Potentiation of autoimmune and inflammatory disease treatments by immune regulatory oligonucleotide (IRO) antagonists of TLR7 and TLR9

1. A method for therapeutically treating a mammal having a disease having an autoimmune or inflammatory component where inhibition of tumor necrosis factor alpha (TNF) would be beneficial, such method comprising administering to the mammal an immune regulatory oligonucleotide (IRO) compound in combination with an anti-inflammatory agent that inhibits TNF in a pharmaceutically effective amount wherein the IRO compound comprises an oligonucleotide having the structure

5′-N m -N 3 N 2 N 1 CGN 1 N 2 N 3 -N m l- 3′:

wherein:

CG is an oligonucleotide motif that is C*pG, C*pG* or CpG*, wherein C is cytosine, C* is a cytosine nucleotide derivative, G is guanosine and G* is a guanosine nucleotide derivative;

N 1 is a modified nucleotide that suppresses the activity of the oligonucleotide motif selected from the group consisting of 2′-substituted ribonucleotide, 2′-O-substituted ribonucleotide, 2′-substituted arabinotide, and 2′-O-substituted arabinotide;

N 2 -N 3 , at each occurrence, is independently a nucleotide or nucleotide derivative or a modified nucleotide that suppresses the activity of the oligonucleotide motif selected from the group consisting of 2′-substituted ribonucleotide, 2′-O-substituted ribonucleotide, 2′-substituted arabinotide, and 2′-O-substituted arabinotide; N 1 —N 3 , at each occurrence, is independently a nucleotide or nucleotide derivative;

N m and N m , at each occurrence, is independently a nucleotide or nucleotide derivative or non-nucleotide linkage;

provided that the IRO compound contains less than 3 consecutive guanosine nucleotides;

wherein the oligonucleotide motif would be immune stimulatory but for the one or more modified nucleotides that suppresses the activity of the oligonucleotide motif;

wherein the IRO compound is an antagonist of TLR7, TLR8 and/or TLR9;

wherein the IRO compound is not an antisense oligonucleotide;

wherein the IRO compound potentiates the activity of the anti-inflammatory agent that inhibits TNF;

and wherein m is a number from 0 to about 30.

2. The method according to claim 1 , wherein the IRO compound and the anti-inflammatory agent that inhibits TNF are administered in combination with one or more vaccines, antigens, antibodies, cytotoxic agents, allergens, antibiotics, antisense oligonucleotides, TLR agonists, TLR antagonists, peptides, proteins, gene therapy vectors, DNA vaccines, adjuvants, kinase inhibitors, antiviral agents, or co-stimulatory molecules.

3. The method according to claim 1 , wherein the route of administration of the IRO compound and the anti-inflammatory agent that inhibits TNF is independently parenteral, mucosal delivery, oral, sublingual, transdermal, topical, inhalation, intranasal, aerosol, intraocular, intratracheal, intrarectal, vaginal, by gene gun, dermal patch, or in eye drop or mouthwash form.

4. The method according to claim 1 , wherein the anti-inflammatory agent that inhibits TNF is etanercept, infliximab, or adalimubab.

5. The method according to claim 1 , wherein the disease having an autoimmune or inflammatory component is lupus erythematosus, rheumatoid arthritis, arthritis of psoriasis, psoriasis, uveitis, ankylosing spondylitis, Crohn's disease, sarcoidosis, colitis, or cancer.

6. The method according to claim 1 , wherein the IRO compound comprises at least two oligonucleotides linked by a non-nucleotide linker at their 3′ ends or by a functionalized sugar or by a functionalized base via a non-nucleotide linker.

7. The method according to claim 6 , wherein the non-nucleotide linker linking the at least two oligonucleotides at their 3′ ends is Glycerol (1,2,3-Propanetriol), 1,2,4, Butanetriol, 2-(hydroxymethyl)-1,3-propanediol, 2-(hydroxymethyl)1,4-butanediol, 1,3,5-Pentanetriol, 1,1,1-Tris(hydroxymethyl)ethane, 1,1,1-Tris(hydroxymethyl)nitromethane, 1,1,1-Tris(hydroxymethyl)propane, 1,2,6-Hexanetriol, 3-Methyl-1,3,5-pentanetriol, 1,2,3-Heptanetriol, 2-Amino-2-(hydroxymethyl)-1,3-propanediol, N-[Tris(hydroxymethyl)methyl]acrylamide, Cis-1,3,5-Cyclohexanetriol, Cis-1,3,5-Tri(hydroxymethyl)cyclohexane, 3,5-Di(hydroxymethyl)phenol, 1,3,5-Trihydroxyl-benzene, 3,5-Di(hydroxymethyl)benzene, 1,3-Di(hydroxyethoxy)-2-hydroxyl-propane, 1,3-Di(hydroxypropoxy)-2-hydroxyl-propane, 2-Deoxy-D-ribose, 1,2,4-Trihydroxyl-benzene, D-Galactoal, 1,6-anhydro-β-D-Glucose, 1,3,5-Tris(2-hydroxyethyl)-Cyanuric acid, Gallic acid, 3,5,7-Trihydroxyflavone, 4,6-Nitropyrogallol, Ethylene glycol, 1,3-Propanediol, 1,2-Propanediol, 1,4-Butanediol, 1,3-Butanediol, 2,3-Butanediol, 1,4-Butanediol, 1,5-Pentanediol, 2,4-Pentanediol, 1,6-Hexanediol, 1,2-Hexanediol, 1,5-Hexanediol, 2,5-Hexanediol, 1,7-Heptanediol, 1,8-Octanediol, 1,2-Octanediol, 1,9-Nonanediol, 1,12-Dodecanediol, Triethylene glycol, Tetraethylene glycol, 2-(1-Aminopropyl)-1,3-propanediol, or 1,2-Dideoxyribose.

8. The method according to claim 1 , wherein the cytosine nucleotide derivative is 2′-deoxythymidine, 1-(2′-deoxy-β-D-ribofuranosyl)-2-oxo-7-deaza-8-methyl-purine, 2′-dideoxy-5-halocytosine, 2′-dideoxy-5-nitrocytosine, arabinocytidine, 2′-deoxy-2′-substituted arabinocytidine, 2′-O-substituted arabinocytidine, 2′-deoxy-5-hydroxycytidine, 2′-deoxy-N4-alkyl-cytidine, 2′-deoxy-4-thiouridine, or other cytosine nucleoside analogs.

9. The method according to claim 1 , wherein the guanosine nucleotide derivative is 2′-deoxy-7-deazaguanosine, 2′-deoxy-6-thioguanosine, arabinoguanosine, 2′-deoxy-2′substituted-arabinoguanosine, 2′-O-substituted-arabinoguanosine, 2′-deoxyinosine, or other guanosine nucleoside analogs.

10. The method according to claim 1 , wherein the 2′-O-substituted ribonucleotide is a 2′-OMe-ribonucleotide.

11. The method according to claim 6 , wherein the IRO compound is selected from

5′-(TCT GA CGTTCT) 2 X 2 (5′-SEQ ID NO: 86-3′-X 2 -3′-SEQ ID NO: 86-5′),

5′-(TCT GA CG 1 TTCT) 2 X 2 (5′-SEQ ID NO: 87-3′-X 2 -3′-SEQ ID NO: 87-5′),

5′-(TCT GA CG 4 TTCT) 2 X 2 (5′-SEQ ID NO: 88-3′-X 2 -3′-SEQ ID NO: 88-5′),

5′-(TCTCT GA CGTT) 2 X 2 (5′-SEQ ID NO: 89-3′-X 2 -3′-SEQ ID NO: 89-5′),

5′-(TCT GU CGTTCT) 2 X 2 (5′-SEQ ID NO: 91-3′-X 2 -3′-SEQ ID NO: 91-5′),

5′-(TCT GU CG 1 TTCT) 2 X 2 (5′-SEQ ID NO: 92-3′-X 2 -3′-SEQ ID NO: 92-5′),

5′-(TCT GA CG 1 TT) 2 X 2 (5′-SEQ ID NO: 94-3′-X 2 -3′-SEQ ID NO: 94-5′),

5′-( UGU CG 1 TTCT) 2 X 2 (5′-SEQ ID NO: 98-3′-X 2 -3′-SEQ ID NO: 98-5′) and

5′-( UGA CG 1 TTCT) 2 X 2 (5′-SEQ ID NO: 99-3′-X 2 -3′-SEQ ID NO: 99-5′),

wherein G 1 =7-deaza, G 4 =araG, G, A or U=2′-OMe and X 2 =glycerol linker.