NZ619942B2 - Leukotoxin e/d as a new anti-inflammatory agent and microbicide - Google Patents

Abstract

Discloses use of a CCR5 antagonist in the manufacture of a medicament for the treatment of an infection caused by a lukE/D+ strain of Staphylococcus aureus in a subject.

Description

LEUKOTOXIN E/D AS A NEW ANTI-INFLAMMATORY AGENT AND MICROBICIDE This application claims the priority benefit of U.S. Provisional Patent Application Serial No. 61/498,606, filed June 19, 2011, which is hereby incorporated by reference in its entirety.

FIELD OF THE INVENTION Described herein are methods of treating and preventing HIV infections.

Also described are methods of treating inflammatory conditions and Staphylococcus aureus infections.

BACKGROUND OF THE INVENTION Staphylococcus aureus

[0003] Staphylococcus aureus (“S. aureus”) is a bacterium that commensally colonizes more than 25% of the human population. Importantly, this organism is capable of breaching its initial site of colonization, resulting in bacterial dissemination and disease.

S. aureus is the leading cause of nosocomial infections, is the most common etiological agent of infectious endocarditis as well as skin and soft tissue infections, and is one of the four leading causes of food-borne illness. Altogether, S. aureus infects more than 1.2 million patients per year in U.S. hospitals. The threat of S. aureus to human health is further highlighted by the emergence of antibiotic-resistant strains (i.e., methicillin- resistant S. aureus (MRSA) strains), including strains that are resistant to vancomycin, an antibiotic considered the last line of defense against S. aureus infection. These facts highlight the importance of developing novel therapeutics against this important pathogen.

S. aureus produces a diverse array of virulence factors and toxins that enable this bacterium to neutralize and withstand attack by different kinds of immune cells, specifically subpopulations of white blood cells that make up the body’s primary defense system. The production of these virulence factors and toxins allow S. aureus to maintain an infectious state (Nizet, “Understanding How Leading Bacterial Pathogens Subvert Innate Immunity to Reveal Novel Therapeutic Targets,” J. Allergy Clin. Immunol. 120(1):13 22 (2007)). Among these virulence factors, S. aureus produces several bi- component leukotoxins, which damage membranes of host defense cells and erythrocytes by the synergistic action of two non-associated proteins or subunits (see Menestrina et al., “Mode of Action of Beta-Barrel Pore-Forming Toxins of the Staphylococcal Alpha- Hemolysin Family,” Toxicol. 39(11):1661-1672 (2001)). Among these bi-component leukotoxins, gamma-hemolysin (HlgAB and HlgCB) and the Pantone-Valentine Leukocidin (PVL) are the best characterized.

The toxicity of the leukocidins towards mammalian cells involves the action of two components. The first subunit is named class S-subunit (i.e., “slow-eluted”), and the second subunit is named class F-subunit (i.e., “fast-eluted”). The S-and F-subunits act synergistically to form pores on white blood cells including monocytes, macrophages, dendritic cells and neutrophils (collectively known as phagocytes) (Menestrina et al., “Mode of Action of Beta-Barrel Pore-Forming Toxins of the Staphylococcal Alpha- Hemolysin Family,” Toxicol. 39(11):1661 1672 (2001)). The mechanism by which the bi- component toxins form pores in target cell membranes is not entirely understood. The proposed mechanism of action of these toxins involves binding of the S-subunit to the target cell membrane, most likely through a receptor, followed by binding of the F-subunit to the S-subunit, thereby forming an oligomer which in turn forms a pre-pore that inserts into the target cell membrane (Jayasinghe et al., “The Leukocidin Pore: Evidence for an Octamer With Four LukF Subunits and Four LukS Subunits Alternating Around a Central Axis,” Protein. Sci. 14(10):2550 2561 (2005)). The pores formed by the bi-component leukotoxins are typically cation-selective. Pore formation causes cell death via lysis, which in the cases of the target white blood cells, has been reported to result from an osmotic imbalance due to the influx of cations (Miles et al., “The Staphylococcal Leukocidin Bicomponent Toxin Forms Large Ionic Channels,” Biochemistry 40(29):8514 8522 (2001)).

Designing effective therapy to treat MRSA infection has been especially challenging. In addition to the resistance to methicillin and related antibiotics, MRSA has also been found to have significant levels of resistance to macrolides (e.g., erythromycin), beta-lactamase inhibitor combinations (e.g., Unasyn, Augmentin) and fluoroquinolones (e.g. ciprofloxacin), as well as to clindamycin, trimethoprim/sulfamethoxisol (Bactrim), and rifampin. In the case of serious S. aureus infection, clinicians have resorted to intravenous vancomycin. However, there have been reports of S. aureus resistance to vancomycin. Thus, there is a need to develop new antibiotic drugs that effectively combat S. aureus infection.

C-C Chemokine Receptor Type 5

[0007] C-C chemokine receptor type 5 (CCR5) is a member of the beta chemokine receptors family (Samson M et al., “Molecular Cloning and Functional Expression of a New Human CC-Chemokine Receptor Gene” Biochemistry 35:3362 (1996)). The normal ligands for this receptor are RANTES, Mip1b, and Mip1a (see Samson, supra and Gon W et al “Monocyte Chemotactic Protein-2 Activates CCR5 and Blocks CD4/CCR5 Mediated HIV-1 Entry/Replication,” J. Biol. Chem. 273:4289 (1998)). CCR5 is expressed on a subset of T cells, macrophages, dendritic cells, natural killer cells, and microglia. CCR5 T cells secrete pro-inflammatory cytokines and are recruited to sites of inflammation.

Thus, it is likely that CCR5 plays a role in inflammatory responses to infection and in pathological conditions such as autoimmune diseases. CCR5 is also the receptor for major strain of HIV (Deng H et al., “Identification of a Major Co-Receptor for Primary Isolates of HIV-1,” Nature 381:661-666 (1996)). In individuals infected with HIV, CCR5-using viruses are the predominant species isolated during the early stages of viral infection, suggesting that these viruses may have a selective advantage during transmission or the acute phase of disease. Moreover, at least half of all infected individuals harbor only CCR5-using viruses throughout the course of infection. Around 1% of Northern Europeans lack functional CCR5 expression, due to a 32 base pair deletion in this gene.

Individuals with the Δ32 allele of CCR5 are healthy, suggesting that CCR5 is largely dispensable. However, these individuals have very strong resistance to HIV infection (Liu R et al., “Homozygous Defect in HIV-1 Coreceptor Accounts for Resistance of Some Multiply-Exposed Individuals to HIV-1 Infection,” Cell 86:367-377 (1996)). Indeed, an AIDS patient who had myeloid leukemia was treated with chemotherapy to suppress the cancer, which killed all of his T cells. The patient was then transplanted with a donor blood that had the 32 bp CCR5 deletion mutant to restore the immune system. After 600 days, the patient was healthy and had undetectable levels of HIV in the blood and in examined brain and rectal tissues (Hütter G et al., “Long-Term Control of HIV by CCR5 Delta32/Delta32 Stem-Cell Transplantation,” N. Engl. J. Med. 360:692-698 (2009)). A number of new experimental HIV drugs, called entry inhibitors have been designed to interfere with the interaction between CCR5 and HIV, including PRO140, Vicriviroc, Aploviroc, and Maraviroc (Pfizer), of which the latter is currently an approved drug for HIV infection.

CCR5 is also involved in uncontrolled inflammation (Charo et al., “The Many Roles of Chemokine Receptors in Inflammation,” N. Engl. J. Med. 354:610-621 (2006)). This association is based on the role of this chemokine receptor in the recruitment of inflammatory leukocytes. In particular, CCR5 is expressed in a subset of effector T cells that produce proinflammatory cytokines such as interferon gamma (IFNg) and interleukin-17 (IL-17), which are enriched locally during inflammation. Thus, CCR5 is being considered as a target to dampen inflammatory disorders, such as rheumatoid arthritis (RA), Crohn’s Disease (CD), atherosclerosis, and psoriasis among others.

The present invention is directed to overcoming these and other limitations in the art; and/or to providing the public with a useful choice.

SUMMARY OF THE INVENTION A first aspect of the present invention relates to use of a CCR5 antagonist in the manufacture of a medicament for the treatment of an infection caused by lukE/D strain of Staphylococcus aureus in a subject. [0010a] Also described is a method of preventing or treating Human Immunodeficiency Virus (HIV) infection in a subject. This method involves administering a composition comprising an isolated Leukocidin E (LukE) protein, or polypeptide thereof, and an isolated Leukocidin D (LukD) protein, or polypeptide thereof in an amount effective to prevent or treat HIV infection in the subject.

Also described is a method of preventing HIV infection in a subject. This method involves providing a composition comprising an isolated LukE protein, or polypeptide thereof, and an isolated LukD protein, or polypeptide thereof, and contacting the tissue of the subject with the composition under conditions effective to block HIV infectivity of cells in the tissue, thereby inhibiting HIV infection of the subject.

Also described is a composition comprising a therapeutically effective amount of an isolated LukE protein or polypeptide thereof, an isolated LukD protein or polypeptide thereof, or a combination thereof, and one or more additional agents selected from the group consisting of a lubricant, an antimicrobial agent, a humectant, an emulsifier, and a mixture of two or more thereof.

Also described is a method of treating an inflammatory condition in a subject. This method involves administering a composition comprising an isolated LukE protein, or polypeptide thereof, and an isolated LukD protein, or polypeptide thereof, in an amount effective to treat an inflammatory condition in the subject.

Also described is a method of preventing graft-versus-host-disease (GVHD) in a subject. This method involves administering a composition comprising an isolated LukE protein, or polypeptide thereof, and an isolated LukD protein, or polypeptide thereof, in an amount effective to prevent graft-versus-host-disease (GVHD) in the subject.

Also described is a method of treating a Staphylococcus aureus infection in a subject. This method involves selecting a subjecting having a S. aureus infection and administering a composition comprising a CCR5 antagonist to the subject in an amount effective to treat the S. aureus infection in the subject.

As demonstrated herein, applicants have found that the bi-component leukotoxin of Staphylococcus aureus, leukocidin E/D, mediates its cytotoxicity via the CCR5 receptor on the surface of leukocytes. Exploitation of this toxin-receptor interaction has a number of therapeutic implications. Firstly, since LukE/D significantly contributes to the pathogenesis of S. aureus infections, CCR5 receptor antagonists offer a novel therapeutic approach to treat S. aureus infections, especially infections caused by MRSA strains. Secondly, due to its role in mediating HIV infectivity, a variety of CCR5 antagonists are being tested in clinical trials as anti-HIV drugs. Use of composition containing LukE and LukD to target latently infected cells in HIV-infected individuals represents a superior therapeutic strategy compared to CCR5-antagonism, because use of this toxin will deplete all CCR5 positive cells, thereby eliminating HIV positive cells. A composition containing LukE and LukD can also be administered prophylactically to prevent the transmission of HIV by killing CCR5-positive cells that are required for HIV transmission. These therapeutic approaches are novel because they will eradicate HIV cells or cells susceptible to HIV infection in a subject. Finally, since CCR5 is also involved in uncontrolled inflammation, use of a LukE/D composition to target and deplete CCR5 positive cells offers a new treatment modality to combat localized inflammatory conditions. This treatment approach is highly targeted to the source of inflammation, thereby avoiding side effects often encountered with current anti-inflammatory strategies. [0016a] Certain statements that appear below are broader than what appears in the statements of the invention above. These statements are provided in the interests of providing the reader with a better understanding of the invention and its practice. The reader is directed to the accompanying claim set which defines the scope of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS Figures 1A–1B illustrate that LukE/D contributes to S. aureus infection in a mouse model of systemic infection. Figure 1A demonstrates that LukE/D is critical for the death of mice infected systemically with S. aureus. The survival of mice was monitored after intravenous injection with ~1X10 CFU with S. aureus strain Newman wild type, a ΔlukE/D mutant, and the complemented ΔlukE/D::plukE/D strain. Total number of mice per group were N=6. Statistical significance between survival curves was determined using the Log-rank (Mantel-Cox) test (p ≤ 0.0005). Figure 1B demonstrates that LukE/D is required for S. aureus proliferation in vivo. The bacterial burden was determined by enumeration of bacterial CFU from kidneys 96 hours post-infection as described for Figure 1A. Statistical significance was determined using 1-Way ANOVA with Tukey’s multiple comparisons posttest (***, p ≤ 0.0005).

[0018] Figures 2A–2B show that LukE/D is toxic to select human immune cell lines. Figure 2A demonstrates that LukE/D is selectively toxic to the monocyte-like cell line THP-1 and the T lymphocyte-like cell line Hut cells. Cytotoxicity was determined by a cell viability assay where indicated human immune cells lines were intoxicated with different concentrations of an equimolar mixture of LukE + LukD (LukE/D). Cell viability was monitored 1 hour post-intoxication using CellTiter, where cells treated with medium were set at 100% viable. Results represent the average of triplicate samples + S.D. Figure 2B depicts that LukE/D kills Hut cell but not other human T lymphocyte-like cell lines. Indicated cell lines were intoxicated with different concentrations of an equimolar mixture of LukE+LukD (LukE/D) and cell viability monitored as in Figure 2A.

Results represent the average of triplicate samples + S.D.

Figure 3 illustrates that the chemokine receptor CCR5 is necessary and sufficient to renders mammalian cells susceptible to LukE/D mediated cytotoxicity.

Parental Jurkat (top, left) and GHOST cells (bottom, left) or these cells transduced with a CCR5 cDNA (Jurkat CCR5 , top/right; GHOST CCR5 , bottom/right), were intoxicated with LukE, LukD, or equimolar mixture of LukE+LukD (LukE/D). One hour post- intoxication cell viability was monitored with CellTiter, where cells treated with medium were set at 100% viable. Results represent the average of triplicate samples + S.D.

Figures 4A–4C show that LukE/D cytotoxicity towards host cells is blocked by CCR5 inhibitors. Figure 4A demonstrates that CCR5-specific antagonist potently block LukE/D cytotoxicity towards CCR5 cells. CCR5 Jurkats were preincubated with different concentrations of Maraviroc (MVC), Vicriviroc (VVC), or TAK-779 (TAK) for 30 minutes followed by intoxication with an equimolar mixture of LukE + LukD (LukE/D). One hour post-intoxication, the percent death was determined by CellTiter where cells treated with media + LukE/D was set to 100% cell death. Results represent the average of triplicate samples + S.D. Figure 4B demonstrates that monoclonal antibodies directed towards CCR5 inhibit LukE/D cytotoxicity towards CCR5 cells. CCR5 Jurkats were preincubated with indicated monoclonal antibodies for minutes followed by intoxication with an equimolar mixture of LukE + LukD (LukE/D). One hour post-intoxication, the viability of the cells was determined by CellTiter. Results represent the average of triplicate samples + S.D. Figure 4C demonstrates that CCR5 ligands inhibit LukE/D cytotoxicity towards CCR5 cells. CCR5 Jurkats were preincubated with buffer (PBS; negative control) or different concentrations of the indicated ligands for 30 minutes followed by intoxication with an equimolar mixture of LukE + LukD (LukE/D). One hour post-intoxication, the viability of the cells was determined by CellTiter. Results represent the average of triplicate samples + S.D.

Figures 5A-5C illustrate that blocking LukE/D binding to the plasma membrane of target cells protects the cells from LukE/D mediated cytotoxicity. Figure 5A demonstrates that LukE/D binds to host cells in a CCR5-dependent manner and that this - + + binding is potently inhibited by Maraviroc. Jurkat (CCR5 ) and CCR5 Jurkat (CCR5 ) cells were preincubated with buffer or with Maraviroc (CCR5 + MVC) followed by incubation of an equimoler mixture of a green fluorescent protein (GFP) fused LukE with LukD toxin ( LukE/D). Binding of the toxin to the plasma membrane of the cells was monitored via flow cytometry. Figures 5B demonstrates that LukE/D forms pores in the plasma membrane of CCR5 cells, which are potently blocked by Maraviroc. CCR5 Jurkat cells were pre-incubated with Maraviroc (MVC) and subsequently intoxicated with an equimolar mixture of LukE + LukD (LukE/D) in the presence of ethidium bromide.

Pore formation was measured over-time by monitoring ethidium bromide incorporation.

Results represent the average of triplicate samples + S.D. Figure 5C show that pore formation by LukE/D is associated with cell swelling, a cytophatic effect potently inhibited by Maraviroc. CCR5 Jurkat cells were pre-incubated with buffer (NO MVC) or with Maraviroc (MVC) and subsequently intoxicated with an equimolar mixture of LukE + LukD (LukE/D) in the presence of ethidium bromide. Intoxicated cells were monitored by light (top panels) and by fluorescence microscopy to determine ethidium bromide uptake. Representative images are shown.

Figures 6A–C show that LukE/D potently kills CCR5 primary human immune cells. Figure 6A demonstrates that LukE/D targets primary human T lymphocytes in a CCR5-dependent manner. T cells from human peripheral blood mononuclear cells (PBMC) from wild type CCR5 and a Δ32CCR5 donor were expanded in vitro and subsequently incubated with media (negative control), an equimolar mixture of LukE + LukD (LukE/D), or with Maraviroc (MVC) followed by intoxication with an equimolar mixture of LukE + LukD (LukE/D). Cells were then stained with an anti-CCR5 antibody and a viability dye prior analysis by flow cytometry. Figures 6B–6C demonstrate that LukE/D is cytotoxic towards primary human macrophages (Figure 6B) and primary human dendtric cells (Figure 6C) and that Maraviroc potently protects these cells from LukE/D mediated cytotoxicity. Macrophages and dendritic cells were incubated with media (negative control), an equimolar mixture of LukE + LukD (LukE/D), or with Maraviroc (MVC) followed by intoxication with an equimolar mixture of LukE + LukD (LukE/D). One hour post-intoxication, the percent death was determined by flow cytometry.

DETAILED DESCRIPTION OF THE INVENTION Described is a composition comprising a therapeutically effective amount of an isolated LukE protein or polypeptide thereof, an isolated LukD protein or polypeptide thereof, and a pharmaceutically acceptable carrier.

In accordance with this embodiment, suitable isolated LukE proteins include those derived from any strain of S. aureus. The amino acid sequence of LukE proteins from various strains of S. aureus that are suitable for the composition are shown in the Table 1 below (i.e., SEQ ID Nos: 1–10). SEQ ID NO: 11 of Table 1 is a LukE consensus sequence demonstrating the high level of sequence identity across LukE proteins of various S. aureus strains. Accordingly, in one embodiment, the isolated LukE protein comprises an amino acid sequence of SEQ ID NO:11. In another embodiment, the isolated LukE protein comprises an amino acid sequence having about 70–80% sequence similarity to SEQ ID NO:11, more preferably, about 80–90% sequence similarity to SEQ ID NO:11, and more preferably 90–95% sequence similarity to SEQ ID NO:11, and most preferably about 95–99% sequence similarity to SEQ ID NO:11.

In another embodiment, the composition comprises an isolated polypeptide of LukE. Suitable LukE polypeptides are about 50 to about 100 amino acids in length.

More preferably LukE polypeptides are between about 100–200 amino acids in length, more preferably between about 200–250 amino acids in length, and most preferably between 250–300 amino acids in length. The N-terminal amino acid residues of the full- length LukE represent the native secretion/signal sequence. Thus, the “mature” secreted form of LukE is represented by amino acid residues 29–311 in each of SEQ ID NOs: 1–10 and SEQ ID NO:11. Correspondingly, amino acid residues 1–311 in each of SEQ ID NOs: 1–10 and SEQ ID NO:11 are referred to as the “immature” form of LukE.

Accordingly, in one embodiment, the LukE polypeptide comprises amino acid residues 29-311 of SEQ ID NO:11., amino acid residues 48-291 of SEQ ID NO:11, amino acid residues 29-301 of SEQ ID NO:11, and amino acids 48-301 of SEQ ID NO:11. In either case, suitable LukE polypeptides also include those polypeptides comprising an amino acid sequence having about 70–80% sequence similarity, preferably 80–90% sequence similarity, more preferably 90–95% sequence similarity, and most preferably 95–99% sequence similarity to amino acid residues 29–311 of SEQ ID NO:11 or 48–291 of SEQ ID NO: 11.

In accordance with this embodiment, suitable isolated LukD proteins include those proteins derived from any strain of S. aureus. The amino acid sequence of LukD proteins from various strains of S. aureus that are suitable for the composition are shown in the Table 2 below (i.e., SEQ ID Nos: 12–21). SEQ ID NO: 22 of Table 2 is a LukD consensus sequence demonstrating the high level of sequence identity across LukD proteins of various S. aureus strains. Accordingly, in one embodiment, the isolated LukD protein comprises an amino acid sequence of SEQ ID NO:22. In another embodiment, the isolated LukD protein comprises an amino acid sequence having about 70–80% sequence similarity to SEQ ID NO:22, preferably, about 80–90% sequence similarity to SEQ ID NO:22, and more preferably 90–95% sequence similarity to SEQ ID NO:22, and most preferably about 95–99% sequence similarity to SEQ ID NO:22.

In another embodiment, the composition comprises an isolated polypeptide of LukD. Suitable LukD polypeptides are about 50 to about 100 amino acids in length.

More preferably LukD polypeptides are between about 100–200 amino acids in length, more preferably between about 200–250 amino acids in length, and most preferably between 250–300 amino acids in length. The N-terminal amino acid residues of the full length LukD represent the native secretion/signal sequence. Thus, the mature secreted form of LukD is represented by amino acid residues 27–327 in each of SEQ ID NOs: 12- 21 and SEQ ID NO: 22. Correspondingly, amino acid residues 1–327 of SEQ ID NOs: 12-21 and SEQ ID NO: 22 are referred to as the “immature” form of LukD. Accordingly, in one embodiment, the LukD polypeptide comprises amino acid residues 27–327 of SEQ ID NO:22. Alternatively, the LukD polypeptide comprises amino acid residues 46–307, amino acid residues 27-312, and amino acid residues 46-312 of SEQ ID NO:22. In either case, suitable polypeptides also include those polypeptide comprising an amino acid sequence having about 70–80% sequence similarity, preferably 80–90% sequence similarity, more preferably 90–95% sequence similarity, and most preferably 95–99% sequence similarity to amino acid residues 27-327 of SEQ ID NO:22, amino acid residues of 46-307 of SEQ ID NO:22, amino acid residues of 46-312 of SEQ ID NO:22, or amino acid residues of 27-312 of SEQ ID NO:22.

Table 1 – S. Aureus LukE Sequence Alignment S. Aureus Strain Newman MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:1 MW2 MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:2 USA_300_FPR3757 MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:3 COL MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:4 USA_300_TCH1516 MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:5 N315 MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:6 D30 MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:7 Mu50 MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:8 TCH_70 MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:9 MRSA131 MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:10 ************************************************** LukE Consensus Sequence MFKKKMLAATLSVGLIAPLASPIQESRANTNIENIGDGAEVIKRTEDVSS 50 SEQ ID NO:11 Newman KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 MW2 KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 USA_300_FPR3757 KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 COL KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 USA_300_TCH1516 KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 N315 KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 D30 KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 Mu50 KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 TCH_70 KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 MRSA131 KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK 100 ************************************************** LukE Consensus Sequence KKWGVTQNVQFDFVKDKKYNKDALIVKMQGFINSRTSFSDVKGSGYELTK Newman RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 MW2 RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 USA_300_FPR3757 RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 COL RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 USA_300_TCH1516 RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 N315 RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 D30 RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 Mu50 RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 TCH_70 RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 MRSA131 RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA 150 ************************************************** LukE Consensus Sequence RMIWPFQYNIGLTTKDPNVSLINYLPKNKIETTDVGQTLGYNIGGNFQSA Newman PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 MW2 PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 USA_300_FPR3757 PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 COL PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 USA_300_TCH1516 PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 N315 PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 D30 PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 Mu50 PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 TCH_70 PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 MRSA131 PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK 200 ************************************************** LukE Consensus Sequence PSIGGNGSFNYSKTISYTQKSYVSEVDKQNSKSVKWGVKANEFVTPDGKK Newman SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 MW2 SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 USA_300_FPR3757 SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 COL SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 USA_300_TCH1516 SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 N315 SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 D30 SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 Mu50 SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 TCH_70 SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 MRSA131 SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG 250 ************************************************** LukE Consensus Sequence SAHDRYLFVQSPNGPTGSAREYFAPDNQLPPLVQSGFNPSFITTLSHEKG Newman SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 MW2 SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 USA_300_FPR3757 SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 COL SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 USA_300_TCH1516 SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 N315 SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 D30 SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 Mu50 SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 TCH_70 SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 MRSA131 SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW 300 ************************************************** LukE Consensus Sequence SSDTSEFEISYGRNLDITYATLFPRTGIYAERKHNAFVNRNFVVRYEVNW Newman KTHEIKVKGHN 311 MW2 KTHEIKVKGHN 311 USA_300_FPR3757 KTHEIKVKGHN 311 COL KTHEIKVKGHN 311 USA_300_TCH1516 KTHEIKVKGHN 311 N315 KTHEIKVKGHN 311 D30 KTHEIKVKGHN 311 Mu50 KTHEIKVKGHN 311 TCH_70 KTHEIKVKGHN 311 MRSA131 KTHEIKVKGHN 311 *********** LukE Consensus Sequence KTHEIKVKGHN Depicts the start of the secreted LukE protein Table 2 – LukD Amino Acid Sequence Alignment Newman MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:12 MW2 MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:13 USA_300_FPR3757 MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:14 COL MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:15 USA_300_TCH1516 MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:16 MRSA131 MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:17 TCH_70 MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:18 D30 MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:19 N315 MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:20 Mu50 MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:21 ************************************************** LukD Consensus Sequence MKMKKLVKSSVASSIALLLLSNTVDAAQHITPVSEKKVDDKITLYKTTAT 50 SEQ ID NO:22 Newman SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 MW2 SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 USA_300_FPR3757 SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 COL SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 USA_300_TCH1516 SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 MRSA131 SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 TCH_70 SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 D30 SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 N315 SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 Mu50 SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS 100 ************************************************** LukD Consensus Sequence SDNDKLNISQILTFNFIKDKSYDKDTLVLKAAGNINSGYKKPNPKDYNYS Newman QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 MW2 QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 USA_300_FPR3757 QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 COL QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 USA_300_TCH1516 QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 MRSA131 QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 TCH_70 QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 D30 QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 N315 QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 Mu50 QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI 150 ************************************************** LukD Consensus Sequence QFYWGGKYNVSVSSESNDAVNVVDYAPKNQNEEFQVQQTLGYSYGGDINI Newman SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 MW2 SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 USA_300_FPR3757 SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 COL SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 USA_300_TCH1516 SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 MRSA131 SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 TCH_70 SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 D30 SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 N315 SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 Mu50 SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN 200 ************************************************** LukD Consensus Sequence SNGLSGGLNGSKSFSETINYKQESYRTTIDRKTNHKSIGWGVEAHKIMNN Newman GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 MW2 GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 USA_300_FPR3757 GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 COL GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 USA_300_TCH1516 GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 MRSA131 GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 TCH_70 GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 D30 GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 N315 GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 Mu50 GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE 250 ************************************************** LukD Consensus Sequence GWGPYGRDSYDPTYGNELFLGGRQSSSNAGQNFLPTHQMPLLARGNFNPE Newman FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWVGNNYKNQNTVTF 300 MW2 FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWVGNNYKNQNTVTF 300 USA_300_FPR3757 FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWVGNNYKNQNTVTF 300 COL FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWVGNNYKNQNTVTF 300 USA_300_TCH1516 FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWVGNNYKNQNTVTF 300 MRSA131 FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWVGNNYKNQNTVTF 300 TCH_70 FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWVGNNYKNQNTVTF 300 D30 FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWVGNNYKNQNTVTF 300 N315 FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWIGNNYKNQNTVTF 300 Mu50 FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWIGNNYKNQNTVTF 300 *************************************:************ LukD Consensus Sequence FISVLSHKQNDTKKSKIKVTYQREMDRYTNQWNRLHWXGNNYKNQNTVTF Newman TSTYEVDWQNHTVKLIGTDSKETNPGV 327 MW2 TSTYEVDWQNHTVKLIGTDSKETNPGV 327 USA_300_FPR3757 TSTYEVDWQNHTVKLIGTDSKETNPGV 327 COL TSTYEVDWQNHTVKLIGTDSKETNPGV 327 USA_300_TCH1516 TSTYEVDWQNHTVKLIGTDSKETNPGV 327 MRSA131 TSTYEVDWQNHTVKLIGTDSKETNPGV 327 TCH_70 TSTYEVDWQNHTVKLIGTDSKETNPGV 327 D30 TSTYEVDWQNHTVKLIGTDSKETNPGV 327 N315 TSTYEVDWQNHTVKLIGTDSKETNPGV 327 Mu50 TSTYEVDWQNHTVKLIGTDSKETNPGV 327 *************************** LukD Consensus Sequence TSTYEVDWQNHTVKLIGTDSKETNPGV Depicts the start of the secreted LukD protein Thus, unless indicated to the contrary, both the immature and the mature forms of native LukE and LukD, and the sequences having less than 100% similarity with native LukE (i.e., native sequences and analogs alike, collectively referred to herein as “LukE” and “LukD”) may be used in the methods described.

[0029] LukE and LukD proteins and polypeptides as described herein may differ from the native polypeptides designated as SEQ ID NOS:1-11 and 12-22 respectively, in terms of one or more additional amino acid insertions, substitutions or deletions, e.g., one or more amino acid residues within SEQ ID NOS:1-22 may be substituted by another amino acid of a similar polarity, which acts as a functional equivalent, resulting in a silent alteration. That is to say, the change relative to the native sequence would not appreciably diminish the basic properties of native LukE or LukD. Any such analog of LukE or LukD may be screened in accordance with the protocols disclosed herein (e.g., the cell toxicity assay and the membrane damage assay) to determine if it maintains native LukE or LukD activity. Substitutions within these leukocidins may be selected from other members of the class to which the amino acid belongs. For example, nonpolar (hydrophobic) amino acids include alanine, leucine, isoleucine, valine, proline, phenylalanine, tryptophan and methionine. Polar neutral amino acids include glycine, serine, threonine, cysteine, tyrosine, asparagine, and glutamine. Positively charged (basic) amino acids include arginine, lysine and histidine. Negatively charged (acidic) amino acids include aspartic acid and glutamic acid.

In other embodiments, non-conservative alterations (e.g., one or amino acid substitutions, deletions and/or additions) can be made for purposes of increasing the selectivity and/or activity of LukE and/or LukD. The modified LukE and LukD may be used in the therapeutic compositions described herein. Molecular alterations can be accomplished by methods well known in the art, including primer extension on a plasmid template using single stranded templates (Kunkel et al.,, Proc. Acad. Sci., USA 82:488-492 (1985), which is hereby incorporated by reference in its entirety), double stranded DNA templates (Papworth et al., Strategies 9(3):3-4 (1996), which is hereby incorporated by reference in its entirety), and by PCR cloning (Braman, J. (ed.), IN VITRO MUTAGENESIS PROTOCOLS, 2nd ed. Humana Press, Totowa, N.J. (2002), which is hereby incorporated by reference in its entirety). Methods of determining whether a given molecular alteration in LukE and LukD alters LukE/D cytotoxicity are described herein.

In a preferred embodiment, a highly purified LukE/LukD preparation is utilized. Methods of purifying LukE and LukD toxins are known in the art (Gravet et al., “Characterization of a Novel Structural Member, LukE-LukD, of the Bi-Component Staphylococcal Leucotoxins Family,” FEBS 436: 202–208 (1998), which is hereby incorporated by reference in its entirety). As used herein, “isolated” protein or polypeptide refers to a protein or polypeptide that has been separated from other proteins, lipids, and nucleic acids with which it is naturally associated with. Purity can be measured by any appropriate standard method, for example, by column chromatography, polyacrylamide gel electrophoresis, of HPLC analysis. An isolated protein or polypeptide as described can be purified from a natural source, produced by recombinant DNA techniques, or by chemical methods.

The therapeutic compositions as described herein are prepared by formulating LukE and LukD with a pharmaceutically acceptable carrier and optionally a pharmaceutically acceptable excipient. As used herein, the terms "pharmaceutically acceptable carrier" and “pharmaceutically acceptable excipient” (e.g., additives such as diluents, immunostimulants, adjuvants, antioxidants, preservatives and solubilizing agents) are nontoxic to the cell or mammal being exposed thereto at the dosages and concentrations employed. Examples of pharmaceutically acceptable carriers include water, e.g., buffered with phosphate, citrate and another organic acid. Representative examples of pharmaceutically acceptable excipients that may be useful in the present invention include antioxidants such as ascorbic acid; low molecular weight (less than about 10 residues) polypeptides; proteins, such as serum albumin, gelatin, or immunoglobulins; adjuvants (selected so as to avoid adjuvant-induced toxicity, such as a β-glucan as described in U.S. Patent 6,355,625 to Pavliak et al., which is hereby incorporated by reference in its entirety, or a granulocyte colony stimulating factor (GCSF)); hydrophilic polymers such as polyvinylpyrrolidone; amino acids such as glycine, glutamine, asparagine, arginine or lysine; monosaccharides, disaccharides, and other carbohydrates including glucose, mannose, or dextrins; chelating agents such as EDTA; sugar alcohols such as mannitol or sorbitol; salt forming counterions such as sodium; and/or nonionic surfactants such as TWEEN , polyethylene glycol (PEG), and PLURONICS .

Therapeutic compositions as described may be prepared for storage by mixing the active ingredient(s) having the desired degree of purity with the pharmaceutically acceptable carrier and optional excipient and/or additional active agent, in the form of lyophilized formulations or aqueous solutions.

Also described is a method of preventing or treating Human Immunodeficiency Virus (HIV) infection in a subject. This method involves administering a composition comprising an isolated LukE protein, or polypeptide thereof, and an isolated LukD protein, or polypeptide thereof in an amount effective to prevent or treat HIV infection in the subject.

In accordance with this embodiment a suitable composition for administration to a subject to treat HIV infection contains both LukE and LukD proteins or polypeptides that retain receptor binding and the cytotoxic function of the full-length LukE or LukD proteins. A suitable composition for administration to a subject to prevent HIV infection contains both LukE and LukD proteins or polypeptides that retain receptor binding functionality and retain cytotoxicity. In another embodiment, LukE and LukD proteins retain receptor binding function but are not cytotoxic or have reduced cytotoxicity.

In accordance with this embodiment, suitable LukE and LukD proteins and polypeptides include those described supra. This embodiment is based on the applicants’ discovery that LukE/D binds to the CCR5 receptor of leukocytes, which mediates HIV cell entry and infectivity. LukE/D binding to CCR5 mediates LukE/D cytotoxicity. Therefore, when treating a subject having HIV, LukE and LukD proteins or polypeptides of the composition bind to the CCR5 receptor and cause cell death of all HIV positive cells. This method of treatment is superior to current HIV therapeutic strategies because LukE/D treatment will selectively and specifically deplete all CCR5 positive, and therefore, all HIV positive cells in a subject.

[0037] When administering the LukE/D composition described herein to prevent HIV infection in a subject, the LukE and LukD proteins or polypeptides are preferably modified to reduce cytotoxicity as described supra and/or to enhance LukE/LukD receptor binding. Accordingly, the composition may comprise a modified LukE or LukD protein or polypeptide that retains at least 70% sequence similarity to SEQ ID NOs: 11 and 22, respectively. Preferably, the LukE and LukD proteins or polypeptides retain at least 80% sequence similarity to SEQ ID NOs: 11 and 22, respectively. More preferably, the LukE and LukD proteins or polypeptides retain at least 90% sequence similarity to SEQ ID NOs: 11 and 22, respectively. Most preferably, the LukE and LukD proteins or polypeptides retain at least 95% sequence similarity to SEQ ID NOs: 11 and 22, respectively.

The therapeutic compositions described can be administered as part of a combination therapy in conjunction with another anti-HIV agent. Accordingly, the composition comprising an isolated LukE protein, or polypeptide thereof, and an isolated LukD protein, or polypeptide thereof may further comprise or be administered in combination with one or more antiviral or other agents useful in the treatment of HIV.

Suitable antiviral agents include nucleoside reverse transcriptase inhibitors, non- nucleoside reverse transcriptase inhibitors and protease inhibitors. More specifically, suitable antiviral agents include, without limitation, zidovudine, lamivudine, zalcitabine, didanosine, stavudine, abacavir, adefovir dipivoxil, lobucavir, BC H-10652, emitricitabine, beta-L-FD4, DAPD, lodenosine, nevirapine, delaviridine, efavirenz, PNU- 142721, AG-1549, MKC-442, (+)-calanolide A and B, saquinavir, indinavir, ritonavir, nelfinavir, lasinavir, DMP-450, BMS-2322623, ABT-378, amprenavir, hydroxyurea, ribavirin, IL-2, IL-12, pentafuside, Yissum No. 1 1607 and AG-1549.

For purposes of this and other embodiments described herein, the target “subject” encompasses any animal, preferably a mammal, more preferably a human. In the context of administering a composition for purposes of preventing HIV infection in a subject, the target subject encompasses any subject that is at risk for being infected by HIV. In the context of administering a composition for purposes of treating HIV infection in a subject, the target subject encompasses any subject infected with HIV.

In the context of using therapeutic compositions as described to treat an HIV infection, a therapeutically effective amount of LukE and LukD is that amount capable of achieving a reduction in symptoms associated with infection, a decrease in the severity of at least one symptom, a decrease in the viral load of the subject, and preferably a complete eradication of the virus from the subject.

Therapeutically effective amounts of a LukE and LukD composition can be determined in accordance with standard procedures, which take numerous factors into account, including, for example, the concentrations of these active agents in the composition, the mode and frequency of administration, the severity of the HIV infection to be treated (or prevented), and subject details, such as age, weight and overall health and immune condition. General guidance can be found, for example, in the publications of the International Conference on Harmonization and in REMINGTON'S PHARMACEUTICAL SCIENCES (Mack Publishing Company 1990), which is hereby incorporated by reference in its entirety. A clinician may administer a composition containing LukE and LukD proteins or polypeptides, until a dosage is reached that provides the desired or required prophylactic or therapeutic effect. The progress of this therapy can be easily monitored by conventional assays.

Therapeutic compositions as described may be administered in a single dose, or in accordance with a multi-dosing protocol. For example, in a multi-dosing protocol, the therapeutic composition may be administered once or twice daily, weekly, or monthly depending on the use and severity of the condition being treated. Different dosages, timing of dosages, and relative amounts of the therapeutic composition can be selected and adjusted by one of ordinary skill in the art. Modes of administration of the therapeutic compositions are described infra.

Another embodiment relates to a method of preventing HIV infection of a subject. This method involves providing a composition comprising an isolated LukE protein, or polypeptide thereof, and an isolated LukD protein, or polypeptide thereof, and contacting the tissue of the subject with the composition under conditions effective to block HIV infectivity of cells in the tissue, thereby inhibiting HIV infection of the subject.

In accordance with this embodiment, the composition comprising LukE and LukD serves as an anti-HIV microbicide, killing cells that are susceptible to HIV infection before infection occurs. The composition can be administered to any female or a male subject that is at risk for exposure to HIV as a prophylactic means of preventing HIV infection.

In accordance with this embodiment, the LukE and LukD containing compositions may further comprise one or more one or more additional agents. The one or more additional agents include, for example, and without limitation, a lubricant, an anti- microbial agent, an antioxidant, a humectant, an emulsifier, a spermicidal agent, or a mixture of two or more thereof.

Suitable lubricants include, without limitation, cetyl esters wax, hydrogenated vegetable oil, magnesium stearate, methyl stearate, mineral oil, polyoxyethylene-polyoxypropylene copolymer, polyethylene glycol, polyvinyl alcohol, sodium lauryl sulfate or white wax, or a mixture of two or more thereof. Suitable antimicrobial agents include, without limitation, propylene glycol, methyl paraben or propyl paraben, or a mixture of two or more thereof. Suitable antioxidants include, without limitation, butylated hydroxyanisole, butylated hydroxytoluene, or edetate disodium, or a mixture of two or more thereof. Suitable humectants include, without limitation, ethylene glycol, glycerin, or sorbitol, or a mixture of two or more thereof.

Suitable emulsifiers include, without limitation, carbomer, polyoxyethylenestearyl ether, polyoxyethylenestearyl ether, cetostearyl alcohol, cetyl alcohol, cholesterol, diglycol stearate, glyceryl monostearate, glyceryl stearate, hydroxypropyl cellulose, hydroxypropylmethyl cellulose, lanolin, polyoxyethylene lauryl ether, methyl cellulose, polyoxyethylene stearate, polysorbate, propylene glycol monostearate, sorbitan esters or stearic acid, or a mixture of two or more thereof.

[0047] In one embodiment, the composition is formulated for topical application.

Compositions for topical administration as described herein can be formulated as solutions, ointments, creams, foams, suspensions, lotions, powders, pastes, gels, sprays, aerosols, or oils for vaginal, anal, or buccal administration. In another embodiment, the composition is formulated for vaginal and/or rectal administration. In another embodiment, the composition is formulated for slow release from a vaginal device, such as a vaginal ring, an IUD, or a sponge, or other contraceptive device (e.g., condom). In yet another embodiment, the composition is formulated for application as an oral rinse. In a preferred embodiment, the composition is applied or contacted directly with the skin or a mucous membrane of the subject.

[0048] Another embodiment relates to a method of treating an inflammatory condition in a subject. This method involves administering a composition comprising an isolated LukE protein, or polypeptide thereof, and an isolated LukD protein, or polypeptide thereof, in an amount effective to treat an inflammatory condition in the subject.

[0049] Applicants have discovered that LukE/D targets and kills human CCR5- positive leukocytes and that this LukE/D mediated cytotoxicity is substantially specific to these cells but not other nucleated mammalian cells. Since CCR5 is expressed in a subset of effector T cells that produce proinflammatory cytokines that are enriched locally during inflammation, compositions comprising LukE and LukD proteins and polypeptides are useful in treating inflammatory conditions by depleting the CCR5 positive cell populations. Any subject, preferably a mammal, more preferably a human, can be treated in accordance with this embodiment, regardless of the cause of the inflammation, e.g., any bacterial or viral infection. Suitable compositions containing LukE and LukD proteins and/or polypeptides are described supra.

The therapeutic compositions described may be used to treat a number of inflammatory conditions, including but not limited to acute inflammatory conditions, rheumatoid arthritis, Crohn’s disease, atherosclerosis, psoriasis, ulcerative colitis, psoriatic arthritis, multiple sclerosis, lupus, type I diabetes, primary biliary cirrhosis, inflammatory bowel disease, tuberculosis, skin wounds and infections, tissue abscesses, folliculitis, osteomyelitis, pneumonia, scalded skin syndrome, septicemia, septic arthritis, myocarditis, endocarditis, toxic shock syndrome, allergic contact dermatitis, acute hypersensitivity, and acute neurological inflammatory injury (e.g., caused by acute infection).

Acute inflammatory conditions encompass the initial response of the body to invading stimuli, and involve the recruitment of plasma and white blood cells (leukocytes) to the localized area of the injured or infected tissues. Acute inflammatory conditions have a rapid onset and severe symptoms. The duration of the onset, from a normal condition of the patient to one in which symptoms of inflammation are seriously manifested, generally lasts up to about 72 hours. Acute inflammatory conditions that are amenable to treatment with the therapeutic compositions described include conjunctivitis, iritis, uveitis, central retinitis, external otitis, acute suppurative otitis media, mastoiditis, labyrinthitis, chronic rhinitis, acute rhinitis, sinusitis, pharyngitis, tonsillitis, contact dermatitis, dermonecrosis, diabetic polyneuritis, polymyositis, myositis ossificans, degenerative arthritis, rheumatoid arthritis, periarthritis scapulohumeralis, and osteitis deformans. In one embodiment, the acute inflammatory condition is an infected wound in the skin or soft tissue.

In the context of treatment of an inflammatory condition, an effective amount of a LukE and LukD composition is the amount that is therapeutically effective in the sense that treatment is capable of achieving a reduction in the inflammation, a decrease in the severity of the inflammation, or even a total alleviation of the inflammatory condition.

The anti-inflammatory compositions described may be administered by any route of administration as described infra. In the case of treatment of acute inflammatory conditions that are localized, non-systemic administration may be preferred in which case the administration of the therapeutic composition is at or around the site of the acute inflammation. In this regard, compositions for topical administration are preferred. In addition to the topical formulations described supra, the topical formulation can also be in the form of patches or dressings impregnated with active ingredient(s), which can optionally comprise one or more excipients or diluents. In some embodiments, the topical formulation includes a material that enhances absorption or penetration of the active agent(s) through the skin or other affected areas.

A therapeutically effective amount of a LukE/LukD composition in accordance with this and other embodiments described herein is the amount necessary to obtain beneficial or desired results. A therapeutically effective amount can be administered in one or more administrations, applications or dosages and is not intended to be limited to a particular formulation or administration route.

Also in accordance with this embodiment, the LukE/LukD composition can be administered in combination with other anti-inflammatory compositions, a TNFα inhibitor, or a combination thereof. Exemplary anti-inflammatory medications include, but are not limited to, non-steroidal anti-inflammatory drugs (NSAID), analgesics, glucocorticoids, disease-modifying anti-rheumatic drugs, dihydrofolate reductase inhibitors (e.g., methotrexate), biologic response modifiers, and any combination thereof.

A suitable NSAID is a selective cyclooxygenase-2 (COX-2) inhibitor.

Exemplary COX-2 inhibitors include, without limitation, nimesulide, 4- hydroxynimesulide, flosulide, meloxicam, celecoxib, and Rofecoxib (Vioxx).

Alternatively, a non-selective NSAID inhibitor is administered in combination with the LukE/D composition. Exemplary non-selective NSAIDS inhibitors include, without limitation, diclofenac, diflunisal, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, salsalate, sulindac and tolmetin.

[0057] Preferred analgesics include, without limitation, acetaminophen, oxycodone, tramadol, and propoxyphene hydrochloride.

Preferred glucocorticoids include, without limitation, cortisone, dexamethosone, hydrocortisone, methylpredisolone, prednisolone, and prednisone.

Preferred biological response modifiers include a B-cell inhibitor, such as Rituximab, or a T cell activation inhibitor, such as, Leflunomide, Etanercept (Enbrel), or Infliximab (Remicade).

Suitable TNFα inhibitors include a TNF-α antibody, a matrix metalloproteinase inhibitor, a corticosteroid, a tetracycline TNFα antagonist, a fluoroquinolone TNFα antagonist, and a quinolone TNFα antagonist. Exemplary TNFα. antagonist antibodies include, without limitation, infliximab, etanercept, CytoFAb, AGT- 1, afelimomab, PassTNF, and CDP-870. Exemplary corticosteroids include, without limitation, mometasone, fluticasone, ciclesonide, budesonide, beclomethasone, beconase, flunisolide, deflazacort, betamethasone, methyl-prednisolone, dexamethasone, prednisolone, hydrocortisone, cortisol, triamcinolone, cortisone, corticosterone, dihydroxycortisone, beclomethasone dipropionate, and prednisone. Exemplary tetracycline TNF-α antagonists include, without limitation, doxycycline, minocycline, oxytetracycline, tetracycline, lymecycline, and 4-hydroxydimethylaminotetracycline.

[0061] Another embodiment relates to a method of preventing graft-versus-host- disease (GVHD) in a subject. This method involves administering a composition comprising an isolated LukE protein, or polypeptide thereof, and an isolated LukD protein, or polypeptide thereof, in an amount effective to prevent graft-versus-host-disease (GVHD) in the subject.

[0062] Graft-versus-host disease (GVHD) remains the primary complication of clinical bone marrow transplantation (BMT) and a major impediment to widespread application of this important therapeutic modality. The hallmark of GVHD is infiltration of donor T lymphocytes into host epithelial compartments of the skin, intestine, and biliary tract. GVHD occurs when mature T cells, contained in the bone marrow of the graft, are transplanted into immuno-suppressed hosts. After transplantation, host antigen presenting cells (APCs) activate T cells of the graft (donor T cells) by presenting host histocompatibility antigens to the graft T-cells. Donor-derived APCs may also activate donor T cells by cross-presenting host alloantigens. The newly generated host-specific T effector (hsTeff) populations then migrate to peripheral host organs and effect target organ damage GVHD generally occurs in an acute and chronic form. Acute GVHD will be observed within about the first 100 days post BMT, whereas chronic GVHD occurs after this initial 100 days. In addition to chronology, different clinical symptoms are also manifest in acute GVHD versus chronic GVHD. Acute GVHD is generally characterized by damage to host liver, skin, mucosa and intestinal epithelium in the host subject, although some forms of idiopathic pneumonia have also been reported. Chronic GVHD is, on the other hand, associated with damage to connective tissue as well as the organs and tissues damaged during acute GVHD in the host subject. In general, the methods described herein relate to therapies for either addressing GVHD that is already present in a host subject or preventing GVHD from arising in a host subject. One embodiment relates to methods of treating or preventing acute GVHD. In particular, the methods are suitable for treating acute GVHD where the GVHD is damaging host intestinal epithelium. The methods are also suitable for treating acute GVHD where the GVHD is damaging at least one tissue selected from the group consisting of the host liver, the host skin, the host lung and the host mucosa. Of course, the methods may be used to treat acute GVHD where the GVHD is damaging more than one tissue.

In accordance with this embodiment, CCR5-positive donor T cells transplanted into the recipient host during allogenic transplantation mediate GVHD.

Accordingly, in one embodiment, donor bone marrow cells are treated with a composition containing LukE and Luke D prior to transplantation to effectuate cell death of all CCR5 cells, thereby preventing GVDH.

In another embodiment, treatment of the donor bone marrow cells is achieved by treating the graft. "Treating the graft" is intended to mean administering a composition or performing a procedure to the graft material, where the treatment is not intended to directly affect the host organism. Of course, successful treatment of the graft will indirectly affect the host organism in that the severity of GVHD may be reduced, or even removed entirely. The methods described are not limited to the location of the graft at the time the graft is treated. Thus, in one embodiment, the graft is treated prior to removal from the donor organism. In another embodiment, the graft is treated after removal from the donor organism. In yet another embodiment, the graft is treated after removal from the donor organism, but prior to transplantation into the host subject. In still another embodiment, the graft is treated after transplantation into the host organism.

[0066] In accordance with this embodiment, the composition comprising LukE and LukD may be administered as part of a combination therapy. For example, the LukE/D composition may be co-administered with another pharmaceutically active substance, such as but not limited to, methotrexate and cyclosporine. Additional agents that may be co- administered include but are not limited to, antibodies directed to various targets, tacrolimus, sirolimus, interferons, opioids, TNFα (tumor necrosis factor-α), binding proteins, Mycophenolate mofetil and other inhibitors of inosine monophosphate dehydrogenase (IMPDH), glucocorticoids, azathioprine and other cytostatic agents such as, but not limited to, antimetabolites and alkylating agents. In one embodiment, the graft or donor may be pretreated by administration of immunosuppressive drugs such as cyclosporine (alone or in combination with steroids) and methotrexate prior to transplantation. For prevention, immunosuppressive therapy typically consists of combined regimens of methotrexate (MTX), cyclosporin (CsA), tacrolimus (FK 506), and/or a corticosteriod. Intravenous gamma-globulin preparations administered prophylactically have also been shown to be beneficial for the prevention of GVHD. In addition, pentoxyfylline, a xanthine derivative capable of down-regulating TNFα production, may be administered with cyclosporin plus either methotrexate or methylprednisolone to further decrease incidence of GVHD. Chronic GVHD may be treated with steroids such as prednisone, ozothioprine and cyclosporine. Also, antithymocyte globulin (ATG) and/or Ursodiol may be used. Thalidomide with immunosuppressive properties has shown promising results in the treatment of chronic GVHD. Similar to thalidomide, clofazimine may also be coadministered with the composition described herein comprising LukE and LukD. Antibody targets for co- administered antibodies include, but are not limited to, T cell receptor (TCR), interleukin- 2 (IL-2) and IL-2 receptors. Additionally, a CD(25) monoclonal antibody, anti-CD8 monoclonal antibody, or an anti-CD103 antibody may be co-administered for GVHD prophylaxis.

In accordance with this and all embodiments described herein, compositions as described can be formulated for pharmaceutical use and administered by parenteral, topical, intravenous, oral, subcutaneous, intraperitoneal, intranasal, intramuscular, intra-arterial, intracranial, intradermal injection for prophylactic and/or therapeutic treatment.

When it is desirable to deliver the pharmaceutical compositions described herein systemically, they may be formulated for parenteral administration by injection, e.g., by bolus injection or continuous infusion. Formulations for injection may be presented in unit dosage form, e.g., in ampoules or in multi-dose containers, with an added preservative. The compositions may take such forms as suspensions, solutions, or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing, and/or dispersing agents. Solutions or suspensions of the agent can be prepared in water suitably mixed with a surfactant such as hydroxypropylcellulose.

Dispersions can also be prepared in glycerol, liquid polyethylene glycols, and mixtures thereof in oils. Illustrative oils are those of petroleum, animal, vegetable, or synthetic origin, for example, peanut oil, soybean oil, or mineral oil. In general, water, saline, aqueous dextrose and related sugar solution, and glycols, such as propylene glycol or polyethylene glycol, are preferred liquid carriers, particularly for injectable solutions.

Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms.

Pharmaceutical formulations suitable for injectable use include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. In all cases, the form must be sterile and must be fluid to the extent that easy syringability exists. It must be stable under the conditions of manufacture and storage and must be preserved against the contaminating action of microorganisms, such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (e.g., glycerol, propylene glycol, and liquid polyethylene glycol), suitable mixtures thereof, and vegetable oils.

[0070] Intraperitoneal or intrathecal administration of the agents as described can also be achieved using infusion pump devices such as those described by Medtronic, Northridge, CA. Such devices allow continuous infusion of desired compounds avoiding multiple injections and multiple manipulations.

In addition to the formulations described previously, the pharmaceutical compositions may also be formulated as a depot preparation. Such long acting formulations may be formulated with suitable polymeric or hydrophobic materials (for example as an emulsion in an acceptable oil) or ion exchange resins, or as sparingly soluble derivatives, for example, as a sparingly soluble salt.

The required dosage of the composition comprising LukE and LukD depends on the choice of the route of administration; the nature of the formulation; the nature of the subject’s illness; the subject's size, weight, surface area, age, and sex; other drugs being administered; and the judgment of the attending physician. Suitable dosages are in the range of 0.01-100 mg/kg. Variations in the needed dosage are to be expected in view of the variety of compounds available and the different efficiencies of various routes of administration. Variations in these dosage levels can be adjusted using standard empirical routines for optimization as is well understood in the art. Encapsulation of the compound in a suitable delivery vehicle (e.g., polymeric microparticles or implantable devices) may increase the efficiency of delivery.

Another embodiment relates to a method of treating a Staphylococcus aureus infection in a subject. This method involves selecting a subject having a S. aureus infection and administering a composition comprising a CCR5 antagonist to the subject in an amount effective to treat the S. aureus infection in the subject.

[0074] For purposes of this embodiment, the target subject encompasses any animal, preferably a mammal, more preferably a human that is infected and/or at risk to be infected with S. aureus or is at risk of S. aureus infection. Particularly suitable subjects include infants, juveniles, adults, and elderly adults, as well as immunocompromised individual. Additionally, suitable subjects include those subjects infected with methicillin- resistant S. aureus (MRSA) infection or methicillin sensitive S. aureus (MSSA) infection.

In accordance with this embodiment, suitable CCR5 antagonists for inhibiting S. aureus LukE/D mediated cytotoxicity, thereby treating or preventing S. aureus infection are known in the art, and include, without limitation, maraviroc, vicriviroc, NCB-9471, PRO-140, CCR5 mAb004, 8-[4-(2-butoxyethoxy)phenyl] isobutyl-N-[4-[[(1-propyl-1H-imadazolyl- )methyl]sulphinyl]phenyl]-1,2,3,4- tetrahydrobenzacocinecarboxamide, methyl1-endo-{8-[(3S)(acetylamino)(3- fluorophenyl)propyl]azabicy- clo[3.2.1]octyl}methyl-4,5,6,7-tetrahydro-1H- imidazo[4,5-c]pyridine-- 5-carboxylate, methyl 3-endo-{8-[(3S)(acetamido)(3- fluorophenyl)propyl]azabicyclo[3.2.- 1]octyl}methyl-4,5,6,7-tetrahydro-3H- imidazo[4,5-c]pyridinecarbox- ylate, ethyl 1-endo-{8-[(3S)(acetylamino)(3- fluorophenyl)propyl]azabicyclo[3.- 2.1]octyl}methyl-4,5,6,7-tetrahydro-1H- imidazo[4,5-c]pyridinecarb- oxylate, and N-{(1S)[3-endo-(5-isobutyrylmethyl- 4,5,6,7-tetrahydro-1H-imidazo[4,- 5-c]pyridinyl)azabicyclo[3.2.1]octyl](3- fluorophenyl)propyl}ac- etamide).

[0076] Additional CCR5 antagonists and compositions containing the same are further described in U.S. Patent Publication No. 2007/0010509 to Shiota et al., and U.S.

Patent No. 7,625,905 to Lemoine et al., U.S. Patent No. 6,476,062 to Chu et al., U.S.

Patent No. 7,728,135 to Shi et al., and U.S. Patent No. 7,220,856 to Dunning et al., which are all hereby incorporated by reference in their entirety.

[0077] The CCR-5 antagonist can be administered as part of a combination therapy in conjunction with another active agent depending upon the nature of the S. aureus infection that is being treated. Such additional active agents include anti-infective agents, antibiotic agents, and antimicrobial agents. Representative anti-infective agents that may be useful in the present invention include vancomycin and lysostaphin. Other suitable anti-infective agents include agents that inhibit LukE/D mediated cytotoxicity (e.g., anti- LukE antibody, anti-LukD antibody, anti-LukE/D antibody).

Representative antibiotic agents and antimicrobial agents that may be useful in the present invention include penicillinase-resistant penicillins, cephalosporins and carbapenems, including vancomycin, lysostaphin, penicillin G, ampicillin, oxacillin, nafcillin, cloxacillin, dicloxacillin, cephalothin, cefazolin, cephalexin, cephradine, cefamandole, cefoxitin, imipenem, meropenem, gentamycin, teicoplanin, lincomycin and clindamycin. Dosages of these antibiotics are well known in the art. See, e.g., MERCK MANUAL OF DIAGNOSIS AND THERAPY, Section 13, Ch. 157, 100 Ed. (Beers & Berkow, eds., 2004), which is hereby incorporated by reference in its entirety. The anti- inflammatory, anti-infective, antibiotic and/or antimicrobial agents may be combined prior to administration, or administered concurrently (as part of the same composition or by way of a different composition) or sequentially with the CCR5 antagonist composition described herein. In certain embodiments, the administering is repeated.

Compositions containing CCR-5 antagonists can be administered by parenteral, topical, intravenous, oral, subcutaneous, intraperitoneal, intranasal, intramuscular, intra-arterial, intracranial, or intradermal injections, for prophylactic and/or therapeutic treatment.

[0080] Another embodiment relates to a method of identifying a suitable treatment for a subjecting having a S. aureus infection. This method involves obtaining a sample from the subject and detecting or quantifying the level of CCR5 expression and CCR5 surface level in the sample. The method further involves comparing the detected level of CCR5 expression and CCR5 surface level in the sample to a control sample having a known or baseline CCR5 expression level and CCR5 surface level and determining a suitable treatment for the subject based on this comparison. The method further involves administering the determined suitable treatment to the subject.

In accordance with this embodiment, individuals lacking CCR5 or having lower levels of CCR5 expression will be more resistant to infection with lukE/D S. aureus compared to individuals with higher levels of CCR5. Individuals having higher levels of CCR5 are more suitable candidates for treatment using a CCR5 receptor antagonist as described herein.

A further embodiment relates to a method of predicting severity of an S. aureus infection in a subject by monitoring CCR5 levels in the subject. This method involves isolating PBMCs from whole blood of the subject and performing flow cytometry analysis to determine CCR5 surface expression. The quantified amounts of surface CCR5 expression in the cells from the subject are compared to the amount of CCR5 in a control sample which produces little or undetectable amounts of CCR5 and control sample which produces high levels of CCR5 (e.g., Jurkat CCR5+) and the severity of the S. aureus infection is predicted based on CCR5 levels. High levels of CCR5 in the subject predict a more severe S. aureus infection, while lower levels of CCR5 in the subject predict a less severe infection. Methods of isolating and/or labeling PBMCs from a whole blood sample for FACs analysis are readily known in the art.

EXAMPLES The following examples are provided to illustrate embodiments of the present invention but are by no means intended to limit its scope.

Example 1 - LukE/D Significantly Contributes to S. aureus Pathogenesis To test whether LukE/D plays a major role in the pathogenesis of S. aureus septicemic infection, a ΔlukE/D mutant in the MSSA strain Newman was constructed and the impact of the lukE/D deletion on virulence examined. Survival over time dramatically increased for mice infected with 10 CFU of the ΔlukE/D mutant compared to that of mice infected with wild type (WT) S. auerus. All mice infected with WT S. aureus succumbed to infection by 250 hours. In contrast, nearly 100% of mice infected with ΔlukE/D mutant survived until at least 300 hours post infection, a phenotype fully complemented by introducing lukE/D into the ΔlukE/D mutant strain (ΔlukE/D::plukE/D; Figure 1A). In addition, bacterial burden to the kidney was reduced by 10-fold compared to the WT or complemented strain (Figure 1B). These results show that LukE/D is a critical virulence factor for S. aureus systemic infection. Thus LukE/D is an attractive novel target for development of new therapeutics to counter S. aureus infection.

Example 2 – LukE/D Selectively Kills Human Immune Cell Lines As described supra, LukE/D contributes to the pathogenesis of S. aureus mediated sepsis and systemic infection (Figures 1A–1B), indicating that inhibiting LukE/D could prove to be a novel mean by which to treat S. aureus infections.

[0086] One mechanism by which LukE/D could be blocked is by inhibiting the interaction of the toxin with its receptor. As an initial strategy to understand how LukE/D interact with host cells, a collection of human immune cell lines were incubated (“intoxicated”) with different concentrations of either individual subunits (i.e., LukE or LukD) or an equimolar mixture of LukE + LukD (LukE/D). These experiments revealed that LukE/D exhibits cytotoxicity toward THP1 cells (human monocytes) and Hut cells (T lymphocyte-like cells) (Figure 2A). Interestingly, LukE/D was cytotoxic towards Hut cells but not towards Jurkat cells, both commonly used T lymphocyte-like cells. This surprising result prompted investigation into what rendered the Hut cells sensitive to LukE/D. Intoxication of additional lymphocyte cell lines (PM1 and H9) revealed that only the Hut cells were susceptible to LukE/D mediated toxicity (Figure 2B). Upon further investigation, it was discovered that the Hut cells employed the experiments described above have been engineered to over-express the CC-chemokine receptor 5 (CCR5), a receptor for the chemokines MIP-1α, MIP-1β, and RANTES.

Example 3 – LukE/D Targets and Kills Cells in a CCR5-Dependent Manner

[0087] To directly determine the contribution of CCR5 for the ability of LukE/D to target and kill host cells, CCR5 was introduced into Jurkat cells by viral transduction of the CCR5 cDNA resulting in CCR5 Jurkat. Jurkat and CCR5 Jurkat cells were subsequently intoxicated with different concentrations of either individual subunits (i.e., LukE or LukD) or equimolar mixtures of LukE + LukD (LukE/D). This experiment revealed that production of CCR5 was sufficient to render Jurkat cells susceptible to LukE/D mediated toxicity (Figure 3, top panel). Importantly, similar results were observed when the human osteosarcoma cell line “GHOST” cells engineered to produce CCR5 on their surface were examined (Figure 3 bottom panel). Altogether, these data indicate that CCR5 renders mammalian cells susceptible to LukE/D mediated cytotoxicity.

Example 4 – LukE/D Mediated Targeting of CCR5 Cells is Blocked With Agonist, Antibodies and CCR5 Ligands CCR5 is a protein that has been highly studied because of its critical role in HIV-1 infection. Together with CD4, CCR5 is used by the virus to gain entry into cells.

The importance of CCR5 to HIV pathogenesis in humans is best highlighted by the identification of subjects that have a mutation in the CCR5 gene (i.e., Δ32CCR5) that prevent the surface exposure of CCR5. Patients with this mutation are highly refractory to HIV infection. Currently, a variety of CCR5 antagonist (e.g., peptide mimetics, antibodies, small molecules) are being tested in clinical trials to be used as anti-HIV drugs as well as anti-inflammatory agents.

To determine if targeting CCR5 blocks LukE/D, the effect of several CCR5 antagonist and ligands on the ability of LukE/D to kill CCR5 cells was evaluated.

Among the CCR5 antagonist, the drugs Selzentry/Celsentri/Maraviroc (MVC), Vicriviroc (VVC) and TAK-779 (TAK) were tested for inhibition of LukE/D activity. CCR5 Jurkat cells were pre-incubated with different concentrations of the antagonists, followed by intoxication with an equimolar mixture of LukE + LukD (LukE/D). These experiments indicated that all three CCR5 antagonists potently blocked LukE/D mediated cytotoxicity (Figure 4A). In addition, the potential of monoclonal antibodies directed against CCR5 to protect cells from LukE/D cytotoxicity was also evaluated following the experimental protocol described for the CCR5 antagonist. These experiments also revealed that several of the tested monoclonal antibodies were indeed able to block LukE/D (Figure 4B).

Lastly, the potential inhibitory effect of natural ligands of CCR5 was also evaluated.

CCR5 Jurkat cells were pre-incubated with different concentrations of RANTES, MIP- 1β, or a combination of equimolar mixture of RANTES+MIP-1β followed by intoxication with an equimolar mixture of LukE + LukD (LukE/D). These experiments also revealed that CCR5 ligands potently inhibit LukE/D cytotoxic effect (Figure 4C). Collectively, these findings indicate that the potent cytotoxic activity of LukE/D could be blocked by employing CCR5 antagonist and/or ligands.

Example 5 – Maraviroc Blocks LukE/D Binding To CCR5 Cells Preventing the Formation of LukE/D Pores To elucidate the mechanism by which LukE/D utilizes CCR5 to target and - + + kill host cells, Jurkat (CCR5 ) and CCR5 Jurkat (CCR5 ) cells were incubated with a GFP-fused LukE/D toxin ( LukE/D) and binding of the fluorescent toxin to the plasma membrane of the cells monitored by flow cytometry. These experiments revealed that LukE/D binds to CCR5 Jurkat cells but not to the parental CCR5 Jurkat cells (Figure 5A). To elucidate the mechanism by which Maraviroc inhibits LukE/D mediated cytotoxicity, CCR5 Jurkat cells were pre-incubated with Maraviroc (MVC) followed by incubation with the GFP-labeled LukE/D toxin and toxin binding to the cells evaluated by flow cytometry. These experiments indicated that Maraviroc potently inhibited LukE/D binding to CCR5 cells (Figure 5A).

To examine the mechanism by which LukE/D is toxic to CCR5 cells, cells were incubated in the presence or absence of Maraviroc and subsequently intoxicated with LukE/D in the presence of ethidium bromide, a small cationic dye that is normally impermeable to host cell membranes, but can gain access to host cells via the toxin pores.

These experiments revealed that LukE/D forms pores in the plasma membrane of CCR5 cells in a time-dependent manner. Importantly, Maraviroc (MVC) potently blocked LukE/D mediated pore formation (Figure 5B). In addition, LukE/D pores were associated with cell swelling, a characteristic of cells intoxicated with leukotoxins, a phenotype fully blocked by Maraviroc (MVC) (Figure 5C). Altogether, these findings indicate that LukE/D binds to host cells in a CCR5-dependent manner resulting in the formation of toxin mediated pores at the plasma membrane of target cells, leading to the observed LukE/D mediated cytotoxicity. Importantly, the CCR5 antagonist Maraviroc, potently inhibits LukE/D by blocking the interaction of LukE/D with the surface of CCR5 cells, thus preventing pore formation and cell death.

Example 6 – LukE/D Targets CCR5 to Kill Primary Human Lymphocytes, Macrophages, and Dendritic Cells

[0092] If CCR5 is the receptor of LukE/D, then primary host cells that their surfaces are decorated with CCR5 (e.g., T lymphocytes, macrophages, natural killer cells, dendritic cells, etc.) will be susceptible to LukE/D mediated cell death. To investigate this in more detail, primary human peripheral blood mononuclear cells (PBMC) were isolated from a wild type CCR5 (CCR5 ) donor and a Δ32CCR5 (CCR5 ) donor and the T lymphocytes expanded followed by intoxication with LukE/D and the viability of the cells determined by flow cytometry. Primary human T lymphocytes from CCR5 donor were highly susceptible to LukE/D (5.4% cell death in the media treated cells vs. 34% in LukE/D intoxicated cells; Figure 6A, top panel), an effect potently neutralized by Maraviroc (LukE/D vs. LukE/D + MVC; Figure 6A, top panel). In contrast, T lymphocytes from the Δ32CCR5 donor were highly refractory to LukE/D mediated cytotoxicity (Figure 6A, bottom panel).

[0093] In addition to T lymphocytes, the cytotoxic activity of LukE/D towards primary human macrophages and dendritic cells was also evaluated. Macrophages and dendritic cells were incubated with LukD (negative control), intoxicated with an equimolar mixture of LukE + LukD (LukE/D), or incubated with Maraviroc (MVC) followed by intoxication with an equimolar mixture of LukE + LukD (LukE/D). LukE/D but not LukD potently killed both macrophages (Figure 6B) and dendritic cells (Figure 6C). Importantly, the cytotoxic effect of LukE/D towards these phagocytes was potently neutralized by Maraviroc (LukE/D vs. LukE/D + MVC; Figures 6B and 6C). Collectively, these data indicate that LukE/D targets and kills primary human leukocytes that harbor CCR5 at their surfaces, and that the CCR5 antagonist Maraviroc potently block LukE/D cytotoxic effects. Thus, blockade of LukE/D with CCR5 antagonist and/or inhibitors will offer a new therapeutic option to prevent and treat S. aureus infection.

Although the invention has been described in detail for the purposes of illustration, it is understood that such detail is solely for that purpose, and variations can be made therein by those skilled in the art without departing from the spirit and scope of the invention which is defined by the following claims.

The term ‘comprising’ as used in this specification and claims means ‘consisting at least in part of’. When interpreting statements in this specification and claims which includes the ‘comprising’, other features besides the features prefaced by this term in each statement can also be present. Related terms such as ‘comprise’ and ‘comprised’ are to be interpreted in similar manner.

In this specification where reference has been made to patent specifications, other external documents, or other sources of information, this is generally for the purpose of providing a context for discussing the features of the invention. Unless specifically stated otherwise, reference to such external documents is not to be construed as an admission that such documents, or such sources of information, in any jurisdiction, are prior art, or form part of the common general knowledge in the art.

Claims (9)

WHAT IS CLAIMED:

1. Use of a CCR5 antagonist in the manufacture of a medicament for 5 the treatment of an infection caused by a lukE/D strain of Staphylococcus aureus in a subject.

2. The use of claim 1, wherein the CCR5 antagonist is selected from the group consisting of maraviroc, vicriviroc, NCB-9471, PRO-140, CCR5 mAb004, 8-[4- 10 (2-butoxyethoxy)phenyl]isobutyl-N-[4-[[(1-propyl-1H-imadazolyl- )methyl]sulphinyl]phenyl]-1,2,3,4-tetrahydrobenzacocinecarboxamide, methyl1- endo-{8-[(3S)(acetylamino)(3-fluorophenyl)propyl]azabicy- clo[3.2.1]octyl}- 2-methyl-4,5,6,7-tetrahydro-1H-imidazo[4,5-c]pyridine-- 5-carboxylate, methyl 3-endo- {8-[(3S)(acetamido)(3-fluorophenyl)propyl]azabicyclo[3.2.- 1]octyl} 15 methyl-4,5,6,7-tetrahydro-3H-imidazo[4,5-c]pyridinecarbox- ylate, ethyl 1-endo-{8- [(3S)(acetylamino)(3-fluorophenyl)propyl]azabicyclo[3.- 2.1]octyl}methyl- 4,5,6,7-tetrahydro-1H-imidazo[4,5-c]pyridinecarb- oxylate, and N-{(1S)[3-endo-(5- isobutyrylmethyl-4,5,6,7-tetrahydro-1H-imidazo[4,- 5-c]pyridinyl) azabicyclo[3.2.1]octyl](3-fluorophenyl)propyl}ac- etamide).

3. The use of claim 1 or claim 2, wherein the medicament further comprises an agent selected from the group consisting of an anti-infective agent, an antibiotic agent, and an antimicrobial agent. 25

4. The use of any one of claims 1 to 3, wherein the Staphylococcus aureus infection is a methicillin-resistant S. aureus (MRSA) infection or methicillin sensitive S. aureus (MSSA) infection.

5. The use of any one of claims 1 to 4, wherein, when administered, 30 the medicament is administered more than once.

6. The use of any one of claims 1 to 4, wherein the medicament is formulated for repeat administration.

7. The use of any one of claims 1 to 4, wherein the medicament is to be administered more than once. 5

8. The use of any one of claims 1 to 7, wherein the medicament comprises a therapeutically effective amount of CCR5 antagonist.

9. A use accordingly to any one of claims 1 to 8, substantially as herein described with reference to any example thereof.