[0001] The present invention relates to a recombinant blood coagulation factor IX (rFIX)
mutant having factor VIII (FVIII) independent factor X (FX) activation potential,
cell cultures expressing the rFIX mutant, and a pharmaceutical composition for treating
a bleeding disorder comprising said rFIX mutant.
[0002] The blood coagulation cascade involves a series of serine protease enzymes (zymogens)
and protein cofactors. When required, an inactive zymogen precursor is converted into
the active form, which consequently converts the next enzyme in the cascade.
[0003] The cascade is divided into three distinct segments: the intrinsic, extrinsic, and
common pathways (
Schenone et al., Curr Opin Hematol. 2004;11:272-7). The activation of factor X (FX) is the common point of the intrinsic and extrinsic
pathways. The activation occurs either by the extrinsic complex formed by activated
factor VII (FVIIa) and tissue factor, or by the intrinsic tenase complex composed
of activated Factor IXa (FIXa) and activated Factor VIIIa (FVIIIa) (
Mann, Thromb. Haemostasis 1999;82:165-74).
[0004] Activated FX along with phospholipids, calcium, and factor Va (FVa) then converts
prothrombin to thrombin (prothrombinase complex), which in turn cleaves fibrinogen
to fibrin monomers. The monomers polymerize to form fibrin strands. Factor Xllla (FXIIIa)
covalently bonds these strands to one another to form a rigid mesh.
[0005] Deficiencies of the components of the intrinsic tenase complex, FVIIIa and FIXa,
lead to severe bleeding disorders, hemophilia A and B, respectively. Hemophilia A
is considered the classic form of hemophilia, whereas hemophilia B is also known as
Christmas disease. Hemophilia A and B are the consequence of congenital deficiencies
of FVIII and FIX, respectively. The worldwide incidence of hemophilia A is approximately
1 case per 5,000 male individuals and of hemophilia B 1 case per 30,000.
[0006] Originally patients with severe hemophilia had a shortened lifespan and diminished
quality of life that was greatly affected by hemophilic arthropathy. But life expectancy
has increased from 11 years before the 1960s for patients who were severely affected
to more than 50-60 years by the early 1980s. This has been accomplished through the
widespread use of replacement therapy.
[0007] Nowadays the treatment of choice for the management of hemophilia A is replacement
therapy with various plasma derived or recombinant FVIII concentrates. Although progress
in the production of FVIII to ensure purity, efficacy and viral safety has been made
over the past decades, some limitations remain. First of all, severe hemophilia A
patients are frequently affected by anti-FVIII inhibitor antibody formation, thus
rendering the therapy ineffective. Approximately 30% of patients with severe hemophilia
A develop alloantibody inhibitors that can neutralize FVIII (
Hay, Haemophilia 2006;12 Suppl 6:23-9,
Peerlinck and Hermans, Haemophilia 2006;12:579-90). Furthermore, acquired hemophilia may occur which is the development of FVIII antibody
inhibitors in persons without a history of FVIII deficiency.
[0008] Attempts to overwhelm the inhibitors with large doses of human FVIII have been tried.
Also porcine FVIII which has low cross-reactivity with human FVIII antibody has been
administered. More frequently, FVIII-bypassing agents, including FEIBA (factor eight
inhibitor bypassing activity), FIX complex and FVIIa have also been used.
[0009] Modification of the functional activity of the tenase complex would also be an elegant
approach to address several of the above discussed issues in hemophilia treatment,
i.e., deficiency of FVIII or FIX and inhibitor development.
[0010] In the tenase complex FIXa has critical importance (
Rawala-Sheikh et al., Biochemistry 1990;29:2606-11). FIXa is a two-chain vitamin K-dependent serine protease capable of hydrolysing
the Arg194-IIe195 peptide bond in the FX molecule which leads to its activation (
Venkateswarlu et al., Biophys. J. 2002;82:1190-206). Although this reaction can proceed slowly in solution, it is significantly accelerated
in the presence of negatively charged phospholipid surfaces.
In vivo, these surfaces are mainly provided by activated platelets and plasma lipoproteins.
The rate of the reaction is increased further by the presence of FVIIIa.
[0011] FIXa exhibits very low catalytic activity in an
in vitro system lacking either the co-factor FVIIIa or the physiologic substrate FX. This
is in contrast to the closest related homologue, FXa, which shows significant activity
towards peptide substrates (in addition to its physiologic substrate prothrombin),
independent of its co-factor protein FVa. Thus the drawback of the sophisticated regulation
of this enzymatic system is that failure of a single component such as FVIIIa or the
development of inhibitors suffices to interrupt the functional activity of the tenase
apparatus.
[0012] An improved FIX protein, which has improved FVIII-independent FX activation potential
could avoid this issue. Several amino acid residues of FIXa are already known to be
important for regulation of enzymatic activity and interaction with both FVIIIa and
FX.
[0013] The surface loop 99 of FIXa is important for regulation of FIXa activity (
Hopfner et al., Structure Fold Des. 1999;7:989-96). In the non-complexed FIXa this loop is stabilized in an inactive conformation and
limits access of substrate to the catalytic machinery.
[0014] The mutations Y94F and K98T are located on the 99-loop, known to contribute to FX
substrate binding by forming of the recognition site of the S2 and S4 pockets of FX.
Y177F mimics the effect of activation by FVIIIa. Tyrosin 177 locks the 99-loop in
an inactive conformation, which is released by binding of FVIIIa to FIXa (
Sichler et al., J Biol Chem. 2003; 278:4121-26).
[0015] Val 213 and Gly 219 are conserved amino acids in most other trypsin-like proteases,
and a double mutant of truncated FIX (I213V-E219G) expressed in
E.
coli showed increased amidolytic activity of FIXa (
Hopfner et al., EMBO J. 1997;16:6626-35).
[0016] However, in none of these publications full length FIX mutants expressed in mammalian
cells showed an improved functional activity in a meaningful activated partial thromboplastin
time (aPTT) assay in FVIII-depleted plasma or FVIII-inhibitor-patient plasma.
[0017] In this context, Kolkman and Mertens (
Kolkman, J. A. and Mertens, K., Biochemistry, 29(25), 2000, pp. 7398-7405) describes mutations in the loop 256-268 of FIX and the functional relevance thereof.
Further, Christophe
et al. (
Christophe, O. D. et al., Journal of Biological Chemistry, 273(1), 1998, pp. 222-227) describes the relevance of residues 78 and 94 of FIX for the interaction of FIX
an FVIII.
[0018] Thus, there remains a great need in the art for compositions and methods that provide
an improved FIX molecule that can be used for treatment of patients with hemophilia
A.
[0019] It was the inventive task of the present invention to develop novel FIX proteins
by introduction of amino acid exchanges, which have improved FVIII-independent FX
activation potential with coagulation FVIII activity useful for the treatment of bleeding
disorders.
[0020] The present invention relates to a recombinant blood coagulation factor IX (rFIX)
mutant having factor VIII (FVIII) independent factor X (FX) activation potential wherein
the amino acid sequence of the rFIX mutant is SEQ ID NO: 10 (FIX-Y94F/K98T/Y177F/I213V/E219G).
Five full length FIX proteins with novel combinations of mutations of amino acids
important for functional activity of FIX, i.e. SEQ ID NO 4 (FIX-Y94F/K98T), SEQ ID
NO 6 (FIX-Y94F/K98T/Y177F), SEQ ID NO 8 (FIX-Y94F/A95aK/K98T/Y177F), SEQ ID NO 10
(FIX-Y94F/K98T/Y177F/I213V/E219G) and SEQ ID NO 12 (FIX-Y94F/A95aK/K98T/Y177F/1213V/E219G)
and SEQ ID NO 2 (FIX wild type) were cloned, expressed in HEK 293 and purified by
a three step purification protocol using anion exchange chromatography, pseudo-affinity
chromatography and affinity chromatography. Pre-activated FIX was removed with biotinylated
chloromethylketones and streptavidine-sepharose. Among other assays the proteins were
tested by an activated partial thromboplastin time (aPTT) assay in FVIII-depleted
plasma as well as FVIII-inhibited patient plasma. In FVIII-depleted plasma functional
activity of a rFIX mutant was calculated as increased FVIII equivalent activity. PdFIX
and FIX-WT had no or only a minor FVIII equivalent activity. From the 5 mutated proteins
(at 5 µg/ mL) FIX-Y94F/K98T and FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G had the greatest
effect with 14.7 and 16 FVIII equivalent mU/mL, and FIX-Y94F/K98T/Y177F/I213V/E219G
resulted in 12 FVIII equivalent mU/mL. In FVIII-inhibited patient plasma the FEIBA
equivalent activity was calculated for analysis of FVIII independent FX activation
potential. PdFIX and FIX-WT had no or only a minor FEIBA equivalent activity. The
best rFIX mutant FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G showed a FEIBA equivalent activity
of 162 mU/mL, FIX-Y94F/K98T and FIX-Y94F/K98T/Y177F/I213V/E219G had both approximately
115 FEIBA equivalent mU/mL. After pre-activation the rFIX proteins were tested in
FIX-depleted plasma containing inhibitors. At 1 µg/mL FIXa-Y94F/K98T/Y177F/I213V/E219G
displayed 73.4 times the activity of pdFIXa, whereas FIXa-Y94F/A95aK/K98T/Y177F/I213V/E219G
had a 17.1-fold increased activity. Therefore the rFIX mutants can be used for the
treatment of bleeding disorder associated with functional defects of FVIII, deficiencies
of FVIII, or anti-FVIII inhibitor antibody formation.
[0021] The present invention relates to a mutated recombinant blood coagulation FIX protein
having an improved FVIII independent FX activation potential as compared to wild type
FIX (FIX-WT) or plasma derived FIX (pdFIX), wherein the amino acid sequence of the
rFIX mutant is SEQ ID NO: 10 (FIX-Y94F/K98T/Y177F/I213V/E219G).
[0023] The rFIX mutant according to the present invention may be derived from any vertebrate,
e.g. a mammal.
[0024] According to the present invention, the term "FIX" does not underlie a specific restriction
and may include any FIX, with heterologous or naturally occurring sequences, obtained
via recombinant DNA technology, or a biologically active derivative thereof. Accordingly,
the term "rFIX mutant" includes any recombinant mutant derived from a FIX protein
sequence of any of the foregoing FIX. Accordingly, a FIX polynucleotide or polypeptide
sequence of the present invention is typically derived from a mammalian FIX sequence
including, but not limited to, primate, e.g., human; rodent, e.g., rat, mouse, hamster;
cow, pig, horse, sheep, or any other mammalian sequence. In one specific example of
the present invention, the rFIX mutant is a recombinant mutant of human FIX. Polynucleotide
and polypeptide sequences of the FIX can be found for example in the UniProtKB/Swiss-Prot
Accession No. P00740. The mutated rFIX of the invention may be a mutated full length
or truncated FIX. In a preferred embodiment of the present invention the mutated rFIX
has a full length sequence. In the present invention the chymotrypsinogen numbering
within the serine protease domain was used according to
Hopfner et al. (EMBO J. 1997;16:6626-35).
[0025] A wide variety of vectors can be used for the preparation of a rFIX mutant according
to the present invention and can be selected from eukaryotic and prokaryotic expression
vectors. Examples of vectors for prokaryotic expression include plasmids such as pRSET,
pET, pBAD, etc., wherein the promoters used in prokaryotic expression vectors include
lac, trc, trp, recA, araBAD, etc. Examples of vectors for eukaryotic expression include:
(i) for expression in yeast, vectors such as pAO, pPIC, pYES, pMET, using promoters
such as AOX1, GAP, GAL1, AUG1, etc; (ii) for expression in insect cells, vectors such
as pMT, pAc5, pIB, pMIB, pBAC, etc., using promoters such as PH, p10, MT, Ac5, OpIE2,
gp64, polh, etc., and (iii) for expression in mammalian cells, vectors such as pSVL,
pCMV, pRc/RSV, pcDNA3, pBPV, etc., and vectors derived from viral systems such as
vaccinia virus, adeno-associated viruses, herpes viruses, retroviruses, etc., using
promoters such as CMV, SV40, EF-1, UbC, RSV, ADV, BPV, and β-actin.
[0026] A mutated rFIX according to the present invention may be produced by any method known
in the art, for example any method applicable to non-mutated rFIX. An example was
first published by
Kaufman et al. (J Biol Chem. 1986;261:9622-8). An example of a commercially available rFIX is BeneFIX® manufactured by Genetics
Institute. The production of a rFIX mutant may include any method for the generation
of recombinant DNA by genetic engineering, e.g. via reverse transcription of RNA and/or
amplification of DNA.
[0027] A nucleic acid sequence encoding a mutant rFIX protein according to the invention
may be generated by any method known in the art. Examples are polymerase chain reaction
(PCR) and cloning methods. In a preferred embodiment of the present invention the
DNA encoding a mutant protein of the invention is generated by
in vitro mutagenesis using specific primers to generate the respective mutations.
[0028] Additionally, the recombinant DNA coding for a mutant rFIX according to the present
invention, e.g. a plasmid, may also contain a DNA sequence encoding a selectable marker
for selecting the cells which have been successfully transfected with the plasmid.
In an example of the present invention, the plasmid may also confer resistance to
a selectable marker, e.g. to the antibiotic drug hygromycin, by delivering a resistance
gene, e.g. the hygromycin resistance gene conferring resistance to the marker.
[0029] The production of a rFIX mutant may include any method known in the art for the introduction
of recombinant DNA into eukaryotic cells by transfection, e.g. via electroporation
or microinjection. For example, the recombinant expression of human FIX mutant can
be achieved by introducing an expression plasmid containing the human FIX mutant encoding
DNA sequence under the control of one or more regulating sequences such as a strong
promoter, into a suitable host cell line by an appropriate transfection method resulting
in cells having the introduced sequences stably integrated into the genome. The lipofection
method is an example of a transfection method which may be used according to the present
invention.
[0030] The production of a rFIX mutant may also include any method known in the art for
the cultivation of said transformed cells, e.g. in a continuous or batchwise manner,
and the expression of the rFIX mutant, e.g. constitutive or upon induction. In one
specific example of the present invention the nucleic acid coding for rFIX mutant
contained in the host organism of the present invention is expressed via an expression
mode selected from the group consisting of induced, transient, and permanent expression.
Any expression system known in the art or commercially available can be employed for
the expression of a recombinant nucleic acid encoding rFIX mutant, including the use
of regulatory systems such as suitable, e.g. controllable, promoters, enhancers etc.
[0031] The production of a rFIX mutant may also include any method known in the art for
the isolation of the protein, e.g. from the culture medium or by harvesting the transformed
cells. For example, the rFIX mutant-producing cells can be identified by isolating
single-cell derived populations, i.e. cell clones, via dilution after transfection
and optionally via addition of a selective drug to the medium. After isolation the
identified cell clones may be cultivated until confluency in order to enable the measurement
of the rFIX mutant content of the cell culture supernatant by enzyme-linked immunosorbent
assay (ELISA) technique. Additionally, rFIX mutant secreted by the cells may be identified
for example by growing the cells in the absence of any growth promoting fetal serum
or components thereof. Vitamin K is added at appropriate concentrations to improve
the functional properties of the rFIX mutant protein. After identification, high rFIX
mutant producing cell clones may for example be further propagated and/or stored via
cryopreservation. The rFIX mutant may be also co-expressed with vitamin K reductase
complex subunit 1 (VKORC1,
Hallgren et al., Biochemistry 2006;45:5587-98) and/or furin (
Wasley et al. J Biol Chem. 1993;268: 8458-65).
[0032] The host cell type according to the present invention may be any eukaryotic cell.
In a preferred embodiment the cell is a mammalian cell with the ability to perform
posttranslational modifications of rFIX mutant. For example said mammalian cell is
derived from a mammalian cell line, like for example a cell line selected from the
group consisting of SkHep-, CHO-, HEK293-, and BHK-cells. In a specific example of
the present invention, the rFIX mutant is expressed in HEK293-derived cells.
[0033] There is no particular limitation to the media, reagents and conditions used for
culturing the cells in the cell culture of the present invention including culturing
the cells in a continuous or batch-wise manner. The cells may be cultured also under
serum-free or serum- and protein-free conditions. In a specific example of the present
invention the cells are cultured in a mixture of Dulbecco's modified Eagle's Medium
and F-12 medium.
[0034] Additionally, the production of a rFIX mutant may include any method known in the
art for the purification of rFIX mutant, e.g. via anion exchange chromatography or
affinity chromatography. In one preferred embodiment rFIX mutant can be purified from
cell culture supernatants by anion exchange chromatography, tandem-pseudoaffinity
and affinity chromatography. The purified rFIX mutant may be analyzed by methods known
in the art for analyzing recombinant proteins, e.g. the ELISA technique and by electrophoresis
techniques including immuno-blotting.
[0035] The term "FVIII independent FX activation potential" as used herein means the functional
activity of a rFIX mutant of the present invention and any other rFIX mutant protein
which may be assessed for example by measuring activated partial thromboplastin time
(aPTT).
[0036] The aPTT assays represent meaningful assays for testing the functional activity of
a mutant rFIX protein because they measure the clotting time in plasma. In principle
the clotting activity of any compound is determined by its addition to plasma samples
and measurement of time to clotting. This can be carried out for example in plasma
depleted with a protein or in plasma from inhibitor patients.
[0037] A variety of methods for an aPTT may be possible. In one preferred embodiment of
the present invention the aPTT is measured in FVIII depleted plasma samples. The FVIII
independent FX activation potential of a FIX mutant may be calculated in FVIII-depleted
plasma as increased FVIII equivalent activity. PdFIX and FIX-WT usually have no or
only a minor FVIII equivalent activity (between 0 mU/mL and 1 mU/mL). Thus any amino
acid mutation leading to an increased FVIII equivalent activity as compared to pdFIX
or FIX-WT can be defined as increase. In a preferred embodiment of the present invention
the increased activity of a rFIX mutant is at least 2 mU/mL, and more preferably more
than 5 mU/mL.
[0038] In another preferred embodiment the FEIBA equivalent activity in FVIII-inhibited
patient plasma can be used for analysis of FVIII independent FX activation potential.
PdFIX and FIX-WT usually have no or only a minor FEIBA equivalent activity (between
0 mU/mL and 15 mU/mL). Any increase in FEIBA equivalent activity as compared to pdFIX
or FIX-WT can be defined as increase. In a preferred embodiment of the present invention
the increased activity is at least 30 mU/mL, and more preferably more than 80 mU/mL.
[0039] In a further preferred embodiment the activity of a pre-activated FIX mutant protein
is determined in a clotting assay in FIX-depleted plasma containing FVIII inhibitors.
FIXa equivalent amounts can be calculated from clotting times of a calibration curve
made with pdFIXa. In a preferred embodiment of the present invention the activity
of a rFIX mutant is increased at least 10 fold and more preferably 15 fold as compared
to pdFIX.
[0040] Another aspect of the present invention relates to a pharmaceutical composition comprising
the rFIX mutant of the present invention having a FVIII independent FX activation
potential for treating a bleeding disorder associated with functional defects of FVIII
or deficiencies of FVIII.
[0041] The pharmaceutical composition may further comprise an auxiliary agent, e.g. selected
from the group consisting of a pharmaceutically acceptable carrier, diluent, salt,
buffer, or excepient. Said pharmaceutical composition can be used for treating the
above-defined bleeding disorders. The pharmaceutical composition of the invention
may be a solution or a lyophilized product.
[0042] As used herein, the term "pharmaceutically acceptable" means approved by a regulatory
agency of US or EU government or listed in the U.S. Pharmacopeia or other generally
recognized pharmacopeia for use in animals, and more particularly in humans.
[0043] The pharmaceutical composition of the present invention can be used in a method for
treating a bleeding disorder associated with functional defects of FVIII or deficiencies
of FVIII comprising the step of administering the pharmaceutical composition comprising
a rFIX mutant having a FVIII independent FX activation potential to a patient in need
thereof.
[0044] The expression "bleeding disorder associated with functional defects of FVIII or
deficiencies of FVIII" as used herein includes bleeding disorders, wherein the cause
of the bleeding disorder may be selected from the group consisting of a shortened
in vivo-half-life of FVIII, altered binding properties of FVIII, genetic defects of
FVIII, and a reduced plasma concentration of FVIII. Genetic defects of FVIII comprise
for example deletions, additions and/or substitution of bases in the nucleotide sequence
encoding FVIII whose absence, presence and/or substitution, respectively, has a negative
impact on the activity of FVIII. FVIII inhibitor development may be also responsible
for defects in FVIII function. In one example of the present invention, the bleeding
disorder is hemophilia A.
[0045] The route of administration does not exhibit particular limitations, and in one embodiment
the protein of the present invention may be administered by injection, such as intravenous,
intramuscular, or intraperitoneal injection. In a preferred embodiment of the present
invention the pharmaceutical composition may be administered intravenously.
[0046] The present invention will be further illustrated in the following examples, without
any limitation thereto.
Figure 1 shows the structure of the rFIX mutant cloning and expression vector
Figure 2 shows a SDS-PAGE and Western Blot analysis of mutated rFIX proteins
Figure 3 shows the FX activation by mutated rFIXa proteins
Figure 4 shows the aPTT assay of mutated rFIX proteins in FVIII-depleted plasma
Figure 5 shows the aPTT assay of mutated rFIX proteins in FVIII inhibited patient plasma
Figure 6 shows the aPTT assay of activated mutated rFIX proteins in FIX depleted and FVIII
inhibited plasma
EXAMPLES
Example 1: Mutagenesis of FIX and Construction of FIX Expression Vectors
[0047] Publications referenced above discussing amino acid residues important for the activation
of FX by FIX and own considerations were used for the construction of mutated FIX
proteins. Two of the FIXa mutations are located on the 99-loop, known to contribute
to substrate binding by forming the S2 and S4 substrate recognition site. The third
FIXa mutation, Y177T, is placed adjacent to the S4 site. Furthermore, in FXa the 99-loop
and 60-loop, both known to be highly involved in substrate recognition, are stabilized
by an inter-loop interaction between the side chains of residues Y60 and K96, which
might contribute to the high amidolytic activity of FXa. Exchanging Ala-95a by Lys
in FIXa should yield in a salt bridge between A95aK and Glu-60 which might influence
the activity of FIXa similar to that of FXa. Finally five FIX-mutants with different
mutation combinations, i.e. SEQ ID NO 4 (FIX-Y94F/K98T), SEQ ID NO 6 (FIX-Y94F/K98T/Y177F),
SEQ ID NO 8 (FIX-Y94F/A95aK/K98T/Y177F), SEQ ID NO 10 (FIX-Y94F/K98T/Y177F/I213V/E219G)
and SEQ ID NO 12 (FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G) were cloned in addition to
SEQ ID NO 2 (FIX-WT). The respective SEQ ID NOs for the encoding nucleic acids are
SEQ ID NO 3 (FIX-Y94F/K98T), SEQ ID NO 5 (FIX-Y94F/K98T/Y177F), SEQ ID NO 7 (FIX-Y94F/A95aK/K98T/Y177F),
SEQ ID NO 9 (FIX-Y94F/K98T/Y177F/I213V/E219G), SEQ ID NO 11 (FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G),
and SEQ ID NO 1 (FIX-WT).
[0048] For the construction of the rFIX plasmids the FVIII cDNA from pCMVrFVIIIdB928/EDHPro
(
Herlitschka et al., J Biotechnol. 1998;61:165-73) was replaced by human FIX cDNA. The FIX cDNA encodes a polymorphism of human FIX
leading to an amino acid exchange of Thr to Ala at position 194 in the activation
peptide. The vector map of the plasmid is shown in Figure 1. A schematic of the transcription
unit, containing the human cytomegalovirus (CMV) promoter/enhancer, the gene of interest
(human FIX cDNA), an internal ribosomal entry site (EMCV IRES), the selection marker,
the SV40 intron and the polyadenylation site is shown. The marker is a chimeric construct,
consisting of the wild-type dihydrofolate reductase cDNA and the hygromycin phosphotransferase
gene fused in frame.
[0049] For the construction of cDNA encoding FIX-Y94F/K98T, FIX-Y94F/K98T/Y177F, FIX-Y94F/A95aK/K98T/Y177F,
FIX-Y94F/K98T/Y177F/I213V/E219G and FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G site-directed
mutagenesis was performed using the QuickChange Site-Directed Mutagenesis Kit (Stratagene,
La Jolla, CA, USA). All PCR reactions contained 125 ng sense primer, 125 ng antisense
primer (Invitrogen, Carlsbad, CA, USA) and 5-50 ng dsDNA template, 2.5 units of PfuTurbo
DNA polymerase and dNTPs in a final volume of 50 µL reaction buffer provided by the
kit. After a pre-denaturation step of 1 minute at 95°C PfuTurbo DNA Polymerase was
added followed by 18 cycles of 95°C for 30 seconds, 55°C for 60 seconds and 68°C for
12 minutes. The amplified product was incubated for 1 hour at 37°C with
Dpnl to digest the methylated parental double stranded DNA before transformation into
XL1-Blue Supercompetent Cells. For the construction of multiply mutated FIX cDNA this
procedure was repeated with the according primers (Invitrogen) as shown in Table 1.
The mutant FIX constructs were digested with restriction enzymes
BsrGI and Xmal (New England Biolabs, Ipswich, MA, USA) and subsequently ligated into
the parental expression vector. Final FIX constructs were sequenced (Applied Biosystems
Model 373A Sequencer Applied Biosystems, Foster City, CA) to confirm the mutations
and were then linearized by
AspEI for transfection.
Example 2: Expression of Recombinant FIX Proteins
[0050] All recombinant FIX proteins were expressed in 293 human embryo kidney cells (HEK293)
using plasmids containing the human FIX-WT cDNA or mutated FIX cDNA and a hygromycin
selection marker.
[0051] HEK 293 cells were grown in a mixture of Dulbecco's modified Eagle's Medium and F-12
medium supplemented with 5% fetal calf serum. Transfection was performed by lipofection
using Lipofectamine™2000 reagent (Invitrogen). One to 2 days before transfection HEK
293 cells were seeded on 5 cm dishes to reach a confluence of 70-80 %. On the day
of transfection the medium was exchanged 2 hours prior to the procedure. Six µg of
FIX cDNA were transfected according to the recommended protocols. After 6 hours, fresh
medium was added and the cells were cultured for 1 to 2 days before passaging into
15 cm dishes and selection of transfected cells with medium containing hygromycin
at a concentration of 200 µg/mL. Two to 3 weeks later, the surviving foci were isolated
into 24-well dishes in selective medium to produce stable cell lines. Each clone was
grown to confluence in the presence of 5 µg/mL vitamin K1, and the secretion of FIX
antigen into the medium was measured by an ELISA. FIX secreted by high-producer clones
was additionally assayed in one-stage activated partial thromboplastin time assays
(aPTT) and visualized on Western blots.
[0052] The best cell lines were selected for large-scale production in one-liter spinner
flasks. Therefore cells were grown on 15 cm dishes to 90 % confluence, trypsinized
and counted in a CASY cell counter with a 150 µm capillary (Schärfe Systems, Reutlingen,
Germany). 500 mL stirred spinner flasks (60 rpm) were inoculated with 10
6 cells/ mL in 200 mL medium without fetal calf serum and supplemented with 5 µg/mL
vitamin K1 and 100 µg/mL hygromycin. The medium was expanded to a final volume of
1000 mL over the next few weeks depended on the rate of growth of the cells. The culture
medium was collected twice weekly. Before storage at -20°C the culture medium was
centrifuged and sterile filtrated (GP EXPRESS PLUS Membrane, SCGPT05RE, Millipore
Corporation, Billerica, MS, USA) to remove cells and debris. The supernatant contained
between 0.4 and 1 µg/mL rFIX antigen. rFIX-WT produced 2.6 µg/mL.
[0053] FIX antigen levels were determined by a double antibody sandwich ELISA. Therefore
a sheep anti-human FIX affinity purified IgG (SAFIX-AP, Affinity Biologicals Inc.,
Ancaster, ON, Canada) was diluted in Tris-buffered saline (TBS, 25 mM Tris/HCl pH
7.4, 150 mM NaCl) to a concentration of 2 µg/mL and dispensed in 100 µL aliquots into
the wells of a 96-well Nunc Maxisorp plate (Nunc, Roskilde, Denmark) which was then
kept at 4°C over night. The plate was washed 3 times with TBST (TBS + 0.1% (v/v) Tween
20) followed by 1 hour blocking with 250 µL 3% non-fat dry milk powder (DMP) in TBS
per well. The plate was then washed and 100 µL of FIX-dilution in 1 % DMP in TBST
were distributed in the wells. Serial dilutions of pdFIX (Enzyme Research Laboratories,
South Bend, IN, USA) were used as standard protein. The plate was incubated for 2
hours and then washed 5 times. Rabbit anti-human FIX IgG (Accurate Chemical & Scientific
Corp., Westbury, NY, USA) was diluted in TBST/1 % DMP in a ratio of 1 to 6,000 and
added to each well in 100 µL aliquots for 1 hour. After 5 washing steps 100 µL of
a goat anti-rabbit IgG (H+L) horseradish peroxidase (HRP)-conjugate (Bio-Rad Laboratories,
Hercules, CA, USA) diluted 1 to 3,000 in TBST/1 % DMP was added and incubated for
1 hour. Unbound conjugated antibody was removed by washing the plate 5 times. The
addition of 100µL 0.4 mg/mL o-phenylenediamine (OPD, Sigma, St. Louis, MO, USA) and
0.4 mg/mL urea hydrogen peroxide in 50 mM phosphate-citrate pH 5.0 started the color
development. After an incubation time of 7.5 min the reaction was stopped by the addition
of 50 µL 0.5 N H2SO
4. The absorbance at 492 nm was measured in an ELISA reader (Labsystems iEMF Reader
MF, Vantaa, Finland).
Example 3: Purification of Recombinant FIX Proteins
[0054] FIX proteins from serum-free conditioned medium were ultrafiltrated, purified by
anion exchange chromatography, tandem-pseudoaffinity and affinity chromatography and
polished by inactivation and removal of preactivated rFIX. All purification steps
have been carried out on the chromatographic system Äkta™Explorer 100 Air (Amersham
Biosciences, Umea, Sweden) at 4°C.
[0055] The collected frozen serum-free culture medium from rFIX expression was supplemented
with 2 mM benzamidine and thawed at room temperature. The pooled supernatants of each
rFIX construct were concentrated on a Sartorius UDF system using a 0.7 m
2 polyvinylidene-difluorid (PVDF) membrane with a 10 kDa molecular weight cut off.
The system was run with a flow of 330 mUmin.
[0056] Recombinant FIX was captured from culture medium by anion exchange chromatography
on Q-Sepharose Fast Flow in a XK26/60 column (Amersham). The matrix was equilibrated
with 20 mM Tris/HCl pH 7.4 containing 0.1 % Tween 80, 2 mM benzamidine and 2 mM ethylenediamine
tetraacetic acid (EDTA). UDF-filtrates supplemented with 2 mM EDTA were applied to
the column at a rate of 23 cm/h. The column was reequilibrated and washed with 20
mM Tris/HCl pH 7.4, 0.1 % Tween 80, 200 mM NaCl, 2 mM benzamidine, 2 mM EDTA at 34
cm/h. The protein was eluted with 400 mM NaCl in equilibration buffer at the rate
of 23 cm/h.
[0057] Tandem chromatography comprised a Ca
2+-filtration of FIX on Q-Sepharose Fast Flow in a XK26/20 column followed by pseudoaffinity
chromatography on Cellufine™ Sulfate (Chisso Corporation, Tokyo, Japan) in a XK26/20
column. The columns were switched on-line at sample application and reequilibration.
Washing and elution was performed with the Cellufine™ Sulfate-column alone. The samples
were equilibrated with 20 mM Tris/HCl pH 7.4, 100 mM NaCl, 0.1 % Tween 80, 2 mM benzamidine,
and 20 mM CaCl
2. The elution-fraction of capture anion exchange chromatography diluted with equilibration-buffer
containing 20 mM CaCl
2 with a conductivity of 16 mS/cm was applied onto the columns at 23 cm/h. After re-equilibration
of both columns the Cellufine™ Sulfate column was washed with 20 mM Tris/HCl pH 7.4,
200 mM NaCl, 0.1 % Tween 80, 2 mM benzamidine and 1 mM CaCl
2. rFIX was eluted in a linear NaCl gradient from 200 to 1000 mM in washing buffer
at a rate of 23 cm/h.
[0058] For affinity chromatography elution fractions of tandem chromatography were concentrated
and buffer exchanged in Centriprep Ultracel YM-10 (Millipore, Bedford, MA, USA) at
2800 g and 8°C. The retentate, supplemented with 10 mM CaCl
2, 40 mM MgCl
2 and 1 mM benzamidine, was applied to a HR 16/10 column containing a Ca
2+ dependent monoclonal antibody against human FIX light chain (American Diagnostica
Inc., Stamford, CT, USA) coupled to NHS-acitivated Sepharose Fast Flow (Amersham)
at 38 cm/h. The matrix was equilibrated before and after sample application with 25
mM Tris pH 7.4, 150 mM NaCl, 10 mM CaCl
2 and 10 mM MgCl
2. For the next washing step the salt concentration was increased to 1000 mM NaCl.
rFIX was eluted with 25 mM Tris pH 7.4, 150 mM NaCl and 20 mM EDTA at a rate of 38
cm/h: The matrix was regenerated after each chromatography run with 25 mM Tris pH
7.4, 1000 mM NaCl and 20 mM EDTA.
[0059] The removal of preactivated rFIX was achieved by incubation of rFIX-solutions with
a fifteen fold molar excess of the two biotinylated inhibitors Biotinyl-ε-aminocaproyl-D-Phe-Pro-Arg-chloromethylketone
(BFPRCK, Bachem, Bubendorf, Switzerland) and Biotinyl-Glu-Gly-Arg-chloromethylketone
(BEGRCK, Haematologic Technologies Inc., Essex Junction, VT, USA) over night at 4°C.
FIX-Y94F/K98T was not treated with chloromethylketones.
[0060] rFIX fractions were supplemented with 0.1% ovalbumin and dialyzed in a Slide-A-Lyzer
MWCO 10 kDa (Pierce, Rockford, IL, USA) against TBS before streptavidin-sepharose
(Amersham) was added in excess to the chloromethylketones. Complexes of streptavidin-sepharose
with biotinylated rFIX-chloromethylketones were formed at 4°C. These complexes were
removed by 10 minute centrifugation at 4000 g and 4°C.
Example 4: Western Blot Analysis of Recombinant FIX Proteins
[0061] For Western blot analysis approximately 800 ng of proteins were separated by a 4-20%
sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE). Gels were either
stained with Coomassie solution (Figure 2 A) or electro-blotted at 0.8 mA/cm
2 for 60 minutes to a Hybond-C-Extra nitrocellulose membrane using a Hoefer TE77 SemiPhor
Semi-Dry Transfer Unit (Amersham). For the detection of FIX and fragments of FIX a
1:6,000 dilution of rabbit anti-human FIX IgG (Accurate Chemical & Scientific Corp.,
Westbury, NY, USA) as first antibody and a 1:3,000 dilution of goat anti-rabbit IgG
(H+L) HRP-conjugate (Bio-Rad Laboratories) as secondary antibody were used. Visualization
was done with AP Conjugate Substrate Kit containing a premixed BCIP/NBT solution (Bio-Rad
Laboratories) according to the manufacturers protocol (Figure 2B). Lane 2: rFIX-WT,
lane 3: FIX-Y94F/K98T; lane 4: FIX-Y94F/K98T/Y177F; lane 5: FIX-Y94F/A95aK/K98T/Y177F;
lane 6: FIX-Y94F/K98T/Y177F/I213V/E219G; lane 7: FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G;
lane 8: pdFIX; lane 1: molecular mass standard (the molecular weight is indicated
in kDa). In addition of the bands of FIX, FIXα and the heavy chain (HC) and light
chain (LC) of FIXaβ are also visible.
Example 5: FX Activation by FIXa
[0062] FX was activated in 25 mM Hepes pH 7.35 with 175 mM NaCl containing 1 mg/mL human
serum albumin, 5 mM CaCl
2 and 10 µM phospholipid (PL) vesicles (phosphatidylcholin / phosphatidylserine, 60/40).
PL vesicles were prepared from synthetic PLs (Avanti Polar Lipids, Alabaster, AL,
USA) by extrusion in 20 mM Tris/HCl pH 7.4, 50 mM NaCl, and 5 % saccharose. The average
vesicle size was 260 nm. After 15 minutes pre-incubation of 130 µL FIXa (6 nM) in
reaction buffer with PL vesicles at 37°C the reaction was started by addition of 20
µL FX in various concentrations (0 to 120 nM). Ten µL subsamples were drawn from 2.5
to 25 minutes and the reaction was terminated for 15 minutes in 200 µL buffer containing
EDTA and Clone HIX-5, a monoclonal anti-human FIX purified antibody (Accurate Chemical
& Scientific Corp., Westbury, NY, USA). The amount of FXa generated was determined
spectrophotometrically with a Tecan SpectrofluorPlus micro-well plate reader (Tecan,
Männedorf, Switzerland) at 405 nm for 30 minutes employing S-2765 substrate (Chromogenix
- Instrumentation Laboratory, Milano, Italy) by adding 800 nM substrate to the stop-reaction-mixture.
[0063] To analyze if binding of FVIIIa to a mutant FIXa protein can neutralize the effect
of the FIX mutations FX activation was also measured in the presence of FVIIIa. Ten
nM Recombinate Antihemophilic Factor (Baxter, Thousand Oaks, CA, USA) was incubated
with FIXa and 4 minutes before the FX activation was started, and 10 nM thrombin (Enzyme
Research Laboratories, South Bend, IN, USA) was added. FIXa concentration was then
0.01 nM and the substrate was supplemented with 1 µM Pefabloc TH (Pentapharm, Basel,
Switzerland) to prevent cleavage of the substrate by thrombin. FXa formation was quantified
as described above by taking subsamples from 20 to 110 seconds.
[0064] Figure 3 shows the FX activation by a FIXa protein (pdFIX, FIX-WT and the 5 mutated
proteins) in the absence (3A) and in the presence of FVIIIa (3B). Apparent KM and
kcat for FX activation without addition of FVIIIa were then calculated and shown in
Table 2. As compared to pdFIX the double mutant FIX-Y94F/K98T showed a two-fold increase
whereas FIX-Y94F/K98T/Y177F/I213V/E219G and FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G
enhanced the kcat by a factor of 17 and 6, respectively. FIX-WT and FIX-Y94F/K98T/Y177F
activated FX at the same rate as pdFIXa.
Table 2: Kinetic parameters for FX activation without the addition of FVIIIa.
| |
KM (nM) |
kcat (10-3min-1) |
kcat/KM (10-6 nM-1 min-1) |
| pdFIX |
65 |
13 |
195 |
| FIX-WT |
68 |
17 |
252 |
| FIX Y94F/K98T |
83 |
35 |
425 |
| FIX-Y94F/K98T/Y177F |
68 |
20 |
293 |
| FIX-Y94F/A95aK/K98T/Y177F |
73 |
4 |
57 |
| FIX-Y94F/K98T/Y177F/I213V/E219G |
40 |
133 |
3296 |
| FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G |
55 |
61 |
1094 |
[0065] Addition of FVIII to the assay expectedly neutralized the FX activating effect. In
contrast to the FIX mutants FVIIIa stimulated FX activation by pdFIXa was 52400-fold,
whereas FX activation of FIX-Y94F/K98T, FIX-Y94F/K98T/Y177F, FIX-Y94F/K98T/Y177F/I213V/E219G
and FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G was reduced to approximately 29100-, 16400-,
9600- and 8400-fold, respectively (Table 3).
Table 3: Kinetic parameters for FX activation with the addition of FVIIIa.
| |
KM |
kcat |
kcat/KM |
ratio kcat/KM |
| |
(nM) |
(min-1) |
(nM-1min-1) |
+/- FVllla |
| pdFIX |
13 |
131 |
10 |
52,430 |
| FIX-WT |
11 |
102 |
9 |
36,695 |
| FIX-Y94F/K98T |
15 |
180 |
12 |
29,122 |
| FIX-Y94F/K98T/Y177F |
14 |
68 |
5 |
16,424 |
| FIX-Y94F/A95aK/K98T/Y177F |
20 |
7 |
0 |
5,705 |
| FIX-Y94F/K98T/Y177F/I213V/E219G |
17 |
528 |
32 |
9,581 |
| FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G |
13 |
122 |
9 |
8,354 |
Example 6: Clotting Assays of FIX Proteins in Plasmatic Samples
[0066] Clotting assays, i.e. aPTT assays in plasmatic samples represent meaningful assays
for testing the functional activity of a mutant rFIX protein. Therefore pdFIX, rFIX-WT
and rFIX mutants were serially diluted from 5 to 0.25 µg/mL in imidazol buffer containing
1 % albumin (Baxter). Fifty µL of these samples, 50 µL of plasma and 50 µL of STA-APTT
reagent (Diagnostica Stago, Asniéres, France) were mixed and incubated at 37°C for
4 minutes. 50 µL of 25 mM CaCl
2 were added and time to clot formation was determined in an ACL10000 (Instrumentation
Laboratory, Milano, Italy).
[0067] For experiments with FVIII depleted plasma (Dade Behring, Marburg, Germany) serial
dilutions of FVIII Immunate (Baxter) were used as standards. FVIII inhibited patient
plasma was from George King (Overland Park, KS, USA).
[0068] FIX proteins were first tested in FVIII-depleted plasma (FVIII levels below 1 %).
Addition of FIX-WT and pdFIX to the plasma resulted in no significant shortening of
clotting time. However, all mutant FIX proteins showed a concentration dependent decrease
of clotting time. Five µg/mL FIX proteins reduced the clotting time from 96 seconds
to 64, 70, 67 and 64 seconds for FIX-Y94F/K98T, FIX-Y94F/K98T/Y177F, FIX-Y94F/K98T/Y177F/I213V/E219G
and FIX-Y94F/A95aK/K98T/Y177F/1213V/E219G, respectively (Figure 4A). Clotting time
of normal plasma (36 seconds) and that of FVIII-depleted plasma (96 seconds) are indicated
by dotted lines. The FVIII Immunate standard titration, fitted to a four-parameter
algorithm, is shown on the lower part of Figure 4A. FVIII equivalent units (Figure
4B) were calculated according to the FVIII Immunate calibration (0.78-200 mU/mL).
[0069] From the 5 mutated proteins FIX-Y94F/K98T and FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G
had the greatest effect with 14.7 and 16 FVIII equivalent mU/mL (Table 4), and the
five-fold mutant FIX-Y94F/K98T/Y177F/I213V/E219G resulted in 12 FVIII equivalent mU/mL.
[0070] An aPTT assay in FVIII-inhibited patient plasma is the most relevant assay because
it indicates for the function of the mutant FIX proteins in Hemophilia A patients
with FVIII inhibitors. Because FEIBA is a possible treatment for these patients, reduced
clotting times of FIX proteins were compared to a standard curve of a FEIBA titration
(0-1,000 mU/mL). One U/mL FEIBA restores the clotting time of normal blood in inhibitor
patient plasma (approximately 36 seconds). Figure 5 shows the results of the aPPT
of pdFIX, FIX-WT and the 5 mutated proteins. Clotting time of normal plasma (36 seconds)
and that of FVIII inhibitor patient plasma (142 seconds) are indicated by dotted lines.
The FEIBA standard titration, fitted to a 4-parameter algorithm, is shown on the lower
part of Figure 5A. FEIBA equivalent units (Figure 5B) were calculated according to
the FEIBA calibration (1.56-1,000 mU/mL).
[0071] The best mutant rFIX protein FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G showed a FEIBA
equivalent activity of 162 mU/mL (Table 4). FIX-Y94F/K98T and FIX-Y94F/K98T/Y177F/I213V/E219G
had both activities of approximately 115 FEIBA equivalent mU/mL.
Table 4: aPTT of FIX proteins in FVIII-depleted plasma (FVIII-DP) and FVIII-inhibited
patient plasma (FVIII-IP).
| |
FVIII-DP FVIII-equ. |
FVIII-IP FEIBA equ. |
| 5µg/mL |
(mU/mL) |
(mU/mL) |
| pdFIX |
0.0 |
inhibitory |
| FIX-WT |
1.0 |
15 |
| FIX-Y94F/K98T |
14.7 |
114 |
| FIX-Y94F/K98T/Y177F |
8.0 |
81 |
| FIX-Y94F/A95aK/K98T/Y177F |
0.2 |
20 |
| FIX-Y94F/K98T/Y177F/I213V/E219G |
11.6 |
115 |
| FIX-Y94F/A95aK/K98T/Y177F/I213V/E219G |
16.0 |
162 |
Example 7: Clotting Assays of Activated FIX Proteins in FIX-depleted Plasmatic Samples
Containing FVIII Inhibitors
[0072] In the clotting assay described above FIX is directly activated by FXIa before it
can activate FX. A poor activity of a rFIXa mutant in the clotting assay could therefore
reflect impaired activation by FXIa or a low activity in FX activation. To further
investigate the FX activation potential of the rFIX mutants without an influence of
activation rates by FXIa the clotting activity of the pre-activated rFIX mutants was
determined in clotting assays in FIX-depleted plasma containing FVIII inhibitors.
For activation pdFIX and rFIX mutants were diluted to 25 µg/mL in TBS containing 5
mM CaCl
2 and 0.1 % ovalbumin. FIX activation was started by the addition of pdFXIa at a molar
enzyme substrate ratio of 1 to 500 at 37°C. FXIa was removed with affinity purified
goat anti-FXI IgG bound to protein G sepharose.
[0073] APTT was measured at concentrations of FIXa proteins between 0.0625 and 1 µg/mL.
50 µL FIX-depleted plasma containing FVIII-inhibitors (goat anti FVIII, 150 BU/mL)
and 50 µL of the respective activated FIX proteins (0-1 µg/mL) were mixed with 50
µL aPTT-reagent for 1 minute at 37°C. Clotting time measurement was started by addition
of 50 µL 25 mM CaCl
2. A titration with pdFIXa standard (0.0625-40 µg/mL), fitted to a four-parameter algorithm,
is shown in black. Black dotted lines show clotting times of FIX-depleted and FVIII-inhibited
plasma and of normal plasma. 20 µg/mL pdFIXa restored clotting time to that of normal
plasma. All activated rFIXa proteins were more efficient than pdFIXa and reduced clotting
times in a concentration-dependent manner (Figure 6A). To reach the clotting time
of normal plasma 1 µg/mL of FIXa-Y94F/A95aK/K98T/Y177F/I213V/E219G and only 0.5 µg/mL
FIXa-Y94F/A95aK/K98T/Y177F were necessary. For a better comparison, FIXa equivalent
amounts were calculated from clotting times of a calibration curve made with pdFIXa.
At 1 µg/mL FIXa-Y94F/K98T/Y177F/I213V/E219G displayed 73.4 times the activity of pdFIXa,
whereas FIXa-Y94F/A95aK/K98T/Y177F/I213V/E219G had a 17.1-fold increased activity
(Figure 6B). Table 5 shows the pdFIXa equivalent activity given for 0.5 µg/mL of FIXa
proteins.
Table 5. APPT of activated pdFIX and rFIX proteins in FIX-depleted plasma containing
FVIII inhibitors.
| |
(µg/mL pdFIXa activity) |
| pdFIXa |
1.7 |
| FIXa-Y94F/K98T |
5.3 |
| FIXa-Y94F/K98T/Y177F |
3.4 |
| FIXa-Y94F/A95aK/K98T/Y177F |
nd |
| FIXa-Y94F/K98T/Y177F/I213V/E219G |
43.6 |
| FIXa-Y94F/A95aK/K98T/Y177F/I213V/E219G |
14.4 |
[0074] This invention shows for the first time that a rationally designed rFIX mutant can
substitute for FVIII activity in both FVIII depleted and FVIII inhibitor plasma. Therefore
a rFIX mutant according to the present invention can be used for treatment of a bleeding
disorder associated with functional defects of FVIII or deficiencies of FVIII and
especially as alternatives for bypassing agents for the treatment of FVIII inhibitor
patients.
Sequence Listings from File Reference #7989
[0075]
SEQ ID NO 1
FIXWT

SEQ ID NO 2
FIXWT

SEQ ID NO 3
FIX94-98


SEQ ID NO 4
FIX94-98

SEQ ID NO 5
FIX94-98-177

SEQ ID NO 6
FIX94-98-177

SEQ ID NO 7
FIX94-95a-98-177


SEQ ID NO 8
FIX94-95a-98-177

SEQ ID NO 9
FIX94-98-177-213-219

SEQ ID NO 10
FIX94-98-177-213-219

SEQ ID NO 11
FIX94-95a-98-177-213-219

SEQ ID NO 12
FIX94-95a-98-177-213-219

SEQ ID NO 13
Y94F-K98Ts
cctcaccaca acttcaatgc agctattaat acctacaacc atgac 45
SEQ ID NO 14
Y94F-K98Tas
gtcatggttg taggtattaa tagctgcatt gaagttgtgg tgagg 45
SEQ ID NO 15
Y94F-A95aK-K98Ts
cctcaccaca acttcaataa ggctattaat acctacaacc atgac 45
SEQ ID NO 16
Y94F-A95aK-K98Tas
gtcatggttg taggtattaa tagccttatt gaagttgtgg tgagg 45
SEQ ID NO 17
Y177Fs
caccatcttt aacaacatgt tctg 24
SEQ ID NO 18
Y177Fas
cagaacatgt tgttaaagat ggtg 24
SEQ ID NO 19
I213V-E219Gs
ctggaattgt gagctggggt gaaggctgtg caatgaaagg c 41
SEQ ID NO 20
I213V-E219Gas
gcctttcatt gcacagcctt caccccagct cacaattcca g 41