The use of the singular herein, for example, “a,” “an,” or “the,” includes the plural (and vice versa) unless specifically stated otherwise.

It should be understood that the order of steps or order for performing certain actions is immaterial so long as the present teachings remain operable. Moreover, two or more steps or actions can be conducted simultaneously.

At various places in the present specification, values are disclosed in groups or in ranges. It is to be understood that such range formats are used merely for convenience and brevity and should be interpreted flexibly. It is specifically intended that the description include each and every individual subcombination of the members of such groups and ranges and any combination of the various endpoints of such groups or ranges. For example, an integer in the range of 0 to 40 is specifically intended to individually disclose 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, and 40, and an integer in the range of 1 to 20 is specifically intended to individually disclose 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, and 20.

As used herein, the term “agent” refers to any molecule, compound, and/or substance for use in the prevention, treatment, management and/or diagnosis of an autoimmune disease, including the diphtheria toxin-interleukin-3 conjugate of the invention.

As used herein, the term “conjugate of the invention” refers to interleukin-3 or a portion, analog or derivative thereof that binds to the interleukin-3 receptor or subunit thereof conjugated to diphtheria toxin, a portion thereof or an analog thereof. Unless otherwise indicated, the terms “compound of the invention” and “composition of the invention” are used as alternatives for the term “conjugate of the invention.”

As used herein, the term “number” as used in the context of the amount of a particular cell population or cells, refers to the frequency, quantity, percentage, relative amount, or number of the particular cell population or cells.

As used herein, the terms “about” or “approximately,” unless otherwise indicated, refer to a value that is no more than 10% above or below the value being modified by the term.

As used herein, the term “therapeutic agent” refers to any molecule, compound, and/or substance that is used for the purpose of treating and/or managing a disease or disorder. Examples of therapeutic agents include, but are not limited to, proteins, immunoglobulins (e.g., multi-specific Igs, single chain Igs, Ig fragments, polyclonal antibodies and their fragments, monoclonal antibodies and their fragments), peptides (e.g., peptide receptors, selectins), binding proteins, biologics, chemospecific agents, chemotoxic agents (e.g., anti-cancer agents), anti-inflammatory agents, proliferation-based therapy, radiation, chemotherapy, anti-angiogenic agents, and small molecule drugs.

As used herein, the term “effective amount” or “amount sufficient” refers to the amount of a therapeutic composition or therapy that is sufficient to result in the prevention of the development, recurrence, or onset of a disease or disorder (e.g., an autoimmune disease or disorder, for example, lupus, SSc, or psoriasis) and one or more symptoms thereof, to reduce the severity or duration of a disease or disorder, to ameliorate one or more symptoms of a disease or disorder, to prevent the advancement of a disease or disorder, to cause regression of a disease or disorder, and/or to enhance or improve the therapeutic effect(s) of another therapy. In an embodiment, the “effective amount” or “therapeutically effective amount” refers to the amount of a composition that is sufficient to effect beneficial or desired results. The therapeutically effective amount may vary depending upon one or more of: the subject and disease condition being treated, the weight and age of the subject, the severity of the disease condition, the manner of administration and the like, which can readily be determined by one of ordinary skill in the art. In a specific embodiment of the invention, a therapeutic composition in an “amount sufficient” refers to the amount of the composition needed to prevent, reduce, or alleviate at least one or more signs or symptoms of an autoimmune disease (e.g., lupus, SSc, psoriasis), and relates to a sufficient amount of the composition to provide the desired effect, e.g., to treat a subject having an autoimmune disease (e.g., lupus, SSc, or psoriasis). The term “effective amount” therefore refers to an amount of a composition that is sufficient to promote a particular effect when administered to a typical subject, such as one who has or is at risk for an autoimmune disease (e.g., lupus, SSc, or psoriasis). An effective amount would also include an amount sufficient to delay the development of a symptom of the disease, alter the course of a symptom of the disease (for example, but not limited to, slow the progression of a symptom of the disease), or reverse a symptom of the disease. It is understood that for any given case, an appropriate “effective amount” can be determined by one of ordinary skill in the art using routine experimentation.

The terms “subject” and “patient” are used interchangeably herein. The subject treated by the presently disclosed methods in their many embodiments is desirably a human subject, although it is to be understood that the methods described herein are effective with respect to all vertebrate species which are intended to be included in the term “subject.” Accordingly, a “subject” can include a human subject for medical purposes, such as for the treatment of an existing condition or disease or the prophylactic treatment for preventing the onset of a condition or disease, or an animal subject for medical, veterinary purposes, or developmental purposes. Suitable animal subjects include mammals including, but not limited to, primates, humans, monkeys, apes, and the like; bovines, e.g., cattle, oxen, and the like; ovines, e.g., sheep and the like; caprines, e.g., goats and the like; porcines, e.g., pigs, hogs, and the like; equines, e.g., horses, donkeys, zebras, and the like; felines, including wild and domestic cats; canines, including dogs; lagomorphs, including rabbits, hares, and the like; and rodents, including mice, rats, and the like. An animal may be a transgenic animal. In certain embodiments, the subject is a human such as an infant, a juvenile, or an adult. Further, a “subject” can include a patient afflicted with or suspected of being afflicted with a condition or disease (e.g., an autoimmune disease, for example but not limited to, lupus (e.g., systemic lupus erythematosus, cutaneous lupus), Sjogren's syndrome, inflammatory arthritis, systemic sclerosis (SSc), morphea, psoriasis, lichen planus, dermatomyositis, lichen sclerosus, or cutaneous graft-versus-host disease (GVHD)).

As used herein, the terms “treat,” “treatment,” and “treating” in the context of the administration of a therapeutic composition to a subject refer to the reversing, reduction or inhibition of the progression and/or duration of the disease, preventing or reducing the likelihood of the disease, reduction or amelioration of the severity, and/or the amelioration of one or more symptoms of the disease, disorder, or condition to which such term applies resulting from the administration of one or more therapies. In certain embodiments, the treatment reduces the number of plasmacytoid dendritic cells of the subject. For example, the treatment can reduce the number of plasmacytoid dendritic cells of the subject by at least 5%, 10%, 15%, 20%, 25%, 30%, 33%, 35%, 40%, 45%, 50%, 55%, 60%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more as compared to the number of plasmacytoid dendritic cells in a subject before undergoing treatment or in a subject who does not undergo treatment.

As used herein, the terms “manage,” “managing,” and “management” in the context of the administration of a therapy to a subject refer to the beneficial effects that a subject derives from a therapy (e.g., a prophylactic or therapeutic composition) or a combination of therapies, while not resulting in a cure of the disease or disorder. In certain embodiments, a subject is administered one or more therapies (e.g., one or more prophylactic or therapeutic compositions) to “manage” an autoimmune disease (for example, but not limited to, lupus (e.g., systemic lupus erythematosus, cutaneous lupus), Sjogren's syndrome, inflammatory arthritis, systemic sclerosis (SSc), morphea, psoriasis, lichen planus, dermatomyositis, lichen sclerosus, or cutaneous graft-versus-host disease (GVHD)) so as to prevent the progression or worsening of the condition.

As used herein, the terms “prevent,” “preventing” and “prevention” in the context of the administration of a therapy to a subject refer to the prevention or inhibition of the recurrence, onset, and/or development of a disease or disorder, or a symptom thereof in a subject resulting from the administration of a therapy (e.g., a prophylactic or therapeutic agent), or a combination of therapies (e.g., a combination of prophylactic or therapeutic agents). In certain embodiments, such terms refer to one, two, three, or more results following the administration of one or more therapies: (1) a delay in the development of a symptom of the disease, (2) an alteration of the course of a symptom of the disease (for example, but not limited to, slowing the progression of a symptom of the disease), (3) a reverse of a symptom of the disease, (4) a decrease in the recurrence rate of the disease, (5) an increase in the time to recurrence of the disease, (6) an increase in the disease-free, relapse-free, progression-free, and/or overall survival of the patient, and (7) an amelioration of disease-related symptoms and/or quality of life. In certain embodiments, such terms refer to a reduction in mortality and/or an increase in survival rate of a patient population. In further embodiments, such terms refer to an increase or enhancement in the quality of life of a patient population. In certain embodiments, such terms refer to a decrease in hospitalization rate of a patient population and/or a decrease in hospitalization length for a patient population.

As used herein, the terms “therapies” and “therapy” can refer to any method(s), composition(s), and/or agent(s) that can be used in the prevention, treatment and/or management of a disease, disorder or condition, or one or more symptoms thereof. In certain embodiments, the terms “therapy” and “therapies” refer to steroid therapy, physical therapy, gene therapy, chemotherapy, small molecule therapy, radioimmunotherapy, toxin therapy, prodrug-activating enzyme therapy, biologic therapy, antibody therapy, surgical therapy, hormone therapy, immunotherapy, anti-angiogenic therapy, targeted therapy, epigenetic therapy, demethylation therapy, histone deacetylase inhibitor therapy, differentiation therapy, radiation therapy, or a combination of the foregoing and/or other therapies useful in the prevention, management and/or treatment of a disease, disorder or condition, or one or more symptoms thereof.

As used herein, the terms “administering” and “administered” refer to the delivery of a composition into a subject by a method or route that results in at least partial localization of the composition at a desired site. A composition can be administered by any appropriate route that results in effective treatment in the subject, i.e., administration results in delivery to a desired location in the subject where at least a portion of the composition is delivered to the desired site for a period of time. Modes of administration include injection, infusion, instillation, or ingestion. “Injection” includes, without limitation, intravenous, intramuscular, intraarterial, intrathecal, intraventricular, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intraarticular, sub capsular, subarachnoid, intraspinal, intracerebro spinal, and intrasternal injection and infusion. In some examples, the route is intravenous.

As used herein, the term “marker” in the context of a cell or tissue (e.g., a normal or cancer cell or tumor) means any antigen, molecule or other chemical or biological entity that is specifically found in or on a tissue that it is desired to identify or identified in or on a particular tissue affected by a disease or disorder. In specific embodiments, the marker is a cell surface antigen that is differentially or preferentially expressed by specific cell types. For example, CD123 (IL-3R alpha chain) is highly expressed on pDCs compared to other blood cell types. As another example, a leukemia cancer stem cell differentially expresses CD123 relative to a normal hematopoietic stem cell.

As used herein, the term “marker phenotype” in the context of a tissue (e.g., a normal or cancer cell or a tumor cell) means any combination of antigens (e.g., receptors, ligands, and other cell surface markers), molecules, or other chemical or biological entities that are specifically found in or on a tissue that it is desired to identify a particular tissue affected by a disease or disorder. In specific embodiments, the marker phenotype is a cell surface phenotype. In accordance with this embodiment, the cell surface phenotype may be determined by detecting the expression of a combination of cell surface antigens. For instance, a non-limiting example of a plasmacytoid dendritic cell surface phenotype is CD14−, CD3−, BDCA4+, CD123+ as well as those that are known in the art.

Methods of Treatment

The present invention provides methods of treating an autoimmune disease in a subject, e.g., a human, by reducing the number of IL-3 receptor expressing cells in the subject in need thereof by administering an effective amount of a DT-IL3 of the invention that is toxic to cells expressing the IL-3 receptor. In certain embodiments, the cells express the alpha subunit of the interleukin-3 receptor. In certain embodiments, the cells express both the alpha and beta subunits of the IL-3 receptor. In certain embodiments, pDCs, which demonstrate high expression of the alpha chain of the IL-3 receptor, are reduced, inhibited, eliminated, or killed by the methods of treatment disclosed herein.

The present disclosure provides therapies which involve administering DT-IL3 and compositions including the DT-IL3 to a subject, e.g., a human subject, for treating an autoimmune disease.

In particular, in one aspect, the present disclosure provides a method of treating an autoimmune disease in a human subject, the method involving reducing the number of pDCs in the subject by administering a therapeutically effective amount of DT-IL3 to the subject. Also provided herein is DT-IL3 for use in a method of treating an autoimmune disease in a human subject. The method involves reducing the number of pDCs in the subject by administering a therapeutically effective amount of the DT-IL3 to the subject. In certain embodiments, the number of pDCs in the subject is reduced by about 20% to about 95% compared to the level before initiation of treatment. For example, in certain embodiments, the number of pDCs in the subject is reduced by about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, or about 90% compared to the level before initiation of treatment. In certain embodiments, the reduction in pDCs is based on a comparison to the number of pDCs in a subject before receiving DT-IL3 treatment.

One of skill in the art will appreciate that the cytotoxic activity of DT-IL3 is dependent on the ability of the IL-3 component of the conjugate to bind to the IL-3 receptor on the surface of a targeted cell. As such, the cytotoxic activity of DT-IL3 can be selectively directed to a specific cell population. In certain embodiments, the methods of treating an autoimmune disease (for example, but not limited to, lupus (e.g., systemic lupus erythematosus, cutaneous lupus), Sjogren's syndrome, inflammatory arthritis, SSc, morphea, psoriasis, lichen planus, dermatomyositis, lichen sclerosus, or cutaneous graft-versus-host disease (GVHD)) by the administered DT-IL3 to a subject involves reduction of pDCs by selective killing of pDCs in the subject. For example, in certain embodiments, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, or about 90% of the population of pDCs prior to DT-IL3 administration is killed. In certain embodiments, the administration of a DT-IL3 does not affect the number of T cells or B cells in the subject. In some embodiments, the administration of a DT-IL3 does not affect the number of T cells or B cells in the subject by more than about 1% to about 15%.

Non-limiting examples of autoimmune disease that can be treated by the methods of the invention include adrenergic drug resistance, alopecia areata, ankylosing spondylitis, antiphospholipid syndrome, autoimmune Addison's disease, autoimmune diseases of the adrenal gland, allergic encephalomyelitis, autoimmune hemolytic anemia, autoimmune hepatitis, autoimmune inflammatory eye disease, autoimmune neonatal thrombocytopenia, autoimmune neutropenia, autoimmune oophoritis and orchitis, autoimmune thrombocytopenia, autoimmune thyroiditis, Behcet's disease, bullous pemphigoid, cardiomyopathy, cardiotomy syndrome, celiac sprue-dermatitis, chronic active hepatitis, chronic fatigue immune dysfunction syndrome (CFIDS), chronic inflammatory demyelinating polyneuropathy, Churg-Strauss syndrome, cicatricial pemphigoid, CREST syndrome, cold agglutinin disease, Crohn's disease, dense deposit disease, discoid lupus, essential mixed cryoglobulinemia, fibromyalgia-fibromyositis, glomerulonephritis (e.g., IgA nephropathy), gluten-sensitive enteropathy, Goodpasture's syndrome, Graves' disease, Guillain-Barre, hyperthyroidism (i.e., Hashimoto's thyroiditis), idiopathic pulmonary fibrosis, idiopathic Addison's disease, idiopathic thrombocytopenia purpura (ITP), IgA neuropathy, juvenile arthritis, lichen planus, lupus erythematosus, Meniere's disease, mixed connective tissue disease, multiple sclerosis, Myasthenia Gravis, myocarditis, type 1 or immune-mediated diabetes mellitus, neuritis, other endocrine gland failure, pemphigus vulgaris, pernicious anemia, polyarteritis nodosa, polychondritis, Polyendocrinopathies, polyglandular syndromes, polymyalgia rheumatica, polymyositis and dermatomyositis, post-MI, primary agammaglobulinemia, primary biliary cirrhosis, psoriasis, psoriatic arthritis, Raynaud's phenomenon, relapsing polychondritis, Reiter's syndrome, rheumatic heart disease, rheumatoid arthritis, sarcoidosis, SSc, Sjögren's syndrome, stiff-man syndrome, systemic lupus erythematosus, takayasu arteritis, temporal arteritis/giant cell arteritis, ulcerative colitis, urticaria, uveitis, Uveitis Ophthalmia, vasculitides such as dermatitis herpetiformis vasculitis, vitiligo, and Wegener's granulomatosis.

In certain embodiments, the autoimmune disease treated by methods disclosed herein is lupus (e.g., systemic lupus erythematosus, cutaneous lupus), Sjogren's syndrome, inflammatory arthritis, SSc (e.g., limited SSc, diffuse SSc, early-onset SSc, or late-onset SSc), morphea, psoriasis, lichen planus, dermatomyositis, lichen sclerosus, or GVHD.

For example, in a specific embodiment, the present disclosure provides a method of treating SSc (e.g., limited SSc, diffuse SSc, early-onset SSc, or late-onset SSc) in a human subject. The method involves reducing the number of pDCs in the subject by administering a therapeutically effective amount of DT-IL3 to the subject. In certain embodiments, administration of DT-IL3 to a patient diagnosed with SSc prevents/delays progression of the patient's condition to pulmonary fibrosis and/or pulmonary arterial hypertension—two sometimes lethal complications in patients with SSc.

In another specific embodiment, the present disclosure provides a method of treating morphea in a human subject. The method involves reducing the number of pDCs in the subject by administering a therapeutically effective amount of a DT-IL3 to the subject.

In yet another embodiment, the present disclosure provides a method of treating psoriasis in a human subject. The method involves reducing the number of pDCs in the subject by administering a therapeutically effective amount of a DT-IL3 to the subject.

In yet another embodiment, provided herein is a method of treating lupus (e.g., systemic lupus erythematosus or cutaneous lupus) in a human subject. The method involves reducing the number of pDCs in the subject by administering a therapeutically effective amount of a DT-IL3 to the subject.

The present invention provides treatment (including reducing symptoms and preventing disease progression) of autoimmune diseases or disorders in which pDCs contribute to or are associated with the pathogenesis of the disease. Different autoimmune diseases may present different phenotypes or symptoms. For example, some autoimmune diseases (for example, lichen planus, dermatomyositis, lichen sclerosus, cutaneous GVHD, and cutaneous lupus) share a common pathological feature called “interface dermatitis” (ID) characterized by vacuolar changes (liquefaction) of the basal layer of the epidermis, appearance of apoptotic keratinocytes (Civatte bodies), and infiltration of CD8+ lymphocytes. Furthermore, ID-related diseases, as well as other autoimmune diseases, exhibit a strong activation of the type I interferon (IFN) system, including type I IFN genes and/or type I IFN-induced genes. The present disclosure contemplates treatment of different subpopulations of patients with an autoimmune disease who may manifest different phenotypes, symptoms, and/or molecular signatures, including a type I IFN-inducible gene signature and/or increased expression of type I IFN-inducible genes.

For example, some methods of treatment provided by the present disclosure include treating subjects who exhibit the presence of a type I interferon (IFN)-inducible gene signature in the affected body part (e.g., the skin). In certain embodiments, the type I IFN-inducible gene signature includes an increased expression compared to healthy individuals of at least one of the following genes: ACTA2, AGRN, ANK3, APOBEC3G, APOL1, BRCA1, BST2, CASP10, CCL8, CD38, CD69, CDCl₂L2, CEACAM1, cig5, CXCL10, CXCL11, CXCL9, CYP2J2, DEFB1, DRAP1, DUSP5, DYNLT1, EF1830, EF2647, ENDOD1, FAS, FASLG, FGL2, GBP1, GBP2, GCH1, GMPR, GPR15, HSPA1A, HSPA1B, IDO1, IFI16, IFI35, IFI44, IFI44L, IFI6, IFI27, IFIT2, IFIT3, IFIT5, IFITM2, IGFBP4, IL12RB2, IL15, IL15RA, IL18RAP, IL1RN, IL6, IRF2, IRF7, IRS1, ISG15, ISG20, JAK2, KLF5, LAG3, LAMP3, LGALS3BP, LGALS9, LPIN2, LY6E, MCP-3, MICB, MT3, MXA, MXB, NMI, OAS1, OAS2, OASL, PALM2-AKAP2, PGAP1, PLSCR1, PMAIP1, PML, PRF1, PRKD2, RABGAP1L, RBCK1, RGS1, RIN2, RSAD2, SECTM1, SERPING1, SOCS1, SP100, SP110, SRGAP2, STAT1, STAT2, SYNE2, TAP1, TARBP1, TDRD7, TMEM187, TNFSF10, TRAFD1, TRANK1, TREX1, TRIM14, TRIM21, TRIM22, UBE2L6, VAMP5, WARS, XAF1, XAF3.

In certain embodiments, the type I IFN-inducible gene signature includes an increased expression compared to the levels in healthy individuals of at least one of IFI27, IFI30, IFI6, IRF1, IFITM1, IFITM2, IFIT1, CXCL9, CXCL10, RSAD2, IFI44, IFI44L, IFI6, GBP1, MxB, SERPING1, LY6E, XAF3, IFIT2, IFIT3, MxA, and IRF7. For example, in a specific embodiment, the present disclosure provides a method of treating SSc in a human subject by reducing the number of pDCs in the subject by administering a therapeutically effective amount of DT-IL3 to the subject, after a blood or skin biopsy from the subject has been determined to exhibit an increased expression compared to the levels of healthy individuals of at least one of IFI27, IFI30, IFI6, IRF1, IFITM1, IFITM2, IFIT1, CXCL9, CXCL10, RSAD2, IFI44, IFI44L, IFI6, GBP1, MxB, SERPING1, LY6E, XAF3, IFIT2, IFIT3, MxA, and IRF7.

In certain embodiments, the methods of treatment provided by the present disclosure include treating subjects who exhibit elevated levels of type I IFNs compared to healthy individuals. Non-limiting examples of type I IFNs include IFN-α, IFN-β, IFN-κ, IFN-δ, IFN-ε, IFN-τ, IFN-ω, and IFN-ξ. In a specific embodiment, for example, the present disclosure provides a method of treating an autoimmune disease (e.g., SSc) in a human subject by reducing the number of pDCs in the subject by administering a therapeutically effective amount of DT-IL3 to the subject, after a skin biopsy from the subject has been determined to exhibit elevated expression of IFN-α compared to the IFN-α levels of healthy individuals.

In certain embodiments, the subject with the autoimmune disease has been determined to have elevated expression of at least one type I IFN-inducible gene. Non-limiting examples of type I IFN-inducible genes include ACTA2, AGRN, ANK3, APOBEC3G, APOL1, BRCA1, BST2, CASP10, CCL8, CD38, CD69, CDCl₂L2, CEACAM1, cig5, CXCL10, CXCL11, CXCL9, CYP2J2, DEFB1, DRAP1, DUSP5, DYNLT1, EF1830, EF2647, ENDOD1, FAS, FASLG, FGL2, GBP1, GBP2, GCH1, GMPR, GPR15, HSPA1A, HSPA1B, IDO1, IFI16, IFI35, IFI44, IFI44L, IFI6, IFI27, IFIT2, IFIT3, IFIT5, IFITM2, IGFBP4, IL12RB2, IL15, IL15RA, IL18RAP, IL1RN, IL6, IRF2, IRF7, IRS1, ISG15, ISG20, JAK2, KLF5, LAG3, LAMP3, LGALS3BP, LGALS9, LPIN2, LY6E, MCP-3, MICB, MT3, MXA, MXB, NMI, OAS1, OAS2, OASL, PALM2-AKAP2, PGAP1, PLSCR1, PMAIP1, PML, PRF1, PRKD2, RABGAP1L, RBCK1, RGS1, RIN2, RSAD2, SECTM1, SERPING1, SOCS1, SP100, SP110, SRGAP2, STAT1, STAT2, SYNE2, TAP1, TARBP1, TDRD7, TMEM187, TNFSF10, TRAFD1, TRANK1, TREX1, TRIM14, TRIM21, TRIM22, UBE2L6, VAMP5, WARS, XAF1, XAF3.

In certain embodiments, non-limiting examples of type I IFN-inducible genes include IFI27, IFI30, IFI6, IRF1, IFITM1, IFITM2, IFIT1, CXCL9, CXCL10, RSAD2, IFI44, IFI44L, IFI6, IFN-α, GBP1, MxB, SERPING1, LY6E, XAF3, IFIT2, IFIT3, MxA, and IRF7. For example, in a specific embodiment, the present disclosure provides a method of treating SSc in a human subject by reducing the number of pDCs in the subject by administering a therapeutically effective amount of DT-IL3 to the subject, after a skin biopsy from the subject has been determined to exhibit an increased expression compared to healthy individuals of at least one of IFI27, IFI30, IFI6, IRF1, IFITM1, IFITM2, IFIT1, CXCL9, CXCL10, RSAD2, IFI44, IFI44L, IFI6, GBP1, MxB, SERPING1, LY6E, XAF3, IFIT2, IFIT3, MxA, and IRF7.

In certain embodiments, methods of treatment provided herein effect reduced levels of at least one type I IFN-inducible gene, reduced levels of at least one type I interferon, or reduction in or loss of the type I IFN-inducible signature in a sample obtained from the treated subject. For example, in certain embodiments, treating the autoimmune disease results in reduced levels of at least one type I IFN-inducible gene (non-limiting examples include IFI27, IFI30, IFI6, IRF1, IFITM1, IFITM2, IFIT1, CXCL9, CXCL10, RSAD2, IFI44, IFI44L, IFI6, IFN-α, GBP1, MxB, SERPING1, LY6E, XAF3, IFIT2, IFIT3, MxA, and IRF7) in a sample obtained from the subject (e.g., blood, skin biopsy).

In general, the skilled artisan will be able to determine the appropriate standard method for measuring expression level of a particular gene or gene product in accordance with the methods of treatment disclosed herein. Standard methods used for assaying the expression level of a gene or gene product include, but are not limited to, quantitative PCR, microarrays, exome sequencing, RNA sequencing, northern blots, immunohistochemistry, enzyme-linked immunosorbent assays (ELISAs), enzyme-linked immunosorbent spot (ELISpot) assays, western blots, antibody arrays, Luminex assays, reverse transcription PCR (RT-PCR), immunofluorescence, flow cytometry, and in situ hybridization.

In certain embodiments, the reduction in the number of pDCs obtained through the methods of treating the autoimmune disease results in amelioration of disease symptoms or reduction in disease. Methods of evaluating autoimmune patients to determine amelioration of disease symptoms or reduction in disease are known by those skilled in the art. For example, amelioration of disease symptoms or reduction in disease may be assessed via a disease score (e.g., mRSS score in SSc). The effects of a therapy can be monitored by continual assessment of a disease score throughout the course of treatment by comparison of the score at a later time point to the score at a prior time point (e.g., before administration of therapy).

In certain embodiments, the reduction in the number of pDCs accomplished through the methods of treatment disclosed herein results in amelioration of disease symptoms or reduction in disease indicated by reduction in the treated subject's disease score (e.g., mRSS score). For example, in a specific embodiment, the present disclosure provides a method of treating SSc in a human subject by reducing the number of pDCs in the subject by administering a therapeutically effective amount of DT-IL3 to the subject, where the reduction in the number of pDCs results in improvement in the treated subject's mRSS score. In certain embodiments, the resulting reduction in the number of pDCs accomplished through the methods of treatment disclosed herein results in, for example, reduced skin thickness, reduced collagen content, reduced levels of α-smooth muscle actin positive cells, reduced levels of fibroblast activation, reduced levels of IFN-inducible genes. In certain embodiments, the present disclosure provides a method of treating SSc in a human subject by reducing the number of pDCs in the subject by administering a therapeutically effective amount of DT-IL3 to the subject, where the reduction in the number of pDCs results in at least one of reduced skin thickness, reduced collagen content, reduced levels of α-smooth muscle actin positive cells, reduced levels of fibroblast activation, and reduced levels of IFN-inducible genes.

Methods of Monitoring

In another aspect, the present disclosure provides a method of using modulation in the levels of a cytokine or chemokine to monitor the effectiveness of a therapeutic treatment of an autoimmune disease in a subject by a) administering DT-IL3 to the subject; and b) subsequently determining levels of at least one cytokine or chemokine from a sample obtained from the subject. The present disclosure also provides DT-IL3 for use in a method of using modulation in the levels of a cytokine or chemokine to monitor the effectiveness of a therapeutic treatment of an autoimmune disease in a subject, by a) administering DT-IL3 to the subject; and b) subsequently determining levels of at least one cytokine or chemokine from a sample obtained from the subject.

In another aspect, the present disclosure provides a method of using modulation in the levels of a type I IFN-inducible gene to monitor the effectiveness of a therapeutic treatment of an autoimmune disease in a subject, by a) administering DT-IL3 to the subject; and b) subsequently determining levels of at least one type I IFN-inducible gene from a sample obtained from the subject. In certain embodiments, the present disclosure provides DT-IL3 for use in a method of using modulation in the levels of a type I IFN-inducible gene to monitor the effectiveness of a therapeutic treatment of an autoimmune disease in a subject by a) administering DT-IL3 to the subject; and b) subsequently determining levels of at least one type I IFN-inducible gene from a sample obtained from the subject.

The levels of a cytokine or chemokine can be assessed at one or more points during the period of treatment. For example, in certain embodiments, the levels of a cytokine or chemokine in a sample from the treated subject is assessed after the first dose of DT-IL3, and/or after the last dose of DT-IL3, per week of the treatment cycle. Similarly, the levels of a type I IFN-inducible gene can be assessed at one or more points during the period of treatment. For example, in certain embodiments, the levels of a type I IFN-inducible gene in a sample from the treated subject is assessed after the first dose of DT-IL3, and/or after the last dose of DT-IL3, per week of the treatment cycle.

In certain embodiments, the sample used to determine cytokine or chemokine levels is a peripheral blood mononuclear cell sample or a skin biopsy. In certain embodiments, the sample used to determine type I IFN-inducible gene levels is a peripheral blood mononuclear cell sample or a skin biopsy. Methods of peripheral blood mononuclear cell isolation are routine are in the art. For example, a common method for PBMC isolation is a method known as Ficoll® or Ficoll-Paque®. See, e.g., Jaatinen T, et al., Curr Protoc Stem Cell Biol, (2007); Chapter 2: Unit 2A.1. A skin biopsy is a safe, easy and out-patient procedure of diagnostic and academic relevance. A skilled artisan will be aware that there are various methods of performing a skin biopsy depending on the size of lesion, suspected clinical diagnosis and site of lesion. Non-limiting examples of skin biopsies for use in accordance with the methods disclosed herein include punch biopsies, shave biopsies, saucerization biopsies, wedge biopsies, incisional biopsies, and excisional biopsies.

In certain embodiments, subsequent to the administration of DT-IL3, levels of one or more of the cytokines or chemokines are determined to be reduced. Exemplary cytokines or chemokines that may be measured, include, but are not limited to, CXCL1, CXCL2, CXCL3, CXCL4, CXCL5, CXCL6, CXCL7, CXCL8, CXCL9, CXCL10, CXCL11, CXCL12, CXCL13, CXCL14, CXCL15, CXCL16, CXCL17, CCL1e, CCL2, CCL3, CCL3L1, CCL4, CCL5, CCL6, CCL7, CCL8, CCL9/10, CCL11, CCL12, CCL13, CCL14, CCL15, CCL16, CCL17, CCL18, CCL19, CCL20, CCL21, CCL22, CCL23, CCL24, CCL25, CCL26, CCL27, CCL28, CX3CL1, XCL1, XCL2, IFN-α, IFN-α, IFN-β, IFN-γ, TNF-α, TNF-β, IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-11, IL-12, IL-13, IL-15, IL-19, IL-20, IL-1α, IL-10, IL-1RA, IL-18, TGF-β1, TGF-02, Rantes, MIP1α, MIP1β, GM-CSF, G-CSF, LIF, and MCP1. In certain embodiments, exemplary cytokines or chemokines that may be measured, include, but are not limited to, CXCL4, CXCL9, CXCL10, IFN-α, IL-6, TNF-α, IFN-γ, IL-8, Rantes, MIP1α, MIP1β, and MCP1.

In certain embodiments, subsequent to the administration of DT-IL3, levels of one or more type I IFN-inducible genes are determined to be reduced. Examples of type I IFN-inducible genes include, but are not limited to, the type I IFN-inducible genes enumerated in the Method of Treatment section above. In certain embodiments, exemplary type I IFN-inducible genes that may be measured, include, but are not limited to, IFI27, IFI30, IFI6, IRF1, IFITM1, IFITM2, IFIT1, CXCL9, CXCL10, RSAD2, IFI44, IFI44L, IFI6, GBP1, MxB, SERPING1, LY6E, XAF3, IFIT2, IFIT3, MxA, and IRF7.

In general, the skilled artisan will be able to determine the appropriate standard method for measuring levels of cytokines, chemokines, or type I IFN-inducible genes in accordance with the methods disclosed herein. Standard methods that may be used include, but are not limited to, quantitative PCR, microarrays, exome sequencing, RNA sequencing, northern blots, immunohistochemistry, enzyme-linked immunosorbent assays (ELISAs), enzyme-linked immunosorbent spot (Elispot) assays western blots, antibody arrays, Luminex assays, reverse transcription PCR (RT-PCR), immunofluorescence, flow cytometry, and in situ hybridization.

Methods of Using Modulation in the Number of pDCs as an Indicator for Continuing Treatment

In another aspect, the present disclosure provides a method of using modulation in the number of pDCs as an indicator for continuing treatment of an autoimmune disease in a subject with a DT-IL3 by determining the number of pDCs in a peripheral blood mononuclear cell sample and/or skin biopsy obtained from the subject who has been administered DT-IL3, in which a reduction of about 20% or more in the number of pDCs in the peripheral blood mononuclear cell sample and/or skin biopsy, in response to the administration of DT-IL3, is an indicator for the continuing treatment of the subject.

In certain embodiments, the present disclosure provides DT-IL3 for use in a method of using modulation in the number of pDCs as an indicator for continuing treatment of an autoimmune disease in a subject with DT-IL3 by determining the number of pDCs in a peripheral blood mononuclear cell sample and/or skin biopsy obtained from the subject who has been administered DT-IL3, in which a reduction of about 20% or more reduction in the number of pDCs in the peripheral blood mononuclear cell sample and/or skin biopsy, in response to the administration of DT-IL3, is an indicator for the continuing treatment of the subject.

In certain embodiments, the number of pDCs in the subject is reduced by about 20% to about 95% compared to the subject's sample prior to DT-IL3 administration. For example, the number of pDCs in the subject may be reduced by about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, or about 90%. In certain embodiments, the reduction in the number of pDCs in the subject is DT-IL3 dose-dependent.

Methods of measuring numbers of pDCs in a sample (e.g., skin biopsy, peripheral blood mononuclear cell (PBMC)) from a subject are well known in the art and are contemplated herein. For example, in certain embodiments, modulation in pDC numbers is determined by immunohistochemistry or immunofluorescence of a skin lesion biopsy. In certain embodiments, modulation in pDC numbers is determined by flow cytometric based quantification of pDCs in a PBMC sample isolated from the subject. For example, in certain embodiments, quantification of a subject's plasmacytoid dendritic cells (pDCs) in the peripheral blood is performed by flow cytometry. Briefly, mononuclear cells (MNCs) are isolated from the subject's sample by Ficoll Hypaque™ density-gradient centrifugation. After isolation, the MNCs are incubated with a combination of fluorescently labeled antibodies that will specifically bind markers that identify pDCs (e.g., phycoerythrin (PE)-conjugated anti-CD123, anti-HLA-DR Pacific Blue, anti-CD303, anti-CD304 (BDCA-4), anti-BDCA-2, FITC-conjugated lineage [lin] markers including anti-CD3, anti-CD14, anti-CD20). After staining, cells are washed in PBS supplemented with fetal calf serum and then fixed in PBS supplemented with paraformaldehyde. Flow cytometry analysis is then performed: within events corresponding to mononuclear cells by the forward and side scatter profiles, the percentage of CD123⁺ pDCs is determined within the HLA-DR⁺, lin⁻ mononuclear cell population. For example, in certain embodiments, the pDC population is identified as CD14−, CD3−, BDCA4+, CD123+. In certain embodiments, to quantify a subject's pDC numbers, whole blood is collected, and the peripheral blood mononuclear cells are isolated by Ficoll Hypaque™ density-gradient centrifugation. pDCs are then isolated from MNCs by magnetic activated cell sorting using CD304⁺ magnetic beads (Miltenyi Biotec), enumerated, and the frequency of pDCs is calculated as a percentage of total MNCs.

The number of pDCs can be assessed at one or more points during the period of treatment. For example, in certain embodiments, the number of pDCs in a sample from the treated subject is assessed after the first dose of DT-IL3, and/or after the last dose of DT-IL3, per week of the treatment cycle.

Dosing of DT-IL3

The therapeutic regimens disclosed herein comprise administration of a conjugate of the invention (e.g., DT-IL3) or pharmaceutical compositions thereof to the subject in need thereof. In general, dosages based on body weight are from about 0.01 μg to about 100 mg per kg of body weight, for example, about 0.01 μg to about 10 mg/kg of body weight, about 0.01 μg to about 50 mg/kg of body weight, about 0.01 μg to about 100 mg/kg of body weight, about 0.01 μg to about 10 mg/kg of body weight, about 0.01 μg to about 1 mg/kg of body weight, about 0.01 μg to about 100 μg/kg of body weight, about 0.01 μg to about 20 μg/kg of body weight, about 0.01 g to about 10 μg/kg of body weight, about 0.01 μg to about 1 μg/kg of body weight, about 0.01 g to about 20 μg/kg of body weight, about 0.01 μg to about 10 μg/kg of body weight, about 0.01 μg to about 1.0 μg/kg of body weight, and ranges based on the boundaries of the preceding ranges of concentrations.

The therapeutic regimens disclosed herein comprise administration of a conjugate of the invention (e.g., DT-IL3) or pharmaceutical compositions thereof to the subject in a single dose or in multiple doses (e.g., 2, 3, 4, 5, 6, 7, 8, 10, or more) in the range of about 1 μg/kg to about 100 μg/kg per dose. For example, the DT-IL3 is administered at a dose of 1 μg/kg, 5 μg/kg, 10 μg/kg, 15 μg/kg, 20 μg/kg, 25 μg/kg, 30 μg/kg, 35 μg/kg, 40 μg/kg, 45 μg/kg, 50 μg/kg, 55 μg/kg, 60 μg/kg, 65 μg/kg, 70 μg/kg, 75 μg/kg, 80 μg/kg, 85 μg/kg, 90 μg/kg, 95 μg/kg, or 100 μg/kg. In certain embodiments, the DT-IL3 is administered at a dose in the range of about 5 μg/kg to about 25 μg/kg. For example, the DT-IL3 is administered at a dose of about 5 μg/kg, about 6 μg/kg, about 7 μg/kg, about 8 μg/kg, about 9 μg/kg, about 10 μg/kg, about 11 μg/kg, about 12 μg/kg, about 13 μg/kg, about 14 μg/kg, about 15 μg/kg, about 16 μg/kg, about 17 μg/kg, about 18 μg/kg, about 19 μg/kg, about 20 μg/kg, about 21 μg/kg, about 22 μg/kg, about 23 μg/kg, about 24 μg/kg, or about 25 μg/kg.

In certain embodiments, the methods of treatment provided herein include administration of DT-IL3 or pharmaceutical compositions thereof in single or multiple doses. When administered in multiple doses, the DT-IL3 or pharmaceutical compositions are administered with a frequency and in an amount sufficient to treat and/or manage the autoimmune disease. In certain embodiments, the frequency of administration ranges from once a day up to about once every eight weeks. In certain embodiments, the conjugate is administered once a day. For example, in certain embodiments, the DT-IL3 is administered once daily at a dose in the range of about 5 μg/kg/day to about 25 μg/kg/day. For example, the DT-IL3 is administered at a dose of about 5 μg/kg/day, about 6 μg/kg/day, about 7 μg/kg/day, about 8 μg/kg/day, about 9 μg/kg/day, about 10 μg/kg/day, about 11 μg/kg/day, about 12 μg/kg/day, about 13 μg/kg/day, about 14 μg/kg/day, about 15 μg/kg/day, about 16 μg/kg/day, about 17 μg/kg/day, about 18 μg/kg/day, about 19 μg/kg/day, about 20 μg/kg/day, about 21 μg/kg/day, about 22 μg/kg/day, about 23 μg/kg/day, about 24 μg/kg/day, or about 25 μg/kg/day. In a specific embodiment, the DT-IL3 is administered once daily at a dose of about 5 μg/kg/day. In a specific embodiment, the DT-IL3 is administered once daily at a dose of about 7 μg/kg/day. In a specific embodiment, the DT-IL3 is administered once daily at a dose of about 9 μg/kg/day. In a specific embodiment, the DT-IL3 is administered once daily at a dose of about 12 μg/kg/day. In certain embodiments, the conjugate is administered more than once a day, for example, twice a day, three times a day, four times a day, five or more times a day.

The per day dosages described herein may be administered on consecutive and/or non-consecutive days. In a specific embodiment, a per day dosage is administered on non-consecutive days throughout a week, e.g., Monday, Wednesday, and Friday. In another specific embodiment, a per day dosage is administered on consecutive days throughout a week, e.g. Monday through Sunday.

In certain embodiments, the DT-IL3 is administered once daily for one or more consecutive days. For example, the DT-IL3 is administered once daily for 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, or 7 days. In certain embodiments, the conjugate is administered once a week, twice a week, three times a week, four times a week, five times a week, six times a week, or seven times a week. In certain embodiments, a DT-IL3 is administered at least twice a week (e.g., 2 times, 3 times, 4 times, 5 or more times) in a week or during a treatment cycle.

In certain embodiments, the DT-IL3 is administered in one cycle, for example the treatment cycle is at least one week long (e.g., 1 week, 2 weeks, 3 weeks, 4 weeks, 5 or more weeks). In certain embodiments, the DT-IL3 is administered for multiple cycles, such that each treatment cycle is at least one week long (e.g., 1 week, 2 weeks, 3 weeks, 4 weeks, 5 or more weeks). For example, in an embodiment, the administering of the DT-IL3 is repeated by administering the DT-IL3 for multiple treatment cycles of 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 or more weeks. In certain embodiments, the administering of the DT-IL3 is repeated by administering the DT-IL3 for at least one dose (e.g., 1 dose, 2 doses, 3 doses, 4 doses, 5 doses, 6 doses, or 7 or more doses) per treatment cycle. In certain embodiments, the administering of the DT-IL3 is repeated by administering the DT-IL3 at 1 to 5 (e.g., 1, 2, 3, 4, 5) doses per treatment cycle. In a certain embodiments, the DT-IL3 is administered once daily for 1-5 consecutive days. For example, in certain embodiments, DT-IL3 is administered once daily for 2 consecutive days in an 8-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day. In certain embodiments, DT-IL3 is administered once daily for 3 consecutive days in an 8-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day.

The DT-IL3 may be administered repeatedly for an unlimited number of cycles. For example, in certain embodiments, the DT-IL3 is administered for as many cycles as deemed warranted by the attending physician or until disease progression. In certain embodiments, the DT-IL3 is administered for 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 or more cycles. For example, in certain embodiments, DT-IL3 is administered once daily for 1-5 consecutive days in a 3-8 week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). For example, in certain embodiments, DT-IL3 is administered once daily for 2 consecutive days in a 3-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). In certain embodiments, for example, DT-IL3 is administered once daily for 3 consecutive days in a 3-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). For example, in certain embodiments, DT-IL3 is administered once daily for 2 consecutive days in a 4-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). In certain embodiments, for example, DT-IL3 is administered once daily for 3 consecutive days in a 4-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). For example, in certain embodiments, DT-IL3 is administered once daily for 2 consecutive days in an 8-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). In certain embodiments, DT-IL3 is administered, for example, once daily for 3 consecutive days in a 8-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times).

In certain embodiments, DT-IL3 is administered once daily for 1-3 consecutive days (e.g., 1 day, 2 days, 3 days) in a 3-8 week treatment cycle (e.g., 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, 8 weeks) at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). For example, in certain embodiments, DT-IL3 is administered once daily for 1-3 consecutive days (e.g., 1 day, 2 days, 3 days) in a 3-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). In certain embodiments, DT-IL3 is administered once daily for 1-3 consecutive days (e.g., 1 day, 2 days, 3 days) in a 4-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). In certain embodiments, DT-IL3 is administered once daily for 1-3 consecutive days (e.g., 1 day, 2 days, 3 days) in a 5-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). In certain embodiments, DT-IL3 is administered once daily for 1-3 consecutive days (e.g., 1 day, 2 days, 3 days) in a 6-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). In certain embodiments, DT-IL3 is administered once daily for 1-3 consecutive days (e.g., 1 day, 2 days, 3 days) in a 7-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times). In certain embodiments, DT-IL3 is administered once daily for 1-3 consecutive days (e.g., 1 day, 2 days, 3 days) in an 8-week treatment cycle at a daily dose of about 5 μg/kg/day to about 25 μg/kg/day, and the treatment cycle is repeated at least once (e.g., 1 time, 2 times, 3 times, 4 times, 5 or more times).

In certain embodiments, the dosage of a conjugate of the invention is administered as an intravenous infusion over, for example, about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 120, 180, or 240 minutes. In certain embodiments, the DT-IL3 is administered as an intravenous infusion over about 15 minutes.

Combination Therapies

The present invention also provides methods for treating, and/or managing an autoimmune disease, involving reducing the number of pDCs in the subject by administering a therapeutically effective amount of a DT-IL3 to the subject and one or more additional therapies, said additional therapy not being a conjugate of the invention. In a specific embodiment, the combination therapies of the invention comprise a pharmaceutical composition in accordance with the invention and at least one other therapy that has the same mechanism of action as said conjugate. In another specific embodiment, the combination therapies of the invention comprise a pharmaceutical composition identified in accordance with the methods of the invention and at least one other therapy (e.g., prophylactic or therapeutic agent), which has a different mechanism of action than said conjugate.

The pharmaceutical composition of the invention and the additional therapy can be administered separately, concurrently, or sequentially. The combination of agents can act additively or synergistically. The combination therapies of the present invention may reduce the side effects associated with the therapies (e.g., prophylactic or therapeutic agents).

The therapeutic agents of the combination therapies can be administered to a subject in the same pharmaceutical composition. Alternatively, the therapeutic agents of the combination therapies can be administered concurrently to a subject in separate pharmaceutical compositions. The prophylactic or therapeutic agents may be administered to a subject by the same or different routes of administration.

Any therapy (e.g., therapeutic or prophylactic agent) which is U.S. Food and Drug Administration (FDA) approved, useful, has been used, or is currently being used for the prevention, treatment, and/or management of an autoimmune disease can be used in compositions and methods of the invention. Such agents include, but are not limited to, Prednisone, Hydroxychloroquine, Chloroquine, Belimumab, Anifrolumab, Abatacept, Atacicept, LUPUZOR™ (rigerimod), Rituximab, Voclosporin, Aldesleukin, Baricitinib, BIIB059, BI655064, Bortezomib, BT063, Cenerimod, Dapirolizumab pegol, Edratide, Filgotinib, GS-9876, Iberdomide, IFN-α kinoid, Iguratimod, Nelfinavir, Obinutuzumab, OMS721, Rapamycin, RC18, RSLV-132, SM101, Theralizumab, Ustekinumab, Vobarilizumab, XmAb5871, Blisibimod, Tabalumab, Epratuzumab, Rigerimod, Tacrolimus, Rontalizumab, Sifalimumab, Anifrolumab, Tocilizumab, Infliximab, Metelimumab, Fresolimumab, Rilonacept, Cyclophosphamide, Methotrexate, Nintedanib, JBT-101, Imatinib, Pirfenidone, Nilotinib, Dasatinib, SAR100842, BMS-986202, BAY41-2272, Riociguat, Resunab, Ixekizumab, Brodalumab, Tralokinumab, Etanercept, Adalimumab, Ustekinumab, Golimumab, Secukinumab, Tildrakizumab, Tofacitinib, and Guselkumab.

In certain embodiments, the combination therapies of the invention comprise a pharmaceutical composition of DT-IL3 in accordance with the invention and at least one agent selected from oligonucleotides, small molecule inhibitors (SMI), antibodies, microRNAs, agomirs, and antagomirs.

Non-limiting examples of oligonucleotides include oligonucleotides that are toll like receptor (TLR) inhibitors, for example, IRS-954, DV-1179, IMO-3100, IMO-8400, IRO-5, and INH-ODN-24888. Non-limiting examples of small molecule inhibitors include inhibitors of a toll like receptor (TLR) pathway such as, HCQ, CpG-52364, SM934, E-6446, AT-791, VTX-763, TMX-302, IMO-9200, ST-2825, AS-2444697, PF-05387252, PF-05388169, PF-06650833, and DZ2002. Exemplary antibodies contemplated by the combination therapies of the present disclosure include, but are not limited to, antibodies that targets a toll like receptor (TLR) or type I IFN pathway such as OPN-305, NI-0101, Mab 9F3, 13H5, ACO-1, AGS-009, Rontalizumab, Sifalimumab, and Anifrolumab.

Protein Conjugate

DT-IL-3 conjugates are known in the art and their administration in accordance with the methods of the present disclosure are contemplated herein. For example, DT-IL-3 conjugates described in U.S. Pat. Nos. 7,763,242; 8,470,307; 9,181,317; and 9,631,006 may be used in accordance with the methods disclosed by the present invention.

A DT-IL3 conjugate of the present disclosure includes the full-length, mature (lacking the signal peptide) interleukin-3 protein (IL-3), or a portion, analog or derivative thereof that binds to the interleukin-3 receptor or a subunit thereof expressed on a cell surface, conjugated through a recombinant technology or through chemical (covalent) bond to diphtheria toxin (DT), or a portion, analog or derivative thereof, which toxin lacks the native cell binding domain. The IL-3 of the present disclosure is human IL-3. In certain embodiments, the conjugate comprises the catalytic and translocation domains of diphtheria toxin fused via a covalent bond to human IL-3. In other embodiments, the diphtheria toxin is linked via a peptide linker to the human IL-3 portion of the conjugate. The linker for the conjugate may be, for example, two, three, four, five, ten, or fifteen amino acids in length. The length of the linker may vary to provide optimal binding of the conjugate. In some embodiments, the peptide linker is two to four amino acids long. The peptide linker may be a His-Met linker. Although not intending to be bound by a particular mechanism of action, the flexible peptide linker facilitates chain pairing and minimizes possible refolding. Linker molecules are commonly known in the art and described in Denardo et al., 1998, Clin. Cancer Res. 4:2483-90; Peterson et al., 1999, Bioconjug. Chem. 10:553; and Zimmerman et al., 1999, Nucl. Med. Biol. 26:943-50 each incorporated by reference in their entireties.

In other embodiments, the invention provides pharmaceutical compositions that include a DT-IL3 of the invention and a pharmaceutically acceptable carrier. In accordance with the present invention, the conjugate can include any domain of DT linked via any linker molecule known in the art to any domain of IL-3. In certain embodiments, the conjugate is DT₃₈₈IL-3, which is a fusion protein of an N-terminal methionine, followed by amino acids 1-388 of DT fused to full-length, mature, human IL-3 via a His-Met amino acid linker.

DT is a protein with three domains: a catalytic domain (amino acids 26-112; bolded sequence within SEQ ID NO: 1 below) connected by an arginine-rich disulfide loop to a translocation domain (amino acids 225-404; italicized sequence within SEQ ID NO: 1 below) followed by a cell binding domain (amino acids 406-559 of SEQ ID NO: 1). Fragments, analogs and derivatives of diphtheria toxin can be useful in the present application. In certain embodiments, the conjugate of the invention consists of the catalytic, the translocation and the cell binding domains of DT. In other embodiments, the conjugate consists of the cell binding and the catalytic domains of DT. In yet other embodiments, the conjugate of the invention consists of the cell binding and the translocation domains of DT. In embodiments, the conjugate of the invention includes the catalytic and translocation domains of DT. In certain embodiments, the conjugate of the invention includes one of either the translocation, catalytic, or cell binding domain.

An exemplary amino acid sequence of DT, accessible from GenBank Accession No. AOU74567.1, is:

[SEQ ID NO: 1]

1
MSRKLFASIL IGALLGIGAP PSAHAGADDV

VDSSKSFVME NFSSYHGTKP GYVDSIQKGI

61
QKPKSGTQGN YDDDWKGFYS TDNKYDAAGY

SVDNENPLSG KAGGVVKVTY PGLTKVLALK

121
VDNAETIKKE LGLSLTEPLM EQVGTEEFIK

RFGDGASRVV LSLPFAEGSS SVEYINNWEQ

181
AKALSVELEI NFETRGKRGQ DAMYEYMAQA

CAGNRVRRSV GSSLSCINLD WDVIRDKTKT

241
KIESLKEHGP IKNKMSESPN KTVSEEKAKQ

YLEEFHQTAL EHPELSELKT VTGINPVFAG

301
ANYAAWAVNV AQVIDSETAD NLEKTTAALS

ILPGIGSVMG IADGAVHHNT EEIVAQSIAL

461
SSLMVAQAIP LVGELVDIGF AAYNFVESII

NLFQVVHNSY NRPAYSPGHK TQPFLHDGYA

421
VSWNTVEDSI IRTGFQGESG HDIKITAENT

PLPIAGVLLP TIPGKLDVNK SKTHISVNGR

481
KIRMRCRAID GDVTFCRPKS PVYVGNGVHA

NLHVAFHRSS SEKIHSNEIS SDSIGVLGYQ

541
KTVDHTKVNS KLSLFFEIKS

Fragments, analogs, and derivatives of IL-3 can be useful in the present invention provided that when fused to the DT portion of the conjugate, such fragments, analogs and derivatives maintain the ability to bind a subunit of the IL-3 receptor or the native IL-3 receptor expressed on the surface of a cell. The binding kinetics of the fragments, analogs or derivatives may remain the same or vary only by not more than 25%. The IL-3 polypeptide may be from any species. In certain embodiments, the IL-3 is a mammalian IL-3, e.g., an IL-3 polypeptide is human IL-3, an analog, derivative, or a fragment thereof. An exemplary amino acid sequence of human IL-3 is:

[SEQ ID NO: 2]

1
MSRLPVLLLL QLLVRPGLQA PMTQTTSLKT

SWVNCSNMID EIITHLKQPP LPLLDFNNLN

61
GEDQDILMEN NLRRPNLEAF NRAVKSLQNA

SAIESILKNL LPCLPLATAA PTRHPIHIKD

121
GDWNEFRRKL TFYLKTLENA QAQQTTLSLA

IF

In another embodiment, an IL-3 polypeptide is at least 50%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, or at least 95% identical to a native IL-3 amino acid sequence (e.g., a native human IL-3 amino acid sequence).

The DT fragment conjugated to the IL-3 is the catalytic domain and the translocation domain of DT, represented by SEQ ID NO: 3:

[SEQ ID NO: 3]

1
GADDVVDSSK SFVMENFSSY HGTKPGYVDS

IQKGIQKPKS GTQGNYDDDW KGFYSTDNKY

61
DAAGYSVDNE NPLSGKAGGV VKVTYPGLTK

VLALKVDNAE TIKKELGLSL TEPLMEQVGT

121
EEFIKRFGDG ASRVVLSLPF AEGSSSVEYI

NNWEQAKALS VELEINFETR GKRGQDAMYE

181
YMAQACAGNR VRRSVGSSLS CINLDWDVIR

DKTKTKIESL KEHGPIKNKM SESPNKTVSE

241
EKAKQYLEEF HQTALEHPEL SELKTVTGTN

PVFAGANYAA WAVNVAQVID SETADNLEKT

301
TAALSILPGI GSVMGIADGA VHHNTEEIVA

QSIALSSLMV AQAIPLVGEL VDIGFAAYNF

361
VESIINLFQV VHNSYNRPAY SPGHKTRP

In some embodiments, the DT fragment is at least 50%, at least 65%, at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% identical to a native DT amino acid sequence.

The conjugates of the present invention can be made by standard recombinant DNA techniques or by protein synthetic techniques, e.g., by use of a peptide synthesizer. For example, a nucleic acid molecule encoding a conjugate of the invention can be synthesized by conventional techniques including automated DNA synthesizers. Alternatively, PCR amplification of gene fragments can be carried out using anchor primers which give rise to complementary overhangs between two consecutive gene fragments which can subsequently be annealed and re-amplified to generate a chimeric gene sequence (see, e.g., Current Protocols in Molecular Biology, Ausubel et al., eds., John Wiley & Sons, 1992).

The nucleotide sequences encoding a conjugate of the invention (IL-3 and diphtheria toxin sequences) may be obtained from any information available to those of skill in the art (i.e., from GenBank, the literature, or by routine cloning). The nucleotide sequence coding for a conjugate can be inserted into an appropriate expression vector, i.e., a vector which contains the necessary elements for the transcription and translation of the inserted protein-coding sequence. In some instances, the diphtheria toxin sequence can be truncated in order to remove a specific domain, such as the targeting domain. The techniques for modifying or truncating DNA are well known to those of skill in the art of molecular biology. Also, the IL-3 and the diphtheria toxin sequences can be ligated in such a way as to generate a DNA sequence that, when translating, creates a polypeptide that is a compound of the invention. In certain embodiments, a linker sequence is introduced into the recombinant sequence that links the IL-3 sequence and the diphtheria toxin sequence. A variety of host-vector systems may be utilized in the present invention to express the protein-coding sequence. These include but are not limited to mammalian cell systems infected with virus (e.g., vaccinia virus, adenovirus, etc.); insect cell systems infected with virus (e.g., baculovirus); microorganisms such as yeast (e.g. Pichia) containing yeast vectors; or bacteria (for example, E. coli) transformed with bacteriophage, DNA, plasmid DNA, or cosmid DNA. The expression elements of vectors vary in their strengths and specificities. Depending on the host-vector system utilized, any one of a number of suitable transcription and translation elements may be used. In a specific embodiment, the protein is expressed in E. coli. In another specific embodiment, the protein is expressed in Pichia.

The expression of a conjugate of the invention may be controlled by any promoter or enhancer element known in the art. In a specific embodiment, the expression of a conjugate of the invention is regulated by a constitutive promoter. In another embodiment, the expression is regulated by an inducible promoter. In another embodiment, the expression is regulated by a tissue-specific promoter.

In a specific embodiment, a vector is used that comprises a promoter operably linked to a conjugate-encoding nucleic acid, one or more origins of replication and, optionally, one or more selectable markers (e.g., an antibiotic resistance gene).

Expression vectors containing inserts of a gene encoding a conjugate can be identified by three general approaches: (a) nucleic acid hybridization, (b) presence or absence of “marker” gene functions, and (c) expression of inserted sequences. In the first approach, the presence of a gene encoding a conjugate in an expression vector can be detected by nucleic acid hybridization using probes, which include sequences that are homologous to an inserted gene encoding the conjugate. In the second approach, the recombinant vector/host system can be identified and selected based upon the presence or absence of certain “marker” gene functions (e.g., thymidine kinase activity, resistance to antibiotics, transformation phenotype, occlusion body formation in baculovirus, etc.) caused by the insertion of a nucleotide sequence encoding a conjugate in the vector. For example, if the nucleotide sequence encoding the conjugate is inserted within the marker gene sequence of the vector, recombinants containing the gene encoding the conjugate insert can be identified by the absence of the marker gene function. In the third approach, recombinant expression vectors can be identified by assaying the gene product (e.g., conjugate) expressed by the recombinant. Such assays can be based, for example, on the physical or functional properties of the conjugate in in vitro assay systems, e.g., binding to an antibody or the IL-3 receptor.

For long-term, high-yield production of recombinant conjugates, stable expression is preferred. For example, cell lines which stably express the conjugate of the invention may be engineered. Rather than using expression vectors which contain viral origins of replication, host cells can be transformed with DNA controlled by appropriate expression control elements (e.g., promoter, enhancer, sequences, transcription terminators, polyadenylation sites, etc.), and a selectable marker. Following the introduction of the foreign DNA, engineered cells may be allowed to grow for 1-2 days in an enriched medium, and then are switched to a selective medium. The selectable marker in the recombinant plasmid confers resistance to the selection and allows cells to stably integrate the plasmid into their chromosomes and grow to form foci which in turn can be cloned and expanded into cell lines. This method may advantageously be used to engineer cell lines which express a conjugate of the invention.

The DT-IL3 of the present disclosure is generally produced recombinantly, using bacterial, insect, or mammalian cells containing a nucleic acid engineered to express the conjugate protein, as described above.

Once a conjugate of the invention has been produced by recombinant expression or by chemical synthesis, it may be purified by any method known in the art for purification of a protein, for example, by chromatography (e.g., ion exchange, affinity, particularly by affinity for the specific antigen after Protein A, and sizing column chromatography), centrifugation, differential solubility, or by any other standard technique for the purification of proteins.

Pharmaceutical Compositions

The present invention provides compositions that include DT-IL3 for use in accordance with the methods of the present disclosure. In particular, the invention provides a pharmaceutical composition, which include an effective amount/dose of DT-IL3 and a pharmaceutically acceptable carrier or vehicle. In a specific embodiment, a pharmaceutical composition includes an effective amount/dose of DT-IL3 and a pharmaceutically acceptable carrier or vehicle. The pharmaceutical compositions are suitable for veterinary and/or human administration. The pharmaceutical compositions are also suitable for treatment of an autoimmune disease (e.g., SSc) in a subject.

The compositions can be in the form of a solid or liquid. Typical routes of administration may include parenteral. Parenteral administration includes subcutaneous injections, intravenous, intramuscular, intraperitoneal, intrapleural, intrasternal injection or infusion techniques. In a specific embodiment, the compositions are administered parenterally. In a more specific embodiment, the compositions are administered intravenously. Pharmaceutical compositions can be formulated so as to allow DT-IL3 to be bioavailable upon administration of the composition to a subject. Compositions can take the form of one or more dosage units.

EXAMPLES

In order that the invention described herein can be more fully understood, the following examples are set forth. It should be understood that these examples are included merely for purposes of illustration of certain aspects and embodiments of the present invention, and are not to be construed as limiting the invention in any manner. Reasonable variations, such as those that occur to a reasonable artisan, can be made herein without departing from the scope of the present invention.

Example 1—DT-IL3 Selectively Kills pDCs from Healthy Volunteers and Systemic Sclerosis (SSc) Patients

In this example, in an ex vivo experiment, the ability of DT-IL3 to specifically target and mediate killing of pDCs from healthy volunteers and SSc patients was evaluated. SSc patients used in this study fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc.

PBMCs from fresh blood were prepared using Ficoll-Paque® density gradient. Due to the low frequency of pDCs in peripheral blood, pDCs were isolated using anti-BDCA4 magnetic beads from one PBMC fraction and added to the remaining PBMC fraction. pDC-enriched PBMCs (3-6% pDCs) were cultured at 2×105 cells per well and incubated with DT-IL3 at various concentrations (0.01-100 ng/ml) in the presence or absence of the TLR9 ligand CpG-274 (0.5 mM) at 37° C., 5% CO2, and 95% humidity. TLR9 activation by CpG-274 was used to mimic the chronic activation of pDCs that characterizes autoimmune diseases. After 24 or 48 hours of culture, pDC survival was assessed by flow cytometry using antibodies directed to CD14, CD3, BDCA4, and CD123. The pDC population was identified as CD14−, CD3−, BDCA4+, CD123+. To evaluate the effects of DT-IL3 on the survival of B cells and T cells, after the pDC-enriched PBMCs were cultured for 24 or 48 hours at various concentrations of DT-IL3 (0.001-1000 ng/ml), flow cytometry was performed using antibodies directed to CD3, CD4, CD8, and CD20. T cells were identified as CD3+ CD4+ or CD3+ CD8+, and B cells were identified as CD20+.

As shown in FIGS. 1A-1E, DT-IL3 was cytotoxic towards pDCs obtained from healthy volunteers (FIGS. 1A-1B) and SSc patients (FIGS. 1C-1D) but no effect was observed on B cells or T cells across the tested range of DT-IL3 concentrations in healthy volunteers (FIG. 1E). Altogether, these data indicate that DT-TL3 selectively targets and eliminates pDCs from PBMCs of healthy volunteers and SSc patients.

Example 2—an In Vitro Model for DT-IL3 Mediated Targeting of Activated pDCs

In this example, an in vitro system for modeling the effects and targeting of chronically activated pDCs was evaluated. The comparable levels of expression in CD123 (IL-3Rα) observed in pDCs from healthy volunteer (HV) and SSc donors (FIG. 2) suggested that targeting of pDCs in SSc could be modeled with results obtained from healthy volunteers.

PBMCs from fresh blood samples of healthy volunteers were isolated and treated with DT-IL3 in the presence or absence of CpG-274 as described in Example 1.

As shown in FIGS. 1A-1B, DT-IL3 was significantly cytotoxic to TLR9 activated pDCs from healthy volunteers. Furthermore, DT-IL3 mediated pDC depletion was accompanied by significant reductions in CpG-induced secretion of IFNα (FIGS. 3A-3B) and IL-6 (FIGS. 3C-3D).

PBMCs from SSc patients were also isolated and treated with DT-IL3 in the presence or absence of CpG-274 as described in Example 1. As shown in FIGS. 1C-1D, DT-IL3 was significantly cytotoxic to TLR9 activated pDCs.

These data demonstrate that DT-IL3 mediated killing of the activated pDCs significantly reduces pro-inflammatory cytokine secretion.

Example 3—Treatment of SSc with DT-IL3

Patients in this study fulfill the 2013 ACR/EULAR classification criteria for SSc and have a minimum skin score of 15. Exclusion criteria include renal involvement and severe interstitial lung disease.

A cohort of 10-15 SSc patients with varying degrees of disease progression (early and late stage SSc) are intravenously administered DT-IL3 (infusion over 15 minutes) once daily at a dose of 7 μg/kg/day for 1-5 consecutive days (e.g., 1 day, 2 days, or 3 days) in a 3-8 week treatment cycle (e.g., 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks). After 3-8 weeks of the first administration of DT-IL3 on day 1, the patients undergo another 3-8 week cycle of intravenous DT-IL3 administration, as described above. Administration of DT-IL3 is repeated for multiple cycles (e.g., 2 cycles, 3 cycles, 4 cycles, or 5 cycles).

In another treatment regimen, a cohort of SSc patients with varying degrees of disease progression (early and late stage SSc) are intravenously administered DT-IL3 (infusion over 15 minutes) once daily at a dose of 7 μg/kg/day for 1-5 days (e.g., 1 day, 2 days, or 3 days) in a 3-8 week treatment cycle. If none of the patients in the 7 μg/kg/day cohort experience a dose-limiting toxicity, another SSc patient cohort is treated at the higher dose of 9 μg/kg/day DT-IL3 for 1-5 days (e.g., 1 day, 2 days, or 3 days) in a 3-8 week treatment cycle. However, if some patients from the 7 μg/kg/day cohort experience a dose-limiting toxicity, more patients are treated at the same dose level. The cycle of dose escalation is continued (e.g., 12 μg/kg/day, 16 μg/kg/day) until at least 33% of patients experience a dose-limiting toxicity at the current dose level.

Patients are monitored for toxicities using the NCI Common Terminology Criteria for Adverse Events (CTCAE). Vital signs are measured frequently on the days of treatment. Careful input/output is recorded daily. CBC, CMP, coagulation panel, LDH, uric acid, and magnesium are tested daily. Blood is drawn for clinical pharmacology studies including pharmacokinetics and immune response.

The effect of DT-IL3 treatment on disease symptoms and/or disease burden is monitored using the mRSS. Additionally, skin thickness, collagen content, levels of α-smooth muscle actin positive cells, and levels of fibroblast activation are observed from patient biopsies. It is contemplated that administration of DT-IL3 will reduce SSc symptoms, will improve the mRSS scores, and be effective at treating SSc.

Example 4—Monitoring SSc Patients Treated with DT-IL3

Patients in this study fulfill the 2013 ACR/EULAR classification criteria for SSc and have a minimum skin score of 15. Exclusion criteria include renal involvement and severe interstitial lung disease.

Prior to commencing treatment, peripheral blood mononuclear cell samples or skin biopsies are isolated from a cohort of SSc patients with varying degrees of disease progression (early and late stage SSc). The number of pDCs and the levels of one or more cytokines and/or chemokines (e.g., CXCL4, CXCL9, CXCL10, IFN-α, IL-6, IP-10, TNF-α, IFN-γ, IL-8, Rantes, MIP1α, MIP1β, or MCP1) in the samples are then determined. The patients are then intravenously administered DT-IL3 (infusion over 15 minutes) once daily at a dose of 7 μg/kg/day for 1-5 consecutive days (e.g., 2 days or 3 days) in a 3-8 week treatment cycle (e.g., 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks). After the first and/or last dose of DT-IL3 for each week in the first cycle, pDC numbers and levels of one or more cytokines and/or chemokines are again measured in peripheral blood mononuclear cell samples or skin biopsies from the patients. Subsequently, the patients undergo multiple alternating phases of 3-8 week cycles of intravenous DT-IL3 administration, and pDC numbers and cytokine and/or chemokine expression levels in patient samples are measured. Administration of DT-IL3 is repeated for multiple cycles (e.g., 2 cycles, 3 cycles, 4 cycles, or 5 cycles).

It is contemplated that treatment with DT-IL3 will cause varied degrees of reduction in pDCs (e.g., about 20% to about 95%). The number of pDCs in a peripheral blood sample and/or skin biopsy is used as an indicator for the continuing treatment of the patient or to inform clinical dosing regimen and related clinical decisions.

It is also contemplated that treatment with DT-IL3 will cause reductions in the levels of the measured cytokine and/or chemokine. Thus, the levels of the measured cytokine and/or chemokine are used to monitor the effectiveness of DT-IL3 therapy.

In another treatment cohort, peripheral blood mononuclear cell samples or skin biopsies are isolated from a cohort of SSc patients with varying degrees of disease progression (early and late stage SSc). Levels of one or more type I IFN-inducible genes (e.g., IFI27, IFI30, IFI6, IRF1, IFITM1, IFITM2, IFIT1, CXCL9, CXCL10, RSAD2, IFI44, IFI44L, IFI6, GBP1, MxB, SERPING1, LY6E, XAF3, IFIT2, IFIT3, MxA, or IRF7) in the samples are then determined. The patients are then intravenously administered DT-IL3 (infusion over 15 minutes) once daily at a dose of 7 μg/kg/day for 1-5 consecutive days (e.g., 1 day, 2 days, or 3 days) in a 3-8 week treatment cycle (e.g., 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, or 8 weeks). After the first and/or last dose of DT-IL3 for each week in the first cycle, levels of one or more type I IFN-inducible genes are again measured in PBMC samples or skin biopsies from the patients. Subsequently, the patients undergo multiple alternating phases of 3-8 week cycles of intravenous DT-TL3 administration and measurement of type I IFN-inducible gene expression levels. Administration of DT-IL3 is repeated for multiple cycles (e.g., 2 cycles, 3 cycles, 4 cycles, or 5 cycles).

It is contemplated that treatment with DT-IL3 will cause reductions in the levels of the measured type I IFN-inducible gene. Thus, the levels of the measured type I IFN-inducible gene are used to monitor the effectiveness of DT-IL3 therapy.

Example 5: Embodiments

The following numbered items represent certain embodiments.

Embodiment 1. A method of treating an autoimmune disease in a human subject, the method comprising reducing the number of plasmacytoid dendritic cells (pDCs) in the subject by administering a therapeutically effective dose of a human interleukin-3 (IL-3)-diphtheria toxin conjugate (DT-TL3) to the subject.

Embodiment 2. A human interleukin-3 (IL-3)-diphtheria toxin conjugate (DT-IL3) for use in a method of treating an autoimmune disease in a human subject, the method comprising: reducing the number of plasmacytoid dendritic cells (pDCs) in the subject by administering a therapeutically effective dose of DT-IL3 to the subject.

Embodiment 3. The method of embodiment 1 or the DT-TL3 for the use according to embodiment 2, wherein the reduction in the number of pDCs is accomplished through selective killing of pDCs by the administered DT-TL3.

Embodiment 4. The method of embodiment 1 or 3, or the DT-TL3 for the use according to embodiment 2 or 3, wherein the autoimmune disease is selected from lupus (e.g., systemic lupus erythematosus, cutaneous lupus, discoid lupus), Sjogren's syndrome, inflammatory arthritis, systemic sclerosis (SSc), morphea, psoriasis, lichen planus, dermatomyositis, lichen sclerosus, and cutaneous graft-versus-host disease (GVHD), adrenergic drug resistance, alopecia areata, ankylosing spondylitis, antiphospholipid syndrome, autoimmune Addison's disease, autoimmune diseases of the adrenal gland, allergic encephalomyelitis, autoimmune hemolytic anemia, autoimmune hepatitis, autoimmune inflammatory eye disease, autoimmune neonatal thrombocytopenia, autoimmune neutropenia, autoimmune oophoritis and orchitis, autoimmune thrombocytopenia, autoimmune thyroiditis, Behcet's disease, bullous pemphigoid, cardiomyopathy, cardiotomy syndrome, celiac sprue-dermatitis, chronic active hepatitis, chronic fatigue immune dysfunction syndrome (CFIDS), chronic inflammatory demyelinating polyneuropathy, Churg-Strauss syndrome, cicatricial pemphigoid, CREST syndrome, cold agglutinin disease, Crohn's disease, dense deposit disease, essential mixed cryoglobulinemia, fibromyalgia-fibromyositis, glomerulonephritis (e.g., IgA nephropathy), gluten-sensitive enteropathy, Goodpasture's syndrome, Graves' disease, Guillain-Barre, hyperthyroidism (i.e., Hashimoto's thyroiditis), idiopathic pulmonary fibrosis, idiopathic Addison's disease, idiopathic thrombocytopenia purpura (ITP), IgA neuropathy, juvenile arthritis, Meniere's disease, mixed connective tissue disease, multiple sclerosis, Myasthenia Gravis, myocarditis, type 1 or immune-mediated diabetes mellitus, neuritis, other endocrine gland failure, pemphigus vulgaris, pernicious anemia, polyarteritis nodosa, polychondritis, polyendocrinopathies, polyglandular syndromes, polymyalgia rheumatica, polymyositis, post-MI, primary agammaglobulinemia, primary biliary cirrhosis, psoriatic arthritis, Raynaud's phenomenon, relapsing polychondritis, Reiter's syndrome, rheumatic heart disease, rheumatoid arthritis, sarcoidosis, stiff-man syndrome, takayasu arteritis, temporal arteritis/giant cell arteritis, ulcerative colitis, urticaria, uveitis, Uveitis Ophthalmia, vasculitides such as dermatitis herpetiformis vasculitis, vitiligo, and Wegener's granulomatosis.

Embodiment 5. The method of embodiment 4, or the DT-IL3 for the use according to embodiment 4, wherein the autoimmune disease is lichen planus, dermatomyositis, lichen sclerosus, or cutaneous graft-versus-host disease (GVHD).

Embodiment 6. The method of embodiment 4, or the DT-IL3 for the use according to embodiment 4, wherein the autoimmune disease is morphea or SSc.

Embodiment 7. The method of embodiment 6, or the DT-IL3 for the use according to embodiment 6, wherein the SSc is limited SSc, diffuse SSc, early-onset SSc, or late-onset SSc.

Embodiment 8. The method of embodiment 4, or the DT-IL3 for the use according to embodiment 4, wherein the autoimmune disease is psoriasis.

Embodiment 9. The method of embodiment 4, or the DT-IL3 for the use according to embodiment 4, wherein the autoimmune disease is systemic lupus erythematosus or cutaneous lupus.

Embodiment 10. The method of any one of embodiments 4-9, or the DT-IL3 for the use according to any one of embodiments 4-9, wherein the subject has been determined to have elevated expression of at least one type I IFN-inducible gene.