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    • 专利摘要:
    The present invention provides the use of the photoactive derivative according to claim 1 for photodynamic treatment to selectively destroy and / or inactivate immunoreactive cells without substantially adversely affecting normal cells or causing systemic toxicity to a patient. The present invention relates to the use of a photoactive derivative, characterized in that radiation of the appropriate wavelength and intensity is applied when a suitable intracellular level of said derivative is achieved.
    公开号:KR20020050234A
    申请号:KR1020027004263
    申请日:2000-10-03
    公开日:2002-06-26
    发明作者:데니스-크라우드 로이；마틴 기몬드；네스터에이 몰피노
    申请人:유니버시떼 드 몬트리얼；호피탈 메조뇌브-로즈몽뜨；
    IPC主号:
    专利说明:

    Rhodamine derivatives for photodynamic diagnosis and treatment
    [2] An immunological disorder is a condition or disease due to the production of immune cells that recognize normal cells and tissues as foreign cells and tissues. Cells with immunoreactivity to normal cells or tissues cause damage in the normal cells or tissues either directly through cellular agonist mechanisms or indirectly through antibodies, cytokines or other mediators. Such immunological disorders are usually classified into either an autoimmune state or an autoimmune state. Alloimmune disorders occur mainly in connection with allogeneic transplants (bone marrow and other organs: kidney, heart, liver, lung, etc.). In bone marrow transplantation, donor immune cells present in hematopoietic stem cell grafts react with host normal tissue to cause graft-versus-host disease (GVHD). This GVHD mainly causes damage to the liver, skin, intestines, lungs, eyes and mouth. Autoimmune disorders include arthritis diseases such as rheumatoid arthritis, scleroderma and lupus erythematosus; Endocrine diseases such as diabetes mellitus; Nervous system diseases such as multiple sclerosis and myasthenia gravis; Gastrointestinal diseases such as Crohn's disease and ulcerative colitis; And hematological disorders such as autoimmune hemolytic anemia. In both homoimmune and autoimmune disorders, an immune response leads to organ dysfunction and impairment.
    [3] Despite significant advances in treatment, immunological complexity remains a major cause of allograft failure, whether in hematopoietic stem cell transplantation (GVHD) or in parenchymal transplantation (graft rejection). Autoimmune disorders also provide a major factor in morbidity and mortality. The prevention and treatment of these immune disorders rely mainly on the use of immunosuppressants, monoclonal antibody based therapies, radiation therapy, and more recently molecular inhibitors. Subsequent development of modalities combinations has markedly improved the results, but this has only been applied to a small number of disorders and patients. However, the resolution and treatment of immunological dysfunction has not yet been achieved for the most common types of transplantation (bone marrow, kidney, liver, heart and lung) and most immune disorders (rheumatic arthritis, connective tissue disease, multiple sclerosis, etc.). It is not. Therefore, there is an urgent need for the development of new methods for the prevention and treatment of immunological disorders in patients at high risk, significantly advanced disease or immune to standard immunosuppressive therapies. Allogeneic stem cell transplantation (AlloSCT) has been used to treat many malignant and non-malignant conditions. Allogeneic stem cell transplantation is based on high dose chemotherapy with or without systemic radioactivity to remove malignant cells and host hematopoietic cells. Normal hematopoietic donor stem cells are injected into the patient to replace the host hematopoietic system. AlloSCT has been shown to cause improved response rates in contrast to standard therapies. An important issue that needs to be addressed when using AlloSCT is the risk of reinjecting immune cells that can cause GVHD by recognizing patient cells as foreign material. Various techniques have been developed to consume 99.999% of T cells from stem cell grafts. These techniques, including purification of immunological and physical purification, are not satisfactory enough. One important consideration when purifying stem cell grafts is to preserve non-host-reactive T cells so that they can exert anti-infective and anti-leukemic activity upon transplantation. When preparing for AlloSCT or Autologous Stem Cell Transplantation (AutoSCT) and after AlloSCT involving donor lymphocyte infusion to remove recurrent leukocytes, immunologically normal donor-non-reactive immune cells do not purify hematopoietic grafts The possibility of photodynamic therapy in conjunction with photosensitive molecules that can destroy reactive cells has not been studied much. To eradicate T cells, the following methods have been proposed:
    [4] 1) exposing the graft in vitro to monoantibodies and immunotoxins (anti-CD3, anti-CD6, anti-CD8, etc.) against antigens present on the surface of T cells;
    [5] 2) in vitro selection method by soy flocculation and sheep erythrocyte rosetting;
    [6] 3) positive selection of CD34 + stem cells with or without additional negative selection of T cells;
    [7] 4) in vivo therapies in combination with anti-thymogenic globulin or monoclonal antibodies;
    [8] 5) intra or extracorporeal treatment with photosensitisers; And
    [9] 6) In Vitro or In Vitro Exposure of Receptor-Reactive Donor T Cells by Monoclonal Antibodies or Immunotoxins Targeting Interleukin 2 Receptor or OX-40 Antigen (Cavazzana-Calvo M. et al. (1990) Transplantation, 50: 1- 7; Tittle TV et al. (1997) Blood 89: 4652-58; Harris DT et al. (1999) Bone Marrow Transplantation 23: 137-44).
    [10] However, most of these methods do not specifically target alloreactive T cell subsets, but rather all T cells or a broad T cell population. This is associated with numerous problems, including disease recurrence, graft rejection, secondary malignancies, and serious infections. In addition, the clinical results of some of the methods described above have not been established.
    [11] There are many reports using photodynamic therapy in the treatment of malignancies (see Daniel MD, Hill JS (1991) Aust. NZJ Surg. , 61 : 340-348). One of these is described in US Pat. Nos. 5,556,992 and 5,773,460, wherein the patent uses novel photoactive rhodamine derivatives for photodynamic therapy of cancer patients by destroying human cancer cells, and suitable cells of the derivatives. My level is achieved and irradiates with light of a suitable wavelength. The method has been applied to cancer of various origins and to eradicate viruses and pathogens (see Raab O. (1990) Infusoria Z. Biol ., 39 : 524).
    [12] Early experiments on the use of photodynamic therapy for the treatment of cancer with various naturally-occurring or synthetically produced photoactive substances were published earlier this century (Jesionek A., Tappeiner VH (1903) Muench Med Wochneshr , 47 : 2042; Hausman W. (1911) Biochem. Z. , 30 : 276). In the 40s and 60s, many tumor types were treated for photodynamic therapy in vitro and in vivo (Kessel, David (199) Photodynamic Therapy of neoplastic disease , Vol. I, II, CRC Press. David Kessel, Ed. ISBN 0-8493-5816-7 (v.1), ISBN 0-8493-5817-5 (v.2)). In the 1970s and 1980s, Dougherty et al. And others studied systematically whether photodynamic therapy could be applied to tumors (Dougherty TJ (1974) J. Natl Cancer Inst ., 51 : 1333-1336; Dougherty TJ et al. (1975) J. Natl Cancer Inst ., 55 : 115-121; Dougherty TJ et al. (1978) Cancer Res. , 38 : 2628-2635; Dougherty TJ (1984) Urol. Suppl ., 23 : 61; Dougherty TJ (1987 Photochem.Photobiol. , 45 : 874-889). Some rhodamine derivatives have been shown to exhibit anti-tumor properties (see US Pat. No. 5,773,460 and US Pat. No. 5,556,992). The specificity of these photosensitisers for malignant cells showing high proliferation rates enabled the evaluation of these materials for the removal of immunological cells.
    [13] Treatment of Immunological Cells Using Photodynamic Therapy
    [14] There is currently a lack of substances that allow for the selective destruction of immunological cells while leaving the normal non-pathogenic residual cell population intact. Selective uptake and lymphoid cells of photosensitive dyes (Greinix HT et al. Blood (1998) 92: 3098-3104; Hunt DW et al. (1999) Immunopharmacology, 41: 31-44; Heykorenko EA et al. (1998) Immunopharmacology 40: 231- 40); And the cytotoxicity of photodynamic therapy against macrophages (Heykorenko E.A. et al. (1998) Immunopharmacology 40: 231-40; King D.E. et al. (1999) Scand J. Immuno 49: 184-92) is previously known and Zic J.A. Et al. Therapeutic Aphresis (1999) 3: 50-62.
    [15] It is particularly preferable to provide a photosensitizer having the following characteristics:
    [16] i) selectively localized outside the nucleus and absorbs immunological cells;
    [17] ii) adding suitable light intensity kills the cells that accumulate and retain the photosensitiser;
    [18] iii) protects a sufficient proportion of normal hematopoietic stem cell parts from the destructive effects of activated photosensitizers;
    [19] iv) the use of photosensitizers for hematopoietic stem cell purification of immunological cells in preparation for allogeneic or autologous stem cell transplantation; And
    [20] v) the possibility of using photosensitizers for ex vivo removal of immune system cells in patients with immunological disorders.
    [21] Rhodamine dye
    [22] Rhodamine 123 (2- (6-amino-3-imino-3H-xanthen-9-yl) benzoic acid methyl ester) hydrochloride, may destroy cell homeostasis and proliferate in high exposure and / or photodynamic therapy Fatty-compatible cationic dyes of pyryllium, which may be inhibitory or cytotoxic but have very poor quantum yields (Darzynkiewicz Z., Carter S. (1988) Cancer Res. , 48 : 1295-1299). This was used to specifically fluoresce mitochondria surviving in vitro. It is absorbed and selectively retained by many tumor cell types and impairs their proliferation and survival by altering membrane and mitochondrial action (Oseroff AR (1992) In Photodynamic therapy (Henderson BW, Dougherty TJ, EDIT). New York: Marcel Dekker, pp. 79-91). In vivo, chemotherapy with rhodamine 123 may further prolong survival of mice with cancer, but despite the initial intention to use rhodamine 123 in the treatment of tumors, systemic toxicity may limit their usefulness. (See Bernal, SD et al. (1983) Science , 222 : 169; Powers, SK et al. (1987) J. Neurosur , 67 : 889).
    [23] Richard L. on 16 September 1986. US Pat. No. 4,612,007 to Edelson discloses a method for external treatment of human blood for the purpose of reducing the lymphocyte populations acting in the blood system of human subjects. Blood taken from the subject is passed through an ultraviolet radiation system in the presence of dissolved photoactive agents capable of forming photoadducts with lymphoid DNA. This method presents the following disadvantages and drawbacks. The procedure described is based on the use of known commercially available photoactive chemicals for external treatment of the patient's blood, wherein immune cells from other sites are left intact during the process. Richard L. According to Edelson, the method only reduces the target cell population but does not eradicate it. This treatment strategy does not have the purpose of improving the immunoreactivity of target cells. Moreover, the wavelength range of the UV radiation used in the method proposed by Richard L. Edelson could damage normal cells.
    [24] International application published January 7, 1993 under International Publication No. WO93 / 00005, discloses a method for inactivating pathogens in body fluids while minimizing adverse effects due to photosensitisers. The method consists in treating the cells in the presence of a photoactive agent, under conditions capable of destroying the pathogen and preventing the treated cells from further contacting the extracellular protein for a period of time. The method relates to eradication of infectious agents prior to storage or transfusion from the collected blood and its components and does not interfere with the present invention.
    [25] It is particularly desirable to provide a novel use of rhodamine derivatives for use in immunological cell treatment that overcomes the above mentioned drawbacks but does not have substantial systemic toxicity to the patient.
    [1] The present invention relates to photodynamic therapy for the selective destruction of immunologically reactive cells without causing substantial harm to normal cells and without causing systemic toxicity to the patient.
    [108] 1 is a phototoxicity graph of 4,5-dibromorodamine 123 hydrobromide salt (TH9402) used according to the method of the present invention for K562 and CEM cell lines mixed with normal irradiated PBMCs and expressed as fractions of clonal cells. ,
    [109] FIG. 2 is a graph showing that PHA activated lymphocytes stop 3H-thymidine incorporation after photodynamic therapy with 7.5 and 5 joules / cm 2 as opposed to moderately treated cells, FIG.
    [110] FIG. 3 is a graph showing that cells from Subject A activated and photodynamically treated for Subject B cells do not proliferate when reexposed to B cells, but proliferate upon exposure to C cells.
    [111] 4 shows TH9402 fluorescence upon flow cytometry evaluation of stable lymphocytes and activated lymphocytes. Cells were evaluated at various times after the end of the TH9402 incorporation period. Activated lymphocytes contain more TH9402 than stable lymphocytes.
    [112] 5 shows the effect of cyclosporin A on TH9402 cell efflux 110 minutes after the end of the TH9402 incorporation period. Cyclosporin A prevents the outflow of TH9402 in stable lymphocytes but not activated lymphocytes.
    [113] 6 shows the effect of PDT and TH9402 on CD4 and CD8 positive cells after activation in lymphocyte cultures mixed with third party cells. Activated cells (CD25), CD4 + and CD8 + are removed by photodynamic therapy.
    [114] 7A and 7B show that about 3 logarithms (99.9%) of human B cells can be removed (A) by PDT using TF9402. In contrast, myeloid (colony forming unit-granulocyte monocytes [CFU-GM], erythrocytes (burst forming unit-erythrocyte monocytes [BFU-E] and mixtures thereof (colony forming unit-granulocyte erythrocyte monocytes [CFU-GEMM]) Hematopoietic primitive cells of less than 1 logarithm of origin (about 50%) are removed by the same PDT procedure.
    [115] 8A, 8B and 8C are three graphs showing the phototoxicity of the 4,5-dibromorodamine 110 n-butyl ester hydrobromide salt used according to the method of the present invention and are expressed in% survival rate.
    [116] 9A and 9B are two graphs showing the phototoxicity of rhodamine B n-butyl ester hydrochloride salt used according to the method of the present invention, expressed in% survival rate.
    [26] Summary of the Invention
    [27] It is a first object of the present invention to provide a new use of a photosensitizer having the following characteristics:
    [28] i) selective localization and uptake by immunological cells;
    [29] ii) by applying suitable light intensity, accumulate photosensitizers to functionally or physically remove retained cells;
    [30] iii) protects a sufficient proportion of normal hematopoietic T and stem cell parts from the destructive effects of activated photosensitizers;
    [31] iv) the use of photosensitizers for hematopoietic stem cell purification of immunological cells with or without strategies to increase immunoreactivity in preparing allogeneic or autologous stem cell transplants;
    [32] v) the use of photosensitizers for in vitro removal of reactive immune cells with or without strategies in patients with immunological disorders; And
    [33] vi) the use of photosensitizers to assess the transport mechanism of immune and malignant cells.
    [34] According to the present invention there is provided a photoactive pharmaceutical composition for selectively destroying and / or inactivating immunologically reactive cells without substantially adversely affecting normal cells or causing systemic toxicity to a patient, wherein the composition comprises 4,5 -Dibromorodamin 123 (2- (4,5-dibromo-6-amino-3-imino-3H-xanthen-9-yl) -benzoic acid methyl ester) hydrobromide; 4,5-dibromorodamine 110 (2- (4,5-dibromo-6-amino-3-imino-3H-xanthen-9-yl) -benzoic acid) ethyl ester hydrobromide; 4,5-dibromorodamin 110 (2- (4,5-dibromo-6-amino-3-imino-3H-xanthen-9-yl) -benzoic acid) octyl ester hydrobromide; 4,5-dibromorodamine 110 (2- (4,5-dibromo-6-amino-3-imino-3H-xanthen-9-yl) -benzoic acid) n-butyl ester hydrobromide; Rhodamine B n-butyl ester (2- (6-diethyl amino-3-ethyl imino-3H-xanthen-9-yl) -benzoic acid) n-butyl diester hydrochloride; And a pharmaceutically acceptable carrier with one or more photoactive rhodamine derivatives selected from the group consisting of photoactive derivatives thereof, wherein photoactivation of the derivatives causes cell death but inactivated derivatives are substantially non-toxic to cells. Adult photoactive pharmaceutical compositions are provided.
    [35] According to the present invention, there is provided the use of the photoactive derivative according to the present invention for selectively destroying and / or inactivating immunologically reactive cells without substantially adversely affecting normal cells or causing systemic toxicity to a patient. When appropriate intracellular levels of the derivative are achieved, radiation of appropriate wavelength and intensity is applied.
    [36] According to the invention,
    [37] a) activating lymphocytes from the donor by mixing the donor cells with a host cell for a time sufficient for an immune response to occur;
    [38] b) substantially removing activated lymphocytes of process a) by photodynamic therapy with a therapeutic amount of the photoactive composition of the present invention under radiation of a suitable wavelength; And
    [39] c) A method for preventing graft-versus-host disease associated with allogeneic stem cell transplantation in a patient, comprising the step of performing allogeneic stem cell transplantation using the treated mixture of process b).
    [40] According to the invention,
    [41] a) collecting hematopoietic cells of the patient;
    [42] b) ex vivo treatment of hematopoietic cells of step a) by photodynamic therapy with a therapeutically effective photoactive composition of the invention under radiation of a suitable wavelength; And
    [43] c) performing a graft infusion or an autograft infusion using the treated hematopoietic cells of step b), to provide a method of treating an immunological disorder in a patient.
    [44] According to a preferred embodiment of the invention, the immunological disorder consists of a state in which the autologous or donor cells respond to host tissue or foreign targets, such as graft-versus-host disease, graft rejection, autoimmune diseases and immunoallergic conditions. Selected from the group.
    [45] In a method according to a preferred embodiment of the invention, the hematopoietic cells are selected from the group consisting of bone marrow, peripheral blood and cord blood mononuclear cells.
    [46] For the purposes of the present invention, the following terms are defined as follows.
    [47] The term "immunological disorder" refers to an immunological disorder such as an autoimmune or autoimmune response and / or disorder.
    [48] The term "TH9402" refers to the 4,5-dibromorodamine 123 hydrobromide salt.
    [49] The expression "selectively destroys immunologically reactive cells without substantially adversely affecting normal cells or causing systemic toxicity to the patient" means maintaining a sufficient number of non-pathogenic cells to produce a beneficial therapeutic effect.
    [50] The expression “photoactive derivatives thereof” means substituted rhodamine 110 (2- (6-amino 3-imino 3H-xanthen-9-yl) benzoic acid) derivatives and salts thereof that are activated by light. Preferred substituted rhodamine 110 derivatives include derivatives comprising at least 1 and up to 8 halogens, preferably bromine atom substituents.
    [51] The photoactive dye is excited to single line excited state in ground state after absorption of photons. Single-line excitation states of organic molecules are generally short-lived (10 -12 -10 -6 seconds) because they quickly return from the relaxed state to the ground state using non-radioactive (vibration mode) and radioactive (fluorescent) processes. The intersystem crossing for a more stable triplet excited state becomes a ground state in competition with the relaxed state. Triplet excited states typically have a long lifetime (10 -6 -10 seconds), which diffuse and react with other molecules in the medium.
    [52] Triplet excited states can react with molecular oxygen through two different mechanisms. The first mechanism (type I) is configured to transfer electrons from the excitation dye to molecular oxygen such that highly reactive free radical-anions are present in the cellular environment.
    [53] The second mechanism (type II) consists of the transfer of energy from excited dyes to molecular oxygen to form cytotoxic singlet oxygen. Therefore, the photosensitizer must satisfy two conditions in order to be an effective phototherapeutic agent. The first condition should be present at a higher concentration in the target cell than in normal cells. Higher concentrations of dyes in malignant and immunological cells result in higher amounts of cytotoxic species generated by light, resulting in higher mortality. The second condition is that the irradiation of the phototherapeutic agent in the presence of intracellular concentrations of molecular oxygen should form a highly efficient cytotoxic species.
    [54] Rhodamine 123 is absorbed and selectively retained by many tumor cells and its use as a phototherapy is also proposed. Intracellular rhodamine is removed from cells by the channel transporter (Pgp-170), which is encoded by the pluripotency gene (MDR-1). T cell activation induced the inactivation of the Pgp-170 transporter to increase the intracellular content of rhodamine (Pilarski LM (1995) Am. J. Hematol. 49: 323-35; Ludescher C (1998) Br.J. Haematol. 101: 722-7). However, the singlet excitation state of rhodamine 123 does not go through the intersystem crossing of the triplet excitation state. For this reason, rhodamine 123 is a weak photosensitizer (Morliere, P et al. (1990) Photochemistry and Photobiology , 52 (4): 703-710).
    [55] In order to overcome the limitations of the prior art methods, the chemical structure of rhodamine 123 can be modified to enhance the intersystem crossing for triplet excited states. In theory, this could be achieved by substituting heavy atoms such as Br or other halides instead of hydrogen atoms in the molecular structure of rhodamine 123. Thus, dibromorhodamine 123 hydrobromide salt (hereinafter referred to as TH9402) was prepared and tested.
    [56] The hydrophilic properties of the amphiphilic structure of the dye could modulate the cytoplasm and mitochondrial membrane and affect the cytotoxicity of the dye. For example, hydrophobicity has been shown to be the most important characteristic affecting in vitro absorption of porphyrin (Chi-Wei Lin (1990) In Photodynamic therapy of neoplastic disease , Vol II, CRC Press, pp 79-101). Thus, different esters of rhodamine 123 and rhodamine B were prepared and tested. More specifically are dibromorhodamine 110 n-butyl ester hydrobromide salt (DBBE) and rhodamine B n-butyl-ester hydrochloride salt (RBBE).
    [57] Different heavy atomic substitutions (halogenous substitutions) of the hydrogen atoms of the rhodamine backbone, such as dibromo and diiodo derivatives of rhodamine B and rhodamine 110 ester, were prepared and tested.
    [58] Dimers / oligomers, heterodimers / oligomers of these compounds could be used if they exhibited suitable cytotoxic properties.
    [59] Substituting oxygen heteroatoms of the rhodamine backbone with heavier atoms to reduce S 0 / S 1 splitting should theoretically increase spin orbital coupling and promote in situ cross-linking from the S 1 state to the T 1 state. Higher triplet yields than the original dye should be obtained. This should increase proportionally the production of singlet oxygen. S (sulfur), Se (selenium) and Te (tellurium) substitutions on the oxygen atom (O) of the rhodamine backbone are tested.
    [60] Moreover, other strategies for increasing the activated immune cell preferential accumulation of dyes, as well as high photon yields of tumors with type I (free radical-anions) or type II (monooxy), are tested.
    [61] According to the present invention, it was found that TH9402 is selectively retained by activated T cells. Stable T cells could remove TH9402 from the intracellular environment, but not activated T cells (FIG. 4). We also found that adding cyclosporin-A inhibits TH9402 outflow. Since cyclosporin-A is a potent inhibitor of Pgp-170, TH9402 efflux will be dependent on the Pgp-170 transporter as previously observed in the rhodamine parent molecule. Thus inactivation of the MDR pathway in activated T cells could explain the preservation of inactivated T cells for preferential removal of activated T cells and subsequent recognition of third cells (FIG. 3). The absence of known strong expression of Pgp-170 on B cells allows the evaluation of PDT capacity using TH9402 to remove B lymphocytes. TH9402 was found to be able to remove about 3 logarithms (99.9%) of B lymphocytes. In contrast, when PDT was performed under the same conditions that have been used to highly remove B lymphocytes, more than half of normal hematopoietic cells in bone marrow (CFU-GM), erythroid (BFU-E), and mixture (CFU-GEMM) This was preserved. Thus, PDT with TH9402 exhibits desirable therapeutic features for the removal of immune cells, including activated T cells, B cells and potentially other cells (dendritic cells) that may be involved in immune disorders. The photodynamic therapy described above is carried out in connection with sensitizing or activating potential agonist cells in advance, or pathogenic immune cells are (1) already activated because the disease is ongoing, or (2) spontaneously sensitive to PDT ( For example B cells) and could therefore be performed without manipulation to increase immunoreactivity. Activation can be achieved by exposure to antigens, cells, cell lysate proteins, peptides, DNA, cytokines, mitogenic factors (mytogens), lectins or other substances directly or indirectly involved in the activation process.
    [62] According to the present invention, the above-mentioned dyes are used together with antibodies specific for immune cell populations, peptides, proteins or toxins, or liposomes or lipoproteins, inhibitors of efflux pathways (such as MDR) or fluorochrome adducts or other substances. do.
    [63] In addition, the above-described photosensitizers have the potential to act synergistically with other photoactive materials.
    [64] Moreover, the negative selection process provided by using photodynamic therapy does not preclude the use of other means to elongate hematopoietic stem cells, such as positive selection with anti-CD34 monoclonal antibodies.
    [65] Clinical application
    [66] The first clinical application of the present invention is the use of a photosensitizer in connection with in vitro purification of allogeneic reactive cells prior to allogeneic stem cell transplantation to prevent graft-versus-host disease. Under these circumstances, the donor cell is first exposed to the recipient cell or antigen or other component to activate the donor cell to the antigen of the recipient cell. These cells are subjected to photodynamic therapy to remove alloreactive donor cells. This strategy preserves hematopoietic cells that are non-reactive to host cells.
    [67] The same strategy in all cases where administration of donor cells can lead to graft-versus-host disease, such as donor lymphocytes injected into the receptor to exhibit anti-leukemia or anti-infective activity (removal of alloreactive cells from the cellular graft) Could apply.
    [68] In the case of autoimmune disorders, some of the immune cells are autoreactive. When autologous stem cell transplantation was performed to treat the disease, the stem cell graft could contain immunoreactive cells that could lead to disease relapse after transplantation. The photodynamic treatment described in this application can be used to remove immunoreactive cells from stem cell grafts prior to autologous transplantation.
    [69] In these immunological disorders (both autoimmune and autoimmune), photodynamic therapy has been available to eliminate the cells involved in the immune disease process. Patient cells were collected by collecting peripheral blood or other cells or tissues and then photodynamically treated in vitro to remove immunoreactive cells. After treatment, the cells were subjected to (1) preservation of the patient pool of non-immunoreactive cells, (2) to induce a desired imbalance between immunoreactive and non-immunoreactive cells, and (3) apoptosis. By injecting rough immunoreactive cells, they can be re-injected to induce immunoregulation through improved preservation of antigens from the immunoreactive cells (Albert ML et al. Nature (1998) 392: 86-9).
    [70] After infusion into the cells, rhodamine is removed via a transport mechanism. Thus, rhodamine derivatives, including TH942, could be used to study the cell handling mechanisms of these molecules. Interestingly, some substances, including chemotherapeutic agents, are removed through the same transport mechanism as rhodamine. Measurement of these transport mechanisms using rhodamine derivatives, such as TH942, could also be used for understanding cell and molecular biology, and also for immunity that could be eliminated by diagnostic and prognostic purposes (chemotherapy, photodynamics or other therapeutic agents). May be used for identifying biologically active cells or malignant cells.
    [71] Chemical synthesis
    [72] Rhodamine B n-butylester hydrochloride, 4,5-dibromorhodamine n-butylester hydrobromide, rhodamine n-butylester hydrochloride, 4,5-dibromordamine 110 n-butylester hydrobromide and The chemical synthesis of 4,5-dibromorhodamine 123 hydrobromide was performed as described in US Pat. No. 5,556,992, issued September 17, 1996, which is incorporated herein by reference.
    [73] Cell line
    [74] T cells are the most important population of immune cells present in peripheral blood. To demonstrate the efficiency of photodynamic therapy with TH9402 to remove activated T cells, the effect on malignant T cell lines was first evaluated. Phototoxicity against the chronic myeloid leukemia cell line K562, which was used in US Pat. Nos. 5,556,992 and 5,773,460, was also evaluated in parallel. CEM T cytotoxic lymphoblastic leukemia cell line and K562 chronic myeloid leukemia cell line (Lozzio, from American Type Culture Collection (ATCC, 20852 Rockville Lacron Drive 1201, US), deposited under accession numbers CCL-119 and CCL-243. BB and Lozzio, CB (1979) Cancer Res. , 3 (6): 363-370). Cultures were maintained at 37 ° C. in a humidified incubator with 95% air and 5% CO 2 atmosphere. Cells were RPMI 1640 medium (manufactured by Gibco, USA) supplemented with 10% fetal bovine serum (FBS), 2 mM L-glutamine, 1 mM sodium pyruvate, 100 U / mL penicillin, and 100 μg streptomycin (manufactured by Life Technology Inc.) New York, Grand Island). Before each experiment, cell viability was evaluated by trypan blue exclusion. CEM or K562 cells were mixed with mononuclear peripheral blood cells normally irradiated in a 1: 1 ratio and then photodynamically treated. Prior to mixing with CEM or K562 cells, normal PBMCs were 25 Gy radioactively treated at 4 Gy / min ( 137 Cs; Gamma Cells, Atomic Energy of Canada, Ottawa, Ontario, Canada).
    [75] Photodynamic processing
    [76] The cell suspension was incubated for 40 min at 37 ° C. with 10 μM TH9402. Cells were treated at 1 × 10 6 cells / mL in X-vivo-15 medium without using phenol red (BioWhittaker, Walkersville, MD) supplemented with 2.5% FBS. At the end of the incubation period, the cells were rolled up and the cell pellet was resuspended in X-vivo culture medium supplemented with 10% FBS without dye. The cells were left for 90 minutes in a T-flask (Corning, Mass., Cambridge, USA) at 37 ° C. After a second incubation in a medium without dye, cells were exposed to the desired light energy, typically 5 joules / cm 2 , 3 mm thick using the previously described light delivery device (US Pat. No. 5,798,523). Light energy was delivered using a fluorescence scan lamp device having a maximum wavelength of about 512 nm.
    [77] Phototoxicity of 4,5-Dibromorodamin 123 Hydrobromide (TH9402)
    [78] In order to assess the photochemotherapy potential and in vitro phototoxicity of 4,5-dibromorodamine 123 hydrobromide (TH9402), T cell line CEM and leukemia line K562 mixed with normal irradiated PBMC were treated with 5 joules / cm 2 of light ( As described above). After photodynamic treatment, cells were washed three times and plated by restriction dilution assay (LDA) as described above (Roy DC et al., JNCI 1996; 88: 1136-45). In sum, each treatment sample was serially diluted to 5 x 10 5 to 0.5 cells per 100 μl in RPMI 1640 supplemented with 10% FBS. Each dilution was then divided into 24 aliquots and plated on a flat bottom microculture plate (Nunclon, Nunk Denmark). Cells were fed every 4 days and incubated at 37 ° C. for 12-14 days. Growth in each sequential dilution was assessed in a "all or nothing" (positive or negative) fashion under reversed phase microscopy. The frequency of clonogenic cells in the test population was assessed using chi-square minimization (Taswell C, J. Immunol . 1981; 126: 1614-19). As shown in FIG. 1, photodynamic therapy with TH9402 removed almost all CEM and K562 cells, and less than 0.1% CEM and K562 were not removed by phototherapy, in contrast to samples containing only medium. These results indicate high levels of malignant T cell clearance as previously reported in leukemia K562 cells and support the efficiency of the process for removing malignant T cells. TH9402 has been shown to be very phototoxic; The improvement of cytotoxic activity is believed to be the result of an increase in the intracellular content of TH9402 in the malignant T and myeloid cell lines.
    [79] T cell activation with PHA
    [80] X- supplemented with 20% AB serum (manufactured by Sigma), 1% pen-strep (manufactured by Gibco), 2% glutamine (manufactured by Gibco) and 20 μg / ml phytohemagglutinin-A (PHA-P) manufactured by Sigma) Normal PBMCs were activated by incubation at 37 ° C. for 48-72 hours in vivo-15 medium (Biowhittaker, Walkersville, MD). Cells were incubated at a concentration of 3 × 10 6 cells / ml in 25 cm 2 flasks. After incubation, the cells were washed and subjected to TH9402 photodynamic treatment as described above to measure proliferative activity as described below.
    [81] Proliferation Assay (Mixed Lymphocyte Response)
    [82] To assess the residual proliferation of activated mononuclear cells after photodynamic therapy, peripheral blood mononuclear cells were placed in 96-well microtiter plates and incubated with PBMCs from various individuals (treated cells and two or more major histocompatibility). Complex antigen mismatch). The cells described below were serially diluted (4 × 10 4 treated agonist cells / well) and incubated at 37 ° C. for 5 days to obtain an agonist (treated cell) to target ratio ranging from 2: 1 to 1: 4. 1 μCi of 3 H-thymidine was added 18 hours before collection. Cells were collected using a PHD cell collector (Cambridge, Boston, Mass.). Radioactivity in the cell collection was counted using a liquid scintillation counter (Beckman, Chicago, Illinois, USA).
    [83] Phototoxicity of 4,5-Dibromorodamin 123 Hydrobromide on PHA Activated Cells
    [84] Phototoxicity of TH9402 against PHA activated PB mononuclear cells was assessed after photodynamic treatment with light energy of 5 and 7.5 joules / cm 2 (FIG. 2). After treatment, cells were washed and evaluated for proliferative activity in mixed lymphocyte responses according to the order described in the paragraphs above. In photodynamic therapy untreated (untreated) PHA activated cells, proliferation in mixed lymphocyte cultures increased with the number of effector cells. In contrast, treatment of PHA activated cells with TH9402 using 5 and 7.5 J / cm 2 light energy eliminated responsiveness to MHC unsuitable cells. These results indicate that photodynamic therapy of PHA-activated cells is a very potent immunoreactive inhibitor in these cells. The number of cells carried out 3 days after rhodamine treatment showed a reduction of 90% or more of the treated cells compared to the media control. These results indicate that the loss of proliferative activity in activated cells is due to removal of effector cells.
    [85] Allogeneic T cell activation
    [86] Other methods were also used in this study to activate cells for specific target antigens. Mononuclear cells from Subject A were incubated with irradiated mononuclear cells from Subject B. In this unidirectional mixed lymphocyte culture, Subject A and Subject B showed only partial human leukocyte antigen (HLA) matching, which was unrelated and showed a difference in the two major histocompatibility complex (MHC) antigens. In sum, 25 x 10 6 PBMC supplemented with 20% AB serum (manufactured by Sigma), 1% pen-strep (manufactured by Gibco), 2% glutamine (manufactured by Gibco) and 50 U / ml IL-2 (manufactured by ID lab) Incubated at 37 ° C. for 4 days with 25 × 10 6 irradiated (25Gy) stimulating mononuclear cells in X-vivo-15 medium (manufactured by BioWhittaker). All cultures were carried out in a 75 cm 2 flask (manufactured by Corning) at a final volume of 25 ml. Unstimulated control cultures were performed using 25 × 10 6 irradiated autologous cells.
    [87] After this activation period, cells were treated with photodynamic therapy with TH9402 as described above. Following the treatment, cells are plated in a proliferation assay for 5 days as described above, with the target consisting of PBMCs obtained from Subject B and Subject C (massed and not relevant). As shown in FIG. 3, when cells from Subject A were activated against TH9402 photodynamic therapy B, they did not proliferate upon re-exposure to cells from B. However, when the same A cells were exposed to C cells, they retained proliferative capacity. These results indicate that photodynamic therapy can specifically remove alloreactive cells, while leaving the possibility of alloreactive cells in inactivated cells. They also indicate that the activation strategy described above can be used to consume immunological populations for the desired antigen.
    [88] Cell concentration of TH9402
    [89] TH9402 cell concentrations in stable lymphocytes and activated lymphocytes were assessed by flow-cytocytometry because TH9402 (green) fluorescence intensity correlated with cell content in TH9402. In sum, 10 6 cells / ml previously activated or not activated by PHA were incubated for 40 min in X-vivo-15 medium supplemented with 2.5% human AB serum and 10 μM TH9402. These cells were washed twice with X-vivo medium supplemented with 10% AB serum and cells were counted by flow-cytocytosis 30, 50, 70, 90 and 110 minutes after the end of TH9402 incorporation period. Analyzed. As shown in FIG. 4, stable lymphocytes rapidly lost TH9402 and showed low TH9402 fluorescence 110 minutes after the incorporation period ended. In addition, the TH9402 fluorescence intensity was much less stable lymphocytes than activated lymphocytes at all time points measured (FIG. 4). Since the cell concentration of TH9402 correlates with the degree of cell clearance, the high concentration of TH9402 maintained in activated lymphocytes accounts for their sensitivity to photodynamic therapy. In contrast, the rapid outflow of TH9402 from stable lymphocytes should explain the preservation of their proliferative activity.
    [90] To identify the mechanism involved in the differential retention of TH9402 between activated and stable lymphocytes, multidrug transporters (P-gp 170) were blocked using cyclosporin-A. These cells were incubated with 10 μM TH9402 for 8 minutes and then washed with medium containing 1 μg / ml cyclosporin-A or medium alone. TH9402 retention was assessed by flow-cell hematology (green fluorescence) (FIG. 5). After 110 minutes from the end of TH9402 incorporation, the fluorescence intensity was the same in activated cells treated with or without cyclosporin A. In contrast, cyclosporin A causes high TH9402 retention in stable lymphocytes, which is involved in TH9402 dye efflux from lymphocytes in which functional P-gp is stable, and these cells are a major mechanism by which photodynamic therapy can avoid elimination To provide. The functional impairment of the pump in activated lymphocytes could explain the high level of phototoxicity observed in these cells.
    [91] Phenotypic Analysis of Residual T Lymphocytes After Phototherapy with TH9402
    [92] To determine whether the clearance of responsiveness to Subject B obtained after PDT correlated with the loss of activated T cells, the percentage of activated cells in the samples exposed or not exposed to PDT was measured. Activated cells can be distinguished from stable T lymphocytes by enhanced expression of CD25, which can be detected as monoclonal antibodies specific for CD25, the inducible α chain of the IL-2 receptor. In sum, after activation of T cells in the mixed lymphocyte response as described above, the activated T lymphocytes were incubated for 40 minutes in X-vivo 15 medium (BioWhittaker) supplemented with 2.5% human AB serum and 10 μM TH9402. These cells were washed twice with X-vivo-15 medium supplemented with 10% AB human serum. 110 minutes after the end of the incubation period, the cells were exposed to light in the range of 2.5 to 10 Joules / cm 2 using the above-described light delivery device (US Pat. No. 5,798,523). Light energy was delivered using a fluorescence scanning device having a maximum wavelength at 512 nm. After the treatment, cells were incubated for 48-72 hours in X-vivo-15 medium supplemented with 15% human AB serum. After the incubation period described below, the number of cells was counted and their immunophenotype was analyzed by dual-color flow cytometry to determine the percentage of activated T lymphocytes. Monoclonal antibodies consist of anti-CD4-APC, -CD8-APC and -CD25-PE with suitable isotype controls (Coulter Immunology, Hialeah FL). Flow cytometry assays were performed using conventional methods (Roy DC et al. (1996) JNCI 88: 1136-45).
    [93] In cells not treated by PDP, activated T lymphocytes represented 14% of the total lymphocyte population (CD8 and CD4) (FIG. 6). 6 shows that both activated cells (CD25 expression), CD4 + and CD8 +, are removed by photodynamic therapy. In contrast, the proportion of activated T lymphocytes, CD4 + and CD8 +, was less than 1% for cells exposed to all light intensities (2.5, 5 and 10 Joules / m 2 ) in this experiment. These results confirm PDT ability using TH9402 to remove activated T cells.
    [94] Differential Phototoxic Activity of TH9402 on B Cells and Non-lymphoid Hematopoietic Primitive Cells
    [95] To assess PDT ability using TH9402 to eliminate other immune cell populations, normal human B cells were used as targets. Mononuclear cells from normal donors were obtained by leukocyte depletion and resuspended at 20 million cells per ml during the entire PDT process. Cells were centrifuged and resuspended with 5 μM TH9402 in preheated (37 ° C.) X-Vivo-15 medium supplemented with 2.5% FCS and 10 U / ml heparin. After 40 minutes of incubation at 37 ° C., the cells are washed and supplemented with X-Vivo-15 medium supplemented with 10% FCS and 10 U / ml heparin (medium without TH9402) for a 50 minute runout period before exposure to light energy. Resuspended. Cells were exposed to light at 2 cm thickness at 20 million cells / ml.
    [96] In vitro B cell culture systems were used to assess PDP throughput for removing B cells. In sum, 5 × 10 6 untreated and treated mononuclear cells were added to a 25 mm 2 monolayer of irradiated mouse fibroblast NIH 3T3, a molecule that was transfected to express CD40 ligand and is an important molecule for B cell activation and proliferation. Interleukin-4 (IL-) supplemented with 2% FCS, 1% penicillin-streptomycin, 50 μg / ml human transferrin, 0.5% BSA, 5 μg / ml bovine insulin, 50 μg / ml of each oleic acid, linoleic acid and palmitic acid 4) incubated in (100 u / ml) containing medium (Iscoves Modified Dulbecco's Medium-1 MDM) for several days. At the end of the incubation period, immunophenotyping of residual CD19 + cells by flow-cytocytometry as well as trypan blue viability test was performed.
    [97] To confirm that the treatment preserves normal hematopoietic primitive cells, a clonalogenic assay was used to measure the amount of hematopoietic clonal progenitors present in the same sample. In sum, after PDP, all samples, including controls, were diluted and plated in semi-solid methylcellulose medium (manufactured by Stemcell Technologies, Inc.) at various cell densities (10,000-800,000). Colonies were counted for myeloid, erythroid and mixed primitive cells after 13-16 days of incubation at 37 ° C. with 5% CO 2 and 98% relative humidity. The analysis was performed two or more times. To determine the contrast reduction in precursor cells, the mean value for each PDP condition was converted to the appropriate percentage of control.
    [98] Normal human mononuclear cells were obtained and subjected to various PDP conditions to evaluate B cell elimination, specificity and stability of the process. The number of B cells removed by TH9402 PDT increased with the light energy level delivered (FIG. 7A). In contrast to untreated cells, PDT resulted in B cell clearance of about 3 logarithms (99.9%). In contrast, when these cells were evaluated for non-lymphoid hematopoietic primitive cell elimination, less than 50% (half of the logarithmic) of these primitive cells were removed by PDT under the same conditions (FIG. 7B). These results indicate that immune cells other than activated T cells, such as B cells, can be eliminated by PDT using TH9402. In addition, preserving large proportions of CFU-GM, BFU-E and CFU-GEMM primitive cells indicates the specificity of the PDT process for a given immune cell population. The above also confirms this PDT ability to preserve normal hematopoietic primitive cells for hematopoietic reconstitution when used in connection with purifying the graft prior to autologous transplantation or allograft.
    [99] Phototoxicity of 4,5-dibromorodamine 110 n-butyl ester hydrobromide
    [100] In vitro phototoxicity was evaluated in the course of the K562 cell line described above to confirm the possibility of photochemistry of 4,5-dibromorodamin 110 n-butyl ester hydrobromide (DBBE). Cells were incubated with increasing concentrations of DBBE and cell viability was measured at different time points following photodynamic therapy. The results shown in FIGS. 8A, 8B and 8C show that a brief dose of 10 μg / ml dye and 0.5 J / cm 2 exposure to 514.5 nm radiation from an argon ion laser completely inhibited cell survival within 24 hours after irradiation. It is displayed.
    [101] Phototoxicity of Rhodamine B n-butyl Ester Hydrochloride
    [102] In vitro phototoxicity of rhodamine B n-butyl ester (RBEE) was evaluated in the course of K-562 cell line to assess the potency of photochemotherapeutic therapy. Control was performed for the induced phototoxicity of rhodamine 123 (RH123) and rhodamine B n-butyl ester hydrochloride. Cell survival was assessed 2 and 20 hours after photodynamic therapy. The results shown in FIGS. 9A and 9B show that the dose of 10 μg / ml dye and light exposure to 5 J / cm 2 from an argon ion laser (514.5 nm) significantly inhibited cell survival of K562 cells within 20 hours of irradiation. It is shown. Rhodamine 123 has no effect on cell survival even when exposed to 5 J / cm 2 . The phototoxicity of 4,5-dibromorodamine 110 n-butyl ester hydrobromide and rhodamineB n-butyl ester hydrobromide and rhodamineB n-butyl ester hydrochloride was assessed only for the K562 cell line. However, it is assumed that their activity on T cells will be similar.
    [103] Phototoxicity of Hematopoietic Primitive Cell Cultures
    [104] Only light treatment at energy levels below 10 J / cm 2, or preculture of cells in saturated dyes, does not affect long-term culture establishment, as well as bone marrow (colony forming unit-erythrocytes (CFU-E), blast formation Semisolid analysis resulting from the proliferation and differentiation of committed primitive cells present in unit-erythrocytes (BFU-E), colony forming units-granulocytes, macrophages, and (CFU-GM) had no effect on the formation of cellular colonies. However, as reported for Rhodamine 123, the establishment of LTC (long term culture) is more sensitive to dyes but the residual number of viable committed primitive and stem cells remained unaffected. 123, rhodamineB n-butyl ester hydrochloride and 4,5-dibromorodamin 110 n-butyl ester hydrochloride and 4,5-dibromorhodamine 110 n-butyl ester Greater chemical therapy with the draw bromide, in establishing and semi-solid analysis of normal mouse long term culture of bone marrow were damaged to a minimum the formation of hematopoietic colonies. This is consistent with the reported previously using rhodamine 123 in other laboratory results.
    [105] Conventional methods for the prevention and treatment of immunological disorders such as immunosuppressants, radiotherapy and monoclonal antibody-based therapies are limited by their inherent toxicity and myelosuppressive effects. Introduction of strategies for eliminating T cells in vitro or in vivo reduced the incidence of graft-versus-host disease after allogeneic stem cell transplantation, improved graft survival in parenchymal transplantation, and for patients with immunological disorders. Improved clinical condition However, T cell depletion is associated with increased production of inflammation and malignancies or recurrence of malignant diseases, thus limiting the use of T cell ablation strategies. This complexity is primarily due to the nonspecific removal of the majority of T cells involved in controlling infection and anti-leukemic activity. In order to overcome these limitations and extend the number of patients and age limits for potent therapy, the benefits of selectively removing immunological cells in vitro prior to allogeneic stem cell transplantation are well known. Moreover, selective removal of immunological cells has very useful potential with regard to autoimmune disorders in which transplantation, donor lymphocyte infusions after parenchymal transplantation, and patients may benefit from the removal of allogeneic or activated immune cell populations.
    [106] In an effort to develop new anti-neoplastic drugs that allow the selective destruction of alloreactive or activated immune cells, new dye molecules have been prepared and tested as novel photosensitizers useful for photodynamic prevention and treatment of immunological disorders. come. Three new photosensitizers of the pyrilium family and their cytotoxic properties similar to TH9402 have evidence for their use in photodynamic treatment of immunological disorders and in the prevention and / or treatment of graft-versus-host disease. To provide.
    [107] The invention will be understood in more detail by reference to the following examples given in order to illustrate the invention in detail without limiting its scope.
    [117] Example I
    [118] Prevention of Graft-versus-host Disease with Allogeneic Stem Cell Transplantation
    [119] Immunological Differences Between Donor and Receptor and Diagnosis and Identification of Graft-versus-Host Disease
    [120] Allogeneic stem cell transplantation was performed in a number of neoplastic and non-neoplastic conditions. Hematopoietic diseases consist of leukemia, lymphoma, multiple myeloma, myelodysplastic symptoms; Non-hematopoietic diseases also include pernicious anemia, congenital disorders, severe immunodeficiency, rheumatoid arthritis, scleroderma, lupus erythematosus, multiple sclerosis, HIV and other immune disorders.
    [121] Graft-versus-host disease is a complication of allogeneic stem cell transplantation in which donor cells respond to host cells and damage target tissues (usually skin, liver, intestine, lung, tear gland or acupuncture, etc.). The diagnosis is based on several clinical and laboratory variables, which have been extensively reviewed in 1997 by Graft-vs-Host Disease, Ferrara JLM, Deeg HJ, Burakoff SJ Edit, Marcel Dekker, New Yo.
    [122] GVHD occurs against antigens present in receptor cells, not in donor cells. Immunological differences between donor and receptor may be present at the level of major histocompatibility antigens, small amounts of histocompatibility antigens or tumor associated antigens. Inhomogeneity occurs in the blood or bone marrow cells using one or more of the following procedures:
    [123] a) HLA classification: conventional serological classes or molecules to identify non-uniformities between donor and receptor in major histocompatibility complex I and II antigens; And
    [124] b) mixed lymphocyte cultures to identify differences in class II antigens; And
    [125] c) Minimal histocompatibility antigens: A small number of cytotoxic T cell lines can be obtained and used to identify minimal histocompatibility antigens, but at present these tests are only useful for research purposes.
    [126] Primitive Cell Collection
    [127] After diagnosis, bone marrow (BM) or peripheral blood (PE) or hematopoietic induced hematopoietic stem cells are collected from the donor using the procedure described above for allogeneic primitive cell transplantation ( Bone Marrow Transplantation , Forman SJ, Blume KG, Thomas ED). Edited, Blackwell Scientific Publications, Cambridge MA, USA, 1994). Donor hematopoietic stem cells collected for allograft can be immediately cultured with (25 Gy) host mononuclear cells or other cells investigated. Host cells mixed with donor cells are incubated for 2 to 5 days in a medium that does not contain sterile dye supplemented with 20% autologous serum and interleukin-2. This process yields donor cell homoreactivity to the host, and the cell graft can be subjected to photodynamic treatment in vitro as described below.
    [128] Selective in vitro purification of immunological cells
    [129] In vitro treatment consists of short-term incubation of previously activated BM or PB stem cells with one or several selected photoactive compounds. During incubation, cell concentration and drug molarity are determined for each patient using aliquots of the collected cell population. Excess dye is removed by washing the cells using a medium that does not contain sterile dye supplemented with 2% autologous serum. The cells are exposed to radioactive energy of sufficient intensity to affect the photodynamic purification of the immune cells. The efficiency of the photodynamic purification process is confirmed for aliquots of the treated cell population prior to cryopreservation and / or reinjection to the patient. Until reinjection into the patient, cells may be stored frozen in 10% dimethylsulfoxide (DMSO) and 90% autologous serum at −196 ° C. in the vapor phase of liquid nitrogen.
    [130] Systemic treatment of patients
    [131] Following stem cell collection, patients are dose intensive chemotherapy and / or radioactive if necessary.
    [132] Allogeneic Stem Cell Transplantation
    [133] After proper treatment of the patient with high dose chemotherapy and / or radiation and at a suitable clinical moment, cryopreserved bone marrow or peripheral blood or debris stem cells are rapidly thawed and returned to the patient.
    [134] Example II
    [135] Treatment of graft-versus-host disease and autoimmune disease
    [136] Diagnostic process
    [137] Diagnosis of graft-versus-host disease or immunological disorders is carried out using conventional clinical, biochemical and / or histopathological tests of blood or suitable tissues. Diagnostic and prophylactic characteristics of GVHD are described in Graft-vs-Host Disease , Ferrara JLM, Deeg HJ, Burakoff SJ Compilation, Marcel Dekker, New York, 1997.
    [138] Collection of Peripheral Blood Cells
    [139] After diagnosis of severe GVHD, autoimmune or immunological disorders, peripheral blood (PB) mononuclear cells are collected using the method described above or a similar leukopheresis procedure ( Bone Marrow Transplantation , Forman SJ, Blume KG, Thomas). ED Edit, Blackwell Scientific Publications, Cambridge MA, USA, 1994). Peripheral blood mononuclear cells of the collected patients are immediately treated in vitro as described below.
    [140] In Vitro Removal of GVHD-Mediated Cells
    [141] In vitro treatment consists of short-term culture of PB mononuclear cells with one or several photoactive compounds selected. During incubation, cell concentrations and drug molar concentrations are determined for each patient using aliquots of the collected cell population. Excess dye is removed by cell washing in medium containing sterile dye supplemented with 2% autologous serum. The cells are then exposed to radiation energy of sufficient intensity to affect the photodynamic purification of activated cells that mediate GVHD.
    [142] Administering Photodynamically Treated Cells to Patients
    [143] Photodynamically treated leukopenia cells are reinjected into the patient. This method allows the removal of many circulating activated lymphocytes and other cells involved in GVHD. In addition, inactivating the cells left by photodynamic treatment and reinjecting them into the patient helps restore normal immunological balance and induces immunomodulation.
    [144] Example III
    [145] Treatment of immunological diseases
    [146] Diagnostic process
    [147] Diagnosis of autoimmune diseases is carried out using conventional clinical, biochemical and / or histopathological tests of blood or suitable tissues. Severe autoimmune diseases are compliant with autologous transplantation (described in Sullivan KM et al . , Am. Soc. Hematol. , Educ. Program Book, 1998: 198-214).
    [148] Collection of Hematopoietic Stem Cells
    [149] After diagnosis, bone marrow (BM), peripheral blood (PB) or debridement (CB) mononuclear cells are collected using the aforementioned procedure for autologous bone marrow transplantation during cancer therapy ( Bone Marrow Transplantation , Forman SJ, Blume KG, Edited by Thomas ED, Blackwell Scientific Publications, Cambridge MA, USA, 1994). Hematopoietic stem cells of the patient collected for autograft are immediately treated in vitro as described below.
    [150] In Vitro Removal of Cells Mediating Autoimmune Disease
    [151] In vitro treatment consists of short-term culture of BM or PB stem cells with one or several photoactive compounds. During incubation, cell concentrations and drug molar concentrations are determined for each patient using aliquots of the collected cell population. Excess dye is removed by cell washing in a medium that does not contain sterile dye supplemented with 2% autologous serum. The cells are then exposed to radiation energy of sufficient intensity to affect the photodynamic purification of immunological cells that mediate immunological disorders.
    [152] Administering Photodynamically Treated Cells to Patients
    [153] Photodynamically treated hematopoietic stem cells are stored (frozen or maintained in culture). This method allows the elimination of many circulating activated lymphocytes and other cells involved in immunological disorders. In addition, inactivating cells left by photodynamic treatment and reinjecting them into the patient helps restore normal immunological balance. After stem cell collection, patients are treated by conventional methods until autologous transplantation is clinically needed or immediately by dose intensive chemotherapy and systemic radiation if necessary.
    [154] Autologous Stem Cell Transplantation
    [155] After high-dose chemotherapy and radiation treatment, frozen stored bone marrow or peripheral blood stem cells are immediately thawed and injected into the patient.
    [156] Example IV
    [157] How to check the membrane transporter
    [158] Diagnosis of autoimmune and neoplastic disorders is carried out using conventional clinician, biochemical and / or histopathological examination of blood or suitable tissue.
    [159] In vitro evaluation of rhodamine derivative transporters (MDR-related and non-related)
    [160] Peripheral blood or bone marrow cells obtained from patients with autoimmune or cancer cells are incubated with one or several photoactive compounds. During incubation, cell concentrations and drug molar concentrations are determined for each type of evaluated cells. Excess dye is removed by cell washing with or without the use of a substance that interferes with cell removal of the rhodamine derivative, such as cyclosporin-A, verapamil or probenside. The material is introduced into a medium that does not contain sterile dye supplemented with 2% autologous serum. Flow-cytocytometry evaluation (light energy) of suitable wavelength and sufficient intensity is subjected to influence the fluorescence of the rhodamine derivative in the target cells. Cells that spontaneously remove photoactive compounds collect multidrug receptor (MDR) -related or other transporters. The addition of a blocking agent (cyclosporin-A or verapamil) prevents the removal of the photoactive compound and also confirms the presence of MDR-related or other transporters acting on the cell.
    [161] conclusion
    [162] Rhodamine derivatives enable the study of specific transporters described above, essentially translation and clinical studies. It is also useful for the study of cell biology and molecular biology. Because MDR and other similar transporters may limit the activity of various therapeutic agents, such as chemotherapeutic and photodynamic agents, these trials should be of importance for diagnostic and prognostic signs and for patients with immunological and neoplastic disorders. It should help identify the optimal treatment strategy.
    [163] While the present invention has been described with reference to specific embodiments, it is further contemplated that the present application should be understood to encompass any variation, use, or modification of the invention, and in general the principles of the invention and the invention. Such modifications, including those which depart from the technical details of the present invention, are known to those skilled in the art or fall within the ordinary scope of the invention, and may be applied to the essential features of the present invention described above and may also be applied to the appended claims.
    权利要求:
    Claims (8)
    [1" claim-type="Currently amended] A photoactive pharmaceutical composition for selectively destroying and / or inactivating immunologically reactive cells without substantially adversely affecting normal cells or causing systemic toxicity to a patient,
    The composition comprises 4,5-dibromorodamin 123 (2- (4,5-dibromo-6-amino-3-imino-3H-xanthen-9-yl) -benzoic acid methyl ester) hydrobromide; 4,5-dibromorodamine 110 (2- (4,5-dibromo-6-amino-3-imino-3H-xanthen-9-yl) -benzoic acid) ethyl ester hydrobromide; 4,5-dibromorodamin 110 (2- (4,5-dibromo-6-amino-3-imino-3H-xanthen-9-yl) -benzoic acid) octyl ester hydrobromide; 4,5-dibromorodamin 110 (2- (4,5-dibromo-6-amino-3-imino-3H-xanthen-9-yl) -benzoic acid) n-butyl ester hydrobromide; Rhodamine B n-butyl ester (2- (6-diethyl amino-3-ethyl imino-3H-xanthen-9-yl) -benzoic acid) n-butyl diester hydrochloride; And a pharmaceutically acceptable carrier with at least one photoactive rhodamine derivative selected from the group consisting of photoactive derivatives thereof; Photoactivation of the derivative causes cell death, but the deactivated derivative is a photoactive pharmaceutical composition, characterized in that it is substantially nontoxic to cells.
    [2" claim-type="Currently amended] In the use of the photoactive derivative according to claim 1 for carrying out photodynamic treatment to selectively destroy and / or inactivate immunoreactive cells without causing substantial adverse effects on normal cells or causing systemic toxicity to the patient. ,
    Use of a photoactive derivative characterized in that radiation of a suitable wavelength and intensity is applied when a suitable intracellular level of said derivative is achieved.
    [3" claim-type="Currently amended] a) activating lymphocytes from the donor by mixing the donor cells with the host cells for a time sufficient for an immune response to occur;
    b) substantially removing activated lymphocytes of step a) by photodynamic therapy with a therapeutic amount of the photoactive composition according to claim 1 under radiation of a suitable wavelength; And
    c) performing allogeneic stem cell transplantation using the treated mixture of step b),
    A method of preventing graft-versus-host disease associated with allogeneic stem cell transplantation in a patient.
    [4" claim-type="Currently amended] a) collecting hematopoietic cells of the patient;
    b) ex vivo treatment of the hematopoietic cells of step a) by photodynamic therapy with a therapeutically effective amount of the photoactive composition according to claim 1 under radiation of a suitable wavelength; And
    c) performing graft infusion or autograft infusion using the treated hematopoietic cells of step b);
    Comprising a method of treating an immunological disorder in a patient.
    [5" claim-type="Currently amended] The group of claim 4, wherein said immunological disorder is comprised of a state in which magnetic or donor cells, such as graft-versus-host disease, graft rejection, autoimmune disease and immunoallergic conditions, respond to host tissues or foreign targets. A method for treating an immunological disorder in a patient, characterized in that is selected from.
    [6" claim-type="Currently amended] The method of claim 4, wherein said hematopoietic cells are selected from the group consisting of bone marrow, peripheral blood and afferent mononuclear cells.
    [7" claim-type="Currently amended] A method for evaluating the delivery mechanism of immune and / or malignant cells comprising using the photoactive pharmaceutical composition according to claim 1.
    [8" claim-type="Currently amended] 8. The method of claim 7, wherein the composition is evaluated by flow cytometry.
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    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    法律状态:
    1999-10-05|Priority to US15779099P
    1999-10-05|Priority to US60/157,790
    2000-10-03|Application filed by 유니버시떼 드 몬트리얼, 호피탈 메조뇌브-로즈몽뜨
    2002-06-26|Publication of KR20020050234A
    2007-03-20|Application granted
    2007-03-20|Publication of KR100697400B1
    优先权:
    申请号 | 申请日 | 专利标题
    US15779099P| true| 1999-10-05|1999-10-05|
    US60/157,790|1999-10-05|
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