•  The$ results$ support$ the$ therapeu-c$ concept$ of$ re1establishing$ T$ cell$ tolerance$ to$ gluten$ in$ CD$ pa-ents.$Importantly,,gluten, tolerance, induc3on,carries,cura3ve,poten3al,, in,contrast, to,most,other,novel, treatments,for,CD,that,are,designed,as,adjunc3ve,therapies,,

1.  COUR1NP1GLI$are$safe$and$effec-vely$induced$immune$tolerance$in$models$of$delayed$hypersensi-vity$and$celiac$disease.$$2.  Treatment$restored$tolerance$to$gluten$and$allowed$for$a$complete$gluten$containing$diet$to$be$consumed$3.  An-gen$presen-ng$cells$capable$of$libera-ng$epitopes$from$Gliadin,$meaning$that$exquisite$epitope$iden-fica-on$is$not$necessary$4.  COUR1NP1GLI$contain$no$other$immune$suppression$agents$(eg$Rapamycin)$and$do$not$depend$on$red$cell$apoptosis.$!

1.$Abstract$

DEVELOPMENT*OF*GLIADIN*CONTAINING*TOLEROGENIC*IMMUNE*MODIFYING*NANOPARTICES*FOR*CELIAC*DISEASE*Daniel$R.$GeQs,$Charles$B.$Smarr,$Derrick$McCarthy,$Marcel$$Messing,$$Leif$C.$Andersson,$Nicholas$J.C.$King,$Stephen$D.$Miller,$Lonnie$D.$Shea$,$Seppo$Meri,$Tobias$L.$Freitag$$

1th$Interna-onal$Celiac$Disease$Symposium,$Prague$2015$

2.$Introduc-on$

•  Presently,$there$is$no$cure$for$CD$•  Gliadin$specifIc$T$cells$are$the$primary$cause$

of$ pathology$ in$ CD$ pa-ent1$ immune*tolerance*is*the*ideal*treatment*for*CD*

•  The$ induc-on$ of$ tolerance$ using$ TIMP$requires$ that$ the$ Gliadin1loaded$ par-cles$must$be$delivered$intravenously.$

•  The$ par-cles$ are$ then$ taken$ up$ via$scavenger$ receptor$ mediated$ processes,$with$ MARCO$ shown$ to$ be$ a$ primary$receptor$media-ng$uptake$and$down$stream$tolerance$induc-on.$$

•  MARCO$ is$ expressed$ on$ circula-ng$inflammatory$ monocytes,$ as$ well$ as$marginal$zone$macrophages.$Based$on$TIMP$size$(500nm)$phagocytosis$is$likely$to$be$the$primary$ uptake$ mechanism.$ Upon$ uptake,$these$macrophage$popula-ons$produce$IL10$and$TGF.$

2.1$Toleragenic$Immune$Modifying$Nanopar-cles$

•  Synthesized$ using$ double$ emulsion$technique$

•  Incorpora-on$ of$ PEMA$ to$ enhance$surface$charge$

•  An-gen$load$~2.9110ug/mg$of$PLGA$•  An-gen$fully$encapsulated$for$safety$•  Lyophilized$vials$•  An-gen$ composi-on$ determined$ by$

mass1spectrometry$•  All$ immunodominate$epitopes$described$

in$the$literature$detected$•  Ova lbumin$ and$ Lysozyme$ T IMP$

generated$as$controls$$

Figure*3*.*TesFng*of*NPGCOURGGLI*in*delayed*type*hypersensiFvity*model$

6.$References$

3.3$COUR1NP1GLI$successfully$inhibits$DTH$in$an$an-gen$specific$fashion$

1.  Freitag,$,et,al.,$Gastroenterology,$SubmiQed$2.  GeQs,$,et,al.,,Trends$in$Immunology,$In$Press$2015$3.  GeQs,$et,al.,.$Science$Transla-onal$Medicine,$2014$

Figure* 4.* COURGNPGGLI* inhibit* DTH* response* and* T* cell*proliferaFon.$ Three$ groupd$ of$ 5$ Balb/c$ mice$ were$ treated$either$with$NP1COUR1GL,$TIMP1OVA$(irrelevant$an-gen$specific$control)$or$nothing,$as$described$in$Fig$3.$TIMP1OVA$and$COUR1NP1GLI$ were$ subsequently$ immunized$ with$ gliadin.$ 10$ days$later$ears$were$challenged$with$10ug$gliadin$an$ear$swelling$(A)$and$ ex, vivo$ T$ cell$ prolifera-on$ was$ examined$ (B).$ Animals$receiving$ TIMP1OVA$ control$ par-cles$ prior$ to$ immunisa-on$with$gliadin$developed$robust$ear$swelling.$In$contrast,$animals$treated$with$COUR1NP1GLI$showed$a$significant$reduc-on$in$ear$swelling$ (*p<0.05).$ Treatment$ also$ resulted$ in$ a$ reduc-on$ of$splenic$T$cell$prolifera-on$ in$ response$ to$gliadin$ res-mula-on$ex$vivo$(*p<0.05).$$

•  Model$of$gluten$induced$enteropathy$•  U-lized$to$examine$the$pathogenesis$of$CD$•  First$-me$used$to$examine$an-gen$specific$tolerance$•  COUR1NP1GLI$ability$to$induce$tolerance$was$examined$afer$two$

infusions$(day$7$and$day$14$post$T$cell$transfer)$•  Body$weight,$histology$and$cytokines$were$examined$as$efficacy$

measures$

3.5$COUR1NP1GLI$showed$an-gen$specific$disease$modifica-on$on$all$end$point$measures$

4.$Conclusions$

5.$Clinical$transla-on$

Control of Autoreactive T cells

Antigen Presenting Cells (APC) take up & process TIMP

Naïve T Cell

Naï

ve

T C

ell

iTreg

Naï

ve

T C

ell

TIMP

Apoptosis •  Apoptosis of TIMP-

monocytes in the spleen/liver

•  TIMP and apoptotic debris picked up by antigen presenting cells (APCs) in spleen/liver

Immune Tolerance T cell deletion or anergy from:

• negative co-stimulation •  lack of positive stimulation

IL-10 and TGF-β induce Tregs

• maintain tolerance

TIMPs bind to monocytes – divert to spleen

Naïv

e T

Cell

iTreg

Proprietary surface

modification: ζ = < 50 mV Disease

specific autoreactive

antigen

Naï

ve

T C

ell

Antigen Presentation Autoreactive antigen is: •  processed by APCs •  presented to T cells

T cells get: • negative co-stimulation – PD-L1 • anti-inflammatory milieu (IL-10 /

TGF-β)

Deletion

Anergy MHC TCR

Peripheral T cell

regulation

SPLEEN/LIVER

Naï

ve

T C

ell

iTreg

Monocyte

APC

SPLEEN

Auto-

reactive T cell

BLOOD

Naïve

T Cell

iTreg

Naïv

e T

Cell

iTreg

BLOOD

PD-L1

PD1

LIVER

TFG$β%%IL$10%

MARCO

- - - -

1

1

2

2

3

3

500 nm

Naïve T cell

CD28

•  When$ integrated$ these$ APC$ responses$ co1ordinate$ the$ regula-on$ of$ auto1reac-ve$ T$ cells$ via$ three$ predominate$pathways:$

2.2$Development$of$the$COUR1NP1GLI$Tolerizing$Nanopar-cle$

In$ celiac$ disease$ (CD),$ tolerance$ to$ gluten$ proteins$ from$ cereals$ is$ lost.$ Toleragenic$ Immune$ Modifying$nanoPar-cles$ (TIMP)$ are$ poly(lac-de1co1glycolide)$ that$ contain$ autoreac-ve$ protein$ or$ pep-de$ epitopes.$ These$nanopar-cles$ have$ been$ shown$ to$ induce$ immune$ tolerance$ in$ numerous$ autoimmune$ condi-ons.$ The$iden-fica-on$of$gliadins$as$the$primary$epitopes$in$celiac$disease$suggest$that$TIMP$containing$gliadin$may$serve$as$a$tool$to$induce$tolerance$to$gluten$and$poten-ally$cure$CD.$Here$we$developed$gliadin$containing$TIMP,$referred$to$ as$ COUR1NP1GLI,$ and$ examined$ its$ safety$ and$ ability$ to$ induce$ immune$ tolerance$ in$ a$ delayed$ type$hypersensi-vity$(DTH)$$and$CD$animal$model$sekng.$

PLGA$with$proprietary$surface$modifica-ons$

10

Gliadins(

Iden+fica+on(of(gliadin1binding(pep+des(by(phage(display,(Tingsu(et#al#Proteomic(anlysis(of(wheat(Gliadins(Dziuba,(et#al(

(((

The$An-gen$

The$Par-cle$

COUR1NP1GLI$

Figure* 2.* COURGNPGGLI* nanoparFcle* development.* (A)$ A$schema-c$ of$ the$ gliadin$ containing$ nanopar-cle.$ (B)$ SDS1Page$ and$ western$ blot$ of$ giadins.$ (C)* COUR1NP1GLI$ is$derived$from$PLGA,$a$regulaotry$body$approved$biodegrable$inert$polymer.$**$$

3.$Results$

AnFgen* Protein*encapsulated*(ug/g*PLGA)* ζ*average*(nm)* PDL* Peak*(nm)* Ζ*potenFal*(mv)*

Gliadin$ 3$ 579.6$ 0.238$ 568.6$ 149.1$

Lysozyme$ 9$ 392.8$ 0.213$ 474.1$ 165$

Ovalbumin$ 25$ 378.2$ 0.246$ 411.8$ 162.4$

3.1$Physiochemical$characteris-cs$of$COUR1NP1GLI$

Figure*1.*TIMP*Tolerance*InducFon$

3.2$Tes-ng$in$delayed$hypersensi-vity$model$(DTH)$$

Day$%7$tolerance$Gliadin'Par*cles'made'with'TFA'

dissolved'gliadin''Average'zeta'poten*al=;48.6'

Average'size'605.6nm'

Day$0$Immuniza4on$Immuniza*on'with'Gliadin'

dissolved'in'TFA'

Day$10$DTH$Challenged'with'gliadin'

dissolved'in'50mm'ace*c'acid'

Day$%1$tolerance$Gliadin'Par*cles'made'with'TFA'

dissolved'gliadin''Average'zeta'poten*al=;48.6'

Average'size'605.6nm'

Day$17$COUR1NP1GLI$

NP1COUR1GLI$ Immuniza-on$ Re1challenge$

Day$11$COUR1NP1GLI$

Day$0$Immuniza-on$

Day$10$Rechallenge$

A$ B$

3.4$COUR1NP1GLI$induce$robust$tolerance$in$rodent$model$of$celiac$disease$

4.  Freitag,,et,al.,$Gut,$2009$5.  GeQs,$et,al.,,Journal$Experimental$Medicine,$2008$6.  GeQs,$et,al.,,Nature$Biotechnology,$2012$

Figure*5.*Mouse*model*of*glutenGs e n s i F v e * e n t e r o p a t h y .$$CD4+CD45RBlow$ CD252$ T$ cells$from$ gliadin1immunised$ donors,$were$transferred$into$$Rag1/1$mice.$R e c i p i e n t s $ w e r e$ e i t h e r$maintained$on$GFD$(gliadin/GFD),$or$ chal lenged$ with$ g luten$(gl iadin/gluten,$ ovalbumin/gluten).$$

A$ Ameliora-on$of$weight$loss$ B$ Reduc-on$in$histopathology$ C$ Reduced$IFN1γ$ D$ Reduced$IL17$

Figure*6.*COURGNPGGLI*treatment*effect*vs.*TIMPGLYS*treatment*control*in*a*CD*mouse*model,*and*vs.*GFD*or*GLUTEN*dietary*controls.*$(A)$body$weight$development$and$(B)$histological$duodeni-s$score.(C*&*D)*T$cell$cytokine$secre-on$in$response$to$gliadin$res-mula-on$of$spleen$cells$ex,vivo.$$***p<0.001,$*p<0.05).$$

A$ B$

C$

Figure*7.*Phase*2*COURGNPGGLI*clinical*trial*schemaFc$

6�E

ar S

wel

ling

(x10

inc

hes)

-4

Mean Ear Swelling

0

20

40

60

80

100 NaiveOVA

TIMP (n=5)

**

Spleen Restimulation

0

5000

10000

15000Naive

COUR-NP-GLIOVA TIMP (n=5)

*

CP

M

COUR-NP-GLI

1.  Naïve$T$cell$anergy$and$dele-on$results$from$signal$1$in$the$absence$of$signal$2$2.  Immune$regula-on$of$ac-vated$T$cells$is$the$result$of$nega-ve$co1s-mula-on,$T$cell$anergy$and$dele-on$3.  Conversion$and$expansion$of$effector$T$cells$and$naïve$T$cells$to$Treg$results$in$tolerance$maintenance$

$