USE

TECHNICAL FIELD

[0001] The present invention relates to glycopeptides. In particular, the invention includes glycopeptide epitopes derived from mucin 1 (MUCl), antibodies targeting the glycopeptide epitopes and use of the epitopes and antibodies in therapeutic and diagnostic methods.

REFERENCE TO SEQUENCE LISTING

[0002] The material contained in the text file identified as "EZS0008-00P1 Sequence

Listing_ST25.txt" (created April 13, 2010; 1,248 bytes) is hereby incorporated by reference.

BACKGROUND

[0003] Mucin 1 (MUCl) is a highly O-glycosylated protein normally expressed on epithelial, endothelial and other normal cell types. MUCl and other members of the mucin family provide lubrication of cell surfaces and serve as a barrier to physical and biological assaults on the cell. However, in human tumors mucins are often aberrantly expressed. This is believed to contribute to tumor progression by altering the surface properties of tumor cells. MUCl is one of the best characterized of the mucins. It has a role in cell adhesion and has been shown to interact with various signaling proteins involved in cellular growth.

[0004] MUCl has been exclusively localized to the apical surfaces of normal epithelial cells of breast, salivary gland and lung. The protein backbone has both highly glycosylated regions and unglycosylated regions. The protein core exhibits of a variable number of tandem repeats (VNTR) each 20 amino acids in length. The carbohydrate side chains are attached by an a-linkage between N-acetylgalactosamine and the oxygen atom of serine or threonine. Each VNTR contains five potential sites for glycosylation.

[0005] Humans are generally immunologically tolerant to the human MUCl protein core and its normal glycoforms. However, MUCl is up-regulated in many malignant tumors. In addition, cancer-associated MUCl is underglycosylated (i.e., hypoglycosylated) and exhibits an abnormal number of truncated immature O-glycan side-chains. The changes in the carbohydrate structure of cancer-associate MUCl distinguish it structurally from MUCl found in normal tissues. As a consequence of hypoglycosylation, regions of the protein backbone that are normally masked by carbohydrate become exposed, making the cancer-associate molecule antigenically distinct from the MUC 1 found in normal epithelia.

[0006] Because MUC 1 is over-expressed in many cancers, it has been used as a serum marker for detecting recurrence or prognosis in cancer patients, particularly breast cancer patients. The MUCl glycoforms associated with normal breast epithelial cells are core 2 glycoforms that are characterized by branching at the 6-position of the GalNAc residue. In contrast, in breast cancer core 1 glycoforms predominate. Core 1 glycoforms are characterized by a lack of branching at the 6-position of GalNAc. The failure of breast cancer cells to produce normally branched glycoforms may be due to a decrease in expression of core2B 6- GlcNAc transferase (C2GnTl). Anti-MUCl antibodies have also been employed as immunohistochemical markers in the diagnosis of such cancers. Anti-MUCl antibodies directed against different regions of MUCl, including the VNTR, are known.

[0007] Cellular immune responses to MUCl have been extensively characterized in cancer patients. Humoral immune responses to MUCl in malignancy have also been reported and correlated with improved outcome in breast cancer. There is therefore interest in developing antibodies to MUCl and immunogens based on the MUCl polypeptide for use in immunotherapy for patients with cancer for use in treating tumors expressing the MUC 1 antigen. It is also of interest to elicit cellular and humoral immune responses directed specifically to cancer-associated glycoforms of MUCl to improve the therapeutic effect.

[0008] The heptapeptide sequence Pro-Asp-Thr-Arg-Pro-Ala-Pro (PDTRPAP, SEQ ID

NO: l) is derived from the VNTR of MUCl and has been identified as the epitope recognized by anti-KL-6 monoclonal antibody (anti-KL-6MAb). Ohyabu, N. J., et al. Am. Chem. Soc. 2009; 131 (47): 17102-9. The threonine residue of this epitope is modified by Neu5Ac alpha 2,3 Gal beta 1,3 GalNAc alpha (2,3 sialyl T antigen or "23ST", a core 1-type O-glycan). The authors report that the antibody is not specific for this epitope structure, and that it reacts with various kinds of tumor-derived MUCl glycoproteins as well as the glycoprotein biomarker associated with interstitial pneumonia. Further, glycosylation of threonine/serine residues outside the epitope strongly influenced the antibody/epitope interaction.

[0009] Two glycoforms of the tetrapeptide GSTA (SEQ ID NO:2) with GalNAcal-O- Ser/Thr (Tn) and NeuAca2-6GalNAcal-0-Ser/Thr (sialyl-Tn or STn) O-glycosylation have also been reported as a cancer-specific immunodominant epitope found in the VNTR. Tarp, M.A., et al. Glycobiology 2007; 17 (2): 197 -209. Vaccines based on this glycopeptide were capable of overriding tolerance in human MUCl transgenic mice and induced humoral immunity. Sorensen, A.L., et al. Glycobiology 2006; 16:96-107.

[0010] In addition, autoantibodies directed to MUCl have been reported in healthy persons and in patients with lung cancer; however, the levels in lung cancer patients were significantly lower than those in normal individuals. Hirasawa, Y., et al. Am. J. Respir. Crit. Care Med. 2000; 161:589-594. These authors also reported that the one-year survival rate of patients with higher concentrations of autoantibody was significantly higher than that of patients with lower levels of autoantibody and suggested that the degree of decrease in autoantibody level may be associated with a patient's prognosis. Autoantibodies in breast cancer patients that are indicators of the outcome of disease have also been reported by von

Mensdorff-Pouilly, S., et al. J. Clin. Oncology 2000; 18(3):574-583. In this study, detection of the antibodies in pretreatment sera had significant prognostic value and was associated with significant benefit in survival, suggesting that vaccination of patients with MUCl -derived (glyco)peptides may influence the outcome of disease. However, in this study, the authors reported that the levels of antibody were significantly higher in the breast cancer group and the benign breast tumor group than in healthy women.

[0011] Autoantibodies to aberrant O-glycopeptide epitopes are therefore of interest as biomarkers for detection of cancer. Based on a failure in one study to detect IgG

autoantibodies to peptide epitopes in human sera, it has been suggested that autoantibody biomarker discovery strategies should be directed to the cancer-associated aberrant posttranslational modifications of MUCl . Such "O-glycopeptide combination epitopes" include both the peptide backbone and the cancer-associated posttranslational modification hapten structure. Wandall,H., et al. Cancer Res 2010; 70(4): 1306-13. Although the aberrantly glycosylated O-glycopeptidome of MUCl has great potential as a source of targets for cancer- associated autoantibodies, there are thousands of distinct MUCl -derived O-glycoproteins that may be combined with numerous distinct aberrant O-glycan structures, any of which may or may not prove to be useful targets for autoantibody-based detection of cancer. Such discovery is further complicated by the presence in sera of natural antibodies to cancer-associated truncated carbohydrate haptens. There continues to be a need for discovery of additional MUCl -derived O-glycopeptide combination epitopes and larger glycopeptides containing such epitopes for use as therapeutic cancer vaccines and for generating specific therapeutic antibodies. Such O-glycopeptide combination epitopes and antibodies targeting them are also desirable for use in diagnostic and prognostic assays for evaluation of the presence or risk of cancer. The invention disclosed herein meets these needs.

SUMMARY

[0012] The present invention provides cancer-associated O-glycopeptide combination epitopes derived from the VNTR of MUC 1. Specifically, the glycosylation of these epitopes is limited to 2,3 sialyl-T (23 ST) at a single threonine residue. The epitopes may, however, be contained within larger peptides as necessary to improve immunogenicity or for other purposes. The epitopes are the targets of autoantibodies in human sera. Autoantibodies directed against the epitopes of the invention are present at high levels in healthy individuals but are reduced or absent in cancer patients. These epitopes are therefore believed to play an important role in preventing development of cancer in humans by eliciting production of the autoantibodies in healthy individuals. The reduction in the level of serum autoantibody directed to the combination epitopes is associated with many types of cancer, but is particularly associated with breast and colon malignancy.

[0013] The O-glycopeptide combination epitopes and larger peptides containing them are useful in therapeutic compositions for treating cancer by eliciting a humoral immune response. The O-glycopeptide combination epitopes and larger peptides containing them are also useful in diagnostic compositions for determining the level of autoantibody in human biological samples as an indicator of the prognosis of cancer patients, for evaluating the risk of developing cancer in healthy individuals and as an indicator of the presence or absence of cancer (i.e., cancer diagnosis). Further, monitoring the generation of specific autoantibodies to these epitopes provides a method for evaluating the efficacy of vaccine treatment employing the combination epitopes. The O-glycopeptide combination epitopes are also useful for generation of polyclonal antibodies directed against the combination epitopes and hybridomas producing monoclonal antibodies that are specific for the 23ST-glycopeptide combination epitopes. Monoclonal antibodies specifically directed against the 23ST-glycopeptide combination epitope are useful in therapeutic compositions for treating cancer and in immunoprophylactic compositions for reducing the risk of developing cancer. Such monoclonal antibody compositions are administered to an individual with reduced levels of serum autoantibodies in order to raise the level of antibodies in the blood that are reactive to the O-glycopeptide combination epitopes to at least normal levels, preferably above normal levels.

BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Fig. 1 describes the structure of the two combination epitopes.

[0015] Fig. 2 illustrates the association of SEQ ID NO:3 (T15-23ST) autoantibody level with the presence or absence of cancer.

[0016] Fig. 3 illustrates the association of SEQ ID NO:4 (T15-23ST) autoantibody level with the presence or absence of cancer.

DETAILED DESCRIPTION

[0017] Before describing several exemplary embodiments of the invention, it is to be understood that the invention is not limited to the details of construction or process steps set forth in the following description. The invention is capable of other embodiments and of being practiced or being carried out in various ways.

[0018] As used herein, the term SEQ ID NO: 3 (T 15 -23 ST) refers to the amino acid sequence of SEQ ID NO:3 including 23ST glycosylation at the position-15 threonine.

Similarly, the term SEQ ID NO:4 (T15-23ST) refers to the amino acid sequence of SEQ ID NO:4 including 23 ST glycosylation at the position-15 threonine. The structures of SEQ ID NO:3 (T15-23ST) and SEQ ID NO:4 (T15-23ST) are illustrated in Fig. 1.

[0019] As used herein, the term SEQ ID NO: 1 (T3-23ST) refers to the amino acid sequence of SEQ ID NO: 1 including 23 ST glycosylation at the position-3 threonine.

Similarly, the term SEQ ID NO:2 (T3-23ST) refers to the amino acid sequence of SEQ ID NO:2 including 23 ST glycosylation at the position-3 threonine. The structures of SEQ ID NO: l (T3-23ST) and SEQ ID NO:2 (T3-23ST) are illustrated in Fig. 1.

[0020] As used herein, the term "combination epitope" with respect to the

glycopeptides of the invention refers to an antigenic or immunogenic epitope defined by both its peptide sequence and a glycan linked to the peptide sequence. That is, antibodies which specifically bind the combination epitope recognize both the peptide and glycan portions of the epitope. Such antibodies do not bind substantially to either the peptide portion or the glycan portion of the epitope alone.

[0021] As used herein, the term "serum" refers to the liquid separated from clotted blood and the term "plasma" refers to the liquid separated from blood without clotting. Both serum and plasma have the cellular components of blood removed but contain a variety of proteins, including immunoglobulins (antibodies). Therefore, "serum" and "plasma" are used interchangeably when referring to the methods and compositions of the invention and use of one term is intended to include the other.

[0022] As used herein, the phrases "treating cancer" and "treatment of cancer" mean to inhibit the replication of cancer cells, inhibit the spread of cancer, decrease tumor size, lessen or reduce the number of cancerous cells in the body, or ameliorate or alleviate the symptoms of the disease caused by the cancer. The treatment is considered therapeutic if there is a decrease in mortality and/or morbidity, or there is a decrease in disease burden as may be manifested by reduced numbers of malignant cells in the body or decreased tumor size.

[0023] As used herein, the term "immunotherapy" and its equivalents refer to treatment of an individual for the purpose of increasing immunity to a cancer. Immunotherapy may comprise treatment with either a therapeutic vaccine or antibody replacement, or both.

[0024] As used herein, the term "therapeutic vaccine" and its equivalents, with respect to methods and compositions, refers to treatment of an individual who has cancer wherein immunogenic molecules intended to elicit an immune response against the cancer are administered to the individual.

[0025] As used herein, the term "antibody replacement" and its equivalents, with respect to methods and composition, refers to treatment of an individual who has cancer or to immunopropylactic methods for prevention of cancer wherein antibody is administered to the individual for the purpose of increasing the amount of antibody in the circulation targeting cancer cells.

[0026] As used herein, the term "immunoprophylaxis," "immunoprophylactic" and their equivalents, with respect to methods and compositions, refers to treatment of an individual who is not known to have cancer but for whom it is desired to increase immunity to cancer for the intended purpose of preventing the cancer. Immunoprophylaxis may be carried out by administration of immunogenic compositions or by antibody replacement.

[0027] A first cancer-associated combination epitope of MUC1 comprises SEQ ID

NO: 1 (PDTRPAP) with 23 ST O-glycosylation on the T residue. The first combination epitope may be contained in a larger peptide sequence, particularly when used as a therapeutic vaccine or for immunoprophylaxis, and in that case there is preferably no additional glycosylation outside of the combination epitope sequence. For example, the first combination epitope may be present in a peptide having the following amino acid sequence:

STAPPAHGVTSAPDTRPAPGSTA (SEQ ID NO:3).

[0028] A second cancer-associated combination epitope of MUC1 comprises SEQ ID

NO:2 (GSTA) with 23 ST O-glycosylation on the T residue. The second combination epitope may be contained in a larger peptide sequence, particularly when used as a therapeutic vaccine or for immunoprophylaxis, and in that case there is preferably no additional glycosylation outside of the combination epitope sequence. For example, the second combination epitope may be present in a peptide having the following amino acid sequence:

G VT S APDTRP APGSTAPP AHG VT (SEQ ID NO:4).

[0029] The first and second combination epitopes described above were discovered in a synthetic combinatorial library of MUC1 glycopeptides derivatives having various

carbohydrate core structures. The library was created at Hokkaido University using the chemoenzymatic synthesis methods of Matsushita, T., et al. {Biochemistry 2009; 48:11117- 11133).

[0030] Microarray slides were printed with the MUC1 glycopeptide library for use in screening against human sera. Sera were obtained from healthy individuals and from cancer patients (representing colon, breast and kidney cancers) and serially diluted from 25- to 800- fold for use in the microarray analysis.

[0031] The glycopeptide arrays were prepared and analyzed as follows:

[0032] Reagents: Reaction buffer (50 mM Tris-HCl, pH 7.4, containinglOO mM NaCl,

1 mM CaC12, 1 mM MnCl, 1 mM MgC12, 0/05% Tween 20); wash buffer (reaction buffer containing 0.05% Triton X-100 instead of Tween 20); secondary antibody (Cy5 -conjugated Affinipure F(ab')2 fragments, IgG + IgM (H+L) goat anti-human from Jackson

Immunoresearch, #109-176-127).

[0033] Prior to use, the secondary antibody was rehydrated with 0.75 ml Milli-Q water and diluted 1 : 100 with reaction buffer.

[0034] The microarray reader was an Axon GenePix 4300A from MDS Analytical

Technologies using GenePix Pro 7 software.

[0035] Methods:

1. Serially dilute sera from 25 to 800-fold.

2. Set the Microarray slide in SIMprex 64 Multi-Array Device (Gentel Biosciences, #4- 1029) with SIMprex Gasket (Gentel Biosciences, #4-1026). 3. Apply ΙΟΟμΙ of the diluted sera to the wells of the device.

4. Cover with SIMprex Well Seal (Gentel Biosciences, #4-1027).

5. Incubate for 2 hours at room temperature.

6. Remove liquid from the device by gently pipeting.

7. Apply ΙΟΟμΙ of the wash buffer to each well during 1 minute.

8. Remove liquid from the device by gently pipeting.

9. Repeat 7) and 8) one additional time.

10. Apply ΙΟΟμΙ of the diluted secondary antibody to the wells.

11. Cover with the well seal.

12. Incubate for 1 hour at room temperature.

13. Remove liquid from the device.

14. Remove the slide from the device and wash the slide with wash buffer.

15. Wash the slide with Milli-Q water.

16. Dry the slide by centrifugation.

17. Scan the slide using GenePix 4300A.

[0036] Using these methods SEQ ID NO:3 (T15-23ST) and SEQ ID NO:4 (T15-23ST) were identified in the glycopeptide library as positive in reactions with normal sera and negative or having reduced reactivity with sera from cancer patients.

Binding of autoantibodies in sera to SEQ ID NO:3 or SEQ ID NO:4 amino acid sequences having various O-glycosylation patterns was evaluated using an experimental protocol similar to the one described above. The glycoforms tested and the results are shown in the following

Tables:

Table 1

SEQ ID NO:4

Table 2

SEQ ID NO:3

[0037] Autoantibodies in the sera of healthy individuals did not bind to the SEQ ID

NO:3 or SEQ ID NO:4 amino acid sequences with O-glycosylation patterns other than 23ST at T-15. It was observed that autoantibody binding was negative for 23 ST at T-8 of SEQ ID NO:4 in spite of the fact that T-8 of SEQ ID NO:4 is contained in an amino acid sequence that is the same as SEQ ID NO: 1. However, the the glycopeptides were linked to the microarray plate via 5-oxo linkages at the N-terminus. The position of SEQ ID NO: 1 in SEQ ID NO:4 is close to this linkage, so it is likely that this configuration prevented antibody access to the epitope. In contrast, the position of SEQ ID NO: 1 in SEQ ID NO:3 is distanced from the linkage point and was therefore accessible for autoantibody binding. The autoantibodies were therefore determined to be specific for SEQ ID NO:3 and SEQ ID NO:4 peptides having only 23ST-glycosylation at the T-15 amino acid residue.

[0038] In addition, the autoantibodies were found to be present at higher levels in normal healthy individuals than in cancer patients. Specifically, autoantibodies were reduced or absent in cancer patients as compared to normal healthy individuals. Absorbance data were plotted as 200-fold serum dilution vs. 400-fold serum dilution for each of SEQ ID NO:3 (T15- 23ST) and SEQ ID NO:4 (T15-23ST) to evaluate the degree of association of autoantibody level with disease. For both glycopeptides the plot was substantially linear and revealed a trend toward higher values (i.e., higher autoantibody levels) in normal healthy individuals as compared to cancer patients (Fig. 2 and Fig. 3). In general, absorbance values for healthy individuals were equal to or greater than about 1 million absorbance units (AU), whereas absorbance values for breast and colon cancer patients were equal to or less than about 1 million AU. Results for renal cancer patients were substantially more variable, with two patients falling well into the range of normal. Values for renal cancer ranged from about 600 thousand to 1.75 million AU.

[0039] The range of normal values for autoantibodies directed to SEQ ID NO:3 (T15-

23ST) and SEQ ID NO:4 (T15-23ST) is therefore typically greater than about 1 million AU, for example from about 1,000,100 AU to about 2.7 million AU, from about 1,000,100 AU to about 1.5 million AU or from about 1.25 million AU to about 1.5 million AU. The range of values indicating the disease state is typically about 1 million AU or less, for example from about 500 thousand AU to about 1 million AU, from about 50 thousand AU to about 500 thousand AU or from about 250 thousand AU to about 900 thousand AU. Autoantibodies may also be essentially undetectable in this assay in the disease state. While these data might suggest that the reduction in autoantibodies may be more reliably predictive for breast and colon cancer than renal cancer, the greater variability in renal cancer patients may also be due to the small sample size in this study.

[0040] The combination epitopes disclosed herein are specifically recognized by autoantibodies that are reduced or absent in patients with cancer. As such, the change in autoantibody level is believed to be an early indicator of disease. One aspect of the present invention therefore relates to use of the combination epitopes in diagnostic assays and methods for detection of cancer. For example, they may be used (alone or within larger peptide sequences as exemplified by SEQ ID NO:3 (T15-23ST) and SEQ ID NO:4 (T15-23ST)) as targets in diagnostic ELISA assays similar to those described above. Absorbance readings indicate the level of autoantibody present in the individual's serum as described above and are indicative of the presence or absence of cancer. Adaptation of the invention to other known assay methods suitable for determining antibody levels in serum is within the ordinary skill in the art. For example, autoantibody titers may be determined as described by Engvall, E., et al. (Immunochemistry 1971; 9(8):871-4. "Enzyme-linked immunosorbent assay (ELISA).

Quantitative assay of immunoglobulin G"). Alternatively, other known antibody quantitation methods suitable for clinical use may be used to determine the level of the autoantibodies described herein. For example, as described in "Antibodies: A Laboratory Manual by Ed

Harlow and David Lane. By determining the range of autoantibody titers in normal serum and the range of autoantibody titers in the sera of cancer patients, the range of autoantibody titers that is indicative of the presence of cancer can be statistically determined. As described above for ELISA assays, autoantibody titers that are reduced in comparison to normal titers indicate the presence of cancer in the patient, especially in the case where MUC1 23 ST epitopes are present in the serum or tissue. .

[0041] The assays described above using the combination epitopes disclosed herein are also useful for determining the prognosis of a cancer patient. In this case, the subnormal ranges of autoantibody are indicative of a relatively poor prognosis, with lower subnormal results being indicative of a worse prognosis than higher subnormal results. In contrast, cancer patients having normal levels of autoantibody will generally be evaluated as having a good prognosis.

[0042] The assays described above using the combination epitopes disclosed herein are also useful in assays for determining an individual's level of risk for developing cancer (including risk of cancer recurrence) and for monitoring changes in cancer risk over time. It is believed that the autoantibodies described herein contribute to immune surveillance against MUC1 -expressing cancer cells. That is, normal or high levels of circulating autoantibody are protective but reduced levels of circulating autoantibody may be inadequate to recognize and remove malignant cells as they arise. In this case, the subnormal ranges of autoantibody are indicative of a relatively higher cancer risk, with lower subnormal results being indicative of a greater risk than higher subnormal results. Individuals having autoantibody levels in the normal range generally will be evaluated as having a normal risk of developing cancer and individuals having autoantibody levels in the high normal range will be evaluated as having particularly high resistance to developing cancer. For monitoring changes in the level of activity of the anti-cancer immune surveillance system of an individual over time, a baseline titer for the autoantibodies is established for the individual. Subsequent testing will detect increases or decreases relative to the baseline titer, wherein increasing values indicate decreasing cancer risk and decreasing values indicate increasing cancer risk.

[0043] In yet another embodiment, the assays described above may be used to monitor the efficacy of cancer therapy

[0044] Because it has been found that autoantibodies directed against the combination epitopes are reduced and may even be substantially absent in patients with cancer, in one aspect the present invention is directed to an immunotherapeutic method of inducing a cancer specific immune response toward the combination epitopes, the method comprising immunizing a human cancer patient with an immunogenic glycopeptide comprising the combination epitopes described herein. While such therapeutic immunization or vaccination will be effective against any cancer which expresses MUC1 having the SEQ ID NO:l (T3- 23ST) or SEQ ID NO:2 (T3-23ST) combination epitope, in a preferred embodiment the immunotherapeutic method is for treatment of breast cancer, colon cancer or renal cancer. In a specific example, therapeutic vaccination may be accomplished by administration of SEQ ID NO:3 (T15-23ST) or SEQ ID NO:4 (T15-23ST) to an individual in need thereof . Desirably, the specific immune response will be a humoral response that mimics the autoantibodies found in healthy individuals. Exposure of the patient to either or both of the combination epitopes (each alone or within a larger peptide sequence) will elicit a humoral immune response, increasing the level of autoantibody and thereby increasing the patient's natural immunity to the abnormal glycopeptides associated with cancer. Ideally, treatment with a combination epitope as disclosed herein will increase the level of autoantibody to at least the minimum normal level (such as 1 million AU or greater in ELISA) or to near-normal levels (80-99%, such as 800 thousand AU-999 thousand AU in ELISA). Preferably, treatment with a combination epitope as disclosed herein will increase the level of autoantibody to at least 60% of the minimum normal level (such as 600 thousand AU or greater in ELISA) or to 60-80% of the minimum normal level (such as 600 thousand AU-800 thousand AU in ELISA). However, use of the therapeutic vaccine will more preferably increase the level of autoantibodies to at least 110% of the minimum normal level (such as at least 1.1 million AU in ELISA), 110-

125% of the minimum normal level (such as 1.1 million AU-1.25 million AU in ELISA), 125- 150% of the minimum normal level (such as 1.25 million AU-1.50 million AU in ELISA) or 150-250% of the minimum normal level (1.50 million AU-2.50 million AU in ELISA).

[0045] Therapeutic vaccine compositions comprising the combination epitopes of the invention are also contemplated by the present invention. In a preferred embodiment, the therapeutic vaccine composition is a cancer vaccine for treatment of breast cancer, colon cancer, renal cancer or other cancers which express MUC1 having the SEQ ID NO: l (T3- 23ST) and/or SEQ ID NO:2 (T3-23ST) combination epitopes. The composition may comprise a peptide containing the combination epitope(s) and at least one pharmaceutically acceptable excipient. For use as a therapeutic vaccine, the composition will typically be in the form of an injectable composition such as a solution, suspension or emulsion incorporating a peptide containing the combination epitope and a liquid excipient (e.g., saline, water, phosphate or carbonate buffer, propylene glycol, sorbitol, sucrose, etc.). To increase the immunogenicity of the vaccine, the peptide containing the combination epitope may be conjugated to a suitable carrier, such as human serum albumin (HSA), Keyhole limpet hemocyanin (KLH), influenza hemagglutinin, cholera toxin, tetanus toxoid, heat shock protein 65 (HSP65), or other carriers known in the art.

[0046] Peptides containing the combination epitopes of the invention for use in the foregoing methods and compositions may be produced by chemoenzymatic synthesis methods known in the art, for example peptide synthesis followed by glycosylation and sialylation of the peptide in vitro using purified recombinant glycosyltransferases and sialyltransferases. See, e.g., Matsushita, T., et al. Biochemistry 2009; 48:11117-11133 ("Functional

neoglycopeptides: Synthesis and characterization of new class MUC1 glycoprotein models having core 2-based O-glycan and complex-type N-glycan chains "). Alternatively, the desired peptide sequence may be produced using known recombinant DNA techniques to express the peptide, followed by enzymatic glycosylation and sialylation of the purified peptide.

[0047] In addition, one aspect of the invention contemplates monoclonal antibodies specific for a combination epitope according to the invention. Such monoclonal antibodies may be produced according to methods known in the art, and are useful as immunotherapeutics for administration to cancer patients to treat the disease by increasing the level of antibodies specifically targeting the cancer-associated combination epitope. This therapeutic approach provides antibody replacement therapy for the naturally occurring autoantibodies that are reduced or absent in cancer patients. Ideally, such immunotherapy will increase the combination epitope-directed antibody level in the serum to at least the minimum normal level of autoantibodies (such as 1 million AU or greater in ELISA) or to near-normal levels (80- 99%, such as 800K AU-999K AU in ELISA). Preferably, the immunotherapy will increase the level of serum antibody to at least 60% of the minimum normal level of autoantibodies (such as 600K AU or greater in ELISA) or to 60-80% of the minimum normal level (such as 600K AU-800K AU in ELISA). However, use of the monoclonal antibody for immunotherapy will more preferably increase the level of combination epitope-directed antibodies in the serum to at least 110% of the minimum normal level of autoantibodies (such as at least 1.1 million AU in ELISA), 110-125% of the minimum normal level (such as 1.1 million AU-1.25 million AU in ELISA), 125-150% of the minimum normal level (such as 1.25 million AU-1.50 million AU in ELISA) or 150-250% of the minimum normal level (1.50 million AU-2.50 million AU in ELISA). By increasing the level of circulating antibody directed against a combination epitope of the invention, the patient's natural immunity to the abnormal glycopeptides associated with cancer cells will be increased and immune surveillance will be increased for improved therapeutic effect. Similarly, when monoclonal antibodies specific for a combination epitope according to the invention are administered to an individual with reduced autoantibody levels but no detectable malignancy the increase in circulating antibody will provide increased immune surveillance for improved immunoprophylaxis.

[0048] Because ELISA methods for quantitation of autoantibodies, monoclonal antibodies and engineered antibodies in the circulation of an individual have been described, the results have been expressed herein in terms of absorbance units. It will be readily apparent to one skilled in the art that other known methods for quantitating antibodies may be substituted for ELISA. The corresponding ranges of normal and abnormal autoantibody levels as well as antibody levels monitored during treatment expressed in the units of measurement of such alternative assays can be determined using ordinary skill. The present invention is not limited to the use of ELISA or to absorbance for detection and quantitation, but contemplates all appropriate methods for detecting and quantitating antibody in the blood. For example, instead of absorbance units, one may determine the range of antibody titer that is indicative of normal or abnormal levels or monitor changes in antibody titer during treatment using methods known in the art.

[0049] Monoclonal antibodies specifically recognizing 23ST-glycosylation at T-15 of

SEQ ID NO:4 may be prepared by immunizing mice, fusing immunized spleen cells with myeloma cells and screening the resulting hybridoma cells by ELISA, as is known in the art, using a glycopeptide containing the combination epitope as the immunogen, for example SEQ ID NO:4 (T15-23ST). An adjuvant such as KLH or tetanus toxoid may be conjugated to the glycopeptide to increase its immunogenicity, for example as described in antibodies: A

Laboratory Manual (Ed Harlow and David Lane). Hybridomas will initially be selected and screened for reactivity with only SEQ ID NO:4 (T 15 -23 ST) and not with other glycopeptides found in the MUC1 glycopeptide library that was originally used to isolate SEQ ID NO:4 (T 15 -23 ST). The selected hybridomas will then be screened for production of monoclonal antibodies that react specifically with the T15-23ST combination epitope. That is, the selected hybridomas will be further screened and selected for monoclonal antibodies that recognize the combination epitope of SEQ ID NO:2 (T3-23ST) (i.e., both the glycoform and the peptide) with high specificity and affinity. The most preferred monoclonal antibody will react strongly with 23 ST core 1 carbohydrate structures linked to T-15 of SEQ ID NO:4 or T-3 of SEQ ID NO:2 but will have substantially no reactivity with other core 1 structures (e.g., T, dST, 26ST), with Tn or STn, or with sialylated or unsialylated core 2 carbohydrate structures when they are present at T-15 of SEQ ID NO:4 or at T-3 of SEQ ID NO:2. Preferably, the specificity of the monoclonal antibody is such that cross-reactivity with non-target carbohydrate structures is 80% or less, preferably 50% or less, more preferably 20%> or less, or most preferably 10%> or less of reactivity with the immunogen glycopeptide (defined as 100% in conventional binding assays). In one embodiment, the monoclonal antibody directed against the SEQ ID NO:4 (T3- ST) combination epitope has binding specificity of 50% or less for combination epitopes in which T3 of SEQ ID NO:4 is linked to a carbohydrate structure comprising a substitution at the 6-position of GalNAc (e.g., NeuNAc or GlcNAc at the 6-position), and for Tn and T combination epitopes. For example, the desired monoclonal antibody may have binding specificity of 10%> or less (such as <0.1-5%, <0.1-1%, or undetectable binding) to 6- substituted epitopes and binding specificity of 50%> or less for Tn and T combination epitopes (such as 10-20%, <0.1-10%, <0.1-1%, or undetectable binding). The binding affinity of the selected monoclonal antibodies for the immunogen glycopeptides will preferably be 1500 nM or less in BIACORE assays (Kd) or 700 nM or less in ELISA assays (IC50). In a specific embodiment the binding affinity is less than 180 nM (Kd) or less than 100 nM (IC50). In a preferred embodiment the binding affinity is about 0.4 nM (Kd) or about 0.6 nM (IC50). Such monoclonal antibodies will be highly specific for the combination epitope that is the target of the protective autoantibodies described herein and will bind with high affinity. They will therefore be highly effective for treatment and prevention of cancers expressing MUC1 having the combination epitope.

[0050] Monoclonal antibodies specifically recognizing 23 ST glycosylation at T-15 of

SEQ ID NO:3 may be prepared in a similar manner and will similarly recognize the combination epitope of SEQ ID NO:3 (T15-23ST) (i.e., both the glycoform and the peptide) with high specificity and affinity. They will be selected to be specific for, and react strongly with, the 23 ST structure at T-15 of SEQ ID NO: 3 or T-3 of SEQ ID NO: 1. The most preferred monoclonal antibody produced will exhibit substantially no reactivity with other core 1 carbohydrate structures (e.g., T, dST, 26ST), with Tn or STn, or with sialylated or unsialylated core 2 carbohydrate structures linked to T-15 of SEQ ID NO:3 or T-3 of SEQ ID NO: l . Preferably, the specificity of the monoclonal antibody is such that cross-reactivity with non- target carbohydrate structures is 80% or less, preferably 50%> or less, more preferably 20%> or less, or most preferably 10% or less of reactivity with the immunogen combination epitope (defined as 100% in conventional binding assays). In one embodiment, the monoclonal antibody directed against SEQ ID NO:4 (T3-ST) combination epitope has a binding specificity of 50% or less for combination epitopes in which T3 of SEQ ID NO:4 is linked to a

carbohydrate structure comprising a substitution at the 6-position of GalNAc (NeuNAc or GlcNAc at the 6-position), and for Tn and T combination epitopes. For example, the desired monoclonal anatibody may have binding specificity of 10%> or less (such as <0.1-5%>, <0.1-1%>, or undetectable binding to 6-substituted epitopes and binding specificity of 50%> or less for Tn and T combination epitopes (such as 10-20%), <0.1-10%>, <0.1-1%>, or undetectable binding). The binding affinity of the selected monoclonal antibodies for the immunogen glycopeptides will preferably be 1500 nM or less in BIACORE assays (Kd) or 700 nM or less in ELISA assays (IC50). In a specific embodiment the binding affinity is less than 180 nM (Kd) or less than 100 nM (IC50). In a preferred embodiment the binding affinity is about 0.4 nM (Kd) or 0.6 nM (IC50). Such monoclonal antibodies will be highly specific for the combination epitope that is the target of the protective autoantibodies described herein and will bind the epitope with high affinity. They will therefore be highly effective for treatment and prevention of cancer expressing MUC1 having the combination epitope.

[0051] Alternatively, the serum autoantibodies directed against the combination epitopes SEQ ID NO:2 (T3-23ST) and/or SEQ ID NO: l (T3-23ST) can be used to design specific engineered antibody therapeutics that are chemically or biologically synthesized (for example, using recombinant DNA methods). Such antibody therapeutics include, but are not limited to, antibody binding fragments such as Fab, Fab ₂ , Fv, scFv, minibodies, diabodies, triabodies and tetrabodies. Engineered antibodies provide substantial technical and therapeutic advantages over conventional mAbs because of their smaller size and because they are easily conjugated to active molecules such as drugs, toxins and radioisotopes for therapeutic use. In addition, engineered antibodies that are multivalent may be designed to react with both SEQ ID NO: 1 (T3-23ST) and SEQ ID NO:2 (T3-23ST). The engineered antibodies will also be designed such that they react specifically with the combination epitope(s) of the invention and not with other glycopeptides found in the MUC1 glycopeptide library that was originally used to isolate SEQ ID NO:4 (T15-23ST) and SEQ ID NO:3 (T15-23ST). More specifically, such antibodies will have little or no reactivity with SEQ ID NO:4 or SEQ ID NO:3 when T-15 O- glycosylation other than 23 ST is present.. Further, the selected antibody will be designed to recognize the combination epitope of SEQ ID NO:2 (T3-23ST) and/or SEQ ID NO: l (T3- 23ST) (i.e., both the glycoform and the peptide) and will be similarly specific for the 23ST structure in these glycopeptides. That is, the preferred antibody designed in this manner will not react with sialylated or unsialylated core 2 structures or with Tn, T, dST, 26ST or STn core 1 carbohydrate structures when they are present at T-15 of SEQ ID NO:4 or at T-3 of SEQ ID NO:2 and/or when they are present at T-15 of SEQ ID NO:3 or at T-3 of SEQ ID NO: 1. Such engineered antibody immunotherapeutics will be useful in the same therapeutic and

immunoprophylactic methods and compositions as the monoclonal antibodies described above.

[0052] Immunotherapeutic and immunoprophylactic compositions comprising the monoclonal antibodies or engineered antibodies are also contemplated by the invention. In a preferred embodiment, the immunotherapeutic or immunoprophylactic antibody composition is a composition for treatment or prevention, respectively, of cancers which express the combination epitope of SEQ ID NO: 1 (T3-23ST), SEQ ID NO:2 (T3-23ST), SEQ ID

NO:3(T15-23ST) or SEQ ID NO:4 (T15-23ST). In a specific aspect, the immunotherapeutic antibody composition is a composition for treatment of breast cancer, colon cancer or, renal cancer. The composition may comprise a monoclonal or engineered antibody as described above and at least one pharmaceutically acceptable excipient. For use in treating or preventing cancer, the composition will typically be in the form of an injectable composition such as a solution, suspension or emulsion incorporating the monoclonal or engineered antibody and a liquid excipient (e.g., saline, water, phosphate or carbonate buffer, propylene glycol, sorbitol, sucrose, etc.).

[0053] Therapeutic utility of the combination epitopes, peptides containing the combination epitopes and monoclonal or engineered antibodies directed to the combination epitopes for eliciting an immune response and for immunotherapy of cancer are confirmed in a murine MUCl model accepted in the field for evaluation of immune response and immune tolerance to MUCl and for evaluation of anti-MUCl vaccine formulation in vivo within the context of an animal that expresses MUC 1. See Rowse, G.J., et al. Cancer Res. 1998; 58:315- 321. This mouse strain (MUCl .Tg) is transgenic for human MUCl and is immune-tolerant to stimulation by MUCl as evidenced by the ability of MUCl -expressing tumors to grow. It is therefore an appropriate preclinical model for evaluating anti-MUCl immunotherapy formulations.

[0054] For confirmation of an in vivo immune response to the combination epitopes of the invention, glycopeptides containing the SEQ ID NO: l (T3-23ST) or SEQ ID NO:2 (T3- 23 ST) epitopes are conjugated to an adjuvant peptide such as KLH and injected

subcutaneously into MUCl .Tg mice in a solution with Freunds adjuvant (e.g., 10-15 μg glycopeptides in 200 total volume). Multiple immunizations (e.g., 4 injections 14 days apart) are administered and blood samples obtained following completion of the immunization schedule.

[0055] Post-immunization response is evaluated by ELISA generally as described by

Sorensen, A.L., et al. Glycobiology 2006; 16(2):96-107, using the immunizing glycopeptides for capture of serum antibodies followed by detection of bound antibodies with labeled anti- mouse immunoglobulins (such as peroxidase-conjugated rabbit anti-mouse immunoglobulins). For isotyping, peroxidase-conjugated isotype-specific antibodies (such as goat anti-mouse IgM, IgGl, IgG2a, IgG2b or IgG3) are used as detection antibodies. Reactivity of induced antibodies with MUCl -expressing cancer cells is evaluated by incubating appropriate cell lines (for example, T47D which is reported to express at least some ST O-glycans) with immunized mouse sera in serial dilutions, followed by incubation with labeled anti-mouse

immunoglobulins (such as FITC-conjugated rabbit anti-mouse immunoglobulins). Labeled cells are mounted on slides and examined under a fluorescence microscope to determine the extent of reaction of immune sera with MUCl ST glycan epitopes on the cell surface.

[0056] The combination epitopes of the invention, either alone or contained in larger peptides as described above, are expected to overcome tolerance in MUC 1.Tg mice and elicit a specific humoral immune response of sufficient strength to produce strong reactivity in the ELISA and immunocytochemistry assays described above. These results will provide a strong indication that peptides containing the combination epitopes SEQ ID NO: l (T3-23ST) and/or SEQ ID NO:2 (T3-23ST) have utility as therapeutic vaccines for treatment of MUC1- expressing cancers in humans, in particular breast cancer, colon cancer and renal cancer.

[0057] As further evidence of the therapeutic utility of peptides containing the combination epitopes SEQ ID NO: 1 (T3-23ST) and/or SEQ ID NO:2 (T3-23ST), anti-tumor response in the MUC 1.Tg murine model is evaluated, generally as described by Mukherjee, P., et al. Vaccine. 2007; 25(9): 1607 1618. The host is injected subcutaneously with MUCl- expressing cancer cells (such as MC28 colon cancer cells transfected with MUC1 or a similar breast cancer cell line), typically in the flank, and the tumors are allowed to grow for a period of time, such as about 7 days, prior to immunization. Combination epitope-containing peptides in compositions with adjuvants (e.g., incomplete Freunds adjuvant) are administered subcutaneously at a site away from the tumor injection site. The immunization schedule is typically every seven days for 21 days, at which time the animals are sacrificed. Tumor size is measured with calipers daily during the immunization cycle and tumor weight in grams is calculated based on length and width of the tumor. An effect of immunization on tumor growth is evidenced by a slower rate of tumor growth in immunized mice as compared to unimmunized animals. Ideally, tumor growth is substantially completely prevented in immunized animals, that is, tumor growth is undetectable by palpation upon completion of the immunization protocol.

[0058] Highly immunotherapeutic peptides according to the invention will reduce tumor burden by at least 50% (either with or without the addition of adjuvants), preferably at least 70%, most preferably at least 90%>. In some cases, complete prevention of tumor growth in MUC1.Tg mice may be achieved by immunotherapy using peptides containing the combination epitopes of the invention.

[0059] Polyclonal antibodies specific for the combination epitopes may also be generated using methods known in the art. Because the combination epitopes are strongly cancer-associated, such polyclonal antibodies will be useful for in vitro assays to determine the presence or absence of the disease, the prognosis of a cancer patient and an individual's level of risk for developing cancer. The monoclonal antibodies and engineered synthetic antibodies described above may also be used in similar assays for similar purposes.

[0060] Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It will be apparent to those skilled in the art that various modifications and variations can be made to the method and apparatus of the present invention without departing from the spirit and scope of the invention. Thus, it is intended that the present invention include modifications and variations that are within the scope of the appended claims and their equivalents.