Title of Invention

A MEDICAMENT COMPOSITION FOR USE IN THE TREATMENT OR PROPHYLAXIS OF A TAUOPATHY

Abstract Use of a phenothiazine in the preparation of a medicament composition for use in the treatment or prophylaxis of a tauopathy, wherein the preparation comprises the step of pre-reducing the phenothiazine such that it is present in at least 80, 90, 95, or 99% educed (leuco-) form.
Full Text WO 02/055720 PCT/GB02/00153
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MATERIALS AND METHODS RELATING TO PROTEIN AGGREGATION IN
NEURODEGENERATIVE DISEASE
Technical field
The present invention concerns cell-based models and other test
systems for modelling the aggregation of proteins associated with.
neurodegenerative disease. It further relates to compounds capable
of modulating such aggregation.
Background art
Conditions of dementia such as Alzheimer's disease (AD) are
frequently characterised by a progressive accumulation of
intracellular and/or extracellular deposits of proteinsceous
structures such as β-amyloid plaques and neurofibrillary tangles in
the brains of affected patients. The appearance of these lesions
largely correlates with pathological neurofibrillary degeneration
and brain atrophy, as well as with cognitive impairment (Mukaetova-
Ladinska, E.B. et al. (2000) Am. J. Pathol. Vol. 157, No. 2, 623-
636) .
Both neuritic plaques and neurofibrillary tangles contain paired
helical filaments (PHFs), of which a major constituent is the
microtubule-associated protein tau (Wischik et al. (1988) PNAS USA
85, 4506). Plaques also contain extracellular β-amyloid fibrils
derived from the abnormal processing of amyloid precursor protein
(APP; Rang et al. (1987) Nature 325, 733). An article by Wischik
et al. (in 'Neurobiology of Alzheimer's Disease', 2nd Edition
(2000) Eds. Dawbarn, D. and Allen, S.J., The Molecular and Cellular
Neurobiology Series, Bios Scientific Publishers, Oxford) discusses
in detail the putative role of tau protein in the pathogenesis of
neurodegenerative dementias.
Studies of Alzheimer's disease indicate that the loss of the normal
form of tau (Mukaetova-Ladinska et al. (1993) Am. J. Pathol., 143,
565; Wischik et aJ. (1995a) Neurobiol. Ageing, 16: 409; Lai et al.

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(1995b) Neurobiol. Ageing, 16: 433), accumulation of pathological
PHFs (Mukaetova-Ladinska et al. (1993), loc. cit.; Harrington et
al. (1994a) Dementia, 5, 215; Harrington et al. (1994b) Am. J.
Pathol., 145, 1472; Wischik et al., (1995a), loc. cit.) and loss of
synapses in the mid-frontal cortex (Terry et al. (1991) Ann.
Neurol., 30, 572) correlate with associated cognitive impairment.
Furthermore, loss of synapses (Terry et al., loc. cit.) and loss of
pyramidal cells (Bondareff et al. (1993) Arch. Gen. Psychiatry, 50:
350) both correlate with morphometric measures of tau-reactive
neurofibrillary pathology, which parallels, at a molecular level,
, an almost total redistribution of the tau protein pool from a
soluble to a.polymerised form (PFFs) in Alzheimer's disease
(Mukaetova-Ladinska et al. (1993), loc. cit.; Lai et al. (1995),
loc. cit.).
Tau exists in alternatively-spliced isoforms, which contain three
or four copies of a repeat sequence corresponding to the
microtubule-binding domain (Goedert, M., et al. (1989) EMBO J. 8,
393-399; Goedert, M., et al. (1989) Neuron 3, 519-526). Tau in
PHFs is proteolytically processed to a core domain (Wischik, CM.,
et al. (1988) Proc. Natl. Acad. Sci. USA 85, 4884-4888; Wischik et
al. PNAS USA 1988, 85:4506-4510); Novak, M., et al. (1993) EMBO J.
12, 365-370) which is composed of a phase-shifted version of the
repeat domain; only three repeats are involved in the stable tau-
tau interaction (Jakes, R., et al. (1991) EMBO J. 10, 2725-2729).
Once formed, PHF-like tau aggregates act as seeds for the further
capture and provide a template for proteolytic processing of full-
length tau protein (Wischik et al. 1996 Proc Natl Acad Sci USA 93,
11213-11218).
In the course of their formation and accumulation, paired helical
filaments (PHFs) first assemble to form amorphous aggregates within
the cytoplasm, probably from early tau oligomers which become
truncated prior to, or in the course of, PHF assembly (Mena, R., et
al. (1995) Acta Neuropathol. 89, 50-56; Mena, R., et al. (1996)
Acta Neuropathol. 91, 633-641). These filaments then go on to form
classical intracellular neurofibrillary tangles. In this state,

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the PHFs consist of a core of truncated tau and a fuzzy outer coat
containing full-length tau (Wischik., C. M., et al, (1996) loc.
cit.). The assembly process is exponential, consuming the cellular
pool of normal functional tau and inducing new tau synthesis to
make up the deficit (Lai, R. Y. K., et al., (1995), Neurobiology of
Ageing, Vol. 16, No. 3, 433-445). Eventually, functional
impairment of the neurone progresses to the point of cell death,
leaving behind an extracellular tangle. Cell death is highly
correlated with the number of extracellular tangles (Wischik et al.
2000, loc. cit). As tangles are extruded into the extracellular
space, there is progressive loss of the fuzzy outer coat of the
neurone-PHF with corresponding loss of N-termir.al tau
immunoreactivity, but preservation of tau immunoreactivity
associated with the PHF core (Figure 1; also Bondareff, W. et al.,
(1994) J. Neuropath. Exper. Neurol. , Vol. 53, No. 2, 158-164).
The phase shift which is observed in the repeat domain of tau
incorporated into PHFs suggests that the repeat domain undergoes an
induced conformational change during incorporation into the
filament. During the onset of Alzheimer's disease, it is envisaged
that this conformational change could be initiated by the binding
of tau to a pathological substrate, such as damaged or mutated
membrane proteins (see Figure 2 - also Wischik, CM., et al. (1997)
in "Microtubule-associated proteins: modifications in disease",
eds. Avila, J., Brandt, R. and Kosik, K. S. (Harwood Academic
Publishers, Amsterdam) pp.185-241).
In the case of Alzheimer's disease, current pharmaceutical
therapies are focused on symptomatic treatment of the loss of
cholinergic transmission which results from neurodegeneration
(Mayeux, R., et al. (1999) New Eng. J. Med. 341, 1670-1679).
However, although the available treatments delay progression of the
disease for up to six to twelve months, they do not prevent it.
The discovery of drugs that could prevent the aggregation of tau
which leads to neurodegeneration would provide a more effective
strategy for prophylaxis or for inhibiting the progression of the
disease, which would not require an immediate knowledge of the
diverse upstream events that initiate the aggregation (see Figure

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3).
Models and assays
WO 96/30766 describes an in vitro assay for tau aggregation in
which a fragment of tau corresponding to the core repeat domain,
which has been adsorbed to a solid phase substrate, is able to
capture soluble full-length tau and bind tau with high affinity
(see Figure 4). This association confers stability against
digestion of proteases on the tau molecules on the repeat domains
of tau molecules which have aggregated. The process is self-
propagating, and can be blocked selectively by prototype
pharmaceutical agents {(Wischik et al. 1996 Proc Natl Acad Sci USA
93, 11213-11218).
Although the in vitro assay described in WO 96/30766 enables the
identification of inhibitors or modulators of tau-tau association,
the present inventors have also recognized that cell-based models
of Alzheimer's disease-like protein aggregation would be useful.
Such cellular models could be used both in the primary screening of
candidate modulators of tau-tau aggregation, and in the secondary
screening of compounds already identified in the in vitro assay of
WO 96/30766. Furthermore, the demonstration of tau aggregation in
cells could also aid in the identification of normal cellular
substrates which are involved in the initiation of pathological tau
aggregation, which substrates could themselves be targets for
pharmaceutical intervention.
However, numerous papers reporting the expression of various tau
constructs in tissue culture models have failed to demonstrate
aggregation (see e.g. Baum, L. et al., (1995) Mol. Brain Res. 34:1-
17) . For. instance,. 3T3 mouse fibroblasts do not possess tau
protein and thus present a cellular environment in which
recombinant tau can be expressed independent of endogenous mouse
tau. Transfection of various cell lines has been reported
previously (Kanai et al. , 1989; Goedert and Jakes, 1990; Knops et
al, 1991; Lee and Rook, 1992; Gallo et al. , 1992; Lo et al., 1993;
Montejo de Garcini et al., 1994; Fasulo et al., 1996). However the

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stable long term expression of truncated tau in such cell lines was
not achieved. For example, tau constructs for residues 164 or 173
to 338 or 352 did not express protein (Lee and Rook, 1992).
Although Fasulo et al. (Alzheimer's Research 1996, 2, 195-200)
reported transient expression of truncated tau in COS cells, data
for stable long term expression of this tau was not shown. These
workers concluded from the use of the transient transfection system
that expression of truncated tau by itself was not sufficient to
induce tau aggregation in a manner suitable for testing drugs.
Thus far, the aggregation of soluble tau in vitro has only been
achieved under non-physiological conditions and at high
concentrations (reviewed in Wischik (2000), loc. cit) .
WO 96/30766 describes two approaches for studying tau aggregation
in a cellular environment. In the first approach, full-length tau
or fragments of tau were stably expressed in cells. In the second
approach, aggregated tau was transiently transfected into cells by-
use of lipofectin.
Although both of these approaches are useful for the study of tau-
tau aggregation, they have some limitations. Transf ection of
aggregated tau into cells using lipofection is of variable
efficiency, as is the production in vitro of aggregated tau itself.
Moreover, the core tau fragment, which is the most efficient seed
for tau aggregation, is found to be toxic when stably expressed in
cells, leading to low expression levels. Thus, constitutive
expression of the truncated tau fragment of the PHF core in
eukaryotic cells is difficult to achieve. Transient expression
systems permit the optimization of expression of tau, but the
inherent toxicity of the fragments renders even these systems
unreliable. Longer fragments of tau are less toxic, but these do
not reliably aggregate when expressed in cells.
Thus it would be desirable for an alternative model system to be
developed, in which the interaction between e.g. tau molecules and
the like could be investigated under physiological conditions, in a

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stable and controllable cell line, and which could be used to
screen for potential diagnostic, prognostic or therapeutic agents
of conditions such as Alzheimer's disease.
Disclosure of the invention
The present inventors have devised a stable cellular test system
which can be used to model the template-driven proteolytic
processing of a protein, the aggregation of which is associated
with neurodegenerative disease. In one test system, exemplified
with the tau protein, very low level constitutive expression of a
fragment of the tau protein was combined with inducible expression
of full-length tau. Induction of the full-length tau lead to its
proteolytic conversion to a processed fragment, confirming that
"teraplated proteolytic processing" of the tau was occurring. The
system readily permits the demonstration of the effects of tau
aggregation inhibitors through their inhibition of production of
the processed, 12 kD, fragment from induced full-length tau.
That such a stable system can be achieved notwithstanding the
inherent toxic properties of the 12 kD fragment is particularly
surprising. For instance, as demonstrated in the Examples below,
although partial truncation at either N- or C-termini of full-
length tau results in cell lines in which stable expression can be
maintained, these longer constructs show only a weak propensity to
aggregate, rather than binding to the microtubular network. Stable
expression of combinations of tau fragments generates aggregates
within the cytoplasm of cells, but this system cannot be maintained
reproducibly. Systems based on the inducible expression of the 12
kD fragment lead to toxicity as a result of unpredictable
intracellular aggregation of the fragment.
Thus there would appear to be a trade-off in stable expression cell
systems between inducing aggregation and hence toxicity on the one
hand, which produces cell lines which are either variable or non-
viable, and maintaining viable cell lines in which tau has a low
propensity to aggregate. Notwithstanding this, the inducible tau
expression system of the present invention is both stable, and yet

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able to provide controlled aggregation of protein for use in
screens and the like.
Additionally, use of the assay has provided evidence that the
mechanism of action of certain inhibitors (e.g. phenothiazines) of
protein aggregation is primarily steric in nature, rather than
essentially redox, as may have been suspected on the basis of the
prior art. This discovery has unexpected implications for the
choice, assessment, formulation and use of such compounds in the
context of the diseases discussed herein. In particular, it shows
that assessment of diffusion coefficients can provide a valuable
screen for identifying putative inhibitors, or optimising the
structure or state of known ones, because the parameters inherently
assessed by measuring the diffusion coefficient may be highly
relevant to the inhibitors' potency.
The assay further shows that use of phenothiazines in their reduced
form can be advantageous for enhancing their inhibitory properties.
These observations form the basis of further aspects of the present
invention.
In general the present invention provides a method for converting,
through proteolytic processing, a precursor protein to a product
fragment of the precursor protein, in a stable cell line, which
method comprises the steps of: (a) providing a stable cell line
transfected with nucleic acid encoding (i) a template fragment of
the precursor protein such that the template fragment is
constitutively expressed in the cell at a level which is not toxic
to the cell; and (ii) the precursor protein, which protein is
inducibly expressed in the cell in response to a stimulus, whereby
interaction of the template fragment with the precursor protein
causes a confomational change in the precursor protein such as to
cause aggregation and proteolytic processing of the precursor
protein to the product fragment.
The method may include subjecting the cell to the stimulus such
that the precursor protein is expressed in the cell. However in
embodiments where an inducible promoter is used which causes low,

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but detectable levels of expression even in the absence of the
stimulus, then the stimulus step may be omitted.
Generally speaking, the precursor protein will be one which, in
vivo, is capable of undergoing an induced conformational
polymerisation interaction (in a self-propagating manner) leading
ultimately to the formation of aggregates comprised of the product
fragment, and associated with the disease state. The product
fragment obtained in the method provided herein is a measure of the
pathological aggregation and proteolysis process which in vivo
leads to the production of one or more toxic products and the
disease state. The product fragment (or one or more of the
fragments) of the present method may be toxic, or may simply be
used as an indicator of the pathological aggregation process.
The proteins and interactions upon which the method is based are
discussed in more detail below.
The present inventors have demonstrated that it is unexpectedly
possible to constitutively express the template fragment at a
(first) concentration which is not toxic to the cell line i.e. the
cell line is viable. Nor does it show cellular abnormalities of
the sort shown e.g. in WO 96/30766 at Fig 29.
Nevertheless {e.g. at a time predetermined by addition of the
stimulus) it is possible to seed the processing of the precursor
protein to a product fragment (which may be the same, broadly
equivalent, or quite different to the template fragment) which can
thus accumulate to a (second, higher) concentration which is toxic
to the cell and which corresponds to the disease state. This in
turn provides convenient methods for modeling the disease state
associated with the effects of the product fragment, and assessing
the effect of modulators on the generation of the product fragment.
In various other, discrete, embodiments the invention provides
corresponding methods for any of initiating, seeding, or
controlling the proteolytic processing and optionally aggregation
of the precursor protein to the product fragment.

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In each case the method may involve monitoring (directly or
indirectly) the level of proteolytic processing of the precursor
protein.
In one embodiment of the present invention fibroblast cells (3T6)
express full-length tau ("T40") under the control of an inducible
promotor and low constitutive levels of the PHF-core tau fragme.it
(12 kD fragment) . When T40 expression is induced in this system, it
undergoes aggregation-dependent truncation within the cell, N-
terminally at ~a.a.295 and C-terminally at ~a.a.390, thereby
producing higher levexs of the 12 kD PHF-core domain fragment.
Production of the 12 kD fragment can be blocked in a dose-dependent
manner by tau-aggregation inhibitors. Indeed the quantitation of
inhibitory activity of compounds with respect to proteolytic
generation of the 12 kD fragment within cells can be described
entirely in terms of the same parameters which describe inhibition
of tau-tau binding in vitro. That is, extent of proteolytic
generation of the 12 kD fragment within cells is determined
entirely by the extent to tau-tau binding through the repeat
domain. The availability of the relevant proteases within the cell
is non-limiting.
Precursor proteins and diseases (including tauopathies)
As stated above, the invention may be based around the use of any
protein which is associated with a disease in which the protein
undergoes an induced conformational polymerisation interaction i.e.
one in which a conformational change of the protein, or in a
fragment thereof, gives rise to templated binding and aggregation
of further (precursor) protein molecules in a self-propagating
manner.
Once nucleation is initiated, an aggregation cascade may ensue
which involves the induced conformational polymerisation of further
protein molecules, leading to the formation of toxic product
fragments in aggregates which are substantially resistant to
further proteolysis. The protein aggregates thus formed are

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thought to be a proximal cause of neurodegeneration, clinical
dementia, and other pathological symptoms of this group of
diseases.
Preferred embodiments of the invention are based on tau protein.
Where used herein, the term "tau protein" refers generally to any
protein of the tau protein family. Tau proteins are characterised
as being one among a larger number of protein families which co-
purify with microtubules during repeated cycles of assembly and
disassembly (Shelanski et al. (1973) Proc. Natl. Acad. Sci. USA,
70., 765-768), and are known as microtubule-associated-proteins
(MAPs) . Members of the tau family share the common features of
having a characteristic N-terminal segment, sequences of
approximately 50 amino acids inserted in the N-terminal segment,
which are developmentally regulated in the brain, a characteristic
tandem repeat region consisting of 3 or 4 tandem repeats of 31-32
amino acids, and a C-terminal tail.
MAP2 is the predominant microtubule-associated protein in the
soraatodendritic compartment (Matus, A., in "Microtubules" [Hyams
and Lloyd, eds. ] pp 155-166, John Wiley and Sons, NY). MAF2
isoforms are almost identical to tau protein in the tandem repeat
region, but differ substantially both in the sequence and extent of
the N-terminal domain {Kindler and Garner (1994) Mol. Brain Res.
26, 218-224). Nevertheless, aggregation in the tandem-repeat
region is not selective for the tau repeat domain. Thus it will be
appreciated that any discussion herein in relation to tau protein
or tau-tau aggregation should be taken as relating also to tau-MAP2
aggregation, MAP2-MAP2 aggregation and so on.
Figure 5 shows a Table listing various other disease-associated
aggregating proteins which may be used in the present invention.
In each case the disease or diseases in which the initiation of
aggregation and\or mutation of the protein(s) may play a role is
also listed. The domain or mutation responsible for the disease
activity is listed, and at least all or part of this minimal
portion of the protein would preferably be encompassed by the
template fragment used in the present invention.

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As can be seen from the table, example diseases which are
characterised by pathological protein aggregation include motor
neurone disease and Lewy body disease.
Notably it is not only Alzheimer's Disease in which tau protein
(and aberrant function or processing thereof) may play a role. The
pathogenesis of neurodegenerative disorders such as Pick' s disease
and Progressive Supranuclear Palsy (PSP) appears to correlate with
an accumulation of pathological truncated tau aggregates in the
dentate gyrus and stellate pyramidal cells of the neocortex, -
respectively. Other dementias include fronto-temporal dementia
(FTD); parkinsonism linked to chromosome 17 (FTDP-17);
disinhibition-dementia-parkinsonism-amyotrophy complex (DDPAC) ;
pallido-ponto-nigral degeneration (PPND); Guam-ALS syndrome;
pallido-nigro-luysian degeneration (PNLD); cortico-basal
degeneration (CBD) and others (see Wischik et al. 2000, loc. cit,
for detailed discussion - especially Table 5.1). All of these
diseases, which are characterized primarily or partially by
abnormal tau aggregation, are referred to herein as "tauopathies" .
Thus it will be appreciated, in. the light of the above discussion,
(and except where context requires otherwise) where the embodiments
of the invention are described with respect to tau protein or tau-
like proteins (e.g. MAP2) the description should be taken as
applying equally to the other proteins discussed above (e.g. β-
amyloid, synuclein, prion etc.) or other proteins which may
initiate or undergo a similar pathological aggregation by virtue of
conformational change in a domain critical for propagation of the
aggregation, or which imparts proteolytic stability to the
aggregate this formed (article by Wischik et al. (in "Neurobiology
of Alzheimer's Disease", 2nd Edition (2000) Eds. Dawbarn, D. and
Allen, S.J., The Molecular and Cellular Neurobiology Series, Bios
Scientific Publishers, Oxford) . All such proteins may be referred
to herein as "aggregating disease proteins."
Likewise, where mention is made herein of "tau-tau aggregation", or
the like, this may also be taken to be applicable to other

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"aggregating-protein aggregation", such as β-amyloid aggregation,
prion aggregation and synuclein aggregation etc. Likewise "tau
proteolytic degradation" and so on.
Tempiate Fragments
In preferred embodiments of the present invention, the template
fragment, comprises, consists essentially of, or consists of a
"core fragment" of the precursor protein, which term refers to that
part of the protein that is able to bind to the precursor protein
to initiate or propagate proteolysis and aggregation as described
above.
In the case of disease proteins which aggregate, such core
fragments are also likely to be those which contribute to the
proteolytic stability of the aggregate.
Thus, for example, a "tau core fragment" is a tau fragment
comprising a truncated tau protein sequence derived from the tandem
repeat region and, which, in the appropriate conditions, is capable
of binding to the tandem repeat region of a further tau protein or
a MAP2 protein with high affinity. In the case of tau, the
preferred fragment is thus exemplified by, but not limited to, the
tau fragments present in PHFs (and, ultimately, neurofibrillary
tangles) in Alzheimer's disease brains.
A preferred tau fragment may thus be from about (say) between 295-
297 extending to about 390-391 (see AdGAE' in Figure 6) although
variants of such fragments may also be used, as discussed below.
In the case of APP (amyloid precursor protein), for instance,
expression of a fragment of the APP that encompasses the Ap domain
of 1-40 or 1-42 amino acids as a fusion protein, may be preferred.
Other core fragments may be based e.g. on the domains discussed
with reference to Figure 5. Template fragments may include domains
from two, or more than two, of these proteins (e.g. as fusions).

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The total length of the template fragment may be any which is
appropriate to the assay and aggregation disease protein core
fragment being used, but will generally be greater than or equal to
about 20, 30, 40, 50, 60, 70, 80, 90, or so amino acids in length.
However in some embodiments it may be greater than 100, 200 or
even 500, if this is desired.
Derivatires
In all instances herein where a named protein (e.g. precursor
protein, template or core fragment) or a recited nucleic acid
sequence is discussed, a derivative or other variant of the
corresponding reference protein (or nucleic acid) may be used as
appropriate, provided that it retains appropriate characteristics
of the reference sequence. Such derivatives will also share
sequence identity with the reference sequence.
For instance the protein used may include an extended N- or C-
terminus, which extension may be heterologous to the protein
sequence. Equally, the derivative will be one by way of amino acid
insertion, deletion, or addition of the reference sequence. For
example, a tau protein, or tau core fragment, derivative will
comprise at least a partial amino acid sequence resembling the
tandem repeat region of the tau proteins, but in which one or more
of the amino acids of the natural tau or its fragments have been
replaced or deleted, or into which other amino acids have been
inserted.
Such changes may be made to enhance or ablate binding activity (the
latter case being useful for control experiments). Controls may
contain deletions of sequences or domains to see what effect on
aggregation these may have.
Preferred derivatives may be those which incorporate mutations
corresponding to those known or suspected to be associated with the
disease state. These may include changes corresponding to P301S
within the tau sequence (see Figure 7) . Other mutations include
G272V, G389R, P301L, N279K, S305N, V337M, G272V, K280A, R406W (see

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also Wischik et al, 2000, supra) .
Other preferred derivatives may include tandem repeats of the core-
fragments discussed above, or binding domains within those
fragments.
Yet further derivatives may be based on chimeric products based on
multiple, related, disease proteins in which their sequences are
mixed or combined. For example restriction enzyme fragments of tau
could be ligated together with fragments of MAP2 or even of an
unrelated gene to generate recombinant derivatives. An alternative
strategy for modifying the core fragments would employ PCR as
described by Ho et al., 1989, Gene 77, 51-59 or DNA shuffling
(Crameri et al., 1998 Nature 291).
Use of nucleic acid constructs
Nucleic acids of, or for use in, the present invention may be
provided isolated and/or purified from their natural environment,
in substantially pure or homogeneous form, or free or substantially
free of other nucleic acids of the species of origin. Where used
herein, the term "isolated" encompasses all of these possibilities.
Nucleic acids e.g. encoding the template fragment, will be at least
partially synthetic in that it will comprise nucleic acid sequences
which are not found together in nature (do not run contiguously)
but which have been ligated or otherwise combined artificially.
Nucleic acid according to the present invention may be in the form
of, or derived from, cDNA, RNA, genomic DNA and modified nucleic
acids or nucleic acid analogs. Where a DNA sequence is specified,
e.g. with reference to a figure, unless context requires otherwise
the RNA equivalent, with U substituted for T where it occurs, is
encompassed.
As described above, the nucleic acids may encode derivatives or
other variants sharing homology with the reference sequences in
question. Preferably, the nucleic acid and/or amino acid sequence
in question would share about 50%, or 60%, or 70%, or 80% identity,

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most preferably at least about 90%, 95%, 96%, 97%, 98% or 99% of
the sequence upon which the variant is based. Similarity or
homology may be as defined and determined by the TBLASTN program,
of Altschul et al. (1990) J. Mol. Biol. 215: 403-10, which is in
standard use in the art, or, and this may be preferred, the
standard program BestFit, which is part of the Wisconsin Package,
Version 8, September 1994, (Genetics Computer Group, 575 Science
Drive, Madison, Wisconsin, USA, Wisconsin 53711) using the default
parameters. One common formula for calculating the stringency
conditions required to achieve hybridization between nucleic acid
molecules of a specified sequence homology is: Tm = 81.5°C + 16.6Log
[Na+] + 0.41 (% G+C) - 0.63 (% formamide) - 600/#bp in duplex.
Nucleic acid sequences which encode the appropriate proteins or
polypeptides can be readily prepared by the skilled person using
the information and references contained herein and techniques
known in the art (for example, see Sambrook, Fritsch and Maniatis,
"Molecular Cloning, A Laboratory Manual", Cold Spring Harbor
Laboratory Press, 1989, and Ausubel et al., Short Protocols in
Molecular Biology, John Wiley and Sons, 1992). These techniques
include (i) the use of the polymerase chain reaction (PCR) to
amplify samples of the relevant nucleic acid, e.g. from genomic
sources, (ii) chemical synthesis, or (iii) preparation of cDNA
sequences.
DNA encoding e.g. tau core fragments may be generated and used in
any suitable way known to those of skilled in the art, including by
taking encoding DNA, identifying suitable restriction enzyme
recognition sites either side of the portion to be expressed, and
cutting out said portion from the DNA. Modifications to the
protein (e.g. tau)-encoding sequences can be made, e.g. using site
directed mutagenesis.
Constructs
Thus the invention also relates, in a further aspect, to nucleic
acid molecules encoding the appropriate precursor and template
fragment proteins. As discussed below, these may be present on the

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same or different constructs, and in the latter case, compositions
comprising two or more types of construct are also provided.
Nucleic acid sequences which enable a vector to replicate in one or
more selected host cells are well known for a variety of bacteria,
yeast, and viruses. For Example, various viral origins (SV40,
polyoma, adenovirus, VSV or BPV) are useful for cloning vectors in
mammalian cells. Expression vectors comprising a nucleic acid as
described herein may, for example, be in the form of a plasmid,
cosmid, viral particle, phage, or any other suitable vector or
construct which can be taken up by a cell and expressed
appropriately.
Expression vectors will contain a promoter which is operably linked
to the protein-encoding nucleic acid sequence of interest, so as to
direct mRNA synthesis. Promoters recognized by a variety of
potential host cells are well known. "Operably linked" means
joined as part of the same nucleic acid molecule, suitably
positioned and oriented for transcription to be initiated from the
promoter. DNA operably linked to a promoter is "under
transcriptional control" of the promoter. Transcription from
vectors in mammalian host cells is controlled, for example, by
promoters obtained from the genomes of viruses such as polyoma
virus, fowlpox virus, adenovirus {such as Adenovirus 2), bovine
papilloma virus, avian sarcoma virus, cytomegalovirus, a
retrovirus, hepatitis-B virus and Simian Virus 40 (SV40), from
heterologous mammalian promoters, e.g. the actin promoter or an
immunoglobulin promoter, and from heat-shock promoters, provided
such promoters are compatible with the host cell systems.
Expression vectors used in eukaryotic host cells (yeast, fungi,
insect, plant, animal, human, or nucleated cells from other
multicellular organisms) will also contain sequences necessary for
the termination of transcription and for stabilizing the mRNA.
The promoter used for the template fragment will be "constitutive".
This promoter may be sufficiently weak that the level of template
fragment expressed in the cell is not itself (directly) detectable
using conventional techniques, other than (indirectly) by its

WO 02/055720 PCT/GB02/00153
17
affect on precursor protein, leading to aggregation and proteolytic
processing thereof (i.e. effectively undetectable when said
aggregation is inhibited). Such promoters may be selected by those
skilled in the art in the light of the present disclosure without
undue burden such as those listed above.
In the case of the precursor protein, the promoter is "inducible" -
which is to say, and as is well understood by those skilled in the
art, expression is "switched on" or increased in response to an
applied stimulus. The nature of the stimulus varies between
promoters. Some inducible promoters cause little or undetectable
levels of expression (or no expression) in the absence of the
appropriate stimulus. Other inducible promoters cause detectable
constitutive expression in the absence of the stimulus. Whatever
the level of expression is in the absence of the stimulus,
expression from any inducible promoter is increased in the presence
of the correct stimulus. In experiments below, a Lac inducible
promoter has been used.
Expression vectors of the invention may also contain one or more
selection genes. Typical selection genes encode proteins that (a)
confer resistance to antibiotics or other toxins e.g. ampicillin,
neomycin, methotrexate, or tetracycline, (b) complement auxotrophic
deficiencies, or (c) supply critical nutrients not available from
complex media, e.g., the gene encoding D-alanine racemase for
Bacilli. An example of suitable selectable markers for mammalian
cells are those that enable the identification of cells competent
to take up the desired protein-encoding nucleic acid, such as DHFR
or thymidine kinase. An appropriate host cell, when wild-type DHFR
is employed, is the CHO cell line deficient in DHFR activity,
prepared and propagated as described by Urlaub et al., Proc. Natl.
Acad Sci USA 77:4216 (1980). A suitable selection gene for use in
yeast is the trpl gene present in the yeast plasmid Rp7 [Stinchcomb
et al., Nature, 282:39 (1979); Kingsman et al., Gene, 7:141 (1979);
Tschemper et al., Gene, 10:157 (1980)J. The trpl gene provides a
selection marker for a mutant strain of yeast which lacks the
ability to grow in tryptophan, for example, ATCC: No. 4407 6 or
PEP4-1 [Jones, Genetics, 85:12 (1977)].

WO 02/055720 PCT/GB02/00153
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Thus a typical vector for use in the present invention may include
an origin of replication, one or more protein sequence (s) operably
linked to a constitutive or inducible promoter as appropriate, a
transcription termination sequence, an enhancer element, a marker
gene. Construction of suitable vectors containing various of these
components employs standard ligation techniques which are known to
the skilled artisan.
Transformation
Also provided, by the present invention is a process for producing a
stable cell for use in a method as described above, which process
comprises the steps of: (a) introducing into a cell nucleic acid
encoding (i) a template fragment of the precursor protein such that
the template fragment is constitutively expressed in the cell at a
level which is not toxic to the cell; and (ii) the precursor
protein such that the disease protein is inducibly expressed in the
cell in response to a stimulus.
The introduction, which may be generally referred to without
limitation as "transformation", may employ any available technique.
For eukaryotic cells, suitable techniques may include calcium
phosphate transfection, DEAE-Dextran, electroporation, liposome-
mediated transfection and transduction using retrovirus or other
virus, e.g. vaccinia or, for insect cells, baculovirus. The
calcium treatment employing calcium chloride, as described in
Sambrook et al., supra, or electroporation is generally used for
prokaryotes or other cells that contain substantial cell-wall
barriers. Infection with Agrobacterium tumefaciens is used for
transformation of certain plant ceils, as described by Shaw et al.,
Gene, 23:315 (1983) and WO 89/05859 published 29 June 1989.
For mammalian cells without such cell walls, the calcium phosphate
precipitation method of Graham and van der Eb, Virology 52:456-4 57
(1978) can be employed. General aspects of mammalian cell host
system transformations have been described in U.S. Patent No.
4,399,216. Transformations into yeast are typically carried out

WO 02/055720 PCT/GB02/00153
19
according to the method of Van Solingen et al. , J. Bact., 130:946
(1977) and Hsiao et al., Proc. Natl. Acad- Sci. (USA), 76:3829
(1979). However, other methods for introducing DNA into cells,
such as by nuclear microinjection, electroporation, bacterial
protoplast fusion with intact cells, or polycations, e.g,
polybrene, polyornithine, may also be used. For various techniques
for transforming mammalian cells, see Keown et al., Methods in
Enzymology, 185:527 537 (1990) and Mansour et al., Nature 336:348-
352 (1988) .
Host cells
Suitable host cells for use in the invention may include bacteria,
eukaryotic cells such as mammalian and yeast cells, and baculovirus
systems.
Mammalian cell lines available in the art for expression of a
heterologous polypeptide include fibroblast 3T6 cells, HeLa cells,
baby hamster kidney cells, COS cells, monkey kidney CV1 line
transformed by SV40 (COS-7, ATCC CRL 1651), Chinese hamster ovary
cells/-DHFR (CHO, Urlaub and Chasin, Proc. Natl. Acad. Sci. USA
77:4216 (1980)); mouse sertoli cells (TM4, Mather, Biol. Reprod.
23:243-251 (1980)); human lung cells (W138, ATCC CCL 75); human
liver cells (Hep G2, HB 8065); mouse mammary tumour cells (MMT
060562, ATCC CCL51) ; and many others.
Suitable prokaryotic hosts include but are not limited to
eubacteria, such as Gram-negative or Gram-positive organisms, for
example, Enterobacteriaceae such as E. coli. Various E. coli
strains are publicly available, such as E. coli K12 strain MM294
(ATCC 31,446); E. coli X1776 (ATCC 31,537); E. coli strain W3110
(ATCC 27,325) and K5 772 (ATCC 53,635). Eukaryotic microbes such
as filamentous fungi or yeast are also suitable cloning or
expression hosts for vectors. Saccharomyces cerevisiae is a
commonly used lower eukaryotic host microorganism. The selection
of the appropriate host cell is deemed to be within the skill in
the art.

WO 02/055720 PCT/GB02/00153
20
In a further aspect, the present invention provides a host cell
containing heterologous nucleic acid of the invention as described
above. The nucleic acid of the invention may be integrated into
the genome (e.g. chromosome) of the host cell. Integration may be
promoted by inclusion of sequences which promote recombination with
the genome, in accordance with standard techniques. Alternatively,
the nucleic acid may be on an extrachromosomal vector within the
cell, or otherwise identifiably heterologous or foreign to the
cell.
The cell may be produced by a method described above (introduction
of nucleic acid construct) or be the ancestor of such a cell.
Corresponding cell-lines are also provided. Preferred cell-lines
may be based on the fibroblast cell line, e.g. 3T6.
Host cells transfected or transformed with expression or cloning
vectors described herein may be cultured in conventional nutrient
media modified as appropriate for inducing promoters, selecting
transformants, or amplifying the genes encoding the desired
sequences. The culture conditions, such as media, temperature, pH
and the like, can be selected by the skilled artisan without undue
experimentation. In general, principles, protocols, and practical
techniques for maximizing the productivity of cell cultures can be
found in "Mammalian Cell Biotechnology: a Practical Approach", M.
Butler, ed. JRL Press, (1991) and Sambrook et al, supra.
Gene expression can be confirmed in a sample directly, for example,
by conventional Southern blotting, Northern blotting to quantitate
the transcription of mSNA [Thomas, Proc. Natl Acad Sci. USA,
77:5201-5205 (1980)], dot blotting (DNA analysis), or in situ
hybridization, using an appropriately labeled probe, based on the
sequence of the aggregating disease protein. Alternatively,
antibodies may be employed that can recognize specific duplexes,
including DNA duplexes, RNA duplexes, and DNA-RNA hybrid duplexes
or DNA-protein duplexes.
Gene expression, alternatively, may be measured by immunological
methods such as immunoiiistochemical staining of cells or tissue

WO 02/055720 PCT/GB02/00153
21
sections, and assay of cell culture, to quantitate directly the
expression of gene product. Antibodies useful for
immunohistochemical staining and/or assay of sample fluids may be
either monoclonal or polyclonal, and may be prepared in any mammal.
Conveniently, the antibodies may be prepared against a native
sequence of the aggregating disease polypeptide.
Thus one aspect of the present invention entails causing or
allowing expression from the nucleic acids discussed herein, e.g.
by culturing host cells under conditions for expression of the gene
(presence of stimulus) so that the product fragment is produced.
The present invention also encompasses a method of producing the
product fragment, the method including expression from nucleic acid
as described above.
Another aspect of the present invention is a kit comprising a
transformed cell or cell line as described herein, plus at least
one further component e.g. an agent for stimulating production of
the precursor protein, or an agent for detecting the interaction of
the precursor protein with the template fragment, as described in
the following section.
Detection of aggregation and\or proteolytic processing and\or toxic
fragment
In various embodiments, the progress of proteolytic processing or
aggregation (or modulation thereof - see below) may be detected
directly or indirectly by monitoring the concentration or level any
one or more of the following species: the precursor protein; the
product fragment; any by-product fragments formed during the
process; an aggregate of any of these (e.g. based on sedimentation
coefficients).
Thus, as exemplified with particular tau proteins and fragments
(based on 297-351 fragment and T40), aggregation can be monitored
on the basis of increasing levels of a 12kDa processed species,
derived primarily from the precursor protein.

WO 02/055720 PCT/GB02/00153
22
Some protein detection methods are discussed in relation to gene
expression above. Where antibodies or fragments thereof are used
in embodiments of the method of the present invention may be
produced by conventional techniques. Polyclonal antibodies may
raised e.g. by injecting the corresponding tau antigen into an
animal, preferably a rabbit, and recovering the antiserum by
immunoaffinity purification, in which the polyclonal antibody is
passed over a column to which the antigen is bound and is then
eluted in a conventional manner. Preferably the invention will use
monoclonal antibodies which are selective to tau epitopes may be
prepared by the method of Kohler and Milstein. Suitable monoclonal
antibodies to tau epitopes can be modified by known methods to
provide Fab fragments or (Fab')2 fragments, chimeric, humanised or
single chain antibody embodiments.
Antibodies according to the present invention may be modified in a
number of ways. Indeed the term "antibody" should be construed as
covering any binding substance having a binding domain with the
required specificity. Thus the invention covers antibody
fragments, derivatives, functional equivalents and homologues of
antibodies, including synthetic molecules and molecules whose shape
mimics that of an antibody enabling it to bind an antigen or
epitope.
Generally speaking, where antibodies are employed for detection,
the antibody may carry a reporter molecule. Alternatively,
detection of binding may be performed by use of a second antibody
capable of binding to a first unlabelled, tau-specific antibody. In
this case, the second antibody is linked to a reporter molecule.
Antibodies may be used in any immunoassay system known in the art,
including, but not limited to.: radioimmunoassays, "sandwich"
assays, enzyme-linked immunosorbent assays (ELISA); fluorescent
immuno-assays, protein A immunoassays, etc. Typically, an
iramunoblot method is used. Preferably the immunoassay is performed
in the solid phase, as would be well known to the skilled person.
For instance, an antibody may be adsorbed to e.g. an assay column,
and the cellular sample may then be washed through the column under

WO 02/055720 PCT/GB02/00153
23
conditions suitable for enabling binding to the solid-phase
antibody of any aggregate of the protein of interest, e.g. a tau-
tau aggregate. Excess reagent is washed away, and the binding of
aggregated protein to the column can then be detected by any
suitable means, e.g. as exemplified above and below.
Preferred monoclonal antibodies are as follows:
- Those which recognise the N-terminal or C-terminal of the tau
epitope permit measuring of binding between truncated and full-
length tau species. Especially useful are antibodies recognising
human-specific epitopes. One such monoclonal antibody (designated
27/499) recognises a human-specific epitope located in the region
between Gly-16 and Gln-26 of tau, and thereby permits measurement
of binding between full-length tau species, provided one is derived
from a non-human source (Lai (1995) ; "The role of abnormal
phosphorylation of tau protein in the development of
neurofibrillary pathology in Alzheimer's disease", PhD Thesis,
University of Cambridge) .
- Those which recognise the core tau fragment truncated at Glu-391.
An example is mAb 423 (Novak et al. (1993), loc. cit.). This
antibody enables detection of the binding of a truncated core tau
fragment terminating at Glu-391 to a similar fragment terminating
at Ala-390, which is not recognised by mAb 423. This truncation
occurs naturally in the course of PHF assembly in Alzheimer's
disease (Mena et al. (1995), (1996), loc. cit.; Novak et al.
(1993), loc. cit.; Mena et al. (1991), loc. cit.). Additionally,
when tau is bound via the repeat domain in vitro, digestion with a
protease (e.g. pronase) generates a fragment detectable by mAb 423
(see Wischik et al, 1996, loc cit) . In the preferred aspects of
the present invention, as it relates to tau protein, this antibody
may be used to distinguish the generation of proteolytically
cleaved product fragment (Glu-391 termination) from constitutive
expression of-template fragment (Ala-390).
- Those which recognise a generic tau epitope in the repeat domain.
A preferred embodiment utilises an antibody (e.g. MAb 7.51). where

WO 02/055720 PCT/GB02/00153
24
tau-MAP2 or MAP2-MAP2 aggregation is to be detected, an antibody
which detects a generic MAP2 epitope could be used. Antibody 7.51
recognises a generic tau epitope located in the antepenultimate
repeat of tau (Novak et al. (1991) Proc. Natl. Acad. Sci. USA, 88,
5837-5841), which is occluded when tau is bound in a PHF-like
imtnunochemical configuration but can be exposed after formic acid
treatment (Harrington et al. ( 1990), (1991), loc. cit.; Wischik et
al. (1995a), loc. cit.). Normal soluble tau, or tau bound to
microtubules, can be detected using mAb 7.51 without formic acid
treatment (Harrington et al. (1991), loc. cit.; Wischik et al.
(1995a), loc. cit.). Binding of full-length tau in the tau-tau
binding assay is associated with partial occlusion of the mAb 7.51
epitope.
Antibody 27/342 recognises a non-species specific generic tau
epitope located between Ser-208 and Ser-238 which is partially
occluded in the course of the tau-tau interaction (Lai, loc. cit.) .
The binding sites of some monoclonal antibodies are shown in Figure
6.
Screening for modulators and inhibitors
As described above, the invention is preferably concerned with use
of a system as provided herein, in a method of modeling, and
identifying therapeutic agents for treatment of, the diseases
discussed herein.
A typical method for assessing the ability of an agent to modulate
the aggregation and\or proteolytic processing of a precursor
protein to a product in response to interaction with a template
fragment, may comprise:
(a) providing a stable cell or cell line as discussed above,
(b) subjecting the cell to the stimulus such that the precursor
protein is expressed in the cell and whereby interaction of the
template fragment with the precursor protein causes a
conformational change in the protein such as to cause aggregation
and proteolytic processing of the precursor protein to a product

WO 02/055720 PCT/GB02/00153
25
fragment,
(c) monitoring the production of the product fragment in the
presence of the agent,
(d) optionally comparing the value obtained in step (c) with a
reference value.
The reference value may be based on historical observation, or may
be based on control experiments carried out in parallel e.g. in
which one integer of the assay (template fragment, precursor
protein, stimulus, agent) is modified or absent.
The various methods described above may comprise the further step
of correlating the result of step (d) with the modulatory activity
of the agent(s) .
Thus a method of identifying a modulator of aggregation of a
protein associated with a disease in which the protein undergoes an
induced conformational interaction, may comprise performing a
method for inducing aggregation as described above in the presence
of one or more agents suspected of being capable of modulating
(e.g. inhibiting or reversing) the aggregation. The degree of
aggregation (and optionally proteolytic processing) may be observed
in the presence or absence of the agent, and the relative values
correlated with its activity as a modulator.
For example, a test substance may be added to a cellular system as
described above, and the cells incubated for a period of time
sufficient to allow binding and to demonstrate inhibition of
binding. The bound tau complex can then be detected, e.g. using a
suitably-labeled antibody such as MAb 7.51 in an immunoblot of
total cell extract, or any other suitable detection method.
Where a screening method is employed for this purpose, i.e. for the
identification of modulatory/inhibitory compounds, a non-
competitive or competitive assay may be used. For instance, in a
competitive assay of the type well known in the art, the effect of
a known inhibitor or modulator can be compared in the presence or
absence of further test substances or agents, to determine the

WO 02/055720 PCT/GB02/00153
26
ability of the test substance to compete with the known
inhibitor/modulator for binding to the protein of interest.
Also provided are methods of producing modulators (e.g. inhibitors)
which are as described above, but which further comprise the step
of producing the modulator this identified.
Specificity of inhibition
Screening methods according to this aspect of the present invention
may be used to screen for compounds which demonstrate the
properties of selective competitive inhibition of disease-related
protein aggregation (e.g. tau-tau, tau-MAP2, or other protein,
binding), without interference with any 'normal' binding in which
the precursor protein participates (e.g. tau or MAP2 to tubulin, or
by analogy, other precursor proteins with their binding partners
insofar as these are known) .
Specifically in the case of tau, a method for determining any
possible interference of the binding of tau, MAP2 or a derivative
thereof to tubulin by potential inhibitors/modulators, comprises
contacting a preparation of depolymerised tubulin or taxol-
stabilised microtubules with the agent, followed by detection of
the tau-tubulin or MAP2-tubulin binding. Tau-tubulin binding could
also, for example, be demonstrated by a normal cytoskeletal
distribution, as described in e.g. WO 96/30766. Methods for the
preparation of tubulin proteins or fragments thereof, possibly in
combination with binding partners, are known in the art and are
described e.g. by Slobada et al. (1976, in: Cell Mobility (R.
Goldman, T. Pollard and J. Rosenbaum, eds.), Cold Spring
Laboratory, Cold Spring Harbor, New York, pp 1171-1212).
Analogous methods for other proteins having 'disease' and 'normal'
functions will occur to those skilled in the art in the light of
the present disclosure.
Cell viability

WO 02/055720 PCT/GB02/00153
27
Where desired, methods of the present invention may further include
the step of testing the viability of the cells expressing the
template protein and optionally precursor protein e.g. by use of a
lactate dehydrogenase assay kit (Sigma).
In the case where tau-tau, tau-MAP2 or MAP2-MAP2 aggregation is
being investigated (see above, under 'specificity' ), this step may
also provide an indication of any interference by the test agent of
the binding of tau or MAP2 to tubulin, since inhibition or
interference of tau-tubulin or MAP2-tubulin binding will correlate
to some extent with a decreased ability of the cells to divide, and
thus with decreased cell viability.
Cell viability may be used to derive an LD50 value for the agent.
Preferred inhibitors will have a therapeutic index (LD50/B50 - see
discussion of Figure 9) of at least 2, 5, 10, or 20.
Choice of test agent
Compounds which are tested may be any which it is desired to assess
for the relevant activity.
The methods can serve either as primary screens, in order to
identify new inhibitors/modulators, or as secondary screens in
order to study known inhibitors/modulators in further detail.
Agents may be natural or synthetic chemical compounds. Antibodies
which recognise an Alzheimer's disease-like protein aggregate
and/or which modulate Alzheimer's disease-like protein aggregation
form one class of putative inhibitory or modulatory compounds with
respect to the aggregation process. More usually, relatively small
chemical compounds, preferably which are capable of crossing the
blood-brain barrier, will be tested. Other qualities which it may
be desirable to establish in conjunction with (before,
simulataneously with, or after) use of the present invention,
include: non-toxic to bone marrow, minimal deleterious
cardiovascular activity; minimal liver and renal toxicity; good

WO 02/055720 PCT/GB02/00153
28
oral absorption; non-metabolised to inactive form, and so on. As
those skilled in the art are aware, these tests can be performed on
a commercial basis by well established methods for compounds which
it is desired to test in this way.
For a typical test substance and putative modulator, where
possible, the solubility will first be determined e.g. from The
Merck Index. Where the substance is soluble in aqueous solution, a
concentrated stock solution may be prepared e.g. at 5-20mM in PBS.
Immediately prior to use this can be diluted with tissue culture
medium to give a working stock solution e.g. at lOOuM and
introduced to* cells to give a final concentration of between 0-10uM
for most compounds. Naturally, if it is desired to test compounds
at a concentration greater than lOuM, the concentration of the
working stock solution may be increased appropriately.
Where the substance is not soluble in aqueous solution, stock
solutions may be made in an appropriate solvent (determined from
The Merck Index or experimentally) e.g. ethanol at 5-29 nM. This
can again be diluted with tissue culture medium immediately prior
to use to give a working solution e.g. at lOOuM concentration, and
added to cells to yield a final concentration of e.g. 0-10uM for
most test compounds. As above, if compounds are to be tested at a
concentration greater than lOuM the concentration of the working
solution will be increased as appropriate.
The skilled person will appreciate that the amount of test
substance or compound which is added in a screening assay according
to this aspect of the invention, and indeed the manner in which it
is introduced, can be determined by those skilled in the art, if
necessary by use of a series of trials. Where the administered
compound and the cell line have conflicting optimal conditions
(e.g. in terms of pH, or ionic strength etc.) a variety of
conditions should be tried to find an optimal, compromise, level.
Initial concentrations may be selected to be a level which could
realistically be used in therapeutic context i.e. would be non-
lethal to a patient (see comments on dosages below) . In the light
of the present disclosure/ such an approach will not present any

WO 02/055720 PCT/GB02/00153
29
undue burden to one skilled in the art.
Screening phenothiazines
The present invention extends, in further aspects, to compounds
identified by a screening method as provided herein, and to
compositions comprising such inhibitors/modulators of induced
conformational polymerisation of a protein.
As described in e.g. WO 96/30766, amongst the agents found to be
able to inhibit pathological induced conformational polymerisation
of proteins such as tau are certain disiminophenothiazines. Examples
include such as thionine, methylene blue (MB), tolonium chloride,
and dimethyl-methylene blue (DMMB) which are of particular interest
as potential therapeutic agents for use in the prevention of tau-
tau aggregation in diseases such as Alzheimer's Disease.
Interestingly, as described in more detail in the Examples, the
present inventors have used the methods described herein to
demonstrate that the mechanism of action of compounds such as MB on
induced conformational polymerisation such as tau-tau aggregation
is primarily steric in nature. Additionally, it has been shown
that the potent steric inhibitory effect, e.g. of the
diaminophenothiazines on tau-tau binding, is dependent on the
diffusion coefficient of the compound. The various implications of
these observations in terms of screening and formulating compounds
are discussed in more detail below.
This finding is particularly unexpected when considering the
description of the use of the such compounds in the prior art.
Thus, for example, such compounds were previously known to be
useful in the treatment of methaemoglobinaemia, where their action
has been shown to be mediated by the catalytic reduction of
oxidised haemoglobin by transfer of electrons from the cell's
intrinsic supply of reduced pyridine nucleotides (see, e.g.
Hauschild, F. (1936) Arch. Exp. Pathol. Pharmacol. 182:118;
"Pharmacological Basis of TherapButics", First Edition (1941),
Goodman and Gilman; Hrgovic, Z. (1990) Anasth. Intensivther.

WO 02/055720 PCT/GB02/00153
30
Notfallmed. 25: 172; and Cudd, L. et al. (1996) Vet Human Toxicol.
38(5): 329) and in the prophylaxis of manic depressive psychosis
(Narsapur, S.L. (1983) Journal of Affective Disorders 5:155;
Naylor, G.J. (1986) Biol. Psychiatry 21:915). Notwithstanding
this, MB, thionine and tolonium chloride are actually intrinsically
weak oxidising agents and, in the absence of a supply of reduced
pyridine nucleotides, they oxidise proteins such as haemoglobin
(Morse, E. (1988) Annals of Clin. Lab. Sci. 18(1): 13). This toxic
effect can be used to inactivate viruses, and MB has consequently
been exploited therapeutically in a process for removing HIV and
hepatitis virus from blood products (Chapman, J. (1994),
Transfusion Today 20:2; Wagner, S. J. (1995) Transfusion
35(5): 407). The mechanism of action of this effect is thought to
involve intercalation of MB into DNA. The compound is boosted to a
higher redox state by photoactivation and, when it drops back down
to its ground state, produces singlet oxygen which oxidises the DNA
and inactivates it (Ben-Hur, E. et al. (1996) Transfusion Medicine
Reviews, Vol. X, No. 1: 15; Margolis-Nunno, H. et al. (1994),
Transfusion 34(9): 802). Exploitation of the toxic effect of
photoactivated diaminophenothiazines has also been suggested for
the treatment of cancer. Within cells, compounds which have been
photoactivated to the oxidised form can damage mitochondria
(Darzynkiewicz, Z. et al- (1988), Cancer Research 48: 1295) and/or
microtubules (Stockert, J. et al. (1996) Cancer Chemother.
Pharmacol. 39: 167) .
Thus, on reviewing the prior art, it is apparent that two possible
mechanisms have been proposed to account for the action of
compounds such as MB and thionine on entities such as DNA or
proteins. The first is the catalytic reduction of e.g. oxidised
proteins by means of transfer of electrons from reduced pyridine
nucleotides in the cell. The second proposed mechanism is the
oxidation, and consequent inactivation of e.g. DNA by a
photoactivated, oxidised form of compounds such as MB. In the
light of these two mechanisms, it could therefore reasonably have
been assumed that the inhibitory effect on tau-tau association of
compounds such as MB was also attributable to a redox activity.

WO 02/055720 PCT/GB02/00153
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That is, it might be assumed that such compounds inhibit induced
conformational polymerisation such as tau-tau association by acting
as weak oxidising agents or as catalytic reducing agents.
Thus the work of the present inventors, in demonstrating that the
mechanism of action is primarily steric in nature, has unexpected
implications for the choice, assessment, formulation and use of
such compounds in the context of the diseases discussed herein.
In particular, certain compounds have been identified as feasible
therapeutics which would have been dismissed based on the result of
prior art assays. Specifically, Wischik et al. 1996 {loc cit)
reported on page 1217 that the concentration of MB required for
inhibition was higher than could be achieved clinically. However
the results herein show that the reduction of MB modifies its
stacking ability in such a way as to enhance its inhibitory
potential to a level at which it becomes clinically relevant for
the treatment of e.g. tau aggregation associated disease. This is
discussed in more detail below in relation to the embodiments of
the invention concerned with measurement of diffusion coefficients
(which are also determined, in part, by the compound's ability to
'stack').
Figure 8 shows the structure of only some of the compounds which
have been tested in the cell based assay. Figures 9-16 demonstrate
the increased potency of certain compounds in the reduced form,
plus some control compounds.
Thus in one aspect of the present invention there is disclosed use,
in the treatment of a disease disclosed herein, of a reduced
('leuco') phenothiazine of the formula:
(I)


WO 02/055720 PCT/GB02/00153
32
wherein R1, R3, R4, R6, R7 and R9 are independently selected from
hydrogen, halogen, hyaroxy, carboxy, substituted or unsubstituted
alkyl, haloalkyl or alkoxy;
R5 is selected from hydrogen, hydroxy, carboxy, substituted or
unsubstituted alkyl, haloalkyl or alkoxy; and each R10 and Ru are
independently selected from hydrogen, hydroxy, carboxy, substituted
or unsubstituted alkyl, haloalkyl or alkoxy;
or a pharmaceutically acceptable salt thereof.
Preferably, Rx, R3, R4, R6, R7 and R9 are independently selected from
-hydrogen, -CH3, -C2H5 or -C3H7;
each R10 and Ru are independently selected from hydrogen, -CH3, -
C2H5 or -C3H7; and
R5 is hydrogen, -CH3, -C2H5 or -C3H7.
Preferably, the compound is a diaminophenothiazine which has 0, 2,
3 or 4 methyl groups around the diaminophenothiazine nucleus.
Preferably, the diaminophenothiazine is asymmetrically methylated
(e.g., tolonium chloride, azure A, azure B and thionine).
Preferably the compound is selected from Methylene Blue, Tolonium
chloride, Thionine, Azure A, Azure B or 1, 9-Dimethylmethylene Blue.
Phenothiazines for use in the present invention may be manufactured
by the processes referred to in standard texts (e.g. Merck Manual,
Houben-Weyl, Beilstein, E. III/IV 27, 1214 ff, J. Heterocycl. Chem.
21, 613 (1984)).
Instead of administering these compounds directly, they could be
administered in a precursor form, for conversion to the active form
by an activating agent produced in, or targeted to, the cells to be

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33
treated. For instance, methylene blue may be administered in a
precursor form, or it may itself serve as a precursor of the
compound Azure A.
Stabilisation of reduced form
Some of these compounds of interest are known to circulate in the
body predominantly in the reduced form. For example, for a
discussion of the pharmacokinetics of MB, see e.g. DiSanto, A. et
al. (1972) Journal Pharm. Sci. 61(7):1086 and DiSanto, A. et al.
(1972) Journal Pharm. Sci 61(7):1090. Thirdly, only the reduced
form of compounds such as MB is found to cross the blood-brain
barrier (Chapman, D.M. (1982) Tissue and cell 14(3):475; Muller, T.
(1992) Acta Anat. 144:39; Muller, T. (1994) J. Anat. 184:419;
Becker, H. et al. (1952) Zeitschrift fur Naturforschung 7:493;
Muller, T. (1995) It. J. Anat. Embryol. 100(3):179; Muller, T.
(1998) Histol. Histopathol. 13:1019).
Such references as these illustrate that the reduced form of
compounds such as MB represents a feasible and pharmaceutically-
acceptable formulation for administration to subjects. MB has
previously been used clinically in an oral preparation. Further
toxicological tests are, however, required before its clinical
acceptability is achieved. The half live of MB and related
compounds (e.g. tolonium chloride) in blood is approximately 100
minutes. It is evident that slow release formulations of compounds
with such, relatively short, half lives can substantially improve
compound availability and hence therapeutic efficacy.
Figure 17 shows that compounds such as those discussed herein
differ greatly in their extent of reduction in the conditions of
the assay (approx. 500:1 DTT excess, at 120 minutes). As this
figure shows, thionine is completely reduced under these
conditions, tolonium chloride is reduced at an intermediate level,
and MB and DMMB are relatively little reduced. The amounts of
commonly used reductant required to achieve, say, 90% reduction of
the oxidized form in 10 minutes, prior to administration\absorption
may not be feasible (e.g. 2000:1 ratio of DTT to MB).

WO 02/055720 PCT/GB02/00153
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As Figure 18 illustrates, the extent of reduction of MB under
physiological conditions can be greatly accelerated by allowing
reduction over night and then lyophilising the reduced form. The
lyophilisate becomes reduced by 90% in 10 minutes, after
solubilisation in conditions mimicking gastric acidity (5mM HC1).
Capsules containing a form of the diaminophenothiazine pre-reduced
with ascorbic acid at a mg ratio of 1.5-2 represent a suitable, if
not optimal, formulation for therapeutic use.
The same considerations apply to other compounds, such as thionine
and tolonium chloride, which are more readily reduced than MB, but
the extent of reduction of which can be accelerated in a manner
such as that described above.
Thus in preferred forms the phenothiazine agents of the present
invention are provided as pre-reduced compounds e.g. in lyophilised
preparations, optionally in the presence of a stabilising agent.
An agent for stabilising the preferred form of the active compound
{i.e. a form of the compound having a low diffusion coefficient,
e.g. the fully-reduced form of the compound) may be a reducing
agent or antioxidant. The agent may serve both to convert one form
of the inhibitory compound (e.g. the oxidised form) to the
preferred form thereof (e.g. the reduced form), and to stabilise
that preferred (e.g. reduced) form. Alternatively, the inhibitory
compound may be added to the composition in its preferred (e.g.
already-reduced) form, so that the agent merely serves to maintain
the compound in this form.
Particularly suitable for use in converting to, and/or stabilising,
the reduced form of the active agent (e.g. the
diaminophenothiazine) comprised in the formulations of the present
invention is the antioxidant ascorbate. Ascorbate has previously
been used to minimise oxidative damage of proteins (Parkkinen J.
(1996), "Thrombosis and Haemostasis" 75(2): 292). A formulation as
provided herein could thus advantageously comprise a
diaminophenothiazine, especially MB, tolonium chloride, DMMB or

WO 02/055720 PCT/GB02/00153
35
thionine, in combination with ascorbate, in suitable proportions,
concentrations and dosages.
In other embodiments the reduced (leuco) form may be favoured by
the addition or selection of appropriate constituent groups.
Thus aspects of the invention further include a method of preparing
a medicament for use in the treatment or prophylaxis of a disease
as described above, which method comprises the step of reducing the
compound (such that it is, say, at least 50, 60, 70, preferably 80,
90, 95, or 99% reduced) and stabilizing it in a lyophilized
composition -in the reduced form, prior to administration of an
appropriate dose to a patient in need of the same.
Dosage of therapeutics
Administration is preferably in a "prophylactically effective
amount" or a "therapeutically effective amount" (as the case may
be, although prophylaxis may be considered therapy), this being
sufficient to show benefit to the individual. The actual amount
administered, and rate and time-course of administration, will
depend on the nature and severity of the disease being treated.
Prescription of treatment, e.g. decisions on dosage etc., is within
the responsibility of general practitioners and other medical
doctors, and typically takes account of the disorder to be treated,
the condition of the individual patient, the site of delivery, the
method of administration and other factors known to practitioners.
CNS penetration of MB following systemic administration has been
described by Miiller (1992; Acta Anat. 144:39). Azure A and B are
known to occur as normal metabolic degradation products of MB
(Disanto and Wagner (1972a) J. Pharm. Sci. 61: 598; Disanto and
Wagner (1972b) J. Pharm. Sci. 61: 1086). The pharmacokinetics and
toxicity of tolonium chloride in sheep is discussed by Cudd et al
(1996) Vet Human Toxic 38 (5) 329-332.
For thionine, which is specifically exemplified herein, a daily
dosage of between 1 and 1000 mg may be suitable, preferably divided

WO 02/055720 PCT/GB02/00153
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into 1 to 8 unit doses, which can, for example, be of the same
amount. It will, however, be appreciated that these limits given
above can be departed from when required, as may be appropriate
with the compounds of the invention other than thionine, which have
higher or lower activity or bioavailability.
Figure 19 shows the variation of tissue levels of MB vs IV dose.
The pharmacokinetics of methylene blue have been studied in humans,
dogs and rats by DiSanto and Wagner, J Pharm Sci 1972, 61:1086-1090
and 1972, 61:1090-1094. Further data on urinary excretion in humans
is also available from Moody et al., Biol Psych 1989, 26: 847-858.
Combining data on urinary excretion of MB in humans, it is possible
to derive an overall model for distribution of MB following single
100 mg dose in a 70 kg subject, assuming instantaneous absorbtion
(Fig 19B) . Urinary excretion accounts for 54 - 98% of the ingested
dose. This variability is most likely due to variability in
absorbtion, although variability in metabolism cannot be excluded.
From urinary excretion data, it is possible to calculate that whole
body clearance is 56 mg/kg/hr. Therefore, the dosage required to
achieve an effective target tissue concentration of 4 uM is 1.73
mg/kg/day (0.58 mg/kg tds) if there were complete absorbtion.
However, from Moody et al., it is clear that total urinary
excretion, and hence effective bioavailability, is itself a
function of dose. The oral dose required to deliver 1-73 mg/kg/day
is approximately 2x the dosage calculated on the basis of whole-
body clearance. Therefore the actual required dosage is on the
order of 3.2 mg/kg/day. This is close to the minimum routine oral
dosage used clinically in humans, eg in the treatment of chronic
urinary tract infection (390 mg/day). The maintenance oral dosage
in humans is therefore approximately 225 mg/day, or 75 mg tds. Peak
tissue levels are reached at approximately 1 hr and the tissue
half-life is about 12 hours.
Methylene blue exists in the charged blue oxidised form, and the
uncharged colourless reduced leukomethylene blue form. We have
shown experimentally in cells that the target tissue concentration
in cells required to prevent tau aggregation by 50% (ie the EC50)

WO 02/055720 PCT/GB02/00153
37
is 4 μM for reduced methylene blue, and that it is the leuko- form
which is preferentially active. It is shown by DiSanto and Wagner
(1972) that approximately 78% of the methylene blue recovered in
urine is in the reduced form, and from anatomical studies following
iv administration, the only form which is bound to tissues is the
colourless reduced form, which becomes oxidised to the blue colour
on exposure to air after post-mortem dissection. The only form of
methylene blue which crosses the blood-brain barrier after iv
administration is the reduced form (Muller, Acta Anat 1992, 144:39-
44 and Becker and Quadbeck, 1952) . Therefore, orally absorbed
methylene blue is very rapidly reduced in the body, and remains so
until excretion, possibly undergoing further chemical modification
which stabilises it in a reduced form.
It is highly likely that variability in oral absorbtion is
determined largely by the efficiency of initial reduction in the GI
tract. One way to achieve more reliable absorbtion is therefore be
to pre-reduce methylene blue with ascorbic acid. We have shown from
in vitro studies that this conversion is rather slow, so that it
takes 3 hours to achieve 90% reduction of methylene blue in water
in the presence of 2x mg ratio of ascorbic acid. Therefore, the
dosage of methylene blue which is most likely to ensure reliable
absorbtion will be 3.5mg/kg/day of methylene blue pre-reduced for
at least 3 hours in the presence of 7 mg/kg/day of ascorbic acid.
It is also possible that MB may be active at lower concentrations
in man, and that a range of clinically feasible doses would be
therefore 20 mg tds, 50 mg tds or 100 mg tds, combined with 2x mg
ratio of ascorbic acid in such a manner as to achieve more than 90%
reduction prior to ingestion.
Formulation and administration of therapeutics
Suitable compounds, such as those with a formula as shown above or
their pharmaceutically-acceptable salts, may be incorporated into
compositions of this aspect of the present invention after further
testing for toxicity. The compositions may include, in addition to
the above constituents, pharmaceutically-acceptable excipients,

WO 02/055720 PCT/GB02/00153
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carriers, buffers, stabilisers or other materials well known to
those skilled in the art. Such materials should be non-toxic and
should not interfere with the efficacy of the active ingredient.
The precise nature of the carrier or other material may depend on
the route of administration.
Where the composition is formulated into a pharmaceutical
composition, the administration thereof can be effected parentally
such as orally, in the form of powders, tablets, coated tablets,
dragees, hard and soft gelatine capsules, solutions, emulsions or
suspensions, nasally (e.g. in the form of nasal sprays) or rectally
(e.g. in the form of suppositories). However, the administration
can also be effected parentally such as intramuscularly,
intravenously, cutaneously, subcutaneously, or intraperitoneally
(e.g. in the form of injection solutions).
Where the pharmaceutical composition is in the form of a tablet, it
may include a solid carrier such as gelatine or an adjuvant. For
the manufacture of tablets, coated tablets, dragees and hard
gelatine capsules, the active compounds and their pharmaceutically-
acceptable acid addition salts can be processed with
pharmaceutically inert, inorganic or organic excipients. Lactose,
maize, starch or derivatives thereof, talc, stearic acid or its
salts etc. can be used, for example, as such excipients for
tablets, dragees and hard gelatine capsules. Suitable excipients
for soft gelatine capsules are, for example, vegetable oils, waxes,
fats, semi-solid and liquid polyols etc.
Where the composition is in the form of a liquid pharmaceutical
formulation, it will generally include a liquid carrier such as
water, petroleum, animal or vegetable oils, mineral oil or
synthetic oil. Physiological saline solution, dextrose or other
saccharide solution or glycols such as ethylene glycol, propylene
glycol or polyethylene glycol may also be included. Other suitable
excipients for the manufacture of solutions and syrups are, for
example, water, polyols, saccharose, invert sugar, glucose,
trihalose, etc. Suitable excipients for injection solutions are,
for example, water, alcohols, polyols, glycerol, vegetable oils,

WO 02/055720 PCT/GB02/00153
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etc.
Suitable excipients for suppositories are, for example, natural or
hardened oils, waxes, fats, semi-liquid or liquid polyols etc.
Moreover, the pharmaceutical preparations may contain preserving
agents, solubilizers, viscosity-increasing substances, stabilising
agents, wetting agents, emulsifying agents, sweetening agents,
colouring agents, flavouring agents, salts for varying the osmotic
pressure, buffers, or coating agents.
For intravenous, cutaneous or subcutaneous injection, or
intracatheter infusion into the brain, the active ingredient will
be in the form of a parenterally-acceptable aqueous solution which
is pyrogen-free and has suitable pH, isotonicity and stability.
Those of relevant skill in the art are well able to prepare
suitable solutions using, for example, isotonic vehicles such as
Sodium Chloride Injection, Ringer's Injection, Lactated Ringer's
Injection- Preservatives, stabilisers, buffers and/or other
additives may be included, as required.
A composition according to the present invention may be
administered alone, or in combination with other treatments, either
simultaneously or sequentially, dependent upon the condition or
disease to be treated.
In accordance with the present invention, the formulations provided
herein may be used for the prophylaxis or treatment of Alzheimer's
disease, motor neuron disease, Lewy body disease, Pick's disease or
Progressive Supranuclear Palsy, or any other condition or disease
in which induced conformational polymerisation of a protein is
implicated (see Figure 5) . In particular, as described in detail
below, the formulation may be used for the blocking, modulation and
inhibition of pathological tau-tau association.
Examples of the techniques and protocols mentioned above can be
found in "Remington's Pharmaceutical Sciences", 16th edition, Osol,
A. (ed.), 1980.

WO 02/055720 PCT/GB02/00153
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In a further aspect, the present invention relates to the use of a
composition of the preceding aspect, in the diagnosis, prognosis or
treatment of a condition in which induced conformational
polymerisation of a protein is implicated. The condition may be a
disease such as Alzheimer's disease, or any other condition of the
type described herein.
Use of diffusion constant as a screen
As stated above, by converting a compound into, and/or stabilising
its reduced form, the inhibitory potency of the compound can be
optimised.
However, as described in more detail in the examples hereinafter,
surprisingly, the redox potential of a compound does not directly
determine its inhibitory activity with respect to induced
conformational polymerisation of proteins, and that, therefore,
neither the oxidation model nor a catalytic reduction model are
relevant to an understanding of the activity of compounds as tau-
tau aggregation inhibitors.
The inventors have found that there is a strong inverse correlation
between the inhibitory potential of a compound towards tau-tau
binding and the square or third power of its diffusion coefficient.
The diffusion coefficient is determined by the amount of stacking
of discharged molecules at a cathode. Experimentally, this can be
evaluated by measuring the current flow in a redox cell at the
reduction potential. The diffusion coefficient is inversely
correlated with the degree of aggregation of the discharged (i.e.
reduced) species within the Helmholtz layer forming at the cathode.
These aggregates form by pi-bonded stacking interactions across the
phenol ring systems.
In one model, the lower the diffusion coeffxcient, the higher the
tendency to stack, and the more potent the compound is in
inhibiting induced conformational polymerisation of proteins such

WO 02/055720 PCT/GB02/00153
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as tau-tau binding, as reflected by a low Ki.
The stacking of diaminophenothiazines may be less favoured when the
molecule is in the oxidised form, since this form is charged, and
so can be envisaged to repel other, like molecules. This phenomenon
may thus explain the greater efficacy of the reduced form of
diaminophenothiazines in the inhibition of tau aggregation (see
e.g. Figure 9).
Thus an assessment of the diffusion coefficient (dependent on
'stackability', which is in turn dependent on shape and charge) can
be a useful step in the development of effective modulators. One
such sterically-relevant parameter is diffusion coefficient which
can be diminished by providing diaminophenothiazines in their
reduced form.
Thus, the present inventors teach herein that the efficacy of a
compound in the blocking, modulation or inhibition of induced
conformational polymerisation of a protein (hereinafter referred to
as "inhibitory potency" can be tested in an assay method which
includes the step of measuring the diffusion coefficient of the
compound.
Hence, in its most general form, the present invention provides a
method of screening for an agent that blocks, modulates or inhibits
induced conformational polymerisation of a protein, which method
includes the step of measuring the diffusion coefficient of the
agent. The use of the diffusion coefficient value, and in
particular the square or third power of its diffusion coefficient,
in assessing the inhibitory potency of a phenothiazine (e.g. as
described above) for the treatment of a disease as described herein
forms a further aspect of the present invention.
The step of measuring the diffusion coefficient of the test agent
may be incorporated at any stage of a larger screening programme
for identifying or optimising putative or established modulators.
The larger method will typically further include assay steps as
described herein, or in the prior art (e.g. WO 96/30766) . Thus, in

WO 02/055720 PCT/GB02/00153
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the latter case for instance, when one wishes to screen for agents
which black, modulate or inhibit tau-tau aggregation, the method
may include the steps of contacting:
(a) a tau protein or a derivative thereof containing the tau core
fragment, with;
(b) a substance to be tested for its ability to block, modulate or
inhibit tau-tau aggregation; and
(c) a labelled tau protein or a labelled derivative thereof which
is capable of binding to the tau protein of step (a) or a tau
protein or a derivative thereof which is distinct from the tau
protein of step (a) and also capable of binding to the tau protein
of step (a).
The diffusion coefficient may be measured by any suitable means,
for instance according to the method of Murthy and Reddy (J Chem
Soc, Faraday Trans J 1984, 80. 2745-2750). This publication also
included some determined values of diffusion coefficients for
phenothiazine dyes and its content is specifically incorporated
herein by reference.
Thus, the diffusion coefficient may suitably be measured by cyclic
voltammetry in an aqueous acidic medium, whereby the magnitude of
current flow in a redox cell is tested at the reduction potential
of the compound.
The method may include the step of performing further tests on the
agent, e.g. to ascertain its specificity as an inhibitor or
modulator of induced conformational polymerisation of a particular
protein (e.g. tau), or to determine its pharmaceutical
acceptability or suitability as an agent for administration to an
animal.
The surprising teaching as provided herein, that the efficacy of an
agent in blocking, modulating or inhibiting induced conformational
polymerisation of a protein is dependent, at least in part, on the
diffusion coefficient of the agent, can be utilised in the
optimisation of an agent's efficacy. The present inventors have

WO 02/055720 PCT/GB02/00153
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established that an agent's inhibitory potency towards induced
conformational polymerisation of a protein is inversely related to
the square or third power of its diffusion coefficient. In other
words, the inhibitory potency of an agent can be optimised by
providing the agent in a form in which its diffusion coefficient is
minimised.
Thus, in a further aspect, the present invention concerns a method
of optimising the efficacy of an agent in blocking, modulating or
inhibiting induced conformational polymerisation of a protein,
which method includes, the step of minimising the diffusion
coefficient of the agent.
In a further aspect, the present invention provides a
pharmaceutical composition for the prophylaxis or treatment of a
condition in which induced conformational polymerisation of a
protein occurs, the composition comprising a compound which is
provided in, or converted into, a form in which its diffusion
coefficient is minimised.
This, and further, aspects of the invention will be better
understood by reference to the following figures and experimental
data, given only by way of example.
Figures
Figure 1 shows a schematic illustration of the structure of a
paired helical filament (top) and the immunochemistry of
neurofibrillary tangles during progression of Alzheimer's disease
(bottom).
Figure 2 shows a conceptual scheme wherein critical nucleating
factors provide a 'seed' which initiates tau capture, which then
becomes autocatalytic.
Figure 3 shows a putative pathogenic model of Alzheimer's disease.
Tau aggregation is a proximal process prior to failure of axonal
transport and consequent neuronal death. The tau aggregation

WO 02/055720 PCT/GB02/00153
44
cascade can be triggered either by a seeding/nucleation event
arising from upstream changes or from primary mutations in the tau
gene.
Figure 4 shows how induction of full-length tau can lead to its
conversion into the 12 kD fragment, provided there is some
preexisting 12 kD tau in the cell.
Figure 5a-b shows a table listing proteins which play a role in
diseases of protein aggregation. Also listed are the diseases
themselves, the aggregating domain and/or mutation believed to be
involved, and the putative (maximum) fibril subunit size. One or
more literature references for each protein is given.
Figure 6 shows a schematic illustration of the binding sites of
various monoclonal antibodies to different forms of N- and C-
truncated tau.
Figure 7a-b shows the nucleotide and predicted amino acid sequences
of a human tau protein isoform. The sequence was deduced from cDNA
clone htau40.
Figure 8 shows the structures of thionine, tolonium chloride,
chlorpromazine and tacrine.
Figure 9 gives cellular assay data for diaminophenothiazines, and a
structurally related anthroquinone along with apparent KI values,
determined as described herein. In the Figures and Examples
herein, a further parameter, B50, has been calculated to express
activity in a manner directly related to the conditions of the
cell-based assay, and therefore providing an indication of the
tissue concentration which would be required to achieve the
corresponding activity in vivo. The B50 value is the concentration
of test compound used in the cell assay at which relative
production of the 12 kD band from full-length tau was reduced to
50% of that observed in the absence of the compound. There is a
simple linear relationship between apparent KI value and B50 value
as follows: RECTIFIED SHEET (RULE 91)

WO 02/055720 PCT/GB02/00153
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Cellular B50 = 0.0217 x KI
In order to compare the relative usefulness of compounds as
therapeutics, it may be desired to calculate an LD50 value. Where
inhibitory properties are similar, preferred compounds for clinical
use may be those which have the highest LD50 value. A therapeutic
index (Rxlndx) may be calculated for each of compounds tested in
the cell assays as follows:
Rxlndx = LD50 / B50
Toxicity of the compounds may be measured by cell numbers after 24
hrs exposure to the compound using a lactate dehydrogenase assay
kit TOX-7 (Sigma Biosciences) according to the manufacturer's
instructions after lysis of remaining cells. Alternatively a kit
from Promega UK (CytoTox 96) may be used, again according to the
manufacturer's instructions.
Figure 10 shows the results of using reduced thionine in the
present invention, based on a data set of 7 experiments. The
observed cell data for production of the 12 kD band can be fitted
closely (ie observed vs predicted correlation coefficient > 0.9),
to a standard function describing inhibition of tau-tau binding in
vitro. To obtain this fit, two assusqptions need to be made, which
are consistent with results from other cell-based and in vitro
studies:
1) the intracellular concentration of tau is approximately 500 nM;
2) the tau-tau binding affinity is 22 nM.
using these assumptions, the function for cellular activity
predicted via standard inhibition model is:
Activity = [tau] / {[tau] Kd* (1 + [thionine] / KI))
can be solved by standard numerical methods to derive a value for
apparent KI. As indicated, the value for the reduced form of

WO 02/055720 PCT/GB02/00153
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thionine is 1.00 nM. which is essentially the same as that observed
for tau-tau binding in vitro at a tau concentration of 500 nM,
where the Kd value for tau-tau binding is known to be 22nM.
Therefore, the activity of thionine, where the read-out is
production of the 12kD truncation product from full-length tau, can
be explained quantitatively on the basis of extent of inhibition of
the tau-tau binding occurring through the repeat domain within the
cell. This confirms that the extent of tau-tau binding determines
production of the proteolytically stable core tau unit of the PHF
within the cell.
All subsequent cellular analyses of activities of other compounds
are reported in the same standardised format, with the same
assumptions regarding intracellular tau concentration (500 nM) and
tau-tau binding affinity (22 nM) through the repeat domain.
Figure 11 shows the results for conditions in which the; reducing
agents have been omitted (i.e. oxidised thionine cf. Figure 10).
Again cellular activity is predicted via standard inhibition model:
Activity = [tau] / ([tau] Kd* (1 + [Ox. Thio.] / KI))
In this case, thionine now has an apparent KI value of 1200 nM.
This confirms that the diaminophenothiazines require to be in the
reduced form for activity. A similar conclusion was derived from
analysis of in vitro binding data (results not shown).
Figure 12 shows that by using reducing or partially reducing
conditions methylene blue appears much more active in the cell-
based assay than predicted from in vitro studies in which the time
course of the assay (1-2 hours) had not been sufficient to achieve
reduction.
Cellular activity is again predicted via standard inhibition model:
Activity = [tau] / ([tau] Kd* (1 + [MB] / KI))

WO 02/055720 PCT/GB02/00153
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In the cell assay, the apparent Kl value for methylene blue is 123
nM, which is within the same range as thionine and toIonium
chloride. As indicated in Figure 9, the corresponding brain tissue
concentration (i.e. B50 value) required to inhibit tau aggregation
would be 2-3 μM.
Figure 13 shows corresponding cell-based activity data for reduced
tolonium chloride, indicating again that the predicted KI value
derived from in vitro studies can be used to describe production of
the 12 kD fragment from full-length tau in cells.
Cellular activity is predicted via standard inhibition model:
Activity = [tau] / ([tau] Kd* (1 + [TC] / KI))
This provides further confirmation of the validity of the
mathematical analysis procedure used.
Figure 14 shows that DH12 (anthroquinone) which is structurally
related to the diaminophenothiazines is inactive in the conditions
of the assay.
Figures 15 & 16 show similar analyses to those given above in
Figures 9-14, but for chlorpromazine and tacrine respectively.
Using the same assumptions (tau concentration 415 nM, and tau-tau
binding Kd 22 nM), and cellular activity predicted via standard
inhibition model:
Activity = [tau] / ([tau] Kd* (1 + [cpz] / KI))
the apparent KI values for chlorpromazine and tacrine (2117 nM and
802 nM respectively) are greater than anticipated from the in vitro
studies.
Figure 17 shows the extent of reduction of various compounds in the
presence of DTT.
Figure 18 shows the percentage reduction of MB plotted against the

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ratio of MB:Vitamin C.
Figure 19(a) shows that by assuming a target tissue concentration
of 4uM (i.e. 1.5 ug/g) it is possible to determine from the data of
DiSanto and Wagner (1972) that tissue concentrations of this order
would be achieved at an IV dosage of 0.11 mg/kg.
Figure 19(b) shows a model for the distribution of MB following a
single 100 mg dose in a 70 kg subject, assuming instantaneous
absorbtion.
Figure 20 summarises the results for the transient expression of
tau fragments in 3T3 and COS-7 cells based upon data from both
microscopical and biochemical experiments.
Expression of recombinant tau fragments in eukaryotic cells was
performed as follows. Eight tau constructs, transiently expressed
in 3T3 cells and COS-7 cells were examined by immunocytochemistry
and immunoblots. The extent of expression in each cell type was
given semi-quantitatively on the basis of both sets of results: -,
no detectable expression; +, very weak immunoreactivity; + to ++++,
increasing levels of positive immunoreactivity. In all cases, mAb
7.51 was used with each construct to obtain the results. In
addition the specificity was confirmed for each construct by using
a panel of antibodies against different domains of tau protein
(mAbs 499, T14, Taul, 342, 7.51, 423 and T46) . Kozak sequences
were absent in the first six contructs, but were present in the
cDNA constructs 7 and 8.
Figure 21 illustrates the inducible expression of full-length human
tau in 3T6 fibroblasts in two cell lines. T40.22 shows low level
background leakage of full length tau in the uninduced state ("U"),
and high levels of expression after addition of IPTG (i.e. induced,
"I"). T40.37 shows the same, but lower levels of expression without
induction.
Figure 22 shows a result of a triple vector system. A vector
permitting very low level constitutive expression of the 12 kD

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fragment was introduced into cells lines in which inducible
expression of full length tau had already taen achieved {in fact
cell line T40.22 shown in Figure 21 above). Low levels of IPTG are
introduced to induce expression of full-length tau. At 0 uM IPTG,
there is very low level expression of the 12 kD band, and low
"background leakage" expression of full-length tau. As
progressively more full-length tau is induced by introducing higher
levels of IPTG, more of the full-length tau is converted to the 12
kD species.
Figure 23 shows the inhibitory effects of reduced thionine. In each
set of lanes," there is inducible production of the 12 kD band in
the presence of increasing concentrations of IPTG inducing higher
levels of T40. As the thionine concentration is increased, the
production of the 12 kD band from T40 is suppressed.
Figure 24 shows quantitatively the results of Figure 23. In the
absence of thionine, induction of T40 at increasing concentrations
of IPTG leads to a corresponding increased production of the 12 kD
fragment. In the presence of 2 uM thionine, there is still
induction of T40, but it is not converted into the 12 kD fragment.
Figure 25 shows comparative in vitro KI values for various
compounds, in nM. The KI values relate to the particular assay
conditions used (500:1 DTT:compound, 120 minutes - see Figure 17).
Figures 26 and 21 show the inhibitory effect on tau-tau binding of
phenothiazines having 0, 2, 3 or 0, 4, 6 methyl groups,
respectively.
Figure 28 shows the derivation of two parameters useful for
measuring the inhibition of tau-tau association by test compounds.
STB is the standardised binding relative to that seen in the
absence of compound, taken as the mean observed at 1 and 10 ug/ml.
As described in WO 96/30766, an STB value of 1.0 represents binding
equivalent to that observed in the absence of compound, whereas a
value of 0.2 indicates that the binding was reduced to a mean of
20% at test compound concentrations of 1 and 10 ug/ml. LB50 is log

WO 02/055720 PCT/GB02/00153
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10 molar ratio of compound:tau producing 50% tau-tau binding
compared with that seen in the absence of compound (B5 0) .
Figure 29 shows the relationship between STB and LB50 parameters.
STB can be shown to be a linear function of the LB50.
STB is a logarithmic function of the molar ratio of compound:tau at
which tau-tau binding is reduced by 50%.
LB50 is the log of the molar ratio of compound with respect to tau
at which tau-tau binding is 50% of that observed in the absence of
compound
LB50 = 0.05 + (2.65 x STB) r=0.95
The determination of in vitro B50 requires that there be some
degree of inhibition of tau-tau binding, and a 50% value is
obtained by extrapolation. Determination of STB requires no such
extrapolation procedure.
Figure 30 shows compounds for which both STB and B50 values have
been determined. Assuming that the total tau concentration in
cells is approximately 500 nM (i.e. the concentration of tau used
in the assay) , the B50 values provide an approximation in the in
vitro assay to the concentration {i.e. [500 x B50] nM) at which the
activity might be expected in cell systems.
Figure 31 shows the formal relationship between the in vitro LB50
value and the log KI value for the diaminophenothiazine series.
Figure 32 shows the relationship between the number of methyl
groups in a diaminophenothiazine (NMETH) and the redox potential
(E) and diffusion coefficient (DIF). Italicised figures indicate
correlation coefficients (R) and p values after exclusion of MB.
Figure 33 shows the relationship between the percentage of compound
that is reduced, as determined experimentally, and the known
reduction potential of the compound. The reduction potential

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predicts the observed extent of reduction of the
diaminophenothiazines.
Figure 34a shows that there is no clear relationship between
inhibitory potency and the extent of reduction of compounds.
Figure 34b shows that inhibitory potency is not determined simply
by reduction potential.
Figure 35 shows that the inhibitory potency can be related directly
to the diffusion coefficient (which is a measure of the tendency of
the reduced form to stack and aggregate).
Figures 36 and 37 show the predicted relationships between
estimated LB50 ("ESTLB50") and STB ("ESTSTB") values, respectively,
and reduction potential and diffusion coefficient, in which the
diffusion coefficient is given the greater weighting.
Figure 38 shows the crystalline structure of Methylene Blue.
Figure 39 shows tau-tau binding in the presence of lmM DTT, as
measured in the solid phase assay of WO 96/30766. Two different
antibodies were used to detect tau-tau binding, namely mAb 342
(top) and 499 (bottom). The vertical axis represents tau-tau
binding, the horizontal axis shows the concentration of full-length
tau in the aqueous phase, and the key shows varying concentrations
of solid-phase tau. As can be seen, tau-tau binding still occurs
in the presence of DTT.
Figure 40 shows various species of tau fragments and doublets which
are present without induction ("U") and following induction ("I")
in a cell line of the present invention. These include species with
mobilities equivalent to 12/14 kD, -25/27 kD, -30/32 kD, -36/38 kD
and -42/44 kD (see Example 3).
Figure 41(a) shows how the 12 kD fragment arises via template-
induced proteolytic processing of full-length tau molecules at the
approximate positions shown by the arrow-heads.

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Figure 41(b) shows how the 25/27 kD species arises via template-
induced proteolytic processing of full-length tau molecules at the
approximate positions shown by the arrow-heads.
Figure 42 shows a plot of the apparent gel mobilities of the
species of Figures 4 0-41 and their lengths in amino-acid residues.
Figure 43 shows the fragments of Figures 40-42 are at intervals of
either ~34 residues or -17 residues which is the equivalent of a
single tau repeat, or half of it. All of the fragments may be
generated from a basic heptameric aggregate as a simple set of
proteolytic cleavages occurring at the positions indicated by the
arrowheads.
Figure 44 shows these same fragments in descending order of length
and increasing gel mobility.
Figure 45 shows that DMMB is surprisingly potent in the cell model.
Its inhibitory activity could be seen both in the absence of IPTG
induction and following induction (see Example 4).
Figure 46 shows the activity of DMMB on base-line expression of the
12/14 kD species, using the same set of assumptions regarding
intracellular tau concentration and in vitro tau-tau binding
affinity used in Figs 10 - 16.
Cellular activity is predicted via standard inhibition model:
activity = [tau] / ([tau] Kd* (1 + [DMMB] / Ki) )
DMMB has an apparent KI within the cell of 4.4 nM, and the cellular
B50 value is -100 nM.
Examples
General materials and methods

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Production of 3T6H cell lines
3T6 cells were ECACC No: 8 6120801 Mouse Swiss Albino ISmbryo
Fibroblasts.
For the inducible system, the experiments employed Lac Switch™ from
Stratagene using the p3'SS vector to express the Lac repressor
protein and pOPRSVICAT to express the full-length tau under the
control of the Lac repressor. Expression is induced by the addition
of IPTG.
Initially 3T6 cells were transfected, by electroporation, with the
p3'SS plasmid and colonies selected by hygromycin resistance. 5
clones that were expressing varying levels of the Lac repressor
protein (determined by immunocytochemistry) were pickeid, and also
the non-cloned cells were retained for comparison.
Production of pOPRSVT40 vector
The T40 insert for cloning into the pOPRSVICAT vector was prepared
by PCR with Vent polymerase (NEB) using primers (shown below) that
included a Not I site and a start or stop codon as appropriate. The
PCR product and pOPRSVICAT vector were cut with Not I and purified.
The vector was dephosphorylated to prevent re-ligation, and the
insert ligated into the vector using standard protocols.
The resulting ligation mix was transfected into competent E. coli
cells and the cells plated out on amp plates. Colonies were picked
and gridded out on a new amp plate. Colony lifts were taken to
Hybond-N 0.45um nylon membrane (Amersham) and possible positives
selected by colony hybridisation using dGA labelled with ( α-32P)
dCTP (Amersham) (using an oligolabelling kit (Pharmacia Biotech)
and purified on a Nap-10 column (Pharmacia Biotech)).
Hybridisation was carried out a 65°C overnight in Church buffer
followed by 2x20 mins washes in Church wash. Positive colonies,
labeled with radioactive probe, were detected by exposing the blots
to x-ray film overnight at - 70°C.

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Positive colonies were selected and grown, then checked by PCR and
restriction digest to confirm the presence of the insert. The use
of a single restriction site for the cloning means that T40 can
insert into the vector in either orientation. The orientation of
the inserts was determined so as to select colonies with the vector
containing T40 in the correct orientation for expression.
Primers used
51-31 T40-Not I
start
5'-gtc gac tct aga ggc ggc cgc ATG GCT GAG CCC CGG CAG GAG-31
Not I
3'-5' T40- Not I
stop
5'-act ctt aag ggt cgc ggc cgc TCA CAA CAA ACC CTG CTT GGC CAG -3'
Not I
Sequence complementary to T40 sequence is shown in capitals, the
start and stop codons are marked. The Not I site to be added is
shown underlined. The remaining sequence shown in lower case is a
13 base pair overhang to allow the Not I enzyme to cut
efficiently. This was complementary to sequence in the hTau4 0
plasmid vector to allow efficient binding of the printers.
Determination of Insert Orientation
Orientation was -determined using a restriction enzyme that cuts the
insert once and the vector at most a few times, and that gives a
differing restriction digest pattern for each orientation. Hind
III fits these criteria for pOPRSVT40. If the insert is absent two
restriction bands are produced. If the insert is present three
bands are produced and the size of the bands depends on the
orientation of the insert as shown below.

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Forward (correct) Orientation 5385 bp 1030 bp 381 bp
Reverse Orientation 6101 bp 381 bp 314 bp
Production of cells expressing T40 under the control of an
inducible promoter
The pOPRSVT40 plasmid was produced and purified by CsCl gradient
centrifugation. This was transfected (by electroporation) into 3T6H
cells (expressing the Lac repressor protein) produced as described
above. Positive cells were selected for by resistance to G418 (at
500ug/ml). Resistant colonies were picked and grown on. The level
of expression of full-length T40 with and without the addition of
IPTG was determined with anti-tau antibodies by both
immunocytochemistry and Western blot.
Production of pZeo295-391
The plasmid pZeo295-391 was designed to express protein
corresponding to the truncated fragment of tau (residues 295-391;
see below). A constitutive system (pcDNA3.1 from InVitrogen,
Netherlands) was used - the plasmid imparts resistance to the
antibiotic zeocin. The cDNA for this region was amplified by
polymerase chain reaction (PCR), using specific oligonucleotide
priaers (sense and antisense; see below). The sense primer
contained an EcoRI site and the antisense, a BamHI site. The
fragments were subcloned into pcDNA3.1 (-)zeo (Invitrogen,
Netherlands) that had been digested with EcoRI and BamHI. The
inserted DNA is downstream from a cytomegalovirus promoter sequence
and upstream of a polyadenylation signal. The plasmid contains the
DNA sequence for the expression of ampicillin and zeocin resistance
for selection in bacteria and eukaryotic cells, respectively. The
authenticity of the inserted DNA was confirmed by full-length
sequencing of both strands.
Nucleotide and amino acid sequence for truncated tau fragment 295-
391

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gataatatcaaacacgtcccgggaggcggcagtgtgcaaatagtctacaaaccagttgacctgagca
aggtgacctccaagtgtggctcattaggcaa
catccatcataaaccaggaggtggccaggtggaagtaaaatctgagaagcttgacttcaaggacaga
gtccagtcgaagattgggtccctggacaatat
cacccacgtccctggcggaggaaataaaaagattgaaacccacaagctgaccttccgcgagaacgcc
aaagccaagacagaccacggggcggag
DNIKHVPGGGSVQIVYKPVDLSKVTSKCGSLGNIHHKPGGGQVEVKSEKLDFKDRVQSKIGSLDNIT
HVPGGGNKKIETHKLTFRENAKAKTDHGAE
295 sense primer
met asp295
5 ' - CGG AAT TCC ACC ATG GAT AAT ATC AAA CAC GTC CCG - 3 '
EcoRI
391 anti-sense primer
stop glu 391
5' - C GCG GGA TCC TCA CTC CGC CCC GTG GTC TGT CTT GGC - 3'
BamHI
The start and stop codons are in bold and the EcoRI and BamHI
restriction sites to be added are underlined.
Tissue Culture of cells for assay
The medium used was DMEM (with Glutamax I, pyruvate, 4.5g/l
glucose) from Life Technologies, Scotland. This was supplemented
with 10% FCS (Helena BioSciences),50 U/ml penicillin, 50 ug/ml
streptomycin, plsu further antibiotic as appropriate for the
selection and maintenance of the relevant plasmid. Antibiotic
concentrations were 200 ug/ml hygromycin (p3'SS selection and

WO 02/055720 PCT/GB02/00153
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maintenance), 500 ug/ml G418(pOPRSVT40 selection and maintenance),
400 or 200 ug/ml zeocin (pZeo295-391 selection or maintenance) .
Cells are grown at 37°C, in a humidified atmosphere of 5% CO2.
Cells are maintained in 10cm dishes, and split when they approach
confluency. Medium is removed, cells washed with PBS and cells
released by trypsinisation with 1 ml of trypsin/EDTA solution /
10cm dish. Cells are resuspended in fresh medium at 1:10 dilution,
or optionally in a range of dilutions from 1:5 to 1:20
(approximately 5000 to 20000 cells/cm2) .
For the testing of drugs, cells are plated in 6 well or 24 well
plates at an initial density that will allow them to grow to 50-80%
confluency within 24 hours. Drugs are added to the well at various
concentrations, expression of full-length tau is induced by the
addition of IPTG at 0 - 50 μM. Cells are grown for a further 24
hours and then collected for analysis by SDS PAGE/Western blotting.
Preparation of tau protein
Recombinant tau (clone htau40) and perchloric acid-soluble tau
extracted from rat and human brain were prepared as described
previously (Goedert, M. & Jakes, R. (1990) EMBO J. 9:4225; Goedert,
M. et al (1993) Proc. Natl. Acad. Sci. USA 90:5066).
Gel Electrophoresis and Blotting
Cells grown as outlined above are washed once with PBS then lysed
in 50 μl (24 well plates) or 100 μl (6 well plates) laemli buffer.
Samples are stored at -20°C, boiled for 4 mins prior to running on
15% acrylamide gels using the BioRad miniProtean III mini gel
system. Protein is transferred to PVDF membrane by Western blotting
using the CAPs buffer system. The membranes are incubated in block
buffer (5% non-fat milk powder (Marvel), 0.1% Tween 20 in PBS) 'for
1 hr to overnight. Tau protein is detected by incubating the
membranes with mAb 7.51 diluted 1 :5 with block buffer for l-3hrs
or overnight, washing well with PBS/0.1% Tween20, incubating with

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anti-mouse HRP 1:5000 dilution in block buffer for 1 hr, and
washing well with PBS/0.1% Tween20.- Bound antibody is detected by
ECL reaction detected on ECL hyperfilm (Amersham) .
Blots are scanned into a computer on a Hewlett Packard ScanJet
6100C flatbed scanner at 600dpi and saved as tiff files.
Densitometry of the T40 and dGAE bands is performed with the
Scananalysis program on an Apple Power Mac G3.
Drug preparation
Thionine, methylene blue, DMMB, and tolonium chloride are all
prepared as a 1 mM stock in ddH2O. Prior to use a 100 uM dilute
stock is prepared in HBSS which is added directly to the medium on
cells.
For oxidised drug this is prepared simply by diluting the lmM stock
in HBSS and filter sterilising.
For reduced drug the 1 mM is treated with ascorbic acid and DTT to
yield 0.5mM drug, 50mM ascorbic acid 50mM OTT, this is allowed to
stand for 15mins (turns blue to colourless) before making the
dilute stock. This is diluted in HBSS to yield 100 μM drug, l0mM
ascorbic acid, l0mM DTT and filter sterilised. Cells are treated
witb the drug at various concentrations, but for the reduced drug
the ascorbic acid and.DTT concentrations are maintained at 40.0 μM
throughout by using appropriate quantities of 100 uM reduced stock,
100 μM oxidised stock and 10 mM ascorbic acid/DTT stock.
SDS Gel Electrophoresis and Immunoblotting
Standard electrophoresis and immunoblotting procedures were used as
described previously (Wischik, C. M. et al. (1988) Proc. Natl.
Acad. Sci. USA 85:4506; Novak, M.,et al. (1993) EMBO J. 12:365;
Jakes, R. et al. (19.91) EMBO J. 10:2725). Immunoblots. were developed
with the ABC kit (Vector Laboratories) . The monoclonal antibodies
(mAbs) 7.51, 21.D10, 499 and 342 were used as undiluted hybridoma

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culture supernatant fluids. mAb AT8 (Innogenetics, Belgium) was
used at 1/1000 dilution. Anti-tau mAbs 7.51 (which recognises an
epitope in the last repeat; see Novak, M. et al. (1991) Proc. Natl.
Acad. Sci. USA 88: 5837), 423 (which recognises tau C-terminally
truncated at residue Glu-391; see Wischik, C. M. et al. (1988)
Proc. Natl. Acad. Sci. OSA 85:4506; Novak, M. et al.(1993) EMBO J.
12:365), 499 {which recognises a human-specific tau segment between
residues Gly-14 and Gln-26; see Wischik, C. M. et al.(1996) Proc.
Natl. Acad. Sci. USA 93:11213), and 342 (which recognises a segment
between residues Ser-208 and Pro-251). mAb 21.D10 was raised
against the A68-tau brain extract (Lee, V. M.-Y. et al.. (1991)
Science 2 51: 675) .
Tau Binding Assay
This was carried out basically as described in Wischik, C. M., et
al.{1996) Proc. Natl. Acad, Sci. USA 93:11213. Solid phase tau (0-
20 ug/ml) was coated on 96-well poly(vinyl chloride) microtitre
plates in 50 mM carbonate buffer at 37°C for 1 h. The plate was
washed twice with 0.05% Tween 20, then blocked with 2% Marvel in
PBST for 1 h at 37°C. After washing again, the plate was incubated
for 1 h at 37°C with aqueous phase tau (0 - 300 ug/ml in PBST
containing 1% gelatin). In the present application, lmM DTT was
also added.
The plate was washed twice and incubated for 1 h at 37°C with mAb
499 or 342, diluted with an equal volume of 2% Marvel in PBST.
After washing, horseradish peroxidase-conjugated goat-anti-mouse
antibody (1/1000 in PBST) was incubated for 1 h at 37°C. The plate
was washed and incubated with substrate solution containing
tetramethylbenzidine and H202 and the rate of change of absorbance
measured using a VMX plate reader (Molecular Diagnostics,
California) as described previously (Harrington, C. R- et al.
(1990) J. Immunol. Meth. 134:261). Each experiment was performed in
triplicate and included controls in which both solid phase end
aqueous phase tau were absent, and also with either one of the two
absent.

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Data Analysis
This was performed as described in Wischik et al. (supra) and
curves were fitted according to the Langmuir equation with the
Kaleidagraph (Synergy, Philadelphia) or Systat (SPSS Inc., Chicago)
programs using quasi-Newton approximation. Curve-fitting
correlation coefficients are given in the Figures.
Example 1 - constitutive expression of full-length, truncated and
mutated tau
Expression of tau in eukaryotic cell lines was sought to generate a
cellular model of tau aggregation under physiological conditions
which did not suffer from the limitations of lipofectin-based
approaches. This involves the expression of full-length tau and
truncated tau fragments for both normal tau and tau carrying
pathogenic mutations.
Full length tau
When normal full-length tau (T40) was transfected into cells (3T3
and NIE-115) it was expressed and involved in the assembly of the
microtubule network within the cells.
Truncated tau
Initially the cDNA for truncated tau fragment from the core of the
PHF, corresponding to fragment 297-391, was transfected into non-
neuronal 3T3 fibroblasts: this truncated tau was selected since it
is: (i) present in the PHF-core; (ii) detected as deposits in AD
brain tissue during the early stages of the disease; (iii) capable
of supporting the catalytic capture and propagation of tau capture
in vitro. Subsequently, a series of transfections was performed in
which the extent of truncation at either N- or C- termini was
varied, based partly on the immunochemical properties of the tau
molecule. Six constructs were created with truncation at the N-
terminus (186-441 ; 297-441) at the C- and N- termini (186-391;

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297-391) and at the C-terminus (1-391). The pattern of
immunoreactivity for the six constructs with a limited panel of
antibodies was capable of discriminating all of the tau fragments
generated in this way.
The constructs were expressed in eukaryotic cells both transiently
(using pSG5 as the vector) and stably (using pIF2 and pZeo as
vectors). Stable transfectants are selected on the basis of
resistance to the antibiotics geneticin and zeocin for pIF2 and
pZeo, respectively. Epitope analysis was performed on bacterially
expressed proteins using pRK172 as the vector. Figure 20 summarises
the results for various fragments in 3T3 and COS-7 cells. Further
results showed that the expression of two forms of tau in the same
cell can affect the pattern of immunoreactivity. For example,
stable expression of 1-391 and 295-391 results in the appearance of
abnormal bundles within the cells. However, maintaining such cells
in a stable and reproducible state proved elusive.
Mutated tau
Mutagenesis of full-length tau was used to generate known clinical
mutations. These were subcloned into pIF2 and stable transfectants
generated in 3T3 and NIE cells for a number of mutations including
those which affect microtubule assembly properties of tau (G272V,
V337M, P301 S, R406W) and S305N, which affects the alternative
splicing of the tau gene in vivo. In general, cells expressing
full-length tau carrying mutations exhibited labelling of the
microtubular network and was indistinguishable from cells
transfected with wild-type tau. Cell lines expressing certain
truncated tau fragments including mutations proved unstable.
Conclusion
In summary, the constitutive expression of truncated tau within
eukaryotic cells proved difficult to achieve. Although transient
transfection systems permitted the optimisation of expression of
tau by manipulating the Kozak consensus surrounding the initiation
codon for 297-tau, the expression of e.g. 297-391 was still modest,

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suggesting some inherent toxic properties of the fragment. Stable
transfections raiterated this conclusion. This latter system
demonstrated that truncation at either N- or C-termini resulted in
a slightly greater propensity for the tau to assemble in amorphous
deposits rather than in a microtubular network. Stable expression
of combinations of tau fragments also generated aggregates within
the cytoplasm of cells, but this system was not readily
reproducible.
Example 2 - inducible expression of truncated tau
In a further attempt to create a stable, reproducible system,
without the toxicity associated with constitutive expression,
inducible expression of the core-tau fragment of the PHF (i.e. 297-
391 - which is 12 kD) was attempted.
Several inducible systems for expression of proteins in eukaryotic
cells were tried, although the preferred system was the "lac
switch" system. In this system, two vectors are incorporated into
cells, typically 3T3 or 3T6 fibroblasts which do not express any
endogenous tau protein. The first, the p3'SS vector codes for
constitutive expression of the lac I gene, and expressors are
selected on the basis of hygroiaycin resistance. The second,
pOPRSVICAT incorporates the DNA coding for the cau protein fragment
under the control of a strong RSV promoter which contains operator
sequences from the Lac operon. Cells which incorporate this vector
are selected on the basis of neomycin resistance. Cells which have
incorporated both vectors have the property that constitutive
expression of lac I prevents expression of the incorporated protein
(i.e. tau ) controlled by the Lac operon. The addition of the sugar
IPTG competes for the binding of lac I to the Lac operon, and so
permits expression of tau protein.
Inducible expression of the 12 kD fragment was carried out in two
cell lines. These did not show appreciable levels of tau protein
expression until after 3 days treatment with IPTG at which stage
high levels of 12 kD suddenly appeared, forming intracellular
aggregates which promptly killed the cell. The process of

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aggregation was, as expected, non-linear progressing from low level
expression to sudden accumulation of toxic aggregates 'without any-
clear gradation, making the aggregation and toxicity impossible to
control. This non-linear progression prevented a proper control of
the system.
Example 3 - expression of tau in stable cell lines according to
invention
In view of the results above, a further system was used as follows.
Tissue culture cell line DH 19.4.1.4 and clones thereof were based
on 3T6 cells.(ECACC No: 86120801 Mouse Swiss Albino Embryo
Fibroblasts) expressing full-length, four repeat human tau under
the control of an inducible promoter and truncated human tau (295-
391) under the control of a constitutive promoter.
Cells expressing T40 under the control of an inducible promoter,
T40.22.10, were transfected (by lipofection) with the pZeo295-391
plasmid. Positive cells were selected for by resistance to zeocin
at 400ug/ml, Expression of truncated tau on a background of
inducible expression of full-length tau was confirmed by Western
blot analysis with Mab 7.51.
Figure 21 illustrates the inducible expression of full-length human
tau only in 3T6 fibroblasts in two cell lines. T40.22 shows low
level background leakage of full length tau in the uninduced state
("U"), and high levels of expression after addition of IPTG (i.e.
induced, "I"). T40.37 shows the same, but lower levels of
expression without induction. Figure 22 shows the results of a
triple vector system. A vector permitting very low level
constitutive expression of the 12 kD fragment was introduced into
cell lines in which inducible expression of full length tau had
already been achieved (T40.22 shown in Figure 21). Figure 22 shows
what happens when low levels of IPTG are introduced to induce
expression of full-length tau. At 0 uM IPTG, there is very low
level expression of the 12 kD band, and low "background leakage"
expression of full-length tau. As progressively more full-length
tau is induced by introducing higher levels of IPTG, more of the

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full-length tau is converted to the 12 kD species, and more of the
intermediate higher molecular weight fragments (described in more
detail in Figs 43 and 44) are produced.
Examination of the original T40-induc.rble cell line (T40.22.10)
which did not contain the vector for constitutive expression of the
12 kD fragment shows that the 12 kD species is not produced as a
truncation by-product of full-length tau induction. Enhanced
expression of the 12 kD band following induction of T4 0 was seen
only in cells with low level prior expression of the 12 kD fragment
(DH19. 4 .1. 4 . 6) . That is, pre-existing 12 kD provides a template for
production of more 12 kD following the induction of full-length
tau. An additional doublet may also appear with apparent gel
mobility of ~25/27 kD when the cells are in the uninduced state
(e.g. in the cell line designated DH 19. 4 .1. 4A.B2) . Following
induction with IPTG, a further series of doublets may appear, with
gel mobilities -30/32 kD, -36/38 kD and -42/44 kD.
These species are shown in Figure 40 both without induction ("U")
and following induction ("I"). Also shown are the patterns of
immunoreactivity of these fragments seen with mAb 342 and a C-
terminal polyclonal antibody T46 which recognises epitopes located
between residues Ser422 and Leu441.
The derivation of the fragments seen in the uninduced state (i.e.
12/14 kD and 25/27 kD) may be explained by reference to Figure 41.
Figure 41(a) shows how the 12 kD fragment arises via template-
induced proteolytic processing of full-length tau molecules at the
approximate positions shown by the arrow-heads.
In the case of the 25/27 kD species, these fragments cannot
represent dimers of the the 12/14 kD species, as these fragments
are immunoreactive with T4 6. Therefore, a further proteolytic
product of the full-length aggregating tau protein must arise via
cleavages occurring at the approximate positions shown by the
arrowheads in Figure 41(b).

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Following induction (Figure 40, I), the further series of doublets
is seen. The derivation of these further fragments can be better
understood with reference to Figures 42-44.
Figure 42 shows a plot of the apparent gel mobilities of these
fragments and their lengths in amino-acid residues, indicating that
the apparent gel mobilities can be understood in terms of a
characteristic set of fragment lengths.
As illustrated in Figure 43, all of these fragments are at
intervals of either ~34 residues or ~17 residues which is the
equivalent of a single tau repeat, or half of it. All of the
fragments generated can therefore be understood as arising from a
simple set of proteolytic cleavages occurring at the positions
indicated by the arrowheads in Figure 4 3 from a basic heptameric
aggregate, formed as shown in the figure. In this scheme the
fragments arise as the full combinatorial set of the proposed
cleavages occurring at the 3 possible approximate positions shown
by the arrowheads at either end of the aggregate. The corresponding
predicted immunoreactivity patterns seen with mAb 342 and T4 6
associated with these fragments are also tabulated.
Figure 44 shows these same fragments in descending order of length
and increasing gel mobility. Although the heptameric aggregate is
shown for convenience as arising entirely from full-length tau
molecules, it will be appreciated that the 12/14 kD fragment could
be interposed within the proposed aggregate, replacing some of the
binding partners, and that the precise pattern of inclusion of
these short fragments in the aggregate will determine which precise
fragments from the full set predominate in a given instance.
Therefore, the production of this family of proteolytic fragments
is better understood as a possible repertoire which can be
instantiated in various ways within the cell.
Example 4 - inhibitory effects of compounds on production of
proteolytic fragment
Having achieved a stable cell system in which production of the 12

WO 02/055720 PCT/GB02/00153
66
kD fragment (and others) could be controlled, the model was used to
test the inhibitory effects of reduced thionine. This is shown in
Figure 23. In each set of lanes, there is inducible production of
the 12 kD band in the presence of increasing concentrations of IPTG
inducing higher levels of T40. As the thionine concentration is
increased, the production of the 12 kD band from T40 is suppressed.
This is shown quantitatively in Figure 24. In the absence of
thionine, induction of T40 at increasing concentrations of IPTG
leads to a corresponding increased production of the 12 Kd
fragment. In the presence of 2 μM thionine, there is still
induction of T40, but it is not converted into to the 12 kD
fragment.
As reduced thionine is itself toxic, it is necessary to control for
reduction in the levels of T4 0 induced by corresponding does of
IPTG at higher levels of thionine. This can be achieved by
determining the ratio of 12 kD : T4 0, which permits averaging the
data across IPTG levels and shows a dose-dependent reduction in the
level of the 12 kD relative to full-length tau.
The activities of various compounds in the T40/12 kD assay are
shown in Figures 9 to 16.
Results are expressed in terms of the ratio of 12 kD : T40
following induction of full-length tau (T40) by treatment cells
with IPTG (0, 10, 25, 50 μM) in the presence of thionine or
tolonium chloride introduced at the concentrations shown in the
presence of reducing agents (200 μM DTT/ascorbate) , or
chlorpromazine or tacrine introduced without reducing agents. As
can be seen, thionine and tolonium chloride produce essentially
identical inhibition, whereas chlorpromazine and tacrine are non-
inhibitory in the same concentration range. The effect of the
reducing agents alone was tested in control experiments which
showed no significant difference was seen in the 12 kD : T40 ratio
in the presence of reducing agents alone.
The properties of the cell line producing higher molecular weight

WO 02/055720 PCT/GB02/00153
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degradation products were also examined with MB and DMMB (dimethyl-
methylene blue).
As can be seen in Figure 45, DMMB proved to be surprisingly potent
in the cell model. Its inhibitory activity could be seen both in
the absence of IPTG induction and following induction. Treatment
with 1 μM DMMB effectively abolished all degradation products
within the cell. Further experience with MB and DMMB has shown that
even apparent base-line production of the 12/14 kD species is
largely determined by aggregation. That is, the constitutive
production of the 295-391 fragment is itself either below the level
of detection by immunoblot or else it is stabilised by spontaneous
aggregation so as to reach levels within the cell which can be
detected by immunoblot.• Alternatively, the apparent base-line
levels of the 12/14 kD fragment seen without IPTG induction and in
the absence of treatment with a tau-aggregation inhibitor may
itself be dominated by templated aggregation-dependent production
from the leakage levels of T40 produced in absence of induction.
Whatever the combination of factors which determines the levels cf
the 12/14 kD fragment in the base-line condition, its apparent
expression can be essentially eliminated, along with higher
molecular weight aggregation products, by a potent aggregation
inhibitor such as DMMB. These results further confirm that
production of the higher molecular weight proteolytic fragments {ie
30/32, 36/38, 42/44 kD) is also dependent on critical tau-tau
binding interactions occurring through the repeat domain, as shown
in Figures 41, 43 and 44.
Figure 46 shows the activity of DMMB on base-line expression of the
12/14 kD species, using the same set of assumptions regarding
intracellular tau concentration and in vitro tau-tau binding
affinity-used in Figs 10 - 16. In this case DMMB is found to have
an apparent KI within the cell of 4.4 nM, and the cellular B50
value is ~100 nM. This indicates that DMMB is highly potent within
the cellular milieu.
Example 5 - comparison of inhibitory effects of reduced and
oxidised compounds

WO 02/055720 PCT/GB02/00153
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The mathematical model used for the in vitro data was used to
analyse the effects of test substances in the T40 : 12kD cell
assay. Using the known values for Kd and KI from in vitro data, the
expression indicated was used to solve for the iptracellular
concentration of full-length tau (see e.g. Figure 10).
This was found to be about 500 nM, which is in the range expected
from studies of tau in brain and in cell systems. A good fit to the
experimental data was obtained implying that for some compounds the
inhibition of production of truncated tau within the cell can be
predicted from the approximate Kd and KI values determined
experimentally in vitro.
Example 6 - examination of inhibitory properties of
diaminophenothiazines
In in vitro studies, the most active inhibitors of tau-tau binding
identified were the reduced forms of diaminophenothiazines having
0, 2 or 3 methyl groups. Figure 25 shows the reduced forms of such
compounds. The corresponding tau-tau binding curves are shown as a
function of molar ratio with respect to tau in Figures 26 and 27.
As shown, compounds of the "desmethyl series" (0, 2 or 3 methyl
groups) produce approximately 50% inhibition of tau-tau binding
(shown on the vertical axis) at molar ratios of 3:1 - 4:1 of
compound:tau 'AMR' shown on log scale on horizontal axis). The
mean molar ratio for 50% inhibition of tau-tau binding for this
group of compounds is 4:1.
Diaminophenothiazines having 4 or 6 methyl groups (the "methylated
group") have a biphasic action, with enhancement of tau-tau binding
at lower concentration, and inhibition of tau-tau binding at high
concentrations (Figure 27). These compounds thus require much
higher molar ratios to effect 50% inhibition of tau-tau binding.
Examination of other features of the diaminophenothiazine compound
was also carried out. Substitution of the heterocyclic nitrogen or
sulphur atoms was found to severely interfere with inhibitory

WO 02/055720 PCT/GB02/00153
69
potency of the compounds. Likewise, removal of the diamino groups
was found to be detrimental to the inhibitory activity. It thus
appeared that the diamino and heterocyclic NB and S- structures are
important for activity of the molecules in the inhibition of tau-
tau binding.
For comparison, two methods were used to determine inhibitory
activity in the tau-tau assay: STB is the mean tau-tau binding
observed at 1 and 10 ug/ml of compound at standard tau
concentrations of 488 nM; LB50 is logl0 molar ratio of compound:tau
producing 50% inhibition of tau-tau binding (Figure 28). As shown
in Figure 29,- there is a strong correlation between the STB and
LB50 values for a range of compounds, with chlorpromazine and
riboflavin being two outliers (see also Figures 30 and 31) .
Example 7 - inhibitory activity and diffusion potential
Figure 32 indicates that there is a correlation between the number
of methyl groups (NMETH) in a test compound and both the reduction
potential (E) and diffusion coefficient (DIF). In all comparisons,
the Spearman rank correlation was used. As shown in Figure 32, a
strong inverse relationship between the number of methyl groups
(NMETH) and the reduction potential can be seen only if methylene
blue is excluded (normal type: correlation values including
methylene blue; italic type: correlation values excluding methylene
blue).
This indicates that methylene blue has a disproportionately high
reduction potential relative to number of methyl groups (NMETH) in
this series. There is also a strong positive correlation between
the number of methyl groups and the diffusion coefficient (DIF,
Figure 32).
As well as there being no observed correlation between the number
of methyl groups and reduction potential (Figure 33), it was
surprisingly found that there was no observed correlation between
reduction potential and inhibitory potential (Figure 34b), although
the extent of reduction of the diaminophenothiazines in the

WO 02/055720 PCT/GB02/00153
70
conditions of the assay is highly correlated with reduction
potential (Figure 33). And indeed, there is no correlation between
the extent of reduction of these compounds and inhibitory potency
(Figure 34a). On the other hand, there is a strong inverse
correlation between the inhibitory potency of a compound and its
diffusion coefficient, and it is possible to predict estimated LB50
and STB values as linear functions of reduction coefficient and
diffusion coefficient when greater weighting is given to the
diffusion coefficient(Figures 35, 36 and 37) . Both the LB50 and
STB values are found to be uniformly low for NMETH values up to and
including 3, but for higher NMETH values (in particular methylene
blue, NMETH=4) there is a disproportionately low inhibitory potency
relative to the number of methyl groups. This may relate to the
symmetric placement of the methyl groups which interferes with the
stacking ability of the molecules, as measured by the diffusion
coefficient. This can be seen, for example, in the crystalline
structure of methylene blue (see Figure 38). The
diaminophenothiazine molecule is essentially flat and forms
stacking arrays. The presence of charge in the molecule, as in the
oxidised form, prevents the formation of such stacking arrays, and
it appears to be the propensity of the reduced form of this
compound to form such stacking relationships that determines the
inhibitory potency of the series.
The experiments carried out by the present inventors examined" the
binding of full-length tau in the aqueous-phase to the truncated
repeat domain fragment of tau in the solid-phase, as described in
further detail in WO96/30766. Binding was detected with either mAb
342 or mAb 499. As shown in Figure 39, there is typical tau
concentration-dependent tau-tau binding in the presence of a large
excess of the standard reducing agent dithiothreitol (DTT, 1 mM).
However, the inhibitory activity of phenothiazines is also
demonstrated in the presence of DTT (1 mM) in the standard
configuration of the assay described above (i.e. the data for STB
and LB50). The present inventors thus conclude that the inhibitory
activity cannot be attributed to DTT per se, but rather to the
presence of the phenothiazines in their reduced form, due to an

WO 02/055720 PCT/GB02/00153
71
excess of DTT.
In summary, the present inventors provide herein a potential,
signxficantly improved, system for the treatment and prophylaxis of
diseases such as Alzheimer's Disease in which proteins undergo
induced conformational polymerisation, e.g. as illustrated in the
case of Alzheimer's disease by pathological tau-tau binding. The
important teachings of this application, viz that the diffusion
coefficient of a compound may important in determining its
inhibitory potency towards this induced conformational protein
polymerisation, are potentially of great benefit in advancing our
understanding of, and ability to provide therapy for, diseases such
as Alzheimer's Disease. Finally, by combining the findings on the
preferality of the reduced form of MB, and demonstration of its
activity in the cell-based assay at concentrations substantially
below those predicted solely on the basis of in vitro data, the
inventors have shown that this compound, and others like it, could
be used an appropriate reducing formulation for the prophylaxis or
treatment of AD and related disorders.
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76
Claims
1. Use of a phenothiazine in the preparation of a medicament composition for use in the
treatment or prophylaxis of a tauopathy,
wherein the preparation comprises the step of pre-reducing the phenothiazine such that it is
present in at least 80, 90, 95, or 99% educed (leuco-) form.
2. Use as claimed in claim 1 wherein the phenothiazine is pre-reduced by addition of an
exogenous reducing agent.
3. Use as claimed in claim 2 wherein the reduced form is stabilised in the reduced state
by addition of a stabilising agent.
4. Use as claimed in claim 3 wherein the reduced form is lyophilised with the stabilising
agent.
5. Use of a pre-reduced phenothiazine in the preparation of a medicament composition
for use in the treatment or prophylaxis of a tauopathy, wherein the medicament comprises at
least 80, 90, 95, or 99% of the reduced (leuco-) form of the phenothiazine.
6. Use as claimed in any one of claims 1 to 5 wherein the medicament composition
further comprises one or more of the following: a pharmaceutically-acceptable excipients,
carriers or buffers.
7. Use as claimed in claim 6 wherein the medicament composition is prepared as a
slow release formulation.
8. Use as claimed in any one of claims 1 to 7 wherein the phenothiazine is a
diaminophenothiazine.
9. Use as claimed in any one of claims 1 to 8 wherein the pre-reduced (leuco-)
phenothiazine has the formula:

wherein R1, R3, R4, R6, R7 and R9 are independently selected from hydrogen halogen,
hydroxy, carboxy, substituted or unsubstituted alkyl, haloalkyl or alkoxy; R5 is selected from
hydrogen, hydroxy, carboxy, substituted or unsubstituted alkyl, haloalkyl or alkoxy; and each
R10 and R11 are independently selected from hydrogen, hydroxy, carboxy, substituted or
unsubstituted alkyl, haloalkyl or alkoxy;
or is a pharmaceutically acceptable salt thereof.

77
10. Use as claimed in claim 9 wherein R1, R3, R4, R6, R7 and R9 are independently
selected from -hydrogen, -CH3, -C2H5 or -C3H7;
each R10 and R11 are independently selected from hydrogen, -CH3, -C2H5 or -C3H7; and
R5 is hydrogen, -CH3, -C2H5 or -C3H7.
11. Use as claimed in any one of claims 8 to 10 wherein the phenothiazine is a
diaminophenothiazine which has 0, 2, 3 or 4 methyl groups around the
diaminophenothiazine nucleus.
12. Use as claimed in any one of claims 8 to 11 wherein the phenothiazine is a
diaminophenothiazine which is asymmetrically methylated.
13. Use as claimed in claim 12 wherein the phenothiazine is tolonium chloride, azure A,
azure B and thionine.
14. Use as claimed in claim any one of claims 8 to 11 wherein the phenothiazine is
selected from Methylene Blue, Toluidine Blue O, or 1,9-Dimethylmethylene Blue
15. A medicament composition comprising a pre-reduced phenothiazine as described in
any one of claims 9 to 14
wherein the phenothiazine is at least 80, 90, 95, or 99% of the reduced (leuco-) form,
in combination with a stabilizer.
16. A medicament composition as claimed in claim 15 which is lyophilised with the
stabiliser.
17. A medicament composition as claimed in claim 15 or claim 16 wherein the stabiliser
is ascorbate.
18. A medicament composition as claimed in any one of claims 15 to 17 for use in the
treatment or prophylaxis of a tauopathy.
19. A method of treatment of a tauopathy comprising use of medicament composition as
claimed in any one of claims 15 to 17.
20. A method as claimed in claim 18 or claim 19 wherein the treatment or prophylaxis
comprises giving a prophylactically effective amount or a therapeutically effective amount of
the medicament composition to a patient in need of the same.
21. A method as claimed in any one of claims 18 to 20 wherein the treatment or
prophylaxis comprises giving a patient in need of same 20 mg tds, 50 mg tds or 100 mg tds,
combined with 2x mg ratio of ascorbic acid in such a manner as to achieve more than 90%
reduction of the phenothiazine prior to ingestion.
22. A method, use as claimed in any one of claims 18 to 21 wherein the treatment or
prophylaxis comprises giving a patient a phenothiazine which is thionine and this is given to
the patient in a daily dosage of between 1 and 1000 mg optionally divided into 1 to 8 unit
doses.
23. A method as claimed in any one of claims 18 to 21 wherein the treatment or
prophylaxis comprises giving a patient a phenothiazine which is methylene blue and the
daily dosage is approximately 3.2-3.5 mg/kg.

Use of a phenothiazine in the preparation of a medicament composition for use in the
treatment or prophylaxis of a tauopathy,
wherein the preparation comprises the step of pre-reducing the phenothiazine such that it is
present in at least 80, 90, 95, or 99% educed (leuco-) form.

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2242-KOLNP-2007-OTHERS DOCUMENTS.pdf

2242-KOLNP-2007-OTHERS-1.3.pdf

2242-KOLNP-2007-OTHERS-1.4.pdf

2242-KOLNP-2007-OTHERS.pdf

2242-kolnp-2007-pa.pdf

2242-KOLNP-2007-PETITION UNDER RULE 137.pdf

2242-KOLNP-2007-REPLY TO EXAMINATION REPORT.pdf


Patent Number 246699
Indian Patent Application Number 2242/KOLNP/2007
PG Journal Number 11/2011
Publication Date 18-Mar-2011
Grant Date 11-Mar-2011
Date of Filing 19-Jun-2007
Name of Patentee WISTA LABORATORIES LTD.,
Applicant Address 51 AYER RAJAH CRESCENT, NO. 07-01/02 SINGAPORE 139948
Inventors:
# Inventor's Name Inventor's Address
1 WISCHIK, CLAUDE, MICHEL DEPARTMENT OF MENTAL HEALTH, UNIVERSITY OF ABERDEEN, UNITERSITY MEDICAL BUILDINGS FORESTERHILL ABERDEEN, ABERDEENSHIRE, AB25 2ZD GREAT BRITAIN
2 RICKARD, JANET, ELIZABETH DEPARTMENT OF MENTAL HEALTH, UNIVERSITY OF ABERDEEN, UNITERSITY MEDICAL BUILDINGS FORESTERHILL ABERDEEN, ABERDEENSHIRE, AB25 2ZD GREAT BRITAIN
3 HARRINGTON, CHARLES, ROBERT DEPARTMENT OF MENTAL HEALTH, UNIVERSITY OF ABERDEEN, UNITERSITY MEDICAL BUILDINGS FORESTERHILL ABERDEEN, ABERDEENSHIRE, AB25 2ZD GREAT BRITAIN
4 HORSLEY, DAVID DEPARTMENT OF MENTAL HEALTH, UNIVERSITY OF ABERDEEN, UNITERSITY MEDICAL BUILDINGS FORESTERHILL ABERDEEN, ABERDEENSHIRE, AB25 2ZD GREAT BRITAIN
PCT International Classification Number A61K31/00
PCT International Application Number PCT/GB02/ 00153
PCT International Filing date 2002-01-15
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 0101049.5 2001-01-15 U.K.