Method For Treatment Of Macular Degeneration By Modulating P2Y12 or P2X7 Receptors
Provided is a method of treating or preventing age-related macular degeneration (AMD) in a patient subject to, or symptomatic of the disease, wherein the method comprises restoring normal lysosomal pH (pHL), or acidifying an abnormally elevated pHL, thus decreasing or preventing a damaging accumulation of lipofuscin or waste products in the retinal pigment epithelium (RPE) cells of the eye of the patient. Further, this method is achieved by modulating the action of the P2X7 and/or P2Y12 receptors of the RPE cells, specifically decreasing the acidity (pHL) of the RPE lysosomes by administering selected receptor antagonists affecting the action of the P2X7 and/or P2Y12 receptors of the RPE. Methods for selecting and quantifying the effectiveness of drugs to restore pHL and determine outer segment clearance rates is also provided using a high through-put screening protocol.
This application is a Divisional of U.S. patent application Ser. No. 13/45,749, filed Apr. 2, 2012, which claims priority to U.S. Provisional Application 61/480,055, filed on Apr. 28, 2011, and is a Continuation-in-Part of U.S. patent application Ser. No. 12/418,328, filed Apr. 3, 2009, which is a continuation of International Application PCT/US2007/021211, filed on Oct. 3, 2007 and published on Apr. 10, 2008, which claims priority to U.S. Provisional Application 60/849,050, filed on Oct. 3, 2006, and U.S. Provisional Application 60/966,086, filed on Aug. 23, 2007, each of which is incorporated herein in its entirety.GOVERNMENT INTEREST
This invention was supported in part by funds from the U.S. Government (Department of Health and Human Services Grant No. EY-13434) and the U.S. Government may therefore have certain rights in the invention.FIELD OF THE INVENTION
The invention relates to treatment of vision loss and retinal diseases, particularly macular degeneration, by modification of the pH of retinal pigment epithelial lysosomes, based upon manipulation of the lysosomal pH.BACKGROUND
Age-related macular degeneration (AMD) is the leading cause of untreatable vision loss in elderly Americans (Klein et al., Invest. Ophthalmol. Vis. Sci. 36:182-191 (1995)). The initial stages of the disease are neither well understood nor currently treatable. The photoreceptors of the retina comprise the rods and cones, each of which is a specialized sensory cell, a bipolar neuron. Each is composed of an inner and an outer region. The cone's outer segment, like that of adjacent rod photoreceptors, consists of a series of stacked cell membranes that are rich in photosensitive pigments. The distal tips of the rod outer segments are intimately associated with the outermost layer of the retina, the pigment epithelium (RPE). The rod outer segments are in a continuous state of flux, wherein new stacks of membrane are added at the base of the outer segment, and old, worn-out stacks of membrane are shed from its distal tip. The shed rhodopsin-laden segments are phagocytosed by cells of the retinal pigment epithelium (RPE) and engulfed by lysosomes, becoming residual bodies in the cytoplasm of the epithelial cells. Daily phagocytosis of spent photoreceptor outer segments is a critical maintenance function performed by the RPE to preserve vision. Aging retinal pigment epithelium (RPE) accumulates lipofuscin, which includes N-retinylidene-N-retinylethanolamine (A2E) as the major autofluorescent component. Additional components include partially degraded lipids and proteins of either photoreceptor or RPE origin which can act as precursors and combine into the lipofuscin complex.
A2E is localized to lysosomes in cultured RPE, as well as in human RPE in situ. Thus, one of the earliest characteristics of the disorder is the accumulation of lipofuscin in the RPE (Feeney-Burns et al., Am. J. Ophthalmol. 90:783-791 (1980); Feeney et al., Invest Ophthalmol Vis. Sci. 17:583-600 (1978)). A2E, a primary constituent of lipofuscin (Eldred et al., Nature. 361:724-726, 1993.)), undermines lysosomal organelles in several ways including by elevating lysosomal pH (pHL) (Eldred et al., Gerontol. 2:15-28 (1995); Holz et al., Invest Ophthalmol Vis. Sci. 40:737-743 (1999)). As key lysosomal enzymes act optimally in a narrow range of acidic environments, an increase in pHL reduces their degradative ability. Because of the circadian rhythm of RPE phagocytosis in the eye, a delay in lipid degradation results in a build up of undigested material in RPE after 24 hours. A consequent accumulation of undigested material compromises RPE cells and appears to hasten the development of AMD. In this regard, the restoration of an optimal acidic environment to lysosomes could enhance enzyme activity and slow or stop the progression of AMD.
Dry AMD is characterized by the failure of multiple systems in the posterior eye and is associated with the accumulation of abnormal deposits within and upon Bruch's membrane (Moore et al., Invest Ophthalmol Vis. Sci. 36:1290-1297 (1995)), which separates the blood vessels of the choriod from the RPE layer. The RPE sends metabolic waste from the photoreceptors across Bruch's membrane to the choroid. The Bruch's membrane allows 2-way transit; in for nutrients and out for waste. Thus, Bruch's membrane's vital function is to supply the RPE and outer part of the sensory retina with all of their nutritional needs. However, as Bruch's membrane thickens and gets clogged with age, the transport of metabolites is decreased. This may lead to the formation of drusen, which can be seen in the eye as yellow-gray nodules located between the RPE and Bruch's membrane in age-related macular degeneration (Kliffen et al., Microsc Res Tech. 36:106-122 (1997); Cousins et al., In Macular Degeneration Eds. Penfold & Provis, Springer-Verlag, New York, pp. 167-200, (2005)). Drusen deposits vary in size and may exist in a variety of forms, from soft to calcified. With increased drusen formation the RPE are gradually thinned and begin to lose their functionality. While drusen formation is not necessarily the cause of dry ARMD, it does provide evidence of an unhealthy RPE. There is also a build up of deposits (Basal Linear Deposits or BLinD and Basal Laminar Deposits BLamD) on and within the membrane. Consequently, the retina, which depends on the RPE for its vitality, may be affected and vision problems arise.
While the initial triggers for these changes are not certain, decline in the hydraulic conductivity of Bruch's membrane, decreased choroidal perfusion (Lutty et al., Mol. Vis. 5:35 (1999)), environmental and immunologic injury (Beatty et al., Surv. Ophthalmol. 45:115-134 (2000); Zhang et al., J. Cell. Sci. 116:1915-1923 (2003)), genetic defects (Kuehn et al., J. Am. Med. Ass. 293:1841-1845 (2005); Ambati et al., Nature. Med. 9:1390-1397 (2003)), and other degenerative diseases (Johnson et al., Proc. Nat. Acad. Sci. USA 99:11830-11835 (2002); Mullins et al., FASEB. J. 14:835-846 (2000)) may all contribute to the development of the pathology. The identification of lysozyme C and oxidation products of docosahexaenoate in material present between Bruch's membrane and the RPE suggests that the extrusion of material from the lipofuscin-laden RPE contributes to sub-retinal deposit formation (Young et al., Surv. Ophthalmol. 31:291-306 (1987); Crabb et al., Proc. Nat. Acad. Sci. USA. 99: 14682-14687 (2002)). The correlation between RPE lipofuscin levels and those retinal regions showing the highest degree of atrophy supports the growing concept that lipofuscin is not just an indicator of disease, but rather, is itself a causal factor von Ruckmann et al., Graefes Arch. Clin. Exp. Ophthalmol. 237:1-9 (1999); Roth et al., Graefes. Arch. Clin. Exp. Ophthalmol. 242:710-716 (2004), suggesting that a reduction in the rate of lipofuscin formation and an enhancement in lysosomal degradative capacity will slow or stop the progression of AMD before substantial degeneration has occurred.
Lipofuscin in the RPE is primarily derived from incomplete digestion of phagocytosed photoreceptor outer segments (Young et al., Surv. Ophthalmol. 31:291-306 (1987); Eldred., In The Retinal Pigment Epithelium, Eds. Marmor & Wolfensberger, Oxford, University Press, New York, pp. 651-668, (1998)), with rates of formation reduced when photoreceptor activity is diminished (Katz et al., Exp. Eye. Res. 43:561-573 (1986); Sparrow et al., Exp. Eye. Res. 80:595-606 (2005)). A2E is a key component of RPE lipofuscin, with A2PE, iso-A2E and other related forms present (Eldred et al., supra, 1993; (Mata et al., Proc. Nat. Acad. Sci. USA 97:7154-7159 (2000)).
A2E has been identified in post-mortem eyes from elderly subjects, while levels are substantially elevated in Stargardt's disease, characterized by early-onset macular degeneration (Mata et al., supra, 2000). The disease is associated with mutations in the ABCA4 (ABCR) gene, whose product transports a phospholipid conjugate of all-trans-retinaldehyde out of the intradisk space of the photoreceptors (Allikmets et al., Nature. Gen. 15:236-246 (1997); Sun et al., Nature. Gen. 17:15-16 (1997)). The accumulation of substrate resulting from the transport failure leads to formation of A2PE, which is subsequently delivered to the RPE after the phagocytosis of the outer segments (Sun et al., J. Biol. Chem. 274:8269-8281 (1999)). A2PE is cleaved to A2E in the RPE, with small amounts of spontaneous isomerization to iso-A2E occurring (Parish et al., Proc. Nat. Acad. Sci. USA 95:14609-1413 (1998); Ben-Shabat et al., J. Biol. Chem. 277:7183-7190 (2002)). Measurements from ABCA4−/− mice, developed by Travis and colleagues, have demonstrated that A2E levels are greatly enhanced in the RPE of ABCA4 mutant mice, consistent with the elevated levels of A2E in patients with Stargardt's disease (Mata et al., supra, 2000). In a rate-determining step in the visual cycle, retinaldehyde is reduced to retinol by the enzyme retinol dehydrogenase located in the photoreceptor outer segment. Thus, only the retinaldehyde that escapes conversion to retinol can react with phosphatidylethanolamine, and enter the A2E biosynthetic pathway to generate A2E in a multistep process.
The above-noted localization of A2E predominantly to lysosomes and late endosomes of RPE cells in vitro and in situ, is consistent with the phagolysosomal origins of lipofuscin granules (Holz et al., supra, 1999; Finnemann et al., Proc. Natl. Acad. Sci. USA 99:3842-3847 (2002)). As lysosomal organelles in the RPE degrade phagocytosed outer segments, the accumulation of undigested material of outer segment origin in AMD is consistent with a lysosomal dysfunction. Addition of A2E to cultured cells reduces the lysosomal degradation of photoreceptor outer segment lipids (Finnemann et al., supra, 2002), and decreases the pH-dependent protein degradation attributed to lysosomal enzymes (Holz et al., supra, 1999).
The mechanisms by which A2E causes lysosomal damage are influenced by levels of light and A2E itself. At high concentrations, the amphiphilic structure leads to a detergent-like insertion of A2E into the lipid bilayer, with consequent loss of membrane integrity and leakage of lysosomal enzymes (Eldred et al., supra, 1993; Sparrow et al., Invest. Ophthalmol. Vis. Sci. 40:2988-2995 (1999); Schutt et al., Graefes. Arch. Clin. Exp. Ophthalmol. 240:983-988 (2002)). Low-wavelength light can oxidize lipofuscin and A2E into toxic forms, which rapidly lead to cell death (Sparrow et al., supra, 2005; Sparrow et al., Invest. Ophthalmol. Vis. Sci. 41:1981-1989 (2000)). The direct effect on degradative lysosomal enzymes is also dependent on light. While lipofuscin directly decreases the activity of several lysosomal enzymes removed from lysosomes when exposed to light, it had little effect on their activity in the dark (Shamsi et al., Invest. Ophthalmol. Vis. Sci. 42:3041-3046 (2001)). The lack of direct effects on lysosomal enzymes in the absence of light treatment has been confirmed by Bermann et al., Exp Eye Res. 72:191-195 (2001).
Conversely, however, indirect effects are likely, since A2E interferes with the function of the lysosomal vH+ ATPase proton pump (Bergmann et al., FASEB. J 18:562-564 (2004)), and low levels of A2E increased lysosomal pH (Holz et al., supra, 1999). The detected lysosomal pH change indicated that A2E could reduce enzyme effectiveness by alkalinizing the lysosomes. Yet, because this pH-dependent effect occurred at low levels of A2E that had little effect on membrane leakage, the alkalinization apparently preceded acute disruption of membrane integrity.
The modification and degradation of material by lysosomes is essential for cellular function. Lysosomes are characterized by their low pH (4.5-5.0), with optimal enzyme activity dependent on vesicle pH (Geisow et al., Exp. Cell. Res. 150:36-46 (1984)). Lysosomes are thought to acidify when positively charged hydrogen ions are pumped across the membrane by an H+-ATPase pump, but the build up of charge limits the degree of acidification. The charge imbalance is overcome by the movement of negatively charged chloride ions into the lysosome through a Cl− channel. Thus, agents that cause the Cl− channel to open, lead to further acidification of the lysosome.
The degradation of outer segment proteins of the photoreceptor is primarily mediated by the aspartic protease cathepsin D (Hayasaka et al., J. Biochem. 78:1365-1367 (1975)). While its pKA varies with substrate, the degradative activity of cathepsin D is generally optimum near pH 4, and falls below 20% of maximum at pH>5.0 (Barrett, In Protinases in Mammalian Cells and Tissues, Elsiver/North-Hollard, Biomedical. Press, New York, pp. 220-224 (1977)). Rats treated with chloroquine, which is known to alkalinize lysosomes (Krogstad et al., Am. J. Trop. Med. Hyg. 36:213-220 (1987)), doubled the number of outer segment-derived lysosome-associated organelles in the RPE (Mahon et al., Curr. Eye. Res. 28:277-284 (2004)), leading to the finding that lysosomal alkalization by A2E contributes to the accumulation of lipofuscin in the AMD. However, pharmacologic restoration in a disorder that progresses over decades can be fully realized only when the mechanisms controlling lysosomal pH are understood. Thus, the present invention serves an important function by meeting this need.
Lysosomal vesicle acidification is regulated by a series of membrane proteins, with proton delivery to lysosomes and late endosomes primarily mediated by the vacuolar proton pump (vH+ ATPase). The transport of protons by vH+ ATPases creates both a proton gradient and an electrical potential across vesicular membranes (Schneider DL., J. Biol. Chem. 256: 3858-3864, 1981; (Faundez et al., Science's Stke. 233:re8 (2004)). While the activity of vH+ ATPase in these vesicles is frequently constitutive, the conductance through Cl− channels is regulated (Hara-Chikuma et al., J. Biol. Chem. 280:1241-1247 (2005); Barasch et al., J. Cell. Biol. 107: 2137-2147 (1988); Sonawane et al., J. Biol. Chem. 277:5506-5513 (2002)).
Thus, a need has remained in the art, until the present invention, to find a way to slow the progression of AMD, particularly by regulating the acidity of the lysosomes within the RPE cells.SUMMARY OF THE INVENTION
The present invention provides a method for slowing the progression of AMD by restoring an optimal acidic pH to pH-compromised lysosomes in the RPE, and identifies compounds that lower lysosomal pH and increase the activity of degradative enzymes. Treatment of the RPE cell, such as by administering exogenous compositions to modulate lysosomal acidity (“lysosomal pH (pHL)), modulates a series of second messenger responses, which result in lysosomal acidification or restore acidity of lysosomes within the RPE cell. Therefore, by combining a mechanistic analysis of lysosomal acidification with a high through-put evaluation of the pharmacologic approach and the application of these findings to animal models, the present invention has determined methods for regulating lysosomal pH (pHL) in the RPE cells. Moreover, since the entry of Cl− channels into the lysosomal lumen electrically balances the accumulation of protons, regulation of the Cl− channels of the RPE offers a further rate-limiting step in vesicle acidification, and thus, is associated with the development of the pathology.
It is, therefore, an object of the invention to provide methods of pharmacologic manipulation to restore a perturbed lysosomal pH and enhance degradative ability in RPE cells. The absolute value over which the defect occurs in the RPE cells of ABCA4−/− mice (animal model of AMD) is highly relevant to the determination of how to change pHL and how to quantify that change. In AMD models the RPE cells are gradually lost over time along with a secondary loss of photoreceptors. One method of regulating lysosomal pHL in the RPE cells is provided by inhibiting the action of compositions that otherwise inhibit acidification of the lysosomes and/or decrease the activity of the degradative enzymes, as measured in both cultured RPE cells, and in defective RPE cells from ABCA4−/− model animals. Thus, an effective treatment is provided by the present invention for reversing the abnormally elevated pHL associated with macular degeneration, particularly for the macular degeneration found in AMD and in Stargardt's disease, and for restoring the damage caused by the increased pHL in the patient's eye. As a result, the photoreceptors repopulate toward normality (meaning photoreceptor levels are restored, preserved or maintained to levels comparable to levels and activity found in a normal eye that is not affected by AMD, i.e., when RPE lysosomal pHL is not abnormally elevated).
Additional objects, advantages and novel features of the invention will be set forth in part in the description, examples and figures which follow, all of which are intended to be for illustrative purposes only, and not intended in any way to limit the invention, and in part will become apparent to those skilled in the art on examination of the following, or may be learned by practice of the invention.
The foregoing summary, as well as the following detailed description of the invention, will be better understood when read in conjunction with the appended drawings. It should be understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown.
While the identification of compounds that can acidify defective lysosomes has direct implications for the health of RPE cells, the development of optimal treatments requires an understanding of the mechanisms controlling pHL. There are many different receptors for ATP each with different effects. Elevation of the lysosomal pH, results in impaired degradation of material by lysosomes, leading to pathological consequences both to the RPE cell and to the immediate area adjacent thereto. As a result, to slow the progression of AMD, particularly by regulating the acidity of the lysosomes within the RPE cells, involves regulation by a series of membrane proteins, with proton delivery primarily mediated by the vacuolar proton pump (vH+ATPase). Re-acidification of pH-compromised lysosomes can rectify an elevated lysosomal pH in RPE cells, and restore or enhance their essential degradative function. However, it has been further determined that stimulation of the P2X7 and P2Y12 receptors has a converse effect, thereby elevating lysosomal pHL in RPE cells.
The P2Y12 and P2X7 receptors are present on the plasma membrane, meaning that when the RPE cells are treated, second messengers are activated, which travel through the cytoplasm to the lysosomal membrane. Stimulation of the P2Y12 receptors and/or the P2X7 receptors thus activates transport mechanisms located on the lysosomal membrane. This is distinct from modulating cellular or cytoplasmic pH. In this situation, lysosomal pHL is modified or modultated via the cytoplasmic messengers—but without affecting cytoplasmic pH. Similarly, mere alteration of the RPE cytoplasmic pH, has no effect on the membrane bound lysosomes that are sequestered from the cytoplasm. The drugs being administered do not usually pass the plasma membrane, but do affect the receptors thereon.
Conversely, as is further shown by the data presented herein, administering “antagonists” to the P2X7 receptor, or alternatively to the P2Y12 receptor, effectively reacidifies lysosomal pHL in the RPE cells to normal or expected levels, as compared to high pHL. levels seen in pH-compromised lysosomes of diseased RPE cells, such as in age-related macular degeneration. As a result, as further demonstrated, administration of an antagonist either to the P2X7 receptor or to the P2Y12 receptor enhances degradative function of RPE lysosomes, and thus provides an alternative to treatment for macular degeneration, and/or offers an element in a combined treatment thereforinvolving modulation of an endogenous agonist or of the receptors themselves. The endogenous agonist to the P2X7 receptor is ATP, while the endogenous P2Y12 agonist is ADP.
Because Cl− conductance is a prime target for manipulating lysosomal acidity, the recognition of Cl− influx as a rate limiting step in vesicular acidification led to the determination that increasing Cl− channel activity could acidify lysosomes regardless of the original source of pathology. Thus, embodiments of the present invention are directed to Cl− channels of the ocular lysosomal epithelia that are most readily manipulated with the aim of developing treatment for the earliest stages of AMD.
Further embodiments of the invention focus on the absolute values of the abnormally elevated pHL in the defective lysosomes in the RPE cells of a patient with AMD or Stargardt's disease, thus permitting correction of the pH to normal levels, restoring the damage associated with macular degeneration. Further, specific drugs are identified in this invention by combining a mechanistic analysis of lysosomal acidification with a high through-put evaluation of this pharmacologic approach. Thus, methods are provided in the present invention for slowing the progression of macular degeneration, specifically AMD and Stargardt's macular degeneration, by restoring an optimal acidic pH to compromised lysosomes in the RPE of the patient's eye.Elevation of Lysosomal pH in RPE Cells
Measuring Lysosomal pH:
In an embodiment of the invention, drugs were identified that lowers lysosomal pH (pHL), recognizing the importance of acidic lysosomal pH for the degradative functions of the RPE and that pHL may be elevated by A2E in early AMD. This required the development of an efficient protocol to screen pHL. Traditional dyes have used fluorescence intensity as an index of pH. However, the ratiometric qualities of Lysosensor Yellow/Blue fluoresced yellow, making readings possible that are independent of dye concentration, providing a clear advantage in acidic organelles, like lysosomes, where the volume fluctuates with the pH (Pothos et al., J Physiol. 542:453-476 (2002); Li et al., Am. J Physiol. Cell. Physiol. 282:C1483-C1491 (2002)).
ARPE19 is a spontaneous, immortalized RPE cell line obtained initially from a single human donor, now available at ATCC. Due to its immortality, this cell line has been studied extensively over the last decade to obtain important insights into RPE cell biology. See, e.g., Dunn et al., Exp. Eye Res. 62:155-69 (1996)). As a result, experiments in ARPE-19 cells were used to verify the source of the signal from Lysosensor Yellow/Blue and to optimize recording conditions.
Lysosensor Yellow/Blue co-localized with the Lysotracker Red dye in small vesicles, with a distribution consistent with lysosomal origin. Measurements of pHL were performed using a high throughput screening (HTS) protocol to maximize output and minimize variation using ARPE-19 cells in 96 well plates. HTS assays are particularly useful in the present invention because of the ability to screen hundreds, thousands, and even millions of compounds in a short period of time. Loading for 5 min. at 23° C. with 5 μM lysosensor, followed by 15 min. for internalization, produced stable and reproducible results.
The ratio of fluorescence (em>527 nm), typically excited at 340 nm and 380 nm, was measured for 20 msec, every 30 seconds, to minimize bleaching, and to determine the response to NH4Cl. The ratio was converted to pH by calibrating with KCl buffered to pH 4.0-6.0 in the presence of monensin and nigericin. Calibration indicated a baseline pH of 4.4 to 4.5, supporting lysosomal localization. NH4Cl (10 mM) increased fluorescence excited at 340 nm, increasing ratios (pH was elevated by 10 mM NH4Cl (n=20, p<0.0001)), by the vH+ ATPase inhibitor bafilomycin-A (pH was elevated by 200 nM BAF (n=20, p<0.0001)) and by chloroquine (pH was elevated by 20 μM CHQ (n=20, p<0.0001)), as expected. NH4Cl decreased the ratios slightly at 380 nm. Nevertheless, absent the addition of the dye, none of these compounds, or any others, altered the fluorescent signal at 340 or 380 nm, showing a specificity of the measured change to pHL. Thus, these results validate the use of the Lysosensor probe to measure pHL using high through-put screening methods and demonstrate that changes in pHL are reliably quantified. This quantification is necessary to predict the potential effectiveness of acidifying drugs to restore lysosomal enzyme activity.
When a population or subpopulation is found to contain a compound having desired properties, the screening step may be repeated with additional subpopulations containing the desired compound until the population has been reduced to one or a sufficiently small number to permit identification of the compound desired. Standard HTS assays may be miniaturized and automated, e.g., by replacing the standard 96-well plate with a 1536-well plate permitting the easy assay of up to 1500 different compounds. See, e.g., U.S. Pat. Nos. 6,306,659 and 6,207,391. Any suitable HTS system can be used in practicing the invention, and many are commercially available (see, e.g., LEADseeker™, Amersham Pharmacia Biotech, Piscataway, N.J.; PE Biosystem FMAT™ 8100 HTS System Automated, PE Biosystem, Foster City, Calif.; Zymark Corp., Hopkinton, Mass.; Air Technical Industries, Mentor, Ohio; Beckman Instruments, Inc. Fullerton, Calif.; Precision Systems, Inc., Natick, Mass., etc.).
The primary trigger for lysosomal alkalinization in RPE cells with macular degeneration is likely A2E. However, the efficient screening for compounds able to restore lysosomal function requires a rapidly-acting alkalinizing agent with similar mode of action that can also reduce the rate of outer segment clearance. When tested, A2E increased pHL in ARPE-19 cells by 0.4 units.
Holz and colleagues previously reported A2E responses, but the increase in pit required four weeks of feeding the cells with A2E (14 nM) every 3-4 days, and the A2E was complexed to low-density lipoprotein (LDL; 10 μg/ml) (Holz et al., supra, 1999). However, as determined in the present study, complexing A2E to LDL did not enhance the effect of A2E in the current trials. In fact, as shown in
Therefore, in an embodiment of the invention, the testing process was significantly advanced when it was determined that tamoxifen rapidly elevated lysosomal pH, with levels reaching a plateau within 10-15 minutes (establishing the time point used in all subsequent measurements). This rapid (<10-15 minute) alkalinization of the RPE cells established a high pHL on which test compounds could be tested for their ability to modulate the pH, as compared with the 4-week, prior art time course of A2E-mediated alkalinization which had been used to achieve similar results. The rise in pH by the present method for increasing pHL was concentration dependent, with EC50=22 μM(
The response to tamoxifen was reversed by the Cl− channel blocker 5-nitro-2-(3-phenylpropylamino)-benzoate (“NPPB”), but was neither mimicked, nor inhibited, by 17-n estradiol (
High through-put screening methods involve providing a library containing a large number of potential therapeutic compounds (“candidate” or “test” compounds”) that may be modulators of lysosomal acidity. Libraries of candidate compounds (“combinatorial libraries”) can be screened using one or more assays of the invention, as described herein, to identify those library compounds that display the desired characteristic activity, e.g., modulation of lysosomal activity. A higher or lower level of pHL in the presence of the test compound, as compared with pHL in the absence of the test compound, is an indication that the test compound affects pHL, and therefore, that it also modulates lysosomal activity.
The results are consistent with previous reports, further confirming that tamoxifen alkalinizes lysosomes through a detergent-like action (Chen et al., J. Biol. Chem. 274:18364-18373 (1999); Altan et al., Proc. Nat. Acad. Sci. USA 96:4432-4437 (1999)). While the incidence of retinopathies with moderate doses of tamoxifen treatment are low, the problems that occur at higher doses are consistent with increased pHL in the RPE (Lazzaroni et al., Graefes. Arch. Clin. Exp. Ophthalmol. 236:669-673 (1998); Noureddin et al., Eye. 13:729-733 (1999)). The decrease in outer segment clearance in the presence of tamoxifen and/or chloroquine supports the dependence of degradative capacity on pHL, although a direct effect of tamoxifen on lysosomal enzymes may also contribute to the overall effect (Toimela et al. Pharmacol. Toxicol. 83:246-251 (1998); Toimela et al., Ophthal Res. 1:150-153 (1995)). Moreover, these experiments demonstrate the feasibility of measuring both pHL and outer segment clearance using the high through-put screening protocol of the present invention, wherein quantifying the effectiveness of drugs to restore pHL and clearance rates is needed.
Receptor-Mediated Restoration of pHL.
Adenosine lowers pHL:
Because identifying a drug capable of acidifying distressed lysosomes in RPE cells holds therapeutic potential for treating AMD, the effect of purinergic signaling to RPE physiology was determined. The present findings demonstrated that purines can be used to restore pHL. Low doses of adenosine and the stable adenosine receptor agonist 5′-(N-ethylcarboxamido) adenosine (NECA) were independently administered to the RPE cells and found to reduce the pHL in cells treated with tamoxifen when each compound was given 15 minutes before measurements were made. A delivery for “prolonged period” of time for the purposes of this invention means ≧1 hour; ≧12 hours, ≧18 hours, ≧24 hours, 1-3 days, 1-7 days, ≧1 week, ≧1-2 weeks, to 1 month or more. However, the response to adenosine was more variable (
As used herein, and as accepted in the art, an “agonist” composition, when administered to a cell, such as an RPE cell or administered in vivo to the cells of a patient, enhances, extends or increases a biological activity, such as the activity of the specified receptor, attributable to the presence of, or level or changes in the level of, an endogenous composition, gene, receptor or component in the cell or in a cell in the patient system. Conversely, an “antagonist” composition, when administered to a cell, such as an RPE cell or administered in vivo to the cells of a patient, inhibits, decreases, diminishes, or may even prevent, a biological activity, such as the activity of the specified receptor, attributable to the presence of, or level or changes in the level of, an endogenous composition, gene, receptor or component in the cell or in a cell in the patient system. Recent evidence has shown that the effect may not always be as direct as previously assumed, and in some cases the effect crosses-over and may be seen in adjacent parts of the cell.
Agonists for the A1 adenosine receptor N6-cyclopentyl-adenosine (CPA) and (2S)—N6-[2-endo-norbornyl] adenosine (ENBA) had no effect (see,
Consequently, it was determined that stimulation of adenosine receptors did, in fact, restore pHL in cells treated with tamoxifen, and likely involves the A2A receptor. The acidification of pHL in bovine cells treated with tamoxifen further showed that the responses to tamoxifen are neither species specific, nor restricted to a particular cell line.
As shown in
β-Adrenergic Receptor and cAMP Lower Lysosomal pH:
The acidification of pHL by adenosine and ATP prompted screening for additional compounds. Drugs currently used for ophthalmic treatment and those known to stimulate classic pharmacologic pathways were examined. However, compounds currently in ophthalmic use, including dorzolamide, timolol or latanaprost, did not lower pHL in ARPE-19 cells treated with 30 μM tamoxifen. Conversely, norepinephrine, epinephrine and isoproterenol did significantly decrease pHL (
Since the A2A adenosine and β-adrenergic receptors can act by stimulating GS, the effect of cAMP was examined directly with cell-permeable forms of cAMP (
Thus, the ability of cpt-cAMP to lower pHL, in conjunction with actions of isoproterenol and CGS21680, indicated that cAMP is a primary regulator of pHL in RPE cells. The magnitude of the acidification is predicted to restore pHL from 4.9 to 4.6 in cells treated with A2E. This corresponds to a predicted increase in activity of cathepsin D from 25% to 60% of maximum rate (Barrett et al., supra, 1977). The small increase in age-related maculopathy found in patients treated with β-blockers (van Leeuwen et al., Ophthalmol. 111:1169-1175 (2004)), might well be assigned to a lessening of β-adrenergic activity with consequent elevation of pHL. Thus, the identification of cAMP as a potential messenger, combined with the findings on the Cl− channels, prompted mechanistic investigations regarding the contribution of Cl− channels to pHL of RPE cells.
Contribution of Cl− Channels to pHL of RPE Cells
The recognition of Cl− influx as a rate limiting step in lysosomal acidification led to the determination that Cl− channel regulation is an effective way to control pHL. The cystic fibrosis transmembrane conductance regulator (“CFTR”) channel (Anderson et al., Science 251:679-682 (1991)) was selected for experimental purposes for evaluating pHL since the Cl− channel is activated by cAMP, and since CFTR is present in RPE cells. Moreover, several tools are available for the manipulation of CFTR, and the relatively high incidence of cystic fibrosis (“CF”) has encouraged the recent development of several drugs that can selectively activate CFTR (Caci et al., Am. J. Physiol. Lung. Cell. Mol. Physiol. 285:L180-L188 (2003); Ma et al., J Biol. Chem. 277:37235-37241 (2002)). Substantial advances have also been made in developing gene therapy for CF (Lee et al., Biochem. J. 387:1-15 (2005); Griesenbach et al., Curr. Op. Pul. Med. 10:542-546 (2004)). Consequently, for experimental purposes, CFTR is considerably more amenable to pharmacologic and genetic manipulation than other Cl− channels. While CFTR has been implicated in vesicular acidification (Barasch et al., Nature 352:70-73 (1991); Biwersi et al., Am. J. Physiol. 266:(1994)), it was understood that it does not have this role in all cell types or vesicles (Van Dyke et al., Biochem. Biophys. Res. Comm. 184:300-305 (1992); Seksek et al., J. Biol. Chem. 271:15542-15548 (1996)). However, it does acidify lysosomes in the RPE.
Effect of Pharmacologic Manipulation of CFTR on pHL:
It was found that the CFTR activator, genistein, acidified lysosomes in cells exposed to tamoxifen. Moreover, the CFTR inhibitor′ glybenclamide, increased pHL (
Genetic Manipulation of CFTR:
Transfection with CFTR provides a mechanism to specifically increase the contribution of CFTR, and thus determine definitively whether it can acidify lysosomes in RPE cells. As a result, the lysosomes of ARPE-19 cells transfected with a full length gene for CFTR were more acidic than control cells when both were exposed to tamoxifen (
Trials to identify optimal conditions found acidification most pronounced in cells transfected within 1 day after plating and measured 48 hours later, demonstrating that transfection of RPE cells with CFTR leads to an increase in CFTR protein of appropriate size and enhanced acidification in cells exposed to tamoxifen. Nonetheless, the results do not define the mechanism underlying the acidification, nor whether the primary action is on the plasma membrane or lysosomal membrane.
The data provide powerful new information to support the hypothesis in
The compounds identified by the methods embodied herein, must be pharmacologically acceptable, but they may be protein or non-proteinaceous, organic or non-organic, and they may be administered exogenously or expression may be up-regulated in the patient. In the alternative, proteinaceous compounds may be produced in vitro, including by recombinant methods, and then administered to the patient.
For proteinaceous compounds, the desired expression products may be generated from transgenic constructs, comprising an isolated nucleic acid or amino acid sequence of the composition, or an active fragment thereof, that lowers pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes. The terms “nucleotide molecule,” “nucleotide sequence,” “nucleic acid molecule” and “polynucleotide” are used interchangeably and refer to a polymeric form of nucleotides of any length, either DNA, RNA or analogs thereof. Non-limiting examples of polynucleotides include a gene, a gene fragment, exons, introns, messenger RNA (mRNA), transfer RNA, ribosomal RNA, ribozymes, cDNA, recombinant polynucleotides, branched polynucleotides, plasmids, vectors, isolated DNA of any sequence, isolated RNA of any sequence, nucleic acid probes and primers (linear or circular). Amino acid sequences refer to “proteins” or “peptides” as used herein is intended to include protein fragments, or peptides. Thus, the term “protein” is used synonymously with the phrase “peptide” or “polypeptide,” and includes “active fragments thereof,” particularly with reference to proteins that are “proteins of interest.” Protein fragments may or may not assume a secondary or tertiary structure. Protein fragments may be of any length, from 2, 3, 5 or 10 peptides in length up to 50, 100, or 200 peptides in length or more, up to the full length of the corresponding protein.
“Library,” particularly as referred to previously with regard to PCR and HTS, refers to a collection of different compounds, including small organic compounds or biopolymers, including proteins and peptides. The compounds may be encoded and produced by nucleic acids as intermediates, with the collection of nucleic acids also being referred to as a library. When a nucleic acid library is used, it may be a random or partially random library, as in a combinatorial library, or it may be a library obtained from a particular cell or organism, such as a genomic library or a cDNA library. Small organic molecules can be produced by combinatorial chemistry techniques as well. Thus, in general, such libraries comprise are organic compounds, including but not limited oligomers, non-oligomers, or combinations thereof. Non-oligomers include a wide variety of organic molecules, such as heterocyclics, aromatics, alicyclics, aliphatics and combinations thereof, comprising steroids, antibiotics, enzyme inhibitors, ligands, hormones, drugs, alkaloids, opioids, benzodiazepenes, terpenes, prophyrins, toxins, catalysts, as well as combinations thereof. Oligomers include peptides (that is, oligopeptides) and proteins, oligonucleotides (the term oligonucleotide also referred to simply as “nucleotide,” herein) such as DNA and RNA, oligosaccharides, polylipids, polyesters, polyamides, polyurethanes, polyureas, polyethers, poly (phosphorus derivatives), such as phosphates, phosphonates, phosphoramides, phosphonamides, phosphites, phosphinamides, etc., poly (sulfur derivatives), such as sulfones, sulfonates, sulfites, sulfonamides, sulfenamides, etc.
A “substantially pure” or “isolated nucleic acid,” as used herein, refers to a nucleic acid sequence, segment, or fragment which has been separated (purified) from the sequences which flank it in a naturally occurring state, e.g., a DNA fragment which has been removed from the sequences which are normally adjacent to the fragment, e.g., the sequences adjacent to the fragment in a genome in which it naturally occurs. The term also applies to nucleic acids which have been substantially purified from other components which naturally accompany the nucleic acid, e.g., RNA or DNA or proteins, which naturally accompany it in the cell. The term therefore includes, for example, a recombinant DNA which is incorporated into a vector, into an autonomously replicating plasmid or virus, or into the genomic DNA of a prokaryote or eukaryote, or which exists as a separate molecule (e.g., as a cDNA or a genomic or cDNA fragment produced by PCR or restriction enzyme digestion) independent of other sequences. It also includes a recombinant DNA which is part of a hybrid gene encoding additional polypeptide sequence.
A “vector” is a composition of matter which comprises an isolated nucleic acid and which can be used to deliver the isolated nucleic acid to the interior of a cell. Numerous vectors are known in the art including, but not limited to, linear polynucleotides, polynucleotides associated with ionic or amphiphilic compounds, plasmids, and viruses. Thus, the term vector includes an autonomously replicating plasmid or a virus. The term should also be construed to include non-plasmid and non-viral compounds which facilitate transfer of nucleic acid into cells, such as, for example, polylysine compounds, liposomes, and the like. Examples of viral vectors include, but are not limited to, adenoviral vectors, adeno-associated virus vectors, retroviral vectors, and the like. Suitable vectors also include, but are not limited to, plasmids containing a sense or antisense strand placed under the control of the strong constitutive promoter or under the control of an inducible promoter. Methods for the generation of such constructs are well known in the art once the sequence of the desired gene is known. Suitable vector and gene combinations will be readily apparent to those of skill in the art.
A nucleic acid encoding the therapeutic compound, or an active fragment thereof, can be duplicated using a host-vector system and traditional cloning techniques with appropriate replication vectors. A “coding sequence” or a sequence which “encodes” the selected polypeptide (its “expression product”), is a nucleotide molecule which is transcribed (in the case of DNA) and translated (in the case of mRNA) into a polypeptide, for example, in vivo when placed under the control of appropriate regulatory sequences (or “control elements”). An “expression vector” refers to a vector comprising a recombinant polynucleotide comprising expression control sequences operatively linked to a nucleotide sequence to be expressed. An expression vector comprises sufficient cis-acting elements for expression; other elements for expression can be supplied by the host cell or in an in vitro expression system. Expression vectors include all those known in the art, such as cosmids, plasmids (e.g., naked or contained in liposomes) and viruses that incorporate the recombinant polynucleotide. A recombinant polynucleotide may also serve a non-coding function (e.g., promoter, origin of replication, ribosome-binding site).
A “host-vector system” refers to host cells, which have been transfected with appropriate vectors using recombinant DNA techniques. The vectors and methods disclosed herein are suitable for use in host cells over a wide range of eukaryotic organisms. This invention also encompasses cells transformed with the replication and expression vectors, using methods known in the art. Indeed, a gene encoding the modulating nucleic acid, such as the nucleic acid sequence encoding a peptide, or an active fragment thereof, that lowers pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes, can be duplicated in many replication vectors, and isolated using methods described, e.g., in Maniatis et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratory, New York (1982) and Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratory, New York (1989), and the various references cited therein.
The selected gene, made and isolated using the above methods, can be directly inserted into an expression vector, such as pcDNA3 (Invitrogen) and inserted into a suitable animal or mammalian cell. In the practice of one embodiment of this invention, the gene or gene fragment, such as the purified nucleic acid molecule encoding the peptide, or an active fragment thereof, that lowers pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes, is introduced into the cell and expressed. A variety of different gene transfer approaches are available to deliver the gene or gene fragment encoding the modulating nucleic acid into a target cell, cells or tissues.
As used herein, “recombinant” is intended to mean that a particular DNA sequence is the product of various combination of cloning, restriction, and ligation steps resulting in a construct having a synthetic sequence that is indistinguishable from homologous sequences found in natural systems. Recombinant sequences can be assembled from cloned fragments and short oligonucleotides linkers, or from a series of oligonucleotides. As noted above, one means to introduce the nucleic acid into the cell of interest is by the use of a recombinant expression vector. “Recombinant expression vector” is intended to include vectors, capable of expressing DNA sequences contained therein, where such sequences are operatively linked to other sequences capable of effecting their expression. It is implied, although not always explicitly stated, that these expression vectors must be replicable in the host organisms, either as episomes or as an integral part of the chromosomal DNA. Suitable expression vectors include viral vectors, e.g., adenoviruses, adeno-associated viruses, retroviruses, cosmids and others, typically in an attenuated or non-replicative form. Adenoviral vectors are a particularly effective means for introducing genes into tissues in vivo because of their high level of expression and efficient transformation of cells, both in vitro and in vivo.
Accordingly, when reference is made herein to “administering” the compound that lowers pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes, or a functionally equivalent peptide fragment thereof, to a patient, it is intended that such methods include not only delivery of an exogenous composition to the patient, but also methods for reducing lysosomal pH (i.e., increasing acidity) within the RPE cells of the patient, or reducing levels of lipofuscin or slowing the rate of lipofuscin accumulation. As noted, the compound may be protein in nature or non-protein. However, when the compound is an expressed protein, expression levels of the gene or nucleotide sequence inside a target cell are capable of providing gene expression for a duration and in an amount such that the nucleotide product therein is capable of providing a therapeutically effective amount of gene product or in such an amount as to provide a functional biological effect on the target cell. By “gene delivery” is meant transportation of a composition or formulation into contact with a target cell so that the composition or formulation is capable of being taken up by means of a cytotic process into the interior or cytoplasmic side of the outermost cell membrane of the target cell, where it will subsequently be transported into the nucleus of the cell in such functional condition that it is capable of achieving gene expression.
By “gene expression” is meant the process, after delivery into a target cell, by which a nucleotide sequence undergoes successful transcription and translation such that detectable levels of the delivered nucleotide sequence are expressed in an amount and over a time period that a functional biological effect is achieved. “Gene therapy” encompasses the terms gene delivery and gene expression. Moreover, treatment by any gene therapy approach may be combined with other, more traditional therapies.
The compounds used for therapeutic purposes are referred to a “substantially pure,” meaning a compound, e.g., a protein or polypeptide which has been separated from components which naturally accompany it. Typically, a compound is substantially pure when at least 10%, or at least 20%, or at least 50%, or at least 60%, or at least 75%, or at least 90%, or at least 99% of the total material (by volume, by wet or dry weight, or by mole percent or mole fraction) in a sample is the compound of interest. Purity can be measured by any appropriate method, e.g., in the case of polypeptides by column chromatography, gel electrophoresis, or HPLC analysis. A compound, e.g., a protein, is also substantially purified when it is essentially free of naturally associated components or when it is separated from the native contaminants which accompany it in its natural state.
By “patient” or “subject” is meant any vertebrate or animal, preferably a mammal, most preferably a human, that is affected by or susceptible to retinal diseases or disorders resulting in macular degeneration and loss of vision. Thus, included within the present invention are animal, bird, reptile or veterinary patients or subjects, the intended meaning of which is self-evident. The methods of the present invention are useful in such a patient for the treatment or prevention of the following, without limitation: macular degeneration, age related macular degeneration, lysosomal alkylinization of the RPE cells of the eye, damaging accumulation of lipofuscin, and other diseases of the retina of the eye.
In another embodiment, the invention may further include the step of administering a test compound to the cell prior to the detecting step, wherein the absence of binding of the detectable group to the internal structure indicates that the test compound inhibits the binding of the members of the specific binding pair. Any test compound can be used, including peptides, oligonucleotides, expressed proteins, small organic molecules, known drugs and derivatives thereof, natural or non-natural compounds, non-organic compounds, etc. Administration of the test compound may be by any suitable means, including direct administration, such as by electroporation or lipofection if the compound is not otherwise membrane permeable, or (where the test compound is a protein), by introducing a heterologous nucleic acid that encodes and expresses the test compound into the cell. Such methods are useful for screening libraries of compounds for new compounds that disrupt the binding of a known binding pair.
In yet another embodiment, the present invention provides an assay for determining agents, which manipulate lysosomal Cl− channel activity to modify pH of the retinal pigment epithelial lysosomes (pHL), or that bind to, neutralize or acidify lysosomes of the RPE, or other factors in a sequence of events leading to the onset of lysosomal alkylinization of the RPE cells of the eye, damaging accumulations of lipofuscin, and eventually macular degeneration, thereby reducing, modulating or preventing such pathologies. Such an assay comprises administering an agent under test to the cells or model animals, such as those described herein, at low cell density, and monitoring the onset of lysosomal alkylinization of the RPE cells of the eye or whether the agent effects a reversal of the problem. For example, Lysosensor Yellow/Blue is an effective method of quantifying pHL in RPE cells. A further assay according to the invention comprises administering the agent under test to determine and quantify the increase in pHL caused by A2E (see,
In still another embodiment, sensitivity of pHL levels in vivo are used as a biomarker for measuring macular disease severity or treatment effectiveness.
In accordance with the present invention, the compound (including organic or non-organic compositions, a peptide, receptor, or an active fragment thereof), that lowers pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes, or fragment thereof, or that binds to, neutralize or inhibit lysosomal alkylinization of the RPE cells, when used in therapy, for example, in the treatment of an aging patient or one with early onset symptoms of macular degeneration, lysosomal alkylinization of the RPE cells, damaging accumulations of lipofuscin, retinal dysfunction, or the like, can be administered to such a patient either alone or as part of a pharmaceutically acceptable composition. Optionally with a preservative, diluent, and the like are also added. The compound may further be administered in the form of a composition in combination with a pharmaceutically acceptable carrier or excipient, and which may further comprise pharmaceutically acceptable salts. Examples of such carriers include both liquid and solid carriers, such as water or saline, various buffer solutions, cyclodextrins and other protective carriers or complexes, glycerol and prodrug formulations. Combinations may also include other pharmaceutical agents.
The term “pharmaceutically acceptable” refers to physiologically and pharmaceutically acceptable compounds of the invention: i.e., those that retain the desired biological activity and do not impart undesired toxicological effects on the patient or the patient's eye or RPE cells.
Various methods of “administration” of the therapeutic or preventative agent (compound or composition) can be used, following known formulations and procedures. Although targeted administration is described herein and is generally preferred, it can be administered intravenously, intramuscularly, subcutaneously, topically, intraorbitally, optionally in a dispersible or controlled release excipient. One or several doses may be administered as appropriate to achieve systemic or parental administration under suitable circumstances. Compounds or compositions suitable for parenteral injection may comprise physiologically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions, or emulsions, and sterile powders for reconstitution into sterile injectable solutions or dispersions. Examples of suitable aqueous and nonaqueous carriers, diluents, solvents, or vehicles include water, saline, buffered saline, dextrose, ethanol, glycerol, polyols, and the like, and suitable mixtures thereof. Proper fluidity can be maintained, for example, by the use of a coating, such as lecithin, by the maintenance of the required particle size in the case of dispersions and by the use of surfactants. These compositions may also contain adjuvants, such as preserving, wetting, emulsifying, and dispensing agents. Sterility can be ensured by the addition of various antibacterial and antifungal agents. It may also be desirable to include isotonic agents, for example sugars, sodium chloride and the like. Prolonged absorption of the injectable pharmaceutical form can be brought about by the use of agents delaying absorption, for example, aluminum monostearate and gelatin.
Persons of ordinary skill can easily determine optimum dosages, dosing methodologies and repetition rates. Repetition rates for dosing can be readily estimated based upon measured residence times and concentrations of the drug in bodily fluids or tissues. Amounts and regimens for the administration of compounds used to lower pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes can be determined readily by those with ordinary skill in the clinical art of treating retinal disease, including macular degeneration. Generally, the dosage of such compounds or treatment using such compounds will vary depending upon considerations, such as: age; health; conditions being treated; kind of concurrent treatment, if any, frequency of treatment and the nature of the effect desired; extent of tissue damage; gender; duration of the symptoms; and, counter-indications, if any, and other variables to be adjusted by the individual physician. Dosage can be administered in one or more applications to obtain the desired results (see, e.g., dosages proposed for human therapy in known references).
When the therapeutic compound is a peptide, or an active fragment thereof, that lowers pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes, instead of direct administration to the target cells, such peptides can also be produced in the target cells by expression from an encoding gene introduced into the cells, e.g., in a viral vector. The vector could be targeted to the specific cells to be treated, or it could contain regulatory elements, such as receptors, which are switched on more or less selectively by the target cells. Increased expression is referred to as “up-regulation” as discussed herein.
By “therapeutically effective” as used herein, is meant that amount of composition that is of sufficient quality and quantity to neutralize, ameliorate, modulate, or reduce the cause of or effect of lysosomal alkylinization of the RPE cells, retinal dysfunction, macular degeneration or the like. Because Ca2+ elevations underlie ion transport changes, and the regulation of lysosomal acidification, it is assumed when the term “therapeutically effective,” with regard to administration of the compound to lower pHL in RPE cells and/or restore the degradative capability of the perturbed lysosomal enzymes, or the functionally equivalent peptide fragment thereof, that Ca2+ or other necessary divalent ion is present at the levels necessary to activate the therapeutic molecule.
By “ameliorate,” “modulate,” or “decrease” is meant a lessening or lowering or prophylactic prevention of the detrimental effect of the disorder in the patient receiving the therapy, thereby resulting in “protecting” the patient. A “sufficient amount” or “effective amount” or “therapeutically effective amount” of an administered composition is that volume or concentration which causes or produces a measurable change from the pre-administration state in the cell or patient, this is also referred to herein as “restoring” or “restoration of” the lysosomal acidity.
While the subject of the invention is preferably a human patient, it is envisioned that any animal with lysosomal alkylinization of the RPE cells, damaging accumulations of lipofuscin, retinal dysfunction, macular degeneration or the like, can be treated by a method of the present invention. As used herein, the terms “treating” and “treatment” are intended to include the terms “preventing” and “prevention.” One embodiment of the present invention includes the administration of a compound (including an organic or inorganic composition, peptide, or an active fragment thereof, receptor, etc) that lowers pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes, in an amount sufficient to treat or prevent lysosomal alkylinization of the RPE cells, lipofuscin accumulation, retinal dysfunction, macular degeneration, or the like.
The terms “inhibition” or “blocking” refer to a statistically significant decrease in lysosomal alkylinization of the RPE cells or lipofuscin accumulation, associated with retinal dysfunction, macular degeneration, or the like, as compared with a selected standard of activity or for cells or tissues grown without the addition of the selected compound (including a peptide, or an active fragment thereof) that lowers pHL in RPE cells and/or restores the degradative capability of the perturbed lysosomal enzymes. “Preventing” refers to effectively 100% levels of prophylactic inhibition. Preferably, the increased levels of the compound (meaning a higher concentration than was present before additional quantities of the compound was administered or before its expression was up-regulated in the patient) decreases lysosomal alkylinization and/or enhances acidity of the RPE cells or lipofuscin accumulation, associated with retinal dysfunction, macular degeneration, or the like, or risk thereof, by at least 5%, or by at least 10%, or by at least 20%, or by at least 50%, or even by 80% or greater, and also preferably, in a dose-dependent manner.
The invention is further defined by reference to the following specific, but nonlimiting, examples that reverse or alter lysosomal alkylinization of the RPE cells or change lipofuscin accumulation, associated with retinal dysfunction, macular degeneration, or the like. Reference is made to standard textbooks of molecular biology that contain definitions and methods and means for carrying out basic techniques, encompassed by the present invention. It will be apparent to one skilled in the art that many modifications, both to materials and methods, may be practiced without departing from the purpose or narrowing the scope of this invention.EXAMPLES Materials and Methods
The following Materials and Methods apply to all of the following Examples of the present invention.
ARPE-19 cells (ATCC) were grown to confluence in 25 cm2 Primary Culture flasks (Becton Dickinson) in a 1:1 mixture of Dulbecco's modified Eagle medium (DMEM) and Ham's F12 medium with 3 mM L-glutamine, 100 μg/ml streptomycin and 2.5 mg/ml Fungizone and/or 50 μg/ml gentamicin and 10% fetal bovine serum (all Invitrogen Corp). Cells were incubated at 37° C. in 5% CO2, and subcultured weekly with 0.05% trypsin and 0.02% EDTA. In many experiments, cells were grown for 2 weeks, with the above growth medium replaced with one containing only 1% serum for the second week to encourage differentiation.
Isolation of Bovine and Mouse RPE Cells:
The bovine RPE-choroid and sclera were removed, incubated in 2.5% trypsin at 37° C. in 5% CO2 for 30 mM, after which RPE sheets are dissected, washed and plated in 96-well plates with 10% serum medium. Mouse eyes were incubated in DMEM for 3 hrs at room temperature (RT), then in 0.1% trypsin and 0.4 mg/ml collagenase IV with 1 mM EDTA for 45 min at RT. RPE sheets were dissected out, washed, and incubated with 0.25% trypsin/0.02% EDTA in order to obtain a suspension of single cells, then grown as above.
HTS Measurement of pHL:
ARPE-19 cells were grown in 96-well plates, rinsed 3× with isotonic solution (IS; prepared from NaCl 105 mM, KCl 5 mM, HEPES Acid 6 mM, Na HEPES 4 mM, NaHCO3 5 mM, mannitol 60 mM, glucose 5 mM, MgCl2 0.5 mM, CaCl2 1.3 mM) and incubated with 5μM LysoSensor Yellow/Blue (Invitrogen Corp.) diluted with IS. Extensive trials determined that the optimal response is obtained with 5 minute dye loading and 15 minute post-incubation. Fluorescence was measured with a Fluroskan 96-well Plate Reader (Thermo Electron Corp.). pHL was determined from the ratio of light excited at 340 nm vs 380 nm (>520 nM em). pHL was calibrated by exposing cells to 10 μM H+/Na+ ionophore monensin and 20 μM H+/K+ ionophore nigericin in 20 MES, 110 KCl and 20 NaCl at pH 3.0-7.0 for 15 min. All reagents were from Sigma Chemical Corp. unless otherwise indicated.
Measurement of pHL from Isolated Mouse Cells:
Based on protocols that are used extensively to measure Ca2+ from retinal ganglion cells (Zhang et al. Invest. Ophthalmol. Vis. Sci. 46:2183-2191 (2005)), cells were fixed on coverslips and mounted on Nikon Eclipse inverted microscope, visualized with a ×40 oil-immersion fluorescence objective, and perfused with control solution. The field was alternatively excited at 340 nm and 380 nm, and fluorescence >515 emitted from the region of interest surrounding individual cells is measured with a CCD camera and Imagemaster software (Photon Technologies International, Inc). After baseline levels were recorded for 3-5 minutes in the absence of dye, solution was replaced with 5 μM Lysosensor Yellow/Blue dye for 5 minutes before washing for an additional 15 minutes. The ratios in the control solutions were recorded, and then acidifying drugs were added. Ratios were converted to pH with monensin/nigericin as above.
Outer Segment Degradation:
Bovine retinas were homogenized in 20% sucrose with 130 mM NaCl, 20 mM Tris-HCl, 10 mM glucose, 5 mM taurine and 2 mM MgCl2 (pH 7.20). The homogenate was placed in ultracentrifuge tubes with 20%, 27%, 33%, 41%, 50% and 60% sucrose, respectively, and centrifuged for 70 minutes at 28,000 rpm on a SW28 rotor (4° C.). The supernatant was filtered, diluted in 0.02M Tris-HCl buffer (pH 7.2) and centrifuged at 13,000×g for 10 minutes (4° C.). The pellet was resuspended in 10 PBS, 0.1 mM NaCl and 2.5% sucrose. Outer segments were loaded with 5 μM calcein-AM in PBS for 10 minutes, and spun 2× at 14,000 rpm to wash. Outer segments were then diluted 1:100 in growth medium and added to ARPE-19 cells in 96-well plates. After 2 hours, cells were washed vigorously 3×, and incubated with growth medium for 3 hours, after which 30 μM tamoxifen was added with acidifying drugs. After 24 hours, wells were washed 3×, and the fluorescence was read with a plate scanner at 485 nm to quantify the signal.
Quantitative polymerase chain reaction (PCR) techniques used previously (see Zhang et al., Mol Vis, under revision) are applied to Cl− channels identified by EST libraries and PCR studies of human RPE cells (Wills et al., Invest. Ophthalmol. Vis. Sci. 41:4247-4255 (2000); Weng et al., Am. J. Physiol. Cell. Physiol. 283:C839-C849 (2002); Wistow et al., Mol. Vis. 8:205-220 (2002); Ida et al. Mol. Vis. 10:439-444 (2004)). As used herein, the term “primer” refers to an oligonucleotide, whether occurring naturally as in a purified restriction digest or produced synthetically, which is capable of acting as a point of initiation of synthesis when placed under conditions in which synthesis of a primer extension product which is complementary to a nucleic acid strand is induced, i.e., in the presence of nucleotides and of an inducing agent, such as DNA polymerase, and at a suitable temperature and pH. The primer is preferably single stranded for maximum efficiency in amplification, but the exact length of the primer will depend on many factors. The amplified segments of the target sequence become the predominant sequences (in terms of concentration) in the mixture, they are said to be “PCR amplified.”
The plasmid DNA containing the appropriate CFTR construct was diluted 1:50 in serum-free Opti-MEM®I Medium, with Lipofectamine 2000™ diluted 1:25 in Opti-MEM®I Medium. After mixing, reagents were combined and incubated for 20 minutes at RT. This mixture was diluted in growth medium and added to ARPE-19 cells grown to 90% confluence in 96-well plates. Plasmids were incubated with cells at 37° C. for 4-6 hrs, after which, the transfection mix was replaced with growth medium. Cells were then grown for a further 48 hrs before measurements.
Isolation of Lysosomes:
ARPE-19 cells were detached with 0.25% trypsin, centrifuged at 1000 rpm for 5 minutes, and resuspended in 0.25M sucrose with 5 mM ATP in 10 mM Tris buffer (pH 7.4 with HCl). After homogenization, samples were spun at 1000×g (10 min). The supernatant was centrifuged (20,000×g, 10 min) and the pellet was resuspended in a 0.25 M sucrose buffer with 8 mM CaCl2 in Tris-HCl buffer (pH 7.4) to lyse mitochondria (15 min, 35° C.). After a subsequent centrifugation (5000×g, 15 min), the supernatant was placed on top of a discontinuous sucrose gradient (45%, 34.5% and 14.3%, Tris-HCl buffer). The lysosomal fraction was collected in the 34.5%-14.3% interface after an ultracentrifugation at 77,000×g for 2 hours in a SW71 rotor. After isolation, lysosomes were diluted 1:10 in a 150 mM KCl solution in Tris-HCl (pH 7.4) and pelleted at 25,000×g. The pellet was then resuspended in 5μM Lysosensor dye. Cells were washed 2× by centrifugation (25,000×g, 15 min), resuspended in test or control solutions including 5 mM MgATP, plated into a 96 well plate (50 μl/well) and the pH was measured as above.
The term “Western blot,” refers to the immunological analysis of protein(s), polypeptides or peptides that have been immobilized onto a membrane support. ARPE-19 were washed 2× and lysed in RIPA (radioimmunoprecipitation assay solution; basically PBS, 1% NP-40, 0.5% sodium doxycholate, 0.1% SDS). Samples were sonicated and cleared by centrifugation (10,000 g; 30 min, 4° C.). Concentrations were determined with BCA ((bicinchoninic acid) protein assay; e.g., Endosafe™-PTS BCA™, Charles River Laboratories. 60 μg of protein was separated by acrylamide gel electrophoresis on a SDS-PAGE gel, and transferred from the gel to a solid support, such as nitrocellulose or a nylon membrane, e.g., a PVDF (polyvinylidene fluoride) membrane (e.g., Millipore). Nonspecific binding was blocked with 5% nonfat dried milk for 1 hr (25° C.). The immobilized proteins were then exposed to an antibody having reactivity towards an antigen of interest, i.e., blots were incubated with monoclonal anti-CFTR (M3A7; Upstate, 0.5 μg/ml) overnight (4° C.). The binding of the antibody (i.e., the primary antibody) is detected by use of a secondary antibody which specifically binds the primary antibody, typically this is conjugated to an enzyme which permits visualization by the production of a colored reaction product or catalyzes a luminescent enzymatic reaction. In this case, the antibody reaction was followed by anti-mouse IgG conjugated with horseradish peroxidase (1:5000; 25° C. for 1 hr), developed by chemiluminescence detection, imaged and quantified.Example 1 Identification of Receptors that Lower pHL in Bovine and Human RPE Cells
Data has shown that the A2A adenosine and P2Y11 receptors linked to GS lower pHL. To test whether pharmacologic manipulation could restore a perturbed lysosomal pH and enhance degradative ability in RPE cells, requires (i) definitively identifying receptors involved in lysosomal acidification, (ii) determining whether compounds found to decrease pHL in cells treated with tamoxifen are effective against A2E, and (iii) assess whether the identified compounds can restore rates of outer segment degradation. The characterization of the receptors is performed on cells treated with tamoxifen since it requires only 15 minutes to modify pHL.
In general, each condition below used 3-12 independent wells per plate, in 3-6 separate plates. As levels from individual plates varied, data was normalized to the mean pHL for control wells from each plate. Fluorescent ratios were converted to pH following calibration performed on each plate as described. Incubation with Lysosensor Yellow/Blue was kept constant and all measurements were performed 15 min after removal of dye from the bath to ensure continuity. Significance was determined with a one-way ANOVA and Tukey post test. Drugs were always tested on control cells to ensure modification of healthy RPE cells was minimal, and cells were not exposed to dye to make sure effects were specific. All background was subtracted from the fluorescence excited at 340 and 380 nm independently before calculation of the ratio.
A2A Adenosine Receptor:
The agonist CGS21680 is selective for the A2A receptor at the low levels used in the preliminary data. EC50 is 290 nM for the A1 receptor; 27 nM for the A2A receptor; >1000 nM for the A2B receptor; and 67 nM for the A3 receptor. Receptor specificity was confirmed with the A2A antagonist, ZM241385, with an 1050 of 536 nM for the A1 receptor; 1.4 nM for the A2A receptor; 31 nM for the A2B receptor; and 269 nM for the A3 receptors. ZM241385 was applied to ARPE-19 cells at 3, 10 and 30 nM, 3 min before application of tamoxifen in the presence and absence of 30 nM NECA (
A2A adenosine receptor agonist CGS21680 (CGS, 100 nM) decreased the lysosomal alkalinization induced by chloroquine (CHQ, 20 μM) in ARPE-19 cells B). See,
The initial investigation screened agonists that act at multiple P2 receptors for their effect on pHL using the high through-put assay. BzATP, ATP, ATPγS, ADPγS and 2 MeSATP and AR-C67085 were added at 10, 30, 100 and 300 μM, respectively, and relative actions were compared with published information for the human P2Y11 receptor (von Kugelgen et al, supra, 2000; Communi et al., supra, 1997; Communi et al., Br. J. Pharmacol. 128:1199-206 (1999)). ATP was added in the presence of ecto-ATPase/eNPP inhibitors βγmATP and ARL67156 (100 μM) since they prevent degradation of ATP in these cells. Receptor involvement was confirmed with antagonists suramin, reactive blue 2 and pyridoxal-phosphate-6-azophenyl-2′,4′-disulphonic acid (PPADS; all at 0.1, 1, 10 and 100 μM). Since the finding that ATP had the ability to elevate cAMP in the RPE was novel, the effect of ATP on cAMP was measured directly using the cAMP-Screen Direct Chemiluminescent Immunoassay System kit from Applied Biosystems using an HTS luminometer to measure ATP levels. The role of cAMP was confirmed by inhibiting pKA with 100 μM Rp-8-Br-cAMPS. As above, the most effective agonists and antagonists were tested on bovine RPE cells.Example 2 Pharmacological Restoration of Lysosomal pH Increased by A2E
To demonstrate that agonists that were effective with tamoxifen also lower pHL in cells treated with A2E, basic protocols used to generate preliminary data were expanded to show the effect of acidifying drugs on ARPE-19 cells exposed to A2E. Cells were challenged with 14 nM A2E (LDL-free) for 4 weeks based on the results of
Preliminary trials indicated that A2E contributed less than 0.4% to the fluorescent signal in dye-loaded cells. This was important, because it suggested that small increases in pHL could be occurring even before an increase in fluorescence can be detected. It is possible that the enhanced emission at 380 nm vs. 340 nm might interfere with ratiometric assessment of the Lysosensor dye in some trials. This contribution was assessed separately in each experiment by exposing cells without dye to 340 or 380 nm light, as performed in preliminary data. If the fluorescence attributed to A2E became greater than 1% of the total signal, the appropriate subtraction was performed before determining the true ratio.
Norepinephrine, isoproteranol, NECA, CGS21680, cpt-cAMP, 8-Br-cAMP, appropriate P2 agonists and dopamine were tested on cells treated with A2E. Receptor identification was confirmed using appropriate antagonists. While the initial concentrations were the same as those found to be effective above, levels were adjusted if A2E-treated cells proved to be more or less resistant to restoration of lysosomal acidity.
Anticipated Results and Interpretation:
Stimulation of β-adrenergic and A2A adenosine receptors was expected to lower pHL elevated by treatment with A2E. The degree of restoration was found to depend on the magnitude of the alkalinization, but the quantification in the data suggested that treatments would restore acidity by >50%. This was predicted to double activity of cathepsin D (Barrett, supra, 1977). Drugs were expected to have a minimal effect on pHL in untreated cells, consistent with preliminary data.
The purification and stability of A2E makes its use challenging (Parish et al., supra, 1998), but the A2E used in these experiments (Neuron Systems Co.) was highly purified and regularly assessed for spontaneous isomerization. In addition, each batch was stored in the dark at −80° C. and purity is assessed regularly. Exposure of cells and A2E to light was minimized since photooxidation of A2E decreases fluorescence and increases toxicity (Sparrow et al., Invest. Ophthalmol. Vis. Sci. 43:1222-1227 (2002). While the photooxidation of A2E clearly enhanced its ability to injure the RPE cells (Sparrow et al., supra, 2005; Schutt et al., Ophthalmologe. 97:682-687 (2000)), the effects of photo-oxidized A2E on pHL were outside the scope of the current invention. Thus, the effects of A2E on pHL were first studied in the absence of added light to properly assess the effects of A2E alone, without added variables.Example 3 Effect of Lysosomal Acidification on Clearance of Photoreceptor Outer Segments
To show that lowering pHL increased the clearance of outer segments, an approach was designed based upon the findings shown in
The primary lysosomal enzymes in RPE cells function optimally in acidic environments, and compounds that alkalinize lysosomes can slow the degradation of outer segments and enhance accumulation of undigested material. Because this accumulation appeared to be a key step in the development and accumulation of lipofuscin, the ability of acidifying drugs to also restore rates of outer segment clearance was central to the potential of a drug. This is particularly important because Cl− concentration can have additional effects on enzyme activity, complicating the relationship between pHL and degradation.
Isolated bovine outer segments loaded with calcein were supplied to ARPE-19 cells in 96-well plates for 2 hrs, washed 3× and maintained in control medium for an additional 3 hr (see Methods). Acidifying drugs were then added at the most effective concentrations as identified above. Drugs were given to cells both with, and without, tamoxifen to determine whether baseline levels of degradation were also altered. Because lipofuscin is distributed heterogeneously across foveal RPE cells in macular degeneration (Holz et al., Invest. Ophthalmol. Vis. Sci. 42:1051-1056 (2001)), drugs with a minimal impact on healthy cells were preferable. As some compounds may have an independent effect on the rates of phagocytosis (Hall et al., Invest. Ophthalmol. Vis. Sci. 34:2392-2401 (1993)), the effect of the signal in the absence of tamoxifen was subtracted from the effect with tamoxifen to isolate specific actions. Promising compounds were examined for their effects on cells treated with A2E, although the restoration of pHL is unlikely to remove A2E itself. However, other components of the outer segments are amendable to digestion by lysosomal enzymes at the appropriate pHL, and acidification could minimize the secondary effect of this accumulation.
Phagocytosis of photoreceptor outer segments by the RPE involves binding, ingestion and degradation. Binding is distinguished by labeling outer segments with FITC, and quenching any fluorescence remaining on the membrane with trypan blue. While the increased brightness, pH independence, and the minimal background fluorescence with calcein-AM, make the outer segments labeled with calcein preferable in studies of lysosomes, it was determined that calcein is relatively resistant to quenching. However, the effect of binding was minimized by the 3 hour window between exposure to outer segments and the application of drugs, and the measurements taken 24 hrs later. As A2E does not affect binding itself, these precautions enabled the use of calcein with its multiple advantages.Experiment 4 Direct Manipulation of pHL in Isolated Lysosomes
While measurements from within intact cells can identify plasma membrane receptors capable of regulating pHL, the topology makes it difficult to deduce the mechanisms that were responsible. Lysosomal isolation enabled the direct access to the pertinent membrane and its Cl− channels, allowing perturbations of the processes contained exclusively on the lysosome. Therefore, the purpose of this experiment was to determine whether the pH of isolated lysosomes is dependant on Cl− influx.
Lysosomes were isolated as they were for the experiments resulting in the data presented in
Effect of Alkalinizing Agents:
The effect of 15 minutes exposure to tamoxifen (30 μM), and chloroquine (20 μM) on the relationship between pH and Cl− concentration was examined on isolated lysosomes. The effect of A2E was explored on lysosomes isolated from cells loaded with A2E for 4 weeks, as above. Cl− and H+ ions were coupled in a 1:1 ratio. ClC-4 and ClC-5 proteins were recently identified as Cl−/H+ exchangers (Scheel et al., Nature 436:424-427 (2005); Picollo et al., Nature 436:420-423 (2005)). Deviation from a 1:1 ratio indicated a significant contribution from such an exchanger. However, since the exchangers were predicted to function on endosomes, with minimal contribution to lysosomes, such deviation was not a problem. To the contrary, the block by NPPB provided additional support for Cl− channels on the membrane, although the effects of phloretin and DIDS were difficult to predict (Sabirov et al., supra, 2001). These experiments also provide baseline pH levels to evaluate the direct effects of channel activation in the following example. Tamoxifen, chloroquine and A2E, all raise pHL. The verification of Cl− as a rate-limiting step, combined with a drop in Cl− conductance in cells exposed to A2E, suggested that the reported decrease in vH+ ATPase activity evoked by A2E is secondary to a drop in Cl− conductance (Bergmann et al., supra, 2004).
Measurement of pH with the Lysosensor dye ensures that signal originates only from intact vesicles with the acidic pH required for dye loading. However, relative purity was further assessed by comparing the ratio of β-hexosaminidase to alkaline phosphodiesterase (Schutt et al., supra, 2002). If the Cl− conductance of the lysosomal membrane is constitutively low, characterizations are performed after activating the conductance with the catalytic subunit of protein kinase A (pKA, see below). However, the findings presented in
Preliminary data demonstrated that the CFTR activators genistein and cAMP lowered pHL, while the CFTR blocker glybenclamide raised it, and that transfection of RPE cells with CFTR decreases the alkalinization caused by tamoxifen (
CFTRAct-11 and CFTRAct-16 were first identified by Verkman and colleagues (Ma et al., supra, 2002) and are now available through the ChemBridge Corp (San Diego, Calif.). CFTRAct-11 activation of CFTR has an EC50 of 3 μM and has no effect on cAMP levels, while CFTRAct-16 activated CFTR with an EC50 0.5 μM and increased cAMP. Both compounds were applied at 0.1, 0.3, 1.3 and 10 μM in the presence, and absence, of a cAMP stimulating cocktail to verify the relationship to cAMP (500 μM cpt cAMP, 10 μM forskolin and 100 μM 3-isobutyl-1-methylxanthine (IBMX)). CFTR was also activated with apigenin (1, 5 and 25 μM (Caci et al., supra, 2003) and by the catalytic subunit of pKA (75 U/ml, Calbiochem), which activates CFTR directly (Berger et al., J. Clin. Invest. 88:1422-1431 (1991); Tilly et al., J Biol. Chem. 267:9470-9473 (1992)). The ability of specific inhibitor, CFTR-172, to prevent the effect of the cAMP cocktail indicated whether all of the acidifications by cAMP require CFTR. Thus, CFTR-172 was applied at 10 μM, since that has previously produced a maximal block in RPE cells. Effective drugs were, therefore, validated on cells treated with A2E, and on outer segment clearance as described.
Role of ATP Release:
The activation of CFTR can trigger release of ATP from RPE cells (Reigada et al., Am. J. Physiol. Cell. Physiol. 289: C617-C624 (2005)). Moreover, ATP and adenosine have been shown to acidify lysosomes. Thus, the effects of CFTR on pHL were expected to be mediated by extracellular purine signaling (
Localization of CFTR Action:
Any effect of CFTR not due to ATP release could result from CFTR located on either the lysosomal membrane or on the plasma membrane. While the permeability of compounds specific for CFTR makes assignment to the plasma membrane difficult, their action on isolated lysosomes indicated a role for CFTR on the lysosomal membrane. The pH of isolated lysosomes was determined as above, but the effects of CFTR-172, CFTRAct-11 and CFTRAct-16 were quantified. Experiments were performed in the presence of the catalytic subunit of pKA and MgATP as necessary cytoplasmic constituents are not otherwise present. A change in the pH of isolated lysosomes by these highly specific compounds provided strong functional support to the localization of CFTR, and confirmed the report that the effect of cAMP on lysosomes requires Cl− (Van Dyke et al., Biochem Biophys Res Comm. 222:312-316 (1996)).
Transfection with CFTR:
Transfection with plasmids containing the CFTR gene provided an additional degree of specificity in assessing the contribution of CFTR to pHL. As done in the preliminary testing, transfection success was confirmed with Western blotting (
As shown in
While CFTR provides an important target to acidify lysosomes, the development of additional approaches was enhanced by the molecular identification of Cl− channels altered in the disease. The addition of A2E to cells allowed the effect of a single parameter to be evaluated.
In this experiment, A2E were fed to flasks of confluent ARPE-19 cells 2-3 times per week. A2E without LDL was given at 14 nM, based upon results shown in
Thus, this experiment determined whether A2E alone is capable of altering expression of Cl− channels. Changes in expression levels that occurred before a rise in pHL was first detected suggested that the change could be causal, while modifications occurring after this point suggested a reactive response. The expression of ClC-7 was expected to decrease early on, since it is highly expressed in lysosomes, and is required for effective lysosomal clearance (Kasper et al., EMBO J 24: 1079-1091 (2005); Kornak et al., Cell 104:205-215 (2001)). Changes in the level of VMD2 were also monitored with particular interest. The contribution of a channel depends upon its cellular location, and transcript levels do not indicate whether the channel is on the plasma or lysosomal membrane. The electrochemical gradient predicts that Cl− leaves the cell through channels on the plasma membrane, which in turn decreases the driving force for Cl− entry into the lysosomes. Thus, either increases or decreases in channel expression can be used to address the problem.Experiment 7 Restoration of Lysosomal Acidity in ABCA4−/− Mice
Because a paucity of molecular information about bovine Cl− channels restricted the experiments in Example 6 to the use of ARPE-19 cells, relevance of the findings to the in vivo state is further explored with ABCA4−/− mice to test the prediction that these manipulations identified in vitro in RPE cells are effective in restoring pHL acidity in vivo to lysosomes in an animal model of macular degeneration, and to identify the Cl− channels that were altered by the pathology. ABCA4−/− mice are missing the gene that is mutated in Stargardt's disease, and share many characteristics with the human form including increased A2E. As shown in
Measurements of Lysosomal pH from Fresh Mouse RPE Cells:
To verify the effectiveness of the ABCA4−/− model, the LysoSensor Yellow/Blue assay system was tested. LysoSensor Yellow/Blue dye was detected in freshly isolated mouse RPE cells, and first viewed as a brightfield image. The same field was exposed to fluorescence imaging, and excited at 360 nm (em:510 nm). It was, thus, confirmed that the pigment does not interfere with fluorescence. As shown in
Drugs that are identified in vitro as effective to lower pHL and restore rates of outer segment clearance will ultimately be confirmed in an animal model of AMD in vivo once details for efficient delivery to the posterior eye have been determined. The early onset of A2E accumulation makes the ABCA4−/− mouse an appropriate animal model for such an evaluation. However, initial studies will focus on the effect of the identified drugs.
Restoration of pHL in ABCA4−/− Mice:
The ABCA4−/− mouse demonstrates a progressive accumulation of A2E in its RPE over 18 weeks when housed in 12 hour cyclic light of 25-30 lux (Mata et al., Proc. Nat. Acad. Sci. USA 97:7154-7159 (2000)). As a result, lysosomal pH increases early, and is measured in ABCA4−/− mice at 6, 12 and 18 weeks from RPE cells within 5 hours of sacrifice. As cell division may dilute the lysosomal contents, culturing these cells would diminish the effect on pH. However, the signal/noise from measurements of isolated cells with the plate reader is not acceptable. Instead, this signal is measured using the microscope-based imaging system, previously used successfully to measure Ca2+ from freshly isolated retinal ganglion cells (Zhang et al., supra, 2005). This system was also used to record pHL from ARPE-19 cells before the high through-put system was developed. Initial readings are made with excitation at 340 and 380 nm in the absence of dye to record any autofluorescence for later subtraction. Next, cells are bathed in 5 μM Lysosensor dye for 5 minutes, followed by 15 minute wash. Baseline pHL is monitored for 3-5 minutes from cells in isotonic solution, after which CFTR activations and other compounds identified above to acidify lysosomes are added at appropriate concentrations. Once a new pH is reached, control solution is returned and the protocol repeated. The pHL is calibrated at the end of the experiment by perfusing with monensin/nigericin solutions. Parallel experiments are then performed on ABCA4+/+ mice.
Assessment of ABCA4−/− Mice:
The correct interpretation of the foregoing experiments depends upon assessment of genotype and phenotype. ABCA4−/− mice are bred and housed as described, using protocols established in the inventors' laboratory. PCR for the ABCA4 gene is performed on all mice used in this study, thus confirming the genotype. Several phenotypic changes have been characterized in ABCA4−/− mice including increases in levels of A2E levels, morphological changes surrounding Bruch's membrane and reduced magnitude of the ERG a-wave maximal response (Weng et al., Cell. 98:13-23 (1999); Mata et al. Invest. Ophthalmol. Vis. Sci. 42:1685-1690 (2001)). While it is neither practical nor necessary to repeat all assays, disease progression in the mice is determined as described by performing full field ERGs on age-matched wild type and knockout mice. The time course of the decrease in the a-wave is compared to that published by Travis and colleagues to orient the progression to other phenotypic changes. Thus, this experiment shows that pHL is elevated in ABCA4−/− mice, as compared to control animals, and that pharmacologic manipulation can restore the acidic pH to lysosomes of ABCA4−/− mice.Experiment 8 Restoring Lysosomal
Having determined the damaging effect of age-increased pH in RPE cells, specifically in the effect on the ability of the lysosomes to clear spent photoreceptor outer segments and lipofusin via the Cl− channels, this experiment focused on how to restore optimal acidic pH to the affected lysosomes in the RPE, and to the identification of drugs or compounds that can achieve that effect and also prevent or restore the damage caused by the increased pH. Further this experiment evaluated the effect of D1-like dopamine receptors and D1-like dopamine receptor agonists, which led to the discovery that the D1-like agonists represent the most likely target. This is particularly relevant since the D1-like agonists are also currently being developed to treat Parkinson's disease.
Initially, the magnitude of the damage to lysosomes in RPE cells from the ABCA4−/− mouse model of Stargardt's disease was evaluated. In 6 trials of in RPE cells from ABCA4−/− mice (26 mice aged 216±28 days), as compared to 7 trials in cells from wild type mice (22 mice aged 215±32 days), increased pHL was clearly documented as rising from 4.65±0.17 to 5.43±0.19 units. See,
Recognizing that increased cAMP, and receptors coupled to the Gs protein that leads to elevated cAMP, led to the general conclusion that stimulation of the receptors coupled to the Gs proteins offered a treatment for restoring an acidic pH to the perturbed lysosomes, and thus, for improving degradative function. The most effective receptor is decided by numerous factors, including the availability and side-effects of appropriate agonists to the selected receptor. As such, D1-like dopamine receptors were selected as a particularly well-suited target.
There are five subtypes of dopamine receptors, D1, D2, D3, D4, and D5. D1 and D5 receptors are members of the D1-like family of dopamine receptors, whereas the D2, D3 and D4 receptors are members of the D2-like family. For the purposes of this invention, D1-like receptors are defined as D1 (D1α) and D5 (D1β) dopamine receptors. Both subtypes have similar affinities for “D1” receptor agonists and antagonists. See U.S. Pat. No. 6,469,141 and the references cited therein, wherein calcyon is defined as a D1 dopamine receptor activity modifying protein. Activation of the D1-like family receptors is coupled to the G protein Gas, which subsequently activates adenylyl cyclase, increasing the intracellular concentration of the second messenger, cyclic adenosine monophosphate (cAMP). Increased cAMP in neurons is typically excitatory and can induce an action potential by modulating the activity of ion channels.
The dopamine receptors are a class of metabotropic G protein-coupled receptors that are prominent in the vertebrate central nervous system (CNS). The neurotransmitter dopamine is the primary endogenous ligand for dopamine receptors. These receptors have key roles in many processes, including the control of normal motor function and learning, as well as modulation of neuroendocrine signaling. Consequently, D1-like agonists are being developed to treat Parkinson's disease (Lewis et al., CNS & Neurol. Disord. Drug Targets 5:345-353 (2006); Mailman et al., Curr. Op. Invest. Drugs 2:1582-1591 (2001)). Abnormal dopamine receptor signaling and dopaminergic nerve function is implicated in several neuropsychiatric disorders.
The specific D1-like receptor agonist A77636 reduces Parkinsonian activity in a primate model of the disease when delivered orally (Smith et al., J. Neur. Trans. 109:123-140 (2002).). Chronic administration of D1-like receptor agonists has also been used as a long-term treatment for Parkinson's disease, demonstrating the relative safety of long-term use of the drug. Most of the known side effects are tolerable, or even beneficial, including increased cognitive ability (Stuchlik et al., Behav. Br. Res. 172:250-255 (2006)) and improved memory (Cai et al., J. Pharm. Exp. Ther. 283:183-189 (1997)).
In the present example, two specific D1-like agonists A77636 and A68930 were tested and shown to lower lysosomal pH in ARPE-19 cells (
Recognizing the significance of acidic conditions to maintain the optimal activity of the degradative enzymes in the lysosomes of the RPE cells, the lysosomal acidification is regulated by a series of membrane proteins, with proton delivery primarily mediated by the vacuolar proton pump (vH+ATPase). Elevation of the lysosomal pH, results in impaired degradation of material by lysosomes, leading to pathological consequences both to the RPE cell and to the immediate area adjacent thereto. While re-acidification of pH-compromised lysosomes can rectify an elevated lysosomal pH in RPE cells and restore or enhance their essential degradative function, it has been further determined that stimulation of the P2X7 and P2Y12 receptors has a converse effect, thereby elevating lysosomal pHL in RPE cells. Consequently, as shown, administering “antagonists” to P2X7 receptor, or alternatively to the P2Y12 receptor, also effectively reacidifies lysosomal pHL in the RPE cells. As a result, as further demonstrated, administration of an antagonist either to the P2X7 receptor or to the P2Y12 receptor enhances degradative function of RPE lysosomes, and thus provides an alternative to treatment for macular degeneration, and/or offers an element in a combined treatment therefor.
There are many different receptors for ATP each with different effects. The endogenous agonist to the P2X7 receptor is ATP, while the endogenous P2Y12 agonist is ADP. The P2X7 receptor is unusual, and recent science suggests that the release site for ATP is close to the receptor. This enables endogenous specificity of action. ATP is not very stable endogenously due to the presence of many ecto-ATPases, and the P2X7 receptor requires large amounts of ATP to open, and thus localized release is logically acceptable.
As previously demonstrated, RPE cells constitutively release ATP, which extracellular enzymes then convert this to ADP (Mitchell, J Physiol 534:193-202, (2001); Reigada et al., Am. J Physiol. Cell Physiol. 289:C617-C624, 2005)). This allows for autostimulation of both P2X7 and P2Y12 receptors. A variety of pathological stimuli that can enhance the release of ATP (Mitchell et al., Purinergic Signal 4:101-107 (2008); Reigada et al., J. Physiol. 575: 707-720 (2006)), which then enhance the autostimulation of P2X7 and P2Y12 receptors, resulting in the increase in lysosomal pHL, leading to reduced degradation of metabolic waste and to subsequent increased lipofuscin production and/or accumulation in the RPE cells. Consequently, by applying “antagonists” to the P2X7 and P2Y12 receptors (“P2X7 receptor-antagonist,” and/or “P2Y12 receptor-antagonist”), the resulting pH elevation by endogenously released ATP is inhibited or prevented, thereby enhancing degradation of the metabolic waste by the lysosomes, reducing lipofuscin accumulation, and thus reducing the onset or progression of AMD.
As shown in
Outer-segment-associated autofluorescence in ARPE-19 cells was decreased in the presence of P2Y12 antagonist AR-C66096 as seen in
Autofluorescence is, therefore, indicative of incomplete degradation of material by the lysosomes, resulting in an analogous autofluorescence is frequently observed in macular degeneration. In effect, age related macular degeneration is the pathological consequence of failed housekeeping by the RPE cell, whereby failure of the lysosomes to completely degrade the ingested material, even in part, leads to accumulation within the RPE cell of autofluorescent lipoprotein aggregates termed lipofuscin. In turn, over time the RPE cell expels some of the aggregates into the subretinal space leading to the pathological sequence recognized as age related macular degeneration (AMD). But fortunately, the concentration of retained material can be quantified by the intensity of an autofluorescent signal emitted by the RPE cell. Thus the demonstration that RPE cells exposed to photoreceptor outer segments for 7 days ingested the outer segments and then developed autofluorescence indicative of impaired degradation provides compelling evidence that the pathological sequence can be interrupted, offering correction options as both in prevention and treatment of AMD, as well as pharmacologically-enhanced clearance of the ingested material.
The effects of the two treatments on autofluorescence were additive (POS+CHQ). However, antagonizing P2Y12 receptor with AR-C66096 reduced this enhanced auto-fluorescence to near control levels, indicating that antagonizing the P2Y12 receptor enhances the breakdown of unwanted autofluorescent material in RPE cells. The ability of the antagonists to reduce autofluorescence in absence of an additional agonist implies that ATP released from the cells is sufficient to stimulate the P2Y12 receptor and slow lysosomal digestion, thus increasing autofluorescence. Consequently, by applying exogenous antagonists to the P2Y12 receptors, the resulting pH elevation by endogenously released ATP is inhibited or prevented, thereby enhancing degradation of the metabolic waste by the lysosomes. This reduces autofluorescent lipofuscin accumulation, and thus reduces the onset or progression of AMD.
As seen in
Similarly, treatment of 20 month old ABCA4−/− mice with 12 ug/ml ticagrelor (Brilinta) in the water for 19 days reduced lysosomal pH of RPE cells. Resulting data, as shown by the graph in
Treatment of 26 month old ABCA4−/− mice with 12 ug/ml ticagrelor (Brilinta) in the water for 4 days resulted in a decreased autofluorescence in RPE cells at various wavelengths observed when excited with a 406 nm laser. See.
Finally, as recorded in the photographic images of
Other known compositions that inhibit the P2Y12 receptor, include cangrelor, ticagrelor (tradename Brilinta developed by AstraZeneca, and safely used in many clinical trials), prasugrel (tradename Effient, a.k.a Effient, Daiichi Sankyo Co.), ticlopidine (tradename Ticlid) and elinogrel (PRT-060128). All are available from AstraZeneca. At least one of the identified antagonists is selected, and dosage can be determined by one skilled in the art in light of the data provided in the foregoing experiments and results shown in the Figures, since these antagonists operate in the manner described herein to inhibit the action of the P2Y12 receptors.
As above, outer-segment-associated autofluorescence in ARPE-19 cells is decreased in the presence of P2X7 antagonists (
Additional evidence to support the beneficial effects of antagonizing the P2X7 receptor is indicated in
Consequently, the foregoing results demonstrate that modulating the P2X7 and P2Y12 receptors, more specifically antagonizing the P2X7 receptor, and by extension the P2Y12 receptor, beneficially enhances the RPE cell's ability to prevent, reduce and/or treat accumulation of unwanted debris. Accordingly administration of antagonist to either the P2X7 receptor or the P2Y12 receptor enhances degradative function of RPE lysosomes, and as a result results in the acidification, or re-acidification, of pH-compromised lysosomes to rectify elevated lysosomal pHL in the cells. Thus the essential degradative function of the lysosome is restored or enhanced, providing a treatment for or prevention of macular degeneration.
In sum, by combining a mechanistic analysis of lysosomal acidification with a high through-put evaluation of this pharmacologic approach, specific compounds that lower lysosomal pH and increase the activity of degradative enzymes have been identified, and the findings are applied to animal models. Thus, methods are provided in the present invention for slowing the progression of AMD by restoring an optimal acidic pH to compromised lysosomes in the RPE, and an effective treatment is provided for reversing macular degeneration and the damaging effects of abnormally elevated pHL, particularly as found in AMD and in Stargardt's disease.
The disclosure of each patent, patent application and publication cited or described in this document is hereby incorporated herein by reference, in its entirety.
While the foregoing specification has been described with regard to certain preferred embodiments, and many details have been set forth for the purpose of illustration, it will be apparent to those skilled in the art without departing from the spirit and scope of the invention, that the invention may be subject to various modifications and additional embodiments, and that certain of the details described herein can be varied considerably without departing from the basic principles of the invention. Such modifications and additional embodiments are also intended to fall within the scope of the appended claims.
1. A method of reducing, treating or preventing age-related macular degeneration (AMD) in a patient subject to or symptomatic of age-related macular AMD, the method comprising modulating P2X7 receptor activity, thereby acidifying lysosomal pH (pHL) in the retinal pigment epithelium (RPE) cell(s) of the patient's eyes.
2. The method for quantifying the effectiveness of the inhibitor or antagonist of the P2X7 receptor to restore pHL of claim 1, and to determine outer segment clearance rates, comprising using a high through-put screening protocol.
3. A method of reducing, treating or preventing age-related macular degeneration (AMD) in a patient subject to or symptomatic of age-related macular AMD, the method comprising modulating P2Y12 receptor activity, thereby acidifying lysosomal pH (pHL) in the retinal pigment epithelium (RPE) cell(s) of the patient's eyes.
4. The method for quantifying the effectiveness of the inhibitor or antagonist of the P2Y12 receptor to restore pHL of claim 3, and to determine outer segment clearance rates, comprising using a high through-put screening protocol.
5. A method of providing RPE cells having lysosomes with elevated pHL to permit the efficient screening of compounds capable of reducing or restoring lysosomal function (acidic pHL), the method comprising stimulating endogenous expression in the RPE cell of endogenous ATP as an agonist of the P2X7 receptor, or by stimulating the P2X7 receptor by administering exogenous BzATP.
6. A method of providing RPE cells having lysosomes with elevated pHL to permit the efficient screening of compounds capable of reducing or restoring lysosomal function (acidic pHL), the method comprising stimulating endogenous expression in the RPE cell of endogenous ADP as an agonist of the P2Y12 receptor, or by administering meSADP, each in an amount sufficient to elevate the pHL to a level equivalent to long-term exposure of the RPE cells to A2E, or to levels representative of AMD.
International Classification: A61K 31/7076 (20060101); A61K 31/4365 (20060101); G01N 33/50 (20060101); A61K 31/47 (20060101); A61K 31/496 (20060101); A61K 31/4439 (20060101); A61K 31/517 (20060101);