations for oral administration include capsules (soft or hard), tablets, pills, powders, and granules. Such formulations may comprise the API along with at least one inert, pharmaceutically acceptable ingredients selected from the following: (a) buffering agents such as sodium citrate or dicalcium phosphate; (b) fillers or extenders such as starches, lactose, sucrose, glucose, mannitol, and silicic acid; (c) binders such as carboxymethylcellulose, alginates, gelatin, polyvinylpyrrolidone, sucrose and acacia; (d) humectants such as glycerol; (e) disintegrating agents such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates and sodium carbonate; (f) solution retarding agents such as paraffin; (g) absorption accelerators such as quaternary ammonium compounds; (h) wetting agents such as cetyl alcohol and glycerol monostearate; (i) absorbents such as kaolin and bentonite clay and (j) lubricants such as talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate. and mixtures thereof; (k) coatings and shells such as enteric coatings, flavoring agents.

Liquid dosage forms for oral administration include pharmaceutically acceptable emulsions, solutions, suspensions, syrups and elixirs. In addition to the API, the liquid dosage forms may contain inert diluents, solubilizing agents, wetting agents, emulsifying and suspending agents, sweetening, flavoring, and perfuming agents used in the art.

Compositions suitable for parenteral injection may comprise physiologically acceptable, sterile aqueous or nonaqueous isotonic solutions, dispersions, suspensions or emulsions, and sterile powders for reconstitution into sterile injectable solutions or dispersions. The compositions may also optionally contain adjuvants such as preserving; wetting; emulsifying; dispensing, and antimicrobial agents. Examples of suitable carriers, diluents, solvents, vehicles, or adjuvants include, to water; ethanol; polyols such as propyleneglycol, polyethyleneglycol, glycerol; vegetable oils such as cottonseed, groundnut, corn, germ, olive, castor and sesame oils; organic esters such as ethyl oleate; phenol, parabens, sorbic acid.

Injectable formulations may also be suspensions that contain suspending agents such as ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar and tragacanth, or mixtures of these substances. Prolonged absorption of the injectable pharmaceutical form can be brought about by the use of agents delaying absorption, for example, aluminum monostearate and gelatin. Proper fluidity can be maintained, for example, by the use of coating materials such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants. In some cases, in order to prolong the effect of the drug, it is desirable to slow the absorption of the drug from subcutaneous or intramuscular injection. This can be accomplished by the use of a liquid suspension. Alternatively, delayed absorption of a parenterally administered drug form is accomplished by dissolving or suspending the drug in an oil vehicle.

Injectable depot forms are made by forming microencapsulated matrices of the drug in biodegradable polymers. Depending upon the ratio of drug to polymer and the nature of the particular polymer employed, these compositions release the active ingredient(s) only, or preferentially, in a certain part of the intestinal tract, optionally, in a delayed manner. Thus, the rate of drug release and the site of delivery can be controlled. Examples of embedding compositions include polylactide-polyglycolide poly(orthoesters), and poly(anhydrides), and waxes. The technology pertaining to controlled release formulations are described in "Design of Controlled Release Drug Delivery Systems," [<NUM>].

Formulations for topical administration include powders, sprays, ointments and inhalants. These formulations include the API along with suitable non-irritating excipients or carriers such as cocoa butter, polyethylene glycol or a suppository wax which are solid at room temperature but liquid at body temperature and therefore melt in the rectum or vaginal cavity and release the active compound.

Compounds of the present invention can also be administered in the form of liposomes. Any non-toxic, physiologically acceptable and metabolizable lipid capable of forming liposomes can be used. The present compositions in liposome form can contain, in addition to a compound of the present invention, stabilizers, preservatives, excipients. The preferred lipids are natural and synthetic phospholipids and phosphatidyl cholines (lecithins) used separately or together. Methods to form liposomes are known in the art and are described in "Liposomes," [<NUM>].

The compounds described herein can also be administered to a patient in the form of pharmaceutically acceptable 'prodrugs. ' Prodrugs are generally used to enhance the bioavailability, solubility, in vivo stability, or any combination thereof of the API. They are typically prepared by linking the API covalently to a biodegradable functional group such as a phosphate that will be cleaved enzymatically or hydrolytically in blood, stomach, or GI tract to release the API. A detailed discussion of the prodrug technology is described in "Prodrugs: Design and Clinical Applications," [<NUM>].

The dosage levels of API in the drug product can be varied so as to achieve the desired therapeutic response for a particular patient. The phrase "therapeutically effective amount" of the compound used according to the invention means a sufficient amount of the compound to treat disorders, at a reasonable benefit/risk ratio applicable to any medical treatment. It will be understood, however, that the total daily usage of the compounds and compositions used according to the present invention will be decided by the attending physician within the scope of sound medical judgment. The specific therapeutically effective dose level for any particular patient will depend upon a variety of factors including the disorder being treated, the severity of the disorder; activity of the specific compound employed; the specific composition employed, age, body weight, general health, sex, diet of the patient; the time of administration, route of administration, and rate of excretion of the specific compound employed, and the duration of the treatment. The total daily dose of the compounds to be administered may range from about <NUM> to about <NUM>/kg/day. For purposes of oral administration, more preferable doses can be in the range from about <NUM> to about <NUM>/kg/day. If desired, the effective daily dose can be divided into multiple doses for optimal therapeutic effect.

The following examples illustrate specific embodiments and utilities of the invention, and are not meant to limit the invention.

Synthesis of AAAPT bioconjugate of Formula <NUM>, wherein A is α-tocopherol; T is Val-Cit; L is -O(CH<NUM>CH<NUM>O)g(CH<NUM>)hO-; and the subscripts "g", and "h" are <NUM>, and <NUM> respectively (AMP-<NUM>).

The general synthesis of cathepsin B cleavable peptide conjugation with pegylated apoptogen and/or other apoptogens is accomplished through Fmoc chemistry to protect N end of peptide with Boc and then couple it with tocopherol derivatives using DCC in DMF. This was further cleaved by TFA and purified using HPLC method. Cathepsin cleavable compounds have been synthesized by Genemed Synthesis using their proprietary peptide synthesis technology. In brief, peptides were synthesized using a microwave peptide synthesizer. The resin (containing <NUM> mmol of peptide anchors) was deprotected using piperidine resulting in the formation of the primary amine. The carboxylic acids of the Fmoc protected amino acids (<NUM> mmol) were activated using COMU and conjugated to the primary amines of the growing peptide on the resin. The process of deprotection, activation and conjugation was repeated until the desired peptide was synthesized. Purification of the peptides was performed using a semi-preparative Kromasil C18, 5u column with a flow rate of <NUM>/min. HPLC solvents were <NUM> % TFA acetonitrile (solvent A) and <NUM>% TFA in water (solvent B). The initial gradient A: B, t =<NUM>, <NUM>: <NUM> and t = <NUM><NUM> % B. <FIG> shows a general synthesis procedure for all the compounds from AMP-<NUM> to AMP-<NUM>.

Step <NUM>. To a stirred solution of α-tocopherol <NUM> (<NUM>, <NUM> mmol) in dry DMF (<NUM>) was added compound <NUM> (<NUM>, <NUM> mmol) followed by K<NUM>CO<NUM> (<NUM>, <NUM> mmol) at RT under inert atmosphere. The resulting reaction mixture was gradually heated up to <NUM> and stirred for <NUM>; progress of the reaction was monitored by TLC. The reaction mixture was diluted with ice-cold water (<NUM>) and extracted with EtOAc (<NUM> x <NUM>). The combined organic extracts were washed with water (<NUM>), brine (<NUM>), dried over anhydrous Na<NUM>SO<NUM> and concentrated under reduced pressure. The crude material was purified by silica gel column chromatography (SiO2, <NUM>-<NUM> mesh) (eluent: <NUM>% EtOAc/Hexane) to afford compound <NUM> (<NUM>, <NUM> mmol, <NUM>%) as off white solid. <NUM>H NMR (CDCI3): δ <NUM> (t, J = <NUM>, <NUM>)), <NUM> (t, J = <NUM>, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM>(t, J = <NUM>, <NUM>), <NUM>-<NUM> (m, <NUM> ), <NUM>-<NUM> (m, <NUM> ), <NUM>-<NUM> (m, <NUM> ), <NUM>-<NUM> (m, <NUM> ), <NUM> (s, <NUM>), <NUM>-<NUM> (m, <NUM>). LRMS (ESI): m/z <NUM> [M+H]+.

Step <NUM>: To a stirred solution of the Boc-protected compound in Step <NUM> (<NUM>, <NUM> mmol) in dry <NUM>,<NUM>-dioxane (<NUM>) was added <NUM> N <NUM>,<NUM>-dioxane solution in HCl (<NUM>) at <NUM>° C under inert atmosphere. The resulting reaction mixture was stirred at RT for <NUM>. After completion of the reaction (by TLC), The resulting mixture was concentrated under reduced pressure to get the sticky syrup, after washing with ether (HPLC, <NUM> x <NUM>) to afford <NUM> as fine brown solid (<NUM>, <NUM>. 45mmol, <NUM>%). <NUM>H NMR (CDCI3): δ <NUM> (bs, <NUM>), δ <NUM> (t, J = <NUM>, <NUM>)), <NUM> (t, J = <NUM>, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM>(t, J = <NUM>, <NUM>), <NUM>-<NUM> (m, <NUM> ), <NUM>-<NUM> (m, <NUM> ), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM> ), <NUM>-<NUM> (m, <NUM>). LRMS (ESI): m /z <NUM> [M+H]+.

Step <NUM>. Briefly, the protected amino acids were mixed with precursor AMP-<NUM> in peptide synthesizer with conditions of conjugating activating agents DCC. The product was chromatographed using solvent system chloroform and ethyl acetate to get the final product AMP-<NUM> (yield <NUM> %). The synthesis of cathepsin B cleavable peptide conjugation with apoptogen is accomplished through Fmoc chemistry to synthesize N end of peptide protected with Boc and then, couple it with tocopherol derivatives with DCC in DMF. This was further cleaved by TFA and purified using HPLC method. Cathepsin cleavable compounds have been synthesized by Genemed Synthesis using their proprietary peptide synthesis technology. In brief, peptides were synthesized using a microwave peptide synthesizer. The resin (containing <NUM> mmol of peptide anchors) was deprotected using piperidine resulting in the formation of the primary amine. The carboxylic acids of the Fmoc protected amino acids (<NUM> mmol) were activated using COMU and conjugated to the primary amines of the growing peptide on the resin. The process of deprotection, activation and conjugation was repeated until the desired peptide was synthesized. Purification of the peptides was performed using a semi-preparative Kromasil C18, 5u column with a flow rate of <NUM>/min. HPLC solvents were <NUM> % TFA acetonitrile (solvent A) and <NUM>% TFA in water (solvent B). The initial gradient A: B, t =<NUM>, <NUM>: <NUM> and t = <NUM><NUM> % B.

Step <NUM>. To a stirred solution of compound <NUM> (<NUM>, <NUM> mmol) in dry DMF (<NUM>) was added compound <NUM> (<NUM>) followed by K<NUM>CO<NUM> (<NUM>, <NUM> mmol) at ambient temperature under inert atmosphere. The resulting reaction mixture was gradually heated to <NUM> and stirred for <NUM>. After completion of the reaction (as determined by TLC), the reaction mixture was diluted with ice-cold water (<NUM>) and extracted with EtOAc (<NUM> x <NUM>). The combined organic extracts were washed with water (<NUM>), brine (<NUM>), dried over anhydrous Na<NUM>SO<NUM> and concentrated under reduced pressure. The crude material was purified by silica gel column chromatography (SiO2, <NUM>-<NUM> mesh) (eluent: <NUM>% EtOAc/Hexane) to afford compound <NUM> (<NUM>, <NUM> mmol, <NUM>%) as off white solid. <NUM>H NMR (CDCl<NUM>): δ <NUM> (bs, <NUM>), <NUM> (s, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM> (t, J = <NUM>, <NUM>), <NUM> (s, <NUM>), <NUM> (s, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>). LRMS (ESI): m /z <NUM> [M+H]+.

Step <NUM>: To a stirred solution of compound-<NUM> (<NUM>, <NUM> mmol) in dry <NUM>,<NUM>-dioxane (<NUM>) was added <NUM> N <NUM>,<NUM>-dioxane solution in HCl (<NUM>) at <NUM> under inert atmosphere. The resulting reaction mixture was stirred at RT for <NUM>. After completion of the reaction (by TLC), The resulting mixture was concentrated under reduced pressure, to get the sticky syrup, after washing with ether (HPLC) to obtain compound <NUM> the fine brown solid (<NUM>, <NUM> mmol, <NUM>%). <NUM>H NMR ( Varian,<NUM>, CDCl<NUM>): δ <NUM> (bs, <NUM>), <NUM> (t, J = <NUM>, <NUM>),), <NUM> (t, J = <NUM>, <NUM>), <NUM> (t, J= <NUM> Hz, <NUM>), <NUM> (s, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM> (q, J = <NUM>, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>), <NUM>-<NUM> (m, <NUM>). MS (ESI): m /z <NUM> [M+<NUM>]+ HPLC: <NUM>%.

The synthesis of Citrulline-valine conjugation with apoptogen is accomplished through Fmoc chemistry to synthesize carboxylic group protection and then, couple it with tocopherol derivatives with DCC in DMF. This was further cleaved by TFA and purified using HPLC method. Cathepsin cleavable compounds have been synthesized by Genemed Synthesis using their proprietary peptide synthesis technology. In brief, peptides were synthesized using a microwave peptide synthesizer. The resin (containing <NUM> mmol of peptide anchors) was deprotected using piperidine resulting in the formation of the primary amine. The carboxylic acids of the Fmoc protected amino acids (<NUM> mmol) were activated using COMU and conjugated to the primary amines of the growing peptide on the resin. The process of deprotection, activation and conjugation was repeated until the desired peptide was synthesized. Purification of the peptides was performed using a semi-preparative Kromasil C18, 5u column with a flow rate of <NUM>/min. HPLC solvents were <NUM> % TFA acetonitrile (solvent A) and <NUM>% TFA in water (solvent B). The initial gradient A: B, t =<NUM>, <NUM>: <NUM> and t = <NUM><NUM> % B.

First, the MMP2- cleavable peptide sequence was synthesized using the procedure described earlier and the beginning amino acid E was capped with acetylation using acetic anhydride. The peptide acid was synthesized on the solid phase starting with commercially available Fmoc-Leu-Wang resin (<NUM>, <NUM> mmol, Advance Chemtech, Louisville, KY). The synthesis was done on an ABI 433A peptide synthesizer (Applied Biosystems, Foster City, CA) using standard Fmoc protocols. The completed peptide on resin was N-acetylated with acetic anhydride. The desired peptide was cleaved from the resin with <NUM>% trifluoroacetic acid in water for <NUM> hours. After solvent removal, the peptide was dissolved in H<NUM>O:CH<NUM>CN and conjugated to the commercially available hBD and freeze dried. Purification of the peptides was performed using a semi-preparative Kromasil C18, 5u column with a flow rate of <NUM>/min. HPLC solvents were <NUM> % TFA acetonitrile (solvent A) and <NUM>% TFA in water (solvent B). The initial gradient A: B, t =<NUM>, <NUM>: <NUM> and t = <NUM><NUM> % B.

The synthesis of citrulline-valine conjugation with apoptogen is accomplished through Fmoc chemistry to synthesize carboxylic group protection and then, couple it with tocopherol derivatives with DCC in DMF. This was further cleaved by TFA and purified using HPLC method. The procedure was similar to the one used in the example <NUM>. The valine-citrulline conjugate of apoptogen was further conjugated to the carboxylic group of commercially available Octreoscan using standard peptide coupling procedure.

The method for determining the extent of apoptosis of cells by fluorescence-activated cell sorter (FACS) analysis is also well known in the art [<NUM>]. Briefly, MDA-MB-<NUM> cells are seeded in <NUM>-well culture plates and grown to <NUM>% confluency, followed by <NUM> treatment with various concentrations of drugs in various combinations; untreated MDA-MB-<NUM> cells are used as control. After the completion of treatment time cells are trypsinized, washed, and analyzed for dead or apoptotic cells by staining with propidium iodide (<NUM>µg/ml) for <NUM>, followed by flow cytometry (FACS Aria III, BD Biosciences, San Jose, CA, USA) at the Stanford FACS Facility. Data are analyzed by Flow Jo FACS analysis software (Tree Star, Ashland, OR, USA). GCV and CB1954 were purchased from Sigma-Aldrich (St Louis, MO, USA).

MDA-MB-<NUM> tumor cells (ATCC) were cultured in <NUM>-well plate for <NUM> hours. MMP2 cleavable AMP-<NUM> was dissolved in culture medium and sonicated for <NUM> each and repeated for <NUM> times. After the cells treated with different concentration of doxorubicin HCl (Bedford Lab, Bedford, OH), AMP compounds alone or combination of doxorubicin and AMP compounds were tested for <NUM> hrs incubation respectively, the cells were washed three times with PBS (pH <NUM>) and incubated with Cy5. <NUM> Annexin-V (BD Bioscience Pharmingen) according to the instructions of the manufacture. The cells were imaged using Nikon Eclipse TE-<NUM> fluorescence microscope and counted under Ex/Em <NUM> - <NUM> nm/ <NUM> - <NUM>.

Concentration dependent treatment of AMP-<NUM> on TNBC MDA-MB-<NUM> cells showed cell death effect with IC-<NUM> around <NUM>-<NUM>. AMP-<NUM> was also treated with PC3 prostate cancer, 4T1 metastatic breast cancer, SKVO3 ovarian cancer, A549 lung cancer, GL <NUM> (Glioma), U <NUM> (Malignant Glioma) and TNBC patients cells using proliferation assays which showed inhibition of proliferation of cancer cells between the range <NUM>-<NUM>.

Concentration dependent treatment of AMP-<NUM> on TNBC MDA-MB-<NUM> cells showed cell death effect with IC-<NUM> around <NUM>. AMP-<NUM> was also treated with PC3 prostate cancer, 4T1 metastatic breast cancer, SKVO3 ovarian cancer, A549 lung cancer, GL <NUM> (Glioma), U <NUM> (Malignant Glioma) and TNBC Patients cells using proliferation assays an showed inhibition of proliferation of cancer cells between the range <NUM>-<NUM>. Pretreatment of same cells with AMP-<NUM> for <NUM> hrs followed by <NUM> doxorubicin treatment resulted synergistic (not additive) effect of greater than <NUM> % cell death compared to AMP-<NUM> or doxorubicin alone. Synergistic effect was same when both were administered together. Treatment of AMP-<NUM> on normal fibroblasts did not show significant cell death compared to cancer cells.

Concentration dependent treatment of AMP-<NUM> on TNBC MDA-MB-<NUM> cells showed cell death effect with IC-<NUM> around <NUM>. AMP-<NUM> was also treated with PC3 prostate cancer, 4T1 metastatic breast cancer, SKVO3 ovarian cancer, A549 lung cancer, GL <NUM> (Glioma), U <NUM> (Malignant Glioma) and TNBC cells. using proliferation assays an showed inhibition of proliferation of cancer cells between the range <NUM>-<NUM>. Pretreatment of same cells with AMP-<NUM> for <NUM> hrs followed by <NUM> doxorubicin treatment resulted synergistic (not additive) effect of greater than <NUM> % cell death compared to AMP-<NUM> or doxorubicin alone. Synergistic effect was same when both were administered together. Treatment of AMP-<NUM> on normal fibroblasts did not show significant cell death compared to cancer cells (<FIG>). Similarly, AMP-<NUM> also showed dose dependent cell death with an IC<NUM> around <NUM>-<NUM> (<FIG>).

Concentration dependent treatment of AMP-<NUM> on TNBC MDA-MB-<NUM> cells showed cell death effect with IC-<NUM> around <NUM> (<FIG>). Pretreatment of same cells with AMP-<NUM> for <NUM> hrs followed by <NUM> doxorubicin treatment resulted synergistic (not additive) effect of greater than <NUM> % cell death compared to AMP-<NUM> or doxorubicin alone. Synergistic effect was same when both were administered together (<FIG>). AMP-<NUM> also showed similar synergistic effect another chemotherapy carboplatin (<FIG>).

Concentration dependent treatment of AMP-<NUM>, AMP-<NUM> and AMP-<NUM> on TNBC MDA-MB-<NUM> cells showed cell death with IC<NUM> around <NUM>, <NUM> and <NUM> respectively (<FIG>).

The anti-tumorogenic potential of AMP-<NUM> was tested using a limited number of female Nu/Nu mice (<NUM>-<NUM> weeks old) which were innoculated in the mammary fat pad with 5x10<NUM> MDA-MB-<NUM> cells stably expressing firefly luciferase. Tumors were allowed to reach <NUM>-<NUM><NUM> before I. administration of AMP-<NUM>. The treatment schedule for this experiment was AMP-<NUM> monotherapy at low (<NUM>/kg) and high (<NUM> /kg) dose x <NUM> days x <NUM> weeks. Tumor response was monitored by bioluminescence (IVIS <NUM>, Perkin Elmer). No toxicity was detected as far as significant weight loss, decreased mobility or labored breathing is concerned. The light intensities emitted from regions of interest were expressed as total flux (photons/second). The data clearly establish that AMP-<NUM> regresses tumor at a reasonable dose <NUM>/Kg while, not showed any toxicity up to <NUM>/kg. The mice were monitored for behavioral changes along with weigh loss for <NUM> days. <FIG> shows a significant reduction in the bioluminescent signal correlated to tumor volume plotted as a percentage of tumor growth normalized at day <NUM> of injection (<FIG>, p < <NUM>) compared to untreated control. The V curve confirms tumor regression for dose <NUM>.

Efficacy and toxicity in vivo are the main criteria for a successful clinical translation from in vitro. Nude mice with age group of <NUM> to <NUM> weeks were purchased from Charles River animal supplier (Charles River Laboratories, Wilmington, MA), and put in to Stanford University animal facility for quarantine. To make sub-cutaneous tumor model, mice were implanted with <NUM> millions of MDA-MB-<NUM> cells stably expressing FLuc-EGFP fusion protein, on either flank regions of hind limps. Animals were maintained in sterile disposable cages until the tumor size reach <NUM> to <NUM><NUM>. Nude mice were divided into <NUM> groups comprising N = <NUM> animals in each group, and <NUM> group with <NUM> animals. Group with <NUM> animals were treated with vehicle control (250µL physiological saline containing <NUM>% PEG400), and other <NUM> groups with N= <NUM> in each group were treated with <NUM>, <NUM> and <NUM>/Kg BW in 250µL physiological saline containing <NUM>% PEG400. AMP-<NUM> was administered by intra-peritoneal route for <NUM> times with a interval of <NUM>. For optical imaging, animals were intraperitoneally injected with <NUM> of D-Luciferin in <NUM>µl PBS, <NUM> to <NUM> minutes before signal acquisition. All mice were imaged with a cooled CCD camera (Spectral Lago; Spectral Instruments Imaging, Tucson, AZ), and photons emitted were collected and integrated for a period of <NUM> seconds for <NUM> acquisitions for FLuc. Images were analyzed by Spectral Instruments Imaging Software (Spectral Instruments Imaging, Tucson, AZ). To quantify the number of emitted photons, regions of interest (ROI) were drawn over the area of the implanted cells, and the maximum photons per second per square centimeter per steradian (p/sec/cm<NUM>/sr) were recorded. Tumor volume and animals weights were recorded after every imaging session. After Imaging, animals were euthanized and tissues samples from tumor, kidney, liver, pancreas, heart, and lung were fixed for histological and toxicological examinations. Result: No toxicity was detected as far as significant weight loss, decreased mobility, grooming behavior or labored breathing are concerned. <FIG> shows a significant reduction in the bioluminescent signal correlated to tumor volume plotted as a percentage of tumor growth normalized at day <NUM> of injection (<FIG>, p < <NUM>) compared to untreated control. The classic V curve confirms tumor regression for dose <NUM>/Kg BW.

Animals from all groups were euthanized and tissue samples were collected. After Imaging, animals were euthanized and tissues samples from kidney, liver, heart, spleen, and tumor were fixed with OCT fixative for histological and toxicological examinations. H&E stained and Ki67 stained tissue sections did not show any toxicological abnormalities. Tumor tissue section from animals treated with AMP-<NUM>, <NUM> dose <NUM> showed marked tissue damage.

In brief, the adult human heart cell line was created by reprogramming an adult human fibroblast cell line by retroviral expression of the reprogramming factors sox7, oct4, nanog, and lin28 using MMLV viral constructs. This line was used to generate stem-cell clones which were engineered to exhibit blasticidin resistance by inserting the coding region of the BSD gene encoding Blasticidin S Deaminase from Aspergillus terreus in-frame downstream of the last exon of the native myosin heavy chain <NUM> (MYH6) gene coding region through homologous recombination. Cardiomyocytes were derived from this engineered stem cell clone line as follows. Stem cell aggregates were formed from single cells and cultured in suspension in medium containing zebrafish bFGF (basic fibroblast growth factor) and fetal bovine serum. Upon observation of beating cardiac aggregates, cultures were subjected to blasticidin selection at <NUM> ug/ml to enrich the cardiomyocyte population. Cardiomyocyte aggregate cultures were maintained in Dulbecco's modified Eagle's medium (DMEM) containing <NUM>% fetal bovine serum during cardiomyocyte selection through the duration of the culture prior to cryopreservation. At <NUM> to <NUM> days of culture the enriched, stem cell-derived cardiomyocytes were subjected to enzymatic dissociation using <NUM>% trypsin to obtain single cell suspensions of purified cardiomyocytes, which were ><NUM>% cardiac troponin-T (cTNT) positive. These cells (iCell® Cardiomyocytes) were cryopreserved and stored in liquid nitrogen before delivery to Ionic Transport Assays from Cellular Dynamics International, Madison, WI.

For this study, single vials containing ≈ <NUM> x <NUM><NUM> cardiomyocytes were thawed by immersing the frozen cryo-vial in a <NUM> water bath, transferring thawed cardiomyocytes into a <NUM> tube and diluting them with room temperature plating medium (iCell® Cardiomyocyte Plating Medium (iCPM), Cellular Dynamics International).

Cells were plated into <NUM> well plates that percolated with <NUM>% gelatin. This was defined as culture day <NUM> for the purpose of this study. Cell plating media was changed at day <NUM> to cell maintenance media and cell maintenance media subsequently was changed three times a week. Day <NUM>-<NUM> cells were re-suspended with trypsin and re-plated as desired density (><NUM>,<NUM>) at <NUM> well plate which percolated with <NUM>% gelatin). Results: The results show the comparison of IC-<NUM> values for AMP-<NUM> compared to doxorubicin and standard Sorafinib. The higher IC<NUM> value for AMP-<NUM> in cardiomyocytes (> <NUM>) compared to doxorubicin (<NUM>) clearly demonstrates better safety profile for AMP-<NUM>. Photomicrographs of the morphology of cardiomyocytes showed that either <NUM> AMP-<NUM> or <NUM> AMP-<NUM> retained viability while, <NUM> doxorubicin resulted in cell death.

Six-week-old athymic BALB/cA nu/nu female mice were purchased from Weitonglihua Laboratory (Beijing, China) and maintained in an Animal Biosafety Level <NUM> Laboratory at the Animal Experimental Center of Wuhan University. All animal experiments were performed according to the Wuhan University Animal Care Facility and National Institutes of Health guidelines. Approximately <NUM>×<NUM><NUM> MGC-<NUM> cells were harvested and suspended in 200µl of PBS and Matrigel (BD Bio-science) (<NUM>:<NUM>), and injected subcutaneously into the right flank of each mouse. After two weeks xenotransplantation, mice were respectively randomized into four groups and treated as follow: VCPA (same as AMP-<NUM>, <NUM>/kg i. every other day for <NUM> weeks), DOX (<NUM>. every other day for <NUM> weeks), their combination, or saline as untreated vehicle. The size of subcutaneous tumors and mice weight were recorded every two days. The tumor volume (V) was calculated according to the formula V=<NUM>×l×w<NUM>, where l is the greatest diameter and w is the diameter at the point perpendicular to l. At the end of treatment, mice were sacrificed, and the tumors were removed and used for immunohistochemical staining. Result: The extent of tumor regression for either doxorubicin or for VCPA (AMP-<NUM>) is reasonable. However, a combination of AMP-<NUM> and doxorubicin showed a significant synergistic tumor regression.

(A) AMP-<NUM> (VCPA) suppresses the growth of human gastric cancer cells (SGC-<NUM> and MGC-<NUM>) (B) AMP-<NUM> (VCPA) induces apoptosis in human gastric cancer cells SGC-<NUM> and MGC-<NUM>, (C) IC<NUM> drift of DOX only or AMP-<NUM> (VCPA)/DOX combination treatment, in gastric cancer cells. Results: (A) Dose dependent AMP-<NUM> reduced the growth of gastric cancer cells back to the base level, (B) induced cell death <NUM> % in SGC-<NUM> while, it induced <NUM>% in MGC-<NUM> gastric cancer cells (C) IC<NUM> of the combination of doxorubicin and AMP-<NUM> is reduced from <NUM> for doxorubicin to <NUM> (almost <NUM> times less) in SGC-<NUM> cells and from <NUM> to <NUM> in MGC-<NUM>.

IC<NUM> of AMP-<NUM> (VCPA) in gastric cancer cell lines. Result: IC<NUM> of AMP-<NUM> (VCPA) is around <NUM> for SGC-<NUM> and <NUM> for MGC-<NUM>.

Inhibition of mammosphere formation by AMP-<NUM> in CSC enriched cancer cells.

Inhibition of mammosphere formation by AMP-<NUM> in cancer stem cells (CSCs) in (MCF-10A) breast cells overexpressed with Src oncogene and b) in TMD-<NUM> cells. Result: Controls showed <NUM>-<NUM> mammosphers/<NUM> MCF-10A-ER-Src Cells (Views <NUM> & <NUM> in Fig ). Post AMP-<NUM> treatment (<NUM>/<NUM>) reduced the mammosphers by <NUM>-<NUM> times (<NUM>-<NUM>/<NUM> cells) C: Control in TMD-<NUM>, <NUM>-<NUM> mammosphers/<NUM>. D-E: Post AMP-<NUM> Treatment: (<NUM>/<NUM>): Mammosphere reduction: <NUM>-<NUM> times (<NUM>-<NUM>/<NUM> cells). Conclusion: AMP-<NUM> Inhibited mammosphere formation, A first step for the survival of CSCs.

Claim 1:
A composition for use in the treatment of cancer, said composition comprising:
(a) an AAAPT bioconjugate of Formula <NUM>:

        A-L-T     Formula <NUM>

and
(b) an agent selected from a chemotherapeutic agent, an immunotherapeutic agent, a radiation therapy agent, and a radionuclide therapy agent;
wherein (a) is selected from the following compounds:
(i) A is alpha-tocopherol, T is Valine-Citrulline (Val-Cit) and L is -O(CH<NUM>)f(CH<NUM>CH<NUM>O)g(CH<NUM>)hO-,
(ii) A is alpha-tocopherol, T is Valine-Citrulline (Val-Cit) and L is -HN(CH<NUM>)e-;
(iii) A is alpha-tocopherol, T is Valine-Citrulline (Val-Cit) and L is -HN(CH<NUM>)bCO-;
(iv) A is alpha-tocopherol, T is Valine-Citrulline (Val-Cit) and L is -OC(CH<NUM>)aCO-;
(v) A is alpha-tocopherol, T is octreotate and L is val-cit-HN(CH<NUM>)e-;
(vi) A is human defensin-<NUM> protein, T is human defensin-<NUM> protein, and L is EEEEEP-Cit-GHof-YL;
(vii) A is alpha-tocopherol, T is Valine-Citrulline (Val-Cit) and L is -O(CH<NUM>)f(CH<NUM>CH<NUM>O)g(CH<NUM>)hO-, g is <NUM> and h is <NUM>;
(viii) A is alpha-tocopherol, T is Valine-Citrulline (Val-Cit) and L is -HN(CH<NUM>)e-, e is <NUM>; and
(ix) A is alpha-tocopherol, T is Valine-Citrulline (Val-Cit) and L is -HN(CH<NUM>)bCO-, b is <NUM>;
unless otherwise defined, subscripts 'a', 'b', 'and 'e' independently vary from <NUM> to <NUM>;
unless otherwise defined, subscripts 'f', 'g', and 'h', independently vary from <NUM>-<NUM>; and
wherein said chemotherapeutic agent comprises doxorubicin, avastin, epirubicin, paclitaxel, docetaxel, <NUM>-fluorouracil, cyclophosphamide, cisplatin, carboplatin, vinorelbine, capecitabine, liposomal doxorubicin, gemcitabine, ixabepilone, albumin-bound paclitaxel, eribulin, irinotecan, etoposide, vinblastine, tamoxifen, methotrexate, or pemetrexed;
said immunotherapeutic agent comprises deactivated viral particles, alemtuzumab, atezolizumab, ipilimumab, ofatumumab, trastuzumab, rituximab, adalimumab, infliximab, etanercpet, or abatacept;
said radiation therapy agent is an external beam radiation; and
said radionuclide therapy agent comprises <NUM>I, <NUM>I, <NUM>I, <NUM>/<NUM>Re, <NUM>In, <NUM>Lu, <NUM>Sm, <NUM>Sr, <NUM>Y, <NUM>Pb, <NUM>P, <NUM>Au, <NUM>Dy, <NUM>Br, <NUM>Cu, or <NUM>Sn.