ROCK inhibitor suppression of GVHD with retention of GVL response

描述（由申请人提供）：消融患者造血系统后的骨髓移植（BMT）是几种类型白血病的救命治疗方法。急性移植物抗宿主病（GVHD）是MHC匹配供体和受体之间超过三分之一的骨髓移植（BMTs）的严重并发症，也是约15%的BMT患者死亡的直接原因。清除所有供体T细胞注入骨髓在很大程度上消除了GVHD，但会导致更频繁的干细胞移植失败，以及更高的白血病复发率。GVHD和复发之间的负相关可归因于移植物抗白血病（GVL）反应，即供体T细胞识别残留白血病细胞上的宿主同种抗原。目前尚不清楚是否有足够数量的供体T细胞识别白血病特异性抗原，以在没有同种异体反应的情况下提供保护，但这个问题目前尚无定论，因为目前还没有一种技术可以有效地去除所有同种异体反应细胞，同时保留白血病特异性细胞。GVHD的严重程度取决于同种异体反应的强度、供体T细胞浸润靶器官（皮肤、肠道、肝脏、肺）的能力以及这些组织对免疫介导损伤的易感性。考虑到消除同种异体反应性供体细胞所固有的问题，最佳的理论方法可能是限制它们进入最易受免疫病理影响和/或最可能诱导反应性的宿主部位。我们的方法可以通过抑制Rho相关的卷曲线圈激酶（rock1和2）酶来实现这一目标，这些酶在白细胞运动和内皮和上皮紧密连接松动期间对细胞骨架功能至关重要。三种小分子ROCK抑制剂将在MHC和次要组织相容性抗原（miHA）不同的BMT小鼠模型中进行测试。两种rock1和rock2抑制剂（替米沙坦和法舒地尔）作为血管舒张剂具有广泛的临床安全性记录。第三种是SLx2119，它是ROCK2特异性的，刚刚通过了抗癌药物的1期临床试验。我们的初步数据表明，10天（而不是1天）的法舒地尔对急性MHC异源性GVHD具有高度保护作用，而不会诱导可能损害有益GVL的同种异体耐受性。我们建议通过在MHC和miHA模型中测试上述三种药物，以1周和2周的时间表来扩展这一观察结果，以找到最大限度抑制GVHD的最短治疗时间。在输注宿主同基因白血病细胞的情况下，每种药物的最佳时间表将用于抑制GVHD，并监测治疗和未治疗小鼠的肿瘤负荷。我们假设ROCK抑制会干扰供体T细胞的同种活化和/或转运到GVHD的原发部位，而同种活化的干扰不会阻碍供体T细胞发现和攻击更容易接近的白血病细胞。我们的目标是确定至少一种抑制GVHD同时保留GVL功能的ROCK抑制剂方案。使用ROCK抑制剂治疗GVHD是一种新方法，成功将加速我们使用ROCK抑制剂治疗BMT的长期目标，以治疗白血病和其他肿瘤。

DESCRIPTION (provided by applicant): Bone marrow transplantation (BMT) following ablation of the patient's hematapoietic system is a life-saving treatment for several types of leukemia. Acute graft vs. host disease (GVHD) is a serious complication in more than a third of bone marrow transplants (BMTs) between MHC matched donors and recipients, and the proximate cause of death in ~ 15% of BMT patients. Purging infused marrow of all donor T cells largely eliminates GVHD, but results in more frequent stem cell failure to engraft, and higher rates of leukemia relapse. The inverse correlation between GVHD and relapse is attributable to the graft vs. leukemia (GVL) response, whereby donor T cells recognize host alloantigens on residual leukemia cells. It is unclear whether sufficient numbers of donor T cells recognize leukemia specific antigens to afford protection in the absence of alloreactivity, but this issue is presently moot, since a technique for efficiently removing all alloreactive cells while retaining leukemia specific cells is not yet available. The severity of GVHD depends on the strength of the alloreactive response, the ability of donor T cells to infiltrate target organs (skin, gut, liver, lungs), and the susceptibility of those tissues to immune mediated damage. Given the problems inherent in eliminating alloreactive donor cells, the optimal theoretical approach might be to limit their access to host sites most susceptible to immunopathology, and/or most likely to induce reactivity. Our approach may accomplish this by inhibition of Rho associated coiled coil kinases (ROCK1&2) enzymes crucial for cytoskeletal function during leukocyte motility and loosening of endothelial and epithelial tight junctions. Three small molecule ROCK inhibitors will be tested in MHC and minor histocompatibility antigen (miHA) disparate BMT mouse models. Two inhibitors of ROCK1&2 (Telmisartan and Fasudil) have extensive clinical safety records as vasodilators. The third, SLx2119 is ROCK2 specific, and has just passed Phase 1 clinical trials on the path to development as an anti-cancer drug. Our preliminary data indicate that 10 days (but not 1 day) of Fasudil is highly protective against acute MHC disparate GVHD, without inducing allotolerance that could compromise beneficial GVL. We propose to extend this observation by testing the three mentioned drugs in both MHC and miHA models in 1 vs. 2 week schedules, to find the shortest duration of treatment that maximally suppresses GVHD. The optimal schedule for each drug will be used to suppress GVHD in the presence of infused host- syngeneic leukemia cells, and tumor burden will be monitored in treated and untreated mice. We hypothesize that ROCK inhibition will interfere with donor T cell alloactivation and/or trafficking to primary sites of GVHD, and that interference with alloactivation will not hinder donor T cells from finding and attacking more accessible leukemia cells. Our objective is to determine at least one schedule of ROCK inhibitor that suppresses GVHD while sparing GVL function. Using ROCK inhibitors for GVHD is novel, and success would accelerate our long term goal of using ROCK inhibitors with BMT, to treat leukemias and other tumors. PUBLIC HEALTH RELEVANCE: Bone marrow transplantation (BMT) is an effective treatment for some leukemias, but is complicated by immune responses from the transferred donor white cells attacking the defenseless host (termed graft vs. host disease, GVHD). These white cells cannot just be removed from the BMT because they also help the transferred stem cells generate new blood cells and they also recognize and destroy any residual leukemia cells that have survived pre-transplant anti-cancer therapy (a phenomenon termed graft vs. leukemia, or GVL). We propose to use drugs which have proven safe for other clinical conditions, to inhibit a key enzyme, ROCK, in order to suppress GVHD while leaving GVL responses largely intact.