KR20190063475A - Methods for reducing proteinuria in human subjects with immunoglobulin A nephropathy - Google Patents

Abstract

In one aspect, the invention provides a method of reducing proteinuria in a human subject suffering from, or at risk of developing, immunoglobulin A nephropathy (IgAN). The method comprises administering to a subject in need thereof an amount of a MASP-2 inhibiting antibody effective to inhibit MASP-2-dependent complement activation.

Description

Methods for reducing proteinuria in human subjects with immunoglobulin A nephropathy

Technical field

The present invention relates to a method for reducing proteinuria in a human subject suffering from Immunoglobulin A nephropathy.

STATEMENT OF SEQUENCE LIST

The sequence listing related to this application is provided in text format instead of a copy of the document and is included in the description by reference. The name of the text file containing the sequence list is MP_1_0269_PCT_sequence_list_20171013_ST25. The text file is 136 KB, created on October 10, 2017, and submitted via EFS-Web with the application of this specification.

The complement system provides an early action mechanism for initiating, amplifying and modulating immune responses to microbial infections and other serious injuries in humans and other vertebrates (MK Liszewski and JP Atkinson, 1993, in Fundamental Immunology , Third Edition, edited by WE Paul, Raven Press, Ltd., New York). Complement activation, which provides important first line defense against potential pathogens, while complement activity that promotes protective immune responses may also represent a potential threat to the host (KR Kalli, et al., Springer Semin. Immunopathol. 15 : 417-431, 1994, BP Morgan, Eur., J. Clinical Investig., 24 : 219-228, 1994). For example, C3 and C5 protein hydrolysis products recruit and activate neutrophils. Although essential for host defense, activated neutrophils release indiscriminately destructive enzymes, which can lead to organ damage. In addition, complement activation may result in the deposition of soluble complement components on nearby host cells, as well as on microbial targets, resulting in the dissolution of the host cells.

Complement systems also appear to be involved in the pathogenesis of many acute and chronic disease states, including: myocardial infarction, stroke, ARDS, reperfusion injury, septic shock Postcardiopulmonary bypass inflammation, transplant rejection, rheumatoid arthritis, multiple sclerosis, myasthenia gravis, and Alzheimer's disease (e. G., Rheumatoid arthritis) Alzheimer's disease). In almost all of these diseases, complement is not a cause but is one of several factors involved in the pathogenesis. Nonetheless, complement activation may be a major physiological mechanism and represents a point effective in clinical control in many of these disease states. Increased awareness of the importance of complement-mediated tissue injury in various disease states underscores the need for effective complement inhibitors. To date, the antibody against C5, Eculizumab (Solaris®), is the only complement-targeted agent approved for human use. However, C5 is one of several effector molecules located "downstream" of the complement system, and blocking of C5 does not inhibit activation of the complement system. Therefore, the inhibitor at the beginning of the complement activation will have a greater advantage than the "downstream" complement inhibitor.

Currently, it is widely accepted that complement systems can be activated through three distinct paths: the classical path, the lectin path, and the alternate path. The classical pathway is usually caused by a complex composed of host antibodies bound to foreign particles (ie, antigens) and thus requires prior exposure to the antigen for the production of a specific antibody response. Because the activation of the classical pathway depends on the host adaptive immune response, the classical pathway is part of the acquired immune system. In contrast, both the lectin pathway and the alternative pathway are independent of adaptive immunity and are part of the innate immune system.

Activation of the complement system results in sequential activation of the serine protease zymogen. The first step in classical pathway activation is the binding of C1q, a specific recognition molecule for antigen-bound IgG and IgM molecules. C1q is associated with the C1r and C1s serine protease enzyme precursors as a complex called Cl. Upon binding of C1q to the immune complexes, C1r-mediated cleavage and activation of C1s follows autoproteolytic cleavage of the Arg-Ile site of C1r, thereby acquiring the ability to cleave C4 and C2. C4 is cut into two pieces designated as C4a and C4b, and likewise, C2 is cut into C2a and C2b. The C4b fragment forms a covalent bond with the adjacent hydroxyl or amino group and can produce the C3 convertase (C4b2a) through interaction by noncovalent bonding with the C2a fragment of activated C2. The C3 convertase (C4b2a) activates C3 by proteolytic cleavage of the C3a and C3b subcomponents to induce the production of the C5 convertase (C4b2a3b), which breaks down the cell membrane to induce cell lysis (Also called C5b, "MAC" in combination with C6, C7, C8 and C-9). Activated forms of C3 and C4 (C3b and C4b) are deposited on the foreign target surface by covalent bonds, which are recognized by complement receptors on a number of phagocyte cells.

Independently, the first step of complement system activation through the lectin pathway is also the binding of a specific recognition molecule, followed by the activation of the associated serine protease enzyme precursor. However, rather than the binding of the immune complex by C1q, the recognition molecule of the lectin pathway collectively binds to carbohydrate-binding proteins called lectins (mannan-binding lectin (MBL), H-picoline, Choline, L-picoline and C-type lectin CL-11). J. Lu et al., Biochim. Biophys. Acta 1572 : 387-400, (2002); Holmskov et al., Annu. Rev. Immunol . 21: 547-578 (2003); Teh et al., Immunology 101 : 225-232 (2000)). J. Luet et al., Biochim Biophys Acta 1572: 387-400 (2002); Holmskov et al., Annu Rev Immunol 21: 547-578 (2003); Teh et al., Immunology 101: 225-232 (2000); Hansen et al, J. Immunol 185 (10): 6096-6104 (2010).

Ikeda et al. First demonstrated that, like C1q, MBL can activate the complement system in a C4-dependent manner upon binding to yeast man-coated red blood cells (Ikeda et al., J. Biol. Chem. 262 : 7451-7454, (1987)). MBL, a member of the colectin protein family, is a calcium-dependent lectin that binds carbohydrates to carbohydrates with 3- and 4-hydroxy groups oriented on the equatorial plane of the pyranose ring. Thus, important ligands for MBL are D-mannose and N-acetyl-D-glucosamine, but carbohydrates that do not conform to this steric requirement do not have detectable affinity for MBL (Weis et al., Nature 360: 127 -134, (1992)). The interactions between MBL and monosaccharide are very weak, and dissociation constants are typically in the millimolar range of single digits. MBL achieves a tight, specific binding to the glycan ligand by interacting simultaneously with multiple monosaccharide residues located close together, i.e., by binding forces (Lee et al., Archiv. Biophys. 299: 129 -136, (1992)). MBL generally recognizes carbohydrate patterns that mimic microbes such as bacteria, yeast, parasites and certain viruses. On the other hand, MBL does not recognize D-galactose and sialic acid, the second and last sugars at the end, which normally mimic the "mature" conjugated conjugate present on mammalian plasma and cell surface glycoproteins. This binding specificity is believed to promote recognition of "foreign" surfaces and to help protect against "self-activation ". However, MBL binds to the cluster of high-mannose "precursors" glycans on glycolipids and glycoproteins isolated from N-linked glycoproteins isolated from the endoplasmic reticulum and Golgi apparatus (Maynard et al., J Biol. Chem. 257 : 3788-3794, (1982)). Thus, damaged cells are potential targets for lectin pathway activation through MBL binding.

Picolin has a different type of lectin domain from MBL, the so-called fibrinogen-like domain. Picoline binds to sugar moieties in a Ca < ⁺⁺ > -independent manner. In humans, three kinds of picoline (L-picoline, M-picoline and H-picoline) were identified. Two serum picolin, L-picoline and H-picoline commonly have specificity for N-acetyl-D-glucosamine; However, H-picoline also binds to N-acetyl-D-galactosamine. The difference in sugar specificities of L-picoline, H-picoline, CL-11, and MBL means that different lectins are complementary and may overlap, but may also target different sugar conjugates. Among the known lectins of the lectin pathway, this concept is based on a recent report that only L-picoline binds specifically to lipoteichoic acid, a per-cell wall conjugate found in all Gram-positive bacteria (Lynch et al., J. Immunol. 172 : 1198-1202, (2004)). Col leptin (i. E., MBL) and picoline do not have significant similarity in amino acid sequence. However, the two groups of proteins have similar domain structures and, like C1q, are assembled into oligomeric structures, maximizing the potential for multimodal binding.

Serum concentrations of MBL are highly variable in healthy populations and this is genetically controlled by polymorphisms / mutations in both the promoter and coding region of the MBL gene. As an acute-phase protein, the expression of MBL is further upregulated during inflammation. L-picoline is present in serum at similar concentrations as MBL. Therefore, the L-picoline branch of the lectin pathway is potentially similar in strength to the MBL arm. MBL and picolin can also function as opsonins, allowing the phagocyte cells to target MBL- and picoline-impregnated surfaces (Jack et al., J Leukoc Biol ., 77 (3): 328 (2004), Matsushita and Fujita, Immunobiology , 205 (4-5): 490-7 (2002), Aoyagi et al., J Immunol, 174 (1): 418-25 (2005)). This opsonization requires the interaction of these proteins with phagocyte cell receptors (Kuhlman et al., J. Exp. Med. 169 : 1733, (1989); Matsushita et al., J. Biol. Chem. 271 : 2448-54, (1996)), the identity of which is not established.

Human MBL forms a specific, high-affinity interaction with the unique C1r / C1s-like serine protease called MBL-associated serine protease (MASP) through the collagen-like domain. So far, three MASPs have been described. First, a single enzyme "MASP" was identified and characterized as an enzyme responsible for the initiation of complement cascades (i.e., cleavage of C2 and C4) (Matsushita et al., J Exp Med 176 (6): 1497-1502 Ji et al., J. Immunol. 150 : 571-578, (1993)). It was then determined that MASP activity was in fact a mixture of two proteases: MASP-1 and MASP-2 (Thiel et al., Nature 386 : 506-510, (1997)). However, it has been demonstrated that the MBL-MASP-2 complex alone is sufficient for complement activation (Vorup-Jensen et al., J. Immunol. 165 : 2093-2100, (2000)). In addition, only MASP-2 cleaves C2 and C4 at high rates (Ambrus et al., J. Immunol. 170 : 1374-1382, (2003)). Therefore, MASP-2 is a protease that activates C4 and C2 to cause the C3 convertase, C4b2a. This is an important difference from the classical C1 complex, and the co-action of two specific serine proteases (C1r and C1s) leads to activation of the complement system. In addition, a third new protease, MASP-3, has been isolated (Dahl, MR, et al., Immunity 15 : 127-35, 2001). MASP-1 and MASP-3 are alternatively spliced products of the same gene.

MASP shares the same domain organization as the C1r and C1s enzymatic components of the C1 complex (Sim et al., Biochem. Soc. Trans. 28 : 545, (2000)). These domains include the N-terminal Clr / C1s / urchin VEGF / osteogenic protein (CUB) domain, epidermal growth factor-like domain, second CUB domain, tandem of the complement control protein domain, and serine protease domain . Activation of MASP-2, as in C1 protease, occurs through cleavage of the Arg-I1e bond adjacent to the serine protease domain, which cleaves the enzyme to disulfide-linked A and B chains, the latter consisting of the serine protease domain .

MBL also associates with an alternatively spliced form of MASP-2, which is known as the 19 kDa MBL-related protein (MAp19) or a small MBL-related protein (sMAP), without the catalytic activity of MASP-2 (Stover, J. Immunol. 162 : 3481-90, (1999); Takahashi et al., Int. Immunol. 11 : 859-863, (1999)). MAp19, following the first two domains of MASP-2, contains four unique amino acid addition sequences. The function of MAp19 is unclear (Degn et al., J Immunol. Methods , 2011). The MASP-1 and MASP-2 genes are located on human chromosome 3 and 1, respectively (Schwaeble et al., Immunobiology 205 : 455-466, (2002)).

Several evidences suggest that different MBL-MASP complexes exist and that large fractions of MASP in serum do not complex with MBL (Thiel, et al., J. Immunol. 165 : 878-887, (2000)). Like MBL, both H- and L-picolines bind to all MASPs and activate the lectin complement pathway (Dahl et al., Immunity 15 : 127-35, (2001); Matsushita et al., J. Immunol 168 : 3502-3506, (2002)). Both the lectin and the classical pathway form a common C3 converter (C4b2a) at which the two pathways are integrated.

The lectin pathway is widely known to play an important role in host defense against infection in naive hosts. Strong evidence for the inclusion of MBL in host defense results from the analysis of patients with reduced serum levels of functional MBL (Kilpatrick, Biochim. Biophys. Acta 1572 : 401-413, (2002)). These patients exhibit susceptibility to recurrent bacterial and fungal infections. These symptoms usually become apparent early in life, while sensitivity is apparent as maternal antibody titer decreases, but before the full repertoire of antibody responses appears. This symptom often results in mutations in several parts of the collagenous part of MBL, which interferes with the proper formation of MBL oligomers. However, it is not known to some extent that increased susceptibility to infection is due to compromised complement activation, as MBL can function as a complement independent opsonin.

All three pathways (i.e., classical, lectin and replacement) were considered to be integrated in C5, which cleaved to form products with multiple proinflammatory effects. The integrated path was referred to as the terminal complement pathway. C5a is the most potent anaphylactoxin, causing smooth muscle and vascular tone, as well as changes in vascular permeability. It is also a potent chemothaxin and activator of both neutrophils and mononuclear cells. C5a-mediated cellular activation can significantly amplify the inflammatory response by inducing the release of a number of additional inflammatory mediators, including cytokines, hydrolyzable enzymes, arachidonic acid metabolites, and reactive oxygen species. C5 cleavage leads to the formation of C5b-9, also known as the membrane attack complex (MAC). There is now strong evidence that low solubility MAC deposits can play an important role in inflammation, in addition to acting as a soluble pore-forming complex.

In addition to its essential role in immune defense, complement systems contribute to tissue damage in many clinical conditions. Although there is widespread evidence relating to both the classical pathway and the alternative complement pathway in the pathogenesis mechanism of non-infectious human disease, the role of the lectin pathway has just begun to be evaluated. Recent studies provide evidence that activation of the lectin pathway may be responsible for complement activation and associated inflammation in ischemia / reperfusion injury. Collard et al. (2000) reported that cultured endothelial cells exposed to oxidative stress bind to MBL and show C3 deposition upon exposure to human serum (Collard et al., Am. J. Pathol. 156 : 1549- 1556, (2000)). In addition, treatment of human serum with blocking anti-MBL monoclonal antibodies inhibited MBL binding and complement activation. These findings were extended to rat models of myocardial ischemia-reperfusion where rats treated with blocking antibodies directed against rat MBL showed much less myocardial damage than rats treated with control antibodies at coronary occlusion (Jordan et < RTI ID = 0.0 > al., Circulation 104 : 1413-1418, (2001)). The molecular mechanism of MBL binding to vascular endothelium after oxidative stress is unclear; Recent studies suggest that activation of the lectin pathway after oxidative stress may be mediated by MBL binding to vascular endothelial cytokaratin, rather than the sugar conjugate (Collard et al., Am. J. Pathol. 159 : 1045 -1054, (2001)). Other studies indicate that classical and alternative pathways are involved in the pathogenesis of ischemia / reperfusion injury, and the role of the lectin pathway in this disease remains controversial (Riedermann, NC, et al., Am. J. Pathol 162 : 363-367, 2003).

Fibrosis is usually the formation of connective tissue in the organ or tissue in excess in response to injury or injury. The characteristic of fibrosis is the production of excess extracellular matrix after local trauma. Although normal physiological responses to injury lead to deposition of connective tissue, this early beneficial recovery process can be continuous and pathological, altering the architecture and function of the tissue. At the cellular level, epithelial cells and fibroblasts proliferate and differentiate into myoblasts, resulting in substrate shrinkage, increased stiffness, microvascular compression, and hypoxia. Infiltration of inflammatory cells, including macrophages and lymphocytes, results in cytokine release and amplification of collagen, fibronectin and other molecular markers of fibrosis. Conventional therapeutic approaches have been targeted towards the inflammatory process of fibrosis, including mostly corticosteroids and immunosuppressive drugs. Unfortunately, these anti-inflammatory agents have shown little clinical efficacy. Although there is currently no effective treatment or treatment for fibrosis, animal studies and anecdotal human reports suggest that fibrosis damage may be reversed (Tampe and Zeisberg, Nat Rev Nephrol , Vol 10: 226-237, 2014) .

The kidneys have a limited capacity to recover from injury. Various renal pathologies result in local inflammation leading to scarring and fibrosis of the kidney tissue. Persistent preservation of inflammatory stimuli results in impaired progressive renal function in tubulointerstitial inflammation and fibrosis and chronic kidney disease. Progression to end-stage renal failure is associated with significant morbidity and mortality. Since tubulointerstitial fibrosis is a common endpoint in multiple renal pathology, it represents a key target for therapy that is intended to prevent kidney failure. Risk factors independent of primary renal disease (such as proteinuria) contribute to the development of renal fibrosis and loss of kidney secretion by invoking local inflammation, and continue to improve disease progression.

There is an urgent need to develop therapeutically effective agents for treating diseases and conditions caused or exacerbated by fibrosis, taking into account the role of fibrosis in tubular interstitial fibrosis leading to many diseases and disorders such as chronic kidney disease . In addition, considering the lack of new and existing therapies targeting the inflammatory pro-fibrotic pathway in renal disease, there is a need for a method for the treatment, prevention, prevention and / or reversal of renal fibrosis, thereby therapeutically for the prevention of progressive chronic kidney disease It is necessary to develop an effective agonist.

This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features of the claimed material, nor is it intended to be used as an aid in determining the category of the claimed material.

In one aspect, the invention provides a method of treating, inhibiting, alleviating, or preventing fibrosis in a mammalian subject suffering from, or at risk of developing, a disease or disorder induced or aggravated by fibrosis and / or inflammation, And the method comprises administering to the subject an amount of a MASP-2 inhibitor effective to inhibit fibrosis. In one embodiment, the MASP-2 inhibitor is a MASP-2 antibody or fragment thereof. In one embodiment, the MASP-2 inhibitor is a MASP-2 monoclonal antibody, or fragment thereof, that specifically binds to a portion of SEQ ID NO: 6. In one embodiment, the MASP-2 inhibitor selectively inhibits lectin pathway complement activation without substantially inhibiting C1q-dependent complement activation. In one embodiment, the subject is suffering from a disease or disorder caused or aggravated by at least one of the following: (i) fibrosis and / or inflammation associated with ischemic perfusion impairment, (ii) renal fibrosis and / or kidney inflammation (E.g., IgA nephropathy, membraneous nephropathy), lupus nephritis (lupus nephropathy), < RTI ID = 0.0 & (Iii) pulmonary fibrosis and / or inflammation (such as chronic obstructive pulmonary disease, chronic obstructive pulmonary disease, and the like), nephrotic syndrome, diabetic nephropathy, tubulointerstitial injury and glomerulonephritis (e.g., C3 glomerulopathy) Cystic fibrosis, pulmonary fibrosis associated with scleroderma, bronchiectasis and pulmonary hypertension), (iv) fibrosis of the liver and / or inflammation (e.g., cirrhosis, nonalcoholic Hepatic fibrosis secondary to alcohol abuse, secondary liver fibrosis secondary to acute or chronic hepatitis, bile disease and toxic liver injury (e.g., drug-induced liver damage induced by acetaminophen or other drugs) (V) cardiac fibrosis and / or inflammation such as cardiac fibrosis, myocardial infarction, heart valve fibrosis, atrial fibrillation, endomyocardial fibrosis, arrhythmogenic right ventricular cardiomyopathy) (ARVC), (vi) vascular fibrosis (e.g., vascular disease, atherosclerotic vascular disease, vascular stenosis, restenosis, vasculitis, phlebitis, deep vein thrombosis and abdominal aortic aneurysm) ), Fibrosis of the skin (e.g., excessive wound healing, scleroderma, systemic sclerosis, keloid, connective tissue disease, scarring, and hyperplastic scarring), (viii) (Ix) fibrosis of the central nervous system (e.g., stroke, traumatic brain injury and spinal cord injury), (x) fibrosis of the digestive tract such as Crohn's disease, fibrosis of the pancreas and ulcerative colitis xi) fibrosis of the eye (e.g., anterior subcapsular cataract, posterior capsule opacification, macular degeneration, and retinitis and vitreoretinopathy), (xii) fibrosis of the musculoskeletal soft tissue structure (xiii) fibrosis of the reproductive organs (e.g., endometriosis and Peyronie's disease), (xiv) fibrosis and / or inflammation (Xv) an autoimmune disease that causes fibrosis and / or inflammation (e.g., autoimmune diseases such as scleroderma and / or autoimmune diseases that cause inflammation and / or inflammation), such as hepatitis B virus whole body (SLE), (xvi) scars associated with trauma (eg, scarring associated with trauma, which can lead to surgical complications, such as scar tissue that can form between internal organs, which can lead to constipation, pain, and infertility (Xvii) organ transplantation, mammary fibrosis, muscle fibrillation, tracheal transplantation, peritoneal fibrosis (RVF), scarring associated with radiation-induced fibrosis, and burns) , Thyroid fibrosis, lymph node fibrosis, bladder fibrosis and pleural fibrosis.

In another aspect, the present invention provides a method of treating, inhibiting, alleviating, or preventing renal fibrosis in a mammalian subject suffering from or ameliorating renal fibrosis and / or inflammatory diseases or disorders, or at risk of developing a disease or disorder The method comprising administering to the subject an amount of a MASP-2 inhibitor effective to inhibit renal fibrosis. In one embodiment, the MASP-2 inhibitor is a MASP-2 antibody or fragment thereof. In one embodiment, the MASP-2 inhibitor is a MASP-2 monoclonal antibody, or fragment thereof, that specifically binds to a portion of SEQ ID NO: 6. In one embodiment, the MASP-2 antibody or fragment thereof specifically binds a polypeptide comprising SEQ ID NO: 6 with an affinity that is at least ten times greater than that binding to a different antigen in the complement system. In one embodiment, the antibody or fragment thereof is selected from the group consisting of a recombinant antibody, an antibody having reduced effector function, a chimeric antibody, a humanized antibody, and a human antibody. In one embodiment, the MASP-2 inhibitor selectively inhibits lectin pathway complement activation without substantially inhibiting C1q-dependent complement activation. In one embodiment, the MASP-2 inhibitor is administered subcutaneously, intraperitoneally, intramuscularly, intraarterially, intravenously, or as an inhalant. In one embodiment, the MASP-2 inhibitor is administered in an amount effective to inhibit tubular fibrosis. In one embodiment, the MASP-2 inhibitor is administered in an amount effective to reduce, delay or eliminate the need for dialysis in the subject. In one embodiment, the subject is selected from the group consisting of chronic renal disease, chronic renal failure, glomerular disease (e.g., focal segmental glomerulosclerosis), immune complex disorders (such as IgA nephropathy, membranous nephropathy), lupus nephritis, Sexual dysfunction and glomerulonephritis (e. G., C3 glomerulopathies). ≪ / RTI > In one embodiment, the subject is suffering from proteinuria and the MASP-2 inhibitor is administered in an amount effective to reduce proteinuria in the subject. In one embodiment, the MASP-2 inhibitor is reduced by at least 20% (e. G., At least 30%, or at least 40% Or at least a 50 percent reduction) in the effective amount. In one embodiment, the subject is selected from the group consisting of nephrotic syndrome, pre-eclampsia, eclampsia, toxic lesions of the kidney, amyloidosis, collagen vascular diseases (e.g. systemic lupus erythematosus), dehydration, glomerulonephritis (such as membranous glomerulonephritis, IgA nephropathy, IgM nephropathy, membrane proliferative glomerulonephritis, membranous nephropathy, nephropathy, nephropathy, nephropathy, nephropathy, nephropathy, glomerulonephritis, glomerulonephritis, (Such as NSAIDS, nicotine, penicillamine, lithium carbonate, gold and other heavy metals, ACE inhibitors, antibiotics, such as adriamycin ) Or opiates (such as heroin) or other quetropoxins); Fabry disease, infection (e.g., HIV, syphilis, Hepatitis A, B or C hepatitis, streptococcal infection, urinary schistosomiasis); (For example, kidney transplant rejection), Ebola hemorrhagic fever, nail palsy patellar syndrome (e. G., Pancreatic ischemic heart disease, Nail patella syndrome, familial mediterranean fever, HELLP syndrome, systemic lupus erythematosus, Wegener's granulomatosis, rheumatoid arthritis, glycogen storage disease type 1, Goodpasture's syndrome, Henoch Renal disease or disorder associated with proteinuria selected from the group consisting of Schönlein purpura, urinary tract infections spreading to the kidney, Sick Gren's syndrome and post-infection glomerulonephritis. In one embodiment, the subject is suffering from IgA nephropathy. In one embodiment, the subject has membranous nephropathy.

In another aspect, the invention provides a method of preventing or reducing renal damage in a subject suffering from a disease or condition associated with proteinuria, comprising administering an amount of a MASP-2 inhibitor effective to reduce or prevent proteinuria in the subject . In one embodiment, the MASP-2 inhibitor is a MASP-2 antibody or fragment thereof. In one embodiment, the MASP-2 inhibitor is a MASP-2 monoclonal antibody or fragment thereof that specifically binds to a portion of SEQ ID NO: 6. In one embodiment, the MASP-2 inhibitor selectively inhibits lectin pathway complement activation without substantially inhibiting C1q-dependent complement activation. In one embodiment, the disease or condition associated with proteinuria is selected from the group consisting of nephrotic syndrome, pre-eclampsia, eclampsia, toxic lesions of the kidney, amyloidosis, collagen vascular diseases (e.g. systemic lupus erythematosus), dehydration, glomerular diseases (Glomerulonephritis), IgM nephropathy, proliferative glomerulonephritis, glomerular glomerulonephritis, glomerulonephritis, glomerulonephritis, glomerulonephritis, glomerulonephritis, glomerulonephritis, (Eg, NSAIDS, nicotine, penicillamine, lithium carbonate, gold and other heavy metals, ACE inhibitors, antibiotics, diabetic nephropathy, diabetic nephropathy, A substance (e.g., adriamycin) or an opiate agent (e.g., heroin); Fabry disease, infection (e.g., HIV, syphilis, Hepatitis A, B or C hepatitis, streptococcal infection, urinary schistosomiasis); (For example, renal transplant rejection), Ebola hemorrhagic fever, nail palate patellar syndrome, familial mediterranean fever, acute myelogenous leukemia, amyotrophic lateral sclerosis, acute myelogenous leukemia, , HELLP syndrome, systemic lupus erythematosus, Wegener's granulomatosis, rheumatoid arthritis, glycogen storage disease type 1, Goodpasture's syndrome, Henoch-Schonlein purpura, urinary tract infection spreading to the kidney, ≪ / RTI > In one embodiment, the MASP-2 inhibitor is reduced by at least 20% (e. G., At least 30%, or at least 40% Or at least a 50 percent reduction) in the effective amount.

In another aspect, the invention provides a method of inhibiting the progression of chronic kidney disease, the method comprising administering to a subject in need thereof an amount of a MASP-2 inhibitor effective to reduce or prevent renal fibrosis, such as tubular interstitial fibrosis Administering to the subject. In one embodiment, the MASP-2 inhibitor is a MASP-2 antibody or fragment thereof. In one embodiment, the MASP-2 inhibitor is a MASP-2 monoclonal antibody, or fragment thereof, that specifically binds to a portion of SEQ ID NO: 6. In one embodiment, the MASP-2 inhibitor selectively inhibits lectin pathway complement activation without substantially inhibiting C1q-dependent complement activation. In one embodiment, the subject in need thereof exhibits proteinuria prior to administration of the MASP-2 inhibitor and administration of the MASP-2 inhibitor reduces proteinuria in the subject. In one embodiment, the MASP-2 inhibitor is reduced by at least 20% (e. G., At least 30%, or at least 40% Or at least a 50 percent reduction) in the effective amount. In one embodiment, the MASP-2 inhibitor is administered in an amount effective to reduce, delay or eliminate the need for dialysis in the subject.

In another aspect, the invention provides a method of protecting the kidneys from renal damage in a subject in progress, or ongoing or progressive treatment with one or more nephrotoxic agents, the method comprising: RTI ID = 0.0 > MASP-2 < / RTI > In one embodiment, the MASP-2 inhibitor is a MASP-2 antibody or fragment thereof. In one embodiment, the MASP-2 inhibitor is a MASP-2 monoclonal antibody, or fragment thereof, that specifically binds to a portion of SEQ ID NO: 6. In one embodiment, the MASP-2 inhibitor selectively inhibits lectin pathway complement activation without substantially inhibiting C1q-dependent complement activation.

In another aspect, the invention provides a method of treating a human subject suffering from immunoglobulin A nephropathy (IgAN), the method comprising administering to the subject a MASP-2 inhibitory antibody effective to inhibit MASP-2-dependent complement activation, Comprising administering to the subject a composition comprising an amount of a binding fragment. In one embodiment, the subject is suffering from steroid-dependent IgAN. In one embodiment, the MASP-2 inhibitory antibody is a monoclonal antibody, or fragment thereof, that specifically binds human MASP-2. In one embodiment, the antibody or fragment thereof is selected from the group consisting of a recombinant antibody, an antibody having reduced effector function, a chimeric antibody, a humanized antibody, and a human antibody. In one embodiment, the MASP-2 inhibitory antibody does not substantially inhibit the classical pathway. In one embodiment, the MASP-2 inhibitory antibody inhibits C3b deposition in 90% human serum with an IC ₅₀ of 30 nM or less. In one embodiment, the method comprises identifying a human subject with steroid-dependent IgAN prior to administering to the subject a composition comprising an amount of the MASP-2 inhibiting antibody, or an antigen-binding fragment thereof, effective to improve renal function. . ≪ / RTI > In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered in an amount effective to improve renal function. In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof achieves at least a 20 percent reduction in 24-hour urinary protein excretion compared to baseline 24-hour urine protein excretion in the subject Is administered in an amount effective to achieve such reduction for a sufficient period of time. In one embodiment, the composition is administered in an amount sufficient to improve renal function and decrease the corticosteroid dose in the subject. In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof comprises a heavy chain variable region comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: 67, And CDR-Ll, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70.

In another aspect, the invention provides a method of treating a human subject suffering from membranous nephrotic syndrome (MN), the method comprising administering to the mammal an effective amount of a MASP-2 inhibiting antibody, or antigen-binding fragment thereof, effective to inhibit MASP- To a subject in need thereof. In one embodiment, the subject is suffering from steroid-dependent MN. In one embodiment, the MASP-2 inhibitory antibody is a monoclonal antibody, or fragment thereof, that specifically binds human MASP-2. In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered in an amount effective to improve renal function. In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered to a subject prior to treatment for a time sufficient to achieve at least a 20 percent reduction in 24-hour urinary protein excretion compared to baseline 24- Administered in an amount effective to achieve a reduction. In one embodiment, the composition is administered in an amount sufficient to improve renal function and decrease the corticosteroid dose in the subject. In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof comprises a heavy chain variable region comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: 67, And CDR-Ll, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70.

In another aspect, the invention provides a method of treating a human subject suffering from lupus nephritis (LN), the method comprising administering to a subject a MASP-2 inhibiting antibody effective to inhibit MASP-2-dependent complement activation, And administering to the subject a composition comprising an amount of the fragment. In one embodiment, the subject is suffering from a steroid-dependent LN. In one embodiment, the MASP-2 inhibitory antibody is a monoclonal antibody, or fragment thereof, that specifically binds human MASP-2. In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered in an amount effective to improve renal function. In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered to a subject prior to treatment for a time sufficient to achieve at least a 20 percent reduction in 24-hour urinary protein excretion compared to baseline 24- Administered in an amount effective to achieve a reduction. In one embodiment, the composition is administered in an amount sufficient to improve renal function and decrease the corticosteroid dose in the subject. In one embodiment, the MASP-2 inhibitory antibody or antigen-binding fragment thereof comprises a heavy chain variable region comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: 67, And CDR-Ll, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70.

In another aspect, the invention provides a method of reducing proteinuria in a human subject suffering from IgAN, the method comprising administering to a subject in need thereof a therapeutically effective amount of a composition comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: A heavy chain variable region and a light chain variable region comprising CDR-L1, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70, or an antigen-binding fragment thereof, Dosage regimen:

a. Administering the antibody at about 4 mg / kg (i.e., 3.6 mg / kg to 4.4 mg / kg) intravenously once a week for at least 12 weeks of treatment period to a subject suffering from IgAN; or

b. Administering the antibody of about 180 mg to about 725 mg (i.e., 162 mg to 797 mg) to a subject suffering from IgAN intravenously once weekly for at least 12 weeks of treatment period

Wherein the method reduces proteinuria in the human subject.

The foregoing aspects and many of the attendant advantages of the present invention will become more readily appreciated as they become better understood with reference to the following detailed description when considered in conjunction with the accompanying drawings.
Figure 1 is a diagram showing the genomic structure of human MASP-2;
2A is a schematic diagram showing the domain structure of a human MASP-2 protein;
Figure 2B is a schematic depicting the domain structure of the human MAp19 protein;
Figure 3 is a plot showing a murine MASP-2 knockout strategy;
Figure 4 is a plot showing the human MASP-2 minigene construct;
Figure 5A provides results demonstrating that MASP-2 deficiency causes loss of lectin-pathway mediated C4 activation as measured by deficiency of C4b deposition on mating, as described in Example 2 ;
Figure 5B provides results demonstrating that MASP-2 deficiency causes loss of lectin-pathway mediated C4 activation as measured by deficiency of C4b deposition on chymotrypsin, as described in Example 2 do;
Figure 5C shows MASP-2 +/- as a measurement by C4b deposition on mannan and chi-mosaic, as described in Example 2; MASP-2 < - > and wild-type strains;
Figure 6 shows that the addition of murine and recombinant MASP-2 to MASP-2 - / - serum samples, as described in Example 2, results in a lectin-pathway in protein concentration dependent manner, as measured by C4b deposition on mannan phase ≪ RTI ID = 0.0 > - < / RTI >
Figure 7 provides results demonstrating that the classical pathway is functional in the MASP-2 - / - line, as described in Example 8;
Figure 8A provides results demonstrating that anti-MASP-2 Fab2 antibody < RTI ID = 0.0 ># 11 < / RTI > inhibits C3 convertase formation, as described in Example 10;
Figure 8B provides results demonstrating that anti-MAASP-2 Fab2 antibody # 11 binds to native rat MASP-2, as described in Example 10;
Figure 8C provides results demonstrating that anti-MASP-2 Fab2 antibody # 41 inhibits C4 cleavage, as described in Example 10;
Figure 9 provides results demonstrating that all anti-MAASP-2 Fab2 antibodies tested that inhibited C3-Conjugate formation, as described in Example 10, were also found to inhibit C4 cleavage;
Figure 10 is a diagram illustrating recombinant polypeptides derived from rat MASP-2 used for epitope mapping of MASP-2 blocking Fab2 antibodies, as described in Example 11;
Figure 11 provides results demonstrating binding of anti-MASP-2 Fab2 # 40 and # 60 to rat MASP-2 polypeptide as described in Example 11;
Figure 12A graphically illustrates the level of MAC deposition in the presence or absence of a human MASP-2 monoclonal antibody (OMS646) under lectin path-specific assay conditions, as described in Example 12, where OMS646 is approximately 1 demonstrates that inhibit MAC-mediated deposition - in nM IC ₅₀ values of the lectins;
Figure 12B graphically illustrates the level of MAC deposition in the presence or absence of a human MASP-2 monoclonal antibody (OMS646) under classical path-specific assay conditions, as described in Example 12, and demonstrates that OMS646 is a classical path- Lt; RTI ID = 0.0 > MAC < / RTI >
Figure 12C graphically illustrates the level of MAC deposition in the presence or absence of a human MASP-2 monoclonal antibody (OMS646) under alternative path-specific assay conditions, as described in Example 12, and demonstrates that OMS646 is an alternative path- Lt; RTI ID = 0.0 > MAC < / RTI >
Figure 13 graphically illustrates the pharmacokinetic (PK) profile of the human MASP-2 monoclonal antibody (OMS646) in mice as described in Example 12 and shows the OMS646 concentration (n = 3 animals / group mean);
14A graphically depicts the pharmacokinetic (PD) response of a human MASP-2 monoclonal antibody (OMS646), measured as a decrease in systemic lectin pathway activity in mice after intravenous administration, as described in Example 12. Fig. do.
14B graphically illustrates the pharmacokinetic (PD) response of a human MASP-2 monoclonal antibody (OMS646), measured as a decrease in systemic lectin pathway activity in mice after subcutaneous administration, as described in Example 12 .
Figure 15 graphically depicts the results of a computer-based image analysis of a kidney tissue section stained with Sirius red, as described in Example 14, wherein the tissue section is located after 7 unilateral ureteral closure (UUO) Lt; / RTI > mice and from sham-operated wild-type and MASP-2 - / - mice;
Figure 16 graphically depicts the results of a computer-based image analysis of a kidney tissue section stained with F4 / 80 macrophage-specific antibody, as described in Example 14, wherein the tissue section has unilateral ureteral obstruction (UUO ) And wild-type and MASP-2 - / - mice from simulated-operated wild-type and MASP-2 - / - mice after 7 days.
Figure 17 is a graph showing the results of a study of the expression of the kidney tissues from wild type and MASP-2 - / - mice and mock-operated wild type and MASP-2 - / - mice 7 days after unilateral ureteral obstruction (UUO) Section graphically shows the relative mRNA expression levels of collagen-4 as measured by quantitative PCR (qPCR).
Figure 18 is a graphical representation of the results obtained from the wild type and MASP-2 - / - mice after 7 days after unilateral ureter occlusion (UUO) and kidney tissue obtained from the simulated-operated wild type and MASP-2 - Section graphically shows the relative mRNA expression levels of transforming growth factor beta-1 (TGF beta-1) as measured by qPCR.
Figure 19 is a graph showing the results of a study of the expression of kidney tissue obtained from wild type and MASP-2 - / - mice and mock-operated wild type and MASP-2 - / - mice 7 days after unilateral ureteral obstruction (UUO) Section graphically shows the relative mRNA expression levels of transforming growth factor beta-1 (TGF beta-1) as measured by qPCR.
Figure 20 is a graphical representation of the results obtained from the wild type and MASP-2 - / - mice after 7 days after unilateral ureter occlusion (UUO) and kidney tissue obtained from simulated-operated wild type and MASP-2 - Section graphically shows the relative mRNA expression levels of interferon-y as measured by qPCR.
Figure 21 graphically illustrates the results of a computer-based image analysis of a kidney tissue section stained with Sirius red, as described in Example 15, wherein the tissue section was treated with MASP-2 inhibitory antibody and isotype control antibody Was obtained 7 days after unilateral ureteral obstruction (UUO) from wild type mice.
Figure 22 is a graph showing the effect of MASP-2 inhibitory antibody on the level of hydroxyl proline compared to the level of hydroxyl proline in tissue from a closed kidney obtained from a wild type mouse treated with an IgG4 isotype control, The hydroxyl proline content from the kidneys obtained 7 days after unilateral ureter occlusion (UUO) is graphically shown.
Figure 23 shows the results of a comparison between wild type control mice (n = 2) receiving saline alone, wild type mice receiving BSA (n = 6) and MASP-2 - / - mice receiving BSA (n = 6) shows the total amount (mg / ml) of serum proteins measured on the 15th day of the protein overload study.
Figure 24 shows the results of a comparison between wild type control mice (n = 2) receiving saline alone, wild type mice receiving BSA (n = 6) and MASP-2 - / - mice receiving BSA 6) graphs the total amount (mg) of protein excreted in urine collected over a 24 hour period on day 15 of the protein overload study.
25 depicts representative hematoxylin and eosin (H & E) stained kidney tissue sections from the following group of mice on day 15 of a protein overload study, as described in Example 16: (Panel A ) Wild-type control mice; (Panel B) MASP-2 - / - Control mice, (Panel C) Wild-type mice treated with BSA; And (Panel D) MASP-2 - / - mice treated with bovine serum albumin (BSA).
Figure 26 graphically depicts the results of a computer-based image analysis of a kidney tissue section stained with macrophage-specific antibody F4 / 80, showing the macrophage mean stained area (%) as described in Example 16. [ , And the tissue sections were analyzed for protein uptake from wild-type control mice (n = 2), wild-type mice treated with BSA (n = 6), and MASP-2 - / - mice Day.
Figure 27A is a plot of the total excreted protein measured in urine from macrophage infiltration (% mean staining area) versus 24-hour sample, as described in Example 16, in each wild type mouse treated with BSA (n = 6 ) Graphically illustrates the presence of macrophage-proteinuria correlations.
FIG. 27B is a graph showing the effect of each of the MASP-2 - / - treated BSAs treated with BSA by plotting total excreted proteins measured in urine from macrophage infiltration (% mean staining area) versus 24- The graphical representation of the presence of macrophage-proteinuria correlations in mice (n = 5) is shown.
Figure 28 shows a tissue section stained with anti-TGF beta antibody in wild type mice (n = 4) treated with BSA and MASP-2 - / - mice (n = 5) treated with BSA as described in Example 16 (Based on% TGF beta antibody-stained area).
Figure 29 shows a tissue section stained with anti-TNFa antibody in wild type mice (n = 4) treated with BSA and MASP-2 - / - mice (n = 5) treated with BSA as described in Example 16 (Based on% TNF [alpha] antibody-stained area).
Figure 30 is a graph showing the effect of wild type mice (n = 7) treated with BSA and MASP-2 - / - mice treated with BSA (n = Image analysis of a tissue section stained with an anti-IL-6 antibody (measured as% IL-6 antibody-stained area) in a mouse model
Figure 31 shows the results of treatment with wild type control mice (n = 1), MASP-2 - / - control mice (n = 1), wild type mice treated with BSA (n = 6) and BSA as described in Example 16 (HPF) consecutively selected from tissue sections from the kidney cortex in MASP-2 - / - mice (n = 7).
Figure 32 depicts representative H & E stained tissue sections from the following group at day 15 after treatment with BSA, as described in Example 17. (Panel A) Wild-type control mice treated with saline, (Panel B) Isotype antibody treated control mice and (Panel C) wild type mice treated with MASP-2 inhibitory antibody.
Figure 33 depicts the results of immunization with wild type mice (n = 8) treated with saline control and BSA, wild type mice (n = 8) treated with isotype control antibody and BSA and MASP- Graphically shows the frequency of TUNEL apoptotic cells counted in 20 high power fields (HPF) consecutively selected from tissue sections from the kidney cortex in wild-type mice (n = 7) treated with BSA.
Figure 34 depicts the results of a comparison of wild type mice (n = 8) treated with BSA and saline, wild type mice (n = 7) treated with BSA and isotype control antibodies, and BSA and MASP-2 inhibitory antibodies Based image analysis of a tissue section (measured as% TGF beta antibody-stained area) stained with anti-TGF beta antibody in wild-type mice (n = 8) treated with anti-TGF beta antibody.
Figure 35 depicts the results of an experiment in which wild type mice (n = 8) treated with BSA and saline, wild type mice (n = 7) treated with BSA and isotype control antibody and BSA and MASP- Based image analysis of a tissue section (measured as% TNFa antibody-stained area) stained with anti-TNFa antibody in wild-type mice (n = 8) treated with anti-TNFa antibody.
Figure 36 is a graph showing the effect of the BSA and MASP-2 inhibitory antibody (n = 7) treated with BSA and saline treated wild type mice (n = 8), BSA and isotype control antibody treated wild type mice Based image analysis of a tissue section (measured as% IL-6 antibody-stained area) stained with anti-IL-6 antibody in wild-type mice (n = 8) treated with anti-IL-6 antibody.
Figure 37 depicts representative H & E stained tissue sections from the following group of mice at day 14 after treatment with adriamycin (adriamycin) or saline alone (control), as described in Example 18: -1, A-2, A-3) wild-type control mice treated with saline alone; (Panel B-1, B-2, B-3) Wild-type mice treated with adriamycin; And MASP-2 - / - mice treated with adriamycin (Panel C-1, C-2, C-3);
Figure 38 is a graph showing the mean macrophage-specific staining area (%) from the following group of mice at day 14 after treatment with adriamycin or saline alone (wild type control), as described in Example 18 A graphical representation of the results of a computer-based image analysis of a kidney tissue section stained with antibody F4 / 80 is shown: a wild type control mouse treated with saline alone; Wild type mice treated with adriamycin; MASP-2 - / - mice treated with saline alone; And MASP-2 - / - mice treated with adriamycin, ** p = 0.007;
Figure 39 is a graph showing the area of collagen deposition staining from the following group of mice at day 14 after treatment with adriamycin or saline alone (wild type control), as described in Example 18, using a Sirius red stained kidney Graphical representation of the results of a computer-based image analysis of the tissue section: wild-type control mice treated with saline alone; Wild type mice treated with adriamycin; MASP-2 - / - mice treated with saline alone; And MASP-2 - / - mice treated with adriamycin, ** p = 0.005;
Figure 40 graphically shows the urine albumin / creatinine ratio (uACR) in two IgA patients during the course of a 12 week study treated weekly with MASP-2 inhibitory antibody (OMS646), as described in Example 19;
Figure 41 graphically shows the uACR for four IgAN patients treated with OMS646 over time from baseline to 120 days, as described in Example 21;
Figure 42 graphically depicts 24-hour urinary protein changes from baseline on day 1 before and after treatment for four IgAN patients treated with OMS646, as described in Example 21;
Figure 43 graphically depicts the mean change from baseline to post-treatment of 24-hour urine protein in four IgAN patients treated with OMS646, as described in Example 21.

Explanation of sequence list

SEQ ID NO: 1 human MAp19 cDNA

SEQ ID NO: 2 human MAp19 protein (including leader)

SEQ ID NO: 3 human MAp19 protein (mature)

SEQ ID NO: 4 human MASP-2 cDNA

SEQ ID NO: 5 human MASP-2 protein (including leader)

SEQ ID NO: 6 human MASP-2 protein (mature)

SEQ ID NO: 7 human MASP-2 gDNA (exons 1-6)

antigen: (Relative to MASP-2 mature protein)

SEQ ID NO: 8 CUBI sequence (aa 1-121)

SEQ ID NO: 9 CUBEGF sequence (aa 1-166)

SEQ ID NO: 10 CUBEGFCUBII (aa 1-293)

SEQ ID NO: 11 EGF region (aa 122-166)

SEQ ID NO: 12 serine protease domain (aa 429-671)

SEQ ID NO: 13 serine protease domain inactivity (aa 610-625 with Ala mutation of Ser618)

SEQ ID NO: 14 TPLGPKWPEPVFGRL (CUBI peptide)

SEQ ID NO: 15 TAPPGYRLRLYFTHFDLELSHLCEYDFVKLSSGAKVLATLCGQ (CUBI peptide)

SEQ ID NO: 16 TFRSDYSN (MBL binding domain core)

SEQ ID NO: 17 FYSLGSSLDITFRSDYSNEKPFTGF (MBL binding region)

SEQ ID NO: 18 IDECQVAPG (EGF peptide)

SEQ ID NO: 19 ANMLCAGLESGGKDSCRGDSGGALV (Serine protease binding core) Detailed Description

Peptide inhibitors:

SEQ ID NO: 20 MBL full-length cDNA

SEQ ID NO: 21 MBL full-length protein

SEQ ID NO: 22 OGK-X-GP (common bond)

SEQ ID NO: 23 OGKLG

SEQ ID NO: 24 GLR GLQ GPO GKL GPO G

SEQ ID NO: 25 GPO GPO GLO GLQ GPO GKL GPO GPO GPO

SEQ ID NO: 26 GKDGRDGTKGEKGEPGQGLRGLQGPOGKLGPOG

SEQ ID NO: 27 GAOGSOGEKGAOGPQGPOGPOGKMGPKGEOGDO (human h-picoline)

SEQ ID NO: 28 GCOGLOGAOGDKGEAGTNGKRGERGPOGPOGKAGPOGPNGAOGEO (human picoline p35)

SEQ ID NO: 29 LQRALEILPNRVTIKANRPFLVFI (C4 cleavage site)

Expression inhibitors:

SEQ ID NO: 30 cDNA of CUBI-EGF domain (nucleotides 22-680 of SEQ ID NO: 4)

SEQ ID NO: 31

5 'CGGGCACACCATGAGGCTGCTGACCCTCCTGGGC 3'

Nucleotides 12-45 of SEQ ID NO: 4 containing the MASP-2 translation initiation site (sense)

SEQ ID NO: 32

5'GACATTACCTTCCGCTCCGACTCCAACGAGAAG3 '

Nucleotides 361-396 of SEQ ID NO: 4 containing the MASP-2 MBL binding site (sense)

SEQ ID NO: 33

5 'AGCAGCCCTGAATACCCACGGCCGTATCCCAAA3'

Nucleotides 610-642 of SEQ ID NO: 4 encoding the region comprising the CUBII domain

Cloning primer:

SEQ ID NO: 34 CGGGATCCATGAGGCTGCTGACCCTC (5 'PCR for CUB)

SEQ ID NO: 35 GGAATTCCTAGGCTGCATA (3 'PCR for CUB)

SEQ ID NO: 36 GGAATTCCTACAGGGCGCT (3 'PCR for CUBIEGF)

SEQ ID NO: 37 GGAATTCCTAGTAGTGGAT (3 'PCR for CUBIEGFCUBII)

SEQ ID NOS: 38-47 are cloning primers for humanized antibodies

SEQ ID NO: 48 is a 9 aa peptide bond

Expression vector:

SEQ ID NO: 49 is a MASP-2 mini gene insert

SEQ ID NO: 50 is murine and MASP-2 cDNA

SEQ ID NO: 51 is murine and MASP-2 protein (w / leader)

SEQ ID NO: 52 is a mature rat and MASP-2 protein

SEQ ID NO: 53 is a rat MASP-2 cDNA

SEQ ID NO: 54 is a rat MASP-2 protein (w / leader)

SEQ ID NO: 55 shows the mature rat MASP-2 protein

SEQ ID NOS: 56-59 are oligonuclelides for site-specific mutagenesis of human MASP-2 used to generate human MASP-2A

SEQ ID NOs: 60 to 63 are oligonuclelides for site-specific mutagenesis of murine and MASP-2 used to generate murine MASP-2A

SEQ ID NOS: 64-65 are oligonuclelides for site-specific mutagenesis of rat MASP-2 used to produce rat MASP-2A

SEQ ID NO: 66 is DNA encoding the 17D20_dc35VH21N11VL (OMS646) heavy chain variable region (VH) (no signal peptide)

SEQ ID NO: 67 is a 17D20_dc35VH21N11VL (OMS646) heavy chain variable region (VH) polypeptide

SEQ ID NO: 68 is a 17N16mc heavy chain variable region (VH) polypeptide

SEQ ID NO: 69 is DNA encoding the 17D20_dc35VH21N11VL (OMS646) light chain variable region (VL)

SEQ ID NO: 70 is a 17D20_dc35VH21N11VL (OMS646) light chain variable region (VL) polypeptide

SEQ ID NO: 71 is a 17N16_dc17N9 light chain variable region (VL) polypeptide

SEQ ID NO: 72: SGMI-2L (full length)

SEQ ID NO: 73: SGMI-2M (intermediate cut version)

SEQ ID NO: 74: SGMI-2S (short cut version)

SEQ ID NO: 75: VH-M2ab6-SGMI-2-N and a mature polypeptide comprising a human IgG4 constant region with hinge mutation

SEQ ID NO: 76: VH-M2ab6-SGMI-2-C and a mature polypeptide comprising a human IgG4 constant region with hinge mutation

SEQ ID NO: 77: A mature polypeptide comprising VL-M2ab6-SGMI-2-N and a human Ig lambda constant region

SEQ ID NO: 78: mature polypeptide comprising VL-M2ab6-SGMI-2-C and human Ig lambda constant region

SEQ ID NO: 79: Peptide linker (10aa)

SEQ ID NO: 80: peptide linker (6aa)

SEQ ID NO: 81: peptide linker (4aa)

SEQ ID NO: 82: a polynucleotide encoding a polypeptide comprising a human IgG4 constant region with VH-M2ab6-SGMI-2-N and a hinge mutation

SEQ ID NO: 83: VH-M2ab 6-SGMI-2-C and a polynucleotide encoding a polypeptide comprising a human IgG4 constant region with a hinge mutation

SEQ ID NO: 84: a polynucleotide encoding a polypeptide comprising a VL-M2ab6-SGMI-2-N and human Ig lambda constant region

A polynucleotide encoding a polypeptide comprising SEQ ID NO: 85: VL-M2ab6-SGMI-2-C and a human Ig lambda constant region

details

The present invention is based on the finding that inhibition of mannan-binding lectin-related serine protease-2 (MASP-2), a key regulator of the lectin pathway of the complement system, is associated with a unilateral UUO model, a protein overload model and adriamycin- Lt; RTI ID = 0.0 > inflammatory < / RTI > fibrosis in a variety of animal models of fibrotic disease, including nephrotic models. Therefore, the inventors have demonstrated that inhibition of MASP-2-mediated lectin pathway activation provides an effective therapeutic approach to improve, treat or prevent renal fibrosis, such as tubular interstitial inflammation and fibrosis, regardless of the underlying cause Respectively. Further described herein is the use of a MASP-2 inhibitory antibody (OMS646), which is effective in improving renal function and reducing corticosteroid demand in human subjects suffering from immunoglobulin A nephropathy (IgAN) and membranous nephropathy (MN) to be.

I. Definition

Unless specifically defined herein, all terms used herein have the same meaning as those understood by those skilled in the art. The following definitions are provided to provide clarity as to terms used in describing the invention in the specification and claims.

As used herein, the term "MASP-2 dependent dependent complement activation" includes MASP-2-dependent activation of the lectin pathway, which under physiological conditions that lead to the formation of the lectin pathway C3 convertase C4b2a Ca ⁺⁺ ) and then accumulation of the C3 truncation product C3b to the C5 convertor C4b2a (C3b) n, which was determined to mainly induce opsonization.

As used herein, the term "alternative pathway" is intended to include, but is not limited to, fungal and yeast cell walls, lipopolysaccharides (LPS) of the Gram negative outer membrane, and rabbit red blood cells, as well as many pure polysaccharides, Refers to complement activation that is caused by chymotrypsin from bacteria, animal tumor cells, parasites and damaged cells, and is believed to originate from spontaneous protein hydrolysis production of C3b from complement factor C3 traditionally.

As used herein, the term " lectin pathway "refers to the ratio of serum and mann-binding lectin (MBL), including CL-11 and picolin (H-picoline, M-picoline, or L- - refers to complement activation that occurs through specific binding of serum carbohydrate-binding proteins.

As used herein, the term "classical pathway" refers to complement activation caused by an antibody bound to the foreign particle and requiring binding of the recognition molecule Clq.

As used herein, the term "MASP-2 inhibitor" refers to an anti-MASP-2 antibody and its MASP-2 binding fragments, natural and synthetic peptides, small molecules, soluble MASP-2 receptors, Refers to any agent that binds to or directly interacts with MASP-2 to effectively inhibit MASP-2-dependent complement activation, including natural inhibitors, and also includes other recognition molecules (e.g., MBL, H - picoline, M-picoline, or L-picoline) but does not include an antibody that binds to such other recognition molecule. MASP-2 inhibitors useful in the methods of the invention may reduce MASP-2-dependent complement activation by more than 20%, such as by more than 50%, such as by more than 90%. In one embodiment, the MASP-2 inhibitor reduces MASP-2-dependent complement activation by greater than 90% (i.e., results in less than 10% MASP-2 complement activation).

As used herein, the term "fibrosis" refers to the formation or presence of excess connective tissue in an organ or tissue. Fibrosis can occur as a recovery or an alternative to stimulation such as tissue damage or inflammation. The characteristic of fibrosis is the production of extra-extracellular matrix. The normal physiological response to injury results in deposition of connective tissue as part of the healing process, but this connective tissue deposit can be persistent and pathological, altering the architecture and function of the tissue. At the cellular level, epithelial cells and fibroblasts proliferate and differentiate into myoblasts, resulting in substrate shrinkage, increased stiffness, microvascular compression, and hypoxia.

As used herein, the term "treating fibrosis in a mammalian subject who is suffering from or at risk of developing a disease or disorder caused or to be aggravated by fibrosis and / or inflammation" is intended to include any agent that reverses, Improvement or suppression.

As used herein, the term "proteinuria" means that the protein of the urine is administered in an abnormal amount, for example, in an amount exceeding 0.3 g protein in a 24-hour urine collection from a human subject, or in a concentration exceeding 1 g per liter in a human subject It indicates that it exists. In some embodiments, the subject suffering from proteinuria exhibits the presence of urinary protein in an amount in excess of 1.0 g protein in a 24-hour urine collection from a human subject, such as a subject suffering from immunoglobulin A (IgA) nephropathy.

As used herein, the term " improving proteinuria "or" reducing proteinuria "refers to a reduction in proteinuria by at least 20%, such as at least 30%, compared to baseline 24-hour urine protein excretion in a subject prior to treatment with a MASP- , Such as at least 40%, such as at least 50% or more, of a 24-hour urinary protein excretion in a subject suffering from proteinuria. In one embodiment, treatment with a MASP-2 inhibitor in accordance with the methods of the invention is administered in excess of a 20 percent reduction in 24-hour urinary protein excretion, or in excess of a 30 percent decrease in, for example, 24- Is effective in reducing proteinuria in a human subject to achieve a 40 percent reduction in 24-hour urinary protein excretion, or in excess of a 50 percent reduction in, for example, 24-hour urinary protein excretion.

As used herein, the term "antibody" refers to any antibody-producing mammal (e. G., Mouse, rat, Rabbits and primates including humans), or antibodies derived from hybridomas, phage selection, recombinant expression or transgenic animals (or other methods of producing antibodies or antibody fragments), and antibody fragments thereof . The term "antibody" is not intended to be limiting as to the source of the antibody or the manner in which it is made (e.g., by hybridoma, phage selection, recombinant expression, transgenic animals, peptide synthesis, etc.). Exemplary antibodies include polyclonal, monoclonal and recombinant antibodies; Pan-specific, multispecific antibodies (e.g., bispecific antibodies, triphospecific antibodies); Humanized antibodies; Murine antibodies; Chimeric, mouse-human, mouse-primate, primate-human monoclonal antibody; And anti-idiotype antibodies, and may be any intact antibody or fragment thereof. As used herein, the term "antibody" refers to a fragment of its intact polyclonal or monoclonal antibody as well as fragments thereof (such as dAb, Fab, Fab ', F (ab') ₂ , Fv), single chain (ScFv) A fusion protein comprising a portion of an antibody with an antigen-binding fragment of the required specificity, a humanized antibody, a chimeric antibody, and an antigen-binding site or fragment (epitope recognition site) of the desired specificity Lt; RTI ID = 0.0 > immunoglobulin < / RTI >

"Monoclonal antibody" refers to a homogeneous population of antibodies in which the monoclonal antibody is composed of amino acids (spontaneous and non-naturally occurring) that accompany the selective binding of the epitope. Monoclonal antibodies are highly specific for the target antigen. The term "monoclonal antibody" is intended to include both monoclonal and full-length monoclonal antibodies as well as fragments thereof (such as Fab, Fab ', F (ab') ₂ , Fv), single chain (ScFv) A fusion protein comprising an antigen-binding portion, a humanized monoclonal antibody, a chimeric monoclonal antibody, and any other of the immunoglobulin molecules comprising an antigen-binding fragment (epitope recognition site) of the ability to bind to the required specificity and epitope And includes modified configurations. But not limited to, the source of the antibody or the manner in which it is made (e.g., by hybridoma, phage selection, recombinant expression, transgenic animals, etc.). The term encompasses the entire immunoglobulin described above under the definition of "antibody ", as well as fragments and the like.

As used herein, the term "antibody fragment" refers to a portion derived from or related to a full length antibody, such as an anti-MASP-2 antibody, and generally includes an antigen binding or variable region thereof. Exemplary examples of antibody fragments include multispecific antibodies formed from Fab, Fab ', F (ab) ₂ , F (ab') ₂ and Fv fragments, scFv fragments, diabodies, linear antibodies, single chain antibody molecules and antibody fragments .

As used herein, a "single chain Fv" or "scFv" antibody fragment comprises the V _H and V _L domains of an antibody and these domains are present in a single polypeptide chain. Generally, the Fv polypeptide further comprises a polypeptide linker between the V _H and V _L domains, which allows the scFv to form the desired structure for antigen binding.

As used herein, a "chimeric antibody" includes a variable domain and a complementarity-determining region derived from a non-human species (e.g., rodent) antibody, while the remaining antibody molecule is a recombinant protein derived from a human antibody.

As used herein, a "humanized antibody" is a chimeric antibody comprising a minimal sequence consistent with a specific complementarity-determining region derived from a non-human immunoglobulin transfected into a human antibody framework. Humanized antibodies are typically recombinant proteins in which only the antibody complementarity-determining region is of non-human origin.

As used herein, the term "mannan-binding lectin" ("MBL") is equivalent to a mannan-binding protein ("MBP").

As used herein, the term " membrane attack complex "(" MAC ") refers to a complex of five terminal complement components (C5b combined with C6, C7, C8 and C-9) -9). ≪ / RTI >

As used herein, "subject" includes, but is not limited to, all mammals, including humans, non-human primates, dogs, cats, horses, sheep, goats, cows, rabbits, pigs and rodents.

As used herein, amino acid residues are abbreviated as follows: alanine (Ala; A), asparagine (Asn; N), aspartic acid (Asp; D), arginine (Arg; R), cysteine ), Glutamic acid (Glu), glutamine (Gln), glycine (GI), histidine (H), isoleucine (Ile), leucine ), Methionine (Met; M), phenylalanine (Phe), proline (P), serine (S), threonine (Thr), tryptophan (Trp) , And valine (Val; V).

In a broad sense, naturally occurring amino acids can be divided into several groups based on the chemical characteristics of the side chains of each amino acid. A "hydrophobic" amino acid refers to Ile, Leu, Met, Phe, Trp, Tyr, Val, Ala, Cys or Pro. "Hydrophilic" amino acid means Gly, Asn, Gln, Ser, Thr, Asp, Glu, Lys, Arg or His. This class of amino acids can be further subclassified as follows. An "non-charged hydrophilic" amino acid refers to Ser, Thr, Asn or Gln. "Acidic" amino acid refers to Glu or Asp. A "basic" amino acid means Lys, Arg or His.

As used herein, the term "conservative amino acid substitution" is exemplified by substitutions in amino acids within each of the following groups: (1) glycine, alanine, valine, leucine, and isoleucine, (2) phenylalanine, tyrosine, and Tryptophan, (3) serine and threonine, (4) aspartate and glutamate, (5) glutamine and asparagine, and (6) lysine, arginine and histidine.

The term "oligonucleotide" as used herein refers to oligomers or polymers of ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) or mimetics thereof. The term also covers the oligonucleotide bases composed of oligonucleotides with naturally occurring nucleotides, sugar and shared nucleoside (backbone) linkages, as well as non-naturally occurring strains.

As used herein, "epitope" refers to a site on a protein (eg, a human MASP-2 protein) that is bound by an antibody. A "redundant epitope" includes at least one (eg, two, three, four, five, or six) common amino acid residue (s) and includes linear and non-linear epitopes.

As used herein, the terms "polypeptide "," peptide ", and "protein" are used interchangeably, regardless of length or post-translational modification, and refer to any peptide-linked chain of amino acids. The MASP-2 protein described herein may be a wild-type protein, or may be a wild-type protein, or may be a protein having less than 50 (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 20, 25, 30, 35, 40, or 50 or fewer) conservative amino acid substitutions. Conservative substitutions typically include substitutions within the following groups: glycine and alanine; Valine, isoleucine, and leucine; Aspartic acid and glutamic acid; Asparagine, glutamine, serine, and threonine; Lysine, histidine and arginine; And phenylalanine and tyrosine.

In some embodiments, the human MASP-2 protein is at least 70%, such as 71, 72, 73, 74, 75, 76, or even more than the human MASP-2 protein having the amino acid sequence set forth in SEQ ID NO: 95, 96, 97, 98, 99, or 100%), and more preferably, May have the same amino acid sequence.

In some embodiments, the peptide fragment has at least six (eg, at least 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 , 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, , 49, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190, 200, , 400, 450, 500, or 600 or more) amino acid residues (e.g., at least six contiguous amino acid residues of SEQ ID NO: 5). In some embodiments, the antigenic peptide fragment of the human MASP-2 protein is less than 500 in length (e.g., 450, 400, 350, 325, 300, 275, 250, 225, 200, 190, 180, 170, 60, 55, 50, 49, 48, 47, 46, 45, 44, 43, 42, 50, 60, 150, 140,130,120,110,100,95,90,85,80,75, 41, 40, 39, 38, 37, 36, 35, 34, 33, 32, 31, 30, 29, 28, 27, 26, 25, (E. G., Fewer than 500 contiguous amino acid residues of any of SEQ ID NO: 5) of less than 1, 16, 15, 14, 13, 12, 11, 10, 9, to be.

Percent (%) amino acid sequence identity is defined as the percentage of amino acids of the same candidate sequence as the amino acid sequence of the reference sequence, after aligning the sequence to achieve maximum percent sequence identity and, if necessary, introducing a gap. Alignment for the purpose of measuring percent sequence identity can be accomplished in a variety of ways within the skill of the art, for example, using publicly available computer software such as BLAST, BLAST-2, ALIGN, ALIGN-2 or Megalign (DNASTAR) Can be achieved using software. Parameters suitable for measuring alignment, including any algorithms necessary to achieve maximum alignment over the entire length of the sequence being compared, can be determined by known methods.

The term " about "or" approximately "as used herein refers to a value in the range of plus or minus 10%

II. Summary of the Invention

As described herein, the inventors have identified a central role for the lectin pathway in the initiation and progression of tubular renal pathology, and have thus been found to be useful in the pathophysiology of a wide range of renal diseases, including IgA nephropathy, C3 glomerulonephritis and other glomerulonephritis Implying a key role in the activation of the lectin pathway. As further described herein, the inventors have found that inhibition of mannan-binding lectin-related serine protease-2 (MASP-2), a key regulator of the lectin pathway of the complement system, leads to unilateral occlusion (UUO) Have found that inflammation and fibrosis are significantly reduced in various animal models of fibrosing disease, including the adriamycin-induced nephrology model of renal fibrosis. Therefore, the inventors have demonstrated that inhibition of MASP-2-mediated lectin pathway activation provides an effective therapeutic approach to improve, treat or prevent renal fibrosis, such as tubular interstitial fibrosis, regardless of the underlying cause.

Lectin (MBL, M-picoline, H-picoline, L-picoline and CL-11) is a specific recognition molecule that leads to the innate complement system and the system has a lectin- Lt; RTI ID = 0.0 > amplification loop. ≪ / RTI > C1q is a specific recognition molecule that results in the acquired complement system, and the system includes a related end pathway amplification loop that amplifies the C1q-initiated activation of the classical initiation pathway and terminal complement effector molecule. The inventors refer to these two major complement activation systems as a lectin-dependent complement system and a C1q-dependent complement system, respectively.

In addition to its essential role in immune defense, complement systems contribute to tissue damage in many clinical diseases. Therefore, it is urgently necessary to develop a therapeutically effective complement inhibitor to prevent these side effects. Recognizing that it is possible to inhibit the lectin-mediated MASP-2 pathway while leaving the classical pathway intact, it is possible to specifically inhibit only the complement activation system that causes certain pathological conditions without completely stopping the immune defense capability of the complement It is very desirable. For example, in a disease state in which complement activation is mediated mostly by a lectin-dependent complement system, it would be advantageous to specifically inhibit this system only. This leaves the C1q-dependent complement activation system intact to handle immune complex processing and to help host defense against infection.

500 ng/ml); 그러므로, MASP-2의 고친화도 억제자의 상응하는 저농도는 완전 억제를 얻기에 충분할 수도 있다 (Moller-Kristensen, M., et al., J. Immunol Methods 282:159-167, 2003).A preferred protein component for targeting the development of therapeutic agents to specifically inhibit the lectin-dependent complement system is MASP-2. Among all known protein components (MBL, H-picoline, M-picoline, L-picoline, MASP-2, C2-C9, factor B, factor D, and proparin) of the lectin- Only MASP-2 is unique to a lectin-dependent complement system and is necessary for the system to function. Lectins (MBL, H-picoline, M-picoline, L-picoline and CL-11) are also a unique component of lectin-dependent complement systems. However, the loss of any one of the lectin components does not necessarily inhibit system activation due to lectin redundancy. It is necessary to inhibit all five lectins to ensure inhibition of the lectin-dependent complement activation system. In addition, since MBL and picolin are also known to have complement independent opsonic activity, inhibition of lectin function will result in the loss of this beneficial host defense mechanism for infection. In contrast, this complement-independent lectin opsonin activity will remain intact when MASP-2 is an inhibitory target. An added benefit of MASP-2 as a therapeutic target to inhibit the lectin-dependent complement activation system is that the plasma concentration of MASP-2 is the lowest among any complement proteins (

500 ng / ml); Therefore, the corresponding low concentration of the high affinity inhibitor of MASP-2 may be sufficient to obtain complete inhibition (Moller-Kristensen, M., et al., J. Immunol Methods 282: 159-167, 2003).

As described in Example 14, it has been shown that the MASP-2 gene-free (MASP-2) gene, as shown by the histological markers of fibrosis (1/3 reduction), such as inflammatory cell infiltration (75% reduction) 2 - / -) mice were measured in animal models of fibrotic kidney disease (unilateral ureteral closed UUO) that displayed significantly fewer renal diseases as compared to wild-type control animals. As further shown in Example 15, wild-type mice that were systematically treated with anti-MAST-2 monoclonal antibodies that selectively blocked the lectin pathway while leaving the classic pathway intact were wild-type mice treated with an isotype control antibody Lt; RTI ID = 0.0 > fibrotic < / RTI > These results demonstrate that the lectin pathway is a key contributor to renal disease and that the MASP-2 inhibitor, such as the MASP-2 antibody, which further blocks the lectin pathway, is effective as an anti-fibrotic agent. As further shown in Example 16, wild-type mice treated with the protein overload model, bovine serum albumin (BSA) showed proteinuria nephropathy whereas MASP-2 - / - mice treated with the same level of BSA showed decreased Kidney damage. As shown in Example 17, wild-type mice treated systemically with anti-MAST-2 monoclonal antibodies that selectively block the lectin pathway and leave the classic pathway intact remain protected from renal damage in a protein overload model. As described in Example 18, MASP-2 - / - mice exhibited less renal inflammation and tubular interstitial damage in the adriamycin-induced kidney model of renal fibrosis compared to wild type mice. Patients with IgA nephropathy treated with anti-MASP-2 antibody, as described in Example 19, undergoing two open-label elongation tests, were tested for urine albumin-versus-creatinine ratio (uACR) Significant and statistically significant reductions were achieved and a reduction in 24-hour urine protein levels from baseline to the end of treatment was demonstrated. As described further in Example 19, patients with membranous nephropathy treated with anti-MASP-2 antibody in the same bi-renal elongation test also demonstrated a decrease in uACR during treatment. As described in Example 20, four of five patients with lupus nephritis (LN) treated with anti-MASP-2 antibody from the baseline to the end of treatment were treated with 24-hour A clinically significant decrease in urinary protein levels was demonstrated.

In accordance with the foregoing description, the present invention provides the use of a MASP-2 inhibitor, such as a MASP-2 inhibitory antibody, as an anti-fibrotic agent, the use of a MASP-2 inhibitor for the manufacture of a medicament for the treatment of fibrosis conditions, Comprising the step of administering to said patient an effective amount of a MASP-2 inhibitor (e. G., An anti-MAsP-2 antibody) in a human subject in order to prevent, treat, ameliorate or reverse the fibrosis condition.

The methods of the invention are useful for the treatment of any disease or disorder caused or exacerbated by fibrosis and / or inflammation, such as diseases of the kidney (e.g., chronic kidney disease, IgA nephropathy, C3 glomerulopathies and other glomerulonephritis) Heart failure (such as myocardial infarction, atrial fibrillation, cardiac valve fibrosis, endocardial myocardial fibrosis), brain diseases (such as stroke), and cardiovascular diseases (Such as atherosclerosis), skin diseases (such as excessive wound healing, scleroderma, systemic sclerosis, keloids), vascular diseases such as atherosclerotic vascular diseases, intestinal diseases such as Crohn's disease, ophthalmic diseases such as anterior subcapsular cataract, (E.g., osteoarthritis, osteoarthritis, osteoarthritis, osteoarthritis, osteoarthritis, osteoarthritis, osteoarthritis, Unit may be used to prevent, treat, alleviate or reverse the fibrosis condition in a human subject suffering from an infectious disease (such as alpha viruses, hepatitis C and hepatitis B).

III. The role of MASP-2 in diseases and conditions caused or exacerbated by fibrosis

Fibrosis is the formation or presence of excess connective tissue in an organ or tissue, usually in response to injury and damage. The characteristic of fibrosis is the production of extracellular matrix after injury. In the kidney, fibrosis is characterized by the deposition of progressive deleterious connective tissue on kidney parenchyma, which inevitably leads to attenuation of renal function independent of primary renal disease causing the original renal injury. Characteristic changes in cells in which tubular epithelial cells transformed into mesenchymal fibroblasts, the so-called epithelial to mesenchymal transition (EMT), constitute the principle mechanism of renal fibrosis. Fibrosis affects almost any tissue and organ system and can occur as a remedy or replacement for irritation such as tissue damage or inflammation. The normal physiological response to injury is the deposition of connective tissue, but if this process is pathological, the replacement of highly differentiated cells by scar tissue will alter the architecture and function of the tissue. At the cellular level, epithelial cells and fibroblasts proliferate and differentiate into myoblasts, leading to substrate shrinkage, increased rigidity, microvascular compression, and hypoxia. Currently, there is no effective treatment or treatment for fibrosis, but animal studies and anecdotal human reports suggest that fibrotic tissue damage may be reversed (Tampe and Zeisberg, Nat Rev Nephrol, vol 10: 226-237, 2014).

(Eg, liver cirrhosis, nonalcoholic fatty liver disease), chronic obstructive pulmonary disease (eg, chronic renal disease, IgA nephropathy, C3 glomerulonephritis and other glomerulonephritis), pulmonary disorders (eg idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis) (E.g., hypertrophic scarring, scleroderma, systemic sclerosis, keloids), vascular diseases (such as atherosclerosis, arteriosclerosis), cardiovascular diseases (such as myocardial infarction, atrial fibrillation, heart valve fibrosis, (E.g., vascular disease), bowel disease (e.g. Crohn's disease), ophthalmic diseases (e.g., anterior subcapsular cataract, lens posterior capsular opacity), diseases of the musculoskeletal soft tissue structure (e.g., conjoined capsulitis, dufrytrene buildup, myelofibrosis) Endometriosis, pharyngeal disease), and some infectious diseases (e.g., alphavirus, hepatitis C and hepatitis B) Resulting in fibrosis leading to organ failure.

While fibrosis occurs in many tissues and diseases, there are common molecular and cellular mechanisms for its pathology. The deposition of extracellular matrix by fibroblasts involves immune cell infiltration, predominantly mononuclear cells (Wynn T., Nat Rev Immunol 4 (8): 583-594, 2004, incorporated herein by reference). The vigorous inflammatory response is mediated by a combination of growth factors (TGF-beta, VEGF, hepatocyte growth factor, connective tissue growth factor), cytokines and hormones (endothelin, IL-4, IL-6, IL-13, chemokines) Starch, substrate metal-containing proteolytic enzymes, cathepsin), and extracellular matrix proteins (collagen, fibronectin, integrin).

In addition, the complement system is activated in many fibrotic diseases. Complement components including membrane attack complexes have been identified in many fibrous tissue samples. For example, the components of the lectin pathway have been identified in fibrotic lesions of renal disease (Satomura et al., Nephron . 92 (3): 702-4 (2002); Sato et al., Lupus 20 (13): 1378-86 Liu et al., Clin Exp Immunol , 174 (1): 152-60 ( 2013)); In fibrotic lesions of liver disease (Rensen et al., Hepatology 50 (6): 1809-17 (2009)); And fibrosis lesions of pulmonary disease (Olesen et al., Clin Immunol 121 (3): 324-31 (2006)).

Excessive complement activation has been established as a key contributor to immune complex-mediated glomerulonephritis as well as antibody-independent glomerulonephritis. However, there is a strong line of evidence to demonstrate that in situ activation of uncontrolled complement is inherently involved in the pathophysiology of TI fibrosis in non glomerular disease (Quigg RJ, J Immunol 171: 3319-3324, 2003, Naik A et al., Semin Nephrol 33: 575-585, 2013, Mathern DR et al., Clin J Am Soc Nephrol 10: P1636-1650, 2015). Strong inflammatory signals triggered by local complement activation are mediated by complement components that are filtered through the proximal tubule and continue into the interstitial space or by abnormal synthesis of complement components to the tubules or other resident and infiltrating cells , Or altered expression of complement control proteins in kidney cells, or the absence or loss or acquisition of functional mutations of complement control elements (Mathern DR et al., Clin J Am Soc Nephrol 10: P1636-1650, 2015, Sheerin NS, et al., FASEB J 22: 1065-1072, 2008). For example, in mice, deficiency of the complement control protein CR1-related gene / protein y (Crry) results in tubular interstitial (TI) complement activation resulting in typical inflammation and fibrosis of damage seen in human TI disease (Naik A. et al., Semin Nephrol 33: 575-585, 2013, Bao L. et al., J Am Soc Nephrol 18: 811-822, 2007). Exposure of tubular epithelial cells to anapylatoxin C3a results in mesial metastasis of the epithelium (Tsang Z. et al., J Am Soc Nephrol 20: 593-603, 2009). The blockade of C3a signaling through the C3a receptor alone has recently been shown to reduce renal TI fibrosis in proteinuria and non-proteinuria (Tsang Z. et al., J Am Soc Nephrol 20: 593-603, 2009 , Bao L. et al., Kidney Int . 80: 524-534, 2011).

As described herein, the present inventors have identified a central role of the lectin pathway in the initiation and progression of tubular renal pathology, and thus have been implicated in a wide range of renal diseases, including IgA nephropathy, C3 glomerulopathy and other glomerulonephritis Roos A. et al., J Am Soc Nephrol 17: 1724-99, 1998. NeoPhlorinolysis Transplant 13: 1984-1990, 1998. Hisano S. et al., Am J Kidney Dis 45: 295-302, 1734, 2006; Liu LL et al , Clin Exp Immunol 174: 152-160, 2013; Lhotta K. et al, Nephrol Dialysis Transplant 14:.... 881-886, 1999; Pickering et al, Kidney International 84: 1079 Diabetes 54: 1523-1527, 2005), ischemic reperfusion injury (Asgari E. et al ., FASEB J 28: 3996-4003, 2014) and transplantation (Berger SP et al., Am J Transplant 5: 1361-1366, 2005) in the pathogenesis of the lectin pathway.

As further described herein, the inventors have demonstrated that MASP-2 inhibition reduces inflammation and fibrosis in a mouse model of interstitial interstitial disease. Thus, it is expected that MASP-2 inhibitors would be useful in the treatment of renal fibrosis, including tubular interstitial inflammation and fibrosis, proteinuria, IgA nephropathy, C3 glomerulopathies and other glomerular nephritis and renal ischemic reperfusion injury.

Kidney diseases and disorders

According to the National Kidney Foundation, 26 million American adults have chronic kidney disease (CKD). Most patients have progressive disease leading to renal failure, require treatment with drugs that stimulate erythropoiesis to survive, dialysis or kidney transplantation. There are several drugs that can cure CKD, the main symptom of hypertension, but there are currently no drugs to address the underlying cause.

Studies have shown that progressive renal injury is caused by capillary hypertension in the kidney's sub-structure known as the nephron (Whitworth JA, Annals Acad of Med , vol. 34 (1): 2005). As the nephron (the filtration unit of the kidney) is damaged or destroyed in this process, inflammation and tissue scarring occur and nephrons are replaced by non-functional scar tissue. As a result, the ability to filter the blood of the kidneys decreases over time. This is referred to as renal fibrosis and is a common pathway for progressive renal disease. Regardless of the nature of the initial impairment, renal fibrosis is thought to be the common final pathway for renal disease to progress to end-stage renal failure. Improvement of renal fibrosis can be measured by one or more of the following: evaluation of epilepsy volume, collagen IV deposition, and / or connective tissue growth mRNA levels. The compounds and / or compounds described herein are useful in the treatment of renal fibrosis.

Renal fibrosis and inflammation are virtually a dominant feature of late renal disease of any etiology (Boor et al., Boor P. et al., J Am Soc . Nephrology 18: 1508-1515, 2007 and Chevalier et al. Kidney International 75: 1145-1152, 2009). Renal failure can be caused by disability in a heterogeneous group. Progressive renal insufficiency causes proteinuria and renal dysfunction. As patient health deteriorates, dialysis may be necessary to simply prevent damage to the kidneys and prevent multiple organ failure. Over time, renal failure and renal dysfunction can progress to end-stage renal disease (ESRD), a global, or almost total, permanent loss of kidney function. Depending on the type of kidney disease, kidney function can be lost in days or weeks, or it can worsen slowly and gradually over decades. Once the patient has progressed to ESRD, dialysis (hemodialysis or peritoneal dialysis) is necessary to prevent death. The patient must maintain some form of dialysis prescription or receive a kidney transplant.

Components of the lectin pathway have been found in fibrosing lesions of renal disease (Satomura et al., Nephron . 92 (3): 702-4 (2002); Sato et al., Lupus 20 (13): 1378-86 Liu et al., Clin Exp Immunol , 174 (1): 152-60 ( 2013)). In IgA nephropathy, patients with glomerular MBL deposition had more severe proteinuria, decreased renal function, lower serum albumin, more severe histology, and greater hypertension than patients without MBL deposition (Liu et al., Clin Exp Immunol . 2013 Oct; 174 (1): 152-60). Patients with lupus nephritis (Sato et al., Lupus, 20 (13): 1378-86, 2011) and patients with chronic renal failure (Satomura et al., Nephron 92 (3): 702-4, It also has an increased level of MBL and lectin pathway activity.

It has also been demonstrated that C5 deficiency has led to significant improvements in the major components of renal fibrosis in the primary tubular interstitial lesion, a non-proteinuria model of unilateral ureteral obstruction (UUO) (Boor P. et al., J of Am Soc of Nephrology 18: 1508-1515, 2007). It was also reported that C3 gene expression was increased after UUO in wild-type mice and collagen deposition was significantly reduced in C3 - / - mice following UUO compared to wild type mice suggesting a role for complement activation in renal fibrosis (Fearn et al., Mol Immunol 48: 1666-1733, 2011: Abstract). However, prior to the discoveries described herein by the present inventors, the complement components involved in renal fibrosis have not been well defined. As described herein in Examples 14-17, the present inventors have unexpectedly found that the blocking of MASP-2 deficiency or blocking MASP-2 inhibitory antibody, which selectively blocks the lectin pathway while leaving the classical pathway intact, Lt; RTI ID = 0.0 > mouse < / RTI > from renal fibrosis in various animal models of disease.

Thus, in certain embodiments, the disclosure provides a method of inhibiting renal fibrosis in a subject suffering from fibrosis and / or inflammatory or renal disease or disorder, comprising administering to a subject in need thereof a MASP -2 inhibitor, such as an anti-MASP-2 antibody. The method comprises administering to a subject suffering from fibrosis and / or inflammation-induced or exacerbated renal disease or disorder a composition comprising an amount of a MASP-2 inhibitor effective to inhibit renal fibrosis.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical application of the composition in a subject. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, or for oral administration for potentially non-peptide agonists ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., An anti-MASP-2 antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for a basal kidney disease or condition. In certain embodiments, a MASP-2 inhibitor (such as an anti-MASP-2 antibody) is administered in combination with a dialysis or plasmapheresis regimen. In certain embodiments, a MASP-2 inhibitor (e. G., Anti-MASP-2 antibody) is used to reduce the frequency with which dialysis or plasmapheresis is required. In certain embodiments, a MASP-2 inhibitor (e. G., Anti-MAsP-2 antibody) is used in combination with a kidney transplant. In certain embodiments, MASP-2 inhibitors (e. G., Anti-MASP-2 antibodies) are used to control renal dysfunction and prevent further loss of renal function in patients awaiting renal transplantation.

For example, in certain embodiments, the anti-MASP-2 antibody inhibits renal fibrosis and thereby treats or ameliorates glomerular disease such as, for example, localized segmental glomerulosclerosis and nephrotic syndrome (including treating or ameliorating the symptoms of the disease) Lt; / RTI > Exemplary symptoms that may be treated include, but are not limited to, hypertension, proteinuria, hyperlipidemia, hematuria, and hypercholesterolemia. In some embodiments, the MASP-2 inhibitor inhibits tubular fibrosis. In certain embodiments, treating includes improving renal function, decreasing proteinuria, improving hypertension, and / or reducing renal fibrosis. In certain embodiments, the treatment comprises (i) delaying or preventing renal dysfunction, renal failure, or progression to ESRD; (ii) delay, reduce or prevent the need for dialysis; Or (iii) delay or prevent a demand for kidney transplantation.

Certain specific renal diseases and disorders caused or exacerbated by fibrosis and / or inflammation are described below.

In certain embodiments, the renal disease caused or exacerbated by fibrosis and / or inflammation is a glomerular disease such as focal segmental glomerulosclerosis (FSGS). Glomerular disease damages the glomeruli, causing proteins and sometimes red blood cells to leak into the urine. Sometimes glomerular disease also interferes with the elimination of excreta by the kidneys, and the excreta begin to accumulate in the blood. Symptoms of glomerular disease include proteinuria, hematuria, reduced glomerular filtration rate, hypoproteinemia, and edema. Many different diseases can cause glomerular disease. It may be a direct result of a drug that is toxic to the kidney or to the kidney, or it may be a result from diseases affecting the whole body, such as hypertension, diabetes or lupus. FSGS is one particular glomerular disease, but there are many causes of this special condition characterized by scarring of the kidneys. Patients with FSGS typically progress to end-stage renal disease within 5 to 20 years, while patients with aggressive forms of disease progress to ESRD within two to three years.

In certain embodiments, the renal disease caused or exacerbated by fibrosis and / or inflammation is diabetic nephropathy (DN), a field with substantial unmet medical needs. Diabetic nephropathy is a kidney disease or injury caused as a complication of diabetes. Conditions are exacerbated by hypertension, high blood sugar levels, and high cholesterol and high levels of lipid. The exact cause of diabetic nephropathy is unknown. However, although not bound by theory, uncontrolled hyperglycemia is thought to cause the development of kidney damage such as fibrosis and scar tissue. In humans, DN appears as a clinical syndrome consisting of proteinuria, a gradually decreasing glomerular filtration rate (GFR), and increased risk for cardiovascular disease. Diabetic proteinuria is associated with the development of characteristic histopathological features, including thickening of the glomerular basement membrane (GBM) and mesangial expansion of the glomeruli. As proteinuria progresses and renal dysfunction continues, glomerular sclerosis, arteriolar hyalinosis and tubular interstitial fibrosis occur.

Thus, in one embodiment, the disclosure provides a method of treating diabetic nephropathy comprising administering to a subject in need thereof an effective amount of a MASP-2 inhibitor (e.g., a MASP-2 inhibiting antibody). In certain embodiments, treating comprises reducing one or more symptoms of diabetic nephropathy. In certain embodiments, treating includes reducing, delaying, or eliminating the need for dialysis. In certain embodiments, treating includes reducing, delaying, or eliminating the need for kidney transplantation. In certain embodiments, the treatment comprises delaying, preventing or reversing the progression of diabetic nephropathy to renal or end-stage renal disease.

In certain embodiments, the renal disease caused or exacerbated by fibrosis and / or inflammation is lupus nephritis. As described in more detail below, lupus nephritis, a serious complication of systemic lupus erythematosus (SLE), is another example of renal fibrosis that can be treated with a MASP-2 inhibitor (such as an anti-MASP-2 antibody) .

Thus, in one embodiment, the disclosure provides a method of treating a fibrotic and / or inflammatory-induced or exacerbated kidney disease or disorder, comprising administering an effective amount of a MASP-2 inhibitor (e.g., a MASP-2 inhibiting antibody) A method of inhibiting renal fibrosis in an afflicted subject is provided. In some embodiments, a renal disease or disorder caused or exacerbated by fibrosis and / or inflammation is selected from the group consisting of chronic renal disease, chronic renal failure, glomerular disease (e.g., focal segmental glomerulosclerosis), immune complex disorders (e.g., IgA nephropathy, Nephropathy), lupus nephritis, nephrotic syndrome, diabetic nephropathy, tubular interstitial damage and C3 glomerulopathies or other types of glomerulonephritis.

Methods for preventing or treating kidney damage caused by drug-induced toxicity

Another cause of kidney damage involves drug-induced toxicity. For example, four prothoxins can cause direct toxicity to tubular epithelial cells. As described herein, the present inventors have demonstrated that MASP-2 deficient mice are protected against adriamycin-induced nephropathy.

Four prothoxins include, but are not limited to, therapeutic agents such as cisplatin, gentamycin, cephaloridine, cyclosporine, amphotericin, adriamycin, radioconjugates, insecticides such as paraquat, ≪ / RTI > ethylene and dichloroacetylene). Other examples include puromycin amino nucleoside (PAN); Aminoglycosides such as gentamicin; Cephalosporins such as cephaloridine; A calcineurin inhibitor, such as tacrolimus or sirolimus. Drug-induced nephrotoxicity may also be induced by non-steroidal anti-inflammatory drugs, anti-retroviruses, anti-cytokines, immunosuppressants, carcinogenic drugs or ACE inhibitors. Drug-induced nephrotoxicity is additionally associated with analgesic abuse, ciprofloxacin, clopidogrel, cocaine, cox-2 inhibitors, diuretics, foscamet, gold, ifosfamide ), Immunoglobin, Chinese herb, interferon, lithium, mannitol, mesalamine, mitomycin, nitrosoureas, penicillamine, penicillin, pentaamidine, quinine, riphamine, streptozocine, sulfonamide, ticlopidine ticlopidine, triamterene, valproic acid, doxorubicin, glycerol, cidofovir, tobramycin, neomycin sulfate, colistimethate, vancomycin, amikacin , Cefotaxime, cisplatin, acyclovir, lithium, interleukin-2, cyclosporine or indinavir.

Thus, in one embodiment, a subject at risk of developing renal impairment or suffering from renal impairment may receive one or more therapeutic agents having a nephrotoxic effect. These subjects may be administered the MASP-2 inhibitor of the invention either before or simultaneously with such treatment. Likewise, the AMSP-2 inhibitor may be administered after a therapeutic agent to treat or reduce the likelihood of developing nephrotoxicity.

Diseases and conditions associated with proteinuria

Damaged glomerular filtration of proteins has been shown to result in proteinuria and accelerate the progressive loss of nephrons that occur in all chronic kidney diseases (Remuzzi and Bertani, New Eng. J Med Vol . 339 (20): 1448-1456, 1998). For example, in a study described in Eddy et al., Am J Pathol 135: 719-33, 1989, glomerular filtration of albumin continued to develop epilepsy lesions and scarring. As described further by Eddy et al. In 1989, deposition of complement C3 on the luminal surface of proximal tubules was observed in rats with nephropathy induced by protein-overload, Indicating that the components of the system can cause epileptic damage. Complement depletion or C6 deficiency has been shown to improve tubular interstitial damage, such as mesenchymal proliferative glomerulonephritis, adriamycin nephrosis, renal resection of 5/6, and puromycin aminonucleotide nephropathy in proteinuria animal models (Boor et al. al., et al ., J Am Soc Nephrology : JASN 18: 1508-1515, 2007). Human studies have shown that proteinuria is an independent predictor of progression to chronic kidney disease and that the reduction of proteinuria is protective of kidneys (Ruggenenti P. et al., J Am Soc Nephrol 23: 1917-1928, 2012).

Thus, in one embodiment, the disclosure provides a method of treating a disease or condition associated with proteinuria comprising administering an amount of a MASP-2 inhibitor (e.g., a MASP-2 inhibiting antibody) effective to reduce or prevent proteinuria in a subject Thereby preventing or reducing proteinuria and / or preventing or reducing renal damage in an affected subject. In some embodiments, the disease or condition associated with proteinuria is selected from the group consisting of nephrotic syndromes, pre-eclampsia, eclampsia, toxic lesions of the kidney, amyloidosis, collagen vascular diseases such as systemic lupus erythematosus, dehydration, glomerular diseases such as membranous glomerulonephritis, IgA nephritis, IgM nephropathy, membranoproliferative glomerulonephritis, glomerulonephritis, glomerulonephritis, glomerulonephritis, glomerulonephritis, glomerulonephritis, glomerulonephritis, glomerulonephritis, (Such as NSAIDS, nicotine, penicillamine, lithium carbonate, gold and other heavy metals, ACE inhibitors, antibiotics or opiates (E.g., heroin)); Fabry disease, infection (e.g., HIV, syphilis, Hepatitis A, B or C hepatitis, streptococcal infection, urinary schistosomiasis); (For example, renal transplant rejection), Ebola hemorrhagic fever, nail palate patellar syndrome, familial mediterranean fever, acute myelogenous leukemia, amyotrophic lateral sclerosis, acute myelogenous leukemia, , HELLP syndrome, systemic lupus erythematosus, Wegener's granulomatosis, rheumatoid arthritis, glycogen storage disease type 1, Goodpasture's syndrome, Henoch-Schonlein purpura, kidney-spreading urethral infection, Lt; / RTI >

Liver disease

Liver fibrosis or hepatic fibrosis is caused by accumulation of scar tissue in the liver and is characteristic of most types of liver disease. Replacement of healthy liver tissue with scar tissue impairs liver's ability to function properly. If the scarring-causing condition is not treated, liver fibrosis can progress to cirrhosis and complete with liver failure, a life-threatening condition. The main causes of liver fibrosis are alcohol abuse, chronic hepatitis C virus infection, nonalcoholic fatty liver and hepatotoxicity (for example, drug-induced liver damage induced by acetaminophen or other drugs).

Components of the lectin pathway have been found in fibrosing lesions of liver disease (Rensen et al., Hepatology 50 (6): 1809-17 (2009)). For example, in nonalcoholic steatohepatitis (also known as fatty liver disease), complement system proteins are extensively activated and their expression is associated with the severity of the disease (Rensen et al., Hepatology 50 (6): 1809-17 (2009), with C3 and C9 deposition, MBL accumulation was found, which confirms activation of the lectin pathway.

Thus, in certain embodiments, the disclosure provides a method of treating a patient suffering from fibrosis and / or inflammation-induced or exacerbated liver disease or disorder, comprising administering to a subject in need thereof a MASP-2 inhibitor, such as a MASP- The present invention provides a method for inhibiting hepatic fibrosis in a subject suffering from liver fibrosis. The method comprises administering to a subject suffering from fibrosis and / or inflammation-induced or aggravated liver disease or disorder an amount of a MASP-2 inhibitor effective to inhibit hepatic fibrosis.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical application of the composition in a subject. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, or for oral administration for potentially non-peptide agonists ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for the underlying liver disease or condition.

In some embodiments, the liver disease or disorder caused or exacerbated by fibrosis and / or inflammation is selected from the group consisting of liver cirrhosis, nonalcoholic fatty liver disease (fatty liver disease), secondary liver fibrosis secondary to alcohol abuse, liver fibrosis secondary to acute or chronic infection , Liver disease and toxic liver injury (for example, hepatotoxicity due to drug-induced liver damage induced by acetaminophen or other drugs).

Lung disease

Pulmonary fibrosis is the formation or development of excess fibrous connective tissue in the lung, where normal pulmonary tissue is replaced by fibrotic tissue. These scars lead to lung stiffness and impaired lung architecture and function. In humans, pulmonary fibrosis is believed to result from repeated damage to tissues in and between the small air sacs (alveoli) of the lung. In the experimental setting, various animal models replicated aspects of human disease. For example, exogenous agents such as bleomycin, fluorescein isothiocyanate, silica, or asbestos may be injected into the period of the animal (Gharaee-Kermani et al., Animal Models of Pulmonary Fibrosis. Methods Mol. Med , ≪ / RTI > 2005, 117: 251-259).

Thus, in certain embodiments, the disclosure provides a method of treating a patient suffering from fibrosis and / or inflammation-induced or exacerbated pulmonary disease or disorder, comprising administering to a subject in need thereof a MASP-2 inhibitor, such as a MASP- The present invention provides a method for inhibiting pulmonary fibrosis in a subject suffering from pulmonary fibrosis. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit pulmonary fibrosis, decrease pulmonary fibrosis, and / or improve pulmonary function. Improvement of symptoms of pulmonary function includes improvement of pulmonary function and / or capacity, decreased fatigue, and improvement of oxygen saturation.

In some embodiments, the disclosure provides a method of treating, inhibiting, preventing, or ameliorating pulmonary fibrosis in a subject suffering from cystic fibrosis, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibitory antibody, . ≪ / RTI >

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical application of the composition in a subject. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, or for oral administration for potentially non-peptide agonists ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for basal pulmonary disease or condition.

Specific specific pulmonary diseases and disorders caused or exacerbated by fibrosis and / or inflammation are described below.

In certain embodiments, the pulmonary disease caused or exacerbated by fibrosis and / or inflammation is chronic obstructive pulmonary disease (COPD). COPD is a disorder in which airway walls become fibrous due to accumulation of myofibroblasts and collagen, a cause of disability, and the fourth leading cause of death in the United States. COPD blocks airflow, making it more and more difficult for people with symptoms to breathe. COPD is caused by damage to the airways and ultimately interferes with the exchange of oxygen and carbon dioxide in the lungs. COPD includes chronic obstructive bronchitis and emphysema and often includes both. Patients with COPD whose lungs are already damaged and whose pulmonary function is already compromised increase the likelihood of complications related to bacterial and viral infections.

Thus, in one embodiment, the disclosure provides a method of treating a patient suffering from chronic obstructive pulmonary disease, comprising administering an effective amount of a MASP-2 inhibitor (e. G., An anti-MAsP-2 antibody) Lt; RTI ID = 0.0 > (COPD). ≪ / RTI > In certain embodiments, treating comprises reducing one or more symptoms of COPD. Symptoms of COPD and / or pulmonary fibrosis include, but are not limited to, cough with mucus, shortness of breath with poor activity (dyspnea), fatigue, frequent respiratory infections, wheezing, chest tightness, irregular (Heart arrhythmia), respiratory and oxygen therapy, right heart failure or cor pulmonale (heart swelling due to chronic lung disease and heart failure), pneumonia, pneumothorax, severe weight loss and malnutrition. Symptoms also include a reduction in pulmonary function as assessed using one or more standard tests of pulmonary function.

In certain embodiments, pulmonary disease caused or exacerbated by fibrosis and / or inflammation is pulmonary fibrosis associated with scleroderma. Pulmonary fibrosis associated with scleroderma is another example of pulmonary fibrosis that can be treated with a MASP-2 inhibitor (such as a MASP-2 inhibitory antibody), as described in more detail below.

In some embodiments, the pulmonary disease or disorder caused or exacerbated by fibrosis and / or inflammation is selected from the group consisting of chronic obstructive pulmonary disease, cystic fibrosis, pulmonary fibrosis associated with scleroderma, bronchiectasis and pulmonary hypertension .

Heart and vascular disease

Many different cardiac and vascular pathologies are caused by a common fibrosis process. Over-deposition of fibrotic tissue in the heart results in cardiopathy, where the over-production of extracellular matrix proteins changes the structure, architecture, and shape of the heart and affects the contractile function (Khan and Sheppard, Immunology 118: 10-24 , 2006).

Studies indicate that fibrosis can contribute significantly to cardiac dysfunction in ischemic, dilated, and non-cardiomyopathies. For example, patients with chronic atrial fibrillation have been shown to have higher levels of myocardial fibrosis compared to controls (Khan and Sheppard, Immunology 118: 10-24, 2006). As another example, most cases of arrhythmogenic right ventricular cardiomyopathy (ARVC) in the United States have been demonstrated to demonstrate fat invasion and scarring (fibrotic ARVC) (Burke et al., Circulation 97: 1571-1580, 1998). In a study of the histopathologic features of the myocardium of the ventricles in human subjects with ARVC, a wide range of fibrosis was measured in biopsy specimens from pediatric patients with ARVC (Nishikawa T. et al., Cardiovascular Pathology vol 8 (4): 185-189, 1999).

Thus, in certain embodiments, the disclosure provides a method of treating a patient suffering from fibrosis and / or inflammation caused or exacerbated by a cardiovascular disease, such as a fibrotic and / or inflammatory disorder, comprising administering a MASP-2 inhibitor such as a MASP- Treating, reverting, inhibiting and / or reducing fibrosis and / or inflammation in a subject suffering from a disorder or disorder. The method includes administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit cardiac and / or vascular fibrosis and / or to improve cardiac and / or vascular function.

In some embodiments, the disclosure provides a method of treating, inhibiting, preventing, or ameliorating fibrosis in a subject suffering from valvular heart fibrosis, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibitory antibody, ≪ / RTI >

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical application of the composition in a subject. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, or for oral administration for potentially non-peptide agonists ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for a baseline heart disease, or vascular disease or condition.

In some embodiments, the disease or disorder of the cardiac or vascular system caused or exacerbated by fibrosis and / or inflammation is selected from the group consisting of cardiomyopathy, myocardial infarction, atrial fibrillation, endocardial myocardial fibrosis, arrhythmogenic right ventricular cardiomyopathy (ARVC) , Atherosclerotic vascular disease, vascular stenosis, restenosis, vasculitis, phlebitis, deep vein thrombosis and abdominal aortic aneurysm.

Chronic infectious disease

Chronic infectious diseases such as hepatitis C and hepatitis B can cause tissue inflammation and fibrosis, and high lectin pathway activity can be harmful. Inhibitors of MASP-2 in such diseases may be beneficial. For example, levels of MBL and MASP-1 appear to be a significant predictor of the severity of hepatic fibrosis in hepatitis C virus infection (Brown et al., Clin Exp Immunol . 147 (1): 90-8, .. 2007; Saadanay et al, Arab J Gastroenterol 12 (2): 68-73, 2011; Saeed et al, Clin Exp Immunol 174 (2):.. 265-73, 2013). MASP-1 has already been shown to be a potent activator of MASP-2 and the lectin pathway (Megyeri et al., J Biol Chem . 29: 288 (13): 8922-34, 2013). Alphaviruses such as chikungunya virus and Ross River virus induce a strong host inflammatory response resulting in arthritis and myositis, which is mediated by the MBL and lectin pathways (Gunn et al ., PLoS Pathog . 8 (3): e1002586, 2012).

Thus, in certain embodiments, the disclosure provides a method of treating a patient suffering from or susceptible to a chronic infectious disease causing inflammation and / or fibrosis, comprising administering to a subject in need thereof a MASP-2 inhibitor, such as a MASP- Thereby preventing, treating, reversing, inhibiting and / or reducing fibrosis and / or inflammation in a subject suffering from it.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical application of the composition in a subject. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, or for oral administration for potentially non-peptide agonists ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities suitable for underlying chronic infectious disease.

In some embodiments, the chronic infectious disease causing inflammation and / or fibrosis is selected from the group consisting of alphavirus, hepatitis A, hepatitis B, V infection, tuberculosis, HIV and influenza.

Autoimmune disease:

Scleroderma is a chronic autoimmune disease characterized by fibrosis, changes in blood vessels, and autoantibodies. There are two main types: limited systemic scleroderma and diffuse systemic scleroderma. Skin symptoms of limited systemic affects the hands, arms and face. Patients with this form of scleroderma often have more than one of the following complications: calcinosis, Raynaud's phenomenon, esophageal dysfunction, hand-to-foot sclerosis and capillary dilatation. Diffuse systemic sclerosis progresses rapidly and affects large areas of the skin and one or more internal organs, frequently the kidneys, esophagus, heart and / or lungs.

Scleroderma affects small vessels, known as arterioles, in all organs. First, the endothelial cells of the arterioles die together with smooth muscle cells apoptosis. These cells are replaced by collagen and other fibrous materials. Inflammatory cells, particularly CD4 + helper T cells, infiltrate the arterioles and cause further damage.

Skin signs of scleroderma can be painful and can impair the use of affected areas (e.g., the use of hands, fingers, toes, feet, etc.) and can make them unsightly. Skin ulceration can occur and such ulcers are susceptible to infection or even gangrene. Ulcerated skin can be difficult or slow to heal. Difficulty in healing skin ulceration may be exacerbated, especially in patients with impaired circulation, such as patients exhibiting Raynaud's phenomenon. In certain embodiments, the methods of the disclosure are used to treat scleroderma, e.g., skin conditions of scleroderma. In certain embodiments, treating scleroderma includes treating skin ulceration, such as a finger ulcer. Administration of a MASP-2 inhibitor, such as an anti-MASP-2 antibody, can be used to reduce inflammatory symptoms of fibrosis and / or scleroderma in affected tissues and / or organs.

In addition to skin symptoms / signs, scleroderma can also affect the heart, kidneys, lungs, joints, and digestive tract. In certain embodiments, treating scleroderma includes treating the symptoms of the disease in any one or more of these tissues, such as by reducing fibrosis and / or inflammatory symptoms. The problem of the lungs is the most serious complication of scleroderma and most of the deaths associated with the disease. Two prominent pulmonary conditions associated with scleroderma are pulmonary fibrosis and pulmonary hypertension. A speaker with a lung can have either one or two states. Pulmonary fibrosis associated with scleroderma is an example of pulmonary fibrosis that can be treated with MASP-2 inhibitors. Scleroderma, including the lung, causes scarring (pulmonary fibrosis). Such pulmonary fibrosis occurs in about 70% of scleroderma patients, but its progression is typically slow and the symptoms vary widely from patient to patient in terms of severity. For patients with symptoms associated with pulmonary fibrosis, symptoms include dry cough, shortness of breath, and reduced exercise capacity. Approximately 16% of patients with some degree of pulmonary fibrosis develop into severe pulmonary fibrosis. Patients with severe pulmonary fibrosis experience a significant reduction in pulmonary function and alveolar inflammation.

In certain embodiments, the methods of the invention are used to treat pulmonary fibrosis associated with scleroderma, e.g., scleroderma. Administration of a MASP-2 inhibitor, such as a MASP-2 inhibitory antibody, may be used to reduce fibrosis symptoms of scleroderma in the lung. For example, the method may be used to improve lung function and / or reduce the risk of death from scleroderma.

Kidney involvement is also common in scleroderma patients. Renal fibrosis associated with scleroderma is an example of renal fibrosis that can be treated by administration of a MASP-2 inhibitor, such as a MASP-2 inhibiting antibody. In certain embodiments, the disclosure is used to treat scleroderma, e.g., renal fibrosis associated with scleroderma. In one embodiment, administration of a MASP-2 inhibitory antibody can be used to reduce fibrosis symptoms of scleroderma in the kidney. For example, the method can be used to improve renal function, reduce the protein in the urine, reduce hypertension, and / or reduce the risk of a kidney crisis that can cause fatal kidney failure.

Systemic lupus erythematosus (SLE) is a chronic, inflammatory autoimmune disorder characterized by spontaneous B and T cell auto-reaction and multi-organ immunity damage and can affect skin, joints, kidneys, and other organs. Nearly everyone with SLE has joint pain and most of them develop arthritis. Frequently affected joints are fingers, hands, wrists, and knees. Common symptoms of SLE include fatigue; General discomfort, nervousness or sickness (anxiety); Joint pain and swelling; Muscle pain; Nausea and vomiting; And skin rash. In addition, symptoms also include abdominal pain; hematuria; A finger under pressure or color change at low temperature; Loose and tingling; And red spots on the skin. In some patients, SLE includes lung or kidney. Without being bound by theory, inflammation and / or fibrosis in the lungs and kidneys can damage the organs and cause symptoms associated with lung and / or kidney damage. In some cases, patients with SLE show a special kidney condition called lupus nephritis. In certain embodiments, the disclosure provides a method of treating an SLE comprising administering an effective amount of a MASP-2 inhibitor, such as an anti-MASP-2 antibody. Administration of a MASP-2 inhibitory antibody can be used to reduce one or more symptoms of SLE. In certain embodiments, administration of an anti-MAST-2 antibody is used to treat SLE in patients with lupus nephritis. In such cases, treating SLE involves treating lupus nephritis, e.g., by reducing the symptoms of lupus nephritis. In certain embodiments, treating includes treating skin conditions of SLE. In certain embodiments, treating comprises reducing one or more symptoms of lupus nephritis. In certain embodiments, treating includes reducing, delaying, or eliminating the need for dialysis. In certain embodiments, treating includes reducing, delaying, or eliminating the need for kidney transplantation. In certain embodiments, the treatment includes delaying or preventing the progression of renal failure or end-stage renal disease of lupus nephritis.

Lupus nephritis is a kidney inflammation and a serious complication of systemic lupus erythematosus (SLE). In the kidney, lupus nephritis may lead to loss of function. Patients with lupus nephritis may ultimately present with renal failure and may require dialysis or kidney transplantation. Related complications that may also be treated using the disclosed methods include interstitial nephritis and nephrotic syndrome. Symptoms of lupus nephritis include hematuria, urinary bubbles, hypertension, proteinuria, fluid retention, and edema. Other symptoms include signs and symptoms of renal fibrosis and / or renal failure. If left untreated, lupus nephritis can lead to kidney failure, and even end-stage renal disease.

Thus, in certain embodiments, the disclosure provides a method of treating a patient suffering from an autoimmune disorder that induces or aggravates fibrosis and / or inflammation, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibitory antibody, Inhibiting, and / or reducing fibrosis and / or inflammation in a subject. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical application of the composition in a subject. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, or for oral administration for potentially non-peptide agonists ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for an underlying autoimmune disease.

In some embodiments, autoimmune diseases that cause or exacerbate fibrosis and / or inflammation are selected from the group consisting of scleroderma and systemic lupus erythematosus (SLE).

CNS disorders and conditions:

In certain embodiments, the disclosure provides a method of treating a disease or disorder of the central nervous system caused or exacerbated by fibrosis and / or inflammation, comprising the step of administering to a subject in need thereof a MASP-2 inhibitor, such as an anti-MASP- Methods of preventing, treating, reversing, inhibiting and / or reducing fibrosis and / or inflammation in a subject suffering from a disorder. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical application of the composition in a subject. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, or for oral administration for potentially non-peptide agonists ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for the underlying central nervous system disease or disorder.

In some embodiments, the diseases or disorders of the central nervous system caused or exacerbated by fibrosis and / or inflammation are selected from the group consisting of stroke, traumatic brain injury, and spinal cord injury.

Skin diseases and conditions

In certain embodiments, the disclosure is directed to a method of treating a subject suffering from fibrosis and / or inflammation-induced or exacerbated skin disease or disorder, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibiting antibody, Treating, restoring, inhibiting and / or reducing fibrosis and / or inflammation in a subject in need thereof. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibiting composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, for example, by topical application of the composition to the skin, or by topical application or topical infusion in a clinic have. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasally, subcutaneously or by other parenteral administration, by topical administration, or by potentially non- ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for underlying skin disease or disorder.

In some embodiments, the skin disease or disorder caused or exacerbated by fibrosis and / or inflammation is selected from the group consisting of dermal fibrosis, wound healing, scleroderma, systemic sclerosis, keloid, connective tissue disease, scarring and hypertrophic scarring .

Musculoskeletal and soft tissue disorders and conditions

In certain embodiments, the disclosure provides a method of treating a bone or soft tissue disorder or disorder caused by or caused by fibrosis and / or inflammation, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibitory antibody, And / or reducing fibrosis and / or inflammation in a subject suffering from fibrosis and / or inflammation. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibitory composition may be administered topically to the fibrogenic area, for example, by catheter, directly or remotely, e.g., by topical application to the bone or soft tissue structure of the composition, ≪ / RTI > Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasally, subcutaneously or by other parenteral administration, by topical administration, or by potentially non- ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities suitable for a basal bone or soft tissue disorder or disorder.

In some embodiments, bone or soft tissue disorders or disorders caused or exacerbated by fibrosis and / or inflammation include, for example, osteoporosis and / or osteomalacia associated with cystic fibrosis, increased bone marrow formation, , Dupyitorin construction, myelofibrosis.

Joint disease and condition

In certain embodiments, the disclosure is directed to a method of treating a patient suffering from fibrosis and / or inflammation-induced or worsened joint disease or disorder, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibiting antibody, Treating, restoring, inhibiting and / or reducing fibrosis and / or inflammation in a subject in need thereof. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application to the joints of the composition or by topical application or topical injection in a clinic have. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasally, subcutaneously or by other parenteral administration, by topical administration, or by potentially non- ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for underlying arthropathy or disorder.

In some embodiments, the joint disease or disorder caused or exacerbated by fibrosis and / or inflammation is joint fibrosis.

Digestive diseases and conditions

In certain embodiments, the disclosure is directed to a method of treating a patient suffering from fibrosis and / or inflammation-induced or exacerbated peptic disease or disorder, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibitory antibody, Treating, restoring, inhibiting and / or reducing fibrosis and / or inflammation in a subject in need thereof. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical injection in a clinic. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasally, subcutaneously or by other parenteral administration, by topical administration, or by potentially non- ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e.g., a MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities suitable for a basal peptic disease or disorder.

In some embodiments, the peptic disease or disorder caused or exacerbated by fibrosis and / or inflammation is selected from the group consisting of Crohn's disease, ulcerative colitis, and pancreatic fibrosis.

Eye diseases and conditions

In certain embodiments, the disclosure is directed to a method of treating a subject suffering from fibrosis and / or inflammation caused or aggravated ophthalmic disease or disorder, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibiting antibody, Treating, restoring, inhibiting and / or reducing fibrosis and / or inflammation in a subject in need thereof. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical injection in a clinic. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by topical administration to the eye (e.g., as an eye drop), by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, Or by oral administration for potentially non-peptide agonists. Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for the underlying ocular disease or disorder.

In some embodiments, ophthalmic diseases or disorders caused or exacerbated by fibrosis and / or inflammation are selected from the group consisting of anterior capsular cataract, lens posterior capsular opacity, macular degeneration, and retinas and vitreoretinopathy.

Diseases and conditions of reproductive organs

In certain embodiments, the disclosure is directed to a method of treating a subject suffering from fibrosis and / or inflammation-induced or exacerbated genital disease or disorder, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibitory antibody, Treating, restoring, inhibiting and / or reducing fibrosis and / or inflammation in a subject in need thereof. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical injection in a clinic. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasally, subcutaneously or by other parenteral administration, by topical administration, or by potentially non- ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for the underlying genital disease or disorder.

In some embodiments, the genital disease or disorder caused or exacerbated by fibrosis and / or inflammation is selected from the group consisting of endometriosis and peyronie's disease.

Trauma-related scar

In certain embodiments, the disclosure provides a method of treating a patient suffering from fibrosis and / or inflammation-induced or exacerbated trauma-related scarring, comprising administering a MASP-2 inhibitor, such as a MASP-2 inhibiting antibody, A method for preventing, treating, reversing, inhibiting and / or reducing fibrosis and / or inflammation in a subject suffering from a disease or disorder. The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical injection in a clinic. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by intravenous, intravenous, intramuscular, inhalation, nasally, subcutaneously or by other parenteral administration, by topical administration, or by potentially non- ≪ / RTI > Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for the underlying disease or disorder.

In some embodiments, the trauma-related scars include surgical complications (such as scar tissue can be formed between internal organs, which may cause constriction, pain and surgical adhesions that can lead to infertility), chemotherapy drug-induced fibrosis, Induced scarring associated with fibrosis and burns.

Further diseases and disorders caused or exacerbated by fibrosis and / or inflammation

In certain embodiments, the disclosure provides a method of treating a patient suffering from a condition selected from the group consisting of organ transplantation, mammary fibrosis, muscle fibrosis, peritoneal fibrosis, thyroid fibrosis, lymphoid fibrosis Inhibiting and / or reducing fibrosis and / or inflammation in a subject suffering from fibrosis and / or inflammation-induced or exacerbated disease or disorder selected from the group consisting of bladder fibrosis and pleuropneumonia. ≪ / RTI > The method comprises administering a composition comprising an amount of a MASP-2 inhibitor effective to inhibit fibrosis and / or inflammation.

The MASP-2 inhibitory composition can be administered topically to the fibrosis area, e.g., by catheter, directly or remotely, e.g., by topical application or topical injection in a clinic. Alternatively, the MASP-2 inhibitor may be administered to a subject systemically, for example, by topical administration to the eye (e.g., as an eye drop), by intravenous, intravenous, intramuscular, inhalation, nasal, subcutaneous or other parenteral administration, Or by oral administration for potentially non-peptide agonists. Administration can be repeated until the condition is resolved or controlled as determined by the physician.

In certain embodiments, a MASP-2 inhibitor (e. G., A MASP-2 inhibitory antibody) is administered in combination with one or more agonists or therapeutic modalities appropriate for the underlying disease or disorder.

In certain embodiments of any of the various methods and pharmaceutical compositions described herein, the MASP-2 inhibitory antibody selectively blocks the lectin pathway while leaving the classical pathway intact.

IV. MASP-2 inhibitor

In various aspects, the invention provides a method of inhibiting the side effects of fibrosis and / or inflammation comprising administering a MASP-2 inhibitor to a subject in need thereof. The MASP-2 inhibitor is administered in an amount effective to inhibit MASP-2-dependent complement activation in a living subject. In practicing this aspect of the invention, representative MASP-2 inhibitors include molecules that inhibit the biological activity of MASP-2 (e.g., a small molecule inhibitor, an anti-MASP-2 antibody (such as a MASP- 2 antisense nucleic acid molecule, MASP-2 specific RNAi molecule, and MASP-2 ribozyme) that reduce the expression of MASP-2 (e.g., a blocking peptide that interacts with the MASP-2 or interferes with protein- ), Thereby preventing MASP-2 from activating the lectin complement pathway. MASP-2 inhibitors may be used alone or in combination with other therapeutic agents as primary therapies to enhance the therapeutic benefit of other medical treatments.

The inhibition of MASP-2-dependent complement activation is characterized by at least one of the following changes in the components of the complement system that occur as a result of administration of a MASP-2 inhibitor according to the methods of the invention: MASP-2-dependent complement activation (E. G., As described in Example 2), inhibition of C4 cleavage and C4b deposition (e. G., As described in Example 2), inhibition of the production or production of system products C4b, C3a, C5a and / or C5b- , Measured as described in Example 2), or a decrease in C3 cleavage and C3b deposition (as measured, for example, as described in Example 2).

According to the present invention, MASP-2 inhibitors are effective in inhibiting fibrosis and / or inflammation, exhibit detectable anti-fibrosis activity and / or induce a decrease in fibrosis. Within the context of the invention, anti-fibrosis activity may include at least one of the following: (1) activating and supplementing, for example, macrophages and endothelial cells; Supplementation and activation of lymphocytes and / or eosinophils through the secretion of many cytokines / chemokines; Reduction in inflammation as assessed by the release of cytotoxic mediators and fibrogenic cytokines; (2) reduced collagen deposition compared to fibrosis activity in the absence of a cell proliferation, ECM synthesis or angiogenesis, and / or (3) inhibition of MASP-2.

The evaluation of anti-fibrotic agents, such as MASP-2 inhibitors, can be detected using any technique known to the skilled artisan. For example, evaluation of anti-fibrotic agents can be evaluated in the UUO model (described in Examples 12 and 14 herein). If a detectable anti-fibrosis activity and / or a reduction or reduction in fibrosis is assessed using a MASP-2 inhibitor, such a MASP-2 inhibitor may be used as a drug to prevent, treat, restore and / or inhibit fibrosis .

Assessment of fibrosis may be performed periodically, e.g., in each week, or each month. The increase / decrease of fibrosis and / or the presence of anti-fibrosis activity can therefore be evaluated periodically, for example in each week or in each month. Such an assessment is preferably performed at a plurality of points for a given subject or at one or more points for a given subject and a healthy control. The evaluation can be performed at regular time intervals, e.g., in each week, or each month. The evaluation can therefore be evaluated regularly, e.g. in each week, or in each month. MASP-2 inhibitors, such as MASP-2 inhibitory antibodies, exhibit detectable anti-fibrosis activity and / or induce a reduction or reduction of fibrosis when the single assessment has led to the discovery of a decrease in fibrosis or the presence of anti-fibrosis activity It can be said that.

MASP-2 inhibitors useful in the practice of this aspect of the invention include, for example, MASP-2 antibodies and fragments thereof, MASP-2 inhibitory peptides, small molecules, MASP-2 soluble receptors and expression inhibitors. MASP-2 inhibitors may inhibit the MASP-2-dependent complement activation system by blocking the biological function of MASP-2. For example, inhibitors can effectively block MASP-2 protein-to-protein interactions, interfere with MASP-2 dimerization or assembly, block Ca ²⁺ binding, interfere with the MASP-2 serine protease active site , Or MASP-2 protein expression.

In some embodiments, the MASP-2 inhibitor selectively inhibits MASP-2 complement activation, leaving a C1q-dependent complement activation system functionally intact.

In one embodiment, the MASP-2 inhibitor useful in the methods of the invention is a specific MASP-2 inhibitor that specifically binds to a polypeptide comprising SEQ ID NO: 6 with an affinity that is at least 10 times higher than the other antigen of the complement system to be. In another embodiment, the MASP-2 inhibitor specifically binds to a polypeptide comprising SEQ ID NO: 6 with a binding affinity that is at least 100 times greater than other antigens of the complement system. In one embodiment, the MASP-2 inhibitor is selected from the group consisting of: (i) a CCP1-CCP2 domain (aa 300-431 of SEQ ID NO: 6) or a serine protease domain of MASP-2 (aa 445-682 of SEQ ID NO: 6) Specific binding to at least one and inhibits MASP-2-dependent complement activation. In one embodiment, the MASP-2 inhibitor is a MASP-2 monoclonal antibody, or a fragment thereof that specifically binds to MASP-2. The binding affinity of a MASP-2 inhibitor can be measured using a suitable binding assay.

MASP-2 polypeptides exhibit molecular structures similar to the C1 complement system proteases MASP-1, MASP-3, and C1r and C1s. The cDNA molecule shown in SEQ ID NO: 4 encodes a representative example of MASP-2 (consisting of the amino acid sequence set forth in SEQ ID NO: 5) and a human MASP-2 with leader sequence (aa 1-15) And produces a mature form of human MASP-2 (SEQ ID NO: 6). As shown in Figure 2, the human MASP2 gene comprises 12 exons. The human MASP-2 cDNA is encoded by exons B, C, D, F, G, H, I, J, An alternative splice is referred to as MBL-related protein 19 (also referred to as "MAp19", "sMAP") (SEQ ID NO: 2) as shown in FIG. 2, (SEQ ID NO: < RTI ID = 0.0 > 1). ≪ / RTI > The cDNA molecule presented in SEQ ID NO: 50 provides murine and MASP-2 polypeptides with leader sequences that encode murine and MASP-2 (consisting of the amino acid sequence set forth in SEQ ID NO: 51) and are truncated after secretion, Of mouse and MASP-2 (SEQ ID NO: 52). The cDNA molecule presented in SEQ ID NO: 53 encodes rat MASP-2 (consisting of the amino acid sequence set forth in SEQ ID NO: 54) and provides a rat MASP-2 polypeptide with leader sequence cleaved after secretion, 0.0 > MASP-2 < / RTI > (SEQ ID NO: 55).

Those skilled in the art will recognize that the sequences set forth in SEQ ID NO: 4, SEQ ID NO: 50 and SEQ ID NO: 53 represent a single allele of human, murine and rat MASP-2, respectively, and allelic variations and alternative splicing Will be expected to occur. Allelic variants of the nucleotide sequence shown in SEQ ID NO: 4, SEQ ID NO: 50 and SEQ ID NO: 53, including those involving silent mutations and mutations leading to amino acid sequence changes, . Allelic variants of the MASP-2 sequence can be cloned by probing cDNA or genomic libraries of different individuals according to standard procedures.

The domain of the human MASP-2 protein (SEQ ID NO: 6) is shown in Figures 1 and 2A and comprises the N-terminal Clr / Cls / urchin Vegf / 121), epidermal growth factor-like domain (aa 122-166), a second CUBI domain (aa 167-293) as well as a tandem of the complement control protein domain and the serine protease domain. Alternative splicing of the MASP 2 gene results in the MAp19 shown in FIG. MAp19 is a non-enzymatic protein comprising the N-terminal CUBI-EGF region of MASP-2 with four additional residues (EQSL) derived from exon E as shown in Fig.

Several proteins have been shown to interact with MASP-2, or through protein-to-protein interactions. For example, MASP-2 is known to bind to the lectin proteins MBL, H-picoline and L-picoline and to form Ca ²⁺ -dependent complexes with them. Each MASP-2 / lectin complex has been shown to activate complement through MASP-2-dependent cleavage of proteins C4 and C2 (Ikeda, K., et al., J. Biol. Chem . 262 : 7451-7454, 1987; Matsushita, M., et al , J. Exp Med 176:... 1497-2284, 2000; Matsushita, M., et al, J. Immunol 168:.. 3502-3506, 2002). Studies have shown that the CUBI-EGF domain of MASP-2 is essential for the association of MASP-2 and MBL (Thielens, NM, et al., J. Immunol. 166 : 5068, 2001). Also, the CUBIEGFCUBII domain mediates the dimerization of MASP-2, which is required for the formation of an active MBL complex (Wallis, R., et al., J. Biol. Chem. 275 : 30962-30969, 2000). Thus, a MASP-2 inhibitor that binds to or interferes with a MASP-2 target region that is known to be important for MASP-2-dependent complement activation can be identified.

Anti-MASP-2 antibody

In some embodiments of this aspect of the invention, the MASP-2 inhibitor comprises an anti-MASP-2 antibody that inhibits the MASP-2-dependent complement activation system. Anti-MASP-2 antibodies useful in this aspect of the invention include polyclonal, monoclonal, or recombinant antibodies derived from any antibody-producing mammal, and include multispecific, chimeric, humanized, anti-idiotypic, And antibody fragments. Antibody fragments include Fab, Fab ', F (ab) ₂ , F (ab') ₂ , Fv fragments, scFv fragments and single chain antibodies as further described herein.

MASP-2 antibodies may be used for the ability to inhibit the MASP-2-dependent complement activation system using the assays described herein and for the ability to inhibit renal damage associated with anti-fibrosis activity and / or proteinuria or adriamycin-induced nephropathy Lt; / RTI > Several MASP-2 antibodies have been described in the literature and some are newly generated, some of which are listed in Table 1 below. For example, anti-MASP-2 Fab2 antibodies that block MASP-2 dependent complement activation have been identified, as described in Examples 10 and 11 herein. As described in Example 12, and as described in WO2012 / 151481, which is also incorporated herein by reference, a whole human MASP-2 scFv antibody that blocks MASP-2-dependent complement activation (e.g., OMS646) has been identified . As described in Example 13, and as described in WO2014 / 144542, which is incorporated herein by reference, the SGMI-2 peptide-containing MASP-2 antibody and its fragments having MASP- Was generated by fusing the peptide amino acid sequence (SEQ ID NO: 72, 73 or 74) to the amino or carboxy terminus of the heavy and / or light chain of a human MASP-2 antibody (e.g., OMS646-SGMI-2).

Thus, in one embodiment, the MASP-2 inhibitor for use in the methods of the invention comprises a human antibody, such as OMS646. Thus, in one embodiment, the MASP-2 inhibitor for use in the compositions and methods of the claimed invention comprises a human antibody that binds to a polypeptide consisting of human MASP-2 (SEQ ID NO: 6) (I) (a) a heavy chain CDR-H1 comprising the amino acid sequence of amino acids 31 to 35 of SEQ ID NO: 67; ii) heavy chain CDR-H2 comprising the amino acid sequence from 50 to 65 of SEQ ID NO: 67; And iii) a heavy chain variable region comprising a heavy chain CDR-H3 comprising an amino acid sequence from 95 to 107 of SEQ ID NO: 67; (b) i) a light chain CDR-L1 comprising the amino acid sequence from 24 to 34 of SEQ ID NO: 70; ii) light chain CDR-L2 comprising the amino acid sequence from 50 to 65 of SEQ ID NO: 70; And iii) a light chain variable region comprising a light chain CDR-L3 comprising the amino acid sequence of 89-97 of SEQ ID NO: 70, or (ii) a light chain variable region comprising at least 90% identity to SEQ ID NO: A heavy chain variable region having at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98% At least 90%, at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98%, at least 99% ≪ / RTI > identity) of the heavy chain variable region.

In some embodiments, the method comprises the step of generating a MASP-2 inhibiting antibody comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67 and a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70, Comprising the step of administering to the subject a composition comprising an amount of an antigen-binding fragment.

In some embodiments, the method comprises comparing the amino acid sequence of a human recognized by reference antibody OMS646, comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67 and a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: Comprising administering to the subject a composition comprising an amount of a MASP-2 inhibiting antibody, or antigen-binding fragment thereof, that specifically recognizes at least a portion of an epitope on MASP-2. In one embodiment, the MASP-2 inhibitor for use in the methods of the invention comprises the human antibody OMS646.

Exemplary MASP-2 specific antibodies antigen Antibody type references Recombinant MASP-2 Rat Dakclon Castle Peterson, SV, et al., Mol. Immunol. 37: 803-811, 2000 Recombinant human CCP1 / 2-SP fragment (MoAb 8B5) Rat MoAb
(Subclass IgG1) Moller-Kristensen, M., et al., J. of Immunol. Methods 282: 159-167, 2003 Recombinant human MAp19 (MoAb 6G12) (cross-reacts with MASP-2) Rat MoAb
(Subclass IgG1) Moller-Kristensen, M., et al., J. of Immunol. Methods 282: 159-167, 2003 hMASP-2 Mouse MoAb (S / P)
Mouse MoAb (N-terminal) Peterson, SV, et al., Mol. Immunol . 35: 409, April 1998 hMASP-2 (CCP1-CCP2-SP domain Rat MoAb: generated by Nimoab101, hybridoma cell line 03050904 (ECACC) WO 2004/106384 hMASP-2 (full length -his tagged) Rat MoAb:
NimoAb104 produced by the hybridoma cell line M0545YM035 (DSMZ)

NimoAb108 produced by the hybridoma cell line M0545YM029 (DSMZ)

NimoAb109 produced by the hybridoma cell line M0545YM046 (DSMZ)

NimoAb110 produced by the hybridoma cell line M0545YM048 (DSMZ) WO 2004/106384 Rat MASP-2 (full length) MASP-2 Fab2 antibody fragment Example 10 hMASP-2 (full length) Whole human scFv clone Example 12 and WO2012 / 151481 hMASP-2 (full length) MASP-2 antibody with SGMI-2 peptide Example 13 and WO2014 / 144542

Anti-MASP-2 antibody with reduced effector function

In some embodiments of this aspect of the invention, the anti-MASP-2 antibody has a reduced effector function to reduce inflammation that may arise from activation of the classical complement pathway. The ability of IgG molecules to trigger the classical complement pathway appears to be present in the Fc portion of the molecule (Duncan, AR, et al., Nature 332 : 738-740 1988). IgG molecules in which the Fc portion of the molecule is removed by enzymatic cleavage do not have this effector function (see Harlow, Antibodies: A Laboratory Manual , Cold Spring Harbor Laboratory, New York, 1988). Thus, antibodies with reduced effector function can be generated as a result of the lack of the Fc portion of the molecule by minimizing the effector function or by having a genetically engineered Fc sequence, either human IgG ₂ or IgG ₄ isotype.

Antibodies with reduced effector function can be generated by standard molecular biological manipulations of the Fc portion of the IgG heavy chain as described herein, and are further described in Jolliffe et al., Int'l Rev. Immunol. 10 : 241-250, 1993, and Rodrigues et al., J. Immunol. 151 : 6954-6961, 1998. Antibodies with reduced effector function also include human IgG2 and IgG4 isotypes that have reduced ability to activate complement and / or interact with Fc receptors (Ravetch, JV, et al., Annu. Rev. Immunol. 9 : 457-492, 1991; Isaacs, JD, et al., J. Immunol. 148 : 3062-3071, 1992; van de Winkel, JG, et al., Immunol. Today 14 : 215-221, 1993). Humanized or fully human antibodies specific for human MASP-2 consisting of IgG2 or IgG4 isotype can be generated by one of several methods known to those skilled in the art and described in Vaughan, TJ, et al., Nature Biotechnical 16 : 535- 539, 1998.

Production of anti-MASP-2 antibody

An anti-MAST-2 antibody may be produced using a MASP-2 polypeptide (e.g., full length MASP-2) or using an antigenic MASP-2 epitope-containing peptide (e.g., a portion of a MASP-2 polypeptide) . The immunogenic peptides can be as small as five amino acid residues. For example, a MASP-2 polypeptide comprising the entire amino acid sequence of SEQ ID NO: 6 may be used to derive an anti-MASP-2 antibody useful in the methods of the invention. Specific MASP-2 domains known to be involved in protein-protein interactions, such as the CUBI and CUBIEGF domains, as well as the region comprising the serine-protease active site, are expressed as recombinant polypeptides as described in Example 3 And may be used as an antigen. In addition, peptides comprising a portion of at least six amino acids of the MASP-2 polypeptide (SEQ ID NO: 6) are also useful for inducing MASP-2 antibodies. Additional examples of MASP-2 derived antigens useful for inducing MASP-2 antibodies are provided in Table 2 below. MASP-2 peptides and polypeptides used to generate antibodies can be isolated as natural polypeptides, or recombinant or synthetic peptides, and catalytic inactive recombinant polypeptides, such as MASP-2A, as further described herein. In some embodiments of this aspect of the invention, the anti-MASP-2 antibody is obtained using the transgenic mouse strain as described herein.

Antigens useful for generating anti-MASP-2 antibodies also include fusion polypeptides such as MASP-2 or a portion thereof and immunoglobulin polypeptide or fusions of maltose-binding protein. Polypeptide immunogens can be full-length molecules or a portion thereof. If some of the polypeptides are hapten-like, this part advantageously provides a polymeric carrier (e.g., keyhole limpet hemocyanin (KLH), bovine serum albumin (BSA) or tetanus toxoid) As shown in FIG.

MASP-2-derived antigen SEQ ID NO: Amino acid sequence SEQ ID NO: 6 Human MASP-2 protein SEQ ID NO: 51 Mouse and MASP-2 protein SEQ ID NO: 8 CUBI domain of human MASP-2
(Aa 1-121 of SEQ ID NO: 6) SEQ ID NO: 9 The CUBIEGF domain of human MASP-2
(Aa 1-166 of SEQ ID NO: 6) SEQ ID NO: 10 The CUBIEGFCUBII domain of human MASP-2
(Aa 1-293 of SEQ ID NO: 6) SEQ ID NO: 11 EGF domain of human MASP-2
(Aa 122-166 of SEQ ID NO: 6) SEQ ID NO: 12 The serine-protease domain of human MASP-2
(Aa 429-671 of SEQ ID NO: 6) SEQ ID NO: 13
GKDSCRGDAGGALVFL Serine-protease-inactivated mutant forms
(Aa 610-625 of SEQ ID NO: 6 with mutated Ser 618) SEQ ID NO: 14
TPLGPKWPEPVFGRL Human CUBI peptide SEQ ID NO: 15: TAPPGYRLRLYFTHFDLELSHLCEYDFVKLSSGAKVLATLCGQ Human CUBI peptide SEQ ID NO: 16:
TFRSDYSN The MBL binding region of the human CUBI domain SEQ ID NO: 17:
FYSLGSSLDITFRSDYSNEKPFTGF The MBL binding region of the human CUBI domain SEQ ID NO: 18
IDECQVAPG EGF peptide SEQ ID NO: 19
ANMLCAGLESGGKDSCRGDSGGALV Peptides from serine-protease active sites

Polyclonal antibody

Polyclonal antibodies to MASP-2 can be prepared by immunizing an animal with a MASP-2 polypeptide or an immunogenic portion thereof using methods well known to those skilled in the art. See, for example, Green et al., "Production of Polyclonal Antisera," in Immunochemical Protocols (Manson, ed.), The immunogenicity of MASP-2 polypeptides can be assessed by the use of mineral gels such as, for example, aluminum hydroxide or Freund's adjuvant (complete or incomplete), surface active substances such as lysolecithin, pluronic polyols, Can be increased through the use of adjuvants including keyhole limpet hemocyanin and dinitrophenol. Polyclonal antibodies are typically raised in animals such as horses, cows, dogs, chickens, rats, mice, rabbits, guinea pigs, goats, or sheep. Alternatively, anti-MASP-2 antibodies useful in the present invention may also be derived from sub-human primates. General techniques for generating genetically and therapeutically useful antibodies in baboons are described, for example, in Goldenberg et al., International Patent Application Publication No. WO 91/11465, and Losman, MJ, et al., Int. J. Cancer 46 : 310, 1990. Serum containing the immunologically active antibody is then generated from the blood of the thus immunized animal using standard procedures known in the art.

Monoclonal antibody

In some embodiments, the MASP-2 inhibitor is an anti-MASP-2 monoclonal antibody. Anti-MASP-2 monoclonal antibodies are highly specific and are directed against a single MASP-2 epitope. As used herein, the modifier "monoclonal" refers to the characteristic of an antibody as being obtained from a substantially homogeneous cohort of antibodies and should not be construed as requiring the production of antibodies by any particular method. Monoclonal antibodies may be obtained using any technique that provides for the production of antibody molecules by an infinite proliferating cell line in culture, such as the hybridoma method described by Kohler, G., et al., Nature 256 : 495, 1975 Or can be prepared by recombinant DNA methods (see, for example, U.S. Patent No. 4,816,567 to Cabilly). Monoclonal antibodies are also described in Clackson, T., et al., Nature 352 : 624-628, 1991, and Marks, JD, et al., J. Mol. Biol. 222 : 581-597, 1991. < / RTI > Such an antibody may be of any immunoglobulin class, including IgG, IgM, IgE, IgA, IgD, and any subclass thereof.

For example, a monoclonal antibody can be obtained by injecting a composition comprising a MASP-2 polypeptide or a portion thereof into a suitable mammal (e.g., BALB / c mouse). After the predetermined period of time, spleen cells are removed from the mice and suspended in the cell culture medium. The spleen cells then fuse with immortal cell lines to form hybridomas. The hybridomas formed are screened for their ability to grow in cell culture and produce monoclonal antibodies to MASP-2. Examples that further describe the generation of anti-MAST-2 monoclonal antibodies are provided herein (see also Current Protocols in Immunology , Vol. 1, John Wiley & Sons, pages 2.5.1-2.6.7, 1991 ).

Human monoclonal antibodies can be obtained through the use of transgenic mice engineered to produce specific human antibodies in response to antigenic challenge. In this technique, elements of the human immunoglobulin heavy chain and light chain locus are introduced into mouse strains derived from embryonic stem cell lines that contain targeted destruction of endogenous immunoglobulin heavy and light chain loci. Transgenic mice can synthesize human antibodies, such as human antibodies specific for the MASP-2 antigens described herein, and mice can be generated using such conventional Kohler-Milstein techniques as described herein. Can be used to generate human MASP-2 antibody-secreted hybridomas by fusing B-cells from animals to suitable myeloma cell lines. Transgenic mice bearing the human immunoglobulin genome are commercially available (see, for example, Abgenix, Inc. of Pemberton, California and Medarex, Inc. of Annandale, NJ). Methods for obtaining human antibodies from transgenic mice are described, for example, in Green, LL, et al., Nature Genet. 7 : 13,1994; Lonberg, N., et al., Nature 368 : 856, 1994; And Taylor, LD, et al., Int. Immun. 6 : 579, 1994.

Monoclonal antibodies can be isolated and purified from hybridoma cultures by a variety of well-established techniques. Such separation techniques include affinity chromatography with protein-A sepharose, size-exclusion chromatography, and ion-exchange chromatography (see, e.g., Coligan at pages 2.7.1-2.7.12 and pages 2.9. See, for example, Baines et al., "Purification of Immunoglobulin G (IgG)", in Methods in Molecular Biology , The Humana Press, Inc., Vol. 10, pages 79-104, 1992).

Once generated, polyclonal, monoclonal or phage-derived antibodies are first tested for specific MASP-2 binding. A variety of assays known to those skilled in the art can be utilized to detect antibodies that specifically bind to MASP-2. Exemplary assays include, but are not limited to, Western blotting or immunoprecipitation assays (as described in Ausubel et al.), Immunoelectrophoresis, enzyme-linked immuno-adsorption assays, dot blot, inhibition or competition assays and sandwich assays Harlow and Land, Antibodies: A Laboratory Manual , Cold Spring Harbor Laboratory Press, 1988). When an antibody specifically binding to MASP-2 is identified, the anti-MASP-2 antibody can be assayed using several assays, such as the lectin-specific C4 cleavage assay (described in Example 2) (Described in Example 2) or C4b deposition assay (described in Example 2).

The affinity of an anti-MAST-2 monoclonal antibody can be readily determined by those skilled in the art (see, e.g., Scatchard, A., NY Acad. Sci. 51 : 660-672, 1949). In one embodiment, an anti-MAST-2 monoclonal antibody useful in the methods of the invention binds MASP-2 with a binding affinity of <100 nM, preferably <10 nM and most preferably <2 nM.

Chimeric / humanized antibody

Monoclonal antibodies useful in the methods of the invention are those in which a portion of the heavy and / or light chain is derived from a particular species or is identical or identical to the corresponding sequence of an antibody belonging to a particular antibody class or subclass, , As well as chimeric antibodies that are the same as or homologous to fragments of such antibodies (Cabilly, U. S. Patent Nos. 4,816, 567; and Morrison &lt; (R) &gt; , SL, et al., Proc Natl Acad Sci USA 81 : 6851-6855, 1984).

One form of chimeric antibody useful in the invention is a humanized monoclonal anti-MAST-2 antibody. A humanized form of a non-human (e.g., murine) antibody is a chimeric antibody, which includes a minimal sequence derived from a non-human immunoglobulin. Humanized monoclonal antibodies are produced by transferring non-human (e.g., murine) complementarity determining regions (CDRs) from the heavy and light chain variable chains of mouse immunoglobulins to human variable domains. Typically, the residue of a human antibody is then substituted in the framework region of the non-human counterpart. Further, the humanized antibody may comprise moieties that are not found in the recipient antibody or donor antibody. These modifications are made to further improve antibody performance. In general, a humanized antibody will comprise substantially all, at least one, and typically two variable domains, wherein all or substantially all hypervariable loops correspond to those of a non-human immunoglobulin and are all or substantially All Fv framework regions are of the human immunoglobulin sequence. The humanized antibody will also optionally include at least a portion of an immunoglobulin constant region (Fc), typically that of a human immunoglobulin. For a more detailed description, see Jones, PT, et al., Nature 321 : 522-525, 1986; Reichmann, L., et al., Nature 332 : 323-329, 1988; And Presta, Curr. Op. Struct. Biol. 2 : 593-596, 1992.

Humanized antibodies useful in the invention include human monoclonal antibodies comprising at least a MASP-2 binding CDRH3 region. In addition, the Fc portion can be substituted to produce IgA or IgM, as well as human IgG antibodies. Such humanized antibodies will have particular clinical utility because they specifically recognize human MASP-2 but do not elicit an immune response against the antibody itself in humans. As a result, they are more suitable for in vivo administration in humans, especially when repeated or long-term administration is needed.

An example of the production of a humanized anti-MAST-2 antibody from murine anti-MASP-2 monoclonal antibody is provided herein in Example 6. Techniques for generating humanized monoclonal antibodies are also described, for example, in Jones, PT, et al., Nature 321 : 522, 1986; Carter, P., et al., Proc. Nat'l. Acad. Sci. USA 89 : 4285, 1992; Sandhu, JS, Crit. Rev. Biotech. 12 : 437,1992; Singer, II, et al., J. Immun. 150 : 2844,1993; Sudhir (ed.), Antibody Engineering Protocols, Humana Press, Inc., 1995; Kelley, "Engineering Therapeutic Antibodies, " in Protein Engineering: Principles and Practice , Cleland et al. (eds.), John Wiley & Sons, Inc., pages 399-434, 1996; And U.S. Patent No. 5,693,762 to Queen, 1997. In addition, there are commercial entities that synthesize humanized antibodies from specific mouse and antibody regions, such as Protein Design Labs (Mountain View, CA).

Recombinant antibody

Anti-MAST-2 antibodies can also be prepared using recombinant methods. For example, the human antibodies containing human immunoglobulin expression libraries (e.g., to produce a fragment (V _H, V _L, Fv, Fd, Fab, or F (ab ') ₂₎ of a human antibody, Stratagene, Corp., La Jolla, Calif.). &Lt; / RTI &gt; These fragments are used to construct whole human antibodies using techniques similar to those for generating chimeric antibodies.

Anti-idiotype antibody

Once anti-MAST-2 antibodies with the desired inhibitory activity are identified, these antibodies can be used to generate anti-idiotype antibodies that are similar to a portion of MASP-2 using techniques well known in the art. See, e.g., Greenspan, NS, et al., FASEB J. 7 : 437, 1993. For example, an antibody that competitively inhibits the MASP-2 protein interaction required for complement activation by binding to MASP-2 is similar to the MBL binding site on the MASP-2 protein and thus is a binding ligand for MASP-2, , Can be used to generate anti-idiotate binding to MBL and neutralize it.

Immunoglobulin fragment

MASP-2 inhibitors useful in the methods of the invention include but are not limited to intact immunoglobulin molecules as well as Fab, Fab ', F (ab) ₂ , F (ab') ₂ and Fv fragments, scFv fragments, diabodies, linear antibodies, And well known fragments including multispecific antibodies formed from antibody fragments.

It is well known in the art that only a small portion of the antibody molecule, paratope, is involved in the binding of antibodies to epitopes (see, for example, Clark, WR, The Experimental Foundations of Modern Immunology , Wiley & Sons, Reference). The pFc 'and Fc regions of the antibody are effectors of the classical complement pathway, but are not involved in antigen binding. An antibody in which the pFc 'region is enzymatically cleaved, or produced without the pFc' region is designated as the F (ab ') ₂ fragment and retains both antigen binding sites of the intact antibody. The isolated F (ab ') ₂ fragment is called a bivalent monoclonal fragment due to its two antigen binding sites. Likewise, an antibody in which the Fc region has been enzymatically cleaved, or produced without an Fc region is designated as a Fab fragment and retains one of the antigen binding sites of the intact antibody molecule.

Antibody fragments can be obtained by proteolytic hydrolysis, such as pepsin or papain digestion of whole antibodies by conventional methods. For example, antibody fragments can be generated by enzymatic cleavage of antibodies using pepsin to provide a 5S fragment denoted F (ab ') ₂ . This fragment can be further cleaved using a thiol reducing agent to generate 3.5S Fab ' 1 fragments. Optionally, the cleavage reaction can be performed using a circuit breaker for the sulfhydryl group resulting from cleavage of the disulfide bond. Alternatively, enzymatic cleavage with pepsin directly produces two monovalent Fab fragments and Fc fragments. These methods are described, for example, in Goldenberg, U. S. Patent Nos. 4,331, 647; Nisonoff, A., et al., Arch. Biochem. Biophys. 89 : 230, 1960; Porter, RR, Biochem. J. 73 : 119, 1959; Edelman, et al., In Methods in Enzymology 1 : 422, Academic Press, 1967; And Coligan on pages 2.8.1-2.8.10 and 2.10.-2.10.4.

In some embodiments, the use of antibody fragments lacking an Fc region is desirable to prevent activation of the classical complement pathway that is initiated when Fc is bound to an Fc [gamma] receptor. There are several ways to generate MoAbs that prevent Fc [gamma] receptor interactions. For example, the Fc region of a monoclonal antibody can be chemically removed using a partial digestion with a protein hydrolase (e. G., Epidermalization), thereby resulting in an antigen-binding antibody fragment, e. Or F (ab) ₂ fragments are produced (Mariani, M., et al., Mol. Immunol. 28 : 69-71, 1991). Alternatively, a human [gamma] 4 IgG isotype that does not bind to the Fc [gamma] receptor can be used in the construction of humanized antibodies as described herein. Antibodies, single chain antibodies and antigen-binding domains deficient in the Fc domain can also be engineered using the recombinant techniques described herein.

Single-chain antibody fragment

Alternatively, a single peptide chain-binding molecule specific for MASP-2 to which the heavy and light chain Fv regions are linked can be generated. Fv fragments can be linked by a peptide linker to form a single chain antigen binding protein (scFv). These single-chain antigen binding proteins are prepared by constructing structural genes comprising DNA sequences encoding V _H and V _L domains linked by oligonucleotides. The structural gene is inserted into an expression vector and then introduced into a host cell such as Escherichia coli. Recombinant host cells synthesize a single polypeptide chain with a linker peptide linking the two V domains. Methods for generating scFv are described, for example, in Whitlow, et al., "Methods: A Companion to Methods in Enzymology" 2 : 97, 1991; Bird, et al., Science 242 : 423, 1988; Ladner, U.S. Patent No. 4,946,778; Pack, P., et al., Bio / Technology 11 : 1271, 1993.

As an illustrative example, a MASP-2 specific scFv may be produced by exposing a lymphocyte to a MASP-2 polypeptide in vitro and selecting an antibody display library in a phage or similar vector (e. G., A fixed or labeled MASP- &Lt; / RTI &gt; peptide). Genes encoding polypeptides with potential MASP-2 polypeptide binding domains can be obtained by screening phage or a library of random peptides displayed on bacteria, e.g., E. coli. These randomized peptide display libraries can be used to screen for peptides that interact with MASP-2. Techniques for generating and screening such random peptide display libraries are well known in the art (Lardner, US Patent No. 5,223, 409; Ladner, US Patent No. 4,946,778; Ladner, US Patent No. 5,403,484; Ladner, US Patent No. 5,571, al., Phage Display of Peptides and Proteins Academic Press, Inc., 1996). Random peptide display libraries and kits for screening such libraries are described, for example, in CLONTECH Laboratories, Inc. (Palo Alto, Calif.), Invitrogen Inc. (San Diego, Calif.), New England Biolabs, Inc. (Ipswich, Mass.), And Pharmacia LKB Biotechnology Inc. (Piscataway, NJ).

Another form of anti-MASP-2 antibody fragment useful in this aspect of the invention is a peptide that encodes a single complementarity-determining region (CDR) that binds to an epitope on the MASP-2 antigen and inhibits MASP- to be. CDR peptides ("minimal recognition units") can be obtained by constructing genes encoding the CDRs of an antibody of interest. These genes are prepared, for example, using polymerase chain reactions to synthesize variable regions from RNA of antibody-producing cells (see, for example, Larrick et al., Methods: A Companion to Methods in Enzymology 2 : Genetic Manipulation of Monoclonal Antibodies in Monoclonal Antibodies: Production, Engineering and Clinical Application , Ritter et al. (Eds.), Page 166, Cambridge University Press, 1995, and Ward et al. , &Quot; Genetic Manipulation and Expression of Antibodies, " in Monoclonal Antibodies: Principles and Applications , Birch et al. (Eds.), Page 137, Wiley-Liss, Inc., 1995).

The MASP-2 antibodies described herein are administered to a subject in need thereof to inhibit MASP-2-dependent complement activation. In some embodiments, the MASP-2 inhibitor is an antibody having high-affinity human or humanized monoclonal anti-MASP-2 reduced effector function.

Peptide inhibitor

In some embodiments of this aspect of the invention, the MASP-2 inhibitor comprises an isolated MASP-2 peptide inhibitor that inhibits the MASP-2-dependent complement activation system, including isolated natural peptide inhibitors and synthetic peptide inhibitors . As used herein, the term "isolated MASP-2 peptide inhibitor" refers to a molecule that binds to MASP-2 and binds to another recognition molecule (eg, MBL, H-picoline, M-picoline, or L -Dependent complement activation by directly interacting with MASP-2 to compete with MASP-2 for the binding to MASP-2-dependent pancolin, and / or to inhibit MASP-2-dependent complement activation, Pure &quot; refers to peptides that are essentially free of other substances that can be found in nature in a practical and appropriate manner for their intended use.

Peptide inhibitors have been used in vivo to successfully interfere with protein-protein interactions and catalytic sites. For example, peptide inhibitors for adhesion molecules structurally related to LFA-1 have recently been approved for clinical use in clotting disorders (Ohman, EM, et al., European Heart J. 16 : 50-55, 1995). Short linear peptides (<30 amino acids) that prevent or interfere with integrin-dependent adhesion have been described (Murayama, O., et al., J. Biochem. 120 : 445-51, 1996). Longer peptides ranging in length from 25 to 200 amino acid residues have also been used to successfully block integrin-dependent adhesion (Zhang, L., et al., J. Biol. Chem. 271 (47): 29953 -57, 1996). In general, the longer peptide inhibitor has a higher affinity and / or a slower off-rate than the shorter peptide and can therefore be a more potent inhibitor. The cyclic peptide inhibitor has also been shown to be an integrin inhibitor effective in the treatment of human inflammatory diseases in vivo (Jackson, DY, et al., J. Med. Chem. 40 : 3359-68, 1997). One method of generating cyclic peptides involves the synthesis of peptides in which the terminal amino acid of the peptide is cysteine, thereby causing the peptide to be present in a cyclic form by a disulfide bond between the terminal amino acids, Have been shown to improve in vivo affinity and half-life for treatment (see, e.g., Larson, U.S. Patent No. 6,649,592).

Synthetic MASP-2 peptide inhibitor

MASP-2 inhibitory peptides useful in this aspect of the invention are exemplified by amino acid sequences that mimic target regions that are important for MASP-2 function. The inhibitory peptides useful in the practice of the methods of the invention range in size from about 5 amino acids to about 300 amino acids. Table 3 provides a list of exemplary inhibitory peptides that may be useful in the practice of this aspect of the invention. The candidate MASP-2 inhibitory peptide may be administered in combination with one or more of the MASP-2 inhibitors (e. G., A lectin-specific C4 cleavage assay (described in Example 2) and a C3b deposition assay &Lt; / RTI &gt;

In some embodiments, the MASP-2 inhibitory peptide is derived from a MASP-2 polypeptide and comprises a full-length mature MASP-2 protein (SEQ ID NO: 6), or a specific domain of a MASP-2 protein, (SEQ ID NO: 8), CUBIEGF domain (SEQ ID NO: 9), EGF domain (SEQ ID NO: 11), and serine protease domain (SEQ ID NO: 12). As described above, CUBEGFCUBII area was found necessary for the coupling with the dimerization and MBL (Thielens et al., Supra ). In particular, the peptide sequence TFRSDYN (SEQ ID NO: 16) in the CUBI domain of MASP-2 was found to be involved in binding to MBL in a study to identify humans having a homozygous mutation from Asp105 to Gly105, Resulting in the loss of MASP-2 (Stengaard-Pedersen, K., et al., New England J. Med. 349 : 554-560, 2003).

In some embodiments, the MASP-2 inhibitory peptide is derived from a lectin protein that binds to MASP-2 and is included in the lectin complement pathway. Several different lectins involved in this pathway have been identified, including mannan-binding lectin (MBL), L-picoline, M-picoline and H-picoline (Ikeda, K., et al., J. Biol .. Chem 262: 7451-7454, 1987 ; Matsushita, M., et al, J. Exp Med 176:..... 1497-2284, 2000; Matsushita, M., et al, J. Immunol 168: 3502 -3506, 2002). These lectins are present in the serum as oligomers of homotrimer subunits and each have an N-terminal collagen-like fiber with a carbohydrate recognition domain. These different lectins have been shown to bind to MASP-2, and the lectin / MASP-2 complex activates complement through cleavage of proteins C4 and C2. Picoline has a collagen-like domain with an amino-terminal region of 24 amino acids, 11 Gly-Xaa-Yaa repeat sites, a neck domain with 12 amino acids, and a fibrinogen-like domain with 207 amino acids (Matsushita, M., et al., J. Immunol. 168 : 3502-3506, 2002). H-picoline binds GlcNAc to aggregate human red blood cells coated with LPS derived from Salmonella typhimurium , S. minnesota and E. coli. H-picoline appears to associate with MASP-2 and MAp19 and activates the lectin pathway. Homology . L-picoline / P35 also binds to GlcNAc and associates with MASP-2 and MAp19 in human serum and this complex has been shown to activate the lectin pathway (Matsushita, M., et al., J. Immunol 164 : 2281,2000). Thus, the MASP-2 inhibitory peptides useful in the present invention may be selected from the group consisting of MBL protein (SEQ ID NO: 21), H-picoline protein (Genbank accession number NM_173452), M-picoline protein (Genbank accession number O00602) Protein (Genbank accession number NM_015838).

More specifically, scientists have identified 12 Gly-XY triplets "GKD GRD GTK GEK GEP GQG LRG LQG (SEQ ID NO: 2) in which the MASP-2 binding site on MBL is between the hinge and neck of the C- terminal portion of the collagen- POG KLG POG NO2 PSG SOG PKG QKG DOG KS "(SEQ ID NO: 26) (Wallis, R., et al., J. Biol. Chem. 279 : 14065, 2004) Is also highly conserved in human H-picoline and human L-picoline. Common binding sites present in all three lectin proteins, including the amino acid sequence "OGK-X-GP" (Wallis et al., 2004, supra ). Thus, in some embodiments, the MASP-2 inhibitory peptide useful in this aspect of the invention is a peptide having the amino acid sequence of SEQ ID NO: Is at least 6 amino acids and comprises SEQ ID NO: 22. A peptide derived from MBL comprising the amino acid sequence "GLR GLQ GPO GKL GPO G" (SEQ ID NO: 24) binds to MASP-2 in vitro (Wallis, et al., 2004, supra ). To enhance binding to MASP-2, the natural MBL protein Peptides with both GPO triplets at each end ("GPO GPO GLR GLQ GPO GKL GPO GGP OGP O" SEQ ID NO: 25) at each end can be synthesized to improve the formation of a triple helix as found Wallis, R., et al., J. Biol. Chem. 279 : 14065, 2004).

The MASP-2 inhibitory peptide may also be derived from human H-picoline comprising the sequence "GAO GSO GEK GAO GPQ GPO GPO GKM GPK GEO GDO" (SEQ ID NO: 27) of the common MASP-2 binding region of H- . Also, a peptide derived from human L-picoline comprising the sequence "GCO GLO GAO GDK GEA GTN GKR GER GPO GPO GKA GPO GPN GAO GEO" (SEQ ID NO: 28) of the common MASP- .

The MASP-2 inhibitory peptide may also be derived from a C4 cleavage site such as "LQRALEILPNRVTIKANRPFLVFI" (SEQ ID NO: 29) which is a C4 cleavage site linked to the C-terminal portion of antithrombin III (Glover, GI, et al. Mol. Immunol. 25 : 1261 (1988)).

Exemplary MASP-2 inhibitory peptides SEQ ID NO Source SEQ ID NO: 6 Human MASP-2 protein SEQ ID NO: 8 The CUBI domain of MASP-2 (aa 1-121 of SEQ ID NO: 6) SEQ ID NO: 9 CUBIEGF domain s of MASP-2 (aa 1-166 of SEQ ID NO: 6) SEQ ID NO: 10 CUBIEGFCUBII domain of MASP-2
(Aa 1-293 of SEQ ID NO: 6) SEQ ID NO: 11 The EGF domain of MASP-2 (aa 122-166) SEQ ID NO: 12 The serine-protease domain (aa 429-671) of MASP-2 SEQ ID NO: 16 MBL binding region of MASP-2 SEQ ID NO: 3 Human MAp19 SEQ ID NO: 21 Human MBL protein SEQ ID NO: 22
OGK-X-GP,
Where "O " = hydroxyproline and" X "is a hydrophobic amino acid residue Synthetic peptide of human MBL and human picoline The common binding site SEQ ID NO: 23
OGKLG Human MBL core binding site SEQ ID NO: 24
GLR GLQ GPO GKL GPO G Human MBP triplet for MASP-2 6-10-Proven Combination SEQ ID NO: 25
GPOGPOGLRGLQGPOGKLGPOGGPOGPO A human MBP triplet with GPO added to improve the formation of a triple helix SEQ ID NO: 26
GKDGRDGTKGEKGEPGQGLRGLQGPOGKLGPOGNOGPSGSOGPKGQKGDOGKS Human MBP triplet 1-17 SEQ ID NO: 27
GAOGSOGEKGAOGPQGPOGPOGKMGPKGEOGDO Human H-picoline (Hataka) SEQ ID NO: 28
GCOGLOGAOGDKGEAGTNGKRGERGPOGPOGKAGPOGPNGAOGEO Human L-picoline P35 SEQ ID NO: 29
LQRALEILPNRVTIKANRPFLVFI Human C4 cleavage site SEQ ID NO: 72
LEVTCEPGTTFKDKCNTCRCGSDGKSAVCTKLWCNQ SGMI-2L (full length) SEQ ID NO: 73
TCEPGTTFKDKCNTCRCGSDGKSAVCTKLWCNQ SGMI-2M (Intermediate Cut Version) SEQ ID NO: 74
TCRCGSDGKSAVCTKLWCNQ SGMI-2S (short cut version)

Note: The letter "O" represents hydroxyproline. The letter "X" is a hydrophobic residue.

Peptides derived from the C4 cleavage site, as well as other peptides that inhibit the MASP-2 serine protease site, can be chemically modified to be irreversible protease inhibitors. For example, suitable modifications include halomethylketone (Br, Cl, I, F) attached at the C-terminus, Asp or Glu, or functional side chains; Haloacetyl (or other? -Haloacetyl) group on the amino group or other functional side chain; An amino or carboxy terminal or functional side chain epoxide or imine-containing group; Or imidate esters on amino or carboxy termini or functional side chains, but are not necessarily limited thereto. This modification will provide the advantage of permanently inhibiting the enzyme by attachment of the peptide by covalent attachment. This results in a lower effective dose and / or a less frequent administration need of the peptide inhibitor.

In addition to the inhibitory peptides described above, the MASP-2 inhibitory peptides useful in the methods of the invention include peptides comprising the MASP-2-linked CDRH3 region of the anti-MASP-2 MoAb obtained as described herein. The sequence of the CDR region used to synthesize the peptides can be determined by methods known in the art. The heavy chain variable region is a peptide that is generally in the range of 100 to 150 amino acids in length. The light chain variable region is a peptide that is generally in the range of 80 to 130 amino acids in length. CDR sequences within the heavy and light chain variable regions include only about 3 to 25 amino acid sequences that can be readily sequenced by one skilled in the art.

Those skilled in the art will recognize that substantially homologous variants of the MASP-2 inhibitory peptides described above also exhibit MASP-2 inhibitory activity. Exemplary variants include, but are not necessarily limited to, peptides having insertions, deletions, substitutions, and / or additional amino acids and mixtures thereof on the carboxy-terminal or amino-terminal portion of the subject peptide. Thus, such homologous peptides with MASP-2 inhibitory activity are considered useful in the methods of the present invention. The peptides described may also include other motifs with replication motifs and conservative substitutions. Conservative variants are described elsewhere herein and involve the exchange of amino acids for another amino acid, such as a similar charge, size or hydrophobicity.

MASP-2 inhibitory peptides can be modified to increase solubility and / or maximize positive or negative charge so as to be more similar to segments of the intact protein. Derivatives may or may not have the correct primary amino acid structure of the peptides disclosed herein so long as the derivatives functionally possess the desired properties of MASP-2 inhibition. Modifications include, but are not limited to, one of the 20 commonly known amino acids, or another amino acid, with an additional preferred feature, for example, an amino acid substitution or amino acid substitution with a deduced amino acid or a D-amino acid with resistance to enzymatic degradation, Or substitution with another molecule or compound, such as a carbohydrate, that mimics the natural identification and function of the peptide; Amino acid deletion; One or another amino acid of 20 commonly known amino acids, with an additional preferred characteristic, for example insertion into an induced or substituted amino acid or D-amino acid with resistance to enzymatic degradation, or the addition of amino acids, amino acids or peptides to a natural Substitution with another molecule or compound, such as a carbohydrate, that mimics, identifies and functions; Or substitution with another molecule or compound, such as a carbohydrate or nucleic acid monomer, that mimics the natural identification, charge distribution and function of the parent peptide. Peptides can also be modified by acetylation or amidation.

The synthesis of derivative inhibition peptides may depend on known techniques such as peptide biosynthesis, carbohydrate biosynthesis, and the like. As a starting point, one of ordinary skill in the art may rely on a computer program suitable for determining the configuration type of the peptide of interest. If the form of the peptide disclosed herein is known, one of ordinary skill in the art will be able to identify a derivative that retains the basic configuration and charge distribution of the parent peptide in a reasonable design manner, but that is not present in the parent peptide or that may have improved properties than those found in the parent peptide It is possible to determine what kind of substitution can be made at one or more sites for manufacture. Once the candidate derivative molecules are identified, the derivatives can be tested using assays described herein to determine whether they function as MASP-2 inhibitors.

Screening for MASP-2 inhibitory peptides

Molecular modeling and rational molecular design can be used to mimic the molecular structure of the major binding region of MASP-2 and generate and screen for peptides that inhibit complement activation of MASP-2. The molecular structure used in the modeling is the same as that described above, including the CDR region of the anti-MASP-2 monoclonal antibody as well as the region required for dimerization, the region involved in binding to MBL, and the serine protease active site, Lt; RTI ID = 0.0 &gt; MASP-2 &lt; / RTI &gt; Methods for identifying peptides that bind to a particular target are well known in the art. For example, it has been used in a de novo configuration of a polymeric structure, such as a peptide in which a molecule imprint is bound to a specific molecule. See, for example, Shea, KJ, "Molecular Imprinting of Synthetic Network Polymers: The De Novo Synthesis of Macromolecular Binding and Catalytic Sties," TRIP 2 (5)

As an illustrative example, one method of preparing a mimetic of a MASP-2 binding peptide is as follows. A functional monomer (template) of the binding region of a known MASP-2 binding peptide or anti-MASP-2 antibody exhibiting MASP-2 inhibition is polymerized. The mold is then removed and then a second class of monomer is polymerized in the void left by the mold to provide a new molecule that exhibits one or more desired properties similar to the mold. In addition to producing peptides in this manner, other MASP-2 binding molecules such as polysaccharides, nucleosides, drugs, nuclear proteins, lipid proteins, carbohydrates, glycoproteins, steroids, lipids and other biologically active substances Can also be prepared. This method is useful for designing various biological mimics that are more potent than natural counterparts because they are typically prepared by free radical polymerisation of functional monomers to produce compounds with non-biodegradable skeletons.

Peptide synthesis

MASP-2 inhibitory peptides are well known in the art, such as Merrifield, in J. Amer. Chem. Soc. 85 : 2149-2154, &lt; RTI ID = 0.0 &gt; 1963. &lt; / RTI &gt; Automated synthesis can be accomplished, for example, using an Applied Biosystems 431A peptide synthesizer (Foster City, Calif.) According to the instructions provided by the manufacturer. Other techniques can be found in, for example, Bodanszky, M., et al., Peptide Synthesis , second edition, John Wiley & Sons, 1976, as well as other references known to those skilled in the art.

Peptides can also be prepared using standard gene engineering techniques known to those skilled in the art. For example, a peptide can be enzymatically produced by inserting a nucleic acid encoding a peptide into an expression vector, expressing the DNA, and translating the DNA into a peptide in the presence of the required amino acid. The peptides can then be fused to the peptide, using a chromatographic or electrophoretic technique, or by inserting the nucleic acid sequence encoding the carrier protein into an in-phase expression vector with the peptide coding sequence and then cleaved from the peptide Lt; / RTI &gt; protein. Fusion protein-peptides may be separated using chromatography, electrophoresis or immunological techniques (e. G., Binding to the resin via an antibody to the carrier protein). The peptides can be cleaved using chemical methodology or enzymatically, for example, by hydrolytic enzymes.

MASP-2 inhibitory peptides useful in the methods of the invention may also be produced in recombinant host cells according to conventional techniques. In order to express a sequence encoding the MASP-2 inhibitory peptide, the nucleic acid molecule encoding the peptide must be operably linked to a regulatory sequence that controls transcription expression in the expression vector and then introduced into the host cell. In addition to transcriptional control sequences, such as promoters and enhancers, the expression vector may comprise a translation control sequence and a marker gene suitable for selection of cells bearing the expression vector.

The nucleic acid molecule encoding the MASP-2 inhibitory peptide can be synthesized as a "gene machine " using a protocol such as the phosphoramidite method. When chemically synthesized double-stranded DNA is required for such uses as synthesis of genes or gene fragments, each complementary strand is made separately. Generation of short genes (60 to 80 base pairs) is technically simple and can be accomplished by synthesizing complementary strands and then annealing them. For the generation of longer genes, the synthetic gene (double-stranded) is assembled in the form of a module of single-stranded fragments of 20 to 100 nucleotides in length. For a review of polynucleotide synthesis, see, for example, Glick and Pasternak, " Molecular Biotechnology, Principles and Applications of Recombinant DNA & quot ;, ASM Press, 1994; Itakura, K., et al., Annu. Rev. Biochem. 53 : 323,1984; And Climie, S., et al., Proc. Nat'l Acad. Sci. USA 87 : 633, 1990.

Small molecule inhibitor

In some embodiments, the MASP-2 inhibitor is a small molecule inhibitor comprising natural and synthetic substances having low molecular weights, such as peptides, peptidomimetics and non-peptide inhibitors (including oligonucleotides and organic compounds). The small molecule inhibitor of MASP-2 can be generated based on the molecular structure of the variable region of the anti-MASP-2 antibody.

Small molecule inhibitors can also be designed and generated based on MASP-2 crystal structures using computer drug design (Kuntz ID, et al., Science 257 : 1078, 1992). The crystal structure of rat MASP-2 has been described (Feinberg, H., et al., EMBO J. 22 : 2348-2359, 2003). Using the method described by Kuntz et al., MASP-2 crystal structure coordinates are used as input values to a computer program such as DOCK, which yields a list of small molecule structures expected to bind to MASP-2. The use of such computer programs is well known to those skilled in the art. For example, the crystal structure of the HIV-1 protease inhibitor can be determined by evaluating the suitability of the compound found in the Cambridge Crystallographic database on the binding site of the enzyme using the program DOCK to determine the specific non-peptide, HIV-1 protease inhibitor (Kuntz, ID, et al., J. Mol. Biol . 161 : 269-288, 1982; DesJarlais, RL, et al., PNAS 87 : 6644-6648, 1990).

The list of small molecule structures identified by the method of using the computer as a potential MASP-2 inhibitor is screened using the MASP-2 binding assay as described in Example 10. [ Small molecules that appear to bind to MASP-2 are assayed by functional assays as described in Example 2 to determine whether they inhibit MASP-2-dependent complement activation.

MASP-2 soluble receptor

Other suitable MASP-2 inhibitors are contemplated to include MASP-2 soluble receptors that can be generated using techniques known to those skilled in the art.

MASP-2 expression inhibitor

In another embodiment of this aspect of the invention, the MASP-2 inhibitor is a MASP-2 expression inhibitor capable of inhibiting MASP-2-dependent complement activation. Representative MASP-2 expression inhibitors include MASP-2 antisense nucleic acid molecules (e.g., antisense mRNA, antisense DNA or antisense oligonucleotides), MASP-2 ribozyme and MASP-2 RNAi molecules in the practice of this aspect of the invention .

Antisense RNA and DNA molecules act directly to block translation of MASP-2 mRNA by hybridizing to MASP-2 mRNA to prevent translation of MASP-2 protein. The antisense nucleic acid molecule can be constructed in many different ways, but it can interfere with the expression of MASP-2. For example, an antisense nucleic acid molecule can be constructed by inverting the coding region (or a portion thereof) of the MASP-2 cDNA (SEQ ID NO: 4) relative to the normal orientation for transcription to allow transcription of the complement .

The antisense nucleic acid molecule is usually substantially the same as at least a portion of the target gene or genes. However, nucleic acids need not be completely identical in order to inhibit expression. Generally, higher homology can be used to supplement the use of shorter antisense nucleic acid molecules. Minimal percent identity is typically higher than about 65%, but higher percent identity may indicate a more effective inhibition of the expression of the endogenous sequence. A substantially higher percent identity of greater than about 80% is typically preferred, but an absolute identity of about 95% is typically most preferred.

The antisense nucleic acid molecule need not have an intron or exon pattern such as the target gene and the non-coding segment of the target gene may be equally effective in achieving antisense suppression of target gene expression as the coding segment. DNA sequences of at least about eight nucleotides can be used as antisense nucleic acid molecules, although longer sequences are preferred. In the present invention, a representative example of a useful inhibitor of MASP-2 is an antisense MASP-2 nucleic acid molecule that is at least 90 percent identical to a complement of a MASP-2 cDNA consisting of the nucleic acid sequence set forth in SEQ ID NO: The nucleic acid sequence presented in SEQ ID NO: 4 encodes a MASP-2 protein consisting of the amino acid sequence set forth in SEQ ID NO: 5.

Targeting of antisense oligonucleotides for binding to MASP-2 mRNA is another mechanism that can be used to reduce the level of MASP-2 protein synthesis. For example, the synthesis of polygalacturonase and muscarinic type 2 acetylcholine receptors is inhibited by the antisense oligonucleotides directed against their respective mRNA sequences (Cheng, U. S. Patent No. 5,739, 119, and Shewmaker, 5,759,829). In addition, examples of antisense inhibition have been demonstrated with nuclear protein cyclins, multidrug resistance genes (MDGl), ICAM-1, E-selectin, STK-1, striatal GABA _A receptors and human EGF (see, for example, U.S. Patent No. 5,801,154 to Baracchini ; US Patent No. 5,789,573 to Baker; US Patent No. 5,718,709 to Considine; and US Patent No. 5,610,288 to Reubenstein).

A system that allows one of ordinary skill in the art to determine if oligonucleotides are useful in the present invention is described, which involves probing the appropriate site in the target mRNA as an indicator of the accessibility of sequence within the transcript using RNAse H cleavage. Scherr, M., et al., Nucleic Acids Res. 26 : 5079-5085,1998; Lloyd, et al., Nucleic Acids Res. 29 : 3665-3673, 2001. A mixture of complementary antisense oligonucleotides for certain regions of the MASP-2 transcript is added to a cell extract such as hepatocytes expressing MASP-2 and hybridized to produce a RNAse H vulnerable site . This method is computer-aided, which can predict optimal sequence selection for antisense compositions based on their relative ability to form dimers, hairpins, or other secondary structures that reduce or inhibit specific binding to the target mRNA in host cells Type sequence selection. These secondary structural analyzes and consideration of target site selection were made using OLIGO primer analysis software (Rychlik, I., 1997) and BLASTN 2.0.5 algorithm software (Altschul, SF, et al., Nucl. Acids Res. 25 : 3389- 3402, 1997). Antisense compounds directed against the target sequence preferably comprise about 8 to about 50 nucleotides in length. Particularly preferred are antisense oligonucleotides comprising from about 9 to about 35 nucleotides. The present inventors have found that the range of 9 to 35 nucleotides (i.e., the lengths of 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 , 27, 28, 29, 30, 31, 32, 33, 34, or about 35) are highly desirable for the implementation of the antisense oligonucleotide-based methods of the invention. Highly preferred target regions of MASP-2 mRNA are those located at or near the AUG translation initiation codon, and those that are located in the region between -10 and +10 of the MASP-2 gene nucleotide sequence (SEQ ID NO: 4) Lt; RTI ID = 0.0 &gt; 5 &apos; of &lt; / RTI &gt; Exemplary MASP-2 expression inhibitors are provided in Table 4.

Exemplary expression inhibitors of MASP-2 SEQ ID NO: 30 (nucleotides 22-680 of SEQ ID NO: 4) The nucleic acid sequence of the MASP-2 cDNA encoding CUBIEGF (SEQ ID NO: 4) SEQ ID NO: 31
5'CGGGCACACCATGAGGCTGCTGACCCTCCTGGGC3 Nucleotides 12-45 of SEQ ID NO: 4 containing the MASP-2 translation initiation site (sense) SEQ ID NO: 32
5'GACATTACCTTCCGCTCCGACTCCAACGAGAAG3 ' Nucleotides 361-396 of SEQ ID NO: 4 which encode a region comprising the MASP-2 MBL binding site (sense) SEQ ID NO: 33
5 'AGCAGCCCTGAATACCCACGGCCGTATCCCAAA3' Nucleotides 610-642 of SEQ ID NO: 4 encoding the region comprising the CUBII domain

As noted above, the term "oligonucleotide" as used herein refers to oligomers or polymers of ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) or mimetics thereof. The term also covers oligonucleotide bases composed of oligonucleotides with spontaneous nucleotides, sugar and nucleoside cascade (skeletal) covalent bonds, as well as non-naturally occurring modifications. These modifications allow the introduction of certain desired properties that are not provided through spontaneous oligonucleotides, such as reduced toxic properties, increased stability to nuclease degradation, and improved cell uptake. In an exemplary embodiment, the antisense compounds of the invention differ from native DNA by modification of the phosphodiester backbone to extend the lifetime of the antisense oligonucleotides in which the phosphate substituent is replaced by phosphorothioate. Likewise, one or both ends of the oligonucleotide may be substituted with one or more acridine derivatives interposed between adjacent base pairs in the strand of the nucleic acid.

Another alternative to antisense is the use of "RNA interference" (RNAi). Double-stranded RNA (dsRNA) can cause gene silencing in vivo in mammals. The natural function and co-suppression of RNAi appears to be genetic protection against invasion by viruses that produce deviating RNA or dsRNA in host cells when they become mobility genetic elements such as retrotransposons and activating , Jensen, J., et al., Nat. Genet. 21 : 209-12, 1999). Double-stranded RNA molecules can be prepared by synthesizing two RNA strands that can form double-stranded RNA molecules, each having a length of about 19-25 nucleotides (e.g., 19-23 nucleotides). For example, dsRNA molecules useful in the methods of the invention may include RNA corresponding to the sequences listed in Table 4 and their complement. Preferably, at least one strand of the RNA has a 3 'overhang of one to five nucleotides. The synthesized RNA strands are combined under conditions that form double-stranded molecules. The RNA sequence may comprise at least 8 nucleotide portions of SEQ ID NO: 4 and has a total length of 25 or fewer nucleotides. The design of siRNA sequences for a given target is within the ordinary skill in the art. Commercial services are available for designing siRNA sequences and ensuring at least 70% knockdown of expression (Qiagen, Valencia, Calif)

The dsRNA can be administered as a pharmaceutical composition and carried out by known methods, and the nucleic acid is introduced into the desired target cell. Commonly used gene delivery methods include calcium phosphate, DEAE-dextran, electroporation, microinjection and viral methods. Such methods are taught in Ausubel et al., Current Protocols in Molecular Biology , John Wiley & Sons, Inc., 1993.

Ribozymes can also be used to reduce the amount and / or biological activity of ribozymes that target MASP-2, such as MASP-2 mRNA. A ribozyme is a catalytic RNA molecule capable of cleaving a nucleic acid molecule having a sequence completely or partially homologous to a ribozyme sequence. It is possible to design a ribozyme transgene gene that encodes an RNA ribozyme that specifically forms a pair with the target RNA and cleaves the phosphodiester skeleton at a specific site, thereby functionally inactivating the target RNA. In carrying out this cleavage, the ribozyme is not changed by itself, and therefore can be cleaved by reusing other molecules. The inclusion of a ribozyme sequence in an antisense RNA confer RNA-cleaving activity on them, thereby increasing the activity of the antisense structure.

A ribozyme useful in the practice of the present invention typically comprises at least about 9 nucleotide hybridization regions complementary to at least a portion of a target MASP-2 mRNA in the nucleotide sequence, and a catalytic region regulated to cleave the target MASP-2 mRNA (Generally EPA No. 0 321 201; WO 88/04300; Haseloff, J., et al., Nature 334 : 585-591, 1988; Fedor, MJ, et al., Proc. Natl. Acad Sci. USA 87 : 1668-1672, 1990; Cech, TR, et al., Ann. Rev. Biochem. 55 : 599-629, 1986).

A ribozyme can be directly targeted to a cell in the form of an RNA oligonucleotide incorporating a ribozyme sequence, or introduced into a cell as an expression vector encoding the desired ribozyme RNA. The ribozyme can be used and applied in the same manner as that used for the antisense polynucleotide.

Antisense RNA and DNA, ribozyme and RNAi molecules useful in the methods of the invention can be prepared by any method known in the art for the synthesis of DNA and RNA molecules. These include techniques for chemically synthesizing oligodeoxyribonucleotides and oligoribonucleotides that are well known in the art, for example, solid phase phosphoramidite chemical synthesis. Alternatively, the RNA molecule can be generated by in vitro and in vivo transcription of a DNA sequence encoding an antisense RNA molecule. Such DNA sequences may be integrated into a variety of vectors including suitable RNA polymerase promoters such as the T7 or SP6 polymerase promoter. Alternatively, an antisense cDNA construct that synthetically or inducibly synthesizes antisense RNA according to the promoter used can be stably introduced into the cell line.

Various well-known modifications of DNA molecules can be introduced as a means of increasing stability and half-life. Useful modifications include the addition of a flanking sequence of ribonucleotides or deoxyribonucleotides to the 5 ' and / or 3 ' ends of the molecule or the addition of phosphorothioate or 2 ' to the phosphodiesterase linkage within the oligodeoxyribonucleotide backbone But are not limited to, the use of &apos; O-methyl.

V. Pharmaceutical compositions and delivery methods

dosage

In another aspect, the invention provides a composition for inhibiting the side effects of MASP-2-dependent complement activation in a subject suffering from a disease or condition as disclosed herein, comprising a therapeutically effective amount of a MASP-2 inhibitor, Comprising administering to the subject a composition comprising a carrier. A MASP-2 inhibitor may be administered to a subject in need thereof in a therapeutically effective amount to treat or ameliorate a disease associated with MASP-2-dependent complement activation. A therapeutically effective amount refers to that amount of a MASP-2 inhibitor sufficient to cause an improvement in the symptoms associated with the disease or disorder.

The toxicity and therapeutic efficacy of the MASP-2 inhibitor is determined by standard pharmaceutical procedures using an experimental animal model, e.g., a mouse and MASP-2 - / - mouse model expressing the human MASP-2 transgene described in Example 1 . In the use of these animal models, NOAEL (no observed side-effect levels) and MED (minimal effective dose) can be measured using standard methods. The capacity ratio between the NOAEL and MED effects is the therapeutic ratio, expressed as the ratio NOAEL / MED. MASP-2 inhibitors that exhibit large therapeutic ratios or indicators are most preferred. Data obtained from cell culture assays and animal studies can be used to formulate a range of dosages for use in humans. The dosage of the MASP-2 inhibitor is preferably within the range of circulating concentrations, including MED, with little or no toxicity. The dosage may vary depending upon the dosage form employed within this range and the route of administration utilized.

In some embodiments, the treatment of a MASP-2 inhibitor for treating, inhibiting, alleviating or preventing fibrosis in a mammalian subject suffering from, or at risk of developing, a disease or disorder caused or to be worsened by fibrosis and / Enzymatic efficacy is measured by one or more of the following: one or more markers of inflammation and scarring (eg, TGFβ-1, CTFF, IL-6, apoptosis, fibronectin, laminin, collagen, EMT, invasive macrophages) Reduction; Inflammation and fibrosis into urine and plasma Decreased release of soluble markers of kidney disease (e.g. by measurement of renal excretion function).

For any compound preparation, a therapeutically effective amount can be estimated using animal models. For example, the dose may be formulated in an animal model to achieve a circulating plasma concentration range that includes MED. Quantitative levels of plasma MASP-2 inhibitors can also be measured, for example, by high performance liquid chromatography.

In addition to toxicity studies, effective doses can also be estimated based on the amount of MASP-2 protein present in a living subject and the binding affinity of the MASP-2 inhibitor. Levels of MASP-2 in normal human subjects are present at low levels in the range of 500 ng / ml in serum, and levels of MASP-2 in certain subjects are determined by Moller-Kristensen M., et al., J. Immunol. Methods 282 : 159-167, 2003, using quantitative assays for MASP-2.

In general, the dosage of the administered composition comprising a MASP-2 inhibitor will depend on such factors as the age, weight, height, sex, general medical condition, and previous medical history of the subject. As an example, a MASP-2 inhibitor, such as an anti-MASP-2 antibody, is administered in a dosage range of about 0.010 to 10.0 mg / kg, preferably 0.010 to 1.0 mg / kg, more preferably 0.010 to 0.1 mg / &Lt; / RTI &gt; In some embodiments, the composition comprises a combination of an anti-MASP-2 antibody and a MASP-2 inhibitory peptide.

The therapeutic efficacy, and the appropriate dosage, of the MASP-2 inhibiting compositions and methods of the invention in a given subject can be determined according to a complement assay well known to those skilled in the art. Complement produces many specific products. Over the last decade, sensitive and specific assays have been developed and are commercially available for most of these activation products, including small activation fragments C3a, C4a, and C5a and large activation fragments iC3b, C4d, Bb, and sC5b-9 . Most of these assays make these assays very simple and specific, using monoclonal antibodies that are exposed to a fragment, but react with a new antigen (neonatal source) that is not exposed to the native protein on which they are formed. Most depend on ELISA technology, but for C3a and C5a, an immunoassay is sometimes used. These latter assays measure both the unprocessed fragments and their 'desArg' fragments, the major forms found in the circulation. The untreated fragment and C5a _desArg bind rapidly to cell surface receptors and are therefore rapidly removed and therefore present in very low concentrations, whereas C3a _desArg accumulates in plasma without binding to cells. Measurement of C3a provides a sensitive, path-independent indicator of complement activation. Alternative pathway activation can be assessed by measuring the Bb fragment. Detection of the fluid phase product, sC5b-9, of the membrane attack pathway activation provides evidence that the complement is activated to completion. Since both the lectin pathway and the classical pathway produce the same activation products, C4a and C4d, the measurement of these two fragments does not provide any information on which of these two pathways produced the activated product.

Inhibition of MASP-2-dependent complement activation is characterized by at least one of the following changes in the components of the complement system that occur as a result of administration of a MASP-2 inhibitor according to the methods of the invention: MASP-2-dependent complement activation system product (E. G., Measured as described in Example 2), C4 cleavage and reduction of C4b deposition (e. G., Inhibition of the production of C4b, C3a, C5a and / or C5b-9 (Measured as described in Example 10), or a decrease in C3 cut and C3b deposition (e.g., as described in Example 10).

Additional Agents

In certain embodiments, the methods of preventing, treating, reversing, and / or inhibiting fibrosis and / or inflammation include administration of one or more other drugs, biologics, or therapeutic interventions suitable for inhibiting fibrosis and / As part of a MASP-2 inhibitor (e. G., A MASP-2 inhibiting antibody). In certain embodiments, the additional medicament, biological agent, or therapeutic intervention is appropriate for certain conditions associated with a disease or disorder caused or exacerbated by fibrosis and / or inflammation. For example, a MASP-2 inhibitory antibody can be administered as part of a therapeutic regimen with one or more immunosuppressants such as methotrexate, cyclophosphamide, azathioprine, and mycophenolate mofetil have. Additionally, for example, the MASP-2 inhibitory antibody can be administered in combination with one or more agents designed to increase blood flow (e.g., nifedipine, amlodipine, diltiazem, felodipine, &lt; / RTI &gt; nicardipine) as part of a therapeutic regimen. Further, for example, the MASP-2 inhibitory antibody may be administered to one or more of the agents contemplated to reduce fibrosis, such as d-penicillamine, colchicine, PUVA, Relaxin, cyclosporine, TGF beta blockers, and / May be administered as part of a therapeutic regimen along with a blocking agent. In addition, for example, a MASP-2 inhibitory antibody may be administered as part of a therapeutic regimen along with steroids or bronchodilators.

Compositions and methods comprising a MASP-2 inhibitor (such as a MASP-2 inhibiting antibody) may optionally comprise one or more additional therapeutic agents, which may enhance the activity of the MASP-2 inhibitor or may include additional or counter- Can provide related therapeutic functions. For example, in the context of treating a subject suffering from a disease or disorder caused or exacerbated by fibrosis and / or inflammation, one or more MASP-2 inhibitors may be administered in combination with one or more additional anti-fibrotic agents and / or one or more anti- Agents and / or immunosuppressants (including simultaneous administration).

MASP-2 inhibitors (e. G., MASP-2 inhibitory antibodies) may be used in combination with other therapeutic agents such as corticosteroids, immunosuppressive or cytotoxic agents, and / or general immunosuppressive drugs such as anti-fibrosis agents.

Pharmaceutical carriers and delivery vehicles

In general, the MASP-2 inhibitor compositions of the present invention in combination with any other selected therapeutic agent are suitably included in a pharmaceutically acceptable carrier. The carrier is selected to be non-toxic, biocompatible, and does not deleteriously affect the biological activity of the MASP-2 inhibitor (and any other therapeutic agent in combination therewith). Exemplary pharmaceutically acceptable carriers for peptides are described in US Patent No. 5,211, 657 to Yamada. Anti-MASP-2 antibodies and inhibitory peptides useful in the invention can be administered in solid, semi-solid, gel, liquid or gaseous forms such as tablets, capsules, powders, granules, ointments, solutions, suppositories, inhalants And injections. &Lt; / RTI &gt; The invention also contemplates topical administration of the composition by coating a medical device or the like.

Suitable carriers for parenteral delivery via injection, infusion or topical delivery and topical delivery include, but are not limited to, distilled water, physiological phosphate-buffered saline, normal or lactated Ringer's solution, dextrose solution, Hank's solution, . In addition, sterilized fixed oils may be used as a solvent or suspending medium. For this purpose, any biocompatible oil may be employed, including synthetic mono- or diglycerides. In addition, fatty acids such as oleic acid are used in the preparation of injectables. The carrier and the agent can be synthesized as a liquid, a suspension, a polymerizable or non-polymerizable gel, a paste or a plaster.

The carrier may also include a delivery vehicle to sustain (i.e., prolong, delay, or modulate) the delivery of the agent (s) or to enhance delivery, absorption, stability, or pharmacokinetics of the therapeutic agent (s). Such delivery vehicles include, by way of non-limiting example, microparticles, microspheres, nanospheres or nanoparticles composed of proteins, liposomes, carbohydrates, synthetic organic compounds, inorganic compounds, polymers or copolymer hydrogels and polymer micelles can do. Suitable hydrogel and micelle delivery systems include the PEO: PHB: PEO copolymer and copolymer / cyclodextrin complex disclosed in WO 2004/009664 A2 and the PEO and PEO / cyclodextrin disclosed in U.S. Patent Application Publication No. 2002/0019369 A1 . Such hydrogels can be injected locally, or subcutaneously or intramuscularly, into the intended site of action to form a sustained depot.

For intra-articular delivery, the MASP-2 inhibitor may be contained in an injectable liquid or gel carrier, an injectable sustained delivery vehicle as described above, or a hyaluronic acid or hyaluronic acid derivative.

For oral administration of a non-peptidic agonist, the MASP-2 inhibitor may be contained in an inert filler or diluent such as sucrose, corn starch, or cellulose.

For topical administration, the MASP-2 inhibitor may be in a gel or microcapsule delivery system via ointment, lotion, cream, gel, eye drops, suppositories, spray, liquid or powder, or transdermal patches.

Various nasal and pulmonary delivery systems, including aerosols, metered dose inhalers, dry powder inhalers, and atomizers, are being developed and may be suitably adapted for delivery to the present invention with an aerosol, inhalant, or sprayed delivery vehicle, respectively.

Transmissive (IT) or intracerebroventricular (ICV) delivery, suitably a sterile delivery system (e.g., liquid; gel, suspension, etc.) may be used to administer the present invention.

The compositions of the present invention may also include biocompatible excipients such as dispersing or wetting agents, suspending agents, diluents, buffers, absorption enhancers, emulsifiers, binders, thickeners, flavoring agents (for oral administration).

Pharmaceutical carriers for antibodies and peptides

More specifically, with respect to the anti-MASP-2 antibody and the inhibitory peptide, the exemplary agent is a solution of the compound in a physiologically acceptable diluent together with a pharmaceutical carrier which may be a sterile liquid such as water, oil, saline, glycerol or ethanol Or parenterally as an injectable dose of a suspension. In addition, auxiliary substances such as wetting or emulsifying agents, surfactants, pH buffering substances, etc. may be present in the composition comprising the anti-MAST-2 antibody and the inhibitory peptide. Additional components of the pharmaceutical composition include petroleum (e.g., animal, vegetable or synthetic origin), such as soybean oil and mineral oil. Generally, glycols, such as propylene glycol or polyethylene glycol, are preferred liquid carriers for injection solutions.

Anti-MASP-2 antibodies and inhibitory peptides can also be administered in the form of depot injections or implants, which may be formulated in such a manner as to permit sustained or pulsatile release of the active agent.

Pharmaceutically acceptable carriers for expression inhibitors

More particularly, with respect to expression inhibitors useful in the methods of the invention, compositions comprising the above described expression inhibitors and a pharmaceutically acceptable carrier or diluent are provided. The composition may further comprise a colloidal dispersion system.

Pharmaceutical compositions comprising an expression inhibitor include, but are not limited to, solutions, emulsions, and liposome-containing agents. These compositions can be produced from a variety of components including, but not limited to, preformed liquids, self-emulsifying solids and self-emulsifying solids. The preparation of such compositions typically involves combining the expression inhibitor with one or more of the following: buffers, antioxidants, low molecular weight polypeptides, carbohydrates including proteins, amino acids, glucose, sucrose or dextrins, chelating agents such as EDTA, glutathione and other stabilizers and excipients. Neutral buffered saline or saline mixed with non-specific serum albumin are examples of suitable diluents.

In some embodiments, the composition can be prepared and formulated as an emulsion, which is a heterogeneous system of a liquid, typically dispersed in other liquids in the form of droplets (Idson, in Pharmaceutical Dosage Forms , Vol. 1, Rieger and Banker , Marcek Dekker, Inc., NY, 1988). Examples of naturally occurring emulsifiers used in emulsion preparations include acacia, beeswax, lanolin, lecithin and phosphatides.

In one embodiment, a composition comprising a nucleic acid can be formulated into a microemulsion. The microemulsion refers to a system of water, oil, and amphipathic materials as used herein, which is a single visually isotropic, thermodynamically stable liquid solution (see Rosoff in Pharmaceutical Dosage Forms , Vol. The methods of the invention may also use liposomes for the transport and delivery of antisense oligonucleotides to the desired site.

Pharmaceutical compositions and formulations of expression inhibitors for topical administration may include transdermal patches, ointments, lotions, creams, gels, eye drops, suppositories, sprays, liquids and powders. Conventional pharmaceutical carriers, as well as aqueous, powder or oily bases and thickeners may be used.

Method of administration

A pharmaceutical composition comprising a MASP-2 inhibitor may be administered in a number of ways depending on which of the topical or systemic modes of administration is most appropriate for the disease being treated. In addition, the compositions of the present invention can be delivered by coating or including the composition on an implantable medical device.

Systemic delivery

As used herein, the terms "systemic delivery" and "systemic administration" include intramuscular (IM), subcutaneous, intravenous (IV), intraarterial, inhalation, sublingual, ball, local, transdermal, But are not limited to, oral and parenteral routes that include other routes of administration that effectively effect the dispersion of the agent delivered to the single or multiple sites of the vaginal and intended therapeutic action. Preferred routes of systemic delivery to the present compositions include intravenous, intramuscular, subcutaneous and inhalation. The precise systemic administration of the selected agonist used in the particular composition of the present invention will be determined in part to account for the sensitivity of the agonist to the metabotropic pathway associated with the given administration route. For example, the peptide agonist may suitably be administered by a route other than orally.

MASP-2 inhibitory antibodies and polypeptides may be delivered to a subject in need by any suitable means. Methods for delivery of MASP-2 antibodies and polypeptides include, but are not limited to, oral, pulmonary, parenteral (e.g. intramuscular, intraperitoneal (IV) or subcutaneous injection), inhalation (e.g. via micropowder formulation) Intramuscular, intrathecal, intranasal, vaginal, rectal, or sublingual routes of administration and may be formulated in a suitable dosage form for each route of administration.

As a representative example, MASP-2 inhibitory antibodies and peptides may be introduced into the living body by a membrane capable of absorbing the polypeptide, e.g., nasal, gastrointestinal, and rectal membranes. Polypeptides are typically applied to absorbent membranes with permeation enhancers (see, e.g., Lee, VHL, Crit. Rev. Ther. Drug Carrier Sys . 5 : 69, 1988; Lee, VHL, J. Controlled Release 13 : 213, 1990 ; Lee, VHL, Ed., Peptide and Protein Drug Delivery, Marcel Dekker, New York (1991); DeBoer, AG, et al., J. Controlled Release 13 : 241, 1990). For example, STDHF is a synthetic derivative of a fosidic acid, a steroidal surfactant similar in structure to bile salts, and has been used as a penetration enhancer for nasal delivery (Lee, WA, Biopharm . 22 , Nov./Dec. 1990) .

MASP-2 inhibitory antibodies and polypeptides may be introduced with another molecule, such as lipid, to protect the polypeptide from enzymatic degradation. For example, the polymer, in particular attached by covalent binding of polyethylene glycol (PEG) can protect certain proteins from enzymatic hydrolysis in the body and therefore was used to extend the half-life (Fuertges, F., et al., J. Controlled Release 11 : 139, 1990). Many polymer systems have been reported for protein delivery (Bae, YH, et al., J. Controlled Release 9 : 271, 1989; Hori, R., et al., Pharm. Res . 6 : 813, .. I., et al, J. Pharm Sci 79: 505, 1990; Yoshihiro, I., et al, J. Controlled Release 10:... 195, 1989; Asano, M., et al, J. Controlled Release 9: 111, 1989; Rosenblatt , J., et al, J. Controlled Release 9: 195, 1989; Makino, K., J. Controlled Release 12:. 235, 1990; Takakura, Y., et al,. J. Pharm. Sci . 78 : 117, 1989; Takakura, Y., et al., J. Pharm. Sci . 78 : 219, 1989).

Recently, liposomes with improved serum stability and circulating half-life have been developed (see, e. G., U.S. Patent No. 5,741,516 to Webb). In addition, various methods of liposome and liposome-like preparation as potential drug carriers have been discussed (see, for example, US Patent No. 5,567,434 to Szoka, US Patent No. 5,552,157 to Yagi, US Patent No. 5,565,213 to Nakamori, US Patent No. 5,738,868 to Shinkarenko, U.S. Patent No. 5,795,587 to Gao).

For transdermal application, the MASP-2 inhibitory antibodies and polypeptides may be combined with other suitable components, such as carriers and / or adjuvants. Are not limited as to the nature of these other ingredients, except that they must be pharmaceutically acceptable for the intended administration and can not degrade the activity of the active ingredient of the composition. Examples of suitable vehicles include ointments, creams, gels, or suspensions, with or without purified collagen. MASP-2 inhibitory antibodies and polypeptides may also be impregnated with transdermal patches, plasters, and bandages, preferably in liquid or semi-liquid form.

The compositions of the present invention may be administered systemically at regular intervals to maintain a desired level of therapeutic effect. For example, the compositions may be administered every 2 to 4 weeks or at less frequent intervals, for example, by subcutaneous injection. The dosage regimen will be determined by the physician in consideration of various factors that may affect the action of the combination of agonists. These factors will include the extent of the disease being treated, the patient's age, sex, weight, and other clinical factors. The dosage for the individual agent will depend on the function of the MASP-2 inhibitor included in the composition as well as on the presence and nature of any drug delivery vehicle (e. G., A delayed delivery vehicle). In addition, dosages can be adjusted to account for changes in the frequency of administration of the delivered agent (s) and pharmacokinetic behavior.

Local delivery

As used herein, the term "topical" includes the application of a drug to or around an intended localized action site, for example, to the skin or other affected tissue and to local delivery, (IT), intraventricular (ICV), intraarticular, intracavitary, intracranial, or intravesical administration, placement or perfusion techniques. Topical administration may be desirable to enable lower doses of administration, to prevent side effects of the system and to more precisely control the delivery timing and concentration of the active agent at the local delivery site. Topical administration provides a known concentration at the target site, regardless of inter-subject variability, such as metabolism, blood flow, and the like. Improved dosage control is also provided by direct delivery.

Local delivery of a MASP-2 inhibitor may be accomplished in the context of surgical methods for treating a disease or disorder caused or exacerbated by fibrosis and / or inflammation, such as during surgery, for example.

Treatment prescription

In a prophylactic application, a pharmaceutical composition comprising a MASP-2 inhibitor (such as a MASP-2 inhibitory antibody) is administered to a subject that is susceptible to, or otherwise at risk of, a disease or disorder caused or exacerbated by fibrosis and / In a sufficient amount to inhibit fibrosis and / or inflammation, thereby eliminating or reducing the risk of developing symptoms of the condition. In some embodiments, the pharmaceutical composition comprises a therapeutically effective amount sufficient to alleviate, or at least partially alleviate, the symptoms of the condition to a subject already suspected or having a suspected or impaired disease or disorder caused or exacerbated by fibrosis and / Lt; / RTI &gt; In prophylactic and therapeutic regimens, a composition comprising a MASP-2 inhibitor may be administered at multiple roundtrip dosages until sufficient treatment results are obtained in the subject. The application of the MASP-2 inhibiting composition of the present invention can be carried out by a single administration of the composition for treatment of an acute condition associated with fibrosis and / or inflammation, or by a limited administration sequence. Alternatively, the composition may be administered at periodic intervals over an extended period of time for the treatment of chronic conditions associated with fibrosis and / or inflammation.

In both prophylactic and therapeutic regimens, a composition comprising a MASP-2 inhibitor may be administered at multiple withdrawal doses until sufficient results are achieved in the subject. In one embodiment of the invention, the MASP-2 inhibitor comprises an anti-MAST-2 antibody, suitably from 0.1 mg to 10,000 mg, more suitably from 1.0 mg to 5,000 mg, more preferably from 10.0 mg to 2,000 (for example, an average adult body weight of 70 kg) at a dosage of about 10 mg to about 1,000 mg, more preferably from about 10.0 mg to about 1,000 mg, and more preferably from about 50.0 mg to about 500 mg. For pediatric patients, the dosage can be adjusted in proportion to the patient &apos; s body weight. The application of the MASP-2 inhibiting composition of the present invention can be used for the treatment of a subject suffering from or at risk of developing a disease or disorder caused or exacerbated by fibrosis and / or inflammation, a single dose of the composition, Lt; / RTI &gt; Alternatively, the composition may be administered at regular intervals for extended periods of time, such as every day, every two weeks, for the treatment of a subject suffering from or at risk of developing a disease or disorder caused or to be exacerbated by fibrosis and / Weekly, biweekly, monthly, or bi-monthly.

In both prophylactic and therapeutic regimens, a composition comprising a MASP-2 inhibitor may be administered at multiple wash doses until sufficient treatment results are obtained in the subject.

In some embodiments, the subject is a subject, for example, by measuring that the subject has at least one symptom of impaired renal function as assessed by the serum creatinine level, serum creatinine clearance, serum urea nitrogen level, urine protein, and / One or more biomarkers associated with the disease or injury are determined to be indicative of a risk of developing a disease or disorder caused or exacerbated by fibrosis or inflammation.

Methods of assessing renal function are well known in the art and include, but are not limited to, blood system and glomerular capillary pressure, proteinuria (e.g., albuminuria), microscopic and gross hematuria, serum creatinine levels (such as 50% and 4.0 mg / dl to 25% of normal renal function), a decrease in glomerular filtration rate (e.g., creatinine clearance), and degree of tubular damage. For example, evaluation of renal function may be accomplished by measuring serum creatinine levels, creatinine clearance, 24-hour urinary protein excretion, glomerular filtration rate, urine albumin creatinine ratio, albumin excretion rate, and renal biopsy (e.g., by measuring collagen and / or fibronectin deposition Or assessing at least one renal function using biological and / or physiological parameters such as the degree of renal fibrosis).

VI. Example

The following examples illustrate only the best mode presently contemplated for carrying out the invention, but are not to be construed as limiting the invention. All citations herein are expressly incorporated by reference.

Example 1

This example describes the generation of the mouse strain deficiency (MASP-2 - / -) of (MAp19 + / +) MASP-2, although MAp19 is sufficient.

Materials and Methods: As shown in Figure 3 , the targeting vector pKO-NTKV 1901 was designed to disrupt three exons encoding the C-terminal end of murine MASP-2, including the exon encoding the serine protease domain . PKO-NTKV 1901 was used to transfect mouse ES cell line E14.1a (SV129 Ola). Neomycin-resistant and thymidine kinase-sensitive clones were selected. 600 ES clones were screened and, among them, four different clones identified and identified by Southern blot as containing the expected selective targeting and recombination events as shown in Figure 3 . Chimeras were generated from these four positive clones by embryo transfer. The chimeras were then reverse mated on the genetic background C57 / BL6 to generate transgenic males. Transgenic males were crossed with females to produce F1 showing heterozygosity for the MASP-2 gene in which 50% of the offspring were destroyed. Heterozygous mice were heterozygous to produce homozygous MASP-2 deficient offspring, producing 1: 2: 1 heterozygosity and wild type mice, respectively.

Results and phenotypes: The resulting homozygous MASP-2 - / - deficient mice were found to be viable and fertile, and were confirmed by southern blot to identify correct targeting events, Northern blot to confirm the absence of MASP-2 mRNA It was confirmed by blotting and MASP-2 deficiency by Western blot to confirm absence of MASP-2 protein (data not shown). The presence of MAp19 mRNA and the absence of MASP-2 mRNA were further confirmed using time-resolved RT-PCR on a LightCycler instrument. MASP-2 - / - mice expressed MAp19, MASP-1, and MASP-3 mRNA and protein as expected (data not shown). The presence and abundance of mRNA for propersin, factor B, factor D, C4, C2, and C3 in MASP-2 - / - mice was assessed by LightCycler analysis and found to be identical to the wild-type colostrum control (data not shown) city). Plasma of homozygous MASP-2 - / - mice is completely deficient in lectin-pathway-mediated complement activation as further described in Example 2.

Generation of MASP-2 - / - Strains of pure C57BL6 background: MASP-2 - / - mice were backcrossed for nine generations with pure C57BL6 strain before use of the MASP-2 - / - strain as an experimental animal model.

Transgenic mouse strains expressing murine MASP-2 - / -, MAp19 + / + and human MASP-2 transgene genes (murine MASP-2 knock-out and human MASP-2 knock-in) I created it as follows:

Materials and Methods: We configure: (49 SEQ ID NO), the mini-gene encoding the human MASP-2, called "mini hMASP-2" comprises a promoter region of the human MASP 2 gene, as shown in Figure 4 Length MASP-2 protein driven by an endogenous promoter, including a cDNA sequence that provides the first three exons (exons 1 to 3) followed by the next eight exon coding sequences. In order to replace the deficient murine MASP 2 gene by the human MASP-2 expression by a transgenic mini hMASP-2 construct MASP-2 - was injected into fertilized eggs of - /.

Example 2

This example demonstrates that MASP-2 is required for complement activation through the lectin pathway.

Methods and Materials:

Lectin specific C4 cleavage path black:. C4 cut test for measuring, lectin activation path generated from the Lipoic table Kosan (LTA) of Staphylococcus aureus to bind to L- picoline is Petersen, et al, J. Immunol. Methods 257 : 107 (2001). The assay described in Petersen et al., (2001) was used to measure lectin pathway activation via MBL by coating plates with LPS and mannan or chimosaccharide before adding sera from ASP-2 - / - mice as described below . The assay was also modified to eliminate the possibility of C4 cleavage due to the classical pathway. This was accomplished using a sample dilution buffer containing 1 M NaCl which allowed for high affinity binding of the lectin pathway recognition element to the ligand but also prevented the activation of endogenous C4, thereby dissociating the C1 complex, We exclude participation. As briefly described, a serum sample (diluted in high salt (1 M NaCl) buffer) was added to the ligand-coated plate in a modified assay followed by the addition of a constant amount of purified C4 Was added. The bound recognition complex containing MASP-2 cleaves C4, resulting in C4b deposition.

Test method:

1) Nunc Maxisorb microtiter plates (MaxiSorb ^® , Nunc, catalog number 442404, Fisher Scientific) were mixed with 1 μg / ml mannitol diluted in coating buffer (15 mM Na ₂ CO ₃ , 35 mM NaHCO ₃ , pH 9.6) ) Or any other ligand (e. G., Those listed below).

The following reagents were used for the assay:

a. (1 μg / well in 100 μl coating buffer (M7504 Sigma)):

b. Chymosan (1 [mu] g / well in 100 [mu] l coating buffer (Sigma);

c. LTA (1 [mu] g / well in 100 [mu] l coating buffer or 2 [mu] g / well in 20 [mu]

d. 1 μg of H-picoline-specific Mab 4H5 in coating buffer

e. PSA (2 μg / well in 100 μl coating buffer) of Aerococcus viridans

f. 100 μl / well (OD ₅₅₀ = 0.5) of formalin-fixed Staphylococcus aureus DSM20233 in coating buffer.

2) Plates were incubated overnight at 4 ° C.

3) After overnight incubation, the residual protein binding sites were washed with 0.1% HSA-TBS blocking buffer (10 mM Tris-CL, 140 mM NaCl, 0.1 mM (w / v) HSA in 1.5 mM NaN ₃ , pH 7.4) For 1-3 hours and then the plate was washed three times with TBS / tween / Ca ²⁺ (TBS containing 0.05% Tween 20 and 5 mM CaCl ₂ , 1 mM MgCl ₂ , pH 7.4) .

4) The serum sample to be tested was diluted in MBL-binding buffer (1 M NaCl) and the diluted sample was added to the plate and incubated overnight at 4 ° C. Wells that received only the buffer solution were used as a negative control.

5) After overnight incubation at 4 ° C, the plate was washed three times with TBS / tween / Ca ²⁺ . Then 100 μl / well of 1 μg / ml diluted in human C4 (4 mM barbiturate, 145 mM NaCl, 2 mM CaCl ₂ , 1 mM MgCl ₂ , pH 7.4) was added to the plates and incubated at 37 ° C Lt; / RTI &gt; for 90 minutes. Plates were washed again with TBS / tween / Ca ²⁺ three times.

6) C4b deposition was detected with alkaline phosphatase-conjugated chicken anti-human C4c (diluted 1: 1000 in TBS / tween / Ca ²⁺ ), which was added to the plate and incubated at room temperature for 90 minutes. The plate was then washed three times with TBS / tween / Ca ²⁺ again.

7) 100 μl of p -nitrophenyl phosphate substrate solution was added, incubated at room temperature for 20 minutes, and an alkaline phosphatase was detected by reading OD ₄₀₅ in a microtiter plate reader

Results: Figures 5A-B were compared in serum dilutions of MASP-2 + / + (cruciform), MASP-2 +/- (closed circles) and MASP-2- (closed triangles) (Fig. 5B). Figure 5C depicts MASP-2 - / + expression in relation to wild type mice (n = 5) based on measurement of the amount of normalized C4b deposition on wild type sera on plates coated with chimosan (white rod) (N = 5) and MASP-2 - / - mice (n = 4). The error bars represent the standard deviation. As shown in Figures 5A-C, the plasma of MASP-2 - / - mice is completely deficient in lectin-pathway mediated complement activation in mannan and chymosan coated plates. These results clearly demonstrate that MASP-2 is an effector component of the lectin pathway.

Recombinant MASP-2 restores lectin pathway-dependent C4 activation in the serum of MASP-2 - / - mice.

In order to establish that the absence of MASP-2 is a direct cause of loss of lectin pathway-dependent C4 activation in MASP-2 - / - mice, the additional effect of recombinant MASP- . Functionally active murine and MASP-2 and catalytically inactive murine MASP-2A recombinant proteins are generated as described in Example 3 below, wherein the active-site serine residue of the serine protease domain is substituted for the alanine residue, Respectively. The serum collected from four MASP-2 - / - mice was preincubated with recombinant murine and MASP-2 or inactive recombinant mice and MASP-2A with increasing protein concentrations and the C4 converter activity was assayed as described above.

Results: As shown in FIG. 6, the addition of functionally active rat and recombinant MASP-2 protein (expressed in open triangles) to serum obtained from MASP-2 - / - mice resulted in a protein concentration- While the catalytically inactive rat and MASP-2A protein (marked with an asterisk) did not restore C4 activation. The results shown in Figure 6 are normalized for C4 activation (indicated by the dashed line) observed with the collected wild type mouse serum.

Example 3

This example describes recombinant expression and protein production of recombinant full-length human, rat and murine MASP-2, MASP-2 derived polypeptides, and mutant forms inactivated by the catalysis of MASP-2.

Expression of full-length human, murine and rat MASP-2:

The full length cDNA sequence (SEQ ID NO: 4) of human MASP-2 was also subcloned with the mammalian expression vector pCI-Neo (Promega), which drives eukaryotic expression under control of the CMV enhancer / promoter region (Kaufman RJ et al., Nucleic Acids Research 19 : 4485-90, 1991; Kaufman, Methods in Enzymology , 185 : 537-66 (1991)). Full-length mouse cDNA (SEQ ID NO: 50) and rat MASP-2 cDNA (SEQ ID NO: 53) were subcloned into pED expression vectors, respectively. The MASP-2 expression vector was then transfected with the adherent Chinese hamster ovary DXB1 using the standard calcium phosphate transfection procedure described in Maniatis et al., 1989. Cells transfected with this construct grew very slowly, indicating that the encoded protease is cytotoxic.

In another approach, a minigene construct (SEQ ID NO: 49) containing a human cDNA of MASP-2 driven by an endogenous promoter was transiently transfected with Chinese hamster ovary cells (CHO). The human MASP-2 protein is secreted into the culture medium and isolated as described below.

Expression of full-length catalytically inactive MASP-2:

Basis: MASP-2 is activated by autocatalytic cleavage after the recognition sub-component MBL or picoline (L-picoline, H-picoline or M-picoline) binds to each carbohydrate pattern. Autocatalytic cleavage resulting in activation of MASP-2 often occurs during the separation of MASP-2 in serum or during purification after recombinant expression. In order to obtain a more stable protein preparation used as an antigen, the catalytic inactive form of MASP-2 designated as MASP-2A was replaced with a serine residue present in the catalytic triplet of the protease domain (from SEQ ID NO: 55 Ser617 to Ala617) ; In mice (from SEQ ID NO: 52 Ser617 to Ala617); Or in humans (from SEQ ID NO: 6 Ser618 to Ala618) alanine residues.

To generate catalytically inactive human and murine MASP-2A proteins, site-specific mutagenesis was performed using the oligonucleotides shown in Table 5. The oligonucleotides in Table 5 were designed to anneal to regions of human and murine cDNA encoding enzymatically active serine and the oligonucleotides included mismatches to replace serine codons with alanine codons. For example, PCR oligonucleotides SEQ ID NO: 56-59 were combined with human MASP-2 cDNA (SEQ ID NO: 4) to amplify regions from the start codon to the enzymatically active serine and from the serine to the termination codon To generate a complete open reading frame of the mutated MASP-2A containing the Ser618 to Ala618 mutation. The PCR product was purified after agarose gel electrophoresis and band fabrication and a standard tailing procedure was used to generate a single adenosine duplication. MASP-2A with adenosine tail was then cloned into a pGEM-T isotype vector and transformed into E. coli.

SEQ ID NO: 64 and SEQ ID NO: 65 were annealed, and the two oligonucleotides were combined in the same molar amount, heated at 100 DEG C for 2 minutes, and slowly cooled to room temperature to obtain a catalytically inactive rat MASP-2A Protein. The resulting annealing fragment was inserted at the position of the Pst1-XbaI fragment of the wild-type rat MASP-2 cDNA (SEQ ID NO: 53) with Pstl and Xba1 compatible ends to generate rat MASP-2A.

5 'GAGGTGACGCAGGAGGGGCATTAGTGTTT 3' (SEQ ID NO: 64)

5 'CTAGAAACACTAATGCCCCTCCTGCGTCACCTCTGCA 3' (SEQ ID NO: 65)

Human, rat and rat MASP-2A were further subcloned into either the mammalian expression vector pED or pCI-Neo, respectively, as described below and transfected with Chinese hamster ovary cell line DXB1.

In another approach, MASP-2 in the catalytic inactive form was prepared according to Chen et al., J. Biol. Chem. , 276 (28): 25894-25902, 2001. Briefly, plasmids containing full-length human MASP-2 cDNA (Thiel et al., Nature 386 : 506, described in 1997) were digested with Xho 1 and EcoR 1 and ligated into MASP-2 cDNA (SEQ ID NO: 4) is cloned into the corresponding restriction sites of the pFastBac1 baculovirus transfer vector (Life Technologies, NY). Subsequently, the double-stranded oligonucleotides encoding the peptide region amino acids 610-625 (SEQ ID NO: 13) were substituted with the intrinsic domain amino acids 610 to 625 to generate the MASP-2 full-length polypeptide with the inactive protease domain The MASP-2 serine protease active site of Ser618 is changed to Ala618.

Construction of the expression plasmid-containing polypeptide region derived from human MASP-2.

The following constructs were generated using the MASP-2 signal peptide (residues 1-15 of SEQ ID NO: 5) to secrete the various domains of MASP-2. The structure expressing the human MASP-2 CUBI domain (SEQ ID NO: 8) was amplified by amplifying the region encoding the residues 1-121 of MASP-2 (SEQ ID NO: 6) (corresponding to the N-terminal CUBI domain) PCR. The structure expressing the human MASP-2 CUBIEGF domain (SEQ ID NO: 9) was amplified by amplifying the region encoding the residues 1-166 of MASP-2 (SEQ ID NO: 6) (corresponding to the N-terminal CUBIEGF domain) PCR. The structure expressing the human MASP-2 CUBIEGFCUBII domain (SEQ ID NO: 10) was amplified (corresponding to the N-terminal CUBIEGFCUBII domain) encoding the residue residue 1-293 of MASP-2 (SEQ ID NO: 6) Lt; / RTI &gt; The above-mentioned domains were amplified by PCR using Vent _R polymerase and pBS-MASP-2 as template according to the established PCR method. Sense primer 5 'primer sequence (5'-CG GGATCC ATGAGGCTGCTGACCCTC-3, SEQ ID NO: 34) introduces a Bam HI restriction site (underlined) at the 5' end of the PCR product. Antisense primers for each of the MASP-2 domains shown in Table 5 below are designed to introduce the Eco RI site (underlined) following the termination codon (bold) at the end of each PCR product. Once amplified, the DNA fragment is digested with Bam HI and Eco RI and cloned into the corresponding site of the pFastBacl vector. The resulting structure is characterized by restriction mapping and confirmed by dsDNA sequencing.

MASP-2 PCR primer MASP-2 domain 5 'PCR primer 3 'PCR primer SEQ ID NO: 8
CUBI (aa 1-121 of SEQ ID NO: 6) GGATCC-3 ATGAGGCTGCTGACCCTC 5'CG '(SEQ ID NO: 34) 5 ' G GAATTC CTAGGCTGCATA (SEQ ID NO: 35) SEQ ID NO: 9
CUBIEGF (aa 1-166 of SEQ ID NO: 6) GGATCC-3 ATGAGGCTGCTGACCCTC 5'CG '(SEQ ID NO: 34) 5 'G GAATTC CTACAGGGCGCT-3' (SEQ ID NO: 36) SEQ ID NO: 10CUBIEGFCUBII (aa 1-293 of SEQ ID NO: 6) GGATCC-3 ATGAGGCTGCTGACCCTC 5'CG '(SEQ ID NO: 34) 5 'G GAATTC CTAGTAGTGGAT 3' (SEQ ID NO: 37) SEQ ID NO: 4
Human MASP-2 5 'ATGAGGCTGCTGACCCTCCTGGGCCTTC 3' (SEQ ID NO: 56) hMASP-2_ forward 5 'TTAAAATCACTAATTATGTTCTCGATC 3' (SEQ ID NO: 59) hMASP-2_ reverse direction SEQ ID NO: 4
Human MASP-2 cDNA 5 'CAGAGGTGACGCAGGAGGGGCAC 3' (SEQ ID NO: 58) hMASP-2_ala_ forward 5'GTGCCCCTCCTGCGTCACCTCTG 3 '(SEQ ID NO: 57) hMASP-2_ala_ reverse direction SEQ ID NO: 50
Mouse and MASP-2 cDNA 5 'ATGAGGCTACTCATCTTCCTGG3' (SEQ ID NO: 60) mMASP-2_ forward 5 'TTAGAAATTACTTATTATGTTCTCAATCC3' (SEQ ID NO: 63) mMASP-2_ reverse direction SEQ ID NO: 50
Mouse and MASP-2 cDNA 5 'CCCCCCCTGCGTCACCTCTGCAG3' (SEQ ID NO: 62) mMASP-2_ala_ forward 5 'CTGCAGAGGTGACGCAGGGGGGG 3' (SEQ ID NO: 61) mMASP-2_ala_ reverse direction

Recombinant eukaryotic cell expression of MASP-2 and protein production of enzymatically inactive mouse, rat, and human MASP-2A

The MASP-2 and MASP-2A expression constructs described above were transfected into DXB1 cells using a standard calcium phosphate transfection procedure (Maniatis et al., 1989). MASP-2A was generated in serum-free medium to ensure that the preparation was not contaminated with other serum proteins. The medium was harvested from fusogenic cells every two weeks (total 4 times). The level of recombinant MASP-2A is on average approximately 1.5 mg / liter of the culture medium for each of the three species.

MASP-2A Protein Purification: MASP-2A (Ser-Ala mutation described above) was purified by affinity chromatography on an MBP-A-agarose column. This strategy enables rapid purification without the use of irrelevant tags. MASP-2A (100-200 ml in media diluted with the same volume of loading buffer (50 mM Tris-Cl, pH 7.5 containing 150 mM NaCl and 25 mM CaCl ₂ ) was preincubated with 10 ml loading buffer MBP- Agarose affinity column (4 ml). After washing with 10 ml of additional loading buffer, proteins were eluted in 1 ml fractions with 50 mM Tris-Cl, pH 7.5, containing 1.25 M NaCl and 10 mM EDTA. Fractions containing MASP-2A were identified by SDS-polyacrylamide gel electrophoresis. If necessary, MASP-2A was purified by ion-exchange chromatography on a MonoQ column (HR 5/5). The protein was dialyzed against 50 mM Tris-Cl pH 7.5 containing 50 mM NaCl and loaded onto the equilibrated column in the same buffer. After washing, bound MASP-2A was eluted with a 0.05-1 M NaCl gradient at 10 ml.

Results: The yield of 0.25-0.5 mg of MASP-2A protein was obtained from 200 ml of medium. The molecular mass of 77.5 kDa as measured by MALDI-MS is determined to be greater than the calculated value of the unmodified polypeptide (73.5 kDa) due to glycosylation. Attachment of glycans at each N- glycosylation site accounts for the observed mass. MASP-2A migrates on a single band on SDS-polyacrylamide gel, demonstrating that it was not engineered by protein hydrolysis during biosynthesis. The weight-average molecular mass measured by equilibrium ultracentrifugation is in agreement with the calculated value for the homodimer of the glycosylated polypeptide.

Generation of Recombinant Human MASP-2 Polypeptide

Another method for generating recombinant MASP-2 and MASP2A derived polypeptides is described in Thielens, NM, et al., J. Immunol. 166: 5068-5077, 2001. Briefly, Spodoptera frugiperda insect cells (Ready-Plaque Sf9 cells from Novagen, Madison, Wis.) Were supplemented with 50 IU / ml penicillin and 50 mg / ml streptomycin (Life Technologies) Grow and maintain in Sf900II serum-free medium (Life Technologies). Trichoplusia ni (High Five) insect cells (provided by Jadwiga Chroboczek, Institut de Biologie Structurale, Grenoble, France) were inoculated into 10% FCS supplemented with 50 IU / ml penicillin and 50 mg / ml streptomycin Dominique Dutscher, Brumath, France) (Life Technologies). Virus Recombinant baculovirus was generated using the Bac-to-Bac System ^® (Life Technologies). Bacmid DNA was purified using a Qiagen midiprep purification system (Qiagen) and used to transfect Sf9 insect cells using cell pectin in Sf900 II SFM medium (Life Technologies) as described in the manufacturer's protocol do. Recombinant viral particles were harvested 4 days later, titrated with viral plaque assay, and King and Possee, in The Baculovirus Expression System: A Laboratory Guide , Chapman and Hall Ltd., London, pp. 0.0 &gt; 111-114, &lt; / RTI &gt;

High Five cells (1.75 x 10 ⁷ cells / 175-cm ² tissue culture flasks) were infected with recombinant virus containing MASP-2 polypeptide at 28 ° C for 96 h in a multiplicity of infection of 2 in Sf900 II SFM medium. The supernatant is collected by centrifugation and diisopropylphosphorofluidide is added to a final concentration of 1 mM.

The MASP-2 polypeptide is branched in the culture medium. The culture supernatant was dialyzed against 50 mM NaCl, 1 mM CaCl ₂ , 50 mM triethanolamine hydrochloride, pH 8.1 and equilibrated with Q-Sepharose Fast Flow column (Amersham Pharmacia Biotech) (2.8 x 12 cm ) At 1.5 ml / min. Elution is performed by applying a 1.2-liter linear gradient to 350 mM NaCl in the same buffer. To recombinant MASP-2 Poly the fraction containing the peptide identified by Western blot analysis and, 60% (w / v) (NH 4) was precipitated by the addition of ₂ SO _4, place left overnight at 4 ℃. Applied to the pellets _{145 mM NaCl, 1 mM CaCl 2} , 50 mM triethanolamine hydrochloride, TSK G3000 SWG column (7.5 x 600 mm) (Tosohaas , Montgomeryville, PA) The resuspended in pH 7.4, equilibrated with the same buffer do. The purified polypeptide is then concentrated to 0.3 mg / ml (mw cut-off = 10,000) (Filtron, Karlstein, Germany) by ultracentrifugation on a Microsep microcentrifuge.

Example 4

This example describes a method for generating a polyclonal antibody to a MASP-2 polypeptide.

Materials and Methods:

MASP-2 Antigen: A polyclonal anti-human MASP-2 antiserum is produced by immunizing rabbits with the following isolated MASP-2 polypeptides: human MASP-2 isolated from serum (SEQ ID NO: 6); Recombinant human MASP-2 (SEQ ID NO: 6), MASP-2A comprising the inactive protease domain (SEQ ID NO: 13) as described in Example 3; And recombinant CUBI (SEQ ID NO: 8), CUBEGFI (SEQ ID NO: 9), and CUBEGFCUBII (SEQ ID NO: 10) expressed as described in Example 3.

Polyclonal antibody: A 6-week-old rabbit primed with BCG (bacillus Calmette-Guerin vaccine) was incubated with 100 μg of MASP-2 polypeptide at 100 μg / ml in sterile saline solution Injection to immunize. Scans are performed every 4 weeks and antibody titers are monitored by ELISA assays as described in Example 5. [ The culture supernatant is collected for antibody purification by protein A affinity chromatography.

Example 5

This example describes a method for generating a murine monoclonal antibody to a rat or human MASP-2 polypeptide.

Materials and Methods:

8-12 week old male A / J mice (Harlan, Houston, Tex.) Were inoculated with 100 μg human or rat rMASP (Invitrogen) in complete Freund's adjuvant (Difco Laboratories, Detroit, Mich.) In 200 μl phosphate buffered saline -2 or rMASP-2A polypeptide (prepared as described in Example 3 ). At 2-week intervals, mice are injected subcutaneously twice with 50 [mu] g of human or rat rMASP-2 or rMASP-2A polypeptide in incomplete Freund's adjuvant. At week 4 mice are injected with 50 [mu] g of human or rat rMASP-2 or rMASP-2A polypeptide in PBS and fused 4 days later.

For each fusion, a single cell suspension is prepared from the spleen of immunized mice and used for fusion to Sp2 / 0 myeloma cells. To 5x10 ⁸ of Sp2 / 0 and 5x10 ⁸ splenocytes medium containing 50% polyethylene glycol (MW 1450) (Kodak, Rochester , NY) and 5% dimethylsulfoxide (Sigma Chemical Co., St. Louis, Mo.) Lt; / RTI &gt; Cells were then cultured in Iscove's medium supplemented with 10% fetal bovine serum, 100 units / ml penicillin, 100 ug / ml streptomycin, 0.1 mM hypoxanthine, 0.4 袖 M aminopterin and 16 袖 M thymidine (Gibco, Grand Island, NY) at a concentration of ^1.5 x ¹⁰ &lt; ⁵ &gt; spleen cells per 200 [mu] l of suspension. 200 microliters of cell suspension is added to each well of about 20 96-well microflora plates. After about 10 days, the culture supernatant is recovered for screening for reactivity with purified factor MASP-2 in an ELISA assay.

ELISA Assay: The wells of Immulon ^® 2 (Dynatech Laboratories, Chantilly, Va.) Microtitre plates were incubated with 50 μl of purified hMASP-2 with 50 ng / ml rat rMASP-2 (or rMASP-2A) Lt; / RTI &gt; A low concentration of MASP-2 for coating allows for the selection of high affinity antibodies. After removing the coating solution by shaking the plate, 200 μl of BLOTTO (fat-free skim milk) in PBS is added to each well for 1 hour to block non-specific sites. After 1 hour, the wells are washed with buffer PBST (PBS containing 0.05% Tween 20). 50 microliters of the culture supernatant from each fusion well is collected, mixed with 50 microliters of BLOTTO and added to each well of the microtitre plate. After 1 hour of incubation, the wells are washed with PBST. Bound murine antibodies were detected by reaction with horseradish peroxidase (HRP) conjugated goat anti-mouse IgG (Fc specific) (Jackson ImmunoResearch Laboratories, West Grove, Pa.) And diluted 1: 2,000 in BLOTTO do. A peroxidase substrate solution of 0.1% 3,3,5,5 tetramethylbenzidine (Sigma, St. Louis, Mo.) and 0.0003% hydrogen peroxide (Sigma) is added to the wells for 30 minutes for color development. The reaction is stopped by the addition of 50 μl of 2M H ₂ SO ₄ per well. The optical density at 450 nm of the reaction mixture is read with ^{(. BioTek ® Instruments, Winooski,} Vt) BioTek ® ELISA Reader.

MASP-2 binding assay:

The binding affinity of the MASP-2 inhibitor to MASP-2 can be determined by testing the culture supernatant that is positive in the MASP-2 ELISA assay described above with a binding assay. Similar assays can also be used to determine if inhibitors bind to other antigens in the complement system.

MASP-2 (20 ng / 100 μl / well in phosphate-buffered saline (PBS) pH 7.4, Advanced Research Technology, San Diego, Calif.) Was added to the polystyrene microtiter plate wells (96- , CA) overnight at &lt; RTI ID = 0.0 &gt; 4 C. &lt; / RTI &gt; After the MASP-2 solution is drained, the wells are blocked with PBS containing 1% bovine serum albumin (BSA; Sigma Chemical) for 2 h at room temperature. MASP-2 uncoated wells serve as background controls. A hybridoma supernatant or a partially sampled solution of purified anti-MASP-2 MoAb is added to the wells at various concentrations in the blocking solution. After 2 h incubation at room temperature, the wells are extensively rinsed with PBS. MASP-2-linked anti-MAASP-2 MoAb is detected by addition of peroxidase-conjugated goat anti-mouse IgG (Sigma Chemical) in blocking solution, which is incubated for 1 h at room temperature. The plate is again rinsed thoroughly with PBS and 100 μl of 3,3 ', 5,5'-tetramethylbenzidine (TMB) substrate (Kirkegaard and Perry Laboratories, Gaithersburg, MD) is added. The reaction of TMB is quenched by the addition of 100 [mu] l of 1M phosphoric acid and the plate is read at 450 nm in a microplate reader (SPECTRA MAX 250, Molecular Devices, Sunnyvale, Calif.).

The culture supernatants of positive wells are tested for their ability to inhibit complement activation in functional assays such as C4 cleavage assays as described in Example 2. [ Cells of positive wells are cloned by limiting dilution. The MoAb is retested in an ELISA assay as described above for its reactivity with hMASP-2. Selected hybridomas are grown in spinner flasks and the spent culture supernatant is collected for antibody purification by protein A affinity chromatography.

Example 6

This example describes the generation and production of humanized murine and anti-MASP-2 antibodies and antibody fragments.

Mouse anti-MASP-2 monoclonal antibodies are generated in male A / J mice as described in Example 5 . The murine antibody is humanized as described below to reduce immunogenicity by replacing the murine and constant region with a human counterpart to produce a Fab of chimeric IgG and an antibody, which in accordance with the invention is a MASP-2-dependent complement It is useful for suppressing side effects of activation.

1. Cloning of anti-MASP-2 variable region gene of murine hybridoma cells. Total RNA is isolated from hybridoma cells (obtained as described in Example 7 ) which secrete anti-MASP-2 MoAb using RNAzol according to the protocol of the manufacturer (Biotech, Houston, Tex.). First strand cDNA was synthesized from total RNA using oligo dT as a primer. PCR is performed using a leader peptide of the murine V _H or V _K gene as an immunoglobulin constant C region-derived 3 'primer and a 5' primer or a set of modified primers derived from the first framework region. Immobilized PCR is performed as described by Chen and Platsucas (Chen, PF, Scand. J. Immunol. 35: 539-549, 1992). In order to clone the V _K gene, double-stranded cDNA a Notl-MAK1 primer (5'-TGCGGCCGCTGTAGGTGCTGTCTTT-3 'SEQ ID NO: 38) prepared using the. The annealed adapter AD1 (5'-GGAATTCACTCGTTATTCTCGGA-3 'SEQ ID NO: 39) and AD2 (5'-TCCGAGAATAACGAGTG-3' SEQ ID NO: 40) were ligated to both the 5 'and 3' ends of the double- . Remove the adapter at the 3 'end by Notl decomposition. The digested product is then used in PCR with AD1 oligonucleotide as a 5 'primer as a template and MAK2 (5'-CATTGAAAGCTTTGGGGTAGAAGTTGTTC-3' SEQ ID NO: 41) as a 3 'primer. A DNA fragment of approximately 500 bp is cloned into pUC19. Multiple clones are selected for sequencing to confirm that the cloned sequence contains the predicted murine and immunoglobulin constant regions. Not1-MAK1 and MAK2 oligonucleotides are nucleotide downstream of the 182 and 84 bp of the first base pair of the C kappa gene derived respectively from the V _K region. Select clones containing complete V _K and leader peptide.

To clone the V _H gene, double-stranded cDNA is prepared using the Notl MAGl primer (5'-CGCGGCCGCAGCTGCTCAGAGTGTAGA-3 'SEQ ID NO: 42). The annealed adapters AD1 and AD2 are ligated to both the 5 ' and 3 ' ends of the double-stranded cDNA. Remove the adapter at the 3 'end by Notl decomposition. The digested product is used in PCR as a template with AD1 oligonucleotide and MAG2 (5'-CGGTAAGCTTCACTGGCTCAGGGAAATA-3 'SEQ ID NO: 43) as primers. A DNA fragment of 500 to 600 bp in length is cloned into pUC19. The Notl-MAG1 and MAG2 oligonucleotides are derived from the murine and C [gamma] .7.1 regions and are 180 and 93 bp downstream of the first bp of the murine C [gamma] .7.1 gene, respectively. Select clones containing complete V _H and leader peptide.

2. Construction of expression vector for chimeric MASP-2 IgG and Fab. The cloned V _H and V _K genes described above are used as templates for PCR reactions to add a splice donor at the 5 'end of the nucleotide sequence and a Kozak common sequence and 3' end. After analyzing the sequence to determine the absence of PCR errors, V _H and V _K C human genes, respectively. _{lt; RTI ID} = 0.0 _&gt; pSV2neoVH-huCy1 _{&lt; /} RTI &_gt; And pSV2neoV-huCy. COS cells are transfected by electroporation using CsCl gradient-purified plasmid DNA of heavy and light chain vectors. After 48 hours, the culture supernatant is tested by ELISA to confirm the presence of approximately 200 ng / ml of chimeric IgG. Cells are harvested to produce total RNA. First strand cDNA was synthesized from total RNA using oligo dT as a primer. This cDNA is used as a template in PCR to generate Fd and kappa DNA fragments. PCR was performed on the Fd gene using 5'-AAGAAGCTTGCCGCCACCATGGATTGGCTGTGGAACT-3 '(SEQ ID NO: 44) and CH1-derived 3' primer (5'-CGGGATCCTCAAACTTTCTTGTCCACCTTGG-3 'SEQ ID NO: 45) as 5' primers do. Verify that the DNA sequence contains the complete V _H and CH1 domains of human IgG1. After digestion with the appropriate enzymes, the Fd DNA fragment is inserted into HindIII and BamHI restriction sites of the expression vector cassette pSV2dhfr-TUS to provide pSV2dhfrFd. The pSV2 plasmid is commercially available and consists of DNA segments from a variety of sources: pBR322 DNA (thin line) contains the pBR322 origin (pBR ori) of DNA replication and the lactamase ampicillin resistance gene (Amp); The SV40 DNA displayed and displayed as a wider hatching contains the SV40 origin (SV40 ori) of DNA replication, the early promoter (5 'for the dhfr and neo genes) and the polyadenylation signal (3' for the dhfr and neo genes) . The SV40-derived polyadenylation signal (pA) is also placed at the 3 'end of the Fd gene.

With respect to the kappa gene, "5'- AAGAAAGCTTGCCGCCACCATGTTCTCACTAGCTCT-3 as primers, 5: -: a PCR using a (SEQ ID NO 46), and C _K derived from the 3 '(Primer 47 5'-CGGGATCCTTCTCCCTCTAACACTCT-3' SEQ ID NO) . Verify that the DNA sequence contains complete V _K and human C _K regions. After digestion with appropriate restriction enzymes, kappa DNA fragments are inserted into HindIII and BamHI restriction sites of the expression vector cassette pSV2neo-TUS to provide pSV2neoK. Expression of Fd and kappa genes is driven by HCMV-derived enhancer and promoter elements. Because the Fd gene does not contain cysteine amino acid residues involved in interchain disulfide bonds, the recombinant chimeric Fabs include heavy and light chains coupled by non-covalent bonds. This chimeric Fab is designated cFab.

To obtain a recombinant Fab with heavy and light chain disulfide bonds, the Fd gene may be extended to include the coding sequence for an additional 9 amino acids (EPKSCDKTH SEQ ID NO: 48) in the hinge region of human IgG1. The BstEII-BamHI DNA segment encoding 30 amino acids at the 3 'end of the Fd gene can be replaced with a DNA segment encoding the extended Fd, generating pSV2dhfrFd / 9aa.

3. Expression and purification of chimeric anti-MASP-2 IgG

To generate cell lines that secrete chimeric anti-MASP-2 IgG, NSO cells are transfected with purified plasmid DNA of pSV2neoV _H -huC. Gamma 1 and pSV2neoV-huC kappa by electroporation. Transfected cells are selected in the presence of 0.7 mg / ml G418. Cells are grown in 250 ml spinner flasks using serum-containing medium.

The culture supernatant of the 100 ml spinner culture is loaded onto a 10-ml PROSEP-A column (Bioprocessing, Inc., Princeton, N.J.). The column is washed with 10 volumes of PBS. The bound antibody is eluted with 50 mM citrate buffer, pH 3.0. The pH is adjusted to 7.0 by adding the same volume of 1 M Hepes, pH 8.0, to the fraction containing the purified antibody. The residual salts are removed by buffer exchange with PBS by Millipore membrane ultrafiltration (M.W. Cutoff: 3,000). The protein concentration of the purified antibody is determined by the BCA method (Pierce).

4. Expression and purification of chimeric anti-MASP-2 Fab

To generate cells that secrete chimeric anti-MASP-2 Fab, CHO cells are transfected by electroporation with purified plasmid DNA of pSV2dhfrFd (or pSV2dhfrFd / 9aa) and pSV2neokappa. Transfected cells are selected in the presence of G418 and methotrexate. Selected cell lines are amplified in increasing concentrations of methotrexate. Cells are single cells cloned by limiting dilution. High production single cell subcloned cell lines are grown in 100 ml spinner culture using serum-free medium.

Chimeric anti-MAASP-2 Fab is purified by affinity chromatography using mouse anti-idiotype MoAb against MASP-2 MoAb. Mice were immunized with keyhole limpet hemocyanin (KLH) conjugated murine anti-MAASP-2 MoAb and screened for specific MoAb binding that could compete with human MASP-2 to generate anti-idiotype MASP-2 MoAb Can be produced. For purification, 100 ml of the supernatant of the spinner culture of CHO cells producing cFab or cFab / 9aa is loaded into an affinity column coupled with anti-idiotype MASP-2 MoAb. The column is washed thoroughly with PBS before the bound Fab is eluted with 50 mM diethylamine, pH 11.5. The residual salt is removed by buffer exchange as described above. The protein concentration of the purified Fab is determined by the BCA method (Pierce).

The ability of chimeric MASP-2 IgG, cFab, and cFAb / 9aa to inhibit the MASP-2-dependent complement pathway can be determined using the inhibition assays described in Example 2 or Example 7.

Example 7

This example demonstrates that in vitro assays used as functional screening to identify MASP-2 inhibitors that can block MASP-2-dependent complement activation via L-picoline / P35, H-picoline, M- Describe the C4 cut test.

C4 cleavage assays: C4 cleavage assays are described in Petersen, SV, et al., J. Immunol. Methods 257: 107, 2001, which measures lectin pathway activation resulting from lipoteichoic acid (LTA) of Staphylococcus aureus binding to L-picoline.

Reagent: Formalin-fixed S. aureous (DSM20233) is prepared as follows: Bacteria are grown in tryptic soy blood medium at 37 &lt; 0 &gt; C overnight, After three washes with PBS, the cells were fixed in PBS / 0.5% formalin for 1 h at room temperature and further incubated with PBS for 3 h before resuspension in coating buffer (15 mM Na ₂ CO ₃ , 35 mM NaHCO ₃ , pH 9.6) Wash thoroughly.

Test: Wells of a Nunc MaxiSorb ^® microtiter plate (Nalgene Nunc International, Rochester, NY) were coated with 1 μg of L-picoline in coating buffer with formalin-fixed Staphylococcus aureus DSM20233 (OD ₅₅₀ = 0.5). After overnight incubation, the wells were blocked with 0.1% human serum albumin (HSA) in TBS (10 mM Tris-HCl, 140 mM NaCl, pH 7.4) and then incubated in TBS containing 0.05% Tween 20 and 5 mM CaCl ₂ (Washing buffer). Human serum samples are diluted in 20 mM Tris-HCl, 1 M NaCl, 10 mM CaCl ₂ , 0.05% Triton X-100, 0.1% HSA, pH 7.4, which prevents the activation of endogenous C4 and cleaves C1 complexes And C1s) are dissociated. MASP-2 inhibitors, including anti-MASP-2 MoAbs and inhibitory peptides, are added to serum samples at various concentrations. The diluted sample is added to the plate and incubated overnight at &lt; RTI ID = 0.0 &gt; 4 C. &lt; / RTI &gt; After 24 hours, thoroughly washing the plate with Washing Buffer, and then, 4 mM barbiturates, 145 mM NaCl, 2 mM CaCl 2, 1 mM MgCl 2, pH 7.4 100 μl of human C4 (Dodds, AW purification of, Methods Enzymol . & Lt; / RTI & gt ; 223: 46, 1993) are added to each well. After 1.5 h at 37 [deg.] C, the plate was washed again and C4b deposition was detected using an alkaline phosphatase-conjugated chicken anti-human C4c (obtained from Immunsystem, Uppsala, Sweden) and a colorless substrate ρ-nitrophenylphosphate .

C4 assays for mannan: The assays described above are adjusted to measure lectin pathway activation through MBL by coating plates with LSP and mannan before adding serum mixed with various MASP-2 inhibitors.

C4 assays for H-picoline (Hakata Ag): The assay described above was performed by coating plates with LSP and H-picoline prior to the addition of serum mixed with various MASP-2 inhibitors, Is adjusted to measure activation.

Example 8

The following test demonstrates the presence of classical pathway activation in wild-type and MASP-2 - / - mice.

Method: After in situ microtiter plates (Maxisorb ^® , Nunc, Catalog No. 442404, Fisher Scientific) were coated with 0.1% human serum albumin in 10 mM Tris, 140 mM NaCl, pH 7.4 for 1 hour at room temperature Followed by incubation overnight at 4 ° C with a 1: 1000 dilution of TBS / tween / Ca ²⁺ diluted total anti-serum anti-serum (Scottish Antibody Production Unit, Carluke, Scotland) to generate an immunocomplex. Serum samples were obtained from wild-type and MASP-2 - / - mice and added to coated plates. A C1q-depleted control sample is prepared from wild-type and MASP-2 - / - sera samples. Rabbit anti according to the instructions provided by the supplier - C1q- produce a depleted mouse serum using human C1q IgG (Dako, Glostrup, Denmark ) with Protein -A- coupled Dyna Beads ^{® (Dynal Biotech, Oslo, Norway} ) coated with ring Respectively. Plates were incubated at 37 [deg.] C for 90 minutes. The bound C3b was detected with a polyclonal anti-human-C3c antibody (Dako A 062) diluted 1: 1000 in TBS / tw / Ca ⁺⁺ . The second antibody is goat anti-rabbit IgG.

Results: Figure 7 shows the relative levels of C3b deposition on plates coated with IgG in wild type serum, MASP-2 - / - serum, C1q-depleted wild type and C1q-depleted MASP-2 - / - sera. These results demonstrate that the classical pathway is intact in the MASP-2 - / - mouse line.

Example 9

The following assays are used to test whether MASP-2 inhibitors block the classical pathway by analyzing the effect of MASP-2 inhibitors under conditions where the classical pathway is initiated by the immune complexes.

Methods: To test the effect of MASP-2 inhibitors on the condition of complement activation when the classical pathway is initiated by immune complexes, a 3-fold volume of 50 μl sample containing 90% NHS was incubated with 10 μg / ml immunocomplex (IC ) Or similar triple samples (+/- IC) containing 200 nM anti-proparin monoclonal antibody during incubation at 37 [deg.] C in the presence of PBS and incubated at 37 [deg.] C. After incubation at 37 [deg.] C for 2 hours, 13 mM EDTA is added to all samples to stop further complement activation and the sample is immediately cooled to 5 [deg.] C. The samples are then stored at -70 ° C before assaying for the complement activation products (C3a and sC5b-9) using ELISA kits (Quidel, catalog numbers A015 and A009) according to the manufacturer's instructions.

Example 10

This example describes the identification of a high affinity anti-MASP-2 Fab2 antibody fragment that blocks MASP-2 activity.

Background and Background: MASP-2 is a complex protein with many distinct functional domains including: binding site (s) to MBL and picoline, serine protease catalytic site, binding site for proteolytic substrate C2, The binding site for protein hydrolysis substrate C4, the MASP-2 cleavage site for self activation of MASP-2 dimention, and two Ca ⁺⁺ binding sites. Fab2 antibody fragments that bind at high affinity to MASP-2 were identified and the identified Fab2 fragments were tested in functional assays to determine if they could block MASP-2 functional activity.

To block MASP-2 functional activity, the antibody or Fab2 antibody fragment must bind to and block the structural epitope on MASP-2, which requires MASP-2 functional activity. Thus, many or all of the high affinity binding anti-MASP-2 Fab2 may not exhibit MASP-2 functional activity unless they bind to a structural epitope on MASP-2 that is directly related to MASP-2 functional activity.

Functional assays to evaluate inhibition of lectin pathway C3 convertase formation were used to evaluate the "blocking activity" of anti-MASP-2 Fab2. The main physiological role of MASP-2 in the lectin pathway is known to produce the next functional component of the lectin-mediated complement pathway, the lectin pathway C3 convertase. The lectin pathway C3 convertase is an important enzyme complex (C4bC2a) that cleaves C3 to C3a and C3b by protein hydrolysis. MASP-2 is not a structural component of the lectin pathway C3 convertase (C4bC2a); However, MASP-2 functional activity is required to produce two protein components (C4b, C2a) that contain the lectin pathway C3 convertase. In addition, all the separate activities of the MASP-2 listed above seem to be necessary for MASP-2 to produce the lectin pathway C3 convertase. For this reason, a preferred assay for use in evaluating the "blocking activity" of anti-MASP-2 Fab2 is believed to be a functional assay evaluating the inhibition of lectin pathway C3 convertase formation.

Generation of high affinity Fab2: The phage display library of human variable light and heavy chain antibody sequences and the rat MASP-2 protein (SEQ ID NO: 55) using an automated antibody selection technique to identify Fab2 that reacts with the selected ligand of interest. Lt; RTI ID = 0.0 > Fab2. &Lt; / RTI &gt; A known amount of rat MASP-2 (~ 1 mg, &gt; 85% purity) protein was used for antibody screening. Three rounds of amplification were used to select antibodies with the highest affinity. Approximately 250 different hits expressing antibody fragments were selected for ELISA screening. The high-affinity heat was then sequenced to determine the toxic properties of the different antibodies.

As described in more detail below, 50 unique anti-MAASP-2 antibodies were purified and 250 μg of each purified Fab2 antibody was used to characterize MASP-2 binding affinity and complement pathway functional tests.

The inhibition (blocking) activity of anti-MASP-2 Fab2

1. Assay to determine inhibition of lectin pathway C3 convertase formation:

Background: The lectin pathway C3 convertase is an enzyme complex (C4bC2a) that cleaves C3 to two potent proinflammatory fragments, anapylatoxin C3a and opsonin C3b, by protein hydrolysis. The formation of the C3 convertase appears to be an important step in the lectin pathway for the mediator of inflammation. MASP-2 is not a structural component of the lectin pathway C3 convertase (C4bC2a); Therefore, the anti-MAST-2 antibody (or Fab2) will not directly inhibit the activity of the existing C3 convertase. However, MASP-2 serine protease activity is required to generate two protein components (C4b, C2a) that contain the lectin pathway C3 convertase. Therefore, anti-MAASP-2 Fab2 that inhibits MASP-2 functional activity (i.e., blocks anti-MAASP-2 Fab2) will inhibit Denobo formation of the lectin pathway C3 convertase. C3 includes a specific and highly reactive thioester group as part of the structure. In this assay, upon cleavage of C3 by the C3 convertase, the thioester group on C3b may form a covalent bond with the hydroxyl or amino group on the polymer immobilized on the bottom of the plastic well via an ester or amide bond, . &Lt; / RTI &gt;

Yeast mannan is a known activator of the lectin pathway. In the following method to measure the formation of the C3 Converting Agent, the mannan coated plastic wells were incubated with diluted rat serum at 37 DEG C for 30 minutes to activate the lectin pathway. The wells were then bled and tested for C3b immobilized in the well using standard ELISA methods. The amount of C3b produced in this assay is a direct reflection of the de novo formation of the lectin pathway C3 convertase. Selected concentrations of anti-MASP-2 Fab2 were tested for their ability to inhibit C3 convertase formation and resulting C3b production in this assay.

Way:

96-well Costar Medium Binding plates were incubated overnight at 5 [deg.] C with mannan diluted to 1 [mu] g / 50 [mu] L / well in 50 mM carbonate buffer, pH 9.5. After overnight incubation, each well was washed three times with 200 [mu] L PBS. The wells were then blocked with 100 μL / well of 1% bovine serum albumin in PBS and incubated with gentle mixing at room temperature for 1 hour. Each well was then washed three times with 200 [mu] L PBS. Samples of anti-MASP-2 Fab2 were selected at 5 ° C in GVB buffer containing Ca ⁺⁺ and Mg ⁺⁺ (4.0 mM barbiturate, 141 mM NaCl, 1.0 mM MgCl ₂ , 2.0 mM CaCl ₂ , 0.1% gelatin, pH 7.4) . 0.5% rat serum was added to the sample at 5 ° C and 100 μL was transferred to each well. The plate was covered and the complement was activated by incubation in a 37 ° C water bath for 30 minutes. The reaction was stopped by transferring the plate from the 37 ° C water bath to a vessel containing the ice water mixture. Each well was washed five times with 200 μL of PBS-Tween 20 (0.05% Tween 20 in PBS) and then twice with 200 μL PBS. 100 μL / well of a 1: 10,000 dilution of the primary antibody (rabbit anti-human C3c, DAKO A0062) was added to PBS containing 2.0 mg / ml bovine serum albumin and incubated for 1 hour at room temperature with gentle mixing. Each well was washed five times with 200 μL PBS. 100 μL / well of a 1: 10,000 dilution of the secondary antibody (peroxidase-conjugated goat anti-rabbit IgG, American Qualex A102PU) was added to PBS containing 2.0 mg / ml bovine serum albumin and incubated at room temperature Lt; / RTI &gt; for 1 hr. Each well was washed five times with 200 μL of PBS. 100 [mu] L / well peroxidase substrate TMB (Kirkegaard &amp; Perry Laboratories) was added and incubated at room temperature for 10 minutes. 100 μL / well of 1.0 MH ₃ PO ₄ was added to stop the peroxidase reaction and OD ₄₅₀ was measured.

2. Assay to determine inhibition of MASP-2-dependent C4 cleavage

Background: The serine protease activity of MASP-2 was very specific and identified only two protein substrates, C2 and C4, for MASP-2. Cleavage of C4 produced C4a and C4b. Anti-MASP-2 Fab2 can bind to a structural epitope on MASP-2 (e.g., MASP-2 binding site for C4; MASP-2 serine protease catalytic site) directly involved in C4 cleavage, -2 &lt; / RTI &gt; cleavage functional activity.

Yeast mannan is a known activator of the lectin pathway. In the following method for measuring the C4 cleavage activity of MASP-2, mannan coated plastic wells are incubated with diluted rat serum at 37 DEG C for 30 minutes to activate the lectin pathway. Since the primary antibody used in this ELISA assay recognizes only human C4, the diluted rat serum also provides human C4 (1.0 μg / ml). The wells were then washed and assayed against human C4b immobilized in wells using standard ELISA methods. The amount of C4b produced in this assay is a measure of MASP-2 dependent C4 cleavage activity. Selected concentrations of anti-MASP-2 Fab2 were tested for their ability to inhibit C4 cleavage in this assay.

Method: 96-well Costar Medium Binding plates were incubated overnight at 5 ° C with 1.0 μg / 50 μL / well of diluted mannan in 50 mM carbonate buffer, pH 9.5. Each well was washed three times with 200 μL PBS. The wells were then blocked with 100 μL / well of 1% bovine serum albumin in PBS and incubated for 1 hour at room temperature with gentle mixing. Each well was washed three times with 200 μL of PBS. Wherein -MASP-2 Fab2 samples the Ca ⁺⁺ and Mg ⁺⁺ at 5 ℃ containing GVB buffer (4.0 mM barbiturates, 141 mM NaCl, 1.0 mM MgCl 2, 2.0 mM CaCl 2, 0.1% gelatin, pH 7.4) to a selected . 1.0 [mu] g / ml human C4 (Quidel) was also included in this sample. 0.5% rat serum was added to the sample at 5 ° C and 100 μL was transferred to each well. Plates were covered and incubated in a 37 ° C water bath for 30 minutes to activate complement. The reaction was stopped by transferring the plate from the 37 ° C water bath to a vessel containing the ice water mixture. Each well was washed five times with 200 [mu] L of PBS-Tween 20 (0.05% Tween 20 in PBS) and then each well was washed twice with 200 [mu] L PBS. Biotin-conjugated chicken 100 μL / well of a 1: 700 dilution of anti-human C4c (Immunsystem AB, Uppsala, Sweden) was added to PBS containing 2.0 mg / ml bovine serum albumin (BSA) Lt; / RTI &gt; for 1 hour. Each well was washed 5 times with 200 [mu] L PBS. 100 μL / well of 0.1 μg / ml peroxidase-conjugated streptavidin (Pierce Chemical # 21126) was added to PBS containing 2.0 mg / ml BSA and incubated for 1 hour at room temperature with gentle mixing. Each well was washed 5 times with 200 [mu] L PBS. 100 [mu] L / well peroxidase substrate TMB (Kirkegaard &amp; Perry Laboratories) was added and incubated at room temperature for 16 minutes. 100 μL / well of 1.0 MH ₃ PO ₄ was added to stop the peroxidase reaction and OD ₄₅₀ was measured.

3. Binding assay of anti-rat MASP-2 Fab2 to 'native' rat MASP-2

background: MASP-2 is usually present in plasma as a MASP-2 dimer complex that contains specific lectin molecules (mannose-binding protein (MBL) and picoline). Therefore, if there is an interest in studying the binding of anti-MAASP-2 Fab2 to a physiologically relevant form of MASP-2, the interaction between 'natural' MASP-2 and Fab2 in plasma, instead of the purified recombinant MASP- It is important to develop the binding assay used. In this binding assay, the 'native' MASP-2-MBL complex of 10% rat serum was first immobilized in the contacted-coated wells. The binding affinities of various anti-MASP-2 Fab2 to immobilized 'native' MASP-2 were studied using standard ELISA methodology.

Methods: 96-well Costar High Binding plates were incubated overnight at 5 ° C with mannan diluted to 1 μg / 50 μL / well in 50 mM carbonate buffer, pH 9.5. Each well was washed three times with 200 μL PBS. Wells were blocked with 100 [mu] L / well of 0.5% fat-free skim milk in PBST (PBS containing 0.05% Tween 20) and incubated for 1 hour at room temperature with gentle mixing. Each well was washed three times with 200 μL of TBS / Tween / Ca ⁺⁺ Wash buffer (Tris-buffered saline, 0.05% Tween 20, containing 5.0 mM CaCl ₂ , pH 7.4). 10% rat serum in high salt binding buffer (20 mM Tris, 1.0 M NaCl , 10 mM CaCl 2, 0.05% Triton-X100, 0.1% (w / v) bovine serum albumin, pH 7.4) was prepared on ice. 100 [mu] L / well was added and incubated overnight at 5 [deg.] C. The wells were washed three times with 200 μL of TBS / Tween / Ca ⁺⁺ wash buffer. The wells were then washed twice with 200 μL PBS. The concentration of anti-MAST-2 Fab2 diluted in Ca ⁺⁺ and Mg ⁺⁺ containing GVB buffer (4.0 mM barbitur, 141 mM NaCl, 1.0 mM MgCl ₂ , 2.0 mM CaCl ₂ , 0.1% gelatin, pH 7.4) 100 [mu] L / well was added and incubated for 1 hour at room temperature with gentle mixing. Each well was washed 5 times in 200 [mu] L PBS. 100 μL / well of HRP-conjugated goat anti-Fab2 (Biogenesis catalog number 0500-0099) diluted 1: 5000 in 2.0 mg / ml bovine serum albumin in PBS was added and incubated for 1 hour at room temperature with gentle mixing Respectively. Each well was washed five times with 200 μL PBS. 100 μL / well of peroxidase substrate TMB (Kirkegaard & Perry Laboratories) was added and incubated at room temperature for 70 minutes. 100 μL / well of 1.0 MH ₃ PO ₄ was added to stop the peroxidase reaction and OD ₄₅₀ was measured.

Methods: 96-well Costar High Binding plates were incubated overnight at 5 ° C with mannan diluted to 1 μg / 50 μL / well in 50 mM carbonate buffer, pH 9.5. Each well was washed three times with 200 μL PBS. Wells were blocked with 100 [mu] L / well of 0.5% fat-free skim milk in PBST (PBS containing 0.05% Tween 20) and incubated for 1 hour at room temperature with gentle mixing. Each well was washed three times with 200 μL of TBS / Tween / Ca ⁺⁺ Wash buffer (Tris-buffered saline, 0.05% Tween 20, containing 5.0 mM CaCl ₂ , pH 7.4). 10% rat serum in high salt binding buffer (20 mM Tris, 1.0 M NaCl , 10 mM CaCl 2, 0.05% Triton-X100, 0.1% (w / v) bovine serum albumin, pH 7.4) was prepared on ice. 100 [mu] L / well was added and incubated overnight at 5 [deg.] C. The wells were washed three times with 200 μL of TBS / Tween / Ca ⁺⁺ wash buffer. The wells were then washed twice with 200 μL PBS. The concentration of anti-MAST-2 Fab2 diluted in Ca ⁺⁺ and Mg ⁺⁺ containing GVB buffer (4.0 mM barbitur, 141 mM NaCl, 1.0 mM MgCl ₂ , 2.0 mM CaCl ₂ , 0.1% gelatin, pH 7.4) 100 [mu] L / well was added and incubated for 1 hour at room temperature with gentle mixing. Each well was washed 5 times in 200 [mu] L PBS. 100 μL / well of HRP-conjugated goat anti-Fab2 (Biogenesis catalog number 0500-0099) diluted 1: 5000 in 2.0 mg / ml bovine serum albumin in PBS was added and incubated for 1 hour at room temperature with gentle mixing Respectively. Each well was washed five times with 200 μL PBS. 100 μL / well of peroxidase substrate TMB (Kirkegaard & Perry Laboratories) was added and incubated at room temperature for 70 minutes. 100 μL / well of 1.0 MH ₃ PO ₄ was added to stop the peroxidase reaction and OD ₄₅₀ was measured.

result:

Approximately 250 different Fab2's were reacted with high affinity for rat MASP-2 protein for ELISA screening. These high affinity Fab2 were sequenced to determine the toxic properties of the different antibodies and 50 unique anti-MASP-2 antibodies were purified for further analysis. 250 [mu] g of each purified Fab2 antibody was used to characterize the MASP-2 binding affinity and complement pathway functional test. The results of this analysis are shown in Table 6 below.

Anti-MASP-2 FAB2 &lt; / RTI &gt; that blocks lectin pathway complement activation Fab2 antibody # C3 Converters
IC ₅₀ (nM) K _d C4 cutting
IC ₅₀ (nM) 88 0.32 4.1 ND 41 0.35 0.30 0.81 11 0.46 0.86 <2 nM 86 0.53 1.4 ND 81 0.54 2.0 ND 66 0.92 4.5 ND 57 0.95 3.6 <2 nM 40 1.1 7.2 0.68 58 1.3 2.6 ND 60 1.6 3.1 ND 52 1.6 5.8 <2 nM 63 2.0 6.6 ND 49 2.8 8.5 <2 nM 89 3.0 2.5 ND 71 3.0 10.5 ND 87 6.0 2.5 ND 67 10.0 7.7 ND

As shown in Table 6, among the tested 50 wherein -MASP-2 Fab2, 17 of the Fab2 was identified as MASP-2 blocking Fab2 that strongly inhibit C3 converter hydratase with IC ₅₀ of less than 10 nM Fab2 (34 % Positive hitting rate). Seven of the identified Fab2 17 has an IC ₅₀ in the range of nanomolar or less. In addition, all 17 MASP-2 blocked Fab2 shown in Table 6 provided essentially complete inhibition of C3 convertase formation in the lectin pathway C3 converter assay. Figure 8A graphically depicts the results of a C3 Converting Formation Assay for Fab2 Antibody # 11, which represents the other Fab2 antibodies tested and the results are shown in Table 6 . This is an important consideration because it is theoretically possible that "blocking" Fab2 can only partially inhibit MASP-2 function when each MASP-2 molecule is bound by Fab2.

Although mannan is a known activator of the lectin pathway, it is theoretically possible that the presence of anti-mannan antibodies in rat serum can activate the classical pathway and produce C3b via the classical pathway C3 convertase. However, each of the 17 blocking anti-MASP-2 Fab2 listed in this example strongly inhibited C3b production (> 95%), thus demonstrating the specificity of this assay for the lectin pathway C3 convertase.

In order to calculate the apparent K _d for each of the binding assay was performed with all seventeen blocking Fab2. The results of the binding assays of anti-rat MASP-2 Fab2 to native rat MASP-2 for six of the blocked Fab2 are shown in Table 6. Figure 8B graphically shows the results of binding assays with Fab2 antibody # 11. A similar binding assay was performed on the other Fab2 and the results are shown in Table 6. In general, the apparent K _d obtained for the binding of each of the six Fab 2 to 'native' MASP-2 corresponds reasonably to the IC ₅₀ for Fab 2 in the C3 Converting Functional Assay. There is evidence that MASP-2 undergoes a change in its configuration from 'inactive' to 'active' upon activation of protease activity (Feinberg et al., EMBO J 22 : 2348-59 (2003); Gal et al. , J. Biol. Chem. 280 : 33435-44 (2005)). In normal rat plasma used for the C3 conversion assay, MASP-2 is predominantly in the 'inactive' chimogen configuration. In the binding assay, MASP-2, on the other hand, exists as part of a complex with MBL bound to a fixed mannan; Thus, MASP-2 will be in an 'active' configuration (Petersen et al., J. Immunol Methods 257 : 107-16, 2001). As a result, since each of the assays binds to different configurations of MASP-2, Fab2 does not anticipate an accurate correspondence between IC ₅₀ and K _d for each of the 17 blocked Fab2 tested in these two functional assays. Nevertheless, except for Fab2 # 88, there appears to be a reasonably close correspondence between the IC ₅₀ and the apparent Kd for each of the other 16 Fab2 tested in the two assays (see Table 6 Reference).

Many of the blocked Fab2 were evaluated for inhibition of MASP-2 mediated cleavage of C4. FIG. 8C illustrates the results of a C4 cleavage black as a graph, shows the inhibition to Fab2 # 41, the IC ₅₀ = 0.81 nM (see Table 6). As shown in Figure 9, all Fab2 tested were found to inhibit C4 cleavage with IC ₅₀ similar to those obtained in the C3 converter hydratase assays (see Table 6).

Although mannan is a known activator of the lectin pathway, it is theoretically possible that the presence of anti-mannan antibodies in rat serum also activates the classical pathway, thereby producing C4b by the C1s-mediated cleavage of C4. However, several anti-MASP-2 Fab2 strongly inhibited the C4b generation (> 95%), thus demonstrating the specificity of this assay for MASP-2 mediated C4 cleavage. Like C3, C4 includes a specific and highly reactive thioester group as part of its structure. In this assay, upon cleavage of C4 by MASP-2, the thioester group on C4b may form a covalent bond with the hydroxyl or amino group on the polymer immobilized on the bottom of the plastic well via an ester or amide bond, C4b. &Lt; / RTI &gt;

These studies demonstrate the production of high affinity Fab2 for rat MASP-2 protein functionally blocking both C4 and C3 convertase activity, thereby preventing lectin pathway activation.

Example 11

This example describes the epitope mapping for a plurality of blocking anti-rat MASP-2 Fab2 antibodies generated as described in Example 10. [

Way:

As shown in Figure 10 , the following proteins with all N-terminal 6X His tags were expressed in CHO cells using the pED4 vector:

Rat MASP-2A, full-length MASP-2 protein, inactivated by changing serine at the active center to alanine (S613A);

Rat MASP-2K, a full-length MASP-2 protein (R424K) modified to reduce self-activation;

An N-terminal fragment of rat MASP-2 containing only CUBI-II, CUBI, EGF-like and CUBII domains; And

N-terminal fragment of rat MASP-2 containing only CUBI / EGF-like, CUBI and EGF-like domains.

These proteins were purified from the culture supernatant by nickel-affinity chromatography as previously described (Chen et al., J. Biol. Chem. 276: 25894-02 (2001)).

The C-terminal polypeptide (CCPII-SP) containing CCPII and the serine protease domain of rat MASP-2 is expressed in thioredoxin fusion protein using pTrxFus (Invitrogen) in E. coli. Proteins were purified from cell lysates using Thiobond affinity resin. The thioredoxin fusion partner is expressed from the empty pTrxFus as a negative control.

All recombinant proteins were dialyzed against TBS buffer and their concentrations were determined by measuring the OD at 280 nm.

Dot blot analysis:

A step dilution of the five recombinant MASP-2 polypeptides described above and shown in Figure 10 (and thioredoxin polypeptide as a negative control for the CCPII-serine protease polypeptide) was spotted onto a nitrocellulose membrane. The amount of protein spotted is in the range of 100 ng to 6.4 pg at 5-fold stage. In subsequent experiments, the amount of protein spotted is again in the range of less than 50 ng to 16 pg in the 5-fold step. Membrane blocked with 5% nonfat dry milk in TBS (blocking buffer) then incubated with 1.0 μg / ml anti--MASP-2 Fab2 in blocking buffer (containing 5.0 mM Ca ^2+). Bound Fab2 was detected using HRP-conjugated anti-human Fab (AbD / Serotec; diluted 1 / 10,000) and ECL detection kit (Amersham). One membrane was incubated with a polyclonal rabbit-anti-human MASP-2 Ab (Stover et al., J Immunol 163 : 6848-59 (1999)) as a positive control. In this case, bound Ab was detected using HRP-conjugated goat anti-rabbit IgG (Dako; diluted 1 / 2,000).

MASP-2 binding assay

ELISA plates were coated overnight at 4 占 폚 with 1.0 占 퐂 / well of recombinant MASP-2A or CUBI-II polypeptide in carbonate buffer (pH 9.0). The wells were blocked with 1% BSA in TBS and a step dilution of anti-MAASP-2 Fab2 was added to TBS containing 5.0 mM Ca &lt; ^{2 + &} gt ;. Plates were incubated at RT for 1 hour. After three washes with TBS / tween / Ca ²⁺ , HRP-conjugated anti-human Fab (AbD / Serotec) diluted 1 / 10,000 in TBS / Ca ²⁺ was added and the plate was further incubated at RT for 1 hour Lt; / RTI &gt; Bound antibodies were detected using TMB peroxidase substrate kit (Biorad).

result:

The results of dot blot analysis demonstrating the reactivity of Fab2 with various MASP-2 polypeptides are provided in Table 7 below. The values provided in Table 7 represent the amount of spotted protein needed to provide half-maximal signal intensity. As indicated, all polypeptides (except thioredoxin fusion partner alone) were recognized by positive control Ab (polyclonal anti-human MASP-2 serum, rabbit).

Reactivity with various recombinant rat MASP-2 polypeptides in dot blots Fab2 antibody # MASP-2A CUBI-II CUBI / EGF-like CCPII-SP Thioredoxin 40 0.16 ng NR NR 0.8 ng NR 41 0.16 ng NR NR 0.8 ng NR 11 0.16 ng NR NR 0.8 ng NR 49 0.16 ng NR NR > 20 ng NR 52 0.16 ng NR NR 0.8 ng NR 57 0.032 ng NR NR NR NR 58 0.4 ng NR NR 2.0 ng NR 60 0.4 ng 0.4 ng NR NR NR 63 0.4 ng NR NR 2.0 ng NR 66 0.4 ng NR NR 2.0 ng NR 67 0.4 ng NR NR 2.0 ng NR 71 0.4 ng NR NR 2.0 ng NR 81 0.4 ng NR NR 2.0 ng NR 86 0.4 ng NR NR 10 ng NR 87 0.4 ng NR NR 2.0 ng NR Positive control group <0.032 ng 0.16 ng 0.16 ng <0.032 ng NR

NR = No reaction. Positive control antibodies are polyclonal anti-human MASP-2 sera generated in rabbits.

All Fab2 reacted with MASP-2K as well as MASP-2A (data not shown). Most Fab2 recognized the CCPII-SP polypeptide but did not recognize the N-terminal fragment. Two exceptions are Fab2 # 60 and Fab2 # 57. Fab2 # 60 recognizes MASP-2A and CUBI-II fragments, but does not recognize CUBI / EGF-like polypeptide or CCPII-SP polypeptide, which binds to an epitope of CUBII or to CUBII and EGF- . Fab2 # 57 recognizes MASP-2A but does not recognize any of the MASP-2 fragments tested, and this Fab2 recognizes an epitope in CCP1. Fab2 # 40 and # 49 bound only to complete MASP-2A. In the ELISA binding assay shown in Figure 11 , Fab2 # 60 also bound to the CUBI-II polypeptide, despite a slightly lower affinity.

These findings demonstrate the identification of a unique blocking Fab2 for multiple regions of the MASP-2 protein.

Example 12

This example describes the identification of whole human scFv antibodies using phage display, binding to MASP-2 and inhibiting lectin-mediated complement activation while leaving the classic (C1q-dependent) pathway components of the immune system intact .

summary:

A complete human, high-affinity MASP-2 antibody was identified by screening the phage display library. The variable light and heavy chain fragments of the antibody were separated into both scFv format and full length IgG format. Human MASP-2 antibodies are useful for inhibiting cellular damage associated with lectin pathway-mediated complement pathway activation while leaving the classic (C1q-dependent) pathway component of the immune system intact. In some embodiments, the subject MASP-2 inhibitory antibody has the following characteristics: (a) a high affinity for human MASP-2 (e.g., a K _{D of} less than or equal to 10 nM); and (b) It inhibits 90% MASP-2- dependent complement activation in human serum as IC _50.

Way:

Expression of full-length catalytically inactive MASP-2 :

The full length cDNA sequence of human MASP-2 (SEQ ID NO: 4) encoding a human MASP-2 polypeptide with leader sequence (SEQ ID NO: 5) was amplified by PCR with the full- length cDNA sequence under the control of the CMV enhancer / (Kaufman RJ et al., Nucleic Acids Research 19 : 4485-90, 1991; Kaufman, Methods in Enzymology , 185 : 537-66 (1991)) in a mammalian expression vector pCI-Neo (Promega) .

To generate the catalytically inactive human MASP-2A protein, site-specific mutagenesis was performed as described in US 2007/0172483, which is incorporated herein by reference. The PCR products were purified after agarose gel electrophoresis and banding and single adenosine overlaps were generated using standard tailing procedures. The adenosine-tail MASP-2A was then cloned into the pGEM-T facilitator vector and transformed into E. coli. Human MASP-2A was further subcloned into either the mammalian expression vector pED or pCI-Neo.

The MASP-2A expression construct described above was transfected into DXB1 cells using a standard calcium phosphate transfection procedure (Maniatis et al., 1989). MASP-2A was prepared in serum-free medium to ensure that the preparation was not contaminated with other serum proteins. The medium was obtained from fusogenic cells every 2 days (total 4 times). The level of recombinant MASP-2A averaged approximately 1.5 mg / culture medium litter. MASP-2A (Ser-Ala mutation described above) was purified by affinity chromatography on an MBP-A-agarose column.

MASP-2A ELISA for scFv candidate clones identified by panning / scFv conversion and filter screening

Antigen panning followed by autoantibody screening and selection was performed to identify high affinity scFv antibodies to the human MASP-2 protein against the phage display library of human immunoglobulin light chain and heavy chain variable region sequences. Panning of scFv phage libraries for HIS-tagged or biotin-tagged MASP-2A was performed in three rounds. The panning of the third round was first eluted with MBL and then eluted with TEA (alkaline). To monitor the specific abundance of phage showing scFv fragments for the target MASP-2A, a polyclonal phage ELISA against immobilized MASP-2A was performed. The scFv gene from panning round 3 was cloned into the pHOG expression vector and run with a small filter screening to find specific clones for MASP-2A.

Bacterial colonies containing plasmids encoding the scFv fragments from the panning of the third round were plucked, grown on nitrocellulose membranes and grown overnight in non-inducing medium to produce a master plate. A total of 18,000 colonies from the third round of panning were analyzed, half of which was competitively eluted and the other half was TEA eluted. 137 positive clones were obtained by panning the scFv phage plasmid complex library for MASP-2A followed by scFv conversion and filter screening. 108/137 clones were positive in an ELISA assay for MASP-2 binding (data not shown), and 45 clones were further analyzed for their ability to block MASP-2 activity in normal human serum.

The assay for measuring inhibition of the formation of the lectin pathway C3 convertase

"Blocking activity" of MASP-2 scFv candidate clones was assessed using functional assays measuring inhibition of lectin pathway C3 convertase formation. MASP-2 serine protease activity is required to produce two protein components (C4b, C2a) that contain the lectin pathway C3 convertase. Therefore, MASP-2 scFv (i.e., blocking MASP-2 scFv) that inhibits MASP-2 functional activity will inhibit denovo formation of the lectin pathway C3 convertase. C3 contains a very unusual highly reactive thioester group as part of its structure. At the time of cleavage of C3 by the C3 convertase in this assay, the thioester group on C3b forms a covalent bond via an ester or amide bond with the hydroxyl or amino group on the molecule of the macromolecule immobilized on the bottom of the plastic well, . &Lt; / RTI &gt;

Yeast mannan is a known activator of the lectin pathway. In the following method for measuring the formation of C3 convertase, mannan coated plastic wells were incubated with diluted human serum to activate the lectin pathway. The wells were then washed and assayed for C3b immobilized on the well using standard ELISA methods. The amount of C3b produced in this assay directly reflects the de novo formation of the lectin pathway C3 convertase. Selected MASP-2 scFv clones at selected concentrations were tested in this assay for their ability to inhibit C3 convertase formation and subsequent production of C3b.

Way:

45 candidate clones identified as described above were expressed, purified and diluted to the same stock concentration and resuspended in Ca ⁺⁺ and Mg ⁺⁺ containing GVB buffer (4.0 mM barbitur, 141 mM NaCl, 1.0 mM MgCl ₂ , 2.0 mM CaCl ₂ , 0.1% gelatin, pH 7.4) to confirm that all clones had the same amount of buffer. scFv clones were each tested in triplicate at a concentration of 2 [mu] g / mL. The positive control was OMS100 Fab ₂ and tested at 0.4 μg / mL. C3c formation was monitored in the presence and absence of scFv / IgG clones.

Mannan was diluted to a concentration of 20 μg / mL (1 μg / well) in 50 mM carbonate buffer (15 mM Na ₂ CO ₃ + 35 mM NaHCO ₃ + 1.5 mM NaN ₃ ), pH 9.5 and the ELISA plates were coated overnight at 4 ° C. . The following day, the mann-coated plates were washed three times with 200 [mu] l of PBS. 100 [mu] l of 1% HSA blocking solution was then added to the wells and incubated for 1 hour at room temperature. Plates were washed three times with 200 μl of PBS and kept on ice with 200 μl of PBS until samples were added.

Normal human serum was diluted to 0.5% with CaMgGVB buffer and scFv clone or OMS100 Fab2 positive control at 0.01 μg / mL; Was added in triplicate to this buffer at 1 ug / mL (OMS100 alone control) and 10 ug / mL, preincubated on ice for 45 minutes and then added to blocked ELISA plates. The reaction was started by incubation at 37 [deg.] C for 1 hour and the plate was stopped by moving to an ice bath. C3b deposition was detected with rabbit a-mouse C3c antibody followed by chlorine a-rabbit HRP. The negative control was an antibody-free buffer (no antibody = maximum C3b deposition) and the positive control was buffer with EDTA added (no C3b deposition). The baseline was measured by performing the same assay, but no wells were encountered. Containing baseline signal for the non-metric plate was subtracted from the signal of the metering-containing well. Half of the activity of the scFv clone (VZV) and the buffer alone independent of the cutoff criterion.

Results: Based on the cutoff criteria, a total of 13 clones blocked the activity of MASP-2. All 13 clones producing> 50% pathway inhibition were selected and sequenced to obtain 10 unique clones. All ten clones appeared to have the same light chain subclass, epsilon 3, but three different heavy chain subclasses: VH2, VH3 and VH6. In the functional assays, five of the 10 candidate scFv clones provided IC ₅₀ nM values less than the 25 nM target reference using 0.5% human serum.

To identify antibodies with improved efficacy, light chain shuffling was performed on the three parental scFv clones identified above. This procedure involved the generation of a combinatorial library consisting of each VH of a mock clone paired with a library of naive, human lambda light chains (VL) derived from six healthy donors. This library was then screened against scFv clones with improved binding affinity and / or functionality.

Comparison of functional efficacy to IC ₅₀ (nM) of the leading daughter clones and their respective mock clones (all in scFv format) scFv clone 1% human serum
C3 black
(IC ₅₀  nM) 90% human serum
C3 black
(IC ₅₀  nM) 90% human serum
C4 black
(IC ₅₀  nM) 17D20mc 38 nd nd 17D20m_d3521N11 26 > 1000 140 17N16mc 68 nd nd 17N16m_d17N9 48 15 230

The heavy chain variable region (VH) sequences for the clones and daughter clones shown in Table 8 below are provided below.

The Kabat CDRs 31-35 (H1), 50-65 (H2) and 95-107 (H3) are displayed in bold; Chothia CDRs (26-32 (H1), 52-56 (H2) and 95-101 (H3)) are underlined.

17D20_35VH-21N11VL heavy chain variable region (VH) (encoded by SEQ ID NO: 67, SEQ ID NO: 66)

QVTLKESGPVLVKPTETLTLTCTVS GFSLS RG KMG VSWIRQPPGKALEW LA HIFSS DEKSYRTSL KSRLTISKDTSKNQVVLTMTNMDPVDTAT YYCARIR RGGIDY WGQGTLVTVSS

d17N9 heavy chain variable region (VH) (SEQ ID NO: 68)

QVQLQQSGPGLVKPSQTLSLTCAIS GDSVS ST SAA WNWIRQSPSRGLEW LG RTYYR SKWYNDYAV SVKSRITINPDTSKNQFSLQLNSVTPEDT AVYYCAR DPFGVPFDI WGQGTMVTVSS

The light chain variable region (VL) sequences for the clones and daughter clones shown in Table 8 below are provided below.

(L2) and 89-97 (L3) are shown in bold and the Chothia CDRs (24-34 (L1); 50-56 97 (L3) are underlined. These areas are the same whether they are numbered by either Kabat or Chothia systems.

The 17D20m_d3521N11 light chain variable region (VL) (SEQ ID NO: 70, encoded by SEQ ID NO: 69)

QPVLTQPPSLSVSPGQTASITCS GEKLGDKYAYW YQQKPGQSPVLVMYQ DKQRPSG IPERFSGSNSGNTATLTISGTQAMDEADYYCQ AWDSSTAVF GGGTKLTVL

17N16m_d17N9 light chain variable region (VL) (SEQ ID NO: 71)

SYELIQPPSVSVAPGQTATITCA GDNLGKKRVHW YQQRPGQAPVLVIYD DSDRPSG IPDRFSASNSGNTATLTITRGEAGDEADYYCQ VWDIATDHV VFGGGTKLTVLAAAGSEQKLISE

The MASP-2 antibodies OMS100 and MoAb_d3521N11VL (shown in SEQ ID NO: 67 and the light chain variable as shown in SEQ ID NO: 70, which have been demonstrated to bind to human MASP-2 at high affinity and have the ability to block functional complement activity Region, also referred to as "OMS646" and "mAb6 ") were analyzed in relation to epitope binding by dottblot analysis. The results show that the OMS646 and OMS100 antibodies are highly specific for MASP-2 and do not bind to MASP-1/3. Antibodies were not bound to MAp19 or MASP-2 fragments that did not contain the CCP1 domain of MASP-2, leading to the conclusion that the binding site contains CCP1.

MASP-2 antibody OMS646 was determined to bind to recombinant MASP-2 (Kd 60-250 pM) vigorously with> 5000-fold selectivity when compared to C1s, Clr or MASP-1 (see Table 9 below).

Affinity and Specificity of OMS646 MASP-2 Antibody-MASP-2 Interactions Evaluated by Solid-State ELISA Studies antigen K _D (pM) MASP-1 > 500,000 MASP-2 62 ± 23 * MASP-3 > 500,000 Purified human C1r > 500,000 Purified human C1s ~ 500,000

* Mean ± SD; n = 12

OMS646 specifically blocks lectin-dependent activation of terminal complement components

Way:

The effects of OMS646 on membrane attack complex (MAC) deposition were analyzed using path-specific conditions for the lectin pathway, the classical pathway and the alternative pathway. For this purpose, a Wieslab Comp300 complement screening kit (Wieslab, Lund, Sweden) was used according to the manufacturer's instructions.

result:

Figure 12A graphically illustrates the level of MAC deposition in the presence or absence of anti-MAST-2 antibody (OMS646) under lectin path-specific assay conditions. Figure 12B graphically illustrates the level of MAC deposition in the presence or absence of anti-MAST-2 antibody (OMS646) under classical path-specific assay conditions. Figure 12C graphically illustrates the level of MAC deposition in the presence or absence of anti-MAST-2 antibody (OMS646) under alternative path-specific assay conditions.

As shown in Figure 12A, MS646 blocks lectin path-mediated activation of MAC deposition with an IC ₅₀ value of approximately 1 nM. However, OMS 646 has shown no effect on MAC deposition generated from classical path-mediated activation (Figure 12B) or from alternative path-mediated activation (Figure 12C).

Pharmacokinetics and pharmacokinetics of OMS646 following intravenous (IV) or subcutaneous (SC) administration to mice

The pharmacokinetics (PK) and pharmacodynamics (PD) of OMS646 were evaluated in a 28 day single dose PK / PD study in mice. The study tested the dose levels of 5 mg / kg and 15 mg / kg of OMS646 administered subcutaneously (SC), as well as the dose level of 5 mg / kg OMS646 administered intravenously (IV).

With respect to the PK profile of OMS 646, Figure 13 graphically shows the OMS646 concentration (mean n = 3 animals / group) as a function of time after administration of OMS646 at the indicated doses. As shown in Figure 13, at 5 mg / kg SC, OMS646 reached a maximum plasma concentration of 5 to 6 ug / mL approximately 1-2 days after dosing. The bioavailability of OMS646 at 5 mg / kg SC was approximately 60%. In addition, as shown in Figure 13, at 15 mg / kg SC, OMS646 reached a maximum plasma concentration of 10-12 ug / mL approximately 1-2 days after dosing. For all groups, OMS646 was slowly removed from the systemic circulation system with a terminal half-life of approximately 8 to 10 days. The profile of OMS646 is typical for human antibodies in mice.

The activity of OMS 646 is graphically shown in FIGS. 14A and 14B. Figures 14A and 14B show the PD response (drop in systemic lectin pathway activity) for each mouse in the 5 mg / kg IV (Figure 55A) and 5 mg / kg SC (Figure 55B) groups. The dashed line represents the baseline of the assay (maximum inhibition; in vitro spiked naive mouse serum with pre-assay OMS646). As shown in Figure 14A, after IV administration of 5 mg / kg OMS646, systemic lectin pathway activity dropped to an undetectable level immediately, and lectin pathway activity showed only moderate recovery over the 28 day observation period. As shown in Figure 14B, in mice dosed with 5 mg / kg OMS646 SC, time-dependent inhibition of lectin pathway activity was observed. Lectin pathway activity dropped to an almost undetectable level within 24 hours of drug administration and remained low for at least 7 days. Lectin pathway activity increased gradually with time but did not reverse to the pre-dose level within the 28 day observation period. The time profile relative to the observed lectin pathway activity after administration of 15 mg / kg SC was similar to the 5 mg / kg SC dose (data not shown), indicating saturation of the PD endpoint. The data further indicated that administration of 5 mg / kg of OMS646 per week dosed with IV or SC was sufficient to achieve a continuous inhibition of systemic lectin pathway activity in mice.

Example 13

This example describes a recombinant antibody that inhibits MASP-2, also comprising a heavy and / or light chain variable region comprising at least one CDR that specifically binds to MASP-2 and at least one SGMI core peptide sequence (also referred to as SGMI- Peptide-containing MASP-2 antibody or antigen-binding fragment thereof).

Background / Basis:

Generation of specific inhibitors of MASP-2, termed SGMI-2, is described in Heja et al., J Biol Chem 287: 20290 (2012) and Heja et al., PNAS 109: 10498 (2012) Incorporated herein by reference. SGMI-2 is a 36 amino acid peptide selected from the phage library of variants of Schistocerca gregaria protease inhibitor 2, in which six of the eight positions of the protease binding loop are fully randomized. Subsequent development in vitro produced single-specific inhibitors with K _I values of single-digit nM (Heja et al., J. Biol. Chem . 287: 20290, 2012). Structural studies have shown that the optimized protease binding loop forms a primary binding site that defines the specificity of the two inhibitors. The amino acid sequence of the extended secondary and internal binding regions is common to the two inhibitors and contributes to the contact interface (Heja et al., 2012. J. Biol. Chem . 287: 20290). Mechanically, SGMI-2 blocks the lectin pathway of complement activation without affecting the classical pathway (Heja et al., 2012. Proc Natl Acad Sci . 109: 10498).

The amino acid sequence of the SGMI-2 inhibitor is given below:

SGMI-2 Full length: LEVTCEPGTTFKDKCNTCRCGSDGKSA VCTKLWCNQ (SEQ ID NO: 72)

SGMI-2- intermediate length: TCEPGTTFKDKCNTCRCGSDGKSA VCTKLWCNQ (SEQ ID NO: 73)

SGMI-2-short length: TCRCGSDGKSA VCTKLWCNQ (SEQ ID NO: 74)

As described in this Example, and also as described in WO2014 / 144542, the SGMI-2 peptide-containing MASP-2 antibody and its fragments can be conjugated to the amino or carboxy of the heavy and / or light chain of the human MASP- Terminus with an SGMI-2 peptide amino acid sequence (e.g., SEQ ID NO: 72, 73 or 74). The SGMI-2 peptide-containing MASP-2 antibodies and fragments were compared to naked MASP-2 peptides not containing the SGMI-2 peptide sequence when measured in C3b or C4b deposition assays using human serum, as described in WO2014 / 144542. 2 scaffold antibody and has enhanced inhibitory activity as compared to the naked MASP-2 scaffold antibody when measured in mouse model in vivo. Methods for generating MASP-2 antibodies containing the SGMI-2 peptide are described below.

Way:

The four exemplary SGMI-2 peptides in which the SGMI-2 peptide is fused to either the N-or C-terminus of the heavy or light chain of a representative MASP-2 inhibitory antibody OMS646 (produced as described in Example 12) Lt; RTI ID = 0.0 &gt; MASP-2 &lt; / RTI &gt;

MASP-2 antibody / SGMI-2 fusion Antibody reference Peptide position on antibody SEQ ID NO: H-N H-C L-N L-C HL-M2
(Naked MASP-2 OMS646) - - - - 67 + 70 H-M2-SGMI-2-N SGMI-2 - - -  75 + 70 H-M2-SGMI-2-C - SGMI-2 - -  76 +70 L-M2-SGMI-2-N - - SGMI-2 -  67+ 77 L-M2-SGMI-2-C - - - SGMI-2  67+ 78

Abbreviations in Table 10:

"H-N" = amino terminal of the heavy chain

"H-C" = the carboxyl end of the heavy chain

"L-N" = amino terminal of light chain

"L-C" = carboxyl terminal of light chain

"M2" = MASP-2 ab scaffold (representative OMS 646)

For the N-terminal fusion shown in Table 10, a peptide linker ('GTGGGSGSSS' SEQ ID NO: 79) was added between the SGMI-2 peptide and the variable region.

For the C-terminal fusion shown in Table 10, the peptide linker ('AAGGSG' SEQ ID NO: 80) was added between the constant region and the SGMI-2 peptide and the second peptide "GSGA" (SEQ ID NO: 81) The C-terminal SGMI-2 peptide was added to the C-terminal end of the fusion polypeptide to protect it from degradation.

Amino acid sequences for the following representative MASP-2 antibody / SGMI-2 fusions are provided below:

H-M2ab6-SGMI-2-N (encoded by SEQ ID NO: 75, SEQ ID NO: 82):

LEVTCEPGTTFKDKCNTCRCGSDGKSAVCTKLWCNQ GTGGGSGSSS QVTLKESGPVLVKPTETLTLTCTVS

GFSLSRGKMGVSWIRQPPGKALEWLAHIFSSDEKSYRTSLKSRLTISKDTSKNQVVLTMTNMDPVDTATYY

CARIRRGGIDYWGQGTLVTVSS ASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNSGALTSG

VHTFPAVLQSSGLYSLSSVVTVPSSSLGTKTYTCNVDHKPSNTKVDKRVESKYGPPCPPCPAPEFLGGPSV

FLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEVQFNWYVDGVEVHNAKTKPREEQFNSTYRVVSVLTVLHQ

DWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKNQVSLTCLVKGFYPSDIAVEWE

SNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMHEALHNHYTQKSLSLSLGK

[491 aa protein, aa 1-36 = SGMI-2 (underlined), aa37-46 = linker (italic); aa47-164 = heavy chain variable region of MASP-2 ab # 6 (underlined); aa165-491 = IgG4 constant region with hinge mutation].

H-M2ab6-SGMI-2-C (encoded by SEQ ID NO: 76, SEQ ID NO: 83):

QVTLKESGPVLVKPTETLTLTCTVSGFSLSRGKMGVSWIRQPPGKALEWLAHIFSSDEKSYRTSLKSRLTI

SKDTSKNQVVLTMTNMDPVDTATYYCARIRRGGIDYWGQGTLVTVSS ASTKGPSVFPLAPCSRSTSESTAA

LGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTKTYTCNVDHKPSNTKVD

KRVESKYGPPCPPCPAPEFLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSQEDPEVQFNWYVDGVEVHN

AKTKPREEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEE

MTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVM

HEALHNHYTQKSLSLSLGK AAGGSG LEVTCEPGTTFKDKCNTCRCGSDGKSAVCTKLWCNQ GSGA

[491aa protein, aa1-118 = heavy chain variable region (underlined) of MASP-2 ab # 6; aa 119-445 = IgG4 constant region with hinge mutation; aa 446-451 = first linker (italic); aa452-487 = SGMI-2; aa488-491 = 2nd linker (italic)].

L-M2ab6-SGMI-2-N (encoded by SEQ ID NO: 77, SEQ ID NO: 84)

LEVTCEPGTTFKDKCNTCRCGSDGKSAVCTKLWCNQ GTGGGSGSSS QPVLTQPPSLSVSPGQTASITCSGE

KLGDKYAYWYQQKPGQSPVLVMYQDKQRPSGIPERFSGSNSGNTATLTISGTQAMDEADYYCQAWDSSTAV

FGGGTKLTVL GQPKAAPSVTLFPPSSEELQANKATLVCLISDFYPGAVTVAWKADSSPVKAGVETTTPSKQ

SNNKYAASSYLSLTPEQWKSHRSYSCQVTHEGSTVEKTVAPTECS

[258aa protein, aa1-36 = SGMI-2 (underlined); aa37-46 = Linker (italic); aa47-152 = light chain variable region of MASP-2 ab # 6 (underlined); aa153-258 = human Ig lambda constant region.

L-M2ab6-SGMI-2-C (encoded by SEQ ID NO: 78, SEQ ID NO: 85)

&Lt; RTI ID =

LTISGTQAMDEADYYCQAWDSSTAVFGGGTKLTVL GQPKAAPSVTLFPPSSEELQANKATLVCLISDFYPG

AVTVAWKADSSPVKAGVETTTPSKQSNNKYAASSYLSLTPEQWKSHRSYSCQVTHEGSTVEKTVAPTECS A

AGGSG LEVTCEPGTTFKDKCNTCRCGSDGKSAVCTKLWCNQ GSGA

[258aa protein, aa1-106 = light chain variable region (underlined) of MASP-2 ab # 6; aa 107-212 = human Ig lambda constant region; aa 213-218 = first linker; aa219-254 = SGMI-2; aa255-258 = second linker].

Functional test:

Four MASP-2-SGMI-2 fusion antibody constructs were transiently expressed in Expi293F cells (Invitrogen) and purified by Protein A Affinity Chromatography followed by 10% normal Were tested for inhibition of C3b deposition in human serum.

Testing of MASP-2-SGMI-2 fusion for C3b deposition in mannan-coated bead assay

MASP-2-SGMI-2 fusion antibody was assessed for lectin pathway inhibitors by assaying for C3b deposition on-coated beads. This assay, which measures the activity level by flow cell analysis, provides a greater resolution than the Wieslab® assay. The lectin pathway-based assay was performed as follows: Mannan was adsorbed to 7 μM-diameter polystyrene beads (Bangs Laboratories; Fishers, IN, USA) overnight in carbonate-bicarbonate buffer (pH 9.6) at 4 ° C. The beads were washed with PBS and exposed to 10% serum, preincubated with 10% human serum or antibody or inhibitor. The serum-bead mixture was incubated with stirring for 1 hour at room temperature. After serum incubation, the beads were washed and C3b deposition on beads was incubated with anti-C3c rabbit polyclonal antibody (Dako North America; Carpinteria, CA, USA) and PE-Cy5 conjugated goat anti-rabbit secondary antibody ; Birmingham, AL, USA). After the staining procedure, the beads were analyzed using a FACSCalibur flow cell analyzer. The beads were collected as a uniform cluster using anterior and side scatters and C3b deposits were expressed as FL3-positive particles (FL-3, or "FL-3 channel" represents the third or red channel on the cell analyzer). The geometric mean fluorescence intensity (MFI) for the clusters for each experimental condition was plotted in proportion to the antibody / inhibitor concentration to assess lectin pathway inhibition.

IC ₅₀ values were calculated using GraphPad PRISM software. Specifically, IC ₅₀ values were obtained by applying variable slope ratios (four parameters) and nonlinear pits to the log fluorescence intensity curve versus log (antibody) obtained from cell assay assays.

The results are shown in Table 11.

C3b deposition in 10% human serum (mannan-coated bead assay) edifice IC ₅₀  (nM) Naked N2 ab (mAb # 6) ≥ 3.63 nM H-M2-SGMI-2-N 2.11 nM L-M2-SGMI-2-C 1.99 nM H-M2-SGMI-2-N 2.24 nM L-M2-SGMI-2-N 3.71 nM

result:

The control, non-SGMI-containing MASP-2 "naked" scaffold antibody (mAb # 6) was inhibitory at this assay with an IC50 value of 3.63 nM or greater, consistent with the results observed in Example 12. Notably, as shown in Table 11, all tested SGMI-2-MASP-2 antibody fusion improved the efficacy of the MASP-2 scaffold antibody in this assay, indicating that increased binding is also beneficial in inhibiting C3b deposition It is possible.

Testing of MASP-2-SGMI-2 fusion for C4b deposition using 10% human serum in mannan-coated bead assay

The C4b deposition assay was performed using the same assay conditions described above for the C3b deposition assay, including the following variants. C4b detection and flow cytometry analyzes were performed by staining the deposition reaction with an anti-C4b mouse monoclonal antibody (1: 500, Quidel) and incubating with a secondary goat anti-mouse F (1: 200, Southern Biotech) conjugated to PE Cy5 ab ') 2 and analyzed by flow cytometry.

result:

SGMI-2-N: IC50 = 0.41 nM) was found to bind to both SGMI-2-containing MASP-2-N-terminal antibody fusions (H-M2-SGMI-2-N: IC50 = 0.34 nM) , And increased efficacy compared to MASP-2 scaffold antibody (HL-M2: IC50 = 0.78 nM).

Testing of MASP-2-SGMI-2 fusion for C3b deposition with 10% mouse serum in mannan-coated bead assay

Mann-coated bead assays for C3b deposition were performed as described above using 10% mouse serum. Similar to the results observed in human sera, SGMI-2-containing MASP-2 fusion was determined to have increased efficacy in mouse serum compared to MASP-2 scaffold antibody.

Summary of Results: The results in this example demonstrate that all tested SGMI-2-MASP-2 antibody fusion improved the efficacy of the MASP-2 scaffold antibody.

Example 14

This example demonstrates the results generated using the unilateral ureter occlusion (UUO) model of renal fibrosis in MASP-2 - / - deficient and MASP-2 + / + sufficient mice to assess the role of the lectin pathway in renal fibrosis to provide.

Background / Basis:

Renal fibrosis and inflammation are the dominant features of late renal disease. Renal tubular interstitial fibrosis is a progressive process involving sustained cell damage, aberrant healing, resident and invasive kidney cell activation, cytokine release, phenotypic activation of kidney cells that produce inflammation and extracellular matrix. Renal tubular interstitial fibrosis (TI) is a common endpoint of multiple renal pathologies and represents an important target for potential therapies aimed at preventing the impairment of progressive renal function in chronic kidney disease (CKD). Renal TI impairment is closely linked to renal function, which is reduced in glomerular disease (Risdon RA et al., Lancet 1: 363-366, 1968; Schainuck LI et al., Hum Pathol 1: 631-640, 1970; Nath KA, Am J Kid Dis 20: 1-17, 1992), a feature of CKD in which accumulation of myofibroblasts is present and the potential space between the capillaries and the capillaries around the tubule is occupied by a matrix composed of collagen and other proteoglycans. The origin of TI myofibroblasts remains highly controversial, but fibrosis generally precedes inflammation characterized by TI accumulation of macrophages after TI accumulation of T lymphocytes in the early stages (Liu Y. et al., Nat Rev Nephrol 7: 684-696, 2011; Duffield JS, J Clin Invest 124: 2299-2306, 2014).

The rodent model of UUO actually produces progressive renal fibrosis, which is characteristic of progressive renal disease of any etiology (Chevalier et al., Kidney International 75: 1145-1152, 2009). C3 gene expression was increased in wild-type mice after UUO and collagen deposition was significantly reduced in C3 - / - knockout mice after UUO compared to wild type mice, suggesting a role for complement activation in renal fibrosis (Fearn et al., Mol Immunol 48: 1666-1733, 2011). It has also been reported that C5 deficiency has led to a significant improvement in the major components of renal fibrosis in a model of tubular interstitial damage (Boor P. et al., J Am Soc Nephrology : 18: 1508-1515, 2007). However, prior to the studies described herein conducted by the present inventors, certain complement components included in renal fibrosis have been widely defined. Therefore, the following study was performed to evaluate MASP-2 (- / -) and MASP-2 (+ / +) male mice in a unilateral ureteral closed (UUO) model.

Way:

MASP-2 - / - mice were generated as described in Example 1 and backcrossed with C57BL / 6 for 10 generations. Male homozygous (WT) C57BL / 6 mice and C57BL / 6 background homozygous MASP-2 deficient mice (MASP-2 - / -) mice were maintained under standardized 12/12 week / night cycles and standard pelleted feed Supply and free access to food and water. Six, 10-week-old mice per group were anesthetized with 2.5% isoflurane in 1.5 L / min oxygen. The right ureters of two groups of 10-week old male C56 / BL6 mice, wild type and MASP-2 - / - were ligated by surgery. The right kidney was exposed through a 1 cm flank incision. The right ureter was closed completely using a 6/0 polyglactin suture at two points. Buprenorphine was used for up to 5 doses of pain perception score every 12 hours before and after surgery. Topical volatile anesthetics were given once during the operation.

Mice were sacrificed 7 days after surgery, renal tissue was collected, fixed and inserted into paraffin blocks. Blood was collected from the mice by cardiac puncture under anesthesia, and the mice were culled by nephrectomy followed by bleeding. The blood was allowed to settle on ice for 2 hours and the serum was separated by centrifugation and stored frozen at -80 ° C as a partial sample.

Immunohistochemistry of kidney tissue

In order to measure the degree of renal fibrosis marked by collagen deposition, five micron-paraffin-embedded kidney slices were stained with collagen-specific antibodies as described in Whittaker P. et al., Basic Res Cardiol 89: 397-410, It was stained with Sirius red as a dyeing peak. Briefly, paraffin was removed from kidney sections, rehydrated and collagen stained with a Sirius red solution (0.5 gm Sirius red, Sigma, Dorset UK) with a peak in a saturated aqueous solution of 500 mL of picric acid for 1 hour. The slides were washed with acidified water (0.5% glacial acetic acid in distilled water) for 5 minutes each, then dehydrated and fixed.

To measure the extent of inflammation as manifested by macrophage infiltration, kidney sections were stained with the macrophage-specific antibody F4 / 80 as follows. Paraffin-embedded, 5-micron kidney sections were fixed with formalin and paraffin was removed and rehydrated. Antigen counts were performed in citrate buffer at 95 ° C for 20 minutes and then quenched by incubation of endogenous peroxidase activity in 3% H ₂ O ₂ for 10 minutes. Tissue sections were incubated for 1 hour at room temperature in blocking buffer (10% heat inactivated normal goat serum containing 1% bovine serum albumin in phosphate buffered saline (PBS)) followed by avidin / biotin blocking. Tissue sections were washed three times with PBS for 5 minutes after each step. F4 / 80 macrophage primary antibody diluted 1: 100 in blocking buffer (Santa Cruz, Dallas, TX, USA) was applied for 1 hour. The biotinylated goat anti-rat secondary antibody diluted 1: 200 was then applied for 30 minutes and the horseradish peroxidase (HRP) conjugated enzyme was applied for 30 minutes. The staining color was developed for 10 minutes using a diaminobenzidine (DAB) substrate (Vector Labs, Peterborough UK), the slides were washed with water, dehydrated and fixed without counter staining to facilitate computer-based analysis.

Image analysis

Percentages of renal cortex staining were measured as described in Furness PN et al., J Clin Pathol 50: 118-122, 1997. Briefly, a 24-bit color image captured from a sequential non-overlapping field of the renal cortex just below the neocortex around the entire periphery of the kidney section. After capturing each image, we extracted the red channel as an 8-bit monochrome image using NIH Image. The inhomogeneity of the background illumination was removed using a pre-recorded image of the illuminated microscope field in place. We applied a fixed limit to the image and confirmed the area of the image corresponding to the staining accuracy. The black pixels were then calculated and all images around the kidney were measured in this manner, and the average percentage was recorded to provide a value corresponding to the percentage of the stained area of the kidney area.

Gene expression analysis

Expression of several genes related to kidney inflammation and fibrosis in mouse kidney was measured by quantitative PCT (qPCR) as follows. Total RNA was isolated from the renal cortex using Trizol ^® (ThermoFisher Scientific, Paisley, UK) according to the manufacturer's instructions. First strand cDNA was synthesized using the AMV reverse transcription system (Promega, Madison, WI, USA) after treatment of the extracted RNA with a Turbo DNA-glass kit (ThermoFisher Scientific) to remove DNA contamination. cDNA integrity was confirmed by a single qPCR reaction using a TaqMan GAPDH assay (Applied Biosystems, Paisley UK) followed by qPCR using a Custom TaqMan Array 96-well plate (Life Technologies, Paisley, UK).

Twelve genes were studied in this assay:

Collagen type IV alpha 1 (col4 alpha 1; test ID: Mm01210125_m1)

-1; 검정 ID: Mm01178820_m1); Transforming Growth Factor Beta-1 (TGF

-One; Test ID: Mm01178820_m1);

Cadherin 1 (Cdh1; test ID: Mm01247357_m1);

Fibronectin 1 (Fn1; test ID: Mm01256744_m1);

Interleukin 6 (IL6; test ID Mm00446191_m1);

Interleukin 10 (IL10; test ID Mm00439614_m1);

Interleukin 12a (IL12a; black ID Mm00434165_m1);

Vimentin (Vim; black ID Mm01333430_m1);

Actinin alpha 1 (Actn1; black ID Mm01304398_m1);

Tumor necrosis factor-alpha (TNF-α; test ID Mm00443260_g1)

Complement component 3 (C3; black ID Mm00437838_m1);

Interferon gamma (Ifn-gamma; black ID Mm01168134)

The following housekeeping control genes were used:

Glyceraldehyde-3-phosphate dehydrogenase (GAPDH; black ID Mm99999915_g1);

Glucuronidase beta (Gus? (Black ID Mm00446953_m1);

Eukaryotic 18S rRNA (18S; test ID Hs99999901_s1);

Hypoxanthin guanine phospholybosyltransferase (HPRT; black ID Mm00446968_m1)

20 μL of the reaction was amplified for 40 cycles using TaqMan Fast Universal Master Mix (Applied Biosystems). Real-time PCR amplification data were analyzed using Applied Biosystems 7000 SDS v1.4 software.

result:

After unilateral ureteral closure (UUO), the occluded kidney experiences infiltration of inflammatory cells, particularly macrophages, and is immediately evidenced by accumulation of collagen alongside ureteric dilation and weakening of proximal tubular epithelium, leading to fibrosis (See Chevalier RL et al., Kidney Int 75: 1145-1152, 2009).

Figure 15 graphically depicts the results of a computer-based image analysis of a kidney tissue section stained with Sirius red, wherein the tissue section was obtained from the wild type and MASP-2 - / - mice after 7 days of unilateral ureteral obstruction (UUO) Mice were obtained from the simulated-operated control mice. As shown in FIG. 15, the kidney section of wild type mice showed considerably larger collagen deposition (p value = 0.0096) as compared to MASP-2 - / - mice 7 days after ureteral occlusion. The mean ± standard error of mean values for wild-type and MASP-2 - / - mice treated with UUO was 4.79 ± 1.908 (n = 6) and 16.58 ± 1.3 (n = 6), respectively. As further shown in FIG. 15, the tissue sections from the simulated-operated control wild type and simulated surgical control MASP-2 - / - mice showed very low levels of collagen staining, as expected.

Figure 16 graphically depicts the results of a computer-based image analysis of a kidney tissue section stained with F4 / 80 macrophage-specific antibody, wherein the tissue section was free of wild-type and MASP- 2 - / - mice or from simulated-operated control mice. As shown in Figure 16, tissue obtained from UUO kidneys from MASP-2 - / - mice showed significantly less macrophage infiltration 7 days after ureteral obstruction (WT: MASP compared to 2.23 +/- 0.4 -2 - / -: 0.53 + 0.06 stained macrophage area, p = 0.0035). As further shown in FIG. 16, tissue sections from the simulated-operated wild-type and simulated-operated MASP-2 - / - mice showed no detectable macrophage staining.

Gene expression analysis of various genes linked to renal inflammation and fibrosis was performed in wild type and MASP-2 - / - mice 7 days after ureteral obstruction and in kidney tissue sections obtained from mock-operated wild type and MASP-2 - / - mice Respectively. The data shown in Figs. 17 to 20 are Log10 of relative quantities for the wild-type simulated sample, and the bars represent the standard error of the mean. With respect to the results of the gene expression analysis of fibrosis-related genes, Figure 17 shows the results of a comparison of the gene expression profiles of fibroblast-associated genes measured by qPCR in kidney sections obtained from wild type and MASP-2 - / - mice and mock- Bar, relative mRNA expression levels of collagen type IV alpha 1 (collagen-4). Figure 18 shows that transforming growth factor beta-1 (TGF beta-1), as measured by qPCR in the kidney tissue sections obtained from wild-type and MASP-2 - / - mice and mock-operated control mice 7 days after ureteral obstruction, Lt; RTI ID = 0.0 &gt; mRNA &lt; / RTI &gt; As shown in Figures 17 and 18, the closed kidneys from wild-type mice were significantly higher in fibrosis-associated gene collagen-type IV (Figure 17) and TGF beta-1 (Figure 18) compared to simulated- Demonstrating significantly increased expression, which, as expected, demonstrates that these fibrosis-related genes were induced after UUO injury in wild-type mice. In contrast, as shown further in Figs. 17 and 18, the closed kidney from MASP-2 - / - in which UUO injury was performed showed a significant increase in expression of collagen-type IV compared to wild type mice in which UUO injury was performed (Fig. 17, p = 0.0388) and a significant decrease in expression of TGF [beta] -I (Fig. 18, p = 0.0174).

With respect to the results of the gene expression analysis of inflammation-associated genes, Figure 19 shows the expression levels of the mRNA in the kidney tissue sections measured by qPCR in the kidney tissue sections obtained from the wild type and MASP-2 - / - mice and the simulated- Bar, and interleukin-6 (IL-6). Figure 20 graphically depicts the relative mRNA expression levels of interferon-y as measured by qPCR in kidney tissue sections obtained from wild-type and MASP-2 - / - mice and mock-operated control mice 7 days after ureteral obstruction do. As shown in Figures 19 and 20, closed kidneys from wild-type mice were significantly lower than those of the inflammation-associated genes interleukin-6 (Figure 19) and interferon-gamma (Figure 20) Demonstrating significantly increased expression, demonstrating that these inflammation-related genes were induced after UUO injury in wild-type mice. In contrast, as shown further in Figs. 19 and 20, the closed kidney from MASP-2 - / - in which UUO damage was performed showed that the expression of interleukin-6 (Fig. 19 , p = 0.0109) and expression of interferon-y (Fig. 20, p = 0.0182).

Gene expression for Vim, Actn-1, TNFa, C3 and IL-10 were both significantly up-regulated in UUO kidneys obtained from both wild-type and MASP-2 - / - mice and wild-type and MASP- , There is no significant difference in the expression levels of these specific genes (data not shown). The gene expression levels of Cdh-1 and IL-12a did not change in the closed kidneys from any group of animals (data not shown).

Argument:

In the rodent, the UUO model induces early, active and marked impairment with reduced renal blood flow, interstitial inflammation and rapid fibrosis within 1-2 weeks after closure in the closed kidney, and understanding common mechanisms and mediators of inflammation and fibrosis in the kidney (See, for example, Chevalier RL, Kidney Int 75: 1145-1152, 2009; Yang H. et al., Drug Discov TodayDis Models 7: 13-19, 2010).

The results described in this example demonstrate a significant reduction in collagen deposition and macrophage infiltration in UUO-operated kidneys in wild-type (+ / +) control mice versus MASP-2 (- / -) mice. An unexpected result showing a significant reduction in renal damage both at the histological and gene expression levels in MASP-2 - / - animals suggests that the lectin pathway of complement activation significantly contributes to the development of inflammation and fibrosis in the closed kidney Prove it. While not wishing to be bound by any particular theory, the lectin pathway continues to induce inflammation that further induces cellular damage, scarring, and tissue loss by triggering and maintaining proinflammatory stimuli that perpetuate a vicious cycle in which cell damage is driven, Which is believed to contribute to the fatal. In view of these results, inhibiting or blocking MASP-2 as an inhibitor is useful for preventing or preventing renal fibrosis and for preventing or preventing fibrosis (i. E., Irrespective of tissue or organ) Will be expected.

Example 15

This example describes the analysis of monoclonal MASP-2 inhibitory antibodies against efficacy in a unilateral ureteral occlusion (UUO) model, a murine model of renal fibrosis.

Background / Basis:

Improvement of renal tubular interstitial fibrosis, a common endpoint of multiple renal pathologies, represents a key target for therapeutic strategies aimed at preventing advanced renal disease. There is an urgent need to develop new therapies because there is not a new, but traditional, treatment to target the inflammatory pro-fibrosis pathway in renal disease. Many patients with proteinuria kidney disease exhibit tubular interstitial inflammation and advanced fibrosis, which is very similar to weakening kidney function. Proteinuria itself induces the development of tubular interstitial inflammation and proteinuria (Brunskill NJ et al., J Am Soc Nephrol 15: 504-505 , 2004). Regardless of primary renal disease, tubulointerstitial inflammation and fibrosis are closely related to excretory function that occurs and weakens in patients with progressive renal impairment (Risdon RA et al., Lancet 1: 363-366, 1968 ; Schainuck LI, et al., Hum Pathol 1: 631-640, 1970). Therapists with the potential to interfere with the core common cell pathway leading to fibrosis have the potential to be widely applied to kidney disorders.

As described in Example 14, in the UUO model of non-proteinuric renal fibrosis, MASP-2 - / - mice were treated with inflammatory cell infiltration (75% reduction) and histologic markers of fibrosis (1 / 3 reduction), as compared to wild-type control animals, which resulted in significantly less renal fibrosis and inflammation, thereby establishing a key role in the lectin pathway in renal fibrosis.

2 antibody (OMS646-SGMI-2 fusion, the C-chain of the heavy chain of OMS646) that specifically blocks the function of the human lectin pathway, which has been shown to block the lectin pathway in the mouse, Containing the SGMI-2 peptide fused at its terminus). In this example, OMS646-SGMI-2 was analyzed in a UUO mouse model of renal fibrosis in wild-type mice to determine whether a specific inhibitor of MASP-2 could inhibit renal fibrosis.

Way:

This study demonstrated the effect of MASP-2 inhibitory antibody (10 mg / kg OMS646-SGMI-2) in male WT C57BL / 6 mice compared to human IgG4 isotype control antibody (10 mg / kg ET904) Respectively. Antibody (10 mg / kg) was administered intraperitoneally (ip) to groups of 9 mice before 7 days, 4 days and 1 day before UUO surgery, and again on day 2 after UUO surgery. Blood samples were taken before and at the end of the experiment to assess the lectin pathway functional activity.

UUO surgery, tissue collection, and staining with Sirius red and macrophage-specific antibody F4 / 80 were performed using the method described in Example 14.

The hydroxyproline content of the mouse kidney was measured using a specific colorimetric assay kit (Sigma) according to the manufacturer's instructions.

In order to evaluate the pharmacodynamic effects of MASP-2 inhibitory mAb in mice, systemic lectin pathway activity was measured by lectin-induced &lt; RTI ID = 0.0 &gt; induction &lt; / RTI &gt; in a minimal diluted serum sample collected at indicated times after ip administration of MASP-2 mAb or control mAb C3 activation. Briefly, 7 μM diameter polystyrene microspheres (Bangs Laboratories, Fisher IN, USA) were incubated overnight with 30 μg / mL mannan (Sigma) in sodium bicarbonate buffer (pH 9.6) % Fetal bovine serum and resuspended in PBS to a final concentration of 1 x ^{10 8} beads / mL. The complement deposition reaction was initiated by the addition of 2.5 μL of man-coated beads (~250,000 beads) to 50 μL of a minimal diluted mouse serum sample (90% final serum concentration), followed by incubation at 4 ° C. for 40 minutes . After the deposition reaction was terminated by adding 250 μL ice-cold cold cell analysis buffer (FB: PBS containing 0.1% fetal bovine serum), the beads were collected by centrifugation and resuspended in 300 μL ice- And washed.

To quantify lectin-induced C3 activation, the beads were incubated with 50 [mu] L of rabbit anti-human C3c antibody (Dako, Carpenteria, CA, USA) diluted in FB at 4 [deg.] C for 1 hour. After washing twice with FB to remove unbound material, the beads were incubated with 50 μL of goat anti-rabbit antibody conjugated to FB-diluted PE-Cy5 (Southern Biotech, Birmingham, AL, USA) Lt; / RTI &gt; for 30 minutes. After washing twice with FB to remove unbound material, the beads were resuspended in FB and analyzed by a FACS Calibur cell analyzer. The beads were collected as a uniform cluster using anterior and side scatters and the C3b deposition of each sample was quantified as mean fluorescence intensity (MFI).

result:

Evaluation of collagen deposition:

Figure 21 graphically depicts the results of a computer-based image analysis of a kidney tissue section stained with Sirius red, wherein the tissue section was removed from wild-type mice treated with MASP-2 inhibitory antibody or isotype control antibody 7 days after ureteral closure . As shown in Figure 21, tissue sections from kidneys obtained 7 days after closure (UUO) obtained from wild-type mice treated with MASP-2 inhibitory antibodies were analyzed from closed kidneys obtained from wild type mice treated with IgG4 isotype control (P = 0.0477) compared to the amount of collagen deposition in the tissue section of the rats.

Evaluation of hydroxyproline content:

Hydroxyproline was measured in renal tissue as an index of collagen content. Hydroxyproline is a parameter that highly represents the pathophysiological progression of the disease induced in this model.

Figure 22 graphically illustrates the hydroxyl proline content from the kidneys obtained 7 days after closure (UUO) obtained from wild-type mice treated with either MASP-2 inhibitory antibody or isotype control antibody. As shown in Figure 22, the closed kidney tissue from mice treated with MASP-2 inhibitory antibody showed significantly less hydroxyl collidine as an indicator of collagen content than the kidney from mice treated with IgG4 isotype control mAb (P = 0.0439).

Evaluation of inflammation:

Closed kidneys from wild-type, isotype control antibody-treated animals, and wild-type animals treated with MASP-2 inhibitory antibodies demonstrated active infiltration of macrophages. Careful quantification revealed no significant difference in macrophage percentage staining areas between these two groups (data not shown). However, despite the equivalent number of invasive macrophages, the closed kidneys from MASP-2 inhibitory antibody-injected animals were significantly reduced compared to the closed kidneys from islet control injected animals, as judged by Sirius red staining And the results are consistent with the results that the closed kidney tissue from mice treated with the MASP-2 inhibitory antibody had significantly less hydroxyl proline than the kidney treated with the IgG4 isotype control mAb .

Argument

The results described in this example demonstrate that the use of MASP-2 inhibiting antibodies provides protection against renal fibrosis in the UUO model, which suggests that MASP-2 - / - mice are significantly reduced in the UUO model Lt; RTI ID = 0.0 &gt; 14, &lt; / RTI &gt; The results of this example show reduced fibrosis in mice treated with MASP-2 inhibitory antibody. The discovery of reduced fibrosis in UUO kidneys in animals with reduced or blocked MASP-2-dependent lectin pathway activity is a very significant new discovery. Taken together, Example 14 and the results provided in this Example demonstrate the beneficial effect of MASP-2 inhibition on renal tubular interstitial inflammation, tubular cell injury, pro-fibrotic cytokine release and scarring. Relief of renal fibrosis remains a key goal for renal cure. The UUO model is a severe model of accelerated renal fibrosis in which intervention to reduce fibrosis, such as the use of MASP-2 inhibitory antibodies, is likely to be used to inhibit or prevent renal fibrosis. The results from the UUO model are likely to be transferred to renal disease characterized by glomerular and / or proteinuric tubular damage.

Example 16

This example provides results generated using the protein overload proteinuria model of renal fibrosis, inflammation and tubular interstitial damage in MASP-2 - / - and wild-type mice to assess the role of the lectin pathway in proteinuria.

Background / Basis:

Proteinuria is a risk factor for the development of renal fibrosis and loss of renal excretion function regardless of primary renal disease (Tryggvason K. et al., J Intern Med 254: 216-224, 2003, Williams M., Am J Nephrol 25: 77-94, 2005). The concept of proteinuric nephropathy describes the toxic effects of excess protein entering the proximal tubule as a result of impaired glomerular selective permeability (Brunskill NJ, J Am Soc Nephrol 15: 504-505 , 2004, Baines RJ, Nature Rev Nephrol 7: 177 -180, 2011). This phenomenon, common to many glomerular diseases, results in a pro-inflammatory scar environment in the kidneys and results in proinflammatory tubular cell growth, apoptosis, gene transcription and inflammatory cytokines as a consequence of the signaling pathways leading to regulatory disorders stimulated by proteinuric tubular fluid It is characterized by a change in cine production. Proteolithic nephropathy is generally recognized as a key contributor to progressive renal damage common to a variety of primary renal pathologies.

Chronic renal disease affects more than 15% of adults in the United States and accounts for approximately 750,000 deaths worldwide annually (Lozano R. et al., Lancet vol 380, Issue 9859: 2095-2128, 2012) . Proteinuria is not only an indicator of chronic kidney disease, but is also a factor promoting disease progression. Many patients with proteinuric renal disease exhibit tubular interstitial inflammation and advanced fibrosis, which is very similar to attenuated renal function. Proteinuria itself induces the development of tubular interstitial inflammation and proteinuria (Brunskill NJ et al., J Am Soc Nephrol 15: 504-505 , 2004). In proteinuric kidney disease, excessive amounts of albumin and other macromolecules are filtered through the glomeruli and reabsorbed by proximal tubular epithelial cells. This results in an inflammatory vicious cycle mediated by complement activation leading to cytokine and leukocyte infiltration leading to tubular-interstitial damage and fibrosis, thereby exacerbating proteinuria and inducing loss of renal function, ultimately leading to end- (See, for example, Clark et al., Canadian Medical Association Journal 178: 173-175, 2008). It is expected that therapies that control these harmful cycles of inflammation and proteinuria will improve the outcome of chronic kidney disease.

From the viewpoint of the beneficial effect of MASP-2 inhibition in the UUO model of tubular interstitial damage, the following experiment was conducted to determine whether MASP-2 inhibition in the protein overload model could reduce renal damage. This study used protein overload to induce proteinuria-induced kidney disease as described by Ishola et al., European Kidney Association 21: 591-597, 2006.

Way:

MASP-2 - / - mice were generated as described in Example 1 and backmixed with BALB / c for 10 generations. Current studies were compared with those of wild-type and MASP-2 - / - BALB / c mice in the protein overload proteinuria model as follows.

One week prior to the experiment, mice were elongated on either side prior to the challenge of protein overload for optimal response. The proteinuria inducer used was a low dose endotoxin bovine serum albumin (BSA, Sigma) supplied ip with normal saline to WT (n = 7) and MASP-2 - / - mice at the following doses: G / m2, 4 mg BSA / gm, 6 mg BSA / gm, 8 mg BSA / gm, 10 mg BSA / gm and 12 mg BSA / gm body weight for a total of 15 doses administered ip over a period of 15 days , And 9 doses of 15 mg BSA / gm body weight. Control WT (n = 4) and MASP-2 - / - (n = 4) mice received saline only ip. After the last dose, the animals were kept in metabolic cages for 24 hours and urine was collected. Blood was collected by cardiac puncture under anesthesia and the blood was allowed to settle on ice for 2 hours to allow it to clot and the serum was separated by centrifugation. Serum and urine samples were collected at the end of the experiment on day 15 and frozen for analysis.

Mice were sacrificed 24 hours after the last dose on day 15 and various tissues were collected for analysis. Kidneys were obtained and processed for H & E and immunostaining. Immunohistochemical staining was performed as follows. The formalin-fixed, paraffin-embedded 5 micron kidney tissue sections from each mouse were paraffin-free and rehydrated. Do antigen recovered in citrate buffer at 95 ℃ for 20 minutes and was then incubated tissue in 3% H ₂ O ₂ for 10 minutes. Tissues were then incubated with blocking buffer (10% serum from secondary antibody generated species and 1% BSA in PBS) with 10% avidin solution for 1 hour at room temperature. The sections were washed three times with PBS each for 5 minutes after each step. The primary antibodies were then incubated in blocking buffer containing 10% biotin for 1 hour with antibodies F4 / 80 (Santa Cruz cat # sc-25830), TGFβ (Santa Cruz cat # sc-7892), IL- # sc-1265), and 1:50 for TNFa antibody (Santa Cruz cat # sc-1348). The biotinylated secondary antibody was then applied at a concentration of 1: 200 for F4 / 80, TGFβ and IL-6 sections for 30 minutes and at a concentration of 1: 100 for the TNFα section, followed by HRP conjugated enzyme And applied again for 30 minutes. The color was developed for 10 minutes using diaminobenzidine (DAB) substrate labs and the slides were washed with water, dehydrated and fixed without contrast dyeing to facilitate computer-based image analysis. Dyed tissue sections from the kidney cortex were analyzed by digital image capture followed by quantification using automated image analysis software.

Apoptosis was assessed by the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) in the tissue section as follows. The kidney section apoptotic cells were stained using the ApopTag® peroxidase kit (Millipore) as follows. Paraffin-inserted from each mouse, formalin-fixed kidney sections were permeabilized with proteinase K (20 μg / mL), which was paraffin-free and rehydrated and then applied to each sample at room temperature for 15 minutes. Samples were washed with PBS between steps. Endogenous peroxidase activity was quenched by incubating the tissues in 3% H ₂ O ₂ for 10 minutes. The tissues were then incubated in equilibrium buffer and then incubated with TdT enzyme for 1 hour at 37 [deg.] C. After washing for 10 minutes with the wash / wash buffer, the anti-digoxigenin conjugate was applied for 30 minutes at room temperature and then washed. The color was developed in the DAB substrate kit for 4 minutes and then washed with water. Tissues were counterstained in hematocillin and fixed in DBX. The frequency of TUNEL stained (brown) apoptotic cells was manually counted in 20 high power fields selected consecutively from the cortex using a Leica DBXM light microscope.

result:

Assessment of proteinuria

To determine the presence of proteinuria in mice, serum total protein was analyzed on day 15 and total excreted protein in urine was measured in urine samples collected over a 24 hour period on day 15 of the study.

Figure 23 shows the results of the measurement on day 15 in wild type control mice (n = 2) receiving saline alone, wild type mice receiving BSA (n = 6) and MASP-2 - / - mice receiving BSA The total amount (mg / ml) of the serum protein is shown graphically. As shown in Figure 23, administration of BSA increased serum total protein levels in both wild type and MASP-2 - / - groups by a factor of more than two times the concentration of the control group that received saline alone and no significant difference between the treated groups .

Figure 24 shows the results of a 24-day, 24-day course from wild-type control mice (n = 2) receiving saline alone, wild type mice receiving BSA (n = 6) and MASP- The graph shows the total amount (mg) of protein excreted in urine collected over a period of time. As shown in Figure 24, on day 15 of the study there was an approximately 6-fold increase in total excreted protein in the urine in the BSA-treated group compared to the simulated-treated control group receiving saline alone. The results shown in Figures 23 and 24 demonstrate that the proteinuria model was acting as expected.

Assessment of histological changes in kidney

Figure 25 shows representative H & E stained kidney tissue sections obtained on day 15 of a protein overload study from the following mouse groups: (Panel A) wild-type control mice; (Panel B) MASP-2 - / - control mice; (Panel C) Wild-type mice treated with BSA; And (Panel D) MASP-2 - / - mice treated with BSA. As shown in Figure 25, there is a much higher degree of tissue preservation in the MASP-2 - / - overload group (Panel D) compared to the wild type overload group (Panel C) at the same level of protein overload challenge. For example, in wild-type mice treated with BSA (overload), the Bowman capsules were observed to be greatly enlarged (Panel C) as compared to the Bowman capsules in the wild-type control group (Panel A). In contrast, Bowman capsules were similar to MASP-2 - / - control mice (Panel B) and wild-type control mice (Panel A) in MASP-2 - / - mice treated with the same level of BSA Respectively. 25, the large protein cast structure was accumulated in the proximal and distal tubules of the wild type kidney section (panel C), which was larger and more abundant compared to the MASP-2 - / - mouse (panel D) .

Analysis of the kidney section from this study by electron transfer microscopy also showed that mice treated with BSA were totally damaged to the capillary boundary of distal and proximal tubular cells as they swept into the cell contents and nucleus ureter lumen do. In contrast, tissues were preserved in MASP-2 - / - mice treated with BSA.

Assessment of macrophage infiltration in the kidney

To determine the degree of inflammation, as indicated by macrophage infiltration, the tissue section of the obtained kidney was also examined using the method described in Boor et al., J of Am Soc . Nephrology 18: 1508-1515, 2007 And stained with macrophage-specific antibody F4 / 80.

Figure 26 graphically depicts the results of a computer-based image analysis of a kidney tissue section stained with macrophage-specific antibody F4 / 80, showing the macrophage mean staining area (%), wherein the tissue section is a wild type control mouse (n = 2) from wild-type mice treated with BSA (n = 6), and MASP-2 - / - mice treated with BSA (n = 5) on the 15th day of the protein overload study. As shown in Figure 26, the kidney tissue section stained with F4 / 80 anti-macrophage antibody showed that both groups treated with BSA showed significant increase in kidney macrophage infiltration compared to wild-type mock control (% F4 / 80 antibody-stained area) and a significant reduction in macrophage infiltration in tissue sections from BSA-treated MASP-2 - / - mice as compared to macrophage infiltration in tissue sections from BSA-treated wild type mice (P value = 0.0345), respectively.

FIG. 27A is a graph showing the percentage of macrophage-proteinuria correlated (FIG. 27A) in each wild type mouse treated with BSA (n = 6) by plotting macrophage infiltration (mean staining area%) versus total excreted protein measured in urine from a 24- Graphs of the analysis of existence are shown. As shown in Figure 27A, samples from wild-type kidneys showed a positive correlation with the level of proteinuria and the degree of macrophage infiltration.

FIG. 28B is a graph showing the effect of macrophage-proteinuria (MASP) on the MASP-2 - / - mice (n = 5) treated with BSA by plotting macrophage infiltration The graph shows the analysis of the existence of the relationship. As shown in FIG. 27B, no positive correlation (shown in FIG. 27A) observed in wild type mice between proteinuria levels and degree of macrophage infiltration was observed in MASP-2 - / - mice. While not wishing to be bound by any particular theory, these results may indicate the presence of a mechanism of inflammation clearance at high levels of proteinuria in MASP-2 - / - mice.

Assessment of cytokine infiltration

Interleukin 6 (IL-6), Transforming Growth Factor Beta (TGFβ) and Tumor Necrosis factor alpha (TNFα) are pro-inflammatory cytokines known to be upregulated in proximal tubules of wild-type mice in a proteinuria model (Abbate M .. et al, Journal of the American Society of Nephrology: JASN, 17:. 2974-2984, 2006; David S. et al, Nephrology, Didalysis, Transplantation, Official Publication of the European Dialysis and Transplant Association- European Renal Association 12 : 51-56, 1997). Tissue sections of the kidney were stained with cytokine-specific antibodies as described above.

28 shows the results of computer-based image analysis of tissue sections stained with anti-TGF beta antibody in wild-type mice (n = 4) treated with BSA and MASP-2 - / - mice The results (measured as% TGF beta antibody-staining area) are plotted. As shown in FIG. 28, a significant increase in the staining of TGFβ was observed in the wild-type BSA-treated (overloaded) group compared to the MASP-2 - / - BSA treated (overloaded) group (p = 0.026).

29 shows the results of computer-based image analysis of tissue sections stained with anti-TNFa antibodies in wild-type mice (n = 4) treated with BSA and MASP-2 - / - mice The results (measured as% TNF [alpha] antibody-staining area) are plotted. As shown in Figure 29, a significant increase in TNFa staining was observed in the wild type BSA treated (overloaded) group compared to the MASP-2 - / - BSA treated (overloaded) group (p = 0.0303).

Figure 30 is a graph showing the effect of the anti-IL-6 antibody in the tissue sections stained with wild-type control mice, wild-type mice treated with BSA (n = 7) and MASP-2 - / - mice The results of the computer-based image analysis (measured as% IL-6 antibody-staining area) are shown graphically. As shown in Figure 30, there was a significant increase in the staining of IL-6 in the wild type BSA treated group compared to the MASP-2 - / - BSA treated group (p = 0.0016).

Assessment of apoptosis

Apoptosis was assessed in tissue sections by staining with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and the frequency of TUNEL stained apoptotic cells was determined from 20 high power fields (HPF) continuously selected from the cortex ).

FIG. 31 shows the results of MASP-2-treated mice treated with wild type control mice (n = 1), MASP-2 - / - control mice (n = 1), wild type mice treated with BSA - graphically shows the frequency of TUNEL apoptotic cells counted in 20 high power fields (HPF) consecutively selected from tissue sections from the kidney cortex in mice (n = 7 horses). As shown in Figure 31, the significantly higher apoptotic rate of the cortex was observed in the kidneys obtained from wild-type mice treated with BSA compared to the kidneys obtained from MASP-2 - / - mice treated with BSA (p = 0.0001) .

A summary of the results and conclusions:

The results of this example demonstrate that MASP-2 - / - mice have reduced renal damage in the protein overload model. Therefore, it is expected that MASP-2 inhibitors, such as MASP-2 inhibitory antibodies, will inhibit or prevent the detrimental circulation of inflammation and proteinuria and improve the outcome of chronic kidney disease.

Example 17

This example describes the analysis of monoclonal MASP-2 inhibiting antibodies against the efficacy of reducing and / or preventing renal inflammation and tubular interstitial damage in a mouse protein overload proteinuria model of wild-type mice.

Background / Basis:

As described in Example 16, in the protein overload model of proteinuria, MASP-2 - / - mice were determined to exhibit significantly better results (such as less tubulointerstitial damage and less kidney inflammation) than wild-type mice, It suggests a pathogenic role for the lectin pathway in proteinuric renal disease.

As described in Example 13, a monoclonal MASP-2 inhibitory antibody (OMS646-SGMI-2) was generated that selectively blocked the function of the human lectin pathway and also blocked the lectin pathway in mice. In this example, the MASP-2 inhibitory antibody OMS646-SGMI-2 was analyzed in a mouse protein overload proteinuria model for efficacy in reducing and / or preventing renal inflammation and tubular interstitial damage in wild type mice.

Way:

This study evaluated the effect of MASP-2 inhibitory antibody (10 mg / kg OMS646-SGMI-2) compared to human IgG4 isotype control antibody, ET904 (10 mg / kg), and saline control.

Similar to the study described in Example 16, this study used protein overload to induce proteinuria kidney disease (Ishola et al., European Renal Association 21: 591-597, 2006). Proteinuria was measured by low daily endotoxin bovine serum albumin (BSA) at increasing doses (2 g / kg to 15 g / kg) in Balb / c mice in one kidney-resected kidney as described in Example 16 Lt; / RTI &gt; days.

Antibody therapy was started 7 days before proteinuria induction and every other week i.p. Administered by injection and continued until the end of the study. This dosing regimen was based on previous PK / PD and pharmacology studies (data not shown) that demonstrated sustained inhibition of leptin pathway. Mice were sacrificed on day 15 and kidneys were obtained and processed for H & E and immunostaining. Dyed tissue sections from the renal cortex were analyzed by digital image capture followed by quantification using automated image analysis software.

Immunohistochemical staining and apoptosis assessments were performed as described in Example 16.

result:

Assessment of proteinuria

To confirm the presence of proteinuria in mice, the total excreted protein of urine was measured in urine samples collected over a 24 hour period on day 15 (at the end of the experiment). Urine samples were measured to show an average nearly 6-fold increase in total protein levels in the BSA-treated group compared to the control group not treated with BSA (data not shown), indicating that proteinuria I confirmed existence. No significant differences in protein levels were observed between the BSA-treated groups.

Assessment of histological changes

Figure 32 shows representative H & E stained tissue sections from the following groups of mice on day 15 after treatment with BSA: (Panel A) Wild type control mice treated with saline; (Panel B) isotype antibody treated control mice; And (Panel C) Wild-type mice treated with MASP-2 inhibitory antibody.

(Panel C) compared to the wild type group (panel A) or isotype control (panel B) treated with saline at the same level of protein overload challenge, as shown in Figure 32 There is a higher degree of tissue preservation.

Assessment of apoptosis

Apoptosis was assessed in tissue sections by staining with terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and the frequency of TUNEL stained apoptotic cells was determined from 20 high power fields (HPF) continuously selected from the cortex ). Figure 33 shows the results of treatment of wild-type mice (n = 8) treated with saline control and BSA (n = 8), isotype control antibody and BSA and wild tongue mice treated with MASP- (HPF) consecutively selected from the tissue sections from the kidney cortex in the nude mice (n = 7 horses). As shown in Figure 33, there was a highly significant increase in the rate of cortical apoptosis in the kidneys obtained from the MASP-2 inhibitory antibody treated group compared to the saline and isotype control treated groups (saline control vs. MASP-2 P = 0.0002 for inhibitory antibody; p = 0.0052 for MASP-2 inhibitory antibody versus isotype control).

Assessment of cytokine infiltration

Interleukin 6 (IL-6), Transforming Growth Factor Beta (TGFβ), and Tumor Necrosis factor alpha (TNFα), pro-inflammatory cytokines known to be upregulated in the proximal tubule of wild-type mice in a proteinuria model, And evaluated in the obtained kidney tissue section.

Fig. 34 shows the results of a comparison between wild type mice treated with BSA and saline (n = 8), BSA and wild type mice (n = 7) treated with isotype control antibody and wild type mice treated with BSA and MASP- (Measured as% TGF beta antibody-staining area) of a tissue section stained with anti-TGF beta antibody at a concentration of 10 &lt; 6 &gt; As shown in Figure 34, quantification of the TGFβ staining area showed a significant decrease in the level of TGFβ in MASP-2 inhibitory antibody-treated mice compared to the saline and isotype control antibody-treated control group (p value = 0.0324 and 0.0349).

Figure 35 shows the results of a comparison between wild type mice (n = 8) treated with BSA and saline (n = 8), BSA and isotype control antibodies (n = 7) and BSA and MASP- A graphical representation of the results of the computer-based imaging analysis (measured as% TNFα antibody-staining area) of tissue sections stained with anti-TNFα antibody is shown. As shown in Figure 35, the analysis of the stained sections showed a significant increase in the level of TNF [alpha] in the MASP-2 inhibiting antibody-treated group compared to the silver isotype control group (p = 0.0285) as well as the saline control group Indicating a significant reduction.

Figure 36 shows the results of a comparison between wild type mice treated with BSA and saline (n = 8), BSA and isotype control antibodies (n = 7) and wild type mice (n = 8) treated with BSA and MASP- The results of a computer-based image analysis (measured as% IL-6 antibody-staining area) of tissue sections stained with anti-IL-6 antibody are shown graphically. As shown in Figure 36, the analysis of the stained sections showed a significant reduction of IL-6 in the MASP-2 inhibitory antibody-treated group compared to the silver isotype control group (p = 0.0445) as well as the saline control group (p = 0.0269) Level in the United States.

A summary of the results and conclusion:

The results of this example demonstrate that the use of a MASP-2 inhibitory antibody provides protection against renal injury in a protein overload model, demonstrating that MASP-2 - / - mice demonstrate reduced kidney damage in a proteinuria model 16).

Example 18

This example was generated using an adriamycin-induced nephrology model of renal fibrosis, inflammation and tubular interstitial damage in MASP-2 - / - and wild-type mice to assess the role of the lectin pathway in adriamycin-induced nephropathy Lt; / RTI &gt;

Background / Basis:

Adriamycin is an anthracycline antitumor antibiotic used in the treatment of a wide range of cancers, including hematological malignancies, soft-tissue sarcomas, and many types of carcinomas. Adriamycin-induced nephropathy is a well-established rodent model of chronic kidney disease that allows a better understanding of the progression of chronic proteinuria (Lee and Harris , Nephrology , 16: 30-38, 2011). The type of structural and functional impairment in adriamycin-induced nephropathy is very similar to that of chronic renal proteinuria in humans (Pippin et al., American Journal of Renal Physiology 296: F213-29, 2009).

Adriamycin-induced nephropathy is characterized by damage to podocytes associated with glomerulosclerosis, tubular interstitial inflammation and fibrosis. In many studies, adriamycin-induced nephropathy has been shown to be regulated by both immune and non-immunogenic mechanisms (Lee and Harris, Nephrology , 16: 30-38, 2011). Adriamycin-induced nephropathy has several strengths as a model of kidney disease. First, it is a model of highly reproducible and predictable kidney damage. This is characterized by the induction of renal damage within a few days after drug administration, since it allows ease of design of the experiment since the timing of the damage is consistent. It is also a model associated with acceptable mortality (<5%) and morbidity (weight loss) while severity of tissue damage is severe. Therefore, due to the severity and timing of renal injury in adriamycin-induced nephropathy, it is a suitable model for testing interventions that protect against kidney damage.

As described in Examples 16 and 17, MASP-2 - / - mice and mice treated with a MASP-2 inhibitory antibody in a protein overload model of proteinuria suggest a pathogenic role for the lectin pathway in proteinuric kidney disease , Significantly better results than wild-type mice (e.g., less tubular interstitial damage, and less kidney inflammation).

In this example, MASP-2 - / - mice were treated with an adriamycin-induced nephrology model (AN) to determine whether MASP-2 deficiency reduced and / or prevented renal inflammation and tubular interstitial damage induced by adriamycin ) Compared to wild type mice.

Way:

1. Dose and timing optimization

Initial experiments were performed to determine when BALB / c mice develop adriamycin dose and kidney inflammation levels suitable for testing therapeutic intervention.

Three groups of wild-type BALB / c mice (n = 8) were injected with a single dose of adriamycin (10.5 mg / kg) administered IV. Mice were scored at three time points: one week, two weeks, and four weeks after adriamycin administration. Control mice were injected with saline only.

RESULTS: All of the three groups of mice showed signs of glomerular sclerosis and proteinuria as measured by H & E staining, and showed a gradual increase in tissue inflammation as measured by macrophage infiltration in the kidney (data not shown) city). The degree of tissue damage was mild in the 1 week group, intermediate in the 2 week group, and severe in the 4 week group (data not shown). Two weeks were chosen for the rest of the study.

2. Analysis of adriamycin-induced nephropathy in wild-type and MASP-2 - / - mice

To illustrate the role of the complement's lectin pathway in adriamycin-induced nephrology, a group of MASP-2 - / - mice (BALB / c) was compared with wild type mice (BALB / c) in the same dose of adriamycin. MASP-2 - / - mice were backcrossed with BALB / c mice for 10 generations.

IV injections were made with adriamycin (10.5 mg / kg) in wild-type (n = 8) and MASP-2 - / - (n = 8) mice and 3 mice in each line were given saline alone as a control. All mice were culled 2 weeks after treatment and tissues were collected. The extent of histopathological damage was assessed by H & E staining.

result:

Figure 37 shows representative H & E stained tissue sections from the following groups of mice on day 14 post-treatment with adriamycin or saline only (control): Panel A-1, A-2, A-3) Wild type control mice; (Panel B-1, B-2, B-3) Wild-type mice treated with adriamycin; And MASP-2 - / - mice treated with adriamycin (Panel C-1, C-2, C-3). Each photograph (e.g., panels A-1, A-2, A-3) represents a different mouse.

As shown in Figure 37, there is a much greater degree of tissue preservation compared to the wild type group treated with the same dose of adriamycin in the MASP-2 - / - group treated with adriamycin.

Figure 38 depicts the kidney tissue sections stained with macrophage-specific antibody F4 / 80, showing the mean macrophage mean staining area (%) from the following group of mice at day 14 after treatment with adriamycin or saline alone The graphical representation of the results of a computer-based image analysis of: a wild-type mouse treated with adriamycin; MASP-2 - / - mice treated with saline only, and MASP-2 - / - mice treated with adriamycin. As shown in Figure 38, MASP-2 - / - mice treated with adriamycin exhibit reduced macrophage infiltration compared to wild type mice treated with adriamycin (** p = 0.007).

Figure 39 shows the results of a computer-based image analysis of the kidney tissue sections stained with Sirius red, showing the collagen deposition staining area (%) from the following group of mice on day 14 after treatment with adriamycin or saline alone (wild- The results are shown graphically: wild type control mice treated with saline alone; Wild type mice treated with adriamycin; MASP-2 - / - mice treated with saline only, and MASP-2 - / - mice treated with adriamycin. As shown in Figure 39, MASP-2 - / - mice treated with adriamycin exhibit reduced collagen deposition (** p = 0.005) compared to wild type mice treated with adriamycin.

Full summary and conclusion:

Improvement of renal tubular interstitial inflammation is a key target for the treatment of renal disease. The results presented here indicate that the lectin pathway of complement activation significantly contributes to the development of renal tubular interstitial inflammation. As further demonstrated herein, MASP-2 inhibitors, such as MASP-2 inhibitory antibodies, can be used as a novel therapeutic approach in the treatment of proteinuria, adriamycin nephropathy and renal tubular interstitial inflammation.

Example 19

This example demonstrates the safety and clinical efficacy of whole human monoclonal MASP-2 inhibiting antibodies in adults with steroid-dependent immunoglobulin A nephropathy (IgAN) and in adults with steroid-dependent membranous nephropathy (MN) Describe the initial results of Phase II trials.

background:

Chronic kidney disease occurs in more than 20 million people in the United States (Drawz P. et al., Ann Intern Med 162 (11); ITC1-16, 2015). In the United States, glomerulonephritis (GN), including IgAN and MN, is a renal disease in which glomeruli are damaged and frequently lead to end-stage renal disease and dialysis. There are several types of primary GNs, most commonly IgAN. Many of these patients experience sustained renal inflammation and progressive deterioration. Often these patients are treated with corticosteroids or immunosuppressants, which have many serious long-term side effects. Many patients continue to worsen these treatments. There is no approved treatment for the treatment of IgAN or MN.

IgA nephropathy

Immunoglobulin A nephropathy (IgAN) is an autoimmune kidney disease that causes renal inflammation and kidney damage. IgAN is the most common form of primary glomerulonephritis worldwide (Magistroni et al., Kidney Int . 88 (5): 974-89, 2015). The annual incidence is estimated to be 2.5 per 100,000 people, and 1 in 1400 people in the US is estimated to represent IgAN. As many as 40% of patients with IgAN will develop into end-stage renal disease (ESRD) within 20 years of diagnosis (Coppo R., D'Amico G., J Nephrol 18 (5): 503-12, 2005; Xie et al., PLoS One, 7 (6): e38904 (2012)). Patients typically have microscopic hematuria with mild to moderate proteinuria and variable levels of renal dysfunction (Wyatt RJ, et al., N Engl J Med 368 (25): 2402-14, 2013). Clinical markers such as impaired renal function, persistent hypertension, and heavy chain proteinuria ( greater than 1 g per day) are associated with poor prognosis (Goto M et al., Nephrol Dial Transplant 24 (10): 3068-74, 2009; Berthoux F. et al., J Am Soc Nephrol 22 (4): 752-61, 2011). Proteolysis is the strongest predictor of many large-scale observational studies and future studies independent of other risk factors (Coppo R. et al., J Nephrol 18 (5): 503-12, 2005; Reich HN, et al ., J Am Soc Nephrol 18 (12): 3177-83, 2007). If 15-20% of the patients remain untreated, it is assumed that the disease is initiated and ESRD is reached within 10 years (D'Amico G., Am J Kidney Dis 36 (2): 227-37, 2000).

The diagnostic feature of IgAN is that IgA deposition in the glomerular epilepsy is dominant, alone or in combination with IgG, IgM, or both. In IgAN, renal biopsy reveals glomerular deposition of mannan-binding lectin (MBL), a key recognition molecule for activation of the effector enzyme of the lectin pathway of the complement system, MASP-2. Glomerular MBL deposits, commonly co-localized with complement IgA and displaying complement activation, and high-level urinary MBL are associated with an undesirable prognosis of IgAN, and these patients are more likely than patients without MBL deposition or high levels of urinary MBL (Matsuda M. et al., Nephron 80 (4): 408-13, 1998; Liu LL et al., Clin Exp Immunol 169 (2): 148-155, 2012) ; Roos A. et al., J Am Soc Nephrol 17 (6): 1724-34, 2006; Liu LL et al., Clin Exp Immunol 174 (1): 152-60, 2013). Treatment remission is also substantially lower for patients with MBL deposition (Liu LL et al., Clin Exp Immunol 174 (1): 152-60, 2013).

Current approaches to the treatment of IgAN all attempt to slow, halt, or delay the deterioration of kidney function. Improvement of kidney disease against glomerulonephritis KDIGO Clinical Practice Guideline recommends treatment plan for IgAN mainly emphasizing blood pressure control through renin-angiotensin system (RAS) blockade [KDIGO Work Group 2012]. For patients with a proteinuria of more than 1 g daily on a continuous basis despite the maximum tolerated dose of the anti-hypertensive agent and well-controlled blood pressure, the recommended treatment is a corticosteroid and / or other immunosuppressive agents such as cyclophosphamide, azathioprine , Or mycophenolate mofetil. (KDIGO) Guideline ( Int. Soc of Nephrol 2 (2): 139-274, 2012) recommends that patients with corticosteroids with proteinuria> 1 g / It is recommended that the patient should be given a treatment period of usually 6 months. For patients exhibiting a rapid deterioration of renal clearance function with meniscus IgAN (defined as meniscus in glomeruli> 50%), other immunosuppressants (such as cyclophosphamide) may be added to the corticosteroids. However, even in aggressive immunosuppressive therapies associated with severe long-term sequelae, some patients progressively worsen kidney function. There is no FDA-approved treatment for IgAN, and despite the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) to control blood pressure, increased proteinuria persists in some patients. Neither of these therapies has been shown to halt or slow the progression of IgAN in patients at risk for the rapid progression of the disease. It would be possible to clearly address the medical requirement for alternative therapies that could reduce or eliminate chronic corticosteroid and / or immunosuppressive therapy.

Membranous nephropathy

The incidence of perennial nephropathy (MN) is approximately 10 to 12 per 1,000,000. MN patients may have a variable clinical course, but approximately 25% will develop into end-stage renal disease.

Membranous nephropathy is an immune-mediated glomerular disease and is one of the most common causes of nephrotic syndrome in adults. The disease is characterized by the formation of immunosuppression, mainly IgG4, which contains podocyte antigens and antibodies specific for such antigens on the external side of the glomerular basement membrane, leading to complement activation. Early signs of NM are associated with nephrotic syndrome: proteinuria, hypoalbuminemia, hyperlipidemia, and edema.

Although MN can be naturally managed without treatment, as many as one third of patients demonstrate progressive loss of kidney function and progress to ESRD on average after 5 years of diagnosis. Often, corticosteroids are used to treat MN and there is a need to develop alternative therapies. Additionally, on the basis of the severity of proteinuria, patients measured to be moderately progressive are treated with prednisone together with cyclophosphamide or calcineurin inhibitors, both of which are often associated with severe systemic side effects.

Way:

Two Phase 1 trials conducted in healthy volunteers have demonstrated that administration of the MASP-2 inhibiting antibody, OMS646, intravenously and subcutaneously resulted in sustained lectin pathway inhibition.

This example describes the interim results from the ongoing two-phase, uncontrolled, multicenter study of MASP-2 inhibitory antibodies, OMS646, in subjects with IgAN and MN. The inclusion criteria required that all patients in this study were maintained with a stable dose of corticosteroid for at least 12 weeks prior to study enrollment, regardless of the type of renal disease (ie, patients were steroid-dependent). The study was a single-arm pilot study involving 12 weeks of treatment and a 6-week follow-up period.

Approximately four subjects will be enrolled per disease. The study is designed to assess whether OMS646 in subjects with IgAN and MN can improve renal function (eg, improve proteinuria) and decrease corticosteroid demand. So far, two patients with IgA nephropathy and two patients with membranous nephropathy have completed the study.

At the start of the study, each subject had to show a high level of protein in their urine, despite the ongoing corticosteroid dose. These criteria will select patients who are not likely to improve naturally during the study period.

Subjects were included in the study only if the age at the time of screening was at least 18 years of age and diagnosed as one of the following: primary MN diagnosed in kidney biopsy or IgAN diagnosed in renal biopsy. Registered patients also had to meet all of the following inclusion criteria:

(1) have an average urinary albumin / creatinine ratio of> 0.6 from three samples collected continuously and daily before each visit of the two visits during the screening period;

(2) be treated with ≥ 10 mg of prednisone or equivalent dose for at least 12 weeks before a single screening visit;

(3) If the immunosuppressive agent is being treated (eg cyclopamide, mycophenolate mofetil), it should be treated at a stable dose for at least 2 months before a single screening visit and no change in dose is expected during the study;

(4) have an estimated glomerular filtration rate (eGFR) of ≥ 30 mL / min / 1.73 m ² calculated by MDRD equation ¹ ;

(5) He is being treated with a stable and optimized angiotensin converting enzyme inhibitor (ACEI) and / or angiotensin receptor blocker (ARB) as directed by the physician and has a systolic blood pressure of <150 mmHg and a diastolic blood pressure of <90 mmHg at rest ;

(6) Do not use Velimad, Ecuriujum or Ltujimab within 6 months of a single screening visit; And

(7) No history of kidney transplantation.

¹ MDRD formula: eGFR (mL / min ^{/1.73m 2) = 175 x (SCr} ) -1.154 x (Age) -0.203 x (0.742, if the female) x (1.212 if African American). Note: SCr = serum creatinine measurement should be mg / dL.

The monoclonal antibody, OMS646, used in this study is a whole human IgG4 monoclonal antibody that binds to and inhibits human MASP-2. MASP-2 is an effector enzyme of the lectin pathway. As demonstrated in Example 12, OMS646 binds strongly to recombinant MASP-2 (apparently equilibrium dissociation constant in the range of 100 pM) and exhibits selectivity over 5,000-fold over the homologous proteins C1s, C1r and MASP-1 . In functional assays, OMS646 inhibits the human lectin pathway with nano-molar potency (a concentration that induces 50% inhibition [IC ₅₀ ] of approximately 3 nM) but has no significant effect on the classical pathway. OMS646 administered by intravenous (IV) or subcutaneous (SC) injection to mice, non-human primates, and humans resulted in high plasma concentrations associated with inhibition of lectin pathway activation in vitro assays.

In this study, OMS646 drug substance was provided at a concentration of 100 mg / mL, which was further diluted for IV administration. A properly calculated volume of OMS646 100 mg / mL injection solution was withdrawn from the vial using a syringe for dose preparation. The infusion bag was administered within 4 hours after the preparation.

The study consists of screening (28 days), treatment (12 weeks) and follow-up (6 weeks) periods as shown in the study design plan below.

Research Design Plan

Within the screening period and prior to the first OMS 646 dose, written consent was obtained by providing three urine samples (collected once daily) for each of the 2/3-consecutive day periods to determine the baseline value of the urine albumin-to-creatinine ratio Respectively. After the screening period, qualified subjects were given OMS646 4 mg / kg IV once a week for 12 weeks (treatment period). After the last OMS646, there was a follow-up period of six weeks.

During the first 4 weeks of treatment with OMS646, subjects maintained their stable study-previous corticosteroid dose. At the end of the initial 4-week period during the 12-week treatment period, if the subjects received a corticosteroid taper (ie, the corticosteroid dose was reduced) and could tolerate it for 4 weeks, the resulting corticosteroid dose was reduced to 4 Week. The target was a taper of ≤6 mg prednisone (or equivalent volume) daily. During this period, the taper was stopped by subjects who showed deterioration of kidney function as measured by the investigator. Subjects were treated with OMS646 via a corticosteroid taper for a total of 12 weeks of treatment. Patients were then followed up for an additional 6 weeks after the last treatment. Taper and OMS646 treatment of corticosteroids allowed an assessment of whether OMS646 allowed a reduction in the dose of corticosteroid needed to maintain stable renal function.

The key efficacy measure in this study is urinary albumin-to-creatinine ratio (uACR) and a 24-hour protein level from baseline to 12 weeks. Measurements of protein or albumin in the urine are routinely used to assess renal improvement and persistent high levels of protein in the urine are correlated with renal disease progression. uACR is used clinically to assess proteinuria.

Efficacy analysis

The analytical value for uACR is defined as the average of all values obtained for the viewpoint. The planned number of uACRs is 3 at each scheduled time. The baseline value of uACR is defined as the average of the analytical values at the time of two screening visits.

result:

Figure 40 graphically shows uACR in two IgAN patients during a 12 week study involving weekly treatment with a 4 mg / kg MASP-2 inhibiting antibody (OMS646). As shown in FIG. 40, the change from the baseline is obtained by the modified analysis at time point "a" ( p = 0.003); And statistically significant at time point "b" ( p = 0.007) and at time point "c" ( p = 0.033). Table 12 provides 24-hour urine-protein data for two IgAN patients treated with OMS646.

In OMS646-treated IgAN patients, 24-hour urine protein (mg / day) Sampling time Patient # 1
(mg / 24 hours) Patient # 2
(mg / 24 hours) Average base line 3876 2437 3156 Day 85 1783 455 1119 p = 0.017

As shown in Figure 40 and Table 12, patients with IgAN have demonstrated clinically and statistically significant improvements in kidney function over the course of the study. There was a statistically significant decrease in both uACR (see FIG. 40) and 24-hour urine protein concentration (see Table 12). As shown in the uACR data of Figure 40, the mean baseline uACR was 1264 mg / g and reached 525 mg / g at the end of treatment (p = 0.011) and decreased to 128 mg / g at the end of the follow-up period. In addition, as shown in FIG. 40, the therapeutic effect was maintained through the follow-up period. Measurement of 24-hour urinary protein excretion followed uACR and decreased from 3156 mg / 24 hours to 1119 mg / 24 hours (p = 0.017). The treatment effect was very consistent across the two patients. Both patients experienced a reduction of approximately 2000 mg / day, and both achieved a partial improvement (a reduction of more than 50 percent in 24-hour urinary protein excretion and / or as a result of protein excretion of less than 1000 mg / day; The carriageway is defined as protein excretion of less than 300 mg / day). The magnitude of 24-hour proteinuria reduction in two patients with IgAN nephropathy is associated with a significant improvement in renal survival. Two patients with IgA nephropathy were also able to substantially reduce their steroids, each reducing the daily dose to ≤5 mg (0 mg at 60 mg; 5 mg at 30 mg).

Two MN patients also demonstrated a decrease in uACR during treatment with OMS646. One MN patient showed a decrease in uACR from 1003 mg / g to 69 mg / g, and this low level was maintained throughout the follow-up period. Other MN patients showed a decrease in uACR from 1323 mg / g to 673 mg / g and there was a variable process after treatment. The first MN patient showed a significant reduction in 24-hour urine protein levels (from baseline of 10,771 mg / 24 hours to 325 mg / 24 hours on day 85), while the other patients achieved essentially complete improvement (4272 mg / 24 hours at baseline and 4502 mg / 24 hours at day 85). Steroids were gradually reduced from 30 mg to 15 mg and from 10 mg to 5 mg in two MN patients.

In summary, a consistent improvement in renal function was observed in IgAN and MN subjects treated with the MASP-2 inhibitory antibody OMS646. The effect of OMS646 treatment in patients with IgAN is vigorous and consistent, suggesting a potent efficacy signal. This effect is supported by results in MN patients. The time course and size of uACR changes during treatment were consistent among all four patients with IgAN and MN. Significant safety concerns were not observed. Patients in this study represented a group that was difficult to treat and the therapeutic effect in these patients was associated with IgAN and MN patients, including patients at risk of rapid progression to end-stage renal disease, such as steroid-dependent IgAN and MN Is thought to predict efficacy with MASP-2 inhibitory antibodies, such as OMS646, in patients (i. E. Patients undergoing treatment with a stable corticosteroid dose prior to treatment with a MASP-2 inhibitory antibody).

In accordance with the foregoing description, in one aspect, the invention provides a method of treating a subject suffering from IgAN or MN, comprising administering to the subject a composition comprising an amount of a MASP-2 inhibiting antibody effective to inhibit MASP- Lt; RTI ID = 0.0 &gt; human &lt; / RTI &gt; In one embodiment, the method comprises administering to a human subject suffering from IgAN or MN an amount of a MASP-2 inhibiting antibody sufficient to improve renal function (e.g., to improve proteinuria). In one embodiment, the subject is suffering from steroid-dependent IgAN. In one embodiment, the subject is suffering from steroid-dependent MN. In one embodiment, the MASP-2 inhibitory antibody is administered to a subject suffering from steroid-dependent IgAN or steroid-dependent MN in an amount sufficient to improve renal function and / or decrease corticosteroid dosage in the subject.

In one embodiment, the method comprises identifying a human subject suffering from steroid-dependent IgAN prior to administering to the subject a composition comprising an amount of a MASP-2 inhibitory antibody effective to inhibit MASP-2-dependent complement activation .

In one embodiment, the method comprises identifying a human subject suffering from steroid-dependent MN prior to administering to the subject a composition comprising an amount of a MASP-2 inhibiting antibody effective to inhibit MASP-2-dependent complement activation .

According to any of the embodiments of the embodiments disclosed herein, the MASP-2 inhibitory antibody exhibits at least one of the following characteristics: the antibody binds to human MASP-2 with a K _D of 10 nM or less, Which binds to an epitope in the CCP1 domain of MASP-2, which inhibits C3b deposition with an IC ₅₀ of 10 nM or less in in vitro assays in 1% human serum and the antibody inhibits C3b deposition in 90% Wherein the antibody inhibits C3b deposition by IC ₅₀ , wherein the antibody is an antibody fragment selected from the group consisting of Fv, Fab, Fab ', F (ab) ₂ and F (ab') ₂ , wherein the antibody is a single chain molecule, The antibody is an IgG1 molecule, the antibody is an IgG4 molecule, and the IgG4 molecule comprises a S228P mutation. In one embodiment, the antibody binds to MASP-2 and selectively inhibits the lectin pathway and does not substantially inhibit the classical pathway (i. E., Leaving the classical complement pathway intact while inhibiting the lectin pathway).

In one embodiment, the MASP-2 inhibiting antibody can be used to ameliorate at least one or more clinical parameters associated with renal function, such as an improvement in proteinuria (e.g., a decrease in uACR and / or a decrease in 24- A reduction of more than 20 percent in urinary protein excretion, or a decrease of more than 30 percent in, for example, 24-hour urinary protein excretion, or a decrease of, for example, more than 40 percent in 24-hour urinary protein excretion, ). &Lt; / RTI &gt;

In some embodiments, the method includes administering IgAN (e.g., steroid-dependent IgAN) via a catheter (e.g. intravenously) during the first period (e.g., at least 1 day to 1 week or 2 weeks or 3 weeks or 4 weeks or more) Administering the MASP-2 inhibitory antibody to the subject suffering from the disease, and then subcutaneously administering the MASP-2 inhibitory antibody to the subject for a second period of time (e.g., a chronic phase of at least two weeks).

In some embodiments, the method includes administering MN (e.g., steroid-dependent MN) through a catheter (e.g., intravenously) during the first period (e.g., at least 1 day to 1 week or 2 weeks or 3 weeks or 4 weeks or more) Administering the MASP-2 inhibitory antibody to the subject suffering from the disease, and then subcutaneously administering the MASP-2 inhibitory antibody to the subject for a second period of time (e.g., a chronic phase of at least two weeks).

In some embodiments, the method comprises intravenously, intramuscularly, or subcutaneously administering a MASP-2 inhibiting antibody to a subject suffering from IgAN (e.g., steroid-dependent IgAN) or MN (e.g., steroid-dependent MN) . The treatment can be chronic and can be administered every day or every month, but may be administered preferably every two weeks, or at least once a week, for example twice or three times a week.

In one embodiment, the method comprises comparing the heavy chain variable region comprising the CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence set forth in SEQ ID NO: 67 and the CDR-L1, CDR Comprising administering to a subject a composition comprising an amount of a MASP-2 inhibitory antibody, or antigen-binding fragment thereof, comprising a light chain variable region comprising a heavy chain variable region (CDR) -L2 and CDR-L3, ) Or MN (e.g., steroid-dependent MN). In some embodiments, the composition comprises: (a) a heavy chain CDR-H1 comprising the amino acid sequence of 31-35 of SEQ ID NO: 67; And ii) heavy chain CDR-H2 comprising the amino acid sequence of 50-65 of SEQ ID NO: 67; And iii) a heavy chain variable region comprising a heavy chain CDR-H3 comprising the amino acid sequence of amino acids 95-107 of SEQ ID NO: 67 and b) a heavy chain variable region comprising a light chain CDR comprising amino acid sequences 24-34 of SEQ ID NO: -L1; And ii) a light chain CDR-L2 comprising the amino acid sequence of 50-56 of SEQ ID NO: 70; And iii) a light chain variable region comprising a light chain CDR-L3 comprising the amino acid sequence of 89-97 of SEQ ID NO: 70, or (ii) a light chain variable region comprising at least 90% identity to SEQ ID NO: : At least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98%, at least 99% identity to SEQ ID NO: 67) : At least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98% identity to SEQ ID NO: 70 %, At least 99% identity) of a light chain variable region of a MASP-2 inhibitory antibody.

In some embodiments, the method comprises the step of generating a MASP-2 inhibiting antibody comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67 and a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70, Comprising the step of administering to the subject a composition comprising an amount of an antigen-binding fragment.

In some embodiments, the method comprises amplifying at least a portion of an epitope on human MASP-2 recognized by reference antibody OMS646 comprising the heavy chain variable region shown in SEQ ID NO: 67 and the light chain variable region shown in SEQ ID NO: 70, , Or a composition comprising an antigen-binding fragment thereof, to a subject in need thereof.

In some embodiments, the method comprises administering to a subject suffering from, or at risk of developing, an IgAN (e. G., A steroid-dependent IgAN) or MN (e. G., Steroid-dependent MN), a heavy chain comprising the amino acid sequence set forth in SEQ ID NO: A composition comprising a MASP-2 inhibitory antibody, or antigen-binding fragment thereof, comprising a variable region and a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70 is administered at a dose of 1 mg / kg to 10 mg / kg , 1 mg / kg, 2 mg / kg, 3 mg / kg, 4 mg / kg, 5 mg / kg, 6 mg / At least three weeks, or at least four weeks, or at least five weeks, or at least six weeks, or at least seven weeks, or at least eight weeks, at least once a week, such as at least twice a week or at least three times a week, , Or at least 9 weeks, or at least 10 weeks, or at least 11 weeks, or at least 12 weeks.

Example 20

This example describes the initial results of an ongoing Phase II trial to assess the safety and clinical efficacy of whole human monoclonal MASP-2 inhibiting antibodies in adults with steroid-dependent lupus nephritis (LN).

Background :

Chronic renal disease affects more than 20 million people in the United States (Drawz P. et al., Ann Intern Med 162 (11); ITC1-16, 2015). Glomerular nephritis (GN), including IgAN, MN and LN, is a renal disease that is often impaired in the glomeruli leading to end-stage renal disease and dialysis. Many of these patients have persistent renal inflammation and gradual deterioration. Often these patients are treated with corticosteroids or immunosuppressants, which can have serious long-term adverse outcomes. Many patients continue to worsen during these treatments.

Lupus nephritis

The major complication of systemic lupus erythematosus (SLE) is nephritis, also known as lupus nephritis, which is a secondary form of glomerulonephritis. Up to 60% of adults with SLE have a form of kidney in the late phase of the disease process with a prevalence of 20 to 70 per 100,000 in the United States (Koda-Kimble et al., Koda-Kimble and Young's Applied Therapeutics: the clinical use of drugs, 10 ^th Ed, Lippincott Williams & Wilkins: pages 792-9, 2012). Lupus nephritis is frequently seen in patients with other symptoms of active SLE, including fatigue, fever, rash, arthritis, serosa, or central nervous system disease (Pisetsky DS et al., Med Clin North Am 81 -28, 1997). Some patients have asymptomatic lupus nephritis; However, during routine follow-up periods, laboratory abnormalities, such as elevated serum creatinine levels, low albumin levels, or urinary protein or precipitation, suggest active lupus nephritis. Autoimmunity plays a major role in the onset of lupus nephritis. These autoantibodies form a pathogenic immune complex in the blood vessels, which are deposited in the glomeruli. Autoantibodies also bind to antigens already located in the glomerular basement membrane to form immune complexes in situ. Immune complexes promote inflammatory responses by activating complement and attracting inflammatory cells (D'Agati VD et al., Lupus nephritis: pathology and pathogenesis: Wallace DJ Hahn, Dubois' Lupus Erythematosus, 7 ^th Ed Philadelpha: Lippincott Williams & Wiklins: p1094-111, 2007). Thus, immune complex-mediated complement activation plays a key role in the pathogenesis of lupus nephritis. C4d deposits are present in kidney tissue and are usually associated with immune complex deposits, C1q, and C3, triggering a classical pathway. In some cases, C4d deposition is present without C1q, indicating the possible inclusion of the lectin pathway (Kim MK, et al. Int J Clin Exp Pathol 6 (10): 2157-67, 2013).

Further support for an important contribution to the lectin pathway, deposition of MBL occurs in skin lesions of SLE patients (Wallim LR et al., Hum Immunol 75 (7): 629-32, 2014). In addition, vigorous deposition of MBL and picolin was observed in most of the renal biopsies from patients with lupus nephritis (Nisihara RM et al., Hum Immunol 74 (8): 907-10, 2013). Renal MBL deposition was most prominent in patients with hyperproteinuria. Furthermore, plasma MBL levels were significantly higher in SLE patients than in healthy controls, and MBL levels correlated with disease activity suggesting that MBL levels may represent biomarkers for SLE disease activity (Panda AK et al Arthritis Res Ther 14 (5): R218, 2012). Corticosteroids are a major conventional treatment option for patients with mild lupus nephritis. In more severe cases, high dose prednisone, methylprednisolone, mycophenolate mopetil, cyclophosphamide, azathioprine, and cyclosporin have been used in clinical practice. Treatment options for SLE and lupus nephritis are highly related to morbidity and mortality. Adverse effects, particularly from long-term corticosteroid use, limit the patient's adherence to subsequent effects on therapeutic efficacy. There is a need to develop better acceptable cure methods.

Methods :

As described in Example 19 above, two Phase 1 clinical trials performed in healthy volunteers demonstrated that intravenous and subcutaneous administration of the MASP-2 inhibiting antibody, OMS646, resulted in sustained lectin pathway inhibition.

This example describes the interim results from two ongoing, uncontrolled, multicenter studies of the MASP-2 inhibitory antibody, OMS646, in subjects with lupus nephritis (LN). The inclusion criteria require that all patients in this study, regardless of renal disease subtype, be maintained with a stable dose of corticosteroid for at least 12 weeks before being enrolled in the study (ie, patients are steroid-dependent). The study was a single-arm pilot study involving 12 weeks of treatment and a 6-week follow-up period.

The study is designed to assess whether OMS646 in subjects with LN can improve renal function (eg, improve proteinuria) and reduce corticosteroid demand. To date, five patients with lupus nephritis (LN) have completed treatment in the study.

At the start of the study, each subject had to show a high level of protein in their urine, despite the ongoing corticosteroid dose. Based on these criteria, patients who are not likely to improve naturally during the study period are selected.

Subjects were included in the study only when they were 18 years of age or older at the time of screening and diagnosed with lupus nephritis diagnosed for renal biopsy. Registered patients also had to meet all of the following inclusion criteria:

(1) have an average urinary albumin / creatinine ratio of> 0.6 from three samples collected continuously and daily before each visit of the two visits during the screening period;

(2) be treated with ≥ 10 mg of prednisone or equivalent dose for at least 12 weeks before the first visit;

(3) If immunosuppressant therapy (eg cyclopamide, mycophenolate mofetil) is being used, the dose should be stable at least 2 months before the first visit and no change in dose is expected during the study;

(4) have an estimated glomerular filtration rate (eGFR) of ≥ 30 mL / min / 1.73 m ² calculated by MDRD equation ¹ ;

(5) are being treated with a stable and optimized angiotensin converting enzyme inhibitor (ACEI) and / or angiotensin receptor blocker (ARB) as directed by the physician and have a systolic blood pressure of <150 mmHg and a diastolic blood pressure of <90 mmHg at rest ;

(6) Within six months of screening visit 1, do not use Velimad, Ecuriujum or Ltujimab; And

(7) No history of kidney transplantation.

¹ MDRD formula: eGFR (mL / min ^{/1.73m 2) = 175 x (SCr} ) -1.154 x ( age) ^-0.203 x (0.742, if the female) x (1.212 if African American). Note: SCr = serum creatinine measurement should be mg / dL.

The monoclonal antibody, OMS646, used in this study is a whole human IgG4 monoclonal antibody that binds to and inhibits human MASP-2. MASP-2 is an effector enzyme of the lectin pathway. As demonstrated in Example 12, OMS646 binds strongly to recombinant MASP-2 (apparently equilibrium dissociation constant in the range of 100 pM) and exhibits selectivity over 5,000-fold over the homologous proteins C1s, C1r and MASP-1 . In a functional assay, OMS646 inhibits the human lectin pathway with nano-molar potency (a concentration that induces a 50% inhibition of [IC ₅₀ ] of approximately 3 nM) but has no significant effect on the classical pathway. OMS646 administered by intravenous (IV) or subcutaneous (SC) injection to mice, non-human primates, and humans resulted in high plasma concentrations associated with inhibition of lectin pathway activation in vitro assays.

In this study, OMS646 drug substance was provided at a concentration of 100 mg / mL, which was further diluted for IV administration. A properly calculated volume of OMS646 100 mg / mL injection solution was withdrawn from the vial using a syringe for dose preparation. The infusion bag was administered within 4 hours after the preparation.

The study consists of screening (28 days), treatment (12 weeks) and follow-up (6 weeks) periods as shown in the study design plan below.

Research Design Plan

Within the screening period and prior to the first OMS646 dose, written consenting subjects were provided with 3 urine samples (collected once daily) for each of the 2/3-consecutive day periods to provide 24-hour urine protein and urine albumin- - The baseline value of the creatinine ratio was established. After the screening period, qualified subjects were given OMS646 4 mg / kg IV once a week for 12 weeks (treatment period). After the last OMS646, there was a follow-up period of six weeks.

During the first 4 weeks of treatment with OMS646, subjects maintained their stable study-previous corticosteroid dose. At the end of the initial 4-week period during the 12-week treatment period, if the subjects received a corticosteroid taper (ie, the corticosteroid dose was reduced) and could tolerate it for 4 weeks, the resulting corticosteroid dose was reduced to 4 Week. The goal was a taper of prednisone (or equivalent volume) less than 6 mg daily. During this period, the taper was stopped by subjects who showed deterioration of kidney function as measured by the investigator. Subjects were treated with OMS646 via a corticosteroid taper for a total of 12 weeks of treatment. Patients were then followed for an additional 6 weeks after the last treatment. Taper and OMS646 treatment of corticosteroids allowed an assessment of whether OMS646 allowed a reduction in the dose of corticosteroid needed to maintain stable renal function.

Efficacy analysis

The key efficacy measure in this study is a 24-hour protein level change from baseline to 12 weeks. Measurements of protein or albumin in the urine are routinely used to assess renal improvement and persistent high levels of protein in the urine are correlated with renal disease progression. uACR is used clinically to assess proteinuria. The partial incidence is defined as a reduction of more than 50 percent in 24-hour urinary protein excretion.

result:

Table 13 provides 24-hour urine protein (mg / day) for 5 LN patients treated with OMS646.

In OMS646-treated LN patients, 24-hour urine protein (mg / day) sampling
time Patient # 1
(mg / 24 hours) Patient # 2
(mg / 24 hours) Patient # 3
(mg / 24 hours) Patient # 4
(mg / 24 hours) Patient # 5
(mg / 24 hours) Mean (Patient # 2-5) base line 1112 7539.0 2066.9 2217.8 4067.0 15890.7 Day 85 13731 2750.9 282.0 1168.0 797.6 4998.5

Note: Patient # 1 suffered systemic disease outbreak during the study.

As can be seen in Table 13, patients with LN have demonstrated clinically and statistically significant improvements in kidney function over the course of the study. As can be seen in Table 13, four of the five LN patients showed a substantial (average 69 percent) reduction in 24-hour urinary protein excretion over the treatment period. The fifth patient (patient # 1) experienced a systemic disease episode and a substantial increase, and most of the lupus patients were able to reduce their steroid dose gradually.

In summary, a consistent improvement in renal function was observed in 4 of the 5 LN patients treated with the MASP-2 inhibitory antibody OMS646. The efficacy of OMS646 treatment in patients with LN is vigorous and consistent, suggesting a potent efficacy signal. Significant safety concerns were not observed. Patients in this study represented a group that was difficult to treat, and the therapeutic effect in these patients was evaluated in LN patients, such as patients suffering from steroid-dependent LN 2 inhibitory antibody, such as OMS646, in patients undergoing treatment with a stable corticosteroid dose prior to treatment with a MASP-2 inhibitory antibody).

According to the foregoing description, in one embodiment, the invention provides a method of treating a human suffering from LN, comprising administering to the subject a composition comprising an amount of a MASP-2 inhibiting antibody effective to inhibit MASP- Thereby providing a method of treating the subject. In one embodiment, the method comprises administering to a human subject suffering from LN an amount of a MASP-2 inhibiting antibody sufficient to improve renal function (e.g., to improve proteinuria). In one embodiment, the subject is suffering from a steroid-dependent LN. In one embodiment, the MASP-2 inhibitory antibody is administered to a subject suffering from a steroid-dependent LN in an amount sufficient to improve renal function and / or decrease a corticosteroid dose in the subject.

In one embodiment, the method comprises identifying a human subject suffering from a steroid-dependent LN prior to administering to the subject a composition comprising an amount of a MASP-2 inhibiting antibody effective to inhibit MASP-2-dependent complement activation .

According to any of the embodiments of the embodiments disclosed herein, the MASP-2 inhibitory antibody exhibits at least one of the following characteristics: the antibody binds to human MASP-2 with a K _D of 10 nM or less, Which binds to an epitope in the CCP1 domain of MASP-2, which inhibits C3b deposition with an IC ₅₀ of 10 nM or less in in vitro assays in 1% human serum and the antibody inhibits C3b deposition in 90% Wherein the antibody inhibits C3b deposition by IC ₅₀ , wherein the antibody is an antibody fragment selected from the group consisting of Fv, Fab, Fab ', F (ab) ₂ and F (ab') ₂ , wherein the antibody is a single chain molecule, The antibody is an IgG1 molecule, the antibody is an IgG4 molecule, and the IgG4 molecule comprises a S228P mutation. In one embodiment, the antibody binds to MASP-2 and selectively inhibits the lectin pathway and does not substantially inhibit the classical pathway (i. E., Leaving the classical complement pathway intact while inhibiting the lectin pathway).

In one embodiment, the MASP-2 inhibitory antibody can be used to ameliorate at least one or more clinical parameters associated with renal function, such as to improve proteinuria (e.g., decrease uACR and / or decrease 24- A reduction of more than 20 percent in urinary protein excretion, or a decrease of more than 30 percent in, for example, 24-hour urinary protein excretion, or a decrease of, for example, more than 40 percent in 24-hour urinary protein excretion, ) Is administered to a subject suffering from LN in an amount effective to: In some embodiments, the MASP-2 inhibitory antibody is administered to a subject suffering from LN in an amount effective to effect at least a partial differential of proteinuria (i. E., A 50 percent or greater decrease in 24-hour urinary protein excretion relative to baseline) do.

In some embodiments, the method includes administering to a subject suffering from an LN (e.g., a steroid-dependent LN) a MASP-2 inhibitory antibody via a catheter (e.g., intravenously) for a first period of time (such as at least one day to one week or two weeks Or 3 weeks or 4 weeks or more) and administering the MASP-2 inhibiting antibody subcutaneously to the subject during a second period of time (e.g., at least two weeks or more in a chronic phase).

In some embodiments, the method comprises intravenously, intramuscularly, or subcutaneously administering a MASP-2 inhibitory antibody to a subject suffering from an LN (e.g., a steroid-dependent LN). The treatment can be chronic and can be administered every day or every month, but may be administered preferably every two weeks, or at least once a week, for example twice or three times a week.

In one embodiment, the method comprises comparing the heavy chain variable region comprising the CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence set forth in SEQ ID NO: 67 and the CDR-L1, CDR Comprising administering to a subject a composition comprising an amount of a MASP-2 inhibitory antibody, or antigen-binding fragment thereof, comprising a light chain variable region comprising a heavy chain variable region (CDR) -L2 and CDR-L3 ). &Lt; / RTI &gt; In some embodiments, the composition comprises: (a) a heavy chain CDR-H1 comprising the amino acid sequence of 31-35 of SEQ ID NO: 67; And ii) heavy chain CDR-H2 comprising the amino acid sequence of 50-65 of SEQ ID NO: 67; And iii) a heavy chain variable region comprising a heavy chain CDR-H3 comprising the amino acid sequence of amino acids 95-107 of SEQ ID NO: 67 and b) a heavy chain variable region comprising a light chain CDR comprising amino acid sequences 24-34 of SEQ ID NO: -L1; And ii) a light chain CDR-L2 comprising the amino acid sequence of 50-56 of SEQ ID NO: 70; And iii) a light chain variable region comprising a light chain CDR-L3 comprising the amino acid sequence of 89-97 of SEQ ID NO: 70, or (ii) a light chain variable region comprising at least 90% identity to SEQ ID NO: : At least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98%, at least 99% identity to SEQ ID NO: 67) : At least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98% identity to SEQ ID NO: 70 %, At least 99% identity) of a light chain variable region of a MASP-2 inhibitory antibody.

In some embodiments, the method comprises the step of generating a MASP-2 inhibiting antibody comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67 and a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70, Comprising administering to a subject suffering from LN (e.g., a steroid-dependent LN) a composition comprising an amount of an antigen-binding fragment.

In some embodiments, the method comprises amplifying at least a portion of an epitope on human MASP-2 recognized by reference antibody OMS646 comprising the heavy chain variable region shown in SEQ ID NO: 67 and the light chain variable region shown in SEQ ID NO: 70, , Or a composition comprising an antigen-binding fragment thereof, to a subject suffering from LN (e. G., A steroid-dependent LN).

In some embodiments, the method comprises administering to a subject suffering from, or at risk of developing, an LN (such as a steroid-dependent LN), a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67 and a heavy chain variable region comprising SEQ ID NO: 70 (I. E., 1 mg / kg, 2 mg / kg) of a composition comprising a MASP-2 inhibitory antibody, or antigen-binding fragment thereof, comprising a light chain variable region comprising the indicated amino acid sequence, kg, 3 mg / kg, 4 mg / kg, 5 mg / kg, 6 mg / kg, 7 mg / kg, 8 mg / kg, 9 mg / kg or 10 mg / At least three weeks, or at least four weeks, or at least five weeks, or at least six weeks, or at least seven weeks, or at least eight weeks, or at least nine weeks, or at least three weeks, 10 weeks, or at least 11 weeks, or at least 12 weeks.

Example 21

This example assesses the safety and clinical efficacy of OMS646, a total human monoclonal MASP-2 inhibiting antibody, in reducing proteinuria in adult patients with glomerulopathies, including IgAN as described in Example 19. [ Desc / Clms Page number 2 &gt; results obtained in the ongoing Phase 2 clinical trials to be performed.

Methods :

As described in Example 19 above, Phase 2 trials included patients with IgAN who received corticosteroids at study introduction, all patients received OMS646 in an open-label fashion, and positive results were obtained from two patients with IgAN. The dosing was now completed using the method described in Example 19 for an additional two IgAN patients and the test was completed for a total of four IgAN patients.

For inclusion in this study, patients with IgAN were (1) diagnosed with IgAN by biopsy, (2) had a uACR greater than 0.6 g / g, (3) eGFR = 30 mL / min / 1.73 m ² , ) Shows controlled blood pressure for stable ACEI / ARB therapy, and (5) has a stable steroid dose above 10 mg prednisone for at least 12 weeks.

All four adult IgAN patients treated with OMS646 in this study had conventional renal impairment and had an estimated eGFR rate of 30 to 46 mL / mg / 1.73 m ^{2 and} an estimated eGFR of 2.44 to 4.87 g / 24 hours 24-hour protein assay. All patients received stable renin-angiotensin system (RAS) blockade and at least 3 months of corticosteroid treatment at the time of study entry.

All patients received OMS646 once a week for 12 weeks. Patients received OMS646 treatment with a 4-week introductory dose followed by a stable steroid dose of 4 weeks, a 4-week steroid taper if tolerable, and a 4-week tapered steroid dose. After OMS646 treatment, patients were followed in the study for an additional 6 weeks or more. After the test was completed, the investigator tracked the patients.

In the test, efficacy measures were: (1) urine albumin / creatinine ratio (uACR) measured 6 times before baseline (baseline) and 3 times during each efficacy assessment during treatment and follow-up; And (2) 24-hour urine protein once measured before OMS646 treatment and once every 2 to 4 weeks after completion of OMS646 treatment. By protocol, the corticosteroids were increasingly reduced in dose from 4 to 8 weeks if clinically appropriate.

result:

Four patients with IgAN completed a follow-up period of 6 weeks after treatment. Table 14 presents the demographic and baseline characteristics of these patients.

Demographic and baseline characteristics Patient 1 Patient 2 Patient 3 Patient 4 Age (years) 35 32 55 45 gender male female female female race White Asian White White Time from diagnosis 8 years 5 months 5 months 2 years uACR (mg / g) 1271 1256 1674 1628 24-hour protein (mg) 3876 2437 4872 4554 eGFR (mL / min / SSA) 46 30 44 42 Blood Pressure (mm Hg) 110/84 124/74 126/74 136/66

eGFR-estimated glomerular filtration rate; SSA-standard surface area (1.73 m ² ); uACR-urine albumin / creatinine ratio

All patients demonstrated a significant decrease in proteinuria during OMS646 treatment. Statistically and clinically significant improvements were observed in both uACR and 24-hour protein measurements, as shown in Figures 41 and 42.

Figure 41 graphically shows uACR (mg / g) for 4 IgAN patients treated with OMS646 over time from baseline to 120 days. As shown in Figure 41, from the baseline to the end of the study, the mean uACR decreased to 1.13 g / g +/- 0.27 (77% reduction, p = 0.026). As further shown in Figure 41, after OMS646 treatment, uACR for each patient was reduced by 94%, 86%, 47% and 89% (for patients 1 to 4, respectively) compared to the last follow-up baseline .

Figure 42 graphically depicts 24 hour urine protein changes from baseline on day 1 before and after treatment for 4 IgAN patients treated with OMS646. As shown in Figure 42, the 24-hour urine protein decreased from 54%, 81%, 63% and 95% (for patients 1 to 4, respectively) from baseline.

Figure 43 graphically illustrates the mean change from baseline to post-treatment of 24-hour urinary protein in 4 IgAN patients treated with OMS646. As shown in Figure 43, the mean 24-hour urine protein decreased to 2.87 ± 1.08 g / 24 hours (73% decrease; p = 0.013).

All patients were able to discontinue corticosteroids during or shortly after the study and demonstrated that the effects of OMS646 on proteinuria were unlikely to be corticosteroid-related. Estimated glomerular filtration rate (eGFR) (calculated by the dietary modification formula in renal disease) was stable throughout the treatment and follow-up period.

OMS646 was well tolerated by all patients.

In summary, in this open-label phase 2 clinical study, a significant and sustained reduction of uACR was observed in all IgAN patients treated with OMS646 for 12 weeks. 24-hour proteinuria was significantly reduced in all patients. The degree of proteinuria observed was associated with a substantial improvement in kidney prediction and clinical outcome (Inker LA et al., Am J Kidney Dis 68 (3): 392-401 (2016)). The discovery of a significant reduction in proteinuria that allows steroid intermedication after treatment with the monoclonal antibody, OMS646, to MASP-2, which eliminates the complement lectin pathway, has led to the use of OMS646 as a therapeutic agent to improve the outcome of IgA glomerulopathy . The effects of OMS646 in IgAN patients are active and consistent, demonstrating efficacy in this population.

Example 22

Maintenance of driveway after completion of OMS646 treatment in IgA nephropathy (IgAN) patients

Background / Basis :

In a two phase study in IgAN patients, as described in Examples 19 and 21, four IgAN patients were treated with OMS646, a total human monoclonal antibody that inhibits MASP-2 activity. As described in Examples 19 and 21, all patients received OMS646 IV once weekly for 12 weeks. As described in Example 21, after OMS646 treatment, patients were followed for more than 6 weeks in the study and all IgAN patients treated with OMS646 were found to have a partial benefit (reduction of more than 50% in 24-hour urinary protein excretion and / Defined as protein excretion of less than 1000 mg / day). As described in this example, these four patients were traced after the study and evaluated the duration of the onset of OMS 646 treatment.

Way:

After completion of the second phase clinical trial described in Example 21, the investigator tracked four IgAN patients treated with OMS646. In the test, endpoints were uACR and 24-hour proteinuria. As described in Example 21, all four IgAN patients achieved a partial improvement at the end of the study. The urinary protein-to-creatinine ratio (uPCR) was measured in the post-test follow-up period. Each uPCR was converted to uACR (urine albumin / creatinine ratio) by multiplying 0.64 (Zhao et al., Clin J Am Soc Nephrol 11: 947-55, 2016).

result:

All patients achieved partial remission after OMS646 treatment. The average age of three women and one male was 42, three were Caucasian, and one was Asian. The mean eGFR was 41 mL / min / 1.73 m ² and the mean dose of steroid was 55 mg. The follow-up range was 2 to 10 months after the last OMS646 dose. As described in Example 21, the mean uACR during the test was reduced by 77% ( p = 0.026). Three patients maintained a partial range of available follow-up (54%, 93% and 78% uACR reduction at 12, 12 and 5 months, respectively). One patient had 88% of baseline uACR at 7 months. Three patients also demonstrated improved eGFR by 7, 13 and 7 ml / min / 1.73 m ² during the follow-up. All patients stopped steroids. OMS646 was well accepted.

In summary, as described in Example 21, proteinuria was significantly reduced in IgAN patients during the 12-week treatment with OMS646 and the 6-week treatment period included in the study. This decrease in proteinuria was maintained for up to 10 months after treatment was completed. This data supports the use of OMS646 as a therapeutic agent to improve outcome in IgA glomerulopathy.

In an update from the investigator regarding the status of the four patients described in this example, at a follow-up of approximately one year after a single 12-week course of treatment with OMS646, three of the four patients maintained a reduction in proteinuria Was reported. In these three patients, uACR remained reduced from 14 percent, 23 percent, and 24 percent of baseline values for patients before OMS646 treatment. In addition, an improvement in the estimated glomerular filtration rate (eGFR), a measure of kidney function, was observed in 3 of 4 patients after the study. Patients with the most severe reduction in renal function demonstrated eGFR improvement of 30 mL / min / 1.73 m ² to 47 mL / min / 1.73 m ² , or 57% improvement.

In summary, the steady decline in proteinuria after the completion of a single course of OMS646 therapy continued to be impressive at a later point in the year. The improvements observed in eGFR are unexpected, especially at the one-year follow-up, because this is expected to take considerably longer to become apparent. As described above, two of the four patients showed a slight increase in eGFR, and one of them showed an exciting response of 50 percent improvement. The improvement observed in eGFR indicates that OMS646 could potentially make or delay a point in time when dialysis is necessary and would provide additional benefit to the patient by reducing the risk of complications associated with the progression of chronic kidney disease.

According to the foregoing description, in one embodiment, the invention provides a method of reducing proteinuria in a human subject suffering from IgAN, the method comprising administering to the subject an effective amount of CDR-H1, CDR- A heavy chain variable region comprising CDR-H3 and a light chain variable region comprising CDR-L1, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70, or a MASP- The binding fragments were formulated as follows:

c. Administering the antibody at about 4 mg / kg (i.e., 3.6 mg / kg to 4.4 mg / kg) intravenously once a week for at least 12 weeks of treatment period to a subject suffering from IgAN; or

d. Administering the antibody of about 180 mg to about 725 mg (i.e., 162 mg to 797 mg) to a subject suffering from IgAN intravenously once weekly for at least 12 weeks of treatment period

Wherein the method reduces proteinuria in the human subject.

In one embodiment, the dosage of the MASP-2 inhibitory antibody is about 4 mg / kg (i.e., 3.6 mg / kg to 4.4 mg / kg) such as about 3.6 mg / kg, about 3.9 m / kg, about 4.0 mg / kg, about 4.1 mg / kg, about 4.2 mg / kg, about 4.3 mg / kg or about 4.4 mg /

In one embodiment, the dosage of the MASP-2 inhibitory antibody is from about 180 mg to about 725 mg (i.e., from 160 mg to 800 mg, or from about 300 mg to 500 mg, such as from about 300 mg to about 400 mg) About 160 mg, about 165 mg, about 170 mg, about 175 mg, about 180 mg, about 185 mg, about 190 mg, about 195 mg, about 200 mg, about 205 mg, about 210 mg, about 215 mg, about 220 mg, about 225 mg, about 230 mg, about 240 mg, about 245 mg, about 250 mg, about 255 mg, about 260 mg, about 265 mg, about 270 mg, about 275 mg, about 280 mg, about 285 mg, About 290 mg, about 295 mg, about 300 mg, about 305 mg, about 310 mg, about 315 mg, about 320 mg, about 325 mg, about 330 mg, about 335 mg, about 340 mg, about 345 mg, about 350 about 355 mg, about 360 mg, about 365 mg, about 370 mg, about 375 mg, about 380 mg, about 385 mg, about 390 mg, about 395 mg, about 400 mg, about 405 mg, about 410 mg, About 415 mg, about 420 mg, about 425 mg, about 430 mg, about 435 mg, about 440 mg, about 445 mg, about 450 mg, about 455 mg, about 460 mg, about 465 mg, about 470 mg, mg, about 480 mg, about 485 mg, about 490 mg, about 495 about 500 mg, about 505 mg, about 510 mg, about 515 mg, about 520 mg, about 525 mg, about 530 mg, about 535 mg, about 540 mg, about 545 mg, about 550 mg, about 555 mg, About 560 mg, about 565 mg, about 570 mg, about 575 mg, about 580 mg, about 585 mg, about 590 mg, about 595 mg, about 600 mg, about 605 mg, about 610 mg, about 615 mg, about 660 mg, about 640 mg, about 640 mg, about 645 mg, about 650 mg, about 655 mg, about 660 mg, about 665 mg, about 670 mg, about 675 mg, about 680 mg, about 625 mg, about 630 mg, about 635 mg, About 725 mg, about 730 mg, about 735 mg, about 740 mg, about 745 mg, about 715 mg, about 715 mg, about 720 mg, about 725 mg, about 730 mg, a fixed dose of about 750 mg, about 755 mg, about 760 mg, about 765 mg, about 770 mg, about 775 mg, about 780 mg, about 785 mg, about 790 mg, about 795 mg, or about 800 mg .

In one embodiment, the treatment period is 12 weeks.

In one embodiment, a rest period of at least 2 months (i.e. no administration of a MASP-2 inhibitor), or a rest period of at least 3 months, or a rest period of at least 4 months, or a rest period of at least 5 months, Or at least six months of rest, or at least seven months of rest, or at least eight months of rest, or at least nine months of rest, or at least ten months of rest, or at least eleven months of rest, A rest period of 12 months or more is followed.

In some embodiments, the method comprises the steps of periodically monitoring urinary protein levels in a subject during a treatment period and / or rest period, and optionally resuming treatment with a MASP-2 inhibiting antibody when a recurrence of proteinuria is found .

In some embodiments, the method comprises administering at least 30%, such as at least 40%, or at least 50%, or at least 50%, more preferably at least 30%, more preferably at least 50% Or to reduce proteinuria by more than 50%.

In some embodiments, the method is effective to increase the estimated glomerular filtration rate (eGFR) in a subject suffering from IgAN.

In some embodiments, a subject suffering from IgAN has proteinuria of greater than 1 gram protein / 24 hour urine protein excretion prior to treatment and the method is measured at the end of the treatment period and / or at the end of the rest period, Or at least 30%, such as at least 40%, or at least 50%, or at least 50%, of the subject's body weight and / or at the end of the treatment period and / Less than 1 gram protein / 24 hour urine protein excretion is effective in reducing proteinuria.

In some embodiments, the subject suffering from IgAN has proteinuria of at least 1 gram protein / 24 hr urinary protein excretion despite the maximum allowable amount of hypertension and well-controlled blood pressure prior to treatment, and the method may be performed at the end of the treatment period and / At least 30%, such as at least 40%, or at least 50%, or at least 50% from the baseline (before treatment) and / or at the end of the treatment period, as measured at the end of the rest period, And / or at the end of the rest period, less than one gram of protein / 24 hours of urine protein excretion is effective in reducing proteinuria.

In some embodiments, the subject suffering from IgAN has not been treated with steroids for at least one year. In some embodiments, the subject suffering from IgAN is treated with steroid therapy during at least a portion of the 12 week treatment with OMS646. In some embodiments, a subject suffering from IgAN is treated with steroid treatment during at least a portion of the 12 week treatment with OMS646, the method comprising reducing proteinuria at the end of the treatment period and / or at the end of the rest period, It is effective to reduce or eliminate the demand.

Other embodiments

All publications, patent applications, and patents mentioned herein are incorporated herein by reference.

Various modifications and variations of the described methods and compositions of the invention will be apparent to those skilled in the art without departing from the scope and spirit of the invention. While the invention has been described in connection with certain preferred embodiments, it should be appreciated that the claimed invention should not be unduly limited to such specific embodiments.

In accordance with the foregoing description, the invention features the following embodiments.

1A. A method for treating, inhibiting, alleviating or preventing fibrosis in a mammalian subject suffering from or at risk of developing a disease or disorder caused or to be exacerbated by fibrosis and / or inflammation, comprising administering to said mammal a therapeutically effective amount of a MASP- 2 &lt; / RTI &gt; inhibitor to the subject.

2A. The method according to paragraph 1A, wherein the MASP-2 inhibitor is a MASP-2 antibody or a fragment thereof.

3A. The method according to paragraph 2A, wherein the MASP-2 inhibitor is a MASP-2 monoclonal antibody that specifically binds to a portion of SEQ ID NO: 6, or a fragment thereof.

4A. As a method according to paragraph 2A, the MASP-2 antibody or fragment thereof specifically binds to a polypeptide comprising SEQ ID NO: 6 with an affinity that is at least ten times greater than that binding to a different antigen in the complement system How it is.

5A. The method according to paragraph 2A, wherein the antibody or fragment thereof is selected from the group consisting of a recombinant antibody, an antibody with reduced effector function, a chimeric antibody, a humanized antibody, and a human antibody.

6A. The method according to paragraph 1A, wherein the MASP-2 inhibitor selectively inhibits lectin pathway complement activation without substantially inhibiting C1q-dependent complement activation.

7A. The method according to paragraph 1A, wherein the MASP-2 inhibitor is administered subcutaneously, intraperitoneally, intramuscularly, intraarterially, intravenously, or as an inhalant.

8A. The method according to any one of paragraphs 1A-7A, wherein the disease or disorder caused or exacerbated by fibrosis and / or inflammation is associated with ischemic reperfusion injury.

9A. The method according to any one of paragraphs 1A-7A, wherein the disease or disorder caused or exacerbated by fibrosis and / or inflammation is not associated with ischemic reperfusion injury.

10A. The method according to any one of paragraphs 1A-7A, wherein the subject exhibits proteinuria prior to administration of the MASP-2 inhibitor and administration of the MASP-2 inhibitor reduces proteinuria in the subject.

11A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis and / or inflammation of the kidney.

12A. The method according to paragraph 11A, wherein the MASP-2 inhibitor is administered in an amount effective to inhibit tubular fibrosis.

13A. The method according to paragraph 11A, wherein the MASP-2 inhibitor is administered in an amount effective to reduce, delay or eliminate the need for dialysis in the subject.

14A. A method according to paragraph 11A, wherein the disease or disorder is selected from the group consisting of chronic renal disease, chronic renal failure, glomerular disease (such as local segmental glomerulosclerosis), immune complex disorder (such as IgA nephropathy, membranous nephropathy), lupus nephritis, , Tubular interstitial damage and glomerulonephritis (e.g., C3 glomerulopathies).

15A. The method according to any one of paragraphs 1A-7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis and / or inflammation of the lung.

16A. The method according to paragraph 15A, wherein the disease or disorder is selected from the group consisting of chronic obstructive pulmonary disease, cystic fibrosis, pulmonary fibrosis associated with scleroderma, bronchiectasis and pulmonary hypertension.

17A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by liver fibrosis and / or inflammation.

18A. A method according to paragraph 17A, wherein the disease or disorder is selected from the group consisting of cirrhosis, nonalcoholic fatty liver disease (nonalcoholic fatty liver disease), secondary liver fibrosis secondary to alcohol abuse, secondary liver fibrosis secondary to acute or chronic hepatitis, , Hepatotoxicity due to drug-induced liver damage induced by acetaminophen or other drugs such as neprotoxin).

19A. The method according to any one of paragraphs 1A-7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis and / or inflammation of the heart.

20A. The method according to paragraph 19A, wherein the disease or condition is selected from the group consisting of cardiac fibrosis, myocardial infarction, heart valve fibrosis, atrial fibrosis, endocardial myocardial fibrosis, arrhythmogenic right ventricular cardiomyopathy (ARVC).

21A. The method according to any one of paragraphs 1A-7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis of the blood vessel.

22A. The method according to paragraph 21A, wherein the disease or disorder is selected from the group consisting of vascular disease, atherosclerotic vascular disease, vascular stenosis, restenosis, vasculitis, phlebitis, deep vein thrombosis and abdominal aortic aneurysm.

23A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis of the skin.

24A. The method according to paragraph 23A, wherein the disease or disorder is selected from the group consisting of excessive wound healing, scleroderma, systemic sclerosis, keloid, connective tissue disease, scarring, and hyperproliferative scarring.

25A. The method according to any one of paragraphs 1A-7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis of the joint.

26A. The method according to paragraph 25A, wherein the disease or disorder is arthropathic fibrosis.

27A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis of the central nervous system.

28A. The method according to paragraph 27A, wherein the disease or disorder is selected from the group consisting of stroke, traumatic brain injury, and spinal cord injury.

29A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis of the digestive system.

30A. The method according to paragraph 29A, wherein the disease or disorder is selected from the group consisting of Crohn's disease, fibrosis of the pancreas and ulcerative colitis.

31A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis of the eye.

32A. The method according to paragraph 31A, wherein the disease or disorder is selected from the group consisting of anterior capsular cataract, lens posterior capsular opacity, macular degeneration, and retinas and vitreoretinopathy.

33A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis of a musculoskeletal bone or soft tissue structure.

34A. The method according to paragraph 33A, wherein the disease or disorder is selected from the group consisting of osteoporosis and / or osteoporosis associated with cystic fibrosis, increased bone marrow formation status, osteoarthritis, Way.

35A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from a disease or disorder caused or exacerbated by fibrosis of the reproductive organs.

36A. The method according to paragraph 35A, wherein the disease or disorder is selected from the group consisting of endometriosis and peyronie's disease.

37A. The method according to any one of paragraphs 1A-7A, wherein the subject is suffering from a chronic infectious disease causing fibrosis and / or inflammation.

38A. The method according to paragraph 37A, wherein the infectious disease is selected from the group consisting of alphavirus, hepatitis A, hepatitis B, hepatitis C, tuberculosis, HIV and influenza.

39A. The method according to any one of paragraphs 1A to 7A, wherein the subject is suffering from an autoimmune disease that causes fibrosis and / or inflammation.

40A. The method according to paragraph 39A, wherein the autoimmune disease is selected from the group consisting of scleroderma and systemic lupus erythematosus (SLE).

41A. The method according to any one of paragraphs 1A-7A, wherein the subject suffers scars associated with trauma.

42A. As a method according to paragraph 41A, scars associated with trauma include surgical complications (for example, scar tissue can be formed between internal organs, which can cause pain, surgical adhesions that can cause infertility), chemotherapy drug- , Radiation-induced fibrosis, and scars associated with burns.

43A. The method according to any of paragraphs 1 to 7A, wherein the disease or disorder caused or exacerbated by fibrosis and / or inflammation is selected from the group consisting of organ transplantation, mammary fibrosis, muscle fibrosis, peritoneal fibrosis, thyroid fibrosis, lymphadenopathy, &Lt; / RTI &gt; fibrosis.

1B. A method of preventing or reducing renal injury in a subject suffering from a disease or condition associated with proteinuria comprising administering an amount of a MASP-2 inhibitor effective to reduce or prevent proteinuria in a subject.

2B. The method according to paragraph 1B, wherein the MASP-2 inhibitor is a MASP-2 inhibitory antibody or a fragment thereof.

3B. The method according to paragraph 1B or 2B wherein the MASP-2 inhibitor is administered for an amount and for a time effective to achieve a reduction of at least 20% in 24-hour urinary protein excretion compared to baseline 24-hour urinary protein excretion Way.

4B. A method according to any one of paragraphs 1B to 3B, wherein the disease or condition associated with proteinuria is selected from the group consisting of nephrotic syndrome, pre-eclampsia, eclampsia, toxic lesions of the kidney, amyloidosis, collagen vascular diseases such as systemic lupus erythematosus, , Glomerular disease (such as glomerulonephritis, local segmental glomerulonephritis, C3 glomerulonephritis, minimal change disease, lipid nephropathy), extreme exercise, stress, benign prostatic hyperplasia, local segmental glomerulosclerosis, IgA nephropathy (Diabetic nephropathy), drug-induced toxicity (such as NSAIDS, nicotine, penicillamine, lithium carbonate, and the like), IgM nephropathy, proliferative glomerulonephritis, membranous nephropathy, minimal change disease, sarcoidosis, Alport syndrome, , Gold and other heavy metals, ACE inhibitors, antibiotics (such as adriamycin) or opiates (such as heroin) or other neptotoxins); Fabry disease, infection (e.g. HIV, syphilis, Hepatitis A, B or C hepatitis, streptococcal infection, urinary schistosomiasis); (For example, renal transplant rejection), Ebola hemorrhagic fever, nail palate patellar syndrome, familial mediterranean fever, acute myelogenous leukemia, amyotrophic lateral sclerosis, acute myelogenous leukemia, , HELLP syndrome, systemic lupus erythematosus, Wegener's granulomatosis, rheumatoid arthritis, glycogen storage disease type 1, Goodpasture's syndrome, Henoch-Schonlein purpura, kidney-spreading urethral infection, &Lt; / RTI &gt;

5B. The method according to any one of paragraphs 1B to 3B, wherein the disease or condition associated with proteinuria is IgA nephropathy (i. E., Burger's disease).

6B. The method according to any of paragraphs 1B to 3B, wherein the disease or condition associated with proteinuria is membranous nephropathy.

7B. The method according to any one of paragraphs 1B to 3B, wherein the disease or condition associated with proteinuria is lupus nephritis.

1C. 26. A method of inhibiting the progression of chronic kidney disease comprising administering an amount of a MASP-2 inhibitor effective to reduce or prevent tubular interstitial fibrosis in a subject in need thereof.

2C. The method according to paragraph 1C, wherein the MASP-2 inhibitor is a MASP-2 inhibiting antibody, or a fragment thereof.

3C. As a method according to paragraph 1C, the required subject exhibits proteinuria prior to administration of the MASP-2 inhibitor and the administration of the MASP-2 inhibitor reduces the proteinuria in the subject so that the subject is able to elicit baseline 24- Wherein the method exhibits a reduction of at least 20% in 24-hour urinary protein excretion.

4C. The method according to paragraph 1C, wherein the MASP-2 inhibitor is administered in an amount effective to reduce, delay or eliminate the need for dialysis in the subject.

1D. A method of protecting the kidney from damage to the kidneys in a subject that has been treated with one or more nephrotoxic agents, ongoing or undergoing treatment, comprising administering an amount of a MASP-2 inhibitor effective to prevent or ameliorate the development of drug- &Lt; / RTI &gt;

2D. The method according to paragraph 1D, wherein the MASP-2 inhibitor is a MASP-2 inhibiting antibody, or a fragment thereof.

3D. The method according to paragraph 1D, wherein the MASP-2 inhibitor is administered prior to the nephrotoxic agent.

4D. The method according to paragraph 1D, wherein the MASP-2 inhibitor is administered concurrently with said nephrotoxic agent.

5D. The method according to paragraph 1D, wherein the MASP-2 inhibitor is administered after the nephrotoxic agent to treat nephrotoxicity.

1E. A method of treating a human subject suffering from immunoglobulin A nephropathy (IgAN) comprising administering to the subject a composition comprising an amount of a MASP-2 inhibitory antibody, or antigen-binding fragment thereof, effective to inhibit MASP- &Lt; / RTI &gt;

2E. The method according to paragraph 1E, wherein the subject is suffering from steroid-dependent IgAN.

3E. The method according to paragraph 1E or 2E, wherein the MASP-2 inhibitory antibody is a monoclonal antibody that specifically binds to human MASP-2, or a fragment thereof.

4E. 61. The method according to any one of paragraphs 1E to 3E, wherein the antibody or fragment thereof is a recombinant antibody, an antibody with reduced effector function, a chimeric antibody, a humanized antibody, and &Lt; / RTI &gt; human antibody.

5E. The method according to any one of paragraphs 1E to 4E, wherein the MASP-2 inhibitory antibody does not substantially inhibit the classical pathway.

6E. The method according to any one of paragraphs 1E to 5E, wherein the MASP-2 inhibitory antibody inhibits C3b deposition in 90% human serum with an IC ₅₀ of 30 nM or less.

7E. A method according to paragraph E2, the method comprising administering to a subject a composition comprising an amount of a MASP-2 inhibitory antibody effective to improve renal function, or an antigen-binding fragment thereof, to a human subject having a steroid- &Lt; / RTI &gt;

8E. The method according to any one of paragraphs 1E to 7E, wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered in an amount effective to improve renal function.

9E. As a method according to paragraph 8E, the MASP-2 inhibitory antibody or antigen-binding fragment thereof achieves a reduction of at least 20% in 24-hour urinary protein excretion compared to baseline 24-hour urine protein excretion in the subject before treatment Lt; RTI ID = 0.0 &gt; effective &lt; / RTI &gt; amount.

10E. The method according to paragraph 1E, wherein the composition is administered in an amount sufficient to improve renal function and decrease the corticosteroid dose in the subject.

11E. The method according to any one of paragraphs 1E to 10E wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof comprises a heavy chain comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: A variable region and a light chain variable region comprising CDR-L1, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70.

1F. A method of treating a human subject suffering from membranous nephropathy (MN) comprising administering to a subject a composition comprising an amount of a MASP-2 inhibiting antibody or antigen-binding fragment thereof effective to inhibit MASP-2-dependent complement activation &Lt; / RTI &gt;

2F. The method according to paragraph 1F, wherein the subject is suffering from steroid-dependent MN.

3F. The method according to paragraph 1F or 2F wherein the MASP-2 inhibitory antibody is a monoclonal antibody that specifically binds to human MASP-2, or a fragment thereof.

4F. The method according to any of paragraphs 1F to 3F, wherein the antibody or fragment thereof is selected from the group consisting of a recombinant antibody, an antibody with reduced effector function, a chimeric antibody, a humanized antibody, and a human antibody.

5F. The method according to any one of paragraphs 1F to 4F, wherein the MASP-2 inhibiting antibody does not substantially inhibit the classical pathway.

6F. The method according to any of paragraphs 1F to 5F, wherein the MASP-2 inhibitory antibody inhibits C3b deposition in 90% human serum with an IC ₅₀ of 30 nM or less.

7F. A method according to paragraph IF, the method comprising administering to a subject a therapeutically effective amount of a human subject having a steroid-dependent MN prior to administering a composition comprising an amount of a MASP-2 inhibiting antibody, or an antigen- &Lt; / RTI &gt;

8F. The method according to any one of paragraphs 1F to 7F, wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered in an amount effective to improve renal function.

9F. As a method according to paragraph 8F, the MASP-2 inhibitory antibody or antigen-binding fragment thereof achieves a reduction of at least 20% in 24-hour urinary protein excretion compared to baseline 24-hour urinary protein excretion in the subject before treatment Lt; RTI ID = 0.0 &gt; effective &lt; / RTI &gt; amount.

10F. The method according to paragraph 1F or 2F, wherein the composition is administered in an amount sufficient to improve renal function and decrease the corticosteroid dose in the subject.

11F. The method of any of paragraphs 1F to 10F wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof comprises a heavy chain comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: A variable region and a light chain variable region comprising CDR-L1, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70.

1G. A method of treating a human subject suffering from lupus nephritis (LN) comprising administering to a subject a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof effective to inhibit MASP-2-dependent complement activation &Lt; / RTI &gt;

2G. The method according to paragraph 1G, wherein the subject is suffering from a steroid-dependent LN.

3G. The method according to paragraph 1G or 2G, wherein the MASP-2 inhibitory antibody is a monoclonal antibody that specifically binds to human MASP-2, or a fragment thereof.

4G. The method according to any one of paragraphs 1G to 3G, wherein the antibody or fragment thereof is selected from the group consisting of a recombinant antibody, an antibody with reduced effector function, a chimeric antibody, a humanized antibody, and a human antibody.

5G. The method according to any one of paragraphs 1G to 4G, wherein the MASP-2 inhibiting antibody does not substantially inhibit the classical path.

6G. The method according to any one of paragraphs 1G to 5G, wherein the MASP-2 inhibiting antibody inhibits C3b deposition in 90% human serum with an IC ₅₀ of 30 nM or less.

7G. A method according to paragraph 1G, the method comprising administering to a subject a composition comprising a MASP-2 inhibiting antibody effective to improve renal function, or a composition comprising an amount of antigen-binding fragment thereof, to a human subject having a steroid- &Lt; / RTI &gt;

8G. The method according to any of paragraphs 1 G to 7G, wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered in an amount effective to improve renal function.

9G. As a method according to paragraph 8G, the MASP-2 inhibitory antibody or antigen-binding fragment thereof achieves a reduction of at least 20% in 24-hour urinary protein excretion compared to baseline 24-hour urinary protein excretion in the subject before treatment Lt; RTI ID = 0.0 &gt; effective &lt; / RTI &gt; amount.

10G. The method according to paragraph 1G or 2G, wherein the composition is administered in an amount sufficient to improve renal function and decrease the corticosteroid dose in said subject.

11G. The method of any of paragraphs 1G to 10G wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof comprises a heavy chain comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: A variable region and a light chain variable region comprising CDR-L1, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70.

While exemplary embodiments have been illustrated and described, it will be appreciated that various changes can be made herein without departing from the spirit and scope of the invention.

                         SEQUENCE LISTING <110> Omeros Corporation        University of Leicester        Brunskill, Nigel        Demopulos, Gregory A.        Dudler, Tom        Schwaeble, Hans-Wilhelm   <120> Methods for Reducing Proteinuria in a Human Subject        Suffering from Immunoglobulin A Nephropathy <130> MP.1.0269.PCT <150> 62 / 527,926 <151> 2017-06-30 <150> 15 / 470,647 <151> 2017-03-27 <150> 15 / 399,524 <151> 2017-01-05 <150> 62 / 407,979 <151> 2016-10-13 <160> 85 <170> PatentIn version 3.5 <210> 1 <211> 725 <212> DNA <213> Homo sapiens <220> <221> CDS &Lt; 222 > (27) .. (584) <400> 1 ggccaggcca gctggacggg cacacc atg agg ctg ctg acc ctc ctg ggc ctt 53                              Met Arg Leu Leu Thr Leu Leu Gly Leu                              1 5 ctg tgt ggc tcg gtg gcc acc ccc ttg ggc ccg aag tgg cct gaa cct 101 Leu Cys Gly Ser Val Ala Thr Pro Leu Gly Pro Lys Trp Pro Glu Pro 10 15 20 25 gtg ttc ggg cgc ctg gca tcc ccc ggc ttt cca ggg gag tat gcc aat 149 Val Phe Gly Arg Leu Ala Ser Pro Gly Phe Pro Gly Glu Tyr Ala Asn                 30 35 40 gac cag gag cgg cgc tgg acc ctg act gca ccc ccc ggc tac cgc ctg 197 Asp Gln Glu Arg Arg Trp Thr Leu Thr Ala Pro Pro Gly Tyr Arg Leu             45 50 55 cgc ctc tac ttc acc cac ttc gac ctg gag ctc tcc cac ctc tgc gag 245 Arg Leu Tyr Phe Thr His Phe Asp Leu Glu Leu Ser His Leu Cys Glu         60 65 70 tac gac ttc gtc aag ctg agc tcg ggg gcc aag gtg ctg gcc acg ctg 293 Tyr Asp Phe Val Lys Leu Ser Ser Gly Ala Lys Val Leu Ala Thr Leu     75 80 85 tgc ggg cag gag agc aca gac acg gag cgg gcc cct ggc aag gac act 341 Cys Gly Gln Glu Ser Thr Asp Thr Glu Arg Ala Pro Gly Lys Asp Thr 90 95 100 105 ttc tac tcg ctg ggc tcc agc ctg gac att acc ttc cgc tcc gac tac 389 Phe Tyr Ser Leu Gly Ser Ser Leu Asp Ile Thr Phe Arg Ser Asp Tyr                 110 115 120 tcc aac gag aag ccg ttc acg ggg ttc gag gcc ttc tat gca gcc gag 437 Ser Asn Glu Lys Pro Phe Thr Gly Phe Glu Ala Phe Tyr Ala Ala Glu             125 130 135 gac att gac gag tgc cag gtg gcc ccg gga gag gcg ccc acc tgc gac 485 Asp Ile Asp Glu Cys Gln Val Ala Pro Gly Glu Ala Pro Thr Cys Asp         140 145 150 cac cac tgc cac aac cac ctg ggc ggt ttc tac tgc tcc tgc cgc gca 533 His His Cys His Asn His Leu Gly Gly Phe Tyr Cys Ser Cys Arg Ala     155 160 165 ggc tac gtc ctg cac cgt aac aag cgc acc tgc tca gag cag agc ctc 581 Gly Tyr Val Leu His Arg Asn Lys Arg Thr Cys Ser Glu Gln Ser Leu 170 175 180 185 tag cctcccctgg agctccggcc tgcccagcag gtcagaagcc agagccagcc 634 tgctggcctc agctccgggt tgggctgaga tggctgtgcc ccaactccca ttcacccacc 694 atggacccaa taataaacct ggccccaccc c 725 <210> 2 <211> 185 <212> PRT <213> Homo sapiens <400> 2 Met Arg Leu Leu Thr Leu Leu Gly Leu Leu Cys Gly Ser Val Ala Thr 1 5 10 15 Pro Leu Gly Pro Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Ala Ser             20 25 30 Pro Gly Phe Pro Gly Glu Tyr Ala Asn Asp Gln Glu Arg Arg Trp Thr         35 40 45 Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His Phe     50 55 60 Asp Leu Glu Leu Ser His Leu Cys Glu Tyr Asp Phe Val Lys Leu Ser 65 70 75 80 Ser Gly Ala Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr Asp                 85 90 95 Thr Glu Arg Ala Pro Gly Lys Asp Thr Phe Tyr Ser Leu Gly Ser Ser             100 105 110 Leu Asp Ile Thr Phe Arg Ser Asp Tyr Ser Asn Glu Lys Pro Phe Thr         115 120 125 Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Ile Asp Glu Cys Gln Val     130 135 140 Ala Pro Gly Glu Ala Pro Thr Cys Asp His His Cys His Asn His Leu 145 150 155 160 Gly Gly Phe Tyr Cys Ser Cys Arg Ala Gly Tyr Val Leu His Arg Asn                 165 170 175 Lys Arg Thr Cys Ser Glu Gln Ser Leu             180 185 <210> 3 <211> 170 <212> PRT <213> Homo sapiens <400> 3 Thr Pro Leu Gly Pro Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Ala 1 5 10 15 Ser Pro Gly Phe Pro Gly Glu Tyr Ala Asn Asp Gln Glu Arg Arg Trp             20 25 30 Thr Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His         35 40 45 Phe Asp Leu Glu Leu Ser His Leu Cys Glu Tyr Asp Phe Val Lys Leu     50 55 60 Ser Ser Gly Ala Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr 65 70 75 80 Asp Thr Glu Arg Ala Pro Gly Lys Asp Thr Phe Tyr Ser Leu Gly Ser                 85 90 95 Ser Leu Asp Ile Thr Phe Arg Ser Asp Tyr Ser Asn Glu Lys Pro Phe             100 105 110 Thr Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Ile Asp Glu Cys Gln         115 120 125 Val Ala Pro Gly Glu Ala Pro Thr Cys Asp His His Cys His Asn His     130 135 140 Leu Gly Gly Phe Tyr Cys Ser Cys Arg Ala Gly Tyr Val Leu His Arg 145 150 155 160 Asn Lys Arg Thr Cys Ser Glu Gln Ser Leu                 165 170 <210> 4 <211> 2460 <212> DNA <213> Homo sapiens <220> <221> CDS (22). (2082) <400> 4 ggccagctgg acgggcacac c atg agg ctg ctg acc ctc ctg ggc ctt ctg 51                         Met Arg Leu Leu Thr Leu Leu Gly Leu Leu                         1 5 10 tgt ggc tcg gtg gcc acc ccc ttg ggc ccg aag tgg cct gaa cct gtg 99 Cys Gly Ser Val Ala Thr Pro Leu Gly Pro Lys Trp Pro Glu Pro Val                 15 20 25 ttc ggg cgc ctg gcc tcc ccc ggc ttt cca ggg gag tat gcc aat gac 147 Phe Gly Arg Leu Ala Ser Pro Gly Phe Pro Gly Glu Tyr Ala Asn Asp             30 35 40 cag gag cgg cgc tgg acc ctg act gca ccc ccc ggc tac cgc ctg cgc 195 Gln Glu Arg Arg Trp Thr Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg         45 50 55 ctc tac ttc acc cac ttc gac ctg gag ctc tcc cac ctc tgc gag tac 243 Leu Tyr Phe Thr His Phe Asp Leu Glu Leu Ser His Leu Cys Glu Tyr     60 65 70 gac ttc gtc aag ctg agc tcg ggg gcc aag gtg ctg gcc acg ctg tgc 291 Asp Phe Val Lys Leu Ser Ser Gly Ala Lys Val Leu Ala Thr Leu Cys 75 80 85 90 ggg cag gag agc aca gac acg gag cgg gcc cct ggc aag gac act ttc 339 Gly Gln Glu Ser Thr Asp Thr Glu Arg Ala Pro Gly Lys Asp Thr Phe                 95 100 105 tac tcg ctg ggc tcc agc ctg gac att acc ttc cgc tcc gac tac tcc 387 Tyr Ser Leu Gly Ser Ser Leu Asp Ile Thr Phe Arg Ser Asp Tyr Ser             110 115 120 aac gag aag ccg ttc acg ggg ttc gag gcc ttc tat gca gcc gag gac 435 Asn Glu Lys Pro Phe Thr Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp         125 130 135 att gac gag tgc cag gtg gcc ccg gga gag gcg ccc acc tgc gac cac 483 Ile Asp Glu Cys Gln Val Ala Pro Gly Glu Ala Pro Thr Cys Asp His     140 145 150 cac tgc cac aac cac ctg ggc ggt ttc tac tgc tcc tgc cgc gca ggc 531 His Cys His Asn His Leu Gly Gly Phe Tyr Cys Ser Cys Arg Ala Gly 155 160 165 170 tac gtc ctg cac cgt aac aag cgc acc tgc tca gcc ctg tgc tcc ggc 579 Tyr Val Leu His Arg Asn Lys Arg Thr Cys Ser Ala Leu Cys Ser Gly                 175 180 185 cag gtc ttc acc cag agg tct ggg gag ctc agc agc cct gaa tac cca 627 Gln Val Phe Thr Gln Arg Ser Gly Glu Leu Ser Ser Pro Glu Tyr Pro             190 195 200 cgg ccg tat ccc aaa ctc tcc agt tgc act tac agc atc agc ctg gag 675 Arg Pro Tyr Pro Lys Leu Ser Ser Cys Thr Tyr Ser Ile Ser Leu Glu         205 210 215 gag ggg ttc agt gtc att ctg gac ttt gtg gag tcc ttc gat gtg gag 723 Glu Gly Phe Ser Val Ile Leu Asp Phe Val Glu Ser Phe Asp Val Glu     220 225 230 aca cac cct gaa acc ctg tgt ccc tac gac ttt ctc aag att caa aca 771 Thr His Pro Glu Thr Leu Cys Pro Tyr Asp Phe Leu Lys Ile Gln Thr 235 240 245 250 gac aga gaa gaa cat ggc cca ttc tgt ggg aag aca ttg ccc cac agg 819 Asp Arg Glu Glu His Gly Pro Phe Cys Gly Lys Thr Leu Pro His Arg                 255 260 265 att gaa aca aaa agc aac acg gtg acc acac ttt gtc aca gat gaa 867 Ile Glu Thr Lys Ser Asn Thr Val Thr Ile Thr Phe Val Thr Asp Glu             270 275 280 tca gga gac cac aca ggc tgg aag atc cac tac acg acc aca gcg cag 915 Ser Gly Asp His Thr Gly Trp Lys Ile His Tyr Thr Ser Thr Ala Gln         285 290 295 cct tgc cct tat ccg atg gcg cca cct aat ggc cac gtt tca cct gtg 963 Pro Cys Pro Tyr Pro Met Ala Pro Pro Asn Gly His Val Val Ser Pro Val     300 305 310 caa gcc aaa tac atc ctg aaa gac agc ttc tcc atc ttt tgc gag act 1011 Gln Ala Lys Tyr Ile Leu Lys Asp Ser Phe Ser Ile Phe Cys Glu Thr 315 320 325 330 ggc tat gag ctt ctg caa ggt cac ttg ccc ctg aaa tcc ttt act gca 1059 Gly Tyr Glu Leu Leu Gln Gly His Leu Pro Leu Lys Ser Phe Thr Ala                 335 340 345 gtt tgt cag aaa gat gga tct tgg gac cgg cca atg ccc gcg tgc agc 1107 Val Cys Gln Lys Asp Gly Ser Trp Asp Arg Pro Met Pro Ala Cys Ser             350 355 360 att gtt gac tgt ggc cct cct gat gat cta ccc agt ggc cga gtg gag 1155 Ile Val Asp Cys Gly Pro Pro Asp Asp Leu Pro Ser Gly Arg Val Glu         365 370 375 tac atc aca ggt cct gga gtg acc acc tac aaa gct gtg att cag tac 1203 Tyr Ile Thr Gly Pro Gly Val Thr Thr Tyr Lys Ala Val Ile Gln Tyr     380 385 390 agc tgt gaa gag acc ttc tac aca atg aaa gtg aat gat ggt aaa tat 1251 Ser Cys Glu Glu Thr Phe Tyr Thr Met Lys Val Asn Asp Gly Lys Tyr 395 400 405 410 gtg tgt gag gct gat gga ttc tgg acg agc tcc aaa gga gaa aaa tca 1299 Val Cys Glu Ala Asp Gly Phe Trp Thr Ser Ser Lys Gly Glu Lys Ser                 415 420 425 ctc cca gtc tgt gag cct gtt tgt gga cta tca gcc cgc aca aca gga 1347 Leu Pro Val Cys Glu Pro Val Cys Gly Leu Ser Ala Arg Thr Thr Gly             430 435 440 ggg cgt ata tat gga ggg caa aag gca aaa cct ggt gat ttt cct tgg 1395 Gly Arg Ile Tyr Gly Gly Gln Lys Ala Lys Pro Gly Asp Phe Pro Trp         445 450 455 caa gtc ctg ata tta ggt gga acc aca gca gca ggt gca ctt tta tat 1443 Gln Val Leu Ile Leu Gly Gly Thr Thr Ala Ala Gly Ala Leu Leu Tyr     460 465 470 gac aac tgg gtc cta aca gct gct cat gcc gtc tat gag caa aaa cat 1491 Asp Asn Trp Val Leu Thr Ala Ala His Ala Val Tyr Glu Gln Lys His 475 480 485 490 gat gca tcc gcc ctg gac att cga atg ggc acc ctg aaa aga cta tca 1539 Asp Ala Ser Ala Leu Asp Ile Arg Met Gly Thr Leu Lys Arg Leu Ser                 495 500 505 cct cat tat aca caa gcc tgg tct gaa gct gtt ttt ata cat gaa ggt 1587 Pro His Tyr Thr Gln Ala Trp Ser Glu Ala Val Phe Ile His Glu Gly             510 515 520 tat act cat gat gct ggc ttt gac aat gac ata gca ctg att aaa ttg 1635 Tyr Thr His Asp Ala Gly Phe Asp Asn Asp Ile Ala Leu Ile Lys Leu         525 530 535 aat aac aaa gtt gta atc aat agc aac atc acg cct att tgt ctg cca 1683 Asn Asn Lys Val Ile Asn Ser Asn Ile Thr Pro Ile Cys Leu Pro     540 545 550 aga aaa gaa gct gaa tcc ttt atg agg aca gat gac att gga act gca 1731 Arg Lys Glu Ala Glu Ser Phe Met Arg Thr Asp Asp Ile Gly Thr Ala 555 560 565 570 tct gga tgg gga tta acc caa agg ggt ttt ctt gct aga aat cta atg 1779 Ser Gly Trp Gly Leu Thr Gln Arg Gly Phe Leu Ala Arg Asn Leu Met                 575 580 585 taste gtc gac ata ccg att gtt gac cat caa aaa tgt act gct gca tat 1827 Tyr Val Asp Ile Pro Ile Val Asp His Gln Lys Cys Thr Ala Ala Tyr             590 595 600 gaa aag cca ccc tat cca agg gga agt gta act gct aac atg ctt tgt 1875 Glu Lys Pro Pro Tyr Pro Arg Gly Ser Val Thr Ala Asn Met Leu Cys         605 610 615 gct ggc tta gaa agt ggg ggc aag gac agc tgc aga ggt gac agc gga 1923 Ala Gly Leu Glu Ser Gly Gly Lys Asp Ser Cys Arg Gly Asp Ser Gly     620 625 630 ggg gca ctg gtg ttt cta gat agt gaa aca gag agg tgg ttt gtg gga 1971 Gly Ala Leu Val Phe Leu Asp Ser Glu Thr Glu Arg Trp Phe Val Gly 635 640 645 650 gga ata gtg tcc tgg ggt tcc atg aat tgt ggg gaa gca ggt cag tat 2019 Gly Ile Val Ser Trp Gly Ser Met Asn Cys Gly Glu Ala Gly Gln Tyr                 655 660 665 gga gtc tac aca aaa gtt att aac tat att ccc tgg atc gag aac ata 2067 Gly Val Tyr Thr Lys Val Ile Asn Tyr Ile Pro Trp Ile Glu Asn Ile             670 675 680 att agt gat ttt taa cttgcgtgtc tgcagtcaag gattcttcat ttttagaaat 2122 Ile Ser Asp Phe         685 gcctgtgaag accttggcag cgacgtggct cgagaagcat tcatcattac tgtggacatg 2182 gcagttgttg ctccacccaa aaaaacagac tccaggtgag gctgctgtca tttctccact 2242 tgccagttta attccagcct tacccattga ctcaagggga cataaaccac gagagtgaca 2302 gtcatctttg cccacccagt gtaatgtcac tgctcaaatt acatttcatt accttaaaaa 2362 gccagtctct tttcatactg gctgttggca tttctgtaaa ctgcctgtcc atgctctttg 2422 tttttaaact tgttcttatt gaaaaaaaaa aaaaaaaa 2460 <210> 5 <211> 686 <212> PRT <213> Homo sapiens <400> 5 Met Arg Leu Leu Thr Leu Leu Gly Leu Leu Cys Gly Ser Val Ala Thr 1 5 10 15 Pro Leu Gly Pro Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Ala Ser             20 25 30 Pro Gly Phe Pro Gly Glu Tyr Ala Asn Asp Gln Glu Arg Arg Trp Thr         35 40 45 Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His Phe     50 55 60 Asp Leu Glu Leu Ser His Leu Cys Glu Tyr Asp Phe Val Lys Leu Ser 65 70 75 80 Ser Gly Ala Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr Asp                 85 90 95 Thr Glu Arg Ala Pro Gly Lys Asp Thr Phe Tyr Ser Leu Gly Ser Ser             100 105 110 Leu Asp Ile Thr Phe Arg Ser Asp Tyr Ser Asn Glu Lys Pro Phe Thr         115 120 125 Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Ile Asp Glu Cys Gln Val     130 135 140 Ala Pro Gly Glu Ala Pro Thr Cys Asp His His Cys His Asn His Leu 145 150 155 160 Gly Gly Phe Tyr Cys Ser Cys Arg Ala Gly Tyr Val Leu His Arg Asn                 165 170 175 Lys Arg Thr Cys Ser Ala Leu Cys Ser Gly Gln Val Phe Thr Gln Arg             180 185 190 Ser Gly Glu Leu Ser Ser Pro Glu Tyr Pro Arg Pro Tyr Pro Lys Leu         195 200 205 Ser Ser Cys Thr Tyr Ser Ile Ser Leu Glu Glu Gly Phe Ser Val Ile     210 215 220 Leu Asp Phe Val Glu Ser Phe Asp Val Glu Thr His Pro Glu Thr Leu 225 230 235 240 Cys Pro Tyr Asp Phe Leu Lys Ile Gln Thr Asp Arg Glu Glu His Gly                 245 250 255 Pro Phe Cys Gly Lys Thr Leu Pro His Arg Ile Glu Thr Lys Ser Asn             260 265 270 Thr Val Thr Ile Thr Phe Val Thr Asp Glu Ser Gly Asp His Thr Gly         275 280 285 Trp Lys Ile His Tyr Thr Ser Thr Ala Gln Pro Cys Pro Tyr Pro Met     290 295 300 Ala Pro Pro Asn Gly His Val Ser Pro Val Gln Ala Lys Tyr Ile Leu 305 310 315 320 Lys Asp Ser Phe Ser Ile Phe Cys Glu Thr Gly Tyr Glu Leu Leu Gln                 325 330 335 Gly His Leu Pro Leu Lys Ser Phe Thr Ala Val Cys Gln Lys Asp Gly             340 345 350 Ser Trp Asp Arg Pro Met Pro Ala Cys Ser Ile Val Asp Cys Gly Pro         355 360 365 Pro Asp Leu Pro Ser Gly Arg Val Glu Tyr Ile Thr Gly Pro Gly     370 375 380 Val Thr Thr Tyr Lys Ala Val Ile Gln Tyr Ser Cys Glu Glu Thr Phe 385 390 395 400 Tyr Thr Met Lys Val Asn Asp Gly Lys Tyr Val Cys Glu Ala Asp Gly                 405 410 415 Phe Trp Thr Ser Ser Lys Gly Glu Lys Ser Leu Pro Val Cys Glu Pro             420 425 430 Val Cys Gly Leu Ser Ala Arg Thr Thr Gly Gly Arg Ile Tyr Gly Gly         435 440 445 Gln Lys Ala Lys Pro Gly Asp Phe Pro Trp Gln Val Leu Ile Leu Gly     450 455 460 Gly Thr Thr Ala Ala Gly Ala Leu Leu Tyr Asp Asn Trp Val Leu Thr 465 470 475 480 Ala Ala His Ala Val Tyr Glu Gln Lys His Asp Ala Ser Ala Leu Asp                 485 490 495 Ile Arg Met Gly Thr Leu Lys Arg Leu Ser Pro His Tyr Thr Gln Ala             500 505 510 Trp Ser Glu Ala Val Phe Ile His Glu Gly Tyr Thr His Asp Ala Gly         515 520 525 Phe Asp Asn Asp Ile Ala Leu Ile Lys Leu Asn Asn Lys Val Val Ile     530 535 540 Asn Ser Asn Ile Thr Pro Ile Cys Leu Pro Arg Lys Glu Ala Glu Ser 545 550 555 560 Phe Met Arg Thr Asp Asp Ile Gly Thr Ala Ser Gly Trp Gly Leu Thr                 565 570 575 Gln Arg Gly Phe Leu Ala Arg Asn Leu Met Tyr Val Asp Ile Pro Ile             580 585 590 Val Asp His Gln Lys Cys Thr Ala Ala Tyr Glu Lys Pro Pro Tyr Pro         595 600 605 Arg Gly Ser Val Thr Ala Asn Met Leu Cys Ala Gly Leu Glu Ser Gly     610 615 620 Gly Lys Asp Ser Cys Arg Gly Asp Ser Gly Gly Ala Leu Val Phe Leu 625 630 635 640 Asp Ser Glu Thr Glu Arg Trp Phe Val Gly Gly Ile Val Ser Trp Gly                 645 650 655 Ser Met Asn Cys Gly Glu Ala Gly Gln Tyr Gly Val Tyr Thr Lys Val             660 665 670 Ile Asn Tyr Ile Pro Trp Ile Glu Asn Ile Ile Ser Asp Phe         675 680 685 <210> 6 <211> 671 <212> PRT <213> Homo sapiens <400> 6 Thr Pro Leu Gly Pro Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Ala 1 5 10 15 Ser Pro Gly Phe Pro Gly Glu Tyr Ala Asn Asp Gln Glu Arg Arg Trp             20 25 30 Thr Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His         35 40 45 Phe Asp Leu Glu Leu Ser His Leu Cys Glu Tyr Asp Phe Val Lys Leu     50 55 60 Ser Ser Gly Ala Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr 65 70 75 80 Asp Thr Glu Arg Ala Pro Gly Lys Asp Thr Phe Tyr Ser Leu Gly Ser                 85 90 95 Ser Leu Asp Ile Thr Phe Arg Ser Asp Tyr Ser Asn Glu Lys Pro Phe             100 105 110 Thr Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Ile Asp Glu Cys Gln         115 120 125 Val Ala Pro Gly Glu Ala Pro Thr Cys Asp His His Cys His Asn His     130 135 140 Leu Gly Gly Phe Tyr Cys Ser Cys Arg Ala Gly Tyr Val Leu His Arg 145 150 155 160 Asn Lys Arg Thr Cys Ser Ala Leu Cys Ser Gly Gln Val Phe Thr Gln                 165 170 175 Arg Ser Gly Glu Leu Ser Ser Pro Glu Tyr Pro Arg Pro Tyr Pro Lys             180 185 190 Leu Ser Ser Cys Thr Tyr Ser Ile Ser Leu Glu Glu Gly Phe Ser Val         195 200 205 Ile Leu Asp Phe Val Glu Ser Phe Asp Val Glu Thr His Pro Glu Thr     210 215 220 Leu Cys Pro Tyr Asp Phe Leu Lys Ile Gln Thr Asp Arg Glu Glu His 225 230 235 240 Gly Pro Phe Cys Gly Lys Thr Leu Pro His Arg Ile Glu Thr Lys Ser                 245 250 255 Asn Thr Val Thr Ile Thr Phe Val Thr Asp Glu Ser Gly Asp His Thr             260 265 270 Gly Trp Lys Ile His Tyr Thr Ser Thr Ala Gln Pro Cys Pro Tyr Pro         275 280 285 Met Ala Pro Pro Asn Gly His Val Ser Pro Val Gln Ala Lys Tyr Ile     290 295 300 Leu Lys Asp Ser Phe Ser Ile Phe Cys Glu Thr Gly Tyr Glu Leu Leu 305 310 315 320 Gln Gly His Leu Pro Leu Lys Ser Phe Thr Ala Val Cys Gln Lys Asp                 325 330 335 Gly Ser Trp Asp Arg Pro Met Pro Ala Cys Ser Ile Val Asp Cys Gly             340 345 350 Pro Pro Asp Leu Pro Ser Gly Arg Val Glu Tyr Ile Thr Gly Pro         355 360 365 Gly Val Thr Thr Tyr Lys Ala Val Ile Gln Tyr Ser Cys Glu Glu Thr     370 375 380 Phe Tyr Thr Met Lys Val Asn Asp Gly Lys Tyr Val Cys Glu Ala Asp 385 390 395 400 Gly Phe Trp Thr Ser Ser Lys Gly Glu Lys Ser Leu Pro Val Cys Glu                 405 410 415 Pro Val Cys Gly Leu Ser Ala Arg Thr Thr Gly Gly Arg Ile Tyr Gly             420 425 430 Gly Gln Lys Ala Lys Pro Gly Asp Phe Pro Trp Gln Val Leu Ile Leu         435 440 445 Gly Gly Thr Thr Ala Gly Ala Leu Leu Tyr Asp Asn Trp Val Leu     450 455 460 Thr Ala Ala His Ala Val Tyr Glu Gln Lys His Asp Ala Ser Ala Leu 465 470 475 480 Asp Ile Arg Met Gly Thr Leu Lys Arg Leu Ser Pro His Tyr Thr Gln                 485 490 495 Ala Trp Ser Glu Ala Val Phe Ile His Glu Gly Tyr Thr His Asp Ala             500 505 510 Gly Phe Asp Asn Asp Ile Ala Leu Ile Lys Leu Asn Asn Lys Val Val         515 520 525 Ile Asn Ser Asn Ile Thr Pro Ile Cys Leu Pro Arg Lys Glu Ala Glu     530 535 540 Ser Phe Met Arg Thr Asp Asp Ile Gly Thr Ala Ser Gly Trp Gly Leu 545 550 555 560 Thr Gln Arg Gly Phe Leu Ala Arg Asn Leu Met Tyr Val Asp Ile Pro                 565 570 575 Ile Val Asp His Gln Lys Cys Thr Ala Ala Tyr Glu Lys Pro Pro Tyr             580 585 590 Pro Arg Gly Ser Val Thr Ala Asn Met Leu Cys Ala Gly Leu Glu Ser         595 600 605 Gly Gly Lys Asp Ser Cys Arg Gly Asp Ser Gly Gly Ala Leu Val Phe     610 615 620 Leu Asp Ser Glu Thr Glu Arg Trp Phe Val Gly Gly Ile Val Ser Trp 625 630 635 640 Gly Ser Met Asn Cys Gly Glu Ala Gly Gln Tyr Gly Val Tyr Thr Lys                 645 650 655 Val Ile Asn Tyr Ile Pro Trp Ile Glu Asn Ile Ile Ser Asp Phe             660 665 670 <210> 7 <211> 4900 <212> DNA <213> Homo sapiens <400> 7 cctgtcctgc ctgcctggaa ctctgagcag gctggagtca tggagtcgat tcccagaatc 60 ccagagtcag ggaggctggg ggcaggggca ggtcactgga caaacagatc aaaggtgaga 120 ccagcgtagg actgcagacc aggccaggcc agctggacgg gcacaccatg aggtaggtgg 180 gcgccacagc ctccctgcag ggtgtggggt gggagcacag gcctgggcct caccgcccct 240 gccctgccca taggctgctg accctcctgg gccttctgtg tggctcggtg gccaccccct 300 taggcccgaa gtggcctgaa cctgtgttcg ggcgcctggc atcccccggc tttccagggg 360 agtatgccaa tgaccaggag cggcgctgga ccctgactgc accccccggc taccgcctgc 420 gcctctactt cacccacttc gacctggagc tctcccacct ctgcgagtac gacttcgtca 480 aggtgccgtc agacgggagg gctggggttt ctcagggtcg gggggtcccc aaggagtagc 540 cagggttcag ggacacctgg gagcaggggc caggcttggc caggagggag atcaggcctg 600 ggtcttgcct tcactccctg tgacacctga ccccacagct gagctcgggg gccaaggtgc 660 tggccacgct gtgcgggcag gagagcacag acacggagcg ggcccctggc aaggacactt 720 tctactcgct gggctccagc ctggacatta ccttccgctc cgactactcc aacgagaagc 780 cgttcacggg gttcgaggcc ttctatgcag ccgagggtga gccaagaggg gtcctgcaac 840 atctcagtct gcgcagctgg ctgtgggggt aactctgtct taggccaggc agccctgcct 900 tcagtttccc cacctttccc agggcagggg agaggcctct ggcctgacat catccacaat 960 gcaaagacca aaacagccgt gacctccatt cacatgggct gagtgccaac tctgagccag 1020 ggatctgagg acagcatcgc ctcaagtgac gcagggactg gccgggcgcg gcagctcacg 1080 cctgtaattc cagcactttg ggaggccgag gctggcttga taatttgagg gtcaggagtt 1140 caaggccagc cagggcaaca cggtgaaact ctatctccac taaaactaca aaaattagct 1200 gggcgtggtg gtgcgcacct ggaatcccag ctactaggga ggctgaggca ggagaattgc 1260 ttgaacctgc gaggtggagg ctgcagtgaa cagagattgc accactacac tccacctggg 1320 cgacagacta gactccgtct caaaaaacaa aaaacaaaaa ccacgcaggg ccgagggccc 1380 atttacaagc tgacaaagtg ggccctgcca gcgggagcgc tgcaggatgt ttgattttca 1440 gatcccagtc cctgcagaga ccaactgtgt gacctctggc aagtggctc atttctctgc 1500 tccttagaag ctgctgcaag ggttcagcgc tgtagccccg ccccctgggt ttgattgact 1560 cccctcatta gctgggtgac ctcggccgga cactgaaact cccactggtt taacagaggt 1620 gatgtttgca tctttctccc agcgctgctg ggagcttgca gcgaccctag gcctgtaagg 1680 tgattggccc ggcaccagtc ccgcacccta gacaggacct aggcctcctc tgaggtccac 1740 tctgaggtca tggatctcct gggaggagtc caggctggat cccgcctctt tccctcctga 1800 cggcctgcct ggccctgcct ctcccccaga cattgacgag tgccaggtgg ccccgggaga 1860 ggcgcccacc tgcgaccacc actgccacaa ccacctgggc ggtttctact gctcctgccg 1920 cgcaggctac gtcctgcacc gtaacaagcg cacctgctca ggtgagggag gctgcctggg 1980 ccccaacgca ccctctcctg ggatacccgg ggctcctcag ggccattgct gctctgccca 2040 ggggtgcgga gggcctgggc ctggacactg ggtgcttcta ggccctgctg cctccagctc 2100 cccttctcag ccctgcttcc cctctcagca gccaggctca tcagtgccac cctgccctag 2160 cactgagact aattctaaca tcccactgtg tacctggttc cacctgggct ctgggaaccc 2220 ctcatgtagc cacgggagag tcggggtatc taccctcgtt ccttggactg ggttcctgtt 2280 ccctgcactg ggggacgggc cagtgctctg gggcgtgggc agccccaccc tgtggcgctg 2340 accctgctcc cccgactcgg tttctcctct cggggtctct ccttgcctct ctgatctctc 2400 ttccagagca gagcctctag cctcccctgg agctccggct gcccagcagg tcagaagcca 2460 gagccaggct gctggcctca gctccgggtt gggctgagat gctgtgcccc aactcccatt 2520 cacccaccat ggacccaata ataaacctgg ccccacccca cctgctgccg cgtgtctctg 2580 gggtgggagg gtcgggaggc ggtggggcgc gctcctctct gcctaccctc ctcacagcct 2640 catgaacccc aggtctgtgg gagcctcctc catggggcca cacggtcctt ggcctcaccc 2700 cctgttttga agatggggca ctgaggccgg agaggggtaa ggcctcgctc gagtccaggt 2760 ccccagaggc tgagcccaga gtaatcttga accaccccca ttcagggtct ggcctggagg 2820 agcctgaccc acagaggaga caccctggga gatattcatt gaggggtaat ctggtccccc 2880 gcaaatccag gggtgattcc cactgcccca taggcacagc cacgtggaag aaggcaggca 2940 atgttggggc tcctcacttc ctagaggcct cacaactcaa atgcccccca ctgcagctgg 3000 gggtggggtg gtggtatggg atggggacca agccttcctt gaaggataga gcccagccca 3060 acaccccgcc ccgtggcagc agcatcacgt gttccagcga ggaaggagag caccagactc 3120 agtcatgatc actgttgcct tgaacttcca agaacagccc cagggcaagg gtcaaaacag 3180 gggaaagggg gtgatgagag atccttcttc cggatgttcc tccaggaacc agggggctgg 3240 ctggtcttgg ctgggttcgg gtaggagacc catgatgaat aaacttggga atcactgggg 3300 tggctgtaag ggaatttagg ggagctccga aggggccctt aggctcgagg agatgctcct 3360 ctcttttccc gaattcccag ggacccagga gagtgtccct tcttcctctt cctgtgtgtc 3420 catccacccc cgccccccgc cctggcagag ctggtggaac tcagtgctct agcccctacc 3480 ctggggttgc gactctggct caggacacca ccacgctccc tgggggtgtg agtgagggcc 3540 tgtgcgctcc atcccgagtg ctgcctgttt cagctaaagc ctcaaagcaa gagaaacccc 3600 ctctctaagc ggcccctcag ccatcgggtg ggtcgtttgg tttctgggta ggcctcaggg 3660 gctggccacc tgcagggccc agcccaaccc agggatgcag atgtcccagc cacatccctg 3720 tcccagtttc ctgctcccca aggcatccac cctgctgttg gtgcgagggc tgatagaggg 3780 cacgccaagt cactcccctg cccttccctc cttccagccc tgtgctccgg ccaggtcttc 3840 acccagaggt ctggggagct cagcagccct gaatacccac ggccgtatcc caaactctcc 3900 agttgcactt acagcatcag cctggaggag gggttcagtg tcattctgga ctttgtggag 3960 tccttcgatg tggagacaca ccctgaaacc ctgtgtccct acgactttct caaggtctgg 4020 ctcctgggcc cctcatcttg tcccagatcc tcccccttca gcccagctgc accccctact 4080 tcctgcagca tggcccccac cacgttcccg tcaccctcgg tgaccccacc tcttcaggtg 4140 ctctatggag gtcaaggctg gggcttcgag tacaagtgtg ggaggcagag tggggagggg 4200 caccccaatc catggcctgg gttggcctca ttggctgtcc ctgaaatgct gaggaggtgg 4260 gttacttccc tccgcccagg ccagacccag gcagctgctc cccagctttc atgagcttct 4320 ttctcagatt caaacagaca gagaagaaca tggcccattc tgtgggaaga cattgcccca 4380 caggattgaa acaaaaagca acacggtgac catcaccttt gtcacagatg aatcaggaga 4440 ccacacaggc tggaagatcc actacacgag cacagtgagc aagtgggctc agatccttgg 4500 tggaagcgca gagctgcctc tctctggagt gcaaggagct gtagagtgta gggctcttct 4560 gggcaggact aggaagggac accaggttta gtggtgctga ggtctgaggc agcagcttct 4620 aaggggaagc acccgtgccc tcctcagcag cacccagcat cttcaccact cattcttcaa 4680 ccacccattc acccatcact catcttttac ccacccaccc tttgccactc atccttctgt 4740 ccctcatcct tccaaccatt catcaatcac ccacccatcc atcctttgcc acacaaccat 4800 ccacccattc ttctacctac ccatcctatc catccatcct tctatcagca tccttctacc 4860 acccatcctt cgttcggtca tccatcatca tccatccatc 4900 <210> 8 <211> 136 <212> PRT <213> Homo sapiens <400> 8 Met Arg Leu Leu Thr Leu Leu Gly Leu Leu Cys Gly Ser Val Ala Thr 1 5 10 15 Pro Leu Gly Pro Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Ala Ser             20 25 30 Pro Gly Phe Pro Gly Glu Tyr Ala Asn Asp Gln Glu Arg Arg Trp Thr         35 40 45 Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His Phe     50 55 60 Asp Leu Glu Leu Ser His Leu Cys Glu Tyr Asp Phe Val Lys Leu Ser 65 70 75 80 Ser Gly Ala Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr Asp                 85 90 95 Thr Glu Arg Ala Pro Gly Lys Asp Thr Phe Tyr Ser Leu Gly Ser Ser             100 105 110 Leu Asp Ile Thr Phe Arg Ser Asp Tyr Ser Asn Glu Lys Pro Phe Thr         115 120 125 Gly Phe Glu Ala Phe Tyr Ala Ala     130 135 <210> 9 <211> 181 <212> PRT <213> Homo sapiens <400> 9 Met Arg Leu Leu Thr Leu Leu Gly Leu Leu Cys Gly Ser Val Ala Thr 1 5 10 15 Pro Leu Gly Pro Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Ala Ser             20 25 30 Pro Gly Phe Pro Gly Glu Tyr Ala Asn Asp Gln Glu Arg Arg Trp Thr         35 40 45 Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His Phe     50 55 60 Asp Leu Glu Leu Ser His Leu Cys Glu Tyr Asp Phe Val Lys Leu Ser 65 70 75 80 Ser Gly Ala Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr Asp                 85 90 95 Thr Glu Arg Ala Pro Gly Lys Asp Thr Phe Tyr Ser Leu Gly Ser Ser             100 105 110 Leu Asp Ile Thr Phe Arg Ser Asp Tyr Ser Asn Glu Lys Pro Phe Thr         115 120 125 Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Ile Asp Glu Cys Gln Val     130 135 140 Ala Pro Gly Glu Ala Pro Thr Cys Asp His His Cys His Asn His Leu 145 150 155 160 Gly Gly Phe Tyr Cys Ser Cys Arg Ala Gly Tyr Val Leu His Arg Asn                 165 170 175 Lys Arg Thr Cys Ser             180 <210> 10 <211> 293 <212> PRT <213> Homo sapiens <400> 10 Met Arg Leu Leu Thr Leu Leu Gly Leu Leu Cys Gly Ser Val Ala Thr 1 5 10 15 Pro Leu Gly Pro Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Ala Ser             20 25 30 Pro Gly Phe Pro Gly Glu Tyr Ala Asn Asp Gln Glu Arg Arg Trp Thr         35 40 45 Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His Phe     50 55 60 Asp Leu Glu Leu Ser His Leu Cys Glu Tyr Asp Phe Val Lys Leu Ser 65 70 75 80 Ser Gly Ala Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr Asp                 85 90 95 Thr Glu Arg Ala Pro Gly Lys Asp Thr Phe Tyr Ser Leu Gly Ser Ser             100 105 110 Leu Asp Ile Thr Phe Arg Ser Asp Tyr Ser Asn Glu Lys Pro Phe Thr         115 120 125 Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Ile Asp Glu Cys Gln Val     130 135 140 Ala Pro Gly Glu Ala Pro Thr Cys Asp His His Cys His Asn His Leu 145 150 155 160 Gly Gly Phe Tyr Cys Ser Cys Arg Ala Gly Tyr Val Leu His Arg Asn                 165 170 175 Lys Arg Thr Cys Ser Ala Leu Cys Ser Gly Gln Val Phe Thr Gln Arg             180 185 190 Ser Gly Glu Leu Ser Ser Pro Glu Tyr Pro Arg Pro Tyr Pro Lys Leu         195 200 205 Ser Ser Cys Thr Tyr Ser Ile Ser Leu Glu Glu Gly Phe Ser Val Ile     210 215 220 Leu Asp Phe Val Glu Ser Phe Asp Val Glu Thr His Pro Glu Thr Leu 225 230 235 240 Cys Pro Tyr Asp Phe Leu Lys Ile Gln Thr Asp Arg Glu Glu His Gly                 245 250 255 Pro Phe Cys Gly Lys Thr Leu Pro His Arg Ile Glu Thr Lys Ser Asn             260 265 270 Thr Val Thr Ile Thr Phe Val Thr Asp Glu Ser Gly Asp His Thr Gly         275 280 285 Trp Lys Ile His Tyr     290 <210> 11 <211> 41 <212> PRT <213> Homo sapiens <400> 11 Glu Asp Ile Asp Glu Cys Gln Val Ala Pro Gly Glu Ala Pro Thr Cys 1 5 10 15 Asp His His Cys His Asn His Leu Gly Gly Phe Tyr Cys Ser Cys Arg             20 25 30 Ala Gly Tyr Val Leu His Arg Asn Lys         35 40 <210> 12 <211> 242 <212> PRT <213> Homo sapiens <400> 12 Ile Tyr Gly Gly Gln Lys Ala Lys Pro Gly Asp Phe Pro Trp Gln Val 1 5 10 15 Leu Ile Leu Gly Gly Thr Thr Ala Gly Ala Leu Leu Tyr Asp Asn             20 25 30 Trp Val Leu Thr Ala Ala His Ala Val Tyr Glu Gln Lys His Asp Ala         35 40 45 Ser Ala Leu Asp Ile Arg Met Gly Thr Leu Lys Arg Leu Ser Pro His     50 55 60 Tyr Thr Gln Ala Trp Ser Glu Ala Val Phe Ile His Glu Gly Tyr Thr 65 70 75 80 His Asp Ala Gly Phe Asp Asn Asp Ile Ala Leu Ile Lys Leu Asn Asn                 85 90 95 Lys Val Val Ile Asn Ser Asn Ile Thr Pro Ile Cys Leu Pro Arg Lys             100 105 110 Glu Ala Glu Ser Phe Met Arg Thr Asp Asp Ile Gly Thr Ala Ser Gly         115 120 125 Trp Gly Leu Thr Gln Arg Gly Phe Leu Ala Arg Asn Leu Met Tyr Val     130 135 140 Asp Ile Pro Ile Val Asp His Gln Lys Cys Thr Ala Ala Tyr Glu Lys 145 150 155 160 Pro Pro Tyr Pro Arg Gly Ser Val Thr Ala Asn Met Leu Cys Ala Gly                 165 170 175 Leu Glu Ser Gly Gly Lys Asp Ser Cys Arg Gly Asp Ser Gly Gly Ala             180 185 190 Leu Val Phe Leu Asp Ser Glu Thr Glu Arg Trp Phe Val Gly Gly Ile         195 200 205 Val Ser Trp Gly Ser Met Asn Cys Gly Glu Ala Gly Gln Tyr Gly Val     210 215 220 Tyr Thr Lys Val Ile Asn Tyr Ile Pro Trp Ile Glu Asn Ile Ile Ser 225 230 235 240 Asp Phe          <210> 13 <211> 16 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 13 Gly Lys Asp Ser Cys Arg Gly Asp Ala Gly Gly Ala Leu Val Phe Leu 1 5 10 15 <210> 14 <211> 15 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 14 Thr Pro Leu Gly Pro Lys Trp Pro Glu Pro Val Phe Gly Arg Leu 1 5 10 15 <210> 15 <211> 43 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 15 Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His Phe Asp 1 5 10 15 Leu Glu Leu Ser His Leu Cys Glu Tyr Asp Phe Val Lys Leu Ser Ser             20 25 30 Gly Ala Lys Val Leu Ala Thr Leu Cys Gly Gln         35 40 <210> 16 <211> 8 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 16 Thr Phe Arg Ser Asp Tyr Ser Asn 1 5 <210> 17 <211> 25 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 17 Phe Tyr Ser Leu Gly Ser Ser Leu Asp Ile Thr Phe Arg Ser Asp Tyr 1 5 10 15 Ser Asn Glu Lys Pro Phe Thr Gly Phe             20 25 <210> 18 <211> 9 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 18 Ile Asp Glu Cys Gln Val Ala Pro Gly 1 5 <210> 19 <211> 25 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 19 Ala Asn Met Leu Cys Ala Gly Leu Glu Ser Gly Gly Lys Asp Ser Cys 1 5 10 15 Arg Gly Asp Ser Gly Gly Ala Leu Val             20 25 <210> 20 <211> 960 <212> DNA <213> Homo sapiens <220> <221> CDS <222> (51). (797) <400> 20 attaactgag attaaccttc cctgagtttt ctcacaccaa ggtgaggacc atg tcc 56                                                        Met Ser                                                        One ctg ttt cca tca ctc cct ctc ctt ctc ctg agt atg gtg gca gcg tct 104 Leu Phe Pro Ser Leu Pro Leu Leu Leu Leu Ser Met Val         5 10 15 tac tca gaa act gtg acc tgt gag gat gcc caa aag acc tgc cct gca 152 Tyr Ser Glu Thr Val Thr Cys Glu Asp Ala Gln Lys Thr Cys Pro Ala     20 25 30 gtg att gcc tgt agc tct cca ggc atc aac ggc ttc cca ggc aaa gat 200 Val Ile Ala Cys Ser Ser Pro Gly Ile Asn Gly Phe Pro Gly Lys Asp 35 40 45 50 ggg cgt gat ggc acc aag gga gaa aag ggg gaa cca ggc caa ggg ctc 248 Gly Arg Asp Gly Thr Lys Gly Glu Lys Gly GIy Pro Gly GInt Gly Leu                 55 60 65 aga ggc tta cag ggc ccc cct gga aag ttg ggg cct cca gga aat cca 296 Arg Gly Leu Gln Gly Pro Pro Gly Lys Leu Gly Pro Pro Gly Asn Pro             70 75 80 ggg cct tct ggg tca cca gga cca aag ggc caa aaa gga gac cct gga 344 Gly Pro Ser Gly Ser Pro Gly Pro Lys Gly Gln Lys Gly Asp Pro Gly         85 90 95 aaa agt ccg gat ggt gat agt agc ctg gct gcc tca gaa aga aaa gct 392 Lys Ser Pro Asp Gly Asp Ser Ser Leu Ala Ala Ser Glu Arg Lys Ala     100 105 110 ctg caa aca gaa atg gca cgt atc aaa aag tgg ctc acc ttc tct ctg 440 Leu Gln Thr Glu Met Ala Arg Ile Lys Lys Trp Leu Thr Phe Ser Leu 115 120 125 130 ggc aaa caa gtt ggg aac aag ttc ttc ctg acc aat ggt gaa ata atg 488 Gly Lys Gln Val Gly Asn Lys Phe Phe Leu Thr Asn Gly Glu Ile Met                 135 140 145 acc ttt gaa aaa gtg aag gcc ttg tgt gtc aag ttc cag gcc tct gtg 536 Thr Phe Glu Lys Val Lys Ala Leu Cys Val Lys Phe Gln Ala Ser Val             150 155 160 gcc acc ccc agg aat gct gca gag aat gga gcc att cag aat ctc atc 584 Ala Thr Pro Arg Asn Ala Gla Asn Gly Ala Ile Gln Asn Leu Ile         165 170 175 aag gag ga gcc ttc ctg ggc atc act gat gag aag aca gaa ggg cag 632 Lys Glu Glu Ala Phe Leu Gly Ile Thr Asp Glu Lys Thr Glu Gly Gln     180 185 190 ttt gtg gat ctg aca gga aat aga ctg acc tac aca aac tgg aac gag 680 Phe Val Asp Leu Thr Gly Asn Arg Leu Thr Tyr Thr Asn Trp Asn Glu 195 200 205 210 ggt gaa ccc aac aat gct ggt tct gat ga gat tgt gta ttg cta ctg 728 Gly Glu Pro Asn Asn Ala Gly Ser Asp Glu Asp Cys Val Leu Leu Leu                 215 220 225 aaa aat ggc cag tgg aat gac gtc ccc tgc tcc acc tcc cat ctg gcc 776 Lys Asn Gly Gln Trp Asn Asp Val Pro Cys Ser Thr Ser Leu Ala             230 235 240 gtc tgt gag ttc cct atc tga agggtcatat cactcaggcc ctccttgtct 827 Val Cys Glu Phe Pro Ile         245 ttttactgca acccacaggc ccacagtatg cttgaaaaga taaattatat caatttcctc 887 atatccagta ttgttccttt tgtgggcaat cactaaaaaat gatcactaac agcaccaaca 947 aagcaataat agt 960 <210> 21 <211> 248 <212> PRT <213> Homo sapiens <400> 21 Met Ser Leu Phe Pro Ser Leu Pro Leu Leu Leu Leu Ser Met Val Ala 1 5 10 15 Ala Ser Tyr Ser Glu Thr Val Thr Cys Glu Asp Ala Gln Lys Thr Cys             20 25 30 Pro Ala Val Ile Ala Cys Ser Ser Pro Gly Ile Asn Gly Phe Pro Gly         35 40 45 Lys Asp Gly Arg Asp Gly Thr Lys Gly Glu Lys Gly Glu Pro Gly Gln     50 55 60 Gly Leu Arg Gly Leu Gln Gly Pro Pro Gly Lys Leu Gly Pro Pro Gly 65 70 75 80 Asn Pro Gly Pro Ser Gly Ser Pro Gly Pro Lys Gly Gln Lys Gly Asp                 85 90 95 Pro Gly Lys Ser Pro Asp Gly Asp Ser Ser Leu Ala Ala Ser Glu Arg             100 105 110 Lys Ala Leu Gln Thr Glu Met Ala Arg Ile Lys Lys Trp Leu Thr Phe         115 120 125 Ser Leu Gly Lys Gln Val Gly Asn Lys Phe Phe Leu Thr Asn Gly Glu     130 135 140 Ile Met Thr Phe Glu Lys Val Lys Ala Leu Cys Val Lys Phe Gln Ala 145 150 155 160 Ser Val Ala Thr Pro Arg Asn Ala Gla Asn Gly Ala Ile Gln Asn                 165 170 175 Leu Ile Lys Glu Glu Ala Phe Leu Gly Ile Thr Asp Glu Lys Thr Glu             180 185 190 Gly Gln Phe Val Asp Leu Thr Gly Asn Arg Leu Thr Tyr Thr Asn Trp         195 200 205 Asn Glu Gly Glu Pro Asn Asn Ala Gly Ser Asp Glu Asp Cys Val Leu     210 215 220 Leu Leu Lys Asn Gly Gln Trp Asn Asp Val Pro Cys Ser Thr Ser His 225 230 235 240 Leu Ala Val Cys Glu Phe Pro Ile                 245 <210> 22 <211> 6 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <220> <221> MISC_FEATURE <222> (1) <223> Wherein X at position 1 represents hydroxyproline <220> <221> MISC_FEATURE <222> (4) (4) <223> Wherein X at position 4 represents hydrophobic residue <400> 22 Xaa Gly Lys Xaa Gly Pro 1 5 <210> 23 <211> 5 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <220> <221> MISC_FEATURE <222> (1) <223> Wherein X represents hydroxyproline <400> 23 Xaa Gly Lys Leu Gly 1 5 <210> 24 <211> 16 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <220> <221> MISC_FEATURE &Lt; 222 > (9) <223> Wherein X at positions 9 and 15 represents hydroxyproline <400> 24 Gly Leu Arg Gly Leu Gln Gly Pro Xaa Gly Lys Leu Gly Pro Xaa Gly 1 5 10 15 <210> 25 <211> 27 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <220> <221> MISC_FEATURE <222> (3) (27) Wherein X at positions 3, 6, 15, 21, 24, 27 represent        hydroxyproline <400> 25 Gly Pro Xaa Gly Pro Xaa Gly Leu Arg Gly Leu Gln Gly Pro Xaa Gly 1 5 10 15 Lys Leu Gly Pro Xaa Gly Pro Xaa Gly Pro Xaa             20 25 <210> 26 <211> 53 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <220> <221> misc_feature &Lt; 222 > (26) <223> Xaa can be any naturally occurring amino acid <220> <221> misc_feature &Lt; 222 > (32) <223> Xaa can be any naturally occurring amino acid <220> <221> misc_feature &Lt; 222 > (35) <223> Xaa can be any naturally occurring amino acid <220> <221> misc_feature &Lt; 222 > (41) .. (41) <223> Xaa can be any naturally occurring amino acid <220> <221> misc_feature (50). (50) <223> Xaa can be any naturally occurring amino acid <400> 26 Gly Lys Asp Gly Arg Asp Gly Thr Lys Gly Glu Lys Gly Glu Glu Pro Gly 1 5 10 15 Gln Gly Leu Arg Gly Leu Gln Gly Pro Xaa Gly Lys Leu Gly Pro Xaa             20 25 30 Gly Asn Xaa Gly Pro Ser Gly Ser Xaa Gly Pro Lys Gly Gln Lys Gly         35 40 45 Asp Xaa Gly Lys Ser     50 <210> 27 <211> 33 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <220> <221> MISC_FEATURE <222> (3) (33) Wherein X at positions 3, 6, 12, 18, 21, 30, 33 represent        hydroxyproline <400> 27 Gly Ala Xaa Gly Ser Xaa Gly Glu Lys Gly Ala Xaa Gly Pro Gln Gly 1 5 10 15 Pro Xaa Gly Pro Xaa Gly Lys Met Gly Pro Lys Gly Glu Xaa Gly Asp             20 25 30 Xaa      <210> 28 <211> 45 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <220> <221> MISC_FEATURE <222> (3). (45) Wherein X at positions 3, 6, 9, 27, 30, 36, 42, 45 represent        hydroxyproline <400> 28 Gly Cys Xaa Gly Leu Xaa Gly Ala Xaa Gly Asp Lys Gly Glu Ala Gly 1 5 10 15 Thr Asn Gly Lys Arg Gly Glu Arg Gly Pro Xaa Gly Pro Xaa Gly Lys             20 25 30 Ala Gly Pro Xaa Gly Pro Asn Gly Ala Xaa Gly Glu Xaa         35 40 45 <210> 29 <211> 24 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 29 Leu Gln Arg Ala Leu Glu Ile Leu Pro Asn Arg Val Thr Ile Lys Ala 1 5 10 15 Asn Arg Pro Phe Leu Val Phe Ile             20 <210> 30 <211> 559 <212> DNA <213> Homo sapiens <400> 30 atgaggctgc tgaccctcct gggccttctg tgtggctcgg tggccacccc cttgggcccg 60 aagtggcctg aacctgtgtt cgggcgcctg gcatcccccg gctttccagg ggagtatgcc 120 aatgaccagg agcggcgctg gaccctgact gcaccccccg gctaccgcct gcgcctctac 180 ttcacccact tcgacctgga gctctcccac ctctgcgagt acgacttcgt caagctgagc 240 tcgggggcca aggtgctggc cacgctgtgc gggcaggaga gcacagacac ggagcgggcc 300 cctggcaagg acactttcta ctcgctgggc tccagcctgg acattacctt ccgctccgac 360 tactccaacg agaagccgtt cacggggttc gaggccttct atgcagccga ggacattgac 420 gagtgccagg tggccccggg agaggcgccc acctgcgacc accactgcca caaccacctg 480 ggcggtttct actgctcctg ccgcgcaggc tacgtcctgc accgtaacaa gcgcacctgc 540 tcagccctgt gctccggcc 559 <210> 31 <211> 34 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 31 cgggcacacc atgaggctgc tgaccctcct gggc 34 <210> 32 <211> 33 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 32 gacattacct tccgctccga ctccaacgag aag 33 <210> 33 <211> 33 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 33 agcagccctg aatacccacg gccgtatccc aaa 33 <210> 34 <211> 26 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 34 cgggatccat gaggctgctg accctc 26 <210> 35 <211> 19 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 35 ggaattccta ggctgcata 19 <210> 36 <211> 19 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 36 ggaattccta cagggcgct 19 <210> 37 <211> 19 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 37 ggaattccta gtagtggat 19 <210> 38 <211> 25 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 38 tgcggccgct gtaggtgctg tcttt 25 <210> 39 <211> 23 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 39 ggaattcact cgttattctc gga 23 <210> 40 <211> 17 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 40 tccgagaata acgagtg 17 <210> 41 <211> 29 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 41 cattgaaagc tttggggtag aagttgttc 29 <210> 42 <211> 27 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 42 cgcggccgca gctgctcaga gtgtaga 27 <210> 43 <211> 28 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 43 cggtaagctt cactggctca gggaaata 28 <210> 44 <211> 37 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 44 aagaagcttg ccgccaccat ggattggctg tggaact 37 <210> 45 <211> 31 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 45 cgggatcctc aaactttctt gtccaccttg g 31 <210> 46 <211> 36 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 46 aagaaagctt gccgccacca tgttctcact agctct 36 <210> 47 <211> 26 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 47 cgggatcctt ctccctctaa cactct 26 <210> 48 <211> 9 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 48 Glu Pro Lys Ser Cys Asp Lys Thr His 1 5 <210> 49 <211> 4960 <212> DNA <213> Homo Sapiens <400> 49 ccggacgtgg tggcgcatgc ctgtaatccc agctactcgg gaggctgagg caggagaatt 60 gctcgaaccc cggaggcaga ggtttggtgg ctcacacctg taatcccagc actttgcgag 120 gctgaggcag gtgcatcgct ttggctcagg agttcaagac cagcctgggc aacacaggga 180 gacccccatc tctacaaaaa acaaaaacaa atataaaggg gataaaaaaa aaaaaaagac 240 aagacatgaa tccatgagga cagagtgtgg aagaggaagc agcagcctca aagttctgga 300 agctggaaga acagataaac aggtgtgaaa taactgcctg gaaagcaact tctttttttt 360 tttttttttt tttgaggtgg agtctcactc tgtcgtccag gctggagtgc agtggtgcga 420 tctcggatca ctgcaacctc cgcctcccag gctcaagcaa ttctcctgcc tcagcctccc 480 gagtagctgg gattataagt gcgcgctgcc acacctggat gatttttgta tttttagtag 540 agatgggatt tcaccatgtt ggtcaggctg gtctcaaact cccaacctcg tgatccaccc 600 accttggcct cccaaagtgc tgggattaca ggtataagcc accgagccca gccaaaagcg 660 acttctaagc ctgcaaggga atcgggaatt ggtggcacca ggtccttctg acagggttta 720 agaaattagc cagcctgagg ctgggcacgg tggctcacac ctgtaatccc agcactttgg 780 gaggctaagg caggtggatc acctgagggc aggagttcaa gaccagcctg accaacatgg 840 agaaacccca tccctaccaa aaataaaaaa ttagccaggt gtggtggtgc tcgcctgtaa 900 tcccagctac ttgggaggct gaggtgggag gattgcttga acacakgaag tagaggctgc 960 agtgagctat gattgcagca ctgcactgaa gccggggcaa cagaacaaga tccaaaaaaa 1020 agggaggggt gaggggcaga gccaggattt gtttccaggc tgttgttacc taggtccgac 1080 tcctggctcc cagagcagcc tgtcctgcct gcctggaact ctgagcaggc tggagtcatg 1140 gagtcgattc ccagaatccc agagtcaggg aggctggggg caggggcagg tcactggaca 1200 aacagatcaa aggtgagacc agcgtagggc tgcagaccag gccaggccag ctggacgggc 1260 acaccatgag gtaggtgggc gcccacagcc tccctgcagg gtgtggggtg ggagcacagg 1320 cctgggccct caccgcccct gccctgccca taggctgctg accctcctgg gccttctgtg 1380 tggctcggtg gccaccccct tgggcccgaa gtggcctgaa cctgtgttcg ggcgcctggc 1440 atcccccggc tttccagggg agtatgccaa tgaccaggag cggcgctgga ccctgactgc 1500 accccccggc taccgcctgc gcctctactt cacccacttc gacctggagc tctcccacct 1560 ctgcgagtac gacttcgtca aggtgccgtc aggacgggag ggctggggtt tctcagggtc 1620 ggggggtccc caaggagtag ccagggttca gggacacctg ggagcagggg ccaggcttgg 1680 ccaggaggga gatcaggcct gggtcttgcc ttcactccct gtgacacctg accccacagc 1740 tgagctcggg ggccaaggtg ctggccacgc tgtgcgggca ggagagcaca gacacggagc 1800 gggcccctgg caaggacact ttctactcgc tgggctccag cctggacatt accttccgct 1860 ccgactactc caacgagaag ccgttcacgg ggttcgaggc cttctatgca gccgagggtg 1920 agccaagagg ggtcctgcaa catctcagtc tgcgcagctg gctgtggggg taactctgtc 1980 ttaggccagg cagccctgcc ttcagtttcc ccacctttcc cagggcaggg gagaggcctc 2040 tggcctgaca tcatccacaa tgcaaagacc aaaacagccg tgacctccat tcacatgggc 2100 tgagtgccaa ctctgagcca gggatctgag gacagcatcg cctcaagtga cgcagggact 2160 ggccgggcgc agcagctcac gcctgtaatt ccagcacttt gggaggccga ggctggctga 2220 tcatttgagg tcaggagttc aaggccagcc agggcaacac ggtgaaactc tatctccact 2280 aaaactacaa aaattagctg ggcgtggtgg tgcgcacctg gaatcccagc tactagggag 2340 gctgaggcag gagaattgct tgaacctgcg aggtggaggc tgcagtgaac agagattgca 2400 ccactacact ccagcctggg cgacagagct agactccgtc tcaaaaaaca aaaaacaaaa 2460 acgacgcagg ggccgagggc cccatttaca gctgacaaag tggggccctg ccagcgggag 2520 cgctgccagg atgtttgatt tcagatccca gtccctgcag agaccaactg tgtgacctct 2580 ggcaagtggc tcaatttctc tgctccttag gaagctgctg caagggttca gcgctgtagc 2640 cccgccccct gggtttgatt gactcccctc attagctggg tgacctcggg ccggacactg 2700 aaactcccac tggtttaaca gaggtgatgt ttgcatcttt ctcccagcgc tgctgggagc 2760 ttgcagcgac cctaggcctg taaggtgatt ggcccggcac cagtcccgca ccctagacag 2820 gacgaggcct cctctgaggt ccactctgag gtcatggatc tcctgggagg agtccaggct 2880 ggatcccgcc tctttccctc ctgacggcct gcctggccct gcctctcccc cagacattga 2940 cgagtgccag gtggccccgg gagaggcgcc cacctgcgac caccactgcc acaaccacct 3000 gggcggtttc tactgctcct gccgcgcagg ctacgtcctg caccgtaaca agcgcacctg 3060 ctcagccctg tgctccggcc aggtcttcac ccagaggtct ggggagctca gcagccctga 3120 atacccacgg ccgtatccca aactctccag ttgcacttac agcatcagcc tggaggaggg 3180 gttcagtgtc attctggact ttgtggagtc cttcgatgtg gagacacacc ctgaaaccct 3240 gtgtccctac gactttctca agattcaaac agacagagaa gaacatggcc cattctgtgg 3300 gaagacattg ccccacagga ttgaaacaaa aagcaacacg gtgaccatca cctttgtcac 3360 agatgaatca ggagaccaca caggctggaa gatccactac acgagcacag cgcacgcttg 3420 cccttatccg atggcgccac ctaatggcca cgtttcacct gtgcaagcca aatacatcct 3480 gaaagacagc ttctccatct tttgcgagac tggctatgag cttctgcaag gtcacttgcc 3540 cctgaaatcc tttactgcag tttgtcagaa agatggatct tgggaccggc caatgcccgc 3600 gtgcagcatt gttgactgtg gccctcctga tgatctaccc agtggccgag tggagtacat 3660 cacaggtcct ggagtgacca cctacaaagc tgtgattcag tacagctgtg aagagacctt 3720 ctacacaatg aaagtgaatg atggtaaata tgtgtgtgag gctgatggat tctggacgag 3780 ctccaaagga gaaaaatcac tcccagtctg tgagcctgtt tgtggactat cagcccgcac 3840 aacaggaggg cgtatatatg gagggcaaaa ggcaaaacct ggtgattttc cttggcaagt 3900 cctgatatta ggtggaacca cagcagcagg tgcactttta tatgacaact gggtcctaac 3960 agctgctcat gccgtctatg agcaaaaaca tgatgcatcc gccctggaca ttcgaatggg 4020 caccctgaaa agactatcac ctcattatac acaagcctgg tctgaagctg tttttataca 4080 tgaaggttat actcatgatg ctggctttga caatgacata gcactgatta aattgaataa 4140 caaagttgta atcaatagca acatcacgcc tatttgtctg ccaagaaaag aagctgaatc 4200 ctttatgagg acagatgaca ttggaactgc atctggatgg ggattaaccc aaaggggttt 4260 tcttgctaga aatctaatgt atgtcgacat accgattgtt gaccatcaaa aatgtactgc 4320 tgcatatgaa aagccaccct atccaagggg aagtgtaact gctaacatgc tttgtgctgg 4380 cttagaaagt gggggcaagg acagctgcag aggtgacagc ggaggggcac tggtgtttct 4440 agatagtgaa acagagaggt ggtttgtggg aggaatagtg tcctggggtt ccatgaattg 4500 tggggaagca ggtcagtatg gagtctacac aaaagttatt aactatattc cctggatcga 4560 gaacataatt agtgattttt aacttgcgtg tctgcagtca aggattcttc atttttagaa 4620 atgcctgtga agaccttggc agcgacgtgg ctcgagaagc attcatcatt actgtggaca 4680 tggcagttgt tgctccaccc aaaaaaacag actccaggtg aggctgctgt catttctcca 4740 cttgccagtt taattccagc cttacccatt gactcaaggg gacataaacc acgagagtga 4800 cagtcatctt tgcccaccca gtgtaatgtc actgctcaaa ttacatttca ttaccttaaa 4860 aagccagtct cttttcatac tggctgttgg catttctgta aactgcctgt ccatgctctt 4920 tgtttttaaa cttgttctta ttgaaaaaaa aaaaaaaaaa 4960 <210> 50 <211> 2090 <212> DNA <213> Murine <220> <221> CDS &Lt; 222 > (33) <400> 50 ggcgctggac tgcagagcta tggtggcaca cc atg agg cta ctc atc ttc ctg 53                                     Met Arg Leu Leu Ile Phe Leu                                     1 5 ggt ctg ctg tgg agt ttg gtg gcc aca ctt ctg ggt tca aag tgg cct 101 Gly Leu Leu Trp Ser Leu Val Ala Thr Leu Leu Gly Ser Lys Trp Pro         10 15 20 gaa cct gta ttc ggg cgc ctg gtg tcc cct ggc ttc cca gag aag tat 149 Glu Pro Val Phe Gly Arg Leu Val Ser Pro Gly Phe Pro Glu Lys Tyr     25 30 35 gct gac cat caa gat cga tcc tgg aca ctg act gca ccc cct ggc tac 197 Ala Asp His Gln Asp Arg Ser Trp Thr Leu Thr Ala Pro Pro Gly Tyr 40 45 50 55 cgc ctg cgc ctc tac ttc acc cac ttt gac ctg gaa ctc tct tac cgc 245 Arg Leu Arg Leu Tyr Phe Thr His Phe Asp Leu Glu Leu Ser Tyr Arg                 60 65 70 tgc gag tat gac ttt gtc aag ttg agc tca ggg acc aag gtg ctg gcc 293 Cys Glu Tyr Asp Phe Val Lys Leu Ser Ser Gly Thr Lys Val Leu Ala             75 80 85 aca ctg tgt ggg cag gag agt aca gac act gag cag gca cct ggc aat 341 Thr Leu Cys Gly Gln Glu Ser Thr Asp Thr Glu Gln Ala Pro Gly Asn         90 95 100 gac acc ttc tac tca ctg ggt ccc agc cta aag gtc acc ttc cac tcc 389 Asp Thr Phe Tyr Ser Leu Gly Pro Ser Leu Lys Val Thr Phe His Ser     105 110 115 gac tac tcc aat gag aag ccg ttc aca ggg ttt gag gcc ttc tat gca 437 Asp Tyr Ser Asn Glu Lys Pro Phe Thr Gly Phe Glu Ala Phe Tyr Ala 120 125 130 135 gcg gag gat gtg gat gaa tgc aga gtg tct ctg gga gac tca gtc cct 485 Ala Glu Asp Val Asp Glu Cys Arg Val Ser Leu Gly Asp Ser Val Pro                 140 145 150 tgt gac cat tat tgc cac aac tac ttg ggc ggc tac tat tgc tcc tgc 533 Cys Asp His Tyr Cys His Asn Tyr Leu Gly Gly Tyr Tyr Cys Ser Cys             155 160 165 aga gcg ggc tac att ctc cac cag aac aag cac acg tgc tca gcc ctt 581 Arg Ala Gly Tyr Ile Leu His Gln Asn Lys His Thr Cys Ser Ala Leu         170 175 180 tgt tca ggc cag gtg ttc aca gga aga tct ggg tat ctc agt agc cct 629 Cys Ser Gly Gln Val Phe Thr Gly Arg Ser Gly Tyr Leu Ser Ser Pro     185 190 195 gag tac ccg cag cca tac ccc aag ctc tcc agc tgc acc tac agc atc 677 Glu Tyr Pro Gln Pro Tyr Pro Lys Leu Ser Ser Cys Thr Tyr Ser Ile 200 205 210 215 cgc ctg gag gac ggc ttc agt gtc atc ctg gac ttc gtg gag tcc ttc 725 Arg Leu Glu Asp Gly Phe Ser Val Ile Leu Asp Phe Val Glu Ser Phe                 220 225 230 gat gtg gag acg cac cct gaa gcc cag tgc ccc tat gac tcc ctc aag 773 Asp Val Glu Thr His Pro Glu Ala Gln Cys Pro Tyr Asp Ser Leu Lys             235 240 245 ggg gaa cac ggc cca ttt tgt ggg aag acg ctg 821 Ile Gln Thr Asp Lys Gly Glu His Gly Pro Phe Cys Gly Lys Thr Leu         250 255 260 cct ccc agg att gaa act gac agc cac aag gtg acc atc acc ttt gcc 869 Pro Pro Arg Ile Glu Thr Asp Ser His Lys Val Thr Ile Thr Phe Ala     265 270 275 act gac gag tcg ggg aac cac aca ggc tgg aag ata cac tac aca agc 917 Thr Asp Glu Ser Gly Asn His Thr Gly Trp Lys Ile His Tyr Thr Ser 280 285 290 295 aca gca cgg ccc tgc cct gat cca acg gcg cca cct aat ggc agc att 965 Thr Ala Arg Pro Cys Pro Asp Pro Thr Ala Pro Pro Asn Gly Ser Ile                 300 305 310 tca cct gtg caa gcc acg taste gtc ctg aag gac agg ttt tct gtc ttc 1013 Ser Pro Val Gln Ala Thr Tyr Val Leu Lys Asp Arg Phe Ser Val Phe             315 320 325 tgc aag aca ggc ttc gag ctt ctg caa ggt tct gtc ccc ctg aaa tca 1061 Cys Lys Thr Gly Phe Glu Leu Leu Gln Gly Ser Val Pro Leu Lys Ser         330 335 340 ttc act gct gtc tgt cag aaa gat gga tct tgg gac cgg ccg atg cca 1109 Phe Thr Ala Val Cys Gln Lys Asp Gly Ser Trp Asp Arg Pro Met Pro     345 350 355 gag tgc agc att gat tgt ggc cct ccc gat gac cta ccc aat ggc 1157 Glu Cys Ser Ile Asp Cys Gly Pro Pro Asp Asp Leu Pro Asn Gly 360 365 370 375 cat gtg gac tat atc aca ggc cct caa gtg act acc tac aaa gct gtg 1205 His Val Asp Tyr Ile Thr Gly Pro Gln Val Thr Thr Tyr Lys Ala Val                 380 385 390 att cag tac agc tgt gaa gag act ttc tac aca atg agc agc aat ggt 1253 Ile Gln Tyr Ser Cys Glu Glu Thr Phe Tyr Thr Met Ser Ser Asn Gly             395 400 405 aaa tat gtg tgt gag gct gat gga ttc tgg acg agc tcc aaa gga gaa 1301 Lys Tyr Val Cys Glu Ala Asp Gly Phe Trp Thr Ser Ser Lys Gly Glu         410 415 420 aaa ctc ccc cgg gtt tgt gag cct gtt tgt ggg ctg tcc aca cac act 1349 Lys Leu Pro Pro Val Cys Glu Pro Val Cys Gly Leu Ser Thr His Thr     425 430 435 ata gga gga cgc atta gtt gga ggg cag cct gca aag cct ggt gac ttt 1397 Ile Gly Gly Arg Ile Val Gly Gly Gln Pro Ala Lys Pro Gly Asp Phe 440 445 450 455 cct tgg caa gtc ttg ttg ctg ggt caa act aca gca gca gca ggt gca 1445 Pro Trp Gln Val Leu Leu Leu Gly Gln Thr Thr Ala Ala Ala Gly Ala                 460 465 470 ctt ata cat gac aat tgg gtc cta aca gcc gct cat gct gta tat gag 1493 Leu Ile His Asp Asn Trp Val Leu Thr Ala Ala His Ala Val Tyr Glu             475 480 485 aaa aga atg gca gcg tcc tcc ctg aac atc cga atg ggc atc ctc aaa 1541 Lys Arg Met Ala Ala Ser Ser Leu Asn Ile Arg Met Gly Ile Leu Lys         490 495 500 agg ctc tca cct cat tac act caa gcc tgg ccc gag gaa atc ttt ata 1589 Arg Leu Ser Pro His Tyr Thr Gln Ala Trp Pro Glu Glu Ile Phe Ile     505 510 515 cat gaa ggc tac act cac ggt gct ggt ttt gac aat gat ata gca ttg 1637 His Glu Gly Tyr Thr His Gly Ala Gly Phe Asp Asn Asp Ile Ala Leu 520 525 530 535 att aaa ctc aag aac aaa gtc aca atac aac gga agc atc atg cct gtt 1685 Ile Lys Leu Lys Asn Lys Val Thr Ile Asn Gly Ser Ile Met Pro Val                 540 545 550 tgc cta ccg cga aaa gaa gct gca tcc tta atg aga aca gac ttc act 1733 Cys Leu Pro Arg Lys Glu Ala Ala Ser Leu Met Arg Thr Asp Phe Thr             555 560 565 gga act gtg gct ggc tgg ggg tta acc cag aag ggg ctt ctt gct aga 1781 Gly Thr Val Ala Gly Trp Gly Leu Thr Gln Lys Gly Leu Leu Ala Arg         570 575 580 aac cta atg ttt gtg gac ata cca att gct gac cac caa aaa tgt acc 1829 Asn Leu Met Phe Val Asp Ile Pro Ile Ala Asp His Gln Lys Cys Thr     585 590 595 acc gt g tat gaa aag ctc tat cca gga gta aga gta agc gct aac atg 1877 Thr Val Tyr Glu Lys Leu Tyr Pro Gly Val Arg Val Ser Ala Asn Met 600 605 610 615 ctc tgt gct ggc tta gag act ggt ggc aag gac agc tgc aga ggt gac 1925 Leu Cys Ala Gly Leu Glu Thr Gly Gly Lys Asp Ser Cys Arg Gly Asp                 620 625 630 agt ggg ggg gca tta gtg ttt cta gat aat gag aca cag cga tgg ttt 1973 Ser Gly Gly Ala Leu Val Phe Leu Asp Asn Glu Thr Gln Arg Trp Phe             635 640 645 gtg gga gga ata gtt tcc tgg ggt tcc att aat tgt ggg gcg gca ggc 2021 Val Gly Gly Ile Val Ser Trp Gly Ser Ile Asn Cys Gly Ala Ala Gly         650 655 660 cag tat ggg gtc tac aca aaa gtc atc aac tat att ccc tgg aat gag 2069 Gln Tyr Gly Val Tyr Thr Lys Val Ile Asn Tyr Ile Pro Trp Asn Glu     665 670 675 aac ata aga aat ttc taa 2090 Asn Ile Ile Ser Asn Phe 680 685 <210> 51 <211> 685 <212> PRT <213> Murine <400> 51 Met Arg Leu Leu Ile Phe Leu Gly Leu Leu Trp Ser Leu Val Ala Thr 1 5 10 15 Leu Leu Gly Ser Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Val Ser             20 25 30 Pro Gly Phe Pro Glu Lys Tyr Ala Asp His Gln Asp Arg Ser Trp Thr         35 40 45 Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His Phe     50 55 60 Asp Leu Glu Leu Ser Tyr Arg Cys Glu Tyr Asp Phe Val Lys Leu Ser 65 70 75 80 Ser Gly Thr Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr Asp                 85 90 95 Thr Glu Gln Ala Pro Gly Asn Asp Thr Phe Tyr Ser Leu Gly Pro Ser             100 105 110 Leu Lys Val Thr Phe His Ser Asp Tyr Ser Asn Glu Lys Pro Phe Thr         115 120 125 Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Val Asp Glu Cys Arg Val     130 135 140 Ser Leu Gly Asp Ser Val Pro Cys Asp His Tyr Cys His Asn Tyr Leu 145 150 155 160 Gly Gly Tyr Tyr Cys Ser Cys Arg Ala Gly Tyr Ile Leu His Gln Asn                 165 170 175 Lys His Thr Cys Ser Ala Leu Cys Ser Gly Gln Val Phe Thr Gly Arg             180 185 190 Ser Gly Tyr Leu Ser Ser Pro Glu Tyr Pro Gln Pro Tyr Pro Lys Leu         195 200 205 Ser Ser Cys Thr Tyr Ser Ile Arg Leu Glu Asp Gly Phe Ser Val Ile     210 215 220 Leu Asp Phe Val Glu Ser Phe Asp Val Glu Thr His Pro Glu Ala Gln 225 230 235 240 Cys Pro Tyr Asp Ser Leu Lys Ile Gln Thr Asp Lys Gly Glu His Gly                 245 250 255 Pro Phe Cys Gly Lys Thr Leu Pro Pro Arg Ile Glu Thr Asp Ser His             260 265 270 Lys Val Thr Ile Thr Phe Ala Thr Asp Glu Ser Gly Asn His Thr Gly         275 280 285 Trp Lys Ile His Tyr Thr Ser Thr Ala Arg Pro Cys Pro Asp Pro Thr     290 295 300 Ala Pro Pro Asn Gly Ser Ile Ser Pro Val Gln Ala Thr Tyr Val Leu 305 310 315 320 Lys Asp Arg Phe Ser Val Phe Cys Lys Thr Gly Phe Glu Leu Leu Gln                 325 330 335 Gly Ser Val Pro Leu Lys Ser Phe Thr Ala Val Cys Gln Lys Asp Gly             340 345 350 Ser Trp Asp Arg Pro Met Pro Glu Cys Ser Ile Asp Cys Gly Pro         355 360 365 Pro Asp Asp Leu Pro Asn Gly His Val Asp Tyr Ile Thr Gly Pro Gln     370 375 380 Val Thr Thr Tyr Lys Ala Val Ile Gln Tyr Ser Cys Glu Glu Thr Phe 385 390 395 400 Tyr Thr Met Ser Ser Asn Gly Lys Tyr Val Cys Glu Ala Asp Gly Phe                 405 410 415 Trp Thr Ser Ser Lys Gly Glu Lys Leu Pro Pro Val Cys Glu Pro Val             420 425 430 Cys Gly Leu Ser Thr His Thr Ile Gly Gly Arg Ile Val Gly Gly Gln         435 440 445 Pro Ala Lys Pro Gly Asp Phe Pro Trp Gln Val Leu Leu Leu Gly Gln     450 455 460 Thr Thr Ala Ala Gly Ala Leu Ile His Asp Asn Trp Val Leu Thr 465 470 475 480 Ala Ala His Ala Val Tyr Ala Ala Ser Ser Leu Asn                 485 490 495 Ile Arg Met Gly Ile Leu Lys Arg Leu Ser Pro His Tyr Thr Gln Ala             500 505 510 Trp Pro Glu Glu Ile Phe Ile His Glu Gly Tyr Thr His Gly Ala Gly         515 520 525 Phe Asp Asn Asp Ile Ala Leu Ile Lys Leu Lys Asn Lys Val Thr Ile     530 535 540 Asn Gly Ser Ile Met Pro Val Cys Leu Pro Arg Lys Glu Ala Ala Ser 545 550 555 560 Leu Met Arg Thr Asp Phe Thr Gly Thr Val Ala Gly Trp Gly Leu Thr                 565 570 575 Gln Lys Gly Leu Leu Ala Arg Asn Leu Met Phe Val Asp Ile Pro Ile             580 585 590 Ala Asp His Gln Lys Cys Thr Thr Val Tyr Glu Lys Leu Tyr Pro Gly         595 600 605 Val Arg Val Ser Ala Asn Met Leu Cys Ala Gly Leu Glu Thr Gly Gly     610 615 620 Lys Asp Ser Cys Arg Gly Asp Ser Gly Gly Ala Leu Val Phe Leu Asp 625 630 635 640 Asn Glu Thr Gln Arg Trp Phe Val Gly Gly Ile Val Ser Trp Gly Ser                 645 650 655 Ile Asn Cys Gly Ala Ala Gly Gln Tyr Gly Val Tyr Thr Lys Val Ile             660 665 670 Asn Tyr Ile Pro Trp Asn Glu Asn Ile Ile Ser Asn Phe         675 680 685 <210> 52 <211> 670 <212> PRT <213> Murine <400> 52 Thr Leu Leu Gly Ser Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Val 1 5 10 15 Ser Pro Gly Phe Pro Glu Lys Tyr Ala Asp His Gln Asp Arg Ser Trp             20 25 30 Thr Leu Thr Ala Pro Pro Gly Tyr Arg Leu Arg Leu Tyr Phe Thr His         35 40 45 Phe Asp Leu Glu Leu Ser Tyr Arg Cys Glu Tyr Asp Phe Val Lys Leu     50 55 60 Ser Ser Gly Thr Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr 65 70 75 80 Asp Thr Glu Gln Ala Pro Gly Asn Asp Thr Phe Tyr Ser Leu Gly Pro                 85 90 95 Ser Leu Lys Val Thr Phe His Ser Asp Tyr Ser Asn Glu Lys Pro Phe             100 105 110 Thr Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Val Asp Glu Cys Arg         115 120 125 Val Ser Leu Gly Asp Ser Val Pro Cys Asp His Tyr Cys His Asn Tyr     130 135 140 Leu Gly Gly Tyr Tyr Cys Ser Cys Arg Ala Gly Tyr Ile Leu His Gln 145 150 155 160 Asn Lys His Thr Cys Ser Ala Leu Cys Ser Gly Gln Val Phe Thr Gly                 165 170 175 Arg Ser Gly Tyr Leu Ser Ser Pro Glu Tyr Pro Gln Pro Tyr Pro Lys             180 185 190 Leu Ser Ser Cys Thr Tyr Ser Ile Arg Leu Glu Asp Gly Phe Ser Val         195 200 205 Ile Leu Asp Phe Val Glu Ser Phe Asp Val Glu Thr His Pro Glu Ala     210 215 220 Gln Cys Pro Tyr Asp Ser Leu Lys Ile Gln Thr Asp Lys Gly Glu His 225 230 235 240 Gly Pro Phe Cys Gly Lys Thr Leu Pro Pro Arg Ile Glu Thr Asp Ser                 245 250 255 His Lys Val Thr Ile Thr Phe Ala Thr Asp Glu Ser Gly Asn His Thr             260 265 270 Gly Trp Lys Ile His Tyr Thr Ser Thr Ala Arg Pro Cys Pro Asp Pro         275 280 285 Thr Ala Pro Pro Asn Gly Ser Ile Ser Pro Val Gln Ala Thr Tyr Val     290 295 300 Leu Lys Asp Arg Phe Ser Val Phe Cys Lys Thr Gly Phe Glu Leu Leu 305 310 315 320 Gln Gly Ser Val Pro Leu Lys Ser Phe Thr Ala Val Cys Gln Lys Asp                 325 330 335 Gly Ser Trp Asp Arg Pro Met Pro Glu Cys Ser Ile Asp Cys Gly             340 345 350 Pro Pro Asp Leu Pro Asn Gly His Val Asp Tyr Ile Thr Gly Pro         355 360 365 Gln Val Thr Thr Tyr Lys Ala Val Ile Gln Tyr Ser Cys Glu Glu Thr     370 375 380 Phe Tyr Thr Met Ser Ser Asn Gly Lys Tyr Val Cys Glu Ala Asp Gly 385 390 395 400 Phe Trp Thr Ser Ser Lys Gly Glu Lys Leu Pro Pro Val Cys Glu Pro                 405 410 415 Val Cys Gly Leu Ser Thr His Thr Ile Gly Gly Arg Ile Val Gly Gly             420 425 430 Gln Pro Ala Lys Pro Gly Asp Phe Pro Trp Gln Val Leu Leu Leu Gly         435 440 445 Gln Thr Thr Ala Ala Gly Ala Leu Ile His Asp Asn Trp Val Leu     450 455 460 Thr Ala Ala His Ala Val Tyr Glu Lys Arg Ala Ala Ser Ser Leu 465 470 475 480 Asn Ile Arg Met Gly Ile Leu Lys Arg Leu Ser Pro His Tyr Thr Gln                 485 490 495 Ala Trp Pro Glu Glu Ile Phe Ile His Glu Gly Tyr Thr His Gly Ala             500 505 510 Gly Phe Asp Asn Asp Ile Ala Leu Ile Lys Leu Lys Asn Lys Val Thr         515 520 525 Ile Asn Gly Ser Ile Met Pro Val Cys Leu Pro Arg Lys Glu Ala Ala     530 535 540 Ser Leu Met Arg Thr Asp Phe Thr Gly Thr Val Ala Gly Trp Gly Leu 545 550 555 560 Thr Gln Lys Gly Leu Ala Arg Asn Leu Met Phe Val Asp Ile Pro                 565 570 575 Ile Ala Asp His Gln Lys Cys Thr Thr Val Tyr Glu Lys Leu Tyr Pro             580 585 590 Gly Val Val Ser Ala Asn Met Leu Cys Ala Gly Leu Glu Thr Gly         595 600 605 Gly Lys Asp Ser Cys Arg Gly Asp Ser Gly Gly Ala Leu Val Phe Leu     610 615 620 Asp Asn Glu Thr Gln Arg Trp Phe Val Gly Gly Ile Val Ser Trp Gly 625 630 635 640 Ser Ile Asn Cys Gly Ala Ala Gly Gln Tyr Gly Val Tyr Thr Lys Val                 645 650 655 Ile Asn Tyr Ile Pro Trp Asn Glu Asn Ile Ile Ser Asn Phe             660 665 670 <210> 53 <211> 2091 <212> DNA <213> Rat <220> <221> CDS &Lt; 222 > (10). (2067) <400> 53 tggcacaca atg agg ct ctg atc gtc ctg ggt ctg ctt tgg agt ttg gtg 51           Met Arg Leu Leu Ile Val Leu Gly Leu Leu Trp Ser Leu Val           1 5 10 gcc aca ctt ttg ggc tcc aag tgg cct gag cct gta ttc ggg cgc ctg 99 Ala Thr Leu Leu Gly Ser Lys Trp Pro Glu Pro Val Phe Gly Arg Leu 15 20 25 30 gtg tcc ctg gcc ttc cca gag aag tat ggc aac cat cag gat cga tcc 147 Val Ser Leu Ala Phe Pro Glu Lys Tyr Gly Asn His Gln Asp Arg Ser                 35 40 45 tgg acg ctg act gca ccc cct ggc ttc cgc ctg cgc ctc tac ttc acc 195 Trp Thr Leu Thr Ala Pro Pro Gly Phe Arg Leu Arg Leu Tyr Phe Thr             50 55 60 cac ttc aac ctg gaa ctc tct tac cgc tgc gag tat gac ttt gtc aag 243 His Phe Asn Leu Glu Leu Ser Tyr Arg Cys Glu Tyr Asp Phe Val Lys         65 70 75 ttg acc tca ggg acc aag gtg cta gcc acg ctg tgt ggg cag gag agt 291 Leu Thr Ser Gly Thr Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser     80 85 90 aca gat act gag cgg gca cct ggc aat gac acc ttc tac tca ctg ggt 339 Thr Asp Thr Glu Arg Ala Pro Gly Asn Asp Thr Phe Tyr Ser Leu Gly 95 100 105 110 ccc agc cta aag gtc acc ttc cac tcc gac tac tcc aat gag aag cca 387 Pro Ser Leu Lys Val Thr Phe His Ser Asp Tyr Ser Asn Glu Lys Pro                 115 120 125 ttc aca gga ttt gag gcc ttc tat gca gcg gag gat gtg gat gaa tgc 435 Phe Thr Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Val Asp Glu Cys             130 135 140 aga aca tcc ctg gga gac tca gtc cct tgt gac cat tat tgc cac aac 483 Arg Thr Ser Leu Gly Asp Ser Val Pro Cys Asp His Tyr Cys His Asn         145 150 155 tac ctg ggc ggc tac tac tgc tcc tgc cga gtg ggc tac att ctg cac 531 Tyr Leu Gly Gly Tyr Tyr Cys Ser Cys Arg Val Gly Tyr Ile Leu His     160 165 170 cag aac aag cat acc tgc tca gcc ctt tgt tca ggc cag gtg ttc act 579 Gln Asn Lys His Thr Cys Ser Ala Leu Cys Ser Gly Gln Val Phe Thr 175 180 185 190 ggg agg tct ggc ttt ctc agt agc cct gag tac cca cag cca tac ccc 627 Gly Arg Ser Gly Phe Leu Ser Ser Pro Glu Tyr Pro Gln Pro Tyr Pro                 195 200 205 aaa ctc tcc agc tgc gcc tac aac atc cgc ctg gag gaa ggc ttc agt 675 Lys Leu Ser Ser Cys Ala Tyr Asn Ile Arg Leu Glu Glu Gly Phe Ser             210 215 220 atc acc ctg gac ttc gtg gag tcc ttt gat gtg gag atg cac cct gaa 723 Ile Thr Leu Asp Phe Val Glu Ser Phe Asp Val Glu Met His Pro Glu         225 230 235 gcc cag tgc ccc tac gac tcc ctc aag att caa aca gac aag agg gaa 771 Ala Gln Cys Pro Tyr Asp Ser Leu Lys Ile Gln Thr Asp Lys Arg Glu     240 245 250 tac ggc ccg ttt tgt ggg aag acg ctg ccc ccc agg att gaa act gac 819 Tyr Gly Pro Phe Cys Gly Lys Thr Leu Pro Pro Arg Ile Glu Thr Asp 255 260 265 270 agc aac aag gtg acc acc acc ttt acc acc gac gag tca ggg aac cac 867 Ser Asn Lys Val Thr Ile Thr Phe Thr Thr Asp Glu Ser Gly Asn His                 275 280 285 aca ggc tgg aag ata cac tac aca agc aca gca cag ccc tgc cct gat 915 Thr Gly Trp Lys Ile His Tyr Thr Ser Thr Ala Gln Pro Cys Pro Asp             290 295 300 cca acg gcg cca cct aat ggt cac att tca cct gtg caa gcc acg tat 963 Pro Thr Ala Pro Pro Asn Gly His Ile Ser Pro Val Gln Ala Thr Tyr         305 310 315 gtc ctg aag gac agc ttt tct gtc ttc tgc aag act ggc ttc gag ctt 1011 Val Leu Lys Asp Ser Phe Ser Val Phe Cys Lys Thr Gly Phe Glu Leu     320 325 330 ctg caa ggt tct gtc ccc ctg aag tca ttc act gct gtc tgt cag aaa 1059 Leu Gln Gly Ser Val Pro Leu Lys Ser Phe Thr Ala Val Cys Gln Lys 335 340 345 350 gat gga tct tgg gac cgg ccg ata cca gag tgc agc att att gac tgt 1107 Asp Gly Ser Trp Asp Arg Pro Ile Pro Glu Cys Ser Ile Asp Cys                 355 360 365 ggc cct ccc gat cac ccc ccc aat ggc cac gtg gac tat atc aca ggc 1155 Gly Pro Pro Asp Asp Leu Pro Asn Gly His Val Asp Tyr Ile Thr Gly             370 375 380 cct gaa gtg acc acc tac aaa gct gtg att cag tac agc tgt gaa gag 1203 Pro Glu Val Thr Thr Tyr Lys Ala Val Ile Gln Tyr Ser Cys Glu Glu         385 390 395 act ttc tac aca atg agc agc aat ggt aaa tat gtg tgt gag gct gat 1251 Thr Phe Tyr Thr Met Ser Ser Asn Gly Lys Tyr Val Cys Glu Ala Asp     400 405 410 gga ttc tgg acg agc tcc aaa gga gaa aaa tcc ctc ccg gtt tgc aag 1299 Gly Phe Trp Thr Ser Ser Lys Gly Glu Lys Ser Leu Pro Val Cys Lys 415 420 425 430 cct gtc tgt gga ctg tcc aca cac act tca gga ggc cgt ata att gga 1347 Pro Val Cys Gly Leu Ser Thr His Thr Ser Gly Gly Arg Ile Ile Gly                 435 440 445 gga cag cct gca aag cct ggt gac ttt cct tgg caa gtc ttg tta ctg 1395 Gly Gln Pro Ala Lys Pro Gly Asp Phe Pro Trp Gln Val Leu Leu Leu             450 455 460 ggt gaa act aca gca gca ggt gct ctt ata cat gac gac tgg gtc cta 1443 Gly Glu Thr Thr Ala Ala Gly Ala Leu Ile His Asp Asp Trp Val Leu         465 470 475 aca gcg gct cat gct gta tat ggg aaa aca gag gcg atg tcc tcc ctg 1491 Thr Ala His Ala Val Tyr Gly Lys Thr Glu Ala Met Ser Ser Leu     480 485 490 gac atc cgc atg ggc atc ctc aaa agg ctc tcc ctc att tac act caa 1539 Asp Ile Arg Met Gly Ile Leu Lys Arg Leu Ser Leu Ile Tyr Thr Gln 495 500 505 510 gcc tgg cca gag gct gtc ttt atc cat gaa ggc tac act cac gga gct 1587 Ala Trp Pro Glu Ala Val Phe Ile His Glu Gly Tyr Thr His Gly Ala                 515 520 525 ggt ttt gac aat gat ata gca ctg att aaa ctc aag aac aaa gtc aca 1635 Gly Phe Asp Asn Asp Ile Ala Leu Ile Lys Leu Lys Asn Lys Val Thr             530 535 540 atc aac aga aac atc atg ccg att tgt cta cca aga aaa gaa gct gca 1683 Ile Asn Arg Asn Ile Met Pro Ile Cys Leu Pro Arg Lys Glu Ala Ala         545 550 555 tcc tta atg aaa aca gac ttc gtt gga act gtg gct ggc tgg ggg tta 1731 Ser Leu Met Lys Thr Asp Phe Val Gly Thr Val Ala Gly Trp Gly Leu     560 565 570 acc cag aag ggg ttt ctt gct aga aac cta atg ttt gtg gac ata cca 1779 Thr Gln Lys Gly Phe Leu Ala Arg Asn Leu Met Phe Val Asp Ile Pro 575 580 585 590 att gtt gac cac caa aaa tgt gct act gcg tat aca aag cag ccc tac 1827 Ile Val Asp His Gln Lys Cys Ala Thr Ala Tyr Thr Lys Gln Pro Tyr                 595 600 605 cca gga gca aaa gtg act gtt aac atg ctc tgt gct ggc cta gac cgc 1875 Pro Gly Ala Lys Val Thr Val Asn Met Leu Cys Ala Gly Leu Asp Arg             610 615 620 ggt ggc aag gac agc tgc aga ggt gac agc gga ggg gca tta gtg ttt 1923 Gly Gly Lys Asp Ser Cys Arg Gly Asp Ser Gly Gly Ala Leu Val Phe         625 630 635 cta gac aat gaa aca cag aga tgg ttt gtg gga gga ata gtt tcc tgg 1971 Leu Asp Asn Glu Thr Gln Arg Trp Phe Val Gly Gly Ile Val Ser Trp     640 645 650 ggt tct aac tgt ggg ggg tca gaa cag tat ggg gtc tac acg aaa 2019 Gly Ser Ile Asn Cys Gly Gly Ser Glu Gln Tyr Gly Val Tyr Thr Lys 655 660 665 670 gtc acg aac tat ccc tgg att gag aac ata aa aat ttc taa 2067 Val Thr Asn Tyr Ile Pro Trp Ile Glu Asn Ile Ile Asn Asn Phe                 675 680 685 tttgcaaaaa aaaaaaaaaa aaaa 2091 <210> 54 <211> 685 <212> PRT <213> Rat <400> 54 Met Arg Leu Leu Ile Val Leu Gly Leu Leu Trp Ser Leu Val Ala Thr 1 5 10 15 Leu Leu Gly Ser Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Val Ser             20 25 30 Leu Ala Phe Pro Glu Lys Tyr Gly Asn His Gln Asp Arg Ser Trp Thr         35 40 45 Leu Thr Ala Pro Pro Gly Phe Arg Leu Arg Leu Tyr Phe Thr His Phe     50 55 60 Asn Leu Glu Leu Ser Tyr Arg Cys Glu Tyr Asp Phe Val Lys Leu Thr 65 70 75 80 Ser Gly Thr Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr Asp                 85 90 95 Thr Glu Arg Ala Pro Gly Asn Asp Thr Phe Tyr Ser Leu Gly Pro Ser             100 105 110 Leu Lys Val Thr Phe His Ser Asp Tyr Ser Asn Glu Lys Pro Phe Thr         115 120 125 Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Val Asp Glu Cys Arg Thr     130 135 140 Ser Leu Gly Asp Ser Val Pro Cys Asp His Tyr Cys His Asn Tyr Leu 145 150 155 160 Gly Gly Tyr Tyr Cys Ser Cys Arg Val Gly Tyr Ile Leu His Gln Asn                 165 170 175 Lys His Thr Cys Ser Ala Leu Cys Ser Gly Gln Val Phe Thr Gly Arg             180 185 190 Ser Gly Phe Leu Ser Ser Pro Glu Tyr Pro Gln Pro Tyr Pro Lys Leu         195 200 205 Ser Ser Cys Ala Tyr Asn Ile Arg Leu Glu Glu Gly Phe Ser Ile Thr     210 215 220 Leu Asp Phe Val Glu Ser Phe Asp Val Glu Met His Pro Glu Ala Gln 225 230 235 240 Cys Pro Tyr Asp Ser Leu Lys Ile Gln Thr Asp Lys Arg Glu Tyr Gly                 245 250 255 Pro Phe Cys Gly Lys Thr Leu Pro Pro Arg Ile Glu Thr Asp Ser Asn             260 265 270 Lys Val Thr Ile Thr Phe Thr Thr Asp Glu Ser Gly Asn His Thr Gly         275 280 285 Trp Lys Ile His Tyr Thr Ser Thr Ala Gln Pro Cys Pro Asp Pro Thr     290 295 300 Ala Pro Pro Asn Gly His Ile Ser Pro Val Gln Ala Thr Tyr Val Leu 305 310 315 320 Lys Asp Ser Phe Ser Val Phe Cys Lys Thr Gly Phe Glu Leu Leu Gln                 325 330 335 Gly Ser Val Pro Leu Lys Ser Phe Thr Ala Val Cys Gln Lys Asp Gly             340 345 350 Ser Trp Asp Arg Pro Ile Pro Glu Cys Ser Ile Asp Cys Gly Pro         355 360 365 Pro Asp Asp Leu Pro Asn Gly His Val Asp Tyr Ile Thr Gly Pro Glu     370 375 380 Val Thr Thr Tyr Lys Ala Val Ile Gln Tyr Ser Cys Glu Glu Thr Phe 385 390 395 400 Tyr Thr Met Ser Ser Asn Gly Lys Tyr Val Cys Glu Ala Asp Gly Phe                 405 410 415 Trp Thr Ser Ser Lys Gly Glu Lys Ser Leu Pro Val Cys Lys Pro Val             420 425 430 Cys Gly Leu Ser Thr His Thr Ser Gly Gly Arg Ile Ile Gly Gly Gln         435 440 445 Pro Ala Lys Pro Gly Asp Phe Pro Trp Gln Val Leu Leu Leu Gly Glu     450 455 460 Thr Thr Ala Gla Ala Leu Ile His Asp Asp Trp Val Leu Thr Ala 465 470 475 480 Ala His Ala Val Tyr Gly Lys Thr Glu Ala Met Ser Ser Leu Asp Ile                 485 490 495 Arg Met Gly Ile Leu Lys Arg Leu Ser Leu Ile Tyr Thr Gln Ala Trp             500 505 510 Pro Glu Ala Val Phe Ile His Glu Gly Tyr Thr His Gly Ala Gly Phe         515 520 525 Asp Asn Asp Ile Ala Leu Ile Lys Leu Lys Asn Lys Val Thr Ile Asn     530 535 540 Arg Asn Ile Met Pro Ile Cys Leu Pro Arg Lys Glu Ala Ala Ser Leu 545 550 555 560 Met Lys Thr Asp Phe Val Gly Thr Val Ala Gly Trp Gly Leu Thr Gln                 565 570 575 Lys Gly Phe Leu Ala Arg Asn Leu Met Phe Val Asp Ile Pro Ile Val             580 585 590 Asp His Gln Lys Cys Ala Thr Ala Tyr Thr Lys Gln Pro Tyr Pro Gly         595 600 605 Ala Lys Val Thr Val Asn Met Leu Cys Ala Gly Leu Asp Arg Gly Gly     610 615 620 Lys Asp Ser Cys Arg Gly Asp Ser Gly Gly Ala Leu Val Phe Leu Asp 625 630 635 640 Asn Glu Thr Gln Arg Trp Phe Val Gly Gly Ile Val Ser Trp Gly Ser                 645 650 655 Ile Asn Cys Gly Gly Ser Glu Gln Tyr Gly Val Tyr Thr Lys Val Thr             660 665 670 Asn Tyr Ile Pro Trp Ile Glu Asn Ile Ile Asn Asn Phe         675 680 685 <210> 55 <211> 670 <212> PRT <213> Rat <400> 55 Thr Leu Leu Gly Ser Lys Trp Pro Glu Pro Val Phe Gly Arg Leu Val 1 5 10 15 Ser Leu Ala Phe Pro Glu Lys Tyr Gly Asn His Gln Asp Arg Ser Trp             20 25 30 Thr Leu Thr Ala Pro Pro Gly Phe Arg Leu Arg Leu Tyr Phe Thr His         35 40 45 Phe Asn Leu Glu Leu Ser Tyr Arg Cys Glu Tyr Asp Phe Val Lys Leu     50 55 60 Thr Ser Gly Thr Lys Val Leu Ala Thr Leu Cys Gly Gln Glu Ser Thr 65 70 75 80 Asp Thr Glu Arg Ala Pro Gly Asn Asp Thr Phe Tyr Ser Leu Gly Pro                 85 90 95 Ser Leu Lys Val Thr Phe His Ser Asp Tyr Ser Asn Glu Lys Pro Phe             100 105 110 Thr Gly Phe Glu Ala Phe Tyr Ala Ala Glu Asp Val Asp Glu Cys Arg         115 120 125 Thr Ser Leu Gly Asp Ser Val Pro Cys Asp His Tyr Cys His Asn Tyr     130 135 140 Leu Gly Gly Tyr Tyr Cys Ser Cys Arg Val Gly Tyr Ile Leu His Gln 145 150 155 160 Asn Lys His Thr Cys Ser Ala Leu Cys Ser Gly Gln Val Phe Thr Gly                 165 170 175 Arg Ser Gly Phe Leu Ser Ser Pro Glu Tyr Pro Gln Pro Tyr Pro Lys             180 185 190 Leu Ser Ser Cys Ala Tyr Asn Ile Arg Leu Glu Glu Gly Phe Ser Ile         195 200 205 Thr Leu Asp Phe Val Glu Ser Phe Asp Val Glu Met His Pro Glu Ala     210 215 220 Gln Cys Pro Tyr Asp Ser Leu Lys Ile Gln Thr Asp Lys Arg Glu Tyr 225 230 235 240 Gly Pro Phe Cys Gly Lys Thr Leu Pro Pro Arg Ile Glu Thr Asp Ser                 245 250 255 Asn Lys Val Thr Ile Thr Phe Thr Thr Asp Glu Ser Gly Asn His Thr             260 265 270 Gly Trp Lys Ile His Tyr Thr Ser Thr Ala Gln Pro Cys Pro Asp Pro         275 280 285 Thr Ala Pro Pro Asn Gly His Ile Ser Pro Val Gln Ala Thr Tyr Val     290 295 300 Leu Lys Asp Ser Phe Ser Val Phe Cys Lys Thr Gly Phe Glu Leu Leu 305 310 315 320 Gln Gly Ser Val Pro Leu Lys Ser Phe Thr Ala Val Cys Gln Lys Asp                 325 330 335 Gly Ser Trp Asp Arg Pro Ile Pro Glu Cys Ser Ile Asp Cys Gly             340 345 350 Pro Pro Asp Leu Pro Asn Gly His Val Asp Tyr Ile Thr Gly Pro         355 360 365 Glu Val Thr Thr Tyr Lys Ala Val Ile Gln Tyr Ser Cys Glu Glu Thr     370 375 380 Phe Tyr Thr Met Ser Ser Asn Gly Lys Tyr Val Cys Glu Ala Asp Gly 385 390 395 400 Phe Trp Thr Ser Ser Lys Gly Glu Lys Ser Leu Pro Val Cys Lys Pro                 405 410 415 Val Cys Gly Leu Ser Thr His Thr Ser Gly Gly Arg Ile Ile Gly Gly             420 425 430 Gln Pro Ala Lys Pro Gly Asp Phe Pro Trp Gln Val Leu Leu Leu Gly         435 440 445 Glu Thr Thr Ala Gla Ala Leu Ile His Asp Asp Trp Val Leu Thr     450 455 460 Ala Ala His Ala Val Tyr Gly Lys Thr Glu Ala Met Ser Ser Leu Asp 465 470 475 480 Ile Arg Met Gly Ile Leu Lys Arg Leu Ser Leu Ile Tyr Thr Gln Ala                 485 490 495 Trp Pro Glu Ala Val Phe Ile His Glu Gly Tyr Thr His Gly Ala Gly             500 505 510 Phe Asp Asn Asp Ile Ala Leu Ile Lys Leu Lys Asn Lys Val Thr Ile         515 520 525 Asn Arg Asn Ile Met Pro Ile Cys Leu Pro Arg Lys Glu Ala Ala Ser     530 535 540 Leu Met Lys Thr Asp Phe Val Gly Thr Val Ala Gly Trp Gly Leu Thr 545 550 555 560 Gln Lys Gly Phe Leu Ala Arg Asn Leu Met Phe Val Asp Ile Pro Ile                 565 570 575 Val Asp His Gln Lys Cys Ala Thr Ala Tyr Thr Lys Gln Pro Tyr Pro             580 585 590 Gly Ala Lys Val Thr Val Asn Met Leu Cys Ala Gly Leu Asp Arg Gly         595 600 605 Gly Lys Asp Ser Cys Arg Gly Asp Ser Gly Gly Ala Leu Val Phe Leu     610 615 620 Asp Asn Glu Thr Gln Arg Trp Phe Val Gly Gly Ile Val Ser Trp Gly 625 630 635 640 Ser Ile Asn Cys Gly Gly Ser Glu Gln Tyr Gly Val Tyr Thr Lys Val                 645 650 655 Thr Asn Tyr Ile Pro Trp Ile Glu Asn Ile Ile Asn Asn Phe             660 665 670 <210> 56 <211> 28 <212> DNA <213> Artificial Sequence <220> <223> Homo Sapiens <400> 56 atgaggctgc tgaccctcct gggccttc 28 <210> 57 <211> 23 <212> DNA <213> Artificial Sequence <220> <223> Homo Sapiens <400> 57 gtgcccctcc tgcgtcacct ctg 23 <210> 58 <211> 23 <212> DNA <213> Artificial Sequence <220> <223> Homo Sapiens <400> 58 cagaggtgac gcaggagggg cac 23 <210> 59 <211> 27 <212> DNA <213> Artificial Sequence <220> <223> Homo Sapiens <400> 59 ttaaaatcac taattatgtt ctcgatc 27 <210> 60 <211> 22 <212> DNA <213> Artificial Sequence <220> <223> Murine <400> 60 atgaggctac tcatcttcct gg 22 <210> 61 <211> 23 <212> DNA <213> Artificial Sequence <220> <223> Murine <400> 61 ctgcagaggt gacgcagggg ggg 23 <210> 62 <211> 23 <212> DNA <213> Artificial Sequence <220> <223> Murine <400> 62 ccccccctgc gtcacctctg cag 23 <210> 63 <211> 29 <212> DNA <213> Artificial Sequence <220> <223> Murine <400> 63 ttagaaatta cttattatgt tctcaatcc 29 <210> 64 <211> 29 <212> DNA <213> Artificial Sequence <220> <223> Rat <400> 64 gaggtgacgc aggaggggca ttagtgttt 29 <210> 65 <211> 37 <212> DNA <213> Artificial Sequence <220> <223> Rat <400> 65 ctagaaacac taatgcccct cctgcgtcac ctctgca 37 <210> 66 <211> 354 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 66 caggtcacct tgaaggagtc tggtcctgtg ctggtgaaac ccacagagac cctcacgctg 60 acctgcaccg tctctgggtt ctcactcagc aggggtaaaa tgggtgtgag ctggatccgt 120 cagcccccag ggaaggccct ggagtggctt gcacacattt tttcgagtga cgaaaaatcc 180 tacaggacat cgctgaagag caggctcacc atctccaagg acacctccaa aaaccaggtg 240 gtccttacaa tgaccaacat ggaccctgtg gacacagcca cgtattactg tgcacggata 300 cgacgtggag gaattgacta ctggggccag ggaaccctgg tcactgtctc ctca 354 <210> 67 <211> 118 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 67 Gln Val Thr Leu Lys Glu Ser Gly Pro Val Leu Val Lys Pro Thr Glu 1 5 10 15 Thr Leu Thr Leu Thr Cys Thr Val Ser Gly Phe Ser Leu Ser Arg Gly             20 25 30 Lys Met Gly Val Ser Trp Ile Arg Gln Pro Pro Gly Lys Ala Leu Glu         35 40 45 Trp Leu Ala His Ile Phe Ser Ser Asp Glu Lys Ser Tyr Arg Thr Ser     50 55 60 Leu Lys Ser Arg Leu Thr Ile Ser Lys Asp Thr Ser Lys Asn Gln Val 65 70 75 80 Val Leu Thr Met Thr Asn Met Asp Pro Val Asp Thr Ala Thr Tyr Tyr                 85 90 95 Cys Ala Arg Ile Arg Arg Gly Gly Ile Asp Tyr Trp Gly Gln Gly Thr             100 105 110 Leu Val Thr Val Ser Ser         115 <210> 68 <211> 121 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 68 Gln Val Gln Leu Gln Gln Ser Gly Pro Gly Leu Val Lys Pro Ser Gln 1 5 10 15 Thr Leu Ser Leu Thr Cys Ala Ile Ser Gly Asp Ser Ser Ser Ser Thr             20 25 30 Ser Ala Ala Trp Asn Trp Ile Arg Gln Ser Ser Ser Gly Leu Glu         35 40 45 Trp Leu Gly Arg Thr Tyr Tyr Arg Ser Lys Trp Tyr Asn Asp Tyr Ala     50 55 60 Val Ser Val Lys Ser Arg Ile Thr Ile Asn Pro Asp Thr Ser Lys Asn 65 70 75 80 Gln Phe Ser Leu Gln Leu Asn Ser Val Thr Pro Glu Asp Thr Ala Val                 85 90 95 Tyr Tyr Cys Ala Arg Asp Pro Phe Gly Val Pro Phe Asp Ile Trp Gly             100 105 110 Gln Gly Thr Met Val Thr Val Ser Ser         115 120 <210> 69 <211> 106 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 69 Gln Pro Val Leu Thr Gln Pro Pro Ser Leu Ser Val Ser Pro Gly Gln 1 5 10 15 Thr Ala Ser Ile Thr Cys Ser Gly Glu Lys Leu Gly Asp Lys Tyr Ala             20 25 30 Tyr Trp Tyr Gln Gln Lys Pro Gly Gln Ser Pro Val Leu Val Met Tyr         35 40 45 Gln Asp Lys Gln Arg Pro Ser Gly Ile Pro Glu Arg Phe Ser Gly Ser     50 55 60 Asn Ser Gly Asn Thr Ala Thr Leu Thr Ile Ser Gly Thr Gln Ala Met 65 70 75 80 Asp Glu Ala Asp Tyr Tyr Cys Gln Ala Trp Asp Ser Ser Thr Ala Val                 85 90 95 Phe Gly Gly Gly Thr Lys Leu Thr Val Leu             100 105 <210> 70 <211> 324 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 70 tcctatgagc tgatacagcc accctcggtg tcagtggccc caggacagac ggccaccatt 60 acctgtgcgg gagacaacct tgggaagaaa cgtgtgcact ggtaccagca gaggccaggc 120 caggcccctg tgttggtcat ctatgatgat agcgaccggc cctcagggat ccctgaccga 180 ttctctgcct ccaactctgg gaacacggcc accctgacca tcactagggg cgaagccggg 240 gatgaggccg actattattg tcaggtgtgg gacattgcta ctgatcatgt ggtcttcggc 300 ggagggacca agctcaccgt ccta 324 <210> 71 <211> 120 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 71 Ser Tyr Glu Leu Ile Gln Pro Pro Ser Val Val Ser Ala Pro Gly Gln 1 5 10 15 Thr Ala Thr Ile Thr Cys Ala Gly Asp Asn Leu Gly Lys Lys Arg Val             20 25 30 His Trp Tyr Gln Gln Arg Pro Gly Gln Ala Pro Val Leu Val Ile Tyr         35 40 45 Asp Asp Ser Asp Arg Pro Ser Gly Ile Pro Asp Arg Phe Ser Ala Ser     50 55 60 Asn Ser Gly Asn Thr Ala Thr Leu Thr Ile Thr Arg Gly Glu Ala Gly 65 70 75 80 Asp Glu Ala Asp Tyr Tyr Cys Gln Val Trp Asp Ile Ala Thr Asp His                 85 90 95 Val Val Phe Gly Gly Gly Thr Lys Leu Thr Val Leu Ala Ala Ala Gly             100 105 110 Ser Glu Gln Lys Leu Ile Ser Glu         115 120 <210> 72 <211> 36 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 72 Leu Glu Val Thr Cys Glu Pro Gly Thr Thr Phe Lys Asp Lys Cys Asn 1 5 10 15 Thr Cys Arg Cys Gly Ser Asp Gly Lys Ser Ala Val Cys Thr Lys Leu             20 25 30 Trp Cys Asn Gln         35 <210> 73 <211> 33 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 73 Thr Cys Glu Pro Gly Thr Thr Phe Lys Asp Lys Cys Asn Thr Cys Arg 1 5 10 15 Cys Gly Ser Asp Gly Lys Ser Ala Val Cys Thr Lys Leu Trp Cys Asn             20 25 30 Gln      <210> 74 <211> 20 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 74 Thr Cys Arg Cys Gly Ser Asp Gly Lys Ser Ala Val Cys Thr Lys Leu 1 5 10 15 Trp Cys Asn Gln             20 <210> 75 <211> 491 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 75 Leu Glu Val Thr Cys Glu Pro Gly Thr Thr Phe Lys Asp Lys Cys Asn 1 5 10 15 Thr Cys Arg Cys Gly Ser Asp Gly Lys Ser Ala Val Cys Thr Lys Leu             20 25 30 Trp Cys Asn Gln Gly Thr Gly Gly Gly Ser Ser Ser Ser Ser Gln Val         35 40 45 Thr Leu Lys Glu Ser Gly Pro Val Leu Val Lys Pro Thr Glu Thr Leu     50 55 60 Thr Leu Thr Cys Thr Val Ser Gly Phe Ser Leu Ser Arg Gly Lys Met 65 70 75 80 Gly Val Ser Trp Ile Arg Gln Pro Pro Gly Lys Ala Leu Glu Trp Leu                 85 90 95 Ala His Ile Phe Ser Ser Asp Glu Lys Ser Tyr Arg Thr Ser Leu Lys             100 105 110 Ser Arg Leu Thr Ile Ser Lys Asp Thr Ser Lys Asn Gln Val Val Leu         115 120 125 Thr Met Thr Asn Met Asp Pro Val Asp Thr Ala Thr Tyr Tyr Cys Ala     130 135 140 Arg Ile Arg Arg Gly Gly Ile Asp Tyr Trp Gly Gln Gly Thr Leu Val 145 150 155 160 Thr Val Ser Ser Ala Ser Thr Lys Gly Pro Ser Val Phe Pro Leu Ala                 165 170 175 Pro Cys Ser Arg Ser Thr Ser Glu Ser Thr Ala Ala Leu Gly Cys Leu             180 185 190 Val Lys Asp Tyr Phe Pro Glu Pro Val Thr Val Ser Trp Asn Ser Gly         195 200 205 Ala Leu Thr Ser Gly Val His Thr Phe Pro Ala Val Leu Gln Ser Ser     210 215 220 Gly Leu Tyr Ser Leu Ser Ser Val Val Thr Val Ser Ser Ser Leu 225 230 235 240 Gly Thr Lys Thr Tyr Thr Cys Asn Val Asp His Lys Pro Ser Asn Thr                 245 250 255 Lys Val Asp Lys Arg Val Glu Ser Lys Tyr Gly Pro Pro Cys Pro Pro             260 265 270 Cys Pro Ala Pro Glu Phe Leu Gly Gly Pro Ser Val Phe Leu Phe Pro         275 280 285 Pro Lys Pro Lys Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr     290 295 300 Cys Val Val Val Asp Val Ser Gln Glu Asp Pro Glu Val Gln Phe Asn 305 310 315 320 Trp Tyr Val Asp Gly Val Glu Val His Asn Ala Lys Thr Lys Pro Arg                 325 330 335 Glu Glu Gln Phe Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val             340 345 350 Leu His Gln Asp Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val Ser         355 360 365 Asn Lys Gly Leu Pro Ser Ser Ile Glu Lys Thr Ile Ser Lys Ala Lys     370 375 380 Gly Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Gln Glu 385 390 395 400 Glu Met Thr Lys Asn Gln Val Ser Leu Thr Cys Leu Val Lys Gly Phe                 405 410 415 Tyr Pro Ser Asp Ile Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu             420 425 430 Asn Asn Tyr Lys Thr Thr Pro Pro Val Leu Asp Ser Asp Gly Ser Phe         435 440 445 Phe Leu Tyr Ser Arg Leu Thr Val Asp Lys Ser Arg Trp Gln Glu Gly     450 455 460 Asn Val Phe Ser Cys Ser Val Met His Glu Ala Leu His Asn His Tyr 465 470 475 480 Thr Gln Lys Ser Leu Ser Leu Ser Leu Gly Lys                 485 490 <210> 76 <211> 491 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 76 Gln Val Thr Leu Lys Glu Ser Gly Pro Val Leu Val Lys Pro Thr Glu 1 5 10 15 Thr Leu Thr Leu Thr Cys Thr Val Ser Gly Phe Ser Leu Ser Arg Gly             20 25 30 Lys Met Gly Val Ser Trp Ile Arg Gln Pro Pro Gly Lys Ala Leu Glu         35 40 45 Trp Leu Ala His Ile Phe Ser Ser Asp Glu Lys Ser Tyr Arg Thr Ser     50 55 60 Leu Lys Ser Arg Leu Thr Ile Ser Lys Asp Thr Ser Lys Asn Gln Val 65 70 75 80 Val Leu Thr Met Thr Asn Met Asp Pro Val Asp Thr Ala Thr Tyr Tyr                 85 90 95 Cys Ala Arg Ile Arg Arg Gly Gly Ile Asp Tyr Trp Gly Gln Gly Thr             100 105 110 Leu Val Thr Val Ser Ser Ala Ser Thr Lys Gly Ser Ser Val Phe Pro         115 120 125 Leu Ala Pro Cys Ser Arg Ser Thr Ser Glu Ser Thr Ala Ala Leu Gly     130 135 140 Cys Leu Val Lys Asp Tyr Phe Pro Glu Pro Val Thr Val Ser Trp Asn 145 150 155 160 Ser Gly Ala Leu Thr Ser Gly Val His Thr Phe Pro Ala Val Leu Gln                 165 170 175 Ser Ser Gly Leu Tyr Ser Leu Ser Ser Val Val Thr Val Ser Ser             180 185 190 Ser Leu Gly Thr Lys Thr Tyr Thr Cys Asn Val Asp His Lys Pro Ser         195 200 205 Asn Thr Lys Val Asp Lys Arg Val Glu Ser Lys Tyr Gly Pro Pro Cys     210 215 220 Pro Pro Cys Pro Ala Pro Glu Phe Leu Gly Gly Pro Ser Val Phe Leu 225 230 235 240 Phe Pro Pro Lys Pro Lys Asp Thr Leu Met Ile Ser Arg Thr Pro Glu                 245 250 255 Val Thr Cys Val Val Val Asp Val Ser Gln Glu Asp Pro Glu Val Gln             260 265 270 Phe Asn Trp Tyr Val Asp Gly Val Glu Val His Asn Ala Lys Thr Lys         275 280 285 Pro Arg Glu Glu Gln Phe Asn Ser Thr Tyr Arg Val Val Val Ser Leu     290 295 300 Thr Val Leu His Gln Asp Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys 305 310 315 320 Val Ser Asn Lys Gly Leu Pro Ser Ser Ile Glu Lys Thr Ile Ser Lys                 325 330 335 Ala Lys Gly Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser             340 345 350 Gln Glu Glu Met Thr Lys Asn Gln Val Ser Leu Thr Cys Leu Val Lys         355 360 365 Gly Phe Tyr Pro Ser Asp Ile Ala Val Glu Trp Glu Ser Asn Gly Gln     370 375 380 Pro Glu Asn Asn Tyr Lys Thr Thr Pro Pro Val Leu Asp Ser Asp Gly 385 390 395 400 Ser Phe Phe Leu Tyr Ser Arg Leu Thr Val Asp Lys Ser Arg Trp Gln                 405 410 415 Glu Gly Asn Val Phe Ser Cys Ser Val Met His Glu Ala Leu His Asn             420 425 430 His Tyr Thr Gln Lys Ser Leu Ser Leu Ser Leu Gly Lys Ala Ala Gly         435 440 445 Gly Ser Gly Leu Glu Val Thr Cys Glu Pro Gly Thr Thr Phe Lys Asp     450 455 460 Lys Cys Asn Thr Cys Arg Cys Gly Ser Asp Gly Lys Ser Ala Val Cys 465 470 475 480 Thr Lys Leu Trp Cys Asn Gln Gly Ser Gly Ala                 485 490 <210> 77 <211> 258 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 77 Leu Glu Val Thr Cys Glu Pro Gly Thr Thr Phe Lys Asp Lys Cys Asn 1 5 10 15 Thr Cys Arg Cys Gly Ser Asp Gly Lys Ser Ala Val Cys Thr Lys Leu             20 25 30 Trp Cys Asn Gln Gly Thr Gly Gly Gly Ser Ser Ser Ser Ser Gln Pro         35 40 45 Val Leu Thr Gln Pro Pro Ser Leu Ser Val Ser Pro Gly Gln Thr Ala     50 55 60 Ser Ile Thr Cys Ser Gly Glu Lys Leu Gly Asp Lys Tyr Ala Tyr Trp 65 70 75 80 Tyr Gln Gln Lys Pro Gly Gln Ser Pro Val Leu Val Met Tyr Gln Asp                 85 90 95 Lys Gln Arg Pro Ser Gly Ile Pro Glu Arg Phe Ser Gly Ser Asn Ser             100 105 110 Gly Asn Thr Ala Thr Leu Thr Ile Ser Gly Thr Gln Ala Met Asp Glu         115 120 125 Ala Asp Tyr Tyr Cys Gln Ala Trp Asp Ser Ser Thr Ala Val Phe Gly     130 135 140 Gly Gly Thr Lys Leu Thr Val Leu Gly Gln Pro Lys Ala Ala Pro Ser 145 150 155 160 Val Thr Leu Phe Pro Pro Ser Ser Glu Glu Leu Gln Ala Asn Lys Ala                 165 170 175 Thr Leu Val Cys Leu Ile Ser Asp Phe Tyr Pro Gly Ala Val Thr Val             180 185 190 Ala Trp Lys Ala Asp Ser Ser Pro Val Lys Ala Gly Val Glu Thr Thr         195 200 205 Thr Pro Ser Lys Gln Ser Asn Asn Lys Tyr Ala Ala Ser Ser Tyr Leu     210 215 220 Ser Leu Thr Pro Glu Gln Trp Lys Ser His Arg Ser Tyr Ser Cys Gln 225 230 235 240 Val Thr His Glu Gly Ser Thr Val Glu Lys Thr Val Ala Pro Thr Glu                 245 250 255 Cys Ser          <210> 78 <211> 258 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 78 Gln Pro Val Leu Thr Gln Pro Pro Ser Leu Ser Val Ser Pro Gly Gln 1 5 10 15 Thr Ala Ser Ile Thr Cys Ser Gly Glu Lys Leu Gly Asp Lys Tyr Ala             20 25 30 Tyr Trp Tyr Gln Gln Lys Pro Gly Gln Ser Pro Val Leu Val Met Tyr         35 40 45 Gln Asp Lys Gln Arg Pro Ser Gly Ile Pro Glu Arg Phe Ser Gly Ser     50 55 60 Asn Ser Gly Asn Thr Ala Thr Leu Thr Ile Ser Gly Thr Gln Ala Met 65 70 75 80 Asp Glu Ala Asp Tyr Tyr Cys Gln Ala Trp Asp Ser Ser Thr Ala Val                 85 90 95 Phe Gly Gly Gly Thr Lys Leu Thr Val Leu Gly Gln Pro Lys Ala Ala             100 105 110 Pro Ser Val Thr Leu Phe Pro Pro Ser Ser Glu Glu Leu Gln Ala Asn         115 120 125 Lys Ala Thr Leu Val Cys Leu Ile Ser Asp Phe Tyr Pro Gly Ala Val     130 135 140 Thr Val Ala Trp Lys Ala Asp Ser Ser Pro Val Lys Ala Gly Val Glu 145 150 155 160 Thr Thr Ser Ser Gln Ser Asn Asn Lys Tyr Ala Ser Ser Ser                 165 170 175 Tyr Leu Ser Leu Thr Pro Glu Gln Trp Lys Ser His Arg Arg Ser Tyr Ser             180 185 190 Cys Gln Val Thr His Glu Gly Ser Thr Val Glu Lys Thr Val Ala Pro         195 200 205 Thr Glu Cys Ser Ala Gly Gly Ser Gly Leu Glu Val Thr Cys Glu     210 215 220 Pro Gly Thr Thr Phe Lys Asp Lys Cys Asn Thr Cys Arg Cys Gly Ser 225 230 235 240 Asp Gly Lys Ser Ala Val Cys Thr Lys Leu Trp Cys Asn Gln Gly Ser                 245 250 255 Gly Ala          <210> 79 <211> 10 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 79 Gly Thr Gly Gly Ser Ser Ser Ser Ser 1 5 10 <210> 80 <211> 6 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 80 Ala Ala Gly Gly Ser Gly 1 5 <210> 81 <211> 4 <212> PRT <213> Artificial Sequence <220> <223> Synthetic <400> 81 Gly Ser Gly Ala One <210> 82 <211> 1533 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 82 atgatgtcct ttgtctctct gctcctggtt ggcatcctat tccatgccac ccaggccttg 60 gaagtgacgt gtgagcccgg aacgacattc aaagacaagt gcaatacttg tcggtgcggt 120 tcagatggga aatcggcggt ctgcacaaag ctctggtgta accagggcac cggtggaggg 180 tcgggatcca gctcacaggt caccttgaag gagtctggtc ctgtgctggt gaaacccaca 240 gagaccctca cgctgacctg caccgtctct gggttctcac tcagcagggg taaaatgggt 300 gtgagctgga tccgtcagcc cccagggaag gccctggagt ggcttgcaca cattttttcg 360 agtgacgaaa aatcctacag gacatcgctg aagagcaggc tcaccatctc caaggacacc 420 tccaaaaacc aggtggtcct tacaatgacc aacatggacc ctgtggacac agccacgtat 480 tactgtgcac ggatacgacg tggaggaatt gactactggg gccagggaac cctggtcact 540 gtctcctcag cctccaccaa gggcccatcc gtcttccccc tggcgccctg ctccaggagc 600 acctccgaga gcacagccgc cctgggctgc ctggtcaagg actacttccc cgaaccggtg 660 acggtgtcgt ggaactcagg cgccctgacc agcggcgtgc acaccttccc ggctgtccta 720 cagtcctcag gactctactc cctcagcagc gtggtgaccg tgccctccag cagcttgggc 780 acgaagacct acacctgcaa cgtagatcac aagcccagca acaccaaggt ggacaagaga 840 gttgagtcca aatatggtcc cccatgccca ccatgcccag cacctgagtt cctgggggga 900 ccatcagtct tcctgttccc cccaaaaccc aaggacactc tcatgatctc ccggacccct 960 gaggtcacgt gcgtggtggt ggacgtgagc caggaagacc ccgaggtcca gttcaactgg 1020 tacgtggatg gcgtggaggt gcataatgcc aagacaaagc cgcgggagga gcagttcaac 1080 agcacgtacc gtgtggtcag cgtcctcacc gtcctgcacc aggactggct gaacggcaag 1140 gagtacaagt gcaaggtctc caacaaaggc ctcccgtcct ccatcgagaa aaccatctcc 1200 aaagccaaag ggcagccccg agagccacag gtgtacaccc tgcccccatc ccaggaggag 1260 atgaccaaga accaggtcag cctgacctgc ctggtcaaag gcttctaccc cagcgacatc 1320 gccgtggagt gggagagcaa tgggcagccg gagaacaact acaagaccac gcctcccgtg 1380 ctggactccg acggctcctt cttcctctac agcaggctaa ccgtggacaa gagcaggtgg 1440 caggagggga atgtcttctc atgctccgtg atgcatgagg ctctgcacaa ccactacaca 1500 cagaagagcc tctccctgtc tctcgggaaa tga 1533 <210> 83 <211> 1533 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 83 atgatgtcct ttgtctctct gctcctggtt ggcatcctat tccatgccac ccaggcccag 60 gtcaccttga aggagtctgg tcctgtgctg gtgaaaccca cagagaccct cacgctgacc 120 tgcaccgtct ctgggttctc actcagcagg ggtaaaatgg gtgtgagctg gatccgtcag 180 cccccaggga aggccctgga gtggcttgca cacatttttt cgagtgacga aaaatcctac 240 aggacatcgc tgaagagcag gctcaccatc tccaaggaca cctccaaaaa ccaggtggtc 300 cttacaatga ccaacatgga ccctgtggac acagccacgt attactgtgc acggatacga 360 cgtggaggaa ttgactactg gggccaggga accctggtca ctgtctcctc agcctccacc 420 aagggcccat ccgtcttccc cctggcgccc tgctccagga gcacctccga gagcacagcc 480 gccctgggct gcctggtcaa ggactacttc cccgaaccgg tgacggtgtc gtggaactca 540 ggcgccctga ccagcggcgt gcacaccttc ccggctgtcc tacagtcctc aggactctac 600 tccctcagca gcgtggtgac cgtgccctcc agcagcttgg gcacgaagac ctacacctgc 660 aacgtagatc acaagcccag caacaccaag gtggacaaga gagttgagtc caaatatggt 720 cccccatgcc caccatgccc agcacctgag ttcctggggg gaccatcagt cttcctgttc 780 cccccaaaac ccaaggacac tctcatgatc tcccggaccc ctgaggtcac gtgcgtggtg 840 gtggacgtga gccaggaaga ccccgaggtc cagttcaact ggtacgtgga tggcgtggag 900 gtgcataatg ccaagacaaa gccgcgggag gagcagttca acagcacgta ccgtgtggtc 960 agcgtcctca ccgtcctgca ccaggactgg ctgaacggca aggagtacaa gtgcaaggtc 1020 tccaacaaag gcctcccgtc ctccatcgag aaaaccatct ccaaagccaa agggcagccc 1080 cgagagccac aggtgtacac cctgccccca tcccaggagg agatgaccaa gaaccaggtc 1140 agcctgacct gcctggtcaa aggcttctac cccagcgaca tcgccgtgga gtgggagagc 1200 aatgggcagc cggagaacaa ctacaagacc acgcctcccg tgctggactc cgacggctcc 1260 ttcttcctct acagcaggct aaccgtggac aagagcaggt ggcaggaggg gaatgtcttc 1320 tcatgctccg tgatgcatga ggctctgcac aaccactaca cacagaagag cctctccctg 1380 tctctcggga aagccgctgg tggtagtggt ttggaagtga cgtgtgagcc cggaacgaca 1440 ttcaaagaca agtgcaatac ttgtcggtgc ggttcagatg ggaaatcggc ggtctgcaca 1500 aagctctggt gtaaccaggg tagtggtgct tga 1533 <210> 84 <211> 834 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 84 atgatgtcct ttgtctctct gctcctggtt ggcatcctat tccatgccac ccaggccttg 60 gaagtgacgt gtgagcccgg aacgacattc aaagacaagt gcaatacttg tcggtgcggt 120 tcagatggga aatcggcggt ctgcacaaag ctctggtgta accagggcac cggtggaggg 180 tcgggatcca gctcacagcc agtgctgact cagcccccct cactgtccgt gtccccagga 240 cagacagcca gcatcacctg ctctggagag aaattggggg ataaatatgc ttactggtat 300 cagcagaagc caggccagtc ccctgtgttg gtcatgtatc aagataaaca gcggccctca 360 gggatccctg agcgattctc tggctccaac tctgggaaca cagccactct gaccatcagc 420 gggacccagg ctatggatga ggctgactat tactgtcagg cgtgggacag cagcactgcg 480 gtattcggcg gagggaccaa gctgaccgtc ctaggccagc ctaaggcggc gccctcggtc 540 accctgttcc cgccctcctc tgaggagctt caagccaaca aggccacact ggtgtgtctc 600 ataagtgact tctacccggg agccgtgaca gtggcctgga aggcagatag cagccccgtc 660 aaggcgggag tggagaccac cacaccctcc aaacaaagca acaacaagta cgcggccagc 720 agctatctga gcctgacgcc tgagcagtgg aagtcccaca gaagctacag ctgccaggtc 780 acgcatgaag ggagcaccgt ggagaagaca gtggccccta cagaatgttc atag 834 <210> 85 <211> 834 <212> DNA <213> Artificial Sequence <220> <223> Synthetic <400> 85 atgatgtcct ttgtctctct gctcctggtt ggcatcctat tccatgccac ccaggcccag 60 ccagtgctga ctcagccccc ctcactgtcc gtgtccccag gacagacagc cagcatcacc 120 tgctctggag agaaattggg ggataaatat gcttactggt atcagcagaa gccaggccag 180 tcccctgtgt tggtcatgta tcaagataaa cagcggccct cagggatccc tgagcgattc 240 tctggctcca actctgggaa cacagccact ctgaccatca gcgggaccca ggctatggat 300 gaggctgact attactgtca ggcgtgggac agcagcactg cggtattcgg cggagggacc 360 aagctgaccg tcctaggcca gcctaaggcg gcgccctcgg tcaccctgtt cccgccctcc 420 tctgaggagc ttcaagccaa caaggccaca ctggtgtgtc tcataagtga cttctacccg 480 ggagccgtga cagtggcctg gaaggcagat agcagccccg tcaaggcggg agtggagacc 540 accacaccct ccaaacaaag caacaacaag tacgcggcca gcagctatct gagcctgacg 600 cctgagcagt ggaagtccca cagaagctac agctgccagg tcacgcatga agggagcacc 660 gtggagaaga cagtggcccc tacagaatgt tcagccgctg gtggtagtgg tttggaagtg 720 acgtgtgagc ccggaacgac attcaaagac aagtgcaata cttgtcggtg cggttcagat 780 gggaaatcgg cggtctgcac aaagctctgg tgtaaccagg gtagtggtgc ttag 834

Claims (31)

CLAIMS 1. A method of reducing proteinuria in a human subject afflicted with IgAN comprising administering to a human subject a heavy chain variable region comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: 67 and an amino acid sequence represented by SEQ ID NO: 70 The MASP-2 inhibitory antibody, or antigen-binding fragment thereof, comprising a light chain variable region comprising CDR-L1, CDR-L2 and CDR-L3 of the sequence,
a. Administering the antibody at about 4 mg / kg (i.e., 3.6 mg / kg to 4.4 mg / kg) intravenously once a week for at least 12 weeks of treatment period to a subject suffering from IgAN; or
b. Administering the antibody of about 180 mg to about 725 mg (i.e., 162 mg to 797 mg) to a subject suffering from IgAN intravenously once weekly for at least 12 weeks of treatment period
, &Lt; / RTI &gt;
Wherein the method reduces proteinuria in the human subject. The method according to claim 1, wherein the treatment period is 12 weeks. 3. A method according to claim 1 or 2, followed by a rest period of at least 2 months (i.e. no administration of a MASP-2 inhibitor) after the treatment period. 3. A method according to claim 1 or 2, followed by a treatment period followed by a rest period of at least 3 months (i.e. no administration of a MASP-2 inhibitor). 3. A method according to claim 1 or 2, followed by a treatment period followed by a rest period of at least 4 months (i.e. no administration of a MASP-2 inhibitor). 3. A method according to claim 1 or 2, followed by a treatment period followed by a rest period of at least 5 months (i.e. no administration of a MASP-2 inhibitor). 3. A method according to claim 1 or 2, followed by a treatment period followed by a rest period of at least 6 months (i.e. no administration of a MASP-2 inhibitor). 8. A method according to any one of claims 1 to 7, wherein the proteinuria in the subject is reduced by at least 20% (i. E., A decrease and / or decrease in uACR) from baseline (before treatment) Or 24-hour urine protein concentration). 8. A method according to any one of claims 1 to 7, wherein the proteinuria in the subject is reduced by at least 30% (i. E., A decrease and / or decrease in uACR) from baseline (before treatment) at the end of the treatment period and / Or 24-hour urine protein concentration). 8. A method according to any one of claims 1 to 7, wherein the proteinuria in the subject is reduced by at least 40% (i. E., A decrease and / or decrease in uACR) from baseline (before treatment) at the end of the treatment period and / Or 24-hour urine protein concentration). 8. The method according to any one of claims 1 to 7, wherein the proteinuria in the subject is reduced by at least 50% (i. E., A decrease in uACR and / or a decrease in &lt; Or 24-hour urine protein concentration). 8. The method according to any one of claims 1 to 7, wherein the proteinuria in the subject is reduced by at least 50% from baseline (before treatment) at the end of the treatment period and / or at the end of the rest period (i. 0.0 &gt; and / or &lt; / RTI &gt; 24-hour urinary protein concentration). 8. The method of any one of claims 1 to 7, wherein the method further comprises periodically monitoring urinary protein levels in a subject during and / or during the treatment period. 8. A method according to any one of claims 1 to 7, wherein the estimated glomerular filtration rate (eGFR) is increased in the subject. 8. A method according to any one of claims 1 to 7, wherein the subject is exposed to a corticosteroid that has been discontinued or substantially effective at the end of the treatment period and / or at the end of the rest period as compared to the corticosteroid taken prior to beginning treatment with the MASP- RTI ID = 0.0 &gt; corticosteroid &lt; / RTI &gt; dosage. 2. The method of claim 1, wherein the MASP-2 inhibitory antibody or fragment thereof is selected from the group consisting of a recombinant antibody, an effector-reduced antibody, a chimeric antibody, a humanized antibody, and a human antibody. The method of claim 1, wherein the MASP-2 inhibitory antibody, or fragment thereof,
(a) i) a heavy chain CDR-H1 comprising the amino acid sequence of 31 to 35 of SEQ ID NO: 67; ii) heavy chain CDR-H2 comprising the amino acid sequence from 50 to 65 of SEQ ID NO: 67; And iii) a heavy chain variable region comprising a heavy chain CDR-H3 comprising an amino acid sequence from 95 to 107 of SEQ ID NO: 67; And
(b) i) a light chain CDR-L1 comprising the amino acid sequence from 24 to 34 of SEQ ID NO: 70; ii) light chain CDR-L2 comprising the amino acid sequence from 50 to 56 of SEQ ID NO: 70; And iii) a light chain variable region comprising a light chain CDR-L3 comprising the amino acid sequence of 89-97 of SEQ ID NO: 70.
&Lt; / RTI &gt; 7. The antibody of claim 1, wherein the MASP-2 inhibitory antibody or fragment thereof comprises a heavy chain variable region comprising an amino acid sequence having at least 95% identity to the amino acid sequence shown as SEQ ID NO: 67 and a heavy chain variable region comprising SEQ ID NO: A light chain variable region comprising an amino acid sequence having at least 95% identity to an amino acid sequence. The method of claim 1, wherein the MASP-2 inhibitory antibody or fragment thereof is characterized in that it comprises a heavy chain variable region comprising the amino acid sequence shown as SEQ ID NO: 67 and a light chain variable region designated SEQ ID NO: 70 How to. The method of claim 1, wherein the subject suffering from IgAN has proteinuria of at least 1 gram protein / 24 hour urinary protein excretion prior to treatment and the method is effective at reducing proteinuria of the subject by at least 30% . A method of treating a human subject suffering from lupus nephritis (LN) comprising administering to a subject a composition comprising an amount of a MASP-2 inhibitory antibody, or antigen-binding fragment thereof, effective to inhibit MASP-2-dependent complement activation &Lt; / RTI &gt; 22. The method of claim 21, wherein the subject is suffering from a steroid-dependent LN. 23. The method of claim 21 or 22, wherein the MASP-2 inhibitory antibody is a monoclonal antibody that specifically binds to human MASP-2, or a fragment thereof. 22. The method of claim 21, wherein the antibody or fragment thereof is selected from the group consisting of a recombinant antibody, an antibody with reduced effector function, a chimeric antibody, a humanized antibody, and a human antibody. 22. The method of claim 21, wherein the MASP-2 inhibitory antibody does not substantially inhibit the classical pathway. 22. The method of claim 21, MASP-2 inhibitory antibodies are characterized in that for suppressing the C3b deposition in 90% human serum with IC ₅₀ of less than 30 nM. 22. The method of claim 21, wherein the method comprises administering to a subject a human subject having a steroid-dependent LN prior to administering a composition comprising an amount of a MASP-2 inhibiting antibody, or an antigen- binding fragment thereof, effective to improve renal function &Lt; / RTI &gt; 22. The method of claim 21, wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof is administered in an amount effective to improve renal function. 22. The method of claim 21, wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof is effective to achieve at least a 20% reduction in 24-hour urinary protein excretion compared to baseline 24- &Lt; / RTI &gt; 22. The method of claim 21, wherein the composition is administered in an amount sufficient to improve renal function and decrease corticosteroid dosage in the subject. 22. The method of claim 21, wherein the MASP-2 inhibitory antibody or antigen-binding fragment thereof comprises a heavy chain variable region comprising CDR-H1, CDR-H2 and CDR-H3 of the amino acid sequence shown as SEQ ID NO: : &Lt; / RTI &gt; a light chain variable region comprising CDR-L1, CDR-L2 and CDR-L3 of the amino acid sequence shown as SEQ ID NO: 70.

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