Compositions for use to treat advanced glycation end products-dependent ocular diseases

Abstract

The disclosure relates to the treatment of blindness due to age-related presbyopia, age-related macular degeneration (AMD), diabetic retinopathy (DR) and/or diabetic macular edema (DME) in a human or animal. Age-related presbyopia is the loss of accommodation in any individual more than 40-50 years old, currently treated by reading glasses. AMD is the most common cause of irreversible loss of sight in persons >65 years in the western world. At this time, no treatment is available for the dry form of AMD. The dry form of AMD is characterized by vision threatening Drsen, which are (sub)retinal accumulations of advanced glycation end products (AGEs) and fluorophores. DR and DME are the most common cause of irreversible loss of sight in persons <65 years in the western world. Current therapies for age-related presbyopia, AMD, DR and DME are disappointing and do not prevent the evolution to vision impairment, atrophy or blindness. The disclosure specifically relates to the administration of fructosamine-3-kinase and its cofactor(s). This results in deglycation and inactivation of AGEs and fluorophores.

Claims

1. A method of treating a subject for a condition selected from the group consisting of age-related macular degeneration, diabetic retinopathy, diabetic macular edema, and a combination of any thereof, wherein the subject is a human or an animal having at least one eye, and wherein the subject has accumulated advance glycation end products (AGEs) in the eye(s), the method comprising: administering to the subject's eye(s) a composition comprising a fructosamine-3-kinase and adenosine triphosphate (ATP) so as to reduce the accumulated AGEs in the subject's eye(s) and thereby treat the subject for the condition.

2. The method according to claim 1, wherein the composition is administered by intravitreal injection.

3. The method according to claim 1, wherein the composition further comprises magnesium ions.

4. The method according to claim 1, wherein the composition further comprises an ATP-generating system.

5. The method according to claim 1, wherein the fructosamine-3-kinase is a recombinant fructosamine-3-kinase.

6. The method according to claim 5, wherein the recombinant fructosamine-3-kinase is produced by recombinant production in Pichia pastoris.

7. The method according to claim 6, wherein the recombinant fructosamine-3-kinase has an amino acid sequence as given by SEQ ID NO: 1 or SEQ ID NO:2.

8. The method according to claim 1, wherein the subject has retinal or subretinal AGEs and fluorophores and the treatment results in a deglycation of the retinal or subretinal advanced glycation end products and fluorophores.

9. The method according to claim 1, wherein the composition further comprises 0.1 mol/L thiosulfate and 5 U/ml hyaluronidase when amounts greater than or equal to 5 l per eye of the composition are administered to the subject.

10. The method according to claim 1, wherein the condition is age-related macular degeneration.

11. The method according to claim 10, which reduces Drsen in the subject's eye(s).

12. The method according to claim 1, wherein the condition is diabetic retinopathy.

13. The method according to claim 1, wherein the condition is diabetic macular edema.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIG. 1 illustrates a system for intravitreal injecting deglycating enzymes according to an embodiment of the disclosure.

(2) FIG. 2 histology of Drsen in treated/untreated human retina. 5 micrometer sections of human retina with Drsen (D) were treated with saline+ATP+MgCl.sub.2 (FIG. 2A) or treated with F3K+ATP+MgCl.sub.2 (FIG. 2B). The Drse treated with saline+ATP+MgCl.sub.2 (untreated Drse) is encircled and is still intact and shows homogenous eosinophil material. The Drse treated with F3K+ATP+MgCl.sub.2 (treated Drse) is encircled and is not intact anymore. The latter shows also less eosinophil material than the Drse treated with saline+ATP+MgCl.sub.2. Doses used ranged between about 4.17 and 12.5 g/ml fructosamine-3-kinase, 2.50 and 4.17 mM ATP and 1.00 and 1.67 mM MgCl.sub.2. (R=retina, C=choroid, S=sclera, D=encircled Drse)

(3) RGB intensity values were calculated of saline treated and FN3K treated Drsen of human retinas (FIG. 2C). Mean intensity values were then calculated of 10 Drsen treated with saline+ATP+MgCl.sub.2 or with FN3K+ATP+MgCl.sub.2 (FIG. 2D)

(4) FIG. 3 NIR of Drsen in treated/untreated human retina.

(5) FIG. 3A: Hotelling's T2 plot of fluorescent AGEs in intraretinal Drsen treated with saline+ATP+MgCl.sub.2 (circles), compared to fluorescent AGEs in intraretinal Drsen treated with F3K+ATP+MgCl.sub.2 (squares) (FIG. 3A). Drsen of 5 micron sections of human retina were treated for 6 hours with saline+ATP+MgCl.sub.2 or with F3K+ATP+MgCl.sub.2. Doses used ranged between about 4.17 and 12.5 g/ml fructosamine-3-kinase, 2.50 and 4.17 mM ATP and 1.00 and 1.67 mM MgCl.sub.2. Near infrared (NIR) spectra were recorded off-line using a NIR spectrometer equipped with an immobilized reflection probe of seven 400 m fibers, an InGaAs detector and a halogen lamp (AvaSpecNIR256-2.5-HSC with an FCR-7UVIR400-2-BX reflection probe, Avantes). The Bruker Vertex 80v FTIR spectrometer was coupled to a Bruker Hyperion 2000 microscope for recording de FT-NIR transmission microspectra. The objective magnification of the microscope was set at 15 and the aperture at 2020 m. The background was collected with 800 co-adds. Spectra were recorded at a resolution of 16 cm.sup.1 in the range 12000-4000 cm.sup.1, and also collected with 800 co-adds. Spectral data analysis was performed using SIMCA software version 15.0 (MKS Data Analytics Solutions). Different preprocessing steps were performed to minimize irrelevant light scatter and standardize the spectroscopic signals. Differentiation was performed to accentuate small structural differences and reduce baseline effects.sup.6, standard normal variate normalization was performed to eliminate multiplicative scaling effects and additive baseline offset variations.sup.6,7 and finally a Savitzky-Golay based smoothing procedure was executed. After preprocessing, spectral data were analyzed by unsupervised pattern recognition methods, such as principal component analysis (PCA), and supervised pattern recognition methods such as partial least squares-discriminant analysis (PLS-DA).

(6) As glycation results in a spectral shift in the near-infrared spectrum of proteins, it is possible to observe specific peak sharpening and spectral variations in NIR spectra due to deglycation of proteins.

(7) FIG. 3B: Hotelling's T2 plot and spectral variations of fluorescent AGEs in Bruch's membrane treated with saline+ATP+MgCl.sub.2 (control) or with FN3K+ATP+MgCl.sub.2.

(8) FIG. 3C: Hotelling's T2 plot and spectral variations of subretinal Drsen treated with saline+ATP+MgCl.sub.2 (control) or with FN3K+ATP+MgCl.sub.2.

(9) FIG. 3D: shows mean spectra of all measured NIR spectra of AGEs in Bruch's membrane (full lines) and of subretinal Drsen (dotted lines) when treated with saline+ATP+MgCl2 (control) or treated with FN3K+ATP+MgCl2.

(10) Results in FIG. 3 show that FN3K+ATP+MgCl2 treatment changes NIR spectra of AGEs at different histological levels: in retinal Drsen (FIG. 3A), in Bruch's membrane (FIG. 3B) and in subretinal Drsen (FIG. 3C)

(11) FIG. 4: fluorometry of Drsen in treated/untreated human retina: UV-fluorescence spectroscopy of Drsen treated with saline+Mg+ATP (black line on top), compared to Drsen treated with F3K+Mg+ATP (grey line below). Drsen of 5 micron sections of human retina were treated for 6 hours with saline+ATP+MgCl.sub.2 or with FN3K+ATP+MgCl.sub.2. Fluorometry was performed with UV fluorescence spectroscopy in the range of 400 nm to 680 nm. Sharp differences were detected specifically in the range of AGE fluorescence (560 nm up to 680 nm).

(12) Human neural retinas were isolated through dissection by a trained ophthalmologist from cadaver eyes that were rejected for corneatransplantation, within 12 h post-mortem and immediately transferred to a sterile 6-well plate. The retinas were carefully washed five times with 5 mL phosphate buffered saline (PBS) solution. Subsequently, maillard type fluorescence measurements (excitation 370 nm, emission 390-700 nm) were performed at baseline on each retina (30 different measurement locations) using a miniature spectrometer system (Flame-S-VIS-NIR, Ocean Optics, Largo, Fla.) at fixed distance and 90 angle. Afterwards, two milliliters of the final FN3K solution were added to each retina well, and human retinas were incubated for 24 h at 37 C. After the treatment procedure, all wells were washed five times with PBS and fluorescence measurements were performed again.

(13) In total, intraretinal AGEs of five different human retinas of cadaver eyes were measured by UV-fluorescence spectroscopy in vitro. FIG. 4A shows fluorometry of intraretinal AGEs of eye of donor 1. FIG. 4B shows fluorometry of intraretinal AGEs in four other cadaver eyes (left eye of donor 2, left eye of donor 3, right eye of donor 3, left eye of donor 10).

(14) Treatment with FN3K+ATP+MgCl.sub.2 reduces fluorescence intensity of intraretinal AGEs.

(15) FIG. 5 Tests are carried out on aged C57/Bl6 mice (>9 months old).

(16) Mice were anesthetized with isoflurane 5% gas inhalation and sacrificed by neck luxation (according to declaration of Helsinki); both eyes were eviscerated and treated immediately by intravitreal injection. Of each mouse, one eye was treated with FN3K+ATP+MgCl.sub.2 and the contralateral eye with saline+ATP+MgCl.sub.2. Eyes were kept for 24 hours in 37 C. and then preserved in paraformaldehyde 2% for preparation for histological sections and staining with hematoxylin/eosin. Drsen were present in eyes treated with saline, but no Drsen were found in eyes treated with FN3K+ATP+MgCl.sub.2. FIG. 5 shows round subretinal Drse (thick arrow mouse 1) and thick flat subretinal Drse in mouse 2 (thick arrow mouse 2) in the saline+ATP+MgCl.sub.2 treated eyes, but no Drsen were present in the FN3K+ATP+MgCl.sub.2 treated eye of the same animal. Of note, the basal lamina (situated at triangle) in the saline+ATP+MgCl.sub.2 treated eye of mouse 1 is completely disrupted but is complete over the whole line in the FN3K+ATP+MgCl.sub.2 treated eye of the same mouse. No Drsen are present and retinal pigment epithelial layers are intact in the FN3K+ATP+MgCl.sub.2 treated eyes Histology in FIG. 5 shows that Drsen are dissolved by Intravitreal injection with FN3K+ATP+MgCl.sub.2 in an ex vivo mouse model.

(17) FIG. 6: Drsen treated by intravitreal injection of FN3K+thiosulfate+hyaluronidase into a human cadaver eye.

(18) Four human cadaver eyes (waste material rejected for corneal transplantation) were treated intravitreally with 50 l FN3K+ATP+MgCl.sub.2. Thiosulfate (0.1 mol/L) and hyaluronidase (5 U/ml) were added to the mixture to facilitate penetration of the hydroxyapatite crust around the Drsen and the vitreous, respectively. Drsen (encircled) were measured by spectroscopy (spectral domain Optical Coherence Tomography Van Hopplynus, Heidelberg, Germany) before injection and 3 hours after injection. The size of Drsen is significantly reduced after FN3K treatment in a human ex vivo model.

(19) FIG. 7: FN3K treatment of retinas in ob/ob mice and wt mice by intravitreal injection in vivo.

(20) Ob/ob mice of 26-30 weeks old were treated by intravitreal injection with 5 l FN3K+ATP+MgCl.sub.2 in one eye and with 5 l saline+ATP+MgCl.sub.2 in the other eye. Mice were sacrificed after 24 hours and eyes were collected and preserved in paraformaldehyde 2% for histology. Retinas of ob/ob mice treated with saline+ATP+MgCl.sub.2 showed signs of diabetic retinopathy with large leaky vessels (large arrow), and a very thick collagenous inner limiting membrane (triangle). Retinas of ob/ob mice treated with FN3K+ATP+MgCl.sub.2 showed normalization of the retina and normal microvasculature (small arrows) comparable with wt mice.

(21) FIG. 8: FN3K treatment of AGEs in the ciliary body of human cadaver eyes in vitro.

(22) Ciliary body was dissected from human cadaver eyes (waste material rejected for corneal transplantation) and treated for 3 hours ex vivo with 3 mL FN3K (41.6 g/mL)+ATP 2.5 mmol/L+MgCl2 (1 mmol/L). Baseline Fluorometry was performed (0 hr dotted line) and after FN3K treatment for 1 hour (dashed line), 2 hours (full line) and 3 hours (line with stripes and dots) using a miniature spectrometer system (Flame-S-VIS-NIR, Ocean Optics, Largo, Fla.) at fixed distance and 90 angle. QR400-7-VIS-BX Premium 400 micron reflection probe was used. Treatment of the ciliary body with FN3K reduces fluorescent signal of AGEs at 490 nm wavelength.

(23) FIG. 9: FN3K treatment of human cadaver eyes by external application of FN3K drops ex vivo.

(24) Human cadaver eyes (waste material rejected for corneal transplantation) were treated within 24 hours after prelevation. For cross over experiments, always two eyes from the same donor are used.

(25) FIG. 9A shows technique of applying FN3K drops to the intact human cadaver eye. 6 to 7 drops of FN3K (25 g/mL)+ATP (5 mmol/L)+MgCl2 (2 mmol/L) solution were applied every hour for 6 hours on one eye and saline drops were applied every hour for 6 hours on the other eye from the same donor. Fluorometry was performed at baseline before treatment and after treatment using a miniature spectrometer system (Flame-S-VIS-NIR, Ocean Optics, Largo, Fla.) at fixed distance and 90 angle. QR400-7-VIS-BX Premium 400 micron reflection probe was used.

(26) FIG. 9B: Fluorescent signal of AGEs is lower in eye 1 than in eye 2 at the start of the experiment (t=0 hr) Eye 1 is then treated with FN3K drops for 6 hours while eye 2 is treated with saline drops. Fluorescent signal of AGEs measured after 6 hours of treatment (t=6 hr) however only drops in the FN3K treated eye. When pursuing the experiment as a cross-over experiment, eye 1 is then treated with saline drops for another 6 hours and eye 2 with FN3K drops. Fluorescent signal of AGEs is measured again (t=12 hr). Fluorescent signal of AGEs decreases significantly in eye 2 but not in eye 1.

(27) FIG. 9 shows that FN3K treatment of the intact human eye by external application such as FN3K drops reduces fluorescent signal of AGEs in the eye.

DETAILED DESCRIPTION

(28) The disclosure relates to the surprising finding that the administration of a fructosamine-3-kinase and its co-factor(s) results in less/less dense Drsen in AMD. In other words, the latter administration restores light transmission and thus vision in patients with AMD.

(29) The disclosure also relates to the surprising finding that treatment with fructosamine-3-kinase and its co-factor(s) reduces AGEs in the retina, in Bruch's membrane, and subretinal. In other words, a composition comprising FN3K and adenosine tri phosphate restores light transmission and thus vision in patients with AGE-dependent ocular diseases such as AMD, DR and DME.

(30) The disclosure also relates to the finding that treatment with fructosamine-3-kinase and its cofactor(s) reduces AGEs in the ciliary body. In other words, a composition comprising FN3K and its cofactors restores accommodation and thus near vision in individuals with age-related presbyopia.

(31) The disclosure thus in first instance relates to a composition comprising a fructosamine-3-kinase and adenosine tri phosphate for use to treat AMD, DR and/or DME, age-related presbyopia in a human or an animal.

(32) The disclosure further relates a composition for use as described above wherein the composition is administered by intravitreal injection.

(33) The disclosure further relates to a composition for use as described above which further comprises magnesium ions and/or an adenosine tri phosphate regenerating system.

(34) The disclosure further relates to a composition comprising a fructosamine-3-kinase and adenosine tri phosphate regenerating system for use to treat AMD, DR and/or DME in a human or an animal wherein the composition is administered by intravitreal injection.

(35) The disclosure further relates a composition comprising a fructosamine-3-kinase and adenosine tri phosphate regenerating system for use as described above which further comprises magnesium ions.

(36) The term a fructosamine-3-kinase relates to enzymes classified as enzymes 2.7.1.171 in, for example, the Brenda enzyme database. The latter enzymes are part of an ATP-dependent system for removing carbohydrates from non-enzymatically glycated proteins and catalyze the following reaction: ATP+ [protein]-N6-D-fructosyl-L-lysine=ADP+[protein]-N6-(3-O-phospho-D-fructosyl)-L-lysine. More specifically, the term a fructosamine-3-kinase relates toas a non-limiting exampleto the human fructosamine-3-kinase having accession number or the National Center for Biotechnology Information (NCBI) Reference sequence number: NP 071441.1. It should be further clear that the term a fructosamine-kinase relates to the enzymes as described above, but also to functional fragments and variants thereof. The term functional fragments and variants relates to fragments and variants of the naturally occurring enzymes. Indeed, for many applications of enzymes, part of the protein may be sufficient to achieve an enzymatic effect. The same applies for variants (i.e., proteins in which one or more amino acids have been substituted with other amino acids, but which retain functionality or even show improved functionality), in particular, for variants of the enzymes optimized for enzymatic activity (as is also described further with regard to recombinant enzymes). The term fragment thus refers to an enzyme containing fewer amino acids than the 309 amino acid sequence of the human fructosamine-3-kinase having NCBI Reference sequence number: NP_071441.1 and that retains the enzyme activity. Such fragments can, for example, be a protein with a deletion of 10% or less of the total number of amino acids at the C- and/or N-terminus. The term variant thus refers to a protein having at least 50% sequence identity, preferably having at least 51-70% sequence identity, more preferably having at least 71-90% sequence identity or most preferably having at least 91, 92, 93, 94, 95, 96, 97, 98 or 99% sequence identity with the 309 amino acid sequence of the human fructosamine-3-kinase having NCBI Reference sequence number: NP_071441.1 and that retains the enzyme activity.

(37) Hence, orthologues, or genes in other genera and species (than the human fructosamine-3-kinase having NCBI Reference sequence number: NP_071441.1) with at least 50% identity at amino acid level, and having the enzyme activity are part of the disclosure. The percentage of amino acid sequence identity is determined by alignment of the two sequences and identification of the number of positions with identical amino acids divided by the number of amino acids in the shorter of the sequences100. The latter variant may also differ from the protein having NCBI Reference sequence number: NP_071441.1 only in conservative substitutions and/or modifications, such that the ability of the protein to have enzymatic activity is retained. A conservative substitution is one in which an amino acid is substituted for another amino acid that has similar properties, such that one skilled in the art of protein chemistry would expect the nature of the protein to be substantially unchanged. In general, the following groups of amino acids represent conservative changes: (1) ala, pro, gly, glu, asp, gln, asn, ser, thr; (2) cys, ser, tyr, thr; (3) val, ile, leu, met, ala, phe; (4) lys, arg, his; and (5) phe, tyr, trp, his. (13,14)

(38) Variants may also (or alternatively) be proteins as described herein modified by, for example, the deletion or addition of amino acids that have minimal influence on the enzymes activity as defined above, secondary structure and hydropathic nature of the enzyme.

(39) The terms adenosine tri phosphate (ATP) and magnesium ions relate to well-known cofactors of the latter enzymes.

(40) The term adenosine tri phosphate generating system relates to several enzymatic and whole-cell based methods to regenerate ATP from ADP or AMP as are, for example, described by Woodyer R. D. et al. 2006 (15,16). In particular, the latter term refers to the following four enzymes commonly used in the regeneration of ATP from ADP: 1) the use of phosphoenolpyruvate in a coupled reaction catalyzed by pyruvate kinase, 2) acetylphosphate coupled with acetate kinase, 3) creatine phosphate coupled with creatine kinase, and 4) polyphosphate coupled with polyphosphate kinase. Preferably, the term ATP generating system refers to the usage of phosphocreatine as a secondary energy source and creatine kinase to transfer its phosphate group to ADP to regenerate ATP. The usage of the latter ATP generating systems thus limits the concentration of ATP present in the mixture injected into the vitreous body as is also described further.

(41) The terms to treat AMD and/or DR and/or DME relate to stabilization and/or improving vision of the treated subject.

(42) The term to treat age-related presbyopia relates to stabilization and/or improving nearby vision of the treated subject.

(43) The term animal may relate to any animal.

(44) The terms administration by intravitreal injection relate to injection of the compounds of the disclosure into the vitreous body of the eye. The intravitreal injection technique is used under controlled aseptic conditions. Adequate anesthesia is given prior to the injection. For the treatment of animal eyes, general anesthesia is used by, for example, inhalation anesthesia with isoflurane 5%. For the treatment of humans, local anesthetic drops can be used. A 32-gauge needle can be used for injection in smaller animal (such as a small rodent) eyes and a 30-gauge needle in human eyes and eyes of bigger animals such as horse and pig. In all species, the sclera is penetrated at an angle from 45-90. In mouse, for example, the sclera can be penetrated at 1-1.5 millimeter from the limbus; and in humans, the sclera can be penetrated at 3-5 millimeter from the limbus. The needle passes through the sclera and choroid until the vitreous body is reached. The needle does not touch the lens, nor the retina. The composition of the disclosure can be as such delivered and the needle is withdrawn immediately.

(45) The disclosure thus relatesin other wordsto a method to treat (or prevent) age-related presbyopia, AMD, DR and/or DME in a subject in need thereof wherein the method comprises administering (for example, by an injection of) a therapeutically effective amount of a compound comprising a fructosamine-3-kinase and adenosine tri phosphate, or, a fructosamine-3-kinase and an adenosine tri phosphate generating system, or, a fructosamine-3-kinase and adenosine tri phosphate and an adenosine tri phosphate generating system, or a fructosamine-3-kinase and adenosine tri phosphate and magnesium ions, or, a fructosamine-3-kinase and adenosine tri phosphate and an adenosine tri phosphate generating system and magnesium ions, or, a fructosamine-3-kinase and an adenosine tri phosphate generating system and magnesium ions to (for example, in the vitreous body of) the eye of the subject.

(46) The term a therapeutically effective amount relates to an amount ranging from 5 l (for administering/injecting into a single mouse eye) to 50 l (for administering/injecting into a single bovine eye) taken from a therapeutic dose ranging between about 4.17 and 12.5 g/ml fructosamine-3-kinase, 2.50 and 4.17 mM ATP and 1.00 and 1.67 mM MgCl2. The latter therapeutic doses can be obtained by mixing 1:1, 1:2, 1:3 or 1:5 a solution of 25 g/ml fructosamine-3-kinase with a fresh solution of 5 mM ATP/2 mM MgCl.sub.2.

(47) 0.1 mol/L thiosulfate and 5 U/ml hyaluronidase are added to the mixture when amounts >5 l are administered (intravitreally) in an animal eye (not mouse) and human eyes.

(48) It should be clear that besides injecting the therapeutically effective amounts intravitreally, which is one way of administration, also other means of administration are envisioned such as, but not limited to, external application such as via drops or gels, and, other internal applications such as suprachoroidal injections or subretinal injections or implants everywhere else in the eye. Hence, and for example, the disclosure therefore relates to a composition comprising a fructosamine-3-kinase and ATP (and which might further comprise magnesium ions) for use to treat age-related presbyopia wherein the composition is administered by intravitreal injection or as external application.

(49) The disclosure further relates to a composition as indicated above wherein the fructosamine-3-kinase is a recombinant fructosamine-3-kinase. The term recombinant refers to fructosamine-3-kinase obtained as an outcome of the expression of recombinant DNA encoding for a fructosamine-3-kinase inside living cells such as bacteria or yeast cells. Practitioners are further directed to Sambrook et al. Molecular Cloning: A laboratory Manual, 4.sup.th ed., Cold Spring Harbor press, Plainsview, New York (2012) and Ausubel et al. Current Protocols in Molecular Biology (supplement 114), John Wiley & Sons, New York (2016).

(50) More specifically the disclosure relates to a recombinant fructosamine-3-kinase, which is obtainable by recombinant production in Pichia pastoris and, even more specifically, wherein the recombinant fructosamine-3-kinase obtainable by recombinant production in Pichia pastoris has the amino acid sequence as given by SEQ ID NO:1 or SEQ ID NO:2. SEQ ID NO:1 is a construct with an N-terminal cleavable HIS-tag and a caspase 3-cleavable Asp-Glu-Val-Asp (DEVD) linker between the His6 tag and the protein coding sequence, which allows for clean removal of the tag. SEQ ID NO:2 is the cleaved version of SEQ ID NO:1.

(51) The amino acid sequences of SEQ ID NO:1 and SEQ ID NO:2 (and their encoding nucleic acid sequences SEQ ID NO:3 and SEQ ID NO:4, respective) are as follows:

(52) TABLE-US-00001 SEQIDNO:1: Type:aminoacid1-letter(underlined:His6-tag,italics:linker, boldunderlined:caspasecleavagesite) MHHHHHHVNGPGSDEVDEQLLRAELRTATLRAFGGPGAGCISEGRAYD TDAGPVFVKVNRRTQARQMFEGEVASLEALRSTGLVRVPRPMKVIDLPGGGAAFVMEH LKMKSLSSQASKLGEQMADLHLYNQKLREKLKEEENTVGRRGEGAEPQYVDKFGFHT VTCCGFIPQVNEWQDDWPTFFARHRLQAQLDLIEKDYADREARELWSRLQVKIPDLFCG LEIVPALLHGDLWSGNVAEDDVGPIIYDPASFYGHSEFELAIALMFGGFPRSFFTAYHRKI PKAPGFDQRLLLYQLFNYLNHWNHFGREYRSPSLGTMRRLLK* SEQIDNO:3: Type:DNA(underlined:His6-tag,italics:linker,boldunderlined: caspasecleavagesite) ATGCATCATCATCATCATCATGTTAACGGTCCAGGTTCTGATGAAGTT GATGAACAGTTGTTGAGAGCTGAGTTGAGAACTGCTACTTTGAGAGCTTTTGGTGGT CCAGGTGCTGGTTGTATTTCTGAGGGTAGAGCTTACGATACTGACGCTGGTCCAGTT TTCGTTAAGGTTAACAGAAGAACTCAGGCTAGACAGATGTTCGAGGGTGAAGTTGC TTCTTTGGAGGCTTTGAGATCCACTGGTTTGGTTAGAGTTCCAAGACCAATGAAGGT TATCGACTTGCCAGGTGGTGGTGCTGCTTTTGTTATGGAACACTTGAAGATGAAGTC CTTGTCCTCCCAGGCTTCTAAGTTGGGTGAACAAATGGCTGACTTGCACTTGTACAA CCAGAAGTTGAGAGAAAAGTTGAAAGAGGAAGAGAACACTGTTGGTAGAAGAGGT GAAGGTGCTGAGCCACAATACGTTGACAAGTTCGGTTTCCACACTGTTACTTGTTGT GGTTTCATCCCACAGGTTAACGAGTGGCAAGATGACTGGCCAACTTTCTTCGCTAGA CACAGATTGCAAGCTCAGTTGGACTTGATCGAGAAGGACTACGCTGACAGAGAAGC TAGAGAATTGTGGTCCAGATTGCAGGTTAAGATCCCAGACTTGTTCTGTGGTTTGGA GATCGTTCCAGCTTTGTTGCACGGTGATTTGTGGTCTGGTAACGTTGCTGAAGATGA CGTTGGTCCAATTATCTACGACCCAGCTTCTTTCTACGGTCACTCTGAATTCGAGTTG GCTATCGCTTTGATGTTCGGTGGTTTCCCAAGATCCTTCTTCACTGCTTACCACAGAA AGATCCCAAAGGCTCCAGGTTTCGACCAGAGATTGTTGTTGTACCAGTTGTTCAACT ACTTGAACCATTGGAACCACTTCGGTAGAGAGTACAGATCTCCATCCTTGGGTACTA TGAGAAGATTGTTGAAGTAA SEQIDNO:2(=FN3KafterN-terminalHIS-tagremoval): Type:aminoacid1-letter EQLLRAELRTATLRAFGGPGAGCISEGRAYDTDAGPVFVKVNRRTQAR QMFEGEVASLEALRSTGLVRVPRPMKVIDLPGGGAAFVMEHLKMKSLSSQASKLGEQM ADLHLYNQKLREKLKEEENTVGRRGEGAEPQYVDKFGFHTVTCCGFIPQVNEWQDDW PTFFARHRLQAQLDLIEKDYADREARELWSRLQVKIPDLFCGLEIVPALLHGDLWSGNV AEDDVGPIIYDPASFYGHSEFELAIALMFGGFPRSFFTAYHRKIPKAPGFDQRLLLYQLFN YLNHWNHFGREYRSPSLGTMRRLLK* SEQIDNO:4: Type:DNA GAACAGTTGTTGAGAGCTGAGTTGAGAACTGCTACTTTGAGAGCTTT TGGTGGTCCAGGTGCTGGTTGTATTTCTGAGGGTAGAGCTTACGATACTGACGCTGG TCCAGTTTTCGTTAAGGTTAACAGAAGAACTCAGGCTAGACAGATGTTCGAGGGTGA AGTTGCTTCTTTGGAGGCTTTGAGATCCACTGGTTTGGTTAGAGTTCCAAGACCAAT GAAGGTTATCGACTTGCCAGGTGGTGGTGCTGCTTTTGTTATGGAACACTTGAAGAT GAAGTCCTTGTCCTCCCAGGCTTCTAAGTTGGGTGAACAAATGGCTGACTTGCACTT GTACAACCAGAAGTTGAGAGAAAAGTTGAAAGAGGAAGAGAACACTGTTGGTAGA AGAGGTGAAGGTGCTGAGCCACAATACGTTGACAAGTTCGGTTTCCACACTGTTACT TGTTGTGGTTTCATCCCACAGGTTAACGAGTGGCAAGATGACTGGCCAACTTTCTTC GCTAGACACAGATTGCAAGCTCAGTTGGACTTGATCGAGAAGGACTACGCTGACAG AGAAGCTAGAGAATTGTGGTCCAGATTGCAGGTTAAGATCCCAGACTTGTTCTGTGG TTTGGAGATCGTTCCAGCTTTGTTGCACGGTGATTTGTGGTCTGGTAACGTTGCTGAA GATGACGTTGGTCCAATTATCTACGACCCAGCTTCTTTCTACGGTCACTCTGAATTCG AGTTGGCTATCGCTTTGATGTTCGGTGGTTTCCCAAGATCCTTCTTCACTGCTTACCA CAGAAAGATCCCAAAGGCTCCAGGTTTCGACCAGAGATTGTTGTTGTACCAGTTGTT CAACTACTTGAACCATTGGAACCACTTCGGTAGAGAGTACAGATCTCCATCCTTGGG TACTATGAGAAGATTGTTGAAGTAA

(53) The disclosure indeed relatesin additionto the finding that the recombinant fructosamine-3-kinase obtainable by recombinant production in Pichia pastoris and having the amino acid sequence as given by SEQ ID NO:1 and 2 are preferred enzymes for treating AMD. Indeed, the latter enzymes are preferred as 1) their production in Pichia resulted in higher yields of the enzyme compared with the production in, for example, E. coli, 2) the enzymes had a higher purity when analyzed on SDS page, and 3) the presence of endotoxin, which is known to provoke an ocular inflammation during intravitreal injection, can be avoided.

(54) The following examples are provided to better illustrate the disclosure and should not be considered as limiting the scope of the disclosure.

EXAMPLES

Example 1: Recombinant Production of Fructosamine-3-Kinase

(55) A gene coding for human fructosamine-3-kinase (having accession number or the National Center for Biotechnology Information (NCBI) Reference sequence number: NP_071441.1, codon-optimized for Pichia pastoris expression (SEQ ID NO:1), was cloned into the pKai61 P. pastoris expression vector according to Claes, K. et al. (Modular Integrated Secretory System Engineering in Pichia Pastoris To Enhance G-Protein Coupled Receptor Expression, ACS Synthetic Biology 5, no. 10 (Oct. 21, 2016): 1070-75). The encoded gene contains an N-terminal His6-tag (MHHHHHH) in frame with a caspase-3 cleavage site (DEVD) and the expression is under control of the methanol inducible AOX1 promoter. The plasmid contains a zeocin resistance marker for selection in bacterial as well as in yeast cells. The vectors were linearized in the AOX1 promoter before transformation to P. pastoris (strain NRRL Y-11430) to promote homologous recombination in the endogenous AOX1 locus for stable integration into the genome.

(56) Stable integrants were grown shaking at 28 C. in BMY buffered complex medium (10 g/L yeast extract, 20 g/L peptone, 100 mM potassium phosphate buffer pH 6.0, 13.4 g/L YNB without amino acids) complemented with 1% glycerol. After 48 hours of growth, recombinant expression was induced by transfer to BMY medium complemented with 1% methanol. After 48 hours of expression, cultures were centrifuged, supernatant was discarded and pellets were flash frozen in liquid nitrogen and stored at 20 C.

(57) Pellets were thawed and resuspended in washing buffer for protein extraction. Pichia pastoris cells were mechanically disrupted using 0.5 mm glass or silica/zirconium beads. The cleared supernatant was purified by Ni.sup.2+ affinity chromatography for the His6-tagged fructosamine-3-kinase, followed by gel filtration. The protein eluted in FN3K sample buffer (20 mM Tris-HCl pH 8.0, 150 mM NaCl, 1 mM DTT) was identified as recombinant human fructosamine-3-kinase by SDS-PAGE and Western blotting with antibodies against the His6-tag and human FN3K (ThermoFisher). Enzymatic activity was confirmed in a kinase activity assay with a 1 deoxy 1 morpholino D fructose substrate (R&D Systems). Fructosamine-3-kinase aliquots were flash frozen in liquid nitrogen and stored at 20 C.

Example 2: Treatment of 5 Micron Slices of Human Eyes with Drsen

(58) 5 micrometer sections of human retina with Drsen (D) are treated with saline+ATP+MgCl.sub.2 or treated with FN3K+ATP+MgCl.sub.2. Doses used ranged between about 4.17 and 12.5 g/ml fructosamine-3-kinase, 2.50 and 4.17 mM ATP and 1.00 and 1.67 mM MgCl.sub.2. Drsen are evaluated by light microscopy for integrity and presence of eosinophil material (FIGS. 2A and B).

(59) Stained tissue sections were scanned by the Olympus dotSlide Digital Virtual Microscopy System and processed using the OlyVIA viewer program (Olympus Corporation, Tokyo, Japan). For subsequent image analysis, the freeware ImageJ v1.8.0 downloaded from the NIH website was used. Red (R), green (G) and blue (B) intensity values were calculated using the RGB Measure plug-in. FIG. 2C shows intensity values on the RGB color histogram of the histological section of a Drse when treated with saline+ATP+MgCl.sub.2 (untreated) or treated with FN3K+ATP+MgCl.sub.2. FIG. 2D shows mean value of all intensity values of 10 Drsen treated with saline+ATP+MgCl.sub.2 (untreated) and 10 FN3K treated Drsen with Near infrared (NIR) spectra are recorded off-line using a NIR spectrometer equipped with an immobilized reflection probe of seven 400 m fibers, an InGaAs detector and a halogen lamp (AvaSpecNIR256-2.5-HSC with an FCR-7UVIR400-2-BX reflection probe, Avantes). As glycation results in a spectral shift in the near-infrared spectrum of proteins, it is possible to observe specific peak sharpening and spectral variations in NIR spectra due to deglycation of proteins (FIG. 3). FIG. 3A shows the Hotelling's T2 plot of intraretinal AGEs in human retina treated with saline+Mg Cl.sub.2+ATP (circles), compared to intraretinal AGEs in human retina treated with FN3K+Mg Cl.sub.2+ATP (squares).

(60) FIG. 3B shows NIR spectra and Hotelling's plot of AGEs in Bruch's membrane treated with saline+Mg Cl.sub.2+ATP (control) compared to AGEs in Bruch's membrane treated with FN3K+Mg Cl.sub.2+ATP. FIG. 3C shows NIR spectra and Hotelling's plot of AGEs in subretinal Drsen treated with saline+Mg Cl.sub.2+ATP (control) compared to AGEs in subretinal Drsen treated with FN3K+Mg Cl.sub.2+ATP.

(61) FIG. 3D shows mean spectra of measured NIR spectra of AGEs in Bruch's membrane (full lines) and in subretinal Drsen (dotted lines) when treated with saline+ATP+MgCl.sub.2 (control) or treated with FN3K+ATP+MgCl.sub.2

(62) Fluorometry of Drsen is performed on 5 micron sections of human retina treated with saline+ATP+MgCl.sub.2 (circles) or with FN3K+ATP+MgCl.sub.2 (squares). Fluorometry is performed with UV fluorescence spectroscopy in the range of 400 nm to 680 nm. Differences are detected specifically in the range of AGE fluorescence (560 nm up to 680 nm) (FIG. 4). Fluorometry is performed on five different retinas of human cadaver eyes. FIG. 4 shows measurements of AGEs of intraretinal Drsen. FIG. 4A shows raw AGE fluorescence spectroscopy curves of eye 1. FIG. 4B shows AGE fluorescence spectroscopy results of four other human retinas after smoothening of the curves.

(63) Mean fluorescence intensities of the four latter human retinas are then calculated and compared (Table 1).

(64) TABLE-US-00002 TABLE 1 Mean fluorescence intensity 420-700 nm (a.u.) of human neural retinas at baseline and after ex vivo FN3K treatment Baseline FN3K % change P-value Eye 2 left 63.2 (55.9) 43.7 (42.4-51.3) 31.2 <0.0001 Eye 3 left 55.5 (52.4-60.5) 42.5 (41.0-44.0) 23.4 <0.0001 right 75.3 (68.2-78.9) 50.7 (45.9-56.5) 32.7 <0.0001 Eye 10 left 71.5 (50.1-95.9) 56.1 (50.4-76.7) 21.5 0.14

Example 3: Treatment of Eyes of Aged C57/Bl6 Mice. In Vivo Experiment

(65) Tests are carried out on aged C57/Bl6 mice, which show the typical AMD lesions as Drsen. Following FN3K treatment in one eye by intravitreal injection, mice retinas are studied using near-infrared (NIR) and fluorescence spectroscopy.

(66) Histological sections are performed to evaluate the presence or absence of the typical Drsen (FIG. 5) Drsen were present when the eyes were treated with intravitreal injection of saline+ATP+MgCl.sub.2 but were absent when eyes (contralateral eye of the same animal) were treated with FN3K+ATP+MgCl.sub.2

(67) Mice from 23 months old are anesthetized during the surgical procedure with inhalation anesthesia (isoflurane 5%). Both eyes of the same animal are injected, one with 5 microliter fructosamine-3 kinase+ATP+MgCl.sub.2 (same preparation as experiment in example 2) and one with 5 microliter saline+ATP+MgCl.sub.2. 24 hours and 1 week later, mice are sacrificed and both eyes are enucleated. Near infrared (NIR) spectra are recorded off-line using a NIR spectrometer equipped with an immobilized reflection probe of seven 400 m fibers, an InGaAs detector and a halogen lamp (AvaSpecNIR256-2.5-HSC with an FCR-7UVIR400-2-BX reflection probe, Avantes). As glycation results in a spectral shift in the near-infrared spectrum of proteins, it is possible to observe specific peak sharpening and spectral variations in NIR spectra due to deglycation of proteins. This allows us to distinguish fructosamine-3-kinase-treated from untreated eyes. The use of non-invasive NIR monitoring enables us to assess the treatment in a non-destructive way.

Example 4. Treatment of Drsen in Human Cadaver Eyes by Intravitreal Injection

(68) Human cadaver eyes (rejected for cornea transplantation) were transported on ice and evaluated for the presence of Drsen by Optical Coherence Tomography within 24 hours after prelevation. When Drsen were present, the Drsen were treated by intravitreal injection into the eye with FN3K+ATP+MgCl.sub.2+0.1 mol/L thiosulfate+5 U/ml hyaluronidase. Thiosulfate was added to the mixture before intravitreal injection for optimal penetration of the calcium hydroxyapatite around large subretinal Drsen. Hyaluronidase was added to the mixture for optimal penetration of the vitreous. Eyes were kept at 37 C. for 2 hours and Drsen were again recorded by Optical Coherence Tomography (FIG. 6). In the four cadaver eyes where Drsen were present, intravitreal injection with FN3K+ATP+MgCl.sub.2 induces a clear reduction in size.

Example 5. FN3K Treatment of AGE-Modified Pig Retina In Vitro

(69) Pig retinas were dissected within 24 hours after prelevation. UV-fluorescence spectroscopy of AGES in pig retina was performed at baseline and after treatment with two of the most prevalent AGEs in human retina (methylglyoxal (MG), glycolaldehyde (GA) for 24 hours. Pig retinas were then washed with PBS and treated with saline+Mg Cl.sub.2+ATP or with FN3K+Mg Cl.sub.2+ATP for 24 hours, and UV-fluorescence spectroscopy was repeated.

(70) TABLE-US-00003 TABLE 2 Norm. fluorescence intensities (a.u.) of neural pig retinas at baseline, AGE-modification and after control and FN3K treatment. MG-AGEs GA-AGEs Control FN3K Control FN3K (n = 30) (n = 30) (n = 30) (control = 30) Baseline 440 nm 5.6 (5.2-6.0) 6.6 (6.1-6.9) 6.4 (6.1-6.9) 6.7 (5.9-6.9) 490 nm 7.1 (6.5-7.4) 7.9 (7.1-8.5) 7.9 (7.3-8.4) 8.5 (8.0-91) 490/440 nm 1.3 (1.1-1.4) 1.2 (1.1-1.3) 1.2 (1.1-1.3) 1.3 (1.2-1.4) AGE-modification 440 nm 26.2 30.6 31.2 23.7 (19.4-40.6) (22.3-43.0) (26.2-50.2) (20.4-28.9) 490 nm 28.8 34.2 55.3 39.3 (22.1-49.6) (23.6-53.0) (47.5-96.0) (31.2-46.3) 490/440 nm 1.1 (1.1-1.2) 1.2 (1.1-1.2) 1.8 (1.8-1.9) 1.6 (1.5-1.7) Treatment 440 nm 32.5 22.5 25.1 16.2 (19.8-44.7) (18.0-26.4) (23.5-32.7) (11.0-20.0) 490 nm 35.8 23.4 40.8 19.4 (19.3-50.3) (18.0-26.4) (36.9-58.6) (13.6-28.2) 490/440 nm 1.1 (1.0-1.1) 1.1 (1.0-1.1) 1.6 (1.6-1.8) 1.3 (1.2-1.4) Baseline vs AGE-modification (P-value) 440 nm <0.0001 <0.0001 <0.0001 <0.0001 490 nm <0.0001 <0.0001 <0.0001 <0.0001 490/440 nm <0.01 0.06 <0.0001 <0.0001 AGE-modification vs Treatment (P-value) 440 nm N.S. <0.05 <0.05 0.0001 490 nm N.S. <0.01 <0.001 <0.0001 490/440 nm <0.05 <0.001 <0.0001 <0.0001

(71) Six porcine eyes were obtained from a local abattoir and stored at 4 C. until processing. Neural retinas were isolated through dissection by a trained ophthalmologist within 12 h post-mortem, transferred to a sterile 6-well plate (Thermo scientific, Roskilde, Denmark) and stored at 4 C. in RPMI-1640 medium (Sigma-Aldrich, St. Louis, Missouri, USA). The experiment was started within 48 h by removing the RPMI medium and carefully washing the retinas five times with 5 mL phosphate buffered saline (PBS) solution. Subsequently, maillard type fluorescence measurements (excitation 370 nm, emission 390-700 nm) were performed at baseline on each retina (30 different measurement locations) using a miniature spectrometer system (Flame-SVIS-NIR, Ocean Optics, Largo, Fla.) at fixed distance and 90 angle. AGE modification was performed by incubation of two retina wells with 4 mL 100 mmol/L methylglyoxal (methyl glyoxal solution 40% in H.sub.2O, Sigma-Aldrich), and two with 4 mL 100 mmol/L glycolaldehyde dimer (crystalline form, Sigma-Aldrich) in phosphate buffered saline (PBS) for 24 h at 37 C. After incubation, the active agents were carefully washed away (10 times) in each well with 5 mL PBS and fluorescence measurements were performed again. Finally, in vitro deglycation was initiated using ATP-dependent FN3K (Fitzgerald Industries International, Acton, MA, USA). A solution containing 0.0016 g/L ATP-dependent FN3K in PBS was added (1:1) to a mixture of 5 mmol/L ATP and 2 mmol/L MgCl.sub.2 (Sigma-Aldrich) in PBS. Two milliliters of the final FN3K solution were added to one retina well incubated with methylglyoxal, and one with glycolaldehyde and incubated for 24 h at 37 C. The remaining wells were control treated with PBS. After the treatment procedure, all wells were washed five times with PBS and fluorescence measurements were performed.

(72) FN3K treatment reduced fluorescence of intraretinal AGEs in pig retinas in vitro.

Example 6. Treatment of Eyes of Ob/Ob Mice and Wt Mice. In Vivo Experiment

(73) Tests are carried out on aged ob/ob mice, which show the typical diabetic lesions. Following FN3K treatment in one eye by intravitreal injection, mice retinas are studied using near-infrared (NIR) and fluorescence spectroscopy.

(74) Histological sections are performed to evaluate typical lesions in DR and DME, such as an increase in large leaky vessels and in thickness of collagen fibers in the inner limiting membrane. FIG. 7 shows signs of diabetic retinopathy in ob/ob mice treated with saline+ATP+MgCl.sub.2 with large leaky vessels (large arrow), and a very thick collagenous inner limiting membrane (triangle). Retinas of ob/ob mice treated with FN3K+ATP+MgCl.sub.2 showed normalization of the retina and normal microvasculature (small arrows) comparable with wt mice.

(75) Mice from 30-36 weeks old are anesthetized during the surgical procedure with inhalation anesthesia (isoflurane 5%). Both eyes of the same animal are injected, one with 5 microliter fructosamine-3 kinase+ATP+MgCl.sub.2 (same preparation as experiment in example 2) and one with 5 microliter saline+ATP+MgCl.sub.2. 24 hours later, mice are sacrificed and both eyes are enucleated. Near infrared (NIR) spectra are recorded off-line using a NIR spectrometer equipped with an immobilized reflection probe of seven 400 m fibers, an InGaAs detector and a halogen lamp (AvaSpecNIR256-2.5-HSC with an FCR-7UVIR400-2-BX reflection probe, Avantes). As glycation results in a spectral shift in the near-infrared spectrum of proteins, it is possible to observe specific peak sharpening and spectral variations in NIR spectra due to deglycation of proteins. This allows us to distinguish fructosamine-3-kinase-treated from untreated eyes. The use of non-invasive NIR monitoring enables us to assess the treatment in a non-destructive way.

Example 7. FN3K Treatment of AGEs in the Ciliary Body of Human Cadaver Eye In Vitro

(76) Ciliary body was dissected from human cadaver eyes (waste material rejected for corneal transplantation) and treated for 3 hours ex vivo with 3 mL FN3K (41.6 g/mL)+ATP 2.5 mmol/L+MgCl2 (1 mmol/L). Fluorometry (FIG. 8) was performed after 1 hour, 2 hours and 3 hours of FN3K treatment using a miniature spectrometer system (Flame-S-VIS-NIR, Ocean Optics, Largo, Fla.) at fixed distance and 90 angle. QR400-7-VIS-BX Premium 400 micron reflection probe was used.

Example 8 Treatment of Human Cadaver Eyes by External Application of FN3K Drops Ex Vivo

(77) Human cadaver eyes (waste material rejected for corneal transplantation) were treated within 24 hours after prelevation. For cross over experiments, always two eyes from the same donor are used.

(78) The technique of applying FN3K drops or saline drops to the intact human cadaver eye consists of the following: 6 to 7 drops of FN3K (25 g/mL)+ATP (5 mmol/L)+MgCl2 (2 mmol/L) solution were applied every hour for 6 hours on one eye and saline drops were applied every hour for 6 hours on the other eye from the same donor. Fluorometry was performed at baseline before treatment and 6 hours after treatment using a miniature spectrometer system (Flame-S-VIS-NIR, Ocean Optics, Largo, Fla.) at fixed distance and 90 angle. QR400-7-VIS-BX Premium 400 micron reflection probe was used. First, one eye is treated with FN3K drops and the other eye of the same donor is treated with saline drops. For cross over experiments, treatment is then switched, and the FN3K treated eyes are further on treated with saline drops, while the eyes initially treated with FN3K are further on treated with saline drops for 6 hours. Fluorometry is performed at baseline (start experiment, t=0 hr), after 6 hours of initial treatment, and after 6 hours of the other treatment.

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