Methods for treating conditions associated with masp-2 dependent complement activation

Description of Sequence Listing The sequence listings related to this application are provided in text form instead of hard copy and are incorporated herein by reference. The name of the text file containing the sequence listing is MP_1_0220_PCT_Sequence_Listing_20141015_ST25.txt. This text file is 115 KB, created on October 15, 2014, and submitted via EFS-Web with the application of this specification.

Background The complement system provides an initial mechanism of action for initiating, amplifying, and organizing an immune response against microbial infections and other acute invasions in humans and other vertebrates (MK Liszewski and JP Atkinson, 1993, in). Fundamental Immunology, Third Edition, WE, Paul ed., Raven Press, Ltd., New York). While complement activation provides beneficial first-line protection against potential pathogens, complement activity that promotes a protective immune response can pose 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 proteolytic products recruit and activate neutrophils. Activated neutrophils are essential for host defense but indiscriminately release destructive enzymes and can cause organ damage. In addition, complement activation may result in the deposition of soluble complement components on the surface of nearby host cells as well as microbial targets, resulting in lysis of the host cells.

The co-system also includes myocardial infarction, stroke, ARDS, reperfusion injury, septic shock, capillary leakage after burns, post-cardiopulmonary bypass inflammation, transplant rejection, rheumatoid arthritis, multiple sclerosis, severe myasthenia, And is involved in the development of numerous acute and chronic disease states, including Alzheimer's disease. In almost all of these conditions, complement is not the cause, but is one of several factors involved in development. Nevertheless, complement activation is considered to be the major pathological mechanism and is an effective point for clinical management in many of these disease states. The growing awareness that complement-mediated tissue damage is important in a variety of disease states underscores the need for effective complement inhibitor drugs. To date, the anti-C5 antibody eculizumab (Solaris®) is the only complement-targeted drug approved for use in humans. However, C5 is one of several effector molecules located "downstream" of the complement system, and blockade of C5 does not inhibit complement system activation. Therefore, inhibitors of the initiation process of complement activation appear to be significantly superior to "downstream" complement inhibitors.

It is now widely accepted that the complement system can be activated via three different pathways: the classical pathway, the lectin pathway, and the second pathway. The classical pathway is usually elicited by a complex of host antibodies bound to foreign particles (ie, the antigen) and therefore requires pre-exposure to the antigen to generate a specific antibody response. The classical pathway is part of the acquired immune system, as activation of the classical pathway depends on the host's previously acquired immune response. In contrast, both the lectin and second pathways are independent of acquired immunity and are part of the innate immune system.

Activation of the complement system results in successive activation of the serine protease zymogen. The first step in classical pathway activation is the binding of the specific recognition molecule C1q to antigen-bound IgG and IgM molecules. C1q binds to C1r and C1s serine protease proenzymes as a complex called C1. Binding of C1q to the immune complex results in C1r-mediated cleavage and activation of C1s after the Arg-Ile site of C1r is cleaved by autoproteolysis, thereby allowing the ability to cleave C4 and C2. Acquired. C4 is cleaved into two pieces called C4a and C4b, and similarly C2 is cleaved into C2a and C2b. The C4b fragment can covalently bind to adjacent hydroxyl or transamination groups and generate C3 convertase (C4b2a) through non-covalent interaction with the C2a fragment of activated C2. C3 convertase (C4b2a) activates C3 by protein cleavage into C3a and C3b minor components, resulting in the production of C5 convertase (C4b2a3b), and C5 convertase (C4b2a3b) disrupts the cell membrane by cleaving C5. It results in the formation of a complement membrane attack complex (C5b is combined with C6, C7, C8, and C9, also called "MAC") that can result in cell lysis. Activated forms of C3 and C4 (C3b and C4b) are covalently deposited on the surface of foreign targets and are recognized by complement receptors on multiple phagocytes.

Independently, the first step in complement system activation via the lectin pathway is also the binding of specific recognition molecules, followed by the activation of related serine protease proenzymes. However, the recognition molecules of the lectin pathway, rather than the binding of immune complexes by C1q, are carbohydrate-binding proteins collectively called lectins (mannan-binding lectin (MBL), H-ficolin, M-ficolin, L-ficolin, and C. Includes a group of type lectins 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: See 225-232 (2000)). J. Luet et al., Biochim Biophys Acta 1572: 387-400 (2002); Holmskov et al., Annu. Rev. Immunol. See also 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. For the first time demonstrated that MBL, like C1q, can activate the complement system in a C4-dependent manner when bound to yeast mannan-coated erythrocytes (Ikeda et al., J. Biol. Chem. 262: 7451). -7454, (1987)). MBL, a member of the collectin protein family, is a calcium-dependent lectin that binds carbohydrates with 3-hydroxy and 4-hydroxy groups oriented to the equatorial junction of the pyranose ring. Thus, the prominent ligands for MBL are D-mannose and N-acetyl-D-glucosamine, whereas carbohydrates that do not meet this steric requirement have an undetectable affinity for MBL (Weis et. al., Nature 360: 127-134, (1992)). The interaction between MBL and monovalent sugar is extremely weak, with dissociation constants typically in the single-digit millimole range. MBL achieves close and specific binding to glycan ligands by avidity, ie, by interacting with multiple monosaccharide residues located close to each other at the same time (Lee et al., Archiv. Biochem. Biophys. 299: 129-136, (1992)). MBL generally recognizes carbohydrate patterns that decorate microorganisms, such as bacteria, yeast, parasites, and certain viruses. In contrast, MBL is the penultimate and last sugar that decorates the "mature" complex glycoproteins normally present on mammalian plasma glycoproteins and cell surface glycoproteins, D-galactose and Does not recognize sialic acid. This binding specificity is thought to promote recognition of "foreign" surfaces and help protect them from "self-activation". However, MBL binds with high affinity to clusters of high mannose "precursor" glycans in N-linked glycoproteins and glycolipids sequestered in the endoplasmic reticulum and Golgi of mammalian cells (Maynard et al., J. et al. Biol. Chem. 257: 3788-3794, (1982)). Therefore, damaged cells are a potential target for lectin pathway activation via MBL binding.

Fibrinogen has a different type of lectin domain than MBL, called the fibrinogen-like domain. Ficholine is Ca⁺⁺It binds to sugar residues independently. In humans, three types of ficholine (L-ficolin, M-ficolin, and H-ficolin) have been identified. The two serum ficholines, L-ficolin and H-ficolin, commonly have specificity for N-acetyl-D-glucosamine. However, H-ficholine also binds to N-acetyl-D-galactosamine. The different sugar specificities of L-ficolin, H-ficolin, CL-11, and MBL mean that different lectins can complement each other and target different complex sugars by duplication. This idea is supported by recent reports that only L-phycholine, a known lectin in the lectin pathway, specifically binds to lipoteichoic acid, a cell wall complex sugar found in all Gram-positive bacteria. (Lynch et al., J. Immunol. 172: 1198-1202, (2004)). Collectin (ie, MBL) and ficholine do not have significant similarities in amino acid sequences. However, these two protein groups have similar domain configurations and assemble like C1q to construct oligomeric structures that maximize the potential for multisite binding.

Serum levels of MBL vary considerably in healthy populations, which are genetically regulated by polymorphisms / mutations in both the promoter and coding regions of the MBL gene. As an acute phase protein, MBL expression is further upregulated during inflammation. L-Ficholine is present in serum at approximately the same concentration as MBL. Therefore, the L-ficolin branch of the lectin pathway is in some cases comparable in strength to the MBL sector. MBL and ficholine can also function as opsonins. This allows phagocytes to target surfaces decorated with MBL and surfaces decorated with ficholine (Jack et al., J Leukoc Biol., 77 (3): 328-36 ( 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 phagocytic receptors (Kuhlman et al., J. Exp. Med. 169: 1733, (1989); Matsushita et al., J. Biol. Chem. 271: 2448-54, (1996)). The identity of the phagocytic receptor has not been proven.

Through its collagen-like domain, human MBLs undergo specific and high-affinity interactions with unique C1r / C1s-like serine proteases called MBL-associated serine proteases (MASPs). To date, three types of MASP have been mentioned. First, the single enzyme "MASP" was identified and characterized as the enzyme responsible for the initiation of the complement cascade (ie, cleavage of C2 and C4) (Matsushita et al., J Exp Med 176 (6)). : 1497-1502 (1992): Ji et al., J. Immunol 150: 571-578, (1993)). Later, it was revealed that the MASP activity was actually a mixture of two proteases: MASP-1 and MASP-2 (Thiel et al., Nature 386: 506-510, (1997)). However, the MBL-MASP-2 complex alone proved to be sufficient for complement activation (Vorup-Jensen et al., J. Immunol 165: 2093-2100, (2000)). In addition, only MASP-2 cleaved C2 and C4 at a high rate (Ambrus et al., J. Immunol, 170: 1374-1382, (2003)). Therefore, MASP-2 is a protease responsible for activating C4 and C2 to produce the C3 convertase C4b2a. This is a major difference from the C1 complex of the classical pathway, in which the coordination of two specific serine proteases (C1r and C1s) leads to complement system activation. In addition, a third novel protease, MASP-3, has been isolated (Dahl, MR et al., Immunity 15: 127-35, 2001). MASP-1 and MASP-3 are alternative splicing products of the same gene.

MASP has the same domain structure as the domain structure of C1r and C1s, which are the enzyme components of the C1 complex (Sim et al., Biochem. Soc. Trans. 28: 545, (2000)). These domains are the N-terminal C1r / C1s / sea urchin VEGF / bone morphogenetic protein (CUB) domain, epithelial cell growth factor-like domain, second CUB domain, columnar sequence of complement regulatory protein domains, and serine. Contains a protease domain. Similar to C1 protease, activation of MASP-2 is caused by cleavage of the Arg-Ile bond adjacent to the serine protease domain. By this cleavage, the enzyme is divided into disulfide-bonded A and B chains. The latter consists of a serine protease domain.

MBL can also bind to alternative splicing MASP-2, known as a 19 kDa MBL-related protein (MAp19) or small MBL-related protein (sMAP), which lacks the catalytic activity of MASP2 (Stover, J. Immunol. 162: 3481-90, (1999); Takahashi et al., Int. Immunol. 11: 859-863, (1999)). MAp19 contains an extra sequence of four unique amino acids, following the first two domains of MASP-2. The function of Map 19 is unknown (Degn et al., J. Immunol. Methods. 2011). The MASP-1 and MASP-2 genes are located on human chromosomes 3 and 1 respectively (Schwaeble et al., Immunobiology 205: 455-466, (2002)).

Some evidence suggests that there are different MBL-MASP complexes and that the majority of MASPs in serum do not form a complex with MBL (Thiel. Et al., J. Immunol. 165: 878-887, (2000)). Both H-ficolin and L-ficolin, like MBL, 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 classical pathways form a common C3 convertase (C4b2a), and the two pathways become one at this stage.

The lectin pathway is widely believed to play a major role in host defense against infectious diseases in naive hosts. Strong evidence of MBL involvement in host defense was obtained from the analysis of patients with low serum levels of functional MBL (Kilpatrick, Biochim. Biophys. Acta 1572: 401-413, (2002)). Such patients are susceptible to recurrent bacterial and fungal infections. These symptoms usually appear at an early age, when maternal antibody titers taper off, but during the apparent vulnerable period before the development of the entire repertoire of antibody responses. This syndrome is often due to mutations at several sites in the MBL collagen moiety, which interfere with the proper formation of MBL oligomers. However, since MBL can function as opsonin independently of complement, it is not known to what extent the increased susceptibility to infection is due to impaired complement activation.

In contrast to the classical and lectin pathways, it has not been found that the initiation factors of the second pathway perform the cognitive functions that C1q and lectins perform in the other two stages. It is now widely accepted that the second pathway is spontaneously subject to low levels of turnover activation. This turnover activation can be easily amplified on foreign or other abnormal surfaces (bacteria, yeast, virus-infected cells, or damaged tissue) that lack the appropriate molecular elements to suppress spontaneous complement activation. it can. There are four plasma proteins that are directly involved in second pathway activation: factors C3, B and D, and propeldin.

Although there is widespread evidence that both the classical and second complement pathways are involved in the development of non-infectious human disease, the role of the lectin pathway is just beginning to be evaluated. Recent studies have provided evidence that activation of the lectin pathway may be responsible for complement activation and associated inflammation in ischemic / reperfusion injury. Collard et al., (2000) reported that cultured endothelial cells subjected to oxidative stress bind to MBL and show C3 deposition when exposed to human serum (Collard et al., Am. J. Pathol 156: 1549-1556, (2000)). In addition, treatment of human serum with a blocking anti-MBL monoclonal antibody inhibited MBL binding and complement activation. These findings were extended to a rat myocardial ischemia-reperfusion model. In this model, rats treated with blocking antibody against rat MBL showed significantly less myocardial damage during coronary artery occlusion than control antibody-treated rats (Jordan et al., Circulation, 104: 1413-1418, (2001). )). The molecular mechanism of MBL binding to the vascular endothelium after oxidative stress is unknown. Recent studies suggest that activation of the lectin pathway after oxidative stress is mediated by MBL binding to vascular endothelial cytokeratin, but may not be mediated by complex sugars (Collard e al. , Am. J. Pathol. 159: 1045-1054, (2001)). Other studies have shown that the classical and second pathways are involved in the development of ischemic / 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).

Recent studies have shown that MASP-1 (and possibly MASP-3) is required to convert factor D, the second pathway activating enzyme, from the enzyme precursor form to the enzyme active form. (See Takahashi M. et al., J Exp Med 207 (1): 29-37 (2010)). The physiological importance of this process is emphasized by the absence of functional second pathway activity in the plasma of MASP-1 / 3-deficient mice. The second pathway needs to function for proteolysis to produce C3b from natural C3. Since the second pathway C3 convertase (C3bBb) contains the essential subunit C3b, the question of the origin of the first C3b via the second pathway is a mysterious question and has energized extensive research.

C3 belongs to a family of proteins containing rare post-translational modifications known as thioester bonds (along with C4 and α-2 macroglobulins). The thioester group consists of a sulfhydryl group of cysteine 3 amino acids apart and glutamine having a terminal carbonyl group forming a thioester covalent bond. This bond is unstable and the electrophilic glutamil-thioester can react with nucleophilic moieties such as hydroxyl or amino groups and thus form covalent bonds with other molecules. The thioester bond is fairly stable when isolated in the hydrophobic pocket of intact C3. However, when C3 is cleaved into C3a and C3b by proteolysis, highly reactive thioester bonds are exposed on C3b and C3b is shared with the target after nucleophilic attack by adjacent moieties containing hydroxyl or transamination groups. Join. C3 thioesters are thought to play a central role in the induction of the second pathway, in addition to their well-recorded role in covalent binding of C3b to complement targets. The widely accepted "tick-over" According to theory), the second pathway is C3 (iC3; C3 (H) with hydrolyzed thioesters.₂It is initiated by the development of the liquid phase convertase iC3Bb formed from O)) and factor B (Lachmann, PJ, et al., Springer Semin. Immunopathol. 7: 143-162, (1984)). C3b-like C3 (H₂O) is produced from natural C3 by the slow spontaneous hydrolysis of the internal thioesters in this protein (Pangburn, MK, et al., J. Exp. Med. 154: 856-867, 1981). .. C3 (H₂O) The activity of Bb convertase deposits the C3b molecule on the target surface, thereby initiating the second pathway.

Little is known about the initiation factors for second pathway activation. Activators are believed to include yeast cell walls (Zymosan), many pure polysaccharides, rabbit erythrocytes, certain immunoglobulins, viruses, fungi, bacteria, animal tumor cells, parasites, and damaged cells. The only feature common to these activators is the presence of carbohydrates, but due to the complexity and diversity of carbohydrate structures, it is difficult to prove a common molecular determinant recognized. Second pathway activation is due to a delicate balance between inhibitory regulators of this pathway, such as factors H, I, DAF, and CR1 and propeldin, the only positive regulator of the second pathway. It is widely accepted to be controlled (see Schwaeble WJ and Reid KB, Immunol Today 20 (1): 17-21 (1999)).

In addition to the apparently disordered activation mechanism described above, the second pathway is the lectin / classical pathway C3, as the C3b produced, along with factor B, can be involved in the formation of additional second pathway C3 convertases (C3bBb). A strong amplification loop of the convertase (C4b2a) can also be provided. The second pathway C3 convertase is stabilized by properdin binding. Properzine prolongs the half-life of the second pathway C3 convertase by 6-10 fold. Addition of C3b to the second pathway C3 convertase forms the second pathway C5 convertase.

All three pathways (ie, the classical pathway, the lectin pathway, and the second pathway) have been thought to be one in C5, which is cleaved to form products with multiple pro-inflammatory effects. The united pathway has been called the terminal complement pathway. C5a is the most potent anaphylatoxin that induces changes in smooth muscle and vascular tone as well as vascular permeability. It is also a potent neutrophil and monocyte chemotaxin and activator. C5a-mediated cell activation can significantly amplify the inflammatory response by inducing the release of multiple additional inflammatory mediators, including cytokines, hydrolases, arachidonic acid metabolites, and reactive oxygen species. When C5 is cleaved, C5b-9, also known as a complement membrane attack complex (MAC), is formed. Currently, there is strong evidence that sublytic MAC deposition, which is insufficient to cause lysis, can play an important role in inflammation in addition to its role as a soluble pore-forming complex.

The complement system contributes to tissue damage in many clinical conditions, in addition to its essential role in immune defense. Therefore, there is an urgent need to develop therapeutically effective complement inhibitors to prevent these side effects.

Overview This overview is provided to briefly introduce a wide range of concepts further explained in the detailed description below. This summary is intended to identify important features of the subject matter described in the claims and is also used to assist in determining the scope of the subject matter stated in the claims. It is not intended to be.

In one aspect, the invention is a method of inhibiting MASP-2 dependent complement activation in a subject suffering from thrombotic microangiopathy (TMA) or at risk of developing the TMA. The subject comprises the step of administering to the subject a composition comprising an amount of a MASP-2 inhibitor effective to inhibit MASP-2 dependent complement activation, wherein the TMA is (i) secondary to cancer; Provided is a method that is at least one of (ii) TMA secondary to chemotherapy or (iii) TMA secondary to transplantation. In some embodiments, the subject has or is at risk of developing TMA secondary to cancer, and MASP-2 inhibitors reduce the risk of developing TMA, or of TMA. It is administered systemically to the subject in an amount effective to reduce the severity. In some embodiments, the subject has or is at risk of developing TMA secondary to chemotherapy, and the MASP-2 inhibitor reduces the risk of developing TMA or TMA. It is administered systemically to the subject before, during, or after chemotherapy in an amount effective to reduce the severity of the disease. In some embodiments, the subject has or is at risk of developing TMA secondary to transplantation, and the MASP-2 inhibitor reduces the risk of developing TMA or TMA. It is administered systemically to the subject before, during, or after the transplant procedure in an amount effective to reduce the severity of the disease. In some embodiments, the transplant procedure is an allogeneic hematopoietic stem cell transplant. In some embodiments, the subject has previously been or is currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5. In some embodiments, the method further comprises administering to the subject a terminal complement inhibitor that inhibits cleavage of the complement protein C5, such as a humanized anti-C5 antibody or antigen-binding fragment thereof, such as eculizumab. ..

In another aspect, the invention comprises a composition comprising an effective amount of a MASP-2 inhibitor to inhibit MASP-2 dependent complement activation, Upshaw-Schulman Syndrome (Upshaw-Schulman Syndrome). Provided is a method of inhibiting MASP-2 dependent complement activation in a subject suffering from USS) or comprising the step of administering to a subject at risk of developing the USS. In some embodiments, the method comprises treating a subject at risk of developing USS and in an amount effective in ameliorating or preventing one or more clinical symptoms associated with TTP. It comprises the step of administering the MASP-2 inhibitor over a period of time effective to ameliorate or prevent the clinical condition. In some embodiments, the method involves regular monitoring of the subject and administration of a MASP-2 inhibitor based on the presence of an event known to be associated with the induction of TTP clinical manifestations. Including further. In some embodiments, the method further comprises the step of regularly monitoring the subject and the step of administering a MASP-2 inhibitor based on the determination that anemia, thrombocytopenia, or increased creatinine is present. .. In some embodiments, the subject has previously been or is currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5. In some embodiments, the method further comprises administering to the subject a terminal complement inhibitor that inhibits cleavage of the complement protein C5, such as a humanized anti-C5 antibody or antigen-binding fragment thereof, such as eculizumab. ..

In another aspect, the present invention comprises administering to a subject suffering from Degos disease a composition comprising an effective amount of a MASP-2 inhibitor to inhibit MASP-2 dependent complement activation. Provided are methods of inhibiting MASP-2 dependent complement activation in the subject, including. In some embodiments, the subject has previously been or is currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5. In some embodiments, the method further comprises administering to the subject a terminal complement inhibitor that inhibits cleavage of the complement protein C5, such as a humanized anti-C5 antibody or antigen-binding fragment thereof, such as eculizumab. ..

In another aspect, the invention presents a composition containing an effective amount of a MASP-2 inhibitor to inhibit MASP-2 dependent complement activation into fulminant antiphospholipid antibody syndrome (CAPS). Provided is a method of inhibiting MASP-2-dependent complement activation in an affected subject, comprising the step of administering to the subject. In some embodiments, the subject has previously been or is currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5. In some embodiments, the method further comprises administering to the subject a terminal complement inhibitor that inhibits cleavage of the complement protein C5, such as a humanized anti-C5 antibody or antigen-binding fragment thereof, such as eculizumab. ..

In some aspects of any of the disclosed methods of the invention, the MASP-2 inhibitor is a MASP-2 inhibitory antibody or fragment thereof. In some embodiments, the MASP-2 inhibitory antibody has reduced effector function. In some embodiments, the MASP-2 inhibitory antibody does not substantially inhibit the classical pathway. In some embodiments, the MASP-2 inhibitor is an anti-MASP-2 monoclonal antibody or fragment thereof that specifically binds to a portion of SEQ ID NO: 6. In some embodiments, the anti-MASP-2 antibody or fragment thereof is selected from the group consisting of recombinant antibodies, antibodies with reduced effector function, chimeric antibodies, humanized antibodies, and human antibodies. In some embodiments, the MASP-2 inhibitory antibody is Fv, Fab, Fab', F (ab).₂, And F (ab')₂It is an antibody fragment selected from the group consisting of. In some embodiments, the MASP-2 inhibitory antibody is a single chain molecule. In some embodiments, the MASP-2 inhibitory antibody is selected from the group consisting of 1 IgG molecule, 2 IgG molecules, and 4 IgG molecules. In some embodiments, the MASP-2 inhibitory antibody is an IgG4 molecule containing the S228P mutation. In some embodiments, the MASP-2 inhibitory antibody has a K of 10 nM or less._DTo bind human MASP-2. In some embodiments, the MASP-2 inhibitory antibody binds an epitope in the CCP1 domain of MASP-2. In some embodiments, the MASP-2 inhibitory antibody results in an IC of 10 nM or less C3b deposition in 1% human serum in an in vitro assay.₅₀Inhibit with. In some embodiments, MASP-2 inhibitory antibodies have an IC of 30 nM or less C3b deposition in 90% human serum.₅₀Inhibit with.

In some embodiments of any of the disclosed methods of the invention, the MASP-2 inhibitory monoclonal antibody or antigen-binding fragment thereof comprises the amino acid sequences 31-35 of (a) (i) SEQ ID NO: 67. Heavy chain CDR-H1; and (ii) Heavy chain containing the amino acid sequence of 50-65 of SEQ ID NO: 67; and (iii) Heavy chain containing the amino acid sequence of 95-102 of SEQ ID NO: 67 Heavy chain variable region containing CDR-H3, and light chain CDR-L1; containing (b) (i) the amino acid sequence of 24-34 of SEQ ID NO: 70; and (ii) 50 of SEQ ID NO: 70. Includes a light chain variable region comprising a light chain CDR-L2 comprising an amino acid sequence of ~ 56; and a light chain CDR-L3 comprising an amino acid sequence of 89-97 of (iii) SEQ ID NO: 70. In some embodiments, the MASP-2 inhibitory monoclonal antibody comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. In some embodiments, the MASP-2 inhibitory antibody or antigen-binding fragment thereof is the heavy chain variable region and SEQ ID shown in SEQ ID NO: 67. It specifically recognizes at least a portion of the epitope recognized by the reference antibody containing the light chain variable region shown in NO: 70.

In another aspect of the invention, an amount of MASP-2 inhibitory antibody or antigen-binding fragment thereof effective in inhibiting MASP-2 dependent complement activation suffers from atypical hemolytic urinary syndrome (aHUS). A method for inhibiting thrombosis in a subject is provided, comprising the step of administering to the subject. In some embodiments, the MASP-2 inhibitory antibody inhibits thrombus formation in serum from a subject suffering from aHUS by at least 40% compared to untreated serum. In some embodiments, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from aHUS rather than the inhibitory effect of the antibody on C5b-9 deposition in serum from the same subject. Inhibits at a level that is at least 20% higher (eg, at least 30% higher, at least 40% higher, or at least 50% higher). In some embodiments, the subject is in the acute phase of aHUS. In some embodiments, the subject is in remission of aHUS. In some embodiments, the MASP-2 inhibitory antibody is a SEQ ID. A monoclonal antibody or fragment thereof that specifically binds to a part of NO: 6. In some embodiments, the MASP-2 inhibitory antibody or fragment thereof is selected from the group consisting of recombinant antibodies, antibodies with reduced effector function, chimeric antibodies, humanized antibodies, and human antibodies. In some embodiments, the MASP-2 inhibitory antibody is Fv, Fab, Fab', F (ab).₂, And F (ab')₂It is an antibody fragment selected from the group consisting of. In some embodiments, the MASP-2 inhibitory antibody is a single chain molecule. In some embodiments, the MASP-2 inhibitory antibody is selected from the group consisting of 1 IgG molecule, 2 IgG molecules, and 4 IgG molecules. In some embodiments, the MASP-2 inhibitory antibody is an IgG4 molecule containing the S228P mutation. In some embodiments, the MASP-2 inhibitory antibody has a K of 10 nM or less._DTo bind human MASP-2. In some embodiments, the MASP-2 inhibitory antibody binds an epitope in the CCP1 domain of MASP-2. In some embodiments, the MASP-2 inhibitory antibody results in an IC of 10 nM or less C3b deposition in 1% human serum in an in vitro assay.₅₀Inhibit with. In some embodiments, MASP-2 inhibitory antibodies have an IC of 30 nM or less C3b deposition in 90% human serum.₅₀Inhibit with. In some embodiments, the MASP-2 inhibitory monoclonal antibody or antigen-binding fragment thereof is a heavy chain CDR-H1; and (ii) SEQ comprising the amino acid sequences 31-35 of (a) (i) SEQ ID NO: 67. Heavy chain variable region containing heavy chain CDR-H2 containing the amino acid sequence of 50-65 of ID NO: 67; and (iii) SEQ ID NO: 67 containing the heavy chain CDR-H3 containing the amino acid sequence of 95-102. And (b) (i) Light chain CDR-L1 containing the amino acid sequence of 24-34 of SEQ ID NO: 70; and (ii) Light chain CDR-L2 containing the amino acid sequence of 50-56 of SEQ ID NO: 70. ; And (iii) Containing a light chain variable region comprising the light chain CDR-L3 comprising the amino acid sequence of 89-97 of SEQ ID NO: 70. In some embodiments, the MASP-2 inhibitory monoclonal antibody comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. In some embodiments, the MASP-2 inhibitory antibody or antigen-binding fragment thereof is the heavy chain variable region and SEQ ID shown in SEQ ID NO: 67. It specifically recognizes at least a portion of the epitope recognized by the reference antibody containing the light chain variable region shown in NO: 70.

In another aspect, the invention inhibits the side effects of MASP-2 dependent complement activation, including therapeutically effective amounts of MASP-2 inhibitors such as MASP-2 inhibitory antibodies and pharmaceutically acceptable carriers. The composition for this is provided. Also provided is a method for making a drug for use in inhibiting the side effects of MASP-2 dependent complement activation in a living subject in need thereof, the drug being treated in a pharmaceutical carrier. Contains an effective amount of MASP-2 inhibitor. Also provided is a method for producing a medicament for use in inhibiting MASP-2-dependent complement activation for the treatment of each of the conditions, diseases, and disorders described herein below. ..

The methods, compositions, and medicaments of the present invention include mammals including humans suffering from thrombotic microangiopathy (TMA) or at risk of developing the TMA, as further described herein. It is useful for inhibiting the side effects of MASP-2-dependent complement activation in vivo in a subject.

[Invention 1001]

A method of inhibiting MASP-2 dependent complement activation in subjects suffering from thrombotic microangiopathy (TMA) or at risk of developing the TMA, the MASP-2 dependent complement activity. The subject comprises the step of administering to the subject a composition comprising an amount of a MASP-2 inhibitor effective to inhibit the formation, wherein the TMA is (i) secondary to cancer; (ii) secondary to chemotherapy. TMA; or (iii) a method that is at least one of the TMAs secondary to transplantation.

[Invention 1002]

The subject has or is at risk of developing TMA secondary to cancer, and the MASP-2 inhibitor reduces the risk of developing TMA or the severity of TMA. The method of the present invention 1001 which is systemically administered to the subject in an amount effective to reduce.

[Invention 1003]

The subject suffers from or is at risk of developing TMA secondary to chemotherapy, and the MASP-2 inhibitor reduces the risk of developing TMA or is severe of TMA. The method of the invention 1001 which is systemically administered to the subject before, during, or after chemotherapy in an amount effective to reduce the degree.

[Invention 1004]

The subject suffers from or is at risk of developing TMA secondary to transplantation, and the MASP-2 inhibitor reduces the risk of developing TMA or the severity of TMA. The method of the present invention 1001 which is systemically administered to the subject before, during, or after the transplantation procedure in an amount effective to reduce.

[Invention 1005]

The method of 1001 of the present invention, wherein the MASP-2 inhibitor is an anti-MASP-2 antibody or fragment thereof.

[Invention 1006]

The method of 1001 of the present invention, wherein the MASP-2 inhibitor is an anti-MASP-2 monoclonal antibody or fragment thereof that specifically binds to a portion of SEQ ID NO: 6.

[Invention 1007]

The method of the invention 1001 wherein said subject has previously been or is currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5.

[Invention 1008]

The method of the present invention 1001 further comprises the step of administering to said subject a terminal complement inhibitor that inhibits cleavage of complement protein C5.

[Invention 1009]

The method of the present invention 1008, wherein the terminal complement inhibitor is a humanized anti-C5 antibody or an antigen-binding fragment thereof.

[Invention 1010]

The method of the present invention 1008, wherein the terminal complement inhibitor is eculizumab.

[Invention 1011]

The method of the present invention 1008, wherein the antibody or fragment thereof is selected from the group consisting of recombinant antibodies, antibodies with reduced effector function, chimeric antibodies, humanized antibodies, and human antibodies.

[Invention 1012]

The method of 1001 of the present invention, wherein the composition is administered subcutaneously, intramuscularly, intraarterically, intravenously, or as an inhalant.

[Invention 1013]

The method of the present invention 1001 wherein the transplant is an allogeneic hematopoietic stem cell transplant.

[Invention 1014]

A composition containing an amount of MASP-2 inhibitor effective to inhibit MASP-2 dependent complement activation in a subject suffering from Upshaw-Schulman syndrome (USS) or developing the USS. A method of inhibiting MASP-2-dependent complement activation in a subject, comprising the step of administering to the subject at risk.

[Invention 1015]

An amount of MASP-2 inhibitor that is effective in ameliorating or preventing one or more clinical symptoms associated with TTP, including the step of treating a subject at risk of developing USS. The method of the present invention 1014, comprising the step of administering over a period of time effective to ameliorate or prevent.

[Invention 1016]

The method of the present invention 1014 or 1015, wherein the MASP-2 inhibitor is an anti-MASP-2 antibody or fragment thereof.

[Invention 1017]

The method of the present invention 1016, wherein the MASP-2 inhibitor is an anti-MASP-2 monoclonal antibody or fragment thereof that specifically binds to a portion of SEQ ID NO: 6.

[Invention 1018]

The method of the invention 1014, wherein the subject has previously or is currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5.

[Invention 1019]

The method of the present invention 1014 further comprising the step of administering to said subject a terminal complement inhibitor that inhibits cleavage of complement protein C5.

[Invention 1020]

The method of the present invention 1019, wherein the terminal complement inhibitor is a humanized anti-C5 antibody or an antigen-binding fragment thereof.

[Invention 1021]

The method of the present invention 1019, wherein the terminal complement inhibitor is eculizumab.

[Invention 1022]

The method of the invention 1015, further comprising the step of periodically monitoring the subject and the step of administering the MASP-2 inhibitor based on the determination that anemia, thrombocytopenia, or increased creatinine is present.

[Invention 1023]

The method of the invention 1015 further comprising the step of periodically monitoring the subject and the step of administering the MASP-2 inhibitor based on the presence of an event known to be associated with the induction of TTP clinical symptoms. ..

[1024 of the present invention]

MASP-2 in a subject comprising the step of administering to a subject suffering from Degos' disease a composition comprising an amount of a MASP-2 inhibitor effective in inhibiting MASP-2 dependent complement activation. A method of inhibiting dependent complement activation.

[Invention 1025]

The method of 1024 of the present invention, wherein the MASP-2 inhibitor is an anti-MASP-2 antibody or fragment thereof.

[Invention 1026]

The method of the present invention 1025, wherein the MASP-2 inhibitor is an anti-MASP-2 monoclonal antibody or fragment thereof that specifically binds to a portion of SEQ ID NO: 6.

[Invention 1027]

The method of 1024 of the present invention, wherein said subject has previously been or is currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5.

[Invention 1028]

The method of 1024 of the present invention further comprising the step of administering to said subject a terminal complement inhibitor that inhibits cleavage of complement protein C5.

[Invention 1029]

The method of the present invention 1028, wherein the terminal complement inhibitor is a humanized anti-C5 antibody or an antigen-binding fragment thereof.

[Invention 1030]

The method of the present invention 1028, wherein the terminal complement inhibitor is eculizumab.

[Invention 1031]

The method of the present invention 1025, wherein the antibody or fragment thereof is selected from the group consisting of recombinant antibodies, antibodies with reduced effector function, chimeric antibodies, humanized antibodies, and human antibodies.

[Invention 1032]

The method of 1024 of the present invention, wherein the composition is administered subcutaneously, intramuscularly, intraarterically, intravenously, or as an inhalant.

[Invention 1033]

The step of administering a composition containing an effective amount of a MASP-2 inhibitor to inhibit MASP-2 dependent complement activation to a subject suffering from fulminant antiphospholipid antibody syndrome (CAPS). A method of inhibiting MASP-2 dependent complement activation in a subject, comprising:

[Invention 1034]

The method of 1033 of the present invention, wherein the MASP-2 inhibitor is an anti-MASP-2 antibody or fragment thereof.

[Invention 1035]

The method of 1034 of the present invention, wherein the MASP-2 inhibitor is an anti-MASP-2 monoclonal antibody or fragment thereof that specifically binds to a portion of SEQ ID NO: 6.

[Invention 1036]

The method of the present invention 1034, wherein the subject has previously or is currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5.

[Invention 1037]

The method of 1034 of the present invention further comprising the step of administering to said subject a terminal complement inhibitor that inhibits cleavage of complement protein C5.

[Invention 1038]

The method of the present invention 1037, wherein the terminal complement inhibitor is a humanized anti-C5 antibody or an antigen-binding fragment thereof.

[Invention 1039]

The method of the present invention 1037, wherein the terminal complement inhibitor is eculizumab.

[Invention 1040]

The method of 1034 of the present invention, wherein the antibody or fragment thereof is selected from the group consisting of recombinant antibodies, antibodies with reduced effector function, chimeric antibodies, humanized antibodies, and human antibodies.

[Invention 1041]

The method of 1033 of the present invention, wherein the composition is administered subcutaneously, intramuscularly, intraarterically, intravenously or as an inhalant.

[Invention 1042]

The step of administering an effective amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof to inhibit MASP-2 dependent complement activation to a subject suffering from atypical hemolytic urinary syndrome (aHUS). A method of inhibiting thrombosis in a subject, comprising:

[Invention 1043]

The method of 1042 of the present invention, wherein the MASP-2 inhibitory antibody is a monoclonal antibody or antigen-binding fragment thereof that specifically binds to a part of SEQ ID NO: 6.

[Invention 1044]

The MASP-2 inhibitory antibody has a K of 10 nM or less._DThe method of the present invention 1042 for binding human MASP-2 in.

[Invention 1045]

The method of 1042 of the invention, wherein the MASP-2 inhibitory antibody binds an epitope in the CCP1 domain of MASP-2.

[Invention 1046]

The MASP-2 inhibitory antibody has an IC of 10 nM or less C3b deposition in 1% human serum in an in vitro assay.₅₀The method of the present invention 1042, which inhibits with.

[Invention 1047]

The MASP-2 inhibitory antibody causes C3b deposition in 90% human serum at 30 nM or less.₅₀The method of the present invention 1042, which inhibits with.

[Invention 1048]

The MASP-2 inhibitory antibody is Fv, Fab, Fab', F (ab).₂, And F (ab')₂The method of 1042 of the present invention, which is an antibody fragment selected from the group consisting of.

[Invention 1049]

The method of 1042 of the present invention, wherein the MASP-2 inhibitory antibody is a single chain molecule.

[Invention 1050]

The method of 1042 of the present invention, wherein the MASP-2 inhibitory antibody is selected from the group consisting of IgG1 molecule, IgG2 molecule, and IgG4 molecule.

[Invention 1051]

The method of 1050 of the present invention, wherein the IgG4 molecule comprises an S228P mutation.

[Invention 1052]

The method of 1042 of the present invention, wherein the MASP-2 inhibitory antibody does not substantially inhibit the classical pathway.

[Invention 1053]

The method of 1042 of the present invention, wherein the MASP-2 inhibitory antibody inhibits thrombus formation in serum from a subject suffering from aHUS by at least 40% compared to untreated serum.

[Invention 1054]

The level at which the MASP-2 inhibitory antibody increases thrombosis in serum from a subject suffering from aHUS by at least 20% higher than the inhibitory effect of the antibody on C5b-9 deposition in serum from the subject. The method of the present invention 1042, which inhibits with.

[Invention 1055]

The method of the invention 1042, wherein the subject is in the acute phase of aHUS.

[Invention 1056]

The method of the invention 1042, wherein the subject is in remission of aHUS.

[Invention 1057]

The MASP-2 inhibitory monoclonal antibody or antigen-binding fragment thereof is a heavy chain CDR-H1; containing the amino acid sequences 31 to 35 of (a) (i) SEQ ID NO: 67; and (ii) 50 of SEQ ID NO: 67. Heavy chain CDR-H2 containing the amino acid sequence of ~ 65; and (iii) Heavy chain variable region containing the heavy chain CDR-H3 containing the amino acid sequence of 95 ~ 102 of SEQ ID NO: 67, and (b) (i) ) Light chain CDR-L1 containing 24-34 amino acid sequences of SEQ ID NO: 70; and (ii) Light chain CDR-L2; containing 50-56 amino acid sequences of SEQ ID NO: 70; and (iii) SEQ The method of 1043 of the present invention comprising a light chain variable region comprising a light chain CDR-L3 comprising an amino acid sequence of 89-97 with ID NO: 70.

[Invention 1058]

The method of 1043 of the present invention, wherein the MASP-2 inhibitory monoclonal antibody comprises a heavy chain variable region shown in SEQ ID NO: 67 and a light chain variable region shown in SEQ ID NO: 70.

[Invention 1059]

The MASP-2 inhibitory antibody or antigen-binding fragment thereof is at least an epitope recognized by a reference antibody containing the heavy chain variable region shown in SEQ ID NO: 67 and the light chain variable region shown in SEQ ID NO: 70. The method of 1043 of the present invention, which specifically recognizes a portion.

Many of the aforementioned aspects and accompanying advantages of the present invention are believed to be more easily recognized as they will be better understood by reference to the following detailed description when used with the accompanying drawings. Be done.<figref num="1">It is a figure which shows the genomic structure of human MASP-2.</figref><figref num="2">FIG. 2A is a schematic diagram showing the domain structure of human MASP-2 protein. FIG. 2B is a schematic diagram showing the domain structure of human MAp19 protein.</figref><figref num="3">It is a figure which showed the mouse MASP-2 knockout strategy.</figref><figref num="4">It is a figure which showed the human MASP-2 mini gene construct.</figref><figref num="5A">As described in Example 2, we show the results demonstrating that MASP-2 deficiency leads to the loss of Lectin pathway-mediated C4 activation when measured by the lack of C4b deposition on mannan. ..</figref><figref num="5B">As described in Example 2, MASP-2 deficiency proved to lead to loss of lectin pathway-mediated C4 activation when measured by lack of C4b deposition on zymosan. ..</figref><figref num="5C">Relative to serum samples obtained from MASP-2 +/-; MASP-2-/-and wild-type strains, as measured by C4b deposition on mannan and zymosan, as described in Example 2. The results of demonstrating the target C4 activation level are shown.</figref><figref num="6">C4 mediated by the lectin pathway by adding mouse recombinant MASP-2 to MASP-2-/-serum samples as measured by C4b deposition on mannan, as described in Example 2. The results show that the activation is restored in a protein concentration-dependent manner.</figref><figref num="7">As described in Example 8, the results demonstrating that the classical pathway functions in the MASP-2-/-lineage are shown.</figref><figref num="8A">As described in Example 10, the results showing that anti-MASP-2 Fab2 antibody # 11 inhibits C3 convertase formation are shown.</figref><figref num="8B">As described in Example 10, the results showing that the anti-MASP-2 Fab2 antibody # 11 binds to native rat MASP-2 are shown.</figref><figref num="8C">As described in Example 10, the results demonstrating that anti-MASP-2 Fab2 antibody # 41 inhibits C4 cleavage are shown.</figref><figref num="9">As described in Example 10, all of the anti-MASP-2 Fab2 antibodies tested that inhibited C3 convertase formation were found to also inhibit C4 cleavage.</figref><figref num="10">As described in Example 11, it is a diagram showing a rat MASP-2 derived recombinant polypeptide used for epitope mapping of an anti-MASP-2 blocking Fab2 antibody.</figref><figref num="11">As described in Example 11, the results of demonstrating the binding of anti-MASP-2 Fab2 # 40 and # 60 to the rat MASP-2 polypeptide are shown.</figref><figref num="12">Blood of wild-type (+ / +) and MASP-2 (-/-) mice 24 and 48 hours after reperfusion in a renal ischemia / reperfusion injury model as described in Example 12. The result of demonstrating the urea nitrogen clearance is shown.</figref><figref num="13A">Shows the results showing baseline VEGF protein levels in RPE-choroidal complexes isolated from wild-type (+ / +) and MASP-2 (-/-) mice as described in Example 13. ..</figref><figref num="13B">VEGF protein in RPE-choroid complex in wild-type (+ / +) and MASP-2 (-/-) mice 3 days after laser-induced injury in a macular degeneration model as described in Example 13. The result showing the level is shown.</figref><figref num="14">Results showing average choroidal angiogenesis (CNV) volume 7 days after laser-induced injury in wild-type (+ / +) and MASP-2 (-/-) mice, as described in Example 13. Is shown.</figref><figref num="15">Figures 15A and 15B show the dose response of inhibition of C4b deposition (FIG. 15A) and inhibition of thrombin activation (FIG. 15B) after administration of MASP-2 Fab2 antibody lysed in normal rat serum, as described in Example 14. Shows a curve.</figref><figref num="16">Figures 16A and 16B show untreated wild-type mice in a localized Schwartzmann reaction model of disseminated intravascular coagulation, as well as the depleting substance cobra toxin factor (CVF) and terminal pathway inhibitors, as described in Example 15. Measures of platelet aggregation in MASP-2 (-/-) mice (expressed as agglutination area) compared to platelet aggregation (Fig. 16A) in wild-type mice in which the complement pathway was inhibited by (C5aR antagonist) (Fig. 16B). ) Is shown.</figref><figref num="17">Blood measured in WT (+ / +) (B6) transplant recipient mice or MASP-2 (-/-) transplant recipient mice of WT (+ / +) donor kidney as described in Example 16. Urea nitrogen (BUN) levels are illustrated.</figref><figref num="18">As described in Example 17, the percent viability of WT (+ / +) and MASP-2 (-/-) mice as a function of days after microbial infection in an intestinal perforation (CLP) model is illustrated.</figref><figref num="19">As described in Example 17, bacterial counts measured in WT (+ / +) and MASP-2 (-/-) after microbial infection in an intestinal perforation (CLP) model are illustrated.</figref><figref num="20">WT (+ / +), MASP-2 (-/-), and C3 (-/-) mice 6 days after intranasal administration of Pseudomonas aeruginosa, as described in Example 18. It is a Kaplan-Mayer plot showing the percentage of survival rate of Pseudomonas aeruginosa.</figref><figref num="21">As described in Example 19, after subcutaneous administration of 0.3 mg / kg or 1.0 mg / kg of mouse anti-MASP-2 monoclonal antibody in WT mice, as a percentage of the control sample taken at various time points. The measured C4b deposition level is illustrated.</figref><figref num="22">C4b deposition measured as% of control in samples taken at various time points after ip administration of 0.6 mg / kg mouse anti-MASP-2 monoclonal antibody in WT mice as described in Example 19. The level is illustrated.</figref><figref num="23">After laser-induced injury in WT (+ / +) mice pretreated with a single ip injection of 0.3 mg / kg or 1.0 mg / kg mouse anti-MASP-2 monoclonal antibody, as described in Example 20 7 The average choroidal angiogenesis (CNV) volume on day is illustrated.</figref><figref num="24A">5 × 10 as described in Example 21⁸The percent viability of MASP-2 (-/-) and WT (+ / +) mice after infection with / 100 μl cfu of N. meningitidis is illustrated.</figref><figref num="24B">5 × 10 as described in Example 21⁸Of meningococci recovered at various time points in blood samples taken from MASP-2 KO (-/-) and WT (+ / +) mice infected with cfu / 100 μl N. meningitidis The log cfu / ml is illustrated.</figref><figref num="25A">2 × 10 as described in Example 21⁸The percent viability of MASP-2 KO (-/-) and WT (+ / +) mice after infection with cfu / 100 μl Neisseria meningitidis is illustrated.</figref><figref num="25B">2 × 10 as described in Example 21⁸The log cfu / ml of meningococci recovered at various time points in blood samples taken from WT (+ / +) mice infected with cfu / 100 μl meningococcus is illustrated.</figref><figref num="25C">2 × 10 as described in Example 21⁸The log cfu / ml of meningococci recovered at various time points in blood samples taken from MASP-2 (-/-) mice infected with cfu / 100 μl meningococcus is illustrated.</figref><figref num="26">FIG. 26A illustrates the results of the C3b deposition assay, which demonstrated that MASP-2 (-/-) mice retain a functional classical pathway, as described in Example 22. FIG. 26B illustrates the results of a C3b deposition assay on a Zymosan coated plate that demonstrated that MASP-2 (-/-) mice retain a functional second pathway, as described in Example 22. To do.</figref><figref num="27">FIG. 27A shows C4 (-/-) mice (n = 6) and corresponding WT littermate controls showing ischemic zone (AAR) and myocardial necrosis zone (INF) as described in Example 22. The myocardial ischemia / reperfusion injury (MIRI) -induced tissue loss after ligation and reperfusion of the left anterior descending coronary artery (LAD) in n = 7) is illustrated. FIG. 27B illustrates the myocardial necrosis region (INF) as a function of the ischemic region (AAR) in C4 (-/-) and WT mice treated as described in FIG. 42A and is described in Example 22. As such, C4 (-/-) mice have been shown to be as sensitive to MIRI as WT controls (dashed line).</figref><figref num="28A">C3b deposition using serum from WT mice, serum from C4 (-/-) mice, and serum from C4 (-/-) mice pre-incubated with mannan, as described in Example 22. The results of the assay are illustrated.</figref><figref num="28B">Serum from WT mice, serum from C4 (-/-) mice, and MASP-2 (MASP-2) mixed with anti-mouse MASP-2 mAb (mAbM11) at various concentrations as described in Example 22. -/-) The results of the C3b deposition assay for mouse-derived serum are illustrated.</figref><figref num="28C">As described in Example 22, the results of the C3b deposition assay for WT-derived human serum (C4 sufficiency) and C4-deficient serum, as well as serum from C4-deficient subjects pre-incubated with mannan are illustrated.</figref><figref num="28D">As described in Example 22, the results of the C3b deposition assay for WT-derived human serum (C4 sufficient) mixed with anti-human MASP-2 mAb (mAbH3) and human serum derived from C4-deficient subjects are illustrated. ..</figref><figref num="29">FIG. 29A shows various complement-deficient mouse strains tested under lectin activation pathway-specific assay conditions or under classical activation pathway-specific assay conditions, as described in Example 22. A comparative analysis of C3 convertase activity in the derived plasma is illustrated. FIG. 29B illustrates the time-resolved kinetics of C3 convertase activity in plasma from various complement-deficient mouse strains tested under lectin activation pathway-specific conditions, as described in Example 22.</figref><figref num="30">As described in Example 23, the results of Western blot analysis showing human C3 activation indicated by the presence of the a'chain by the thrombin substrates FXIa and FXa are shown.</figref><figref num="31">Obtained from WT, MASP-2 (-/-), F11 (-/-), F11 (-/-) / C4 (-/-), and C4 (-/-), as described in Example 23. The results of the C3 deposition assay for the resulting serum samples are shown.</figref><figref num="32">FIG. 32A shows after exposure to 7.0 Gy radiation in control mice and mice treated with anti-mouse MASP-2 antibody (mAbM11) or anti-human MASP-2 antibody (mAbH6), as described in Example 29. It is a Kaplan-Meier survival plot showing the percentage of survival over time. FIG. 32B shows after exposure to 6.5 Gy radiation in control mice and mice treated with anti-mouse MASP-2 antibody (mAbM11) or anti-human MASP-2 antibody (mAbH6), as described in Example 29. It is a Kaplan-Meier survival plot showing the percentage of survival over time.</figref><figref num="33">Infection dose 2.6 × 10⁷Kaplan-Meier plots illustrating the percentage survival rates of MASP-2 KO and WT mice after administration of cfu meningococcal serogroup A Z2491, and as described in Example 30, MASP-2 deficient mice It proves to be protected from meningococcal-induced death.</figref><figref num="34">Infection dose 6 × 10⁶A Kaplan-Meier plot illustrating the percentage survival rates of MASP-2 KO and WT mice after administration of cfu meningococcal serogroup B MC58 strain, as described in Example 30, MASP-2 deficient mice. Prove to be protected from meningococcal serogroup B MC58 strain-induced death.</figref><figref num="35">6×10⁶Cfu meningococcal serogroup B MC58 strain collected at various time points in blood samples collected from MASP-2 KO and WT mice after ip infection with meningococcal serogroup B MC58 strain Log cfu / ml of (n = 3 at various time points for both groups of mice; results expressed as mean ± SEM), and as described in Example 30, MASP-2 KO mice were associated with WT mice. Infected with the same dose of meningococcal serogroup B MC58 strains, MASP-2 KO mice demonstrated significant elimination of mycemia compared to WT.</figref><figref num="36">6×10⁶cfu / 100 μl meningococcal serogroup serogroup B MC58 strain of disease scores (illness score) of MASP-2 and WT mice 3 hours, 6 hours, 12 hours, and 24 hours after infection. Illustrating the mean, as described in Example 30, MASP-2 deficient mice showed high resistance to infection, demonstrating a very low disease score at 6 hours.</figref><figref num="37">Infection dose 4 x 10⁶Kaplan illustrated the percentage survival rate of mice treated with the inhibitory anti-MASP-2 antibody (1 mg / kg) or control isotype antibody 3 hours after infection after administration of the / 100 μl cfu meningococcal serogroup B MC58 strain. A Meyer plot, as described in Example 31, proving that anti-MASP-2 antibody is effective in treating and improving survival in subjects infected with N. meningitidis. ..</figref><figref num="38">6.5×10⁶After ip infection with cfu / 100 μl meningitis serum group B MC58 strain, (A) normal human serum (NHS) + human anti-MASP-2 antibody: (B) normal human serum (NHS) + isotype control antibody Incubate in the presence of (C) MBL-/-human serum; (D) normal human serum (NHS), and (E) heat-inactivated normal human serum (NHS) 0 minutes, 30 minutes, 60 Log cfu / ml of viable cell counts of the meningitis serum group B MC58 strain recovered at various time points at 20% human serum concentration after minutes and 90 minutes is illustrated and described in Example 32. As such, it is shown that the complement-dependent killing of meningitis bacteria in human serum was significantly enhanced by the addition of human anti-MASP-2 antibody.</figref><figref num="39">Log cfu / ml of viable cell counts of N. meningitidis serum group B-MC58 recovered at various time points in mouse serum samples is shown and as described in Example 32, MASP-2-/-mice. It has been demonstrated that the bactericidal activity level of serum against Neisseria meningitidis is higher than that of WT mouse serum.</figref><figref num="40">Hemolysis of mannan-coated mouse erythrocytes with human serum at serum concentrations in a range (measured by hemoglobin release of lysed mouse erythrocytes (Crry / C3-/-) into the supernatant, measured by photometrics) is illustrated. As described in Example 33, the sera tested contained heat-inactivated (HI) NHS, MBL-/-, NHS + anti-MASP-2 antibody, and NHS controls.</figref><figref num="41">Hemolysis of uncoated mouse erythrocytes with human serum at a serum concentration in a range of serum concentrations (measured by hemoglobin release of WT mouse erythrocytes dissolved in supernatant; measured by photometric method) is illustrated. Serum tested included heat-inactivated (HI) NHS, MBL-/-, NHS + anti-MASP-2 antibody, and NHS controls. As described in Example 33, inhibition of MASP-2 has been demonstrated to inhibit complement-mediated lysis of non-sensitized WT mouse erythrocytes.</figref><figref num="42">Hemolysis of uncoated mouse erythrocytes with human serum at serum concentrations in a range (measured by hemoglobin release of lysed mouse erythrocytes (CD55 / 59-/-) into supernatant, measured by photometric method) is illustrated. As described in Example 33, the sera tested contained heat-inactivated (HI) NHS, MBL-/-, NHS + anti-MASP-2 antibody, and NHS controls.</figref><figref num="43">As described in Example 34, the percentage of survival over time (days) after exposure to 8.0 Gy radiation in control mice and anti-human MASP-2 antibody (mAbH6) treated mice is illustrated.</figref><figref num="44">The time to onset of microvascular occlusion after LPS injection in MASP-2 mice-/-and WT mice, showing the percentage of mice with thrombosis measured over 60 minutes, is illustrated. As described in Example 35, thrombus formation was detected in WT mice after 15 minutes, but up to 80% of WT mice showed thrombus formation in 60 minutes. In contrast, none of the MASP-2-/-mice showed thrombus formation during 60 minutes (log rank: p = 0.0005).</figref><figref num="45">Percentages of survival (time) over time in saline-treated control mice (n = 5) and anti-MASP-2 antibody-treated mice (n = 5) in STX / LPS-induced HUS models are illustrated and described in Example 36. As such, all of the control mice died by 42 hours, and in contrast, 100% of the anti-MASP-2 antibody-treated mice survived over the course of the experiment.</figref><figref num="46">As described in Example 37, in a FITC / dextran UV model, after treatment with an isotype control or human MASP-2 antibody mAbH6 (10 mg / kg) administered 16 hours and 1 hour prior to FITC / dextran injection. The percentage of mice with microvascular occlusion as a function of time after injury induction is illustrated.</figref><figref num="47">As described in Example 37, the occlusion time of mice treated with human MASP-2 antibody (mAbH6) and mice treated with isotype control antibody is illustrated in minutes. The data were reported as scatter-dots with mean (horizontal bars) and standard error bars (vertical bars). The statistical test used for the analysis was an independent t-test. symbol"^*"Indicates p = 0.0129.</figref><figref num="48">Wild-type mice, MASP-2 KO mice, and thrombosis induction in a FITC-dextran / photo-induced endothelial cell injury model of thrombosis using low light intensity (800-1500) as described in Example 37. The time to occlusion of human MASP-2 antibody (mAbH6) pretreated wild-type mice by ip administration of 10 mg / kg 16 hours before and again 1 hour before is shown in minutes.</figref><figref num="49">As described in Example 39, in mice with thrombus as a function of time in FITC-dextran-induced thrombotic microangiopathy mice treated with increasing doses of human MASP-2 inhibitory antibody (mAbH6) or isotype control antibody. Kaplan-Meier plot showing percentages.</figref><figref num="50">As described in Example 39, the median time to onset of thrombus formation as a function of mAbH6 dose is illustrated (compared to controls).^*p &lt;0.01).</figref><figref num="51">As described in Example 39, having microvascular occlusion as a function of time in FITC-dextran-induced thrombotic microangiopathy mice treated with increasing doses of human MASP-2 inhibitory antibody (mAbH6) or isotype control antibody. It is a Kaplan-Meier plot showing the percentage of mice.</figref><figref num="52">As described in Example 39, the median time to microvascular occlusion as a function of mAbH6 dose is illustrated (compared to controls).^*p &lt;0.05).</figref><figref num="53A">As described in Example 40, the level of MAC deposition in the presence or absence of the human MASP-2 monoclonal antibody (OMS646) under lectin pathway-specific assay conditions is illustrated. From now on, OMS646 is an IC of about 1nM.₅₀Values prove to inhibit lectin-mediated MAC deposition.</figref><figref num="53B">As described in Example 40, the level of MAC deposition in the presence or absence of human MASP-2 monoclonal antibody (OMS646) under classical pathway-specific assay conditions is illustrated. From this, it is proved that OMS646 does not inhibit MAC deposition via the classical pathway.</figref><figref num="53C">As described in Example 40, MAC deposition levels in the presence or absence of human MASP-2 monoclonal antibody (OMS646) under second pathway-specific assay conditions are illustrated. From this, it is proved that OMS646 does not inhibit MAC deposition via the second pathway.</figref><figref num="54">The pharmacokinetic (PK) profile of a human MASP-2 monoclonal antibody (OMS646) in mice is illustrated as described in Example 40. The OMS646 concentration (mean of n = 3 animals / group) as a function of time after administration at the indicated dose was shown.</figref><figref num="55A">As described in Example 40, the pharmacodynamic (PD) response of human MASP-2 monoclonal antibody (OMS646) as measured as reduced systemic lectin pathway activity in mice after intravenous administration is illustrated.</figref><figref num="55B">As described in Example 40, the pharmacodynamic (PD) response of human MASP-2 monoclonal antibody (OMS646) measured as a decrease in systemic lectin pathway activity in mice after subcutaneous administration is illustrated.</figref><figref num="56">As described in Example 41, the inhibitory effect of MASP-2 antibody (OMS646) compared to sCR1 on aHUS serum-induced C5b-9 deposition on ADP-activated HMEC-1 cells is illustrated.</figref><figref num="57">As described in Example 42, the inhibitory effect of MASP-2 antibody (OMS646) compared to sCR1 on aHUS serum-induced thrombus formation on ADP-activated HMEC-1 cells is illustrated.</figref>

Sequence Listing Description SEQ ID NO: 1 Human MAp19 cDNA SEQ ID NO: 2 Human MAp19 Protein (with reader) SEQ ID NO: 3 Human MAp19 Protein (Mature) SEQ ID NO: 4 Human MASP-2 cDNA SEQ ID NO: 5 Human MASP -2 protein (with leader) SEQ ID NO: 6 human MASP-2 protein (mature) SEQ ID NO: 7 human MASP-2 gDNA (exon 1-6) antigen: (based on MASP-2 mature protein) SEQ ID NO: 8 CUBI sequence (aa1 ~ 121) SEQ ID NO: 9 CUBEGF sequence (aa1 ~ 166) SEQ ID NO: 10 CUBEGFCUBII (aa1 ~ 293) SEQ ID NO: 11 EGF region (aa122 ~ 166) SEQ ID NO: 12 Serine Protease Domain (aa429 ~ 671) SEQ ID NO: 13 Serine Protease Domain Inactive (aa610 ~ 625 with Ser618 to Ala Mutation)<img file="JP2020037568A_D0001.tif" />Peptide inhibitor: SEQ ID NO: 20 MBL Full-length cDNA SEQ ID NO: 21 MBL Full-length protein SEQ ID NO: 22 OGK-X-GP (consensus binding)<img file="JP2020037568A_D0002.tif" />Expression inhibitor: SEQ ID NO: 30 cDNA of CUBI-EGF domain (nucleotides 22 to 680 of SEQ ID NO: 4) SEQ ID NO: 31<img file="JP2020037568A_D0003.tif" /> MASP-2 Nucleotides 12 to 45 (sense) of SEQ ID NO: 4 containing translation start point SEQ ID NO: 32<img file="JP2020037568A_D0004.tif" /> Nucleotides 361-396 (sense) of SEQ ID NO: 4 encoding the region containing the MASP-2 MBL binding site SEQ ID NO: 33<img file="JP2020037568A_D0005.tif" /> Nucleotides 610 to 642 cloning primers for SEQ ID NO: 4, which encode the region containing the CUBII domain:<img file="JP2020037568A_D0006.tif" />SEQ ID NO: 38-47 are cloning primers for humanized antibodies. SEQ ID NO: 48 is a 9aa peptide bond. Expression vector: SEQ ID NO: 49 is a MASP-2 minigene insert. SEQ ID NO: 50 is the mouse MASP-2 cDNA. SEQ ID NO: 51 is a mouse MASP-2 protein (w / leader). SEQ ID NO: 52 is a mature mouse 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 is a mature rat MASP-2 protein. SEQ ID NOs: 56-59 are site-specific mutagenesis oligonucleotides of human MASP-2 used to generate human MASP-2A. SEQ ID NOs: 60-63 are site-specific mutagenesis oligonucleotides of mouse MASP-2 used to generate mouse MASP-2A. SEQ ID NO: 64-65 are site-specific mutagenesis oligonucleotides of rat MASP-2 used to generate rat MASP-2A. SEQ ID NO: 66 17D20_dc35VH21N11VL (OMS646) DNA SEQ ID NO: 67 17D20_dc35VH21N11VL (OMS646) heavy chain variable region (VH) polypeptide SEQ ID NO: 68 17N16mc heavy chain Variable Region (VH) Polypeptide SEQ ID NO: 69: 17D20_dc35VH21N11VL (OMS646) DNA SEQ ID NO: 70: 17D20_dc35VH21N11VL (OMS646) Light Chain Variable Region (VL) Polypeptide SEQ ID NO: 71: 17N16_dc17N9 Light chain variable region (VL) polypeptide

Detailed Description The present invention is based on the surprising finding by the inventors that it is possible to inhibit the lectin-mediated MASP-2 pathway while leaving the classical pathway intact. The present invention also presents MASP as a therapeutic target for inhibiting cytotoxicity associated with lectin-mediated complement pathway activation, while leaving the classical (C1q-dependent) pathway components of the immune system intact. Explain the use of -2.

I. Definitions Unless otherwise defined herein, all terms used herein have the same meaning as understood by one of ordinary skill in the invention. The following definitions are provided to simplify the terms used in the specification and claims to illustrate the invention.

As used herein, the term "MASP-2 dependent complement activation" refers to the formation of the lectin pathway C3 convertase C4b2a followed by the formation of the C5 convertase C4b2a (C3b) n during the accumulation of the C3 cleavage product C3b. Connected, physiological conditions (ie Ca⁺⁺It has been shown to include MASP-2-dependent activation of the lectin pathway that occurs in the presence of) and primarily cause opsonization.

As used herein, the term "second pathway" refers to, for example, zymosan from the fungal and yeast cell walls, lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria, and rabbit erythrocytes, and many pure. Induced by endotoxins, rabbit erythrocytes, viruses, bacteria, animal tumor cells, parasites, and damaged cells, complement activation traditionally thought to result from the spontaneous proteolytic production of complement factors C3 to C3b. Point to.

As used herein, the term "lectin pathway" refers to serum carbohydrate-binding proteins and non-serum, including mannan-binding lectins (MBL), CL-11, and phycholine (H-ficolin, M-ficolin, or L-ficolin). Refers to complement activation that occurs through the specific binding of carbohydrate-binding proteins.

As used herein, the term "classical pathway" refers to complement activation that is induced by an antibody bound to a foreign particle and requires binding of the recognition molecule C1q.

As used herein, the term "MASP-2 inhibitor" effectively inhibits MASP-2 dependent complement activation by binding to MASP-2 or interacting directly with MASP-2. Refers to any agent, including anti-MASP-2 antibody and its MASP-2 binding fragment, native and synthetic peptides, small molecules, soluble MASP-2 receptor, expression inhibitor, and isolated native inhibitor. Also includes peptides that compete with MASP-2 in binding to another recognition molecule in the lectin pathway (eg, MBL, H-ficolin, M-ficolin, or L-ficolin), but to such other recognition molecules. Does not include binding antibodies. MASP-2 inhibitors useful in the methods of the invention can reduce MASP-2 dependent complement activation by more than 20%, eg, more than 50%, eg, more than 90%. In one embodiment, the MASP-2 inhibitor reduces MASP-2 dependent complement activation by more than 90% (ie, causes MASP-2 complement activation by 10% or less).

As used herein, the term "antibody" refers to any antibody-producing mammal (eg, mouse, rat, rabbit, etc.) that specifically binds to a target polypeptide, eg, a MASP-2 polypeptide or a portion thereof. Includes antibodies and antibody fragments thereof derived from (and primates, including humans) or from hybridomas, phage selection, recombinant expression, or transgenic animals (or antibodies or other methods of producing antibody fragments). The term "antibody" is not intended to be limited in terms of the source of the antibody, or the way in which the antibody is made (eg, by hybridoma, phage selection, recombinant expression, transgenic animals, peptide synthesis, etc.). Exemplary antibodies are polyclonal antibodies, monoclonal antibodies, and recombinant antibodies; pan-specific, multispecific antibodies (eg, bispecific, trispecific); humanized antibodies: mouse antibodies; It includes chimeric, mouse-human, mouse-primate, primate-human monoclonal antibodies; and anti-idiotype antibodies, and may be any intact antibody or fragment thereof. The term "antibody" as used herein refers to not only an intact polyclonal antibody or monoclonal antibody, but also fragments thereof (eg, dAb, Fab, Fab', F (ab')).₂, Fv), single chain (ScFv), synthetic variants, natural variants, fusion proteins containing antigen binding fragments of the required specificity, humanized antibodies, chimeric antibodies, and required specificity. Also includes any other modified composition of the immunoglobulin molecule, including the antigen binding site or fragment (epitope recognition site) of.

"Monoclonal antibody" refers to a homogeneous antibody population, which consists of amino acids (natural and non-natural) involved in the selective binding of epitopes. Monoclonal antibodies are highly specific for the target antigen. The term "monoclonal antibody" refers to not only intact and full-length monoclonal antibodies, but also fragments thereof (eg, Fab, Fab', F (ab')).₂, Fv), single chain (ScFv), variants thereof, fusion proteins containing antigen-binding moieties, humanized monoclonal antibodies, chimeric monoclonal antibodies, and antigen-binding fragments (epitope recognition) of the required specificity and ability to bind to epitopes. Also includes any other modified composition of the immunoglobulin molecule, including the site). The term is not intended to be limited in terms of the source of the antibody, or the way in which the antibody is made (eg, by hybridoma, phage selection, recombinant expression, transgenic animals, etc.). The term includes whole and fragments of immunoglobulins mentioned above in the definition of "antibody".

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

The "single chain Fv" or "scFv" antibody fragment used herein is the V of the antibody._HDomain or V_LIncludes domains, which are present in a single polypeptide chain. In general, Fv polypeptides are V_HDomain and V_LIt further comprises a polypeptide linker with the domain, which allows scFv to form the desired structure for antigen binding.

As used herein, a "chimeric antibody" contains a variable domain and complementarity determining regions derived from a non-human (eg, rodent) antibody, but the rest of the antibody molecules are derived from a human antibody. It is a substitute protein.

As used herein, a "humanized antibody" is a chimeric antibody ported into a human antibody framework that contains a minimal sequence that corresponds to a specific complementarity determining region derived from a non-human immunoglobulin. Humanized antibodies are typically recombinant proteins from which only the antibody complementarity determining regions are derived from non-humans.

The term "mannan-binding lectin" ("MBL") as used herein is synonymous with mannan-binding protein ("MBP").

As used herein, the "complement membrane attack complex" ("MAC") is a complex of five terminal complement components (C5b and C6, C7, C8, and C9) that penetrate and destroy the membrane. (A combination of) (also called C5b-9).

"Subjects" as used herein include, but are not limited to, humans, non-human primates, dogs, cats, horses, sheep, goats, cows, rabbits, pigs, and rodents. Includes all mammals.

The abbreviations for amino acid residues used herein are: alanine (Ala; A), asparagine (Asn; N), aspartic acid (Asp; D), arginine (Arg; R), cysteine (Cys). ; C), glutamic acid (Glu; E), glutamine (Gln; Q), glycine (Gly; G), histidine (His; H), isoleucine (Ile; I), leucine (Leu; L), lysine (Lys; K), methionine (Met; M), phenylalanine (Phe; F), proline (Pro; P), serine (Ser; S), threonin (Thr; T), tryptophan (Trp; W), tyrosine (Tyr; Y) ), And Val; V.

In the broadest sense, natural amino acids can be grouped based on the chemical properties of the side chains of each amino acid. By "hydrophobic" amino acid is meant Ile, Leu, Met, Phe, Trp, Tyr, Val, Ala, Cys or Pro. By "hydrophilic" amino acid is meant Gly, Asn, Gln, Ser, Thr, Asp, Glu, Lys, Arg, or His. This amino acid group can be further subdivided as follows. "Uncharged hydrophilic" amino acid means Ser, Thr, Asn, or Gln. "Acid" amino acid means Glu or Asp. "Basic" amino acid means Lys, Arg, or His.

The term "conservative amino acid substitution" as used herein is exemplified by substitutions between amino acids within their respective groups: (1) glycine, alanine, valine, leucine, and isoleucine, (2) phenylalanine. , Tyrosine, and tryptophan, (3) serine and threonine, (4) aspartic acid and glutamic acid, (5) glutamine and asparagine, and (6) lysine, arginine and histidine.

As used herein, the term "oligonucleotide" refers to an oligomer or polymer of ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) or imitations thereof. The term also covers oligonucleobases consisting of natural nucleotides, sugars, and nucleoside covalent bonds (backbone), as well as oligonucleotides with unnatural modifications.

As used herein, "epitope" refers to the site on a protein (eg, human MASP-2 protein) to which an antibody binds. A "overlapping epitope" comprises at least one (eg, 2, 3, 4, 5, or 6) common amino acid residues, including linear and non-linear epitopes.

As used herein, the terms "polypeptide," "peptide," and "protein" are used synonymously to mean any peptide-bonded amino acid chain, regardless of length or post-translational modification. The MASP-2 proteins described herein may contain wild-type proteins and may be wild-type proteins, up to 50 (eg, 1 or less, 2 or less, 3 or less, 4 or less, 5). Less than, 6 or less, 7 or less, 8 or less, 9 or less, 10 or less, 12 or less, 15 or less, 20 or less, 25 or less, 30 or less, 35 or less, 40 or less , Or 50 or less) variants with 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; aspartic acid, glutamine, serine, and threonine; lysine, histidine, and arginine. ; And phenylalanine and tyrosine.

In some embodiments, the human MASP-2 protein is 70 (eg, 71, 72, 73, 74, 75, 76, 77, etc.) with the human MASP-2 protein having the amino acid sequence shown in SEQ ID NO: 5. 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100)% identical, Or 70 (eg 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93 , 94, 95, 96, 97, 98, 99, or more than 100)% may have the same amino acid sequence.

In some embodiments, the peptide fragments are at least 6 in length (eg, at least 7, 8, 9, 10, 11, 12, 13, 14, 14, 15, 16, ... 17 pieces, 18 pieces, 19 pieces, 20 pieces, 21 pieces, 22 pieces, 23 pieces, 24 pieces, 25 pieces, 26 pieces, 27 pieces, 28 pieces, 29 pieces, 30 pieces, 31 pieces, 32 pieces, 33 pieces , 34 pcs, 35 pcs, 36 pcs, 37 pcs, 38 pcs, 39 pcs, 40 pcs, 41 pcs, 42 pcs, 43 pcs, 44 pcs, 45 pcs, 46 pcs, 47 pcs, 48 pcs, 49 pcs, 50 pcs 55 pieces, 60 pieces, 65 pieces, 70 pieces, 75 pieces, 80 pieces, 85 pieces, 90 pieces, 95 pieces, 100 pieces, 110 pieces, 120 pieces, 130 pieces, 140 pieces, 150 pieces, 160 pieces, 170, 180, 190, 200, 250, 300, 350, 400, 450, 500, or 600, or more) Amino acid residues (eg, SEQ ID) It may be at least 6 consecutive amino acid residues of NO: 5). In some embodiments, the antigenic peptide fragment of the human MASP-2 protein is less than 500 in length (eg, less than 450, less than 400, less than 350, less than 325, less than 300, less than 275). , Less than 250, less than 225, less than 200, less than 190, less than 180, less than 170, less than 160, less than 150, less than 140, less than 130, less than 120, less than 110, 100 Less than 95 pieces, less than 90 pieces, less than 85 pieces, less than 80 pieces, less than 75 pieces, less than 70 pieces, less than 65 pieces, less than 60 pieces, less than 55 pieces, less than 50 pieces, less than 49 pieces, less than 48 pieces , Less than 47, less than 46, less than 45, less than 44, less than 43, less than 42, less than 41, less than 40, less than 39, less than 38, less than 37, less than 36, 35 Less than 34 pieces, less than 33 pieces, less than 32 pieces, less than 31 pieces, less than 30 pieces, less than 29 pieces, less than 28 pieces, less than 27 pieces, less than 26 pieces, less than 25 pieces, less than 24 pieces, less than 23 pieces , Less than 22, less than 21, less than 20, less than 19, less than 18, less than 17, less than 16, less than 16, less than 15, less than 14, less than 13, less than 12, less than 12, less than 11, 10 With less than, less than 9, less than 8, less than 8, or less than 6 amino acid residues (eg, less than 500 consecutive amino acid residues in any one of SEQ ID NO: 5) is there.

Percent (%) amino acid sequence identity is an amino acid in the same candidate sequence as the amino acid in the reference sequence after the sequence has been aligned to achieve maximum percent sequence identity and a gap has been introduced if necessary. Defined as a percentage of. For the purpose of seeking percent sequence identity, in various ways within the art within the art, for example, publicly available computer software such as BLAST, BLAST-2, ALIGN, ALIGN-2, or Megalign ( Alignment can be achieved using DNASTAR) software. Appropriate parameters for measuring the alignment, including any algorithm required to achieve maximum alignment over the full length of the sequence being compared, can be determined by known methods.

II. Outline of the present invention Lectins (MBL, M-ficolin, H-ficolin, L-ficolin, and CL-11) are specific recognition molecules that induce the innate complement system, and this system is a lectin initiation pathway. And includes a related terminal pathway amplification loop that amplifies terminal complement effector molecular activation initiated by lectins. C1q is a specific recognition molecule that induces an acquired complement system, which contains the classical initiation pathway and the associated terminal pathway amplification loop that amplifies terminal complement effector molecular activation initiated by C1q. We refer to these two major complement activation systems as the lectin-dependent complement system and the C1q-dependent complement system, respectively.

The complement system contributes to tissue damage in many clinical conditions, in addition to its essential role in immune defense. Therefore, there is an urgent need to develop therapeutically effective complement inhibitors to prevent these side effects. Certain conditions without completely blocking the immune defenses of complement, with the recognition that it is possible to block the lectin-mediated MASP-2 pathway while leaving the classical pathway intact. I have found that it is extremely desirable to specifically inhibit only the complement activation system that causes the disease. For example, in disease states where complement activation is primarily mediated by the lectin-dependent complement system, it may be advantageous to specifically inhibit only this system. For this reason, the C1q-dependent complement activation system is thought to remain in perfect condition to handle immune complex processing and aid host defense against infectious diseases.

A preferred protein component of interest in the development of therapeutic substances that specifically inhibit the lectin-dependent complement system is MASP-2. Of all the known protein components of the lectin-dependent complement system (MBL, H-ficolin, M-ficolin, L-ficolin, MASP-2, C2-C9, factor B, factor D, and propeldin), lectin-dependent MASP-2 is the only complement system that is unique and required for the system to function. Lectins (MBL, H-ficolin, M-ficolin, L-ficolin, and CL-11) are also unique components in the lectin-dependent complement system. However, even if any one of these lectin components disappears, it is considered that the activation of the system is not necessarily inhibited due to the lectin duplication. Inhibition of all five lectins may be necessary to ensure inhibition of the lectin-dependent complement activation system. In addition, since MBL and ficholine are also known to have opsonin activity independent of complement, inhibition of lectin function would result in the loss of this beneficial host defense mechanism against infections. In contrast, when MASP-2 is an inhibitory target, this complement-independent lectin opsonin activity is considered to remain in perfect condition. The additional benefit of MASP-2 as a therapeutic target that inhibits the lectin-dependent complement activation system is that the plasma concentration of MASP-2 (approximately 500 ng / ml) is among the lowest plasma concentrations of complement protein. That is. Therefore, correspondingly low concentrations of high affinity MASP-2 inhibitors may be sufficient to obtain complete inhibition (Moller-Kristensen, M., et al., J. Immunol Methods 282). : 159-167, 2003).

III. Role of MASP-2 in thrombotic microangiopathy and treatment methods using MASP-2 inhibitors<u style="single">Overview</u> Thrombotic microangiopathy (TMA) is a condition characterized by blood clots in small blood vessels (Benz. K .; et al., Curr Opin Nephrol Hypertens 19 (3): 242-7 (2010)). Stress or damage to the underlying vascular endothelium is considered to be the primary driver. Clinical and laboratory findings of TMA include thrombocytopenia, anemia, purpura, and renal failure. The classic TMA is hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). The pathological features underlying the characteristic of TMA are platelet activation and microthrombus formation in arterioles and venules. Complement activation, at least partially initiated by damage or stress to the microvascular endothelium, is also associated with fulminant antiphospholipid antibody syndrome (CAPS), systemic degoss disease, and TMA secondary to cancer, cancer chemotherapy. He is involved in secondary TMA and other TMA, including TMA secondary to transplantation.

Studies of patients with genetic deficiencies in certain complement components provided direct evidence of the pathological role of complement in nephritis hosts. Many reports have described a relationship between renal injury and complement regulatory H factor deficiency (Ault, BH, Nephrol. 14: 1045-1053, 2000; Levy, M., et al., Kidney Int. 30: 949-56, 1986; Pickering, MC, et al., Nat. Genet, 31: 424-8, 2002). Factor H deficiency results in lower plasma levels of these components due to the consumption of factors B and C3 associated with activation. Circulation levels of C5b-9 in the serum of these patients are also increased. This means complement activation. Membranoproliferative glomerulonephritis (MPGN) and idiopathic hemolytic uremic syndrome (HUS) are associated with factor H deficiency or mutation. Factor H-deficient pigs (Jansen, JH, et al., Kidney Int. 53: 331-49, 1998) and factor H knockout mice (Pickering, MC, 2002) exhibit MPGN-like symptoms. This supports the importance of factor H in complement regulation. Deficiency of other complement components is associated with renal disease secondary to the development of systemic lupus erythematosus (SLE) (Walport, MJ, Davies, et al., Ann. NY Acad. Sci. 815: 267-81, 1997 ). Deficiencies in C1q, C4, and C2 are a strong predisposing factor for the development of SLE through mechanisms associated with incomplete clearance of immune complexes and apoptotic substances. Many of these SLE patients develop lupus nephritis, which is characterized by the deposition of immune complexes throughout the glomerulus.

<u style="single">aHUS</u> Atypical Hemolytic Urotoxicosis Syndrome (aHUS) is part of a group of conditions called "thrombotic microangiopathy". In atypical HUS (aHUS), the disease is associated with incomplete complement regulation and can be sporadic or familial. Familiar aHUS cases include complement activity, including complement factor H, factor I, factor B, membrane cofactor CD46, and complement factor H-related protein 1 (CFHR1) and complement factor H-related protein 3 (CFHR3). Associated with mutations in genes encoding chemical or complement regulatory proteins (Zipfel, PF, et al.,, PloS Genetics 3 (3): e41 (2007)). An integrated feature of this widespread genetic mutation associated with aHUS is a predisposition to enhanced complement activation on the cell or tissue surface. Thus, one aspect of the invention comprises treating a patient suffering from aHUS associated with an H factor deficiency by administering an effective amount of a MASP-2 inhibitor. Another aspect of the invention is for patients suffering from HUS associated with a deficiency of factor I, factor B, membrane cofactor CD46, CFHR1, or CFHR3 by administering an effective amount of MASP-2 inhibitor. Including treating.

Recently, considerable progress has been made towards understanding the molecular pathophysiology underlying the enhancement of complement activation in aHUS caused by diverse mutant complement factor sets. This mechanism is best understood for factor H mutations. Factor H is a rich serum protein containing 20 short consensus repeat (SCR) domains that act as a negative regulator of complement activation in the lysed state as well as on the host cell surface. It targets activated C3 along with factor I and other cofactors, promotes its inactivation and prevents further complement activation. In order to effectively regulate complement activation on the surface of the host cell, factor H needs to interact with the host cell, which is mediated by SCR domains 16-20. All aHUS-related factor H mutations described to date are clustered in the C-terminal region containing (SCR) domains 16-20. Although these mutant H-factor proteins function fully in the regulation of C3 activation in the lysed state, they are unable to interact with the host cell surface and, as a result, are unable to regulate C3 activation on the cell surface. (Exp Med 204 (6): 1249-56 (2007)). Therefore, certain H-factor mutations are associated with aHUS because mutant H-factor proteins do not interact with the host cell surface and therefore cannot effectively reduce complement activation on the host cell surface, including microvascular endothelium. To do. As a result, when early C3 activation occurs, subsequent complement activation on the microvascular endothelial surface proceeds unchanged in patients with H-factor mutations. This uncontrolled complement activation is ultimately caused by progressive damage to the vascular endothelium, followed by platelet aggregation and microvascular coagulation, and the shear stress of passing through RBC through partially occluded microvessels. Leads to hemolysis. Therefore, aHUS disease manifestation and clinical and laboratory findings are directly associated with deficiencies in negative complement regulation on the microvascular endothelial surface.

Similar to factor H mutations, atypical mutations in the negative complement modulators factor I and membrane cofactor protein (CD46) are also associated with aHUS. The opposite has been observed for these proteins, as aHUS was found to be associated with gain-of-function mutations in factor B and C3 proteins (Pediatr Nephrol 25 (12): 2431-42 (2010)). ). Therefore, a large number of cohesive data indicate that complement activation is associated with aHUS development. This idea is most convincingly supported by the therapeutic efficacy of eculizumab, a monoclonal antibody that blocks the terminal complement protein C5 in the treatment of aHUS.

Although the central role of complement as an effector mechanism in aHUS is widely recognized, the triggers that initiate complement activation and the molecular pathways involved are unresolved. Not all individuals with the above mutations develop aHUS. In fact, family studies suggest that aHUS penetration is only about 50% (Ann Hum Genet 74 (1): 17-26 (2010)). The natural course of the disease suggests that aHUS most often develops after an onset event such as an infectious episode or injury. It is well known that infectious agents activate the complement system. In the absence of existing adaptive immunity, complement activation by infectious agents can be initiated primarily via the lectin pathway. Thus, infection-induced lectin pathway activation can trigger initiation for pathological amplification after complement activation in individuals predisposed to aHUS and ultimately disease. It may lead to progress. Thus, another aspect of the invention comprises treating a patient suffering from aHUS secondary to an infection by administering an effective amount of a MASP-2 inhibitor.

Other forms of damage to the host tissue, especially damage to the vascular endothelium, activate complement via the lectin pathway. Human vascular endothelial cells under oxidative stress react, for example, by binding to lectins and expressing surface moieties that activate the complement lectin pathway (Am J. Pathol 156 (6): 1549-56 (Am J. Pathol 156 (6): 1549-56). 2000)). Vascular injury after ischemia / reperfusion also activates complement in vivo via the lectin pathway (Scand J Immunol 61 (5): 426-34 (2005)). Lectin pathway activation in this context has pathological consequences for the host, and inhibition of the lectin pathway by MASP-2 blockade prevents further host tissue damage and adverse events (Sehwaeble PNAS 2011).

Therefore, it is known that other processes that cause aHUS suddenly also activate the complement lectin pathway. Therefore, the lectin pathway is likely to be an early complement activation mechanism that is improperly amplified in a chaotic manner in individuals with a genetic predisposition to aHUS and thus initiates aHUS pathology. By reasoning, agents that block complement activation via the lectin pathway, including anti-MASP-2 antibodies, are expected to inhibit disease progression or reduce exacerbations in aHUS-sensitive individuals.

To further support this idea, recent studies have identified Streptococcus pneumoniae (S. pneumonia) as an important pathogenic agent in pediatric cases of aHUS (Nephrology (Carlton), 17: 48-52 (2012). ); Pediatr Infect Dis J. 30 (9): 736-9 (2011)). This particular etiology appears to have an unfavorable prognosis and high mortality and long-term morbidity. In particular, these cases have no evidence of co-occurring complement gene mutations known to predispose to aHUS, leading to microangiopathy, uremia, and hemolytic symptoms of non-enteric infections. Was accompanied by. It is important to note that Streptococcus pneumoniae is particularly effective in complement activation and activates complement primarily via the lectin pathway. Therefore, in the case of non-enteric HUS associated with pneumoniae infection, the manifestation of microangiopathy, uremia, and hemolysis is expected to be driven primarily by lectin pathway activation, and lectins containing anti-MASP-2 antibodies. Agents that block the pathway are expected to block aHUS progression and reduce disease severity in these patients. Therefore, another aspect of the present invention comprises treating a patient suffering from non-enteric aHUS associated with Streptococcus pneumoniae infection by administering an effective amount of a MASP-2 inhibitor .

As described above, in some embodiments, in the context of a subject at risk of developing aHUS-related renal failure, an amount of MASP-2 inhibitor effective in ameliorating or preventing renal failure in the subject. Methods are provided for reducing the likelihood of developing aHUS or developing aHUS-related renal failure, including the step of administration over a period of time effective to ameliorate or prevent renal failure. In some embodiments, the method further comprises determining whether the subject is at risk of developing aHUS before developing aHUS-related symptoms. In other embodiments, the method comprises the subject developing at least one or more symptoms indicating aHUS (eg, the subject presenting with anemia, thrombocytopenia, and / or renal dysfunction), and / or the subject. Including the step of determining whether or not there is a risk of developing aHUS based on the presence of thrombotic microangiopathy in the biopsy material obtained from. Determining whether a subject is at risk of developing aHUS involves determining whether a subject has a genetic predisposition to develop aHUS, which includes (eg, from a database containing the genotype of the subject). ) By assessing genetic information or by performing at least one gene screening test on the subject to determine the presence or absence of genetic markers associated with aHUS (ie, genome sequencing or gene-specific analysis (ie) For example, by PCR analysis), factor H (CFH), factor I (CFI), factor B (CFB), membrane cofactor CD46, C3, factor H-related protein 1 (CFHR1), or THBD (anticoagulation) Determines the presence or absence of aHUS-related gene mutations in the gene encoding the protein thrombodulin), or factor H-related protein 3 (CFHR3), or factor H-related protein 4 (CFHR4). (By) and / or determining if the subject has aHUS family history May be carried out by. Methods for gene screening for the presence or absence of aHUS-related gene mutations are well established. For example, Noris M et al. "Atypical Hemolytic-Uremic Syndrome", 2007 Nov 16 [Updated May 10, 2011]. In: Pagon RA, Bird TD, Dolan CR, et al., Ed. GeneReviews , Seattle (WA): See University of Washington, Seattle.

For example, overall, disease penetration in people with the complement factor H (CFH) mutation is 48%, CD46 mutation penetration is 53%, and CFI mutation penetration is 50%. The penetration of the C3 mutation is 56% and the penetration of the THBD mutation is 64% (Caprioli J. et al., Blood, 108: 1267-79 (2006); Noris et al., Clin J). Am Soc Nephrol 5: 1844-59 (2010)). Caprioli et al., (2006), as described above, a significant number of individuals with factor H (CFH) mutations never developed aHUS and under physiological conditions complement activation. Suboptimal CFH activity in these individuals is assumed to be sufficient to protect the host from effects. However, suboptimal CFH activity is sufficient to prevent C3b from depositing on vascular endothelial cells when exposed to agents that activate complement and produce higher than normal amounts of C3b. Not.

Thus, in one embodiment, non-H factor dependent atypical hemolysis comprising the step of administering to the subject a composition comprising an amount of MASP-2 inhibitor effective to inhibit MASP-2 dependent complement activation. Provided is a method for inhibiting MASP-2 dependent complement activation in a subject suffering from sexual uremic syndrome or at risk of developing the non-H factor dependent atypical hemolytic uremic syndrome. Will be done. In another embodiment, MASP is based on the step of regularly monitoring the subject to determine the presence or absence of anemia, thrombocytopenia, or increased creatinine, and the determination that anemia, thrombocytopenia, or increased creatinine is present. A method for inhibiting MASP-2-dependent complement activation in a subject at risk of developing H-factor-dependent atypical hemolytic urocytosis syndrome, including treatment with a -2 inhibitor, is provided. .. Events known to be associated with the induction of aHUS clinical manifestations in another embodiment, such as drug exposure (eg, chemotherapy), infections (eg, bacterial infections), malignancies, injuries, organ transplants or tissue transplants. Reduces the likelihood that subjects at risk of developing H-factor-independent aHUS will develop aHUS-related clinical symptoms, including the step of administering MASP-2 inhibitors before, during, or after pregnancy. A way to get it done is provided.

In one aspect, there is a step of regularly monitoring subjects at risk of developing aHUS to determine the presence or absence of anemia, thrombocytopenia, or increased creatinine, and anemia, thrombocytopenia, or increased creatinine. A method for reducing the likelihood of the subject suffering from aHUS-related clinical symptoms is provided, including the step of treating with a MASP-2 inhibitor based on the determination.

In another embodiment, events known to be associated with the induction of aHUS clinical manifestations, such as drug exposure (eg, chemotherapy), infections (eg, bacterial infections), malignancies, injuries, organ transplants or tissues. Methods for reducing the likelihood that a subject at risk of developing aHUS will be affected by clinical symptoms associated with aHUS, including transplantation or the step of administering a MASP-2 inhibitor before, during, or after pregnancy. Is provided.

In some embodiments, the MASP-2 inhibitor is used for at least 1 day, 2 days, 3 days, 4 days, or longer, before, during, or after an event associated with the induction of aHUS clinical symptoms. It may be administered and repeated as determined by the physician until the condition is restored or managed. In the pre-aHUS situation, the MASP-2 inhibitor may also be systemically administered to a subject by, for example, intra-arterial, intravenous, intramuscular, inhalation, nasal, subcutaneous, or other parenteral administration. Good.

In some embodiments, in the context of the initial diagnosis of aHUS, or in subjects exhibiting one or more symptoms consistent with the diagnosis of aHUS (eg, anemia, thrombocytopenia, and / or the presence of renal dysfunction). Subjects are treated with an effective amount of MASP-2 inhibitor (eg, anti-MASP-2 antibody) in the absence of plasmapheresis as first-line therapy or in combination with plasmapheresis. As a first-line therapy, the MASP-2 inhibitor is systemically administered to the subject by, for example, intra-arterial, intravenous, intramuscular, inhalation, nasal, subcutaneous, or other parenteral administration. May be good. In some embodiments, in the absence of plasmaferresis to avoid potential plasmapheresis complications, including exposure to bleeding, infections, and disorders, and / or allergies inherent in plasma donors. Alternatively, in subjects who otherwise dislike plasmapheresis, or in situations where plasmaferresis is not available, MASP-2 inhibitors are administered to the subject as first-line therapy.

In some embodiments, the method applies a MASP-2 inhibitor to a subject suffering from aHUS via a catheter (eg, intravenously) for a first period (eg, at least 1 day to 1 week or 2). After weekly administration, the subject comprises the step of subcutaneously administering the MASP-2 inhibitor for a second period (eg, at least 2 weeks or longer in the chronic phase). In some embodiments, administration during the first and / or second period is performed in the absence of plasmapheresis. In some embodiments, the method further comprises the step of determining the level of at least one complement factor (eg, C3, C5) in the subject before and optionally during treatment, the standard value or Determining the level of at least one complement factor that was reduced compared to healthy controls indicates the need for continued treatment with MASP-2 inhibitors.

In some embodiments, the method provides a MASP-2 inhibitor, eg, an anti-MASP-2 antibody, intravenously, intramuscularly, to a subject suffering from aHUS or at risk of developing the aHUS. Alternatively, it preferably comprises the step of administering either subcutaneously. Treatment is chronic and may be given daily to monthly, preferably every two weeks. The anti-MASP-2 antibody may be administered alone or in combination with a C5 inhibitor such as eculizamab.

<u style="single">HUS</u> Like atypical HUS, typical HUS shows all the clinical and laboratory findings of TMA. However, typical HUS is often a childhood disorder and usually has no family component or direct association with complement gene mutations. Typical causes of HUS are closely associated with infections of certain intestinal pathogens. Patients typically present with acute renal failure, hemoglobinuria, and thrombocytopenia, typically following an episode of bloody diarrhea. This condition is caused by enterohemorrhagic Escherichia coli strains produced by Shigella dissenteria, Salmonella, or Shiga toxin-like production, such as Escherichia coli O157: H7. These pathogens are obtained from contaminated food or water supplies. HUS is a medical emergency with a mortality rate of 5-10%. A significant proportion of survivors develop chronic kidney disease (Corrigan and Boineau, Pediatr Rev 22 (11): 365-9 (2011)) and may require kidney transplantation.

Microvascular coagulation in typical HUS occurs mainly in the renal microvascular system, but not necessarily in the renal microvascular system alone. The underlying pathophysiology is mediated by Shiga toxin (STX). STX is excreted into the intestinal lumen by enteropathy microorganisms, crosses the intestinal barrier, enters the bloodstream, and binds to vascular endothelial cells via the blobotriaosyl ceramide receptor CD77 (Boyd and Lingwood Nephron 51: 207 (1989)), CD77 is preferentially expressed on the glomerular endothelium and mediates the toxic effects of STX. When STX binds to the endothelium, it damages the vascular endothelium, activates leukocytes, and induces a series of events that lead to vWF-dependent thrombus formation (Forsyth et al., Lancet 2: 411-414 (1989); Zoja et al. , Kidney Int. 62: 846-856 (2002); Zanchi et al., J. Immunol 183: 1460-1469 (2008); Morigi et al., Blood 98: 1828-1835 (2001); Guessou et al., Infect. Immun., 73: 8306-8316 (2005)). These microthrombi interfere with or occlude the arterioles and capillaries of the kidneys and other organs. As the RBC pushes through the narrowed blood vessels, the obstruction of blood flow in the arterioles and capillaries by microthrombus increases the shear stress applied to the RBC. As a result, shear stress can destroy RBCs and form RBC fragments called dividing erythrocytes. The presence of dividing erythrocytes is a characteristic finding in HUS. This mechanism is known as microangiopathic hemolysis. In addition, obstruction of blood flow causes ischemia and initiates a complement-mediated inflammatory response that causes further damage to the affected organ.

The complement lectin pathway is due to two main mechanisms: (1) MASP-2 mediated direct coagulation cascade activation caused by endothelial damage, and (2) early occlusion of microvascular blood flow. It contributes to HUS development by lectin-mediated subsequent complement activation induced by ischemia.

STX damages microvascular endothelial cells, and the damaged endothelial cells are known to activate the complement system. As detailed above, complement activation after endothelial cell damage is driven primarily by the lectin pathway. Oxidatively stressed human vascular endothelial cells react by binding to lectins and expressing surface moieties that activate the complement lectin pathway (Collard et al., Am J Pathol. 156 (5): 1549- 56 (2000)). Vascular injury after ischemia-reperfusion also activates complement in vivo via the lectin pathway (Scand J Immunol 61 (5): 426-34 (2005)). Activation of the lectin pathway in this situation has pathological consequences for the host, and inhibition of the lectin pathway by MASP-2 blockade prevents further host tissue damage and adverse events (Schwaeble et al.,, PNAS (2011)). In addition to complement activation, lectin-dependent activation of MASP-2 has been shown to cleave prothrombin to form thrombin and promote coagulation. Therefore, activation of the complement lectin pathway by injured endothelial cells can directly activate the coagulation system. Therefore, the MASP-2 mediated prothombin-activated complement lectin pathway may be the major molecular pathway linking STX-induced early endothelial damage to coagulation and microvascular thrombosis that occur in HUS. high. Thus, lectin pathway inhibitors, including but not limited to antibodies that block MASP-2 function, are expected to block or reduce microvascular coagulation, thrombosis, and hemolysis in patients suffering from HUS. In fact, administration of anti-MASP-2 antibody significantly protects typical HUS model mice. As described in Example 36 and as shown in FIG. 45, all control mice exposed to STX and LPS developed severe HUS and were moribund or died within 48 hours. On the other hand, all mice further treated with anti-MASP-2 antibody and then exposed to STX and LPS survived (Fisher's exact test p &lt;0.01; N = 5), as further shown in Figure 45. Therefore, anti-MASP-2 therapy significantly protects mice in this HUS model. Administration of MASP-2 inhibitors, such as MASP-2 antibody, is effective in treating HUS patients and protects against microvascular coagulation, thrombosis, and hemolysis caused by infections with intestinal disease E. coli or other STX-producing pathogens. Is expected to provide.

Although indicated herein for HUS caused by STX, anti-MASP-2 therapy is also expected to be beneficial for HUS-like syndrome due to endothelial damage caused by other toxic substances. This includes agents such as mitomycin, ticlopidine, cycplatin, quinine, cyclosporine, bleomycin, as well as other chemotherapeutic and immunosuppressive drugs. Therefore, anti-MASP-2 antibody therapy or other modalities that inhibit MASP-2 activity effectively block or limit coagulation, thrombus formation, and RBC disruption, and HUS and other TMA-related diseases (ie, aHUS and). It is expected to prevent renal failure in TTP).

Patients with HUS often present with diarrhea and vomiting, usually with low platelet counts (thrombocytopenia) and low RBC (anemia). The pre-HUS diarrhea phase typically lasts about 4 days, and during this period subjects at risk of developing HUS typically have one of the following symptoms, in addition to severe diarrhea: Or show multiple: less than 30% hematocrit level with smear evidence of intravascular red blood cell destruction, thrombocytopenia (platelet count &lt;150 x 10)³/ mm³), And / or the presence of renal dysfunction (serum creatinine concentration above the upper limit of the age reference range). The presence of oliguria (urine volume of 0.5 mL / kg / h over a day) can be used as a measure of progression to the development of HUS (C. Hickey et al., Arch Pediatr Adolesc Med 165). (10): See 884-889 (2011)). Typically, tests are performed for the presence of infections of Escherichia coli (Escherichia coli O157: H7) or Shigella or Salmonella species. The use of antibiotics is contraindicated in subjects who test positive for infections with enterogenic E. coli (eg, E. coli O157: H7). This is because the use of antibiotics may increase the risk of developing HUS by increasing STX production (Wong C. et al., N Engl J. See Med 342: 1930-136 (2000)). For subjects who test positive for the genus Shigella or Salmonella, antibiotics are typically given to eliminate the infection. Other well-established first-line therapies for HUS include volume expansion, dialysis, and plasmaferresis.

As described above, in some embodiments, a subject suffering from one or more pre-HUS-related symptoms and a subject at risk of developing HUS (ie, the subject is one or more of the following: Shows: diarrhea, hematocrit levels less than 30% with smear evidence of intravascular red blood cell destruction, thrombocytopenia (150 x 10)³/ mm³In the presence of (less than platelet count) and / or renal dysfunction (serum creatinine concentration above the upper limit of the age reference range)), an effective amount of MASP-2 to ameliorate or prevent renal dysfunction Methods for reducing the risk of developing HUS in the subject or reducing the likelihood of renal failure include the step of administering the inhibitor over a period of time effective to ameliorate or prevent the renal dysfunction. Provided. In some embodiments, the MASP-2 inhibitor is administered over a period of at least 1 day, 2 days, 3 days, 4 days, or longer and is determined by the physician until the condition recovers or is controlled. It may be repeated as follows. In the pre-HUS context, MASP-2 inhibitors are systemically administered to a subject by, for example, intra-arterial, intravenous, intramuscular, inhalation, nasal, oral, subcutaneous, or other parenteral administration. May be done.

Treatment of Escherichia coli O157: H7 infections with bactericidal antibiotics, especially β-lactams, has been associated with an increased risk of developing HUS (Smith et al., Pediatr Infect Dis J 31 (1): 37-41 ( 2012). In some embodiments, suffering from pre-HUS-related symptoms known to be infected with enteric E. coli (eg, E. coli O157: H7), which is contraindicated for the use of antibiotics. In the subject's situation, an amount of MASP-2 inhibitor effective to suppress or prevent the presence of urinary illness in the subject, a first period effective to suppress or prevent the presence of urinary dysfunction. Methods are provided to reduce the risk of developing HUS in the subject or reduce the likelihood of renal failure, including the step of administration over (eg, at least 1, 2, 3, or 4 days). The administration of the MASP-2 inhibitor during the first period is carried out in the absence of antibiotics. In some embodiments, the method comprises MASP over a second period (eg, at least 1-2 weeks). -2 Further includes the step of administering the inhibitor in combination with an antibiotic to the subject.

In other embodiments, in the context of a subject who suffers from pre-HUS-related symptoms and is known to be infected with Shigella or Salmonella, the presence of oliguria in the subject is suppressed or prevented. A method for reducing the risk of developing HUS in a subject, comprising the step of administering an effective amount of MASP-2 inhibitor to the subject over a period of time effective to suppress or prevent the presence of the oliguria. Methods are provided to reduce the likelihood of renal failure, and administration of MASP-2 inhibitors is in the presence or absence of appropriate antibiotics.

In some embodiments, microangiopathic hemolytic anemia, in the context of the initial diagnosis of HUS, or in the presence of one or more symptoms consistent with the diagnosis of HUS (eg, renal failure, or the absence of low fibrinogen). Alternatively, in subjects exhibiting thrombocytopenia), the subject should have an effective amount of MASP-2 inhibitor (eg, anti-MASP) in the absence of plasmaferresis as first-line therapy or in combination with plasmaferresis. -2 antibody) is treated. As a first-line therapy, the MASP-2 inhibitor is systemically administered to the subject by, for example, intra-arterial, intravenous, intramuscular, inhalation, nasal, subcutaneous, or other parenteral administration. May be good. In some embodiments, in the absence of plasmapheresis or to avoid plasmapheresis complications such as exposure to bleeding, infections, and disorders, and / or allergies inherent in plasma donors, or plasmapheret. MASP-2 inhibitors are administered to subjects as first-line therapy in subjects who otherwise dislike cis or in situations where plasmaferresis is not available.

In some embodiments, the method applies a MASP-2 inhibitor to a subject suffering from HUS via a catheter (eg, intravenously) for a first period (eg, at least 1 day to 1 week or 2). It comprises the step of administering the MASP-2 inhibitor to the subject subcutaneously for a second period (eg, at least 2 weeks or more in the chronic phase). In some embodiments, administration during the first and / or second period is performed in the absence of plasmapheresis. In some embodiments, the method further comprises the step of determining the level of at least one complement factor (eg, C3, C5) in the subject prior to treatment, optionally during treatment, and is standard or healthy. Determining the level of the at least one complement factor, which is reduced compared to the control subject, indicates the need for treatment, and determination of the normal level indicates improvement.

In some embodiments, the method administers a MASP-2 inhibitor, eg, an anti-MASP-2 antibody, subcutaneously or intravenously to a subject suffering from HUS or at risk of developing the HUS. Includes steps. Treatment is preferably daily, but may be less frequent, weekly or monthly. Treatment lasts as long as at least 1 week and 3 months. The anti-MASP-2 antibody may be administered alone or in combination with a C5 inhibitor such as eculizumab.

<u style="single">TTP:</u> Thrombotic thrombocytopenic purpura (TTP) is a life-threatening blood coagulation disorder caused by autoimmunity or hereditary dysfunction that activates the coagulation cascade or complement system (George, JN, N Engl J Med). 354: 1927-35 (2006)). It causes a large number of tiny blood clots or thrombosis in small blood vessels throughout the body. Red blood cells are subjected to shear stress, which damages the red blood cell membrane, which causes intravascular hemolysis. The resulting loss of blood flow and endothelial damage causes damage to organs, including the brain, heart, and kidneys. TTP is clinically characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurological changes, renal failure, and fever. In the pre-plasmapheresis era, mortality during acute episodes was 90%. Survival at 6 months is about 80% even with plasmapheresis.

TTP can result from genetic or acquired inhibition of the enzyme ADAMTS-13, a metalloprotease responsible for cleavage of von Willebrand factor (vWF) from large multimers to small units. Inhibition or deficiency of ADAMTS-13 ultimately results in increased coagulation (Tsai, H. J Am Soc Nephrol 14: 1072-1081, (2003)). ADAMTS-13 regulates vWF activity. In its absence, vWF forms large multimers that are likely to bind to platelets, making patients susceptible to platelet aggregation and thrombosis in the microvasculature.

Upshaw-Schulman syndrome (USS, also known as congenital TTP) is a congenital ADAMTS13 activity deficiency due to a mutation in the ADAMTS13 gene (Schulman et al., Blood, 16 (1): 943-57, 1960; Upshaw et. al., New Engl. J. Med, 298 (24): 1350-2, 1978). A large number of ADAMTS13 mutations have been identified in individuals with congenital TTP (Kinoshita et al., International Journal of Hematology, 74: 101-108 (2001); Levy et al., Nature, 413 (6855): 488-494 (2001); Kokame et al., PNAS 99 (18): 11902-11907 (2002); Savasan et al., Blood, 101: 4449-4451 (2003); Matsumoto et al., Blood, 103: 1305-1310 (2004) and Fujimura et al., Brit. J. Haemat 144: 742-754 (2008)). Subjects with USS typically have 5-10% of normal ADAMTS13 activity (Kokame et al., PNAS 99 (18): 11902-11907, 2002). Although acquired TTP and USS have some similarities, USS has some important differences in clinical features. USS usually appears in infancy or childhood and is characterized by severe hyperbilirubinemia and postnatal Coombs test negative, response to fresh plasma infusion, and frequent recurrence (Savasan et al., Blood, 101). : 4449-4451, 2003). In some cases, patients with this hereditary ADAMTS13 deficiency have a mild phenotype at birth and develop TTP-related symptoms only in clinical situations with high von Willebrand factor levels, such as infection or pregnancy. Does not develop. For example, Fujimura et al. Reported nine Japanese women diagnosed with disability during their first pregnancy from six families with genetically confirmed USS. Thrombocytopenia occurred during the second to third trimesters of each of the 15 pregnancies, often followed by TTP. All of these women were found to be severely deficient in ADAMTS13 activity (Fujimura et al., Brit. J. Haemat 144: 742-754, 2008).

As described above, in some embodiments, a subject with Upshaw-Schulmann syndrome (USS) (ie, the subject is known to lack ADAMTS13 activity and / or the subject has one or more ADAMTS13 genes. In situations of (known to have mutations), an amount of MASP-2 inhibitor (eg, MASP-2 antibody) effective to ameliorate or prevent one or more clinical symptoms associated with TTP. Congenital TTP-related clinical symptoms (eg, thrombocytopenia, anemia, fever, and / or renal failure), including the step of administering over a period of time effective to ameliorate or prevent the clinical symptoms. Methods are provided to reduce the likelihood of developing the disease. In some embodiments, the method involves the development of at least one or more symptoms (eg, anemia, thrombocytopenia, and / / Alternatively, it further comprises the step of determining whether or not there is a risk of developing symptoms associated with congenital TTP based on the presence of renal failure). The step of determining whether a subject is at risk of developing symptoms associated with congenital TTP (ie, whether the subject has USS) determines whether the subject has a mutation in the gene encoding ADAMTS13. And / or determining if the subject is deficient in ADAMTS13 activity, and / or determining if the subject has a family history of USS. Methods for gene screening for the presence or absence of USS-related gene mutations are well established. For example, Kinoshita et al., International Journal of Hematology, 74: 101-108 (2001); Levy et al., Nature, 413 (6855): 488-494 (2001); Kokame et al., PNAS 99 (18) : 11902-11907 (2002);

In one aspect, there is a step of regularly monitoring a subject diagnosed with USS to determine the presence or absence of anemia, thrombocytopenia, or increased creatinine, and that there is anemia, thrombocytopenia, or increased creatinine. Events that are known to be based on judgment or related to the induction of TTP clinical manifestations, such as drug exposure (eg, chemotherapy), infections (eg, bacterial infections), malignant tumors, injuries, transplants, or Methods are provided to reduce the likelihood that a subject will be affected by TTP-related clinical symptoms, including the step of treating with a MASP-2 inhibitor (eg, MASP-2 antibody) based on the presence of pregnancy. ..

In another embodiment, an amount of MASP-2 inhibitor (eg, MASP-2 antibody) effective to ameliorate or prevent one or more clinical symptoms associated with TTP is used to ameliorate the clinical symptoms. Methods are provided for treating subjects with USS and subjects suffering from TTP-related clinical symptoms, including the step of administering over a period of time effective to cause or prevent.

TTP can also be caused by autoantibodies to ADAMTS-13. In addition, TTP is breast cancer, gastrointestinal cancer, or prostate cancer (George. JN., Oncology (Wiiliston Park). 25: 908-14 (2011)), pregnancy (second stage or postpartum), George JN., It can develop during Curr Opin Hematol 10: 339-344 (2003)) or is associated with a disease, such as an autoimmune disease such as HIV or systemic erythematosus (Hamasaki K, et al., Clin Rheumatol. 22: 355-8 (2003)). TTP also includes heparin, quinine, immune components, cancer chemotherapeutic agents (bleomycin, cisplatin, citocin arabinoside, daunomycin, gemcitabine, mitomycin C, and tamoxyphene), cyclosporin A, oral contraceptives, penicillin, riphanpine, and ticlopidine. And may be caused by certain medications, including antiplatelet drugs, including clopidogrel (Azarm, T. et al. et al., J Res Med Sci., 16: 353-357 (2011)). Other factors or conditions associated with TTP include toxins such as bee venom, sepsis, splenic sequestration, transplantation, vasculitis, vascular surgery, and infections such as streptococcus pneumoniae and cytomegalovirus. (Moake JL., N Engl J Med., 347: 589-600 (2002)). Endothelial cell damage associated with Streptococcus pneumoniae infection may result in TTP due to transient functional ADAMTS-13 deficiency (Pediair Nephrol., 26: 631-5 (2011)).

Plasmapheresis is the standard treatment for TTP (Rock GA, et al., N Engl J Med 325: 393-397 (1991)). Plasmapheresis replaces ADAMTS-13 activity in patients with genetic defects and eliminates ADAMTS-13 autoantibodies in patients with acquired autoimmune TTP (Tsai, HM, Hematol Oncol Clin North Am., 21). (4): 609-v (2007)). Additional agents, such as immunosuppressive drugs, are routinely added to the therapy (George, JN, N Engl J Med, 354: 1927-35 (2006)). However, plasmapheresis is successful in only about 20% of patients, recurrence occurs in more than one-third of patients, and plasmapheresis is expensive and technically labor intensive. In addition, many patients cannot tolerate plasmapheresis. As a result, there is still a great need for additional and better TTP therapies.

Because TTP is a disorder of the blood coagulation cascade, treatment with complement system antagonists can help stabilize and treat the disease. Pathological activation of the second complement pathway has been linked to aHUS, but the role of complement activation in TTP is less clear. Functional deficiency of ADAMTS13 is important for TTP susceptibility but is not sufficient to cause acute episodes. Environmental factors and / or other genetic mutations can contribute to the development of TTP symptoms. For example, genes encoding proteins involved in coagulation cascade, vWF, platelet function, endothelial vascular surface components, or regulation of the complement system may be involved in the development of acute thrombotic microangiopathy (Galbusera, M. et al., Haematologica, 94; 166-170 (2009)). In particular, complement activation has been shown to play an important role. Serum from thrombotic microangiopathy associated with ADAMTS-13 deficiency has been shown to cause C3 and MAC deposition and subsequent neutrophil activation, which can be suppressed by complement inactivation ( Ruiz-Torres MP, et al., Thromb Haemost, 93: 443-52 (2005)). In addition, it has recently been shown that levels of C4d, C3bBbP, and C3a increase during acute episodes of TTP, consistent with activation of the classical / lectin pathway and the second pathway (M. Reti et al.,, J Thromb Haemost. Feb 28. (2012) doi: 10.1111 / j.1538-7836.2012.04674.x. [Electronic publications prior to printing]). In acute episodes, this increase in complement activation initiates terminal pathway activation and can cause further exacerbations of TTP.

The roles of ADAMTS-13 and vWF in TTP are clearly responsible for platelet activation and aggregation in microangiopathy and subsequent roles in shear stress and deposition. Activated platelets interact with and induce the classical and second pathways of complement. Platelet-mediated complement activation increases the inflammatory mediators C3a and C5a (Peerschke E et al., Mol Immunol, 47: 2170-5 (2010)). Therefore, platelets can serve as targets for classical complement activation in hereditary or autoimmune TTP.

As mentioned above, the MASP-2 mediated prothombin activation complement lectin pathway is the major molecular pathway that links endothelial damage occurring in HUS with coagulation and microvascular thrombosis. Similarly, activation of the complement lectin pathway can directly drive the coagulation system in TTP. Lectin pathway activation can be initiated in TTP in response to early endothelial damage caused by ADAMTS-13 deficiency. Thus, lectin pathway inhibitors, including but not limited to antibodies that block MASP-2 function, reduce microangiopathy associated with microangiopathy, thrombosis, and hemolysis in patients with TTP. It is expected that.

Patients with TTP are typically in the emergency room with one or more of the following: purpura, renal failure, low platelets, anemia, and / or thrombosis including stroke. .. The current treatment standard for TTP is intravascular catheter delivery of exchange plus maferesis (eg, intravenous catheter or others) over a period of 2 weeks or longer, typically 3 times a week but up to daily. Accompanied by a catheter in the form of). If the subject is tested positive for the presence of an inhibitor of ADAMTS13 (ie, an endogenous antibody against ADAMTS13), plasmaferresis is immunosuppressive therapy (eg, corticosteroid, rituximab, or cyclosporine). Can be done in combination with. Subjects with refractory TTP (approximately 20% of TTP patients) do not respond to plasmaferresis therapy for at least 2 weeks.

As described above, in one aspect, in the context of the initial diagnosis of TTP, or one or more symptoms consistent with the diagnosis of TTP (eg, central nervous system complications, severe thrombocytopenia (not taking aspirin). If less than 5000 / μL or 5000 / μL platelet count, if taking aspirin, less than 20,000 / μL or 20,000 / μL platelet count), serious cardiac complications, serious pulmonary complications, gastrointestinal complications Effective amounts of MASP-2 inhibitors (eg, anti-MASP-2 antibodies) as first-line therapy in the absence of plasmaferesis or in combination with plasmaferesis in subjects presenting with vascular infarction or necrosis) Provides a method for treating the subject. As a first-line therapy, the MASP-2 inhibitor is systemically administered to the subject by, for example, intra-arterial, intravenous, intramuscular, inhalation, nasal, subcutaneous, or other parenteral administration. May be good. In some embodiments, in the absence of plasmapheresis to avoid potential plasmapheresis complications such as bleeding, infections, and exposure to plasma donor-specific disorders and / or allergies, or In subjects who otherwise dislike plasmapheresis, or in situations where plasmaferresis is not available, MASP-2 inhibitors are administered to subjects as first-line therapy. In some embodiments, the MASP-2 inhibitor is combined with an immunosuppressant (eg, corticosteroid, rituximab, or cyclosporine) (including co-administration) and / or in combination with high concentrations of ADAMTS-13. Administered to subjects suffering from TTP.

In some embodiments, the method applies a MASP-2 inhibitor to a subject suffering from TTP via a catheter (eg, intravenously) for a first period (eg, at least 1 day to 1 week or 2). It comprises the step of administering the MASP-2 inhibitor to the subject subcutaneously for a second period (eg, at least 2 weeks or longer in the chronic phase). In some embodiments, administration during the first and / or second period is performed in the absence of plasmapheresis. In some embodiments, the method is used to maintain a subject so that it does not suffer from one or more TTP-related symptoms.

In another embodiment, a subject suffering from refractory TTP (ie, Plasma for at least 2 weeks) by administering an effective amount of MASP-2 inhibitor to alleviate one or more symptoms of TTP. Methods for treating subjects who do not respond to feresis therapy) are provided. In one aspect, MASP-2 inhibitors (eg, anti-MASP-2 antibodies) are chronically refractory TTP via subcutaneous or other parenteral administration for a period of at least 2 weeks or longer. Is administered to. Administration may be repeated as determined by the physician until the condition is resolved or managed.

In some embodiments, the method further comprises the step of determining the level of at least one complement factor (eg, C3, C5) in the subject prior to treatment, optionally during treatment, and is standard or healthy. Determining the level of the at least one complement factor reduced compared to the control subject indicates the need for continued treatment with MASP-2 inhibitors.

In some embodiments, the method comprises subcutaneously or intravenously administering a MASP-2 inhibitor, such as an anti-MASP-2 antibody, to a subject suffering from TTP or at risk of developing the TTP. including. Treatment is preferably daily, but may be less frequent, biweekly. Treatment is continued until the platelet count of the subject exceeds 150,000 / ml for at least 2 consecutive days. The anti-MASP-2 antibody may be administered alone or in combination with a C5 inhibitor such as eculizumab.

In one embodiment, the MASP-2 inhibitory antibody exhibits at least one or more of the following characteristics: K: the antibody is 10 nM or less._DTo bind human MASP-2 in, the antibody binds an epitope in the CCP1 domain of MASP-2, the antibody results in 1% C3b deposition in human serum at 10 nM or less in in vitro assays. IC₅₀Inhibiting with, the antibody causes C3b deposition in 90% human serum at 30 nM or less IC₅₀Inhibiting with, the antibody is Fv, Fab, Fab', F (ab)₂, And F (ab')₂It is an antibody fragment selected from the group consisting of, the antibody is a single chain molecule, the antibody is an IgG2 molecule, the antibody is an IgG1 molecule, and the antibody is IgG4 containing an S228P mutation. Being a molecule and / or the antibody does not substantially block the classical pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the second pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the classical or secondary pathway (ie, complete the classical and complement secondary pathways). Inhibits the lectin pathway while leaving it alone).

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from TTP by at least 30%, eg, at least 40%, eg, at least 50%, compared to untreated serum. For example, at least 60%, for example, at least 70%, for example, at least 80%, for example, at least 85%, for example, at least 90%, for example, at least 95%, up to 99%. In some embodiments, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from TTP by at least 20 percent or more than its inhibitory effect on C5b-9 deposition in serum (eg,). Inhibits at high levels (at least 30%, at least 40%, at least 50%).

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from TTP patients by at least 30%, eg, at least 40%, eg, at least 50%, eg, at least 60%, as compared to untreated serum. For example, at least 70%, for example, at least 80%, for example, at least 85%, for example, at least 90%, for example, at least 95%, up to 99%.

In one aspect, the MASP-2 inhibitory antibody is administered to the subject via an intravenous catheter or other catheter delivery method.

In one aspect, the invention is a method of inhibiting thrombosis in a subject suffering from TTP, the step of administering to the subject a composition comprising a certain amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof. Heavy chain CDR-H1; and (ii) SEQ ID NO: 67, wherein the antibody or antigen-binding fragment thereof comprises the amino acid sequences 31-35 of (I) (a) (i) SEQ ID NO: 67. Heavy chain CDR-H2 containing the amino acid sequence of 50-65 and (iii) heavy chain variable region containing the heavy chain CDR-H3 containing the amino acid sequence of 95-102 of SEQ ID NO: 67, and (b). ) (I) Light chain CDR-L1 containing the amino acid sequence of 24-34 of SEQ ID NO: 70; and (ii) Light chain CDR-L2; containing the amino acid sequence of 50-56 of SEQ ID NO: 70; 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) at least 90% identity with SEQ ID NO: 67 (eg, SEQ). ID Heavy chain variable region with NO: 67 and 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) and SEQ ID NO: 70 and at least 90% identity (eg, 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% Provided are methods comprising those variants comprising light chain variable regions having (identity).

In some embodiments, the method administers a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67. Includes the process of In some embodiments, the method is administered to a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof, comprising a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70. Includes the process of

In some embodiments, the method is on human MASP-2 recognized by reference antibody OMS646, which comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. A step of administering to a subject a composition comprising a MASP-2 inhibitory antibody or an antigen-binding fragment thereof that specifically recognizes at least a part of an epitope.

<u style="single">Degos disease</u> Degos disease, also known as malignant papule disease, is an extremely rare TMA that affects the endothelium of the skin, gastrointestinal tract, and small blood vessels of the CNS. This vascular disorder causes obstruction of venules and arterioles, resulting in skin lesions, intestinal ischemia, and CNS disorders including stroke, epilepsy, and cognitive impairment. Connective tissue necrosis in the skin is due to thrombotic obstruction of small arteries. However, the cause of Degos' disease is unknown. Vascular inflammation, coagulopathy, or primary endothelial cell dysfunction has been linked. The 50% survival rate for Degos disease is only 2-3 years. There is no effective treatment for Degos' disease, but antiplatelet drugs, anticoagulants, and immunosuppressants are used to relieve symptoms.

The mechanism of Degos' disease is unknown, but complement pathways have been linked. Margo et al. Confirmed prominent C5b-9 deposits in cutaneous, gastrointestinal, and cerebrovascular vessels in four terminally ill Degos patients (Margo et al., Am J Clin Pathol 135 (4)). : 599-610, 2011). Experimental treatment with eculizumab was initially effective in treating cutaneous and intestinal lesions, but did not stop the progression of systemic disease (Garrett-Bakelman F. et al., "C5b-9". is a potential effector in the pathophysiology of Degos disease; a case report of treatment with eculizumab "(Abstract), Jerusalem: International Society of Hematology; 2010, Poster # 156; and Polito J. et al, "Early detection of systemic Degos disease (DD) or malignant atrophic papulosis (MAP) may increase survival" (Abstract), San Antonio, TX: American College of Gastroenterology; 2010, Poster # 1205).

Many patients with Degos' disease have blood coagulation deficiencies. Thrombotic obstruction of small arteries in the skin is unique to the disease. Because the complement pathway is linked to this disease, other TMA lectin pathway inhibitors, including but not limited to antibodies that block MASP-2 function, as described herein, are degos. It is expected to be beneficial in the treatment of patients suffering from the disease.

Thus, in another embodiment, the invention comprises a composition comprising a therapeutically effective amount of a MASP-2 inhibitor, such as a MASP-2 antibody, in a pharmaceutical carrier, suffering from Degos's disease or a condition resulting from Degos' disease. Provided is a method for treating Degos' disease by administering to a subject. MASP-2 inhibitors can be administered, for example, by intra-arterial administration, intravenous administration, intramuscular administration, inhalation administration, subcutaneous administration, or other parenteral administration, or in the case of non-peptidic agents. , Degos disease or systemically administered to subjects suffering from conditions caused by Degos disease. The anti-MASP-2 antibody may be administered alone or in combination with a C5 inhibitor, such as eculizamab.

In one embodiment, the MASP-2 inhibitory antibody exhibits at least one or more of the following characteristics: K: the antibody is 10 nM or less._DTo bind human MASP-2 in, the antibody binds an epitope in the CCP1 domain of MASP-2, the antibody results in 1% C3b deposition in human serum at 10 nM or less in in vitro assays. IC₅₀Inhibiting with, the antibody causes C3b deposition in 90% human serum at 30 nM or less IC₅₀Inhibiting with, the antibody is Fv, Fab, Fab', F (ab)₂, And F (ab')₂The antibody fragment is selected from the group consisting of, the antibody is a single chain molecule, the antibody is an IgG2 molecule, the antibody is an IgG1 molecule, and the antibody is IgG4 containing an S228P mutation. Being a molecule and / or the antibody does not substantially block the classical pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the second pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the classical or secondary pathway (ie, complete the classical and complement secondary pathways). Inhibits the lectin pathway while leaving it alone).

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from Degos' disease by at least 30%, eg, at least 40%, eg, at least 50%, compared to untreated serum. For example, at least 60%, for example, at least 70%, for example, at least 80%, for example, at least 85%, for example, at least 90%, for example, at least 95%, up to 99%. In some embodiments, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from Degos' disease by at least 20 percent or more than its inhibitory effect on C5b-9 deposition in serum (eg,). , At least 30%, at least 40%, at least 50%) Inhibit at high levels.

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from patients with Degos' disease by at least 30%, eg, at least 40%, eg, at least 50%, eg, at least 60, as compared to untreated serum. %, For example, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%.

In one aspect, the MASP-2 inhibitory antibody is administered to the subject via an intravenous catheter or other catheter delivery method.

In one aspect, the invention is a method of inhibiting thrombosis in a subject suffering from Degos' disease, wherein a composition comprising an amount of a MASP-2 inhibitory antibody or an antigen-binding fragment thereof is administered to the subject. Including the steps, the antibody or antigen-binding fragment thereof comprises a heavy chain CDR-H1; and (ii) SEQ ID NO: containing the amino acid sequences 31-35 of (I) (a) (i) SEQ ID NO: 67. A heavy chain variable region comprising a heavy chain CDR-H2 containing an amino acid sequence of 50 to 65 of 67; and a heavy chain CDR-H3 containing an amino acid sequence of 95 to 102 of (iii) SEQ ID NO: 67, and (iii). b) (i) Light chain CDR-L1 containing the amino acid sequence of 24-34 of SEQ ID NO: 70; and (ii) Light chain CDR-L2; containing 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 at least 90% identity with (II) SEQ ID NO: 67 (eg,). SEQ ID Heavy chain variable region with NO: 67 and 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) and SEQ ID NO: 70 and at least 90% identity (eg, 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% Provided are methods comprising those variants comprising light chain variable regions having (identity).

In some embodiments, the method administers a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67. Includes the process of In some embodiments, the method is administered to a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof, comprising a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70. Includes the process of

In some embodiments, the method is on human MASP-2 recognized by reference antibody OMS646, which comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. A step of administering to a subject a composition comprising a MASP-2 inhibitory antibody or an antigen-binding fragment thereof that specifically recognizes at least a part of an epitope.

<u style="single">Fulminant antiphospholipid antibody syndrome (CAPS)</u> Fulminant antiphospholipid antibody syndrome (CAPS) is an extreme variant of antiphospholipid antibody (APLA) syndrome. CAPS is characterized by venous thrombosis and arterial thrombosis due to pathogenic antibodies. CAPS is a TMA with multi-organ thrombosis, ischemia, and multiple organ failure. Like other TMAs, it is characterized by obstruction of small blood vessels in various organs. The mortality rate of CAPS is as high as about 50% and is often associated with infection or trauma. Patients have antiphospholipid antibodies, generally IgG.

Clinically, CAPS involves at least three organs or tissues that provide histopathological evidence of small vascular occlusion. Peripheral thrombosis may involve veins and arteries in the CNS, cardiovascular, renal, or pulmonary systems. Patients are treated with antibiotics, anticoagulants, corticosteroids, plasmapheresis, and intravenous immunoglobulin. Nevertheless, multiple organ failure can cause death.

The complement pathway is associated with CAPS. For example, studies in animal models have shown that complement inhibition can be an effective means of blocking CAPS-related thrombosis (Shapira L. et al., Arthritis Rheum 64 (8). ): 2719-23, 2012). In addition, as further reported by Shapira et al., Administration of doses of eculizumab that block the complement pathway to subjects suffering from CAPS stopped acute progressive thrombotic events and reversed thrombocytopenia () See also Lim W., Curr Opin Hematol 18 (5): 361-5, 2011). Thus, lectin pathway inhibitors, including but not limited to antibodies that block MASP-2 function, may be beneficial in the treatment of patients suffering from CAPS, as described herein for other TMAs. There is expected.

Thus, in another aspect, the invention suffers from a composition comprising a therapeutically effective amount of a MASP-2 inhibitor, such as a MASP-2 antibody, in a pharmaceutical carrier, suffering from a condition caused by or due to CAPS. Provide a method for treating CAPS by administering to a subject. MASP-2 inhibitors can be administered, for example, by intra-arterial administration, intravenous administration, intramuscular administration, inhalation administration, subcutaneous administration, or other parenteral administration, or in the case of non-peptidic agents. , CAPS or systemically administered to subjects suffering from conditions caused by CAPS. The anti-MASP-2 antibody may be administered alone or in combination with a C5 inhibitor such as ecrizamab.

In one embodiment, the MASP-2 inhibitory antibody exhibits at least one or more of the following characteristics: K: the antibody is 10 nM or less._DTo bind human MASP-2 in, the antibody binds an epitope in the CCP1 domain of MASP-2, the antibody results in 1% C3b deposition in human serum at 10 nM or less in in vitro assays. IC₅₀Inhibiting with, the antibody causes C3b deposition in 90% human serum at 30 nM or less IC₅₀Inhibiting with, the antibody is Fv, Fab, Fab', F (ab)₂, And F (ab')₂The antibody fragment is selected from the group consisting of, the antibody is a single chain molecule, the antibody is an IgG2 molecule, the antibody is an IgG1 molecule, and the antibody is IgG4 containing an S228P mutation. Being a molecule and / or the antibody does not substantially block the classical pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the second pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the classical or secondary pathway (ie, complete the classical and complement secondary pathways). Inhibits the lectin pathway while leaving it alone).

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from CAPS by at least 30%, eg, at least 40%, eg, at least 50%, compared to untreated serum. For example, it inhibits at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%. In some embodiments, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from CAPS by at least 20 percent or more than its inhibitory effect on C5b-9 deposition in serum (eg,). Inhibits at high levels (at least 30%, at least 40%, at least 50%).

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from CAPS patients by at least 30%, eg, at least 40%, eg, at least 50%, eg, at least 60%, as compared to untreated serum. For example, at least 70%, for example, at least 80%, for example, at least 85%, for example, at least 90%, for example, at least 95%, up to 99%.

In one aspect, the MASP-2 inhibitory antibody is administered to the subject via an intravenous catheter or other catheter delivery method.

In one aspect, the invention is a method of inhibiting thrombosis in a subject suffering from CAPS, the step of administering to the subject a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof. Heavy chain CDR-H1; and (ii) SEQ ID NO: 67, wherein the antibody or antigen-binding fragment thereof comprises the amino acid sequences 31-35 of (I) (a) (i) SEQ ID NO: 67. Heavy chain CDR-H2 containing the amino acid sequence of 50-65 and (iii) heavy chain variable region containing the heavy chain CDR-H3 containing the amino acid sequence of 95-102 of SEQ ID NO: 67, and (b). ) (I) Light chain CDR-L1 containing the amino acid sequence of 24-34 of SEQ ID NO: 70; and (ii) Light chain CDR-L2; containing the amino acid sequence of 50-56 of SEQ ID NO: 70; 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) at least 90% identity with SEQ ID NO: 67 (eg, SEQ). ID Heavy chain variable region with NO: 67 and 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) and SEQ ID NO: 70 and at least 90% identity (eg, 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% Provided are methods comprising those variants comprising light chain variable regions having (identity).

In some embodiments, the method administers a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67. Includes the process of In some embodiments, the method is administered to a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof, comprising a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70. Includes the process of

In some embodiments, the method is on human MASP-2 recognized by reference antibody OMS646, which comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. A step of administering to a subject a composition comprising a MASP-2 inhibitory antibody or an antigen-binding fragment thereof that specifically recognizes at least a part of an epitope.

<u style="single">TMA secondary to cancer</u> All types of systemic malignancies can cause clinical and pathological manifestations of TMA (see, eg, Batts and Lazarus, Bone Marrow Transplantation 40: 709-719, 2007). Cancer-related TMA is often found in the lung and appears to be associated with tumor embolism (Francis KK et al., Commun Oncol 2: 339-43, 2005). Tumor embolization reduces blood flow and can therefore lead to hypoperfusion in the affected arterioles and venules. The resulting tissue stress and damage are expected to locally activate the lectin pathway of complement. The activated lectin pathway may then activate the coagulation cascade through MASP-2-dependent cleavage from prothrombin to thrombin, leading to a TMA-specific thrombus-promoting state. Inhibition of MASP-2 in this situation is expected to reduce local thrombin activation, thereby reducing the thrombus-promoting state.

Thus, as described herein for other TMAs, lectin pathway inhibitors, including but not limited to antibodies that block MASP-2 function, treat patients with TMA secondary to cancer. Expected to be beneficial in.

Thus, in another aspect, the invention presents a composition comprising a therapeutically effective amount of a MASP-2 inhibitor, such as a MASP-2 antibody, in a pharmaceutical carrier for a subject suffering from TMA secondary to cancer or Provided is a method for treating or preventing TMA secondary to cancer by administering to a subject at risk of developing the TMA. MASP-2 inhibitors can be administered, for example, by intra-arterial administration, intravenous administration, intramuscular administration, inhalation administration, subcutaneous administration, or other parenteral administration, or in the case of non-peptidic agents. , Systemically administered to subjects suffering from TMA secondary to cancer or at risk of developing the TMA. The anti-MASP-2 antibody may be administered alone or in combination with a C5 inhibitor such as ecrizamab.

In one embodiment, the MASP-2 inhibitory antibody exhibits at least one or more of the following characteristics: K: the antibody is 10 nM or less._DTo bind human MASP-2 in, the antibody binds an epitope in the CCP1 domain of MASP-2, the antibody results in 1% C3b deposition in human serum at 10 nM or less in in vitro assays. IC₅₀Inhibiting with, the antibody causes C3b deposition in 90% human serum at 30 nM or less IC₅₀Inhibiting with, the antibody is Fv, Fab, Fab', F (ab)₂, And F (ab')₂The antibody fragment is selected from the group consisting of, the antibody is a single chain molecule, the antibody is an IgG2 molecule, the antibody is an IgG1 molecule, and the antibody is IgG4 containing an S228P mutation. Being a molecule and / or the antibody does not substantially block the classical pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the second pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the classical or secondary pathway (ie, complete the classical and complement secondary pathways). Inhibits the lectin pathway while leaving it alone).

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from TMA secondary to cancer by at least 30%, eg, at least 40%, eg, compared to untreated serum. Inhibits at least 50%, eg, at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%.

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from TMA secondary to cancer by at least 30%, eg, at least 40%, eg, compared to untreated serum. Inhibits at least 50%, eg, at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%.

In one aspect, the MASP-2 inhibitory antibody is administered to the subject via an intravenous catheter or other catheter delivery method.

In one aspect, the invention is a method of inhibiting thrombosis in a subject suffering from TMA secondary to cancer, the subject of a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof. A heavy chain CDR-H1; and (ii) SEQ ID comprising the step of administration, wherein the antibody or antigen-binding fragment thereof comprises the amino acid sequences 31-35 of (I) (a) (i) SEQ ID NO: 67. Heavy chain variable region containing heavy chain CDR-H2 containing the amino acid sequence of 50-65 of NO: 67; and (iii) heavy chain CDR-H3 containing the amino acid sequence of 95-102 of SEQ ID NO: 67, and the heavy chain variable region. , (B) (i) Light chain CDR-L1 containing the amino acid sequence of 24-34 of SEQ ID NO: 70; and (ii) Light chain CDR-L2 containing the amino acid sequence of 50-56 of SEQ ID NO: 70. ; And (iii) a light chain variable region containing the light chain CDR-L3 containing the amino acid sequence of 89-97 of SEQ ID NO: 70, or at least 90% identity with (II) SEQ ID NO: 67 ( For example, SEQ ID Heavy chain variable region with NO: 67 and 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) and SEQ ID NO: 70 and at least 90% identity (eg, 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% Provided are methods comprising those variants comprising light chain variable regions having (identity).

In some embodiments, the method administers a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67. Includes the process of In some embodiments, the method is administered to a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof, comprising a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70. Includes the process of

In some embodiments, the method is on human MASP-2 recognized by reference antibody OMS646, which comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. A step of administering to a subject a composition comprising a MASP-2 inhibitory antibody or an antigen-binding fragment thereof that specifically recognizes at least a part of an epitope.

<u style="single">TMA secondary to cancer chemotherapy</u> Post-chemotherapy TMA (chemotherapy-associated TM) is a thrombocytopenia that occurs in 2-10% of patients with a history of malignant neoplasms treated with chemotherapeutic agents such as gemcytabin, mitomycin, oxaliplatin, etc. It is a condition with illness, microvascular hemolytic anemia, and renal dysfunction. Post-chemotherapy TMA is associated with high mortality and poor clinical outcome (see, eg, Blake-Haskins et al., Clin Cancer Res 17 (18): 5858-5866, 2011).

The causes of TMA after chemotherapy are thought to include non-specific and toxic injuries to the microvascular endothelium. Direct damage to endothelial cells has been shown in animal models of mitomycin-induced TMA (Dlott J. et al., Ther Apher Dial 8: 102-11, 2004). Endothelial cell damage through various mechanisms has been shown to activate the lectin pathway of complement. For example, Stahl et al. Have shown that endothelial cells exposed to oxidative stress activate the lectin pathway of complement both in vitro and in vivo (Collard et al., Am J Pathol. 156 (5): 1549-56, 2000; La Bonte et al., J Immunol. 15; 188 (2): 885-91, 2012). In vivo, this process leads to thrombosis, and inhibition of the lectin pathway has been shown to block thrombosis (La Bonte et al. J Immunol. 15; 188 (2): 885-91, 2012). In addition, as demonstrated in Examples 37-39 herein, a TMA mouse model in which local photoexcitation of FITC-Dex is used to induce local damage to the microvascular system and subsequent TMA response development. In, we show that TMA can be blocked by MASP-2 inhibition. Therefore, chemotherapeutic agent-induced microvascular endothelial damage may activate the lectin pathway of complement, and then activation of the lectin pathway of complement results in a localized thrombosis-promoting state, resulting in a TMA response. Be promoted. Since the activation of the lectin pathway and the generation of thrombus-promoting states are MASP-2 dependent, MASP-2 inhibitors, including but not limited to, that block MASP-2 function, reduce the TMA response. It is expected to reduce the risk of TMA after cancer chemotherapy.

Thus, in another aspect, the invention presents a composition comprising a therapeutically effective amount of a MASP-2 inhibitor, such as a MASP-2 antibody, in a pharmaceutical carrier, subject to TMA secondary to chemotherapy. Alternatively, it provides a method for treating or preventing TMA secondary to chemotherapy by administering it to a subject at risk of developing the TMA. MASP-2 inhibitors can be administered, for example, by intra-arterial administration, intravenous administration, intramuscular administration, inhalation administration, subcutaneous administration, or other parenteral administration, or in some cases oral administration in the case of non-peptide agonists. , Systemically administered to subjects who have received chemotherapy, who have received chemotherapy, or who are to receive chemotherapy. The anti-MASP-2 antibody may be administered alone or in combination with a C5 inhibitor such as ecrizamab.

In one embodiment, the MASP-2 inhibitory antibody exhibits at least one or more of the following characteristics: K: the antibody is 10 nM or less._DTo bind human MASP-2 in, the antibody binds an epitope in the CCP1 domain of MASP-2, the antibody results in 1% C3b deposition in human serum at 10 nM or less in in vitro assays. IC₅₀Inhibiting with, the antibody causes C3b deposition in 90% human serum at 30 nM or less IC₅₀Inhibiting with, the antibody is Fv, Fab, Fab', F (ab)₂, And F (ab')₂The antibody fragment is selected from the group consisting of, the antibody is a single chain molecule, the antibody is an IgG2 molecule, the antibody is an IgG1 molecule, and the antibody is IgG4 containing an S228P mutation. Being a molecule and / or the antibody does not substantially block the classical pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the second pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the classical or secondary pathway (ie, complete the classical and complement secondary pathways). Inhibits the lectin pathway while leaving it alone).

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from TMA secondary to cancer chemotherapy by at least 30%, eg, at least 40%, compared to untreated serum. For example, it inhibits at least 50%, eg, at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%.

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from subjects suffering from TMA secondary to cancer chemotherapy by at least 30%, eg, at least 40%, compared to untreated serum. For example, it inhibits at least 50%, eg, at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%.

In one aspect, the MASP-2 inhibitory antibody is administered to the subject via an intravenous catheter or other catheter delivery method.

In one aspect, the invention is a method of inhibiting thrombosis in a subject suffering from TMA secondary to cancer chemotherapy, comprising a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof. A heavy chain CDR-H1; and (ii) comprising the step of administering to the subject, wherein the antibody or antigen-binding fragment thereof comprises the amino acid sequences 31-35 of (I) (a) (i) SEQ ID NO: 67. ) Heavy chain CDR-H2 containing the amino acid sequence of 50-65 of SEQ ID NO: 67; and (iii) Heavy chain variable containing the heavy chain CDR-H3 containing the amino acid sequence of 95-102 of SEQ ID NO: 67. Region and light chain containing (b) (i) SEQ ID NO: 70 24-34 amino acid sequence; and (ii) SEQ ID NO: 70 containing 50-56 amino acid sequence. At least 90% of the light chain variable region, or (II) SEQ ID NO: 67, containing the light chain CDR-L3 containing the amino acid sequences 89-97 of CDR-L2; and (iii) SEQ ID NO: 70. Identity (eg SEQ ID Heavy chain variable region with NO: 67 and 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) and SEQ ID NO: 70 and at least 90% identity (eg, 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% Provided are methods comprising those variants comprising light chain variable regions having (identity).

In some embodiments, the method administers a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67. Includes the process of In some embodiments, the method is administered to a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof, comprising a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70. Includes the process of

In some embodiments, the method is on human MASP-2 recognized by reference antibody OMS646, which comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. A step of administering to a subject a composition comprising a MASP-2 inhibitory antibody or an antigen-binding fragment thereof that specifically recognizes at least a part of an epitope.

<u style="single">TMA secondary to transplantation</u> Post-transplantation TMA (transplantation-associated TMA) (TA-TMA) is a catastrophic syndrome that can occur in transplant patients, eg, allogeneic hematopoietic stem cell transplant recipients (eg, Batts and Lazarus, Bone Marrow Transplantation 40: 709-). See 719, 2007). The cause of this condition is not well understood, but it is likely that a collection of responses resulting in endothelial cell damage is involved (Laskin BL et al., Blood 118 (6): 1452-62, 2011). As discussed above, endothelial cell damage is a typical stimulus for activation of the lectin pathway and creation of a thrombus-promoting environment.

Recent data further support the role of lectin-mediated complement activation in TA-TMA development. Laskin et al. Proven that renal arteriole C4d deposits (75%) in subjects with histological TA-TMA were much more common compared to controls (8%) (Laskin BL, et al.,, Transplantation, 27; 96 (2): 217-23, 2013). Thus, C4d can be a pathological marker of TA-TMA, meaning local complement fixation via the lectin or classical pathway.

Since the activation of the lectin pathway and the generation of thrombus-promoting states are MASP-2 dependent, MASP-2 inhibitors, including but not limited to, that block MASP-2 function, reduce the TMA response. It is expected to reduce the risk of TMA (TA-TMA) after transplantation.

Thus, in another aspect, the invention presents a composition comprising a therapeutically effective amount of a MASP-2 inhibitor, such as a MASP-2 antibody, in a pharmaceutical carrier, subject to TMA secondary to transplantation or Provided is a method for treating or preventing TMA secondary to transplantation by administering to a subject at risk of developing the TMA. MASP-2 inhibitors can be administered, for example, by intra-arterial administration, intravenous administration, intramuscular administration, inhalation administration, subcutaneous administration, or other parenteral administration, or in the case of non-peptidic agents. , Systemically administered to subjects who have undergone transplantation, who have undergone transplantation, or who are to undergo transplantation. The anti-MASP-2 antibody may be administered alone or in combination with a C5 inhibitor such as ecrizamab. In some embodiments, the invention comprises a composition comprising an amount of a MASP-2 inhibitor, eg, a MASP-2 inhibitory antibody, in a subject before, during, or after receiving an allogeneic stem cell transplant. Provided is a method for treating or preventing TMA secondary to allogeneic stem cell transplantation, which comprises the step of administering.

In one embodiment, the MASP-2 inhibitory antibody exhibits at least one or more of the following characteristics: K: the antibody is 10 nM or less._DTo bind human MASP-2 in, the antibody binds an epitope in the CCP1 domain of MASP-2, the antibody results in 1% C3b deposition in human serum at 10 nM or less in in vitro assays. IC₅₀Inhibiting with, the antibody causes C3b deposition in 90% human serum at 30 nM or less IC₅₀Inhibiting with, the antibody is Fv, Fab, Fab', F (ab)₂, And F (ab')₂It is an antibody fragment selected from the group consisting of, the antibody is a single chain molecule, the antibody is an IgG2 molecule, the antibody is an IgG1 molecule, and the antibody is an IgG4 molecule containing an S228P mutation. And / or the antibody does not substantially block the classical pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the second pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the classical or secondary pathway (ie, complete the classical and complement secondary pathways). Inhibits the lectin pathway while leaving it alone).

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from TMA secondary to transplantation by at least 30%, eg, at least 40%, eg, compared to untreated serum. Inhibits at least 50%, eg, at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%.

In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from TMA secondary to transplantation by at least 30%, eg, at least 40%, eg, compared to untreated serum. Inhibits at least 50%, eg, at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%.

In one aspect, the MASP-2 inhibitory antibody is administered to the subject via an intravenous catheter or other catheter delivery method.

In one aspect, the invention is a method of inhibiting thrombosis in a subject suffering from TMA secondary to transplantation, the subject comprising a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof. The antibody or antigen-binding fragment thereof comprises the step of administering to (I) (a) (i) heavy chain CDR-H1; and (ii) SEQ containing the amino acid sequence of 31 to 35 of SEQ ID NO: 67. Heavy chain variable region containing heavy chain CDR-H2 containing the amino acid sequence of 50-65 of ID NO: 67; and (iii) SEQ ID NO: 67 containing the heavy chain CDR-H3 containing the amino acid sequence of 95-102. In addition, (b) (i) light chain CDR-L1 containing the amino acid sequence of 24-34 of SEQ ID NO: 70; and (ii) light chain CDR-containing the amino acid sequence of 50-56 of SEQ ID NO: 70- At least 90% identity with the light chain variable region, or (II) SEQ ID NO: 67, which comprises the light chain CDR-L3 containing the amino acid sequences 89-97 of L2; and (iii) SEQ ID NO: 70. (For example, SEQ ID Heavy chain variable region with NO: 67 and 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) and SEQ ID NO: 70 and at least 90% identity (eg, 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% Provided are methods comprising those variants comprising light chain variable regions having (identity).

In some embodiments, the method administers a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67. Includes the process of In some embodiments, the method is administered to a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof, comprising a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70. Includes the process of

In some embodiments, the method is on human MASP-2 recognized by reference antibody OMS646, which comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. A step of administering to a subject a composition comprising a MASP-2 inhibitory antibody or an antigen-binding fragment thereof that specifically recognizes at least a part of an epitope.

IV. Role of MASP-2 in other diseases and conditions, and treatment methods with MASP-2 inhibitors Activation of the renal condition complement system is mesangial proliferative glomerulonephritis (IgA nephropathy, Berger's disease) (Endo) , M., et al., Clin. Nephrology 55: 185-191, 2001), Mesangial glomerulonephritis (Kerjashki, D., Arch B Cell Pathol. 58: 253-71, 1990; Brenchley, PE, et al ., Kidney Int., 41: 933-7, 1992; Salant, DJ, et al., Kidney Int. 55: 976-84, 1989), Mesangial proliferative glomerulonephritis (mesangial capillary glomerulonephritis) ( Bartlow, BG. Et al., Kidney Int. 15: 294-300, 1979; Meri, S. et al., J. Exp. Med. 175: 939-50, 1992), Post-acute infection glomerulonephritis (post-linkage glomerulonephritis), Cryoglobulinemia glomerulonephritis (Ohsawa, I., et al., Clin Immunol, 101: 59-66) , 2001), Lupus nephritis (Gatenby, PA, Autoimmunity 11: 61-6, 1991), and Henojo-Schoenlein purpura nephritis (Endo, M., et al., Am. J. Kidney Dis. 35: 401- It is involved in the development of a wide variety of kidney diseases, including 407, 2000). Although the involvement of complement in kidney disease has been recognized for decades, its exact role in the onset, onset, and recovery of kidney disease remains a significant debate. While the contribution of complement under normal conditions is beneficial to the host, improper activation and deposition of complement can contribute to tissue damage.

Glomerulonephritis, an inflammation of the glomerulus, is often initiated by the deposition of immune complexes on the glomerular or tubular structure, which then induces complement activation, inflammation, and tissue damage. There is a lot of evidence that it will be done. Kahn and Sinniah demonstrated increased C5b-9 deposition in the tubular basement membrane in biopsy materials taken from patients with various forms of glomerulonephritis (Kahn, TN, et al., Histopath. 26: 351-6, 1995). In a study of patients with IgA nephrology (Alexopoulos, A., et al., Nephrol. Dial. Transplant 10: 1166-1172, 1995), C5b-9 deposits in tubular epithelial / basement membrane structure were in plasma. It was correlated with creatinine levels. Another study of membranous nephropathy demonstrated a link between clinical outcomes and urinary sC5b-9 levels (Kon, SP, et al., Kidney Int. 48: 1953-58, 1995). High sC5b-9 levels were positively correlated with poor prognosis. Lehto et al. Measured high levels of CD59, a complement regulator that inhibits the complement membrane attack complex in the plasma membrane, and C5b-9 in urine from patients with membranous glomerulonephritis ( Lehto, T., et al., Kidney Int. 47; 1403-11, 1995). Histopathological analysis of biopsy samples taken from these same patients demonstrated deposition of C3 and C9 proteins in the glomerulus, whereas CD59 expression in these tissues was compared to normal kidney tissue. Diminished. These various studies suggest that ongoing complement-mediated glomerulonephritis results in urinary excretion of complement protein that correlates with the degree of tissue damage and disease prognosis.

Inhibition of complement activation in various animal models of glomerulonephritis also demonstrated the importance of complement activation in the cause of the disease. In the Membranoproliferative Glomerulonephritis (MPGN) model, injection of anti-Th1 anti-serum into C6-deficient rats (which cannot form C5b-9) results in 90% less glomerular cell proliferation than normal C6 + rats. , Platelet and macrophage infiltration decreased by 80%, collagen type IV synthesis (marker of mesangial matrix expansion) decreased, proteinuria decreased by 50% (Brandt. J., et al., Kidney Int. 49: 335-343, 1996). These results imply C5b-9 as the major complement-induced tissue damage mediator in this rat antithymocyte serum model. In another glomerulonephritis model, injecting a gradual dose of rabbit anti-rat glomerular basement membrane results in a dose-dependent influx of polymorphonuclear leukocytes (PMNs), which (consumes complement). Attenuated by pretreatment with cobra venom factor (Scandrett, AL, et al., Am. J. Physiol 268: F256-F265, 1995). Rats treated with cobra venom factor also showed reduced histopathological changes, reduced long-term proteinuria, and lower creatinine levels than control rats. Using three GN models in rats (anti-thymocyte serum, ConA anti-ConA, and passive Hayman nephritis), Couser et al. Latent an approach to inhibit complement by using recombinant sCR1 protein. Proven therapeutic efficacy (Couser, WG, et al., J. Am. Soc. Nephrol. 5: 1888-94, 1995). Rats treated with sCR1 showed a significant reduction in PMN, platelet, and macrophage influx, mesangial melting, and reduced proteinuria compared to control rats. The use of anti-C5 MoAb in the NZB / W F1 mouse model provides further evidence of the importance of complement activation in glomerulonephritis. Anti-C5 MoAb inhibits C5 cleavage and thus blocks the production of C5a and C5b-9. Six months of continuous therapy with anti-C5 MoAb significantly ameliorated the course of glomerulonephritis. Humanized anti-C5 MoAb monoclonal antibody (5G1.1), which blocks the cleavage of human complement component C5 to pro-inflammatory components, is a potential treatment for glomerulonephritis, Alexion Pharmaceuticals, Inc., New Haven, Connecticut. Is being developed by.

Studies of patients with genetic deficiencies in certain complement components provided direct evidence of the pathological role of complement in renal injury. Many reports have demonstrated a link between kidney disease and deficiency of complement regulatory H factor (Ault, BH. Nephrol. 14: 1045-1053, 2000; Levy, M., et al., Kidney Int. 30: 949-56, 1986; Pickering, MC, et al., Nat. Genet, 31: 424-8, 2002). When factor H is deficient, plasma levels of factors B and C3 decrease and C5b-9 is consumed. Both atypical membranous proliferative glomerulonephritis (MPGN) and idiopathic hemolytic uremic syndrome (HUS) have been associated with factor H deficiency. Factor H-deficient pigs (Jansen, JH, et al., Kidney Int. 55: 331-49, 1998) and factor H knockout mice (Pickering, MC, 2002) exhibit MPGN-like symptoms. This supports the importance of factor H in complement regulation. Deficiencies in other complement components have been associated with kidney disease secondary to the development of systemic lupus erythematosus (SLE) (Walport, MJ, Davies, et al., Ann. N. Y, Acad. Sci. 815: 267-81, 1997). Deficiencies in C1q, C4, and C2 are a strong predisposing factor for the development of SLE through mechanisms associated with incomplete clearance of immune complexes and apoptotic materials. Many of these SLE patients develop lupus nephritis, which is characterized by the deposition of immune complexes throughout the glomerulus.

The identification of autoantibodies to complement components in patients provides further evidence linking complement activation to kidney disease. Some of these autoantibodies are directly associated with kidney disease (Trouw, LA, et al., Mol. Immunol. 38: 199-206, 2001). The term nephritis factor (NeF) was introduced to indicate this activity because many of these autoantibodies show a fairly high degree of correlation with kidney disease. In clinical studies, approximately 50% of nephritis factor-positive patients developed MPGN (Spitzer, RE et al., Clin. Immunol. Immunopathol. 64: 177-83, 1992). C3NeF is an autoantibody against the second pathway C3 convertase (C3bBb), which stabilizes this convertase and thereby promotes the activation of the second pathway (Daha, MR, et al., J. Immunol. 116: 1-7, 1976). Similarly, autoantibodies with specificity to the classical pathway C3 convertase (C4b2a) are called C4NeF, which stabilizes this convertase and thereby promotes activation of the classical pathway (Daha, MR et al., J). Immunol. 125: 2051-2054, 1980; Halbwachs, L., et al., J, Clin. Invest. 65: 1249-56, 1980). Anti-C1q autoantibodies have been described to be associated with nephritis in patients with SLE (Hovath, L. et al., Clin. Exp. Rheumatol, 19: 667-72, 2001; Siegert, C, et al., J. Rheumatol 18: 230-34, 1991; Siegert, C, et al., Clin. Exp. Rheumatol. 10: 19-23, 1992). Increased titers of these anti-C1q autoantibodies were reported to predict the spread of nephritis (Coremans, IE et al., Am. J. Kidney Dis. 26: 595-601, 1995). Immunizations eluted from the kidneys of SLE patients after death revealed an accumulation of these anti-C1q autoantibodies (Mannick, M, et al., Arthritis Rheumatol. 40: 1504-11, 1997). All of these facts suggest the pathological role of these autoantibodies. However, not all patients with anti-C1q autoantibodies develop kidney disease, and some healthy individuals have low-titer anti-C1q autoantibodies (Siegert, CE, et al., Clin). Immunol. Immunopathol. 67: 204-9, 1993).

In addition to the second and classical pathways of complement activation, the lectin pathway may also have an important pathological role in kidney disease. Henoho-Schoenline purpura nephritis (Endo, M. et al., Am. J. Kidney Dis. 35: 401-407, 2000), cryoglobulinemia glomerulonephritis (Ohsawa, I., et al., Clin) Patients diagnosed with several different kidney diseases, including Immunol. 101: 59-66, 2001) and IgA neuropathy (Endo, M., et al., Clin. Nephrology 55: 185-191, 2001). High levels of MBL, MBL-related serine proteases, and complement activators have been detected by immunohistochemical techniques in kidney biopsy materials obtained from. Therefore, despite the fact that the relationship between complement and kidney disease has been known for decades, the exact data on how complement affects these kidney diseases is far from perfect. ..

Blood disorders Sepsis is caused by the patient's uncontrollable response to invasive microorganisms. The main function of the complement system is to organize the inflammatory response to invading bacteria and other pathogens. Consistent with this physiological role, numerous studies have shown that complement activation has a major role in the development of sepsis (Bone, RC, Annals. Internal, Med. 115: 457). -469, 1991). The definition of clinical signs of sepsis is constantly evolving. Sepsis is usually defined as a systemic host response to an infection. However, many times, no clinical evidence of infection (eg, positive bacterial blood cultures) has been found in patients with septic symptoms. This contradiction was first taken into account at the Consensus Conference in 1992, when the term "systemic inflammatory response syndrome" (SIRS) was established, which required a definable presence of bacterial infections. Lost (Bone, RC, et al., Crit. Care Med. 20: 724-726, 1992). Currently, there is a general consensus that sepsis and SIRS are associated with dysregulation of the inflammatory response. To briefly review this, we consider the clinical definition of sepsis to include severe sepsis, septic shock, and SIRS.

Gram-negative bacteria were the predominant source of infection in patients with sepsis before the late 1980s. Lipopolysaccharide (LPS), the main component of the Gram-negative bacterial cell wall, has been known to stimulate the release of inflammatory mediators from various cell types and induce acute infection symptoms when injected into animals ( Haeney, MR, et al., Antimicrobial Chemotherapy 41 (Suppl. A): 41-6, 1998). Interestingly, the spectrum of causative organisms now appears to have changed primarily from Gram-negative bacteria in the late 1970s and 1980s to now predominantly Gram-positive bacteria for unclear reasons (Martin). , GS, et al., N. Eng. J. Med. 348: 1546-54, 2003).

Numerous studies have shown the importance of complement activation in mediating inflammation and contributing to the characteristics of shock, especially septic and hemorrhagic shock. Usually, both Gram-negative and Gram-positive organisms cause septic shock. LPS is a potent complement activator primarily via the second pathway, but also results in antibody-mediated classical pathway activation (Fearon, DT, et al., N. Engl. J. Med. 292: 937-400, 1975). The main components of the Gram-positive cell wall are peptidoglycan and lipoteichoic acid, both of which are potent complement second pathway activators, but can also activate the classical complement pathway in the presence of specific antibodies. (Joiner, KA, et al., Ann. Rev. Immunol. 2: 461-2, 1984).

The complement system was first associated with the development of sepsis when researchers realized that the anaphylatoxins C3a and C5a mediated various inflammatory responses that could occur during sepsis. These anaphylatoxins induce vasodilation and increased microvascular permeability, which are events that play a central role in septic shock (Schumacher, WA, et al., Agents Actions 34: 345-349, 1991). In addition, anaphylatoxin induces bronchospasm, histamine release from mast cells, and platelet aggregation. In addition, they exert numerous actions on granulocytes, such as chemotaxis, aggregation, adhesion, release of lysosomal enzymes, production of toxic superoxide anions, and leukotriene formation (Shin, HS). , et al., Science 162: 361-363, 1968; Vogt, W., Complement 3: 177-86, 1986). These biological actions are thought to play a role in the development of septic complications such as shock or acute respiratory distress syndrome (ARDS) (Hammerschmidt, DE, et al., Lancet 1: 947-949, 1980; Slotman). , GT, et al., Surgery 99: 744-50, 1986). In addition, high levels of anaphylatoxin C3a have been associated with fatal outcomes in sepsis (Hack, CE, et al., Am. J. Med. 86: 20-26, 1989). In some shock animal models, certain complement-deficient strains (eg, C5-deficient strains) are more resistant to the effects of LPS infusion (Hseuh, W, et al., Immunol. 70: 309-14, 1990). ).

Blockade of C5a production by antibodies during the pathogenesis of sepsis in rodents has been shown to significantly improve survival (Czermak, BJ, et al., Nat. Med. 5: 788-792, 1999). ). Similar findings were made when the C5a receptor (C5aR) was blocked with an antibody or small molecule inhibitor (Huber-Lang, MS, et al., FASEB J. 16: 1567-74, 2002; Riedemann, NC, et al., J. Clin. Invest. 110: 101-8, 2002). Early experimental studies in monkeys suggest that antibody blockade of C5a attenuated E. coli-induced septic shock and adult respiratory distress syndrome (Hangen, DH et al., J. Surg. Res). . 46: 195-9, 1989; Stevens, JH, et al., J. Clin. Invest. 77: 1812-16, 1986). In humans with sepsis, C5a was increased and associated with significantly lower survival with multiple organ failure compared to patients and survivors with less severe sepsis (Nakae, H ,, et al. , Res. Commun. Chem. Pathol. Pharmacol. 84: 189-95, 1994; Nakae, et al., Surg. Today 26: 225-29, 1996; Bengtson, A., et al., Arch. Surg. 123 : 645-649, 1988). The mechanism by which C5a exerts adverse effects during sepsis has not yet been investigated in detail, but recent data show that the production of C5a during sepsis results in the innate immune function of blood neutrophils (Huber-Lang). , MS, et al., J. Immunol. 169: 3223-31, 2002), the ability to express respiratory bursts, and the ability to produce cytokines (Riedemann, NC, et al., Immunity 19: 193-202, 2003) have been suggested to be significantly impaired. .. In addition, C5a production during sepsis appears to have a procoagulant effect (Laudes, IJ, et al., Am. J. Pathol. 160: 1867-75, 2002). The complement regulatory protein CI INH has also been shown to be effective in animal models of sepsis and ARDS (Dickneite, G., Behring Ins. Mitt. 93: 299-305, 1993).

The lectin pathway may also play a role in the development of sepsis. MBL has been shown to bind to a range of clinically significant microorganisms, including Gram-negative and Gram-positive bacteria, and activate the lectin pathway (Neth, O., et al., Infect. Immun, 68: 688, 2000). Lipoteichoic acid (LTA) is increasingly regarded as a Gram-positive counterpart of LPS. It is a potent immunostimulant that induces cytokine release from mononuclear phagocytes and whole blood (Morath, S., et al., J. Exp. Med. 195: 1635, 2002; Morath, S. , et al., Infect. Immun. 70: 938, 2002). Recently, it has been demonstrated that L-phycholine specifically binds to LTA isolated from a large number of Gram-positive bacterial species, including Staphylococcus aureus, and activates the lectin pathway (Lynch). , NJ, et al., J. Immunol. 172: 1198-02, 2004). MBL also binds to LTAs from Enterococcus species whose polyglycerophosphate chains are substituted with glycosyl groups, but not LTAs from 9 other species, including Staphylococcus aureus. It has been shown (Polotsky, VY, et al., Infect. Immun. 64: 380, 1996).

Therefore, one aspect of the invention is to combine a composition containing a therapeutically effective amount of MASP-2 inhibitor in a pharmaceutical carrier with severe sepsis, septic shock, acute respiratory distress syndrome due to sepsis, and systemic inflammation. Provided is a method for treating sepsis or a condition caused by sepsis by administering to a subject suffering from sepsis or a condition caused by sepsis, including, but not limited to, reaction syndrome. Compositions containing therapeutically effective amounts of MASP-2 inhibitors in pharmaceutical carriers, hemorrhagic shock, hemolytic anemia, autoimmune thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS) Related methods for treating such conditions by administration to subjects suffering from atypical hemolytic uremic syndrome (aHUS), or other blood disorders, including other bone marrow / blood disruption conditions. Is provided. The MASP-2 inhibitor may be systemically administered to a subject by, for example, intra-arterial, intravenous, intramuscular, inhalation (especially in the case of ARDS), subcutaneous, or other parenteral administration. In some cases, it is administered to the subject by oral administration in the case of non-peptide agonists. The MASP-2 inhibitor composition may be combined with one or more additional therapeutic agents to combat the sequelae of sepsis and / or shock. In the case of advanced sepsis or shock or the resulting distress, the MASP-2 inhibitory composition is optionally in fast-acting dosage form, eg, intravenous delivery of a bolus of a solution containing the MASP-2 inhibitory composition. Alternatively, it may be administered by intra-arterial delivery. Repeated doses may be given as determined by the physician until the condition is resolved.

Coagulopathy Evidence has been obtained for the role of the complement system in disseminated intravascular coagulation (DIC), eg, DIC secondary to significant physical trauma.

Previous studies have shown that C4-/-mice are not protected from renal reperfusion injury (Zhou, W., et al., "Predominant role for C5b-9 in renal ischemia / reperfusion injury", J Clin Invest 105: 1363-1371 (2000)). C4-/-A assay specific for the classical or lectin pathway activation pathway to determine if mice may be able to activate complement via either the classical or lectin pathway. C3 turnover in C4-/-plasma was measured in. No C3 cleavage was observed during induction of activation via the classical pathway, but highly efficient lectin pathway-dependent C3 activation was observed in C4-deficient sera (Fig. 30). According to many previously published papers on second pathway activation, C3b deposition on mannan and zymosan is significant in MASP-2-/-mice, even under acceptable experimental conditions for all three pathways. It can be seen that it is damaged. C3b deposition and factor B cleavage were seen in MASP-2 + / + mouse sera and MASP-2-/-sera when the same sera were used in wells coated with immunoglobulin complex instead of mannan or zymosan. However, it is not found in C1q-depleted serum. This indicates that second pathway activation is promoted in MASP-2-/-serum when early C3b is provided via classical activity. Figure 30C shows the surprising finding that C3 can be efficiently activated in a lectin pathway-dependent manner in C4-deficient plasma.

This "C4 bypass" is lost by inhibiting lectin pathway activation by preincubation of plasma with soluble mannose or mannose.

Abnormal non-immune activation of the complement system is potentially detrimental to humans and in hematological pathway activation, especially in severe traumatic situations where both the inflammatory and hematological pathways are activated. May also play an important role. In normal health, C3 conversion is &lt;5% of total plasma C3 protein. In severe infections, including sepsis and immune complex disease, C3 conversion spontaneously recovers to about 30% and complement levels are often below normal due to increased utilization and altered pool distribution. Rapid C3 pathway activation of&gt; 30% generally provides clear clinical evidence of vasodilation and fluid loss to tissues. With more than 30% C3 conversion, the initiation mechanism is predominantly non-immune and the resulting clinical signs are detrimental to the patient. Complement C5 levels in health and controlled illness appear to be significantly more stable than C3. Significant reductions and / or conversions of C5 levels are associated with the patient's response to abnormal polytrauma (eg, traffic accidents) and the likely onset of shock lung syndrome. Thus, any evidence of complement C3 activation of more than 30% of the vascular pool, or any C5-involved complement C3 activation, or both, heralds adverse pathological changes in the patient. Can be considered likely to be.

Both C3 and C5 release anaphylatoxins (C3a and C5a) that act on mast cells and basophils to release vasodilatory chemicals. They provide a chemotactic gradient that guides polymorphonuclear cells (PMNs) to the center of immunological disruption (beneficial response), but C5a exerts a specific clamping action on these phagocytes. It is different because it has and prevents phagocytes from randomly leaving the reaction site. Under normal control of infectious diseases, C3 activates C5. However, in polytrauma, C5 appears to be extensively activated and produce C5a anaphylatoxin systemically. This uncontrolled activity causes clusters of polymorphs within the vasculature, which are then swept into the pulmonary capillaries and occluded, resulting in local damaging effects as a result of superoxide release. Without being bound by theory, this mechanism is probably important in the development of acute respiratory distress syndrome (ARDS). But lately, there has been some disagreement with this idea. Although C3a anaphylatoxins can be shown to be potent agglutinators in vitro, their involvement is less clear in vivo and the release of platelet substances and plasmin in wound healing is only secondary. May not be involved in complement C3. Long-term increased C3 activation may be required to generate DIC.

In addition to the cellular and vascular effects of the activated complement components outlined above, which can explain the relationship between trauma and DIC, new emerging scientific discoveries have been made between the complement system and the coagulation system. We have identified direct molecular relationships and functional crosstalks between them. Supporting data are obtained from studies in C3-deficient mice. Since C3 is a common component of each complement pathway, C3-deficient mice are expected to lack all complement function. Surprisingly, however, C3-deficient mice are able to perfectly activate terminal complement components (Huber-Lang, M., et al., "Generation of C5a in the absence of C3: a new complement activation". pathway ", Nat. Med 12: 682-687 (2006)). In-depth studies have revealed that C3-independent activation of terminal complement components is mediated by thrombin, the rate-limiting enzyme in the coagulation cascade (Huber et al., 2006). The molecular components that mediate thrombin activation after initial complement activation remain a mystery.

We elucidated what is believed to be the molecular basis of crosstalk between the complement cascade and the coagulation cascade, and identified MASP-2 as the central control point connecting the two systems. Biochemical studies of the substrate specificity of MASP-2 have identified prothrombin as a potential substrate in addition to the well-known C2 and C4 complement proteins. MASP-2 specifically cleaves the function-related sites of prothrombin to produce thrombin, the rate-limiting enzyme in the coagulation cascade (Krarup, A., et al., "Simultaneous Activation of Complement and Coagulation by MBL-Associated Serine Protease". 2 ", PLoS. ONE. 2; e623 (2007)). Thrombin produced by MASP-2 can promote fibrin deposition in a defined reconstituted in vitro system. This demonstrates the functional relevance of MASP-2 cleavage (Krarup et al., 2007). As discussed in the following examples herein, we present the physiological significance of this discovery by recording thrombin activation in normal rodent serum after activation of the lectin pathway. We further confirmed that this process was blocked by the neutralized MASP-2 monoclonal antibody.

MASP-2 may be a central turning point in the lectin pathway that can promote activation of both the complement and coagulation systems. Since lectin pathway activation is a physiological response to many types of traumatic injury, we present co-occurring systemic inflammation (mediated by complement components) and diffuse coagulation (coagulation pathway). It is believed that MASP-2 can be explained by its ability to activate both pathways. These findings clearly suggest the role of MASP-2 in the development of DIC and the therapeutic benefit of MASP-2 inhibition in the treatment or prevention of DIC. MASP-2 may provide a molecular link between the complement system and the coagulation system, and lectin pathway activation occurs via the MASP-2-thrombin axis as it occurs in traumatic situations. Can be initiated directly, thus providing a mechanical association between trauma and DIC. According to one aspect of the invention, inhibition of MASP-2 is thought to inhibit lectin pathway activation and reduce the production of anaphylatoxins C3a and C5a. It is considered that long-term increase in C3 activation is required to generate DIC.

Microcirculatory coagulation (blot clot in capillaries and small blood vessels) occurs in the context of such septic shock. The role of the lectin pathway in septic shock has been elucidated, as demonstrated by the protective phenotype of the MASP-2 (-/-) mouse model of sepsis, as described in Example 17 and FIGS. 18 and 19. There is. In addition, as demonstrated in Example 15 and FIGS. 16A and 16B, MASP-2 (-/-) mice have localized intravascular coagulation (DIC), which is a model of localized coagulation in microvessels. Protected in the Schwartzman reaction model.

V. MASP-2 Inhibitor In one aspect, the invention presents MASP-2 dependent complement activation in a subject suffering from thrombotic microangiopathy or at risk of developing the thrombotic microangiopathy. Provide a method of inhibiting. 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, typical MASP-2 inhibitors include molecules that inhibit the biological activity of MASP-2 (eg, small molecule inhibitors, anti-MASP-2 antibodies, or MASP-2). A blocking peptide that interacts with or interferes with protein-protein interactions), as well as molecules that reduce MASP-2 expression, thereby preventing MASP-2 from activating the lectin complement pathway (eg,). MASP-2 antisense nucleic acid molecule, MASP-2 specific RNAi molecule, and MASP-2 ribozyme) are included. The MASP-2 inhibitor may be used alone as first-line therapy or in combination with other therapeutic agents as an adjunct therapy to improve the therapeutic benefit of other medical treatments.

Inhibition of MASP-2 dependent complement activation is characterized by at least one of the following changes in complement system components resulting from administration of a MASP-2 inhibitor according to the method of the invention: MASP- Inhibition of the production or production of the two-dependent complement activation system products C4b, C3a, C5a, and / or C5b-9 (MAC) (eg, measured as described in Example 2), sensitized. Decreased complement activation (eg, measured as described in Example 33), reduced C4 cleavage and C4b deposition (eg, eg, Example) as assessed in a hemolytic assay with no rabbit or guinea pig erythrocytes. (Measured as described in 2), or reduced C3 cleavage and C3b deposition (eg, measured as described in Example 2).

According to the present invention, a MASP-2 inhibitor effective in inhibiting the MASP-2 dependent complement activation system is used. MASP-2 inhibitors useful in practicing this aspect of the invention include, for example, anti-MASP-2 antibodies and fragments thereof, MASP-2 inhibitory peptides, small molecules, MASP-2 soluble receptors, and expression inhibitors. included. MASP-2 inhibitors may inhibit the MASP-2 dependent complement activation system by blocking the biological function of MASP-2. For example, the inhibitor may effectively block the MASP-2 protein-protein interaction, may interfere with MASP-2 dimerization or assembly, and may interfere with Ca.²⁺Binding may be blocked, the MASP-2 serine protease active site may be blocked, or MASP-2 protein expression may be reduced.

In some embodiments, the MASP-2 inhibitor selectively inhibits MASP-2 complement activation without impairing the function of the C1q-dependent complement activation system.

In one aspect, the MASP-2 inhibitor useful in the methods of the invention is a specific that specifically binds to a polypeptide containing SEQ ID NO: 6 with at least 10-fold higher affinity than other antigens of the complement system. MASP-2 inhibitor. In another embodiment, the MASP-2 inhibitor specifically binds to a polypeptide containing SEQ ID NO: 6 with at least 100-fold higher affinity than other antigens in the complement system. The binding affinity of MASP-2 inhibitors can be determined using appropriate binding assays.

The MASP-2 polypeptide exhibits a molecular structure 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 shown in SEQ ID NO: 5) and is cleaved after secretion to mature human MASP-2 (consisting of the amino acid sequence shown in SEQ ID NO: 5). Provided are a human MASP-2 polypeptide having a leader sequence (aa1-15) that yields SEQ ID NO: 6). As shown in Figure 2, the human MASP2 gene contains 12 exons. The human MASP-2 cDNA is encoded by exons B, C, D, F, G, H, I, J, K, and L. MBL-related protein 19 (also called "MAp19", "sMAP") encoded by (SEQ ID NO: 1) resulting from exons B, C, D, and E from alternative splices, as shown in Figure 2 (also referred to as "MAp19", "sMAP") ( A 20 kDa protein called SEQ ID NO: 2) is produced. The cDNA molecule shown in SEQ ID NO: 50 is mouse MASP-2 (SEQ ID). Provided is a mouse MASP-2 polypeptide having a leader sequence, which encodes (consisting of the amino acid sequence shown in NO: 51) and is cleaved after secretion to give the mature mouse MASP-2 (SEQ ID NO: 52). .. The cDNA molecule shown at SEQ ID NO: 53 encodes rat MASP-2 (consisting of the amino acid sequence shown at SEQ ID NO: 54) and is cleaved after secretion to mature rat MASP-2 (SEQ ID NO). A rat MASP-2 polypeptide having a leader sequence that yields: 55) is provided.

For those skilled in the art, the sequences disclosed in SEQ ID NO: 4, SEQ ID NO: 50, and SEQ ID NO: 53 are simply human MASP-2, mouse MASP-2, and rat MASP-2, respectively. It is considered to acknowledge that it is an allele and is expected to undergo allelic alterations and alternative splicing. Allelic variants of the nucleotide sequences shown in SEQ ID NO: 4, SEQ ID NO: 50, and SEQ ID NO: 53, including allelic variants containing silent mutations and allelic variants whose amino acid sequences are altered by mutations It is within the scope of the present invention. Allelic variants of the MASP-2 sequence can be cloned by probing cDNA or genomic libraries from different individuals according to standard procedures.

The domain of the human MASP-2 protein (SEQ ID NO: 6) is shown in FIGS. 1 and 2A, and the N-terminal C1r / C1s / Uni Vegf / bone morphogenetic protein (CUBI) domain (SEQ ID NO: 6 aa1 ~ 121) ), Epithelial cell growth factor-like domain (aa122-166), another CUBI domain (aa167-293), and a columnar sequence of complement control protein domains and serine protease domains. Alternative splicing of the MASP2 gene yields MAp19 as shown in FIG. MAp19 is a non-enzymatic protein containing the N-terminal CUBI-EGF region of MASP-2 and four additional residues (EQSL) derived from exon E, as shown in FIG.

Several proteins have been shown to bind to or interact with MASP-2 via protein-protein interactions. For example, MASP-2 binds to the lectin proteins MBL, H-ficolin, and L-ficolin, and Ca²⁺It is known to form a dependent complex. Each MASP-2 / lectin complex has been shown to activate complement via 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: 197-2284, 2000; Matsushita, M., et al., J. Immunol. 168: 3502-3506 , 2002). Studies have shown that the CUB1-EGF domain of MASP-2 is essential for the binding of MASP-2 to MBL (Thielens, NM, et al., J. Immunol. 166: 5068, 2001). The CUB1EGFCUBII domain has also been shown to mediate the MASP-2 dimerization required for the formation of active MBL complexes (Wallis, R., et al., J. Biol. Chem. 275: 30962-30969, 2000). Therefore, identify MASP-2 inhibitors that bind to the MASP-2 target region, or MASP-2 inhibitors that interfere with the MASP-2 target region, which are known to be important for MASP-2 dependent complement activation. can do.

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

Several anti-MASP-2 antibodies have been described in the literature, some of which are listed in Table 1 below. The ability of these anti-MASP-2 antibodies to inhibit the MASP-2 dependent complement activation system described earlier can be screened using the assays described herein. For example, an anti-rat MASP-2 Fab2 antibody that blocks MASP-2 dependent complement activation has been identified, as further detailed in Examples 10 and 11 herein. Once an anti-MASP-2 antibody that acts as a MASP-2 inhibitor has been identified, it can be used to make anti-idiotype antibodies and identify other MASP-2 binding molecules, as further described below. Can be used to.

(Table 1) MASP-2 specific antibodies from the literature<img file="JP2020037568A_D0007.tif" />

Anti-MASP-2 Antibodies with Reduced Effector Function In some aspects of this aspect of the invention, anti-MASP-2 antibodies have reduced effector function to alleviate inflammation that can result from activation of the classical complement pathway. Have. The ability of IgG molecules to induce the classical complement pathway has been shown to be within the Fc portion of this molecule (Duncan, AR. Et al., Nature 332: 738-740 1988). IgG molecules in which the Fc portion of this molecule has been removed by enzymatic cleavage do not have this effector function (see Harlow, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, New York, 1988). Therefore, by having a genetically engineered Fc sequence that minimizes effector function, or by human IgG₂Or IgG₄Isotypes allow the production of antibodies with reduced effector function as a result of the lack of the Fc portion of this molecule.

Antibodies with reduced effector function are described in Example 9 herein, as well as Jolliffe et al., Int'l Rev. Immunol. 10: 241-250, 1993 and Rodrigues et al., J. Immunol. As also described in 151: 6954-6961, 1998, it can be made by standard molecular biological manipulation of the Fc portion of the IgG heavy chain. Antibodies with reduced effector function also include human IgG2 and IgG4 isotypes with 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, consisting of IgG2 or IgG4 isotypes, specific for human MASP-2 are known to those of skill in the art as described in Vaughan, TJ, et al., Nature Biotechnical 16: 535-539, 1998. It can be made by one of several methods.

Preparation of anti-MASP-2 antibody Anti-MASP-2 antibody can be a MASP-2 polypeptide (eg, full-length MASP-2) or an antigenic MASP-2 epitope-containing peptide (eg, part of a MASP-2 polypeptide). Can be made using. The immunogenic peptide may be as small as 5 amino acid residues. For example, a MASP-2 polypeptide containing the entire amino acid sequence of SEQ ID NO: 6 may be used to induce 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 regions containing serine-protease active sites, as recombinant polypeptides as described in Example 3. It may be expressed and used as an antigen. In addition, MASP-2 polypeptide (SEQ ID) Peptides containing at least the 6 amino acid portion of NO: 6) are also useful in inducing MASP-2 antibodies. Further examples of MASP-2-derived antigens useful for inducing MASP-2 antibody are shown in Table 2 below. The MASP-2 peptides and polypeptides used to produce antibodies are native or recombinant or synthetic peptides and catalytically inactive recombinant polypeptides, as further described in Examples 5-7. , For example, it may be isolated as MASP-2A. In some aspects of this aspect of the invention, anti-MASP-2 antibodies are obtained using transgenic mouse strains as described in Examples 8 and 9, and as further described below.

Antigens useful in the preparation of anti-MASP-2 antibodies also include fusion of fusion polypeptides, such as MASP-2 or parts thereof, with immunoglobulin polypeptides or maltose binding proteins. The polypeptide immunogen may be a full-length molecule or a portion thereof. If the polypeptide moiety is hapten-like, such moiety is conveniently for immunity, a macromolecular carrier (eg, keyhole limpet hemocyanin (KLH), bovine serum albumin (BSA), or tetanus. It may be joined or linked to (toxoid).

(Table 2) MASP-2 -derived antigen<img file="JP2020037568A_D0008.tif" />

Polyclonal Antibodies Polyclonal antibodies against 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 of skill in the art. For example, Green et al., "Production of Polyclonal Antisera", Immunochemical Protocols (Manson, ed.), See page 105. Further described in Example 6. The immunogenicity of MASP-2 polypeptides includes mineral gels such as aluminum hydroxide or Freund's adjuvant (complete or incomplete), surfactants such as lysolecithin, pluronic polyols, polyanions, oil emulsions, keyhole limpet hemocyanins. , And can be enhanced with an adjuvant containing dinitrophenol. Polyclonal antibodies are typically produced in animals such as horses, cows, dogs, chickens, rats, mice, rabbits, guinea pigs, goats, or sheep. Alternatively, the anti-MASP-2 antibody useful in the present invention may also be derived from primates close to humans. Common techniques for producing antibodies useful for diagnosis and treatment in baboons are, for example, Goldenberg et al., International Patent Publication WO91 / 11465, and Losman, MJ, et al., Int. J. It can be seen in Cancer 46: 310, 1990. Serum containing immunologically active antibodies is then produced from the blood of such immune animals using standard procedures well known in the art.

Monoclonal Antibodies In some embodiments, the MASP-2 inhibitor is an anti-MASP-2 monoclonal antibody. Anti-MASP-2 monoclonal antibodies are highly specific as they are made against a single MASP-2 epitope. The modifier "monoclonal" as used herein is characterized by the fact that the antibody is obtained from a substantially homogeneous population of antibodies and should not be construed as requiring the production of the antibody by any particular method. Monoclonal antibodies can be obtained using any technique that provides the production of antibody molecules with serially cultured cell lines, eg, the hybridoma method described in Kohler, G., et al., Nature 256: 495, 1975. Alternatively, the monoclonal antibody may be made by recombinant DNA methods (see, eg, US Pat. No. 4,816,567 for Variable). Monoclonal antibodies are available in Clackson, T., et al., Nature 352: 624-628, 1991, and Marks, JD, et al., J. Mol Biol. It can also be isolated from the phage antibody library using the technique described in 222: 581-597, 1991. Such antibodies may be antibodies 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 suitable mammal (eg, BALB / c mouse) with a composition comprising the MASP-2 polypeptide or a portion thereof. After a predetermined period of time, spleen cells are removed from the mouse and suspended in cell culture medium. The spleen cells are then fused with an immortalized cell line to form a hybridoma. The hybridomas formed are grown in cell culture and screened for their ability to produce monoclonals for MASP-2. An example further describing the production of an anti-MASP-2 monoclonal antibody is shown in Example 7 (see also Current Protocols in Immunology, Vol.1., John Wiley &amp; Sons, 2.5.1-2.6.7, 1991). ).

Human monoclonal antibodies can be obtained using transgenic mice engineered to produce specific human antibodies in response to antigen exposure. In this technique, elements of the human immunoglobulin heavy and light chain loci are transferred to mouse strains derived from embryonic stem cell lines containing targeted disruption of the endogenous immunoglobulin heavy and light chain loci. Introduce. The transgenic mouse is capable of synthesizing a human antigen, eg, a human antibody specific for the MASP-2 antigen described herein, a conventional Koehler-Millstein technique as further described in Example 7. Can be used to generate human MASP-2 antibody-secreting hybridomas by fusing B cells from such animals with a suitable myeloma cell line. Transgenic mice bearing the human immunoglobulin genome are commercially available (eg, from Abgenix, Inc., Fremont, CA. And Medarex, Inc., Annandale, NJ). Methods for obtaining human antibodies from transgenic mice include, for example, Green, LL, et al., Described by Nature Genet. 7:13, 1994; Lonberg, N., et al., Nature 368: 856, 1994; and Taylor, LD, et al., Int. Immun. 6:579, 3994.

Monoclonal antibodies can be isolated and purified from hybridoma cultures by a variety of well-established techniques. Such isolation methods include affinity chromatography with protein A Sepharose, size exclusion chromatography, and ion exchange chromatography (eg, Coligan, pages 2.7.1-2.7.12 and 2.9.1-). 2.9.3; see Baines et al., "Purification of Immunoglobulin G (IgG)", Methods in Molecular Biology, The Humana Press, Inc., Vol. 10, pp. 79-104, 1992).

Once a polyclonal antibody, monoclonal antibody, or phage-derived antibody is made, it is first tested for specific MASP-2 binding. Various assays known to those of skill in the art can be used to detect antibodies that specifically bind to MASP-2. Exemplary assays include Western blot or immunoprecipitation analysis by standard methods (eg, described in Ausubel et al.,), Immunoelectrophoresis, enzyme-bound immunoadsorption assay, dot blot, inhibition assay or competition. Assay methods and sandwich assays (described in Harlow and Land, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory Press, 1988) are included. Once an antibody that specifically binds to MASP-2 has been identified, the anti-MASP-2 antibody can be used in one of several assays, such as the lectin-specific C4 cleavage assay (described in Example 2), C3b deposition. The ability to function as a MASP-2 inhibitor in an assay (described in Example 2) or C4b deposition assay (described in Example 2) is tested.

The affinity of the anti-MASP-2 monoclonal antibody can be readily determined by one of ordinary skill in the art (eg, Scatchard, A., NY Acad. Sci. 51: 660-672, See 1949). In one aspect, the anti-MASP-2 monoclonal antibody useful for the methods of the invention binds to MASP-2 with a binding affinity of &lt;100 nM, preferably &lt;10 nM, most preferably &lt;2 nM. In some embodiments, the MASP-2 inhibitory monoclonal antibody useful in the methods of the invention is a heavy chain CDR-H1; comprising the amino acid sequences 31-35 of (I) (a) (i) SEQ ID NO: 67; And (ii) heavy chain CDR-H2 containing the amino acid sequence of 50-65 of SEQ ID NO: 67; and (iii) heavy chain CDR-H3 containing the amino acid sequence of 95-102 of SEQ ID NO: 67. The heavy chain variable region and the light chain CDR-L1; containing the amino acid sequences of 24 to 34 of (b) (i) SEQ ID NO: 70; and the amino acid sequences of 50 to 56 of (ii) SEQ ID NO: 70. Contains light chain CDR-L2; and (iii) light chain variable region containing light chain CDR-L3 containing the amino acid sequence of 89-97 of SEQ ID NO: 70, or at least with (II) SEQ ID NO: 67. 90% identity (eg SEQ ID) Heavy chain variable region with NO: 67 and 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) and SEQ ID NO: 70 and at least 90% identity (eg, 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% A MASP-2 inhibitory monoclonal antibody or antigen-binding fragment thereof, which comprises a variant thereof comprising a light chain variable region having (identity).

Chimeric / Humanized Antibodies The monoclonal antibodies useful in the methods of the invention include heavy and / or light chain portions of antibodies derived from a particular species or corresponding sequences of antibodies belonging to a particular antibody class or subclass. Chimeric antibodies, and such antibodies, which are identical or homologous to, but the rest of the chain is identical or homologous to the corresponding sequence of an antibody derived from another species or an antibody belonging to another antibody class or subclass. (U.S. Pat. No. 4,816,567 to Cabilly; and Morrison, SL, et al., Proc. Nat'l Acad. Sci. USA 81: 6851-6855, 1984).

One form of chimeric antibody useful in the present invention is a humanized monoclonal anti-MASP-2 antibody. The humanized form of a non-human (eg, mouse) antibody is a chimeric antibody containing the smallest sequence derived from a non-human immunoglobulin. Humanized monoclonal antibodies are made by introducing non-human (eg, mouse) complementarity determining regions (CDRs) from the variable and variable light chains of mouse immunoglobulin into the human variable domain. Human antibody residues are then typically substituted in the framework region of the non-human counterpart. In addition, humanized antibodies may contain residues not found in either recipient or donor antibodies. These modifications are made to further refine the performance of the antibody. In general, humanized antibodies contain substantially all of at least one, and typically two, variable domains. All or substantially all of the hypervariable loops correspond to the hypervariable loops of non-human immunoglobulins, and all or substantially all of the Fv framework regions correspond to the Fv framework regions of the human immunoglobulin sequence. Humanized antibodies also optionally include at least a portion of the immunoglobulin constant region (Fc), typically at least a portion of the immunoglobulin constant region (Fc) of human immunoglobulin. For more details, 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 present invention include human monoclonal antibodies containing at least the MASP-2 binding CDR3 region. In addition, the Fc moiety may be exchanged to make IgA or IgM antibodies as well as human IgG antibodies. Such humanized antibodies specifically recognize human MASP-2 but do not elicit an immune response against the antibody itself in humans and are therefore considered to be particularly clinically useful. As a result, such humanized antibodies are more suitable for in vivo administration in humans, especially when repeated or long-term administration is required.

An example of the production of a humanized anti-MASP-2 antibody from a mouse anti-MASP-2 monoclonal antibody is shown in Example 6 herein. Techniques for making humanized monoclonal antibodies include, for example, 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", Protein Engineering: Principles and Practice, Cleland et al. (eds.), John Wiley It is also described in &amp; Sons, Inc., pp. 399-434, 1996; and US Pat. No. 5,693,762 to Queen, 1997. In addition, there are commercial entities that synthesize humanized antibodies from specific mouse antibody regions, such as Protein Design Labs (Mountain View, CA).

Recombinant antibody Anti-MASP-2 antibody can also be produced using the recombinant method. For example, a human antibody fragment (V)_H, V_L, Fv, Fd, Fab, or F (ab')₂) Can be used to generate human antibodies using a human immunoglobulin expression library (eg, available from Stratagene, Corp., La Jolla, CA). These fragments are then used to construct the entire human antibody using techniques similar to those used to make chimeric antibodies.

Anti-Idiotype Antibodies Once anti-MASP-2 antibodies with the desired inhibitory activity have been identified, these antibodies are used to resemble some of MASP-2 using techniques well known in the art. Can be generated. See, for example, Greenspan, NS, et al., FASEB J. 7: 437, 1993. For example, with an antibody that binds to MASP-2 and completely inhibits the MASP-2 protein interaction required for complement activation, it resembles the MBL binding site on the MASP-2 protein, thus It is possible to generate an anti-idiotype that binds to and neutralizes a binding ligand for MASP-2, eg, MBL.

Immunoglobulin Fragments The MASP-2 inhibitors useful in the methods of the invention are Fab, Fab', F (ab) formed from antibody fragments as well as intact immunoglobulin molecules.₂, F (ab')₂, And well-known fragments including Fv fragments, scFv fragments, diabodies, linear antibodies, single chain antibody molecules, and multispecific antibodies.

It is well known in the art that only a small portion of the antibody molecule, the paratope, is involved in the binding of the antibody to its epitope (eg, Clark, WR, The Experimental Foundations of Modern Immunology, Wiley &amp; Sons, Inc., NY). , 1986). The pFc'and Fc regions of the antibody are effectors of the classical complement pathway but are not involved in antigen binding. Antibodies with the pFc'region enzymatically cleaved or made without the pFc' region are F (ab')₂Called a fragment, it retains both antigen-binding sites of intact antibodies. Isolated F (ab')₂Fragments are called divalent monoclonal fragments because of their two antigen binding sites. Similarly, an antibody in which the Fc region is enzymatically cleaved, or an antibody produced without the Fc region, is called a Fab fragment and retains one of the antigen-binding sites of an intact antibody molecule.

Antibody fragments can be obtained by protein hydrolysis of the entire antibody by conventional methods, such as pepsin digestion or papain digestion. For example, antibody fragments are obtained by enzymatically cleaving the antibody with pepsin and then using F (ab').₂It can be made by obtaining a 5S fragment called. This fragment can be further cleaved with a thiol reducing agent that yields a 3.5S Fab'monovalent fragment. Optionally, a cleavage reaction can be carried out using a blocking group of sulfhydryl groups that cleaves disulfide bonds. Alternatively, enzymatic cleavage with pepsin produces two monovalent Fab fragments and one Fc fragment directly. These methods include, for example, US Pat. No. 4,331,647 to Goldenberg; Nisonoff, A., et al., Arch. Biochem. Biophys. 89: 230, 1960; Porter, RR, Biochem, J. 73: 119, 1959; Edelman, et al., Methods in Enzymology 1: 422, Academic Press, 1967; and Coligan, pp. 2.8.1-2.8.10 and 2.10.-2.10.4.

In some embodiments, it is preferable to use an antibody fragment without the Fc region in order to avoid activation of the classical complement pathway that initiates when Fc binds to the Fcγ receptor. There are several ways in which MoAbs can be made that evade Fcγ receptor interactions. For example, the Fc region of a monoclonal antibody is chemically removed using partial digestion with a proteolytic enzyme (eg, ficin digestion), thereby, for example, an antigen-binding antibody fragment, eg, a Fab fragment or F (ab).₂Fragments can be produced (Mariani, M., et al., Mol. Immunol. 28: 69-71, 1991). Alternatively, a human γ4 IgG isotype that does not bind to the Fcγ receptor can be used during the construction of humanized antibodies as described herein. Antibodies without Fc domains, single chain antibodies, and antigen binding domains can also be engineered using the recombinant methods described herein.

Single Chain Antibody Fragment Alternatively, a MASP-2 specific peptide single chain binding molecule can be made in which the heavy and light chain Fv regions are linked. The Fv fragments may be linked with a peptide linker to form a single chain antigen binding protein (scFv). These single-chain antigen-binding proteins are linked by oligonucleotides, V_HAnd V_LIt is prepared by constructing a structural gene that contains the DNA sequence that encodes the domain. The structural gene is inserted into an expression vector and then introduced into a host cell such as E. coli. Recombinant host cells synthesize a single polypeptide chain with a linker peptide that crosslinks two V domains. Methods for making 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; US Patent to Ladner. No. 4,946,778; Pack, P., et al., Bio / Technology 11: 1271, 1993.

As an exemplary example, MASP-2 specific scFv exposes lymphocytes to a MASP-2 polypeptide in vitro and phages (eg, by using an immobilized or labeled MASP-2 protein or peptide). It can be obtained by selecting an antibody display library in a vector or a similar vector. Genes encoding polypeptides with a potential MASP-2 polypeptide binding domain can be obtained by screening a random peptide library displayed on phage or bacteria, such as E. coli. These random peptide display libraries can be used to screen for peptides that interact with MASP-2. Techniques for making and screening such random peptide display libraries are well known in the art (US Pat. No. 5,223,409 to Lardner; US Pat. No. 4,946,778 to Ladner; US Pat. No. 5,403,484 to Ladner; US Pat. No. 5,571,698 to Ladner; and Kay et al., Phage Display of Peptides and Proteins Academic Press, Inc., Inc., 1996). Random peptide display libraries and kits for screening such libraries include, for example, CLONTECH Laboratories, Inc. (Palo Alto, Calif.), Invitrogen Inc. (San Diego, Calif.), New England Biolabs, Inc. It is commercially available from. (Beverly, 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 single complementarity determining that binds to an epitope on the MASP-2 antigen and inhibits MASP-2 dependent complement activation. A peptide that encodes a region (CDR). The CDR peptide (minimum recognition unit) can be obtained by constructing the gene encoding the CDR of the antibody of interest. Such genes are prepared, for example, by synthesizing variable regions from RNA of antibody-producing cells using the polymerase chain reaction (eg, Larrick et al., Methods; A Companion to Methods in Enzymology 2: 106, 1991; Courtenay-Luck, "Genetic Manipulation of Monoclonal Antibodies", Monoclonal Antibodies: Production, Engineering and Clinical Application, Ritter et al., (eds.), P. 166, Cambridge University Press, 1995; and Ward et al., "Genetic Manipulation". and Expression of Antibodies , Monoclonal Antibodies: Principles and Applications, Birch et al., (eds,), p. 137, Wiley-Liss, Inc., 1995).

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

Peptide Inhibitors In some aspects of this aspect of the invention, MASP-2 inhibitors are isolated native and synthetic peptide inhibitors that inhibit the MASP-2 dependent complement activation system. Includes an isolated MASP-2 peptide inhibitor. As used herein, the term "isolated MASP-2 peptide inhibitor" refers to another recognizing molecule of the lectin pathway by binding to MASP-2 (eg, MBL, H-ficolin, M-ficolin). , Or by competing with MASP-2 for binding to L-phycholine) and / or by interacting directly with MASP-2 to inhibit MASP-2 dependent complement activation. Refers to a peptide that inhibits sexual complement activation, which is essentially pure and essentially other substances that can be found together in nature to the extent that it is realistic and suitable for the intended use. Not included.

Peptide inhibitors have been successfully used in vivo to interfere with protein-protein interactions and catalytic sites. For example, a peptide inhibitor for adhesion molecules structurally associated with LFA-1 was recently approved for clinical use in coagulopathy (Ohman, EM, et al., European Heart J. 16: 50-55, 1995). Short linear peptides (&lt;30 amino acids) that block or interfere with integrin-dependent adhesion have been described (Murayama, O., et al., J. Biochem. 120: 445-51, 1996). Long peptides ranging in length from 25 to 200 amino acid residues have also been successfully used to block integrin-dependent adhesions (Zhang, L., et al., J. Biol. Chem. 271 (47): 29953-57, 1996). In general, long peptide inhibitors have higher affinity and / or slow off-rate than short peptides and can therefore be potent inhibitors. Cyclic peptide inhibitors have also been shown to be in vivo effective integrin inhibitors for the treatment of human inflammatory diseases (Jackson, DY, et al., J. Med. Chem. 40: 3359-68, 1997). ). One method of making a cyclic peptide involves peptide synthesis in which the terminal amino acid of the peptide is cysteine, which allows the peptide to exist in cyclic form by disulfide bonds between the terminal amino acids. This cyclic form has been shown to improve in vivo affinity and half-life for the treatment of hematopoietic neoplasms (eg, US Pat. No. 6,649,592 to Larson).

Synthetic MASP-2 Peptide Inhibitors MASP-2 inhibitory peptides useful in the methods of this aspect of the invention are exemplified by amino acid sequences that mimic target regions important for MASP-2 function. Inhibitor peptides useful in practicing 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 practicing this aspect of the invention. In one of several assays, including, for example, the lectin-specific C4 cleavage assay (described in Example 2) and the C3b deposition assay (described in Example 2), the candidate MASP-2 inhibitory peptide is MASP-. 2 The ability to function as an inhibitor can be tested.

In some embodiments, the MASP-2 inhibitory peptide is derived from a MASP-2 polypeptide and is a fully long mature MASP-2 protein (SEQ ID NO: 6), or a specific domain of the MASP-2 protein, eg, the CUBI domain. It is selected from (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 mentioned above, the CUBEGFCUBII region has been shown to be required for dimerization and binding to MBL (Thielens et al., Supra). In particular, the peptide sequence TFRSDYN (SEQ ID NO: 16) in the CUBI domain of MASP-2 identified a human who had a homozygous mutation from Asp105 to Gly105, resulting in the loss of MASP-2 from the MBL complex. Studies have shown that it is involved in binding to MBL (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 participates in the lectin complement pathway. Several different lectins involved in this pathway have been identified, including mannan-binding lectins (MBL), L-ficolin, M-ficolin, and H-ficolin (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 serum as oligomers of homotrimeric subunits with N-terminal collagen-like fibers, each with a carbohydrate recognition domain. These different lectins have been shown to bind to MASP-2, and the lectin / MASP-2 complex activates complement by cleaving proteins C4 and C2. H-Ficholine has a 24-amino acid amino-terminal region, a collagen-like domain with 11 Gly-Xaa-Yaa repeats, a 12-amino acid neck domain, and a 207-amino acid fibrinogen-like domain (Matsushita, M. , et al., J. Immunol. 168: 3502-3506, 2002). H-Ficholine binds to GlcNAc and aggregates LPS-coated human erythrocytes derived from Salmonella typhimurium, S. minnesota, and E. coli. H-ficolin has been shown to bind to MASP-2 and MAp19 and activate the lectin pathway. That is, it has been shown that L-ficholine / P35 also binds to GlcNAc and to MASP-2 and MAp19 in human serum. This complex has been shown to activate the lectin pathway (Matsushita, M., et al., J. Immunol. 164: 2281, 2000). Therefore, the MASP-2 inhibitory peptides useful in the present invention are MBL protein (SEQ ID NO: 21), H-ficolin protein (GenBank accession number NM_173452), M-ficolin protein (GenBank accession number O00602), And may contain regions of at least 5 amino acids selected from the L-ficolin protein (GenBank Accession No. NM_015838).

More specifically, scientists have found that the MASP-2 binding site on the MBL is the 12 Gly-XY triplets between the hinge and neck at the C-terminus of the collagen-like domain of MBP.<img file="JP2020037568A_D0009.tif" />Identified to be within (Wallis, R. et al., J. Biol Chem. 279: 14065, 2004). This MASP-2 binding site region is also highly conserved in human H-ficolin and human L-ficolin. It is present in all three lectin proteins, including the amino acid sequence "OGK-X-GP" (SEQ ID NO: 22), where the letter "O" represents hydroxyproline and the letter "X" is a hydrophobic residue. The consensus binding site is described (Wallis et al., 2004, supra). Thus, in some embodiments, the MASP-2 inhibitory peptide useful in this aspect of the invention is at least 6 amino acids in length and comprises SEQ ID NO: 22. Amino acid sequence<img file="JP2020037568A_D0010.tif" />Peptides derived from MBL, including, have been shown to bind to MASP-2 in vitro (Wallis, et al., 2004, supra). To enhance binding to MASP-2, peptides can be synthesized with two GPO triplets flanking each end that enhance triple helix formation as seen in native MBL proteins.<img file="JP2020037568A_D0011.tif" />(More explained in Wallis, R., et al., J. Biol. Chem. 279: 14065, 2004).

The MASP-2 inhibitory peptide is also a sequence derived from the consensus MASP-2 binding region of H-ficolin.<img file="JP2020037568A_D0012.tif" />May be derived from human H-ficholine, including. Sequence derived from the consensus MASP-2 binding region of L-ficolin<img file="JP2020037568A_D0013.tif" />Also included are human L-phycholine-derived peptides, including.

The MASP-2 inhibitory peptide is also a C4 cleavage site linked to the C-terminal portion of antithrombin III.<img file="JP2020037568A_D0014.tif" />It may be derived from a C4 cleavage site such as (Glover, GI, et al., Mol. Immunol. 25: 1261 (1988)).

(Table 3) Exemplified MASP-2 inhibitory peptides<img file="JP2020037568A_D0015.tif" /><img file="JP2020037568A_D0016.tif" />Note: The letter "O" stands for hydroxyproline. The letter "X" is a hydrophobic residue.

Peptides derived from the C4 cleavage site and other peptides that inhibit the MASP-2 serine protease site can be chemically modified to be irreversible protease inhibitors. For example, suitable modifications are halomethyl ketones (Br, Cl, I, F) at the C-terminal, Asp, or Glu, or added to functional side chains; haloacetyls (or haloacetyls (or) on amino groups or other functional side chains. Other α-haloacetyl) groups; epoxide-containing or imine-containing groups at the amino-terminal or carboxy-terminal or functional side chains; or imitated esters at the amino-terminal or carboxy-terminal or functional side chains, but not necessarily. Not limited. It is believed that such modifications would have the advantage of permanently inhibiting the enzyme by covalent binding of the peptides. This may result in lower effective doses and / or may require less frequent administration of peptide inhibitors.

In addition to the above-mentioned inhibitory peptides, the MASP-2 inhibitory peptides useful in the methods of the present invention include peptides containing the MASP-2 bound CDR3 region of the anti-MASP-2 MoAb obtained as described herein. Is included. The sequences of the CDR regions for use in peptide synthesis can be determined by methods known in the art. The heavy chain variable region is generally a peptide with a length of 100-150 amino acids. The light chain variable region is generally a peptide with a length of 80-130 amino acids. The CDR sequences within the heavy and light chain variable regions include sequences of only about 3-25 amino acids that can be readily sequenced by those skilled in the art.

Those skilled in the art will recognize that substantially homologous variations of MASP-2 inhibitory peptides also exhibit MASP-2 inhibitory activity. Exemplary variations include, but are not limited to, peptides having insertions, deletions, exchanges, and / or additional amino acids at the carboxy-terminal or amino-terminal portion of the peptide, and mixtures thereof. Therefore, homologous peptides with MASP-2 inhibitory activity are considered useful in the methods of the invention. The described peptides may also include overlapping motifs and other modifications by conservative substitutions. Conservative variants are described elsewhere herein and involve exchanging certain amino acids for amino acids of similar charge, size, or hydrophobicity.

To better resemble a segment in an intact protein, the MASP-2 inhibitory peptide may be modified to increase solubility and / or maximize positive or negative charge. Derivatives may or may not have the exact primary amino acid structure of the peptides disclosed herein as long as they functionally retain the desired MASP-2 inhibitory properties. Modifications include amino acid substitutions using one or another of the 20 commonly known amino acids, ancillary desirable features, such as derivatized or substituted amino acids or D amino acids that are resistant to enzymatic degradation. Amino acid substitutions used, or substitutions with natural conformations and other molecules or compounds that mimic the function of one amino acid, multiple amino acids, or peptides, such as carbohydrates; amino acid deletions; generally known. Amino acid insertion with one or another of the 20 amino acids, auxiliary desirable features, such as derivatized or substituted amino acids with resistance to enzymatic degradation or amino acid insertion with D amino acids, or natural conformation. And another amino acid, multiple amino acids, or another molecule or compound that mimics the function of a peptide, eg, substitution with a carbohydrate; or another molecule that mimics the function of a natural conformation, charge distribution, and parent peptide. Alternatively, it may include substitutions with compounds such as carbohydrates or nucleic acid monomers. Peptides may also be modified by acetylation or amidation.

Derivative-inhibiting peptide synthesis may rely on known techniques such as peptide biosynthesis and carbohydrate biosynthesis. As a starting point, those skilled in the art may rely on appropriate computer programs to determine the conformation of the peptide of interest. Once the conformation of the peptides disclosed herein is known, those skilled in the art will retain the basic conformation and charge distribution of the parent peptide, but will be enhanced beyond the features not present in the parent peptide or found in the parent peptide. It is possible to determine what kind of substitution can be made to one or more sites in a rational design manner to make a derivative that may have these characteristics. Once the candidate derivative molecule has been identified, the derivative can be tested using the assays described herein to determine if it functions as a MASP-2 inhibitor.

Screening for MASP-2 Inhibiting Peptides Molecular modeling and rational molecular design are also used to generate and screen peptides that mimic the molecular structure of key binding regions of MASP-2 and inhibit the complement activity of MASP-2. can do. As previously mentioned, the molecular structures used for modeling include the CDR regions of the anti-MASP-2 monoclonal antibody, as well as the regions required for dimerization, the regions involved in MBL binding, and the serine protease activity. Includes target regions known to be important for MASP-2 function, including sites. Methods of identifying peptides that bind to a particular target are well known in the art. For example, molecular imprinting can be used for the construction of new macromolecular structures that bind to a particular molecule, eg, peptides. For example, Shea, KJ, "Molecular Imprinting of Synthetic Network Polymers: The De Novo synthesis of Macromolecular Binding and Catalytic Sties", See TRIP 2 (5) 1994.

As an exemplary example, one method of preparing a mimic of a MASP-2 binding peptide is as follows. A known MASP-2 binding peptide or a functional monomer (template) in the binding region of an anti-MASP-2 antibody that exhibits MASP-2 inhibition is polymerized. The template is then removed and then another class of monomer is polymerized in the voids left by the template to give new molecules that exhibit one or more desirable properties similar to the template. In addition to preparing peptides in this way, other MASP-2 binding molecules that are MASP-2 inhibitors, such as polysaccharides, nucleosides, drugs, nucleoproteins, lipoproteins, carbohydrates, glycoproteins, steroids, lipids, And other biologically active materials can also be prepared. This method is useful for the design of a wide variety of biological mimetics that are more stable than their natural counterparts. This is because these biological mimetics are typically prepared by free radical polymerization of functional monomers, resulting in compounds with a non-biodegradable backbone.

Peptide Synthesis MASP-2 inhibitory peptides are prepared using techniques well known in the art, such as the solid phase synthesis technique first described by Merrifield in J. Amer. Chem. Soc. 85: 2149-2154, 1963. can do. Autosynthesis can be achieved, for example, using Applied Biosystems 431 A Peptide Synthesizer (Foster City, Calif.) According to the instructions provided by the manufacturer. Other techniques can be found, for example, in Bodanszky, M., et al., Peptide Synthesis, Second Edition, John Wiley &amp; Sons, 1976 and other references known to those of skill in the art.

Peptides can also be prepared using standard genetic engineering techniques known to those of skill in the art. For example, a peptide can be made enzymatically by inserting the nucleic acid encoding the peptide into an expression vector, expressing the DNA, and translating the DNA into the peptide in the presence of the required amino acids. The peptide is then purified using chromatography or electrophoresis, or the peptide-encoding sequence is inserted into the expression vector in phase with the carrier protein-encoding nucleic acid sequence. Purify with a carrier protein that can be fused to the peptide and cleaved later. The fusion protein peptide may be isolated using chromatography, electrophoresis, or immunological techniques (eg, antibody-mediated binding of the resin to the carrier protein). Peptides can be cleaved using chemical methodologies or enzymatically, for example, by hydrolases.

The MASP-2 inhibitory peptides useful in the methods of the invention can also be produced in recombinant host cells according to conventional techniques. In order to express the sequence encoding the MASP-2 inhibitory peptide, the nucleic acid molecule encoding the peptide must be functionally linked within the expression vector to a regulatory sequence that regulates transcriptional expression and then introduced into the host cell. It doesn't become. In addition to transcriptional regulatory sequences such as promoters and enhancers, the expression vector may contain a translational regulatory sequence and a marker gene suitable for cell selection with the expression vector.

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

Small Molecule Inhibitors In some embodiments, MASP-2 inhibitors are small molecule inhibitors, including natural and synthetic substances with low molecular weight, such as peptides, peptide mimetics, and non-peptide inhibitors (oligonucleotides and (Including organic compounds). MASP-2 small molecule inhibitors can be made based on the molecular structure of the variable region of the anti-MASP-2 antibody.

Small molecule inhibitors may also be designed and generated based on the MASP-2 crystal structure using computational 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 the input for a computer program that outputs a list of low molecular weight structures expected to bind to MASP-2, such as the DOCK. The use of such computer programs is well known to those of skill in the art. For example, to identify a unique non-peptide ligand that is an HIV-1 protease inhibitor by assessing the fit of a compound to an enzyme binding site found in the Cambridge Crystalographic database using the program DOCK, HIV-1 The crystal structure of the protease inhibitor was used (Kuntz, ID, et al., J. Mol. Biol. 161: 269-288, 1982; DesJarlais, RL, et al., PNAS 87: 6644-6648, 1990).

A list of small molecular structures identified as potential MASP-2 inhibitors by computer computing methods is screened using the MASP-2 binding assay, eg, the MASP-2 binding assay described in Example 10. .. A functional assay, eg, the functional assay described in Example 2, to determine if a small molecule found to bind to MASP-2 inhibits MASP-2 dependent complement activation. Assayed at.

MASP-2 Soluble Receptors Other suitable MASP-2 inhibitors are believed to include MASP-2 soluble receptors that can be made using techniques known to those of skill in the art.

MASP-2 Expression Inhibitor In another aspect of this aspect of the invention, the MASP-2 inhibitor is a MASP-2 expression inhibitor capable of inhibiting MASP-2 dependent complement activation. In practicing this aspect of the invention, typical MASP-2 expression inhibitors include MASP-2 antisense nucleic acid molecules (eg, antisense mRNA, antisense DNA, or antisense oligonucleotide), MASP-2 ribozymes. , And the MASP-2 RNAi molecule.

Antisense RNA and DNA molecules act to directly block the translation of MASP-2 mRNA by hybridizing to MASP-2 mRNA and blocking the translation of the MASP-2 protein. Antisense nucleic acid molecules may be constructed in a number of different ways, provided they can interfere with MASP-2 expression. For example, an antisense nucleic acid molecule can transcribe the complementary strand of the coding region (or part thereof) of the MASP-2 cDNA (SEQ ID NO: 4) in the normal transcription direction. It can be constructed by reversing (or part of) the coding region of SEQ ID NO: 4).

An antisense nucleic acid molecule is usually substantially identical to at least a portion of one target gene or multiple target genes. However, the nucleic acids do not have to be exactly the same to inhibit expression. In general, high homology can be used to supplement the use of short antisense nucleic acid molecules. The minimum percent identity is typically greater than about 65%, but higher percent identity may more effectively suppress the expression of endogenous sequences. A fairly high percent identity, greater than about 80%, is typically preferred, but from about 95% to full identity is typically most preferred.

The antisense nucleic acid molecule need not have the same intron or exon pattern as the target gene. The non-coding segment of the target gene may be equally effective as the coding segment in achieving antisense suppression of target gene expression. DNA sequences of at least about 8 or so nucleotides can be used as antisense nucleic acid molecules, but longer sequences are preferred. Representative examples of useful MASP-2 inhibitors in the present invention are antisense MASP-2 nucleic acid molecules that are at least 90 percent identical to the complementary strand of the MASP-2 cDNA consisting of the nucleic acid sequence shown in SEQ ID NO: 4. is there. The nucleic acid sequence shown in SEQ ID NO: 4 encodes the MASP-2 protein consisting of the amino acid sequence shown in SEQ ID NO: 5.

Targeting antisense oligonucleotides that bind 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 antisense oligonucleotides to their respective mRNA sequences (US Pat. No. 5,739,119 to Cheng and US Pat. No. 5,759,829 to Shewmaker). In addition, examples of antisense inhibition include the nucleoprotein cyclin, multi-criminal resistance gene (MDG1), ICAM-1, E-selectin, STK-1, striatal GABA._ASee, eg, US Pat. No. 5,801,154 to Baracchini; US Pat. No. 5,789,573 to Baker; US Pat. No. 5,718,709 to Considine; and US Pat. No. 5,610,288 to Reubenstein, demonstrated using receptors and human EGF. I want to be).

A system has been described in which one of ordinary skill in the art can determine which oligonucleotide is useful in the present invention. This system involves probing appropriate sites within the target mRNA using Rnase H cleavage as an indicator of sequence reachability within the transcript. Scherr, M., et al., Nucleic Acids Res. 25: 5079-5085, 1998; Lloyd, et al., Nucleic Acids Res. 29: 3665-3673, 2001. To create sites vulnerable to RNAseH, a mixture of antisense oligonucleotides complementary to certain regions of the MASP-2 transcript is applied to MASP-2 expressing cell extracts, such as hepatocytes. It is added and hybridized. This method is based on the relative ability to form dimers, hairpins, or other secondary structures that reduce or prevent specific binding to target mRNAs in host cells. It can be combined with computer-assisted sequence selection that can predict optimal sequence selection. These secondary structure analysis and target site selection studies were conducted by OLIGO primer analysis software (Rychlik, I., 1997) and BLASTN 2.0.5 algorithm software (Altschul, SF, et al., Nucl. Acids Res. It can be done using 25: 3389-3402, 1997). The antisense compound against the target sequence preferably comprises about 8 to about 50 nucleotides in length. Antisense oligonucleotides containing nucleotides such as about 9 to about 35 are particularly preferred. We have 9 to 35 nucleotides (ie, 9, 10, 11, 12, 13, 14, 15, 16, 17, in length, for the practice of the method of the invention based on antisense oligonucleotides, All oligonucleotide compositions in the range of 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, or about 35 bases) Intended to be very favorable. Highly preferred target regions for MASP-2 mRNA are target regions that are at or near the AUG translation initiation codon, and these sequences that are substantially complementary to the 5'region of the mRNA, eg, It is the -10 to +10 region of the MASP-2 gene nucleotide sequence (SEQ ID NO: 4). An exemplary MASP-2 expression inhibitor is shown in Table 4.

(Table 4) Exemplary expression inhibitors of MASP-2<img file="JP2020037568A_D0017.tif" />

As mentioned above, the term "oligonucleotide" as used herein refers to an oligomer or polymer of ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) or imitations thereof. The term also covers oligonucleotides of natural nucleotides, sugars, and oligonucleosides consisting of covalent nucleoside-linked (backbone) bonds, as well as oligonucleotides with non-natural modifications. These modifications allow the introduction of certain desirable properties not provided by native oligonucleotides, such as low toxicity, high stability to nuclease degradation, and high cell uptake. In an exemplary embodiment, the antisense compounds of the invention differ from native DNA only in phosphodiester backbone modifications that extend the life of the antisense oligonucleotide, where the phosphate substituents are substituted with phosphorothioates. Similarly, one or both ends of an oligonucleotide may be replaced with one or more acridine derivatives that intercalate between adjacent base pairs within the nucleic acid chain.

Another alternative to antisense is the use of "RNA interference" (RNAi). Double-stranded RNA (dsRNA) can induce gene silencing in mammals in vivo. The natural function of RNAi and cosuppression appears to be the protection of the genome from mobile genetic elements such as retrotransposons and invasion by viruses that produce abnormal RNA or dsRNA in the host cell when activated ( For example, Jensen, J., et al., Nat. Genet. See 27: 209-12, 1999). Double-stranded RNA molecules are prepared by synthesizing two RNA strands capable of forming double-stranded RNA molecules, each of which is approximately 19-25 (eg, 19-23 nucleotides) in length. be able to. For example, dsRNA molecules useful in the methods of the invention may include RNA corresponding to the sequences listed in Table 4 and their complementary strands. Preferably, at least one RNA strand has a 3'overhang of 1-5 nucleotides. The synthesized RNA strands are combined under conditions that form a double-stranded molecule. This RNA sequence may contain at least 8 nucleotide moieties of SEQ ID NO: 4 with a total length of 25 nucleotides or less. The design of siRNA sequences for a particular target is within the bounds of conventional art in the art. Commercial services are available that design siRNA sequences and guarantee at least 70% expression knockdown (Qiagen, Valencia, Calif).

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

Ribozymes that target MASP-2 mRNA, such as ribozymes, can also be used to reduce the amount and / or biological activity of MASP-2. A ribozyme is a catalytic RNA molecule capable of cleaving a nucleic acid molecule having a sequence completely or partially homologous to the ribozyme sequence. Ribozyme transgenes that encode RNA ribozymes that specifically pair with the target RNA and cleave the phosphodiester backbone at specific positions, thereby functionally inactivating the target RNA, can be designed. When performing this cleavage, the ribozyme itself remains unchanged and can therefore be reused to cleave other molecules. Inclusion of the ribozyme sequence in the antisense RNA imparts RNA cleavage activity to the antisense RNA, thereby increasing the activity of the antisense construct.

Ribozymes useful in the practice of the present invention typically include hybrid regions of at least about 9 nucleotides that are complementary in nucleotide sequence to at least a portion of the target MASP-2 mRNA, and the target MASP-2 mRNA. Includes catalytic regions adapted to cleave (generally EPA No. 0321201; WO 88/04300; Haseloff, J., et al., Nature 534: 585-591, 1988; Fedor, MJ, et al. , Proc. Natl. Acad, Sci. USA 87: 1668-1672, 1990; see Cech, TR, et al., Ann. Rev, Biochem. 55: 599-629, 1986).

The ribozyme may be directly targeted to the cell in the form of an RNA oligonucleotide incorporating the ribozyme sequence, or may be introduced into the cell as an expression vector encoding the desired ribozyme RNA. Ribozymes can be used and applied in much the same way as described for antisense polynucleotides.

Antisense RNA and DNA, ribozymes, and RNAi molecules useful in the methods of the invention can be prepared by any method known in the art for synthesizing DNA and RNA molecules. These include techniques for chemically synthesizing oligodeoxyribonucleotides and oligoribonucleotides well known in the art, such as solid phase phosphoramidite chemical synthesis. Alternatively, the RNA molecule may be made by in vitro and in vivo transcription of the DNA sequence encoding the antisense RNA molecule. Such DNA sequences may be incorporated into a wide variety of vectors incorporating suitable RNA polymerase promoters such as the T7 or SP6 polymerase promoter. Alternatively, an antisense cDNA construct that constructively or inductively synthesizes antisense RNA depending on 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 extending half-life. Useful modifications include the addition of flanking sequences of ribonucleotides or deoxyribonucleotides to the 5'and / or 3'ends of the molecule, or the use of phosphorothioates or 2'O-methyl rather than phosphodiesterase binding within the oligodeoxyribonucleotide backbone. Includes, but is not limited to.

VI. Pharmaceutical Compositions and Delivery Methods Dosing In another aspect, the invention comprises administering to a subject a composition comprising a therapeutically effective amount of a MASP-2 inhibitor and a pharmaceutically acceptable carrier. Provided are compositions for inhibiting the side effects of MASP-2-dependent complement activation in subjects suffering from the diseases or conditions disclosed herein. To treat or ameliorate conditions associated with MASP-2 dependent complement activation, MASP-2 inhibitors can be administered at therapeutically effective doses to subjects in need. A therapeutically effective dose refers to the amount of MASP-2 inhibitor sufficient to ameliorate the symptoms associated with the disease or condition.

Toxicity and therapeutic efficacy of MASP-2 inhibitors are standard pharmaceuticals using laboratory animal models, eg, mouse MASP-2-/-mouse models expressing the human MASP-2 transgene described in Example 1. It can be obtained by a specific procedure. Using such animal models, NOAEL (non-toxic dose) and MED (minimum effective dose) can be determined using standard methods. The dose ratio between the NOAEL effect and the MED effect is the cure ratio and is expressed as the ratio NOAEL / MED. Most preferred are MASP-2 inhibitors that show a large cure ratio or index. Data obtained from cell culture assays and animal studies can be used in formulating a range of doses for use in humans. The dose of the MASP-2 inhibitor is preferably in the range of circulating concentrations containing MED, which is almost non-toxic or non-toxic. Dosages can vary within this range, depending on the dosage form used and the route of administration used.

Animal models can be used to assess therapeutically effective doses of any compound formulation. For example, doses that reach the circulating plasma concentration range, including MED, can be prescribed in animal models. Quantitative levels of MASP-2 inhibitors in plasma can also be measured, for example, by high performance liquid chromatography.

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

In general, the dose of the composition administered, including the MASP-2 inhibitor, will vary depending on factors such as the subject's age, weight, height, gender, general medical condition, and medical history. To do. By way of example, MASP-2 inhibitors such as anti-MASP-2 antibody are about 0.010 to 10.0 mg / kg target body weight, preferably 0.010 to 1.0 mg / kg target body weight, more preferably 0.010 to 0.1 mg / kg target body weight. It can be administered within the dose range. In some embodiments, the composition comprises a combination of an anti-MASP-2 antibody and a MASP-2 inhibitory peptide.

The therapeutic efficacy of the MASP-2 inhibitory compositions and methods of the invention in a particular subject, as well as the appropriate dosage, can be determined according to complement assay methods well known to those of skill in the art. Complement produces a great many specific products. Sensitive and specific essays for most of these activation products, including small activation fragments C3a, C4a, and C5a, as well as large activation fragments iC3b, C4d, Bb, and sC5b-9 over the last decade. Has been developed and is commercially available. Most of these assays are monoclonal antibodies that react with a new antigen (neoantigen) that is exposed on the fragment but not on the intrinsically disordered protein on which the new antigen (neoantigen) is formed. To use. For this reason, these assays are very simple and specific. Most rely on ELISA technology, but for C3a and C5a, radioimmunoassay may still be used. These latter assays measure both untreated fragments and these "desArg" fragments, which are the predominant form found in the circulation. Unprocessed fragments and C5a_desArgIs rapidly cleaved by binding to cell surface receptors and is therefore present in very low concentrations. On the other hand, C3a_desArgDoes not bind to cells and accumulates in plasma. C3a measurements provide a sensitive, path-dependent indicator of complement activation. Second pathway activation can be assessed by measuring Bb fragments. Detection of sC5b-9, a liquid phase product of membrane invasion pathway activation, provides evidence that complement is fully activated. Since both the lectin and classical pathways produce the same activators, C4a and C4d, measuring these two fragments does not give any information as to which of these two pathways produced the activator. I can't get it.

Inhibition of MASP-2 dependent complement activation is characterized by at least one of the following changes in complement system components resulting from administration of a MASP-2 inhibitor by the methods of the invention: MASP-2 Inhibition of production or production of the products C4b, C3a, C5a, and / or C5b-9 (MAC) of the dependent complement activation system (eg, measured as described in Example 2), C4 cleavage and C4b Reduction of deposition (eg, measured as described in Example 10), or reduction of C3 cleavage and C3b deposition (eg, measured as described in Example 10).

Additional agents Compositions and methods comprising MASP-2 inhibitors optionally add or synergize with one or more additional therapeutic agents, or related therapeutic functions, that may increase the activity of the MASP-2 inhibitor. May include one or more additional therapeutic substances provided in. For example, in the context of treating a subject suffering from TTP who is positive for ADAM-TS13 inhibitors, one or more MASP-2 inhibitors may be combined with one or more immunosuppressants. It may be administered (including co-administration). Suitable immunosuppressive agents include corticosteroids, Rituxan, cyclosporine and the like. In the context of treating a subject suffering from HUS or aHUS or at risk of developing the HUS or aHUS, one or more MASP-2 inhibitors may be combined with appropriate antibiotics (co-administration). May be administered (including). In the context of treating a subject suffering from aHUS or at risk of developing that aHUS, one or more MASP-2 inhibitors can be other complement inhibitors such as eculizumab (Soliris). It may be administered in combination (including co-administration) with antibodies to TT-30, factor B, or terminal complement components or other agents that inhibit second pathway amplification.

It is believed that the inclusion and selection of additional agents will be determined to achieve the desired therapeutic outcome. In some embodiments, the MASP-2 inhibitor may be administered in combination with one or more anti-inflammatory and / or analgesics. Suitable anti-inflammatory and / or analgesic agents include serotonin receptor antagonists; serotonin receptor agonists; histamine receptor antagonists; bradykinin receptor antagonists; kallikrein inhibitors; neurokinins.₁And neurokinin₂Takikinin receptor antagonists, including receptor subtype antagonists; calcitonin gene-related peptide (CGRP) receptor antagonists; interleukin receptor antagonists; PLA₂Isoform inhibitors and PLC_γPhosphorlipase inhibitors, including isoform inhibitors, cyclooxygenase (COX) inhibitors (either COX-1 inhibitors, COX-2 inhibitors, or non-selective COX-1 and -2 inhibitors), lipo Inhibitors of enzymes active in the arachidonic acid metabolite synthesis pathway, including oxygenase inhibitors; prostanoid receptor antagonists, including eicosanoid EP-1 and EP-4 receptor subtype antagonists and thromboxane receptor subtype antagonists Leukotrien B₄Receptor subtype antagonist and leukotriene D₄Leukotriene receptor antagonists, including receptor subtype antagonists; opioid receptor agonists, including μ opioids, δ opioids, and κ opioid receptor subtype agonists; P_2XReceptor antagonist and P_2YPurine receptor agonists and antagonists, including receptor agonists; adenosine triphosphate (ATP) -sensitive potassium channel openers; MAP kinase inhibitors; nicotinic acetylcholine inhibitors; and α-adrenergic receptor agonists (α-1, α-2) , As well as non-selective α-1 and α-2 agonists).

The MASP-2 inhibitors of the present invention may also be administered in combination with one or more other complement inhibitors, eg, C5 inhibitors. To date, the antibody against C5, eculizumab (Solaris®), is the only complement-targeted drug approved for use in humans. However, it has been shown that some pharmacological agents block complement in vivo. K76COOH and nafamstat mesylate are two agents that have shown considerable efficacy in animal transplantation models (Miyagawa, S., et al., Transplant Proc. 24: 483-484, 1992). Low molecular weight heparin has also been shown to be effective in regulating complement activity (Edens, RE, et al., Complement Today, pp. 96-120, Basel: Karger, 1993). It is believed that these small molecule inhibitors may be useful as agents for use in combination with the MASP-2 inhibitors of the present invention.

Other natural complement inhibitors may be useful in combination with the MASP-2 inhibitors of the invention. Biological inhibitors of complement include soluble complement factor 1 (sCR1). It is a natural inhibitor found in the outer membrane of human cells. Other membrane inhibitors include DAF, MCP, and CD59. Recombinant anti-complement activity has been tested in vitro and in vivo. sCR1 is effective in xenotransplantation where the complement system (second and classical) triggers hyperactive rejection syndrome within minutes of perfusing blood into a newly transplanted organ. Is shown (Piatt, JL, et al., Immunol. Today 11: 450-6, 1990; Marino, IR, et al., Transplant Proc. 1071: 6, 1990; Johnstone, PS, et al., Transplantation 54: 573-6, 1992). The use of sCR1 protects the transplanted organ and prolongs the survival of the transplanted organ. This means that the complement pathway is involved in the development of organ survival (Leventhal, JR, et al., Transplantation 55: 857-66, 1993; Pruitt, SK, et al., Transplantation 57: 363). -70, 1994).

Additional complement inhibitors suitable for use with the compositions of the invention include, for example, anti-C5 antibodies developed by MoAb, eg Alexion Pharmaceuticals, Inc., New Haven, Connecticut (eg, eculizumab). , And anti-properdin MoAb.

Pharmaceutical Carriers and Delivery Vehicles Generally, the MASP-2 inhibitor composition of the invention in combination with any other selected therapeutic agent is optionally included in a pharmaceutically acceptable carrier. The carrier is selected so that it is non-toxic, biocompatible and does not adversely affect the biological activity of the MASP-2 inhibitor (and any other therapeutic agent in combination with it). An exemplary pharmaceutically acceptable carrier for peptides is described in US Pat. No. 5,211,657 to Yamada. Anti-MASP-2 antibodies and inhibitory peptides useful in the present invention are preparations in the form of solids, semi-solids, gels, liquids, or gases that allow oral, parenteral, or surgical administration, eg. , Tablets, capsules, powders, granules, ointments, solutions, depository, inhalants, and injections. The present 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 irrigation, and local delivery include distilled water, physiological phosphate buffered saline, conventional ringer or lactated ringer, dextrose, Hanks, etc. Alternatively, propanediol is included. In addition, sterile non-volatile oils may be used as the solvent or dispersion medium. Any biocompatible oil can be used for this purpose, including synthetic monoglycerides or diglycerides. In addition, fatty acids such as oleic acid are useful in the preparation of injections. Carriers and agents may be formulated as liquids, suspensions, polymerizable or non-polymerizable gels, pastes, or ointments.

The carrier may also include a delivery vehicle to sustain (ie, prolong, delay, or regulate) delivery of the agent, or to enhance delivery, uptake, stability, or pharmacokinetics of the therapeutic substance. .. Such delivery vehicles include, as a non-limiting example, microparticles, microspheres, nanospheres, or nanoparticles consisting of proteins, liposomes, carbohydrates, synthetic organic compounds, inorganic compounds, polymer or copolymer hydrogels, and polymer micelles. It may be included. Suitable hydrogel and micelle delivery systems include PEO: PHB: PEO copolymers and copolymers / cyclodextrin complexes disclosed in WO2004 / 009664A2, and PEO and PEO / cyclo disclosed in US Patent Application Publication No. 2002/0019369A1. Includes dextrin complex. Such hydrogels may be injected topically at the site of action of interest or subcutaneously or intramuscularly to form a long-acting depot.

For intra-articular delivery, the MASP-2 inhibitor is carried in the injectable liquid or gel carrier, the injectable long-acting delivery vehicle, or hyaluronic acid or hyaluronic acid derivatives. May be good.

For oral administration of non-peptide agonists, the MASP-2 inhibitor may be carried in an inert bulking or diluent such as sucrose, cornstarch, or cellulose.

For topical administration, the MASP-2 inhibitor may be carried in ointments, lotions, creams, gels, eye drops, suppositories, sprays, liquids or powders, in gel or microcapsule delivery systems. It may be placed inside and carried via a transdermal patch.

Various nasal and pulmonary delivery systems are under development, including aerosols, metered dose inhalers, dry powder inhalers, and nebulizers, each placed in an aerosol, inhalant, or spray delivery vehicle to the present invention. Can be adequately adapted to the delivery of.

For intrasubarachnoid (IT) or intraventricular (ICV) delivery, the compositions of the invention may be administered using a properly sterile delivery system (eg, liquid; gel, suspension, etc.). it can.

The compositions of the present invention also include biocompatible excipients such as dispersants or wetting agents, suspending agents, diluents, buffers, permeation enhancers, emulsifiers, binders, thickeners, seasonings ( In the case of oral administration) may be included.

Pharmaceutical Carriers for Anti-MASP-2 Anti-MASP-2 Anti-MASP-2 Anti-Anti-MASP-2 Antibodies and Inhibitors More specifically, exemplary formulations may be in sterile liquids such as water, oil, saline, glycerol, or ethanol. Together with it, it can be administered parenterally as a solution or suspension of an injectable dose of the compound dissolved in a physiologically acceptable diluent. In addition, auxiliary substances such as wetting or emulsifying agents, surfactants, pH buffering substances and the like may be present in the composition containing the anti-MASP-2 antibody and inhibitory peptide. Further components of the pharmaceutical composition include petroleum (eg, animal-derived, vegetable-derived, or synthetic-derived petroleum), such as soybean oil and mineral oil. In general, glycols such as propylene glycol or polyethylene glycol are preferred liquid carriers for injections.

Anti-MASP-2 antibodies and inhibitory peptides can also be administered in the form of depot injections or graft preparations that can be formulated for sustained release or pulsatile release of the active agent.

Pharmaceutically Acceptable Carriers for Expression Inhibitors More specifically with respect to expression inhibitors useful in the methods of the invention, compositions comprising said expression inhibitors and pharmaceutically acceptable carriers or diluents. Is provided. The composition may further comprise a colloidal dispersion system.

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

In some embodiments, the composition can typically be prepared and formulated as an emulsion, which is a heterogeneous system in which one liquid is dispersed in another in the form of droplets (Idson, See Pharmaceutical Dosage Forms, Vol.1, Rieger and Banker (eds.), Marcek Dekker, Inc., NY, 1988). Examples of natural emulsifiers used in emulsion formulations include gum arabic, beeswax, lanolin, lecithin, and phosphatide.

In one aspect, the composition comprising nucleic acid can be formulated as a microemulsion. As used herein, microemulsion refers to a system of water, oil, and amphiphiles that are a single, optically isotropic, and thermodynamically stable liquid solution (Rosoff, Pharmaceutical). See Dosage Forms, Vol.1). The methods of the invention may also use liposomes to introduce and deliver 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.

Methods of Administration Pharmaceutical compositions containing MASP-2 inhibitors can be administered in many ways, depending on whether topical or systemic methods of administration are most suitable for the condition being treated. In addition, as described herein with respect to in vitro reperfusion methods, MASP-2 inhibitors can be administered to recirculated blood or plasma via the introduction of the compositions of the invention. In addition, the compositions of the invention can be delivered by coating or incorporating the compositions of the invention on the surface of or implantable medical devices.

Systemic delivery As used herein, the terms "systemic delivery" and "systemic administration" are intramuscular (IM) route of administration, subcutaneous route of administration, intravenous (IV) route of administration, intraarterial route of administration, inhalation route of administration, Effectively distributes sublingual, buccal, local, transdermal, nasal, rectal, vaginal, and delivery agents to one or more therapeutic sites of interest It is intended to include, but are not limited to, oral and parenteral routes of administration, including other routes of administration. Preferred systemic delivery routes for the composition include intravenous, intramuscular, subcutaneous, and inhalation routes. The exact systemic route of administration of the selected agent used in the particular composition of the invention has been determined, in part, to account for the susceptibility of the agent to metabolic conversion pathways associated with that particular route of administration. Is considered to be understood. For example, peptide substances can most appropriately be administered by routes other than oral.

MASP-2 inhibitory antibodies and polypeptides can be delivered to the subject in need thereof by any suitable means. MASP-2 antibodies and polypeptides can be delivered by oral route, pulmonary route, parenteral route of administration (eg, intramuscular route, intraperitoneal route, intravenous (IV) route of administration, or subcutaneous injection route of administration. ), Inhalation routes (eg, inhalation routes via fine powder preparations), transdermal routes, nasal routes, vaginal routes, rectal routes, or sublingual routes of administration, suitable for each route of administration. It can be prescribed in the form of a drug.

As a typical example, MASP-2 inhibitory antibodies and peptides can be introduced into vivo by application to body membranes capable of absorbing polypeptides, such as nasal, gastrointestinal, and rectal membranes. .. Polypeptides are typically applied to absorbent membranes with permeation enhancers (eg Lee, VHL, Crit. Rev. Ther. Drug Carrier Sys. 5:69, 1988; Lee, VHL, J. Controlled Release. See 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 fusidic acid, a steroidal surfactant that is similar in structure to bile salts and has been used as a penetration enhancer for nasal delivery (Lee, WA, Biopharm. 22, Nov./ Dec. 1990).

To protect the polypeptide from enzymatic degradation, MASP-2 inhibitory antibodies and polypeptides can be introduced by binding to other molecules such as lipids. For example, covalent bonds of polymers, especially polyethylene glycol (PEG), have been used to protect certain proteins from enzymatic hydrolysis in the body and thus prolong their half-life (Fuertges, P., et al). ., J. Controlled Release 11: 139, 1990). Many polymer systems for protein delivery have been reported (Bae, YH, et al., J. Controlled Release 9: 271, 1989; Hori, R., et al., Pharm. Res. 6: 813, 1989: Yamakawa, L, et al., J. Pharm. Sci. 79: 505, 1990; Yoshihiro, I., et al., 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, eg, US Pat. No. 5,741,516 to Webb). In addition, various methods of liposomes as potential drug carriers and liposome-like preparations have been investigated (eg, US Pat. No. 5,567,434 to Szoka; US Pat. No. 5,552,157 to Yagi; US Pat. No. 5,565,213 to Nakamori. See U.S. Pat. No. 5,738,868 to Shinkarenko; and U.S. Pat. No. 5,795,587 to Gao).

For transdermal application, MASP-2 inhibitory antibodies and polypeptides may be combined with other suitable components such as carriers and / or adjuvants. Nothing is said to be the component, except that such other components need to be pharmaceutically acceptable for the intended administration and cannot degrade the activity of the active component of the composition. There is no limit to what. 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 into transdermal patches, ointments, and bandages, preferably in liquid or semi-liquid form.

The compositions of the invention may be administered systemically on a regular basis at intervals determined to maintain the desired level of therapeutic effect. For example, the composition may be administered, for example, by subcutaneous injection every 2-4 weeks or less frequently. The dosing regimen may be determined by the physician taking into account various factors that may affect the action of the agent combination. These factors may include the degree of progression of the condition being treated, the patient's age, gender, and weight, as well as other clinical factors. The dose of each individual agent is believed to vary as a function of the presence and content of the MASP-2 inhibitor contained in the composition, as well as any drug delivery vehicle (eg, long-acting delivery vehicle). In addition, the dose can be adjusted to cause variations in the frequency and pharmacokinetic behavior of the delivery agent.

Topical delivery As used herein, the term "local" includes the application of a drug within or around the site of target localization, eg, skin or other. It may include local delivery to affected tissue, ocular delivery, intrathecal (IT), intraventricular (ICV), intra-articular, sinus, intracranial, or intravesicle administration, placement, or irrigation. Topical administration may be preferred for low dose administration to avoid systemic side effects and to more precisely control the timing of delivery and concentration of the active agent at the site of local delivery. Topical administration provides known concentrations at the target site regardless of patient-to-patient variability such as metabolism and blood flow. Improved dose control is also provided by direct delivery methods.

Topical delivery of MASP-2 inhibitors is used in the context of surgical methods to treat a disease or condition, such as arterial bypass surgery, atelectomy, laser treatment, ultrasound treatment, balloon angioplasty, and stent placement. Can be achieved during the procedure of. For example, MASP-2 inhibitors can be administered to a subject along with balloon angioplasty. Balloon angioplasty involves inserting a catheter with a contracted balloon into an artery. The contracted balloon is placed near the atherosclerotic lesion and inflated so that the plaque is pressed against the vessel wall. As a result, the balloon surface contacts a layer of vascular endothelial cells on the surface of the blood vessel. The MASP-2 inhibitor may be attached to a balloon angioplasty catheter so that the substance can be released to the site of the atherosclerotic lesion. The material can be attached to a balloon catheter according to standard procedures known in the art. For example, the material may be stored in a compartment of the balloon catheter until the balloon is inflated, at which time the material is released into the local environment. Alternatively, when the balloon is inflated, the substance may be impregnated with the balloon surface in contact with arterial parietal cells. The material may also be delivered in a perforated balloon catheter, eg, a perforated balloon catheter disclosed in Flugelman, MY, et al., Circulation 85: 1110-1117, 1992. See also published PCT application WO 95/23161 for exemplary procedures for attaching therapeutic proteins to balloon angioplasty catheters. Similarly, the MASP-2 inhibitor may be included in the gel or polymer coating applied to the stent, or may be incorporated into the stent material so that the stent elutes the MASP-2 inhibitor after vascular placement. Good.

The MASP-2 inhibitory composition used in the treatment of arthritis and other musculoskeletal disorders may be delivered topically by intra-articular injection. Such compositions may optionally include a long-acting delivery vehicle. As a further example where topical delivery may be desirable, the MASP-2 inhibitory composition used in the treatment of genitourinary conditions may be infused as appropriate into the bladder or into another genitourinary structure. ..

Coating on medical devices MASP-2 inhibitors, such as antibodies and inhibitory peptides, may be immobilized on (inside) the surface of a implantable or attachable medical device. The modified surface typically comes into contact with living tissue after transplantation into the animal body. A "transplantable or attachable medical device" is a device that is transplanted into or attached to an animal body tissue during normal surgery of the device (eg, a stent and an implantable drug delivery device). Any device is intended. Such implantable or attachable medical devices include, for example, nitrocellulose, diazocellulose, glass, polystyrene, polyvinyl chloride, polypropylene, polyethylene, dextran, Sepharose, agar, starch, nylon, stainless steel, titanium, as well. It can be made from biodegradable and / or biocompatible polymers. Linkage of the protein to the device is achieved by any technique that does not disrupt the biological activity of the linked protein, for example by attaching one or both of the N-terminal and C-terminal residues of the protein to the device. be able to. Attachment may be made at one or more internal sites of the protein. Multiple attachments (inside and end of protein) can also be used. Functional groups for protein immobilization (eg, carboxyl, amide, amino, ether, hydroxyl, cyano, nitride, sulfanamido, acetylinic, epoxide, silanic, anhydric, succinimic) ), Azide) can be modified to include the surface of the implantable or attachable medical device. Coupling chemistry includes the formation of esters, ethers, amides, azides and sulfanamide derivatives, cyanate, and other linkages with functional groups available on MASP-2 antibodies or inhibitory peptides. Not limited to. MASP-2 Antibodies or inhibitory fragments also have affinity tag sequences, such as proteins such as GST (DB Smith and KS Johnson, Gene 67: 31, 1988), polyhistidine (E. Hochuli et al., J. Chromatog. 411: 77,). 1987), or can also be attached by non-covalent attachment by addition to biotin. Such affinity tags may be used to reversibly attach the protein to the device.

The protein can also be covalently attached to the surface of the device body, for example by covalent activation of the surface of the medical device. As a typical example, a matrix cell protein is deviced by one of the following reactive group pairs (one member of the pair is on the surface of the device body and the other member of the pair is on the matrix cell protein). Can be attached to the body: hydroxyl / carboxylic acid that produces an ester bond; hydroxyl / anhydride that produces an ester bond; hydroxyl / isocyanate that produces a urethane bond. To allow deposition of matrix cell proteins, the surface of the device body, which lacks useful reactive groups, can be treated with high frequency discharge plasma (RFGD) etching to generate reactive groups (eg, oxygen-containing groups). Oxygen plasma treatment to introduce; propylaminoplasma treatment to introduce amine groups).

A MASP-2 inhibitor containing a nucleic acid molecule, such as antisense, RNAi, or DNA encoding a peptide inhibitor, can be implanted in a porous matrix attached to the body of the device. Typical porous matrices useful for making surface layers are porous matrices prepared from tendon or dermal collagen such as those available from various commercial suppliers (eg, Sigma and Collagen Corporation), Alternatively, it is a collagen matrix prepared as described in US Pat. Nos. 4,394,370 to Jefferies and 4,975,527 to Koezuka. One collagen material is called UltraFiber and is available from Norian Corp. (Mountain View, California).

If desired, certain polymer matrices may be used, including, for example, acrylic ester polymers and lactic acid polymers as disclosed in US Pat. Nos. 4,526,909 and 4,563,489 to Urist. Specific examples of useful polymers include orthoesters, anhydrides, propylene-cowmalate polymers, or one or more α-hydroxycarboxylic acid monomers (eg, α-hydroxyacetic acid (glycolic acid) and / or α-hydroxy). It is a polymer of propionic acid (lactic acid).

In therapeutic regimen prophylactic applications, the pharmaceutical composition develops symptoms of the condition in subjects who are susceptible to the condition associated with MASP-2 dependent complement activation, or who are otherwise at risk of the condition. It is given in an amount sufficient to eliminate or reduce the risk of In therapeutic applications, the pharmaceutical composition reduces the symptoms of the condition in subjects suspected of suffering from a condition associated with MASP-2 dependent complement activation, or in subjects already suffering from the condition. It is administered in a therapeutically effective amount sufficient to, or at least partially relieve. In both the prophylactic and therapeutic regimens, the composition containing the MASP-2 inhibitor may be administered in several doses until sufficient therapeutic outcomes are obtained in the subject. The application of the MASP-2 inhibitory composition of the present invention is made by a single dose of the composition or by a limited series of doses in the case of treatment of acute conditions such as reperfusion injury or other trauma. May be good. Alternatively, the composition may be administered at regular intervals over a long period of time in the case of treatment of chronic conditions such as arthritis or psoriasis.

The methods and compositions of the present invention can be used to inhibit inflammation and related processes typically resulting from diagnostic and therapeutic medical and surgical procedures. To inhibit such processes, the MASP-2 inhibitory compositions of the present invention may be applied periprocedurally. As used herein, "perioperative" means preoperatively and / or intraoperatively and / or postoperatively, i.e., before, during, before and after, before and after treatment. , During, and after, during, during, and after the treatment, or after the treatment, the inhibitory composition is administered. Perioperative application may be made, for example, by injection into the site or continuous or intermittent irrigation, or by topical administration of the composition to the surgical or treated site by systemic administration. Suitable methods for local perioperative delivery of MASP-2 inhibitor solutions are disclosed in US Pat. Nos. 6,420,432 to Demopulos and 6,645,168 to Demopulos. Suitable methods for topical delivery of cartilage protective compositions containing MASP-2 inhibitors are disclosed in International PCT Patent Application WO 01/07067A2. Suitable methods and compositions for targeted systemic delivery of cartilage protective compositions containing MASP-2 inhibitors are disclosed in International PCT Patent Application WO 03/063799A2.

In one aspect of the invention, the pharmaceutical composition is administered to a subject suffering from thrombotic microangiopathy (TMA) or at risk of developing the TMA. In one aspect, TMA is selected from the group consisting of hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), and atypical hemolytic uremic syndrome (aHUS). In one aspect, the TMA is aHUS. In one aspect, the composition is administered to aHUS patients during the acute phase of the disease. In one aspect, the composition is an aHUS patient in remission (ie, a subject who has recovered or partially recovered from an episode of acute aHUS. For example, such remission is, for example, by reference herein. Incorporated, Loirat C et al., Orphanet Journal of Rare Diseases 6:60, As described in 2011, it is administered to high platelet counts and / or low serum LDH concentrations). In one aspect, the subject is secondary to (i) TMA secondary to cancer; (ii) TMA secondary to chemotherapy; or (iii) transplantation (eg, organ transplantation, eg kidney transplantation or allogeneic hematopoietic stem cell transplantation). Have or are at risk of developing TMA, which is TMA. In one aspect, the subject has or is at risk of developing Upshaw-Schulman syndrome (USS). In one aspect, the subject has or is at risk of developing Degos's disease. In one aspect, the subject has or is at risk of developing fulminant antiphospholipid antibody syndrome (CAPS). In therapeutic applications, the pharmaceutical composition is TMA in a therapeutically effective amount sufficient to inhibit thrombosis, alleviate the symptoms of the condition, or at least partially alleviate the symptoms of the condition. It is administered to subjects suffering from or at risk of developing the TMA.

In both the prophylactic and therapeutic regimens, the composition containing the MASP-2 inhibitor may be administered in several doses until sufficient therapeutic outcomes are obtained in the subject. In one aspect of the invention, the MASP-2 inhibitor comprises an anti-MASP-2 antibody, the anti-MASP-2 antibody being more appropriately 0.1 mg to 10,000 mg, more appropriately 1.0 mg to 5,000 mg, more appropriate. May be administered to an adult patient (eg, an average adult body weight of 70 kg) at a dose of 10.0 mg to 2,000 mg, more preferably 10.0 mg to 1,000 mg, and even more appropriately 50.0 mg to 500 mg. For pediatric patients, the dose can be adjusted in proportion to the patient's weight. The application of the MASP-2 inhibitory composition of the present invention may be made by a single dose of the composition or by a limited series of doses in the case of treatment of TMA. Alternatively, the composition may be administered over a long period of time at regular intervals, eg, daily, twice weekly, weekly, biweekly, monthly, or bimonthly, for the treatment of TMA.

In some embodiments, has the subject suffering from TMA or at risk of developing the TMA previously been treated with a terminal complement inhibitor that inhibits cleavage of the complement protein C5? Or currently receiving. In some embodiments, the method comprises administering to the subject the composition of the invention comprising a MASP-2 inhibitor, and administering to the subject a terminal complement inhibitor that inhibits cleavage of complement protein C5. Includes additional steps. In some embodiments, the terminal complement inhibitor is a humanized anti-C5 antibody or antigen-binding fragment thereof. In some embodiments, the terminal complement inhibitor is eculizumab.

In one aspect of the invention, the pharmaceutical composition eliminates or reduces the risk of developing symptoms of the condition in subjects who are susceptible to aHUS or who are otherwise at risk of developing the aHUS. It is administered in a sufficient amount. In therapeutic applications, the pharmaceutical composition may reduce, or at least partially reduce, the symptoms of the condition in subjects suspected of having aHUS, or those already suffering from the aHUS. Is administered in a therapeutically effective amount. Whether in one aspect of the invention present with one or more symptoms of aHUS, including (i) anemia, (ii) thrombocytopenia, (iii) renal dysfunction, and (iv) increased creatinine prior to administration. The subject may be inspected to determine. The compositions of the present invention are then administered in an amount effective and for a sufficient time to ameliorate these symptoms.

In another aspect of the invention, the MASP-2 inhibitory composition of the invention prophylactically treats a subject at high risk of developing aHUS, thereby reducing the likelihood that the subject will deliver aHUS. Can be used for. The presence of a genetic marker known to be associated with aHUS in a subject is determined by first performing a genetic screening test on a sample obtained from the subject to supplement at least one genetic marker associated with aHUS. Factor H (CFH), Factor I (CFI), Factor B (CFB), Membrane Cofactor CD46, C3, Factor H-related protein (CFHR1), Anticoagulant protein thrombomodulin (THBD), Factor H-related Determined by identifying the presence of protein 3 (CFHR3), or factor H-related protein 4 (CFHR4). Subjects are then routinely (eg, monthly, four times a year, twice a year) to determine the presence or absence of at least one symptom of aHUS, such as anemia, thrombocytopenia, renal dysfunction, and increased creatinine. Or monitor (or every year). Based on the determination that at least one of these symptoms is present, the subject is given one or more MASP-2 inhibitors in an amount effective to inhibit MASP-2 dependent complement activation. It can be administered in an amount effective for improving the symptom and for a sufficient time. In a further aspect of the invention, subjects at high risk of developing aHUS are subject to drug exposure, infections (eg, bacterial infections) because they have been screened and determined to have one of the aHUS-related genetic markers. , Malignant tumors, injuries, organ transplants or tissue transplants, and the occurrence of events associated with the induction of aHUS clinical symptoms, including pregnancy, may be monitored.

In a further aspect of the invention, a composition comprising an effective amount of a MASP-2 inhibitor to inhibit MASP-2 dependent complement activation is atypical hemolytic uremic syndrome (secondary to infection). It can be administered to subjects suffering from aHUS) or at risk of developing the aHUS. For example, a patient suffering from non-enteric aHUS associated with Streptococcus pneumoniae infection or at risk of developing the non-enteric aHUS may be treated with the compositions of the invention.

In a further aspect of the invention, subjects suffering from aHUS first have a first period, eg, 1 hour, 12 hours, 1 day, 2 days, or 3 days, catheter line, eg, intravenous. It may be treated with the MASP-2 inhibitory composition of the present invention administered through a catheter line or a subcutaneous catheter line. Subjects are then treated with a MASP-2 inhibitory composition administered by regular subcutaneous injections, eg, daily, twice weekly, weekly, biweekly, monthly, or bimonthly injections for a second period. May be good.

In yet further aspects of the invention, the MASP-2 inhibitory compositions of the invention avoid potential plasmaferresis complications including exposure to bleeding, infections, and plasma donor-specific disorders and / or allergies. In the absence of plasmaferesis, or in subjects who otherwise dislike plasmaferresis, or in situations where plasmaferresis is not available, subjects suffering from aHUS (ie, aHUS symptoms are plasmaferet) It may be administered to subjects who have not been treated with cis and who are not treated with plasmaferresis when treated with the MASP-2 inhibitory composition).

In a further aspect of the invention, the MASP-2 inhibitory composition of the invention may be administered to a subject suffering from aHUS while treating the patient with plasma feresis. The MASP-2 inhibitory composition can then be administered, for example, after or alternating with plasmapheresis, to subjects undergoing plasmapheresis treatment.

In a further aspect of the invention, the subject is at least one complement that is suffering from or at risk of developing the aHUS and is being treated with the MASP-2 inhibitory composition of the invention. The level of the factor can be monitored by determining it on a regular basis, eg, every 12 hours or daily, and the level of the at least one complement factor is reduced compared to the standard value or healthy subjects. The decision indicates the need for continued treatment with the composition.

In both the prophylactic and therapeutic regimens, the composition containing the MASP-2 inhibitor may be administered in several doses until sufficient therapeutic outcomes are obtained in the subject. In one aspect of the invention, the MASP-2 inhibitor comprises an anti-MASP-2 antibody, the anti-MASP-2 antibody being more appropriately 0.1 mg to 10,000 mg, more appropriately 1.0 mg to 5,000 mg, more appropriate. May be administered to an adult patient (eg, an average adult body weight of 70 kg) at a dose of 10.0 mg to 2,000 mg, more preferably 10.0 mg to 1,000 mg, and even more appropriately 50.0 mg to 500 mg. For pediatric patients, the dose can be adjusted in proportion to the patient's weight. The application of the MASP-2 inhibitory composition of the present invention may be made by a single dose of the composition or by a limited series of doses in the case of treatment of aHUS. Alternatively, the composition may be administered at regular intervals over a long period of time, eg, daily, twice weekly, weekly, biweekly, monthly, or bimonthly, for the treatment of aHUS.

In some embodiments, subjects suffering from aHUS have previously been or are currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5. In some embodiments, the method comprises administering to the subject the composition of the invention comprising a MASP-2 inhibitor, and administering to the subject a terminal complement inhibitor that inhibits cleavage of complement protein C5. Includes additional steps. In some embodiments, the terminal complement inhibitor is a humanized anti-C5 antibody or antigen-binding fragment thereof. In some embodiments, the terminal complement inhibitor is eculizumab.

In one aspect of the invention, the pharmaceutical composition eliminates or reduces the risk of developing symptoms of the condition in subjects who are susceptible to HUS or who are otherwise at risk of developing the HUS. It is administered in a sufficient amount. In therapeutic applications, the pharmaceutical composition is sufficient to alleviate or at least partially alleviate the symptoms of the condition in subjects suspected of having HUS or already suffering from the HUS. It is administered in a therapeutically effective amount.

In another aspect of the invention, the likelihood of developing renal dysfunction in a subject at risk of developing HUS is an effective amount of MASP-of the invention to inhibit MASP-2 dependent complement activation. 2 It can be reduced by administering the inhibitory composition to the subject. For example, subjects at risk of developing HUS and treated with the MASP-2 inhibitory composition of the invention have diarrhea, hematocrit levels of less than 30% with smear evidence of intravascular red blood cell destruction, thrombocytopenia, and creatinine. May present with one or more HUS-related symptoms, including elevated levels. As a further example, subjects at risk of developing HUS and treated with the MASP-2 inhibitory composition of the present invention may be infected with Escherichia coli, Shigella, or Salmonella. Such subjects infected with Escherichia coli, Shigella, or Salmonella may be treated with the MASP-2 inhibitory composition of the invention at the same time as antibiotic treatment, especially antibiotic treatment. Contraindicated enteric Escherichia coli may be treated with the MASP-2 inhibitory composition without simultaneous treatment with antibiotics. Subjects infected with enterogenic E. coli who have been treated with antibiotics may be at increased risk of developing HUS, and in order to reduce this risk, the MASP-2 inhibitory composition of the present invention is appropriately used. It may be treated with an object. Subjects infected with enterogenic E. coli are treated with the MASP-2 inhibitory composition of the invention for a first period in the absence of antibiotics, and then for a second period, MASP-2 of the invention. It may be treated with both the inhibitory composition and the antibiotic.

In a further aspect of the invention, a subject suffering from HUS first has a first period, eg, 1 hour, 12 hours, 1 day, 2 days, or 3 days, catheter line, eg, intravenous. It may be treated with the MASP-2 inhibitory composition of the invention administered through a catheter line or a subcutaneous catheter line. Subjects are then treated with a MASP-2 inhibitory composition administered by regular subcutaneous injections, eg, daily, twice weekly, weekly, biweekly, monthly, or bimonthly injections for a second period. May be good.

In yet further aspects of the invention, the MASP-2 inhibitory compositions of the invention avoid potential plasmaferresis complications, including exposure to bleeding, infections, and disorders, and / or allergies inherent in plasma donors. In the absence of plasmaferesis, or in subjects who otherwise dislike plasmaferresis, or in situations where plasmaferresis is not available, subjects suffering from HUS (ie, HUS symptoms are plasmaferet) It may be administered to subjects who have not been treated with cis and who are not treated with plasmaferresis when treated with the MASP-2 inhibitory composition).

In a further aspect of the invention, the MASP-2 inhibitory composition of the invention may be administered to a subject suffering from HUS at the same time as treating the patient with plasma feresis. The MASP-2 inhibitory composition can then be administered, for example, after or alternating with plasmapheresis, to subjects undergoing plasmapheresis treatment.

In a further aspect of the invention, the subject is at least one complement factor suffering from or at risk of developing the HUS and being treated with the MASP-2 inhibitory composition of the invention. Levels can be monitored by determining regularly, eg, every 12 hours or daily, and determination of the level of at least one complement factor that is reduced compared to standard values or healthy subjects. Indicates the need for continued treatment with the composition.

In both the prophylactic and therapeutic regimens, the composition containing the MASP-2 inhibitor may be administered in several doses until sufficient therapeutic outcomes are obtained in the subject. In one aspect of the invention, the MASP-2 inhibitor comprises an anti-MASP-2 antibody, the anti-MASP-2 antibody being more appropriately 0.1 mg to 10,000 mg, more appropriately 1.0 mg to 5,000 mg, more appropriate. May be administered to an adult patient (eg, an average adult body weight of 70 kg) at a dose of 10.0 mg to 2,000 mg, more preferably 10.0 mg to 1,000 mg, and even more appropriately 50.0 mg to 500 mg. For pediatric patients, the dose can be adjusted in proportion to the patient's weight. The application of the MASP-2 inhibitory composition of the present invention may be made by a single dose of the composition or by a limited series of doses in the case of treatment of HUS. Alternatively, the composition may be administered over a long period of time at regular intervals, eg, daily, twice weekly, weekly, biweekly, monthly, or bimonthly, for the treatment of HUS.

In some embodiments, subjects suffering from HUS have previously been or are currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5. In some embodiments, the method comprises administering to the subject the composition of the invention comprising a MASP-2 inhibitor and administering to the subject a terminal complement inhibitor that inhibits cleavage of complement protein C5. Includes additional steps. In some embodiments, the terminal complement inhibitor is a humanized anti-C5 antibody or antigen-binding fragment thereof. In some embodiments, the terminal complement inhibitor is eculizumab.

In one aspect of the invention, the pharmaceutical composition eliminates or reduces the risk of developing symptoms of the condition in subjects who are susceptible to TTP or who are otherwise at risk of developing the TTP. It is administered in a sufficient amount. In therapeutic applications, the pharmaceutical composition is sufficient to alleviate or at least partially alleviate the symptoms of the condition in subjects suspected of having TTP or already suffering from TTP. It is administered in a therapeutically effective amount.

In another aspect of the invention, one or more of the symptoms of TTP, including central nervous system complications, thrombocytopenia, severe cardiac complications, severe pulmonary complications, gastrointestinal infarction, and gangrene. The indicated subject may be treated with the MASP-2 inhibitory composition of the present invention. In another aspect of the invention, a subject determined to have low levels of ADAMTS13 and also tested positive for the presence of an inhibitor (ie, antibody) of ADAMTS13 is the MASP-2 inhibitory composition of the invention. May be treated with. In a further aspect of the invention, subjects tested positive for the presence of inhibitors of ADAMTS13 are treated with immunosuppressants (eg, corticosteroids, Rituxan) at the same time as treatment with the MASP-2 inhibitory composition of the invention. , Or cyclosporine). In a further aspect of the invention, subjects determined to have low levels of ADAMTS13 and tested positive for the presence of inhibitors of ADAMTS13 are treated with the MASP-2 inhibitory composition of the invention and at the same time ADAMTS13. May be treated with.

In a further aspect of the invention, a subject suffering from TTP first has a first period, eg, 1 hour, 12 hours, 1 day, 2 days, or 3 days, catheter line, eg, intravenous. It may be treated with the MASP-2 inhibitory composition of the invention administered through a catheter line or a subcutaneous catheter line. Subjects are then treated with a MASP-2 inhibitory composition administered by regular subcutaneous injections, eg, daily, twice weekly, weekly, biweekly, monthly, or bimonthly injections for a second period. May be good.

In yet further aspects of the invention, the MASP-2 inhibitory compositions of the invention avoid potential plasmaferresis complications, including exposure to bleeding, infections, and disorders, and / or allergies inherent in plasma donors. In the absence of plasmaferresis, or in subjects who otherwise dislike plasmaferresis, or in situations where plasmaferresis is not available, subjects suffering from HUS (ie, TTP symptoms are plasmaferet) It may be administered to subjects who have not been treated with cis and who are not treated with plasmaferresis when treated with the MASP-2 inhibitory composition).

In a further aspect of the invention, the MASP-2 inhibitory composition of the invention may be administered to a subject suffering from TTP while treating the patient with plasmaferresis. The MASP-2 inhibitory composition can then be administered, for example, after or alternating with plasmapheresis, to subjects undergoing plasmapheresis treatment.

In a further aspect of the invention, subjects suffering from refractory TTP, ie, symptoms of TTP that have not adequately responded to other treatments such as plasmapheresis, with or with additional plasmaferresis. It may be treated with the MASP-2 inhibitory composition of the present invention without ferresis.

In a further aspect of the invention, the subject is at least one complement factor suffering from or at risk of developing the TTP and being treated with the MASP-2 inhibitory composition of the invention. Levels can be monitored by determining regularly, eg, every 12 hours or daily, and determination of the level of at least one complement factor that is reduced compared to standard values or healthy subjects. Indicates the need for continued treatment with the composition.

In both the prophylactic and therapeutic regimens, the composition containing the MASP-2 inhibitor may be administered in several doses until sufficient therapeutic outcomes are obtained in the subject. In one aspect of the invention, the MASP-2 inhibitor comprises an anti-MASP-2 antibody, the anti-MASP-2 antibody being more appropriately 0.1 mg to 10,000 mg, more appropriately 1.0 mg to 5,000 mg, more appropriate. May be administered to an adult patient (eg, an average adult body weight of 70 kg) at a dose of 10.0 mg to 2,000 mg, more preferably 10.0 mg to 1,000 mg, and even more appropriately 50.0 mg to 500 mg. For pediatric patients, the dose can be adjusted in proportion to the patient's weight. The application of the MASP-2 inhibitory composition of the present invention may be made by a single dose of the composition or by a limited series of doses in the case of treatment of TTP. Alternatively, the composition may be administered at regular intervals over a long period of time, eg, daily, twice weekly, weekly, biweekly, monthly, or bimonthly, for the treatment of TTP.

In some embodiments, subjects suffering from TTP have previously been or are currently being treated with a terminal complement inhibitor that inhibits cleavage of complement protein C5. In some embodiments, the method comprises administering to the subject the composition of the invention comprising a MASP-2 inhibitor, and administering to the subject a terminal complement inhibitor that inhibits cleavage of complement protein C5. Includes additional steps. In some embodiments, the terminal complement inhibitor is a humanized anti-C5 antibody or antigen-binding fragment thereof. In some embodiments, the terminal complement inhibitor is eculizumab.

<p>VI. Examples The following examples are merely illustrations of the best embodiments intended for the practice of the invention and should not be construed as limiting the invention. All citations herein are expressly incorporated by reference.</p><p>Example 1 This example describes the generation of a mouse strain in which MASP-2 is deficient but (MASP-2-/-) MAp19 is sufficient (MAp19 + / +).</p><p> Materials and Methods: As shown in Figure 3, the targeting vector pKO-NTKV1901 was designed to disrupt the three exons encoding the C-terminus of mouse MASP-2, including the exons encoding the serine protease domain. Mouse ES cell line E14.1a (SV129Ola) was transfected using pKO-NTKV1901. Neomycin-resistant and thymidine kinase-sensitive clones were selected. 600 ES clones were screened. Four of these different clones were identified and, as shown in Figure 3, Southern blots demonstrated that they contained the expected selective targeting and recombination events. Embryo transfer generated chimeras from these four positive clones. The chimeras were then backcrossed in genetic background C57 / BL6 to generate transgenic males. Transgenic males were mated with females to give F1. Fifty percent of offspring showed heterozygosity for the disrupted MASP-2 gene. Heterozygous mice were crossed to obtain homo-MASP-2 deficient offspring, heterozygous mice, and wild-type mice in a ratio of 1: 2: 1, respectively.</p><p> Results and Phenotype: The resulting homo-MASP-2-/-deficient mice were found to be viable and fertile, and by Southern blotting to confirm the correct targeting event, MASP-2. Northern lots to confirm the absence of mRNA and Western blots to confirm the absence of MASP-2 protein demonstrated MASP-2 deficiency (data not shown). Presence of MAp19 mRNA and MASP-2 using time-resolved RT-PCR with LightCycler apparatus The absence of mRNA was further confirmed. MASP-2-/-Mice continue to express MAp19, MASP-1, and MASP-3 mRNAs and proteins, as expected (data not shown). MASP-2-/-The presence and amount of propeldin, factor B, factor D, C4, C2, and C3 mRNA in mice was evaluated by LightCycler analysis and found to be identical to that of wild-type litter control. Was done (data not shown). Plasma from homo-MASP-2-/-mice is completely deficient in complement activation via the lectin pathway, as further described in Example 2.</p><p> Generation of MASP-2-/-lineages in pure C57BL6 background: After backcrossing MASP-2-/-mice with pure C57BL6 lines for 9 generations, the MASP-2-/-lineage was used as an experimental animal model.</p><p> A transgenic mouse strain that is mouse MASP-2-/-, MAp19 + / + and expresses human MASP-2 transgene (mouse MASP-2 knockout and human MASP-2 knockin) was also generated as follows.</p><p> Materials and Methods: As shown in Figure 4, the promoter region of the human MASP2 gene, which contains the first three exons (exons 1 to 3), is followed by a cDNA sequence corresponding to the following eight exon coding sequences. A mini gene (SEQ ID NO: 49) encoding human MASP-2 called "mini hMASP-2" was constructed that contained and thereby encoded the full-length MASP-2 protein driven by its endogenous promoter. A mini hMASP-2 construct was injected into MASP-2-/-fertilized eggs to replace the deficient mouse MASP2 gene with human MASP-2 expressed by gene transfer.</p><p>Example 2 This example demonstrates that MASP-2 is required for complement activation via the lectin pathway.</p><p>Methods and Materials: Lectin Pathogenic C4 Cleavage Assay: The C4 cleavage assay is described in Petersen, SV, et al., J. et al. Described by Immunol Methods 257: 107 (2001), it measures lectin pathway activation due to Staphylococcus aureus-derived lipoteichoic acid (LTA) that binds to L-ficholine. Petersen et al., By coating the plate with LPS and mannan or zymosan as described below and then adding serum from MASP-2-/-mouse. The assay described in (2001) was adapted to measure MBL-mediated lectin pathway activation. This assay was also modified to eliminate the possibility of C4 cleavage by the classical pathway. This allows for high affinity binding of the lectin pathway recognition component to its ligand, but blocks the activation of endogenous C4, thereby eliminating the involvement of the classical pathway by dissociating the C1 complex. , Achieved by using a sample dilution buffer containing 1 M NaCl. Briefly, in a modified assay, a serum sample (diluted with high salt (1 M NaCl) buffer) was added to a ligand-coated plate and then dissolved in a buffer containing physiological concentrations of salt. Purified C4 was added. The bound recognition complex containing MASP-2 cleaves C4, resulting in the deposition of C4b.</p><p>Assay Method; (1) Nunc Maxisorb microtiter plate (Maxisorb, Nunc, Catalog No. 442404, Fisher Scientific), coated buffer (15 mM Na).₂CO₃, 35mM LVDS₃, pH 9.6) diluted with 1 μg / ml mannan (M7504 Sigma) or any other ligand (eg, the ligands listed below).</p><p> The following reagents were used in the assay: a. Mannan (1 μg / well of mannan in 100 μl coating buffer (M7504 Sigma)); b. Zymosan (1 μg / well of zymosan (Sigma) in 100 μl coating buffer). c. LTA (1 μg / well in 100 μl coating buffer or 2 μg / well in 20 μl methanol); d. 1 μg H-ficolin-specific Mab 4H5 in coating buffer; e. Aerococcus viridans ) Derived from PSA (2 μg / well in 100 μl coating buffer); f. 100 μl / well formalin-fixed sigma 20233 (OD) in coating buffer₅₅₀=0.5)。 </p><p> (2) The plate was incubated overnight at 4 ° C.</p><p> (3) After overnight incubation, plate plate with 0.1% HSA-TBS blocking buffer (10 mM Tris-CL, 140 mM NaCl, 1.5 mM NaN containing 0.1% (w / v) HSA.₃, PH 7.4) for 1-3 hours, then plate TBS / tween / Ca²⁺(0.05% Tween 20 and 5 mM CaCl₂, 1 mM MgCl₂The remaining protein binding sites were saturated by washing 3 times with TBS) containing pH 7.4.</p><p> (4) The serum sample to be tested was diluted with MBL binding buffer (1 M NaCl), the diluted sample was added to a plate, and the mixture was incubated overnight at 4 ° C. Wells containing only buffer were used as the negative control.</p><p> (5) After overnight incubation at 4 ° C, place the plate on TBS / tween / Ca.²⁺Washed 3 times with. Then human C4 (100 μl / well. 1 μg / ml. BBS (4 mM barbital, 145 mM NaCl, 2 mM CaCl)₂, 1 mM MgCl₂(Diluted at pH 7.4)) was added to the plate and incubated at 37 ° C for 90 minutes. Plate TBS / tween / Ca²⁺Was rewashed 3 times.</p><p> (6) C4b deposition, alkaline phosphatase-bound chicken anti-human C4c (TBS / tween / Ca)²⁺Detected at 1: 1000), alkaline phosphatase-bound chicken anti-human C4c was added to the plate and incubated for 90 minutes at room temperature. Then the plate is TBS / tween / Ca²⁺Was rewashed 3 times.</p><p> (7) Add 100 μl of p-nitrophenyl phosphate substrate solution, incubate for 20 minutes at room temperature, and OD in a microtiter plate reader.₄₀₅Alkaline phosphatase was detected by reading.</p><p> Results: Figures 5A and B show mannans in serum diluents of MASP-2 + / + (cross), MASP-2 +/- (black circles), and MASP-2-/-(black triangles) (Figure 5A). And the amount of C4b deposition in Zymosan (Fig. 5B) is shown. Figure 5C shows MASP-2-/ + mice (n = 5) and MASP-2 compared to wild-type mice (n = 5) based on standardized C4b deposition measurements for wild-type serum. -/-Shows relative C4 convertase activity in mice (n = 4) on plates coated with zymosan (white bar) or mannan (shaded bar). Error bars indicate standard deviation. As shown in Figures 5A-C, plasma from MASP-2-/-mice is completely deficient in complement activation via the lectin pathway on mannan-coated and zymosan-coated plates. .. These results clearly prove that MASP-2 is an effector component of the lectin pathway.</p><p>Recombinant MASP-2 reconstitutes lectin pathway-dependent C4 activation in MASP-2-/-mouse-derived serum Lectin pathway-dependent C4 in MASP-2-/-mice in the absence of MASP-2 The effect of addition of recombinant MASP-2 protein to serum samples was examined in the C4 cleavage assay method described above to prove that it was the direct cause of loss of activation. Functionally active mouse MASP-2 recombinant protein and catalytically inactive mouse MASP-2A (active site serine residue in the serine protease domain replaced by alanine residue) recombinant protein in Example 3 below. Produced and purified as described. Serum pooled from 4 MASP-2-/-mice was pre-incubated with recombinant mouse MASP-2 or Inactive recombinant mouse MASP-2A with increasing protein concentration and assayed for C4 convertase activity as described above. did.</p><p> Results: As shown in FIG. 6, addition of a functionally active mouse recombinant MASP-2 protein (shown as a white triangle) to serum obtained from MASP-2-/-mice was lectin pathway dependent. C4 activation was restored in a protein concentration-dependent manner, whereas the catalytically inactive mouse MASP-2A protein (shown as a star) did not restore C4 activation. The results shown in FIG. 6 are standardized for C4 activation (shown as dotted) observed with pooled wild-type mouse sera.</p><p>Example 3 In this example, recombinant full-length human MASP-2, rat and mouse MASP-2, polypeptides derived from MASP-2, and recombinant expression and protein production of catalytically inactivated mutant MASP-2. Will be described.</p><p>Full-length human MASP-2, mouse MASP-2, and rat MASP-2 expression: Human MASP-2 full-length cDNA sequence (SEQ ID NO: 4) is eukaryotic under the control of the CMV enhancer / promoter region. It was also subcloned into the expression-driven mammalian expression vector pCI-Neo (Promega) (Kaufman RJ). et al., Nucleic Acids Research 19: 4485-90, 1991; Kaufman, Methods in Emymology, 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 into the adherent Chinese hamster ovary cell line DXB1 using the standard calcium phosphate transfection procedure described in Maniatis et al., 1989. Cells transfected with these constructs proliferated very slowly. This means that the encoded protease is cytotoxic.</p><p> Another approach transiently transfected Chinese hamster ovary cells (CHO) with a minigene construct (SEQ ID NO: 49) containing human MASP-2 cDNA driven by the endogenous promoter of MASP-2. .. Human MASP-2 protein was secreted into culture medium and isolated as follows.</p><p>Full-length catalytically inactive MASP-2 expression: Principle: After the small recognition component MBL or phycholine (either L-ficolin, H-ficolin, or M-ficolin) binds to each carbohydrate pattern, MASP-2 Activated by autocatalytic cleavage. Autocatalytic cleavage that activates MASP-2 often occurs during the procedure for isolating MASP-2 from serum or during purification after recombinant expression. In order to obtain a more stable protein preparation for use as an antigen, in rats the serine residue present at the catalytic triad of the protease domain is replaced with an alanine residue (from SEQ ID NO: 55 Ser 617). By substituting with (SEQ ID NO: 52 Ser617 to Ala617) in Ala617) or (SEQ ID NO: 3 Ser618 to Ala618) in humans, a catalytically inactive MASP-2 called MASP-2A was produced. did.</p><p> Site-specific mutagenesis was performed using the oligonucleotides shown in Table 5 to generate the catalytically inactive human MASP-2A protein and mouse MASP-2A protein. The oligonucleotides in Table 5 were designed to anneal to regions of human and mouse cDNA encoding enzymatically active serine. Oligonucleotides contain a mismatch to convert serine codons to alanine codons. For example, to amplify the region from the start codon to the enzymatically active codon, from this codon to the stop codon, to generate a fully open reading frame from the mutant MASP-2A containing the Ser618 to Ala618 mutation. , PCR oligonucleotide SEQ ID NO: 56-59 was used in combination with human MASP-2 cDNA (SEQ ID NO: 4). PCR products were purified after agarose gel electrophoresis and band preparation to create single adenosine duplications using standard tailing procedures. MASP-2A with an adenosine tail was then cloned into a pGEM-T easy vector and transformed into E. coli.</p><p> Kinase treatment of SEQ ID NO: 64 and SEQ ID NO: 65, combining these two oligonucleotides in equimolar amounts, annealing at 100 ° C for 2 minutes, and slowly cooling to room temperature. Produced a catalytically inert rat MASP-2A protein. The resulting annealing fragment had Pst1 and Xba1 compatible ends and was inserted in place of the Pst1-Xba1 fragment of wild-type rat MASP-2 cDNA (SEQ ID NO: 53) to generate rat MASP-2A.<img file="JP2020037568A_D0018.tif" /></p><p> Human MASP-2A, mouse MASP-2A, and rat MASP-2A were further subcloned into the mammalian expression vector pED or pCI-Neo, respectively, and transfected into the Chinese hamster ovary cell line DXB1 as described below.</p><p> Another approach is to construct the catalytically inactive MASP-2 using the method described in Chen et al., J. Biol. Chem., 276 (28): 25894-25902, 2001. Briefly, a plasmid containing full-length human MASP-2 cDNA (described in Thiel et al., Nature 386: 506, 1997) was digested with Xho1 and EcoR1 as MASP-2 cDNA (SEQ ID NO: 4). (As described herein) is cloned into the corresponding restriction site of the pFastBac1 baculovirus transfer vector (Life Technologies, NY). The double-stranded oligonucleotide (SEQ ID NO: 13) encoding the peptide region amino acids 610-625 is then replaced with the native region amino acids 610-625 to produce a MASP-2 full-length polypeptide having an inactive protease domain. By doing so, the MASP-2 serine protease active site in Ser618 is changed to Ala618.</p><p>Construction of an expression plasmid containing a polypeptide region derived from human Masp-2 A MASP-2 signal peptide (residues 1-15 of SEQ ID NO: 5) was used to secrete various domains of MASP-2. To prepare the following constructs. Human MASP-2 CUB1 domain (SEQ ID NO: 8) is expressed by PCR that amplifies the region encoding residues 1-121 of MASP-2 (SEQ ID NO: 6) (corresponding to the N-terminal CUBI domain). Create a structure to be used. Human MASP-2 CUBIEGF domain (SEQ ID NO: 9) is expressed by PCR that amplifies the region encoding residues 1 to 166 of MASP-2 (SEQ ID NO: 6) (corresponding to the N-terminal CUB1EGF domain). Create a structure to be used. Human MASP-2 CUBIEGF CUBII domain (SEQ ID NO: 10) is expressed by PCR that amplifies the region encoding residues 1-293 of MASP-2 (SEQ ID NO: 6) (corresponding to the N-terminal CUBIEGF CUBII domain). Create a structure to be used. According to the established PCR method, Vent_RThe aforementioned domain is amplified by PCR using polymerase and pBS-MASP-2 as a template. 5'primer sequence of sense primer<img file="JP2020037568A_D0019.tif" />Introduces a BamHI restriction site (underlined) at the 5'end of the PCR product. The antisense primers for each MASP-2 domain shown in Table 5 below are designed to introduce an EcoRI site (underlined) after the stop codon (bold) at the end of each PCR product. Once the DNA fragment is amplified, it is digested with BamHI and EcoRI and cloned into the corresponding site of the pFastBac1 vector. The resulting construct is characterized by restriction enzyme mapping and confirmed by dsDNA sequencing.</p><p> (Table 5) MASP-2 PCR primer<img file="JP2020037568A_D0020.tif" /></p><p>Recombinant eukaryotic expression of MASP-2, and protein production of enzymatically inactive mouse MASP-2A, rat MASP-2A, and human MASP-2A Standard calcium phosphate transfection procedure (Maniatis et al., 1989) ) Was used to transfected the above-mentioned MASP-2 expression construct and MASP-2A expression construct into DXB1 cells. MASP-2A was produced in serum-free medium to ensure that the preparation was not contaminated with other serum proteins. Medium was collected from confluent cells every other day (4 times in total). The average recombinant MASP-2A level was about 1.5 mg per liter of medium for each of the three species.</p><p> Purification of MASP-2A protein: MASP-2A (the Ser-Ala mutant described above) was purified by affinity chromatography on an MBP-A-agarose column. This strategy allowed rapid purification without the use of external tags. MASP-2A (equal volume of loading buffer (150 mM NaCl and 25 mM CaCl)₂50 mM Tris-Cl containing, 100-200 ml of medium diluted with pH 7.5) was loaded onto an MBP-agarose affinity column (4 ml) pre-equilibrium with 10 ml loading buffer. After further washing with 10 ml of loading buffer, the protein was eluted in 1 ml fraction 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 further purified by ion exchange chromatography on a MonoQ column (HR5 / 5). The protein was dialyzed against 50 mM Tris-Cl pH 7.5 containing 50 mM NaCl and loaded onto a column equilibrated with the same buffer. After washing, bound MASP-2A was eluted over 10 ml with a NaCl gradient of 0.05-1M.</p><p> Results: MASP-2A protein with a yield of 0.25 to 0.5 mg was obtained from 200 ml of medium. The molecular weight of 77.5 kDa determined by MALDI-MS is greater than the calculated value (73.5 kDa) of the unmodified polypeptide due to glycosylation. Adhesion of glycans at each N-glycosylation site is responsible for the observed mass. MASP-2A migrates as a single band on SDS-polyacrylamide gels, demonstrating that MASP-2A is not proteolyticized during biosynthesis. The weight average molecular weight determined by equilibrium ultracentrifugation is consistent with the calculated value of the homodimer of the glycosylated polypeptide.</p><p>Production of Recombinant Human MASP-2 Polypeptides Another method for producing recombinant MASP-2 and MASP2A-derived polypeptides is Thielens, NM, et al., J. et al. Immunol 166: 5068-5077, 2001. Briefly, Spodoptera frugiperda insect cells (Ready-Plaque Sf9 cells from Novagen, Madison, WI), Sf900II serum-free medium supplemented with 50 IU / ml penicillin and 50 mg / ml Streptomycin (Life Technologies) ( Life Technologies) grows and maintains. 10% FCS (provided by Jadwiga Chroboczek, Institut de Biologie Structurale, Grenoble, France) with 50 IU / ml penicillin and 50 mg / ml streptomycin added to the cabbage looper (Trichoplusia ni) (High Five) insect cells Dominique Dutscher, Brumath, Maintained in TC100 medium (Life Technologies) containing France). Recombinant baculovirus is produced using the Bac-to-Bac system (Life Technologies). Bactid DNA was purified using the Qiagen midiprep purification system (Qiagen) and trans Sf9 insect cells using cellfectin dissolved in Sf900 II SFM medium (Life Technologies) as described in the manufacturer's protocol. Used to effect. Recombinant virus particles were collected after 4 days and titrated by viral plaque assay as described in King and Possee, The Baculovirus Expression System: A Laboratory Guide, Chapman and Hall Ltd., London, pp.111-114, 1992. Amplify as</p><p> High Five cells (1.75 × 10⁷Cell / 175 cm²Tissue culture flask) is infected with a recombinant virus containing the MASP-2 polypeptide at 28 ° C. for 96 hours in Sf900 II SFM medium with an infection efficiency of 2. The supernatant is collected by centrifugation and diisopropylphosphorofluorideate is added to a final concentration of 1 mM.</p><p> The MASP-2 polypeptide is secreted into the medium. Culture supernatant, 50 mM NaCl, 1 mM CaCl₂, 50 mM triethanolamine hydrochloride, pH 8.1 and load on a Q-Sepharose Fast Flow column (Amersham Pharmacia Biotech) (2.8 × 12 cm) equilibrated with the same buffer at 1.5 ml / min. Elution is carried out by applying a 1.2 liter linear gradient up to 350 mM NaCl dissolved in the same buffer. Fractions containing the recombinant MASP-2 polypeptide were identified by Western blot analysis and up to 60% (w / v) (NH).₄)₂SO₄Is settled by adding and allowed to stand overnight at 4 ° C. Pellets, 145 mM NaCl, 1 mM CaCl₂, 50 mM triethanolamine hydrochloride, applied to TSK G3000 SWG columns (7.5 × 600 mm) (Tosohaas, Montgomeryville, PA) resuspended in pH 7.4 and equilibrated with the same buffer. The purified polypeptide is then concentrated to 0.3 mg / ml by ultrafiltration with a Microsep microconcentrator (mw cutoff = 10,000) (Filtron, Karlstein, Germany).</p><p>Example 4 This example describes a method for producing a polyclonal antibody against the MASP-2 polypeptide.</p><p>Materials and Methods; MASP-2 Antigen: Prepare polyclonal anti-human MASP-2 antiserum by immunizing rabbits with the following isolated MASP-2 polypeptide: Human MASP isolated from serum -2 (SEQ ID NO: 6); Recombinant human MASP-2 (SEQ ID NO: 6) according to Example 3, MASP-2A containing an inactive protease domain (SEQ ID NO: 13); and the above. Recombinant CUBI (SEQ ID NO: 8), CUBEGFI (SEQ ID NO: 9), and CUBEGF CUBII (SEQ ID NO: 10) expressed as described in Example 3 of.</p><p> Polyclonal Antibody: A 6-week-old rabbit initially stimulated with BCG (Calmet-Guerin bacillus vaccine) is immunized by injection of 100 μg of MASP-2 polypeptide dissolved in sterile saline. Injections are made every 4 weeks and antibody titers are monitored by ELISA assay as described in Example 5. Culture supernatants are collected for antibody purification by Protein A affinity chromatography.</p><p>Example 5 This Example describes a method for making a mouse monoclonal antibody against a rat MASP-2 polypeptide or a human MASP-2 polypeptide.</p><p>Materials and Methods: Male A / J mice (Harlan, Houston, Tex.), 8-12 weeks old, 200 μl phosphate buffered saline (PBS) pH 7 containing complete Freund's adjuvant (Difco Laboratories, Detroit, Mich.) Subcutaneous injection of 100 μg of human or rat rMASP-2 or rMASP-2A polypeptide (made as described in Example 3) dissolved in .4. Mice are subcutaneously injected with 50 μg of human or rat rMASP-2 or rMASP-2A polypeptide dissolved in incomplete Freund's adjuvant twice at 2-week intervals. At week 4, mice are injected with 50 μg of human or rat rMASP-2 or rMASP-2A polypeptide dissolved in PBS and fused after 4 days.</p><p> For each fusion, a single cell suspension is prepared from the spleen of immunized mice and used for fusion with Sp2 / 0 myeloma cells. 5 × 10 in medium containing 50% polyethylene glycol (MW1450) (Kodak, Rochester, NY) and 5% dimethyl sulfoxide (Sigma Chemical Co., St. Louis. Mo.)⁸Sp2 / 0 and 5x10⁸Fuse individual spleen cells. It was then dissolved in Iscove medium (Gibco, Grand Island, NY) supplemented with 10% fetal bovine serum, 100 units / ml penicillin, 100 μg / ml streptomycin, 0.1 mM hypoxanthin, 0.4 μM aminopterin, and 16 μM thymidine. And 1.5 x 10 cells⁵Adjust to a concentration of 200 μl of spleen cells / suspension. 200 microliters of cell suspension is added to each well of approximately 20 96-well microculture plates. After about 10 days, the culture supernatant is removed to screen for reactivity with the purification factor MASP-2 in the ELISA assay.</p><p> ELISA assay: Immulon2 (Dynatech Laboratories, Chantilly,) by adding 50 ng / ml purified hMASP-2 50 μl or rat rMASP-2 (or rMASP-2A) overnight at room temperature. Va.) Coat the wells of the microtest plate. Due to the low MASP-2 concentration for coating, high affinity antibodies can be selected. After removing the coating solution by snapping the plate, 200 μl of BLOTTO (fat-free dry milk) dissolved in PBS is added to each well for 1 hour to block non-specific sites. Then, after 1 hour, the wells are washed with buffer PBST (PBS containing 0.05% Tween 20). 50 microliters of culture supernatant are collected from each fusion well, mixed with 50 μl BLOTTO, and then added to the individual wells of the microtest plate. After 1 hour incubation, the wells are washed with PBST. The bound mouse antibody is then detected by reaction with horseradish peroxidase (HRP) -bound goat anti-mouse IgG (Fc-specific) (Jackson ImmunoResearch Laboratories, West Grove, Pa.) And diluted 1: 2,000 with BLOTTO. .. 0.1% 3,3,5,5 tetramethylbenzidine (Sigma, St.) for color development. A peroxidase substrate solution containing Louis, Mo.) And 0.0003% hydrogen peroxide (Sigma) is added to the wells for 30 minutes. Reaction to 50 μl 2M H₂SO₄/ Stop by adding wells. The optical density of the reaction mixture at 450 nm is read by BioTek ELISA Reader (BioTek Instruments, Winooski, Vt.).</p><p>MASP-2 binding assay: Culture supernatants tested positive in the MASP-2 ELISA assay test above are used in the binding assay to determine the binding affinity of the MASP-2 inhibitor for MASP-2. Can be tested. Similar assays can also be used to determine if the inhibitor binds to other antigens in the complement system.</p><p> MASP-2 (20 ng / 100 μl / well, Advanced Research Technology, San) in which polystyrene microtiter plate wells (96-well medium binding plate, Corning Costar, Cambridge, MA) were dissolved in phosphate buffered saline (PBS) pH 7.4. Coat overnight at 4 ° C with Diego, CA). After aspirating the MASP-2 solution, the wells are filled with 1% bovine serum albumin (BSA; Block with PBS containing Sigma Chemical) for 2 hours at room temperature. Wells without MASP-2 coating serve as background controls. Add various concentrations of hybridoma supernatant or aliquots of purified anti-MASP-2 MoAb dissolved in the blocking solution to the wells. After 2 hours of incubation at room temperature, the wells are extensively rinsed with PBS. It was added to the blocking solution dissolved peroxidase-conjugated goat anti-mouse IgG (Sigma Chemical), child incubated for 1 hour at room temperature by the, detecting anti MASP-2 MoAb bound to MASP-2. The plate is thoroughly rerinsed 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 was quenched by the addition of 100 μl of 1M phosphoric acid and the plates were microplate readers (SPECTRA MAX 250, Molecular Devices, Sunnyvale, Read at 450 nm at CA).</p><p> Culture supernatants from positive wells are then tested for their ability to inhibit complement activation in a functional assay, eg, the C4 cleavage assay described in Example 2. The cells in the positive wells are then cloned by limiting dilution. MoAb is retested for reactivity with hMASP-2 in the ELISA assay as described above. The selected hybridomas are grown in spinner flasks and used culture supernatants are collected for antibody purification by Protein A affinity chromatography.</p><p>Example 6 This example describes the production and production of humanized mouse anti-MASP-2 antibody and antibody fragments.</p><p> As described in Example 5, mouse anti-MASP-2 monoclonal antibody is produced in male A / J mice. The mouse antibody was then humanized as follows by substituting the mouse constant region with its human counterpart to generate chimeric IgG and Fab fragments of the antibody in order to weaken the immunogenicity of the mouse antibody. Chimeric IgG and Fab fragments of the antibody are useful for inhibiting the side effects of MASP-2-dependent complement activation in human subjects according to the invention.</p><p>1. Cloning of anti-MASP-2 variable region gene derived from mouse hybridoma cells Hybridoma cells that secrete total RNA and anti-MASP-2 MoAb according to the manufacturer's protocol (Biotech, Houston, Tex.) Using RNAzol (Biotech, Houston, Tex.) (Obtained as described in Example 7). First-strand cDNA is synthesized from total RNA using oligo dT as a primer. Leader peptide or mouse V as 3'primer and 5'primer derived from immunoglobulin constant C region_HGene or V_KPCR is performed with a set of degenerate primers derived from the first framework region of the gene. Anchor PCR is performed as described in Chen and Platsucas (Chen, PF, Scand. J. Immunol. 35: 539-549, 1992). V_KNot1-MAK1 primer for cloning genes<img file="JP2020037568A_D0021.tif" />To prepare double-stranded cDNA using. Annealed Adapter AD1<img file="JP2020037568A_D0022.tif" />And AD2<img file="JP2020037568A_D0023.tif" />Is ligated to both the 5'and 3'ends of the double-stranded cDNA. Remove the adapter at the 3'end by Not1 digestion. The digest product is then used as an AD1 oligonucleotide as a 5'primer and MAK2 as a 3'primer.<img file="JP2020037568A_D0024.tif" />Is used as a template in PCR. A DNA fragment of about 500 bp is cloned into pUC19. Several clones are selected for sequence analysis to ensure that the cloned sequence contains the expected mouse immunoglobulin constant region. Not1-MAK1 and MAK2 oligonucleotides are V_KDerived from the region, 182 bp and 84 bp downstream from the first base pair of the Cκ gene, respectively. Complete V_KAnd select clones containing leader peptides.</p><p> V_HNot1 MAG1 primer for cloning genes<img file="JP2020037568A_D0025.tif" />To prepare double-stranded cDNA using. 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 Not1 digestion. Digested products as primers AD1 oligonucleotide and MAG2<img file="JP2020037568A_D0026.tif" />Is used as a template in PCR. A DNA fragment with a length of 500 to 600 bp is cloned into pUC19. The Notl-MAG1 and MAG2 oligonucleotides are derived from the mouse Cγ.7.1 region, 180 bp and 93 bp downstream from the first base pair of the mouse Cγ.7.1 gene, respectively. Complete V_HAnd select clones containing leader peptides.</p><p>2. Construction of expression vectors for chimeric MASP-2 IgG and Fab The cloned above as a template for the PCR reaction to add the Kozak consensus sequence to the 5'end of the nucleotide sequence and the splice donor to the 3'end. V_HGenes and V_KUse genes. After analyzing the sequence to confirm that there are no PCR errors, V_HGenes and V_KThe genes were inserted into an expression vector cassette containing human C.γ1 and an expression vector cassette containing human C.κ, respectively, to pSV2neoV._H-Obtain huCγ1 and pSV2neoV-huCγ. CsCl gradient purified plasmid DNA from heavy and light chain vectors is used to transfect COS cells by electroporation. After 48 hours, the culture supernatant is tested by ELISA to confirm the presence of approximately 200 ng / ml chimeric IgG. Collect cells and prepare total RNA. First-strand cDNA is synthesized from total RNA using oligo dT as a primer. This cDNA is used as a template in PCR to generate Fd DNA and κ DNA fragments. For the Fd gene, as a 5'primer<img file="JP2020037568A_D0027.tif" />And CH1-derived 3'primers<img file="JP2020037568A_D0028.tif" />Perform PCR using. The DNA sequence is the complete V of human IgG1_HIt is confirmed to contain a domain and a human CH1 domain. After digestion with the appropriate enzyme, the Fd DNA fragment is inserted into the HindIII and BamHI restriction sites of the expression vector cassette pSV2dhfr-TUS to obtain pSV2dhfrFd. The pSV2 plasmid is commercially available and consists of DNA segments from various sources. The pBR322DNA (thin line) contains the pBR322 DNA origin of replication (pBRori) and the lactamase ampicillin resistance gene (Amp). The SV40 DNA represented and marked by wide hatching is the SV40 origin of replication (SV40ori), the early promoter (5'side of the dhfr and neo genes), and the polyadenylation signal (dhfr and neo genes). 3'side) is contained. The SV40-derived polyadenylation signal (pA) is also located at the 3'end of the Fd gene.</p><p> For the κ gene, as a 5'primer<img file="JP2020037568A_D0029.tif" />And C_KOrigin 3'primer<img file="JP2020037568A_D0030.tif" />Perform PCR using. The DNA sequence is the complete V_KRegion and Human C_KIt is confirmed that it contains a region. After digestion with an appropriate restriction enzyme, a κ DNA fragment is inserted into the HindIII and BamHI restriction sites of the expression vector cassette pSV2neo-TUS to obtain pSV2neoK. Expression of the Fd and κ genes is driven by HCMV-derived enhancers and promoter elements. Since the Fd gene does not contain cysteine amino acid residues involved in interchain disulfide bonds, this recombinant chimeric Fab contains heavy and light chains linked by non-covalent bonds. This chimeric Fab is called cFab.</p><p> To obtain a recombinant Fab having a disulfide bond between the heavy and light chains, said to include the coding sequence of 9 additional amino acids (EPKSCDKTH SEQ ID NO: 48) from the hinge region of human IgG1. Fd gene can be extended. The BstEII-BamHI DNA segment encoding the 30 amino acids at the 3'end of the Fd gene can be replaced with the extended Fd-encoding DNA segment to obtain pSV2dhfrFd / 9aa.</p><p>3. Expression and purification of chimeric anti-MASP-2 IgG NSO cells were electroporated into pSV2neoV to generate cell lines that secrete chimeric anti-MASP-2 IgG._H-Transfect with purified plasmid DNA of huC.γ1 and pSV2neoV-huCκ. Transfect cells are selected in the presence of 0.7 mg / ml G418. Cells are grown in a 250 ml spinner flask using serum-containing medium.</p><p> The culture supernatant of the 100 ml spinner culture is loaded onto a 10 ml PROSEP-A column (Bioprocessing, Inc., Princeton, NJ.). Wash the column with 10 bed volumes of PBS. Elute the bound antibody at 50 mM citrate buffer, pH 3.0. To adjust the pH to 7.0, add an equal volume of 1M Hepes, pH 8.0 to the fraction containing the purified antibody. Residual salts are removed by buffer exchange with PBS by Millipore membrane ultrafiltration (MW cutoff: 3,000). The protein concentration of the purified antibody is determined by the BCA method (Pierce).</p><p>4. Expression and purification of chimeric anti-MASP-2 Fab Purified plasmid DNA of pSV2dhfrFd (or pSV2dhfrFd / 9aa) and pSV2neoκ by electroporation of CHO cells to generate cell lines that secrete chimeric anti-MASP-2 Fab. Transfect with. Transfect cells are selected in the presence of G418 and methotrexate. The selected cell line is amplified in increasing concentrations of methotrexate. Cells are single-cell subcloned by limiting dilution. Highly produced single cell subcloning cell lines are then grown in a 100 ml spinner flask using serum-free medium.</p><p> The chimeric anti-MASP-2 Fab is purified by affinity chromatography with mouse anti-idiotype MoAb against MASP-2 MoAb. Anti-idiotype MASP-2 MoAb immunizes mice with mouse anti-MASP-2 MoAb bound to keyhole limpet hemocyanin (KLH) and screens for specific MoAb binding that can compete with human MASP-2. Can be made by. For purification, 100 ml of supernatant from a spinner culture of cFab or cFab / 9aa-producing CHO cells is loaded onto an affinity column bound to anti-idiotype MASP-2 MoAb. The column is then thoroughly washed with PBS and then the bound Fab is eluted with 50 mM diethylamine, pH 11.5. Residual salts are removed by buffer exchange as described above. The protein concentration of the purified Fab is determined by the BCA method (Pierce).</p><p> The ability of chimeric MASP-2 IgG, cFab, and cFAb / 9aa to inhibit the MASP-2 dependent complement pathway can be determined by using the inhibition assay method described in Example 2 or Example 7.</p><p>Example 7 This Example identifies a MASP-2 inhibitor capable of blocking MASP-2 dependent complement activation via L-ficolin / P35, H-ficolin, M-ficolin, or mannan. The in vitro C4 cleavage assay used as a functional screening for the purpose is described.</p><p> C4 cleavage assay: The C4 cleavage assay is described by Petersen, SV, et al., J. Immunol. Methods 257: 107, 2001 and is a Staphylococcus aureus-derived lipoteichoic acid (LTA) that binds to L-ficholine. The activation of the lectin pathway due to is measured.</p><p> Reagent: Prepare formalin-fixed Staphylococcus aureus (DSM20233) as follows. Bacteria were grown overnight in triptic soy blood agar at 37 ° C., washed 3 times with PBS, then fixed in PBS / 0.5% formalin at room temperature for 1 hour, washed 3 more times with PBS and then coated. Buffer solution (15 mM Na)₂Co₃, 35mM LVDS₃, PH 9.6).</p><p> Assay: 100 μl formalin-fixed Staphylococcus aureus DSM20233 (OD) in wells of a Nunc MaxiSorb microtiter plate (Nalgene Nunc International, Rochester, NY) with 1 ug of L-ficholine in coating buffer.₅₅₀= 0.5) to coat. After overnight incubation, wells were blocked with 0.1% human serum albumin (HSA) dissolved in TBS (10 mM Tris-HCl, 140 mM NaCl pH 7.4), followed by 0.05% Tween 20 and 5 mM CaCl.₂Wash with TBS (cleaning solution buffer) containing. Human serum samples, 20 mM Tris-HCl, 1 M NaCl, 10 mM CaCl, which block the activation of endogenous C4 and dissociate the C1 complex (consisting of C1q, C1r, and C1s).₂, 0.05% Triton X-100, 0.1% HSA, dilute with pH 7.4. MASP-2 inhibitors, including anti-MASP-2 MoAb and inhibitory peptides, are added to serum samples at various concentrations. Add the diluted sample to the plate and incubate overnight at 4 ° C. After 24 hours, the plate is thoroughly washed with wash buffer. Then 100 μl of 4 mM barbital, 145 mM NaCl, 2 mM CaCl₂, 1 mM MgCl₂, 0.1 μg of purified human C4 (obtained as described in Dodds, AW, Methods Enzymol. 223: 46, 1993) dissolved in pH 7.4 is added to each well. After 1.5 hours at 37 ° C, the plates were rewashed and C4b deposition was detected using alkaline phosphatase-bound chicken anti-human C4c (obtained from Immunsystem, Uppsala, Sweden) and the colorimetric substrate ρ-nitrophenyl phosphate. Measure using.</p><p> C4 assay on mannan: To measure MBL-mediated lectin pathway activation, the plate was coated with LSP and mannan, followed by the addition of serum mixed with various MASP-2 inhibitors. To adapt the assay method.</p><p> C4 Assay on H-Ficolin (Hakata Ag): To measure Lectin pathway activation via H-Ficolin, after coating the plate with LPS and H-Ficolin, with various MASP-2 inhibitors The assay is adapted by adding mixed serum.</p><p>Example 8 The following assays demonstrate the presence of classical pathway activation in wild-type and MASP-2-/-mice.</p><p> METHODS: Microtiter plates (Maxisorb, Nunc, Catalog No. 442404, Fisher Scientific) were coated with 0.1% human serum albumin dissolved in 10 mM Tris, 140 mM NaCl, pH 7.4 for 1 hour at room temperature and then TBS / tween / Ca.²⁺Immune complexes were generated in situ by incubating overnight at 4 ° C with Sheep Anti-Whole Serum (Scottish Antibody Production Unit, Carluke, Scotland) diluted 1: 1000 in. Serum samples were obtained from wild-type and MASP-2-/-mice and added to coated plates. C1q-depleted control samples were prepared from wild-type serum samples and MASP-2-/-serum samples. C1q-depleted mouse sera were prepared according to supplier instructions using protein A-linked Dynabeads (Dynal Biotech, Oslo, Norway) coated with rabbit anti-human C1q IgG (Dako, Glostrup, Denmark). The plate was incubated at 37 ° C for 90 minutes. Combined C3b, TBS / tw / Ca⁺⁺It was detected using a polyclonal anti-human C3c antibody (DakoA062) diluted 1: 1000 in. The secondary antibody is goat anti-rabbit IgG.</p><p> Results: Figure 7 shows relative C3b deposition levels on IgG-coated plates in wild-type serum, MASP-2-/-serum, C1q-depleted wild-type serum, and C1q-depleted MASP-2-/-serum. Shown. These results prove that the classical pathway is not impaired in the MASP-2-/-mouse strain.</p><p>Example 9 Testing whether a MASP-2 inhibitor blocks the classical pathway by analyzing the effect of the MASP-2 inhibitor under conditions where the immune complex initiates the classical pathway using the following assay. To do.</p><p> METHODS: To test the effect of MASP-2 inhibitors on the state of complement activation initiated by the classical pathway by immune complexes, 50 μl of a triple sample containing 90% NHS, 10 μg / ml immune complex. Incubate at 37 ° C in the presence of body (IC) or PBS. Also include a triple set of corresponding samples (+/- IC) containing a 200 nM anti-properdin monoclonal antibody during incubation at 37 ° C. After 2 hours of incubation at 37 ° C, 13 mM EDTA is added to all samples to stop further complement activation and immediately cool the samples to 5 ° C. The sample is then stored at -70 ° C and then assayed for complement activators (C3a and sC5b-9) using an ELISA kit (Quidel Catalog Nos. A015 and A009) according to the manufacturer's instructions.</p><p>Example 10 This example describes the identification of a high-affinity anti-MASP-2 Fab2 antibody fragment that blocks MASP-2 activity.</p><p> Background and Principles: MASP-2 is a binding site for MBL and ficholine, a serine protease catalytic site, a binding site for proteolytic substrate C2, a binding site for proteolytic substrate C4, and MASP for MASP-2 zymogen self-activation. -2 cutting sites, as well as 2 Ca⁺⁺It is a complex protein with many distinct functional domains, including binding sites. Fab2 antibody fragments that bind to MASP-2 with high affinity were identified and tested in a functional assay to determine if the identified Fab2 fragments could block MASP-2 functional activity.</p><p> To block MASP-2 functional activity, the antibody or Fab2 antibody fragment must bind to and interfere with structural epitopes on MASP-2 required for MASP-2 functional activity. Thus, many or all of the high affinity binding anti-MASP-2 Fab2s exert MASP-2 functional activity unless they bind to structural epitopes on MASP-2 that are directly involved in MASP-2 functional activity. It may not interfere.</p><p> The "blocking activity" of anti-MASP-2 Fab2 was evaluated using a functional assay that measures inhibition of lectin pathway C3 convertase formation. It is known that the most important physiological role of MASP-2 in the lectin pathway is to produce the next functional component of the lectin-mediated complement pathway, namely the lectin pathway C3 convertase. The lectin pathway C3 convertase is an important enzymatic complex (C4bC2a) that proteolytically cleaves C3 into C3a and C3b. MASP-2 is not a structural component of the lectin pathway C3 convertase (C4bC2a). However, the functional activity of MASP-2 is required to produce the two protein components (C4b, C2a) that make up the lectin pathway C3 convertase. Moreover, it appears that all of the distinct functional activities of MASP-2 listed above are required for MASP-2 to produce the lectin pathway C3 convertase. For these reasons, the preferred assay for use in assessing the "blocking activity" of anti-MASP-2 Fab2 is considered to be a functional assay that measures inhibition of lectin pathway C3 convertase formation.</p><p> High Affinity Fab2 Generation: Using a phage display library of human light chain antibody variable sequences and heavy chain antibody variable sequences, and automated antibody selection techniques to identify Fab2 that reacts with selected ligands of interest. High affinity Fab2 for rat MASP-2 protein (SEQ ID NO: 55) was prepared. A known amount of rat MASP-2 (approximately 1 mg,&gt; 85% pure) protein was utilized for antibody screening. Three amplifications were used to select the antibody with the highest affinity. Approximately 250 different hits expressing antibody fragments were selected for ELISA screening. This was followed by sequencing high affinity hits to determine the uniqueness of the different antibodies.</p><p> Fifty unique anti-MASP-2 antibodies were purified and 250 μg of each purified Fab2 antibody was used to characterize MASP-2 binding affinity and test the function of the complement pathway, as described in more detail below.</p><p>Assay method used to evaluate inhibitory (blocking) activity of anti-MASP-2 Fab2 1. Assay method for measuring inhibition of lectin pathway C3 convertase formation: Background: The lectin pathway C3 convertase is an enzyme complex (C4bC2a) that proteolytically cleaves C3 into two potent pro-inflammatory fragments, anaphylatoxin C3a and opsonin C3b. The formation of C3 convertase appears to be an important step in the lectin pathway in mediating inflammation. MASP-2 is not a structural component of the lectin pathway C3 convertase (C4bC2a). Therefore, the anti-MASP-2 antibody (or Fab2) does not directly inhibit the activity of the existing C3 convertase. However, MASP-2 serine protease activity is required to produce the two protein components (C4b, C2a) that make up the lectin pathway C3 convertase. Therefore, anti-MASP-2 Fab2 that inhibits MASP-2 functional activity (ie, blocking anti-MASP-2) Fab2) inhibits the novel formation of the lectin pathway C3 convertase. C3 contains a rare and highly reactive thioester group as part of its structure. In this assay, when C3 is cleaved by C3 convertase, the thioester group on C3b is covalently bonded to a hydroxyl or amino group on a macromolecule immobilized at the bottom of the plastic well via an ester or amide bond. Can be formed, thus facilitating the detection of C3b in the ELISA assay.</p><p> Yeast mannan is a known activator of the lectin pathway. In the following method of measuring C3 convertase formation, mannan-coated plastic wells were incubated with diluted rat serum at 37 ° C for 30 minutes to activate the lectin pathway. The wells were then washed and assayed for C3b immobilized on the wells using standard ELISA methods. The amount of C3b produced in this assay directly reflects the novel formation of the lectin pathway C3 convertase. This assay tested the ability of selected concentrations of anti-MASP-2 Fab2 to inhibit C3 convertase formation and the resulting C3b production.</p><p>METHODS: 96-well Costar Medium Binding plates were incubated overnight at 5 ° C with 50 mM carbonate buffer, mannan diluted at pH 9.5, at 1 ug / 50 Tl / well. After overnight incubation, each well was washed 3 times with 200 Tl PBS. Wells were then blocked with 100 Tl / well of 1% bovine serum albumin dissolved in PBS and incubated for 1 hour at room temperature with gentle mixing. Each well was then washed 3 times with 200 Tl of PBS. Anti-MASP-2 Fab2 sample at 5C, Ca⁺⁺And Mg⁺⁺GVB buffer (4.0 mM barbital, 141 mM NaCl, 1.0 mM MgCl)₂, 2.0mM CaCl₂, 0.1% gelatin, pH 7.4) diluted to the selected concentration. 0.5% rat serum was added to the sample at 5C and 100Tl was transferred to each well. The plate was capped and incubated in a 37C water bath for 30 minutes to allow complement activation. The reaction was stopped by transferring the plate from the 37C water bath to a container containing a mixture of ice and water. Each well was washed 5 times with 200 Tl with PBS-Tween 20 (PBS containing 0.05% Tween 20) and then twice with 200 Tl of PBS. A 1: 10,000 dilution of 100 Tl / well primary antibody (rabbit anti-human C3c, DAKO A0062) dissolved in PBS containing 2.0 mg / ml bovine serum albumin was added and incubated for 1 hour at room temperature with gentle mixing. Each well was washed with 5 x 200 Tl PBS. 100 Tl / well secondary antibody (peroxidase-conjugated goat anti-rabbit IgG,) dissolved in PBS containing 2.0 mg / ml bovine serum albumin American Qualex A102PU) 1: 10,000 diluent was added, placed on a shaker and incubated for 1 hour at room temperature with gentle mixing. Each well was washed 5 times with 200 Tl with PBS. 100 Tl / well of peroxidase substrate TMB (Kirkegaard &amp; Perry Laboratories) was added and incubated for 10 minutes at room temperature. 100Tl / well 1.0MH₃PO₄Stops the peroxidase reaction by adding OD₄₅₀Was measured.</p><p>2. Assay method for measuring inhibition of MASP-2 dependent C4 cleavage: Background: The serine protease activity of MASP-2 is highly specific, and there are only two protein substrates for MASP-2, C2 and C4. Not specified. Cleavage of C4 produces C4a and C4b. Anti-MASP-2 Fab2 binds to structural epitopes on MASP-2 that are directly involved in C4 cleavage (eg, the MASP-2 binding site of C4; the MASP-2 serine protease catalytic site), thereby the MASP-2. May inhibit C4 cleavage function activity.</p><p> Yeast mannan is a known activator of the lectin pathway. The following method of measuring the C4 cleavage activity of MASP-2 activated a lectin pathway by incubating a mannan-coated plastic well with diluted rat serum for 30 minutes at 37C. Since the primary antibody used in this ELISA method recognizes only human C4, human C4 (1.0 Tg / ml) was also added to diluted rat serum. The wells were then washed and assayed for human C4b immobilized in the wells using standard ELISA methods. The amount of C4b produced in this assay is a measure of MASP-2 dependent C4 cleavage activity. This assay tested the ability of selected concentrations of anti-MASP-2 Fab2 to inhibit C4 cleavage.</p><p> METHODS: 96-well Costa Medium Binding plates were incubated overnight at 1.0 Tg / 50 Tl / well with 50 mM carbonate buffer, mannan diluted at pH 9.5 and 5 C. Each well was washed 3 times with 200 Tl PBS. Wells were then blocked with 100 Tl / well of 1% bovine serum albumin dissolved in PBS and incubated for 1 hour at room temperature with gentle mixing. Each well was washed 3 times with 200 Tl of PBS. Anti-MASP-2 Fab2 sample at 5C, Ca⁺⁺And Mg⁺⁺GVB buffer (4.0 mM barbital, 141 mM NaCl, 1.0 mM MgCl)₂, 2.0mM CaCl₂, 0.1% gelatin, pH 7.4) diluted to the selected concentration. 1.0 Tg / ml / human C4 (Quidel) was also included in these samples. 0.5% rat serum was added to the sample at 5C and 100Tl was transferred to each well. The plate was capped and incubated in a 37C water bath for 30 minutes to activate complement. The reaction was stopped by transferring the plate from the 37C water bath to a container containing a mixture of ice and water. Each well was washed 5 times with 200 Tl with PBS-Tween 20 (PBS containing 0.05% Tween 20). Each well was then washed twice with 200 Tl of PBS. 100 Tl / well biotin-conjugated chicken anti-human C4c (Immunsystem AB, Uppsala,) dissolved in PBS containing 2.0 mg / ml bovine serum albumin (BSA) Sweden) 1: 700 diluent was added and incubated for 1 hour at room temperature with gentle mixing. Each well was washed 5 times with 200 Tl of PBS. Add 100 Tl / well 0.1 Tg / ml peroxidase-conjugated streptavidin (Pierce Chemical # 21126) dissolved in PBS containing 2.0 mg / ml BSA, place on shaker and incubate for 1 hour at room temperature with gentle mixing. did. Each well was washed 5 times with 200 Tl of PBS. 100 Tl / well of peroxidase substrate TMB (Kirkegaard &amp; Perry Laboratories) was added and incubated for 16 minutes at room temperature. 100Tl / well 1.0MH₃PO₄Stops the peroxidase reaction by adding OD₄₅₀Was measured.</p><p>3. Binding assay for anti-rat MASP-2 Fab2 and "natural" rat MASP-2 Background: MASP-2 usually also contains specific lectin molecules (mannose-binding protein (MBL) and ficholine). It is present in plasma as a mass complex. Therefore, if you are interested in studying the binding of anti-MASP-2 Fab2 to a physiologically related form of MASP-2, then Fab2 and "natural" MASP- in plasma rather than purified recombinant MASP-2 It is important to develop a binding assay that uses the interaction with 2. In this binding assay, a "natural" MASP-2-MBL complex derived from 10% rat serum was first immobilized in a mannan-coated well. The binding affinities of various anti-MASP-2 Fab2s for immobilized "natural" MASP-2 were then studied using standard ELISA methods.</p><p> METHODS: 96-well Costar High Binding plates were incubated overnight at 5 ° C with 50 mM carbonate buffer, mannan diluted at pH 9.5, at 1 Tg / 50 Tl / well. Each well was washed 3 times with 200 Tl of PBS. Wells were blocked with 100 Tl / well of 0.5% non-fat dry milk dissolved in PBST (PBS containing 0.05% Tween 20) and incubated for 1 hour at room temperature with gentle mixing. 200 Tl of each well TBS / Tween / Ca⁺⁺Wash buffer (5.0 mM CaCl₂Was washed 3 times with Tris-buffered saline containing 0.05% Tween20, pH 7.4). High Salt Binding Buffer (20mM Tris, 1.0M NaCl, 10mM CaCl₂, 0.05% Triton-X100, 0.1% (w / v) bovine serum albumin, pH 7.4) 10% rat serum was prepared on ice. 100 Tl / well was added and incubated overnight at 5 ° C. 200 Tl of well TBS / Tween / Ca⁺⁺Washed 3 times with wash buffer. The wells were then washed twice with 200 Tl of PBS. Ca⁺⁺And Mg⁺⁺GVB buffer (4.0 mM barbital, 141 mM NaCl, 1.0 mM MgCl)₂, 2.0mM CaCl₂, 0.1% gelatin, pH 7.4) diluted 100 Tl / well of anti-MASP-2 Fab2 at selected concentrations was added and incubated for 1 hour at room temperature with gentle mixing. Each well was washed 5 times with 200 Tl of PBS. 100 Tl / well HRP-conjugated goat anti-Fab2 (Biogenesis Catalog No. 0500-0099) diluted 1: 5000 with PBS containing 2.0 mg / ml bovine serum albumin was added and incubated for 1 hour at room temperature with gentle mixing. Each well was washed 5 times with 200 Tl of PBS. 100 Tl / well of peroxidase substrate TMB (Kirkegaard &amp; Perry Laboratories) was added and incubated for 70 minutes at room temperature. 100Tl / well 1.0MH₃PO₄Stops the peroxidase reaction by adding OD₄₅₀Was measured.</p><p>RESULTS: For ELISA screening, approximately 250 different Fab2s that reacted with the rat MASP-2 protein with high affinity were selected. These high affinity Fab2s were sequenced to determine the uniqueness of the different antibodies. For further analysis, 50 unique anti-MASP-2 antibodies were purified. 250 μg of each purified Fab2 antibody was used to characterize MASP-2 binding affinity and to test the function of the complement pathway. The results of this analysis are shown in Table 6 below.</p><p> (Table 6) Anti-MASP-2 FAB2 that blocks complement activation of the lectin pathway<img file="JP2020037568A_D0031.tif" /></p><p> As shown in Table 6, 17 of the 50 anti-MASP-2 Fab2s tested were ICs with equal to or less than 10nM Fab2.₅₀Was identified as a MASP-2 blocking Fab2 that strongly inhibits C3 convertase formation (34% positive hit rate). 8 ICs out of 17 Fab2₅₀Is in the range of nM or less. In addition, all 17 of the MASP-2 blocking Fab2 shown in Table 6 showed essentially complete inhibition of C3 convertase formation in the lectin pathway C3 convertase assay. FIG. 8A illustrates the results of the C3 convertase formation assay for Fab2 antibody # 11, which represents the other Fab2 antibodies tested. The results are shown in Table 6. This is an important consideration as it is theoretically possible that "blocking" Fab2 may only slightly interfere with MASP-2 function, even if each MASP-2 molecule is bound to Fab2. ..</p><p> Mannan is a known activator of the lectin pathway, but the presence of anti-mannan antibody in rat serum also activates the classical pathway, and it is theoretically possible that C3b can be produced via the classical pathway C3 convertase. is there. However, each of the 17 blocking anti-MASP-2 Fab2s listed in this example strongly inhibits C3b production (&gt; 95%). Therefore, this demonstrates the specificity of this assay for the lectin pathway C3 convertase.</p><p> Apparent K of each blocking Fab2_dA binding assay was also performed using all 17 blocking Fab2s to calculate. Table 6 also shows the results of the anti-rat MASP-2 Fab2 binding assay against native rat MASP-2 for 6 of the blocked Fab2s. FIG. 8B illustrates the results of the binding assay using Fab2 antibody # 11. A similar binding assay was performed for other Fab2s. The results are shown in Table 6. In general, the apparent K obtained for the binding of each of the 6 Fab2s to the "natural" MASP-2_dIs the Fab2 IC in the C3 convertase function assay₅₀It matches reasonably well with. There is evidence that MASP-2 undergoes a conformational change from the "inactive" type to the "active" type when its protease activity is activated (Feinberg et al., EMBO J 22: 2348-59 (2003)). Gal et al., J. Biol. Chem. 250: 33435-44 (2005)). In normal rat plasma used in the C3 convertase formation assay, MASP-2 is predominantly present in an "inactive" zymogen conformation. In contrast, in the binding assay, MASP-2 is present as part of the complex of immobilized mannan with the bound MBL. Therefore, MASP-2 is considered to be in an "active" conformational state (Petersen et al., J. Immunol Methods 257: 107-16, 2001). As a result, ICs were obtained for each of the 17 blocking Fab2s tested in these two functional assays.₅₀And K_dIt is considered that a strict correspondence is not always expected between the two. This is because Fab2 binds different conformational forms of MASP-2 in each assay. Nonetheless, with the exception of Fab2 # 88, ICs for each of the other 16 Fab2s tested in the two assays.₅₀And apparent K_dThere seems to be a reasonably close correspondence between the two (see Table 6).</p><p> We evaluated some of the blocking Fab2 for inhibition of C4 cleavage mediated by MASP-2. Figure 8C shows inhibition by Fab2 # 41, IC₅₀The results of the C4 cleavage assay showing = 0.81 nM are illustrated (see Table 6). As shown in Figure 9, all of the Fab2 tested were ICs obtained in the C3 convertase assay.₅₀Almost the same IC₅₀Was found to inhibit C4 cleavage (see Table 6).</p><p> Mannan is a known activator of the lectin pathway, but it is also theorized that the presence of anti-mannan antibodies in rat serum also activates the classical pathway, which can result in C4b production by C1s-mediated C4 cleavage. It is possible. However, several anti-MASP-2 Fab2s have been identified that strongly inhibit C4b production (&gt; 95%). Therefore, this demonstrates the specificity of this assay for MASP-2 mediated C4 cleavage. C4, like C3, contains a rare and highly reactive thioester group as part of its structure. When C4 is cleaved by MASP-2 in this assay, the thioester group on C4b is shared with the hydroxyl or amino group on the macromolecule immobilized at the bottom of the plastic well via an ester or amide bond. Bonds can be formed, thus facilitating the detection of C4b in the ELISA method.</p><p> These results clearly demonstrate that high-affinity FAB2 to rat MASP-2 protein, which functionally blocks both C4 and C3 convertase activities, is produced, thereby blocking lectin pathway activation. To.</p><p>Example 11 This Example describes some epitope mappings of the blocking anti-rat MASP-2 Fab2 antibody produced as described in Example 10.</p><p><u style="single">Method:</u> As shown in FIG. 10, the following proteins, all with N-terminal 6 × His tags, were expressed in CHO cells using the pED4 vector: rat MASP-2A, by converting serine at the active center to alanine. Inactivated full-length MASP-2 protein (S613A); rat MASP-2K, full-length MASP-2 protein modified to reduce self-activation (R424K); CUBI-II, CUBI domain, EGF-like Rat MASP-2 N-terminal fragment containing only domain and CUBII domain; and rat MASP-2 N-terminal fragment containing only CUBI / EGF-like, CUBI domain and EGF-like domain.</p><p> As previously mentioned (Chen et al., J. Biol. Chem. 276: 25894-02 (2001)), these proteins were purified from culture supernatants by nickel-affinity chromatography.</p><p> A C-terminal polypeptide (CCPII-SP) containing the CCPII and serine protease domains of rat MASP-2 was expressed in E. coli as a thioredoxin fusion protein using pTrxFus (Invitrogen). The protein was purified from the cell lysate using a Thiobond affinity resin. The thioredoxin fusion partner was expressed from empty pTrxFus as a negative control.</p><p> All recombinant proteins were dialyzed against TBS buffer and their concentrations were determined by measuring OD at 280 nm.</p><p>Dot Blot Analysis: A serial dilution of the five recombinant MASP-2 polypeptides described above and shown in Figure 10 (and thioredoxin polypeptide as a negative control for the CCP II-serine protease polypeptide) was spotted on the nitrocellulose membrane. .. The amount of spotted protein was 100 ng to 6.4 pg in 5-fold steps. In later experiments, the amount of spotted protein was again 50 ng ~ 16 pg in 5-fold steps. The membrane is blocked with 5% skim milk powder dissolved in TBS (blocking buffer), followed by blocking buffer (5.0 mM Ca).²⁺Incubated with 1.0 μg / ml of anti-MASP-2 Fab2 dissolved in). Bound Fab2 was detected using an HRP-bound anti-human Fab (AbD / Serotec; diluted to 1 / 10,000) and an ECL detection kit (Amersham). One membrane was incubated with polyclonal rabbit anti-human MASP-2 Ab (described in Stover et al., J Immunol 163: 6848-59 (1999)) as a positive control. In this case, bound Ab was detected using HRP-bound goat anti-rabbit IgG (Dako; diluted to 1/2000).</p><p><u style="single">MASP-2 binding assay</u> ELISA plates were coated overnight at 4 ° C with 1.0 μg / well recombinant MASP-2A or CUBI-II polypeptide dissolved in carbonate buffer (pH 9.0). Wells were blocked with 1% BSA dissolved in TBS, then 5.0 mM Ca²⁺A serial dilution of anti-MASP-2 Fab2 dissolved in TBS containing the above was added. The plates were incubated at RT for 1 hour. TBS / tween / Ca²⁺After washing 3 times with TBS / Ca²⁺HRP-conjugated anti-human Fab (AbD / Serotec) diluted to 1 / 10,000 was added and the plates were incubated at RT for an additional hour. Bound antibodies were detected using the TMB Peroxidase Substrate Kit (Biorad).</p><p>Results: The results of dot blot analysis demonstrating the reactivity of Fab2 with various MASP-2 polypeptides are shown in Table 7 below. The numbers shown in Table 7 indicate the amount of spotted protein required to obtain approximately up to half the signal intensity. As shown, all polypeptides (except thioredoxin fusion partner alone) were recognized by a positive control Ab, polyclonal anti-human MASP-2 serum, produced in rabbits.</p><p> (Table 7) Reactivity with various recombinant rat MASP-2 polypeptides in dot blots<img file="JP2020037568A_D0032.tif" />Pathogenic activity was observed over the 2nd and 3rd weeks, and the lectin pathway was completely restored in mice by 17 days after anti-MASP-2 MoAb administration. NR = No reaction. The positive control antibody is the polyclonal anti-human MASP-2 serum produced in rabbits.</p><p> All Fab2s reacted with MASP-2A and MASP-2K (data not shown). The majority of Fab2 recognized the CCPII-SP polypeptide, but not the N-terminal fragment. The two exceptions are Fab2 # 60 and Fab2 # 57. Fab2 # 60 recognizes MASP-2A and CUBI-II fragments, but neither CUBI / EGF-like polypeptides nor CCPII-SP polypeptides. This suggests that Fab2 # 60 binds to an epitope in CUBII or an epitope that spans CUBII and the EGF-like domain. Fab2 # 57 recognizes MASP-2A, but not any MASP-2 fragment tested, indicating that this Fab2 recognizes an epitope in CCP1. Fab2 # 40 and # 49 bound only to full MASP-2A. In the ELISA binding assay shown in FIG. 11, Fab2 # 60 also bound to the CUBI-II polypeptide, albeit with a slightly lower apparent affinity.</p><p> These findings demonstrate that a unique blocking Fab2 for multiple regions of the MASP-2 protein has been identified.</p><p>Example 12 This example describes the analysis of MASP-2-/-mice in a mouse renal ischemia / reperfusion model.</p><p> Principle / Background: Ischemic-reperfusion (I / R) injury in the kidney at body temperature is associated with a number of clinical conditions, including hypovolemia, renal artery occlusion, and cross-clamping. There is.</p><p> Renal ischemia-reperfusion (I / R) is an important cause of acute renal failure associated with mortality up to 50% (Levy et al., JAMA 275: 1489-94, 1996; Thadhani et al. , N. Engl. J. Med. 334: 1448-60, 1996). Post-transplant renal failure is a common and threatening complication after kidney transplantation (Nicholson et al., Kidney Int. 55: 2585-91, 2000). No effective treatment for renal I / R injury is currently available and hemodialysis is the only available treatment. The pathophysiology of renal I / R injury is complex. Recent studies have shown that the lectin pathway of complement activation may play an important role in the development of renal I / R damage (deVries et al., Am. J. Path. 165: 1677- 88, 2004).</p><p>METHODS: MASP-2 (-/-) mice were generated as described in Example 1 and backcrossed with C57B1 / 6 for at least 10 generations. 6 male MASP-2 (-/-) and 6 wild-type (+/+) mice, weighing 22-25 g, Hypnovel (6.64 mg / kg; Roche products Ltd. Intraperitoneal injection of Welwyn Garden City, UK) was administered, followed by anesthesia by inhalation of isoflurane (Abbott Laboratories Ltd., Kent, UK). Isoflurane was selected because it is a mild inhalational anesthetic with little hepatotoxicity. Concentrations are made accurately and animals recover quickly even after long-term anesthesia. Hypnovel was given because it caused a state of neuroblocking analgesia in animals, meaning that small doses of isoflurane need to be given. A warm pad was placed beneath the animal to maintain a constant body temperature. Next, a longitudinal abdominal incision was made and the body cavity was opened using a pair of retractors. The connective tissue above and below the renal veins and arteries of the right and left kidneys was removed and the renal stalk was tightened by applying capillary aneurysm forceps for 55 minutes. This ischemic period was initially based on previous studies conducted in this laboratory (Zhou et al., J. Clin. Invest. 105: 1363-71 (2000)). In addition, a standard ischemic time of 55 minutes was selected after ischemic titration, and it was found that 55 minutes consistently resulted in damage that was also reversible, with a low mortality rate of less than 5%. It was issued. After occlusion, 0.4 ml of warm saline (37 ° C) was placed in the abdominal cavity and then the abdomen was closed during the ischemic period. After removing the capillary aneurysm forceps, the kidneys were observed until a color change indicating that blood had begun to flow back into the kidneys. An additional 0.4 ml of warm saline was placed in the abdominal cavity and the opening was sutured. The animals were then returned to their cages. Tail blood samples were taken 24 hours after removing the forceps, the mice were sacrificed at 48 hours and additional blood samples were collected.</p><p> Assessment of renal injury: Six male MASP-2 (-/-) and six WT (+ / +) mice were evaluated for renal function 24 and 48 hours after reperfusion. Blood creatinine measurements were determined by mass spectrometry. Blood creatinine measurements provide a reproducible renal function index (sensitivity &lt;1.0 μmol / L). FIG. 12 illustrates the blood urea nitrogen clearance of wild-type C57B1 / 6 controls and MASP-2 (-/-) 24 and 48 hours after reperfusion. As shown in FIG. 12, MASP-2 (-/-) mice showed a significant reduction in blood urea levels at 24 and 48 hours compared to wild-type control mice. This showed a protective function effect from kidney damage in the ischemia-reperfusion injury model.</p><p> Overall, increased blood urea was seen in both WT (+ / +) and MASP-2 (-/-) mice 24 and 48 hours after surgical procedures and ischemic attacks. It was. Separately, the blood urea level in non-ischemic WT (+ / +) surgical animals was determined to be 5.8 mmol / L. In addition to the data shown in Figure 12, one MASP-2 (-/-) animal had a value of 6.8 mmol / L at 24 hours and 9.6 mmol / L at 48 hours, approximately from an ischemic attack. Showed full protection. This animal was excluded from the group analysis as a potential outlier in which ischemic injury may not have been present. Therefore, the final analysis shown in FIG. 12 included 5 MASP-2 (-/-) mice and 6 WT (+ / +) mice, 24 hours and 48 in MASP-2 (-/-) mice. There was a statistically significant decrease in blood urea over time (Student's t-test p &lt;0.05). These findings indicate that inhibition of MASP-2 activity is expected to have a protective or therapeutic effect from kidney damage due to ischemic injury.</p><p>Example 13 This example describes the results of MASP-2-/-in a mouse macular degeneration model.</p><p> Principle / Background: Age-related macular degeneration (AMD) is the leading cause of blindness after age 55 in developed countries. AMD occurs in two main types: neovascularized (wet) AMD and atrophic (dry) AMD. Neovascular (wet) forms account for 90% of severe AMD-related blindness, but only about 20% of AMD individuals develop wet forms. AMD's clinically prominent features include multiple drusen, geographic atrophy, and choroidal angiogenesis (CNV). In December 2004, the FDA announced Macugen, a new type of ocular drug that specifically targets and blocks vascular endothelial growth factor (VEGF) for the treatment of wet (neovascular) AMD. Pegaptanib) was approved (Ng et al., Nat Rev. Drug Discov 5: 123-32 (2006)). Although Macugen is a promising new treatment option for the AMD patient subgroup, there is still an urgent need to develop further treatments for this complex disease. Several independent research disciplines have linked the central role of complement activation to AMD development. Activation of the complement pathway may be involved in the development of the most severe form of AMD, choroidal angiogenesis (CNV).</p><p> More than 25 years ago, Ryan described a laser-induced injury model of CNV in animals (Ryan, SJ, Tr. Am. Opth. Soc. LXXVII: 707-745, 1979). Initially, this model was developed in rhesus monkeys, but later the same technique has been used in various research animals, including mice, to develop similar CNV models (Tobe et al., Am. J). .Pathol. 153: 1641-46, 1998). In this model, laser photocoagulation is used to break the Bruch film, which is the act of forming a CNV-like film. Laser-guided models capture many of the key features of the human condition (see Ambati et al., Survey Ophthalmology 48: 251-293, 2003 for a recent review). Currently, the laser-guided mouse model is well established and will be used as an experimental basis for large-scale and ever-increasing research projects. Laser-guided models are generally accepted to share sufficient biological similarity with human CNV so that preclinical development and drug inhibition studies using this model are relevant to CNV in humans.</p><p>METHODS: MASP-2-/-mice were generated as described in Example 1 and backcrossed with C57Bl / 6 for 10 generations. In this study, the results of evaluating MASP-2 (-/-) male mice and MASP-2 (+ / +) male mice in the course of laser-induced CNV, which is a promotion model of neovascular AMD, are used for tissue damage. Determination of laser-induced CNV volume by scanning laser confocal microscopy as a measure of, and VEGF levels, a potent angiogenic factor involved in CNV in retinal pigment epithelium (RPE) / choroid by ELISA after laser injury We focused on and compared.</p><p> Induction of choroidal angiogenesis (CNV): On day 0, one person who was not informed of the drug group allocation applied laser photocoagulation (532 nm, 200 mW, 100 ms, 75 μm; Oculight) to both eyes of each animal. GL, Iridex, Mountain View, CA) was performed. Laser spots were applied around the optic nerve in a standard manner using a slit lamp delivery system and a cover glass as a contact lens. The morphological endpoint of laser damage was the appearance of a cavitation bubble, a sign believed to correlate with Bruch's membrane destruction. The detailed method and evaluated endpoints are as follows.</p><p> Fluorescein angiography: One week after laser photocoagulation, fluorescein angiography was performed using a camera and imaging system (TRC501A camera; ImageNet 2.01 system; Topcon, Paramus, NJ). After intraperitoneal injection of 0.1 ml of 2.5% sodium fluorescein, photographs were taken with a 20-D lens in contact with the fundus camera lens. A retinal expert who was not involved in laser photocoagulation or angiography evaluated the fluorescein angiography in a blinded manner.</p><p> Volume of choroidal angiogenesis (CNV): One week after laser injury, the eye was removed and fixed in 4% paraformaldehyde at 4 ° C for 30 minutes. An optic cup was obtained by removing the anterior segment, washed 3 times with PBS, and then dehydrated and rehydrated with a methanol series. After blocking twice with buffer (PBS containing 1% bovine serum albumin and 0.5% Triton X-100) for 30 minutes at room temperature, dilute the optic cup with PBS containing 0.2% BSA and 0.1% Triton X-100. 0.5% FITC-isolectin B4 (Vector laboratories, Burlingame, Incubated overnight at 4 ° C with CA). 0.5% FITC-isolectin B4 binds to terminal β-D-galactose residues on the surface of endothelial cells and selectively labels mouse vasculature. After washing twice with PBS containing 0.1% Triton X-100, the neurosensory retina was gently peeled off and separated from the optic nerve. Make four relaxing radial incisions and flatmount the remaining RPE-choroid-sclera complex into antifade medium (Immu-Mount Vectashield Mounting Medium; Vector Laboratories). I put a cover glass on it.</p><p> The flat mount was examined with a scanning laser confocal microscope (TCS SP; Leica, Heidelberg, Germany). Blood vessels were visualized by exciting at a blue argon wavelength (488 nm) and capturing luminescence from 515 to 545 nm. A 40x oil-immersed objective was used for all imaging studies. Horizontal optical sections (1 μm steps) were obtained from the surface of the RPE-choroid-sclera complex. The deepest focal plane that can identify the surrounding choroidal vascular network connected to the lesion was determined to be the lesion floor. Any blood vessel within the area targeted by the laser and on the surface of this datum was determined to be CNV. Images of each section were digitally stored. The area of CNV-related fluorescence was measured by computer image analysis with microscope software (TCS SP; Leica). The sum of the total fluorescence areas in each horizontal section was used as an index of CNV volume. Imaging was performed by a worker who was not informed of the treatment group assignment.</p><p> Since the probability of each laser lesion developing CNV is affected by the group to which it belongs (mouse, eye, and laser spot), the average lesion volume should be averaged with a linear mixed model and split plot repeated-measures. ) Compared using design. The whole plot factor was the genetic group to which the animal belonged, whereas the split plot factor was the eye. Statistical significance was determined to be at the 0.05 level. Mean post-hook comparisons were constructed using Bonferroni adjustment for multiple comparisons.</p><p> VEGF ELISA After 3 days of injury from 12 laser spots, the RPE-choroid complex was lysed buffer (20 mM imidazole HCl, 10 mM KCl, 1 mM MgCL).₂, 10 mM EGTA, 1% Triton X-100, 10 mM NaF, 1 mM Na molybdate, and 1 mM EDTA and protease inhibitor) and sonicated on ice for 15 minutes. VEGF protein levels in the supernatant were determined by an ELISA kit (R &amp; D Systems, Minneapolis, MN) that recognizes all spliced variants at 450-570 nm (Emax; Molecular Devices, Sunnyvale, CA) and standardized for total protein. did. Workers who were not involved in photocoagulation, imaging, or angiography performed the two sets of measurements in a blinded manner. VEGF numbers were expressed as the mean +/- SEM of at least 3 independent experiments and compared using the Mann-Whitney U test. The null hypothesis was rejected at P &lt;0.05.</p><p>Results: Evaluation of VEGF levels: Figure 13A illustrates VEGF protein levels in RPE-choroidal complexes isolated from C57Bl6 wild-type and MASP-2 (-/-) mice on day 0. As shown in FIG. 13A, assessment of VEGF levels indicates a decrease in VEGF baseline levels in MASP-2 (-/-) mice relative to C57bl wild-type control mice. FIG. 13B illustrates VEGF protein levels measured 3 days after laser-induced injury. As shown in Figure 13B, VEGF levels were significantly increased in wild-type (+ / +) mice 3 days after laser-induced injury, a published study (Nozaki et al., Proc. Natl. Acad. Sci). . USA 103: 2328-33 (2006)). Surprisingly, however, very low levels of VEGF were found in MASP-2 (-/-) mice.</p><p>Evaluation of choroidal angiogenesis (CNV): In addition to the decrease in VEGF levels after laser-induced macular degeneration, CNV area was determined before and after laser injury. FIG. 14 illustrates CNV volumes measured in C57bl wild-type and MASP-2 (-/-) mice 7 days after laser-induced injury. As shown in FIG. 14, MASP-2 (-/-) mice showed a reduction of approximately 30% in CNV area compared to wild-type control mice 7 days after laser-induced injury.</p><p> These findings indicate a reduction in VEGF and a reduction in CNV as evidenced by MASP (-/-) mouse vs. wild-type (+ / +) controls, and blockade of MASP-2 by inhibitors is a treatment for macular degeneration. It is shown that it has a preventive effect or a therapeutic effect.</p><p>Example 14 This example demonstrates that thrombin activation occurs after lectin pathway activation under physiological conditions and to the extent that MASP-2 is involved. In normal rat serum, activation of the lectin pathway activates complement (evaluated as C4 deposition) and thrombin (evaluated as thrombin deposition). As can be seen from FIGS. 15A and 15B, thrombin activation in this system is inhibited by the MASP-2 blocking antibody (Fab2 form), which is consistent with the inhibition concentration response curve for complement activation (FIG. 15A). (Fig. 15B) is shown. These data suggest that activation of the lectin pathway to occur in trauma activates the complement and coagulation systems in a process that is completely dependent on MASP-2. Inference may prove that MASP2-blocking antibodies are effective in alleviating cases of disseminated intravascular coagulation, which is one of the prominent features leading to excessive systemic coagulation, eg, death in severe traumatic cases. is there.</p><p>Example 15 This example localizes DIC in MASP-2-/-deficient and MASP-2 +/+ sufficient mice to assess the role of the lectin pathway in disseminated intravascular coagulation (DIC). The results obtained using the sex Schwartzman reaction model are provided.</p><p>Background / Principle: As mentioned above, blocking MASP-2 inhibits lectin pathway activation and reduces the production of the anaphylatoxins C3a and C5a. Although C3a anaphylatoxins can be shown to be potent platelet agglutinins in vitro, their involvement is less clear in vivo and the release of platelet substances and plasmin in wound healing is only secondary to complement C3. May not be needed. In this example, the role of the lectin pathway is played in MASP-2 (-/-) mice and WT (+/) to address whether long-term increased C3 activation is required to produce disseminated intravascular coagulation. +) Analyzed in mice.</p><p>METHODS: MASP-2 (-/-) mice used in this study were generated as described in Example 1 and backcrossed with C57Bl / 6 for at least 10 generations.</p><p> A localized Schwartzman reaction model was used in this experiment. The localized Schwartzman reaction (LSR) is a lipopolysaccharide (LPS) -induced reaction, and contributions from the cellular and humoral components of the innate immune system are well characterized. The dependence of LSR on complement is well documented (Polak, L. et al., Nature 223: 738-739 (1969); Fong JS, et al., J Exp Med 134: 642-655 (1971)). In the LSR model, mice were stimulated with TNFα (500 ng, intrasacral) for 4 hours, then the mice were anesthetized and prepared for in vivo microscopy of the cremaster muscle. For observation, a network of posterior capillary veins (15-60 μm diameter) with good blood flow (1-4 mm / s) was selected. Animals were treated with fluorescent antibodies to selectively label neutrophils or platelets. The vascular network was continuously scanned and images of all vessels were digitally recorded for later analysis. To record the basal state of microcirculation, mice were injected intravenously with LPS (100 μg) alone or once with the agents listed below. The same vascular network was then scanned every 1 hour, 10 minutes. The specific accumulation of fluorophores was identified by subtracting background fluorescence and emphasized by thresholding the image. The magnitude of the reaction was measured from the recorded images. The primary measure of the Schwartzman reaction was agglutination data.</p><p> This study compared MASP-2 +/+ sufficiently or wild-type mice exposed to known complement pathway depleting substances, cobra venom factors (CVF), or terminal pathway inhibitors (C5aR antagonists). The results (Fig. 16A) demonstrate that both CVF and C5aR antagonists blocked the appearance of aggregates within the vasculature. In addition, MASP-2-/-deficient mice (Fig. 16B) also showed complete inhibition of the localized Schwartzman response, supporting involvement in the lectin pathway. These results clearly demonstrate the role of MASP-2 in DIC production and support the use of MASP-2 inhibitors for the treatment and prevention of DIC.</p><p>Example 16 This example describes the analysis of MASP-2 (-/-) mice in a mouse kidney transplant model.</p><p>Background / Principle: The role of MASP-2 in the functional consequences of kidney transplantation was evaluated using a mouse model.</p><p>METHODS: The functional consequences of kidney transplantation were unilateral nephrectomy recipients with 6 WT (+ / +) transplant recipients (B6) and 6 MASP-2 (-/-) transplant recipients. Evaluated using single kidney allogeneic transplantation into mice. To assess the function of the transplanted kidney, renal function by removing the remaining original kidney from the recipient 5 days after transplantation and measuring blood urea nitrogen (BUN) levels 24 hours later. Was evaluated.</p><p>Results: Figure 17 illustrates blood urea nitrogen (BUN) levels in the kidney 6 days after kidney transplantation in WT (+ / +) and MASP-2 (-/-) recipients. As shown in FIG. 17, a significant increase in BUN levels indicating renal failure was observed in WT (+ / +) (B6) transplant recipients (normal BUN levels in mice are &lt;5 mM). In contrast, MASP-2 (-/-) allogeneic transplant recipient mice showed substantially lower BUN levels. This suggests an improvement in renal function. Note that these results were obtained using grafts from WT (+ / +) kidney donors. This suggests that the absence of a functional lectin pathway solely in the transplant recipient is sufficient to achieve therapeutic benefit.</p><p> Taken together, these results provide a way for transient lectin pathway inhibition via MASP-2 inhibition to alleviate pathological conditions and delayed graft function in kidney transplants, and this approach offers other transplants. It is shown that it is likely to be useful in the field.</p><p>Example 17 This example demonstrates that MASP-2 (-/-) mice are resistant to septic shock in a mouse model of polymicrobial septic peritonitis.</p><p>Background / Principle: To evaluate the potential effect of MASP-2 (-/-) on infectious diseases, we evaluated the intestinal perforation (CLP) model, which is a multibacterial septic peritonitis model. This model is believed to most accurately mimic the course of human septic peritonitis. In the intestinal perforation (CLP) model, the cecum is ligated, punctured with a needle, bacteria continuously leak into the abdominal cavity, reach the blood through lymphatic drainage, and then are distributed to all abdominal organs, many. It is a model that causes organ failure and septic shock (Eskandari et al., J Immunol 148 (9): 2724-2730 (1992)). The CLP model mimics the course of sepsis observed in patients and induces a marked hypoinflammatory phase after an initial hyperinflammatory response. During this period, animals become hypersensitive to bacterial exposure (Wichterman et al., J. Surg. Res. 29 (2): 189-201 (1980)).</p><p>METHODS: Mortality from multibacterial infections using an intestinal perforation (CLP) model was measured in WT (+ / +) (n = 18) and MASP-2 (-/-) (n = 16) mice. Briefly, MASP-2 deficient mice and their wild-type littermates were anesthetized, the cecum was removed from the body and ligated 30% above the distal end. After that, the cecum was punctured once with a 0.4 mm diameter needle. The cecum was then returned to its original location in the abdominal cavity and the skin was closed with forceps. Survival of mice subjected to CLP was monitored for 14 days after CLP. Peritoneal lavage fluid was collected in mice 16 hours after CLP to measure bacterial mass. A serial dilution of the peritoneal lavage fluid was prepared in PBS, inoculated into Mueller-Hinton plates, and then incubated under anaerobic conditions at 37 ° C. for 24 hours. After this, the amount of bacteria was calculated.</p><p> Quantitative real-time polymerase chain reaction (qRT-PCR) also measures TNF-α cytokine response to bacterial infections in the lungs and spleen of WT (+ / +) and MASP-2 (-/-) mice 16 hours after CLP did. TNF-α serum levels 16 hours after CLP in WT (+ / +) and MASP-2 (-/-) mice were also quantified by sandwich ELISA.</p><p>Results: Figure 18 illustrates the percentage survival rate of CLP-treated animals as a function of the number of days after the CLP procedure. As shown in FIG. 18, lectin pathway deficiency in MASP-2 (-/-) mice compared mouse mortality after multiple bacterial infections using an intestinal perforation model with WT (+ / +) mice. Do not increase. However, as shown in FIG. 19, MASP-2 (-/-) mice had a significantly higher amount of bacteria (about the number of bacteria) in the peritoneal lavage fluid after CLP when compared to WT (+ / +) litters. 1000 times increase) was shown. These results indicate that MASP-2 (-/-) deficient mice are resistant to septic shock. Decreased bacterial clearance in MASP-2 deficient mice in this model may be due to impaired phagocytosis mediated by C3b, as C3 deposition has been shown to be MASP-2 dependent.</p><p> The TNF-α cytokine response to bacterial infections in MASP-2 (-/-) mice was found to be modest compared to WT (+ / +) controls (data not shown). 16 hours after CLP, serum levels of TNF-α in WT (+ / +) mice were also found to be significantly higher in contrast to MASP-2 (-/-) mice, MASP-2 (-/-). -) In mice, serum levels of TNF-α remained largely unchanged. These results suggest that the vigorous inflammatory response to septic conditions was mitigated in MASP-2 (-/-) mice and that animals were able to survive in the presence of high bacterial counts.</p><p> Taken together, these results demonstrate the potential adverse effects of lectin pathway complement activation in cases of sepsis and high mortality in patients with uncontrollable sepsis. These results further demonstrate that MASP-2 deficiency regulates the inflammatory immune response and reduces the expression level of inflammatory mediators during sepsis. Therefore, inhibition of MASP-2 (-/-) by administration of an inhibitory monoclonal antibody against MASP-2 is considered to be effective in reducing the inflammatory response in subjects suffering from septic shock.</p><p>Example 18 This example describes the analysis of MASP-2 (-/-) mice in a mouse intranasal infection model.</p><p>Background / Principle: Pseudomonas aeruginosa is a gram-negative opportunistic human bacterial pathogen that causes widespread infections, especially in immunocompromised individuals. Pseudomonas aeruginosa is a major cause of acquired nosocomial infections, especially nosocomial pneumonia. Pseudomonas aeruginosa is also responsible for high morbidity and mortality in patients with cystic fibrosis (CF). Pseudomonas aeruginosa lung infection is characterized by strong neutrophil recruitment and severe lung inflammation resulting in widespread tissue damage (Palanki MS et al., J. Med. Chem 51: 1546-1559 (2008)).</p><p> In this example, studies were undertaken to determine whether removal of the lectin pathway in MASP-2 (-/-) mice increases the susceptibility of mice to bacterial infection.</p><p>METHODS: Twenty-two WT (+ / +) mice, 22 MASP-2 (-/-) mice, and 11 C3 (-/-) mice were intranasally administered with a Pseudomonas aeruginosa strain. Mice were monitored 6 days after infection and a Kaplan-Meier plot showing percent survival was constructed.</p><p>Results: Figure 20 is a Kaplan-Meier plot of percent viability of WT (+ / +), MASP-2 (-/-), or C3 (-/-) mice 6 days after infection. As shown in FIG. 20, no difference was observed in MASP-2 (-/-) and WT (+ / +) mice. However, elimination of the classical (C1q) pathway in C3 (-/-) mice resulted in severe susceptibility to bacterial infection. These results demonstrate that MASP-2 inhibition does not increase susceptibility to bacterial infections, by inhibiting MASP-2 without compromising the ability of patients to combat infections using the classical complement pathway. It has been shown that it is possible to reduce unwanted inflammatory complications in trauma patients.</p><p>Example 19 This Example describes a pharmacodynamic analysis of a representative high affinity anti-MASP-2 Fab2 antibody identified as described in Example 10.</p><p>Background / Principle: As described in Example 10, a phage display library was panned with rat MASP-2 protein to identify high affinity antibodies that block the rat lectin pathway. This library was designed to provide a great deal of immunological diversity and was constructed using the complete human immunoglobin gene sequence. As described in Example 10, about 250 individual phage clones that bind with high affinity to rat MASP-2 protein were identified by ELISA screening. Sequencing of these clones identified 50 unique MASP-2 antibody-coding phages. Fab2 protein was expressed from these clones, purified, and analyzed for MASP-2 binding affinity and inhibition of lectin complement pathway function.</p><p> As a result of this analysis, 17 anti-MASP-2 Fab2 with functional blocking activity were identified (34% hit rate for blocking antibody), as shown in Table 6 of Example 10. Inhibition of the lectin complement pathway by Fab2 was evident at the level of C4 deposition, which is a direct measure of C4 cleavage by MASP-2. Importantly, inhibition was equally apparent when assessing C3 convertase activity. This demonstrates the blockade of the lectin complement pathway. The 17 MASP-2 blocking Fab2 identified as described in Example 10 are ICs equal to or less than 10nM Fab2.₅₀By value, it strongly inhibits C3 convertase formation. 8 ICs out of 17 Fab2 identified₅₀Is in the range of nM or less. In addition, as shown in FIGS. 8A-C and summarized in Table 6 of Example 10, all 17 of the MASP-2 blocking Fab2 are essential for C3 convertase formation in the lectin pathway C3 convertase assay. Showed complete inhibition. In addition, each of the 17 blocking anti-MASP-2 Fab2s shown in Table 6 strongly inhibits C3b production (&gt; 95%). Therefore, the specificity of this assay for the lectin pathway C3 convertase is demonstrated.</p><p> Full-length antibody isotype variants of rat IgG2c and mouse IgG2a were obtained from Fab2 # 11. This example describes in vivo characterization of these isotypes for pharmacodynamic parameters.</p><p>METHODS: The Fab phage display library was panned with rat MASP-2 protein as described in Example 10. From now on, I have identified Fab2 # 11. Full-length antibody isotype variants of rat IgG2c and mouse IgG2a were obtained from Fab2 # 11. Rat IgG2c and mouse IgG2a full-length antibody isotypes were characterized in vivo for pharmacodynamic parameters as follows:</p><p>In vivo studies in mice: Pharmacodynamic studies were performed in mice to investigate the effect of anti-MASP-2 antibody administration on plasma lectin pathway activity in vivo. In this study, 0.3 mg / kg or 1.0 mg / kg of mouse anti-MASP-2 MoAb (mouse IgG2a full-length antibody isotype derived from Fab2 # 11) was administered subcutaneously (sc) and intraperitoneally (ip). At various time points, C4 deposition was measured exvivo in the lectin pathway assay.</p><p> FIG. 21 is measured exvivo in undiluted serum samples taken from mice (n = 3 mice / group) at various time points after subcutaneous administration of 0.3 mg / kg or 1.0 mg / kg mouse anti-MASP-2 MoAb. The lectin pathway-specific C4b deposition was illustrated. Mouse-derived serum samples collected prior to antibody administration served as a negative control (100% activity), whereas serum supplemented with 100 nM of the same blocking anti-MASP-2 antibody in vitro was used as a positive control (0% activity). ) Was used.</p><p> The results shown in FIG. 21 demonstrate rapid and complete inhibition of C4b deposition after subcutaneous administration of 1.0 mg / kg dose of mouse anti-MASP-2 MoAb. Partial inhibition of C4b deposition was observed after subcutaneous administration of 0.3 mg / kg dose of mouse anti-MASP-2 MoAb.</p><p> After a single ip administration of 0.6 mg / kg mouse anti-MASP-2 MoAb to mice, the time course for recovery of the lectin pathway continued for 3 weeks. As shown in FIG. 22, the lectin pathway activity decreased sharply after antibody administration, followed by complete lectin pathway inhibition that lasted about 7 days after ip administration. Slow recovery of lectins.</p><p> These results demonstrate that Fab2 # 11-derived mouse anti-MASP-2 Moab inhibits the mouse lectin pathway in a dose-response manner when systemically delivered.</p><p>Example 20 This Example describes an analysis of Fab2 # 11-derived mouse anti-MASP-2 Moab for efficacy in a mouse model of age-related macular degeneration.</p><p>Background / Principle: The Fab phage display library was panned with rat MASP-2 protein as described in Example 10. From this, Fab2 # 11 was identified as a functionally active antibody. Full-length antibodies of the rat IgG2c and mouse IgG2a isotypes were obtained from Fab2 # 11. As described in Example 19, the pharmacodynamic parameters of the full-length anti-MASP-2 antibody of the mouse IgG2a isotype were characterized. In this example, a mouse anti-MASP-2 full-length antibody derived from Fab2 # 11 is used as a mouse model of age-related macular degeneration (AMD) described in Bora PS et al., J Immunol 174: 491-497 (2005). Analyzed in.</p><p>METHODS: Mice IgG2a full-length anti-MASP-2 antibody isotypes derived from Fab2 # 11 as described in Example 19 with age-related macular degeneration (AMD) as described in Example 13 with the following modifications. Tested in a mouse model.</p><p>Administration of Mouse Anti-MASP-2 MoAb Two different doses of mouse anti-MASP-2 MoAb (0.3 mg / kg and 1.0 mg / kg) were administered to WT (+/) 16 hours prior to CNV induction, along with isotype-controlled MoAb treatment. +) Mice (n = 8 mice / group) were injected with ip.</p><p>Induction of Choroidal Neovascularization (CNV) As described in Example 13, induction of choroidal angiogenesis (CNV) and measurement of CNV volume were performed using laser photocoagulation.</p><p>Results: Figure 23 illustrates the CNV area measured 7 days after laser injury in mice treated with isotype control MoAb or mouse anti-MASP-2 MoAb (0.3 mg / kg and 1.0 mg / kg). As shown in FIG. 23, statistically significant (p &lt;0.01) about 50% CNV reduction was observed in mice pretreated with 1.0 mg / kg anti-MASP-2 MoAb 7 days after laser treatment. It was. As further shown in FIG. 23, it was observed that a 0.3 mg / kg dose of anti-MASP-2 MoAb was not effective in reducing CNV. As described in Example 19 and as shown in FIG. 21, a 0.3 mg / kg dose of anti-MASP-2 MoAb has been shown to have partial and transient inhibition of C4b deposition after subcutaneous administration. Pay attention to that.</p><p> The results described in this example demonstrate that blocking MASP-2 by inhibitors such as anti-MASP-2 MoAb has prophylactic and / or therapeutic effects in the treatment of macular degeneration. These results show that MASP-2 (-/-) mice described in Example 13 showed a 30% reduction in CNV after 7 days of laser treatment in MASP-2 (-/-) mice compared to wild-type control mice. /-) Note that this is consistent with the results observed in studies conducted in mice. In addition, the results of this example further demonstrate that systemically delivered anti-MASP-2 antibodies provide local therapeutic benefits in the eye, which may allow systemic routes of administration to treat AMD patients. Be emphasized. In summary, these results provide evidence to support the use of MASP-2 MoAb in the treatment of AMD.</p><p>Example 21 In this example, MASP-2 deficient mice were protected from meningococcal-induced death after meningococcal infection and had enhanced bloodstream clearance compared to wild-type control mice. To prove.</p><p> Principle: Meningococcus is a dependent gram-negative diplococcal bacterium known for its role in meningitis and other forms of meningococcal disease, such as meningococcalemia. Neisseria meningitidis is one of the leading causes of morbidity and death in childhood. Serious complications include sepsis, Waterhouse Friederixen syndrome, adrenal insufficiency, and disseminated intravascular coagulation (DIC). See, for example, Rintala E. et al., Critical Care Medicine 28 (7): 2373-2378 (2000). In this example, we analyzed the role of the lectin pathway in MASP-2 (-/-) and WT (+ / +) mice to address whether MASP-2 deficient mice are susceptible to meningococcal-induced death. ..</p><p>METHODS: MASP-2 knockout mice were generated as described in Example 1 and backcrossed with C57Bl / 6 for at least 10 generations. Dosage 5 × 10 dissolved in 400 mg / kg iron dextran⁸cfu / 100 μl, 2 × 10⁸cfu / 100 μl, or 3 × 10⁷10-week-old MASP-2 KO mice (n = 10) and wild-type C57 / B6 mice (n = 10) were inoculated by intravenous injection using cfu / 100 μl meningococcal serogroup A Z2491. Survival of mice after infection was monitored over a 72 hour period. Blood samples are taken from mice every hour after infection and analyzed to determine the serum level of Neisseria meningitidis (log cfu / ml) to verify infection and determine the percentage of bacterial clearance from serum. I asked.</p><p>Results: Figure 24A shows the infection dose 5 × 10.⁸The percent viability of MASP-2 KO and WT mice after administration of / 100 μl cfu meningococcus is illustrated. Maximum dose 5 × 10 as shown in Figure 24A⁸After infection with / 100 μl cfu meningococcus, 100% of MASP-2 KO mice survived throughout the 72 hour post-infection period. In contrast, only 20% of WT mice survived 24 hours after infection. These results demonstrate that MASP-2-deficient mice are protected from meningococcal-induced death.</p><p> Figure 24B shows 5x10⁸The log cfu / ml of meningococci recovered at various time points in blood samples collected from MASP-2 KO and WT mice infected with cfu / 100 μl meningococcus is illustrated. As shown in FIG. 24B, in WT mice, blood levels of meningococci peaked at about 6.5 log cfu / ml 24 hours after infection and dropped to 0 48 hours after infection. In contrast, in MASP-2 KO mice, meningococcal levels peaked at about 3.5 log cfu / ml 6 hours after infection and dropped to 0 by 36 hours after infection.</p><p> Figure 25A shows 2x10⁸The percent viability of MASP-2 KO and WT mice after infection with cfu / 100 μl Neisseria meningitidis is illustrated. Dose 2 × 10 as shown in Figure 25A⁸After infection with cfu / 100 μl N. meningitidis, 100% of MASP-2 KO mice survived throughout the 72 hour post-infection period. In contrast, only 80% of WT mice survived 24 hours after infection. Consistent with the results shown in FIG. 24A, these results further demonstrate that MASP-2 deficient mice are protected from meningococcal-induced death.</p><p> Figure 25B shows 2x10⁸The log cfu / ml of meningococci recovered at various time points in blood samples collected from WT mice infected with cfu / 100 μl meningococcus is illustrated. 2x10 as shown in Figure 25B⁸Blood levels of meningococci in cfu-infected WT mice peaked at about 4 log cfu / ml 12 hours after infection and dropped to 0 24 hours after infection. Figure 25C shows 2x10⁸The log cfu / ml of meningococci recovered at various time points in blood samples taken from MASP-2 KO mice infected with cfu / 100 μl meningococcus is illustrated. 2x10 as shown in Figure 25C⁸Blood levels of meningococci in cfu-infected MASP-2 KO mice reached a peak level of approximately 3.5 log cfu / ml 2 hours after infection and dropped to 0 3 hours after infection. Consistent with the results shown in FIG. 24B, these results showed that MASP-2 KO mice were infected with the same dose of meningococcus as WT mice, whereas MASP-2 KO mice were compared to WT. It is proven to enhance the clearance of bloodstream.</p><p> Minimum dose 3x10⁷The percentage survival rate of MASP-2 KO and WT mice after infection with cfu / 100 μl Neisseria meningitidis was 100% over a 72-hour period (data not shown).</p><p>Discussion These results indicate that MASP-2 deficient mice were protected from meningococcal-induced death and had enhanced bloodstream clearance compared to WT mice. Therefore, in view of these results, therapeutic application of MASP-2 inhibitors such as MASP-2 MoAb prevents the treatment of meningococcal infections (ie, sepsis and DIC). It is expected to be effective in reducing or mitigating its effects. In addition, these results indicate that therapeutic application of MASP-2 inhibitors such as MASP-2 MoAb does not increase the risk of developing a meningococcal infection in the subject.</p><p>Example 22 This example describes the discovery of novel lectin pathway-mediated and MASP-2-dependent C4 bypass complement C3 activation.</p><p>Principle: The main therapeutic benefit of limiting myocardial ischemia / reperfusion injury (MIRI) with complement activation inhibitors was convincingly demonstrated 20 years ago in an experimental rat model of myocardial infarction. Recombinant sCR1, a soluble cleavage derivative of cell surface complement receptor type 1 (CR1), was administered intravenously and its effect was evaluated in a rat in vivo model of MIRI. Treatment with sCR1 reduced infarct volume by more than 40% (Weisman, HF, et al., Science 249: 146-151 (1990)). The therapeutic potential of this recombination inhibitor was subsequently demonstrated in clinical trials, showing that administration of sCR1 to MI patients prevented systolic dysfunction in the post-ischemic heart (Shandelya, S., et al. , Circulation 87: 536-546 (1993)). However, the main mechanisms leading to complement activation in ischemic tissue are the molecular processes leading to complement activation of oxygen-deficient cells and the crosstalk and synergies between different complement activation pathways without a suitable experimental model. Is not finally clarified, mainly because it is not fully understood.</p><p> As a basic component of the immune response, the complement system provides protection against invading microorganisms through both antibody-dependent and antibody-independent mechanisms. The complement system organizes many cellular and humoral interactions within the immune response, including chemotaxis, phagocytosis, cell adhesion, and B cell differentiation. Three different pathways: the classical pathway, the second pathway, and the lectin pathway initiate the complement cascade. A small recognition component of the classical pathway, C1q binds to various targets, most notably immune complexes, and initiates stepwise activation of the associated serine proteases C1r and C1s, involving the adaptive immune system. It provides the main mechanism for eliminating pathogens and immune complexes after illness. Upon binding of C1q to the immune complex, the C1r zymogen dimer is converted to its active form, cleaving C1s and thereby activating C1s. C1s convert C1q binding to complement activation at two cleavage steps. That is, first, C1s converts C4 to C4a and C4b, and then cleaves C2 that binds to C4b to form the C3 convertase C4b2a. This complex converts the abundant plasma component C3 to C3a and C3b. Accumulation of C3b near the C4b2a complex changes substrate specificity from C3 to C5, resulting in the C5 convertase C4b2a (C3b)._nIs formed. The C3 and C5 convertase complexes produced via classical pathway activation are identical to those produced via the lectin pathway activation pathway. In the second pathway, spontaneous low-level hydrolysis of component C3 deposits protein fragments on the cell surface, inducing complement activation in foreign cells, whereas cell-related on the surface of host tissue. Regulatory proteins prevent activation and thus prevent self-damage. Like the second pathway, the lectin pathway may be activated in the absence of immune complexes. Multimolecular lectin pathway activation complexes are pathogen-associated molecular patterns (PAMPs), primarily carbohydrate structures present on the surface of pathogens, fungal pathogens, or viral pathogens, or apoptotic cells, necrotic cells, malignant cells, or oxygen. Activation is initiated by binding to an abnormal glycosyl pattern present on the surface of deficient cells (Collard, CD, et al., Am. J. Pathol. 156: 1549-1556 (2000); Walport, MJ , N. Engl. J. Med. 344: 1058-1066 (2001); Schwaeble, W., et al., Immunobiology 205: 455-466 (2002); and Fujita, T., Nat. Rev. Immunol. 2: 346-353 (2002)).</p><p> Mannan-binding lectins (MBLs) are the first carbohydrate-recognizing subcomponents that have been shown to form a complex with a group of novel serine proteases called MBL-associated serine proteases (MASPs), numbered according to the order of their discovery. Attached (ie, MASP-1, MASP-2, and MASP-3). In humans, the lectin pathway activation complex contains four alternative carbohydrate-recognizing minor components with different carbohydrate binding specificities, namely MBL2, and three different phycholine family members, namely L-ficolin, H-ficolin. , And M-ficolin, and can be formed using MASP. Two forms of MBL, MBL A and MBL C, and ficholine-A form a lectin activation pathway complex with MASP in mouse and rat plasma. Previously, we cloned and characterized MASP-2 and a further truncated MASP-2 gene product of 19 kDa called MAp19 or sMAP in humans, mice, and rats (Thiel, S., et. al., Nature 386: 506-510 (1997); Stover, CM, et al., J. Immunol. 162: 3481-3490 (1999); Takahashi, M., et al., Int. Immunol. 11: 859-863 ( 1999): and Stover, CM, et al., J. Immunol. 163: 6848-6859 (1999)). MAp19 / sMAP has no protease activity but may regulate lectin pathway activation by competing in binding of MASP to carbohydrate recognition complexes (Iwaki, D. et al., J. Immunol. 77: 8626-8632 (2006)).</p><p> Evidence suggests that only MASP-2 of the three MASPs is required to convert lectin pathway recognition complex binding to complement activation (Thiel, S., et al. (1997). ); Vorup-Jensen, T., et al., J. Immunol. 165: 2093-2100 (2000); Thiel, S., et al., J. Immunol. 165: 878-887 (2000); Rossi, V., et al., J. Biol Chem. 276: 40880-40887 (2001)). This conclusion is highlighted by the most recently mentioned phenotype of MASP-1 and MASP-3 deficient mouse strains. MASP-1 / 3-deficient mice retain lectin pathway functional activity in addition to delayed initiation of lectin pathway-mediated complement activation in vitro. Reconstitution of MASP-1 and MASP-3 deficient sera with recombinant MASP-1 overcomes this delay in lectin pathway activation. This means that MASP-1 can promote MASP-2 activation (Takahashi, M., et al., J. Immunol. 180: 6132-6138 (2008)). Very recent studies have shown that MASP-1 (and possibly MASP-3) is required to convert the second pathway activating enzyme D factor from its enzyme precursor form to the enzyme active form. (Takahashi, M., et al., J. Exp. Med. 207: 29-37 (2010)). The physiological importance of this process is emphasized by the lack of second pathway functional activity in the plasma of MASP-1 / 3-deficient mice.</p><p> Lectin pathway Carbohydrate recognition minor component MBL A and MBL C complex target deficiency, recently generated mouse strains may still initiate lectin pathway activation via the remaining mouse lectin pathway recognition minor component ficholine A (Takahashi, K., et al., Microbes Infect. 4: 773-784 (2002)). Having no residual lectin pathway functional activity in MASP-2 deficient mice provides a definitive model for studying the role of this effector sector in natural humoral immunity in health and disease.</p><p> Since C4-deficient and MASP-2-deficient mouse strains are available, we define a novel lectin pathway-specific, but MASP-2-dependent, C4 bypass complement C3 activation pathway. Was made. The essential contribution of this novel lectin pathway-mediated C4 bypass activation pathway to post-ischemic tissue loss is highlighted by the prominent protective phenotype of MASP-2 deficiency in MIRI. In contrast, C4-deficient mice tested in the same model show no protection.</p><p> In this example, we describe a novel lectin pathway mediation and MASP-2-dependent C4 bypass complement C3 activation. The physiological relevance of this new activation pathway is demonstrated by the protective phenotype of MASP-2 deficiency in an experimental model of myocardial ischemia / reperfusion injury (MIRI). In contrast, C4-deficient animals were not protected.</p><p>METHODS: MASP-2 deficient mice generated MASP-2 deficient mice showing no gross abnormalities as described in Example 1. Hetero (^+/-) MASP-2 deficient mice and homo (^-/-) All MASP-2 deficient mice are healthy, fertile, and show no gross abnormalities. Their life expectancy is about the same as the life expectancy of WT litters (&gt; 18 months). Before testing the phenotypes of these mice in a disease experimental model, we made MASP-2.^-/-The strain was backcrossed with C57BL / 6 background for 11 generations. The absence of MASP-2 mRNA was confirmed by Northern blotting of liver RNA preparations selected with poly A +, whereas it encodes MAp19 or sMAP (a truncated alternative splicing product of the MASP2 gene) 1.2 kb mRNA was abundantly expressed.</p><p> From qRT-PCR analysis using a primer pair specific for the coding sequence of the serine protease domain of MASP-2 (B chain) or the rest of the coding sequence of A chain, the mRNA encoding B chain is MASP-2.^-/-Although undetectable in mice, the abundance of disrupted A-chain mRNA transcripts was found to be quite high. Similarly, MASP-2^+/-Mouse and MASP-2^-/-In mice, the abundance of mRNA encoding MAp19 / sMAP is high. Plasma MASP-2 levels determined by ELISA for 5 animals of each genotype were 300 ng / ml (range 260-330 ng / ml) for WT controls and 360 ng / ml (range 330 ng / ml) for heterozygous mice. ~ 395ng / ml), MASP-2^-/-It could not be detected in the mouse. The mRNA expression profile was clarified using qRT-PCR, and MASP-2^-/-Mice have approximately the same abundance of MASP-2 as littermates of MBL A, MBL C, Phicolin A, MASP-1, MASP-3, C1q, C1rA, C1sA, B, D, C4, and C3 It was proved to express mRNA (data not shown).</p><p> MASP-2^-/-(n = 8) and MASP-2^+/+(n = 7) Plasma C3 levels in littermates were measured using a commercially available mouse C3 ELISA kit (Kamiya, Biomedical, Seattle, WA). C3 levels in MASP-2 deficient mice (mean 0.84 mg / ml, +/- 0.34) were similar to those in WT controls (mean 0.92, +/- 0.37).</p><p>Results: MASP-2 is essential for lectin pathway functional activity As described in Example 2 and as shown in Figure 5, MASP-2^-/-In vitro analysis of plasma revealed that when the mannan-coated and zymosan-coated surfaces were activated for C4 activation, they had no lectin pathway functional activity. Similarly, MASP-2^-/-No lectin path-dependent C4 or C3 cleavage was detected in plasma on the surface coated with N-acetylglucosamine. N-Acetylglucosamine binds to MBL A, MBL C, and Phycholine A and induces activation through these (data not shown).</p><p> Analysis of MASP-2-/-mouse serum and plasma clearly demonstrated that MASP-2 is essentially required to activate complement via the lectin pathway. However, even if the lectin pathway functional activity is completely deficient, the other complement activation pathways remain in perfect condition. That is, MASP-2-/-plasma can still activate complement via the classical pathway (Fig. 26A) and the second pathway (Fig. 26B). In Figure 26A and Figure 26B, the symbol "^*The symbol indicates serum derived from WT (MASP-2 (+ / +)). The symbol "" indicates WT-derived serum (C1q depletion). The symbol "" indicates serum derived from MASP-2 (-/-). The symbol "" indicates serum derived from MASP-2 (-/-) (C1q depletion).</p><p> FIG. 26A illustrates that MASP-2-/-mice retain a functional classical pathway. C3b deposition was assayed on immunocomplex-coated microtiter plates (generated by coating with BSA and then adding goat anti-BSA IgG). FIG. 26B illustrates that MASP-2 deficient mice retain a functional second pathway. Conditions that activate C3b deposition only in the second pathway (Mg)²⁺And EGTA-containing buffer) were assayed on Zymosan-coated microtiter plates. The results shown in Figures 26A and 26B are the mean of the two sets and represent three independent experiments. The same symbol was used from beginning to end for plasma sources. These results indicate that the second pathway is directly induced, but the functional second pathway is demonstrated by the results shown in FIG. 26B under experimental conditions designed to inactivate the classical and lectin pathways. Two pathways are shown to be present in MASP-2 deficient mice.</p><p>The lectin pathway of complement activation contributes decisively to the loss of inflammatory tissue in myocardial ischemia / reperfusion injury (MIRI) To study the contribution of lectin pathway function activity to MIRI, we coronary. MASP-2 in the MIRI model after transient ligation and reperfusion of the left anterior descending artery (LAD)^-/-Mouse and WT litter controls were compared. The presence or absence of complement C4 does not affect the degree of ischemic tissue loss in MIRI. We evaluated the effect of C4 deficiency on myocardial necrosis after experimental MIRI. As shown in FIGS. 27A and 27B, the same myocardial necrosis zone was observed in both C4-deficient mice and their WT litters. FIG. 27A illustrates MIRI-induced tissue loss after LAD ligation and reperfusion in C4-/-mice (n = 6) and the corresponding WT litter control (n = 7). Figure 27B illustrates INF as a function of AAR, clearly demonstrating that C4-/-mice are as susceptible to MIRI as WT controls (dashed line).</p><p> These results demonstrate that C4-deficient mice are not protected from MIRI. This result was surprising as it contradicts the widely accepted belief that the major C4 activating fragment, C4b, is an essential component of the classical and lectin pathways C3 convertase C4b2a. Therefore, we evaluated whether residual lectin pathway-specific complement C3 activation could be detected in C4-deficient mouse and human plasma.</p><p>The lectin pathway indicates the presence of a C4 bypass activation pathway in C4-deficient guinea pig sera that can activate complement C3 in the presence of C4 via a novel MASP-2 dependent C4 bypass activation pathway. Encouraged by historical reports (May, JE, and M Frank, J. Immunol. 111: 1671-1677 (1973)), we found that C4-deficient mice had residual classical pathway function activity or lectins. The possibility of pathway function activity was analyzed and C3 activation was monitored under path-specific assay conditions to rule out the contribution of the second pathway.</p><p> C3b deposition was assayed on mannan-coated microtiter plates with plasma concentrations (1.25% and less) of plasma replenished plasma that blocked second pathway activation. C3 cleavage was not detected in C4-deficient plasma tested for classical pathway activation (data not shown), but is potent in C4-deficient mouse plasma when complement activation is initiated via the lectin pathway. Residual C3 cleavage activity was observed. Lectin path dependence is demonstrated by competitive inhibition of C3 cleavage after preincubating a C4-deficient plasma diluent with soluble mannan (see Figure 28A). As shown in FIGS. 28A to 28D, MASP-2-dependent C3 activation was observed in the absence of C4. FIG. 28A illustrates C3b deposition by C4 +/+ (cross) and C4-/-(white circle) mouse plasma. Preincubation of C4-/-plasma with excess (1 μg / ml) liquid phase mannan prior to the assay completely inhibits C3 deposition (black circles). The results represent three independent experiments. Figure 28B shows wild-type, MASP-2 deficient (white squares), and C4-/-mouse plasma (1%) at varying concentrations of anti-rat MASP-2. The results of an experiment in which C3b deposition was assayed on a Mannan coated plate mixed with mAbM11 (abscissa) are illustrated. The result is the mean (± SD) of the four assays (two pairs of plasma of each of the two types). Figure 28C illustrates the results of an experiment in which human plasma: pooled NHS (cross), C4-/-plasma (white circles), and C4-/-plasma (black circles) were pre-incubated with 1 μg / ml mannan. The results represent three independent experiments. FIG. 28D illustrates inhibition of C3b deposition in C4 sufficient human plasma and C4-deficient human plasma (1%) by anti-human MASP-2 mAb H3 (mean ± SD in triplicate). As shown in FIG. 28B, no lectin path-dependent C3 activation was detected in the simultaneously assayed MASP-2-/-plasma. This means that this C4 bypass C3 activation pathway is MASP-2 dependent.</p><p> To further corroborate these findings, we found recombinant human MASP-2A and rat MASP-2A, an active protease domain by site-directed mutagenesis to prevent autolytic degradation of the antigen. A series of recombinant inhibitory mAbs isolated from the phage display antibody library was created by affinity screening for (serine residues replaced with alanine residues). Recombinant antibodies against MASP-2 (AbH3 and AbM11), recombinant human MASP-2A and rat MASP-2A (Chen, CB and Wallis, J. Biol. Chem. 276: 25894-25902 (2001)) as antigens Combinatory antibody library using (Knappik, A., et al., J. Mol. Biol. 296: 57-86 (2000)). An anti-rat Fab2 fragment (IC50 approximately 1 nM) that strongly inhibited lectin-mediated C4 and C3 activation in mouse plasma was converted to full-length IgG2a antibody. Polyclonal anti-mouse MASP-2A antiserum was produced in rats. These tools allowed us to confirm the MASP-2 dependence of this novel lectin pathway-specific C4 bypass C3 activation pathway, as further described below.</p><p> As shown in FIG. 28B, the inhibitory monoclonal antibody M211 that selectively binds to mouse MASP-2 and rat MASP-2 activates C4 bypass C3 in C4-deficient mice and C3 activity in WT mouse plasma via the lectin pathway. IC similar to₅₀The value was concentration-dependently inhibited. All assays were performed with a highly diluted plasma solution that dysfunctional the second pathway activation pathway (highest plasma concentration was 1.25%).</p><p> To investigate the presence of similar lectin pathway-specific C4 bypass C3 activation in humans, we have a gene defect in both human C4 genes (ie, C4A and C4B), resulting in complete C4. Plasma of donors absent from was analyzed (Yang, Y., et al., J. Immunol., 173: 2803-2814 (2004)). FIG. 28C shows that this patient's plasma efficiently activates C3 in a highly diluted plasma solution (which renders the second activation pathway dysfunctional). A lectin pathway-specific C3 activation form on a mannan-coated plate was demonstrated in mouse C4-deficient plasma (Fig. 28A) and human C4-deficient plasma (Fig. 28C) by adding an excess concentration of liquid-phase mannan. The MASP-2 dependence of this C3 activation mechanism in human C4-deficient plasma was evaluated using AbH3, a monoclonal antibody that specifically binds to human MASP-2 and eliminates MASP-2 functional activity. .. As shown in Figure 28D, AbH3 inhibited C3b (and C3dg) deposition in both C4 sufficient human plasma and C4-deficient human plasma with equal efficacy.</p><p> To assess the possible role of other complement components in C4 bypass C3 activation, we discuss MASP-2-under lectin pathway-specific and classical pathway-specific assay conditions. Plasma from MASP-1 / 3-/-mice and Bf / C2-/-mice was tested with /-, C4-/-, and C1q-/-plasma (as controls). Relative amounts of C3 cleavage were plotted against the amount of C3 deposited when using WT plasma.</p><p> FIG. 29A provides a comparative analysis of C3 convertase activity in plasma from various complement-deficient mouse strains tested under lectin activation pathway-specific assay conditions or classical activation pathway-specific assay conditions. Illustrated. WT mouse (n = 6), MASP-2-/-mouse (n = 4), MASP-1 / 3-/-mouse (n = 2), C4-/-mouse (n = 8), C4 / MASP Diluted plasma samples (1%) of -1 / 3-/-mice (n = 8), Bf / C2-/-(n = 2), and C1q-/-mice (n = 2) were tested simultaneously. Reconstitution of Bf / C2-/-plasma with 2.5 μg / ml recombinant rat C2 (Bf / C2-/-+ C2) restored C3b deposition. The result is mean (± SD).^**p &lt;0.01 (compared to WT plasma). As shown in Figure 29A, C4-/-plasma tested under lectin pathway-specific assay conditions show significant C3 deposition, but not under classical pathway-specific conditions. In addition, MASP-2 deficient plasma did not show C3 deposition via the lectin pathway activation pathway, but the same plasma deposited C3 via the classical pathway. In MASP-1 / 3-/- plasma, C3 deposition occurred under both lectin-specific assay conditions and classical pathway-specific assay conditions. No C3 deposition was observed in plasma with a complex deficiency of C4 and MASP-1 / 3 using either lectin pathway-specific conditions or classical pathway-specific conditions. C3 deposition cannot be detected in C2 / Bf-/-plasma via either the lectin pathway or the classical pathway. However, reconstitution of C2 / Bf-/-mouse plasma with recombinant C2 restored C3 cleavage via the lectin pathway and C3 cleavage via the classical pathway. Assay conditions were validated using C1q-/-plasma.</p><p> FIG. 29B shows various complement-deficient mouse strains WT, fB-/-, C4 tested under lectin activation pathway-specific assay conditions (1% plasma, results representative of 3 independent experiments). Plasma derived from-/-, MASP-1 / 3-/-, and time-resolved kinetics of C3 convertase activity in MASP-2-/-plasma are illustrated. As shown in FIG. 29B, no C3 cleavage was observed in MASP-2-/-plasma, but fB-/-plasma cleaved C3 with almost the same kinetics as WT plasma. Significant delays in the lectin path-dependent conversion of C3 to C3b (and C3dg) were observed in C4-/-and MASP-1 / 3-deficient plasma. This delay in C3 activation in MASP-1 / 3-/- plasma has recently been shown to be MASP-1 dependent rather than MASP-3 dependent (Takahashi, M., et al., J. Immunol. 180: 6132-6138 (2008)).</p><p>Consideration: The results described in this example strongly suggest that MASP-2 functional activity is essential for lectin pathway-mediated C3 activation both in the presence of C4 and in the absence of C4. In addition, C2 and MASP-1 are required for this novel lectin pathway-specific C4 bypass C3 activation pathway to work. Comparative analysis of lectin pathway function activity in MASP-2-/-plasma and C4-/-plasma revealed previously unrecognized, C4-independent, but MASP-2-dependent complement C3 activation. The existence of the pathway was revealed, and it was found that C3 can be activated in a lectin pathway-dependent manner even in the absence of C4 at all. Although the detailed molecular composition and sequence of activation events for this novel MASP-2-dependent C3 convertase have not yet been elucidated, our results show that this C4 bypass activation pathway further complements C2 and MASP. It means that the existence of -1 is required. The loss of Lectin pathway-mediated C3 cleavage activity in the plasma of mice with C4 and MASP-1 / 3 complex deficiency is due to MASP-1 directly cleaving and activating MASP-2. The most recently described role of enhancing -2 dependent complement activation may explain it (Takahashi, M., et al., J. Immunol. 180: 6132-6138 (2008)). ). Similarly, MASP-1 may aid MASP-2 functional activity by its ability to cleave C2 (Moller-Kristensen, et al., Int. Immunol. 19: 141-149 (2007)). Both activities require MASP-1 to slow down the rate at which MASP-1 / 3-deficient plasma cleaves C3 via the lectin activation pathway and to maintain C3 conversion via the C4 bypass activation pathway. May explain why you get it.</p><p> Addition of recombinant rat C2 to C2 / fB-/-plasma restored the ability of the reconstituted plasma to activate C3 on a mannan-coated plate, allowing C2 / fB-/-plasma to pass through the lectin pathway. It was shown that the inability to activate C3 is C2-dependent.</p><p> Findings that the lectin pathway retains physiologically important levels of C3 convertase activity via the MASP-2 dependent C4 bypass activation pathway, while C4 deficiency specifically disrupts the classical complement activation pathway. From Experimental Streptococcus pneumoniae infection (Brown, JS, et al., Proc. Natl. Acad. Sci. USA 99: 16969-16974 (2002); Experimental allergic encephalomyelitis (Boos, LA, et al.). , Glia 49: 158-160 (2005); and C3-dependent mouse liver regeneration model (Clark, A., et al., Mol. Immunol. A reassessment of the role of the lectin pathway in various disease models, including 45: 3125-3132 (2008)) was called for. The latter group showed that in vivo inhibition of the second pathway by antibody-mediated depletion of factor B function activity in C4-/-mice did not affect C3-cleavage-dependent liver regeneration, thus C4-deficient mice. Demonstrated that C3 can be activated independently of the second pathway (Clark, A., et al., (2008)). This lectin pathway-mediated C4 bypass C3 activation pathway may also explain the lack of a protective phenotype for C4 deficiency in our MIRI model as well as the previously described renal allograft rejection model ( Lin, T., et al., Am. J. Pathol. 168: 1241-1248 (2006)). In contrast, our recent results have independently demonstrated an important protective phenotype of MASP-2-/-mice in a kidney transplant model (Farrar, CA, et al., Mol. Immunol. 46: 2832 (2009)).</p><p> In summary, the results of this example indicate that MASP-2 dependent C4 bypass C3 activation is a physiologically relevant mechanism in which the availability of C4 can be important under conditions that limit C3 activation. The idea is supported.</p><p>Example 23 This example is thrombin in WT (+ / +), MASP-2 (-/-), F11 (-/-), F11 / C4 (-/-), and C4 (-/-) mice. C3 activation by the substrate and C3 deposition on mannan are described.</p><p>Principle: As described in Example 14, thrombin activation was found to occur after lectin pathway activation under physiological conditions and to demonstrate the extent to which MASP-2 is involved. C3 plays a central role in complement system activation. C3 activation is required for both the classical and second complement activation pathways. Experiments were performed to determine if C3 was activated by the thrombin substrate.</p><p>METHODS: C3 activation with thrombin substrate C3 activation was measured in the presence of the following activated thrombin substrates: human FCXIa, human FVIIa, bovine FXa, human FXa, human activated protein C, and human thrombin. C3 was incubated with various thrombin substrates and then separated on a 10% SDS-polyacrylamide gel under reducing conditions. After electrophoresis transfer using a cellulose membrane, the membrane was incubated with monoclonal biotin-bound rat anti-mouse C3, detected using the streptavidin-HRP kit, and colored with the ECL reagent.</p><p>Results: Activation of C3 requires that the intact a chain be cleaved into a truncated a'chain and soluble C3a (not shown in Figure 30). FIG. 30 shows the results of Western blot analysis on human C3 activation by thrombin substrate. The uncleaved C3α chain and the activation product a'chain are indicated by arrows. As shown in FIG. 30, in vitro incubation of C3 with activated human coagulation factor XI and factor X as well as activated bovine coagulation factor X can cleave C3 in the absence of complement protease. ..</p><p>C3 deposition on mannan Serum obtained from WT, MASP-2 (-/-), F11 (-/-), F11 (-/-) / C4 (-/-), and C4 (-/-) A C3 deposition assay was performed on the sample. F11 is a gene encoding coagulation factor XI. To measure C3 activation, microtiter plates are coated with mannan (1 μg / well) and then TBS / tween / Ca.²⁺Sheep anti-HSA serum (2 μg / ml) dissolved in was added. The plate was blocked with 0.1% HSA dissolved in TBS and washed as described above. Plasma samples, 4 mM barbital, 145 mM NaCl, 2 mM CaCl₂, 1 mM MgCl₂, Diluted at pH 7.4, added to plates and incubated at 37 ° C for 1.5 hours. After washing, bound C3b was detected using rabbit anti-human C3c (Dako) followed by alkaline phosphatase-bound goat anti-rabbit IgG and pNPP.</p><p>Results: Figure 31 shows sera from WT, MASP-2 (-/-), F11 (-/-), F11 (-/-) / C4 (-/-), and C4 (-/-). The results of the C3 deposition assay for the sample are shown. As shown in FIG. 31, there is a functional lectin pathway in the absence of any C4. Furthermore, as shown in FIG. 31, this novel lectin pathway-dependent complement activation requires coagulation factor XI.</p><p>Discussion: Prior to the results obtained in this experiment, those skilled in the art believed that the lectin pathway of complement requires C4 for activity. Therefore, data from C4 knockout mice (and C4-deficient humans) were interpreted assuming that such organisms lack the lectin pathway (in addition to the classical pathway deficiency). This result proves that this idea is wrong. Therefore, based on the phenotype of C4-deficient animals, the conclusions of previous studies suggesting that the lectin pathway is not important in certain disease situations may be incorrect. The data described in this example also show that the lectin pathway can activate components of the coagulation cascade in the physiological context of whole serum. Therefore, it is demonstrated that there is crosstalk between complement and coagulation involving MASP-2.</p><p>Example 24 This example describes a method for evaluating the effect of an anti-MASP-2 antibody on the lysis of red blood cells derived from a blood sample obtained from a patient with paroxysmal nocturnal hemochromatosis (PNH).</p><p>Background / Principle: Paroxysmal nocturnal hemochromatosis (PNH), also known as Marquia Faba Micheli Syndrome, is an acquired, potentially life-threatening blood characterized by complement-induced intravascular hemolytic anemia. It is a disease. A prominent feature of PNH is chronic intravascular hemolysis as a result of the disorderly activation of the second complement pathway. Lindorfor, MA, et al., Blood 115 (11) (2010). Anemia in PNH is due to the destruction of red blood cells in the bloodstream. Symptoms of PNH include red urine due to the appearance of hemoglobin in the urine, and thrombosis. PNH can occur spontaneously and is called "primary PNH" or "secondary PNH" in the context of other bone marrow disorders such as aplastic anemia. Treatment of PNH includes blood transfusions in the case of anemia, inhibition of blood coagulation in the case of thrombosis, and the use of the monoclonal antibody eculizumab (Soliris), which protects blood cells from immune destruction by inhibiting the complement system (Hillmen P. et al). ., N. Engl. J. Med. 350 (6) 552-9 (2004)) is included. However, a significant proportion of PNH patients treated with eculizumab remain with clinically significant immune-mediated hemolytic anemia. This is because this antibody does not block activation of the second complement pathway.</p><p> This example shows the effect of anti-MASP-2 antibody on lysis of erythrocytes derived from blood samples obtained from PNH patients (not treated with Solidris) in which ABO type was incubated with the same acidified normal human serum. The evaluation method will be described.</p><p>METHODS: Red blood cells from normal donors and erythrocytes from patients with PNH (not treated with Solidris) are obtained by venipuncture and incorporated by reference herein, Wilcox, LA, Prepare as described in et al., Blood 78: 820-829 (1991). An anti-MASP-2 antibody having a function blocking activity of the lectin pathway can be produced as described in Example 10.</p><p>Hemolysis analysis: A method for determining the effect of anti-MASP-2 antibody on the ability of erythrocytes from PNH patients to block hemolysis is from Lindorfer, MA, et al., Blood 15 (11): 2283-91 (2010). ) And Wilcox, LA, et al., Blood 78: 820-829 (191). Both references are incorporated herein by reference. As described in Lindorfer et al., Red blood cells from PNH patient samples are centrifuged, a buffy coat is aspirated, and cells are washed with gelatin veronal buffer (GVB) prior to each experiment. Red blood cells are tested for susceptibility to APC-mediated lysis as follows. Normal human serum with the same ABO type, 0.15 mM CaCl₂And 0.5 mM MgCl₂GVB (GVB) containing⁺²) And acidify to pH 6.4 (acidified NHS, aNHS), which is used to dissolve erythrocytes in 50% aNHS and reconstitute to 1.6% hematocrit. The mixture is then incubated at 37 ° C. After 1 hour, the erythrocytes are pelleted by centrifugation. The optical density of the aliquots of the recovered supernatant is measured at 405 nM and used to calculate the percentage dissolution. Samples reconstituted in acidified serum-EDTA are treated similarly and used to define lysis (typically less than 3%) that was not mediated by background complement. Complete lysis (100%) is determined after incubating erythrocytes in distilled water.</p><p> To determine the effect of anti-MASP-2 antibody on hemolysis of PNH erythrocytes, erythrocytes from PNH patients were incubated in aNHS in the presence of increasing concentrations of anti-MASP-2 antibody, followed by the presence of hemolysis / Quantify the amount.</p><p> Given the fact that anti-MASP-2 antibody has been shown to block later complement second pathway activation, anti-MASP-2 antibody is used in blocking PNH erythrocyte hemolysis via the second pathway. It is effective and is expected to be useful as a therapeutic agent for treating patients suffering from PNH.</p><p>Example 25 This example describes a method for evaluating the effect of an anti-MASP-2 blocking antibody on complement activation by cryoglobulin in a blood sample obtained from a patient suffering from cryoglobulinemia.</p><p>Background / Principle: Cryoglobulinemia is characterized by the presence of cryoglobulins in serum. Cryoglobulin is a single or mixed immunoglobulin (typically an IgM antibody) that reversibly aggregates at low temperatures. Aggregation leads to complement activation of the classical pathway and inflammation of the vascular bed, especially in the periphery. Clinical manifestations of cryoglobulinemia include vasculitis and glomerulonephritis.</p><p> Cryoglobulinemia may be classified as follows based on the composition of cryoglobulin. Type I cryoglobulinemia, or simple cryoglobulinemia, is the result of monoclonal immunoglobulins, usually immunoglobulin M (IgM). Type II and type III cryoglobulinemia (mixed cryoglobulinemia) include rheumatoid factor (RF). Rheumatoid factor (RF) is usually IgM complexed with the Fc portion of polyclonal IgG.</p><p> Conditions associated with cryoglobulinemia include hepatitis C infections, lymphoproliferative disorders, and other autoimmune diseases. Immune complexes containing cryoglobulin are responsible for the clinical syndrome of systemic inflammation, probably due to their ability to activate complement. IgG immune complexes usually activate the classical pathway of complement, but IgM-containing complexes can also activate complement via the lectin pathway (Zhang, M .. et al.,, Mol Immunol 44 (1-3): 103-110 (2007) and Zhang. M., et al., J. Immunol. 177 (7): 4727-34 (2006)).</p><p> Immunohistochemical studies have further demonstrated that cryoglobulin immune complexes contain lectin pathway components. Biopsy material from patients with cryoglobulinemia glomerulonephritis showed immunohistochemical evidence of lectin pathway activation in situ (Ohsawa, I., et al., Clin Immunol 101 (1): 59-66) (2001)). These results suggest that the lectin pathway can contribute to inflammation and adverse events in cryoglobulin disease.</p><p>METHODS: Methods for determining the effect of anti-MASP-2 antibody on the ability to block the side effects of cryoglobulinemia are incorporated herein by reference to Ng YC et al., Arthritis and Rheumatism 31 (1) :. It is performed using a liquid phase C3 conversion assay as described in 99-107 (1988). As described in Ng et al., In essential mixed cryoglobulinemia (EMC), monoclonal rheumatoid factor (mRF), usually IgM, forms a complex with polyclonal IgG and is characteristic of cold sedimentation. It forms a descendant immune complex (IC) (type II cryoglobulin). Immunoglobulins and C3 have been shown to be on the walls of affected tissues such as skin, nerves, and kidneys. As described in Ng et al.,¹²⁵I-labeled mRF is added to serum (normal human serum and serum obtained from patients suffering from cryoglobulinemia) and incubated at 37 ° C to measure binding to red blood cells.</p><p> Liquid phase C3 conversion is the presence of anti-MASP-2 antibody in serum (normal human serum and serum obtained from patients suffering from cryoglobulinemia) in the presence or absence of the following ICs: Determined below or in the absence: BSA-anti-BSA, mRF, mRF + IgG, or cryoglobulin. Fixation of C3 and C4 to the IC is measured using a coprecipitation assay with F (ab') 2 anti-C3 and F (ab') 2 anti-C4.</p><p> Given the fact that anti-MASP-2 antibodies have been shown to block lectin pathway activation, anti-MASP-2 antibodies are effective in blocking complement-mediated side effects associated with cryoglobulinemia. It is expected to be useful as a therapeutic agent for treating patients suffering from cryoglobulinemia.</p><p>Example 26 This example describes a method for evaluating the effect of an anti-MASP-2 antibody on a blood sample obtained from a patient with cold agglutinin who manifested as anemia.</p><p>Background / Principle: Cold agglutinin disease (CAD) is a type of autoimmune hemolytic anemia. Cold agglutinin antibodies (usually IgM) are activated by low temperatures, bind to red blood cells, and aggregate red blood cells. Cold agglutinin antibodies, together with complement, attack antigens on the surface of red blood cells. This causes erythrocyte opsoniation (hemolysis), which induces erythrocyte clearance by the reticuloendotheli system. The temperature at which agglomeration occurs varies from patient to patient.</p><p> CAD manifests itself as anemia. Anemia occurs when the rate of red blood cell destruction exceeds the ability of the bone marrow to produce a sufficient number of oxygen-carrying cells. CAD can be caused by underlying diseases or disorders such as infectious diseases (mycoplasma pneumonia, mumps, mononucleosis), lymphoproliferative disorders (lymphoma, chronic lymphocytic leukemia), or connective tissue disorders. It is called "secondary CAD". Patients with primary CAD are considered to have low-grade lymphoproliferative myelopathy. Primary CAD and secondary CAD are acquired states.</p><p>METHODS: Reagents: Patients with red blood cells from normal donors and CAD are obtained by venipuncture. An anti-MASP-2 antibody having a function blocking activity of the lectin pathway can be produced as described in Example 10.</p><p> The effect of the anti-MASP-2 antibody on blocking lectin pathway activation mediated by cold aggultinin can be determined as follows. Red blood cells from blood group I-positive patients are sensitized with cold agglutinin (ie, IgM antibody) in the presence or absence of anti-MASP-2 antibody. The ability of erythrocytes to activate the lectin pathway is then tested by measuring C3 binding.</p><p> Given the fact that anti-MASP-2 antibodies have been shown to block lectin pathway activation, anti-MASP-2 antibodies are effective in blocking complement-mediated side effects associated with cold agglutinin disease. It is expected to be useful as a therapeutic agent for treating patients suffering from cold agglutinin disease.</p><p>Example 27 This example describes a method for evaluating the effect of an anti-MASP-2 antibody on the lysis of red blood cells in a blood sample obtained from atypical hemolytic urinary syndrome (aHUS) mice.</p><p>Background / Principle: Atypical Hemolytic Urotoxicosis Syndrome (aHUS) is characterized by hemolytic anemia, thrombocytopenia, and renal failure caused by platelet thrombi in the microcirculation of the kidney and other organs. aHUS is associated with incomplete complement regulation and can be sporadic or familial. aHUS is associated with mutations in genes encoding complement activation, including complement factor H, membrane cofactors B and I, and complement factor H-related 1 (CFHR1) and complement factor H-related 3 (CFHR3). To do. Zipfel, PF, et al., PloS Genetics 3 (3): e41 (2007). This example describes a method for evaluating the effect of an anti-MASP-2 antibody on the lysis of erythrocytes derived from a blood sample obtained from aHUS mice.</p><p>METHODS: To determine the efficacy of anti-MASP-2 antibody in treating aHUS in a mouse model of the disease in which the endogenous mouse fH gene is replaced with a human homolog that encodes a variant of fH commonly found in aHUS patients. Can be done. See Pickering MC et al., J. Exp. Med. 204 (6): 1249-1256 (2007), incorporated herein by reference. As described in Pickering et al., Such mice develop aHUS-like pathologies. To assess the efficacy of anti-MASP-2 antibody for aHUS treatment, anti-MASP-2 antibody was administered to mutant aHUS mice and lysis of erythrocytes obtained from anti-MASP-2 ab treated and untreated controls. Compare. Given the fact that anti-MASP-2 antibodies have been shown to block lectin pathway activation, anti-MASP-2 antibodies are used in blocking erythrocyte lysis in mammalian subjects suffering from aHUS. Expected to be effective.</p><p>Example 28 This example describes a method for evaluating the effect of anti-MASP-2 antibody for the treatment of glaucoma.</p><p>Principle / Background: Uncontrolled complement activation has been shown to contribute to the progression of degenerative damage to retinal ganglion cells (RGCs), RGC synapses, and RGC axons in glaucoma. See Tezel G. et al., Invest Ophthalmol Vis Sci 51: 5071-5082 (2010). For example, histopathological studies of human tissues and in vivo studies using various animal models have demonstrated that complement components, including C1q and C3, are synthesized in the glaucomatous retina to form the terminal complement complex. (See Stasi K. et al., Invest Ophthalmol Vis Sci 47: 1024-1029 (2006), Kuehn MH et al., Exp Eye Res 83: 620-628 (2006)). Kuehn MH As further described in et al., Experimental Eye Research 87: 89-95 (2008), complement synthesis and deposition are induced by retinal I / R, and disruption of the complement cascade delays RGC degeneration. In this study, mice with targeted disruption of complement component C3 were found to exhibit delayed RGC degeneration after transient retinal I / R when compared to normal animals.</p><p>METHODS: Methods for determining the effect of anti-MASP-2 antibodies on RGC denaturation are incorporated herein by reference as described in Kuehn MH et al., Experimental Eye Research 87: 89-95 (2008). It is performed in an animal model of retinal I / R. As described in Kuehn et al., Retinal ischemia anesthetizes the animal and then passes a 30 gauge needle through the cornea to a reservoir containing phosphate buffered saline to pass the anterior chamber of the eye. Induced by inserting into. The saline reservoir is then lifted to an intraocular pressure of 104 mmHg sufficient to completely block circulation through the retinal vasculature. Increased intraocular ischemia is confirmed by iris and retinal blanching, and ischemia is maintained in the left eye only for 45 minutes. The right eye serves as a control and is not cannulated. Mice are then euthanized 1 or 3 weeks after the ischemic attack. To evaluate the effect of anti-MASP antibody administered before ischemic attack, anti-MASP-2 antibody is administered locally or systemically to the eye of mice.</p><p> Immunohistochemistry of the eye is performed using antibodies against C1q and C3 to detect complement deposition. Optic nerve damage can also be assessed using standard electron microscopy. Quantification of surviving retinal RGC is performed using γ-synuclein labeling.</p><p>RESULTS: As described in Kuehn et al., Transient retinal ischemia results in optic nerve metamorphism and immunohistochemically detectable retinal deposition of C1q and C3 in normal control mice. In contrast, C3-deficient mice showed a marked reduction in axonal degeneration, showing negligible levels of optic nerve damage one week after induction. Based on these results, similar results are observed when this assay is performed in MASP-2 knockout mice and when anti-MASP-2 antibody is administered to normal mice prior to an ischemic attack. It is expected to be.</p><p>Example 29 This Example demonstrates that MASP-2 inhibitors, such as anti-MASP-2 antibodies, are effective in treating radiation exposure and / or in treating, ameliorating, or preventing acute radiation syndrome.</p><p>Principle: When exposed to high doses of ionizing radiation, death is caused by two main mechanisms: bone marrow toxicity and gastrointestinal syndrome. Bone marrow toxicity reduces all blood cells, making organisms more susceptible to death from infections and bleeding. Gastrointestinal syndrome is more severe and is induced by the loss of intestinal barrier function due to the destruction of the gastrointestinal epithelial layer and the loss of enteroendocrine function. This leads to fatal sepsis and associated systemic inflammatory response syndrome.</p><p> The complement lectin pathway is an innate immune system that causes inflammation in response to tissue damage and exposure to foreign surfaces (ie, bacteria). Blocking this pathway yields good outcomes in a mouse model of ischemic intestinal tissue damage or septic shock. It has been hypothesized that the lectin pathway can induce excessive and detrimental inflammation in response to radiation-induced tissue damage. Therefore, blockade of the lectin pathway may reduce secondary damage and prolong survival after acute radiation exposure.</p><p> The purpose of the studies conducted as described in this example was to evaluate the effect of lectin pathway blockade on survival in a radiation-damaged mouse model by administration of anti-mouse MASP-2 antibody.</p><p>Methods and Materials: Materials The test article used in this study blocks the MASP-2 protein component of the lectin complement pathway produced in transfected mammalian cells, (i) high affinity anti-mouse MASP- Two antibodies (mAbM11) and (ii) high affinity anti-human MASP-2 antibody (mAbH6). The dosing concentration was 1 mg / kg anti-mouse MASP-2 antibody (mAbM11), 5 mg / kg anti-human MASP-2 antibody (mAbH6), or sterile saline. A sufficient amount of fresh dosing solution was prepared for each dosing session.</p><p> Animals Young adult male Swiss-Webster mice were obtained from Harlan Laboratories (Houston, TX). Animals were housed in solid bottom cages with Alpha-Dri bedding and provided with guaranteed PMI 5002 Rodent Diet (Animal Specialties, Inc., Hubbard OR) and free water. The temperature was monitored and the animal breeding room was operated with a 12-hour light / 12-hour dark photoperiod.</p><p> After acclimatizing the irradiated mice for 2 weeks in the facility, the Therapy X-RAD 320 system (Precision X-) equipped with a 320 kV highly stable X-ray generator, metal ceramic X-ray tube, variable X-ray beam collimator, and filter. Ray Incorporated, East Haven, CT) was used to irradiate 6.5 Gy and 7.0 Gy with systemic exposure at a dose rate of 0.78 Gy / min in a group of 10 animals. The dose level is LD_50/30Was selected based on a previous study (data not shown) performed with mice of the same strain, which showed that was 6.5-7.0 Gy.</p><p> 0.2 mg / ml anti-mouse MASP-2 antibody (mAbM11) or 0.5 mg / ml anti-human MASP-2 antibody (mAbH6) diluted with ice-cold brine in an appropriate volume according to the drug formulation and dosing protocol. The administration solution of was prepared. Administration of anti-MASP-2 antibodies mAbM11 and mAbH6 was performed via IP injection using a 25 gauge needle to deliver 1 mg / kg mAbM11, 5 mg / kg mAbH6, or saline vehicle based on animal body weight. It was.</p><p> Study Design As shown in Table 8, mice were randomly assigned to groups. Body weight and temperature were measured and recorded daily. Mice in groups 7, 11 and 13 were sacrificed 7 days after irradiation and blood was collected by cardiac puncture under deep anesthesia. Surviving animals were sacrificed in the same manner 30 days after irradiation and blood was collected. Plasma was prepared from the collected blood samples according to the protocol and returned to the sponsor for analysis.</p><p> (Table 8) Test group<img file="JP2020037568A_D0033.tif" /></p><p> Statistical analysis A Kaplan-Meier survival curve was created and used to compare mean survival between treatment groups using the Logrank and Wilcoxon methods. Report the mean and standard deviation, or the mean and mean standard error. Statistical comparisons were performed using a two-tailed unpaired t-test between irradiated control animals and individual treatment groups.</p><p>Results Kaplan-Meier survival plots for the 7.0 Gy and 6.5 Gy exposed groups are shown in Figures 32A and 32B, respectively, and are summarized in Table 9 below. Overall, treatment with anti-mouse MASP-2 ab (mAbM11) prior to irradiation resulted in 6.5 Gy (20% increase) and 7.0 Gy (20% increase) in survival of irradiated mice compared to vehicle-treated controlled animals. 30% increase) Increased in both exposure levels. At 6.5 Gy exposure levels, treatment with anti-mouse MASP-2 ab after irradiation resulted in a moderate (15%) increase in survival compared to vehicle-controlled animals.</p><p> By comparison, all treated animals at 7.0 Gy exposure levels showed increased survival compared to vehicle-treated irradiated controls. The largest change in survival occurred in animals fed mAbH6, a 45% increase compared to control animals. In addition, at 7.0 Gy exposure levels, death in vehicle-treated irradiated controls first occurred 8 days after irradiation, whereas deaths in the mAbH6 treated group first occurred 15 days after irradiation, control animals. 7 days longer than. At 7.0 Gy exposure levels, the mean time to death (27.3 ± 1.3 days) of mAbH6-fed mice was significantly longer than that of control animals (20.7 ± 2.0 days) (p = 0.0087).</p><p> Percentages of body weight change compared to the day before irradiation (Day 1) were recorded throughout the study. Transient weight loss occurred in all irradiated animals. There was no evidence of difference in change with mAbM11 or mAbH6 treatment compared to controls (data not shown). At the end of the study, all surviving animals showed weight gain from the onset (day-1) body weight.</p><p> (Table 9) Survival rate of test animals exposed to radiation<img file="JP2020037568A_D0034.tif" />^*P = 0.0087 by bilateral independent t-test between control irradiated animals and treatment group at the same irradiation exposure level.</p><p>Discussion Acute radiation syndrome consists of three defined subsyndromes: hematopoietic subsyndrome, gastrointestinal subsyndrome, and cerebrovascular subsyndrome. The syndrome observed depends on the radiation dose, and hematopoietic effects are observed in humans who have been exposed to significant partial or systemic radiation above 1 Gy. Hematopoietic syndrome is characterized by severe bone marrow dysfunction that accompanies damage to the immune system, leading to pancytopenia with changes in blood cell count, red blood cells and white blood cells, and platelets. When the bottom develops, there are few neutrophils and platelets in the peripheral blood, and neutropenia, fever, complications of sepsis, and uncontrolled bleeding lead to death.</p><p> In this study, administration of mAbH6 was found to increase the viability of whole-body X-ray irradiation in 7.0 Gy-irradiated Swiss-Webster male mice. In particular, at 7.0 Gy exposure levels, 80% of animals fed mAbH6 survived up to 30 days, whereas 35% of vehicle-treated control-irradiated animals survived up to 30 days. Importantly, the first day of death in this treatment group did not occur until 15 days after irradiation, which was 7 days longer than the first day of death observed in vehicle-treated control-irradiated animals. Curiously, at low x-ray exposure (6.5 Gy), administration of mAbH6 did not appear to affect viability or delayed mortality compared to vehicle-treated control-irradiated animals. There may be multiple reasons for this difference in response between exposure levels, but further research, including tentative sampling for microbial culture and hematological parameters, in testing all hypotheses. May be needed. One explanation may simply be that the number of animals assigned to the group may have overlooked slight treatment-related differences. For example, if the group size is n = 20, the difference in survival between 65% (mAbH6 at 6.5 Gy exposure) and 80% (mAbH6 at 7.0 Gy exposure) is 3 animals. On the other hand, the difference between 35% (vehicle control at 7.0 Gy exposure) and 80% (mAbH6 at 7.0 Gy exposure) is 9 animals, providing solid evidence of treatment-related differences.</p><p> These results demonstrate that anti-MASP-2 antibodies are effective in the treatment of mammalian subjects at risk of acute radiation syndrome adverse effects or those suffering from acute radiation syndrome adverse effects. Ru</p><p>Example 30 This Example demonstrates that MASP-2 deficient mice are protected from N. meningitidis-induced death after infection with N. meningitidis serogroup A or N. meningitidis serum group B.</p><p>METHODS: MASP-2 knockout mice (MASP-2 KO mice) were generated as described in Example 1. Dosage 2.6 x 10 in 100 μl volume⁷Intraperitoneal (ip) injection of CFU meningococcal serogroup A Z2491 into 10-week-old MASP-2 KO mice (n = 10) and wild-type (WT) C57 / BL6 mice (n = 10) Inoculated. The infectious dose was administered to mice with a final concentration of 400 mg / kg of iron dextran. Survival of mice after infection was monitored for a period of 72 hours.</p><p> In another experiment, a dose of 6 x 10 in a volume of 100 μl⁶10-week-old MASP-2 KO mice (n = 10) and wild-type C57 / BL6 mice (n = 10) were inoculated by ip injection of CFU meningococcal serogroup B MC58 strain. The infectious dose was administered to mice with a final dose of 400 mg / kg iron dextran. Survival of mice after infection was monitored for a period of 72 hours. During the 72 hour post-infection period, disease scores for WT and MASP-2 KO mice were also determined based on the disease scoring parameters listed in Table 10 below. This disease scoring is based on the method of Francen et al., (2010) with minor modifications.</p><p> (Table 10) Disease scoring associated with clinical signs in infected mice<img file="JP2020037568A_D0035.tif" /></p><p> Blood samples are taken from mice every hour after infection and analyzed to determine the serum level of Neisseria meningitidis (log cfu / mL) to verify infection and determine the percentage of bacterial clearance from serum. I asked.</p><p><u style="single">result:</u> Figure 33 shows the infection dose 2.6 × 10.⁷It is a Kaplan-Meier plot illustrating the percentage of survival of MASP-2 KO and WT mice after administration of cfu meningococcal serogroup A Z2491. As shown in Figure 33, 100% MASP-2 KO mice survived throughout the 72 hour post-infection period. In contrast, 24 hours after infection, only 80% of WT mice were alive (p = 0.012), and 72 hours after infection, only 50% of WT mice were alive. These results demonstrate that MASP-2-deficient mice are protected from meningococcal serogroup A Z2491 induced death.</p><p> Figure 34 shows the infection dose 6 × 10.⁶It is a Kaplan-Meier plot illustrating the percentage of survival of MASP-2 KO and WT mice after administration of cfu meningococcal serogroup B MC58 strain. As shown in Figure 34, 90% of MASP-2 KO mice survived throughout the 72 hour post-infection period. In contrast, 24 hours after infection, only 20% of WT mice survived (p = 0.0022). These results demonstrate that MASP-2-deficient mice are protected from meningococcal serogroup B MC58-induced death.</p><p> Figure 35 shows 6x10⁶Cfu meningococcal serogroup B MC58 strain collected at various time points in blood samples collected from MASP-2 KO mice and WT mice after ip infection with meningococcal serogroup B MC58 strain Log cfu / mL is illustrated (n = 3 at various time points in both mouse groups). The results are expressed as mean ± SEM. As shown in Figure 35, in WT mice, blood meningococcal levels peaked at about 6.0 log cfu / mL 24 hours after infection and dropped to about 4.0 log cfu / mL by 36 hours after infection. It was. In contrast, in MASP-2 KO mice, meningococcal levels peaked at about 4.0 log cfu / mL 12 hours after infection and dropped to about 1.0 log cfu / mL by 36 hours after infection. (symbol"^*Indicates p &lt;0.05; the symbol "^**"Indicates p = 0.0043). Based on these results, MASP-2 KO mice were infected with the same dose of meningococcal serogroup B MC58 as WT mice, but MASP-2 KO mice enhanced the clearance of bloodstream infections compared to WT. It is proved that it was done.</p><p> Figure 36 shows 6x10⁶The mean disease scores of MASP-2 KO and WT mice 3 hours, 6 hours, 12 hours, and 24 hours after infection with the cfu meningococcal serogroup B MC58 strain are illustrated. As shown in FIG. 36, MASP-2 deficient mice showed high resistance to infection 6 hours after infection (symbol ""^*"Indicates p = 0.0411), 12 hours later (symbol"^**"Indicates p = 0.0049), and after 24 hours (symbol"^***The disease score (indicating p = 0.0049) was very low compared to WT mice. The results in Figure 36 are shown as mean ± SEM.</p><p> In summary, the results of this example demonstrate that MASP-2 deficient mice are protected from N. meningitidis-induced death after infection with N. meningitidis serogroup A or N. meningitidis serum group B. Serotype.</p><p>Example 31 This Example demonstrates that administration of anti-MASP-2 antibody after infection with N. meningitidis increases the survival rate of mice infected with N. meningitidis.</p><p><u style="single">Background / Principle:</u> The Fab phage display library was panned with rat MASP-2 protein as described in Example 10. From this, Fab2 # 11 was identified as a functionally active antibody. Full-length antibodies of the rat IgG2c and mouse IgG2a isotypes were generated from Fab2 # 11. The pharmacodynamic parameters of the full-length anti-MASP-2 antibody of the mouse IgG2a isotype (as described in Example 19) were characterized.</p><p> In this example, a mouse anti-MASP-2 full-length antibody derived from Fab2 # 11 was analyzed in a mouse model of meningococcal infection.</p><p><u style="single">Method:</u> The mouse IgG2a full-length anti-MASP-2 antibody isotype produced as described above, derived from Fab2 # 11, was tested in a mouse model of meningococcal infection as follows.</p><p>Administration of mouse anti-MASP-2 monoclonal antibody (MoAb) after infection High dose (4 × 10)⁶3 hours after ip injection with cfu) meningococcal serogroup B MC58 strain, 9-week-old C57 / BL6 Charles River mice were subjected to inhibitory mouse anti-MASP-2 antibody (1.0 mg / kg) (n = 12). Alternatively, it was treated with a control serotype antibody (n = 10).</p><p><u style="single">result:</u> Figure 37 shows the infection dose 4 × 10.⁶Caplan illustrated the percentage survival rate of mice treated with the inhibitory anti-MASP-2 antibody (1.0 mg / kg) or control isotype antibody 3 hours after infection after administration of cfu meningococcal serogroup B MC58 strain. Meyer. As shown in FIG. 37, 90% of mice treated with anti-MASP-2 antibody survived throughout the 72 hour post-infection period. In contrast, only 50% of mice treated with isotype-controlled antibody survived throughout the 72-hour period after infection. symbol"^*Indicates p = 0.0301 when determined by comparing the two survival curves.</p><p> These results demonstrate that anti-MASP-2 antibody administration is effective in treating and improving survival in subjects infected with N. meningitidis.</p><p> As demonstrated herein, the use of anti-MASP-2 antibody in the treatment of subjects infected with N. meningitidis is effective when administered 3 hours after infection, from 24 hours after infection. Expected to be valid within 48 hours. Meningococcal disease (meningococcal disease or meningitis) is a medical emergency and if meningococcal disease is suspected (ie, meningococcus is a pathogenic agent) Treatment is typically considered to begin promptly (before it is clearly identified).</p><p> Considering the results in MASP-2 knockout mice demonstrated in Example 30, anti-MASP-2 antibody administration prior to meningococcal infection is also to prevent or severe the infection. It is considered to be effective in improving the degree.</p><p>Example 32 This Example demonstrates that administration of anti-MASP-2 antibody is effective in treating meningococcal infections in human serum.</p><p><u style="single">principle:</u> Patients with low serum levels of functional MBL are highly susceptible to recurrent bacterial and fungal infections (Kilpatrick et al., Biochim Biophys Acta 1572: 401-413 (2002)). Meningococci are known to be recognized by MBL, and MBL-deficient sera have been shown to not lyse the genus Neisseria.</p><p> A series of experiments to determine the efficacy of anti-MASP-2 antibody administration to treat meningococcal infections in complement-deficient and control human sera, taking into account the results described in Examples 30 and 31. Was done. Experiments were performed in high concentrations of serum (20%) to preserve the complement pathway.</p><p><u style="single">Method:</u>1. Serum bactericidal activity in various complement-deficient human sera and in human sera treated with human anti-MASP-2 antibody The following complement-deficient human sera and control human sera were used in this experiment.</p><p> (Table 11) Human serum samples tested (shown in Figure 38)<img file="JP2020037568A_D0036.tif" /></p><p> Recombinant antibody against human MASP-2 is a combinatorial antibody library (Knappik, Knappik,) using recombinant human MASP-2A (Chen, CB and Wallis, J. Biol. Chem. 276: 25894-25902 (2001)) as an antigen. It was isolated from A., et al., J. Mol Biol. 296: 57-86 (2000)). Anti-human scFv fragments (IC50-20nM) that strongly inhibited lectin-mediated C4 and C3 activation in human serum were identified and converted to full-length human IgG4 antibody.</p><p> Meningococcal serogroup B-MC58 with or without inhibitory human anti-MASP-2 antibody (3 μg in 100 μl total volume) was 20% each with the various serotypes shown in Table 11. Incubated with shaking at 37 ° C. Samples were collected and plated at the following time points: 0 minute, 30 minute, 60 minute, and 90 minute intervals, and then viable cell counts were determined. Heat-inactivated human serum was used as a negative control.</p><p><u style="single">result:</u> FIG. 38 illustrates log cfu / mL of viable cell counts of meningococcal serogroup B-MC58 recovered at various time points in the human serum samples shown in Table 11. Table 12 shows the Student's t-test results in Fig. 38.</p><p> (Table 12) Student's t-test results in Fig. 38 (at 60 minutes)<img file="JP2020037568A_D0037.tif" /></p><p> As shown in Figure 38 and Table 12, the addition of human anti-MASP-2 inhibitory antibody significantly increased complement-dependent killing of N. meningitidis in 20% human serum.</p><p>2. Complement-dependent killing of Neisseria meningitidis in 20% (v / v) MASP-2 deficient mouse sera In this experiment, the following complement deficient and control mouse sera were used.</p><p> (Table 13) Tested mouse serum samples (as shown in Figure 39)<img file="JP2020037568A_D0038.tif" /></p><p> Meningococcal serogroup B-MC58 was incubated with various complement-deficient mouse sera at a serum concentration of 20% each with shaking at 37 ° C. Samples were collected and plated at the following time points: 0 minutes, 15 minutes, 30 minutes, 60 minutes, 90 minutes, and 120 minutes, followed by viable cell counts. Heat-inactivated human serum was used as a negative control.</p><p><u style="single">result:</u> FIG. 39 illustrates log cfu / mL of viable cell counts of N. meningitidis serum group B-MC58 recovered at various time points in the mouse serum samples shown in Table 13. As shown in FIG. 39, the level of bactericidal activity of MASP-2-/-mouse serum against meningococci is higher than that of WT mouse serum. symbol"^**"Indicates p = 0.0048. symbol"^***Indicates p = 0.001. Table 14 shows the Student's t-test results in Fig. 39.</p><p> (Table 14) Results of Student's t-test in Fig. 39<img file="JP2020037568A_D0039.tif" /></p><p> In summary, the results of this example demonstrate that MASP-2-/-serum has higher bactericidal activity levels against meningococci than WT serum.</p><p>Example 33 This example demonstrates the inhibitory effect of MASP-2 deficiency on the lysis of erythrocytes derived from blood samples obtained from a mouse model of paroxysmal nocturnal hemochromatosis (PNH).</p><p><u style="single">Principle / Background:</u> Paroxysmal nocturnal hemochromatosis (PNH), also known as Marquiafarva Micheli syndrome, is an acquired, potentially life-threatening blood disorder characterized by complement-induced intravascular hemolytic anemia. A prominent feature of PNH is chronic complement-mediated intravascular hemolysis, which is the result of the disorderly activation of the second complement pathway due to the absence of complement regulators CD55 and CD59 on PNH erythrocytes. Hemoglobinuria and anemia that occur in. Lindorfer, MA, et al., Blood 115 (11) (2010), Risitano, AM, Mini-Reviews in Medicinal Chemistry, 11: 528-535 (2011). Anemia in PNH is due to the destruction of red blood cells in the bloodstream. Symptoms of PNH include red urine due to the appearance of hemoglobin in the urine, back pain, fatigue, shortness of breath, and thrombosis. PNH can occur spontaneously and is called "primary PNH" or "secondary PNH" in the context of other bone marrow disorders such as aplastic anemia. Treatment of PNH is the use of the monoclonal antibody eculizumab (Soliris®), which protects blood cells from immune destruction by transfusing blood in the case of anemia, blocking blood coagulation in the case of thrombosis, and inhibiting the complement system (Hillmen). P. et al., N. Engl. J. Med. 350 (6) 552-9 (2004)) is included. Eculizumab (Soliris®) is a humanized monoclonal antibody that targets complement component C5 and blocks C5 cleavage by C5 convertase, thereby blocking C5a production and MAC assembly. Treatment of PNH patients with eculizumab reduced intravascular hemolysis as measured by lactate dehydrogenase (LDH), leading to hemoglobin stabilization and transfusion independence in about half of the patients (Hillmen P, et al). ., Mini-Reviews in Medicinal Chemistry, vol11 (6) (2011)). LDH levels were normal or near normal in almost all patients receiving eculizumab therapy (to control intravascular hemolysis), but only about one-third of the patients reached hemoglobin levels above 11 gr / dL. Remaining patients taking eculizumab continue to show moderate to severe (ie, transfusion-dependent) anemia at about the same rate (Risitano AM) et al., Blood 113: 4094-100 (2009)). As described in Risitano et al., Mini-Reviews in Medicinal Chemistry 11: 528-535 (2011), PNH patients taking eculizumab contain C3 fragments that are bound to a significant portion of PNH erythrocytes. It proved to be (but did not include untreated patients). From this, it is said that C3 bound to the membrane acts as an opsonin for PNH erythrocytes, and as a result, is trapped in the reticular endothelial cells via specific C3 receptors, and then extravascular hemolysis occurs. A conclusion was drawn. Therefore, patients developing extravascular hemolysis via the C3 fragment continue to require red blood cell transfusions, and these patients require treatment strategies in addition to the use of eculizumab.</p><p> This example describes a method for assessing the effects of MASP-2 deficient serum and serum treated with MASP-2 inhibitors on lysis of erythrocytes derived from blood samples obtained from a mouse model of PNH. To demonstrate the effectiveness of MASP-2 inhibition in treating affected subjects and to ameliorate the effects of C3 fragment-mediated extravascular hemolysis in PNH subjects receiving therapy with C5 inhibitors such as eculizumab. We also support the use of MASP-2 inhibitors.</p><p><u style="single">Method:</u><u style="single">PNH animal model:</u> Blood samples were obtained from Crry and C3 deficient gene targeting mice (Crry / C3-/-) and CD55 / CD59 deficient mice. These mice lack their respective surface complement regulators, and therefore the erythrocytes of these mice are susceptible to spontaneous complement autolysis, similar to PNH human blood cells.</p><p> To further sensitize these red blood cells, these cells were used with and without mannan coating, followed by WT C56 / BL6 plasma, MBL null plasma, MASP-2-/-plasma. Was tested for hemolysis in NHS treated with human NHS, human MBL-/-plasma, and human anti-MASP-2 antibody.</p><p>1. Hemolytic assay of Crry / C3 double-deficient mouse erythrocytes and CD55 / CD59 double-deficient mouse erythrocytes in MASP-2 deficient / depleted serum and controls Day 1, preparation of mouse RBC (± mannan coating)<u style="single">Materials included:</u>Fresh mouse blood, BBS / Mg²⁺/ Ca²⁺(4.4 mM barbituric acid, 1.8 mM sodium barbitone, 145 mM NaCl, pH 7.4, 5 mM Mg²⁺, 5mM Ca²⁺), Chromium chloride, CrCl₃ 6H₂O (0.5 mg / mL dissolved in BBS / Mg2 + / Ca2 +), and 100 μg / mL dissolved in mannan, BBS / Mg2 + / Ca2 +.</p><p> Whole blood (2 mL) was placed in a cooling centrifuge and spun down at 2000 xg at 4 ° C for 1-2 minutes. Plasma and buffy coat were aspirated. The RBC pellet was then resuspended in 2 mL ice-cold BBS / gelatin / Mg2 + / Ca2 + and the sample was washed 3 times by repeating the centrifugation step. After the third wash, the pellet was resuspended in 4 mL of BBS / Mg2 + / Ca2 +. 2 mL of RBC aliquot was set aside as an uncoated control. To the remaining 2 mL, 2 mL CrCl3 and 2 mL mannan were added and the samples were incubated for 5 minutes at room temperature with gentle mixing. The reaction was terminated by adding 7.5 mL of BBS / gelatin / Mg2 + / Ca2 +. Samples were spun down as described above, resuspended in 2 mL of BBS / gelatin / Mg2 + / Ca2 +, washed twice more as described above, and then stored at 4 ° C.</p><p>Day 2, hemolysis assay Material: BBS / gelatin / Mg²⁺/ Ca²⁺Included (above), test serum, 96-well round-bottomed and 96-well flat-bottomed plates, and a spectrophotometer reading 96-well plates at 410-414 nm.</p><p> First, determine the RBC concentration and add 10 cells⁹It was adjusted to / mL and stored at this concentration. 10 assay buffers before use⁸Dilute to / mL and then use 100 ul / well. Hemolysis was measured at 410-414 nm (allowing greater sensitivity than 541 nm). The test serum diluent was prepared by dissolving it in ice-cold BBS / gelatin / Mg2 + / Ca2 +. 100 μl of each serum diluent was pipette into a round bottom plate (see Plate Layout). Add 100 μl of an appropriately diluted RBC preparation (ie, 10).⁸/ mL) (see plate layout), incubated at 37 ° C for about 1 hour and observed for lysis (plates may be photographed at this point). The plate was then spun down at maximum speed for 5 minutes. 100 μl of the liquid phase was aspirated, transferred to a flat bottom plate and the OD was recorded at 410-414 nm. RBC pellets were retained (which can later be dissolved in water to give the opposite result).</p><p><u style="single">Experiment # 1:</u> Fresh blood was obtained from the blood of CD55 / CD59 double-deficient and Crry / C3 double-deficient mice, and erythrocytes were prepared as detailed in the protocol above. Separate cells, coat half of the cells with mannan, leave the other half untreated, final concentration 1x10⁸Adjusted to / mL. Of this, 100 μl was used in the hemolysis assay. The hemolysis assay was performed as described above.</p><p><u style="single">Results of Experiment # 1: Lectin pathway is involved in erythropoiesis in PNH animal models</u> In initial experiments, uncoated WT mouse erythrocytes were found to be insoluble in any mouse serum. In addition, mannan-coated Crry-/-mouse erythrocytes were found to dissolve slowly in WT mouse serum (&gt; 3 hours at 37 ° C) but not in MBL null serum (data not shown).</p><p> Mannan-coated Crry-/-mouse erythrocytes were found to dissolve rapidly in human serum but not in heat-inactivated NHS. Importantly, mannan-coated Crry-/-mouse erythrocytes were lysed in NHS diluted to 1/640 (ie, 1/40, 1/80, 1/160, 1/320, and 1/40). All 640 diluents were dissolved) (data not shown). In this diluent, the second pathway does not work (AP functional activity is significantly reduced below 8% serum concentration).</p><p><u style="single">Conclusion from experiment # 1</u> Mannan-coated Crry-/-mouse erythrocytes are very well lysed in highly diluted human serum containing MBL rather than highly diluted human serum without MBL. Efficient lysis at all serum concentrations tested means that the second pathway is not involved in this lysis and is not required. The inability of MBL-deficient mouse and human sera to lyse mannan-coated Crry-/-mouse erythrocytes indicates that the classical pathway is also completely unrelated to the observed lysis. This lysis is mediated by the lectin pathway, as a lectin pathway recognition molecule (ie, MBL) is required.</p><p><u style="single">Experiment # 2:</u> Fresh blood was obtained from Crry / C3 double-deficient mice and CD55 / CD59 double-deficient mice, and mannan-coated Crry-/-mouse erythrocytes were analyzed in the presence of the following sera in the hemolysis assay method as described above: MBL null; WT; NHS pretreated with human anti-MASP-2 antibody; and heat-inactivated NHS as a control.</p><p><u style="single">Results of Experiment # 2: MASP-2 inhibitors block erythrocyte lysis in PNH animal models</u> Mannan-coated Crry-/-NHS diluted to 1/640 (ie 1/40, 1/80, 1/160, 1/320, and 1/640) with mouse erythrocytes, human MBL- / -Incubated in serum, NHS pretreated with anti-MASP-2 mAb, and heat-inactivated NHS as a control.</p><p> The ELISA microtiter plate was spun down to collect unlysed red blood cells at the bottom of the round bottom well plate. The supernatant of each well was collected and read at OD415 nm in an ELISA reader to measure the amount of hemoglobin released from the lysed erythrocytes.</p><p> As expected, no lysis was observed in the control heat-inactivated NHS (negative control). MBL-/-human serum diluted 1/8 and 1/16 lysed mannan-coated mouse erythrocytes. NHS pretreated with 1/8 and 1/16 diluted anti-MASP-2-antibodies lysed mannan-coated mouse erythrocytes, whereas WT human serum lysed mannan-coated mouse erythrocytes up to 1/32 dilution. Was dissolved.</p><p> FIG. 40 shows mannan-coated mouse erythrocytes with human sera at serum concentrations in a range of serum from heat-inactivated (HI) NHS, MBL-/-, NHS pretreated with anti-MASP-2 antibody, and NHS control. Hemolysis (measured by hemoglobin release from lysed mouse erythrocytes (Cryy / C3-/-) into the supernatant, measured by photometric method) is illustrated.</p><p> From the results shown in Fig. 40, MASP-2 inhibition using anti-MASP-2 antibody is CH.₅₀It is demonstrated that the protection from autologous complement activation inhibited complement-mediated lysis of sensitized erythrocytes.</p><p><u style="single">Experiment # 3</u> Fresh blood from Crry / C3 double-deficient mice and CD55 / CD59 double-deficient mice in uncoated Crry-/-mouse erythrocytes was analyzed in the presence of the following sera in the hemolysis assay method as described above. : MBL-/-; WT serum; NHS pretreated with anti-MASP-2 antibody, and heat-inactivated NHS as a control.</p><p><u style="single">result:</u> FIG. 41 shows uncoated mouse erythrocytes with human serum at a range of serum concentrations in serum from heat-inactivated (HI) NHS, MBL-/-, NHS pretreated with anti-MASP-2 antibody, and NHS control. Hemolysis (measured by hemoglobin release from erythrocytes of dissolved WT mice to the supernatant, measured by photometric method) is illustrated. As shown in FIG. 41, inhibitory MASP-2 was demonstrated to inhibit complement-mediated lysis of non-sensitized WT mouse erythrocytes.</p><p> FIG. 42 shows uncoated mouse erythrocytes with human sera at a range of serum concentrations in serum from heat-inactivated (HI) NHS, MBL-/-, NHS pretreated with anti-MASP-2 antibody, and NHS control. Hemolysis (measured by hemoglobin release from lysed mouse erythrocytes (CD55 / 59-/-) into the supernatant, measured by photometric method) is illustrated.</p><p> (Table 12) CH expressed as serum concentration₅₀value<img file="JP2020037568A_D0040.tif" />Note: "CH₅₀Is the point where complement-mediated hemolysis reached 50%.</p><p> In summary, the results of this example demonstrate that inhibitory MASP-2 inhibits complement-mediated lysis of sensitized and unsensitized erythrocytes with incomplete protection from autologous complement activation. .. Therefore, MASP-2 inhibitors can be used to treat subjects suffering from PNH and are extravascular in PNH patients treated with C5 inhibitors such as eculizumab (Soliris®). It can also be used to ameliorate hemolysis (ie, to inhibit extravasation, prevent extravasation, or reduce the severity of extravasation).</p><p>Example 34 This Example describes a follow-up study to the study described above in Example 29, in which MASP-2 inhibitors such as MASP-2 antibody treat radiation exposure and / or treat acute radiation syndrome, remission. Or provide further evidence that it is effective in prevention.</p><p><u style="single">principle:</u>In the initial study described in Example 29, treated mice with anti-MASP-2 antibody prior to irradiation at both 6.5 Gy and 7.0 Gy exposure levels compared to irradiated mice treated with vehicles. It has been demonstrated that the survival rate of mice is increased. In Example 29, at 6.5 Gy exposure levels, treatment with anti-MASP-2 antibody after irradiation was further demonstrated to moderately increase survival compared to vehicle-controlled animals. This example describes another radiation study conducted to confirm the results of the first study.</p><p><u style="single">Method:</u><u style="single">Study A Design:</u> Swiss Webster mice (n = 50) were exposed to ionizing radiation (8.0 Gy). The effect on mortality of anti-MASP-2 antibody therapy (mAbH6 5 mg / kg) performed 18 hours before and 2 hours after radiation exposure and then weekly was evaluated.</p><p><u style="single">Study A Results:</u> As shown in FIG. 43, administration of the anti-MASP-2 antibody mAbH6 increased survival in mice exposed to 8.0 Gy, with adjusted median survival compared to mice fed vehicle control. Increased from day 4 to day 6, mortality was reduced by 12% compared to vehicle-controlled mice (Logrank test, p = 0.040).</p><p><u style="single">Study B Design:</u> Swiss Webster mice (n = 50) were exposed to ionizing radiation (8.0 Gy) in the following groups: (I: vehicle) saline control; (II: low) anti-MASP-2 antibody mAbH6 (5 mg / kg) ) Was administered 18 hours before and 2 hours after irradiation; (III; high) mAbH6 (10 mg / kg) was administered 18 hours before and 2 hours after irradiation; and (IV: high, after irradiation) mAbH6 (10 mg / kg) ) Is administered only 2 hours after irradiation.</p><p><u style="single">Study B Results:</u> Administration of anti-MASP-2 antibody before and after irradiation adjusted the mean survival to 4 to 5 days compared to animals fed vehicle controls. Mortality in anti-MASP-2 antibody-treated mice was reduced by 6-12% compared to vehicle control mice. Furthermore, note that no significant and detrimental therapeutic effects were observed (data not shown).</p><p> In summary, the results shown in this example are consistent with the results shown in Example 29. This further demonstrates that anti-MASP-2 antibodies are effective in the treatment of mammalian subjects at risk of adverse effects of acute radiation syndrome or those suffering from adverse effects of acute radiation syndrome. ..</p><p>Example 35 This study examines the effect of MASP-2-deficiency in a mouse model of LPS (lipopolysaccharide) -induced thrombosis.</p><p><u style="single">principle:</u> Hemolytic uremic syndrome (HUS), caused by infection with Shiga toxin-producing Escherichia coli, is the leading cause of acute renal failure in children. In this example, LPS-induced thrombosis (microscopic) in MASP-2-/-(KO) mice to determine if MASP-2 inhibition is effective in inhibiting or preventing the formation of intravascular thrombi. A Schwartzmann model of thrombus) was performed.</p><p><u style="single">Method:</u> MASP-2-/-(n = 9) and WT (n = 10) mice were analyzed in a Schwartzman model of LPS-induced thrombosis (microvascular coagulation). Serratia LPS was administered to mice and thrombus formation was monitored over time. The incidence of microthrombus and LPS-induced microvascular coagulation was compared.</p><p><u style="single">result:</u> In particular, after Serratia LPS, all MASP-2-/-mice tested (9/9) did not form intravascular thrombi. In contrast, microthrombus was detected in 7 of the 10 WT mice tested simultaneously (p = 0.0031, Fisher's exact test). As shown in FIG. 44, the time to onset of microvascular occlusion after LPS infection was measured in MASP-2-/-mice and WT mice. The percentage of WT mice with thrombus formation measured over 60 minutes was shown, and thrombus formation was detected as early as about 15 minutes. Up to 80% of WT mice showed thrombus formation in 60 minutes. In contrast, as shown in Figure 44, none of MASP-2-/-was thrombus formation at 60 minutes (log rank: p = 0.0005).</p><p> These results demonstrate that MASP-2 inhibition prevents the development of intravascular thrombus in the HUS model.</p><p>Example 36 This example describes the effect of anti-MASP-2 antibody in a HUS mouse model using simultaneous intraperitoneal injection of purified Shiga toxin 2 (STX2) + LPS.</p><p><u style="single">background:</u> A HUS mouse model was developed using simultaneous intraperitoneal injection of purified Shiga toxin 2 (STX2) + LPS. Biochemical and microarray analysis of mouse kidneys revealed that STX2 + LPS exposure was different from the effects of either agent alone. Blood and serum analysis of these mice showed neutrophilia, thrombocytopenia, erythrocyte hemolysis, and increased serum creatinine and blood urea nitrogen. In addition, histological analysis of mouse kidneys and electron microscopy demonstrated glomerular fibrin deposition, erythrocyte congestion, microthrombosis, and glomerular ultrafine changes. This HUS model has been shown to induce all clinical manifestations of human HUS pathology in C57BL / 6 mice, including thrombocytopenia, hemolytic anemia, and renal failure, which define human disease (J. Immunol. 187 (1): 172-80 (2011)).</p><p><u style="single">Method:</u> C57BL / 6 female mice weighing 18-20 g were purchased from Charles River Laboratories and divided into two groups (5 mice in each group). One group of mice was pretreated by intraperitoneal (ip) injection with recombinant anti-MASP-2 antibody mAbM11 (100 μg / mouse; corresponding to the final concentration of 5 mg / kg body weight) diluted in 150 μl saline. Control groups were fed saline solution without any antibody. Six hours after ip injection of the anti-MASP-2 antibody mAbM11, all mice were dissolved in a total volume of 150 μl, a sublethal dose (3 μg / animal; equivalent to 150 μg / kg body weight) of Serratia marcescens LPS. Combined ip injections of (L6136; Sigma-Aldrich, St. Louis, MO) and STX2 (twice the LD50 dose) at a dose of 4.5 ng / animal (corresponding to 225 ng / kg) were given. Saline injection was used as a control.</p><p> Mouse survival was monitored every 6 hours after administration. Mice were screened as soon as they reached the lethargic stage of HUS pathology. After 36 hours, all mice were screened and both kidneys were removed for immunohistochemistry and scanning electron microscopy. Blood samples were taken by cardiac puncture at the end of the experiment. Serum was isolated and kept frozen at -80 ° C to measure BUN and serum creatinine levels in the treatment and control groups.</p><p><u style="single">Immunohistochemistry:</u> One-third of each mouse kidney was fixed with 4% paraformaldehyde for 24 hours, treated and paraffin-embedded. Sections 3 micrometers thick were cut and placed on charged slides for later staining with HE stain.</p><p><u style="single">electronic microscope:</u> Approximately 1-2 mm in the central part of the kidney³It was cut into blocks and fixed overnight at 4 ° C with 2.5% glutaraldehyde dissolved in 1 × PBS. The University of Leicester Electron Microscopy Facility then processed the fixative.</p><p><u style="single">Cryostat intercept:</u> Approximately 1-2 mm for the remaining 1/3 of the kidney³It was cut into blocks of liquid nitrogen, instantly frozen in liquid nitrogen, and kept at -80 ° C for cryostat sections and mRNA analysis.</p><p><u style="single">result:</u> FIG. 45 illustrates the percentage of survival (time) over time in saline-treated control mice (n = 5) and anti-MASP-2 antibody-treated mice (n = 5) in a model induced by STX / LPS. .. In particular, as shown in Figure 45, all control mice died by 42 hours. In contrast, 100% anti-MASP-2 antibody-treated mice survived throughout the time of the experiment. Consistent with the results shown in Figure 45, all untreated mice that had died or had to be thinned out due to signs of serious illness had severe glomerular damage, whereas all Glomeruli in anti-MASP-2 treated mice were observed to appear normal (data not shown). Based on these results, subjects suffering from thrombotic microangiopathy (TMA), such as hemolytic uremic syndrome (HUS), atypical HUS (aHUS), or thrombotic thrombocytopenic purpura (TTP), Alternatively, it is demonstrated that MASP-2 inhibitors such as anti-MASP-2 antibodies can be used to treat subjects at risk of developing TMA, such as HUS, aHUS, or TTP.</p><p>Example 37 This example describes the effects of MASP-2 deficiency and MASP-2 inhibition in a mouse FITC-dextran / photoinduced endothelial cell injury model of thrombosis.</p><p><u style="single">Background / Principle:</u>Mice are protected in a typical HUS model by MASP-2 deficiency (MASP-2 KO) and MASP-2 inhibition (via administration of inhibitory MASP-2 antibody), as demonstrated in Example 35 and Example 36. In contrast, all control mice exposed to STX and LPS developed severe HUS, became moribund, and died within 48 hours. For example, all mice treated with MASP-2 inhibitory antibody and then exposed to STX and LPS survived (Fisher's exact p &lt;0.01; N = 5), as shown in Figure 54. Therefore, anti-MASP-2 therapy protects mice in this HUS model.</p><p> Fluorescein isothiocyanate (FITC) -dextran induction of thrombotic microangiopathy (TMA) with the aim of further demonstrating the benefits of MASP-2 inhibitors to treat TMA with HUS, aHUS, TTP, and other causes. The following experiments were performed to analyze the effects of MASP-2 deficiency and MASP-2 inhibition in a model of sexual endothelial cell damage.</p><p><u style="single">Method:</u>Biomicroscopic Observation Mice were prepared for biomicroscopic observation as described in Frommhold et al., BMC Immunology 12: 56-68, 2011. Briefly, ketamine (125 mg / kg body weight, Ketanest, Pfitzer GmbH, Karlsruhe, Germany) and xylazine (12.5 mg / kg body weight; Mice were anesthetized by intraperitoneal (ip) injection of Rompun, Bayer, Leverkusen, Germany) and placed on a heating pad to maintain body temperature at 37 ° C. Biomicroscopic observations were performed on an upright microscope (Leica, Wetzlar, Germany) equipped with a saline immersion objective (SW40 / 0.75 numerical aperture, Zeiss, Jena, Germany). Mice were intubated using a PE90 tube (Becton Dickson and Company, Sparks, MD, USA) to facilitate breathing. The left carotid artery was cannulated using a PE10 tube (Becton Dickson and Company, Sparks, MD, USA) for blood sampling and administration of systemic monoclonal antibody (mAb).</p><p>Cremaster muscle preparation As described in Sperandio et al., Blood, 97: 3812-3819, 2001, the cremaster muscle was surgically prepared for biomicroscopic observation. Briefly, the scrotum was dissected and the cremaster muscle was immobilized. After making a longitudinal incision and spreading the muscles on the cover glass, the epididymis and testis were moved and pinned to the sides so that all microcirculation of the cremaster muscle was visible under a microscope. The venules of the cremaster muscle were recorded by a CCD camera (CF8 / 1; Kappa, Gleichen, Germany) mounted on the Panasonic S-VHS recorder. As previously described by Frommhold et al., BMC Immunology 12: 56-68, 2011 2011, temperature controlled (35 ° C bicarbonate buffer saline) was perfused into the cremaster muscle.</p><p>Photoexcited FITC dextran injury model Controlled light beam-dependent vascular injury of the cremaster venules and arteriole endothelium by phototoxicity (FITC) -dextran (Cat. Induced. This procedure causes local thrombosis. As a phototoxic reagent, 60 μL of a 10% w / v solution of FITC-dextran was injected through the left carotid access and spread homogeneously throughout the circulating blood for 10 minutes. After selecting well-perfused venules, low to induce FITC-dextran fluorescence and low to moderate phototoxicity to the endothelial surface in order to stimulate thrombosis in a reproducible and controlled manner. ~ Medium intensity (800 ~ 1500) halogen light was concentrated on the blood vessels of interest. Halogen lamp (12V, 100W, Zeiss, Oberkochen, Germany) was used to generate the phototoxic light intensity required to excite FITC-dextran. Phototoxicity due to photoinduced excitation of fluorescent dyes requires a certain threshold of light intensity and / or irradiation period, by directly heating the endothelial surface, or by Steinbauer et al., Langenbecks Arch Surg 385: 290- Caused by the generation of reactive oxygen radicals as described in 298, 2000.</p><p> The intensity of light applied to each vessel was measured by a wavelength correction diode detector (Labmaster LM-2, Coherent, Auburn, USA) for low power measurements for adjustment. Offline analysis of video scans was performed by a computer-assisted microcirculation analysis system (CAMAS, Dr. Zeintl, Heidelberg). Red blood cell velocities were measured as described in Zeintl et al., Int J Microcirc Clin Exp, 8 (3): 293-302, 2000.</p><p>Application of Monoclonal Anti-Human MASP-2 Inhibition Antibodies (mAbH6) and Vehicle Controls Before Thrombosis Induction 16 hours prior to the induction of thrombosis phototoxicity in a biomicroscopic cremaster muscle model using a blinded study design. 9-week-old male C57BL / 6 WT littermate mice were given a recombinant monoclonal human MASP-2 antibody (mAbH6) (given at a final concentration of 10 mg / kg body weight) or an equal dose of a MASP-2 functional activity inhibitor. An isotype control antibody (without MASP-2 inhibitory activity) was injected by ip. Another dose of mAbH6 or control antibody was given 1 hour before the induction of thrombosis. MASP-2 knockout (KO) mice were also evaluated in this model.</p><p> mAbH6 (created for recombinant human MASP-2) is a potent human MASP-2 functional activity inhibitor that cross-reacts with mouse MASP-2 due to species specificity and binds to mouse MASP-2. However, it inhibits mouse MASP-2, but its affinity is low (data not shown). To compensate for the low affinity of mAbH6 for mouse MASP-2, to overcome changes in species specificity and low affinity for mouse MASP-2 to effectively interfere with mouse MASP-2 functional activity under in vivo conditions. Was given a high concentration of mAbH6 (10 mg / kg body weight).</p><p> This blind study recorded the time required for complete occlusion of each individual venule tested (selection criteria were based on comparable diameter and blood flow velocity). ..</p><p> Biomicroscopic observation video recordings were used to assess the percentage of mice with microvascular occlusion, time to onset, and time to occlusion over a 60-minute observation period.</p><p><u style="single">result:</u> FIG. 46 shows in a FITC / dextran UV model after injury induction after treatment with an isotype control or human MASP-2 antibody mAbH6 (10 mg / kg) administered 16 hours and 1 hour before FITC / dextran injection. The percentage of mice with microvascular occlusion as a function of time is illustrated. As shown in FIG. 46, 85% of wild-type mice fed the isotype control antibody occluded in 30 minutes or less, whereas wild-type mice pretreated with the human MASP-2 antibody (mAbH6). Only 19% had obstruction within the same period. The time to occlusion was prolonged in mice that were finally occluded in the human MASP-2 antibody-treated group. Furthermore, it should be noted that 3 of the MASP-2 mAbH6 treated mice did not occlude at all (ie, protected from thrombotic obstruction) within the 60 minute observation period.</p><p> FIG. 47 illustrates the occlusion time in minutes of mice treated with human MASP-2 antibody (mAbH6) and mice treated with isotype control antibody. The data were reported as scatter dots with mean (horizontal bars) and standard error bars (vertical bars). This figure shows the occlusion time in mice in which occlusion could be observed. Therefore, three MASP-2 antibody-treated mice that did not occlude during the 60-minute observation were not included in this analysis (no control-treated mice did not occlude). The statistical test used for the analysis was an independent t-test. symbol"^*"Indicates p = 0.0129. As shown in FIG. 47, in four occluded MASP-2 antibody (mAbH6) treated mice, thrombotic FITC-dextran / light with low light intensity (800-1500) by MASP-2 antibody treatment. The venous occlusion time in the inducible endothelial cell injury model was significantly extended compared to mice treated with the isotype control antibody. The mean complete occlusion time of the isotype control was 19.75 minutes, whereas the average complete occlusion time of the MASP-2 antibody-treated group was 32.5 minutes.</p><p> FIG. 48 shows wild-type mice, MASP-2 KO mice, and 16 hours prior to thrombosis induction in a FITC-dextran / photoinduced endothelial cell injury model of thrombosis using low light intensity (800-1500). The time to occlusion of human MASP-2 antibody (mAbH6) pretreated wild-type mice by ip administration of 10 mg / kg and then iv administration 1 hour before is shown in minutes. Figure 48 included only occluded animals. N = 2 for wild-type mice fed isotype-controlled antibody; n = 2 for MASP-2 KO; and n = 4 for wild-type mice fed human MASP-2 antibody (mAbH6). symbol"^*"Indicates p &lt;0.01. As shown in FIG. 48, FITC-dextran / photo-induced endothelial cell damage in thrombosis with low light intensity (800-1500) due to MASP-2 deficiency and MASP-2 inhibition (10 mg / kg mAbH6). The venous occlusion time in the model was extended.</p><p><u style="single">Conclusion:</u> From the results of this example, MASP-2 inhibitors that block the lectin pathway (eg, antibodies that block MASP-2 function) are a prominent feature of many microangiopathy in the TMA mouse model. It is further demonstrated to inhibit coagulation and thrombosis. Therefore, administration of MASP-2 inhibitors, such as MASP-2 inhibitory antibodies, is an effective therapy in patients suffering from HUS, aHUS, TTP, or other microangiopathy, and microvascular coagulation and thrombosis. Expected to prevent.</p><p>Example 38 This Example describes a study that demonstrated that human MASP-2 inhibitory antibody (mAbH6) did not affect platelet function in platelet-rich human plasma.</p><p><u style="single">Background / Principle:</u>Demonstration that MASP-2 inhibition with human MASP-2 inhibitory antibody (mAbH6) prolongs venous occlusion time in a FITC-dextran / photoinduced endothelial cell injury model of thrombosis, as described in Example 37. Was done. The following experiments were performed to determine whether the MASP-2 inhibitory antibody (mAbH6) affects platelet function.</p><p> METHODS: The effect of human mAb H6 MASP-2 antibody on ADP-induced platelet aggregation was tested as follows. 40 μL of a solution of human MASP-2 mAbH6 at a concentration of 1 μg / ml or 0.1 μg / ml was added to 360 μL of freshly prepared platelet-rich human plasma. An isotype control antibody was used as the negative control. Platelet activation was induced by adding ADP with a final concentration of 2 μM after addition of the antibody to plasma. The assay was initiated by stirring the solution in a 1 mL cuvette with a small magnet. Platelet aggregation was measured with a 2-channel Chrono-log Platelet Aggregometer Model 700 Whole Blood / Optical Lumi-Aggregometer.</p><p><u style="single">result:</u> Percentage of agglutination in solution was measured over 5 minutes. The results are shown in Table 13 below.</p><p> (Table 13) Platelet aggregation over 5 minutes<img file="JP2020037568A_D0041.tif" /></p><p> As shown in Table 13 above, no significant difference was observed between aggregation of ADP-induced platelets treated with control antibody or MASP-2 mAb H6 antibody. These results demonstrate that human MASP-2 antibody (mAbH6) does not affect platelet function. Thus, described in Example 37, which demonstrated that MASP-2 inhibition with a human MASP-2 inhibitory antibody (mAbH6) prolongs venous occlusion time in a FITC-dextran / photoinduced endothelial cell injury model of thrombosis. The results were not due to the effect of mAbH6 on platelet function. Therefore, MASP-2 inhibition blocks thrombosis without directly affecting platelet function. From this, a treatment mechanism different from that of existing antithrombotic agents was clarified.</p><p>Example 39 This example describes the effect of MASP-2 inhibition on thrombus formation and vascular occlusion in a TMA mouse model.</p><p><u style="single">Background / Principle</u>: The lectin pathway plays a central role in complement system activation in the context of endothelial cell stress or damage. This activation is rapidly amplified by a dysfunctional second pathway in many patients with aHUS. Therefore, blocking activation of the MASP-2 and lectin pathways is expected to stop a series of enzymatic reactions leading to complement membrane attack complex formation, platelet activation, and leukocyte recruitment. This effect limits tissue damage.</p><p> In addition, MASP-2 has factor Xa-like activity and cleaves prothrombin to form thrombin. This activation of the coagulation system driven by MASP-2 imbalances hemostasis and may cause the pathology of TMA. Therefore, inhibition of MASP-2 with MASP-2 inhibitors that block the activation of the complement and coagulation systems, such as MASP-2 inhibitory antibodies, is expected to improve outcomes in aHUS and other TMA-related conditions. To.</p><p> As described in Example 37, MASP-2 inhibition with human MASP-2 inhibitory antibody (mAbH6) prolonged venous occlusion time in the FITC-dextran / photo-induced endothelial cell injury model of thrombosis. Proven. In this TMA model, IV injections of FITC-dextran sensitized mice, followed by local photoactivation of FITC-dextran in the microvasculature of the cremaster muscle of mice (Thorlacius H et al). ., Eur J Clin. Invest 30 (9): 804-10, 2000; Agero et al., Toxicon 50 (5): 698-706, 2007).</p><p> In a TMA mouse model, the following experiments were performed to determine whether the MASP-2 inhibitory antibody (mAbH6) had a dose-response effect on thrombus formation and vascular occlusion.</p><p><u style="single">Method:</u>Photoactivation of fluorescein isothiocyanate-labeled dextran (FITC-dextran) induced local thrombosis in the microvasculature of the cremaster muscle of C57Bl / 6 mice. The expression of thrombus formation and vascular occlusion was measured using biomicroscopic observation using the method described in Example 37 and the following modifications. Mice were administered mAbH6 (2 mg / kg, 10 mg / kg, or 20 mg / kg) or isotype control antibody (20 mg / kg) by intravenous (iv) injection 1 hour prior to TMA induction. The time to onset of thrombus formation and the time to complete vascular occlusion were recorded. Using video reproduction analysis of biomicroscopic observation images recorded over 30-60 minutes, blood vessel size, blood flow velocity, light intensity, rate of thrombus formation, which is equivalent to platelet adhesion, time to thrombus formation, The rate of complete vascular occlusion and the time to complete vascular occlusion were evaluated. Statistical analysis was performed using SigmaPlot v12.0.</p><p><u style="single">result</u>:<u style="single">Start of thrombus formation</u> Figure 49 shows the time in FITC-dextran-induced thrombotic microangiopathy mice treated with increasing doses of human MASP-2 inhibitory antibody (2 mg / kg, 10 mg / kg, or 20 mg / kg mAbH6) or isotype control antibody. It is a Kaplan-Meier plot showing the percentage of mice with thrombus as a function. As shown in FIG. 49, the initiation of thrombus formation was delayed in a dose-dependent manner in mAbH6-treated mice compared to control-treated mice.</p><p> FIG. 50 illustrates the median time to onset of thrombus formation as a function of mAbH6 dose (minutes) (^*P &lt;0.01 compared to the control). As shown in FIG. 50, the median time to onset of thrombus formation increased from 6.8 minutes in the control group to 17.7 minutes in the 20 mg / kg mAbH6 treatment group with increasing doses of mAbH6 (p &lt;0.01). The underlying experimental data and statistical analysis are shown in Tables 14 and 15.</p><p> The time to thrombus formation in each mouse recorded based on the evaluation of videographic recording is detailed in Table 14 below.</p><p> (Table 14) Time to thrombus formation after photopigment-induced injury<img file="JP2020037568A_D0042.tif" />^*Blood vessels showed no expression during the indicated observation period.</p><p> A statistical analysis comparing the time to onset of obstruction between controls and mAbH6-treated animals is shown in Table 15 below.</p><p> (Table 15) Time to onset: Data from FITC Dex dose-response study<img file="JP2020037568A_D0043.tif" />Event = Median time to onset observed (minutes) and its 95% CI were based on the Kaplan-Meier estimation method. NE = unpresumable^*The p-value was adjusted by Dunnett-Hsu multiplex comparison.</p><p><u style="single">Microvascular occlusion</u> FIG. 51 shows the time in FITC-dextran-induced thrombotic microangiopathy mice treated with increasing doses of human MASP-2 inhibitory antibody (2 mg / kg, 10 mg / kg, or 20 mg / kg mAbH6) or isotype control antibody. It is a Kaplan-Meier plot showing the percentage of mice with microvascular occlusion as a function. As shown in FIG. 51, complete microvascular occlusion in the mAbH6 treatment group was delayed compared to control mice.</p><p> FIG. 52 illustrates the median time to microvascular occlusion as a function of mAbH6 dose (^*Compared to the control, p &lt;0.05). As shown in Figure 52, the median time to complete microvascular occlusion increased from 23.3 minutes in the control group to 38.6 minutes in the 2 mg / kg mAb H6 treatment group (p &lt;0.05). Similar to the 2 mg / kg mAbH6 treatment group, 10 mg / kg or 20 mg / kg mAbH6 was administered (median time to complete microvessel obstruction was 40.3 and 38 minutes, respectively). The underlying experimental data and statistical analysis are shown in Tables 16 and 17.</p><p> The time to complete vascular occlusion in each mouse recorded based on the primary evaluation of videographic recording is detailed in Table 16 below.</p><p> (Table 16) Time to complete occlusion after photopigment-induced injury<img file="JP2020037568A_D0044.tif" />^*Blood vessels were not completely occluded during the indicated observation period.</p><p> A statistical analysis comparing the time to complete occlusion between controls and mAbH6-treated animals is shown in Table 17 below.</p><p> (Table 17) Time to complete microvascular occlusion: Data from FITC Dex dose-response study<img file="JP2020037568A_D0045.tif" />Event = Median time to observed obstruction (minutes) and its 95% CI were based on the Kaplan-Meier estimation method. NE = unpresumable^*The p-value was adjusted by Danette-F multiple comparison.</p><p><u style="single">Overview</u> As summarized in Table 18, initiation of thrombus formation was delayed in a dose-dependent manner in mAbH6-treated mice compared to control-treated mice (median time to onset 10.4 to 17.7 min vs. 6.8 min). The median time to complete occlusion was significantly delayed in the total mAbH6 treatment group compared to the control treatment group (Table 18).</p><p> (Table 18) Median time to onset of thrombus formation and complete occlusion<img file="JP2020037568A_D0046.tif" />#Median was based on Kaplan-Meier estimation.^*P &lt;0.05 compared to control (Wilcoxon adjusted by Danette F for multiple comparisons).</p><p> These results demonstrate that mAbH6, a human monoclonal antibody that binds to MASP-2 and blocks the lectin pathway of the complement system, alleviated microvascular thrombosis in a dose-dependent manner in an experimental mouse model of TMA. .. Therefore, administration of MASP-2 inhibitors, such as MASP-2 inhibitory antibodies, may result in HUS, aHUS, TTP, or other microangiopathy, such as fulminant antiphospholipid antibody syndrome (CAPS), systemic degoss disease, It is an effective therapy in patients suffering from TMA secondary to cancer, TMA secondary to cancer chemotherapy, and other TMA including TMA secondary to transplantation, and is expected to prevent microangiopathy and thrombosis. To.</p><p>Example 40 This example binds to MASP-2 and lectin-mediated complement activity, leaving the classical (C1q-dependent) and second pathway components of the immune system intact. It will be described to identify a fully human scFv antibody that inhibits the formation using a phage display.</p><p><u style="single">Outline</u>: Full human high affinity MASP-2 antibody was identified by screening the phage display library. Variable light chain and variable heavy chain fragments of the antibody were isolated in scFv and full-length IgG formats. Human MASP-2 antibody inhibits cell damage associated with complement second pathway activation via the lectin pathway, while leaving the classical (C1q-dependent) pathway components of the immune system intact. It is useful for. In some embodiments, the MASP-2 inhibitory antibody has the following characteristics: (a) High affinity for human MASP-2 (eg, 10 nM or less K_D), And (b) ICs of 30nM or less₅₀Inhibiting MASP-2-dependent complement activity in 90% human serum.</p><p><u style="single">Method</u>: Full-length catalytically inactive MASP-2 expression: Mammalian expression of the human MASP-2 full-length cDNA sequence (SEQ ID NO: 4) and leader sequence (SEQ ID NO: 5) encoding the human MASP-2 polypeptide. It was subcloned into the vector pCI-Neo (Promega). The mammalian expression vector pCI-Neo (Promega) drives expression in eukaryotes under the 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)).</p><p> To generate the catalytically inert human MASP-2A protein, site-directed mutagenesis was performed as described in US 2007/0172483, which is incorporated herein by reference. PCR products were purified after agarose gel electrophoresis and band preparations and 1 adenosine overlaps were made using standard tailing methods. The adenosine tail MASP-2A was then cloned into the pGEM-T easy vector and transformed into E. coli. Human MASP-2A was further subcloned into either the mammalian expression vector pED or pCI-Neo.</p><p> The above MASP-2A expression construct was introduced into DXB1 cells using a standard calcium phosphate transfection method (Maniatis et al., 1989). MASP-2A was produced in serum-free medium to ensure that the preparation was not contaminated with other serum proteins. Medium was collected from confluent cells every other day (4 times in total). The average recombinant MASP-2A level was about 1.5 mg per liter of culture medium. MASP-2A (the Ser-Ala mutant described above) was purified by affinity chromatography using an MBP-A-agarose column.</p><p>MASP-2A ELISA for ScFv candidate clones identified by panning / scFv conversion and filter screening A phage display library of human immunoglobulin light chain variable region sequences and heavy chain variable region sequences was subjected to antigen panning, followed by human MASP-2. Automated antibody screening and selection was performed to identify high affinity scFv antibodies to the protein. Three scFv phage library pannings were performed on HIS-tagged MASP-2A or biotin-tagged MASP-2A. The third panning was first eluted with MBL and then with TEA (alkaline). Polyclonal phage ELISA against immobilized MASP-2A was performed to monitor specific enrichment of phage showing scFv fragments against target MASP-2A. The scFv gene from the third panning was cloned into a pHOG expression vector and subjected to small scale filter screening to look for specific clones for MASP-2A.</p><p> Bacterial colonies containing the plasmid encoding the scFv fragment from the third panning were pecked, gridded on a nitrocellulose membrane and grown overnight on non-inducible medium to make a master plate. A total of 18,000 colonies were pecked and analyzed from the third panning. Half came from competitive elution and half came from subsequent TEA elution. Panning of the scFv phagemid library for MASP-2A followed by scFv conversion and filter screening yielded 137 positive clones. 108 of the 137 clones were positive in the Elisa assay for MASP-2 binding (data not shown). Forty-five of these clones were further analyzed for their ability to interfere with MASP-2 activity in normal human serum.</p><p>Assay Methods for Measuring Inhibition of Lectin Pathway C3 Convertase Formation The "blocking activity" of MASP-2 scFv candidate clones was evaluated using a functional assay method for measuring inhibition of lectin pathway C3 convertase formation. MASP-2 serine protease activity is required to produce the two protein components (C4b, C2a) that make up the lectin pathway C3 convertase. Therefore, MASP-2 scFv (ie, blocking MASP-2 scFv), which inhibits MASP-2 functional activity, inhibits the novel formation of the lectin pathway C3 convertase. C3 contains a rare highly reactive thioester group as part of its structure. When C3 is cleaved by C3 convertase in this assay, the thioester groups on C3b are hydroxyl or amino groups on the polymer immobilized at the bottom of the plastic well via ester or amide bonds. Can form covalent bonds with and thus facilitate C3b detection in ELISA assays.</p><p> Yeast mannan is a known lectin pathway activator. In the following method of measuring the formation of C3 convertase, mannan-coated plastic wells were incubated with diluted human serum to activate the lectin pathway. Wells were then washed and assayed for C3b immobilized on the wells using standard ELISA methods. The amount of C3b produced in this assay directly reflects the novel formation of the lectin pathway C3 convertase. This assay tested the ability of selected concentrations of MASP-2 scFv clones to inhibit C3 convertase formation and the resulting C3b production.</p><p><u style="single">Method</u>: Express the 45 candidate clones identified above, purify, dilute to the same stock concentration, and ensure that all clones have an equal volume of buffer Ca.⁺⁺And Mg⁺⁺GVB buffer (4.0 mM barbital, 141 mM NaCl, 1.0 mM MgCl)₂, 2.0mM CaCl₂, 0.1% gelatin, pH 7.4). Each scFv clone was tested in triads at a concentration of 2 μg / mL. The positive control was OMS100 Fab2, tested at 0.4 μg / mL. C3c formation was monitored in the presence and absence of scFv / IgG clones.</p><p> Mannan, 50 mM carbonate buffer (15 mM Na)₂CO₃+ 35mM LVDS₃+ 1.5mM NaN₃), Dilute to a concentration of 20 μg / mL (1 μg / well) at pH 9.5 and coat the ELISA plate overnight at 4 ° C. The next day, the mannan coating plate was washed 3 times with 200 μl PBS. 100 μl of 1% HSA blocking solution was then added to the wells and incubated for 1 hour at room temperature. The plate was washed 3 times with 200 μl PBS and stored on ice with 200 μl PBS added until sample addition.</p><p> Normal human serum was diluted to 0.5% with CaMgGVB buffer and added to this buffer in triplets at 0.01 μg / mL; 1 μg / mL (OMS100 control only) and 10 μg / mL with scFv clones or OMS100 Fab2 positive controls. And after 45 minutes pre-incubation on ice, added to the blocked ELISA plate. The reaction was initiated by incubation at 37 ° C for 1 hour. The reaction was stopped by transferring the plate to an ice bath. C3b deposition was detected using goat α-rabbit HRP after rabbit α-mouse C3c antibody. The negative control was antibody-free buffer (no antibody = maximum C3b deposition). The positive control was a buffer containing EDTA (no C3b deposition). Background was determined by performing the same assay, except that the wells did not contain mannan. The background signal for the mannan-free plate was subtracted from the mannan-containing well signal. The cutoff criteria were set to half the activity of unrelated scFv clones (VZV) and buffer alone.</p><p><u style="single">result</u>: Based on cutoff criteria, a total of 13 clones were found to interfere with MASP-2 activity. All 13 clones that produced&gt; 50% pathway suppression were selected and sequenced to give 10 unique clones. All 10 clones were found to have the same light chain subclass, λ3, but were found to have three different heavy chain subclasses: VH2, VH3, and VH6. In the functional assay, 5 out of 10 candidate scFv clones are less than the 25 nM target criteria using 0.5% human serum.₅₀The nM value is shown.</p><p> To identify antibodies with improved efficacy, the three mother scFv clones identified above were subjected to light chain shuffling. This process involved the production of a combinatorial library of VHs from each mother clone paired with a naive human λ light chain (VL) library from 6 healthy donors. The library was then screened for scFv clones with improved binding affinity and / or function.</p><p> (Table 19) ICs of major daughter clones and their respective mother clones (all in scFv format)₅₀ Comparison of functional effectiveness expressed in (nM)<img file="JP2020037568A_D0047.tif" /></p><p> The heavy chain variable region (VH) sequences of the mother and daughter clones shown in Table 19 above and listed in Tables 20A-F below are shown below.</p><p> The Kabat CDRs (31-35 (H1), 50-65 (H2), and 95-102 (H3)) are shown in bold. The Chothia CDRs (26-32 (H1), 52-56 (H2), and 95-101 (H3)) are underlined.</p><p><u style="single">17D20_35VH-21N11VL Heavy Chain Variable Region (VH) (encoded by SEQ ID NO: 66, SEQ ID NO: 67)</u><img file="JP2020037568A_D0048.tif" /></p><p><u style="single">d17N9 Heavy Chain Variable Region (VH) (SEQ ID NO: 68)</u><img file="JP2020037568A_D0049.tif" /></p><p><u style="single">Heavy chain variable region</u> (Table 20A) Heavy chain (aa1 ~ 20)<img file="JP2020037568A_D0050.tif" /></p><p> (Table 20B) Heavy chain (aa21 ~ 40)<img file="JP2020037568A_D0051.tif" /></p><p> (Table 20C) Heavy chain (aa41 ~ 60)<img file="JP2020037568A_D0052.tif" /></p><p> (Table 20D) Heavy chain (aa61 ~ 80)<img file="JP2020037568A_D0053.tif" /></p><p> (Table 20E) Heavy chain (aa81 ~ 100)<img file="JP2020037568A_D0054.tif" /></p><p> (Table 20F) Heavy chain (aa101 ~ 118)<img file="JP2020037568A_D0055.tif" /></p><p> The light chain variable region (VL) sequences of the mother and daughter clones listed in Tables 21A to F below are shown below.</p><p> Kabat CDR (24 ~ 34 (L1); 50 ~ 56 (L2); and 89 ~ 97 (L3) are shown in bold. Chothia CDR (24 ~ 34 (L1); 50 ~ 56 (L2); and 89 ~ Underlined 97 (L3). These regions are the same whether they are numbered on the Kabat system or the Chothia system.</p><p><u style="single">17D20m_d3521N11 Light chain variable region (VL) (encoded by SEQ ID NO: 69, SEQ ID NO: 70)</u><img file="JP2020037568A_D0056.tif" /></p><p><u style="single">17N16m_d17N9 Light chain variable region (VL) (SEQ ID NO: 71)</u><img file="JP2020037568A_D0057.tif" /></p><p> (Table 21A) Light chain (aa1 ~ 20)<img file="JP2020037568A_D0058.tif" /></p><p> (Table 21B) Light chain (aa21 ~ 40)<img file="JP2020037568A_D0059.tif" /></p><p> (Table 21C) Light chain (aa41-60)<img file="JP2020037568A_D0060.tif" /></p><p> (Table 21D) Light chain (aa61-80)<img file="JP2020037568A_D0061.tif" /></p><p> (Table 21E) Light chain (aa81 ~ 100)<img file="JP2020037568A_D0062.tif" /></p><p> (Table 21F) Light chain (aa101 ~ 120)<img file="JP2020037568A_D0063.tif" /></p><p> The MASP-2 antibodies OMS100 and MoAb_d3521N11VL (including the heavy chain variable region shown in SEQ ID NO: 67 and the light chain variable region shown in SEQ ID NO: 70; also referred to as "OMS646" and "mAbH6") will either Has also been shown to have a high affinity for binding to human MASP-2 and the ability to interfere with functional complement activity, which were analyzed for epitope binding by dot blot analysis. These results indicate that the OMS646 and OMS100 antibodies are highly specific for MASP-2 and do not bind to MASP-1 / 3. Neither antibody bound to MAp19 or a MASP-2 fragment that did not contain the CCP1 domain of MASP-2. From this, it was concluded that the binding site contained CCP1.</p><p> It was determined that the MASP-2 antibody OMS646 strongly binds to recombinant MASP-2 with greater than 5000-fold selectivity compared to C1s, C1r, or MASP-1 (Kd60-250pM) (Table 22 below). Please refer to).</p><p> (Table 22) Affinity and specificity of OMS646 MASP-2 antibody-MASP-2 interaction as assessed by solid-phase ELISA testing<img file="JP2020037568A_D0064.tif" />^*Mean ± SD; n = 12.</p><p><u style="single">OMS646 specifically blocks lectin-dependent terminal complement component activation</u>METHODS: The effects of OMS646 on complement membrane attack complex (MAC) deposition were analyzed using pathway-specific conditions of the lectin, classical, and second pathways. For this purpose, the Wieslab Comp 300 complement screening kit (Wieslab, Lund, Sweden) was used according to the manufacturer's instructions.</p><p><u style="single">result</u>: Figure 53A illustrates the level of MAC deposition in the presence or absence of anti-MASP-2 antibody (OMS646) under lectin pathway-specific assay conditions. FIG. 53B illustrates the level of MAC deposition in the presence or absence of anti-MASP-2 antibody (OMS646) under classical pathway-specific assay conditions. FIG. 53C illustrates the level of MAC deposition in the presence or absence of anti-MASP-2 antibody (OMS646) under second pathway-specific assay conditions.</p><p> As shown in Figure 53A, OMS646 is an IC with approximately 1 nM of MAC deposition activation via the lectin pathway.₅₀Block by value. However, OMS646 did not affect MAC deposition resulting from activation via the classical pathway (Fig. 53B) or MAC deposition resulting from activation via the second pathway (Fig. 53C).</p><p><u style="single">Pharmacokinetics and pharmacokinetics of OMS646 after intravenous (IV) or subcutaneous (SC) administration to mice</u> The pharmacokinetics (PK) and pharmacokinetics (PD) of OMS646 were evaluated in a 28-day single-dose PK / PD study in mice. This study tested subcutaneous (SC) -administered OMS646 at dose levels of 5 mg / kg and 15 mg / kg and intravenous (IV) -administered OMS646 at dose levels of 5 mg / kg.</p><p> For the PK profile of OMS646, FIG. 54 illustrates the OMS646 concentration (n = 3 animal / group mean) as a function of time after administration of the indicated dose of OMS646. As shown in FIG. 54, OMS646 at 5 mg / kg SC reached a maximum plasma concentration of 5-6 ug / mL approximately 1-2 days after administration. The bioavailability of OMS646 at 5 mg / kg SC was approximately 60%. As further shown in FIG. 54, OMS646 at 15 mg / kg SC reached a maximum plasma concentration of 10-12 ug / mL approximately 1-2 days after administration. For all groups, OMS646 was slowly removed from the systemic circulation, with a terminal half-life of approximately 8-10 days. The profile of OMS646 is typical of human antibodies in mice.</p><p> The PD activity of OMS646 is illustrated in Figures 55A and 55B. Figures 55A and 55B show the PD response (decreased systemic lectin pathway activity) of each mouse in the 5 mg / kg IV (Figure 55A) and 5 mg / kg SC (Figure 55B) groups. The dashed line indicates the assay baseline (maximum inhibition; naive mouse serum supplemented with excess OMS646 in vitro prior to assay). As shown in FIG. 55A, systemic lectin pathway activity immediately decreased to almost undetectable levels after IV administration of 5 mg / kg OMS646. Lectin pathway activity showed little recovery over the 28-day observation period. As shown in FIG. 55B, time-dependent inhibition of lectin pathway activity was observed in mice treated with 5 mg / kg OMS646 SC. Within 24 hours of administration of the drug, lectin pathway activity decreased to nearly undetectable levels and remained at low levels for at least 7 days. Lectin pathway activity gradually increased over time, but did not return to pre-dose levels within the 28-day observation period. 15mg / kg The lectin pathway activity vs. time profile observed after administration of SC was similar to the 5 mg / kg SC dose (data not shown). This indicates saturation of the PD endpoint. In addition, the data showed that a weekly dose of 5 mg / kg OMS646 administered either IV or SC was sufficient to achieve continuous suppression of systemic lectin pathway activity in mice.</p><p>Example 41 In this example, the MASP-2 inhibitory antibody (OMS646) was obtained after exposure to serum from a patient with this disease obtained during the acute and remission phase of atypical hemolytic urinary toxicosis syndrome (aHUS). It has been demonstrated to inhibit aHUS serum-induced complement C5b-9 deposition on the surface of human microvascular endothelial cells (HMEC-1).</p><p><u style="single">Background / Principle</u>: Obtained during the (1) acute phase and (2) remission phase of the disease in the presence or absence of OMS646, a MASP-2 antibody that specifically binds to MASP-2 and inhibits lectin pathway activation. The following tests were performed to analyze aHUS serum-induced complement C5b-9 deposition on the surface of activated HMEC-1 cells after exposure to aHUS patient serum.</p><p><u style="single">Method:</u><u style="single">patient</u>: For this study, it is included in the International Registry of HUS / TTP, Mario Negri Institute, Laboratory of Immunology and Genetics of Transplantation and Among the aHUS patients genetically identified by the Rare Diseases of the Mario Negri Institute, four aHUS patients to be tested during the acute phase and remission of the disease were selected. One aHUS patient had a heterozygous p.R1210C factor H (CFH) mutation, one aHUS patient had anti-CFH autoantibodies, but two other aHUS patients No CFH mutations or antibodies were found in.</p><p> Tables 23 and 24 summarize the results of screening for complement gene mutations and anti-CFH autoantibodies in the four aHUS patients analyzed in this study, as well as clinical and biochemical data measured during the acute phase or during remission. Is.</p><p> (Table 23) Clinical parameters of 4 aHUS patients in this study<img file="JP2020037568A_D0065.tif" />Note: na = Not available.</p><p> (Table 24) Complement parameters of 4 aHUS patients in this study<img file="JP2020037568A_D0066.tif" /></p><p><u style="single">experimental method</u>: Cells derived from dermis-derived human microvascular endothelial cell line (HMEC-1) were plated on glass slides and used in the confluent case. 10 μM confluent HMEC-1 cells Activated with ADP (adenosine diphosphate) for 10 minutes and then collected in the acute phase of the disease from the 4 aHUS patients listed above in Tables 23 and 24 or the same aHUS patients in remission or 4 healthy patients. Incubated with serum from the control subject for 4 hours. In the presence or absence of the MASP-2 inhibitory antibody OMS646 (100 μg / mL) prepared as in Example 40 above, or in the presence or absence of complement inhibition, soluble complement receptor 1 ( Serum was diluted 1: 2 in test medium (HBSS with 0.5% BSA) in the presence of sCR1) (150 μg / mL). At the end of the incubation phase, HMEC-1 cells were treated with rabbit anti-human complement C5b-9 followed by FITC-binding secondary antibody. In each experiment, sera from one healthy control were tested at the same time as aHUS patient sera (acute phase and remission). A confocal inverted laser scanning microscope was used to obtain fluorescent staining on the surface of endothelial cells. 15 fields of view are acquired for each sample, and automatic edge detection (edge) is performed using a specific function built into the software ImageJ. Pixels per field of view analyzed by evaluating the area occupied by fluorescent staining by detection)²It was represented by. The fields of view showing the lowest and highest values were excluded from the calculation.</p><p> 13 visual field pixels considered in each experimental condition for each patient and control for statistical analysis (one-way ANOVA followed by Tukey's test for multiple comparisons)²The result shown in is used.</p><p><u style="single">result:</u> The results of complement deposition analysis using sera from 4 aHUS patients are summarized in Table 25A below. The results using sera from 4 healthy subjects are summarized in Table 25B below.</p><p> (Table 25A) Effect of complement inhibitor on aHUS serum-induced C5b-9 deposition on ADP-activated HMEC-1 cells<img file="JP2020037568A_D0067.tif" /></p><p> (Table 25B) Effect of complement inhibitors on sera from 4 healthy controls (not affected by aHUS) on C5b-9 deposition on ADP-activated HMEC-1 cells<img file="JP2020037568A_D0068.tif" /></p><p> For Table 25A and Table 25B, the data are mean ± SE. ° P &lt;0.001 contrast;^*P &lt;0.001,^**P &lt;0.01 vs. aHUS acute phase untreated; §P &lt;0.001, §§P &lt;0.01, §§§P &lt;0.05 vs. aHUS untreated in remission phase.</p><p> FIG. 56 illustrates the inhibitory effect of MASP-2 antibody (OMS646) and sCR1 on aHUS serum-induced C5b-9 deposition on ADP-activated HMEC-1 cells. In Figure 56, the data are mean ± SE. ° P &lt;0.0001 contrast;^*P &lt;0.0001 vs. aHUS acute phase untreated; ^ P &lt;0.0001 vs. aHUS acute phase + sCR1; § P &lt;0.0001 vs. aHUS remission phase untreated, and # P &lt;0.0001 vs. aHUS remission phase + sCR1.</p><p> As shown in Tables 25A, 25B, and FIG. 56, ADP-stimulated HMEC-1 cells confocally exposed to serum from aHUS patients (collected either during acute phase or during remission) for 4 hours at rest were confocal. Very dense C5b-9 deposits were shown on the cell surface when detected by confocal microscopy. By measuring the C5b-9 coverage, sera from healthy controls were on cells exposed to sera from aHUS patients, regardless of whether aHUS sera were collected during the acute phase or during remission. Significantly higher amounts of C5b-9 deposits were observed than cells exposed to. No difference in serum-induced endothelial C5b-9 deposition was observed between the acute phase and remission.</p><p> As further shown in Tables 25A, 25B, and FIG. 56, addition of the MASP-2 antibody OMS646 to aHUS serum (obtained from patients during the acute phase or during remission) compared to untreated aHUS serum on the endothelial cell surface. C5b-9 deposition in was significantly reduced. However, the inhibitory effect of OMS646 on C5b-9 deposition was no greater than that produced by the complement pan-inhibitor sCR1. In fact, a statistically significant difference was observed between aHUS serum-induced C5b-9 deposition in the presence of OMS646 and aHUS serum-induced C5b-9 deposition in the presence of sCR1 (Fig. 56 and also). Table 25A and Table 25B).</p><p> C5b- observed in the presence of complement inhibitors (compared to 100% C5b-9 deposition induced by untreated serum from the same patient) when calculated as an average of 4 aHUS patients 9 Percentages of reduction in deposition were:<u style="single">Acute phase</u>: sCR1 (150 μg / ml): 91% reduction in C5b-9 deposition OMS646 (100 μg / ml): 40% reduction in C5b-9 deposition<u style="single">Relief period</u>: sCR1 (150 μg / ml): 91% reduction in C5b-9 deposition OMS646 (100 μg / ml): 54% reduction in C5b-9 deposition</p><p><u style="single">Conclusion</u>: From the results described in this example, activated microvascular endothelial cells stimulate the lectin pathway of complement, which is a significant promoter of the aggravated complement activation response peculiar to aHUS. Prove. It is also demonstrated that this lectin pathway stimulation and the resulting exacerbated complement activation response occur both in the acute phase of aHUS and during clinical remission. Moreover, this finding does not appear to be limited to specific complement defects associated with aHUS. As further demonstrated in this example, selective inhibition of the lectin pathway with MASP-2 inhibitory antibodies, such as OMS646, reduces complement deposition in aHUS patients with a wide variety of causes.</p><p>Example 42 In this example, the MASP-2 inhibitory antibody (OMS646) was activated after exposure to aHUS patient sera obtained during the (1) acute phase and (2) remission phase of aHUS. (HMEC-1) Demonstrated to inhibit aHUS serum-induced platelet aggregation and thrombus formation on the surface.</p><p><u style="single">Method:</u><u style="single">patient</u>: 3 aHUS patients (Patient numbers 1, 2, and 4 shown in Table 23, Table 24, Table 25A, and Table 25B of Example 41) (1 patient is heterozygous p.R1210C CFH No mutations or anti-CFH antibodies were found in the other two patients who had the mutations) were tested during the acute phase of the disease and during remission. For this study, patients were selected from among those who were placed in the International HUS / TTP Registry and genotyped by the Mario Negri Institute, Transplantation / Rare Disease Immunology / Genetics Laboratory. Five healthy subjects were also selected as blood donors for the perfusion experiment.</p><p><u style="single">Method</u>: Confluent HMEC-1 cells activated at 10 μM ADP for 10 minutes, then serum from 3 aHUS patients (patient numbers 1, 2, and 4 in Example 41) collected during the acute phase of the disease or during remission Was incubated with serum from the same patient or control serum from a healthy subject for 3 hours. Serum was tested in the presence or absence of OMS646 (100 μg / mL) prepared as described in Example 40, which is a MASP-2 inhibitory antibody, or sCR1 (150 μg / mL), which is a positive control for complement inhibition. Diluted 1: 2 with medium (HBSS with 0.5% BSA). For patient numbers 1 and 2, additional wells were incubated with serum (acute phase and remission) diluted 1: 2 in test medium containing 100 μg / mL unrelated isotype control antibody or 20 μg / mL OMS646. (For the latter, case number 1 was tested only during remission and case number 2 was tested both in the acute phase and in remission).</p><p> At the end of the incubation phase, HMEC-1 cells are placed in a flow chamber and occur in the microcirculation with heparinized whole blood (10UI / mL) (containing the platelet-labeling fluorescent dye mepacrine) from healthy subjects. Slip stress (60 dyne / cm², 3 minutes). Three minutes after perfusion, the endothelial cell monolayer was fixed with acetone. Fifteen images of platelet thrombi on the surface of endothelial cells were obtained for each sample by confocal inverted laser scanning microscopy. The area occupied by the thrombus was evaluated using ImageJ software. The fields of view showing the lowest and highest values were excluded from the calculation.</p><p> 13 visual field pixels considered in each experimental condition for each patient and control for statistical analysis (one-way ANOVA followed by multiple comparison Chuky test)²The result shown in is used.</p><p><u style="single">result:</u> The results of thrombus formation experiments using sera from three aHUS patients are summarized in Table 26A below. The results using sera from 5 healthy subjects are summarized in Table 26B.</p><p> (Table 26A) Effect of complement inhibitors on aHUS serum-induced thrombus formation on ADP-activated HMEC-1 cells (pixels)²± SE)<img file="JP2020037568A_D0069.tif" /></p><p> (Table 26B) Effect of complement inhibitors on sera from 5 healthy controls (not affected by aHUS) in thrombus formation assay on ADP-activated HMEC-1 cells (pixels)²± SE)<img file="JP2020037568A_D0070.tif" /></p><p> For Table 26A and Table 26B, the data are mean ± SE. ° P &lt;0.001 contrast;^*P &lt;0.001,^***P &lt;0.05 vs. aHUS acute phase untreated; §P &lt;0.001, §§§P &lt;0.05 vs. aHUS untreated in remission phase.</p><p> FIG. 57 illustrates the effect of MASP-2 antibody (OMS646) and sCR1 on aHUS serum-induced thrombus formation on ADP-activated HMEC-1 cells. In FIG. 57, the data shown are mean ± SE. ° P &lt;0.0001, ° ° P &lt;0.01 contrast;^*P &lt;0.0001,^**P &lt;0.01 vs. aHUS acute phase untreated; § P &lt;0.0001 vs. aHUS remission phase untreated.</p><p> As shown in Table 26A and FIG. 57, there was a significant increase in thrombus coverage in HMEC-1 cells treated with aHUS serum collected during the acute phase or during remission compared to cells exposed to serum from healthy control subjects. Was observed (Table 26B and Figure 57). As shown in Figure 57 and Table 26A, OMS646 (both 100 μg / ml and 20 μg / ml) partially inhibited thrombosis on cells pre-exposed to aHUS serum collected during the acute phase. .. The antithrombotic effect was comparable between the two different doses of OMS646 and was not different from the effect of sCR1 (Fig. 57 and Table 26A). The addition of an unrelated isotype control antibody had no inhibitory effect on aHUS serum-induced thrombus formation.</p><p> As further shown in Figure 57 and Table 26A, the inhibitory effect of OMS646 was much more pronounced with aHUS sera collected during remission. In fact, addition of OMS646 to aHUS patient sera collected at remission at both 100 μg / ml and 20 μg / ml doses almost completely inhibited thrombus formation, similar to the thrombus formation observed with sCR1 addition. Unrelated isotype control antibodies showed no significant inhibitory effect.</p><p> Covered by thrombus deposits (compared to thrombi induced by untreated serum from the same patient at 100 percent) recorded with complement inhibitors when calculated as an average of 3 aHUS patients The percentage of reduction in the surface of HMEC-1 was as follows.<u style="single">Acute phase</u>: sCR1 (150 μg / ml): 60% decrease OMS646 (100 μg / ml): 57% decrease OMS646 (20 μg / ml): 45% decrease<u style="single">Remission period:</u>sCR1 (150 μg / ml): 85% decrease OMS646 (100 μg / ml): 79% decrease OMS646 (20 μg / ml): 89% decrease</p><p><u style="single">Consideration of results</u>: From the results in this example, MASP-2 inhibitory antibody, eg, OMS646 (prepared as described in Example 40), has a strong inhibitory effect on aHUS serum-induced thrombosis in HMEC-1 cells. Prove to have. Surprisingly, the inhibitory effect of OMS646 on thrombus formation was greater than the effect on C5b-9 deposition induced in HMEC-1 (as described in Example 41). It is also surprising that the addition of 100 μg / ml and 20 μg / ml doses of OMS646 to aHUS patient sera collected at the time of remission almost completely inhibited thrombus formation. Another surprising finding was that OMS646 was observed to be as effective as positive control sCR1, a broad and near-perfect complement system inhibitor, both in the acute phase and during remission (Weisman). H. et al., Science 249: 146-151, 1990; Lazar H. et al., Circulation 100: 1438-1442, 1999).</p><p> It should be noted that control sera from healthy subjects also induced moderate thrombus formation in HMEC-1 cells. We did not observe a consistent inhibitory effect on control serum-induced thrombus formation with either OMS646 or sCR1. Although not bound by any particular theory, control-induced thrombi should be complement-independent, as evidenced by the very weak C5b-9 deposition observed in HMEC-1 incubated with control serum. Possible (see Example 41).</p><p><u style="single">Conclusion:</u> In conclusion, the observed antithrombotic effect of a MASP-2 inhibitory antibody, eg, OMS646, is the OMS646 for C5b-9 deposition observed in this experimental system (as described in Example 41 and shown in FIG. 56). It appears to be significantly larger than expected based on the inhibitory effect of. For example, Gastoldi et al., entitled "C5a / C5aR interaction mediates complement activation and thrombosis on endothelial cells in atypical hemolytic uremic syndrome (aHUS)". As described in Immunobiology 217: 1129-1222 Abstract 48 (2012), the addition of C5 antibody, which inhibits C5b-9 deposition (60% reduction), results in a comparable degree of thrombus formation in HMEC-1 (60% reduction). It was decided that it was restricted to. In contrast, MASP-2 inhibitory antibody (100 μg / mL OMS646) inhibited C5b-9 deposition on average (acute phase = 40% reduction; remission phase = 54% reduction), a significantly higher percentage. Inhibition of thrombosis in (acute phase = 57% decrease; remission phase = 79% decrease). By comparison, OMS646 inhibited complement deposition at a lower percentage than the positive control complement inhibitor (150 μg / mL sCR1, acute inhibition of C5b-9 deposition = 91% reduction; remission phase = 91% reduction). However, it was as effective as the positive control sCR1 (150 μg / mL sCR1, acute phase = 60% reduction; remission phase = 85% reduction) in terms of inhibition of thrombosis. These results demonstrate that MASP-2 inhibitory antibodies (eg, OMS646) have a surprising effect on inhibiting thrombus formation in sera obtained from aHUS subjects during both acute and remission phases. ..</p><p> As described above, in one aspect, the invention inhibits MASP-2 dependent complement activation in a subject suffering from thrombotic microangiopathy (TMA) or at risk of developing the TMA. Provided is a method of inhibiting thrombus formation in a subject, comprising the step of administering a composition comprising an effective amount of MASP-2 inhibitory antibody. In one aspect, TMA is selected from the group consisting of hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), and atypical hemolytic uremic syndrome (aHUS). In one aspect, the TMA is aHUS. In one aspect, the composition is administered to aHUS patients during the acute phase of the disease. In one aspect, the composition is an aHUS patient in remission (ie, a subject who has recovered or partially recovered from an episode of acute aHUS, eg, such remission, eg, as referred to herein. Incorporated (provided by high platelet count and / or low serum LDH concentration as described in Loirat C et al., Orphanet Journal of Rare Diseases 6:60, 2011).</p><p> In one embodiment, the MASP-2 inhibitory antibody exhibits at least one or more of the following characteristics: K: the antibody is 10 nM or less._DTo bind human MASP-2 in, the antibody binds an epitope in the CCP1 domain of MASP-2, the antibody results in 10 nM or less C3b deposition in 1% human serum in in vitro assay. IC₅₀Inhibiting with, the antibody causes C3b deposition in 90% human serum at 30 nM or less IC₅₀Inhibiting with, the antibody is Fv, Fab, Fab', F (ab)₂, And F (ab')₂The antibody fragment is selected from the group consisting of, the antibody is a single chain molecule, the antibody is an IgG2 molecule, the antibody is an IgG1 molecule, and the antibody is IgG4 containing an S228P mutation. Being a molecule and / or the antibody does not substantially block the classical pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the second pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the classical or secondary pathway (ie, complete the classical and complement secondary pathways). Inhibits the lectin pathway while leaving it alone).</p><p> In one embodiment, the MASP-2 inhibitory antibody causes at least 30% of thrombus formation in serum from a subject suffering from TMA, eg, aHUS (acute or remission phase), compared to untreated serum, eg. At least 40%, eg, at least 50%, eg at least 60%, eg at least 70%, eg at least 80%, eg at least 85%, eg at least 90%, eg at least 95% up to 99% Inhibit. In some embodiments, the MASP-2 inhibitory antibody causes thrombus formation in serum from a subject suffering from aHUS by at least 20 percent or more than its inhibitory effect on serum C5b-9 deposition (eg,). Inhibits at high levels (at least 30%, at least 40%, at least 50%).</p><p> In one embodiment, the MASP-2 inhibitory antibody causes thrombus formation in serum from aHUS patients in remission by at least 30%, eg, at least 40%, eg, at least 50%, eg, compared to untreated serum. Inhibits at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%. In some embodiments, the MASP-2 inhibitory antibody causes thrombus formation in serum in aHUS patients in remission by at least 20 percent (eg, at least 30 percent) of its inhibitory effect on serum C5b-9 deposition. %, At least 40%, at least 50%) Inhibits at high levels.</p><p> In one aspect, the MASP-2 inhibitory antibody is administered to the subject via an intravenous catheter or other catheter delivery method.</p><p> In one aspect, the invention is a method of inhibiting thrombosis in a subject suffering from TMA, wherein a composition comprising an amount of a MASP-2 inhibitory antibody or an antigen-binding fragment thereof is administered to the subject. Heavy chain CDR-H1; and (ii) SEQ ID NO: 67, wherein the antibody or antigen-binding fragment thereof comprises the amino acid sequences 31-35 of (I) (a) (i) SEQ ID NO: 67. Heavy chain CDR-H2 containing the amino acid sequence of 50-65 and (iii) heavy chain variable region containing the heavy chain CDR-H3 containing the amino acid sequence of 95-102 of SEQ ID NO: 67, and (b). ) (I) Light chain CDR-L1 containing the amino acid sequence of 24-34 of SEQ ID NO: 70; and (ii) Light chain CDR-L2; containing the amino acid sequence of 50-56 of SEQ ID NO: 70; 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) at least 90% identity with SEQ ID NO: 67 (eg, SEQ). ID Heavy chain variable region with NO: 67 and 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) and SEQ ID NO: 70 and at least 90% identity (eg, 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% Provided are methods comprising those variants comprising light chain variable regions having (identity).</p><p> In one aspect, TMA is selected from the group consisting of atypical hemolytic uremic syndrome (aHUS) (either acute or remission), HUS, and TTP. In one aspect, the subject is in the acute phase of aHUS. In one aspect, the subject is in remission of aHUS.</p><p> In some embodiments, the method administers a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67. Includes the process of In some embodiments, the method is administered to a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof, comprising a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70. Includes the process of</p><p> In some embodiments, the method is on human MASP-2 recognized by reference antibody OMS646, which comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. A step of administering to a subject a composition comprising a MASP-2 inhibitory antibody or an antigen-binding fragment thereof that specifically recognizes at least a part of an epitope. Conflicts between binding members are detected in vitro, for example, using ELISA and / or in the presence of other untagged binding members so that specific binding members that bind to the same or overlapping epitopes can be identified. It can be readily assayed by tagging a particular reporter molecule that can be attached to one binding member. Therefore, a specific antibody or antigen-binding fragment thereof containing a human antibody-antigen binding site that competes with the reference antibody OMS646 in binding to human MASP-2 is provided in the present invention.</p><p>Example 43 This Example demonstrates that the human MASP-2 inhibitory antibody (OMS646) can inhibit plasma-mediated apoptosis induction in TMA patients in dermis-derived primary human microvascular endothelial cells (MVEC).</p><p><u style="single">Background / Principle:</u> The pathophysiology of TMA is known to be accompanied by various factor-induced endothelial cell damage followed by obstruction of small blood vessels (eg, small arterioles and capillaries) by platelet and / or fibrin thrombi. (Hirt-Minkowsk P. et al., Nephron Clin Pract 114: c219-c235, 2010; Goldberg RJ et al., Am J Kidney Dis 56 (6): 1168-1174, 2010). MVEC has been shown to undergo apoptotic damage when exposed to plasma from patients with TMA-related disorders in vitro (Stefanescu et al., Blood Vol 112 (2): 340-349, 2008; Mitra). D. See et al., Blood 89: 1224-1234, 1997). Apoptotic damage associated with TMA has been demonstrated in MVECs obtained from tissue biopsy materials (skin, bone, bone marrow, spleen, kidney, ileum) of such patients. Apoptotic damage to MVEC has also been shown to reduce levels of membrane-bound complement regulatory proteins in MVEC (eg, Mold and Morris, Immunology 102: 359-364, 2001; Christmas et al., Immunology 119: See 522, 2006).</p><p> Positive feedback loops involving terminal complement components include atypical hemolytic urinary toxicosis syndrome (aHUS), and fulminant antiphospholipid antibody syndrome (CAPS), TMA associated with Degos disease, and TMA secondary to cancer. , TMA secondary to cancer chemotherapy, TMA secondary to autoimmunity, and TMA including TMA secondary to transplantation are thought to be involved in the pathophysiology. Each of these conditions is known to respond to anti-C5 therapy with mAb eculizumab or is thought to respond to anti-C5 therapy with mAb eculizumab (Chapin J. et al., Brit). J. Hematol 157: 772-774, 2012; Tsai et al., Br J Haematol 162 (4): 558-559, 2013); Magro CM et al., Journal of Rare Diseases 8: 185, 2013).</p><p> Human MASP-2 inhibitory antibody (OMS646) is used for aHUS, ADAMTS13 deficiency-related thrombotic thrombocytopenic purpura (TTP), CAPS and systemic Degos disease, as well as TMA secondary to cancer, TMA secondary to transplantation, and autoimmune diseases. The following experiments to analyze the ability of TMA patients to block plasma-mediated induction of apoptosis in primary human dermal MVEC in plasma samples obtained from patients with secondary TMA and secondary chemotherapy TMA. Was done.</p><p><u style="single">Method</u>: Induction of apoptosis in TMA patients in primary human MVECs derived from the dermis, as described in Stefanescu R. et al., Blood Vol 112 (2): 340-349, 2008, incorporated herein by reference. An in vitro assay was performed to analyze the efficacy of the blocking MASP-2 inhibitory antibody (OMS646). Plasma samples used in this assay were obtained from a collection of healthy control subjects and from individuals with acute or convalescent thrombotic microangiopathy. The presence of microangiopathy in TMA patients was assessed by detecting split erythrocytes on peripheral blood smear. In addition, TTP was evaluated as described in Stefanescu R. et al., Blood Vol 112 (2): 340-349, 2008.</p><p><u style="single">Endothelial cell (EC) culture</u> As described by Stefanescu et al., The first human MVEC from the dermis was purchased from ScienCell Research Labs (San Diego, CA). MVEC expressed CD34 up to 5 and 6 passages (Blood 89: 1224-1234, 1997). MVEC was maintained in polystyrene flasks coated with 0.1% aqueous gelatin solution dissolved in ECM1001 medium (Scien Cell Research Labs) containing endothelial cell growth aids, penicillin, streptomycin and 15% fetal bovine serum. All MVECs were used in 2 to 6 passages. Subcultures were accompanied by exposure to 0.25% trypsin-EDTA for 5-10 minutes.</p><p><u style="single">Apoptosis assay</u> A typical dermis-derived primary human MVEC known to be sensitive to TTP / HUS plasma-induced apoptosis was washed with phosphate buffered saline (PBS) and coated with a 0.1% gelatin aqueous solution in a 12-well plate. 0.15 x 10 in the chamber⁶Plated with live cells / mL. Plated MVEC cells were starved in complete medium for 24 hours, then in various concentrations (2% -20% v / v) in the presence or absence of MASP-2 mAb OMS646 (150 μg / mL). TMA patient plasma samples or healthy donor plasma were exposed for 18 hours, then cells were collected by trypsin treatment. Each TMA patient sample was analyzed in pairs. The degree of plasma-mediated apoptosis was evaluated using propidium iodide (PI) staining. &gt; 5 × 10³Cells were analyzed by cytofluorograph and A0 peaks were revealed by computer software (MCycle Av, Phoenix Flow Systems, San Diego, CA). Quantification of cytoplasmic histone-binding DNA fragments from enzyme-linked immunosorbent assay (ELISA) was also performed according to the manufacturer's instructions (Roche Diagnostics, Mannheim, Germany).</p><p><u style="single">result</u>: The results of the plasma-induced MVEC apoptosis assay for TMA patients in the presence of MASP-2 mAb (OMS646) are shown in Table 27 below.</p><p> (Table 27) Plasma of TMA patients tested against dermal-derived primary human MVEC in the presence of MASP-2 mAb (OMS646)<img file="JP2020037568A_D0071.tif" />Abbreviations used in Table 27: "APLA" = antiphospholipid antibody "SLE" associated with fulminant antiphospholipid antibody syndrome (CAPS) = systemic lupus erythematosus "CVA" = cerebrovascular attack (stroke)</p><p> Stefanescu R. et al., Blood Vol 112 (2): 340-349, Consistent with the results reported in 2008, significant apoptosis of dermis-derived primary MVEC was observed in the presence of 13 TMA patient plasma samples and in the absence of MASP-2 antibody. Control plasma samples from healthy human subjects were also tested and did not induce apoptosis in MVEC (data not shown). As shown in Table 27, MASP-2 inhibitory mAb (OMS646) inhibited TMA patient plasma-mediated apoptosis induction in primary MVEC in 6 (46%) of the 13 patient plasma samples tested. ("Responder" in Table 27). In particular, it is noted that the MASP-2 inhibitory mAb (OMS646) inhibited apoptosis in plasma obtained from patients suffering from aHUS, TTP, Degos' disease, SLE, transplantation, and APLA (CAPS). .. For the seven patient samples tested in this assay in which MASP-2 mAb did not block apoptosis (non-responders in Table 27), apoptosis could be induced by several pathways, thus. It should be noted that not all of these pathways are complement-dependent. For example, Stefanescu R. Apoptosis in EC assays may play a role in determining the level of injury required to induce apoptosis, as described in et al., Blood Vol 112 (2): 340-349, 2008. Depends on the EC activation basal state affected by. As further described in Stefanescu R. et al., Additional factors that can regulate apoptosis, such as cytokines and various complement system components, may be present in TMA patient plasma. Therefore, it is not surprising that the MASP-2 antibody did not show a blocking effect in all plasma samples that showed TMA plasma-induced apoptosis due to these complex factors.</p><p> Furthermore, in this regard, it should be noted that similar analyzes were performed using the TMA plasma-induced apoptosis assay and the anti-C5 antibody eculizumab, with similar results observed (Chapin et al., Blood (ASH). Annual Meeting Abstracts): Abstract # 3342, 120: 2012). The clinical efficacy of eculizumab, a fairly successful product, appears to be greater than the efficacy demonstrated in this model. This suggests that this in vitro model may underestimate the clinical capacity of complement inhibitor drugs.</p><p> From these results, MASP-2 inhibitory antibodies, such as OMS646, are TMA in plasma obtained from patients suffering from TMA, such as aHUS, TTP, Degos' disease, SLE, transplantation, and APLA (CAPS). It proves to be effective in inhibiting plasma-induced apoptosis. Endothelial damage and apoptosis have been shown to play important roles in the pathology of TMA, such as idiopathic TTP and sporadic HUS (Kim et al., Microvascular Research vol 62 (2): 83-93, 2001). Apoptosis was demonstrated in the red pulp of TTP patients, as described by Dang et al., But not in healthy controls (Dang et al., Blood 93 (4): 1264-1270, 1999). Evidence of apoptosis has also been observed in MVEC-derived renal glomerular cells in HUS patients (Arends MJ). et al., Hum Pathol 20:89, 1989). Thus, administration of a MASP-2 inhibitor, eg, a MASP-2 inhibitor antibody (eg, OMS646), includes TMA, eg, aHUS, TTP, or other microangiopathy disorders, eg, CAPS, systemic Degos disease, etc. TMA and TMA secondary to cancer; TMA secondary to chemotherapy or TMA secondary to transplantation is expected to be an effective therapy in patients suffering from TMA.</p><p> As described above, in one embodiment, the present invention suffers from thrombotic microangiopathy (TMA) with a composition comprising an amount of MASP-2 inhibitory antibody effective in inhibiting MASP-2 dependent complement activation. Provided are methods of inhibiting endothelial cell damage and / or endothelial cell apoptosis and / or thrombosis in a subject, including administration to a subject or a subject at risk of developing the TMA. In one aspect, TMA is selected from the group consisting of atypical hemolytic uremic syndrome (aHUS), thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS). In one aspect, the TMA is aHUS. In one aspect, the composition is administered to aHUS patients during the acute phase of the disease. In one aspect, the composition is a patient with aHUS in remission (ie, a subject who has recovered or partially recovered from an episode of acute aHUS, eg, such remission is incorporated herein by reference, eg. Loirat C et al., Orphanet Journal of Rare Diseases 6:60, Administered to high platelet counts and / or low serum LDH concentrations as described in 2011).</p><p> In one aspect, the subject is secondary to (i) TMA secondary to cancer; (ii) TMA secondary to chemotherapy; or (iii) transplantation (eg, organ transplantation, eg kidney transplantation or allogeneic hematopoietic stem cell transplantation). Have or are at risk of developing TMA, which is TMA. In one aspect, the subject has or is at risk of developing Upshaw-Schulman syndrome (USS). In one aspect, the subject has or is at risk of developing Degos's disease. In one aspect, the subject has or is at risk of developing fulminant antiphospholipid antibody syndrome (CAPS).</p><p> According to any of the embodiments disclosed herein, a MASP-2 inhibitory antibody exhibits at least one or more of the following characteristics: the antibody has K of 10 nM or less._DTo bind human MASP-2 in, the antibody binds an epitope in the CCP1 domain of MASP-2, the antibody results in 10 nM or less C3b deposition in 1% human serum in in vitro assay. IC₅₀Inhibiting with, the antibody causes C3b deposition in 90% human serum at 30 nM or less IC₅₀Inhibiting with, the antibody is Fv, Fab, Fab', F (ab)₂, And F (ab')₂The antibody fragment is selected from the group consisting of, the antibody is a single chain molecule, the antibody is an IgG2 molecule, the antibody is an IgG1 molecule, and the antibody is IgG4 containing an S228P mutation. Being a molecule and / or the antibody does not substantially block the classical pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the second pathway. In one embodiment, the antibody binds to MASP-2, selectively inhibits the lectin pathway, and substantially does not inhibit the classical pathway (ie, lectin while leaving the classical complement pathway intact. Block the pathway).</p><p> In one embodiment, the MASP-2 inhibitory antibody is a TMA secondary to TMA, eg, aHUS (acute or remission), hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), cancer; TMA secondary to chemotherapy; in plasma from a subject suffering from TMA secondary to a transplant (eg, organ transplant, eg kidney transplant or allogeneic hematopoietic stem cell transplant), or Upshaw-Schulman syndrome (USS) Plasma in serum from a subject suffering from) or in serum from a subject suffering from Degos' disease, or in a subject suffering from fulminant antiphospholipid antibody syndrome (CAPS) Inhibits inducible MVEC apoptosis, plasma-induced MVEC apoptosis is at least 5%, eg, at least 10%, eg, at least 20%, eg, at least 30%, eg, at least 40%, eg, at least 40% of untreated serum. , At least 50%, eg, at least 60%, eg, at least 70%, eg, at least 80%, eg, at least 85%, eg, at least 90%, eg, at least 95%, up to 99%. In some embodiments, MASP-2 inhibitory antibodies are used in TMA (eg, aHUS (acute or remission), hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), cancer). Secondary TMA; TMA secondary to chemotherapy; in serum from subjects suffering from TMA secondary to transplantation (eg, organ transplantation, eg kidney transplantation or allogeneic hematopoietic stem cell transplantation), or Upshaw-Schul Patients with Man's Syndrome (USS) in serum, or from subjects with Degos's disease in serum, or with fulminant anti-phospholipid antibody syndrome (CAPS) Inhibits thrombosis in a subject at a level that is at least 20% (eg, at least 30%, at least 40%, at least 50%) higher than the inhibitory effect on C5b-9 deposition in serum.</p><p> In one aspect, the MASP-2 inhibitory antibody is administered to the subject via an intravenous catheter or other catheter delivery method.</p><p> In one aspect, the invention relates to TMA (eg, aHUS (acute or remission), hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura (TTP), TMA secondary to cancer; chemotherapy. Secondary TMA; Derived from a subject suffering from TMA secondary to a transplant (eg, organ transplant, eg kidney transplant or allogeneic hematopoietic stem cell transplant), or from a subject suffering from Upshaw-Schulman syndrome (USS) A method of inhibiting thrombosis in the serum of a subject suffering from Degos' disease, in the serum of a subject suffering from Degos' disease, or in a subject suffering from fulminant anti-phospholipid antibody syndrome (CAPS). A composition comprising a certain amount of a MASP-2 inhibitory antibody or an antigen-binding fragment thereof is administered to the subject, and the antibody or the antigen-binding fragment thereof is (I) (a) (i) SEQ ID NO. Heavy chain CDR-H1 containing the amino acid sequence of 31-35 of: 67; and (ii) SEQ ID NO: Heavy chain CDR-H2 containing the amino acid sequence of 50-65 of 67; and (iii) SEQ ID NO: 67 Heavy chain variable region containing heavy chain CDR-H3 containing the amino acid sequence of 95-102, as well as (b) (i) SEQ ID. Light chain CDR-L1; containing the 24-34 amino acid sequence of NO: 70; and (ii) SEQ ID NO: Light chain CDR-L2; containing the 50-56 amino acid sequence of 70; and (iii) SEQ ID NO: A light chain variable region comprising a light chain CDR-L3 containing an amino acid sequence of 70 89-97, or at least 90% identity with (II) SEQ ID NO: 67 (eg, at least with SEQ ID NO: 67). Heavy chain variable region with 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) and SEQ ID NO: 70 And at least 90% identity (eg, 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) Provided are methods comprising those variants comprising light chain variable regions having.</p><p> In one aspect, the subject is selected from the group consisting of TMA secondary to cancer; TMA secondary to chemotherapy; TMA secondary to transplantation (eg, organ transplantation, eg kidney transplantation or allogeneic hematopoietic stem cell transplantation). He has Upshaw-Schulmann syndrome (USS), Degos' disease, and fulminant antiphospholipid antibody syndrome (CAPS).</p><p> In some embodiments, the method administers a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof comprising a heavy chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 67. Includes the process of In some embodiments, the method is administered to a composition comprising an amount of a MASP-2 inhibitory antibody or antigen-binding fragment thereof, comprising a light chain variable region comprising the amino acid sequence set forth in SEQ ID NO: 70. Includes the process of</p><p> In some embodiments, the method is on human MASP-2 recognized by reference antibody OMS646, which comprises a heavy chain variable region set forth in SEQ ID NO: 67 and a light chain variable region set forth in SEQ ID NO: 70. A step of administering to a subject a composition comprising a MASP-2 inhibitory antibody or an antigen-binding fragment thereof that specifically recognizes at least a part of an epitope.</p><p> Although exemplary embodiments have been exemplified and described, it will be appreciated that various modifications are possible without departing from the spirit and scope of the invention. Aspects of the invention claiming exclusive rights or privileges are set forth in the appended claims.</p>