Preparation containing human antibodies for the treatment of disorders associated with TNF-α

Description of the invention

State of the art

The present invention relates to a stable liquid aqueous pharmaceutical preparation containing human anti-tumor necrosis factor alpha antibodies.

Tumor necrosis factor? (TNF?) Is a cytokine produced by numerous cell types, including monocytes and macrophages, that was originally detected for its ability to induce necrosis of certain tumors in mice (see, e.g., Old, L. (1985) Science 230: 630- 632). Subsequently, it was shown that a factor called cachectic, related to cachexia, has a molecule identical to TNFα. TNF? Mediates shock (see, e.g., Beutler, B. and Cerami, A. (1988) Annu. Rev. Biochem. 57: 505-518; Beutler, B. and Cerami, A. (1989) Annu. Rev. Immunol. 7: 625-655). In addition, TNFα is involved in the pathophysiology of a wide variety of other human diseases and disorders, including sepsis, infection, autoimmune diseases, transplant rejection, and graft versus host reactions (see, e.g., Moeller, A., et al. (1990) Cytokine 2: 162 169; U.S. Patent No. 5,231,024, Moeller et al; European Patent Publication No. 2,60610 B1, Moeller, A., et al. Yasilli, P. (1992) Annu. Rev. Immunol. 10: 411-452; Tracey, KJ. and Cerami, A. (1994) Annu. Rev. Med. 45: 491-503).

Due to the deleterious effects of human TNF? (HTNF?) In a wide variety of human disorders, therapeutic strategies have been devised to inhibit or counteract hTNF? Activity. In particular, antibodies that bind to and neutralize hTNFa are sought as a means to inhibit hTNFa activity. Some of the earliest such antibodies were murine monoclonal antibodies (mAbs), secreted by hybridomas produced from the lymphocytes of mice immunized with hTNF? (See e.g. Hahn T; et al. (1985) Proc Natl Acad Sci USA 82: 3814-3818; Liang, CM., Et al. (1986) Biochem. Biophys. Res. Commun. 137: 847-854; Hirai, M., et al. (1987) J. Immunol. Methods 96: 57-62; Fendly, BM, et al. (1987) Hybridoma 6: 359-370; Moeller, A., et al. (1990) Cytokine 2: 162-169; U.S. Patent No. 5,231,024 to Moeller et al; European Patent Publication No. 186833 B1, Wallach, D .; European Patent Application Publication No. 218,868 A1, Old et al; European Patent Publication No. 260610 B1, Moeller, A., et al.). While these murine anti-hTNFa antibodies often exhibited high affinity for hTNFa (e.g., Kd <10^-9 M) and were able to neutralize hTNFa activity, their in vivo use may be limited by problems associated with administering murine antibodies to humans, such as the short plasma half-life, the inability to induce certain effector functions in humans, and the induction of an unwanted immune response against murine antibodies in humans. humans ("human anti-mouse antibody (HAMA) response).

In an attempt to overcome the difficulties associated with the use of all-murine antibodies in humans, genetic engineering resulted in more "human-like murine anti-hTNF? Antibodies." For example, chimeric antibodies have been prepared in which the variable portions of the antibody chains are of murine origin and the constant portions of the antibody chains are of human origin (Knight, DM, et al. (1993) Mol Immunol. 30: 1443-1453; PCT Publication No. WO 92 / 16553, Daddon,

PE, et al.). In addition, humanized antibodies have also been produced in which the hypervariable domains of the antibody variable regions are of murine origin and the remainder of the variable and constant regions of the antibodies are of human origin (PCT Publication No. WO 92/11383, Adair, JR, et al.). However, since these chimeric and humanized antibodies still contain some murine sequences, they may still elicit an unwanted immune response, an anti-chimeric antibody response (HACA) in humans, especially when administered over an extended period of time, e.g. as indicated by chronic conditions such as as rheumatoid arthritis (see, e.g., Elliott, MJ, et al. (1994) Lancet 344: 1125-1127; Elliot, MJ, et al. (1994) Lancet 344: 1105-1110).

A more preferred agent than murine mAbs or derivatives thereof (e.g., chimeric or humanized antibodies), an agent that inhibits hTNFa would be a fully human antibody to hTNFa, as such an agent should not induce a HAMA response, even on long-term use. Human monoclonal antibodies against hTNFa have been generated using human hybridoma techniques (Boyle, P., et al. (1993) Cell. Immunol. 152: 556-568; Boyle, P., et al. (1993) Cell. Immunol. 152: 569-581; European Patent Application Publication No. 614,984 A2, Boyle, et al.). However, hybridoma-derived monoclonal autoantibodies were reported to have too little affinity for hTNFa to be calculated by conventional methods, unable to bind soluble hTNFa or abolish hTNFa induced cytotoxicity (see Boyle, et al; supra). Moreover, the success of techniques using human hybridomas depends on the natural presence in human peripheral blood lymphocytes producing autoantibodies specific for hTNF ?. Some studies have detected plasma autoantibodies against hTNFa in humans (Fomsgaard, A., et al. (1989)

Scand. J. Immunol. 30: 219-223; Bendtzen, K., et al. (1990) Prog. Leukocyte Biol 10B: 447-452), while not in other studies (Leusch, HG., Et al. (1991) J. Immunol. Methods 13 9: 145-147).

An alternative to naturally occurring human anti-hTNFa antibodies would be a recombinant hTNFa antibody. To date, recombinant human hTNFa binding antibodies have been described

-7 -2 -1 with relatively weak affinity (i.e., Kd ~ 10^-7 M) and large dissociation constant (i.e., Koff ~ 10^-2 s^-1) (Griffiths, AD, et al. (1993) EMBO J. 12: 725-734). However, due to their relatively rapid dissociation kinetics, these antibodies may not be suitable for therapeutic use. In addition, a recombinant human anti-hTNFa antibody has been described that does not neutralize hTNFa activity, but rather increases hTNFa binding to the cell surface and enhances hTNFa internalization (Lidbury, A., et al. (1994) Biotechnol Ther. 5: 27-45; PCT Publication WO 92/03145, Aston, R. et al.)

Recombinant human antibodies that bind soluble hTNFa with high affinity and slow dissociation kinetics, which can neutralize hTNFa activity, including abolition of hTNFa-induced cytotoxicity (in vitro and in vivo) and hTNFa-induced cell activation, have also been described (see US Patent No. 6,090,382. ).

The essence of the invention

There is a need for a stable pharmaceutical formulation in the form of an aqueous solution with a long shelf life containing an antibody that is capable of being used therapeutically to inhibit or counteract the deleterious activity of hTNF ?. There is also a need for a stable pharmaceutical formulation in the form of an aqueous solution with a long shelf life containing an antibody that is therapeutically useful, easy to administer, and contains a high concentration of protein.

The present invention relates to a liquid aqueous pharmaceutical preparation characterized in that it comprises 30 to 120 mg / ml of a human anti-tumor necrosis factor alpha (hTNFa) antibody, or antigen binding portion thereof, in a buffering solution containing citrate and phosphate buffers, the formulation having pH 4 to 8, and wherein the formulation has a shelf life of at least 18 months; or has a shelf life of at least 18 months in the liquid state; or is stable after at least 3 freezing / thawing cycles of the formulation; or has an enhanced shelf life of at least 12 months at 2-8 ° C. Preferably, the formulation is suitable for a single subcutaneous injection.

In a preferred embodiment of the preparation, the antibody concentration is between about 40-110 mg / ml.

Preferably the antibody concentration is between about 45-105 mg / ml.

Also preferably, the antibody concentration is between about 25-50 mg / ml.

Also preferably, the antibody concentration is greater than about 45 mg / ml.

Also preferably, the antibody concentration is about 50 mg / ml.

The invention also relates to a liquid aqueous pharmaceutical preparation, characterized in that it comprises (a) 30-120 mg / ml of a human anti-tumor necrosis factor alpha (hTNFa) antibody or antigen binding portion thereof, (b) 5-20 mg / ml of mannitol , (c) 0.1-10 mg / mL of polyoxyethylene sorbitan monooleate, and (d) a citrate and / or phosphate-containing buffering system having a pH of 4 to 8.

In a preferred embodiment of the formulation, the pH is selected from a range ranging from about 4.5 to about 6.0, from about 4.5 to about 5.5, and from about 5.0 to about 5.2.

Preferably the formulation comprises (a) about 50 mg / ml of the antibody or antigen binding portion thereof, (b) about 12 mg / ml mannitol, (c) about 1 mg / ml polyoxyethylene sorbitan monooleate and (d) a citrate and phosphate buffer system having pH 4 to 8.

More preferably, the buffering system comprises (a) about 1.3 mg / mL of citric acid, (b) about 0.3 mg / mL of sodium citrate, (c) about 1.5 mg / mL of disodium phosphate dihydrate, (d) about 0, 9 mg / mL of sodium dihydrogen phosphate dihydrate and (e) about 6.2 mg of sodium chloride. The invention also relates to a liquid aqueous pharmaceutical composition, characterized in that it comprises a polyol, a surfactant and a buffering system containing citrate and phosphate, having a pH of 4 to 8, in amounts sufficient to formulate a human anti-tumor necrosis factor alpha (TNF?) Antibody. or an antigen-binding portion thereof, for therapeutic use at a concentration of greater than about 45 mg / ml.

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In a preferred formulation form, the polyol is mannitol.

More preferably the formulation contains 5-20 mg / ml mannitol.

In a preferred formulation embodiment, the surfactant is polyoxyethylene sorbitol monooleate.

More preferably the formulation contains 0.1-10 mg / ml of polyoxyethylene sorbitan monooleate.

In a preferred embodiment of the preparation, the antibody or antigen binding portion thereof is a human antibody, or antigen binding portion thereof, that dissociates from human TNF? With the constant K_d amount of 1 x 10^-8 M or less and with a Koff constant of 1 x 10^-3 s^-1 or less, both of which are determined by surface plasmon resonance techniques, and neutralize the cytotoxicity of human TNFα in a standard in vitro L929 test with IC₅₀ of 1 x 10^-7 M or less.

In another preferred embodiment of the preparation, the antibody or antigen binding portion thereof (a) dissociates

-3 -1 from human TNF? With a Koff constant of 1 x 10^-3 s^-1 or less as determined by the surface plasmon resonance technique; (b) contains a light chain CDR3 domain comprising the amino acid sequence designated SEQ ID NO: 3 or SEQ ID NO: 3 modified by a single alanine substitution at position 1, 4, 5, 7 or 8 or by one to five conservative amino acid substitutions at positions 1, 3, 4, 6, 7, 8 and / or 9; (c) a heavy chain CDR3 domain comprising the amino acid sequence designated as SEQ ID NO. 4 or SEQ ID NO: 4 as modified by a single alanine substitution at position 2, 3, 4, 5, 6, 8, 9, 10 or 11 or by one to five conservative amino acid substitutions at positions 2, 3, 4, 5, 6 8, 9, 10, 11 and / or 12.

In a further preferred embodiment of the preparation, the antibody comprises a light chain CDR2 variable domain comprising the amino acid sequence designated SEQ ID NO: 5 and a heavy chain CDR2 variable domain comprising the amino acid sequence designated SEQ ID NO: 6; optionally wherein the antibody comprises a light chain CDR1 variable domain comprising the amino acid sequence designated SEQ ID NO: 7 and a heavy chain CDR2 variable domain comprising the amino acid sequence designated SEQ ID NO: 8.

In another preferred embodiment of the preparation, the antibody or antigen binding portion thereof comprises a light chain variable region (LCVR) comprising the amino acid sequence of SEQ ID NO: 1 and a heavy chain variable region (HCVR) comprising the amino acid sequence of SEQ ID NO: 2

More preferably the antibody or antigen binding portion thereof is a D2E7 antibody or antigen binding portion thereof.

The invention also relates to the use of a formulation as defined above for the manufacture of a medicament for the treatment of a subject with a disorder wherein TNF? Activity is deleterious.

In a preferred embodiment, the disorder in which TNF? Activity is deleterious is an autoimmune disorder.

In a more preferred embodiment, the autoimmune disorder is selected from the group consisting of rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and gouty arthritis, allergy, multiple sclerosis, autoimmune disease diabetes, autoimmune uveitis, and nephrotic syndrome.

In a preferred embodiment, the disorder where TNF? Activity is deleterious is an intestinal disorder.

In a more preferred embodiment, the intestinal disorder is idiopathic inflammatory bowel disease.

In particular, the idiopathic inflammatory bowel disease is Crohn's disease or ulcerative colitis.

In a preferred embodiment, the disorder in which TNF? Activity is deleterious is selected from the group consisting of infectious disease, transplant rejection, malignant neoplasm, pulmonary disorder, cardiac disorder, and sepsis.

In particular, the infectious disease is selected from the group consisting of malaria, meningitis, AIDS and influenza.

In particular, the pulmonary disorder is selected from the group consisting of adult respiratory distress syndrome, shock lung, chronic pulmonary inflammatory disease, pulmonary fibrosis, pulmonary sarcoidosis, and silicosis.

A cardiac disorder in particular is cardiac ischemia or heart failure.

In particular, the disorder in which TNFα activity is deleterious is selected from the group consisting of psoriasis, psoriatic arthritis, Still's disease in adults, Alzheimer's disease, ankylosing spondylitis, asthma, cancer and cachexia, atherosclerosis,

Chronic atherosclerosis, chronic fatigue syndrome, liver failure, chronic liver failure, obstructive pulmonary disease, chronic obstructive pulmonary disease, congestive heart failure, dermatomyositis and polymyositis, diabetic macrovasculopathy, endometriosis, febrile familial, hemodialysis, hemodialysis Jarisch-Herxheimer reaction, juvenile arthritis, Kawasaki syndrome, myelodysplastic syndrome, myocardial infarction, a disorder called panciaticular vulgaris, periodontitis, peripheral neuropathy, polyarthritis, polymyositis, progressive renal failure, Reiter's syndrome, sarcoidosis, scleroderma, spondyloarthropathies, Still's disease, stroke, therapy-related syndrome, therapy-induced inflammatory syndrome, inflammatory syndrome as a result of IL-2 administration, thoracoabdominal aortic aneurysm (TAAA) surgery, Vasulo-Behcet's disease, yellow fever vaccine, type 1 diabetes, type 2 diabetes, neuropathic pain, sciatica, cerebral edema, edema of the spine and / or around the spinal cord, vasculitis, Wegener's granulomatosis, temporal arteritis, rheumatoid muscle pain, Takayasu's arteritis, polyarteritis nodosa, microscopic polyangiitis, Churg-Strauss syndrome, Felty's syndrome, Sjogren's syndrome, mixed connective tissue disease, recurrent polychondritis, gout-like inflammation, loose dentures autoimmune hepatitis, sclerosing cholangitis, acute pancreatitis, chronic pancreatitis, glomerulonephritis, post streptococcal glomerulonephritis or post streptococcal IgA nephropathy, rheumatic heart disease, cardiomyopathy, orchitis, pyoderma gangrenosum, multiple myeloma TNF [TRAPS], atherosclerosis, steroid-dependent giant cell arteritis and myositis, uveitis and drug reactions.

The liquid pharmaceutical formulation in the form of an aqueous solution may contain an antibody, or an antigen binding portion thereof, that has a light chain variable region (LCVR) with a CDR3 domain containing an amino acid sequence selected from the group consisting of SEQ ID NO: 3, SEQ ID NO: 11, SEQ ID NO: 12, SEQ ID NO: 13, SEQ ID NO: 14, SEQ ID NO: 15, SEQ ID NO: 16, SEQ ID NO: 17, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 20, SEQ ID NO: 21, SEQ ID NO: 22, SEQ ID NO: 23, SEQ ID NO: 24, SEQ ID NO: 25, SEQ ID NO: 26 or a heavy chain variable region (HCVR) with a CDR3 domain containing an amino acid sequence selected from the group consisting of SEQ ID NO: 4, SEQ ID NO: 27, SEQ ID NO: 28, SEQ ID NO: 29, SEQ ID NO: 30, SEQ ID NO: 31, SEQ ID NO: 32, SEQ ID NO: 33 and SEQ ID NO: 34. The antibody, or antigen binding portion thereof, can neutralize the activity of human TNFα, chimpanzee TNFα, and TNFα from at least one additional primate selected from the group consisting of baboon TNFα, marmoset TNFα, cynomolgus monkey TNFα, and rhesus TNFα. The preparation of the invention may contain an antibody, or antigen-binding portion thereof, that also neutralizes murine TNF? Activity. The preparation of the invention may also contain an antibody, or antigen-binding portion thereof, that neutralizes porcine TNFα activity.

Detailed Description of the Invention

The present invention relates to a liquid pharmaceutical formulation in the form of an aqueous solution having a pH of about 4 to about 8, containing a high concentration of protein, containing antibodies in a concentration ranging from about 30 to about 120 mg / ml, and improved stability. The invention also relates to a liquid pharmaceutical formulation in the form of an aqueous solution for therapeutic use in a subject afflicted with a condition characterized by the deleterious effects of TNFα. The formulation of the invention comprises the following components: an antibody that binds human TNF? With high affinity, low dissociation constant and high neutralization potential; buffer including citric acid, sodium citrate, disodium phosphate dihydrate, and sodium dihydrogen phosphate dihydrate; osmotic agents, including mannitol and sodium chloride; a detergent, including polysorbate 80; and sodium hydroxide to adjust the pH.

Definitions

In order to facilitate understanding of the invention, certain terms have been defined at the outset.

The term "subject refers to a living organism, eg, Prokaryote and Eukaryote. Examples of subjects include mammals, e.g., humans, dogs, cows, horses, pigs, sheep, goats, cats, mice, rabbits, rats, and transgenic animals. In specific embodiments of the invention, the subject is a human.

The term "pharmaceutical preparation" refers to preparations which are in a form which allows the active ingredients to be substantially biologically effective and which do not contain any additional ingredients which are substantially toxic to the subjects to which the preparation would be administered. Pharmaceutically acceptable excipients (vehicles, additives) are those which can be reasonably administered to a mammal to give an effective dose of the active ingredient to be used.

PL 218 221 B1

The term "stable preparation" refers to one in which the antibody retains substantially physical and / or chemical stability and / or biological activity during storage. Various analytical techniques known in the art for measuring protein stability are described, for example, in Peptide and Protein Drug Delivery, 247-301, Vincent Lee Ed., Marcel Dekker, Inc. , New York, NY, Pubs. (1991) and Jones, A. Adv. Drug Delivery Rev. 10: 29-90 (1993). Life can be measured at a selected temperature over a selected period of time. Preferably, the formulation is stable at room temperature (about 30 ° C) or at 40 ° C for at least 1 month and / or stable at about 2-8 ° C for at least 1 year or for at least 2 years. In addition, it is preferred that the formulation is stable after being frozen (down to eg -70 ° C) and thawed, which is hereinafter referred to as a "freeze / thaw cycle."

An antibody "retains physical stability in a pharmaceutical formulation if, when viewed with the naked eye or measured by UV light scattering or size exclusion chromatography, it shows no signs of aggregation, precipitation, and / or denaturation as manifested by a change in color and / or clarity.

An antibody in a pharmaceutical formulation "is chemically stable if the chemical stability at a given point in time is such that the antibody retains biological activity, as defined below. Chemical stability can be determined by detecting and quantifying chemically altered forms of the antibody. A chemical change may include a change in magnitude (e.g. trimming), which can be assessed using, for example, size exclusion chromatography, SDS-PAGE, and / or sample-assisted matrix assisted laser desorption and ionization mass spectrometry with a time-of-flight analyzer (MALDI / TOF MS). Other types of chemical changes include change in charge (e.g., through deamination), which can be assessed, for example, by ion exchange chromatography.

An antibody in a pharmaceutical preparation "retains biological activity when the antibody in the pharmaceutical preparation is biologically active to an extent compatible with its intended purpose. For example, biological activity is retained when the biological activity of the antibody in the pharmaceutical preparation is in the range of about 30%, about 20%, or about 10% (within the measurement error) of the biological activity exhibited during the preparation of the pharmaceutical preparation (e.g. determined in an antigen binding assay).

The term "isotonic" is known in the art. Isotonic can mean, for example, that a given preparation has essentially the same osmotic pressure as human blood. Isotonic preparations generally have an osmotic pressure of from about 250 to 350 mOsm. Isotonicity can be measured using, for example, a steam-type or ice-freeze osmometer. The term "osmotic agent" means a compound that renders a preparation isotonic.

The term "polyol" means a substance containing multiple hydroxyl groups and includes sugars (reducing and non-reducing sugars), alcohols, and sugar acids. Preferred polyols herein have a molecular weight of less than about 600 kD (e.g., in the range of about 120 to about 400 kD). The term "reducing sugar" means a sugar containing a hemiacetal group, reducing metal ions or covalently reacting with lysine and other protein amino groups, and the term "non-reducing sugar" means a sugar that does not have the property of a reducing sugar. Examples of reducing sugars are fructose, mannose, maltose, lactose, arabinose, xylose, ribose, rhamnose, galactose and glucose. Non-reducing sugars include sucrose, trehalose, sorbose, melesitose, and raffinose. Mannitol, xylitol, erythritol, threitol, sorbitol and glycerol are examples of sugar alcohols. Sugar acids include L-gluconate and its metal salts. Where it is desired that the formulation be stable despite being frozen and thawed, it is preferred that the polyol does not crystallize at freezing temperature (e.g. -20 ° C) which would destabilize the antibodies in the formulation. The polyol can also act as an osmotic agent. In one embodiment of the invention, one component of the formulation is mannitol at a concentration of 5 to 20 mg / ml. In a preferred embodiment of the invention, the mannitol concentration is 7.5 to 15 mg / ml. In a more preferred embodiment of the invention, the mannitol concentration is 10-14 mg / ml.

The term "buffer as used herein" refers to a buffer solution that counteracts pH changes mediated by the conjugate acid and base components. A buffer in accordance with the invention has a pH ranging from about 4 to about 8; preferably from about 4.5 to about 7; and most preferably, a pH in the range of from about 5.0 to about 6.5. Examples of buffers to control the pH in this range include acetate (e.g. sodium acetate), succinate (such as sodium succinate), gluconate, histidine, citrate, and other organic acid buffers.

PL 218 221 B1

Pharmacologically, in the context of the present invention, the term "therapeutically effective amount or" effective amount of an antibody "refers to an amount effective in preventing or treating the disorder for which the antibody has been found to be effective. The term "disorder" means any condition in which treatment with an antibody provides benefits. It includes chronic and acute disorders or diseases including those pathological conditions which predispose the disorder to occur.

The term "preservative" means a compound that can be included in a formulation to significantly reduce its bacterial activity and thereby facilitate, for example, the preparation of formulations for various uses. Examples of potential preservatives include octadecyldimethylbenzylammonium chloride, hexamethonium chloride, benzalkonium chloride (a mixture of alkyl benzyldimethyl ammonium chlorides in which the alkyl groups are long chain compounds) and benzethonium chloride. Other types of preservatives include aromatic alcohols such as phenol, butyl and benzyl alcohol, alkyl parabens such as methyl or propyl paraben, catechol, resorcinol, cyclohexanol, 3-pentanol, and m-cresol.

The term "treatment" refers to both therapeutic treatment and prophylaxis or preventive measures. Persons in need of treatment include those already suffering from the disorder as well as those for whom it is intended to be prophylaxis for the disorder.

As used herein, the terms "parenteral administration and" parenteral administration mean modes of administration, other than enteral and topical administration, typically by injection, which include, without limitation: intravenous, intramuscular, intraarterial, intrathecal, intracapsular, intraorbital, intracardiac, intradermal, intra-dermal, intravenous, and intraperitoneal, intratracheal, subcutaneous, subepidermal, intraarticular, subcapsular, subarachnoid, spinal and intrasternal.

As used herein, the terms "systemic administration," systemically administered, "peripheral administration, and" peripherally administered, e.g., subcutaneously, mean administering a compound, drug, or other agent by any means other than directly to the central nervous system, so that it enters the body. patient, and was thus subjected to metabolism and other similar processes.

The term "pharmaceutically acceptable carrier is known in the art and includes a pharmaceutically acceptable agent, composition or vehicle suitable for administration to mammals. Carriers include liquid or solid fillers, diluents, excipients, solvents, or encapsulating agents for carrying or transporting an agent from one organ or part of the body to another organ or part of the body. Each carrier must be "acceptable, that is, compatible with the other ingredients of the formulation and not injurious to the patient.

As used herein, the term "human TNF? (Represented herein by the abbreviation hTNF? Or simply hTNF) refers to a human cytokine that exists as a 17 kD secreted and 26 kD membrane-bound form, the biologically active form of which consists of a trimer of non-covalently linked molecules 17. kD. The structure of hTNFa is described in more detail e.g. in Pennica, D., et al. (1984) Nature 312: 724-729; Davis, JM, et al. (1987) Biochemistry 26: 1322-132 6; and Jones, EY, et al. (1989) Nature 338: 225-228. The term "human TNFα" includes recombinant human TNFα (rhTNFα) which can be produced by standard recombinant expression methods or purchased by purchase (R&D Systems, Catalog No. 210-TA, Minneapolis, MN).

The term "antibody as used herein" refers to immunoglobulin molecules consisting of four polypeptide chains, two heavy (H) chains, and two light (L) chains linked together by disulfide bonds. Each heavy chain consists of a heavy chain variable region (abbreviated herein as HCVR or VH) and a heavy chain constant region. The heavy chain constant region is comprised of three domains, CH1, CH2, and CH3. Each light chain consists of a light chain variable region (abbreviated herein as LCVR or VL) and a light chain constant region. The light chain constant region consists of one domain, CL. The VH and VL regions may be further subdivided into hypervariable regions, termed complementarity determining regions (CDRs), alternating with regions of less variability, termed framework regions (FRs). Each VH and VL consists of three CDR regions and four FR regions arranged in the following order from the amino terminus to the carboxyl terminus: FR1, CDR1, FR2, CDR2, FR3, CDR3, FR4. In one embodiment of the invention, the preparation comprises an antibody having CDR1, CDR2, and CDR3 sequences such as those set forth in US Patent Nos. 6,090,382 and 6,258,562, incorporated herein by reference.

The term "antigen-binding portion of an antibody (or simply" antibody portion) "as used herein refers to one or more antibody fragments that retain the ability to

By specific binding to an antigen (e.g., hTNFa). It has been shown that fragments of full-length antibodies can act as antibodies by antigen-binding. Examples of binding fragments encompassed by the term "antigen-binding portion of an antibody include (i) a Fab fragment, a monovalent fragment consisting of the VL, VH, CL, and CH1 domains; (ii) a F (ab ') 2 fragment, a bivalent fragment containing two Fab fragments linked by a disulfide bridge at the hinge region; (iii) the Fd fragment consisting of the VH and CH1 domains; (iv) a Fv fragment consisting of the VL and VH domains of single-armed antibodies, (v) a dAb fragment (Ward et al., (1989) Nature 341: 544-546) which consists of a VH domain; and (vi) an isolated complementarity determining region (CDR). Moreover, although the two domains of the Fv fragment, VL and VH, are encoded by separate genes, they can be linked, using recombinant methods, by a synthetic linking group that allows them to arise as a single protein chain in which the VL and VH regions join pairing to form a monovalent molecule (known as single chain Fv (scFv), see e.g. Bird et al (1988) Science 242: 423-426; and Huston et al (1988) Proc. Natl. Acad. Sei. USA 85: 58795883). The term "antigen-binding portion of an antibody" also includes such single chain antibodies.

It also includes other forms of single chain antibodies, such as dual specificity antibody fragments (diabodes). Dual specificity antibody fragments are bivalent, dual-antigen-specific antibodies whose VH and VL domains are expressed on a single polypeptide chain with a linking group too short to allow the joining of the two domains of the same chain, causing the domains to join with the complementary ones. domains of other chains, in effect, forming two antigen binding sites (see, e.g., Holliger, P., et al. (1993) Proc. Natl. Acad. Sei. USA 90: 6444-6448; Poljak, RJ, et al. (1994) Structure 2: 1121-1123). In one embodiment of the invention, the formulation comprises an antigen-binding fragment as set forth in US Patent Nos. 6,090,382 and 6,258,562, incorporated herein by reference.

In addition, the antibody, or antigen binding portion thereof, may be part of a larger immunoadhesive molecule, formed by covalently or non-covalently binding the antibody or antibody portion to one or more other proteins or peptides. Examples of such immunoadhesive molecules include the use of the streptavidin core region to generate a tetrameric scFv molecule (Kipriyanov, SM, et al. (1995) Human Antibodies and Hybridomas 6: 93-101) and the use of a cysteine ​​residue, a peptide marker and a C-terminal poly-histidine tag to generate a bivalent and biotinylated scFv molecule (Kipriyanov, SM, et al. (1994) Mol. Immunol. 3J. ,: 1047-105 8). Antibody fragment such as Fab and F (ab ') 2 fragments can be prepared from whole antibodies using conventional techniques, such as papain or pepsin digestion of whole antibodies. In addition, antibodies, antibody fragments, and immunoadhesive molecules can be obtained using standard recombinant DNA techniques as described.

The term "human antibody," as used herein, includes antibodies with variable and constant regions derived from human germ cell immunoglobulin sequences. Human antibodies of the invention may include amino acid residues not encoded by human germ cell immunoglobulin sequences (e.g., by random or directed mutations in vitro or by somatic mutations in vivo), e.g. in CDRs, and in particular in CDR3. However, as used herein, the term "human antibody does not include antibodies in which CDR sequences are derived from germ cells of other mammalian species such as mouse, were grafted into human framework sequences.

As used herein, the term "recombinant human antibody includes all human antibodies prepared, expressed, produced, or isolated by recombinant methods, such as those expressed using a recombinant expression vector that has been transfected into host cells (as further detailed below in Chapter II). antibodies isolated from a combinatorial library of recombinant human antibodies (as more fully described below in Chapter III), antibodies isolated from an animal (e.g., mouse) that are transgenic for human immunoglobulin genes (see, e.g., Taylor, LD, et al. (1992) Nucl Acids Res. 20: 6287-6295), or antibodies prepared, expressed, produced, or isolated by any other means by assembling human immunoglobulin gene sequences together with other DNA sequences. Such recombinant human antibodies have variable and constant regions derived from human germ cell immunoglobulin sequences. In some embodiments, however, such recombinant human antibodies are mutagenized in vitro (or, using animals transgenic for human Ig sequences, somatic mutagenesis).

PL 218 221 B1 in vivo), thus, the amino acid sequences of the VH and VL regions of recombinant antibodies are sequences which, although derived from and related to the VH and VL sequences of human germ cells, may not naturally occur in vivo in the antibody repertoire human embryonic cells.

As used herein, the term "isolated antibody refers to antibodies substantially free of other antibodies with distinct antigenic properties (e.g., an isolated antibody that binds specifically to hTNF? Being substantially free of antibodies that specifically bind to antigens other than hTNF?). An isolated antibody that binds specifically to hTNFa may, however, display cross-reactivity to other antigens, such as TNFa molecules from other species.

Moreover, an isolated antibody may be substantially free of other cellular substances and / or chemicals.

The term "neutralizing antibody," (or "antibody neutralizing hTNFa activity) as used herein, refers to antibodies whose binding to hTNFa results in inhibition of hTNFa biological activity. Inhibition of hTNF? Biological activity can be determined by measuring one or more indicators of hTNF? Biological activity, such as hTNF? Induced cytotoxicity (in vitro or in vivo), hTNF? Induced cell activation, and hTNF? Binding to hTNF? Receptors. These markers of hTNFa biological activity can be assessed by one or more of several standard in vitro or in vivo assays known in the art set forth in US Patent Nos. 15,690,382 and 6,258,562, incorporated herein by reference. Preferably, the ability of the antibody to neutralize hTNF? Activity is determined by inhibiting hTNF? Induced cytotoxicity on L929 cells. As an additional or alternative parameter of hTNFα activity, the ability of the antibody to inhibit hTNFα-induced ELAM-1 expression on HUVEC can be determined as an indicator of hTNFα-induced cell activation.

As used herein, the term "surface plasmon resonance technique" refers to an optical phenomenon that enables real-time analysis of specific biological interactions by detecting changes in protein concentration in a biological sensor array, e.g. using a BIAcore system (Pharmacia Biosensor AB, Uppsala, Sweden and Piscataway, NJ) . For a more detailed description, see Jonsson, U., et al. (1993) Ann. Biol. Clin. 51: 19-26; Jonsson, U., et al. (1991) Biotechniques 11: 620-627; Johnsson, B., et al. (1995) J. Mol Recognit. 8: 125-131; and Johnsson, B., et al. (1991) Anal. Biochem. 198: 268-277.

The term "Koff" as used herein means the dissociation constant of an antibody from an antibody / antigen complex. The term "Kd" as used herein refers to the dissociation constant of a particular antibody-antigen interaction.

II. Antibodies of the preparation

The invention relates to a liquid pharmaceutical preparation in the form of an aqueous solution containing the antibodies in a therapeutically effective amount in a buffer solution causing the pH of the preparation to be between about 4 and about 8, and the entire preparation having an extended shelf life, preferably at least about 18 months. In another embodiment, the aqueous liquid pharmaceutical formulation of the present invention has increased stability. In a further embodiment of the invention, the formulation is not photosensitive. In yet another embodiment, the formulation of the invention remains stable after at least 3 freeze / thaw cycles. In yet another embodiment, the pharmaceutical formulation of the invention is suitable for single use as a subcutaneous injection.

Antibodies that can be used in the preparation include polyclonal, monoclonal, recombinant, single chain, hybrid antibodies, chimeric antibodies, humanized antibodies, or fragments thereof. Antibody-like molecules having one or two antigen binding sites and an immunoglobulin Fc fragment can also be used. An example of an antibody-like particle is the active ingredient etanercept or infliximab. The preferred antibodies for use in the preparation are human antibodies which are cloned from human cells or from the gene archives constituting the human antibody stock. Among human antibodies, antibodies directed against a TNF? Antigen, including human TNF? (Or hTNF?), Are especially preferred.

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In one embodiment, the formulation of the invention comprises a combination of antibodies (two or more) or an "antibody cocktail." For example, a formulation can include the D2E7 antibody and one or more accessory antibodies.

In a preferred embodiment, the preparation of the invention comprises an antibody, or antigen-binding portion thereof, that dissociates from human TNF? With a Kd constant of 1 x 10^-8 m or less and a Koff constant of 1 x 10^-3 s^-1 or less, with both constants determined by surface plasmon resonance, and canceling the cytotoxicity of human TNF? in a standard in vitro L929 assay with an IC50 of 1 x 10^-7 M or less. The formulation of the invention may include an antibody, or an antigen-binding portion thereof, as set forth in US Patent Nos. 6,090,382 and 6,258,562, incorporated herein by reference.

The preparation of the invention may contain D2E7 antibodies and antibody fragments, D2E7 related antibodies and antibody fragments, and other human antibodies and antibody fragments with properties corresponding to D2E7, such as high affinity binding to hTNFa with slow dissociation kinetics and high neutralization capacity. Preferably, the preparation of the invention comprises a human antibody, or antigen-binding portion thereof, that dissociates from human TNF? With a Kd constant of 1 x 10^-8 M or less and a Koff constant of 1 x 10^-3 s^-1 or less, as determined by surface plasmon resonance techniques, and abolished the cytotoxicity of human TNFα in standard in vitro L929 assay with an IC50 of 1 x 10^-7 M or less. The isolated human antibody, or antigen-binding portion thereof, can dissociate from human TNF? With a Koff constant of 5 x 10^-4 s^-1 or less, or even more preferably, with the Koff constant being -4-1c 1 x 10^-4 s^-1 or less. An isolated human antibody, or antigen-binding portion thereof, can abolish the cytotoxicity of human TNFα in a standard in vitro L929 assay with an IC50 of 1 x 10^-8 M or less, and even more preferably, with an IC50 of 1 x 10^-9 M or less, -10 and even more preferably with an IC50 of 5 x 10^-10 M or less. The preparation may contain an antibody that is an isolated recombinant human antibody, or an antigen-binding portion thereof. The formulation may contain an antibody that also neutralizes TNF? Induced cell activation as assessed using a standard assay for detecting ELAM-1 expression on human umbilical vein endothelial cells (HUVEC) induced by TNF? In vitro.

III. Preparation of the preparation

The invention relates to preparations (e.g., protein preparations and / or antibody preparations) with superior properties as compared to preparations known in the art. For example, the formulations of the invention have a longer shelf life and / or greater shelf life than those formulated in the art. In a preferred aspect, the preparations according to the invention contain the protein at a high concentration, e.g. protein concentration greater than about 45 mg / ml, protein concentration greater than about 50 mg / ml, protein concentration greater than about 100 mg / ml. In a preferred embodiment, the antibody is D2E7 antibody. The invention also relates to an aqueous pharmaceutical composition comprising a polyol, a surfactant and a buffering system containing citrate and / or phosphate at a pH of about 4 to 8, in an amount sufficient to produce an antibody for therapeutic use at a concentration greater than about, e.g., 45 mg / ml.

Production of the given antibody is performed by standard methods known in the art. In a preferred embodiment of the invention, the antibody used in the preparation is expressed in CHO cells and then purified by a series of standard chromatography steps. In a further preferred embodiment, the antibody is directed against hTNFa and is prepared according to the methods set forth in US Patent Nos. 6,090,382 and 6,258,562, incorporated herein by reference.

After producing a given antibody, a pharmaceutical preparation containing that antibody is prepared. The therapeutically effective amount of the antibody present in a formulation is determined, e.g., with the desired dose volume and the mode (s) of administration. In one embodiment of the invention, the concentration of the antibody in the preparation is between about 30 to about 120 mg of the antibody per ml of the liquid preparation. In a further preferred embodiment, the concentration of the antibody in the preparation is between about 25 to about 50 mg / ml. In a preferred embodiment, the antibody concentration is 50 mg / ml.

In another embodiment of the invention, the concentration of the antibody in the preparation is about 30-120 mg / ml, about 35-115 mg / ml, about 40-110 mg / ml, about 45-105 mg / ml, about 50-100 mg / ml, about 55-95 mg / ml, about 60-90 mg / ml, about 65-85 mg / ml, about 70-80 mg / ml, or about 75 mg / ml. The invention also covers the intermediate ranges of the concentrations mentioned. For example, the invention includes any range of values ​​that is a combination of any of the above values ​​as an upper and / or lower limit.

In one embodiment, the invention relates to a formulation with an extended shelf life comprising an active ingredient, preferably an antibody, in combination with mannitol, citric acid monohydrate, sodium citrate, disodium phosphate dihydrate, sodium dihydrogen phosphate dihydrate, sodium chloride, Polysorbate 80, water, and sodium hydroxide. . In a further embodiment, the formulation of the invention has an extended shelf life in the liquid state of at least about 18 months. Freezing the formulation according to the invention can also be used to further extend the shelf life.

An aqueous solution formulation is made by placing the antibody in a buffer solution. The buffer of the invention maintains the pH in the range from about 4 to about 8, preferably from about 4.5 to about 6.0, more preferably from about 4.8 to about 5.5, and most preferably, maintains the pH between about 5.0 to about 5.2. Ranges intermediate to the pH values ​​mentioned are also within the scope of the invention. For example, the invention also encompasses value ranges using a combination of any of the above-mentioned values ​​as upper and / or lower limit. Examples of buffers that adjust the pH in this range include acetate (e.g., sodium acetate), succinate (such as sodium succinate), gluconate, histidine, citrate, and other organic acid buffers.

In a preferred embodiment of the invention, the formulation comprises a buffering system composed of citrate and phosphate to maintain the pH in the range of about 4 to about 8. In a further preferred embodiment, the pH range is from about 4.5 to about 6.0, more preferably from about pH 4.8 to about 5.5, and most preferably from about 5.0 to about 5.2. In a further preferred embodiment, the buffering system comprises citric acid monohydrate, sodium citrate, disodium phosphate dihydrate, and / or sodium dihydrogen phosphate dihydrate. In a further preferred embodiment, the buffer system comprises about 1.3 mg / ml citric acid (e.g. 1.305 mg / ml), about 0.3 mg / ml sodium citrate (e.g. 0.305 mg / ml), about 1.5 mg / ml. mL disodium phosphate dihydrate (e.g. 1.53 mg / mL), approximately 0.9 mg / mL sodium dihydrogen phosphate dihydrate (e.g. 0.86), and approximately 6.2 mg / mL sodium chloride (e.g. 6.165 mg / ml). In further preferred embodiments, the buffering system comprises 1-1.5 mg / mL of citric acid, 0.25 to 0.5 mg / mL of sodium citrate, 1.25 to 1.75 mg / mL of disodium phosphate dihydrate, 0.7 to 1.1 mg / ml sodium dihydrogen phosphate dihydrate and 6.0 to 6.4 mg / ml sodium chloride. In a further embodiment, the pH of the formulation is adjusted with sodium hydroxide.

Also included in the formulation is a polyol which acts as an osmolarity regulator and may stabilize the antibody. The polyol is added to the formulation in an amount that depends on the desired degree of isotonicity of the formulation. Preferably, the aqueous solution formulation is isotonic. The amount of polyol added may also depend on the molecular weight of the polyol. For example, a smaller amount of monosaccharide (e.g. mannitol) may be added compared to a disaccharide (such as trehalose). In a preferred embodiment of the invention, the polyol used in the formulation as osmotic agent is mannitol. In a preferred embodiment of the invention, the mannitol concentration is about 5 to 20 mg / ml. In a further preferred embodiment of the invention, the mannitol concentration is about 7.5 to 15 mg / ml. In a more preferred embodiment of the formulation according to the invention, the concentration of mannitol is about 10-14 mg / ml. In a most preferred embodiment, the mannitol concentration is about 12 mg / ml. In another embodiment of the invention, the polyol in the formulation is sorbitol.

A detergent or surfactant is also added to the antibody preparation. Exemplary detergents include nonionic detergents such as polysorbates (e.g., Polysorbate 20, 80, etc.) or poloxamers (e.g., Poloxamer 188). The amount of detergent is added to reduce antibody aggregation and / or minimize particle formation in the formulation and / or reduce adsorption. In a preferred embodiment of the invention, the formulation comprises a surfactant which is a polysorbate. In a further preferred embodiment of the invention, the formulation comprises a detergent which is Polysorbate 80 or Tween 80. Tween 80 is the term used for polyoxyethylene (20) sorbitan monooleate (see Fiedler, Lexikon der Hifsstoffe, Editio Cantor Verlag Aulendorf, 4th edition, 1996). In a preferred embodiment, the formulation contains between about 0.1 and about 10 mg / ml of Polysorbate 80, more preferably between about 0.5 and about 5 mg / ml. In a further preferred embodiment, about 0.1% of Polysorbate 80 is present in the formulation of the invention.

In a preferred embodiment of the invention, the formulation is a 0.8 ml solution in a vial containing the ingredients shown in Table 1 below.

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Table 1

One vial of 0.8 ml solution for injection¹) includes:

<td>Ingredient</td><td>Quantity</td><td>Function</td>

<td>active ingredient: antibody (D2E7)²)</td><td>40.0 mg</td><td>the active substance</td>

<td>excipients:</td><td></td><td></td>

<td>mannitol</td><td>9.6 mg</td><td>osmotic agent</td>

<td>citric acid monohydrate citric acid</td><td>1.044 mg</td><td>buffer</td>

<td>sodium citrate sodium citrate</td><td>0.244 mg</td><td>buffer</td>

<td>disodium phosphate dihydrate dibasic sodium phosphate dihydrate</td><td>1.224 mg</td><td>buffer</td>

<td>Sodium dihydrogen phosphate dihydrate, monobasic sodium phosphate dihydrate</td><td>0.688 mg</td><td>buffer</td>

<td>sodium chloride</td><td>4.932 mg</td><td>osmotic agent</td>

<td>Polysorbate 80</td><td>0.8 mg</td><td>detergent</td>

<td>water for injections water for injections</td><td>759,028-759,048 mg</td><td>solvent</td>

<td>sodium hydroxide³)</td><td>0.02-0.04 mg</td><td>pH adjustment</td>

<td>Together</td><td>817.6 mg</td><td></td>

1) Solution density: 1.022 g / ml

2) It is used as a concentrate

3) Added as a 1M solution

In one embodiment, the formulation comprises the above-mentioned substances (ie, antibody, buffer, polyol, and detergent) and is substantially free of one or more preservatives, such as benzyl alcohol, phenol, m-cresol, chlorobutanol, and benzethonium chloride. In another embodiment, the formulation may contain a preservative, especially when the formulation is a multi-dose formulation. The formulation may contain one or more other pharmaceutically acceptable carriers, excipients, or stabilizers, such as those described in Remington's Pharmaceutical Sciences 16th edition, Osol, A. (1980) eds, provided that they do not significantly adversely affect the desired effect. properties of the preparation. Acceptable carriers, excipients, or stabilizers are nontoxic to recipients at the dosages and concentrations employed, and include: additional buffers; co-solvents; antioxidants including ascorbic acid and methionine; chelating agents such as EDTA; metal complexes (e.g. Zn-protein complexes); biodegradable polymers such as polyesters; and / or salt-forming counterions such as sodium.

As required by the particular condition to be treated, the present formulation can also be combined with one or more other therapeutic agents, preferably complementary to the antibodies of the formulation. Such therapeutic agents are formulated in an amount that is effective for its intended purpose. Additional therapeutic agents that may be combined with the formulation of the invention are described in more detail in US Patent Nos. 6,090,382 and 6,258,562, each of which is herein incorporated by reference.

Preparations intended for in vivo administration must be sterile. This is readily accomplished by filtration through sterilizing filter membranes before or after preparation of the formulation.

IV. Administration of the preparation

The formulation of the invention can be used with indications similar to those set forth in US Patent Nos. 6,090,382 and 6,258,562, both of which are hereby incorporated by reference, and detailed below.

The term "effective amount of a preparation" means an amount necessary or sufficient to inhibit TNF? Activity, e.g., prevent various morphological and somatic symptoms of a disorder caused by the deleterious effects of TNF ?. In another embodiment, the effective amount of the formulation is the amount necessary to obtain the desired effect. For example, an effective amount of a formulation is

An amount sufficient to inhibit the deleterious activity of TNFα. In another example, the effective amount of the formulation is 0.8 ml of a 40 mg antibody formulation as shown in Table 1. The effective amount may vary, depending upon factors such as the size and weight of the subject, or the type of disease. For example, the selection of a preparation that inhibits TNF? Activity can affect the "effective amount." Considering the above-mentioned factors, one skilled in the art can, without undue experimentation, determine an effective amount of a TNF? Inhibitory preparation.

The schedule of administration can influence the effective amount. The TNF? Inhibitory preparation can be administered to the subject either before or after the onset of the deleterious effects of TNF ?. In addition, several sub-doses as well as staggered doses may be administered daily or sequentially, or the dose may be continuously infused or injected as a bolus. Moreover, depending on the exigencies of the therapeutic or prophylactic situation, the doses of the TNF? Inhibitory preparation may be proportionally increased or decreased. The terms "treated," treatment, or "method of treatment" mean the reduction or amelioration of at least one symptom associated with or caused by the condition, disorder or disease treated. For example, treatment can mean the reduction of one or more symptoms of the disorder, or the elimination of the disorder completely.

The actual dosage levels of the active ingredients (antibodies) in a pharmaceutical formulation of the invention can be varied so as to obtain an amount of the active ingredient that is effective to achieve the desired therapeutic effect in a given patient, for a given composition and mode of administration, without being toxic to the patient.

The dosage level selected will depend on a variety of factors including the activity of the antibodies in the formulation, route of administration, time of administration, rate of excretion of the particular compound employed, duration of treatment, other drugs, compounds, and / or substances used in conjunction with the compound, age, the sex, weight, condition, general health, and medical history of the treated patient, and similar factors well known in the art.

A physician or veterinarian of average experience can readily determine and prescribe the required effective amount of the pharmaceutical composition of the invention. For example, a physician or veterinarian may initiate dosing of the compounds of the invention contained in the pharmaceutical formulation at a dose lower than that necessary to achieve the desired therapeutic effect, and then gradually increase the dose until the desired effect is achieved.

In general, a suitable daily dose of a formulation of the invention will be that amount of the formulation which is the lowest dose effective to produce a therapeutic effect. Such effective dose will generally depend on the factors described above. An effective amount of a formulation according to the invention is an amount which inhibits TNF? Activity in an individual suffering from a disorder wherein the TNF? Activity is detrimental. In a preferred embodiment, the formulation provides an effective dose of the active ingredient of 40 mg of antibody per injection. In another embodiment, the formulation provides an effective dose of the antibody which ranges from about 30 to 120 mg. If necessary, an effective daily dose of the pharmaceutical preparation may be administered in two, three, four, five, six or more sub-doses administered separately at appropriate intervals throughout the day, optionally in unit dosage forms.

In one embodiment of the invention, the dosage of the antibodies in the formulation is between about 30 and about 80 mg. In another embodiment, the dose of the antibodies in the formulation is between about 30 and about 50 mg. In a preferred embodiment, the formulation of the invention provides antibodies in a dose of about 40 mg. In a further preferred embodiment, the antibody is directed against TNFα. In a most preferred embodiment, the antibody is D2E7.

In one embodiment of the invention, the dose of the antibody in the formulation is between about 30-120 mg, about 35-115 mg, about 40-110 mg, about 45-105 mg, about 50-100 mg, about 55-95 mg, about 60- 90 mg, about 65-85 mg, about 70-80 mg, or about 75 mg. In a preferred embodiment, the dose of the antibody is 40 mg. In a further preferred embodiment, the antibody is directed against TNFα. In a most preferred embodiment, the antibody is D2E7. Intermediate ranges of the doses mentioned are also part of the invention. For example, the invention also includes ranges of values ​​using a combination of any of the above-mentioned values ​​as upper and / or lower limit. It is worth noting that the size of the dose may vary depending on the severity of the disorder to be alleviated. In addition, it is to be understood that the particular dosing regimen for an individual subject should be adapted over time as needed and by the expert judgment of the person administering or supervising the administration of the composition, and that the dosage ranges provided herein are exemplary only and should not be construed as limiting the scope or use of the composition. of this composition.

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The invention relates to a pharmaceutical formulation with an extended shelf life which, in one embodiment, is used to inhibit TNF? Activity in individuals suffering from a disorder wherein TNF? Activity is deleterious. This use consists in administering to an individual the antibody or antibody portion of the invention so as to inhibit TNF? Activity in the individual. Preferably, the TNFα used is human TNFα and the subject is human. Alternatively, the subject may be a mammal that expresses TNFα with which an antibody of the invention cross-reacts. In addition, the subject may be a mammal into an organism with hTNFa (eg, by administration of hTNFa or by expressing the hTNFa transgene). The formulation of the invention can be administered to humans for therapeutic purposes (detailed below). In one embodiment of the invention, the fluid pharmaceutical preparation is easy to administer, and the preparation, e.g. is self-administered by the patient. In a preferred embodiment, the formulation according to the invention is administered by subcutaneous injection, preferably single injection. In addition, the formulation of the invention may be administered to a non-human mammal that expresses TNF? With which the antibody cross-reacts (e.g. in a primate, porcine, or mouse) for veterinary purposes or as an animal model of human disease. Regarding this second application, such animal models may be useful for evaluating the therapeutic efficacy of the antibodies of the invention (e.g., in dose and timing testing).

The term "disorder in which TNFα activity is deleterious" as used herein includes diseases and other disorders in which the presence of TNFα in the subject suffering from the disorder has been shown or suspected to be responsible for the pathophysiology of the disorder or as a factor contributing to the aggravation of the disorder. Accordingly, a disorder in which TNF? Activity is deleterious is a disorder in which inhibition of TNF? Activity is expected to alleviate the symptoms and / or the progress of the disorder. This can be demonstrated, e.g., by the observation of an increase in TNF? Concentration in the physiological fluids of a subject suffering from a given disorder (e.g. an increase in serum, plasma, synovial fluid, etc. TNF? Concentration, etc.) which can be detected as described above, e.g. TNFa.

There are numerous examples of disorders in which TNFα activity is detrimental. Examples of disorders in which TNFα activity is deleterious are set out in US Application No. 60/397275, incorporated herein by reference. Examples of the deleterious activity of TNFα are also shown in U.S. Patent Nos. 6,015,557, 6,177,077, 6,379,666, 6,419,934, 6,419,944, 6,423,321, and 6,428,787; US Application Nos. US2001 / 0016195, US2001 / 0004456, and US2001 / 026801; WO 00/50079 and WO 01/49321, each of which is incorporated herein by reference.

The use of the antibodies and antibody fragments of the invention in the treatment of specific disorders is discussed in more detail below:

A. Sepsis

Through biological actions including blood pressure lowering, myocardial inhibition, vascular hyperpermeability syndrome, organ necrosis, stimulation of the release of toxic secondary mediators, and activation of the coagulation cascade, tumor necrosis factor plays a specific role in the pathophysiology of sepsis (see, e.g., Tracey, KJ and Cerami, A. (1994) Annu. Rev. Med. 45: 491-503; Russell, D and Thompson, RC (1993) Curr. Opin. Biotech. 4: 714-721). Accordingly, the formulation of the invention can be used to treat sepsis in any clinical form, including septic shock, endotoxin shock, gram-negative sepsis, and toxic shock syndrome.

In addition, in the treatment of sepsis, the formulation of the present invention may be co-administered with one or more additional therapeutic agents, the presence of which may better ameliorate sepsis, including an interleukin-1 inhibitor (such as those described in PCT Publication No. WO 92/16221). and WO 92/17583), the cytokine interleukin-6 (see, e.g., PCT publication No. WO 93/11793), or a platelet activating factor antagonist (see, e.g., European Patent Application Publication No. EP 374510).

Moreover, in a preferred embodiment, the formulation of the invention is administered to sepsis patients whose serum or plasma IL-6 concentration exceeds 500 pg / ml, and more preferably 1000 pg / ml during treatment (see PCT Publication No. WO 95/20978, p. Daum, L., et al.).

B. Autoimmune diseases

Tumor necrosis factor plays a role in the pathophysiology of a variety of autoimmune diseases. For example, TNF? Is believed to induce tissue inflammation and damage joints in rheumatoid arthritis (see, e.g., Tracey and Cerami, supra; Arend, WP and Dayer, JM. (1995) Arth.

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Rheum. 38: 151-160; Fava, RA, et al. (1993) Clin. Exp. Immunol. 94: 261-266). TNFα is also believed to cause pancreatic islet cell death and mediate insulin resistance in diabetes (see, e.g., Tracey and Cerami, supra; PCT Publication No. WO 94/08609). TNF? Is also believed to mediate oligodendrocyte cytotoxicity and induction of inflammatory plaques in multiple sclerosis (see, e.g., Tracey and Cerami, supra). Chimeric and humanized murine anti-hTNFa antibodies have been studied in clinical trials for the treatment of rheumatoid arthritis (see, e.g., Elliott, MJ, et al. (1994) Lancet 344: 1125-1127; Elliot, MJ, et al. (1994) Lancet 344: 1105 -1110; Rankin, EG, et al (1995) Br. J. Rheumatol. 34: 334-342).

The preparation according to the invention can be used in the treatment of autoimmune diseases, in particular those related to inflammation, including rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and gouty arthritis, allergy, multiple sclerosis, diabetes caused by autoimmune disease, autoimmune disease. uveitis and nephrotic syndrome. Typically, the formulation is administered systemically, however, in some disorders, local administration of the antibody or antibody portion at the site of inflammation may be beneficial (e.g., topical administration to joints in rheumatoid arthritis or topical administration to diabetic ulcers, alone or in combination. with an ylidene derivative of cyclohexane as described in PCT Publication No. WO 93/19751).

C. Infectious diseases

Tumor necrosis factor is believed to mediate the biological effects observed in a wide variety of infectious diseases. For example, TNF? Is believed to mediate encephalitis as well as capillary thrombosis and infarction in malaria (see, e.g., Tracey and Cerami, supra). TNFα is also believed to mediate encephalitis, induce damage to the blood-brain barrier, induce septic shock syndrome, and activate venous embolism in meningitis (see, e.g., Tracey and Cerami, supra). TNFα also is believed to induce cachexia, stimulate viral proliferation, and mediate central nervous system damage in acquired immune deficiency syndrome (AIDS) (see, e.g., Tracey and Cerami, supra). Accordingly, the antibodies and antibody fragments of the invention can be used in the treatment of infectious diseases, including bacterial meningitis (see, e.g., European Patent Application Publication No. EP 585705), malaria cerebral complications, AIDS and AIDS related syndrome (ARC). (see, e.g., European Patent Application Publication No. EP 230574), as well as cytomegalovirus infection following transplantation (see, e.g., Fietze, E., et al. (1994) Transplantation 58: 675-680). The formulation of the invention may also be used to relieve symptoms associated with infectious diseases, including fever and muscle pain due to infections (such as influenza) and cachexia due to infection (e.g., AIDS or ARC).

D. Transplantation

Tumor necrosis factor is assumed to be a key mediator of allograft rejection and graft versus host response (GVHD), and to mediate the deleterious response that has been observed when the rat antibody OKT3, directed against the CD3 receptor complex of T cells, is used to inhibit renal graft rejection (see e.g., Tracey and Cerami, supra; Eason, JD, et al. (1995) Transplantation 59: 300-305; Suthanthiran, M. and Strom, TB (1994) New Engl. J. Med. 331: 365-375). Accordingly, the formulation of the invention can be used to inhibit graft rejection, including allograft and heterogeneous graft rejection, and to inhibit GVHD. Although the antibody or antibody portion may be used alone, it is more preferred to use in combination with one or more other agents that suppress the immune response to allograft or inhibit GVHD. For example, in one embodiment, the formulation of the invention is used in combination with OKT3 to inhibit reactions induced by OKT3. In another embodiment, the formulation of the invention is used in combination with one or more antibodies to other target molecules involved in the regulation of the immune response, such as CD25 cell surface molecules (interleukin-2 receptor), CD11a (LFA-1). , CD54 (ICAM-1), CD4, CD45, CD28 / CTLA4, CD80 (B7-1) and / or CD86 (B7-2). In yet another embodiment, the formulation of the invention is used in combination with one or more general immunosuppressants such as cyclosporin A or FK506.

E. Malignant neoplasms

Tumor necrosis factor is assumed to induce cachexia, stimulate tumor growth, increase the likelihood of metastasis, and play a role in cytotoxicity in malignant neoplasms16

(See, e.g., Tracey and Cerami, supra). Accordingly, the formulation according to the invention may be used in the treatment of malignant neoplasms, for inhibiting tumor growth or metastasis, and / or for ameliorating cachexia caused by a malignant tumor. The preparation can be administered systemically or locally to the tumor.

F. Pulmonary disorders

Tumor necrosis factor is believed to be involved in the pathophysiology of adult respiratory distress syndrome, including stimulation of leukocyte and endothelial cell activation, cytotoxicity to pneumocytes, and induction of vascular hyperpermeability syndrome (see, e.g., Tracey and Cerami, supra). Accordingly, the formulation of the invention can be used in the treatment of a variety of pulmonary disorders, including adult respiratory distress syndrome (see e.g. PCT Publication No. WO 91/04054), shock lung, chronic pulmonary inflammatory disease, pulmonary sarcoidosis, pulmonary fibrosis and silicosis. The preparation can be administered systemically or locally to the lungs, e.g. as an aerosol.

G. Intestinal disorders

Tumor necrosis factor is believed to be involved in the pathophysiology of inflammatory bowel disorders (see, e.g., Tracy, KJ, et al (1986) Science 234: 470-474; Sun, XM., Et al (1988) J. Clin. Invest. 81: 1328-1331; MacDonald, TT, et al. (1990) Clin. Exp. Immunol. 81; 301-305). For the treatment of Crohn's disease, chimeric murine anti-hTNFa antibodies (van Dullemen, HM, et al. (1995) Gastroenterology 109: 129-135) have been tested in clinical trials. The preparation according to the invention can also be used in the treatment of intestinal disorders, such as idiopathic inflammatory bowel diseases, among which we distinguish between two disease entities: Crohn's disease and ulcerative colitis.

H. Cardiac disorders

The formulation according to the invention can also be used in the treatment of various cardiac disorders, including cardiac ischemia (see e.g. European Patent Application Publication No. EP 453 898) and heart failure (myocardial weakness) (see e.g. PCT Publication No. WO 94/20139).

And other

The pharmaceutical preparation according to the invention can also be used in the treatment of various other disorders in which TNF? Activity is deleterious. Examples of other diseases and disorders in the pathophysiology mediated by TNF? Activity and thus treatable with the formulation of the invention include: bone inflammatory disorders and bone resorption diseases (see, e.g., Bertolini, DR, et al. (1986) Nature 319: 516-518; Konig, A., et al. (1988) J. Bone Miner. Res. 3: 621-627; Lerner, UH and Ohlin, A. (1993) J. Bone Miner. Res. 8: 147-155; and Shankar, G. and Stern, PH (1993) Bone 14: 871-876), hepatitis, including alcoholic hepatitis (see, e.g., McClain, CJ and Cohen, DA (1989) Hepatology 9: 349-351; Felver , ME, et al. (1990) Alcohol Clin. Exp. Res. 14: 255-259; and Hansen, J., et al. (1994) Hepatology 20: 461-474) and viral hepatitis (Sheron, N , et al (1991) J. Hepatol 12: 241-245; and Hussain, MJ, et al (1994) J. Clin Pathol. 47: 1112-1115), coagulation disorders (see, e.g., van der Poll, T., et al. (1990) N. Engl. J. Med. 322: 1622-1627; and van der Poll, T., et al. . (1991) Prog. Clin. Biol. Res. 367: 55-60), burns (see, e.g., Giroir, BP, et al. (1994) Am. J. Physiol 267: H118-124; and Liu, XS, et al. (1994) Burns 20: 40-44), tissue damage by reperfusion (see, e.g., Scales, WE, et al. (1994) Am. J. Physiol. 267: G1122-1127; Serrick, C, and in. (1994) Transplantation 58: 1158-1162; and Yao, YM, et al. (1995) Resuscitation 29: 157-168), keloid formation (see, e.g., McCauley, RL, et al. (1992) J. Clin. Immunol. 12: 300-308), scar tissue formation; fever; periodontal disease; obesity and the harmful effects of radiation.

Other disorders in which TNFα activity is detrimental include, but are not limited to: Still's disease in adults, Alzheimer's disease, ankylosing spondylitis, asthma, cancer and cachexia, atherosclerosis, chronic atherosclerosis, chronic fatigue syndrome, liver failure, chronic liver failure, obstructive pulmonary disease, chronic obstructive pulmonary disease, congestive heart failure, dermatomyositis and polymyositis, diabetic macroangiopathy, endometriosis, periodic familial fever, fibrosis, hemodialysis, Jarisch-Herxheimer reaction, juvenile arthritis, Kawasaki syndrome, myelodysplastic syndrome, myocardial infarction, a disorder called panciaticular vulgaris, periodontitis, peripheral neuropathy, polyarthritis, polymyositis, progressive kidney failure, psoriasis, psoriatic arthritis, Rehen's syndrome sarcoidosis, scleroderma, spondyloarthropathies, Still's disease, stroke, therapy-related syndrome, therapy-induced inflammatory syndrome, inflammatory syndrome following administration of IL-2, thoracic aortic aneurysm (TAAA) surgery, Vasulo-Behcet disease, yellow fever vaccine, type 1 diabetes mellitus,

Type 2 diabetes mellitus, neuropathic pain, sciatica, cerebral edema, edema of the spine and / or around the spinal cord, vasculitis, Wegener's granulomatosis, temporal arteritis, rheumatoid muscle pain, Takayasu's arteritis, polyarteritis nodosa, microscopic multivesselitis, Churg-Strauss syndrome, Felty syndrome, Sjogren's syndrome, mixed connective tissue disease, recurrent polychondritis, gout-like inflammation loosening of prostheses, autoimmune hepatitis, sclerosing cholangitis, acute pancreatitis, chronic pancreatitis, glomerulonephritis, post streptococcal glomerulonephritis or post streptococcal IgA nephropathy, rheumatic heart disease, cardiomyopathy, orchitis, pyoderma, period myeloma associated with the TNF receptor [TRAPS], atherosclerosis, steroid-dependent giant cell arteritis and myositis, uveitis and drug reactions.

The following examples, which should not be construed as limiting, illustrate the invention. The content of all references, pending patent applications, and published patent descriptions cited in this application are expressly incorporated herein by reference.

Examples

Example 1: Preparation of the formulation

The pharmaceutical preparation according to the invention was prepared according to the following protocol.

The substances used in the preparation include: mannitol, citric acid monohydrate (citric acid), sodium citrate, disodium phosphate dihydrate (sodium phosphate dibasic dihydrate), sodium dihydrogen phosphate dihydrate (monobasic sodium phosphate dihydrate), sodium chloride, polysorbate 80, water for injection , sodium hydroxide, which was used as a 1M solution for pH control, and a protein concentrate (e.g., an antibody concentrate).

Preparation of 20 l buffer (equivalent to 20.180 kg - solution density: 1.009 g / ml)

The ingredients were weighed as follows: 240.0 g of mannitol, 26.1 g of citric acid monohydrate, 6.1 g of sodium citrate, 30.6 g of disodium phosphate dihydrate, 17.2 g of sodium dihydrogen phosphate dihydrate, 123.3 g of sodium chloride, 20, 0 g of Polysorbate 80 and 19715.7 to 19716.1 g of water.

The sodium hydroxide solution was prepared by combining 40.0 g of sodium hydroxide with 1000.8 g of water for injection.

Then, a buffer was prepared by dissolving the following pre-weighed ingredients (described above) in approximately 90% water for injection: mannitol, citric acid monohydrate, sodium citrate, disodium phosphate dihydrate, sodium dihydrogen phosphate, sodium chloride, and Polysorbate 80. The order of addition of the ingredients was found to be buffer was irrelevant, so it could be freely chosen.

After all buffer components had been added, the pH of the solution was adjusted with 1M sodium hydroxide which was prepared as described above. Finally, after adding sodium hydroxide, water was added. Thereafter, the buffer solution was filtered through a sterilized filter (hydrophilic polyvinylidene difluoride, 0.22 µm pore diameter) into a sterilized container.

Filtration was performed in a sterile nitrogen environment.

Production of 40 l of the preparation (equivalent to 40.88 kg)

Then, the filtered buffer solution was added to the thawed and pooled antibody concentrate (active ingredient of pharmaceutical formulation) prepared in the following manner. Before starting the pharmaceutical preparation, the antibody (concentrate) was thawed in a water bath. 34.207 g of the antibody concentrate were used which for a protein concentrate of 60 mg protein / ml corresponds to 2.0 kg protein. The density of the concentrate was 1.0262 g / ml. Any protein concentrate can be used in the range from 25,655 to 37,316, which corresponds to a protein concentration in the protein concentrate of 55 to 80 mg / ml. The buffer was added with stirring until the final weight of the total solution was reached.

The formulation, containing all ingredients, was then filter sterilized as described above, except that the formulation was filtered through two sterile 0.22 µm pore membrane filters. After sterilization, the formulation was packaged in either vials or prefilled syringes.

It is also appreciated in the art that weights and / or mass / volume ratios given herein can be converted into moles and / or molar concentrations using art-known molecular weights of the listed components. Weights exemplified herein (e.g. in grams or kilograms) correspond to the volume stated (e.g. in buffer or pharmaceutical formulation). It is appreciated in the art that weights can be converted on a proportional basis for the various formulation volumes required. For example, 32L, 20L, 10L, 5L or 1L formulations contain 80%, 50%, 25%, 12.5% ​​or 2.5%, by weight of examples exemplified herein, respectively.

PL 218 221 B1

Example 2:

Freeze-thaw studies

After selecting the buffer for the D2E7 antibody, the drug substance was formulated on the same template as the finished product.

The behavior of the drug substance containing the D2E7 antibody at a protein concentration of 63 mg / ml upon freezing and thawing was assessed by alternating the frozen state of the drug substance into the liquid state 3 times. Table N shows the results of an experiment evaluating the effects of three cycles of fast and slow freeze-thaw in the presence and absence of 0.1% Polysorbate 80 starting at -80 ° C or -30 ° C, respectively.

As shown in Table 2, the drug substance containing the D2E7 antibody can be alternately thawed and frozen at least 3 times without any deleterious consequences for both chemical (cation exchange HPLC, HPLC exclusion chromatography, color, pH) and physicochemical (particles below the limit of visibility, clarity) and for biological activity (in vitro TNF neutralization test). Table 2 also shows that the incorporation of Polysorbate 80 improves the physicochemical properties of the drug substance containing the D2E7 antibody as evidenced by the lower number of particles below the limit of visibility, regardless of whether a slow or fast freeze / thaw cycle was used (see shaded areas in Table 2).

Table 2

Effect of freezing and thawing on drug substance containing D2E7 antibody with / without Polysorbate 80

<td>Criteria test</td><td>Polysorbate (0.1%)¹)</td><td>Number of freeze / thaw cycles</td><td>-30 ° C slow defrosting in the refrigerator</td><td>Quick defrost -30 ° C in a water bath</td><td>-80 ° C slow defrosting in a refrigerator</td><td>Quick defrost -80 ° C in a water bath</td>

<td>clarity</td><td> +</td><td> 25,0</td><td> 22,5</td><td> 25,3</td><td> 25,8</td><td> 25,6</td>

<td></td><td></td><td> 27,8</td><td> 28,1</td><td> 28,2</td><td> 28,0</td><td> 28,1</td>

<td>coloring</td><td> +</td><td>&lt;B9</td><td>&lt;B9</td><td>&lt;B9</td><td>&lt;B9</td><td>&lt;B9</td>

<td></td><td></td><td>&lt;B9</td><td>&lt;B9</td><td>&lt;B9</td><td>&lt;B9</td><td>&lt;B9</td>

<td>pH</td><td></td><td> 5,01</td><td> 5,02</td><td> 5,02</td><td> 5,02</td><td> 5,02</td>

<td></td><td> +</td><td> 5,02</td><td> 5,02</td><td> 5,02</td><td> 5,02</td><td> 5,02</td>

<td>particles</td><td> +</td><td> 42</td><td> 600</td><td> 303</td><td> 1891</td><td> 303</td>

<td>the border</td><td></td><td> 2</td><td> 4</td><td> 5</td><td> 8</td><td> 0</td>

<td>visibility</td><td></td><td> 0</td><td> 5</td><td> 1</td><td> 0</td><td> 8</td>

<td></td><td></td><td> 0</td><td> 0</td><td> 0</td><td> 0</td><td> 1</td>

<td rowspan="2">chromato-</td><td></td><td></td><td></td><td></td><td></td><td></td>

<td>_-</td><td> 99,8</td><td> 99,8</td><td> 99,8</td><td> 99,8</td><td> 99,8</td>

<td>HPLC exclusion graph</td><td> +</td><td> 99,8</td><td> 99,8</td><td> 99,8</td><td> 99,8</td><td> 99,8</td>

<td>cation-</td><td> +</td><td> 87,1</td><td> 87,0</td><td> 87,2</td><td> 86,9</td><td> 86,9</td>

<td>removable</td><td></td><td> 86,8</td><td> 87,0</td><td> 87,1</td><td> 87,3</td><td> 86,8</td>

<td>HPLC</td><td></td><td></td><td></td><td></td><td></td><td></td>

<td>Test</td><td></td><td> 118,0</td><td> 123,8</td><td> 118,0</td><td> 103,3</td><td> 120,5</td>

<td>in vitro neutralization of TNF</td><td> +</td><td> 111,8</td><td> 96,2</td><td> 100,9</td><td> 96,7</td><td> 95,8</td>

1) + = preparation containing 0.1% Polysorbate 80; - = preparation without 0.1% Polysorbate 80

Example 3: Tests on the proliferation of microorganisms

Tests were carried out to determine whether the preparation allowed for the multiplication of microorganisms. The results of these experiments showed that the preparation did not allow the multiplication of microorganisms if it was stored for 14 days at a temperature of 20 to 25 ° C. This result was obtained directly by sowing microorganisms (e.g. Staphylococcus aureus, ATCC #: 6538P, Candida albicans, ATCC #: 10231, Aspergillus niger, ATCC #: 16404, Pseudomonas aeruginosa, ATCC #: 9027, ambient bacterial sample) at low concentration (NMT 100 colony forming units / ml) per a sterile preparation. Thereafter, the total multiplication of the microorganisms, e.g. changes in turbidity, is examined in the inoculated preparations. No turbidity found in inoculated containers after

At 218 221 B1 days indicated a lack of multiplication. Moreover, no microorganisms could be isolated from the containers. Thus, it was concluded that the formulation did not allow the multiplication of the microorganisms under these conditions.

Literature references

All references and patents cited herein are hereby incorporated by reference in their entirety.

Equivalent solutions

Those skilled in the art will be able to recognize or ascertain, based solely on routine testing, of many equivalents to those described in the present invention. Such equivalent arrangements are intended to be included within the scope of the following claims.

SEQUENCE LIST &lt;110? Krause, Hans Juergen Baust, Lisa Dickes, Michael &lt;120&gt; PREPARATION CONTAINING HUMAN ANTIBODIES FOR THE TREATMENT OF DISORDERS RELATED TO TNF-ALFA &lt;130&gt; BBC-166 &lt;140&gt; 10/222140 &lt;141: »2002-08-16 &lt;160&gt; 34 &lt;170&gt; FastSEQ for Windows version 4.0 &lt;210? 1 &lt;211&gt; 107 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody

<td colspan="15"> &lt;400&gt; 1</td>

<td>Asp</td><td>How much</td><td>Gin</td><td>Underworld</td><td>Thr</td><td>Gin</td><td>Cheese</td><td>Pro</td><td>Cheese</td><td>Cheese</td><td>Leu</td><td>Cheese</td><td>Ala Ser</td><td>Val</td><td>Gly</td>

<td> 1</td><td></td><td></td><td></td><td> 5</td><td></td><td></td><td></td><td></td><td> 10</td><td></td><td></td><td></td><td> 15</td><td></td>

<td>Asp</td><td>Arg</td><td>Val</td><td>Thr</td><td>How much</td><td>Thr</td><td>Cys</td><td>Arg</td><td>Ala</td><td>Cheese</td><td>Gin</td><td>Gly</td><td>How many Arg</td><td>Asn</td><td>Tyr</td>

<td></td><td></td><td></td><td> 20</td><td></td><td></td><td></td><td></td><td> 25</td><td></td><td></td><td></td><td> 30</td><td></td><td></td>

<td>Leu</td><td>Ala</td><td>Trp</td><td>Tyr</td><td>Gin</td><td>Gin</td><td>Lys</td><td>Pro</td><td>Gly</td><td>Lys</td><td>Ala</td><td>Pro</td><td>Lys Leu</td><td>Leu</td><td>How much</td>

<td></td><td></td><td> 35</td><td></td><td></td><td></td><td></td><td> 40</td><td></td><td></td><td></td><td></td><td> 45</td><td></td><td></td>

<td>Tyr</td><td>Ala</td><td>Ala</td><td>Cheese</td><td>Thr</td><td>Leu</td><td>Gin</td><td>Cheese</td><td>Gly</td><td>Val</td><td>Pro</td><td>Cheese</td><td>Arg Phe</td><td>Cheese</td><td>Gly</td>

<td></td><td> 50</td><td></td><td></td><td></td><td></td><td> 55</td><td></td><td></td><td></td><td></td><td> 60</td><td></td><td></td><td></td>

<td>Cheese</td><td>Gly</td><td>Cheese</td><td>Gly</td><td>Thr</td><td>Asp</td><td>Phe</td><td>Thr</td><td>Leu</td><td>Thr</td><td>How much</td><td>Cheese</td><td>Leu cheese</td><td>Gin</td><td>Pro</td>

<td> 65</td><td></td><td></td><td></td><td></td><td> 70</td><td></td><td></td><td></td><td></td><td> 75</td><td></td><td></td><td></td><td> 80</td>

<td>Glu</td><td>Asp</td><td>Val</td><td>Ala</td><td>Thr</td><td>Tyr</td><td>Tyr</td><td>Cys</td><td>Gin</td><td>Arg</td><td>Tyr</td><td>Asn</td><td>Arg Al</td><td>Pro</td><td>Tyr</td>

<td></td><td></td><td></td><td></td><td> 85</td><td></td><td></td><td></td><td></td><td> 90</td><td></td><td></td><td></td><td> 95</td><td></td>

<td>Thr</td><td>Phe</td><td>Gly</td><td>Gin</td><td>Gly</td><td>Thr</td><td>Lys</td><td>Val</td><td>Glu</td><td>How much</td><td>Lys</td><td></td><td></td><td></td><td></td>

<td></td><td></td><td></td><td> 100</td><td></td><td></td><td></td><td></td><td> 105</td><td></td><td></td><td></td><td></td><td></td><td></td>

<td> &lt;210&gt; &lt;211&gt; &lt;212? &lt;213&gt;</td><td>2 121 PRT Sequence</td><td>artificial</td>

<td> &lt;220&gt;</td><td></td><td></td>

<td> &lt;223 &gt;</td><td>mutated</td><td>human antibody</td>

<td> &lt;400?</td><td> 2</td><td></td>

<td colspan="2">Glu Val Gin Leu</td><td>Val Glu Ser Gly Gly Gly Leu Val Gin Pro Gly Arg</td>

<td> 1</td><td></td><td> 5 10 15</td>

<td colspan="2">Leu Arg Leu cheese</td><td>Ser Cys Ala Ala Ser Gly Phe Thr Phe Asp Asp Tyr</td>

<td></td><td> 20</td><td> 25 30</td>

<td colspan="2">Ala Met His Trp</td><td>Val Arg Gin Ala Pro Gly Lys Gly Leu Glu Trp Val</td>

<td></td><td> 35</td><td> ' 40 45</td>

<td colspan="2">Ala Ile Thr</td><td>Trp Asn Ser Gly His Ile Asp Tyr Ala Asp Ser Val</td>

PL 218 221 B1

<td></td><td> 50</td><td></td><td></td><td></td><td></td><td> 55</td><td></td><td></td><td></td><td></td><td> 60</td><td></td><td></td><td></td><td></td>

<td>Glu</td><td>Gly</td><td>Arg</td><td>Phe</td><td>Thr</td><td>How much</td><td>Cheese</td><td>Arg</td><td>Asp</td><td>Asn</td><td>Ala</td><td>Lys</td><td>Asn</td><td>Cheese</td><td>Leu</td><td>Tyr</td>

<td> 65</td><td></td><td></td><td></td><td></td><td> 70</td><td></td><td></td><td></td><td></td><td> 75</td><td></td><td></td><td></td><td></td><td> 80</td>

<td>Leu</td><td>Main</td><td>Underworld</td><td>Asn</td><td>Cheese</td><td>Leu</td><td>Arg</td><td>Ala</td><td>Glu</td><td>Asp</td><td>Thr</td><td>Ala</td><td>Val</td><td>Tyr</td><td>Tyr</td><td>Cys</td>

<td></td><td></td><td></td><td></td><td> 85</td><td></td><td></td><td></td><td></td><td> 90</td><td></td><td></td><td></td><td></td><td> 95</td><td></td>

<td>Ala</td><td>Lys</td><td>Val</td><td>Cheese</td><td>Tyr</td><td>Leu</td><td>Cheese</td><td>Thr</td><td>Ala</td><td>Cheese</td><td>Cheese</td><td>Leu</td><td>Asp</td><td>Tyr</td><td>Trp</td><td>Gly</td>

<td></td><td></td><td></td><td> 100</td><td></td><td></td><td></td><td></td><td> 105</td><td></td><td></td><td></td><td></td><td> 110</td><td></td><td></td>

<td>Gin</td><td>Gly</td><td>Thr</td><td>Leu</td><td>Val</td><td>Thr</td><td>Val</td><td>Cheese</td><td>Cheese</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td>

<td></td><td></td><td> 115</td><td></td><td></td><td></td><td></td><td> 120</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td>

&lt;210&gt; 3 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;220&gt;

&lt;221&gt; VARIANT &lt;222&gt; 9 &lt;223&gt; Xaa = Thr or Ala &lt;400&gt; 3

Gin Arg Tyr Asn Arg Ala Pro Tyr Xaa 1 5 &lt;210&gt; 4.

&lt;211&gt; 12 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;220&gt;

&lt;221&gt; VARIANT &lt;222&gt; 12 &lt;223&gt; Xaa = Tyr or Asn &lt;400&gt; 4

Val Ser Tyr Leu Ser Thr Ala Ser Ser Leu Asp Xaa 15 10 &lt;210&gt; 5 &lt;211&gt; 7 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;22O&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 5

Ala Ala Ser Thr Leu Gin Ser

5 &lt;21Q&gt; 6 &lt;211&gt; 17

PL 218 221 B1 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 6

Ala Ile Thr Trp Asn Ser Gly His Ile Asp Tyr Ala Asp Ser Val Glu 15 10 15

Gly &lt;210&gt; 7 &lt;211&gt; 11 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 7

Arg Ala Ser Gin Gly Ile Arg Asn Tyr Leu Ala

10 &lt;210&gt; 8 &lt;211&gt; 5 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;40O&gt; 8

Asp Tyr Ala Met His

5 &lt;210&gt; 9 &lt;400&gt; 9 000

<td colspan="2"> &lt;210&gt; 10 &lt;400&gt; 10</td>

<td>&lt;210&gt; 11 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Sequence</td><td>s artificial</td>

<td>&lt;22Q&gt; &lt;223&gt; mutated</td><td>human antibody</td>

<td>&lt;400&gt; 11 Gin Lys Tyr Asn 1</td><td>Ala Pro Tyr Ala cheese 5</td>

&lt;210&gt; 12

PL 218 221 B1 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 12

Gin Lys Tyr Asn Aig Ala Pro Tyr Ala 1 5 '&lt;210&gt; 13 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 13

Gin Lys Tyr Gin Arg Ala Pro Tyr Thr 1 5 &lt;210&gt; 14 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 14

Gin Lys Tyr Ser Ser Ala Pro Tyr Thr 1 5 &lt;210&gt; 15 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 15

Gin Lys Tyr Asn Ser Ala Pro Tyr Thr 1 5 &lt;210&gt; 16 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody

PL 218 221 B1 &lt;400&gt; 16

Gin Lys Tyr Aan Arg Ala Pro Tyr Thr 1 5 &lt;210&gt; 17 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 17

Gin Lys Tyr Asn Ser Ala Pro Tyr Tyr 1 5 &lt;210&gt; 18 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 18

Gin Lys Tyr Asn Ser Ala Pro Tyr Asn 1 5 &lt;210&gt; 19 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 19

Gin Lys Tyr Thr Ser Ala Pro Tyr Thr 1 5 &lt;210&gt; 20 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;22 0&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 20

Gin Lys Tyr Asn Arg Ala Pro Tyr Asn 1 5 &lt;210&gt; 21 &lt;211&gt; 9 &lt;212&gt; PRT

Artificial sequence &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 21

Gin Lys Tyr Asn Ser Ala Ala Tyr Ser 1 S &lt;210&gt; 22 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 22

Gin Gin Tyr Asn Ser Ala Pro Asp Thr 1 '5 &lt;210&gt; 23 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213? · Artificial sequence &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 23

Gin Lys Tyr Asn Ser Asp Pro Tyr Thr 1 5 &lt;210&gt; 24 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 24

Gin Lys Tyr Ile Ser Ala Pro Tyr Thr 1 5 &lt;210&gt; 25 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;22O&gt;

&lt;223&gt; mutant human antibody &lt;4Q0&gt; 25

Gin Lys Tyr Asn Arg Pro Bro Tyr Thr 1 5

PL 218 221 B1 &lt;210&gt; 26 &lt;211&gt; 9 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 26

Gin Arg Tyr Asn Arg Ala Pro Tyr Ala 1 5 &lt;210&gt; 27 &lt;211&gt; 12 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 27

Ala Ser Tyr Leu Ser Thr Ser Ser Ser Leu Asp Asn 1 5 10 &lt;210&gt; 28 &lt;211&gt; 12 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 28

Ala Ser Tyr Leu Ser Thr Ser Ser Ser Leu Asp Lys 15 10 &lt;210&gt; 29 &lt;211&gt; 12 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 29

Ala Ser Tyr Leu Ser Thr Ser Ser Ser Leu Asp Tyr

<td colspan="2"> 1</td>

<td> &lt;210&gt;</td><td> 30</td>

<td> &lt;211&gt;</td><td> 12</td>

<td> &lt;212&gt;</td><td>PRT</td>

<td> &lt;213&gt;</td><td>Sequence</td>

<td> &lt;220&gt;</td><td></td>

PL 218 221 B1 &lt;223&gt; mutant human antibody &lt;400&gt; 30

Ala Ser Tyr Leu Ser Thr Ser Ser Ser Leu Asp Asp 15 10 &lt;210&gt; 31 &lt;211&gt; 12 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 31

Ala Ser Tyr Leu Ser Thr Ser Phe Ser Leu Asp Tyr 15 10 &lt;210&gt; 32 &lt;211&gt; 12 &lt;212&gt; PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 32

Ala Ser Tyr Leu Ser Thr Ser Ser Ser Sar Leu His Tyr 15 10 &lt;210&gt; 33 &lt;211&gt; 12 &lt;212? PRT &lt;213&gt; Dummy &lt;220&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 33

Ala Ser Phe Leu Ser Thr Ser Ser Ser Leu Glu Tyr 15 10 &lt;210&gt; 34 &lt;211&gt; 12 &lt;212&gt; PRT &lt;213&gt; Artificial sequence &lt;22 0&gt;

&lt;223&gt; mutant human antibody &lt;400&gt; 34

Ala Ser Tyr Leu Ser Thr Ala Ser Ser Leu Glu Tyr 15 10