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WO2021139687A1 - 抗cd47抗体和抗cd20抗体的组合在制备用于预防或治疗肿瘤的药物中的应用 - Google Patents

抗cd47抗体和抗cd20抗体的组合在制备用于预防或治疗肿瘤的药物中的应用 Download PDF

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Publication number
WO2021139687A1
WO2021139687A1 PCT/CN2021/070493 CN2021070493W WO2021139687A1 WO 2021139687 A1 WO2021139687 A1 WO 2021139687A1 CN 2021070493 W CN2021070493 W CN 2021070493W WO 2021139687 A1 WO2021139687 A1 WO 2021139687A1
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Prior art keywords
antibody
amino acid
seq
acid sequence
sequence shown
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PCT/CN2021/070493
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English (en)
French (fr)
Inventor
陈炳良
吴敏
伍伟伟
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信达生物制药(苏州)有限公司
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Priority to EP21738450.2A priority Critical patent/EP4089114A1/en
Priority to CA3163939A priority patent/CA3163939A1/en
Priority to CN202180008421.7A priority patent/CN114929749A/zh
Priority to JP2022542078A priority patent/JP2023509083A/ja
Priority to AU2021205144A priority patent/AU2021205144A1/en
Publication of WO2021139687A1 publication Critical patent/WO2021139687A1/zh

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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
    • C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
    • C07K16/28—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
    • C07K16/2803—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against the immunoglobulin superfamily
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
    • C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
    • C07K16/28—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
    • C07K16/2887—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against CD20
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
    • A61K2039/507—Comprising a combination of two or more separate antibodies

Definitions

  • the present invention belongs to the field of biotechnology, and relates to an anti-tumor drug combination and its application, in particular to a combination comprising an anti-CD47 antibody or an antigen-binding fragment thereof and an anti-CD20 antibody in preparation for preventing and/or treating tumors and/or Application of cancer drugs.
  • Rituximab is a monoclonal antibody that targets human CD20 molecules. It can eliminate CD20-positive tumor cells through ADCC, CDC, etc., and is currently used as a first-line treatment for non-Hodgkin’s lymphoma. Although rituximab is effective as a treatment for non-Hodgkin’s lymphoma, existing data indicate that FcR polymorphism and loss of CD20 target in patients lead to resistance to rituximab and show Relapse and refractory.
  • CD47 Cluster of Differentiation 47
  • IAP integrin-associated protein
  • the purpose of the present invention is to provide a better application of the combination of anti-CD47 antibody and anti-CD20 antibody in the preparation of drugs for preventing and/or treating tumors and/or cancers than in the prior art.
  • the present invention provides an application of an anti-CD47 antibody or a combination of an antigen-binding fragment thereof and an anti-CD20 antibody in the preparation of a medicament for the prevention and/or treatment of tumors and/or cancers, wherein the anti-CD47 antibody is Fully human anti-CD47 monoclonal antibody;
  • the fully human anti-CD47 monoclonal antibody includes a heavy chain variable region VH and a light chain variable region VL, wherein the VH includes complementarity determining regions HCDR1, HCDR2, and HCDR3, and HCDR1 is as SEQ ID NO: 3 or SEQ ID NO :
  • the amino acid sequence shown in 11 HCDR2 is the amino acid sequence shown in SEQ ID NO: 4
  • HCDR3 is the amino acid sequence shown in SEQ ID NO: 5 or SEQ ID NO: 12
  • the VL includes complementarity determining regions LCDR1, LCDR2 And LCDR3, where LCDR1 is the amino acid sequence shown in SEQ ID NO: 6, LCDR2 is the amino acid sequence shown in SEQ ID NO: 7, and LCDR3 is the amino acid sequence shown in SEQ ID NO: 8.
  • the heavy chain variable region VH of the fully human anti-CD47 monoclonal antibody comprises the amino acid sequence shown in SEQ ID NO: 9 or has at least 90%, 95%, or 98% of the amino acid sequence shown in SEQ ID NO: 9 Or a sequence with 99% identity
  • the light chain variable region comprises the sequence shown in SEQ ID NO: 10 or a sequence with at least 90%, 95%, 98% or 99% identity therewith;
  • amino acid sequence of the heavy chain variable region VH is shown in SEQ ID NO: 9
  • amino acid sequence of the light chain variable region VL is shown in SEQ ID NO: 10.
  • the fully human anti-CD47 monoclonal antibody comprises a heavy chain and a light chain
  • the heavy chain comprises the amino acid sequence shown in SEQ ID NO: 1 or in combination therewith.
  • the light chain includes the amino acid sequence shown in SEQ ID NO: 2 or has at least 90%, 95%, 98%, or 99% therewith.
  • the heavy chain has an amino acid sequence as shown in SEQ ID NO: 1
  • the light chain has an amino acid sequence as shown in SEQ ID NO: 2.
  • the fully human anti-CD47 monoclonal antibody is the anti-CD47 monoclonal antibody disclosed in Patent Publication No. WO2019042285A1.
  • the entire content of the PCT application is hereby incorporated herein by reference.
  • the anti-CD47 antibody is preferably the anti-CD47 antibody ADI-26630 disclosed in WO2019042285A1.
  • the sequence of the anti-CD47 antibody used herein is renumbered.
  • the anti-CD20 antibody is an anti-CD20 monoclonal antibody, such as obinutuzumab, ibritumomab tiuxetan, or Ofatumumab, tositumomab, ocrelizumab, or rituximab.
  • the anti-CD20 monoclonal antibody is rituximab.
  • the present invention also provides a single drug dosage unit, which contains an effective amount of any one of the above-mentioned anti-CD47 antibodies or antigen-binding fragments thereof and anti-CD20 antibodies.
  • the present invention also provides a pharmaceutical composition, which comprises an effective amount of the anti-CD47 antibody or an antigen-binding fragment thereof and the combination of the anti-CD20 antibody described above and a pharmaceutically acceptable carrier.
  • the present invention also provides a kit of medicines comprising the above-mentioned pharmaceutical composition
  • the kit is in the form of a single drug dosage unit.
  • -A second container containing a pharmaceutical composition for parenteral administration the pharmaceutical composition comprising any of the anti-CD20 antibodies described above.
  • the present invention also provides the use of any one of the above-mentioned drug combinations, single drug dosage units or complete kits in the preparation of drugs for the prevention and/or treatment of tumors and/or cancers.
  • And/or cancer is preferably hematoma, more preferably lymphoma, and still more preferably CD20-positive non-Hodgkin's lymphoma.
  • the present invention also provides the use of any one of the above-mentioned compositions in the preparation of a medicament for the prevention and/or treatment of tumors and/or cancers.
  • the tumors and/or cancers are preferably hematomas, more preferably Lymphoma is more preferably CD20-positive non-Hodgkin's lymphoma.
  • the present invention also provides the use of anti-CD47 antibodies in the preparation of products that enhance the efficacy of anti-CD20 antibodies in the prevention and/or treatment of tumors and/or cancers.
  • the tumors and/or cancers are preferably hematomas, more preferably lymphomas , CD20-positive non-Hodgkin's lymphoma is more preferred.
  • the present invention also provides a method for preventing and/or treating tumors and/or cancers, comprising combining an effective amount of any of the anti-CD47 antibodies or antigen-binding fragments thereof and anti-CD20 antibodies, The step of administering any one of the above-mentioned single drug dosage units, any one of the above-mentioned pharmaceutical compositions, or any one of the above-mentioned kits of kits to an individual.
  • the anti-CD47 antibody involved in the present invention is a brand-new fully human anti-CD47 monoclonal antibody. Whether it is used alone or in combination with the anti-CD20 monoclonal antibody rituximab, it has a better performance than forty-seven's Hu5F9 antibody. Excellent anti-tumor efficacy, especially, the anti-tumor efficacy of the fully human anti-CD47 monoclonal antibody combined with rituximab is significantly better than that of the combination of Hu5F9 antibody and rituximab Medicinal effect.
  • the present invention can help increase macrophage-mediated phagocytosis by combining the anti-CD47 antibody of the present invention, which can further increase the efficacy of rituximab.
  • the combination of exhibits better anti-tumor efficacy, and has a good application prospect in effectively solving the problem of resistance to rituximab in patients caused by FcR polymorphism and loss of CD20 target in patients.
  • antibody refers to a polypeptide comprising at least a light chain or heavy chain immunoglobulin variable region, which specifically recognizes and binds to an antigen.
  • the term encompasses various antibody structures, including but not limited to monoclonal antibodies, polyclonal antibodies, single-chain antibodies or multi-chain antibodies, monospecific or multispecific antibodies (such as bispecific antibodies), fully human antibodies, or chimeric antibodies. Combine antibodies or humanized antibodies, full-length antibodies, and antibody fragments, as long as they exhibit the desired antigen-binding activity.
  • antigen-binding fragment of an antibody (which can be used interchangeably with “antibody fragment” and “antigen-binding portion” herein) refers to a molecule that is not an intact antibody, which includes the intact antibody used to bind the intact antibody. Part of the antigen. As understood by those skilled in the art, the antigen-binding portion of an antibody usually contains amino acid residues from the "complementarity determining region" or "CDR".
  • the antigen-binding fragment can be prepared by recombinant DNA technology, or by enzymatic or chemical cleavage of the intact antibody.
  • Antigen-binding fragments include but are not limited to Fab, scFab, Fab', F(ab')2, Fab'-SH, Fv, single-chain Fv, double-chain antibody (diabody), triabody (triabody), four-chain antibody ( tetrabody), minibody (minibody), single domain antibody (sdAb).
  • Fab fragment antigen-binding fragments
  • prevention includes the suppression or delay of the occurrence or frequency of the occurrence or occurrence of a disease or disorder or its symptoms, and it generally refers to the administration of drugs before the occurrence or occurrence of the symptoms or symptoms, especially before the occurrence of the symptoms or symptoms in individuals at risk.
  • treatment refers to the slowing, prevention or reversal of the progression of a subject's cancer as evidenced by the reduction or elimination of the clinical or diagnostic symptoms of the disease. Treatment may include, for example, reducing the severity of symptoms, the number of symptoms, or the frequency of recurrence, for example, tumor growth inhibition, tumor growth arrest, or regression of existing tumors.
  • single drug dosage unit refers to a single drug dosage form administered to a patient at the time of the dosing schedule, including injections, tablets, and freeze-dried powders.
  • drug combination refers to a non-fixed combination product or a fixed combination product, such as a kit.
  • non-fixed combination means that the active ingredients (e.g., (i) anti-CD47 antibody or antigen-binding fragment thereof, and (ii) anti-CD20 antibody are separated entities at the same time, without specific time limit, or at the same or different time.
  • the two agents are administered to the patient at intervals and sequentially, wherein such administration provides a preventive or therapeutically effective level of the two active agents in the patient.
  • the anti-CD47 antibody molecule and the anti-CD20 antibody used in the drug combination are both The molecules are administered at a level not exceeding the level when they are used alone.
  • the term "fixed combination" means that the two active agents are administered to the patient simultaneously in the form of a single entity.
  • the dosage and/or time interval of the two active agents are preferably selected , So that the combined use of each part can produce an effect greater than that achieved by using any one component alone in the treatment of diseases or conditions.
  • Each component can be in a separate preparation form, and the preparation form can be the same or different.
  • administration refers to the physical introduction of each active ingredient of the pharmaceutical combination of the present invention into an individual using any of a variety of methods and delivery systems known to those skilled in the art.
  • the route of administration of each active ingredient in the pharmaceutical combination of the present invention includes oral, intravenous (e.g., infusion (also known as drip) or injection), intramuscular, subcutaneous, intraperitoneal, spinal, local or other parenteral routes of administration .
  • parenteral administration refers to methods of administration other than gastrointestinal and topical administration, usually via intravenous, and without limitation includes intramuscular, intraarterial, intrathecal, intralymphatic, intralesional, intrasaccular , Intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcutaneous, intra-articular, subcapsular, subarachnoid, intraspine, epidural and intrasternal injection and infusion, as well as in vivo electroporation.
  • each active ingredient in the pharmaceutical combination of the present invention can be formulated into capsules, tablets, injections (including infusions or injections), syrups, sprays, lozenges, liposomes or suppositories, etc.
  • dose is the amount of a drug that induces a therapeutic effect. Unless otherwise stated, the dosage is related to the amount of the free form of the drug. If the drug is in the form of a pharmaceutically acceptable salt, the amount of the drug is increased in proportion to the amount of the drug in the free form. For example, the dosage will be stated on the product packaging or product information sheet.
  • the drug combination of the present invention can be administered to individuals who have been treated with one or more previous therapies but subsequently relapsed or metastasized.
  • the term "monoclonal antibody” refers to a preparation of antibody molecules having a single amino acid composition, and does not refer to the method by which it is produced. Monoclonal antibodies or antigen-binding fragments thereof can be produced, for example, by hybridoma technology, recombinant technology, phage display technology, synthetic technology such as CDR grafting, or a combination of such or other techniques known in the art.
  • binding and specific binding refer to the binding of an antibody or antigen-binding portion to an epitope in an in vitro assay, preferably in a bio-optical interferometry (ForteBio) using purified wild-type antigen.
  • FormeBio bio-optical interferometry
  • the antibody or antigen-binding portion when an antibody or antigen-binding portion preferably recognizes its target antigen in a complex mixture of proteins and/or macromolecules, the antibody or antigen-binding portion is referred to as specifically binding antigen.
  • variable region refers to the domain of the heavy or light chain of an antibody that participates in the binding of an antibody to an antigen.
  • the variable domains of the heavy and light chains of natural antibodies usually have similar structures, where each domain contains four conserved framework regions (FR) and three complementarity determining regions.
  • FR conserved framework regions
  • a single VH or VL domain may be sufficient to give antigen binding specificity.
  • VH or VL domains from antibodies that bind to a specific antigen can be used to isolate antibodies that bind to the antigen to screen libraries of complementary VL or VH domains, respectively. See, for example, Portolano et al., J. Immunol. 150:880-887 (1993); Clarkson et al., Nature 352:624-628 (1991).
  • Variable regions generally exhibit the same general structure of relatively conserved framework regions (FR) connected by three hypervariable regions, which are also referred to as complementarity determining regions or CDRs.
  • the CDRs from the two chains of each pair are usually aligned by the framework regions, which allow the binding of specific epitopes.
  • the variable regions of the two light and heavy chains usually comprise the domains FR1, CDR1, FR2, CDR2, FR3, CDR3, and FR4 from N-terminus to C-terminus.
  • CDR region or “CDR” or “hypervariable region” (herein can be used interchangeably with hypervariable region “HVR”) is an antibody variable domain that is hypervariable in sequence and A structurally defined loop ("hypervariable loop") and/or a region containing antigen contact residues ("antigen contact point”) is formed.
  • CDR is mainly responsible for binding to antigen epitopes.
  • the CDRs of the heavy and light chains are usually called CDR1, CDR2, and CDR3, and are numbered sequentially from the N-terminus.
  • the CDRs located in the variable domain of the antibody heavy chain are called HCDR1, HCDR2, and HCDR3, and the CDRs located in the variable domain of the antibody light chain are called LCDR1, LCDR2, and LCDR3.
  • the precise amino acid sequence boundaries of each CDR can be determined using any one or a combination of many well-known antibody CDR assignment systems, which include For example: Chothia based on the three-dimensional structure of antibodies and the topology of CDR loops (Chothia et al.
  • the CDR of the antibody of the present invention can be defined according to any scheme in the art or its combination and human evaluation.
  • the CDR can also be determined based on the same Kabat numbering position as the reference CDR sequence.
  • variable region residues in an antibody refers to residue positions in the variable region of an antibody (including heavy chain variable region residues and light chain variable region residues).
  • the CDR of the antibody of the present invention is bounded by the Kabat rule, for example, as shown in Table 2 below.
  • the CDR of the antibody of the present invention determines the boundary by combining Kabat, AbM, Chothia, and empirical factors, for example, as shown in Table 2 below: position RASQGISRWLA (LCDR1) in VL, position AASSLQS (LCDR2), and Position QQTVSFPIT (LCDR3), and position GSISSYYWS (HCDR1), position YIYYSGSTNYNPSLKS (HCDR2), and position ARGKTGSAA (HCDR3) in VH.
  • the boundaries of the CDRs of the variable regions of the same antibody obtained based on different assignment systems may be different. That is, the CDR sequences of the variable regions of the same antibody defined under different assignment systems are different. Therefore, when it comes to defining antibodies with specific CDR sequences defined in the present invention, the scope of the antibodies also covers antibodies whose variable region sequences include the specific CDR sequences, but due to the application of different schemes (for example, Different assignment system rules or combinations) cause the claimed CDR boundary to be different from the specific CDR boundary defined in the present invention.
  • Antibodies with different specificities have different CDRs.
  • CDRs are different from antibody to antibody, there are only a limited number of amino acid positions within the CDR that directly participate in antigen binding.
  • the minimum overlap area can be determined, thereby providing the "minimum binding unit" for antigen binding.
  • the minimum binding unit can be a sub-portion of the CDR.
  • the structure of the antibody and protein folding can determine the residues of the rest of the CDR sequence. Therefore, the present invention also considers any CDR variants given herein. For example, in a CDR variant, the amino acid residues of the smallest binding unit can remain unchanged, while the remaining CDR residues defined by Kabat or Chothia can be replaced by conserved amino acid residues.
  • the sequences are aligned for optimal comparison purposes (for example, the first and second amino acid sequences or nucleic acid sequences can be compared for optimal alignment. Gaps can be introduced in one or both or non-homologous sequences can be discarded for comparison purposes).
  • the length of the compared reference sequence is at least 30%, preferably at least 40%, more preferably at least 50%, 60%, and even more preferably at least 70%, 80% , 90%, 100% of the reference sequence length.
  • the amino acid residues or nucleotides at corresponding amino acid positions or nucleotide positions are then compared. When a position in the first sequence is occupied by the same amino acid residue or nucleotide at the corresponding position in the second sequence, then the molecules are identical at this position.
  • Mathematical algorithms can be used to achieve sequence comparison between two sequences and calculation of percent identity.
  • the Needlema and Wunsch ((1970) J.Mol.Biol.48:444-453) algorithm (at http://www.gcg.com) that has been integrated into the GAP program of the GCG software package is used. Available), use Blossum 62 matrix or PAM250 matrix and gap weight 16, 14, 12, 10, 8, 6 or 4 and length weight 1, 2, 3, 4, 5 or 6, to determine the difference between two amino acid sequences Percent identity.
  • the GAP program in the GCG software package (available at http://www.gcg.com) is used, the NWSgapdna.CMP matrix and gap weights 40, 50, 60, 70, or 80 are used. Length weights 1, 2, 3, 4, 5, or 6, determine the percent identity between two nucleotide sequences.
  • a particularly preferred parameter set (and a parameter set that should be used unless otherwise specified) is a Blossom 62 scoring matrix with a gap penalty of 12, a gap extension penalty of 4, and a frameshift gap penalty of 5.
  • the effective amount can be easily determined by the attending physician as a person skilled in the art by considering various factors such as the species of mammal; its size, age and general health; the specific disease involved; the degree or severity of the disease; The response of the individual patient; the specific antibody administered; the mode of administration; the bioavailability characteristics of the administered formulation; the selected dosing regimen; and the use of any concomitant therapy.
  • the interaction between the antibody and its target antigen can interfere with the function of the target.
  • the amount required for administration further depends on the binding affinity of the antibody to its specific antigen, and also on the rate of elimination of the antibody administered in the subject receiving the administration.
  • "Individual" or “subject” includes mammals. Mammals include, but are not limited to, domestic animals (e.g., cattle, sheep, cats, dogs, and horses), primates (e.g., human and non-human primates such as monkeys), rabbits, and rodents (e.g., , Mice and rats). In some embodiments, the individual or subject is a human.
  • anti-CD47 antibody refers to antibodies that are capable of binding CD47 protein or fragments thereof with sufficient affinity so that the antibody can be used as Targeting diagnostic and/or therapeutic agents in CD47.
  • the heavy chain sequence of the anti-CD47 antibody of the present invention is the heavy chain sequence of the anti-CD47 antibody of the present invention.
  • the light chain sequence of the anti-CD47 antibody of the present invention is the light chain sequence of the anti-CD47 antibody of the present invention.
  • the CDR sequences of the heavy chain and light chain of the anti-CD47 antibody of the present invention are shown in Table 2.
  • the sequences of the heavy chain variable region and the light chain variable region of the anti-CD47 antibody of the present invention are shown in Table 3.
  • Figure 1 shows the weight change rate of tumor-bearing mice in each group.
  • Figure 2 shows the changes in tumor volume of tumor-bearing mice in each group.
  • Figure 3 shows the tumor volume changes of tumor-bearing mice in the low-dose group.
  • Figure 4 shows the tumor volume changes of tumor-bearing mice in the high-dose group.
  • Raji lymphoma cells are ATCC products, the product number is CCL-86TM, and the lot number is 58770576.
  • Matrigel glue is a CORNING product from the United States, the article number is 356231.
  • NOD-SCID mice female, 35-41 days old were purchased from Beijing Weitong Lihua Experimental Animal Technology Co., Ltd., and the certificate number was 1100111911006865.
  • h-IgG is an Equitech-Bio product, the article number is SLH56, and the batch number is 160308-02.
  • Example 1 Production and purification of anti-CD47 antibody, Hu5F9 antibody and rituximab
  • the anti-CD47 antibody in this example is the anti-CD47 monoclonal antibody disclosed in the patent publication number WO2019042285A1.
  • the entire content of the PCT application is hereby incorporated herein by reference.
  • the anti-CD47 antibody is preferably the anti-CD47 antibody ADI-26630 disclosed in WO2019042285A1.
  • the sequence of the anti-CD47 antibody used herein is renumbered.
  • amino acid sequences of the CDR region, the light chain variable region and the heavy chain variable region, the light chain and the heavy chain of the anti-CD47 antibody exemplified in the present invention are listed in the "Sequence Listing" of the present application.
  • sequence numbers of the CDR regions, light chain variable regions, and heavy chain variable regions of the exemplified antibodies of the present invention are shown in Table 2 and Table 3.
  • the anti-CD47 antibody of the present invention is expressed and purified in yeast and CHO-S cells.
  • Yeast-based antibody presentation library (Adimab) was amplified according to existing methods (WO2009036379; WO2010105256; WO2012009568), and the diversity of each library reached 1 ⁇ 10 9 .
  • the first two rounds of screening used Miltenyi's MACS system for magnetically activated cell sorting.
  • FACS washing buffer phosphate buffer, containing 0.1% bovine serum protein
  • the buffer containing 100 nM biotin label CD47 antigen (Acro Biosystems, catalog number CD7-H5227-1 mg).
  • LC-FITC FITC labeled goat anti-human immunoglobulin F(ab') kappa chain antibody, Southern Biotech
  • SA-633 streptavidin-633, Molecular Probes
  • SA-PE streptavidin-phycoerythrin, Sigma
  • the yeast cells expressing the anti-CD47 antibody obtained by the screening were induced by shaking at 30° C. for 48 hours to express the anti-CD47 antibody. After the induction, the yeast cells were removed by centrifugation at 1300 rpm for 10 min, and the supernatant was harvested. Protein A was used to purify the anti-CD47 antibody in the supernatant, eluted with pH2.0 acetic acid solution, and the anti-CD47 antibody was harvested, and the antibody purity was >95%. Use papain digestion and purification with KappaSelect (GE Life Medical Group) to obtain the corresponding Fab fragments.
  • KappaSelect GE Life Medical Group
  • the kit produces a CHO-S cell line expressing antibodies.
  • the constructed pCHO1.0 plasmid was transformed into the CHO cell line by chemical transfection and electrotransfection. ForteBio was used to detect the antibody production to judge the transfection efficiency 48 hours after transfection.
  • the transfected cells undergo two rounds of pressure screening to obtain a pool of highly expressing antibodies. Then expand the cell pool to express a large amount of antibody, and collect the cell supernatant and purify the supernatant with ProteinA to make the purity of the antibody>95%.
  • Hu5F9 is a human CD47 antibody transiently expressed in 293HEK cells, and its sequence is the same as that of the antibody "5F9" in US Patent US2015/0183874A1.
  • the vector pTT5 (product of Addgene, catalog number 52326) was used.
  • the heavy and light chains of the antibody were cloned into separate pTT5 vectors.
  • the pTT5 vector with the heavy and light chains of antibody molecules was transferred into 293HEK cells by chemical transfection.
  • the chemical transfection reagent used was PEI (purchased from Polysciences), and the cultured 293HEK was transiently transfected according to the protocol provided by the manufacturer.
  • Hu5F9 heavy chain sequence
  • the original research drug Rituximab trade name Rituxan
  • IBI301 is a biosimilar of the original rituximab, produced by Xinda Biopharmaceutical (Suzhou) Co., Ltd., and IBI301 is used as rituximab in the subsequent embodiments of the present invention.
  • the antibody preparation method of IBI301 is as follows:
  • the kit produces a CHO-S cell line expressing antibodies.
  • the constructed pCHO1.0 plasmid was transformed into the CHO cell line by chemical transfection and electrotransfection.
  • the transfected cells undergo two rounds of pressure screening to obtain a pool of highly expressing antibodies. Then expand the cell pool to express a large amount of antibody, and collect the cell supernatant and purify the supernatant with Protein A to make the purity of the antibody>95%.
  • the right back of NOD-SCID mice was shaved, and the above cell suspension was injected subcutaneously at a dose of 1 ⁇ 10 6 cells/0.2 mL/mouse.
  • mice with successful modeling (tumor volume between 44.30mm 3 ⁇ 97.65mm 3 ) were selected and divided into 11 groups, 7 mice in each group, and the dosing schedule for each group is as follows:
  • PBS group PBS was intraperitoneally injected into each mouse at a dose volume of 10 ml/kg, once every two days, for 6 consecutive doses.
  • h-IgG group Dissolve h-IgG with PBS to 1.62 mg/ml, and intraperitoneally inject each mouse at a dose volume of 10 ml/kg, once every two days, for 6 consecutive administrations.
  • Hu5F9-0.02mg/kg group Dissolve Hu5F9 in PBS to 0.002mg/ml, and intraperitoneally inject each mouse at a dose volume of 10ml/kg, once every two days, for 6 consecutive administrations.
  • Hu5F9-0.1mg/kg group Dissolve Hu5F9 with PBS to 0.01mg/ml, and intraperitoneally inject each mouse at a dose volume of 10ml/kg, once every two days, for 6 consecutive administrations.
  • Anti-CD47 antibody-0.02mg/kg group Dissolve the anti-CD47 antibody with PBS to 0.002mg/ml, and intraperitoneally inject each mouse according to the administration volume of 10ml/kg, once every two days, for 6 consecutive administrations.
  • Anti-CD47 antibody-0.1mg/kg group Dissolve anti-CD47 antibody with PBS to 0.01mg/ml, and intraperitoneally inject each mouse according to the administration volume of 10ml/kg, once every two days, for 6 consecutive administrations.
  • Rituximab-1.5mg/kg group Dissolve rituximab with PBS to 0.15mg/ml, and inject it into each mouse intraperitoneally according to the administration volume of 10ml/kg, once every two days for 6 consecutive administrations Times.
  • Hu5F9+rituximab-0.02mg/kg+1.5mg/kg group Dissolve Hu5F9 and rituximab in PBS to prepare a solution containing 0.002mg/ml Hu5F9 and 0.15mg/ml rituximab, according to The administration volume of 10ml/kg was intraperitoneally injected into each mouse once every two days for 6 consecutive administrations.
  • Hu5F9+rituximab-0.1mg/kg+1.5mg/kg group Dissolve Hu5F9 and rituximab in PBS to prepare a solution containing 0.01mg/ml Hu5F9 and 0.15mg/ml rituximab, according to The administration volume of 10 ml/kg was intraperitoneally injected to each mouse once every two days for 6 consecutive administrations.
  • Anti-CD47 antibody + rituximab-0.02mg/kg+1.5mg/kg group dissolve anti-CD47 antibody and rituximab in PBS to prepare containing 0.002mg/ml anti-CD47 antibody and 0.15mg/ml ritux The solution of ciximab was intraperitoneally injected into each mouse at an administration volume of 10 ml/kg, once every two days, for 6 consecutive administrations.
  • Anti-CD47 antibody + rituximab-0.1mg/kg+1.5mg/kg group dissolve anti-CD47 antibody and rituximab in PBS to prepare 0.01mg/ml anti-CD47 antibody and 0.15mg/ml ritux The solution of ciximab was intraperitoneally injected into each mouse at an administration volume of 10 ml/kg, once every two days, for 6 consecutive administrations.
  • the body weight, the largest long axis (L) and the largest wide axis (W) of the tumor tissues in each group were monitored twice a week for 4 weeks. After the experiment, the relative tumor inhibition rate of each group of mice was calculated.
  • Tumor inhibition rate TGI (%) 100% ⁇ (terminal tumor volume after administration of the control group-terminal tumor volume after administration of the administration group) / (terminal tumor volume after administration of the control group-before administration of the control group Tumor volume)
  • control group is the h-IgG group.
  • the tumor inhibition rate of each group is shown in Table 4.
  • TGI Tumor Inhibition Rate
  • the body weight change rate of each group of tumor-bearing mice is shown in Figure 1.
  • the inhibition of tumor volume of tumor-bearing mice by each group is shown in Figure 2.
  • the inhibition of tumor volume in tumor-bearing mice by the low-dose group and the high-dose group are shown in Figure 3 and Figure 4, respectively.
  • the anti-CD47 antibody -0.1mg/kg group anti-CD47 antibody + rituximab -0.02mg/kg+1.5mg/kg
  • the anti-CD47 antibody+rituximab-0.1mg/kg+1.5mg/kg group has a significant inhibitory effect on the tumor growth of Raji tumor-bearing mice, the tumor volume is smaller, anti-CD47 antibody+rituximab -0.1mg/kg+1.5mg/kg group has better efficacy than anti-CD47 antibody + rituximab -0.02mg/kg+1.5mg/kg group, showing that the tumor efficacy is dose-dependent with anti-CD47 antibody Sex.
  • anti-CD47 antibody+rituximab-0.02mg/kg+1.5mg/kg group anti-CD47 antibody+rituximab-0.1mg/kg+1.5mg/kg group had much higher tumor inhibition rates Hu5F9+rituximab-0.02mg/kg+1.5mg/kg group, Hu5F9+rituximab-0.1mg/kg+1.5mg/kg group.
  • Hu5F9-0.02mg/kg group and rituximab-1.5mg/kg did not show anti-tumor effect;
  • the tumor inhibition rates of anti-CD47 antibody-0.1mg/kg group were 20%, 24% and 52% respectively;
  • Hu5F9+rituximab-0.02mg/kg+1.5mg/kg group Hu5F9+rituximab- 0.1mg/kg+1.5mg/kg group, anti-CD47 antibody+rituximab-0.02mg/kg+1.5mg/kg group, anti-CD47 antibody+rituximab-0.1mg/kg+1.5mg/kg group
  • the tumor inhibition rates of kg group were 33%, 28%, 56% and 92%, respectively.
  • the anti-CD47 antibody+rituximab-0.02mg/kg+1.5mg/kg group of mice has stronger tumor suppressive effect than anti-CD47 antibody-0.02mg/kg, rituximab-1.5mg/kg and Hu5F9+Li Tuximab-0.02mg/kg+1.5mg/kg group; anti-CD47 antibody+rituximab-0.1mg/kg+1.5mg/kg group mice have stronger tumor suppressive effect than anti-CD47 antibody-0.1mg /kg, rituximab-1.5mg/kg and Hu5F9+rituximab-0.1mg/kg+1.5mg/kg groups.
  • the results show that the anti-CD47 antibody + rituximab tumor suppression effect is better than the anti-CD47 antibody single-agent group and rituximab single-agent group, showing the combined effect, and at the same dose, the anti- The tumor suppression effect of the CD47 antibody + rituximab combination group was better than that of the Hu5F9 + rituximab combination group.
  • the anti-CD47 antibody has a certain anti-tumor efficacy, and its combination with rituximab significantly enhances its anti-tumor effect, indicating that the combination of the two drugs has a synergistic effect.
  • the combination of anti-CD47 antibody and rituximab has better tumor suppression effect on tumor-bearing mice than the combination of Hu5F9 and rituximab.

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Abstract

提供抗CD47抗体或其抗原结合片段和抗CD20抗体的组合在制备用于预防和/或治疗肿瘤和/或癌症的药物中的应用，其中所述抗CD47抗体为全人源抗CD47单克隆抗体。另外，还提供了一种抗肿瘤药物组合及其应用。所提供的抗CD47抗体或其抗原结合片段联合抗CD20抗体具有优异的抗肿瘤药效。

Description

抗CD47抗体和抗CD20抗体的组合在制备用于预防或治疗肿瘤的药物中的应用 技术领域
本发明属于生物技术领域，涉及一种抗肿瘤药物组合及其应用，尤其涉及一种包含抗CD47抗体或其抗原结合片段和抗CD20抗体的组合在制备用于预防和/或治疗肿瘤和/或癌症的药物中的应用。
背景技术
利妥昔单抗是靶向人CD20分子的单克隆抗体，能够通过ADCC、CDC等作用清除CD20阳性的肿瘤细胞，目前作为非霍奇金淋巴瘤一线治疗手段。尽管利妥昔单抗作为非霍奇金淋巴瘤治疗效果出众，但已有数据表明，患者体内FcR多态性、CD20靶标丢失等原因导致患者对利妥昔单抗出现耐药，并表现出复发难治性。
分化抗原簇47(CD47)，也被称为整联蛋白相关蛋白(IAP)，是免疫球蛋白超家族成员。不同的研究表明，几乎所有的肿瘤细胞和组织都高表达CD47。目前已经报道了多个抗CD47抗体被开发用于各种肿瘤和/或癌症的治疗中。
虽然forty-seven公司存在抗CD47抗体与利妥昔单抗联合用药方案和产品，但是鉴于肿瘤发生机制的复杂性、不同抗CD47抗体药物与利妥昔单抗相互作用的不可预见性等因素，发现可行且能够带来相比已知联合用药的方案而言具有更优异效果(减少单药剂量、改善治疗中的不良事件(AE)发生率和/或严重程度，和/或以协同作用的方式起作用等)的联合用药的方案和产品，仍然是医药领域的一大挑战。
鉴于此，仍然有必要研发一种改进的抗肿瘤的药物组合，其可以展现出更优的抗肿瘤药效。
发明内容
有本发明的目的是提供比现有技术中更好的抗CD47抗体与抗CD20抗体的组合在制备用于预防和/或治疗肿瘤和/或癌症的药物中的应用。
在一个方面，本发明提供一种抗CD47抗体或其抗原结合片段和抗CD20 抗体的组合在制备用于预防和/或治疗肿瘤和/或癌症的药物中的应用，其中所述抗CD47抗体为全人源抗CD47单克隆抗体；
所述全人源抗CD47单克隆抗体包含重链可变区VH和轻链可变区VL，其中所述VH包含互补决定区域HCDR1、HCDR2和HCDR3，HCDR1如SEQ ID NO：3或SEQ ID NO：11所示的氨基酸序列，HCDR2如SEQ ID NO：4所示的氨基酸序列，HCDR3如SEQ ID NO：5或SEQ ID NO：12所示的氨基酸序列；所述VL包含互补决定区域LCDR1、LCDR2和LCDR3，其中LCDR1如SEQ ID NO：6所示的氨基酸序列，LCDR2如SEQ ID NO：7所示的氨基酸序列，LCDR3如SEQ ID NO：8所示的氨基酸序列。
在一些实施方案中，上述应用中，所述全人源抗CD47单克隆抗体的重链可变区VH包含SEQ ID NO：9所示的氨基酸序列或与其具有至少90％、95％、98％或99％同一性的序列，所述轻链可变区包含SEQ ID NO：10所示的序列或与其具有至少90％、95％、98％或99％同一性的序列；
优选地，所述重链可变区VH的氨基酸序列如SEQ ID NO：9所示，所述轻链可变区VL的氨基酸序列如SEQ ID NO：10所示。
在一些实施方案中，上述任一所述的应用中，所述全人源抗CD47单克隆抗体包含重链和轻链，所述重链包含SEQ ID NO：1所示的氨基酸序列或与之具有至少90％、95％、98％或99％同一性的氨基酸序列，以及所述轻链包含SEQ ID NO：2所示的氨基酸序列或与之具有至少90％、95％、98％或99％同一性的氨基酸序列；
优选地，所述重链具有如SEQ ID NO：1所示的氨基酸序列，所述轻链具有如SEQ ID NO：2所示的氨基酸序列。
在一些实施方案中，所述全人源抗CD47单克隆抗体为专利公开号WO2019042285A1公开的抗CD47单克隆抗体。为了本申请的目的，该PCT申请的全部内容特此并入本文作为参考。其中，所述抗CD47抗体优选是WO2019042285A1中公开的抗CD47抗体ADI-26630。本文中对所用的该抗CD47抗体的序列进行重新编号。
在一些实施方案中，上述任一所述的应用中，所述抗CD20抗体为抗CD20单克隆抗体，例如奥滨尤妥珠单抗(obinutuzumab)、替伊莫单抗(ibritumomab tiuxetan)、奥法木单抗(ofatumumab)、托西莫单抗(tositumomab)、 奥美珠单抗(ocrelizumab)或利妥昔单抗(rituximab)。
在一些实施方案中，上述任一所述的应用中，所述抗CD20单克隆抗体为利妥昔单抗。
在另一个方面，本发明还提供一种单次药物剂量单元，其包含有效量的上述任一所述的抗CD47抗体或其抗原结合片段和抗CD20抗体。
在另一个方面，本发明还提供一种药物组合物，其包含有效量的上述任一所述的抗CD47抗体或其抗原结合片段和抗CD20抗体的组合和药学上可接受的载体。
在另一个方面，本发明还提供一种成套药盒，其包含上述药物组合物；
优选地，所述药盒为单次药物剂量单元形式。
在一些实施方案中，上述药盒中，在同一包装内其包含：
-含有用于胃肠外施用的药物组合物的第一容器，所述药物组合物包含上述任一所述的抗CD47抗体；
-含有用于胃肠外施用的药物组合物的第二容器，所述药物组合物包含上述任一所述的抗CD20抗体。
在另一个方面，本发明还提供上述任一所述的药物组合、单次药物剂量单元或成套药盒在制备用于预防和/或治疗肿瘤和/或癌症的药物中的应用，所述肿瘤和/或癌症优选血液瘤，更优选淋巴瘤，进一步优选CD20阳性非霍奇金淋巴瘤。
在另一个方面，本发明还提供上述任一所述的组合物在制备用于预防和/或治疗肿瘤和/或癌症的药物中的应用，所述肿瘤和/或癌症优选血液瘤，更优选淋巴瘤，进一步优选CD20阳性非霍奇金淋巴瘤。
在另一个方面，本发明还提供抗CD47抗体在制备增强抗CD20抗体预防和/或治疗肿瘤和/或癌症疗效的产品中的应用，所述肿瘤和/或癌症优选血液瘤，更优选淋巴瘤，进一步优选CD20阳性非霍奇金淋巴瘤。
在另一个方面，本发明还提供一种预防和/或治疗肿瘤和/或癌症的方法，包括将有效量的上述任一所述的抗CD47抗体或其抗原结合片段和抗CD20抗体的组合、上述任一所述的单次药物剂量单元、上述任一所述的药物组合物或上述任一所述的成套药盒施用给个体的步骤。
本发明涉及的抗CD47抗体是全新的全人源抗CD47单克隆抗体，无论是 单独用药还是与抗CD20单克隆抗体利妥昔单抗联合用药，都表现出比forty-seven公司的Hu5F9抗体更优的抗肿瘤药效，尤其是，该全人源抗CD47单克隆抗体与利妥昔单抗联合用药取得的抗肿瘤药效显著优于Hu5F9抗体与利妥昔单抗联合用药取得的抗肿瘤药效。
本发明通过联合本发明的抗CD47抗体有助于增加巨噬细胞介导的吞噬作用，可以进而增加利妥昔单抗的药效，相对于现有技术的抗CD47抗体和利妥昔单抗的组合，展现出更优的抗肿瘤药效，在有效解决患者体内FcR多态性、CD20靶标丢失等原因导致的患者对利妥昔单抗出现的耐药问题上具有良好的应用前景。
发明详述
定义
术语“和/或”应理解为意指可选项中的任一项或可选项中的任意两项或多项的组合。
术语“包含”或“包括”意指包括所述的要素、整数或步骤，但是不排除任意其他要素、整数或步骤。在本文中，当使用术语“包含”或“包括”时，除非另有指明，否则也涵盖由所述及的要素、整数或步骤组成的情形。例如，当提及“包含”某个具体序列的抗体可变区时，也旨在涵盖由该具体序列组成的抗体可变区。
在本文中，术语“抗体”是指至少包含轻链或重链免疫球蛋白可变区的多肽，所述免疫球蛋白可变区特异性识别并结合抗原。该术语涵盖各种抗体结构，包括但不限于单克隆抗体、多克隆抗体、单链抗体或多链抗体、单特异性或多特异性抗体(例如双特异性抗体)、全人源抗体或嵌合抗体或人源化抗体、全长抗体和抗体片段，只要它们呈现期望的抗原结合活性即可。
术语抗体的“抗原结合片段”(在本文中可与“抗体片段”和“抗原结合部分”互换使用)，是指并非完整抗体的分子，其包含完整抗体中用于结合该完整抗体所结合的抗原的部分。如本领域技术人员理解的，抗体的抗原结合部分通常包含来自“互补决定区”或“CDR”的氨基酸残基。可以通过重组DNA技术、或通过酶或化学切割完整的抗体制备抗原结合片段。抗原结合片段包括但不限于Fab、scFab、Fab’、F(ab’)2、Fab’-SH、Fv、单链Fv、双链抗体(diabody)、三链抗体(triabody)、四链抗体(tetrabody)、微抗体 (minibody)、单结构域抗体(sdAb)。关于抗体片段的更详细的描述，可以参见：基础免疫学(Fundamental Immunology)，W.E.Paul编辑，Raven Press，N.Y.(1993)；邵荣光等人(编辑)，抗体药物研究与应用，人民卫生出版社(2013)；Hollinger等人，PNAS USA 90：6444-6448(1993)；Hudson等人，Nat.Med.9：129-134(2003)。
术语“预防”包括对疾病或病症或其症状的发生或发生频率的抑制或推迟，其通常是指在病征或症状发生前，特别是在具有风险个体的病征或症状发生前的药物施用。
本文所用术语“治疗”指通过疾病的临床或诊断症状的减轻或消除来证明的对象癌症进展的减缓、阻止或逆转。治疗可包括例如，降低症状严重程度、症状数量或复发频率，例如，肿瘤生长抑制、肿瘤生长阻滞或已有肿瘤的消退。
本文所用术语“单次药物剂量单元”表示在给药方案的时刻给予病人的单次药物剂型，包括注射液、药片以及冻干粉等。
术语“药物组合”是指非固定组合产品或固定组合产品，例如药盒。术语“非固定组合”意指活性成分(例如，(i)抗CD47抗体或其抗原结合片段、和(ii)抗CD20抗体以分开的实体被同时、无特定时间限制或以相同或不同的时间间隔、依次地施用于患者，其中这类施用在患者体内提供预防或治疗有效水平的所述两种活性剂。在一些实施方案中，药物组合中使用的抗CD47抗体分子和抗CD20抗体这两种分子以不超过它们单独使用时的水平施用。术语“固定组合”意指两种活性剂以单个实体的形式被同时施用于患者。优选对两种活性剂的剂量和/或时间间隔进行选择，从而使各部分的联合使用能够在治疗疾病或病症时产生大于单独使用任何一种成分所能达到的效果。各成分可以各自呈单独的制剂形式，其制剂形式可以相同也可以不同。
术语“施用”指用本领域技术人员已知的多种方法和递送系统中的任一种将本发明的药物组合中的各活性成分物理导入至个体。本发明的药物组合中的各活性成分的施用途径包括口服、静脉内(例如输注(又称滴注)或注射)、肌内、皮下、腹膜内、脊髓、局部或其他胃肠外施用途径。本文所用的短语“胃肠外施用”指胃肠和局部施用之外的施用方式，通常通过静脉内，且非限制性地包括肌内、动脉内、鞘内、淋巴内、病灶内、囊内、眶内、心内、 皮内、腹膜内、经气管、皮下、表皮下、关节内、囊下、蛛网膜下、脊柱内、硬膜外和胸骨内注射和输注，以及体内电穿孔。相应地，本发明的药物组合中的各活性成分可以被配制成胶囊剂、片剂、注射剂(包括输液或注射液)、糖浆、喷雾剂、锭剂、脂质体或栓剂等。
术语“剂量”是引发治疗效果的药物的量。除非另有说明，否则剂量与游离形式的药物的量有关。如果药物是可药用盐形式，药物的量与游离形式的药物的量相比成比例地增加。例如，剂量将在产品包装或产品信息单中声明。
本发明的药物组合可以施用于已经用一种或多种先前疗法治疗但随后复发或转移的个体。
如本文所用，术语“单克隆抗体”指具有单一氨基酸组成的抗体分子的制备物，而不指其产生的方法。单克隆抗体或其抗原结合片段可以例如通过杂交瘤技术、重组技术、噬菌体展示技术、合成技术例如CDR嫁接、或此类或其它本领域已知的技术的组合来产生。
如本文所用，术语“结合”和“特异性结合”指抗体或抗原结合部分在体外测定法中，优选地在采用纯化的野生型抗原的生物光干涉测量(ForteBio)中与抗原表位结合。在某些实施方案中，在抗体或抗原结合部分优选地识别蛋白质和/或大分子的复杂混合物中其靶抗原时，将抗体或抗原结合部分称作特异性结合抗原。
术语“可变区”或“可变结构域”是指参与抗体与抗原结合的抗体重或轻链的结构域。天然抗体的重链和轻链的可变结构域通常具有相似的结构，其中每个结构域包含四个保守的框架区(FR)和三个互补决定区。(参见，例如，Kindt等Kuby Immunology，6th ed.，W.H.Freeman and Co.91页(2007))。单个VH或VL结构域可以足以给予抗原结合特异性。此外，可以使用来自与特定抗原结合的抗体的VH或VL结构域来分离结合所述抗原的抗体，以分别筛选互补VL或VH结构域的文库。参见，例如，Portolano等，J.Immunol.150：880-887(1993)；Clarkson等，Nature 352：624-628(1991)。
可变区通常表现出由三个高变区连接的相对保守的构架区(FR)的相同的一般结构，所述高变区也被称为互补决定区或CDR。通常通过构架区定位(align)来自每对的两条链的CDR，所述CDR使得可结合特异性表位。两条轻 链和重链可变区从N-末端到C-末端通常包含结构域FR1、CDR1、FR2、CDR2、FR3、CDR3和FR4。
“互补决定区”或“CDR区”或“CDR”或“高变区”(在本文中与超变区“HVR”可以互换使用)，是抗体可变结构域中在序列上高变并且形成在结构上确定的环(“超变环”)和/或含有抗原接触残基(“抗原接触点”)的区域。CDR主要负责与抗原表位结合。重链和轻链的CDR通常被称作CDR1、CDR2和CDR3，从N-端开始顺序编号。位于抗体重链可变结构域内的CDR被称作HCDR1、HCDR2和HCDR3，而位于抗体轻链可变结构域内的CDR被称作LCDR1、LCDR2和LCDR3。在一个给定的轻链可变区或重链可变区氨基酸序列中，各CDR的精确氨基酸序列边界可以使用许多公知的抗体CDR指派系统的任一种或其组合确定，所述指派系统包括例如：基于抗体的三维结构和CDR环的拓扑学的Chothia(Chothia等人.(1989)Nature 342：877-883，Al-Lazikani等人，“Standard conformations for the canonical structures of immunoglobulins”，Journal of Molecular Biology，273，927-948(1997))，基于抗体序列可变性的Kabat(Kabat等人，Sequences of Proteins of Immunological Interest，第4版，U.S.Department of Health and Human Services，National Institutes of Health(1987))，AbM(University of Bath)，Contact(University College London)，国际ImMunoGeneTics database(IMGT)(万维网imgt.cines.fr/)，以及基于利用大量晶体结构的近邻传播聚类(affinity propagation clustering)的North CDR定义。
例如，使用Kabat和Chothia编号的CDR区域的不同定义范围。
表1
Figure PCTCN2021070493-appb-000001
本发明抗体的CDR可以根据本领域的任何方案或其组合及人为评估确定边界。
CDR也可以基于与参考CDR序列具有相同的Kabat编号位置而确定。
除非另有说明，否则在本发明中，术语“CDR”或“CDR序列”涵盖以上述任一种方式确定的CDR序列。
除非另有说明，否则在本发明中，当提及抗体可变区中的残基位置(包括重链可变区残基和轻链可变区残基)时，是指根据Kabat编号系统(Kabat等人，Sequences of Proteins of Immunological Interest，5th Ed.Public Health Service，National Institutes of Health，Bethesda，Md.(1991))的编号位置。
在一个实施方案中，本发明抗体的CDR通过Kabat规则确定边界，例如下文表2所示。
在一个实施方案中，本发明抗体的CDR通过结合Kabat、AbM、Chothia及经验性等综合因素确定边界，例如下文表2所示：VL中的位置RASQGISRWLA(LCDR1)、位置AASSLQS(LCDR2)、和位置QQTVSFPIT(LCDR3)，以及VH中的位置GSISSYYWS(HCDR1)、位置YIYYSGSTNYNPSLKS(HCDR2)、和位置ARGKTGSAA(HCDR3)。
然而，应该注意，基于不同的指派系统获得的同一抗体的可变区的CDR的边界可能有所差异。即不同指派系统下定义的同一抗体可变区的CDR序列有所不同。因此，在涉及用本发明定义的具体CDR序列限定抗体时，所述抗体的范围还涵盖了这样的抗体，其可变区序列包含所述的具体CDR序列，但是由于应用了不同的方案(例如不同的指派系统规则或组合)而导致其所声称的CDR边界与本发明所定义的具体CDR边界不同。
具有不同特异性(即，针对不同抗原的不同结合位点)的抗体具有不同的CDR。然而，尽管CDR在抗体与抗体之间是不同的，但是CDR内只有有限数量的氨基酸位置直接参与抗原结合。使用Kabat，Chothia，AbM、Contact和North方法中的至少两种，可以确定最小重叠区域，从而提供用于抗原结合的“最小结合单位”。最小结合单位可以是CDR的一个子部分。正如本领域技术人员明了，通过抗体的结构和蛋白折叠，可以确定CDR序列其余部分的残基。因此，本发明也考虑本文所给出的任何CDR的变体。例如，在一个CDR的变体中，最小结合单位的氨基酸残基可以保持不变，而根据Kabat或Chothia定义的其余CDR残基可以被保守氨基酸残基替代。
如下进行序列之间序列同一性的计算。
为确定两个氨基酸序列或两个核酸序列的同一性百分数，将所述序列出于最佳比较目的比对(例如，可以为了最佳比对而在第一和第二氨基酸序列或核酸序列之一或二者中引入空位或可以为比较目的而抛弃非同源序列)。在一个优选实施方案中，为比较目的，所比对的参考序列的长度是至少30％、优选地至少40％、更优选地至少50％、60％和甚至更优选地至少70％、80％、90％、100％的参考序列长度。随后比较在对应氨基酸位置或核苷酸位置处的氨基酸残基或核苷酸。当第一序列中的位置由第二序列中对应位置处的相同氨基酸残基或核苷酸占据时，则所述分子在这个位置处是相同的。
可以利用数学算法实现两个序列间的序列比较和同一性百分数的计算。 在一个优选实施方案中，使用已经集成至GCG软件包的GAP程序中的Needlema和Wunsch((1970)J.Mol.Biol.48：444-453)算法(在http：//www.gcg.com可获得)，使用Blossum 62矩阵或PAM250矩阵和空位权重16、14、12、10、8、6或4和长度权重1、2、3、4、5或6，确定两个氨基酸序列之间的同一性百分数。在又一个优选的实施方案中，使用GCG软件包中的GAP程序(在http：//www.gcg.com可获得)，使用NWSgapdna.CMP矩阵和空位权重40、50、60、70或80和长度权重1、2、3、4、5或6，确定两个核苷酸序列之间的同一性百分数。特别优选的参数集合(和除非另外说明否则应当使用的一个参数集合)是采用空位罚分12、空位延伸罚分4和移码空位罚分5的Blossum 62评分矩阵。
还可以使用PAM120加权余数表、空位长度罚分12，空位罚分4，利用已经并入ALIGN程序(2.0版)的E.Meyers和W.Miller算法，((1989)CABIOS，4：11-17)确定两个氨基酸序列或核苷酸序列之间的同一性百分数。
有效量可以由作为本领域技术人员的主治医师通过考虑以下多种因素来容易地确定：诸如哺乳动物的物种；它的大小、年龄和一般健康；涉及的具体疾病；疾病的程度或严重性；个体患者的应答；施用的具体抗体；施用模式；施用制剂的生物利用率特征；选择的给药方案；和任何伴随疗法的使用。
如上所述，在某些情况下，抗体及其靶抗原之间的相互作用会干扰靶标的功能。给药所需的量进一步取决于抗体对其特异抗原的结合亲和力，还取决于在接受给药的受试者中给予的抗体清除的速率。“个体”或“受试者”包括哺乳动物。哺乳动物包括但不限于，家养动物(例如，牛，羊，猫，狗和马)，灵长类动物(例如，人和非人灵长类动物如猴)，兔，以及啮齿类动物(例如，小鼠和大鼠)。在一些实施方案中，个体或受试者是人。
术语“抗CD47抗体”、“抗CD47”、“CD47抗体”或“结合CD47的抗体”是指这样的抗体，所述抗体能够以足够的亲和力结合CD47蛋白或其片段以致所述抗体可以用作靶向CD47中的诊断剂和/或治疗剂。
本发明的抗CD47抗体的重链序列：
Figure PCTCN2021070493-appb-000002
Figure PCTCN2021070493-appb-000003
本发明的抗CD47抗体的轻链序列：
Figure PCTCN2021070493-appb-000004
本发明的抗CD47抗体重链和轻链CDR的序列如表2所示。本发明的抗CD47抗体重链可变区和轻链可变区的序列如表3所示。
表2.本发明的抗CD47抗体重链和轻链CDR的序列
Figure PCTCN2021070493-appb-000005
表3.本发明的抗CD47抗体重链可变区和轻链可变区的序列
Figure PCTCN2021070493-appb-000006
附图说明
图1为各组荷瘤小鼠的体重变化率。
图2为各组荷瘤小鼠的肿瘤体积变化。
图3为低剂量组荷瘤小鼠的肿瘤体积变化。
图4为高剂量组荷瘤小鼠的肿瘤体积变化。
具体实施方式
下述实施例中所使用的实验方法如无特殊说明，均为常规方法。
下述实施例中所用的材料、试剂等，如无特殊说明，均可从商业途径得到。
以下结合具体实施例，对本发明作进一步说明。应理解，以下实施例仅用于说明本发明而非用于限定本发明的范围。
Raji淋巴瘤细胞为ATCC产品，货号为CCL-86TM，批号为58770576。
Matrigel胶为美国CORNING产品，货号为356231。
NOD-SCID小鼠(雌性，35-41日龄)购自北京维通利华实验动物技术有限公司，合格证号为1100111911006865。
h-IgG为Equitech-Bio产品，货号为SLH56，批号为160308-02。
实施例1.抗CD47抗体、Hu5F9抗体和利妥昔单抗的生产和纯化
1、抗CD47抗体
本实施例中的抗CD47抗体为专利公开号WO2019042285A1中公开的抗CD47单克隆抗体。为了本申请的目的，该PCT申请的全部内容特此并入本文作为参考。其中，所述抗CD47抗体优选是WO2019042285A1中公开的抗CD47抗体ADI-26630。本文中对所用的该抗CD47抗体的序列进行重新编号。
本发明示例的抗CD47抗体的CDR区、轻链可变区和重链可变区、轻链和重链的氨基酸序列在本申请的“序列表”中列出。另外，上述本发明示例抗体的CDR区、轻链可变区和重链可变区的序列编号如表2和表3所示。
在酵母以及CHO-S细胞中表达并且纯化本发明的抗CD47抗体。
酵母中的表达和纯化：
基于酵母的抗体展示(yeast-based antibody presentation)文库(Adimab)，按照现有的方法(WO2009036379；WO2010105256；W02012009568)进行扩 增，其中每个库的多样性达到1×10 9。简言之，前两轮的筛选使用Miltenyi公司的MACS系统进行磁性激活细胞分选。首先，将文库的酵母细胞(～1×10 10细胞/文库)分别在FACS洗涤缓冲液中(磷酸盐缓冲液，含有0.1％牛血清蛋白)室温孵化15分钟，缓冲液中含有100nM生物素标记的CD47抗原(Acro Biosystems，目录号CD7-H5227-1mg)。使用50ml预冷的FACS洗涤缓冲液洗一次，再用40ml相同洗涤缓冲液重悬细胞，并加入500μl链霉素微珠(Miltenyi LS)于4℃孵化15分钟。1000rpm离心5min弃去上清后用5ml FACS洗涤缓冲液重悬细胞，将细胞溶液加到Miltenyi LS柱中。加样完成后，用FACS洗涤缓冲液洗柱3次，每次3ml。从磁性区域取下Miltenyi LS柱，用5ml生长培养基洗脱，收集洗脱的酵母细胞并在37℃过夜生长。
使用流式细胞仪进行下一轮的分选：将经过MACS系统筛选获得的大约1×10 8的酵母细胞用FACS缓冲液洗三次，于含有低浓度生物素(100-1nM)标记的CD47抗原中室温下培养。弃去培养液，细胞用FACS洗涤缓冲液洗两次之后，将细胞与LC-FITC(FITC标记山羊抗人免疫球蛋白F(ab’)kappa链抗体，Southern Biotech)(1∶100稀释)混合，并与SA-633(链霉亲和素-633，Molecular Probes)(1∶500稀释)或SA-PE(链霉亲和素-藻红蛋白，Sigma)(1∶50稀释)试剂混合，4℃下培养15分钟。用预冷的FACS洗涤缓冲液洗脱两次，并重悬于0.4ml缓冲液中，将细胞转移到带滤器的分离管中。使用FACS ARIA(BD Biosciences)分选细胞。
将通过筛选获得的表达抗CD47抗体的酵母细胞在30℃下震荡诱导48小时以表达抗CD47的抗体。诱导结束之后，1300rpm离心10min去除酵母细胞，收获上清液。使用Protein A对上清液中的抗CD47抗体进行纯化，pH2.0醋酸溶液洗脱，收获抗CD47抗体，抗体纯度＞95％。使用木瓜蛋白酶消化并用KappaSelect(GE生命医疗集团)进行纯化可获得相应的Fab片段。
CHO-S细胞中的表达和纯化：
根据制造商的说明书，使用
Figure PCTCN2021070493-appb-000007
试剂盒(Invitrogen)产生表达抗体的CHO-S细胞系。首先将抗体分子重链和轻链的DNA序列插入到同一个pCHO1.0质粒中，其中重链在轻链的上游。之后采用化学转染法和电转染法将构建的pCHO1.0质粒转入CHO细胞系，转染48小时之后利用ForteBio检测抗体产量以判断转染效率。转染后的细胞经过两轮加压筛选得到高表达抗 体的细胞池(pool)。之后扩增细胞池，大量表达抗体，并收集细胞上清用ProteinA纯化上清液，使抗体的纯度＞95％。
2、Hu5F9抗体
在293HEK细胞中表达并且纯化对照抗体Hu5F9：
Hu5F9是在293HEK细胞中瞬时表达的人CD47抗体，其序列与美国专利US2015/0183874A1中的抗体“5F9”的序列相同。
对于293HEK细胞中抗体的瞬时表达，使用载体pTT5(Addgene公司产品，货号为52326)。首先将抗体的重链和轻链克隆到单独的pTT5载体中。使用化学转染的方法将带有抗体分子重链和轻链的pTT5载体转入293HEK细胞中。采用的化学转染试剂为PEI(购自Polysciences)，按照生产产商提供的方案瞬时转染培养的293HEK。首先在超净工作台中准备质粒DNA和转染试剂，将F17培养基(Gibco)(体积为转染体积的1/5)各一半加入50ml离心管中，一份加入已过滤的质粒(130μg/100ml)，另一半加入已过滤的PEI(1g/L，Polysciences)(质量比(质粒∶PEI)＝1∶3)，混匀5min，将二者轻柔混匀20次，静置15-30min，不要超过30min。将DNA/PEI混合物轻柔倒入293HEK细胞并混匀，在37℃，8％CO2的条件下培养细胞7天，每48小时流加新鲜培养基。7天后或者连续培养至细胞活力≤60％时，13000rpm离心20min。取上清液，用ProteinA纯化上清液，使抗体的纯度＞95％。
Hu5F9重链序列：
Figure PCTCN2021070493-appb-000008
Hu5F9轻链序列：
Figure PCTCN2021070493-appb-000009
3、利妥昔单抗
原研药利妥昔单抗，商品名美罗华，由百健和罗氏制药公司联合生产。IBI301是原研利妥昔单抗的生物类似药，由信达生物制药(苏州)有限公司生产，本发明后续的实施例中采用IBI301作为利妥昔单抗使用。
IBI301的抗体制备方法如下：
根据制造商的说明书，使用
Figure PCTCN2021070493-appb-000010
试剂盒(Invitrogen)产生表达抗体的CHO-S细胞系。首先将抗体分子重链和轻链的DNA序列插入到同一个pCHO1.0质粒中，其中重链在轻链的上游。之后采用化学转染法和电转染法将构建的pCHO1.0质粒转入CHO细胞系。转染后的细胞经过两轮加压筛选得到高表达抗体的细胞池(pool)。之后扩增细胞池，大量表达抗体，并收集细胞上清用Protein A纯化上清液，使抗体的纯度＞95％。
IBI301重链序列：
Figure PCTCN2021070493-appb-000011
IBI301轻链序列：
Figure PCTCN2021070493-appb-000012
Figure PCTCN2021070493-appb-000013
实施例2、Raji肿瘤细胞荷瘤小鼠模型的建立
以PBS(1×)分散Raji淋巴瘤细胞使得细胞密度为10×10 6个/mL，再与Matrigel胶以体积比1∶1混合制备成细胞浓度为5×10 6个/mL的细胞悬液。
NOD-SCID小鼠右侧背部剃毛，皮下注射接种上述细胞悬液，剂量为1×10 6个细胞/0.2mL/只小鼠。
在接种后第7天挑选建模成功(肿瘤体积在44.30mm 3～97.65mm 3)的77只小鼠蛇形分组分为11组，每组7只，各组的给药方案如下：
PBS组：按照10ml/kg的给药体积将PBS腹腔注射给各小鼠，两天一次，连续给药6次。
h-IgG组：将h-IgG用PBS溶解为1.62mg/ml，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
Hu5F9-0.02mg/kg组：将Hu5F9用PBS溶解为0.002mg/ml，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
Hu5F9-0.1mg/kg组：将Hu5F9用PBS溶解为0.01mg/ml，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
抗CD47抗体-0.02mg/kg组：将抗CD47抗体用PBS溶解为0.002mg/ml，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
抗CD47抗体-0.1mg/kg组：将抗CD47抗体用PBS溶解为0.01mg/ml，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
利妥昔单抗-1.5mg/kg组：将利妥昔单抗用PBS溶解为0.15mg/ml，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
Hu5F9+利妥昔单抗-0.02mg/kg+1.5mg/kg组：将Hu5F9和利妥昔单抗用PBS溶解制备含有0.002mg/ml Hu5F9、0.15mg/ml利妥昔单抗的溶液，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
Hu5F9+利妥昔单抗-0.1mg/kg+1.5mg/kg组：将Hu5F9和利妥昔单抗用PBS溶解制备含有0.01mg/ml Hu5F9、0.15mg/ml利妥昔单抗的溶液，按照10 ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
抗CD47抗体+利妥昔单抗-0.02mg/kg+1.5mg/kg组：将抗CD47抗体和利妥昔单抗用PBS溶解制备含有0.002mg/ml抗CD47抗体、0.15mg/ml利妥昔单抗的溶液，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
抗CD47抗体+利妥昔单抗-0.1mg/kg+1.5mg/kg组：将抗CD47抗体和利妥昔单抗用PBS溶解制备含有0.01mg/ml抗CD47抗体、0.15mg/ml利妥昔单抗的溶液，按照10ml/kg的给药体积腹腔注射给各小鼠，两天一次，连续给药6次。
每周监测各组小鼠体重、瘤组织最大长轴(L)和最大宽轴(W)两次，连续监测4周。实验结束后，计算各组小鼠相对肿瘤抑制率。
肿瘤体积测定：
采用游标卡尺测定肿瘤的最大长轴(L)和最大宽轴(W)，肿瘤体积按如下公式计算：V＝L×W 2/2。
相对肿瘤抑制率计算：
肿瘤抑制率TGI(％)＝100％×(对照组给药后肿瘤终末体积-给药组给药后肿瘤终末体积)/(对照组给药后肿瘤终末体积-对照组给药前肿瘤体积)
其中，对照组为h-IgG组。
各组的肿瘤抑制率见表4。
表4肿瘤抑制率(TGI)％
Figure PCTCN2021070493-appb-000014
各组荷瘤小鼠的体重变化率如图1所示。各组对荷瘤小鼠的肿瘤体积抑制如图2所示。低剂量组和高剂量组对荷瘤小鼠的肿瘤体积抑制分别如图3和图4所示。
由表4可知，给药6次后，相对于PBS组和h-IgG组，抗CD47抗体-0.1mg/kg组、抗CD47抗体+利妥昔单抗-0.02mg/kg+1.5mg/kg组以及抗CD47抗体+利妥昔单抗-0.1mg/kg+1.5mg/kg组对Raji荷瘤小鼠肿瘤增长具有明显的抑制作用，瘤体积更小，抗CD47抗体+利妥昔单抗-0.1mg/kg+1.5mg/kg组的药效优于抗CD47抗体+利妥昔单抗-0.02mg/kg+1.5mg/kg组，显示出该肿瘤药效对抗CD47抗体表现出剂量依赖性。另外，抗CD47抗体+利妥昔单抗-0.02mg/kg+1.5mg/kg组、抗CD47抗体+利妥昔单抗-0.1mg/kg+1.5mg/kg组的肿瘤抑制率远高于Hu5F9+利妥昔单抗-0.02mg/kg+1.5mg/kg组、Hu5F9+利妥昔单抗-0.1mg/kg+1.5mg/kg组。
与h-IgG组相比，Hu5F9-0.02mg/kg组和利妥昔单抗-1.5mg/kg没有显示出抗肿瘤效果；Hu5F9-0.1mg/kg组、抗CD47抗体-0.02mg/kg组、抗CD47抗体-0.1mg/kg组的肿瘤抑制率分别为20％、24％和52％；Hu5F9+利妥昔单抗 -0.02mg/kg+1.5mg/kg组、Hu5F9+利妥昔单抗-0.1mg/kg+1.5mg/kg组、抗CD47抗体+利妥昔单抗-0.02mg/kg+1.5mg/kg组、抗CD47抗体+利妥昔单抗-0.1mg/kg+1.5mg/kg组的肿瘤抑制率分别为33％、28％、56％和92％。
抗CD47抗体+利妥昔单抗-0.02mg/kg+1.5mg/kg组小鼠的肿瘤抑制效果强于抗CD47抗体-0.02mg/kg、利妥昔单抗-1.5mg/kg和Hu5F9+利妥昔单抗-0.02mg/kg+1.5mg/kg组；抗CD47抗体+利妥昔单抗-0.1mg/kg+1.5mg/kg组小鼠的肿瘤抑制效果强于抗CD47抗体-0.1mg/kg、利妥昔单抗-1.5mg/kg和Hu5F9+利妥昔单抗-0.1mg/kg+1.5mg/kg组。综上，结果说明抗CD47抗体+利妥昔单抗的肿瘤抑制效果均优于抗CD47抗体单药组和利妥昔单抗单药组，显示出了联用效果，并且相同剂量下，抗CD47抗体+利妥昔单抗联合组的肿瘤抑制效果优于Hu5F9+利妥昔单抗联合组。抗CD47抗体-0.1mg/kg组有1只小鼠肿瘤完全消退；Hu5F9+利妥昔单抗-0.02mg/kg+1.5mg/kg组有1只小鼠肿瘤完全消退；抗CD47抗体+利妥昔单抗-0.1mg/kg+1.5mg/kg组有4只小鼠肿瘤完全消退，表现出极强的肿瘤抑制效果。
由图1可知，抗CD47抗体、利妥昔单抗单药或者联合用药在临床前小鼠模型并未见到明显毒副作用，小鼠体重正常，未出现下降。
由图2、3、4和表4可以看出，抗CD47抗体具有一定的抗肿瘤药效，与利妥昔单抗联用显著增强了其抗肿瘤作用，说明两药联用具有协同效应。并且，在相同剂量的情况下，抗CD47抗体和利妥昔单抗联合用药对荷瘤小鼠肿瘤抑制效果优于Hu5F9和利妥昔单抗联合用药。

Claims (10)

  1. 抗CD47抗体或其抗原结合片段和抗CD20抗体的组合在制备用于预防和/或治疗肿瘤和/或癌症的药物中的应用，其中所述抗CD47抗体为全人源抗CD47单克隆抗体；
    所述全人源抗CD47单克隆抗体包含重链可变区VH和轻链可变区VL，其中所述VH包含互补决定区域HCDR1、HCDR2和HCDR3，HCDR1如SEQ ID NO：3或SEQ ID NO：11所示的氨基酸序列，HCDR2如SEQ ID NO：4所示的氨基酸序列，HCDR3如SEQ ID NO：5或SEQ ID NO：12所示的氨基酸序列；所述VL包含互补决定区域LCDR1、LCDR2和LCDR3，其中LCDR1如SEQ ID NO：6所示的氨基酸序列，LCDR2如SEQ ID NO：7所示的氨基酸序列，LCDR3如SEQ ID NO：8所示的氨基酸序列。
  2. 根据权利要求1所述的应用，其特征在于：所述重链可变区VH包含SEQ ID NO：9所示的氨基酸序列或与其具有至少90％、95％、98％或99％同一性的序列，所述轻链可变区VL包含SEQ ID NO：10所示的序列或与其具有至少90％、95％、98％或99％同一性的序列；
    优选地，所述重链可变区VH的氨基酸序列如SEQ ID NO：9所示，所述轻链可变区VL的氨基酸序列如SEQ ID NO：10所示。
  3. 根据权利要求1所述的应用，其特征在于：所述全人源抗CD47单克隆抗体包含重链和轻链，所述重链包含SEQ ID NO：1所示的氨基酸序列或与之具有至少90％、95％、98％或99％同一性的氨基酸序列，以及所述轻链包含SEQ ID NO：2所示的氨基酸序列或与之具有至少90％、95％、98％或99％同一性的氨基酸序列；
    优选地，所述重链具有如SEQ ID NO：1所示的氨基酸序列，所述轻链具有如SEQ ID NO：2所示的氨基酸序列。
  4. 根据权利要求1-3任一项所述的应用，其特征在于：所述抗CD20抗体为抗CD20单克隆抗体；
    优选地，所述抗CD20单克隆抗体为奥滨尤妥珠单抗(obinutuzumab)、替伊莫单抗(ibritumomab tiuxetan)、奥法木单抗(ofatumumab)、托西莫单抗(tositumomab)、奥美珠单抗(ocre1izumab)或利妥昔单抗(rituximab)；
    优选地，所述抗CD20单克隆抗体为利妥昔单抗。
  5. 一种单次药物剂量单元，其包括有效量的权利要求1-4中任一项所述 的抗CD47抗体或其抗原结合片段和抗CD20抗体。
  6. 一种药物组合物，其包含有效量的权利要求1-4中任一项所述的抗CD47抗体或其抗原结合片段和抗CD20抗体的组合和药学上可接受的载体。
  7. 一种成套药盒，其包含有效量的权利要求1-4中任一项所述的抗CD47抗体或其抗原结合片段和抗CD20抗体的组合、权利要求5所述的单次药物剂量单元或权利要求6所述的药物组合物；
    优选地，在同一包装内其包含：
    -含有用于胃肠外施用的药物组合物的第一容器，所述药物组合物包含所述的抗CD47抗体；
    -含有用于胃肠外施用的药物组合物的第二容器，所述药物组合物包含所述的抗CD20抗体。
  8. 权利要求1-4中任一项所述的抗CD47抗体或其抗原结合片段和抗CD20抗体的组合、权利要求5所述的单次药物剂量单元、权利要求6所述的药物组合物或权利要求7所述的成套药盒在制备用于预防和/或治疗肿瘤和/或癌症的药物中的应用；
    优选地，所述肿瘤和/或癌症为血液瘤，更优选为淋巴瘤，进一步优选为CD20阳性非霍奇金淋巴瘤。
  9. 抗CD47抗体在制备增强抗CD20抗体预防和/或治疗肿瘤和/或癌症疗效的产品中的应用；
    优选地，所述抗CD47抗体为权利要求1-3中任一项所述的抗CD47抗体；
    优选地，所述抗CD20抗体为权利要求4中所述的抗CD20抗体；
    优选地，所述肿瘤为血液瘤，更优选为淋巴瘤，进一步优选为CD20阳性非霍奇金淋巴瘤。
  10. 一种预防和/或治疗肿瘤和/或癌症的方法，包括将有效量的权利要求1-4中任一项所述的抗CD47抗体或其抗原结合片段和抗CD20抗体的组合、权利要求5所述的单次药物剂量单元、权利要求6所述的药物组合物或权利要求7所述的成套药盒施用给个体的步骤。
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