International Application No. PCT/GB2017/ 053172

FURTHER INFORMATION CONTINUED FROM PCT/ISA/ 210

This International Searching Authority found multiple (groups of)

inventions in this international application, as follows:

1. claims: l-21(partial ly)

Claims 1-5 (second medical use): a pharmaceutically acceptable small molecule which inhibits GSK-3 activity for use in the repair or regeneration of dentine selected from

the group of formula (I) and (II);

Claims 6-14 and 21 (product claims): a combination of a

matrix material and a pharmaceutically acceptable small

molecule selected from the group of formula (I) and (II); a kit as far as it refers back to Claim 6.

Claims 15-20 a method for repairing or regenerating dentine which comprise a small molecule which inhibits GSK-3 activity selected from the group of formula (I) and (II);

2. claims: l-21(partial ly)

Claims 1-5 (second medical use): a pharmaceutically acceptable small molecule which inhibits GSK-3 activity for use in the repair or regeneration of dentine selected from

the group of formula (III) ;

Claims 6-14 and 21 (product claims): a combination of a

matrix material and a pharmaceutically acceptable small

molecule selected from the group of formula (III); a kit.

Claims 15-20 a method for repairing or regenerating dentine which comprise a small molecule which inhibits GSK-3 activity selected from the group of formula (III)

levels of free target than post treatment samples, often requiring different sample dilutions for each situation.

SUMMARY

[0005] This disclosure provides a method of quantitating free

(unbound) human C5 complement protein (C5) from a sample comprising: a. binding biotinylated anti-C5 capture antibody to

strepavidin-coated particles; wherein said biotinylated anti-C5 capture antibody is added by capillary action to a Gyros Bioaffy 200 CD comprising columns with the strepavidin-coated particles; wherein said CD is subjected to centrifugal force inside a Gyrolab xPlore or a Gyrolab XP instrument, thus driving the biotinylated anti-C5 capture antibody to the strepavidin-coated particles in the columns; b. capturing the free (unbound) C5 in the sample; wherein the sample is added to the CD by capillary action; wherein said CD is subjected to centrifugal force inside the Gyrolab xPlore or a

Gyrolab XP instrument, thus driving the sample to the biotinylated anti-C5 capture antibody bound to the strepavidin-coated particles in the columns;

c. detecting the captured free C5; wherein an AlexaFluor labeled anti-C5 detection antibody is added to the CD by capillary action, wherein said anti-C5 detection antibody binds C5 at a different epitope from the epitope bound by the capture antibody; wherein said CD is subjected to centrifugal force inside the Gyrolab xPlore or a Gyrolab XP instrument, thus driving the detection antibody to the free C5 bound to the capture antibody bound to the strepavidin-coated particles in the columns; and

d. quantitating the captured free C5 using laser-induced fluorescence detection.

[0006] Without limiting the disclosure, a number of embodiments of the disclosure are described below for purpose of illustration.

[0007] Item 1. A method of quantitating free (unbound) human C5 complement protein (C5) from a sample comprising: a. binding biotinylated anti-C5 capture antibody to strepavidin-coated Meso Scale Discovery ^® (MSD ^® ) 96-well assay plate; b. capturing the free

(unbound) C5 in the sample by adding the sample to the plate; c. detecting the captured free C5 by adding sulfo-tagged anti-C5 detection antibody to the plate; and d. quantitating the captured free C5 using electrochemiluminescence; wherein the sample is diluted by about 1:2; wherein the sample is kept on ice; wherein steps b.-c. are about 15 to 30 minutes, and wherein the biotinylated capture anti-C5 antibody is added at a concentration of about

5μg/mL .

[0008] Item 2. A method of quantitating free (unbound) human C5 complement protein (C5) from a sample comprising: a. binding biotinylated anti-C5 capture antibody to strepavidin-coated

particles; wherein said biotinylated anti-C5 capture antibody is added by capillary action to a Gyros Bioaffy 200 CD comprising columns with the strepavidin-coated particles; wherein said CD is subjected to centrifugal force inside a Gyrolab xPlore or a Gyrolab XP instrument, thus driving the biotinylated anti-C5 capture antibody to the strepavidin-coated particles in the columns; b.

capturing the free (unbound) C5 in the sample; wherein the sample is added to the CD by capillary action; wherein said CD is subjected to centrifugal force inside the Gyrolab xPlore or a Gyrolab XP

instrument, thus driving the sample to the biotinylated anti-C5 capture antibody bound to the strepavidin-coated particles in the columns; c. detecting the captured free C5; wherein an AlexaFluor labeled anti-C5 detection antibody is added to the CD by capillary action, wherein said anti-C5 detection antibody binds C5 at a different epitope from the epitope bound by the capture antibody; wherein said CD is subjected to centrifugal force inside the Gyrolab xPlore or a Gyrolab XP instrument, thus driving the detection antibody to the free C5 bound to the capture antibody bound to the strepavidin-coated particles in the columns; and d. quantitating the captured free C5 using laser-induced fluorescence detection.

[0009] Item 3. The method of item 1, further comprising

calculating the concentration or amount of free C5 antibody by comparing the data obtained from step d. to a standard curve prepared from known amounts of C5 added to a C5 depleted sample using the method of item 1. [0010] Item 4. The method of item 2, further comprising calculating the concentration or amount of free C5 antibody by comparing the data obtained from step d. to a standard curve prepared from known amounts of C5 added to a C5 depleted sample using the method of item 2.

[0011] Item 5. The method of item 3, further comprising

calculating the concentration of free C5 antibody with the Gyros Evaluator software.

[0012] Item 6. The method of any one of the preceding items, wherein the sample is obtained from a human patient.

[0013] Item 7. The method of item 6, wherein said sample is a serum sample or a plasma sample.

[0014] Item 8. The method of any one of the preceding items, wherein the patient has been treated with an anti-C5 antibody.

[0015] Item 9. The method of item 8, wherein the patient has been treated with eculizumab.

[0016] Item 10. The method of item 8, wherein the patient has been treated with ALXN1210.

[0017] Item 11. The method of any one of the preceding items, wherein the biotinylated capture antibody is eculizumab or ALXN1210.

[0018] Item 12. The method of any one of the preceding items, wherein the detection anti-C5 antibody is N19-8 (mouse anti-human C5 antibody) .

[0019] Item 13. The method of item 2, wherein Rexxip A buffer is used for diluting samples and Rexxip F buffer is used for diluting the detection antibody.

[0020] Item 14. The method of item 2, further comprising priming the Gyros instrument two separate times with Bioaffy wash 1 and pH 11 buffer.

[0021] Item 15. The method of item 2, wherein the sample is a human serum sample from a patient, wherein the free C5 of the patient's pre-treatment and post-treatment with an anti-C5 antibody serum samples are quantitated, and wherein both the pre-treatment and the post-treatment sample is diluted to the same dilution. [0022] Item 16. The method of item 15, wherein the both the pr treatment and the post-treatment sample is diluted by a 1:20 to a 1:30 dilution.

[0023] Numerous other aspects are provided in accordance with these and other aspects of the invention. Other features and aspec of the present invention will become more fully apparent from the following detailed description and the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

[0024] FIG. 1 is a graph showing parallelism.

[0025] FIG. 2 is a graph showing parallelism of 7 individual donor sera.

[0026] FIG. 3 shows parallelism of 7 individual donor sera.

[0027] Early Contract Research Organization (CRO) assay transfer results are shown in FIG. 4A and FIG. 4B FIG. 4C shows selectivity in early CRO transfer results .

[0028] FIG. 5 shows that MRD (minimum required dilution) of 30 is optimal.

[0029] FIG. 6 shows that no carryover in a carryover assessment.

[0030] FIG. 7 shows a summary comparison.

DETAILED DESCRIPTION

[0031] As used herein, the word "a" or "plurality" before a noun represents one or more of the particular noun. For example, the phrase "a mammalian cell" represents "one or more mammalian cells . "

[0032] The term "mammalian cell" is known in the art and can refer to any cell from or derived from any mammal including, for example, a human, a hamster, a mouse, a green monkey, a rat, a pig, a cow, a hamster, or a rabbit. In some embodiments, the mammalian cell can be an immortalized cell, a differentiated cell, an

undifferentiated cell, a stem cell, etc.

[0033] As used herein, the terms "subject" and "patient" are used interchangeably. A patient or a subject can be a human patient or a human subject.

[0034] The term "recombinant protein" is known in the art.

Briefly, the term "recombinant protein" can refer to a protein that can be manufactured using a cell culture system. The cells in the cell culture system can be derived from, for example, a mammalian cell, including a human cell, an insect cell, a yeast cell, or a bacterial cell. In general, the cells in the cell culture contain an introduced nucleic acid encoding the recombinant protein of interest

(which nucleic acid can be borne on a vector, such as a plasmid vector) . The nucleic acid encoding the recombinant protein can also contain a heterologous promoter operably linked to a nucleic acid encoding the protein.

[0035] The term "immunoglobulin" is known in the art. Briefly, the term "immunoglobulin" can refer to a polypeptide containing an amino acid sequence of at least 15 amino acids (e.g., at least 20, 30, 40, 50, 60, 70, 80, 90, or 100 amino acids, or more than 100 amino acids) of an immunoglobulin protein (e.g., a variable domain sequence, a framework sequence, or a constant domain sequence) . The immunoglobulin can, for example, include at least 15 amino acids of a light chain immunoglobulin, e.g., at least 15 amino acids of a heavy chain immunoglobulin, such as a CDRH3. The immunoglobulin may be an isolated antibody (e.g., an IgG, IgE, IgD, IgA, or IgM) . The immunoglobulin may be a subclass of IgG (e.g., IgGl, IgG2, IgG3, or IgG4) . The immunoglobulin can be an antibody fragment, e.g., a Fab fragment, a F(ab' )2 fragment, or a scFv. The immunoglobulin can also be an engineered protein containing at least one immunoglobulin domain (e.g., a fusion protein) . The engineered protein or

immunoglobulin-like protein can also be a bi-specific antibody or a tri-specific antibody, or a dimer, trimer, or multimer antibody, or a diabody, a DVD-Ig, a CODV-Ig, an Affibody®, or a Nanobody®. Non- limiting examples of immunoglobulins are described herein and additional examples of immunoglobulins are known in the art.

[0036] The term "engineered protein" is known in the art.

Briefly, the term "engineered protein" can refer to a polypeptide that is not naturally encoded by an endogenous nucleic acid present within an organism (e.g., a mammal) . Examples of engineered proteins include modified enzymes with one or more amino acid substitutions, deletions, insertions, or additions that result in an increase in stability and/or catalytic activity of the engineered enzyme, fusion proteins, humanized antibodies, chimeric antibodies, divalent antibodies, trivalent antibodies, four binding domain antibodies, a diabody, and antigen-binding proteins that contain at least one recombinant scaffolding sequence.

[0037] The terms "polypeptide," "peptide," and "protein" are used interchangeably and are known in the art and can mean any peptide-bond linked chain of amino acids, regardless of length or post-translational modification.

[0038] The term "antibody" is known in the art. The term

"antibody" may be used interchangeably with the term

"immunoglobulin." Briefly, it can refer to a whole antibody

comprising two light chain polypeptides and two heavy chain

polypeptides. Whole antibodies include different antibody isotypes including IgM, IgG, IgA, IgD, and IgE antibodies. The term

"antibody" includes, for example, a polyclonal antibody, a

monoclonal antibody, a chimerized or chimeric antibody, a humanized antibody, a primatized antibody, a deimmunized antibody, and a fully human antibody. The antibody can be made in or derived from any of a variety of species, e.g., mammals such as humans, non-human primates (e.g., orangutan, baboons, or chimpanzees), horses, cattle, pigs, sheep, goats, dogs, cats, rabbits, guinea pigs, gerbils, hamsters, rats, and mice. The antibody can be a purified or a recombinant antibody.

The antibody can also be an engineered protein or antibody-like protein containing at least one immunoglobulin domain (e.g., a fusion protein) . The engineered protein or antibody-like protein can also be a bi-specific antibody or a tri-specific antibody, or a dimer, trimer, or multimer antibody, or a diabody, a DVD-Ig, a CODV- Ig, an Affibody ^® , or a Nanobody ^® .

[0039] The term "antibody fragment," "antigen-binding fragment," or similar terms are known in the art and can, for example, refer to a fragment of an antibody that retains the ability to bind to a target antigen (e.g., human C5) and inhibit the activity of the target antigen. Such fragments include, e.g., a single chain antibody, a single chain Fv fragment (scFv) , an Fd fragment, a Fab fragment, a Fab' fragment, or an F(ab')2 fragment. A scFv fragment is a single polypeptide chain that includes both the heavy and light chain variable regions of the antibody from which the scFv is derived. In addition, intrabodies, minibodies, triabodies, and diabodies are also included in the definition of antibody and are compatible for use in the methods described herein. See, e.g., Todorovska et al. (2001) J Immunol Methods 2 8 ( 1 ) : 7-66 ; Hudson and Kortt (1999) J Immunol Methods 231 ( 1 ) : 177-189; Poljak (1994)

Structure 2 ( 12 ) : 1121-1123 ; Rondon and Marasco (1997) Annual Review of Microbiology 51:257-283. An antigen-binding fragment can also include the variable region of a heavy chain polypeptide and the variable region of a light chain polypeptide. An antigen-binding fragment can thus comprise the CDRs of the light chain and heavy chain polypeptide of an antibody.

[0040] The term "antibody fragment" also can include, e.g., single domain antibodies such as camelized single domain antibodies.

See, e.g., Muyldermans et al. (2001) Trends Biochem Sci 26:230-235; Nuttall et al . (2000) Curr Pharm Biotech 1:253-263; Reichmann et al . (1999) J Immunol Meth 231:25-38; PCT application publication nos. WO 94/04678 and WO 94/25591; and U.S. patent no. 6,005,079. The term "antibody fragment" also includes single domain antibodies

comprising two V _H domains with modifications such that single domain antibodies are formed.

[0041] The term "antibody" also includes "antigen-binding fragment" and "antibody fragment."

[0042] For the terms "for example" and "such as," and

grammatical equivalences thereof, the phrase "and without

limitation" is understood to follow unless explicitly stated otherwise. As used herein, the term "about" is meant to account for variations due to experimental error. All measurements reported herein are understood to be modified by the term "about," whether or not the term is explicitly used, unless explicitly stated otherwise. As used herein, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise.

[0043] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Methods and materials are described herein for use in the present invention; other, suitable methods and materials known in the art can also be used. The materials, methods, and examples are

illustrative only and not intended to be limiting. All

publications, patent applications, patents, sequences, database entries, and other references mentioned herein are incorporated by reference in their entirety. In case of conflict, the present specification, including definitions, will control.

[0044] The Complement System

[0045] As is well known, the complement system acts in

conjunction with other immunological systems of the body to defend against intrusion of cellular and viral pathogens . There are at least 25 complement proteins. Complement components achieve their immune defensive functions by interacting in a series of intricate but precise enzymatic cleavage and membrane binding events. The resulting complement cascade leads to the production of products with opsonic, immunoregulatory, and lytic functions.

[0046] The complement cascade can progress via the classical pathway ("CP"), the lectin pathway ("LP"), or the alternative pathway ("AP"). The lectin pathway is typically initiated with binding of mannose-binding lectin ("MBL") to high mannose

substrates. The AP can be antibody independent, and can be initiated by certain molecules on pathogen surfaces . The CP is typically initiated by antibody recognition of, and binding to, an antigenic site on a target cell. These pathways converge at the C3 convertase - the point where complement component C3 is cleaved by an active protease to yield C3a and C3b.

[0047] The AP C3 convertase is initiated by the spontaneous hydrolysis of complement component C3, which is abundant in the plasma in the blood. This process, also known as "tickover, " occurs through the spontaneous cleavage of a thioester bond in C3 to form C3i or C3 (H2O) . Tickover is facilitated by the presence of surfaces that support the binding of activated C3 and/or have neutral or positive charge characteristics (e.g., bacterial cell surfaces) . This formation of C3(H20) allows for the binding of plasma protein Factor B, which in turn allows Factor D to cleave Factor B into Ba and Bb. The Bb fragment remains bound to C3 to form a complex containing C3(H20)Bb - the "fluid-phase" or "initiation" C3

convertase. Although only produced in small amounts, the fluid-phase C3 convertase can cleave multiple C3 proteins into C3a and C3b and results in the generation of C3b and its subsequent covalent binding to a surface (e.g., a bacterial surface) . Factor B bound to the surface-bound C3b is cleaved by Factor D to thus form the surface- bound AP C3 convertase complex containing C3b,Bb. See, e.g., Miiller- Eberhard (1988) Ann Rev Biochem 57:321-347.

[0048] The AP C5 convertase - (C3b)2,Bb - is formed upon addition of a second C3b monomer to the AP C3 convertase. See, e.g., Medicus et al. (1976) J Exp Med 144:1076-1093 and Fearon et al. (1975) J Exp

Med 142:856-863. The role of the second C3b molecule is to bind C5 and present it for cleavage by Bb . See, e.g., Isenman et al . (1980) J Immunol 124:326-331. The AP C3 and C5 convertases are stabilized by the addition of the trimeric protein properdin as described in, e.g., Medicus et al . (1976), supra. However, properdin binding is not required to form a functioning alternative pathway C3 or C5 convertase. See, e.g., Schreiber et al. (1978) Proc Natl Acad Sci USA 75: 3948-3952, and Sissons et al. (1980) Proc Natl Acad Sci USA 77: 559-562.

[0049] The CP C3 convertase is formed upon interaction of complement component CI, which is a complex of Clq, Clr, and Cls, with an antibody that is bound to a target antigen (e.g., a

microbial antigen) . The binding of the Clq portion of CI to the antibody-antigen complex causes a conformational change in CI that activates Clr. Active Clr then cleaves the Cl-associated Cls to thereby generate an active serine protease. Active Cls cleaves complement component C4 into C4b and C4a. Like C3b, the newly generated C4b fragment contains a highly reactive thiol that readily forms amide or ester bonds with suitable molecules on a target surface (e.g., a microbial cell surface). Cls also cleaves

complement component C2 into C2b and C2a. The complex formed by C4b and C2a is the CP C3 convertase, which is capable of processing C3 into C3a and C3b. The CP C5 convertase - C4b,C2a,C3b - is formed upon addition of a C3b monomer to the CP C3 convertase. See, e.g., Miiller-Eberhard (1988), supra and Cooper et al. (1970) J Exp Med 132:775-793.

[0050] In addition to its role in C3 and C5 convertases, C3b also functions as an opsonin through its interaction with complement receptors present on the surfaces of antigen-presenting cells such as macrophages and dendritic cells. The opsonic function of C3b is generally considered to be one of the most important anti-infective functions of the complement system. Patients with genetic lesions that block C3b function are prone to infection by a broad variety of pathogenic organisms, while patients with lesions later in the complement cascade sequence, i.e., patients with lesions that block C5 functions, are found to be more prone only to Neisseria infection, and then only somewhat more prone.

[0051] The AP and CP C5 convertases cleave C5, which is a 190 kDa beta globulin found in normal human serum at approximately 75 μg/m.l (0.4 μΜ) . C5 is glycosylated, with about 1.5-3 percent of its mass attributed to carbohydrate. Mature C5 is a heterodimer of a 999 amino acid 115 kDa alpha chain that is disulfide linked to a 655 amino acid 75 kDa beta chain. C5 is synthesized as a single chain precursor protein product of a single copy gene (Haviland et al .

(1991) J Immunol. 146:362-368). The cDNA sequence of the transcript of this human gene predicts a secreted pro-C5 precursor of 1658 amino acids along with an 18 amino acid leader sequence. See, e.g., U.S. Patent No. 6,355,245.

[0052] The pro-C5 precursor is cleaved after amino acids 655 and

659, to yield the beta chain as an amino terminal fragment (amino acid residues +1 to 655 of the above sequence) and the alpha chain as a carboxyl terminal fragment (amino acid residues 660 to 1658 of the above sequence), with four amino acids (amino acid residues 656- 659 of the above sequence) deleted between the two.

[0053] C5a is cleaved from the alpha chain of C5 by either alternative or classical C5 convertase as an amino terminal fragment comprising the first 74 amino acids of the alpha chain (i.e., amino acid residues 660-733 of the above sequence). Approximately 20 percent of the 11 kDa mass of C5a is attributed to carbohydrate. The cleavage site for convertase action is at, or immediately adjacent to, amino acid residue 733. A compound that would bind at, or adjacent to, this cleavage site would have the potential to block access of the C5 convertase enzymes to the cleavage site and thereby act as a complement inhibitor. A compound that binds to C5 at a site distal to the cleavage site could also have the potential to block

C5 cleavage, for example, by way of steric hindrance-mediated inhibition of the interaction between C5 and the C5 convertase. A compound, in a mechanism of action consistent with that of the tick saliva complement inhibitor, Ornithodoros moubata C inhibitor

('OmCI"), may also prevent C5 cleavage by reducing flexibility of the C345C domain of the alpha chain of C5 , which reduces access of the C5 convertase to the cleavage site of C5. See, e.g., Fredslund et al. (2008) Nat Immunol 9 ( 7 ) : 753-760.

[0054] C5 can also be activated by means other than C5

convertase activity. Limited trypsin digestion (see, e.g., Minta and Man (1997) J Immunol 119:1597-1602 and Wetsel and Kolb (1982) J Immunol 128:2209-2216) and acid treatment (Yamamoto and Gewurz

(1978) J Immunol 120:2008 and Damerau et al . (1989) Molec Immunol 26:1133-1142) can also cleave C5 and produce active C5b.

[0055] Cleavage of C5 releases C5a, a potent anaphylatoxin and chemotactic factor, and leads to the formation of the lytic terminal complement complex, C5b-9. C5a and C5b-9 also have pleiotropic cell activating properties, by amplifying the release of downstream inflammatory factors, such as hydrolytic enzymes, reactive oxygen species, arachidonic acid metabolites and various cytokines.

[0056] The first step in the formation of the terminal

complement complex involves the combination of C5b with C6, C7, and C8 to form the C5b-8 complex at the surface of the target cell.

Upon the binding of the C5b-8 complex with several C9 molecules, the membrane attack complex ("MAC", C5b-9, terminal complement complex-- "TCC") is formed. When sufficient numbers of MACs insert into target cell membranes the openings they create (MAC pores) mediate rapid osmotic lysis of the target cells, such as red blood cells. Lower, non-lytic concentrations of MACs can produce other effects. In particular, membrane insertion of small numbers of the C5b-9 complexes into endothelial cells and platelets can cause deleterious cell activation. In some cases, activation may precede cell lysis.

[0057] C3a and C5a are anaphylatoxins . These activated

complement components can trigger mast cell degranulation, which releases histamine from basophils and mast cells, and other

mediators of inflammation, resulting in smooth muscle contraction, increased vascular permeability, leukocyte activation, and other inflammatory phenomena including cellular proliferation resulting in hypercellularity . C5a also functions as a chemotactic peptide that serves to attract pro-inflammatory granulocytes to the site of complement activation.

[0058] C5a receptors are found on the surfaces of bronchial and alveolar epithelial cells and bronchial smooth muscle cells . C5a receptors have also been found on eosinophils, mast cells,

monocytes, neutrophils, and activated lymphocytes.

[0059] While a properly functioning complement system provides a robust defense against infecting microbes, inappropriate regulation or activation of complement has been implicated in the pathogenesis of a variety of disorders, including, e.g., rheumatoid arthritis; lupus nephritis; asthma; ischemia-reperfusion injury; atypical hemolytic uremic syndrome ("aHUS"); dense deposit disease;

paroxysmal nocturnal hemoglobinuria (PNH); macular degeneration

(e.g., age-related macular degeneration; hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; thrombotic

thrombocytopenic purpura (TTP) ; spontaneous fetal loss; Pauci-immune vasculitis; epidermolysis bullosa; recurrent fetal loss; multiple sclerosis (MS); traumatic brain injury; and injury resulting from myocardial infarction, cardiopulmonary bypass and hemodialysis. See, e.g., Holers et al. (2008) Immunological Reviews 223:300-316.

[0060] Anti-C5 Antibody

[0061] An anti-C5 antibody for use in the methods of this disclosure for treating patients, for use as a capture antibody, and/or for use as a detection antibody, is any anti-human C5 antibody .

[0062] In certain embodiments, the anti-C5 antibody is

eculizumab, an antigen-binding fragment thereof, a polypeptide comprising the antigen-binding fragment of eculizumab, a fusion protein comprising the antigen binding fragment of eculizumab, or a single chain antibody version of eculizumab.

[0063] In some embodiments, the complement C5 protein is a human complement C5 protein (the human proprotein is depicted in SEQ ID NO : ) . [0064] The anti-C5 antibody is one that binds to a complement C5 protein and is also capable of inhibiting the generation of C5a. An anti-C5 antibody can also be capable of inhibiting, e.g., the cleavage of C5 to fragments C5a and C5b, and thus preventing the formation of terminal complement complex.

[0065] For example, an anti-C5 antibody blocks the generation or activity of the C5a active fragment of a C5 protein (e.g., a human C5 protein) . Through this blocking effect, the antibody inhibits, e.g., the proinflammatory effects of C5a. An anti-C5 antibody can further have activity in blocking the generation or activity of C5b. Through this blocking effect, the antibody can further inhibit, e.g., the generation of the C5b-9 membrane attack complex at the surface of a cell.

[0066] In some embodiments, the anti-C5 antibody is eculizumab.

SEQ ID NO : 5 depicts the entire heavy chain of eculizumab; SEQ ID NO: 6 depicts the entire light chain of eculizumab; SEQ ID NOs:9-ll depict, respectively, CDRl-3 of the heavy chain of eculizumab; SEQ ID NOs: 12-14 depict, respectively, CDRl-3 of the light chain of eculizumab; SEQ ID NO: 15 depicts the variable region of the heavy chain of eculizumab; and SEQ ID NO: 16 depicts the variable region of the light chain of Eculizumab.

[0067] Eculizumab is a humanized anti-human C5 monoclonal antibody (Alexion Pharmaceuticals, Inc.), with a human IgG2/IgG4 hybrid constant region, so as to reduce the potential to elicit proinflammatory responses . Eculizumab has the trade name Soliris ^® and is currently approved for treating paroxysmal nocturnal

hemoglobinuria ("PNH") and atypical hemolytic uremic syndrome

("aHUS"). Paroxysmal nocturnal hemoglobinuria is a form of hemolytic anemia, intravascular hemolysis being a prominent feature due to the absence of the complement regulatory protein CD59 and CD55. CD59, for example, functions to block the formation of the terminal complement complex. AHUS involves chronic uncontrolled complement activation, resulting in, inter alia, inhibition of thrombolitic microangiopathy, the formation of blood clots in small blood vessels throughout the body, and acute renal failure. Eculizumab specifically binds to human C5 protein and blocks the formation of the generation of the potent proinflammatory protein C5a. Eculizumab further blocks the formation of the terminal complement complex. Eculizumab treatment reduces intravascular hemolysis in patients with PNH and decreases complement levels in aHUS . See, e.g., Hillmen et al., N Engl J Med 2004; 350:552-9; Rother et al., Nature

Biotechnology 2007; 25(11): 1256-1264; Hillmen et al., N Engl J Med 2006, 355; 12, 1233-1243; Zuber et al., Nature Reviews Nephrology 8, 643-657 (2012) | doi : 10.1038 /nrneph .2012.214 ; U.S. Patent

Publication Number 2012/0237515, and U.S. Patent Number 6,355,245.

[0068] In yet further other embodiments, the anti-C5 antibody is a single chain version of eculizumab, including pexelizumab (SEQ ID NO:l) -- a specific single chain version of the whole antibody eculizumab. See, e.g., Whiss (2002) Curr Opin Investig Drugs

3(6): 870-7; Patel et al . (2005) Drugs Today (Bare) 41 ( 3 ) : 165-70 ; Thomas et al. (1996) Mol Immunol 33 (17-18 ): 1389-401; and U.S. patent no. 6,355,245. In yet other embodiments, the inhibitor for use in methods of this invention is a single chain variant of pexelizumab, with the arginine (R) at position 38 (according to Kabat numbering and the amino acid sequence number set forth in SEQ ID NO : 2 ) of the light chain of the pexelizumab antibody amino acid sequence changed to a glutamine (Q) . The single chain antibody having the amino acid sequence depicted in SEQ ID NO: 2 is a variant of the single chain antibody pexelizumab (SEQ ID NO : 1 ) , in which the arginine (R) at position 38 has been substituted with a glutamine (Q) . An exemplary linker amino acid sequence present in a variant pexelizumab antibody is shown in SEQ ID NO : 3.

[0069] In certain embodiments, the anti-C5 antibody is a variant derived from eculizumab, having one or more improved properties

(e.g., improved pharmacokinetic properties) relative to eculizumab.

The variant eculizumab antibody (also referred to herein as an eculizumab variant, a variant eculizumab, or the like) or C5-binding fragment thereof is one that: (a) binds to complement component C5;

(b) inhibits the generation of C5a; and can further inhibit the cleavage of C5 into fragments C5a and C5b. The variant eculizumab antibody can have a serum half-life in a human that is greater than, or at least, 10 (e.g., greater than, or at least, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 or 34) days. Such variant eculizumab antibodies are described in PCT/US2015/019225 and U.S. Patent Number 9,079,949.

[0070] In certain embodiments, the eculizumab variant antibody is an antibody defined by the sequences depicted in SEQ ID NO : 7

(heavy chain) and SEQ ID NO : 8 (light chain), or an antigen-binding fragment thereof. This antibody is also known as ALXN1210. This antibody binds to human C5 and inhibits the formation of C5a, as well as the cleavage of C5 to fragments C5a and C5b, and thus preventing the formation of terminal complement complex.

[0071] In certain embodiments, the eculizumab variant is BNJ441

(an antibody comprising the sequences depicted in SEQ ID NO:24, SEQ ID NO:25, and SEQ ID NO:16; see also the sequences depicted in SEQ ID NOs:6-8). In certain embodiments, the eculizumab variant is defined by the sequences depicted in SEQ ID NO: 24, SEQ ID NO: 25 and SEQ ID NO: 8.

[0072] In certain embodiments, the anti-C5 antibody is a polypeptide C5 inhibitor comprising or consisting of one or more sequences depicted by SEQ ID NOs:l-3, 5-16, and 23-29, and 33, such that the resulting polypeptide binds to complement protein C5

("C5") .

[0073] In some embodiments, an anti-C5 antibody for use in methods of this disclosure is not a whole antibody. In some

embodiments, an anti-C5 antibody is a single chain antibody. In some embodiments, an anti-C5 antibody for use in methods of this

disclosure is a bispecific antibody. In some embodiments, an anti-C5 antibody for use in methods of this disclosure is a humanized monoclonal antibody, a chimeric monoclonal antibody, or a human monoclonal antibody, or an antigen binding fragment of any of them.

[0074] The anti-C5 antibody for use in methods of this

disclosure can comprise, or can consist of, the amino acid sequence depicted in SEQ ID NO:l, SEQ ID NO : 2 , SEQ ID NO : 5 and SEQ ID NO:6, or SEQ ID NO: 7 and SEQ ID NO: 8, or an antigen binding fragment of any of the above. The polypeptide can comprise one or more of the amino acid sequence depicted in SEQ ID NOs:9-16.

[0075] In yet other embodiments, the anti-C5 antibody is LFG316

(Novartis, Basel, Switzerland, and MorphoSys, Planegg, Germany) or another antibody defined by the sequences of Table 1 in US8,241,628 and US8,883,158, Mubodina ^® (Adienne Pharma & Biotech, Bergamo, Italy) {see, e.g., US7 , 999, 081 ) , rEV576 (coversin) (Volution Immuno- pharmaceuticals , Geneva, Switzerland) {see, e.g., Penabad et al . , Lupus, 2014 Oct;23 (12) : 1324-6. doi: 10.1177/0961203314546022.), ARC1005 (Novo Nordisk, Bagsvaerd, Denmark) , SOMAmers (SomaLogic, Boulder, CO), SOB1002 (Swedish Orphan Biovitrum, Stockholm, Sweden), RA101348 (Ra Pharmaceuticals, Cambridge, MA) .

[0076] In some embodiments, the anti-C5 antibody may be a monoclonal antibody. In other embodiments, the anti-C5 antibody comprises the variable region, or a fragment thereof, of an

antibody, such as a monoclonal antibody. In other embodiments, the anti-C5 antibody is an immunoglobulin that binds specifically to a C5 complement protein. In other embodiments, the anti-C5 antibody is an engineered protein or a recombinant protein. In some embodiments, an anti-C5 antibody is not a whole antibody, but comprises parts of an antibody. In some embodiments, an anti-C5 antibody is a single chain antibody. In some embodiments, an anti-C5 antibody is a bispecific antibody. In some embodiments, the anti-C5 antibody is a humanized monoclonal antibody, a chimeric monoclonal antibody, or a human monoclonal antibody, or an antigen binding fragment of any of them. Methods of making an anti-C5 antibody are known in the art.

[0077] As stated above, the anti-C5 antibody inhibits complement component C5 protein. In particular, the anti-C5 antibody inhibits the generation of the C5a anaphylatoxin, or the generation of c5a and the C5b active fragments of a complement component C5 protein

(e.g., a human C5 protein). Accordingly, the anti-C5 antibody inhibits, e.g., the pro-inflammatory effects of C5a; and may inhibit the generation of the C5b-9 membrane attack complex ("MAC") at the surface of a cell and subsequent cell lysis. See, e.g., Moongkarndi et al. (1982) Immunobiol 162:397 and Moongkarndi et al. (1983) Immunobiol 165:323.

[0078] In some embodiments, the anti-C5 antibodies are variant antibodies of an anti-C5 antibody (such as eculizumab) that still bind to the antigen, including deletion variants, insertion

variants, and/or substitution variants. See, e.g., the polypeptides depicted in SEQ ID NO:l, SEQ ID NO: 2, or SEQ ID NO : 7 and SEQ ID NO: 8. Methods of making such variants, by, for example, recombinant DNA technology, are well known in the art.

[0079] In some embodiments, an anti-C5 antibody is a fusion protein. The fusion protein can be constructed recombinantly such that the fusion protein is expressed from a nucleic acid that encodes the fusion protein. The fusion protein can comprise one or more C5-binding polypeptide segments (e.g., C5-binding segments depicted in SEQ ID NO:l, SEQ ID NO: 2, or SEQ ID NO : 5 and/or SEQ ID NO: 6, SEQ ID NO: 7 and/or SEQ ID NO: 8, or any one or more of SEQ ID NOs:9-16) and one or more segments that are heterologous to the C5- binding segment (s). The heterologous sequence can be any suitable sequence, such as, for example, an antigenic tag (e.g., FLAG, polyhistidine , hemagglutinin ("HA"), glutathione-S-transferase

("GST"), or maltose-binding protein ("MBP")). Heterologous sequences can also be proteins useful as diagnostic or detectable markers, for example, luciferase, green fluorescent protein ("GFP"), or

chloramphenicol acetyl transferase ("CAT"). In some embodiments, the heterologous sequence can be a targeting moiety that targets the C5- binding segment to a cell, tissue, or microenvironment of interest. In some embodiments, the targeting moiety is a soluble form of a human complement receptor (e.g., human complement receptor 2) or an antibody (e.g., a single chain antibody) that binds to C3b or C3d. In some embodiments, the targeting moiety is an antibody that binds to a tissue-specific antigen, such as a kidney-specific antigen. Methods of constructing such fusion proteins, such as by recombinant DNA technology, are well known in the art. [0080] In some embodiments, the anti-C5 antibodies are fused to a targeting moiety. For example, a construct can contain a C5- binding polypeptide and a targeting moiety that targets the

polypeptide to a site of complement activation. Such targeting moieties can include, e.g., soluble form of complement receptor 1

(CR1), a soluble form of complement receptor 2 (CR2), or an antibody

(or antigen-binding fragment thereof) that binds to C3b and/or C3d.

[0081] Methods for generating fusion proteins (e.g., fusion proteins containing a C5-binding polypeptide and a soluble form of human CR1 or human CR2 ) , including recombinant DNA technology, are known in the art and described in, e.g., U.S. patent no. 6,897,290; U.S. patent application publication no. 2005265995; and Song et al .

(2003) J Clin Invest 11 ( 12 ) : 1875-1885.

[0082] In certain embodiments, the anti-C5 antibody is a bispecific antibody. Methods for producing a bispecific antibody

(e.g., a bispecific antibody comprising an anti-C5 antibody and an antibody that binds to C3b and/or C3d) are also known in the art. A bispecific antibody comprising a C5-binding antibody and any other antibody is contemplated.

[0083] A wide variety of bispecific antibody formats are known in the art of antibody engineering and methods for making the bispecific antibodies (e.g., a bispecific antibody comprising an anti-C5 antibody [i.e., a C5-binding antibody] and an antibody that binds to C3b, C3d, or a tissue-specific antigen) are well within the purview of those skilled in the art. See, e.g., Suresh et al. (1986) Methods in Enzymology 121:210; PCT Publication No. WO 96/27011;

Brennan et al . (1985) Science 229:81; Shalaby et al . , J. Exp. Med.

(1992) 175:217-225; Kostelny et al. (1992) J Immunol 148(5) :1547- 1553; Hollinger et al . (1993) Proc Natl Acad Sci USA 90:6444-6448; Gruber et al. (1994) J Immunol 152:5368; and Tutt et al . (1991) J Immunol 147:60.

[0084] Bispecific antibodies also include cross-linked or heteroconjugate antibodies. Heteroconjugate antibodies may be made using any convenient cross-linking methods. Suitable cross-linking agents are well known in the art, and are disclosed in U.S. Pat. No. 4,676,980, along with a number of cross-linking techniques. U.S. Patent No. 5,534,254 describes several different types of bispecific antibodies including, e.g., single chain Fv fragments linked together by peptide couplers, chelating agents, or chemical or disulfide couplings. In another example, Segal and Bast [(1995) Curr Protocols Immunol Suppl . 14:2.13.1-2.13.16] describes methods for chemically cross-linking two monospecific antibodies to thus form a bispecific antibody. A bispecific antibody can be formed, e.g., by conjugating two single chain antibodies which are selected from, e.g., a C5-binding antibody and an antibody that binds to, e.g., C3b, C3d, or a lung-specific antigen, an eye-specific antigen, a kidney-specific antigen, etc.

[0085] The bispecific antibody can be a tandem single chain (sc)

Fv fragment, which contains two different scFv fragments covalently tethered together by a linker (e.g., a polypeptide linker). See, e.g., Ren-Heidenreich et al . (2004) Cancer 100:1095-1103 and Korn et al . (2004) J Gene Med 6:642-651. Examples of linkers can include, but are not limited to, (Gly ₄ Ser) ₂ [GGGGSGGGGS , SEQ ID NO: 17], (Gly ₄ Ser) ₃ [GGGGSGGGGSGGGGS , SEQ ID NO: 18], (Gly ₃ Ser) ₄

[GGGSGGGSGGGSGGGS, SEQ ID NO:19], (G ₃ S) [GGGS, SEQ ID NO : 20 ] , SerGly ₄ [SGGGG, SEQ ID NO:21], and SerGly ₄ SerGly ₄ [SGGGGSGGGG, SEQ ID NO: 22] .

[0086] In some embodiments, the linker can contain, or be, all or part of a heavy chain polypeptide constant region such as a CHI domain as described in, e.g., Grosse-Hovest et al . (2004) Proc Natl

Acad Sci USA 101:6858-6863. In some embodiments, the two antibody fragments can be covalently tethered together by way of a

polyglycine-serine or polyserine-glycine linker as described in, e.g., U.S. patent nos . 7,112,324 and 5,525,491, respectively. See also U.S. patent no. 5,258,498. Methods for generating bispecific tandem scFv antibodies are described in, e.g., Maletz et al . (2001)

Int J Cancer 93:409-416; Hayden et al . (1994) Ther Immunol 1:3-15; and Honemann et al. (2004) Leukemia 18:636-644. Alternatively, the antibodies can be "linear antibodies" as described in, e.g., Zapata et al. (1995) Protein Eng. 8 ( 10 ): 1057-1062. Briefly, these antibodies comprise a pair of tandem Fd segments (V _H -C _H 1-V _H -C _H 1 ) that form a pair of antigen binding regions.

[0087] A bispecific antibody can also be a diabody. Diabody technology described by, e.g., Hollinger et al. (1993) Proc Natl Acad Sci USA 90:6444-6448 has provided an alternative mechanism for making bispecific antibody fragments. The fragments comprise a heavy-chain variable domain (V _H ) connected to a light-chain variable domain (V _L ) by a linker which is too short to allow pairing between the two domains on the same chain. Accordingly, the V _H and V _L domains of one fragment are forced to pair with the complementary V _L and V _H domains of another fragment, thereby forming two antigen-binding sites. See also Zhu et al . (1996) Biotechnology 14:192-196 and Helfrich et al. (1998) Int J Cancer 76:232-239. Bispecific single chain diabodies ("scDb") as well as methods for generating scDb are described in, e.g., Brusselbach et al . (1999) Tumor Targeting 4:115- 123; Kipriyanov et al . (1999) J Mol Biol 293:41-56; and Nettlebeck et al. (2001) Mol Ther 3:882-891.

[0088] Variant forms of bispecific antibodies such as the tetravalent dual variable domain immunoglobulin (DVD-Ig) molecules described in Wu et al . (2007) Nat Biotechnol 25 ( 11 ) : 1290-1297 can also be used in the methods of this invention. The DVD-Ig molecules are designed such that two different light chain variable domains

(V _L ) from two different parent antibodies are linked in tandem directly or via a short linker by recombinant DNA techniques, followed by the light chain constant domain. Methods for generating DVD-Ig molecules from two parent antibodies are further described in, e.g., PCT Publication Nos . WO 08/024188 and WO 07/024715. Also embraced is the bispecific format described in, e.g., U.S. patent application publication no. 20070004909. Another bispecific format that can be used is the Cross-Over Dual V Region (CODV-Ig) which is a format for engineering four domain antibody-like molecules described in WO2012/135345. CODV-Ig was shown to be useful in engineering bispecific antibody-like molecules where steric hindrance at the C-terminal V domains (internal) may prevent construction of a DVD-Ig.

[0089] The C5-binding antibodies and/or targeting-moieties that are used to form the bispecific antibody molecules can be, e.g., chimeric, humanized, rehumanized, deimmunized, or fully human, all of which are well known in the art.

[0090] An anti-C5 antibody may be produced by recombinant DNA techniques. For example, a nucleic acid encoding a C5-binding polypeptide (e.g., a C5-binding polypeptide comprising or consistin of the amino acid sequence depicted in SEQ ID NO: 2) can be inserted into an expression vector that contains transcriptional and translational regulatory sequences, which include, e.g., promoter sequences, ribosomal binding sites, transcriptional start and stop sequences, translational start and stop sequences, transcription terminator signals, polyadenylation signals, and enhancer or activator sequences . The regulatory sequences include a promoter and transcriptional start and stop sequences. In addition, the expression vector can include more than one replication system such that it can be maintained in two different organisms, for example i mammalian or insect cells for expression and in a prokaryotic host for cloning and amplification.

[0091] Several possible vector systems (such as plasmid vector systems) well known in the art are available for the expression of an anti-C5 antibody from nucleic acids in a number of cells, including in mammalian cells.

[0092] The expression vectors can be introduced by methods well known in the art into cells in a manner suitable for subsequent expression of the nucleic acid.

[0093] An anti-C5 antibody may be expressed in any appropriate host cells. Appropriate host cells include, for example, yeast, bacteria, insect, plant, and mammalian cells, including bacteria such as E. coli _f fungi such as Saccharomyces cerevisiae and Pichia pastoris, insect cells such as SF9, mammalian cell lines (e.g., human cell lines), primary cell lines (e.g., primary mammalian cells), Chinese hamster ovary ("CHO") cells, and a suitable myeloma cell line such as NSO .

[0094] In some embodiments, an anti-C5 antibody may be expressed in, and purified from, transgenic animals (e.g., transgenic

mammals) . For example, an anti-C5 antibody may be produced in transgenic non-human mammals (e.g., rodents, sheep or goats) and isolated from milk as described in, e.g., Houdebine (2002) Curr Opin Biotechnol 13 ( 6 ) : 625-629 ; van Kuik-Romeijn et al. (2000) Transgenic Res 9 (2) : 155-159; and Pollock et al . (1999) J Immunol Methods 231(1- 2) : 147-157.

[0095] The anti-C5 antibody may be produced from cells by culturing a host cell transformed with the expression vector containing nucleic acid encoding the polypeptides, under conditions, and for an amount of time, sufficient to allow expression of the proteins. Such conditions for protein expression will vary with the choice of the expression vector and the host cell, and will be easily ascertained by one skilled in the art through routine experimentation. See, e.g., Current Protocols in Molecular Biology, Wiley & Sons, and Molecular Cloning--A Laboratory Manual --3rd Ed., Cold Spring Harbor Laboratory Press, New York (2001), which has comprehensive disclosure of recombinant DNA technology.

[0096] Following expression, the anti-C5 antibody may be isolated or purified in a variety of ways known to those skilled in the art .

[0097] In some embodiments, an anti-C5 antibody described herein comprises a heavy chain variable region comprising the following amino acid sequence :

[0099] In some embodiments, an anti-C5 antibody comprises a light chain variable region comprising the following amino acid sequence : DIQMTQSPSSLSASVGDRVTITCGASENIYGALNWYQQKPGKAPKLLIYGATNLADGVPS RFSGSGSG TDFTLTISSLQPEDFATYYCQNVLNTPLTFGQGTKVEIK (SEQ ID NO: 16).

[00100] An anti-C5 antibody can, in some embodiments, comprise a variant human Fc constant region that binds to human neonatal Fc receptor (FcRn) with greater affinity than that of the native human Fc constant region from which the variant human Fc constant region was derived. For example, the Fc constant region can comprise one or more (e.g., two, three, four, five, six, seven, or eight or more) amino acid substitutions relative to the native human Fc constant region from which the variant human Fc constant region was derived. The substitutions can increase the binding affinity of an IgG antibody containing the variant Fc constant region to FcRn at pH 6.0, while maintaining the pH dependence of the interaction. See, e.g., Hinton et al. (2004) J Biol Chem 279:6213-6216 and Datta- Mannan et al. (2007) Drug Metab Dispos 35:1-9. Methods for testing whether one or more substitutions in the Fc constant region of an antibody increase the affinity of the Fc constant region for FcRn at pH 6.0 (while maintaining pH dependence of the interaction) are known in the art and exemplified in the working examples. See, e.g., Datta-Mannan et al. (2007) J Biol Chem 282 ( 3 ) : 1709-1717 ;

International Publication No. WO 98/23289; International Publication No. WO 97/34631; and U.S. Patent No. 6,277,375.

[00101] Substitutions that enhance the binding affinity of an antibody Fc constant region for FcRn are known in the art and include, e.g., (1) the M252Y/S254T/T256E triple substitution described by Dall'Acqua et al . (2006) J Biol Chem 281: 23514-23524;

(2) the M428L or T250Q/M428L substitutions described in Hinton et al. (2004) J Biol Chem 279:6213-6216 and Hinton et al . (2006) J Immunol 176:346-356; and (3) the N434A or T307/E380A/N434A

substitutions described in Petkova et al. (2006) Int Immunol

18 (12) : 1759-69. The additional substitution pairings: P257I/Q311I, P257I/N434H, and D376V/N434H are described in, e.g., Datta-Mannan et al. (2007) J Biol Chem 282 ( 3 ) : 1709-1717.

[00102] In some embodiments, the variant constant region has a substitution at EU amino acid residue 255 for valine. In some embodiments, the variant constant region has a substitution at EU amino acid residue 309 for asparagine . In some embodiments, the variant constant region has a substitution at EU amino acid residue 312 for isoleucine. In some embodiments, the variant constant region has a substitution at EU amino acid residue 386.

[00103] In some embodiments, the variant Fc constant region comprises no more than 30 (e.g., no more than 29, 28, 27, 26, 25, 24, 23, 22, 21, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, nine, eight, seven, six, five, four, three, or two) amino acid

substitutions, insertions, or deletions relative to the native constant region from which it was derived. In some embodiments, the variant Fc constant region comprises one or more amino acid

substitutions selected from the group consisting of: M252Y, S254T, T256E, N434S, M428L, V259I, T250I, and V308F. In some embodiments, the variant human Fc constant region comprises a methionine at position 428 and an asparagine at position 434, each in EU

numbering. In some embodiments, the variant Fc constant region comprises a 428L/434S double substitution as described in, e.g., U.S. Patent No. 8.088,376.

[00104] In some embodiments, the variant constant region

comprises a substitution at amino acid position 237, 238, 239, 248,

250, 252, 254, 255, 256, 257, 258, 265, 270, 286, 289, 297, 298,

303, 305, 307, 308, 309, 311, 312, 314, 315, 317, 325, 332, 334,

360, 376, 380, 382, 384, 385, 386, 387, 389, 424, 428, 433, 434, or

436 (EU numbering) relative to the native human Fc constant region.

In some embodiments, the substitution is selected from the group consisting of: methionine for glycine at position 237; alanine for proline at position 238; lysine for serine at position 239;

isoleucine for lysine at position 248; alanine, phenylalanine, isoleucine, methionine, glutamine, serine, valine, tryptophan, or tyrosine for threonine at position 250; phenylalanine, tryptophan, or tyrosine for methionine at position 252; threonine for serine at position 254; glutamic acid for arginine at position 255; aspartic acid, glutamic acid, or glutamine for threonine at position 256; alanine, glycine, isoleucine, leucine, methionine, asparagine, serine, threonine, or valine for proline at position 257; histidine for glutamic acid at position 258; alanine for aspartic acid at position 265; phenylalanine for aspartic acid at position 270;

alanine, or glutamic acid for asparagine at position 286; histidine for threonine at position 289; alanine for asparagine at position

297; glycine for serine at position 298; alanine for valine at position 303; alanine for valine at position 305; alanine, aspartic acid, phenylalanine, glycine, histidine, isoleucine, lysine, leucine, methionine, asparagine, proline, glutamine, arginine, serine, valine, tryptophan, or tyrosine for threonine at position

307; alanine, phenylalanine, isoleucine, leucine, methionine, proline, glutamine, or threonine for valine at position 308;

alanine, aspartic acid, glutamic acid, proline, or arginine for leucine or valine at position 309; alanine, histidine, or isoleucine for glutamine at position 311; alanine or histidine for aspartic acid at position 312; lysine or arginine for leucine at position

314; alanine or histidine for asparagine at position 315; alanine for lysine at position 317; glycine for asparagine at position 325; valine for isoleucine at position 332; leucine for lysine at position 334; histidine for lysine at position 360; alanine for aspartic acid at position 376; alanine for glutamic acid at position

380; alanine for glutamic acid at position 382; alanine for

asparagine or serine at position 384; aspartic acid or histidine for glycine at position 385; proline for glutamine at position 386;

glutamic acid for proline at position 387; alanine or serine for asparagine at position 389; alanine for serine at position 424;

alanine, aspartic acid, phenylalanine, glycine, histidine,

isoleucine, lysine, leucine, asparagine, proline, glutamine, serine, threonine, valine, tryptophan, or tyrosine for methionine at position 428; lysine for histidine at position 433; alanine, phenylalanine, histidine, serine, tryptophan, or tyrosine for asparagine at position 434; and histidine for tyrosine or

phenylalanine at position 436, all in EU numbering.

[00105] An anti-C5 antibody may be used as a therapeutic agent and is administered to a patient in needed thereof as any suitable formulation/composition and by any suitable route (such as by IV injection) . An anti-C5 antibody may also be used as a capture antibody or a detection antibody in methods disclosed herein.

[00106] Back Disassociation ELSIA Assay Modeling

[00107] When quantifying target/efficacy biomarkers, traditional plate based ligand binding assays have potential to overestimate free analyte. Overestimation of free analyte in such situations suggests lower lack of efficacy than that which is true in vivo. Eculizumab is a mAb therapeutic approved for 2 ultra rare disease indications, and targets complement factor C5 (190 kD) . Proper quantification of free C5 in the presence of drug is crucial.

[00108] Based on Biacore results, approximately 15% of

Eculizumab-C5 complexes dissociate in 60 minutes, with (1/M

s) and (1/s) at 25°C, in traditional plate based ligand binding assays.

[00109] Table 1 shows the amount (in %) of antibody that remains bound to its antigen as a function (Kd - percent that dissociates per second) of time.

[00110] Table 1

[00111] The experimental evidence shows that antigen binding to

ELSIA plate requires at least 30 hours for solution and plate to arrive at equilibrium.

[00112] The critical parameters are incubation time, dilution time, dilution temperature, and sample vs. assay range. Shorter plate incubation time may decrease disassociation. Cooling during two dilution steps may slow off rate kd and keep antigen-mAb and antigen-mAb-antigen from disassociating. Shorter dilution time may decrease disassociation. Dilute less may decrease disassociation. Measure neat samples if possible.

[00113] Antigen Concentration and mAb concentration (PK) data mismatch is due to: Different assay dilutions and times; Measured Antigen Concentration is over estimating free Antigen; and measured mAb (PK) is over estimating true free mAb due to disassociation from dilution and under estimating total mAb due to solution antigen.

[00114] Hemolysis modeling (using hemolytic assay for human serum samples containing C5 ) suggests that antigen, PK, and hemolysis (PD) data mismatch is due to: Different assay dilutions and times;

Measured antigen concentration is over estimating free Antigen in hemolysis assay; Measured mAb - Eculizumab -- (PK) is over

estimating true free mAb due to disassociation from dilution and under estimating total mAb due to solution antigen; and Measured hemolysis is over estimating true free Antigen due to disassociation from dilution.

[00115] Equilibrium Equation

[00116] kon

[00117] mAb + L = mAb * L

[00118]

[00119] K _d = 1/ka = [mAb] f _ree X [L] free/ [mAb*L] bound

[00120]

[00121] K _d = dissociation constant, K _a = association constant

[00122] Koff = dissociation rate, k _on = association rate

[00123] After dosing, binding of mAb to soluble L (ligand) in vivo assumed to follow law of mass action. Ex vivo conditions such as sample collection, storage, etc. may shift equilibrium to conditions different from in vivo.

[00124] koff values often strongly temperature and buffer

sensitive. Equilibration time increases by about 30-fold at 0°C compared to 30°C. The dissociation rate constant should always be determined under the conditions of the assay.

[00125] Lf _ree Measurements

[00126] Increasingly used in drug development to guide decisions; useful in dose and schedule selection. Understanding L kinetics can help define efficacious mAbfree levels.

[00127] Assays for Measuring Free C5 Target Ligand

[00128] Modified ELISA assay format

[00129] Remove bound forms prior to performing ELISA. Measure amount of dissociation using biacore or ELISA and subtract from what is measured. Measure total Eculizumab concentration using LC/MS or other method (s) and determine total C5. Calculate free C5 using equilibrium equation. Calculation is based on the equilibrium equation, which requires a good estimate of K in vivo.

[00130] Modified MSD free C5 Assay

[00131] Sample incubation decreased from 60-minute to proposed 15-minute incubation. Sample dilution decreased from 1:1000 to 1:2 (50% serum) . Samples incubated on ice instead of at RT to possibly reduce dissociation.

[00132] Remove Bound Forms before ELISA:

[00133] Molecular Sieve

[00134] Solid Phase extraction

[00135] Affinity separation, i.e. protein G, protein A or anti- human FC column

[00136] Additional processes may introduce error due to

adsorption to column or filter [00137] Dissociation may also occur and processes are labor intensive

[00138] CERTAIN EMBODIMENT METHODS OF QUANTIFYING FREE C5

[00139] The Gyros system (Gyros AB, Uppsala, Sweden;

www . gyros . com.) is used in the methods disclosed herein. Since a Gyros assay passes samples along the microstructures in a matter of seconds, there may not be opportunity for back dissociation to occur. The Gyros system uses an affinity flow-through format and eliminates incubations and shortens run times . The Gyros platform uses Gyros' proprietary CD technology engineered with highly reproducible nanoliter microfluidics integrated with Gyrolab platforms, which automate immunoassays with parallel processing using laser-induced fluorescence detection. This is possible through precise, automated control of centrifugal and capillary forces which steer liquid flow through nanoliter-scale microfluidic structures contained within the CD.

[00140] Circular Bioaffy compact disc (CD) is used. PCR plates may be used for samples and reagents. Many available PCR plates may be used. The plates are sealed with foil to prevent evaporation. The capture reagent (such as a biotinylated anti-C5 antibody) enters the CD by capillary action. Hydrophobic breaks stop liquid flow. The CD is subjected to centrifugal force inside an instrument dedicated for the assay, such as a Gyrolab xPlore or Gyrolab XP . The centrifugal force drives reagents into columns inside the CD. Capture reagent binds to strepavidin-coated particles in the columns. The sample then enters the CD by capillary action and the sample applied to activated columns. The detection reagent (e.g. AlexaFluor labeled anti-C5 antibody; one that binds to a different epitope than the anti-C5 antibody used as capture reagent) then enters by capillary action and applied to columns. The columns are then scanned by laser

(112 columns within 90 seconds) . Rexxip A may be used for standards, QCs, samples and Rexxip F for detection Ab. Laser induced

fluorescence is then used to measure the concentration or amount of the sample (e.g., C5) . [00141] The Gyros assay uses very little sample volume (such as 4 L) and takes very little time (such as 1.5 hours) . It has a calibration range of 0.78 pM - 300 pM.

[00142] This disclosure provides a method of quantitating free (unbound) human C5 complement protein (C5) from a sample comprising: a. binding biotinylated anti-C5 capture antibody to

strepavidin-coated particles; wherein said biotinylated anti-C5 capture antibody is added by capillary action to a Gyros Bioaffy 200 CD comprising columns with the strepavidin-coated particles; wherein said CD is subjected to centrifugal force inside a Gyrolab xPlore or a Gyrolab XP instrument, thus driving the biotinylated anti-C5 capture antibody to the strepavidin-coated particles in the columns; b. capturing the free (unbound) C5 in the sample; wherein the sample is added to the CD by capillary action; wherein said CD is subjected to centrifugal force inside the Gyrolab xPlore or a

Gyrolab XP instrument, thus driving the sample to the biotinylated anti-C5 capture antibody bound on the strepavidin-coated particles in the columns;

c. detecting the captured free C5 ; wherein an AlexaFluor labeled anti-C5 antibody detection is added to the CD by capillary action, wherein said anti-C5 detection antibody binds C5 at a different epitope from the epitope bound by the capture antibody; wherein said CD is subjected to centrifugal force inside the Gyrolab xPlore or a Gyrolab XP instrument, thus driving the detection antibody to the free C5 bound to the capture antibody bound on the strepavidin-coated particles in the columns; and

d. quantitating the captured free C5 using laser-induced fluorescence detection.

[00143] Any suitable instrument for use of a Gyro assay, such as Gyrolab xPlore or Gyrolab XP, may be used.

[00144] In certain embodiments, Rexxip A buffer is used for samples and Rexxip F buffer is used for diluting the detection antibody. Any suitable buffer may be used. [00145] In certain embodiments, the Gyros instrument is primed two separate times with Bioaffy wash 1 and pH 11 buffer. Any suitable buffer may be used and priming may be skipped and may be done any suitable number of times .

[00146] In another aspect, a method is provided of quantitating free (unbound) human C5 complement protein (C5) from a sample comprising: a. binding biotinylated anti-C5 capture antibody to strepavidin-coated Meso Scale Discovery ^® (MSD ^® ) (Meso Scale

Diagnostic, Rockville, MD; https://www.mesoscale.com/en 96-well assay plate; b. capturing the free (unbound) C5 in the sample by adding the sample to the plate; c. detecting the captured free C5 by adding sulfo-tagged anti-C5 (in certain embodiments, ruthenyled sulfo-tagged anti-C5) detection antibody to the plate; and d.

quantitating the captured free C5 using electrochemiluminescence ; wherein the sample is diluted by about 1:2; wherein the sample is kept on ice; wherein steps b . -C . are about 15 to 30 minutes, and wherein the biotinylated capture anti-C5 antibody is added at a concentration of about 5μg/mL.

[00147] C5 in a sample, such as a serum sample from a patient treated with eculizumab, may be free (unbound) or may be bound to eculizumab .

[00148] In certain embodiments, the method further comprises calculating the concentration or amount of free C5 antibody in the sample by comparing the data obtained from step d. to a standard curve prepared from known amounts of C5 added to a C5 depleted sample. The sample with the controls is processed the same way as the patient's sample.

[00149] In certain embodiments, the method further comprises calculating the concentration of free C5 antibody with the Gyros Evaluator software, or other suitable software.

[00150] In certain embodiments, the sample is obtained from a human patient. In certain further embodiments, the sample is a serum sample. In yet other embodiments, the sample is from a patient undergoing treatment with an anti-C5 antibody, such as eculizumab or ALXN1210. In certain embodiments, the sample is taken before treatment with eculizumab or ALXN1210. In other embodiments, the sample is taken after treatment with eculizumab or ALXN1210. The sample may be any suitable sample that may contain C5 and may be serum, plasma, blood, urine, solid sample, etc. The samples may be obtained and prepared for use according to methods known in the art .

[00151] In certain embodiments, the biotinylated capture antibody is eculizumab or ALXN1210. The biotinylated capture antibody may be any anti-C5 antibody.

[00152] In certain embodiments, the detection anti-C5 antibody is N19-8 (mouse anti-human C5 antibody) . The detection anti-C5 antibody may be any anti-C5 antibody. The detection anti-C5 antibody in any given assay is one that recognizes a different epitope on C5 as compared to the capture antibody used in that assay; and thus does not compete for binding to C5 with the capture antibody.

[00153] Methods of conjugating an antibody with biotin or

AlexaFluor are known in the art.

[00154] In certain embodiments, the sample is a human serum sample from a patient; the free C5 of the patient's pre-treatment and post-treatment with an anti-C5 antibody serum samples are quantitated, and both the pre-treatment and the post-treatment sample is diluted to the same dilution. In further embodiments, the dilution used is 1:30.

[00155] EXAMPLARY UTILITY

[00156] The methods disclosed herein may be used for any purpose that requires quantifying the concentration or amount of free

(unbound) C5 in a sample. The methods, for example, may be used to detect the concentration or amount of free (unbound) C5 in a human serum sample from a patient being treated by eculizumab therapy. The concentration or amount of free (unbound) C5 in such a sample would allow the patient's disease state be monitored. This assay has the advantage in such an example of quantifying free (unbound) C5 and not the C5 molecules bound to eculizumab used as therapy. [00157] Proper quantification of free C5 is essential for a number of reasons, such as monitoring disease state, modeling, dosage selection, and label claims.

[00158] Examples

[00159] For this invention to be better understood, the following examples are set forth. These examples are for purposes of

illustration only and are not be construed as limiting the scope of the invention in any manner.

[00160] Example 1. Gyrolab Platform for Quantifying Free C5

[00161] Complement protein C5 is an important component of the complement cascade, and a target of Alexion drugs eculizumab and ALXN1210. Proper quantification of this target is essential for both modeling and label claims. Many ligand binding assay formats that use drug as a capture reagent for free target are inherently flawed in that during sample incubation, the capture reagent can set up a dynamic equilibrium with target that is already bound to drug in matrix. Due to this equilibrium, it is possible for the assay to overestimate the amount of free target in matrix, thus leading to potentially inaccurate modeling, dosage selection, filing data, and label claims .

[00162] A common strategy for overcoming this overestimation in ligand binding assays is to abbreviate sample incubation time, thus reducing the opportunity for capture reagent to pull bound target from drug in matrix. In order to accomplish this, it is often necessary to increase the coating reagent concentration by as much as 5 times, which can in essence minimize the effects of the shortened sample incubation. Also, pretreatment samples tend to have much higher levels of free target than post treatment samples, often requiring different sample dilutions for each situation.

[00163] The Gyrolab technology is based on assay washes,

reagents, and samples spinning across microstructures on a disc at proscribed intervals. The required time for a sample to be spun across a microstructure immobilized with capture reagent is about six seconds, so theoretically there is almost no time for any bound target in matrix to dissociate and be bound by the drug used as capture antibody. Additionally, the broad dynamic range of Gyros assays is more amenable to having one universal sample dilution across a range of study samples, rather than one for pretreatment samples and another for post treatment.

[00164] Materials & Methods

[00165] Materials:

[00166] Bioaffy 200 discs, Rexxip A buffer, Rexxip F buffer, pH 11 buffer, plate foil (Gyros US, Inc., Warren NJ)

[00167] Purified human C5 , C5 depleted serum (CompTech, Tyler TX)

[00168] Biotinylated eculizumab, biotinylated ALXN1210,

AlexaFluor labeled N19/8 antibody (Alexion Pharmaceuticals, New

Haven CT)

[00169] 96 well PCR plates, Bioaffy wash 1 (PBS with 0.1% Tween 20, 0.02% sodium azide) (All wash ingredients from ThermoFisher, Waltham, MA)

[00170] Equipment:

[00171] Gyros xPlore or XP Workstation instrument (Gyros US, Inc., Warren NJ)

[00172] Method:

[00173] The Gyros instrument is primed two separate times with Bioaffy wash 1 and pH 11 buffer, each buffer with its own station. During these prime cycles (about twenty minutes each) , assay reagents, washes, and samples are prepared as described below. The number of Bioaffy 200 discs required for the run (one for Gyros xPlore, up to five for Gyros XP Workstation) are removed from refrigerated storage and allowed to come to ambient room

temperature .

[00174] The assay's standard curve is prepared from purified human C5 protein which is spiked into C5 depleted human serum at 300 μg/mL and then diluted 3 fold as follows: 300 (initial spike), 100, 33.3, 11.1, 3.70, 1.23, 0.41, 0.14, 0.045, 0.015, and 0.005 μg/mL. The 0.005 μg/mL standard sample is an anchor point. Once formulated in C5 depleted serum, the curve is diluted 1:5 in Rexxip A buffer, mixed, and then diluted one more time in Rexxip A buffer at 1:6 with mixing for a final dilution of 1:30. Diluted standards are put on the PCR plate in their respective positions and at their required volumes.

[00175] Quality control (QC) samples are formulated in the same manner as standard samples. Purified human C5 is spiked into C5 depleted human serum at 240, 10.0, and 0.045 μg/mL. These samples are then diluted twice (1:5 and then 1:6 in Rexxip A buffer) as described for the standard curve samples for a final dilution of 1:30. When required, samples at the limits of detection (300 μg/mL for upper limit of detection (ULOQ) and 0.015 μg/mL for lower limit of detection (LLOQ) ) are formulated the same way. Diluted QCs are put on the PCR plate in their respective positions and at their required volumes.

[00176] Unknown human serum samples are diluted twice (1:5 and then 1:6 in Rexxip A buffer) for a final dilution of 1:30. Diluted unknown serum samples are put on the PCR plate in their respective positions and at their required volumes.

[00177] Biotinylated capture reagent (eculizumab or ALXN1210) is formulated to a working concentration of 100 μg/mL in Bioaffy wash 1, and AlexaFluor labeled N19/8 is formulated to a working

concentration of 1 μg/mL in Rexxip F. Both of these reagents are placed in their respective predetermined locations on the PCR plate at their required volumes. Bioaffy wash 1 is used as the assay buffer and is loaded into respective predetermined locations on the PCR plate.

[00178] The PCR plate loaded with standards, QCs, any unknown serum samples, assay reagents, and assay washes is sealed with foil and then loaded onto the Gyros instrument. The required number of Bioaffy 200 discs is also loaded onto the instrument.

[00179] Assays are run on the Gyros system using the Gyros Client software. This is a three step assay (capture, analyte, detect) whereby capture antibody, sample, and detection antibody are added at programmed intervals and between intermittent wash steps . Assay run time is about one hour per disc. Data is processed by the Gyros Evaluator software, or can be exported for import into a laboratory information system (LIMS) such as Watson. This assay uses a 5PL curve fit with response weighting.

[00180] Results

[00181] The Gyros assay for the quantification of free C5 in human serum has a dynamic range of 0.039 - 18.75 μg/mL or 0.015 - 300 μg/mL, regardless of capture reagent used (eculizumab or

ALXN1210) . This dynamic range and sample dilution (in certain embodiments, 1:20 to 1:30 for the initial pre-treatment samples and then 2-fold for all samples after initial treatment) cover all anticipated concentrations of samples, whether pretreatment which could have free levels as high as 240 μg/mL (although rarely over 200 μg/mL) , or post treatment which could have levels well below 0.5 μg/mL. See table 2 for details on assay performance over this range with ALXN1210 as capture reagent.

[00182] Table 2 Gyros QC Performance Across Dynamic Range of Free C5 Measurement in Human Serum (2 days, 4 separate runs)

[00183] Selectivity of a target biomarker assay is an important assay parameter. Table 3 shows data for ten donor sera spiked with 50 μg/mL of purified C5 reference material, which has an additive effect on the measurement of the endogenous C5 levels already in each sample. The Gyros assay accurately measured purified C5 spiked into samples containing the endogenous counterpart.

[00184] Table 3 Gyros Selectivity of Ten Donor Samples for Free C5 in Human Serum (ALX 1210 capture)

[00185] Parallelism is an important element to determine in a biomarker assay, as it can be a determination of the goodness of fit of a surrogate matrix (here, C5 depleted human serum) standard curve and its purified reference material (here, purified human C5) . By pretreating matrix samples with extra dilutions prior to the proscribed dilution of 1:30, parallelism can show differences in assay response between the surrogate curve and unknown samples measured from it. Figure 1 shows parallelism results for both three individual donor sera and three QC sample concentrations that are prepared similarly to the QC samples described above. These data suggest that the assay has parallelism, and that the surrogate curve is appropriate. FIG. 1. Individual sera samples and QC samples spiked in C5 depleted serum then diluted in same serum prior to MRD pass parallelism test.

[00186] A human serum pool was spiked at various concentrations of eculizumab. This was repeated with another aliquot of the same pool with various concentrations of ALXN1210. Both sets of spiked samples were assayed on both the plate based free C5 assay and the Gyros free C5 assay. Eculizumab spiked samples were assayed using eculizumab as a capture reagent on both assay platforms, and

ALXN1210 samples were assayed using ALXN1210 as capture on both. Tables 4 and 5 show results for the plate based and Gyros assay, respectively. Gyros assay results for each set of spiked samples are lower, indicating that unlike the plate based assay, there is little to no bound C5 being pulled from drug in serum and bound to the capture reagent .

[00187] Table 4 Plate Based Assay Results for Free C5 in Human Serum, ALX 1210 and Eculizumab Spike

[00188] Table 6 Gyros Assay Results for Free C5 in Human Serum, ALXN1210 and Eculizumab Spikes

[00189]

[00190] Discussion

[00191] The Gyros assay for the quantification of free C5 in human serum has a broad dynamic range (0.015 - 300 μg/mL for either eculizumab or ALXN1210 capture reagent) . This dynamic range at the sample dilution of 1:30 enables measurement of both pretreatment and post treatment samples, thereby eliminating the requirement for different dilutions for each respective scenario. This common dilution also takes away sample processing errors, whereby samples can be assayed at incorrect dilutions. [00192] The selectivity and parallelism of the assay show that the surrogate matrix and reference material are appropriate for the endogenous counterpart being measured in human serum.

[00193] Data from spiked samples run on both the Gyros assay and a plate based assay, both using therapeutic drugs as a capture reagent, suggest that the Gyros assay vastly reduces the potential of drug being used as a capture reagent to reach any equilibrium with C5 that is already bound to drug in a serum sample. This reduction in equilibrium and its associated potential for over quantifying C5 that truly is free, along with the extended dynamic range that affords a common sample dilution, enable the end user to have more accurate measurements .

[00194] Example 2. Free C5 Gyro Assay

[00195] Assay Parameters

[00196] Capture Ab @ 100 μg/mL

[00197] Detect Ab @ 1 μg/mL

[00198] Purified human C5 as reference material

[00199] C5 depleted serum for formulation of standards and QCs

[00200] Bioaffy 200 nL discs

[00201] Rexxip A for standards, QCs, samples (sample dilution 30)

[00202] Rexxip F for detection Ab

[00203] Wash 1: Bioaffy wash 1

[00204] Wash 2: pH 11 buffer

[00205] 3 step assay (C-A-D)

[00206] PMT 1%

[00207] Current plate based ECL assay format has dynamic range of 0.0274 - 20.0 μg/mL

[00208] Sample dilution scheme: 20 for pretreatment , 2 for treatment

[00209] Typical endogenous concentrations of free C5 range from 50.0 to 150.0 μg/mL

[00210] Proposed curve range 0.005-300.0 μg/mL, preferably common dilution for all samples [00211] Parallelism of 7 individual donor sera is shown in FIG. 2 and FIG. 3. This is an improvement over prior ECL assays, where dilutions beyond MRD yielded diminishing returns.

[00212] Early CRO assay transfer results are shown in FIG. 4A and FIG. 4B (summary data for two days; N=6 for each QC level (2 runs, each of N=3 ) (Confirmation of MRD (30)) . Limits of quantitation cover desired range of assay; one dilution covers all anticipated eventualities. FIG. 4C shows selectivity in early CRO transfer results .

[00213] FIG. 5 shows that MRD (minimum required dilution) of 30 is optimal. Going from 25 to 30 lost a bit of low end sensitivity (5 ng/mL vs. 15 ng/mL) ; 15 ng/mL still 2x more sensitive than ECL

(Electrochemiluminescence ) assay.

[00214] FIG. 6 shows that no carryover in a carryover assessment, confirming concentration of reagents and parameters .

[00215] FIG. 7 shows summary comparison.

[00216] Example 3. Prior Art Free C5 Assay Using Meso Scale Discovery® Electrochemiluminescence Technology

[00217] Prior art free C5 assays have shown to have limitations. An example is shown below.

[00218] This prior art free C5 assay is designed to quantify free C5 complement protein in human serum samples using Meso Scale

Discovery® electrochemiluminescence technology. Eculizumab is conjugated to biotin and immobilized on a streptavidin coated MSD® 96-well assay plate. Assay standard curve samples are prepared by serial dilution of purified human C5 in C5 depleted serum and added to the plate along with test and quality control samples. Captured C5 on the immobilized eculizumab is detected using N19-8 conjugated to a MSD® SulfoTag, which binds to a different epitope on C5 than that bound by eculizumab. The N19-8-Tag emits light as an ECL signal upon electrochemical stimulation initiated at the electrode surface of the assay plate. The intensity of the signal is proportional to the amount of C5 captured. The ECL signal of the captured complex is measured using the MSD® Sector Imager 2400. A weighted 4-parameter curve fit standard curve is generated by plotting the ECL signal of the standard samples on the y-axis against the corresponding C5 concentration on the x-axis . The concentration of C5 in each serum sample can be determined by interpolating the ECL signals of samples with readings in the linear range of the standard curve to the standard curve of known C5 concentrations . The mean of triplicate wells for each standard curve dilution, QC samples, and patient samples is calculated and reported.

[00219] This assay has been found to have certain limitations for measuring free C5 in the presence of eculizumab. A consistent bias was noted between measured free C5 concentration compared to theoretical calculation based on eculizumab to C5 binding molar ratio (1: 2.53) . This bias leads to an overestimation of free C5 even at high concentrations of eculizumab (35-2000μg/mL) . Therefore, an experiment was performed to assess the limitations of the assay by spiking 35μg/mL eculizumab against various C5 concentrations. The results clearly demonstrated a bias between measured free C5 concentration and theoretical free C5 concentration. This bias may be introduced by dissociation between eculizumab and C5 in the test sample during assay procedures. Certain assay conditions are determined to shift the binding equilibrium towards dissociation based on Le Chatelier' s principle.

[00220] Assay Modification and Rationale

[00221] Using the same assay platform, four major modifications were implemented into the new C5 assay as summarized in the table below :

[00222] Table 6: Modifications to Old Free C5 Assay

[00223] Results

[00224] With the four modifications, additional experiments were performed to compare old and new free C5 assay in terms of assay accuracy. Theoretically calculated free C5 concentrations were produced to illustrate the target concentration we expected to see in a human body. Various concentrations of eculizumab were spiked into pooled normal human serum and measured on both old and new free C5 assay. The results strongly suggest that the new free C5 assay provided much more accurate results as compared to the theoretical values. Additionally, the results, confirmed by several different analysts, demonstrated the accuracy, precision and robustness of the assay. All results are within the range of the assay (0.0016 to 20μg/mL) with precision of ≤25% CV. [00225] Table 7: Old Vs. New C5 Assay Results Comparison

[00226] Conclusion

[00227] The modifications of old free C5 assay have resulted in improvements in assay accuracy by minimizing the effects of eculizumab-C5 dissociation. The % bias increases with increasing eculizumab concentration, compared to the theoretical % free C5 , at concentrations ≥250 g/mL. Serum free C5 results at eculizumab concentrations ≥250μg/mL, with the new assay, should therefore be interpreted with caution. However, these very low levels of free C5 concentrations are not expected to initiate hemolysis in clinical samples .

[00228] Because of the improved performance of the new serum free C5 assay compared to the old assay, Switch from eculizumab coated plate to ALXN1210 coated plate is adapted to ensure the assay is more reflective of free C5 measurement in ALXN1210 serum samples.

[00229] Example 4. Assay for the Quantification of C5a in Human Plasma Using the GyroLab Platform

[00230] This study validated a Gyros assay to measure free C5a in Human Plasma. This assay employed the GyroLab platform and used a biotinylated antibody (ALXN1007) to capture free C5a and an Alexa 647 labeled anti C5a antibody to detect C5a in human plasma. The study demonstrated that the method is suitable for its intended purpose of quantifying C5a in human plasma.

[00231] ABBREVIATIONS

BPM: Bioanalytical Project Manager

CV: Coefficient of Variation

C5a: Complement Factor 5a

Low VS : Low Validation Sample

Mid VS: Mid Validation Sample

High VS : High Validation Sample

LLOQ: Lower Limit of Quantitation

ULOQ: Upper Limit of Quantification

BLQ : Below Limit of Quantification

ALQ : Above the Limit of Quantification

MRD: Minimum Required Dilution

PBST: Phosphate Buffer Saline, 0.01% Tween

[00232] C5a DesArg purified human complement protein at 0.51 mg/ML is used as reference standard. [00233] A freshly prepared quantification standard curve consisting of 11 non-zero standards was spiked with C5a, diluted into Rexxip AN buffer and was included on all CDs tested. A Blank was also tested and included on all CDs. The concentrations of C5a were 60, 30, 15, 7.5, 3.75, 1.88, 0.938, 0.469, 0.234, 0.117, and 0.059 ng/mL. The 0.059 ng/mL and 0.117 ng/mL data points were evaluated as anchor points. All calibration standards were diluted 2-fold into assay diluent before testing and were tested in

duplicate on each CD tested. The Gyrolab XP performed the duplicates by adding sample twice from the same well. The data was fit to a five-parameter logistical curve regression model within the Gyros data analysis software.

[00234] Validation control samples representing an Upper Limit (ULOQ), High (High-VS), Mid (Mid- VS) , Low (Low-VS) and 2 Lower limit (LLOQ-1 and LLOQ-2) concentrations of the biomarker C5a were prepared by spiking C5a into Rexxip AN at levels to assess the quantification range. A Blank, consisting of Rexxip AN, was used for all assays. One set of each ULOQ, High VS, Mid- VS, Low-VS, LLOQ-1 and LLOQ-2, and a Blank was included on each CD during validation. All controls were prepared fresh and diluted 2-fold into assay diluent. C5a was spiked at the following concentrations.

• ULOQ = 40 ng/mL

• High VS = 20 ng/mL

• Mid-VS = 2.5 ng/mL

• Low VS = 0.625 ng/mL

• LLOQ-1 = 0.200 ng/mL

• LLOQ-2 = 0.156 ng/mL

[00235] To remove C5, endogenous samples (Individuals 2 and 11) were subjected to Dynabead treatment, included on all CDs and tested in duplicate to access the utility of using the samples for trending purposes . [00236] GENERAL ASSAY PROCEDURE

[00237] The C5a quantification curve and validation control samples were prepared and diluted in a PCR plate containing Rexxip AN buffer then subsequently diluted to an MRD of 2 in assay diluent

(1M NaCl+ 0.5% Tween) .

[00238] Samples used for the validation assessment may be subjected to incubation with anti-C5 antibody coupled to magnetic beads for a minimum of 1 hour with rapid shaking to remove C5. For those samples, 10 uL of sample was added to 20 uL of anti C5 coupled beads and incubated with vigorous shaking for 1 hour. After

incubation with shaking, the plate was subjected to a plate based magnet for a minimum of 2 minutes to separate the beads from the solution. IOUL of sample was carefully removed without disturbing the bead pellet and added to a PCR plate according to the Gyros loading list. The final MRD for the samples is 3 and the dilution factor on the Gyros loading list is 1.5.

[00239] Biotinylated ALXN1007 (capture antibody) was prepared at lOOug/mL in PBST and added to the PCR plate according to the Gyro Lab loading list. Alexa 647 labeled anti-C5a (detection antibody) was prepared at 4ug/ml in Rexxip F buffer and added to the PCR plate according to the Gyro Lab loading list.

[00240] Alexa 647 labeled anti-C5a/C5a des-Arg purified human complement protein is a mouse IgG _2a mAb, labeled at 4.2 moles of Alexa Fluor ^® 647 dye per mole antibody.

[00241] METHOD VALIDATION

[00242] Method validation of the assay included intra and inter- assay precision and accuracy, calibration curve response and range, dilutional linearity, selectivity, parallelism, short term

stability, long term stability, freeze thaw stability and process stability. During validation, runs were accepted based on the acceptance criteria stated for the calibration curve. A summary of all runs performed during validation is shown in Table 8. [00243] Table 8. Run Summary

[00244] Calibration Curve Range

[00245] To evaluate precision and accuracy of the standard curve, each run for validation contained a standard curve consisting of nine non-zero standards and two anchor points, defined in section 15. The inclusion or exclusion of anchor points was based on the fitting of the curve within the quantifiable range of the curve. A zero (no analyte) blank was included in each assay but was not included in the fitting of the curve. All points were tested in duplicate on seven separate runs by two analysts and the standard curve was calculated using a 5-parameter logistic curve fit within the Gyro Lab Evaluator software.

[00246] Precision, represented by the coefficient of variation (CV) expressed as a percent, was calculated using the following expression :

[00247]

[00248] % Relative Error ( %RE ) , was calculated using the

following expression, where the nominal concentration is equal to the concentration of reference standard spiked into the matrix:

[00249]

[00250] The total error of the assay was assessed using the following equation:

[00251] % TE = absolute %RE + %CV

[00252] Target Acceptance Criteria: A minimum of 75% of the nonzero standards must have a mean back calculated concentration (BCC) equal to or within +20% of the nominal value, except at the lowest and highest standards where the mean BCC can be equal to or within +25%. The CV for each standard must be equal to or less than 20%, except at the lowest and highest standards where the CV may be ≤25%. [00253] All nine non-zero calibration standards met the acceptance criteria at all levels tested, with recoveries ranging from 99.2 - 109.2% and precision that ranged from 1.5 - 13.1% CV. The relative error was between 0.4 - 9.2% RE with total error ranging from 2.1 - 22.3% TE . The two lowest calibrator

concentrations of 0.117 ng/mL and 0.059 ng/mL are used as anchor points during sample analysis and will be included or excluded from analysis based on the fit of the curve. The calibration curve range for the assay was 0.234 - 60 ng/mL. Data is shown in Table 9.

[00254] Table 9. Calibration Curve Range

[00255] Quantifiable Range (Assay Range), Accuracy and Precision

[00256] To evaluate the quantifiable range and assay accuracy and precision, each run contained controls.

[00257] For intra-assay precision each control was tested one time in replicates of six by one analyst over 1 run. The intra-assay precision run met acceptance criteria for all controls tested.

Recoveries ranged for 96.3 to 111.7% with precision that ranged from 2.3 to 20.2% CV. Relative Error ranged from 0.0 to 10.5% and Total Error ranged from 6.6 to 25.3%. Data are shown in Table 10.

[00258] Table 10 Intra-assay Precision

[00259] Target Acceptance Criteria: For accuracy, the mean calculated concentration for each control must be equal to or within +25% of the nominal value, except at the LLOQ and ULOQ, where the mean calculated concentration can be equal to or within +30% of the nominal value. For precision, the CV for each control must be ≤25%, except at the LLOQ and ULOQ, where the CV is <30%. The LLOQ of the assay is the lowest control with acceptable precision and accuracy, and the ULOQ of the assay is the highest control with acceptable precision and accuracy. The total error must be ≤40%. [00260] For inter-assay precision each control was tested over seven in runs in duplicate by two analysts. The first two replicates of the intra-assay assessment (Run 7) were included as one inter- assay assessment. Intra-assay precision criteria was met for all controls tested. Recoveries ranged from

96.4 to 116.6% with precision that ranged from 2.0 to 20.5% CV.

Relative Error ranged from 1.4 to 16.6% and Total Error ranged from 3.4 to 34.0%. Data are shown in Table 11.

[00261] Table 11. Inter-assay Precision

[00262] Target Acceptance Criteria: For accuracy, the mean calculated concentration for each control must be equal to or within

+25% of the nominal value, except at the LLOQ and ULOQ, where the mean calculated concentration can be equal to or within +30% of the nominal value. For precision, the CV for each control must be ≤25%, except at the LLOQ and ULOQ, where the CV is <30%. The LLOQ of the assay is the lowest control with acceptable precision and accuracy, and the ULOQ of the assay is the highest control with acceptable precision and accuracy. The total error must be ≤40%.

[00263] Dilutional linearity and minimum required dilution (MRD) were evaluated in four individual lots of matrix. Matrices were spiked with reference standard above the ULOQ at 100 ng/mL and diluted 4 fold 3 times in assay diluent then treated with anti C5 coupled magnetic beads to remove any contaminating C5. Dilutional linearity samples were evaluated one time over two runs and tested in duplicate by one analyst. Individual-13 from run 5 was reevaluated in run 9 due high CV associated with the 64 fold dilution. The assay demonstrates dilution linearity with the four lots of spiked matrix with all dilutions for all lots meeting acceptance criteria. The maximum dilution is 64 fold. The recovery for each dilution when corrected for dilution ranged from 94.0 to 117% with CVs that ranged from 0.8 to 11.1%. The minimum required dilution for plasma samples as required by bead treatment is three. Samples that are ALQ with the standard bead treatment MRD can be diluted up to 64 fold to obtain results that are within the quantifiable range of the assay. Data is shown in Table 11.

[00264] Target Acceptance Criteria: For dilutional linearity, the mean concentrations of dilutions that fall within the quantifiable range, when corrected for dilution, must be equal to or within 25% of the nominal value and have CVs ≤25%. The largest dilution in any of the samples that meets the acceptance criteria is the maximum allowed sample dilution.

[00265] Table 11. Dilutional Linearity

[00266] The prozone (Hock Effect) was evaluated in matrix spiked at 500 ng/mL. Prozone was evaluated one time in duplicate by one analyst. The sample was treated with anti C5 coupled magnetic beads . The calculated response was greater than the quantifiable range of the assay and demonstrated that no prozone (hook effect) was observed. Data are shown in Table 12.

[00267] Table 12. Prozone (Hook Effect)

[00268] The prozone effect is demonstrated if the observed response is within or below the quantifiable range of the assay for a sample whose nominal concentration is above the ULOQ.

[00269] Assay selectivity was evaluated by spiking ten

individual lots of matrix with C5a at 5 , 1, and 0.3 ng/mL and subsequently treating with anti C5 antibody coupled magnetic beads . An un-spiked sample of each individual was also evaluated. Lots that were shown to contain low levels of C5a during pre- qualification were selected. Selectivity samples were evaluated one time in duplicate over 2 runs by one analyst. The assay met target acceptance criteria for selectivity. Eight out of ten spiked individuals when corrected for endogenous C5a recovered within 25% of the nominal value. Data are shown in Table 13.

[00270] Target Acceptance Criteria: A minimum of 80% of the spiked matrices must be equal to or within +25% of the nominal value .

[00271] Table 13. Selectivity

IND= individual

[00272] Parallelism

[00273] Six individuals (3 males and 3 females) shown to have endogenous detectable levels of C5a during pre-qualification were selected to assess parallelism. Samples were subjected to 3 two-fold serial dilutions in assay diluent then subjected to bead treatment with anti C5 coupled magnetic beads . Parallelism samples were evaluated over 2 runs by 2 analysts . Four out of the six individuals that were tested in Run 4 were repeated in Run 9 due to high sample CVs . The assay demonstrated a lack of parallelism and underscores the relative quantitative nature of the assay, but does not preclude it from use. Samples CVs ranged from 0.1% to 27.1%. Data are shown in Table 14. [00274] Table 14. Parallelism

[00275] Stability

[00276] The stability of samples subjected to short-term storage at approximately 4°C and at room temperature, long-term storage at the intended storage temperature, and several freeze and thaw cycles were investigated. Matrix spiked with a high (5 ng/mL) and low

concentration (1 ng/mL) of C5a was used for stability assessment.

Multiple aliquots of the stability samples were prepared for storage at the intended storage temperature, (-80°C) , room temperature, approximately 4°C, and for freeze/thaw experiments. One aliquot at each level was analyzed immediately as the fresh control sample

(Reference condition) . The remaining samples were tested after the specified storage period and condition. All stability assessments included a freshly prepared standard curve and validation samples to assess the assay acceptability. All stability samples were treated with anti C5 antibody coupled magnetic beads. Process stability was also evaluated.

[00277] Short Term Stability

[00278] Aliquots of the low and high stability samples were thawed and stored at room temperature for 2 hours and 20 minutes, and at approximately 4°C for up to 23 hours and 29 minutes. All short term stability samples were run in replicates of six. The stability samples met the acceptance criteria for short term stability. The samples for each condition were within 30% of the reference standard and the CVs ranged from 4.6 to 11.6%. Data are shown in Table 15.

[00279] Table 15. Short Term Stability

[00280] Target Acceptance Criteria: The mean calculated

concentration for each short-term stability sample must be equal to or within +30% of the value of the fresh control sample and have a CV <30%.

[00281] Long term stability will be evaluated at 1, 3, 6, 9, 12,

15, 18, 21 and 24 months. Aliquots of the low and high concentration stability samples were prepared and stored at the appropriate

temperature (-80°C) . All long-term stability samples will be run, at minimum, in replicates of six. The validation report will be amended to include the long-term stability data.

[00282] Target Acceptance Criteria: The mean calculated

concentration for each long-term stability sample must be equal to or within +30% of the value of the fresh control sample and have a CV <30%.

[00283] Freeze and Thaw Stability [00284] Aliquots of the low and high concentration stability samples were subjected to 6 freeze and thaw cycles at approximately - 80°C. The stability samples were thawed at room temperature for at least one hour and then re-frozen for a minimum of 12 hours before being subjected to a new cycle. Assessment of freeze and thaw

stability was conducted on samples that completed three and six freeze/thaw cycles. All freeze and thaw stability samples were tested in replicates of six. The stability samples met the acceptance criteria for freeze and thaw stability. The samples for each condition were within 30% of the reference standard and the CVs ranged from 1.4 to 8.1%. Data are shown in Table 16.

[00285] Table 16. Freeze Thaw Stability

Target Acceptance Criteria: The mean calculated concentration for each freeze and thaw stability sample must be equal to or within +30% of the value of the fresh control sample and have a CV that is ≤30%.

[00286] Process Stability (Robustness)

[00287] Process stability was evaluated by preparing a standard curve, QC's and capture and detection reagents that were then split into in two assay-ready PCR plates. The endogenous samples were also included for each time point. The plates were sealed and placed on the deck of the Gyros Instrument. Each plate was evaluated at time 0 hours and 2 hours using one disk per plate. The standard curves met acceptance criteria for both time points tested. The grand mean % recovery for nine zero standards ranged from 96.8 to 104.4% with CV s that ranged from 0.4 to 8.3%. The grand mean recovery for the QC s ranged from 98.3 to 118.3% with CV s that ranged from 1.5 to 18%. Data for the standard curves and QC s tested for each time point are shown in Table 17. Data for the endogenous samples are shown in Table 18. The assay demonstrates process stability for up to 2 hours.

[00288] Table 17. Process Stability Standards and QC s

[00289] Table 18. Process Stability for Endogenous samples

[00290] Assay plates were read on a Gyrolab XP workstation and were analyzed using the GyroLab evaluator software and imported into

Microsoft Excel 2007 or later version. Descriptive statistics, such as arithmetic means, standard deviations, precision (% CV) were

determined using Microsoft Excel 2007 or later version.

[00291] There was one plan amendment that allowed for the masking of a maximum of two of the nine non-zero standard points if the CV was greater than 25%.

[00292] There were two Deviations noted during the study.

[00293] Deviation #226

[00294] The clock and thermometer were not documented on the

Supplemental Bioanalytical Worksheets for Runs 1 through 8. The deviation had no impact on the study data as all runs performed as expected and the time and temperature were noted by using the

calibrated clock and thermometer in the laboratory.

[00295] Deviation #237

[00296] · Requirement: Biotin ALXN1007 (capture antibody) is prepared at lOOug/mL in PBST and added to the PCR plate according to the Gyro Lab loading list. [00297] · Deviation: Biotin ALXN1007 (capture antibody) was prepared at 89 ug/mL in PBST and added to the PCR plate according to the Gyro Lab loading list.

[00298] The deviation occurred on Run 1. The deviation was that the Biotin ALXN was prepared at 89 ug/ml and not 100 ug/mL as specified in the General Assay procedure section. A typographical error was discovered on the supplemental worksheet by the analyst during the analysis for run 1 where a previous stock concentration of the

ALXN1007 was noted on the worksheet and used for the calculation. The analyst made the correction to the worksheet and documented the correction. Upon peer review of the run it was discovered and

documented that the correction was calculated incorrectly.

[00299] The deviation had no impact on the study as the Run is noted as failed and data was not used for analysis in the study. The run failed to meet target criteria due to high CV s associated with the standard curve.

[00300] Table 19 Assay Procedure

[00301] Table 20 Assay Procedure (Bead Preparation)

[00302] Table 21 CRITICAL REAGENTS

The following reagents are used from the specified providers and lots .

[00303] Table 22 ADDITIONAL REAGENTS

[00304] Other Embodiments

[00305] The foregoing description discloses only exemplary embodiments of the invention.

[00306] It is to be understood that while the invention has been described in conjunction with the detailed description thereof, the foregoing description is intended to illustrate and not limit the scope of the invention, which is defined by the scope of the appended claims. Other aspects, advantages, and modifications are within the scope of the appended claims. Thus, while only certain features of the invention have been illustrated and described, many modifications and changes will occur to those skilled in the art. It is therefore to be understood that the appended claims are intended to cover all such modifications and changes as fall within the true spirit of the invention .

[00307] TABLE 23: SOME NUCLEIC ACID AND AMINO ACID SEQUENCES

SEQ ID NO:l (coded protein disclosed as SEQ ID NO: 2)

SEQ ID NO: 23 amino acid sequence of heavy chain constant region of eculizumab

SEQ ID NO: 24 amino acid sequence of heavy chain variable region of BNJ441 antibody

SEQ ID NO: 25 amino acid sequence of heavy chain constant region of BNJ441 antibody

SEQ ID NO: 26 amino acid sequence of IgG2 heavy chain constant region variant comprising YTE substitutions

SEQ ID NO: 27 amino acid sequence of entire heavy chain of eculizumab variant comprising heavy chain constant region depicted in SEQ ID NO: 26 (above)

SEQ ID NO: 28 amino acid sequence of light chain CDR1 of eculizumab (as defined under Kabat definition) with glycine to histidine substitution at position 8 relative to SEQ ID NO: 12 GASENIYHALN

SEQ ID NO: 29 depicts amino acid sequence of heavy chain CDR2 of eculizumab in which serine at position 8 relative to SEQ ID NO: 10 is substituted with histidine EILPGSGHTEYTENFKD

SEQ ID NO: 30 amino acid sequence of "FLAG" tag DYKDDDDK

SEQ ID NO: 31 polyhistidine sequence commonly used as antigenic tag.

HHHHHH

SEQ ID NO: 32 amino acid sequence of hemagglutinin tag. YPYDVPDYA

SEQ ID NO: 33 amino acid sequence of heavy chain CDR1 of eculizumab in which tyrosine at position 2 (relative to SEQ ID NO : 9 ) is substituted with histidine

GHIFSNYWIQ