RELATED APPLICATION DATA

This Application is a Continuation-in-Part Application of Co-Pending Application Serial No. 07/995,388, filed on December 21, 1992.

FIELD OF THE INVENTION

The present invention relates to therapeutics for the prevention and treatment of blood- borne and toxin mediated diseases, and in particular the prevention and treatment of sepsis in humans as well as other animals.

BACKGROUND OF THE INVENTION I. Sepsis

Sepsis is a major cause of morbidity and mortality in humans and other animals. It is estimated that 400,000-500,000 episodes of sepsis resulted in 100,000-175,000 human deaths in the U.S. alone in 1991. Sepsis has become the leading cause of death in intensive care units among patients with non-traumatic illnesses. [G.W. Machiedo et al., Surg. Gyn. & Obstet. 152:757-759 (1981).] It is also the leading cause of death in young livestock, affecting 7.5-29% of neonatal calves [D.D. Morris et al, Am. J. Vet. Res. 47:2554-2565 (1986)], and is a common medical problem in neonatal foals. [A.M. Hoffman et al., J. Vet. Int. Med. 6:89-95 (1992).] Despite the major advances of the past several decades in the treatment of serious infections, the incidence and mortality due to sepsis continues to rise. [S.M. Wolff, New Eng. J. Med. 324:486-488 (1991).]

Sepsis is a systemic reaction characterized by arterial hypotension, metabolic acidosis, decreased systemic vascular resistance, tachypnea and organ dysfunction. Sepsis can result from septicemia (i.e., organisms, their metabolic end-products or toxins in the blood stream), including bacteremia (i.e., bacteria in the blood), as well as toxemia (i.e., toxins in the blood), including endotoxemia (i.e., endotoxin in the blood). The term "bacteremia" includes occult bacteremia observed in young febrile children with no apparent foci of infection. The term "sepsis" also encompasses fungemia (i.e., fungi in the blood), viremia (i.e., viruses or virus particles in the blood), and parasitemia (i.e., helminthic or protozoan parasites in the blood).

Thus, septicemia and septic shock (acute circulatory failure resulting from septicemia often associated with multiple organ failure and a high mortality rate) may be caused by a number of organisms.

The systemic invasion of microorganisms presents two distinct problems. First, the growth of the microorganisms can directly damage tissues, organs, and vascular function. Second, toxic components of the microorganisms can lead to rapid systemic inflammatory responses that can quickly damage vital organs and lead to circulatory collapse (i.e., septic shock) and oftentimes, death.

There are three major types of sepsis characterized by the type of infecting organism. Gram-negative sepsis is the most common and has a case fatality rate of about 35%. The majority of these infections are caused by Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Gram-positive pathogens such as the staphylococci and streptococci are the second major cause of sepsis. The third major group includes the fungi, with fungal infections causing a relatively small percentage of sepsis cases, but with a high mortality rate.

Many of these infections are acquired in a hospital setting and can result from certain types of surgery (e.g., abdominal procedures), immune suppression due to cancer or transplantation therapy, immune deficiency diseases, and exposure through intravenous catheters. Sepsis is also commonly caused by trauma, difficult newborn deliveries, and intestinal torsion (especially in dogs and horses).

A well established mechanism in sepsis is related to the toxic components of gram- negative bacteria. There is a common cell-wall structure known as lipopolysaccharide (LPS) that is widely shared among gram-negative bacteria. The "endotoxin" produced by gram- negative organisms is comprised of three major structures: a lipoprotein; a lipid (lipid A), thought to be responsible for most of the biological properties of endotoxin; and polysaccharide structures unique to each species and distinct strains of bacteria. [D.C. Morrison, Rev. Infect. Dis. 5(Supp 4):S733-S747 (1983).] Research over the past decade or so has demonstrated that purified endotoxin can elicit all of the features of full-blown gram- negative bacteremia. Furthermore, several of the host responses to endotoxin have been identified. Two key mediators of septic shock are tumor necrosis factor (TNF) and interleukin-1 (IL-1) which are released by macrophages and appear to act synergistically in

causing a cascade of physiological changes leading to circulation collapse and organ failure.

[R.C. Bone, Ann. Intern. Med. 1 15:457-469 (1991).] Indeed, large doses of TNF [K.J.

Tracey et <_/., Science 234:470-474 (1986)] and/or IL-1 [A. Tewari et al, Lancet 336:712-714

(1990)] can mimic the symptoms and outcome of sepsis. It is generally thought that the distinct cell wall substances of gram-positive bacteria and fungi trigger a similar cascade of events, although the structures involved are not as well studied as gram-negative endotoxin.

Regardless of the etiologic agent, many patients with septicemia or suspected septicemia exhibit a rapid decline over a 24-48 hour period. Thus, rapid methods of diagnosis and treatment delivery are essential for effective patient care. Unfortunately, a confirmed diagnosis as to the type of infection traditionally requires microbiological analysis involving inoculation of blood cultures, incubation for 18-24 hours, plating the causative organism on solid media, another incubation period, and final identification 1-2 days later. Therefore, therapy must be initiated without any knowledge of the type and species of the pathogen, and with no means of knowing the extent of the infection.

II. Prevention And Treatment A. Antibiotics

Antibiotics of enormously varying structure [Berdy in Advances in Applied Microbiology, (D. Perlman, ed.), Academic Press, New York, 18:309-406 (1974)] are widely used to prevent and control infections. Nonetheless, up to one half of the patients in whom bacteremia develops in the hospital die (i.e., nosocomial or iatrogenic bacteremia). [D.G. Maki, Am. J. Med. 70:719-732 (1981).] The causes for this are many-fold. First, for many commonly used antibiotics, antibiotic resistance is common among various species of bacteria. This is particularly true of the microbial flora resident in hospitals, where the organisms are under constant selective pressure to develop resistance. Furthermore, in the hospital setting, spread of antibiotic-resistant organisms is facilitated by the high density of potentially infected patients and the extent of staff-to-staff and staff-to-patient contact. Second, those antibiotics that are the most economical, safest, and easiest to administer may not have a broad enough spectrum to suppress certain infections. For example, many antibiotics with broad spectra are not deliverable orally and physicians are reluctant to place patients on intravenous lines due to

the enhanced risk of infection. Third, antibiotics can be toxic to varying degrees including causing allergy, untoward interactions with other drugs, and direct damage to major organs (e.g., kidneys, liver). Many potent antibiotics are eliminated from routine use due to the probability of adverse reactions at therapeutic doses. Fourth, many antibiotics alter the normal intestinal flora and frequently cause diarrhea and nutritional malabsoφtion; some may even unleash opportunistic organisms which can cause life-threatening infections of the gastrointestinal (GI) tract such as Clostridium difficile. For example, antimicrobial-associated pseudomembranous colitis caused by C. difficile is a potentially serious complication associated with administration of certain antimicrobials. Physicians must therefore consider the impact of prophylactic antibiotic use on the development of resistant organisms, on overall patient health, and on the economics of health care.

While many infections are controlled by antibiotics, gram-negative bacteremia presents some special challenges. It has been shown that treatment of bacteria with antibiotics may catalyze the release of endotoxin from dying cells as their cell walls disintegrate. In experimental E. coli sepsis in rabbits, antibiotics cause a 10 to 2,000 fold increase in endotoxin levels despite decreasing levels of bacteremia. [J.L. Shenep and K.A. Morgan, J. Infect. Dis. 150:380-388 (1984).] Thus, once gram-negative bacteremia is established, there is justifiable concern that antibiotic therapy may augment symptoms while mitigating the infection. Fortunately, certain antibiotics are known to neutralize the action of endotoxin. The polymyxin antibiotics, most notably polymyxin B and polymyxin Ε (also known as colistin) are cyclic polypeptide compounds produced by certain strains of Bacillus polymyxa. These antibiotics bind to the lipid A portion of endotoxin [D.C. Morrison and D.M. Jacobs, Immunochem. 13:813-818 (1976)] and neutralize its activity as measured by lethality tests in animals [D. Rifkind and J.D. Palmer, J. Bacteriol. 92:815-819 (1966)], activation of serum complement [D.C. Morrison and D.M. Jacobs, Infect. Immun. 13:298-301 (1976)], and the Limulus amebocyte lysate (LAL) assay. [M.S. Cooperstock, Antimicrob. Agents Chemother. 6:422-425 (1974).] Unfortunately, the polymyxins are not absorbed from the GI tract and must be administered parenterally. At the recommended therapeutic dose for systemic infection by P. aeruginosa (l-2.5mg/kg body weight/day), there is a significant risk of renal impairment. [Physicians' Desk Reference, 47th Εd., pp. 818-819 (1993).] This is a major

concern in patients already suffering from kidney disease. In addition to nephrotoxicity, neurotoxic reactions have been observed, the most severe being respiratory paralysis when given soon after anesthesia and/or muscle relaxants. Polymyxin B, in its intravenous form, is only given to hospitalized patients under constant supervision and monitoring of renal function. As such, polymyxins are not used routinely for systemic infections (but they are quite common as components of topical ointments).

Several approaches have been taken to reduce the toxicity of polymyxins. Colistin exhibits a lower systemic toxicity, and when complexed as methanesulfonate salt, the locally severe pain experienced at intramuscular injection sites is diminished. The toxicity of polymyxin B is also reduced by attachment to dextran, a high molecular weight carrier.

[D.A. Handley, Eur. Patent Appl. Pub. No. 428486.] Conjugation to dextran is often used in an attempt to decrease the toxicity and/or increase the circulating half-lives of drugs. [P.E. Hallaway et al, Proc. Natl. Acad. Sci. USA 86:10108-101 12 (1989); M.J. Poznansky and L.G. Cleland in Drug Delivery Systems: Characteristics and Biomedical Applications, (R.L. Juliano, ed.), Oxford University Press, New York, pp. 253-315 (1980); L. Molteni in Drug Carriers in Biology and Medicine, (G. Gregoriadis, ed.), Academic Press, New York, pp. 107- 125 (1979); C. Larsen, Adv. Drug Delivery Rev. 3:103-154 (1989); A.D. Virnik et al, Russian Chem. Rev. 44:588-602 (1975); and Hager et al, French Patent No. 2,342,740 (1977).] Alone, polymyxin B has a half-life of only a few hours [G. Brownlee et al, Brit. J. Pharmacol. 7:170-188 (1952)], while dextran (M.W. 70,000) has a half-life in humans of about a day, depending upon the dose infused. [Reynolds et al, in Martindale - The Extra Pharmacopoeia, 28th Ed., The Pharmaceutical Press, London, pp. 512-513 (1982); and W.A. Gibby et al, Invest. Radiol. 25:164-172 (1990).]

Polymyxin B has been investigated as a specific therapy for gram-negative sepsis or endotoxemia over the past 20 years in both animal models and human trials but with mixed results. For example, endotoxin-induced disseminated intravascular coagulation (DIC) was not prevented in rabbits administered polymyxin B fifteen (15) minutes after endotoxin challenge. [J.J. Corrigan, Jr. and B.M. Bell, J. Lab. Clin. Med. 77:802-810 (1971).] In fact, most experimental studies have shown a requirement for premixture of endotoxin and polymyxin B, or administration of polymyxin B prior to endotoxin challenge to reduce or abolish the effects of endotoxin. [D. Rifkind and J.D. Palmer, J. Bact. 92:815-819 (1966);J.J.

Corrigan, Jr. and B.M. Bell, J. Lab. Clin. Med. 77:802-810 (1971); B. Hughes et al, Br. J. Pharmac. 74:701-707 (1981); J.J. Corrigan, Jr. and J.F. Kiernat, Pediat. Res. 13:48-51 (1979); G. Ziv and W.D. Schultze, Am. J. Vet. Res. 44:1446-1450 (1982); and G. Baldwin et al. J. Infect. Dis. 164:542-549 (1991).] Some studies have found little benefit in polymyxin B, even as a pretreatment. [A.H.L. From et al, Infect. Immun. 23:660-664 (1979).]

Importantly, clinical studies on endotoxemia in human obstructive jaundice found no benefit _. in polymyxin B therapy [C.J. Ingoldby et al. Am. J. Surgery 147:766-771 (1984)], consistent with results in animal models. [C.J.H. Ingoldby, Br. J. Surg. 67:565-567 (1980).]

Low dose polymyxin B therapy has also been investigated in animals and humans. In the infant rat, subinhibitory doses of polymyxin B, administered 12 hours after infection with live Haemophilus influenzae Type B organisms alone or in combination with a large dose of ampicillin, significantly reduced mortality due to the infection. The theory here is that the polymyxin B neutralizes endotoxin released by organisms killed by other antibiotics. [J.W. Walterspiel et al, Pediat. Res. 20:237-241 (1986).] It should be noted that the design of this experiment differed from the endotoxin challenge experiments, in that live organisms, not free endotoxin were the starting materials for the challenge. In humans, continuous infusion of subtherapeutic doses of polymyxin B (10-50% of normal dosage) was found to reduce endotoxin levels, restore some immune functions, and apparently (i.e., results were not statistically significant) reduce wound infection in burn patients. [A.M. Munster et al, J. Burn Care Rehab. 10:327-330 (1989).]

B. Immunization

In addition to antibiotic research and development, the effort to control bacterial infections has focused on the role of host defenses, and in particular, the humoral immune system. The role of active immunization against bacterial components and the utility of passive immunization with antibodies or plasma derived from immunized donors is a highly controversial area. While there is abundant experimental evidence that specific antibodies can protect experimental animals from infections and toxin challenge, the nature and degree of this protection and its relevance to in vivo infection is not clear despite the large volume of literature on the subject. [J.D. Baumgartner and M.P. Glauser, Rev. Infect. Dis. 9:194-205 (1987); and E.J. Ziegler, J. Infect. Dis. 158:286-290 (1988).] Disease progression in the

critically ill patient, and its prevention, involves a myriad of factors which complicate the design and inteφretation of human clinical trials.

In gram-negative bacteremia and endotoxemia. it was found that the frequency of septic shock was inversely related to the titer of antibodies cross-reactive with shared antigens of bacterial LPS. [W.R. McCabe et al, New Eng. J. Med. 287:261-267 (1972).] Given this correlation, an enormous effort has been expended to develop a means of raising endotoxin antibody titers and/or passively transferring endotoxin antibody from donors to experimental subjects and patients.

Antibodies to endotoxin have two important functions. First, by binding free endotoxin, antibodies may block endotoxin activity or remove it from the circulation. Second, immunoglobulin effector functions such as complement fixation and binding to Fc receptors on phagocytes can mediate killing and opsonophagocytosis of bacteria. Thus, endotoxemia, bacteremia, and the onset of sepsis, may be thwarted by such antibodies.

i) Active Immunization One approach to protecting animals and humans from endotoxin-mediated effects is by immunization with bacteria or LPS. For example, it has been shown that immunization of rabbits with a mutant E. coli strain (J5) which lacks certain polysaccharide side chains but possesses a widely shared core lipid A structure can protect the animals from challenge with live Pseudomonas. [A.I. Braude et al, J. Infect. Dis. 136(Supp):S167-S173 (1977).] The J5 vaccine was found to be only weakly protective in a guinea pig model of Pseudomonas pneumonia, whereas a species-specific Pseudomonas LPS was greatly protective. [J.E. Pennington and E. Menkes, J. Infect. Dis. 144:599-603 (1981).] These results suggest that species-specific vaccines may be superior to cross-protective antigens for immunization of humans and other animals against endotoxin. Unfortunately, the vast diversity of LPS antigens makes the former an unlikely prospect.

While active immunization against endotoxin continues to be investigated, there are some important limitations to this approach. First, endotoxin is weakly immunogenic, eliciting only a three- to five-fold increase in antibody titers to LPS with virtually no booster response. [E.J. Ziegler et al, New. Eng. J. Med. 307:1225-1230 (1982).] Second, many patients at risk for sepsis are immunocompromised and may not be capable of mounting

and/or sustaining a sufficient response to be protective upon administration of vaccine. And third, the degree of cross-protection afforded by immunization with one or more core glycolipid antigens is not well understood clinically.

ii) Passive Immunization In order to overcome some of the limitations inherent to active immunization, various techniques have been used to produce endotoxin-binding antibodies that could be passively transferred to experimental animals or human subjects. A large number of endotoxin antibodies have been prepared by: (i) immunization of animals or humans with bacteria, LPS, or derivatives thereof and collection of immune serum or plasma; or (ii) production of monoclonal murine or human antibodies and collection and purification of these antibodies by established methods.

The two major antibody types elicited by either procedure are IgM and IgG antibodies. These antibodies differ in important aspects of their structure and effector functions as well as their titer in normal and hyperimmune plasma. Most studies suggest that IgM antibodies, by virtue of their greater avidity are more effective than IgG antibodies at protecting animals [W.R. McCabe et al, J. Infect. Dis. 158:291-300 (1988)] and humans [Id.; E.J. Ziegler et al. New. Eng. J. Med. 307:1225-1230 (1982)] from gram-negative bacteremia or endotoxin challenge. However, it should be noted that numerous IgG preparations from immunized animal donors have been developed and demonstrated to have some protective effect in experimental studies. [D.L. Dunn et al, Surgery 96:440-446 (1984); and S.J. Spier et al, Circulatory Shock 28:235-248 (1989).] The advantage to IgG preparations is that IgG titers may increase in response to repeated immunization whereas IgM titers are relatively constant. No matter what the immunization course, however, the total amount of bacterially-reactive or endotoxin-reactive antibodies in hyperimmune plasma or serum is only a small fraction of total antibody and is highly variable from donor to donor.

In order to develop more consistent preparations of therapeutic antibodies, numerous LPS-reactive monoclonal antibodies have been developed to both shared and unique epitopes. Since gram-negative sepsis can be caused by a number of species, emphasis has been placed on widely cross-reactive antibodies as potential therapeutics. Two IgM monoclonal antibodies have received the most study. A human-derived antibody now known as Centoxin-HA-IA

[N.N.H. Teng et al, Proc. Natl. Acad. Sci. USA 82:1790-1794 (1985)] and a mouse-derived antibody now known as XOMEN-E5 [Young and Alam, U.S. Patent No. 4,918.163] have been tested in both animals and humans. The animal data suggest that both antibodies are capable of binding endotoxin, neutralizing its biological activity, and suppressing gram- negative bacteremia. Unfortunately, the human clinical studies have not yielded clear benefits [E.J. Ziegler et al, New. Eng. J. Med. 324:429-436 (1991); R.L. Greenman et al, JAMA 266:1097-1 102 (1991)] despite the optimism of the authors and sponsors of these trials. The U.S. Food and Drug Administration has refused to approve either antibody for the treatment of sepsis based upon the extensive clinical trials performed to date. It should be noted that each antibody was tested in humans after the onset of symptoms of sepsis and when the type of organism was uncertain. It is widely believed that anti-endotoxin antibody treatment administered after sepsis is established may yield little benefit because these antibodies cannot reverse the inflammatory cascade initiated by endotoxin and the attendant triggering of mediators such as TNF and IL- 1. In addition, the high cost of each antibody (Centoxin HA-IA was expected to cost $3700 per 100 mg dose) would limt physicians' use of aproduct where no clear benefit has been demonstrated. [K.A. Schulman et al, JAMA 266:3466-3471 (1991).] Of course, these endotoxin antibodies only target gram-negative sepsis; no equivalent antibodies exist for the array of gram-positive organisms and fungi.

III. Inhibiting Cytokines Released During Sepsis

With new knowledge regarding the effects of endotoxin on host inflammatory responses, other therapies are being targeted towards blockage of IL-1 and TNF functions. For example, an IL-1 receptor antagonist has been identified that occupies the same receptor site as IL-1, but mediates no biological effect. Blockage of the IL-1 receptor with this molecule can reduce mortality from endotoxin shock. [K. Ohlsson et al. Nature 348:550-552 (1990).] While the IL-1 receptor antagonist appears to be well-tolerated, the required dosage is extremely large (over 100 mg of recombinant protein per kg of body weight is infused over a period of hours to days). For human therapy, the 8-10 grams of recombinant protein anticipated to be required is likely to be extremely costly (several thousand dollars).

TNF therapies target removal of this mediator from the circulation. Monoclonal antibodies have been found to offer some protection in experimental animals [S.M. Opal et al, J. Infect. Dis. 161 :1 148-1 152 (1990)] but studies in human patients with sepsis have not been conclusive. Once again, these antibodies are likely to be expensive therapeutic agents administered only when signs of sepsis are present.

IV. Prophylaxis

Since the treatment of ongoing septicemia presents so many challenges, there have been several attempts at prevention. These attempts have provided mixed results. One promising study utilized hyperimmune plasma against core glycolipid in surgical patients at high risk of infection. While antibody prophylaxis did not lower the infection rate, it did reduce the severity of gram-negative infections and improved the survival of such patients. [J.-D. Baumgartner et al. Lancet 2:59-63 (1985).] Numerous studies using intravenous immunoglobulin, collected from large numbers of normal donors and containing a wide range of antibodies, have given mixed results. [J.D. Baumgartner and M.P. Glauser, Rev. Infect. Dis. 9:194-205 (1987).] The primary limitations to these studies would appear to be the variable and relatively low potency of pooled immunoglobulin preparations that were used. [T. Calandra et al, J. Infect. Dis. 158:312-319 (1988).]

Monoclonal antibodies have also been made. While these preparations should possess greater potency, their high cost, immunogenicity [S. Harkonen et al, Antimicrob. Agents Chemother. 32:710-716 (1988)] and unusually short circulating half-lives (less than 24 hr) [S. Harkonen et al, Antimicrob. Agents Chemother. 32:710-716 (1988); and C.J. Fisher et al, Clin. Care Med. 18:1311-1315 (1990)] make them unattractive candidates for prophylaxis.

Clearly, there is a great need for agents capable of preventing and treating sepsis. These agents must be capable of neutralizing the effects of endotoxin in gram-negative sepsis as well as controlling and reducing bacteremia. It would be desirable if such agents could be administered prophylactically in a cost-effective fashion. Furthermore, approaches are needed to combat all forms of sepsis, not just gram-negative cases.

SUMMARY OF THE INVENTION

The present invention relates to therapeutics for the prevention and treatment of blood- borne and toxin-mediated diseases, and in particular the prevention and treatment of sepsis in humans as well as other animals. In one embodiment, the present invention relates to compositions and methods for preventing sepsis in high-risk patients (e.g., immunocompromised patients such as surgical and other hospitalized patients, low birth weight infants, and burn and trauma victims). In another embodiment, the present invention contemplates treatment of humans and animals having symptoms of a systemic septic reaction. In accordance with the present invention, a member from the class of compounds broadly described as antibody-antibiotic conjugates or "antibodiotics" is employed for intravenous, intramuscular, intrathecal or topical administration. Antibodiotics are comprised of antibody (e.g., IgG, IgM, IgA) to which an antibiotic is covalently attached to make an antibody-antibiotic conjugate. Preferably, the antibody is non-specific IgG. By non-specific, it is meant that no single specificity within the antibody population or pool is dominant. Thus, it is to be contrasted with the use of antigen-specific antibodies.

In one embodiment, the present invention contemplates an antibiotic-antibody conjugate, comprising antibiotic covalently bound to non-specific immunoglobulin. It is preferred that the immunoglobulin is IgG having an Fc region and is capable of binding to phagocytic cells via the Fc region. In one embodiment, the conjugate is capable of binding to bacteria via the antibiotic.

The conjugate may be bacteriostatic, bactericidal, neither, or both.

However, the antibiotics contemplated are not limited to antibacterial agents; antifungal agents and antiviral agents are also contemplated. Where antibacterial antibiotics are used, agents effective against both gram-positive and gram-negative organisms are contemplated. The present invention contemplates conjugates capable of binding lipopolysaccharide on gram negative bacteria as well as conjugates capable of binding free endotoxin and neutralizing free endotoxin.

Preferred antibiotics include polymyxins, specifically polymyxin B. Polymyxin is a known endotoxin-binding compound capable of binding free endotoxin. The present invention also contemplates a therapeutic preparation, comprising antibiotic covalently bound to non-specific immunoglobulin, wherein the preparation is

bactericidal for both gram-positive and gram-negative organisms. In one embodiment of the therapeutic preparation, the antibiotic is selected from the group comprising cephalosporins and penicillins. In another embodiment, the therapeutic preparation further comprises: (i) a first conjugate consisting of a first antibiotic covalently bound to non-specific immunoglobulin; and (ii) a second conjugate consisting of a second antibiotic covalently bound to non-specific immunoglobulin (e.g., where the first antibiotic is polymyxin and the second antibiotic is vancomycin or bacitracin). In still another embodiment of the therapeutic preparation, two different antibiotics are covalently bound to the same immunoglobulin molecule, one capable of binding to gram-positive organisms and the other capable of binding to gram-negative organisms.

The present invention contemplates a method of treatment, comprising: (a) providing a mammal for treatment; (b) providing a therapeutic preparation, comprising an endotoxin- binding compound covalently bound to protein; and (c) administering the preparation to the mammal (e.g., intravenous). The endotoxin-binding compound may be polymyxin and the protein is preferably non-specific immunoglobulin such as IgG.

The treatment with the antibodiotic is expected to have many of the effects of the antibiotic alone ~ however, without the toxicity and short half-life typically associated with these agents. Furthermore, these conjugates are expected to possess the opsonizing function of immunoglobulin which may facilitate clearance of both the toxin and organism. The present invention contemplates a method of treatment of mammals at risk for developing sepsis, in which a therapeutic preparation comprised of an antibiotic capable of binding to a microorganism covalently bound to a non-specific immunoglobulin is administered to the at-risk animal prior to the onset of any septic symptoms. In a preferred embodiment, it is contemplated that the method of the present invention will be administered intravenously.

The present invention contemplates that the method will be used for such animals as neonatal calves and foals, as well as human and veterinary surgical patients, trauma, and burn victims. It is contemplated that the method will be used to treat immunocompromised patients. It is contemplated that the present invention will be useful for the treatment of mammals potentially exposed to gram-negative and/or gram-positive bacteria. It is

contemplated that the therapeutic preparation used in the method of the present invention is capable of binding endotoxin.

The present invention further contemplates a method of treatment of mammals infected with a pathogenic organism, wherein a therapeutic preparation, comprising a surface-active antibiotic covalently bound to a non-specific immunoglobulin G having an Fc region capable of mediating opsonization of the pathogenic organism is administered. It is contemplated that the infecting pathogen is a gram-negative or gram-positive bacterial organism. It is contemplated that the surface-active antibiotic used in the therapeutic preparation is a polymyxin (e.g., polymyxin B). One embodiment of the present invention contemplates a method of diagnosis, comprising: (a) an antigen associated with the surface of a pathogenic organism immobilized to a solid support; (b) a conjugate comprising a surface-active antibiotic covalently bound to a non-specific immunoglobulin; and (c) a competitor comprising the surface antigen present in solution. The immobilized antigen is incubated with the conjugate in the presence of the competitor, washed to remove unbound conjugate and competitor, followed by detection of the conjugate bound to the immobilized surface antigen.

In a preferred embodiment, the present method of diagnosis comprises immobilization of surface antigen in the well(s) of a microtiter plate. It is also contemplated that the surface antigen of the method is isolated from bacterial organisms. It is contemplated that the surface antigen be isolated from such gram-negative bacteria as Escherichia coli, (e.g., lipopolysaccharide). It is also contemplated that the competitor in the present method of diagnosis is comprised of lipopolysaccharide from gram-negative bacteria. It is further contemplated that the competitor will be comprised of lipopolysaccharide from such gram- negative bacteria as Escherichia coli, Salmonella typhimurium, Pseudomonas aeruginosa, Vibrio cholerae, Shigella flexneri, Klebsiella pneumoniae, Salmonella enter itidit is, Serratia marcescens and Rhodobacter sphaeroides.

The present invention also contemplates a method of synthesizing a conjugate comprising the steps of: a) reacting an antibiotic with a crosslinking agent to form a derivatized antibiotic; and b) reacting the derivatized antibiotic with non-specific immunoglobulin, to form a conjugate. It is further contemplated that the antibiotic will bind to the surface of microorganisms. In a preferred embodiment, the antibiotic is a peptide. In

another preferred embodiment, the peptide is Limulus antilipopolysaccharide factor, in another, the peptide is a D-amino acid-containing peptide. It is also contemplated that the peptide binds endotoxin. In a preferred embodiment, the antibiotic is a polymyxin such as polymyxin B. In an alternative preferred embodiment, the antibiotic used is bactericidal to gram- negative bacteria. In another, the antibiotic is bactericidal to gram-positive bacteria. In one embodiment, the antibiotic is vancomycin. In one embodiment, the non-specific immunoglobulin consists of an Fc region.

The present invention also contemplates a method of synthesizing a conjugate comprising the steps of: a) reacting an antibiotic with a first bifunctional crosslinking agent to form a derivatized antibiotic; b) reacting non-specific immunoglobulin with a second bifunctional crosslinking agent to form a derivatized immunoglobulin; and c) reacting the derivatized antibiotic with the derivatized immunoglobulin to form a covalent bond between the derivatized antibiotic with the derivatized immunoglobulin to form a conjugate. In one embodiment of this method, the antibiotic binds to the surface of microorganisms. In preferred embodiments, the antibiotic is a peptide, such as (but not limited to) Limulus antilipopolysaccharide factor In another preferred embodiment, the peptide is a D-amino acid-containing peptide. In an alternative embodiment, the peptide binds endotoxin. In a preferred embodiment, the antibiotic is a polymyxin, such as (but not limited to) polymyxin B.

In one embodiment of the method, the antibiotic is bactericidal to gram-negative bacteria. In another embodiment, the antibiotic is bactericidal to gram-positive bacteria. In a preferred embodiment, the antibiotic is vancomycin. In an alternative preferred embodiment, the first and second bifunctional crosslinking agents are N-succinimidyl 3-(2-pyridyldithio) propionate. In another embodiment of the method, the first bifunctional crosslinking agent is S-acetylmercaptosuccinic anhydride. In an additional embodiment, the second bifunctional crosslinking agent is sulfosuccinimidyl 4-(N-maleimidomethyl) cyclohexane-1 -carboxylate.

The present invention also contemplates a method of synthesizing a conjugate comprising the steps of: a) providing in any order: i) a crosslinking agent having first and second reactive sites, with the first site being exposed, active, and reactive with primary amino groups, and the second site being blocked by a cleavable group; ii) an antibiotic having

one or more primary amino groups; and iii) non-specific immunoglobulin having one or more primary amino groups; b) reacting in any order: i) the crosslinking agent with the antibiotic, forming a blocked derivatized antibiotic; and ii) the crosslinking agent with immunoglobulin, forming a blocked derivatized immunoglobulin; c) reacting in any order: i) the blocked derivatized antibiotic with a modifying reagent, forming a free derivatized antibiotic; ii) the blocked derivatized immunoglobulin with a modifying reagent, forming a free derivatized immunoglobulin; and d) reacting the free derivatized antibiotic with the free derivatized immunoglobulin to form a conjugate.

In a preferred embodiment of this method, the antibiotic binds to the surface of microorganisms. In another preferred embodiment, the antibiotic is a peptide, such as (but not limited to) Limulus antilipopolysaccharide factor. In one embodiment, the peptide is a D- amino acid-containing peptide. In one embodiment, the peptide binds endotoxin. In a preferred embodiment, the antibiotic is a polymyxin, including (but not limited to) polymyxin B. In a preferred embodiment, an antibiotic bactericidal to gram-negative bacteria is used in the method of the present invention. In another embodiment, the antibiotic is bactericidal to gram-positive bacteria. In a preferred embodiment,, the antibiotic is vancomycin. In an alternative embodiment, the non-specific immunoglobulin consists of an Fc region. In one embodiment of the method, the modifying reagent is a reducing agent. In a preferred embodiment, the reducing agent is dithiothreitol.

The present invention further contemplates a method of synthesizing a conjugate comprising the steps of: a) providing in any order: i) a first crosslinking agent having first and second reactive sites, with the first site being reactive with primary amino groups, and the second site being reactive with maleimide groups; ii) an antibiotic having one or more primary amino groups; iii) a second crosslinking agent having first and second reactive sites, with the first site being reactive with primary amino groups, and the second site being reactive with sulfhydryl groups; and iv) non-specific immunoglobulin having one or more primary amino groups; b) reacting in any order: i) the first crosslinking agent with the antibiotic, forming a derivatized antibiotic; and ii) the second crosslinking agent with the immunoglobulin, forming a derivatized immunoglobulin; and c) reacting the derivatized antibiotic with the derivatized immunoglobulin to form a conjugate.

In one embodiment of this method, the first crosslinking agent is bifunctional. In a preferred embodiment, the first bifunctional crosslinking agent is S-acetylmercaptosuccinic anhydride. In an alternative preferred embodiment, the second crosslinking agent is bifunctional. In one embodiment, the second bifunctional crosslinking agent is sulfosuccinimidyl 4-(N-maleimidomethyl) cyclohexane-1 -carboxylate.

The present invention also contemplates a method of synthesizing a conjugate comprising the steps of: a) reacting a non-specific immunoglobulin with a first modifying reagent to form an oxidized immunoglobulin preparation;and b) reacting the oxidized immunoglobulin preparation with an antibiotic and a second modifying reagent to form an antibiotic-immunoglobulin conjugate. In a preferred embodiment, the immunoglobulin consists of an Fc region.

In one embodiment of this method, the first modifying reagent is an oxidizing agent. In a preferred embodiment, the oxidizing agent is periodate. In an alternative embodiment, the method includes a second modifying reagent which is a reducing agent. In a preferred embodiment, the reducing agent is sodium borohydride.

The present invention also contemplates a method of synthesizing a conjugate comprising the steps of: a) reacting an antibiotic precursor with a first crosslinking agent, the antibiotic precursor possessing limited bactericidal activity to form a derivatized antibiotic precursor, and a derivatized antibiotic precursor possessing increased bactericidal activity; b) reacting non-specific immunoglobulin with a second crosslinking agent, to form a derivatized immunoglobulin; and c) reacting the derivatized antibiotic precursor with derivatized immunoglobulin to form a covalent bond between the derivatized antibiotic precursor and derivatized immunoglobulin to form a conjugate.

In one preferred embodiment, the antibiotic precursor is selected from the group consisting of 7-aminocephalosporanic acid and 6-aminopenicillanic acid. In another embodiment, the first crosslinking agent is bifunctional. In one preferred embodiment, the first bifunctional crosslinking agent is m-maleimidobenzoyl-N-hydroxysulfosuccinimide ester. In another embodiment the second crosslinking agent is bifunctional. In one preferred embodiment, the second bifunctional crosslinking agent is iminothiolane. The present invention further contemplates a method of synthesizing a conjugate comprising the steps of: a) providing in any order: i) a first crosslinking agent having first and

second reactive sites, the first site being reactive with primary amino groups, and the second site being reactive with sulfhydryl groups; ii) an antibiotic precursor having one or more primary amino groups, with the antibiotic precursor possessing limited bactericidal activity; iii) a second crosslinking agent having first and second reactive sites, the first site being reactive with primary amino groups, and the second site being reactive with maleimide groups; and iv) non-specific immunoglobulin having one or more primary amino groups; b) reacting in any order: i) the first crosslinking agent with the antibiotic precursor, forming a derivatized antibiotic precursor; ii) the second crosslinking agent with the immunoglobulin, forming a derivatized immunoglobulin; c) reacting the derivatized antibiotic precursor with the derivatized immunoglobulin to form a conjugate.

In a preferred embodiment, the antibiotic precursor is selected from the group consisting of 7-aminocephalosporanic acid and 6-aminopenicillanic acid. In another preferred embodiment, the first crosslinking agent is bifunctional. In an additional embodiment, the first bifunctional crosslinking agent is m-maleimidobenzoyl-N-hydroxysulfosuccinimide ester. In an alternative preferred embodiment, the second crosslinking agent is bifunctional. In another preferred embodiment, the second bifunctional crosslinking agent is iminothiolane.

DESCRIPTION OF THE DRAWINGS

Figure IA schematically shows the design of an antibodiotic of the present invention. Figure IB schematically shows the design of another antibodiotic of the present invention. Figure 2 schematically shows a means of screening modified antibiotics for anti¬ bacterial activity.

Figure 3 outlines an alternative method by which new antibiotics can be screened for use as compounds for conjugation with immunoglobulins. Figure 3A shows a means by which the minimum concentration for bacterial growth inhibition is established. Figure 3B shows a means by which a new antibiotic can be assessed for bactericidal activity.

Figure 4 describes solid phase assays for determining the level of binding of antibodiotics of the present invention. Step 1 shows toxin or organisms in a testing microwell. Step 2 schematically represents the binding of antibodiotic. Step 3 schematically shows the binding of secondary reagents.

Figure 5 shows conjugates of the present invention binding to LPS, as measured by ELISA.

Figure 6 shows additional conjugates of the present invention binding to LPS, as measured by ELISA. Figure 7 shows inhibition of LPS binding of conjugates of the present invention using free polymyxin (PMB), as measured by ELISA.

Figure 8 shows periodate conjugates of the present invention binding to LPS, as measured by ELISA.

Figure 9 shows inhibition of LPS binding of conjugates of the present invention using LPS of various bacterial species, as measured by ELISA.

Figure 10 shows the binding of conjugates of the present invention to phagocytic cells in a radioactive competition assay.

Figure 1 1 shows the pharmacokinetic profile of intravenously administered PMB-HlgG and HIgG in rabbits expressed in absorbance at 410 nm. Figure 12 shows the pharmacokinetic profile of intravenously administered PMB-HlgG and HIgG in rabbits expressed in IgG concentration.

Figure 13 shows the sequence of Limulus antilipopolysaccharide factor (LALF), a single chain peptide known to bind and neutralize endotoxin.

DESCRIPTION OF THE INVENTION The present invention relates to therapeutics for the prevention and treatment of blood- borne and toxin mediated diseases, and in particular the prevention and treatment of sepsis caused by various types of organisms in humans as well as other animals. The present invention is particularly suited for the in vivo neutralization of the effects of endotoxin. However, it is contemplated that the present invention will be used in the treatment of gram- negative and gram-positive sepsis. Although the invention may be used for treatment of sepsis due to one organism, it may also be used to treat sepsis caused by multiple organisms (e.g., sepsis and/or bacteremia due to gram-negative and gram-positive organisms). The present invention also contemplates treatment comprising multiple antibody-antibiotic conjugates used in combination. It is also contemplated that the present invention will be

used to treat bacteremia, viremia or fungemia, by enhancing the removal of organisms by opsonization.

In accordance with the present invention, soluble antibody-antibiotic conjugates or "antibodiotics" are administered intravenously, intra-muscularly, subcutaneously, intradermally, intraperitoneally, intrapleurally, intrathecally or topically. The conjugate is water-soluble if it has a solubility in physiologic saline of at least 0.1 mg/ml, and preferably of at least 1.0 mg/ml, when measured at room temperature. The present invention contemplates the use of antibodiotics in a therapeutic preparation for both prophylactic and acute treatment. While the benefit conveyed by treatment according to the present invention is not dependent on the understanding of the mechanism(s) by which soluble antibody-antibiotic conjugates achieve a therapeutic result, it is believed that, in the case of bacteria, success is accomplished by: (i) binding and opsonization of bacteria; (ii) bacterial killing (direct killing by the conjugate and/or complement-mediated); and (iii) neutralization and removal of free bacterial toxins (e.g., gram-negative endotoxin, thereby preventing initiation and/or escalation of the septic reaction).

It is believed that antibodiotics provide a low cost, reasonably effective and needed preventive as well as treatment. Antibodiotics can suppress fungal and viral infection. Furthermore, antibodiotics suppress bacteremia as well as endotoxin-mediated effects. Antibodiotics with long (e.g., days to weeks) duration of action are easily administered. Furthermore, since the invention encompasses antibodiotics with reactivity against gram- negative organisms as well as antibodiotics with reactivity to gram-positive organisms, a wider spectrum of protection is expected than any other known approach.

It is also contemplated that this invention will be used in diagnostic applications. These diagnostic applications include methods to detect LPS from particular organisms or the surface structures present on organisms which are recognized by antibiotics (i,e., the receptors expressed on cell surfaces which bind antibiotic).

The description of the invention involves: (I) Antibodiotic Design and Characterization; (II) Antibodiotic in vitro and in vivo Efficacy; (III) Antibodiotic Applications; and (IV) Therapeutic Preparations and Combinations. Section III describes the

use of antibodiotics for: (A) Prophylactic Use in Humans; (B) Acute Therapy in Humans; and (C) Veterinary Care.

I. Antibodiotic Design And Characterization

A. Antibodies In designing antibodiotics, all types of antibody (e.g., IgG, pentameric and monomeric

IgM, secretory and monomeric IgA, IgE and IgD) are contemplated. Nonetheless, there are advantages to using a particular class of antibody. Table 1, for example, compares the characteristics of IgG and IgM. While IgM has the advantage of better opsonization and complement activation, IgG has a longer half-life in vivo and can be raised to higher titers because of the fact that it is the primary antibody raised during secondary responses to antigen. Consequently, the preferred antibody for conjugation according to the present invention is IgG.

While antigen-specific IgG can be employed (e.g., bacteria-seeking antibodies), antigen-specificity may result in a shorter half-life of the compound (and/or greater cost). Consequently, the preferred antibody is non-specific. [Contrast CH. J. Ford et al, Indian J. Pediatr. 57:29-46 (1990).]

Goers et al (U.S. Patent No. 4,867,973) describe the use of antibody conjugated to antimicrobials, but with antigen-specific antibody. In contrast, the conjugates of the present invention utilize non-specific antibody. Goers et al describe in particular the conjugation to antigen-specific monoclonal antibodies. Monoclonal antibodies have not been a step forward in the prevention and/or treatment of bacteremia and sepsis. While these preparations should possess greater potency and specificity than polyclonal sera, they are: a) prohibitively expensive; b) frequently immunogenic; and c) exhibit unusually short circulating half-lives (typically less than 24 hours). With respect to cost, Centoxin (a commercially produced antigen-specific monoclonal antibody) serves as a real life example; the price was approximately $3,700.00 per 100 mg dose. Pharmacoeconomic analysis indicated that - even if the product was used under strict guidelines for acute cases - "its use could add $2.3 billion to the nation's health care budget." [K.A. Schulman et al, JAMA 266:3466-3471 (1991).] The expense of Centoxin is such that it simply could not be used prophylactically. The conjugates of the present invention, on the

other hand, are produced from materials costing a fraction of this figure (e.g., $2.00 per 100 mg dose) because of the readily available inexpensive source of pooled donor IgG.

Also, human monoclonals while perhaps lessening the chance of immunogenicity, do not overcome the problem of short circulating half-lives. In a study using human monoclonal anti-lipid A antibody in patients with sepsis syndrome, the mean serum half-life was approximately sixteen (16) hours. [See C.J. Fisher et al, Clin. Care Med. 18:131 1-1315 (1990).] To maintain a protective level of antibody, this reagent would need to be given repeatedly. Again, the cost of such an approach would be staggering.

From the above, it should now be clear why the limitation to "non-specific immunoglobulin" is a critical limitation that is unique to the present invention. Non-specific IgG is easily and cheaply obtained, requiring no immunization and eliciting no immune response in a syngeneic setting. Non-specific IgG does not have the standardization problems of antigen-specific antibody. Simply put, there is no antigen-specific titer to be concerned about (let alone variability in the titer from unit to unit). Rather, standardization comes from the conjugated ligand; conjugation of non-specific IgG results in >1000-fold increase in LPS- binding titer and by standardization of the ligand that is attached, one standardizes the activity of the therapeutic. Finally, non-specific IgG, unlike monoclonals, has a long half-life needed for a prophylactic (compare the >21 day half-life of pooled polyclonal human IgG with the mean serum half-life of 16 hours for the human monoclonal antibodies discussed above). For puφoses of expense, IgG from donors (i.e., human and animal) rather than cell lines is desirable. In this regard, typically large pools of plasma are used as starting material. Large scale fractionation techniques known in the art include ethanol precipitation and precipitation with high concentrations of salt. [See H.F. Deutsch in Methods in Immunology and Immunochemistry, (CA. Williams and M.W. Chase, eds.), Academic Press, New York, pp. 315-321 (1967).] There is also the somewhat complicated procedure where the immunoglobulin is isolated from Cohn Effluent III by diafiltration and ultrafiltration. [See E.J. Cohn et al, J. Am. Chem Soc. 68:459-475 (1946).]

This latter procedure is used to make a commercially available human IgG preparation called Gammimune® N (Miles, Inc., West Haven, CT). Of course, each individual donor used to make the product must be tested and found nonreactive in tests to determine exposure to or the presence of pathogens. In this product, which is intended for intravenous

administration, the protein (as a 4.5-5.5% solution) has not been chemically modified other than in the adjustment of the pH of the solution to 4.0-4.5. Isotonicity is achieved by the addition of (9-11%) maltose.

Each milliliter (ml) contains approximately 50 mg of protein, of which not less than 98% has the electrophoretic mobility of gamma globulin. Not less than 90% of the gamma globulin is monomeric. There are traces of IgA and IgM. The distribution of IgG subclasses is similar to that found in normal serum.

The commercial product displays a broad spectrum of opsonic and neutralizing antibody activities. When administered intravenously, essentially 100% of the infused IgG antibodies are immediately available in the recipient's circulation. The in vivo half-life equals or exceeds the three week half-life reported for IgG in the literature. It is therefore quite acceptable for use in the preparation of antibody-antibiotic conjugates of the present invention.

Of course, the infusion of large amounts of antibody in humans is contraindicated in individuals who are known to have had previous anaphylactic or severe systemic responses to IgG. Care must also be taken to confirm that there is no sensitivity to the trace amounts of other antibody (e.g., IgA).

Before administration of the antibody-antibiotic conjugates of the present invention to humans, it may be good medical practice to have an antibodiotic sensitivity test performed. This can be done by subcutaneously injecting a small amount of the conjugate in the arm of the patient. A salt solution is injected in the other arm as a control. Normally, a positive

TABLE 1

hypersensitivity test is indicated by no more than formation of a welt on the skin surface with surrounding swelling. Some patients, however, develop anaphylactic shock (i.e., a full-blown immediate hypersensitivity reaction). It is recommended that adrenalin be available for these cases. The usual dosage of the commercial intravenous immunoglobulin product is 100-200 mg/kg (2-4 ml/kg) of body weight administered approximately once a month by intravenous infusion. The dosage may be given more frequently or increased as high as 400 mg/kg (8 ml/kg) body weight, if the clinical response is inadequate, or the level of IgG achieved in the circulation is felt to be insufficient. The present invention contemplates a typical dosage for antibodiotics that is much less than that given for the commercial immunoglobulin preparations. This is particularly true where the number of conjugated antibiotic molecules exceeds one (1) per immunoglobulin molecule. The present invention contemplates a conjugate dosage range of 0.1-100 mg/kg, and a preferred range of 1-20 mg/kg. The amount of PMB (assuming 3 molecules per IgG molecule) contained in a dose for this preferred range will be 0.025 - 0.5 mg/kg.

B. Antibiotics

Thousands of natural, synthetic, and semi-synthetic compounds have been identified that possess antibacterial, antifungal, antiviral, or antiparasitic activity.

In the design of antibody-antibiotic conjugate, a primary consideration is the mode of action of the antibiotic. Since the conjugates will be much larger molecules than the parent antibiotics, only antibiotics that bind to exposed or secreted components (e.g., toxins) of the bacteria, fungus, virus, or parasite are likely to target the antibody carrier to the pathogen or its products. For example, penicillin antibiotics disrupt bacterial cell wall synthesis and bind to surface-exposed components of certain bacteria whereas aminoglycoside antibiotics commonly bind to ribosome subunits in the cell cytoplasm. The former is a much better candidate for effective antibody-antibiotic conjugates than the latter.

Antibiotics vary greatly in the type and species of organisms upon which they are active. For example, certain antibiotics such as the polymyxins are far more effective against gram-negative bacteria, whereas other antibiotics such as vancomycin tend to be more effective against gram-positives. Some, like the cephalosporins, and broad-spectrum

penicillins are comparably effective against both types. Other antibiotics, such as amphotericin are primarily antifungal agents whereas amantadine exhibits activity against certain influenza viruses. In designing antibody-antibiotic conjugates for the prevention or treatment of disease one must consider the spectrum of antibiotic activity desired and select those antibiotic(s) that are active against the target pathogen(s) and, as described above, act primarily on exposed components of the pathogen(s).

As used herein, the term "pathogen" refers to any organism which is associated with infection or disease, whether that organism is among those traditionally considered pathogens (e.g., S. aureus, S. pyogenes, S. dysenteriae, S. flexneri, etc.) or is an opportunistic pathogen (e.g., P. aeruginosa, S. marcesens, S. mitis, etc.).

Within a family of antibiotics (e.g., penicillins, cephalosporins, polymyxins) there are structural features common to all members. However, there often exists a wide variety of natural and synthetic variations on this common structure that may influence the activity spectrum, pharmacokinetics, or other properties of the antibiotic. In the design of antibody- antibiotic conjugates, these structural differences within an antibiotic family are important from two perspectives. First, the activity spectrum may influence the choice of antibiotic; and, second, the chemical differences between antibiotics will influence the range of cross- linking chemistries available to conjugate the antibiotic. For example, the variable side chain component of penicillin antibiotics is a methyl benzyl group in penicillin G but the variable side chain group is a phenolic group with a primary amine side chain in amoxicillin. The latter antibiotic presents a wider array of potential modes for cross-linking than does penicillin G.

In Table 2, several families of antibiotics are disclosed that possess surface- and/or product-reactive activities against various pathogens. This is just for illustration and by no means is intended to limit the invention to these compounds alone.

A preferred antibiotic of the present invention is polymyxin B (PMB). As noted above, this antibiotic binds to and neutralizes endotoxin. However, when used in vivo, PMB is short-lived, and furthermore, at the recommended therapeutic dose for systemic infections, there is a significant risk of nephrotoxicity. The level of protection achieved by the present invention is best understood when compared with other known approaches (see Table 3). For example, the widely-tested and

TABLE 2

Antibiotics That May Be Conjugated To Antibodies

G L Mandell and M A Sande in Goodman and Gilman s The Pharmacological Basis of Therapeutics, 8th Ed ,

(Gilman, Rail, Nies and Taylor, eds ), Pergamon Press, New York, pp 1065-1097 (1990)

Id

M A Sande and G L Mandell in Goodman and Gilman s The Pharmacological Basis of Therapeutics, 8th Ed ,

(Gilman Rail, Nies and Taylor, eds ), Pergamon Press, New York, pp 1 1 17-1 145 (1990)

A Fiechter, Trends in Biotech 10 208-217 (1992)

G L Mandell and M A Sande in Goodman and Gilman _ The Pharmacological Basis of Therapeutics, 8th E ,

(Gilman, Rail, Nies and Taylor, eds ), Pergamon Press. New York, pp 1 146-1 164 (1990)

R G Douglas in Goodman and Gilman s The Pharmacological Basis of Therapeutics, 8th Ed , (Gilman, Rail, Nies, and Taylor, eds ), Pergamon Press, New York, pp 1 182-1201 (1990)

J E Bennett in Goodman and Gilman s The Pharmacological Basis of Therapeutics, 8th Ed , (Gilman Rail, Nies, and

Taylor, eds ), Pergamon Press New York, pp 1 165-1181 (1990)

T Nakamura e/ α. , J Biol Chem 263 16709-16713 (1988)

G Alpert e. α. J Infect Dis 165 494-500 (1992)

R R Schumann et al , Science 249 1429-1431 (19901

M N Marra e. a/ , J Immunol 148 532-537 (1992)

TABLE 3

publicized monoclonal antibody Centoxin-HA-IA is capable of binding endotoxin and neutralizing its biological activity. However, when compared to an IgG-PMB conjugate of the present invention, the monoclonal antibody is costly and suffers from low affinity and short half-life. The latter characteristics may explain why the human clinical studies have yet to yield clear benefits.

Others have attempted to reduce the toxicity of polymyxin B by attachment to dextran.

[D.A. Handley, Eur. Patent Appl. Pub. No. 428486.] However, dextran has a half-life in humans of only about a day. By use of immunoglobulin according to the present invention, a much longer half-life is achieved (see Table 4 and Examples 24 and 25). Dextran, having no

Fc receptor (FcR), also has no known capacity to promote opsonization or activate complement (C).

As it important that the antibodiotics be non-toxic to the host animal, the present invention contemplates the use of conjugates which are effective against the organisms of interest, yet are non-toxic to the host. The non-toxic character of IgG-PMB is demonstrated in Example 27.

As noted previously, the present invention also contemplates antibodiotics having reactivity with gram-positive organisms and their toxins. In one embodiment, the present invention contemplates the use of bacitracin conjugated to immunoglobulin. In another embodiment, the present invention contemplates the use of vancomycin conjugated to immunoglobulin.

Bacitracin is a polypeptide produced by a strain of Bacillus subtil is (Tracy strain), which is primarily bactericidal for gram-positive organisms including Streptococcus pyogenes, other β-haemolytic streptococci, Pneumococcus pneumoniae, and certain strains of Clostridium species. Bacitracin exerts its effect by inhibiting early steps in the biosynthesis of peptidoglycan interfering with cell wall synthesis. Commercially available bacitracin is stable and poorly absorbed from the intestinal tract or wounds. Because of the proteinuria, hematuria and nitrogen retention observed upon systemic administration, its use is usually restricted to topical application. [See e.g., R. Berkow and A.J. Fletcher (eds.), The Merck Manual, 16th ed., 1992, p. 46; and G.F. Brooks et al, Jawet∑, Melnick & Adelberg 's Medical Microbiology, 19th ed., 1991 , pp. 172-173).]

Despite the unacceptable occurrence of nephrotoxicity associated with systemic administration of free bacitracin, when it is conjugated to immunoglobulin according to the present invention, the advantages of bacitracin can be achieved without this side-effect. It is not intended that the present invention be limited by the mechanism of action of any particular antimicrobial.

Vancomycin is active, principally, against gram-positive organisms including Staphylococcus aureus and Clostridium difficile . While it is not intended that the present invention be limited by the mechanisms of action, it is believed that vancomycin exerts its bactericidal action by interfering with cell-wall synthesis. This invention contemplates conjugates synthesized from vancomycin and non-specific human immunoglobulin using a variety of crosslinking agents and schemes. These conjugates, like the ones previously listed, suppress bacteremia as well as toxin-mediated effects for gram-positive organisms.

In one embodiment, the method involves conjugating the vancomycin to non-specific immunoglobulin by first treating the vancomycin and the immunoglobulin with different heterobifunctional crosslinking agents, and second reacting the derivatized species with each other to form a conjugate. In a second embodiment, the method involves conjugating the vancomycin to non-specific immunoglobulin by first reacting the same heterobifunctional crosslinking agent with both the vancomycin and the non-specific immunoglobulin, then second reacting both derivatized species with each other forming a conjugate. For both synthetic schemes a variety of crosslinker combinations have been contemplated and tested. Below is a table which lists the crosslinking compounds which have been tested to date for

TABLE 4

reaction with vancomycin. Some of the crosslinking agents, upon reaction with vancomycin, were insoluble in aqueous solution and were not further pursued. It is recognized, however, that should steps be taken to render them soluble (e.g. addition of solvents, further side group modification of the base vancomycin structure, etc.) that such crosslinking agents could prove useful. The table describes the crosslinking approach, the group on the modified vancomycin that is reactive ("reactive group") with either immunoglobulin or the corresponding linker on immunoglobulin (if any), the solubility, and the biological activity of the conjugate. The following examples describe representative reactions set forth in the table.

C. Conjugates And Cross-linking Numerous agents have been developed for the cross-linking of biological molecules.

[Pierce Chemical Co., (Rockford, IL), General Catalog, pp. E-10 - E-39 (1992).] In general, these agents possess functional groups that are reactive with the side chains of different amino acids found in proteins or peptides. As summarized in Table 5, various functional groups will react with primary amino groups, carboxyl groups, hydroxyl groups, or thiol groups of

proteins or other compounds. In the design of antibody-antibiotic conjugates, the reactive groups of both the antibody and antibiotic must be considered. In general, antibodies have many reactive groups that can be used in direct conjugation schemes (amino acids containing primary amine, carboxyl, hydroxyl, thiol [after reduction]) or modified groups (glycosylated amino acids that can be oxidized to aldehyde; or primary amines that can be made thiol- reactive) for conjugation schemes. Individual antibiotics will not, in general, possess very many different reactive groups and offer fewer choices for conjugation to antibodies. The selection of an antibiotic from a family of related compounds and the selection of a cross- linking scheme must take into consideration the reactive groups on an antibiotic. A key concern in modifying an antibiotic is the preservation of its ability to bind to the surface or secreted products of a pathogen. The modification of individual reactive groups or excessive modification of more than one reactive group with cross-linking agents, or the steric hindrance created by attachment to a large protein such as immunoglobulin may abolish antibiotic activity. Therefore, before conjugate activity is considered, conditions for preservation of antibiotic activity must be determined by examining the biological activity of the modified or cross-linked antibiotic in simple antimicrobial assays. Preferably, one chooses a cross-linker type and concentration that preserves antibiotic activity.

o

Different cross-linkers may influence the activity of individual antibiotics and the efficiency with which they are conjugated to antibodies. In the design of antibody-antibiotic conjugates, the discovery of more optimal cross-linkers relies on the empirical analysis of conjugates prepared using varying concentrations of different cross-linkers. The in vivo safety and efficacy of antibody-antibiotic conjugates will depend upon their activity, toxicity and stability. The selection of the cross-linking agent may also affect these aspects of conjugate performance. For example, in addition to influencing the activity of the conjugate imparted by the antibiotic, the cross-linker employed may affect the properties of the antibody. Effector functions dependent upon the Fc region of the antibody such as opsonization or complement fixation may be influenced by which reactive groups are utilized and their location on the antibody molecule. Furthermore, some cross-linkers may cause adverse reactions by eliciting an immune response to the haptenic groups on the cross- linker. Finally, the in vivo stability of the bonds created by the cross-linking scheme may vary in important ways. Disulfide bonds linking the antibiotic and antibody may not be as stable, for example, as amide bonds created by other cross-linkers. Dissociation between antibody and antibiotic may not be tolerable in cases where long-term prophylaxis is desired.

D. Analogues

The present invention contemplates the use of antibody analogues. Antibody analogues are those compounds which act in an analogous manner to antibodies. In one embodiment, the present invention contemplates fragments of antibodies (e.g., Fc fractions) to make antibody-antibiotic conjugates. As herein used, the terms "antibody" and "immunoglobulin" are meant to include antibody analogues.

E. New Antibiotics And Conjugates

Antibiotic compounds have been isolated from many different microbial, plant, and animal sources and new promising compounds continue to be discovered. In addition, synthetic derivatives of natural compounds as well as wholly synthetic compounds such as small peptides are also being screened for antibiotic activities in many laboratories. As used herein, the term "antibiotic" refers to any chemical compound which destroys, inhibits the growth of, or binds to microorganisms (i.e., "antimicrobials"). It is not intended that the term

TABLE 5

Conjugates

e.g., N-hydroxyl succinimide ester of N-(-4-carboxycyclo-hexyl methyl) maleimide.

be limited only to those compounds which are produced by microorganisms. "Antibiotic" therefore includes compounds which are produced synthetically, as indeed many of the antibiotics are now produced in the chemistry lab rather than by microorganisms. Polymyxin and other compounds discussed herein may be produced synthetically or obtained from

"natural" sources (e.g. B. polymyxa). Therefore, the invention contemplates the design and synthesis of a variety of antibody-antibiotic conjugates utilizing antibiotics from all sources. Figures 2-4 outline the methods by which new antibiotics can be screened for use as compounds for conjugation with immunoglobulins. The "Screening Modes" consist of the following temporal steps:

Mode 1: Conjugate the antibiotic to a cross-linker only and then assess for inhibition of organism growth in liquid culture and on a disc inhibition lawn assay (e.g., Kirby-Bauer).

Mode IIA: Conjugate the antibiotic via the cross-linker to immunoglobulin and then assess for binding to bacteria and bacterial toxin by a solid phase assay. Mode IIB: Conjugate the antibiotic to immunoglobulin without the use of a cross- linker (e.g., periodate oxidation of the carbohydrate groups ["CHO"] of IgG) and then assess for binding to bacteria and bacterial toxin by a solid phase assay.

Mode III: Check specificity of the antibodiotic by inhibition of bacterial toxin binding with the antibiotic. Mode IV: Assess the antibodiotic for inhibition of organisms growth in liquid culture.

By using this approach, a new antibiotic ("X") can be evaluated for use in the present invention. Although it is not required for research use, it is contemplated that in the clinical setting, the current protocols for broth dilution, disk diffusion, and other methods developed by the National Committee for Clinical Laboratory Standards (NCCLS) will be followed. For example, antibiotic X may initially be evaluated by Mode I. In this Mode, X is only conjugated to a cross-linker "c" to create "X-c"; this compound is then added to a liquid or solid phase culture. By creating only part of antibodiotic, the question of compatibility with immunoglobulin is avoided; Mode I only addresses compatibility of "X" with the conjugation chemistry. The assay is performed and the results are compared to an identical assay of unconjugated antibiotic X.

For the lawn assay comparison in Mode I, an agar-filled petri dish is inoculated with the organism (Step 1, Figure 2). A small filter-paper disc containing a known amount of antibiotic X or X-c is placed on the agar surface and allowed to diffuse into the medium over an 18- to 24-hr period (Step 2, Figure 2). After this incubation, a zone of growth inhibition is apparent with X and this is compared to the zone (if any) achieved with X-c (Step 3, Figure 2).

Alternatively for Mode I, known concentrations of X or X-c are diluted in broth in a test tube, which is then inoculated with an organism susceptible to X (Figure 3). After incubation, the concentration that inhibits growth (i.e., no visible growth, as indicated by lack of turbidity) is determined. This value corresponds to the minimum inhibitory concentration

("MIC") (Figure 3A). To assess bactericidal activity, an aliquot is taken from a tube showing bacteriostatic activity, and this aliquot is added to agar plates (Figure 3B). If growth occurs,

then the agent is bacteriostatic; if no growth occurs, the agent is bactericidal. The minimal bactericidal (lethal) concentration is the lowest concentration of X-c or X that produces a 99.9% reduction in organisms from the original inoculum of approximately 100,000 organisms. In this manner the minimum bactericidal concentration ("MBC") is established. [ S. Snyder and R.G. Finch in Modern Pharmacology, 2d Ed. (CR. Craig and R.E. Stitzel, eds.), Little, Brown and Company, Boston, pp. 631-640 (1986); J.E. Conte, Jr. and S.L. Barriere, Manual of Antibiotics and Infectious Diseases, 6th Ed., Lea and Febiger, Philadelphia, pp. 135-152 (1988).]

When comparing X-c with X, some reduction in activity is expected. However, the more potent X is, the greater the reduction in X-c activity permissible. Overall, a range of 0.01 to 50 μg/ml for both the MIC and the MBC is practical.

If the activity of X-c is good, it is further evaluated in Mode IIA. If the activity of X- c is poor, X is evaluated in Mode IIB. Both Modes IIA and IIB contemplate covalent attachment; Mode IIA uses a cross-linker to create "X-c-Ig", while Mode IIB does not use a cross-linker and generates "X-CHO-Ig." In both cases, the antibody-antibiotic conjugate, or simply the "antibodiotic", is assayed on a solid phase assay such as shown schematically in Figure 4.

Toxin or organisms may be used in the solid phase assay to coat a microwell or other appropriate surface (Step 1, Figure 4A). The antibodiotic is then added to test for binding (Step 2, Figure 4A). Standard washing procedures are used to avoid non-specific binding. The antibody portion of the conjugate may thereafter serve as a target for secondary reagents (e.g., goat anti-human IgG antibody having an enzyme reporter group such as horseradish peroxidase) (see Step 3, Figure 4A). An appropriate substrate for the enzyme may then be added (not shown) to generate a colorimetric signal. Where toxin is used in the solid phase assay, X-c-Ig binding may be compared with that of X-CHO-Ig. Where the organism is used, care must be taken that binding is not via the Fc receptor of lg. Unconjugated lg can be used as a control for this puφose.

To avoid any binding due to denaturation or other artifact, conjugates showing reactivity in Mode IIA or Mode IIB should be evaluated in Mode III. As shown in Figure 4B, this simply involves adding free antibiotic to show that it will compete specifically for binding.

The next portion of the evaluation involves testing the antibody-antibiotic conjugate for growth inhibition and/or bactericidal activity (Mode IV). This is the same assay as shown in Figure 2, the difference being that now the complete conjugate X-c-lg (or X-CHO-Ig) is evaluated rather than just the antibiotic (X-c). Both X-c-Ig and X-CHO-Ig may show good toxin binding in Mode II but poor anti¬ bacterial activity in Mode IV. If the specificity of the binding is nonetheless confirmed in Mode III, these compounds are candidates for diagnostic reagents. Alternatively, they may be used in vivo simply to bind free toxin and thereby reduce toxin load.

Thoughtful consideration of the results of each of these steps allows any antibiotic to be analyzed for potential use in the form of an antibodiotic. Following these in vitro tests, the antibiotic can then be evaluated in vivo for reduced toxicity and pharmacokinetics. "antibody" and "immunoglobulin" are meant to include antibody analogues.

F. Antibiotic Precursors And Conjugates

"Antibiotic precursors" as herein defined are reactants used in the synthesis of semi- synthetic antibiotics that possess limited in vitro and in vivo anti-microbial activity.

Therefore one would not typically use such compounds as anti-microbial agents. The present invention contemplates, however, that the "latent" anti-microbial potential of such compounds can be activated upon conjugation, according to the methods herein described, with immunoglobulin. In one embodiment , the method involves, as a first step, the unlocking of the anti¬ microbial potential of antibiotic precursors by derivatizing them with a crosslinking agent. These derivatized antibiotic precursors by themselves possess increased anti-microbial effects compared to the free antibiotic precursors. As a second step, conjugates are made between the derivatized antibiotic precursors and human immunoglobulin. Through this latter step, a conjugate is created that possesses the benefits exhibited by the earlier described conjugates (increased half life, reduced nephrotoxicity, etc.).

II. Antibodiotic In Vitro And In Vivo Efficacy

A. In Vitro Reactivity Of The Fc Region

In the previous section, the key question was whether the antibiotic portion of the conjugate shows the same or similar reactivity as the native antibiotic. However, it must be emphasized that immunoglobulin is not simply an inert carrier. The Fc portion of the antibody can mediate pathogen elimination by two mechanisms that are distinct from the effects of the antibiotic. First, it is known that following binding of antibody to antigen, the Fc region can activate the classical pathway of complement, ultimately resulting in the lysis of organisms. Second, binding of the conjugate to bacteria can lead to the ingestion or opsonization of the organism by recognition of the Fc region by phagocytes (e.g., macrophages) and/or lysis by killer cells. [See L.E. Hood et al, Immunology. 2d Ed., The Benjamin Cummings Publishing Company, Inc., Menlo Park, pp. 339-340 (1984).]

The present invention contemplates antibody-antibiotic conjugates with the capability of binding Fc receptors on phagocytes. It is preferred that in competition binding, the binding of the antibody-antibiotic conjugates of the present invention to such cells is substantially similar to that of normal IgG.

The present invention contemplates antibody-antibiotic conjugates which, while not activating complement systemically, are capable of binding complement to facilitate pathogen killing. Furthermore, conjugates are contemplated which bind phagocytes via the Fc region to facilitate pathogen elimination. Thus, it is contemplated that the antibody-antibiotic conjugates will mediate or enhance opsonization and removal (opsonophagocytosis) of the etiologic agent(s) of sepsis in the treated patient.

B. Efficacy Of The Conjugate In Vivo

Regardless of the manner in which the conjugate is used in vivo (acute, prophylactic. etc.), the conjugate will be present in a background of the entire repertoire of host immune mediators. These immune mediators include, of course, humoral immune mediators such as endogenous antibodies directed against bacteria and their toxins.

In this regard, several studies have suggested a causal relationship between a person ^' s humoral immune status and the susceptibility to gram-negative infections. In patients who survived Pseudomonas aeruginosa septicemia. both total IgG levels and the circulating titer of

core antigen-specific anti-LPS levels were significantly higher than in those patients who succumbed. [M. Pollack et al, J. Clin. Invest. 72:1874-1881 (1983).] Similarly, a correlation has been found between the titer of IgG against the patient's infecting organism and the frequency of shock and death. [S.H. Zinner and W.R. McCabe, J. Infect. Dis. 133:37-45 (1976).]

These studies suggest that patients at risk of gram-negative sepsis and endotoxemia may be so because of weakened humoral immune defenses. For this reason, the present invention contemplates, in one embodiment, determining the immune status of the host prior to administration of the antibodiotic. This determination can be made by screening potential risk groups for total and endotoxin core antigen-specific IgG and IgM levels. [B.J. Stoll et al, Serodiagnosis and Immunotherapy 1 :21-31 (1987).] Screening is believed to be particularly important with the elderly, full-term and pre-term neonates [W. Marget et al. Infection 1 1 :84-86 (1983)], patients with malignancies [C Stoll et al, Infection 13:115-119 (1985)], abdominal surgery candidates, individuals under long-term catheterization or artificial ventilation, and burn and other trauma victims.

Where the immune status is poor (e.g., low total IgG levels and low levels of anti¬ bacterial antibodies), the efficacy of the antibody-antibiotic conjugate is expected to be most dramatic. Where the host's immune status is good, use of the conjugate will support the endogenous anti-bacterial defenses. For optimal in vivo treatment, the conjugate itself must be effective against clinically relevant organisms, non-toxic and non-immunogenic. Thus, it is contemplated that the conjugates of the present invention will be effective against gram-positive and gram-negative organisms which are commonly associated with sepsis (e.g., E. coli, K. pneumoniae, P. aeruginosa, S. pyogenes, S. aureus, S. epidermidis, etc.). It is also contemplated these conjugates will be non-toxic to the host animal. As with any chemotherapeutic, the conjugate must be effective against the infecting organisms, but not harm the host. In addition, in order to enhance the host's response to the infecting organism and to prevent such complications as serum sickness upon subsequent administration of conjugate, the conjugates themselves must be non-immunogenic. This characteristic permits the immune system of the host to focus on battling the infecting organisms, rather than attack the conjugates intended as treatment. As it is contemplated that these conjugates may be administered to the same animal multiple times

(i.e., upon subsequent exposures to potentially pathogenic organisms) it is important that the

host not produce antibodies against the conjugates themselves. Such antibody production would be likely to lead to rapid clearance of the conjugate upon subsequent administration or result in a serious, potentially life-threatening hypersensitivity response.

Conjugates which are non-immunogenic or poorly immunogenic due to high concentrations of D-configuration amino acids are also contemplated. Synthetic polypeptides entirely comprised of D-amino acids are generally unable to elicit an immune response. [M. Sela, in Advances in Immunology, Vol. 5, (F.Dixon and J. Humphrey, eds,), pp. 29-129 (1966).] Thus, conjugation of a synthetic antimicrobial comprised entirely of D-amino acids to the antibody would be beneficial in the present invention.

III. Antibodiotic Applications

A. Prophylactic Use In Humans

The diagnosis of sepsis is problematic. First, the development of sepsis does not require the persistent release of toxin(s) into, nor the presence of organisms the circulation. Thus, many patients who die of sepsis are never shown to be bacteremic. [R.C Bone, Ann. Intern. Med. 115:457-469 (1991).] Second, even if bacteria are detected, the amount of time needed for this detection is often too great to be practical.

For these reasons and others, the present invention contemplates the use of antibodiotics in humans prior to the onset of symptoms (e.g., prophylactically). In particular, the present invention contemplates the use of antibodiotics as a prophylactic in patients at high risk for infection, as well as sepsis.

High risk patients include surgical patients (particularly the elderly), low birth weight infants, burn and trauma. Trauma patients are particularly difficult to examine because of the multitude of invasive procedures that they have undergone. Trauma patients are also typically hooked up to a number of devices, including intravascular lines, mechanical ventilators and Foley catheters. While every attempt is made to change intravascular lines, this is frequently impossible because of the extent of trauma and the lack of venous accessibility. [E.S. Caplan and N. Hoyt, Am. J. Med. 70:638-640 (1981).]

Most patients with multiple trauma have fever, as well as increased white cell counts due to the stress of the trauma itself. The classic indicators of infection, therefore, may or may not reflect an ongoing infection.

Because of this, current clinical practice involves treating patients with antibiotics only, for specific indications, and for as short a period of time as possible. Generally, the average course for any documented infection is seven to ten days. Prophylactic antibiotics are used in only three instances: open fractures, penetrating abdominal injuries and penetrating facial injuries in which there is injury to the respiratory mucosa. Even in these situations, antibiotics are used for only three to five days, depending on the injury.

In contrast, the present invention contemplates treating all trauma patients prophylactically with antibodiotics. Because of the reduced toxicity of the conjugates and their longer residence time in the circulation, the present invention contemplates administering antibodiotics immediately to the trauma patient upon admission. Indeed, the antibodiotics may successfully be used at the first moment that clinical care is available (e.g., emergency mobile care).

Rather than the short (i.e., three to seven day) period of protection provided by native antibiotics, the use of the antibiotic-antibody conjugates of the present invention should protect the trauma patient during the entire period of risk.

Burn patients have many of the same problems with respect to the diagnosis and therapy for infection. Since the magnitude of thermal injury is related to the level of trauma in a burn victim, this even becomes more of a problem with acute cases.

It is reported that septicemia appears in the blood cultures of burn patients almost four days after a septic state. [M. Meek et al, J. Burn Care Rehab. 12:564-568 (1991).]

Consequently, therapy with the conjugates of the present invention is particularly appropriate immediately after the burn injury as a means of preventing a septic reaction. Furthermore, in severe cases, consideration should be given to the topical administration of antibodiotics to prevent wound sepsis. Importantly, burn victims are exposed equally to both gram negative and gram positive organisms. Burn victims are particularly good candidates for therapeutic preparations having bactericidal activity for both gram-positive and gram-negative organisms. This includes conjugates using a single antibiotic with reactivity for both groups of organisms (e.g., antibiotics such as a cephalosporin or broad-spectrum penicillin) and well as therapeutic "cocktail" preparations comprising: (i) a first conjugate consisting of a first antibiotic covalently bound to non-specific immunoglobulin; and (ii) a second conjugate consisting of a second antibiotic covalently bound to non-specific immunoglobulin (e.g., where the first

antibiotic is polymyxin and the second antibiotic is bacitracin). Alternatively, two different antibiotics can be covalently bound to the same immunoglobulin molecule.

The use of blood cultures and the like has also been shown to be unreliable in the diagnosis of neonatal sepsis. Indeed, in practice cultures appear to have little or no influence on antibiotic therapy decision-making for at-risk infants. [T.J. Zuerlein et al, Clin. Ped. 29:445-447 (1990).] For this reason, the conjugates of the present invention can be applied with great advantage (i.e., antibiotics can be used without the concern of toxicity, and the longer circulating half-life allows for antibiotic therapy without necessarily prolonging hospitalization). Finally, surgical patients also represent a risk group where the conjugates of the present invention can be used successfully. Current practice involves the prophylactic use of antibiotics in a very narrow category of cases (e.g., elective colorectal procedures, cholecystectomy, hysterectomy and Caesarean sections). [R.L. Nichols in Decision Making in Surgical Sepsis, B.C. Decker, Inc., Philadelphia, pp. 20-21 (1991).] One to two grams of a broad-spectrum antibiotic are administered intravenously at the induction of anesthesia. An additional dose may be given during an extensive procedure or post-operatively but prophylaxis beyond 24 hours is not indicated. Twenty-four hours of antibiotic prophylaxis is considered to be sufficient to control contamination. Continuance of antibiotic prophylaxis beyond 24 hours is an added expense, particularly when using an antibiotic with short serum and tissue half-lives. Most importantly, continuation of antibiotic prophylaxis also runs an excessive risk of drug toxicity and emergence of resistant strains.

By contrast as shown in rabbits in the accompanying Examples, the longer serum half- life of the conjugates of the present invention provide extended protection against sepsis without the expense of multiple dosing. Furthermore, since the distribution of immunoglobulin is predominantly to vascular compartments, the use of the conjugates of the present invention may reduce the risk of disruption of endogenous flora. Consequently, the conjugates of the present invention may be used liberally (e.g., in more categories of surgical procedures).

B. Acute Therapy In Humans

As noted previously, the present invention also contemplates the use of antibodiotics in a therapeutic preparation for acute treatment. In this case, treatment involves administration of the antibody-antibiotic conjugates after infection is detected and/or sepsis is suspected. Evidence suggestive of gram-negative infection includes the following: (1) core temperature higher than 38°C or lower than 35°C; (2) peripheral blood leukocyte count greater than 12 x 10 ⁹ /L or less than 3 x 10 ⁹ /L (not due to chemotherapy), or at least 20% immature forms; (3) growth of gram-negative organisms from a blood culture drawn within the preceding 48 hours; or (4) documented or suspected site of gram-negative infection. Current medical practice accepts sepsis as having no specific pharmacotherapy available. [R.L. Greenman et al, JAMA 266:1097-1102 (1991).] A systemic septic reaction is characterized by at least one of the following: arterial hypotension (systolic blood pressure <90 mm Hg or an acute drop of 30 mm Hg); metabolic acidosis (base deficit >5 mEq/L); decreased systemic vascular resistance (systemic vascular resistance <800 dynes/s ^• cm ⁵ ); tachypnea (respiratory rate >20/min or ventilation >10 L/min if mechanically ventilated); or otherwise unexplained dysfunction of the kidney (urine output <30 ml/h), or lungs.

It must be stressed that the antibodiotics of the present invention should ideally be used prior to a systemic infection, if possible. For example, the conjugates can be administered immediately after bacteremia or fungemia is detected. Similarly, conjugate(s) can be administered where there is an obvious sign of infection at a particular site (e.g., wounds, sinusitis, meningitis, respiratory, gastrointestinal, or urinary tract infections, etc.).

Primary bacteremia is typically defined as two or more blood cultures with the same bacterial organism occurring in a patient with no other obvious site of infection. Sinusitis is diagnosed in a patient who has at least two of the following: purulent nasal discharge, roentgenographic evidence of sinusitis or purulent material aspirated from the sinuses.

The lower respiratory tract is a common site of infection. Pneumonia in the intubated patient is diagnosed in a patient when there is fever, leukocytosis and a Gram stain with many polymoφhonuclear leukocytes. Pneumonia may also be diagnosed in the patient with a new infiltrate that has not cleared with intensive physical therapy (this last criterion helps rule out atelectasis).

C. Veterinary Care

Septicemia and sepsis are by no means limited to human beings. Infection by gram- negative bacteria accounts for significant morbidity and mortality in neonatal livestock, such as calves. [D.D. Morris et al, Am. J. Vet. Res. 47:2554-2565 (1986).] Interestingly, humoral immune status is again related to susceptibility to sepsis and this is largely dependent on passive transfer from colostrum. For this reason, the present invention contemplates, in one embodiment, determining the immune status of the animal prior to administration of the antibodiotic. This determination can be made by screening neonatal calves for total circulating serum immunoglobulin (e.g., by ELISA). Where the immune status is poor (e.g., low total IgG levels), the conjugate should be used prophylactically. Where the animal's immune status is good, use of the conjugate may be needed for acute therapy of gram-negative bacterial sepsis, which remains prevalent in neonatal calves even with high antibody levels.

The present invention contemplates the treatment of other animals as well. Among foals less than 10 days of age in critical distress, sepsis is the most serious problem. [A.M. Hoffman et al, J. Vet. Int. Med. 6:89-95 (1992).] Symptoms highly indicative of sepsis risk include weakness, metabolic disturbance and dehydration. In one embodiment, the invention contemplates using antibodiotics for prophylactic treatment of foals less than 10 days of age having these indicators, or those at risk of infection. While positive blood cultures are found in less than half of the cases, those animals found positive have a very poor chance of survival. The present invention therefore contemplates using antibodiotics for acute treatment of any animal with evidence of septicemia, with or without culture-proven cases.

IV. Therapeutic Preparations And Combinations The present invention contemplates using therapeutic compositions of soluble antibodiotics. It is not intended that the present invention be limited by the particular nature of the therapeutic preparation. For example, such compositions can be provided together with physiologically tolerable liquid, gel or solid carriers, diluents, adjuvants and excipients. In addition, antibodiotics may be used together with other therapeutic agents, including unconjugated immunoglobulin.

As noted above, these therapeutic preparations can be administered to mammals for veterinary use, such as with domestic animals, and clinical use in humans in a manner similar to other therapeutic agents. In general, the dosage required for therapeutic efficacy will vary according to the type of use and mode of administration, as well as the particularized requirements of individual hosts.

With respect to the mode of administration, the antibodiotics may be employed for intravenous, intramuscular, intrathecal or topical (including topical ophthalmic) administration.

Formulations for such administrations may comprise an effective amount of antibodiotic in sterile water or physiological saline. On the other hand, formulations may contain such normally employed additives as binders, fillers, carriers, preservatives, stabilizing agents, emulsifiers, buffers and excipients as, for example, pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharin, cellulose, magnesium carbonate, and the like. These compositions typically contain l%-95% of active ingredient, preferably 2%-70%. The compositions are preferably prepared as injectables, either as liquid solutions or suspensions; solid forms suitable for solution in, or suspension in, liquid prior to injection may also be prepared.

The antibodiotics of the present invention are often mixed with diluents or excipients which are compatible and physiologically tolerable. Suitable diluents and excipients are, for example, water, saline, dextrose, glycerol, or the like, and combinations thereof. In addition, if desired the compositions may contain minor amounts of auxiliary substances such as wetting or emulsifying agents, stabilizing or pH buffering agents.

Where repeated administrations are required, it may be beneficial to first clear any anti-hapten antibodies by administering free antibiotic. This can then be followed by administration of the antibodiotic.

EXPERIMENTAL

The following examples serve to illustrate certain preferred embodiments and aspects of the present invention and are not to be construed as limiting the scope thereof.

In the experimental disclosure which follows, the following abbreviations apply: eq (equivalents); M (Molar); μM (micromolar); N (Normal); mol (moles); mmol (millimoles); μmol (micromoles); nmol (nanomoles); gm (grams); mg (milligrams); μg (micrograms); ng

(nanograms); L (liters); ml (milliliters); μl (microliters); cm (centimeters); mm (millimeters); . μm (micrometers); nm (nanometers); °C (degrees Centigrade); AUFS (absoφtion units full scale); hr (hour); sec (second); min (minutes); IV (intravenous); lg (immunoglobulin); FCS (fetal calf serum); CFU (colony forming units); ELISA (Enzyme-Linked Immunosorbent Assay); Aldrich (Aldrich Chemical Co., Milwaukee, WI); Amicon (Beverly, MA); Baxter (Deerfield, IL); BBL (Becton Dickinson Microbiology Systems, Cockeysville. MD); Bio-Rad (Richmond, CA); Corning (Corning, Inc., Coming, NY); Falcon (Lincoln Park, NJ); Lee (Lee Laboratories, Grayson, Georgia); Harlan Sprague-Dawley (Harlan Sprague-Dawley, Indianapolis, IN); ICN (ICN Biomedicals, Costa Mesa, CA); Mallinckrodt (Mallinckrodt, St. Louis, MO); Pharmacia (Pharmacia, Inc., Piscataway, NJ); Pierce (Pierce Chemical Co.,

Rockford, IL.); Prochem (Prochem, Inc., Rockford, IL); Scientific Products or S/P (Scientific Products, McGraw Park, IL); S & S (Schleicher & Schuell, Inc., Keene, NH); Sigma (Sigma Chemical Co., St. Louis, MO.);Spectrum (Spectrum, Houston, TX); Whatman (Whatman, Inc., Clifton, NJ). In some of the examples below, purification of products from reactants is performed using various types of chromatography. Standard terms understandable to those skilled in the art are employed to describe this purification. For example, "eluent" is a chemical solution capable of dissociating desired products bound to the column matrix (if any) that passes through the column matrix and comprises an "eluate". Products that are dissociated (if any) are freed from the column matrix and pass by elution with the "eluent" into the "eluate".

EXAMPLE 1

Attachment Of An Antibiotic To Human IgG Using A Carbodiimide Cross-Linker

This example describes attempts to attach antibiotics to a carrier (i.e., in this case antibodies). In this regard, K. Hanasawa et al. describe the attachment of PMB to an immobilized fiber via carbodiimide chemistry. [Surg. Gyn. & Ob. 168:323-331 (1989).] In this example, the ability of a carbodiimide cross-linker to conjugate polymyxin B (PMB) to human IgG was analyzed.

It is known that l-ethyl-3(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) cross-links proteins and peptides between amine and carboxylic acids. The example involved:

(a) EDC-mediated cross-linking of PMB and IgG; and (b) enzyme-linked immunoassay (ELISA) of conjugate binding to LPS.

a) EDC-Mediated Cross-Linking Of PMB To IgG

In this and in all examples, measures were taken to make glassware, solutions, and other materials and reagents pyrogen-free because adventitious pyrogen (e.g., LPS) could inhibit conjugation reactions, absorb PMB or conjugates, or block the activity of PMB conjugates.

Human IgG (Sigma) and PMB (Sigma) were each dissolved at a concentration of 8 mg/ml in pyrogen-free MES (2-[N-Mθφholino]ethanesulfonic acid) buffer (0.1M MES, 0.09 M NaCl pH 4.7). 0.5 ml of each solution were mixed together and 0.15 ml of the mixture was incubated with 0.15 ml of either 0.4 M EDC, 0.2 M EDC, 0.1 M EDC (Pierce), or control solution in MES buffer, for 2 hrs at room temperature. The reactions were stopped by the addition of 2.7 ml of TBS (50 mM Tris-HCl, 150 mM NaCl, pH 7.2). The five mixtures were dialyzed separately (molecular weight cut-off of dialysis tubing 12-14,000, Scientific Products) at 4°C against four changes of 1500 ml of PBS over a 36 hr period. The samples containing human IgG at 0.2 mg/ml were stored at 4°C.

b) Enzyme-Linked Immunoassay Of EDC-PMB Conjugate Binding To LPS

In order to determine whether the attachment of PMB facilitated the binding of IgG to LPS, a simple indirect binding assay was performed. To each well of a 96-well microtiter plate (Falcon), 100 μl of a 2.0 μg/ml solution of E. coli 0111 :B4 LPS (Sigma) in PBS was coated, except for those control wells in which PBS but no LPS was added. After an overnight incubation at 4°C, the coating solutions were decanted and all wells were washed three times with PBS. Non-specific binding sites were blocked by the addition of 100 μl of PBS containing 5 mg/ml bovine serum albumin (BSA, Sigma) for 2 hrs at room temperature. After decanting the blocking solution, samples of the conjugates prepared in (a) above were diluted in PBS containing 1 mg/ml BSA to an initial concentration of 10 μg/ml IgG followed by five-fold dilutions. A positive control antiserum of commercially prepared rabbit anti-E. coli 0111 :B4 antiserum (Lee Laboratories, Lot M25082) was initially diluted 1 :100. One hundred (100) μl of each sample was incubated in duplicate for two hours at room

temperature and the plates were washed three times with BBS-Tween 20 (0.1 M boric acid, 0.025 M Na borate, 1.0 M NaCl, 0.1% Tween 20, pH 8.3), followed by two washes with PBS-Tween 20 (0.1% Tween 20 (v/v)), and finally, two washes with PBS.

In order to detect bound antibodies, the wells incubated with the human antibody conjugates were incubated with 100 μl of a 1 :500 dilution of goat anti-human IgG (whole molecule)-alkaline phosphatase conjugate (Sigma) and the wells incubated with the rabbit serum were incubated with 100 μl of a 1 :500 dilution of goat anti-rabbit IgG (whole molecule)-alkaline phosphatase conjugate (Sigma) for 2 hours at room temperature. The secondary antibody solutions were discarded, the plates were washed with BBS-Tween 20, and PBS-Tween 20 as above and then twice with 50 mM Na ₂ Co ₃ , 10 mM MgCl ₂ , pH 9.5. After 45 minutes at room temperature, the absorbance of each well was measured at 410 nm on a Dynatech MR700 plate reader using diluent control wells as blanks. Tables 6 and 7 show the results for the rabbit control serum and EDC-conjugates.

The results in Table 6 show that the positive control serum, as expected, bound to LPS-coated wells in a specific manner. These data validate the ELISA design as being capable of detecting LPS binding antibodies.

The results in Table 7 appear to indicate that EDC cross-linking caused the IgG-PMB to bind to the LPS. However, the titration of the conjugates drops off rather abruptly between 5 and 1 μg/ml. To verify that the observed binding is specific, it must be determined that the binding is inhibitable by PMB and antigen-dependent.

TABLE 6

Binding Of Rabbit Anti-E. coli 0111 :B4 Antiserum To E. coli 0111 :B4 LPS (OD _4I0 Values)

The ELISA described above was repeated; however, in this instance, a fixed concentration of the EDC-conjugate (10 μg/ml) that yielded the highest binding by ELISA was incubated with five-fold dilutions of polymyxin B (beginning with 10 mg/ml) and the LPS-binding activity was determined. In addition, the binding was

TABLE 7

Binding Of EDC-Mediated Human IgG-PMB Conjugates To E. coli 01 11 :B4 LPS (OD _{4 ]0} Values)

tested in control wells containing no antigen. The results are shown in Tables 8 and 9. Since the binding of the conjugate is only inhibited at the very highest concentration of PMB tested and because the conjugate exhibited significant binding to wells that contained no antigen, it is clear that most of the binding observed is was not specific. This may reflect an inappropriate type or number of bonds between PMB and IgG and, since IgG that was not treated with a cross-linker shows very little binding to LPS, it suggests that the cross-linking of the IgG molecule is causing nonspecific binding.

TABLE 8

Specificity Of EDC-Conjugates Of IgG-PMB Binding To LPS: PMB Inhibition Test (OD ₄₁₀ Values)

Clearly, carbodiimide chemistry does not work at a level which is practical. Indeed, it is evident that the interactions of the cross-linking reagent with the antibiotic are somewhat complex. It is to be remembered that three reactions arepossible: PMB to PMB; IgG to IgG; and PMB to IgG. Only the latter reaction is productive.

TABLE 9

Antigen-Dependent Binding Of EDC-Conjugate Of IgG-PMB To LPS (OD ₄₁₀ Values)

EXAMPLE 2

Attachment Of An Antibiotic To Human IgG Using A Disuccinimide Ester

In an attempt to remedy the difficulties observed with EDC conjugates, different cross- linkers and chemistries were investigated. Talmadge and Siebert describe the attachment of PMB via a hvdroxysuccinimide ester reagent. [J. Chrom. 476:175-185 (1989).] Along the lines of this approach, this example examines the ability of a homobifunctional cross-linking agent suberic acid bis-(N-hydroxysuccinimide ester) (DSS), which cross-links peptides and proteins via their amine groups, to conjugate PMB to IgG. The example involved: (a) DSS- mediated cross-linking of PMB and IgG; and (b) ELISA of conjugate binding to LPS.

a) DSS-Mediated Cross-Linking Of PMB To IgG

Pyrogen-free PBS was prepared in pyrogen-free water (Baxter), and stock solutions of human IgG (40 mg/ml) and PMB (40 mg/ml) were dissolved in pyrogen-free PBS. A 60 mM stock solution of DSS was prepared in 100% dimethylsulfoxide (DMSO). This solution was diluted to 6.0 mM DSS in PBS where some precipitation was noted. A stock solution of human IgG and PMB was prepared containing 20 mg/ml IgG and 20 mg/ml PMB in PBS. Five different conjugates were prepared by mixing two-fold dilutions of the stock DSS solution (0.15 ml) with a constant (0.15 ml) volume of the IgG/PMB stock solution. The five resulting DSS concentrations were 3.0 mM, 1.5 mM, 0.75 mM, 0.375 mM , and 0.0 mM DSS. After incubation for 1 hour at room temperature, the reactions were stopped by the addition of 2.7 ml of TBS. The five mixtures were dialyzed against PBS as described in Example 1 for the EDC conjugates. The resulting dialyzed conjugates contained a final concentration of 1 mg/ml IgG and were stored at 4°C

b) ELISA Of DSS Conjugated Binding to LPS

The ELISA was performed essentially as in Example 1(b) using the DSS conjugates at starting concentrations of 10 μg/ml and the same control rabbit anti-E. coli 01 1 1 :B4 antiserum. The results of the initial binding assay are shown in Table 10.

TABLE 10

Binding Of DSS Conjugates Of IgG-PMB To LPS (OD _4I0 Values)

The results indicate a low level of binding that is correlated with the concentration of

DSS utilized. The specificity of this binding was then tested by examining the ability of PMB to inhibit binding and its dependence on antigen. The assays were performed exactly as described for the EDC conjugates in Example 1(b). The results are shown in Tables 11 and

12.

These results indicate that the DSS conjugate binds somewhat non-specifically. The pattern of PMB inhibition is erratic in that the highest concentration shows no inhibition of binding but intermediate PMB concentrations do apparently inhibit.

These results indicate some level of specific binding above a significant amount of non-specific binding. The binding of the control rabbit antiserum at 1 :500 and 1 :12,500 dilution was 1.766 and 0.380, respectively and was virtually all antigen-dependent. The relatively low level of binding here suggests that hydroxysuccinimide ester reagents such as DSS are not very effective cross-linkers for PMB and IgG. This could be due to the amine- amine chemistry employed, or the properties of the DSS agent. We did note some insolubility of DSS in PBS; perhaps a more water soluble form of DSS would perform better.

TABLE 11

Inhibition Of IgG-PMB Binding To LPS By Free PMB (OD ₄₁₀ Values)

TABLE 12

Antigen-Dependent Binding Of DSS Conjugate Of IgG-PMB To LPS (OD ₄₁₀ Values)

In addition, in both cases of the EDC and DSS conjugates, the PMB was exposed to a vast excess of cross-linker which could inhibit the ability of PMB to bind to LPS.

EXAMPLE 3

Two-Step Conjugation Of PMB To IgG Using EDC And A Water Soluble Analogue Of DSS

In the previous two examples, cross-linkers were present in molar excess over IgG and were mixed simultaneously with both antibody and antibiotic. In this example, IgG was first modified with the cross-linker, the cross-linker removed, and then PMB added to the coupling reaction. In this way, the binding activity of PMB might be improved and the non-specific binding of the IgG reduced. In order to have an amine to amine coupling reagent that was more water soluble, BS ³ (Pierce), a water soluble analogue of DSS was employed. The example involved: (a) two-step conjugation of IgG-PMB with EDC; (b) two step conjugation of IgG-PMB with BS ³ ; and (c) ELISA of conjugate binding to LPS.

a) Two-Step Conjugation Of IgG-PMB With EDC

A 0.75 ml of a 4 mg/ml IgG solution in MES buffer was prepared as described in Example 1, and mixed with 0.75 ml of a 0.4 M EDC solution in MES buffer at room temperature for 2 hours. The unreacted cross-linker was removed by passing the 1.5 ml reaction mixture over a Sephadex G-10 (Pharmacia) column that was poured into a sterile 10 ml pipette and equilibrated with pyrogen-free MES buffer. The void volume was collected and the IgG content was determined by measuring the OD ₂₈₀ of a 1 :40 dilution of each fraction. The peak fraction containing 2.37 mg IgG/ml was divided into two fractions: 1.5 mg of PMB was added and dissolved in one volume; nothing was added to the other

(control). After incubation at room temperature overnight, the reaction was stopped with TBS and the final IgG concentration was adjusted to 0.2 mg/ml. Both samples were dialyzed as in Example 1 (a) and stored at 4°C

b) Two-Step Conjugation Of IgG To PMB With BS ³

A 0.75 ml of a 20 mg/ml IgG solution was mixed with 0.75 ml of a 6.0 mM BS ³ solution, each prepared in PBS and incubated at room temperature for 1 hr. Unreacted cross- linker was removed as in Example 3(a) above and the peak IgG fractions identified and pooled. Two equal fractions of IgG at 8.35 mg/ml were made and 7.5 mg of PMB was added and dissolved in one while nothing was added to the other. After overnight incubation at room temperature, the reactions were stopped with TBS, the conjugates dialyzed and the final IgG concentration adjusted to 1.0 mg/ml.

c) ELISA Of Conjugate Binding To LPS This LPS-binding assay was performed as described in Example (1 ) except that the

BBS-Tween 20 washes were eliminated and the Tween 20 concentration in the PBS-Tween 20 wash was lowered to 0.05% (v/v). The results are shown in Tables 13 and 14.

The 0.2 M EDC IgG-PMB conjugate exhibited a high level of binding but this was partly due to non-specific binding as evidenced by the binding to control wells containing no LPS. Further evidence of non-specific binding created by EDC cross-linking is shown by the results for the conjugate containing no PMB (which exhibited somewhat comparable levels of binding to the wells regardless of whether antigen was present or not).

TABLE 13

Binding Of Two-Step EDC Conjugates To LPS (OD ₄₁₀ Values)

TABLE 14

Binding Of Two-Step BS ³ Conjugate To LPS (OD _4l0 Values)

The BS ³ conjugates exhibited no specific binding to LPS whatsoever at the concentrations tested. However, they did not exhibit much non-specific binding either, indicating that this cross-linker may not be as problematic as EDC in causing non-specific binding of IgG.

Given the low level of BS ³ conjugate background binding, the ELISA was performed again using igher concentrations of the conjugates and a tenfold higher concentration of LPS coated onto the wells (2 μg LPS/well). This increased the assay sensitivity. The results shown in Table 15 indicate that the BS ³ conjugates do possess LPS-binding activity above background.

Together, the results of the two-step conjugations described in this example indicate that EDC creates an unacceptable level of non-specific binding, while BS ³ , the water soluble analogue of DSS, effects a modest level of specific binding and causes very little non-specific binding in this two-step conjugation format. Additional two-step conjugation procedures using other cross-linkers were investigated to determine whether higher levels of LPS-binding activity could be achieved than those obtained with BS ³ .

TABLE 15

More Sensitive Detection Of BS ³ Conjugates Of IgG-PMB Binding To LPS (OD ₄₁₀ Values)

EXAMPLE 4

Three Step Conjugation Of PMB To IgG Using An Amine To Sulfhydryl Coupling Chemistry With SMCC

Because of the unsatisfactory results of previous examples in obtaining high specific- binding of IgG-PMB conjugates to PMB, an alternative cross-linking method was investigated using sulfosuccinimidyl 4-(N-maleimidomethyl) cyclohexane-1 -carboxylate [sulfo-SMCC] in a three-step procedure similar to that of T. Kitagawa et al. [J. Assoc. Anal. Chem. (1985).] The example involved: (a) three-step conjugation of PMB to reduced IgG with sulfo-SMCC; and (b) ELISA of conjugate binding to LPS.

a) Three-Step Conjugation Of PMB To IgG In the first step of this procedure, reactive thiol groups were created in the IgG by treatment with 2-mercaptoethanol. In this procedure, 4.0 mg of IgG was first dissolved in 0.45 ml of pyrogen-free 0.1M NaPO ₄ pH 6.0. Fifty μl of 0.1 M 2-mercaptoethanol in 5 mM EDTA, 0.1 NaPO ₄ , pH 6.0 was then added and incubated at 37°C for 1.5 hours. The free 2- mercaptoethanol was separated by applying the 0.5 ml sample to a 5 ml Sephadex G-10

column equilibrated in 0.1 M NaPO ₄ , 5 mM EDTA, pH 6.0 and the IgG containing fractions identified and pooled.

The second step of this procedure involved preparation of malemide-activated PMB.

This involved mixing 1.5 ml of a 0.16 mg/ml PMB solution in 50 mM sodium borate buffer, pH 7.6 (pyrogen-free) and 1.5 ml of a 0.46 mg/ml sulfo-SMCC (Pierce) solution in the same borate buffer (creating a final concentration of 0.053 mM of each reactant). This "SMCC- activated" PMB was incubated at 30°C for 60 minutes.

The third step of the procedure involved incubation of 0.65 ml of the reduced IgG with 0.65 ml of the SMCC-activated PMB. The concentrations of the two reactants were 0.0265 mM PMB and 0.013 mM IgG (a

2:1 molar ratio). After incubation at 4°C for 20 hrs, 8.7 μl of a fresh solution of 0.1 M 2- mercaptoethanol was added and incubated at room temperature for 20 minutes. The IgG concentration was adjusted to 1.0 mg/ml with an equal volume of PBS. Samples of the conjugates were purified by dialysis against two 800 ml volumes of PBS over a 20 hour period or by gel filtration on a Sephadex G-10 column equilibrated in PBS. A control reduced human IgG fraction was prepared from the reduced IgG pool and the three preparations stored at 4°C

b) ELISA Of Conjugate-Binding To LPS

The LPS binding assay procedure was the same as that described in Example 1(b) except that the LPS was coated at 2 μg/well, the BBS-Tween 20 washes were eliminated, and the Tween 20 concentration in the PBS-Tween 20 wash was lowered to 0.05%. The blocking solution and sample diluent were prepared using pyrogen-free PBS and low-endotoxin BSA (Sigma). The results are shown in Table 16.

TABLE 16

Binding Of An SMCC Conjugate Of IgG-PMB To LPS (OD _4l0 Values)

The SMCC IgG-PMB exhibited slightly higher binding to LPS than the control but the overall level of binding was far below that of the positive control rabbit anti-E. coli 01 1 1 :B4 antiserum (1.097 at a 1 :25,000 dilution). It is possible that reduced IgG possesses only a few thiol groups available for cross-linking and that higher concentrations of activated PMB might drive the reaction more effectively.

EXAMPLE 5

Conjugation Of An Antibiotic To IgG Without Using A Bifunctional Cross-linker

In all of the previous examples, free bifunctional cross-linkers were employed in attempts to covalently attach the antibiotic polymyxin to IgG. The configurations failed to yield a conjugate with LPS-binding activity comparable to that of an immune serum. Because of the binding observed in the absence of antigen, there were probably conjugates having less than one active PMB molecule to each molecule of IgG. To investigate means of attaching antibiotics to IgG without the involvement of a bifunctional cross-linker, periodate oxidation of the carbohydrate groups of IgG [D.A. Handley, Eur. Patent Appl. Pub. No. 428486] was used to create amine-reactive aldehyde groups that could potentially react with PMB and be reduced to establish a stable covalent linkage.

The example involved: (a) periodate oxidation of IgG in pH 4.0 sodium acetate buffer; and (b) conjugation of polymyxin B to periodate oxidized IgG.

a) Periodate oxidation of IgG in pH 4.0 sodium acetate buffer was achieved by dissolving 5 mg human IgG in 1 ml of water and mixing this solution with 200 μl of sodium acetate pH 4.0 (0.3 g sodium acetate and 960 μl glacial acetic acid in 100 ml H ₂ O) and 200 μl of 0.2 M NaIO ₄ . [Modification of J.W. Goding, Monoclonal Antibodies: Principles and Practice, Academic Press, New York, p. 84 (1986).] After 15 minutes at room temperature in the dark, the periodate solution was removed by gel filtration on a P-10 column in 50 mM Na ₂ CO ₃ , pH 9.5.

b) Conjugation of periodate-oxidized IgG with PMB was carried out by adding 10 mg of PMB to the IgG prepared in (a) and incubating for 1 hour at room temperature, followed by the addition of 100 μl of NaBH ₃ CN (4 mg/ml) and room temperature incubation for another hour and dialysis against PBS overnight at 4°C

Inspection of the LPS binding activity (not shown) revealed that the prepared conjugate was inactive. These results suggest that the periodate-oxidation of IgG, without the use of a cross-linker, is an ineffective means of covalent conjugation of antibiotics to antibody.

EXAMPLE 6

The Derivatization Of Antibiotics With Cross-Linkers: Preservation Of Antibiotic Activity

A significant concern with either one-step or multi-step schemes for conjugating antibiotics to antibodies is whether the conjugation scheme reduces or inactivates antibiotic function. In order to determine the best cross-linker concentration for derivatization of PMB in a multi-step conjugation scheme, the effect of the concentration of cross-linker on antibiotic activity was determined (see discussion of Mode I A above). The example involved: (a) modification of PMB with SPDP and the separation of free cross-linker; and (b) assay of derivatized PMB antibacterial activity.

a) Modification of PMB with SPDP and the separation of free cross-linker was carried out by mixing three different molar ratios of SPDP (2: 1, 3:1 and 4:1) to PMB. First, 2.1 mg, 3.15 mg or 4.2 mg of SPDP (Pierce) dissolved in dimethyl sulfoxide was added to 5 mg of PMB in 0.5 ml of 50 mM sodium borate, 300 mM NaCl, pH 9.0 and incubated for 30 minutes at room temperature with occasional shaking. Free cross-linker was then removed from each sample by chromatography on a 15 ml Swift desalting column equilibrated with PBS-EDTA. The peak fractions containing the derivatized PMB were collected and pooled.

b) Assay of derivatized PMB antibacterial activity was carried out in a disc inhibition assay (see Figure 2). E. coli HB101 was plated on Trypticase Soy Agar (TSA; BBL) to create a confluent lawn of bacteria. One-quarter inch blank paper discs (BBL) were then applied to the surface of the lawn and 20 μl of each test solution applied. After incubation at 37°C overnight, zones of inhibition surrounding the disc were observed. The results (not shown) indicate that PMB derivatized at 2:1 or 3: 1 molar ratios of SPDP-PMB were still active whereas antibiotic derivatized at a 4:1 molar ratio was inactive. Therefore, derivatization of PMB with SPDP should be carried out at ratios of SPDP to PMB of less than or equal to 3:1.

EXAMPLE 7

Conjugation Of SPDP-PMB To IgG

Having determined an SPDP cross-linker concentration that preserved the antibiotic activity of polymyxin B in Example 6, conjugates were prepared between SPDP-PMB and IgG by reacting the derivatized antibiotic with IgG to which sulfhydryl (-SH) groups were introduced with Traut's reagent.

The example involved: (a) derivatization of PMB with SPDP; (b) derivatization of IgG with Traut's reagent; (c) conjugation of Traut-IgG with SPDP-PMB; and (d) conjugate LPS-binding activity assessment.

a) Derivatization of PMB with SPDP was carried out by adding 7 μmoles of

SPDP (2.1 mg) in 50 μl of dimethyl-sulfoxide to 10 mg of PMB in 1 ml of 50 mM sodium borate, 300 mM NaCl, pH 9.0 and incubating at room temperature for 30 minutes on a

rotating shaker. The unconjugated cross-linker was removed by applying the sample to 15 ml. Swift desalting column (Pierce) equilibrated with 20 mM NaPO ₄ , 150 mM NaCl, 1 mM EDTA, pH 7.2 (PBS-EDTA). Peak fractions were pooled and stored at 4°C.

b) Derivatization of IgG with Traut's reagent was carried out by adding a five- fold molar excess (100 μl of a 0.2 mg/ml stock) of Traut's reagent (Pierce) to 5 mg of IgG dissolved in 1 ml of 50 mM triethanolamine, 0.15 M NaCl, 1 mM EDTA, pH 8.0 and incubating under nitrogen for 45 minutes at room temperature. The excess Traut's reagent was removed by gel filtration on a P- 10 column equilibrated with PBS-EDTA. The peak fractions were combined.

c) Conjugation of Traut-IgG with SPDP-PMB was carried out by adding 3.5 mg

Traut-IgG and 2 mg SPDP-PMB (77 fold molar excess of PMB) and incubating for 18 hours at room temperature. The conjugates were separated from free SPDP-PMB by gel filtration on a P- 10 column (50 ml) equilibrated with PBS-EDTA and the peak fractions containing the IgG were collected, pooled, and stored at 4°C

d) Conjugate LPS-binding activity assessment was carried out by evaluating the ability of each conjugate in (c) to bind LPS in an ELISA assay (see Figure 4). The results indicated that the Traut IgG-PMB conjugate possessed limited binding activity (not shown).

EXAMPLE 8

Conjugation Of SPDP-PMB To SPDP-IgG

Having determined that Traut's reagent does not generate a conjugate with preserved antibiotic activity in Example 7, conjugates were prepared between SPDP-PMB and IgG by reacting the derivatized antibiotic with IgG in which amino (NH ₂ ) groups were convered to sulfhydryl (-SH) groups by activation with SPDP.

The example involved: (a) derivatization of PMB with SPDP; (b) derivatization of IgG with SPDP; (c) conjugation of SPDP-IgG with SPDP-PMB; and (d) conjugate LPS- binding activity assessment.

a) Derivatization of PMB with SPDP was carried out as in Example 7.

b) Derivatization of IgG with SPDP was carried out by adding 20 μl of 20 mM SPDP to 10 mg of IgG in 1 ml of 50 mM sodium borate, 300 mM NaCl, pH 9.0 and incubating 30 minutes at room temperature with shaking. The free cross-linker was removed by chromatography on a 15 ml Swift desalting column equilibrated in 100 mM sodium acetate, 100 mM sodium chloride pH 4.5. The peak fractions were collected and concentrated on Centriprep-30 concentrator (Amicon). To this sample, 7.7 mg of dithiothreitol in 250 μl of 100 mM sodium acetate, 100 mM sodium chloride, pH 4.5 was added and incubated at room temperature for 30 minutes. The sample was again applied to a 15 ml Swift desalting column equilibrated with PBS-EDTA and peak fractions with the highest OD ₂₈₀ were collected, pooled, and concentrated on a Centriprep-30 concentrator (Amicon).

c) Conjugation of SPDP-IgG with SPDP-PMB was carried out by adding the following combinations of reactants:

5 mg SPDP-IgG and 2 mg SPDP-PMB (43 fold molar excess of PMB) - 2 mg SPDP-IgG and 2 mg SPDP-PMB (107 fold molar excess of PMB) and incubating for 18 hours at room temperature. The conjugates were each separated from free SPDP-PMB by gel filtration on a P- 10 column (50 ml) equilibrated with PBS-EDTA. Fractions containing PMB-IgG conjugate were collected, pooled, and stored at 4°C

d) Conjugate LPS-binding activity assessment was carried out by evaluating the ability of each conjugate in (c) to bind LPS in an ELISA assay and comparing them with the

Traut conjugate produced in Example 7. The results (Figure 5) indicated that both SPDP- IgG-PMB conjugates possessed considerable activity ~ a much higher activity than that of the Traut IgG-PMB conjugate.

EXAMPLE 9 Conjugation Of PMB To IgG Using A Long Chain SPDP Cross-Linker

Since SPDP proved to be an effective agent for the derivatization and cross-linking of

IgG and PMB, a long chain form of SPDP (sulfo-LC-SPDP) was then examined to see if the

addition of a larger spacer arm between the IgG and PMB enhanced the activity of the conjugate. This example involved: (a) derivatization of PMB with sulfo-LC-SPDP; (b) derivatization of IgG with sulfo-LC-SPDP; (c) conjugation of derivatized IgG with derivatized PMB; and (d) conjugate activity assessment by ELISA.

a) Derivatization of PMB with sulfo-LC-SPDP was carried out by adding 35 μl of a 9 mg/ml solution of sulfo-LC-SPDP to 10 mg of PMB in 1 ml of 50 mM sodium borate, 300 mM NaCl, pH 9.0 and incubating for 30 minutes at room temperature. Free cross-linker was removed by gel filtration on a 1.5 x 35 cm P-2 column equilibrated in PBS-EDTA. Peak fractions containing derivatized PMB were combined and stored at 4°C

b) Derivatization of IgG with sulfo-LC-SPDP was carried out by adding 0.3 mg of sulfo-LC-SPDP to 10 mg of IgG in 50 mM sodium borate, 300 mM NaCl pH 9.0 and incubating for 30 minutes on a rotating shaker. The derivatized IgG was separated from free cross-linker on a 5 ml Swift desalting column (Pierce) equilibrated with 100 mM sodium acetate, 100 mM sodium chloride, pH 4.5 and the peak fractions collected and pooled. This sample was then reduced by adding 7.7 mg of dithiothreitol in 250 μl of the same sodium acetate buffer and incubated for 30 minutes at room temperature. Excess reducing agent was removed by gel filtration on a 10 ml P- 10 column equilibrated in PBS-EDTA. The peak fractions were collected and pooled.

c) Conjugation of derivatized IgG with derivatized PMB was carried out by adding 2.5 mg of IgG to 2.5 mg of PMB (107-fold molar excess of PMB) and 3.5 mg of IgG to 1.4 mg of PMB (43-fold molar excess of PMB), and incubating for 18 hours at room temperature. The IgG-PMB conjugate was separated from the rest of the reaction mixture on a 50 ml P- 10 gel filtration column equilibrated with PBS-EDTA.

d) Conjugate activity assessment by ELISA indicated that the sulfo-LC-SPDP conjugates did not possess greater activity than the shorter SPDP molecule (Figure 6).

EXAMPLE 10

Inhibition Of Specific Binding Of Antibodiotic To LPS By Free Antibiotic

In order to determine that the antibody-antibiotic conjugate binding observed in Figure 5 is specific, free antibiotic was used to block conjugate binding (see Mode III discussion, above). This example involved: (a) mixing of the antibodiotic with free antibiotic; and (b) assaying the degree of conjugate binding to LPS in the presence of different concentrations of free antibiotic.

a) Mixing of antibodiotic with free antibiotic was performed by adding an equal volume of a 1 :125 dilution (32 μg/ml) of the SPDP IgG-PMB conjugate in PBS-Tween 20 (0.05%>) containing 1 mg/ml BSA with polymyxin at 0-20 μg/ml in the same buffer. Two hundred (200) μl of this mixture containing 0-2 μg of PMB and 3.2 μg of conjugate was then assayed for binding activity.

b) Assaying the degree of conjugate binding to LPS in the presence of different concentrations of free antibiotic was performed by adding 200 μl of the antibodiotic/free antibiotic mixture to wells of a 96-well microtiter plate that was coated with 2 μg of E. coli 0111 :B4 LPS and blocked as described in Example 1. The wells were washed, goat anti- human Ig-alkaline phosphatase was added, and the binding assayed quantitatively on a MicroELISA reader exactly as described in Example 1.

The results are shown in Figure 7 and demonstrate that free polymyxin competitively inhibits IgG-PMB binding to LPS. Clearly, the antibodiotic is binding specifically to LPS (i.e., via the conjugated PMB moieties).

Inspection of the inhibition curve gives some indication of the extent of active PMB conjugation, in that a 16 μg/ml solution of antibody (1.1 x 10 ^"7 M) is 50% inhibited in its binding to LPS by a concentration of 40 ng/ml PMB (2.6 x 10 ^"8 M). If one molecule of PMB was present on each PMB (making the PMB concentration on IgG equal to 1.1 x 10 ^"7 ) one would expect that an equimolar concentration of free PMB would inhibit binding by 50%.

Since it requires one fourth the concentration of free PMB to inhibit this antibodiotic, one may conclude that there is at least one PMB molecule per four IgG molecules. In fact, since

SPDP-modified PMB has a four-fold lower antibiotic activity than free PMB, the actual

degree of IgG conjugation with PMB is probably at least four-fold higher than that calculated above (i.e., there is probably at least one PMB conjugated to each IgG molecule).

EXAMPLE 11

Conjugation Using Periodate Oxidation Of IgG In NaPO ₄

In Example 5, a means of attaching antibiotics to IgG without the involvement of a bifunctional cross-linker (i.e., periodate oxidation of the carbohydrate groups of IgG) was attempted. This involved, in part, periodate oxidation of IgG in pH 4.0 sodium acetate buffer and failed to yield a conjugate with significant activity. Because this failure may have been due to the reaction conditions, different reaction conditions were explored. This example involves: (a) periodate oxidation of IgG in phosphate buffer; and (b) conjugation of polymyxin B to periodate oxidized IgG.

a) Periodate oxidation of IgG in phosphate buffer was achieved by dissolving 10 mg of human IgG in 1 ml of 50 mM NaPO ₄ , pH 7.2 and adding 0.011 g sodium metaperiodate (final concentration 50 mM). After 30 minutes at room temperature, the periodate was removed by gel filtration on a 10 ml P- 10 gel filtration column equilibrated in 50 mM NaPO ₄ , pH 7.2. The peak fractions containing antibody were pooled and concentrated to 1.5 ml.

b) Conjugation of periodate-oxidized IgG with PMB was carried out by adding 10 mg of PMB to either 5 mg or 3 mg of IgG prepared in (a) at 4°C overnight with gentle shaking, followed by reduction with 0.1 mg/ml NaBH ₃ CN in 20 mM NaPO ₄ , pH 6.5 for 3 hours at room temperature. The IgG-PMB was separated from the rest of the reaction products by gel filtration on a 10 ml P- 10 column.

Inspection of the LPS binding activity (Figure 8) revealed that the conjugates prepared were active. This is in contrast to the conjugate prepared in Example 5.

EXAMPLE 12

Antibacterial Activity Of IgG-PMB Conjugates

Having determined which conjugates of IgG-PMB possessed LPS binding activity, the biological activity of the conjugates were examined (see discussion of Mode IV, above). Since polymyxin possesses direct antibiotic activity, it was possible that the conjugated polymyxin was also active. To determine whether the conjugates had any antibacterial activity, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for the SPDP-conjugated IgG-PMB (107-fold molar excess of PMB, Example 8) and the periodate mediated IgG-PMB conjugate (3:1 ratio of PMB, Example 11) were determined. The example involved: (a) preparation of an E. coli bacterial inoculum; (b) determination of the MIC; and (c) determination of the MBC.

a) Preparation of an E. coli bacterial inoculum was initiated by first culturing E. coli HB101 overnight on TSA agar at 37°C. Colonies were suspended in sterile saline at 1.2 x 10 ⁸ organisms/ml then diluted to 5 x 10 ⁵ organisms/ml in Trypticase-Soy Broth (TSB; BBL). This concentration was confirmed by dilution plating.

b) Determination of MIC for each conjugate and a native polymyxin B control was made by mixing 0.5 ml of the 5 x 10 ⁵ organisms/ml inoculum with 0.5 ml of a two-fold dilution series of each conjugate and incubating overnight in sterile 12 x 75 mm culture tubes at 37°C The MIC was defined as the lowest concentration of the conjugate or PMB which resulted in complete inhibition of visible growth.

For the PMB control, the MIC was found to be 0.031 μg/ml while for the SPDP conjugate, the MIC was found to be 0.25 mg/ml. For the 3:1 (PMB:IgG) periodate conjugate, the MIC was found to be 0.031 mg/ml, which is approximately 1000-fold higher than for native PMB and eight-fold lower than for the SPDP IgG-PMB conjugate. Thus, both IgG- PMB conjugates do indeed retain antibacterial activity with the periodate conjugate exhibiting the highest degree of activity. The difference between the PMB and IgG-PMB values reflect in part, the greater size of IgG (about 100 times that of PMB) in that if PMB activity was perfectly preserved during conjugation and one PMB molecule was conjugated to each IgG molecule, the MIC would increase 100-fold due to the size of the IgG. The 1000-fold shift

observed suggests that the activity of PMB is reduced by conjugation, and/or not all IgG molecules are conjugated. Nonetheless, it is suφrising that a small surface-active antibiotic can still inhibit bacterial growth when conjugated to a much larger protein.

c) Determination of the MBC for each conjugate was made by plating serial dilutions of the mixtures in (b) above that exhibited no growth on TSA agar overnight at 37°C The MBC was defined as the lowest concentration of conjugate of PMB which resulted in 99.9% or more of the viable organisms in the primary inoculum being killed. The MBC for the PMB was found to be 0.031 μg/ml, for the SPDP IgG-PMB it was 0.5 mg/ml, and for the periodate it was 0.031 mg/ml. The ability of the IgG-PMB conjugates to suppress bacterial growth and to kill bacteria on contact suggests that these compounds may be effective in preventing or treating bacteremia.

EXAMPLE 13

The Effect Of IgG-PMB Conjugate On Complement And Its Activation By LPS

Both immunoglobulin and LPS have the potential to interact with complement. The interaction of LPS with complement can exacerbate the inflammatory response to endotoxemia or bacteremia. In this example, the ability of IgG-PMB conjugate to block complement activation by LPS was investigated. In addition, since immunoglobulin can also trigger adverse complement reactions [S. Barandun et al, Vox Sang. 7:157-174 (1962)], the ability of conjugate alone to activate complement was also determined. The example involved: (a) determination of the LPS concentrations sufficient to activate complement; and (b) blocking LPS-induced complement activation with IgG-PMB.

a) Determination of the LPS concentrations sufficient to activate complement was carried out by adding varying concentrations of LPS to a standard quantity of a complement source (CH50 Reference Standard; Sigma) and measuring the amount of complement consumed by titration on sensitized sheep red blood cells (SRBCs). [Modification of A. Chonn et al, J. Immunol. 146:4234-4241 (1991).]

To 40 μl of the Reference Standard, 40 μl of solution containing 80 μg, 8μg, 0.8 μg, 0.0 μg of E. coli LPS or GVB+2 buffer (Sigma) were added, mixed, and incubated for 30 minutes at 37°C Five or 10 μl aliquots of each mixture or a blank control were then added to CompQuick CH50 tubes (Sigma), mixed by repeated inversion and incubated for 60 minutes at room temperature with occasional mixing. The tubes were then centrifuged at 600 x g for 10 minutes at 4°C and the hemolysis present in the supernatant measured at 415 nm versus the lysis control blank solution. The CH ₅₀ value of each mixture was calculated as follows:

„ _Υ1 . „ . Absorbance of Sample „„ , _ , , CH, _n of Sample = — x CH ₅₀ of Standard

Absorbance of Standard

The results are shown in Table 17.

TABLE 17

Activation Of Complement By LPS

These results show that preincubation of a complement source with LPS consumes complement which is then unavailable for action on SRBCs in the second phase of the assay. The LPS effect was concentration-dependent.

b) Blocking of LPS-induced complement activation with IgG-PMB was carried out by mixing SPDP-conjugated IgG-PMB prepared as described in Example 7 with LPS and then examining the effect of pretreated LPS on complement activation. To 1.5 μg of E. coli

026:B6 LPS, 7.5 μg of IgG PMB or 15 μl of a buffer control was added and incubated at 37°C for 60 minutes. Thirty (30) μl of complement (Ref-Std as in (a) above) or GVB+2 buffer was added to each sample and incubated for 60 minutes at 37°C. Twenty (20) μl of each mixture was added to CompQuick CH50 tubes (Sigma), mixed and incubated for 60 minutes at room temperature. The tubes were centrifuged as in (a) above and hemolysis quantitated at 415 nm. The results are shown in Table 18.

The results show that preincubation of IgG-PMB with LPS blocks the effect of LPS on complement activation. Furthermore, the IgG-PMB conjugate has no effect on complement activation on its own, suggesting that cross-linking with PMB has not perturbed IgG structure such that it would have a deleterious effect through

TABLE 18

Inhibition Of LPS-Mediated Complement Activation By IgG-PMB

spontaneous complement reactions. The ability to block LPS effects and the apparent safety of the IgG-PMB conjugate suggests that it could possess both prophylactic and therapeutic value against bacteremia and endotoxemia.

EXAMPLE 14

Improved IgG-PMB Conjugates

Methods were investigated for improving the activity of the IgG-PMB conjugates prepared by the methods of Example 7 (SPDP) and Example 1 1 (periodate oxidation Schiff base reduction). Since both families of conjugates exhibited much higher levels of LPS- binding than conjugates prepared with other chemistries, it was possible that even higher levels of binding could be achieved by increasing the degree of PMB-substitution on the IgG. The two mechanisms employed for achieving greater substitution were to increase the reactant (IgG and PMB) concentration at the conjugation step and to use more highly derivatized SPDP-PMB. The example involved: (a) preparation of a new periodate IgG-PMB conjugate; (b) preparation of new SPDP IgG-PMB conjugates; (c) ELISA of conjugate binding to LPS; (d) determination of conjugate MICs and MBCs; and (e) determination of the degree of conjugation by amino acid analysis.

a) Preparation of a new periodate IgG-PMB conjugate was carried out by oxidizing 30 mg of IgG dissolved in 1 ml of 50 mM NaPO ₄ , pH 7.2 with 10.7 mg of sodium periodate (Sigma) for 30 minutes at room temperature. The 1 ml reaction mixture was applied to a 15 ml Swift desalting column equilibrated in 50 mM NaPO ₄ , pH 7.2 and the peak IgG fractions were pooled to an IgG concentration of 7.1 mg/ml. To 1 ml of this lg mixture containing 0.0476 μmoles of IgG, 20 mg of PMB (14.44 μmoles) was added and incubated overnight at 4°C The reaction mixture was adjusted to pH 6.5 with 1.0 N HCI, and 10 μl of a 10 mg/ml NaBH ₃ CN solution was added and incubated at room temperature for 4 hours. The conjugate was then chromatographed on a 10 ml P- 10 column and stored at 4°C

b) Preparation of new SPDP IgG-PMB conjugates was carried out by first derivatizing PMB at 2:1 and 3:1 molar ratios of SPDP:PMB as described in Example 6. For each reaction, 5 mg of IgG in 0.5 ml was derivatized with 15 μl of 20 mM SPDP solution in

DMSO by incubating for 30 minutes at room temperature with intermittent shaking. The derivatized IgG was purified on a 15 ml Swift desalting column equilibrated with acetate buffer and the peak fractions were pooled and concentrated on a Centriprep-30 concentrator

(Amicon). To the 5 mg of IgG in 1.8 ml of acetate buffer, 7.7 mg of dithiothreitol in 250 μl

of acetate buffer was added and incubated at room temperature for 30 minutes. Each sample was then purified on a 15 ml Swift desalting column equilibrated in PBS-EDTA. To each sample containing approximately 5 mg of SPDP derivatized IgG, 5 mg of PMB derivatized at either a 2:1 or 3:1 molar ratio of SPDP was added and incubated for 18 hours at room temperature. Each conjugate was then separated from free SPDP-PMB by gel filtration on a P-10 column (50 ml) equilibrated with PBS-EDTA, and the peak fractions were collected, pooled, and stored at 4°C

c) ELISA analysis of conjugate binding to LPS was performed as described in Example 1 using E. coli 0111 :B4 LPS (Sigma). The binding of different dilutions of the periodate conjugate made in (a) above, and the two SPDP conjugates made in (b) above to LPS coated and uncoated wells of a 96 well microtiter plate are shown as averages of duplicate samples in Table 19.

The results show that the 3:1 SPDP:PMB conjugate had the highest specific LPS binding activity, approximately 2-4 times the binding exhibited by the 2:1 SPDP: PMB conjugate and the periodate conjugate at concentrations of 0.8-4.0 μg/ml.

d) Determination of conjugate MICs and MBCs was carried out exactly as described in Example 12 using E. coli HB101 as the susceptible test strain. The results are shown in Table 20.

When compared with these determinations for the conjugates examined in Example 12, the new periodate conjugate is four times as potent, and the 3:1 SPDP-PMB conjugate is twice as potent. Suφrisingly, the periodate conjugate exhibits lower LPS-binding activity by ELISA but stronger antibacterial activity than the 3:1 SPDP-PMB conjugate. Perhaps the modification of PMB and IgG with SPDP improves the conjugation efficacy but decreases the antibiotic activity compared to the conjugation of native PMB to periodate-treated IgG.

e) Determination of the degree of conjugation by amino acid analysis was carried out by examining the amino acid composition of 2:1 SPDP Ig-PMB, 3:1 SPDP Ig-PMB, and the periodate Ig-PMG conjugates above, compared with control samples of native human IgG and free polymyxin B. The novel amino acid diaminobutyric acid (DAB) which constitutes 6 of the 10 residues of PMB was the key component that was detected and quantitated.

Five samples in all were analyzed, including:

1. Free PMB (25 nmoles in 50 μl H ₂ 0)

2. Periodate Ig-PMB (600 pmoles in 100 μl PBS)

3. SPDP 3:1 Ig-PMB (600 pmoles in 100 μl PBS)

4. SPDP 2:1 Ig-PMB (600 pmoles in 100 μl PBS)

5. Human IgG (600 pmoles in 100 μl PBS)

TABLE 19

LPS-Binding Activity Of New IgG-PMB Conjugates

TABLE 20

MIC And MBC For The New IgG-PMB Conjugates

The samples were prepared by transferring each to a glass hydrolysis tube using three rinses of 100 μl of pure water and then concentrated to dryness in a vacuum centrifuge. To each of the sample tubes, 500 μl of distilled 6N HCI, 10 μl of 2-mercaptoethanol, and 10 μl of a 50% aqueous phenol solution were added. The tubes were then purged with nitrogen gas and capped. The samples were hydrolyzed by heating at 110°C for 22 hours and then concentrated again to dryness. The PMB sample was suspended in 500 μl of 0.2 N sodium citrate buffer, pH 2.2 while the other four samples were suspended in 250 μl of this buffer. After thorough mixing, the sample solutions were passed through a 0.2 μm pore nylon membrane syringe filter.

A Beckman instruments 6300 Amino Acid Analyzer was used to analyze 20 μl of each filtered hydrolysate solution. The machine was equipped with a Beckman 10 cm cationic exchange HPLC column, a Beckman sodium buffer system, a 60 minute analysis methodology, and a Beckman ninhydrin reagent detection system with absorbance measured at the 570 nm and 440 nm wavelengths. The detector sensitivity was set at 1.0 AUFS for the PMB sample and 0.5 AUFS for the other four samples.

All data collection and peak integration calculations were performed with a Gilson HPLC System Controller 712 v. 1.1 software package (Middleton, WI). Sample peak identification and amino acid concentrations were determined by comparison to analyses made at known concentrations of a 17 amino acid standard mixture (Beckman Standard, Lot #A108039) and (S) - (+) 2,4 - Diaminobutyric acid dihydrochloride (Aldrich Chemical, Lot #07301 CY). The results of the amino acid analyses are shown in Table 21.

The values represent the estimated amino acid composition of each sample, determined by multiplying the percentage of each amino acid measured by the expected total number of amino acids (1320 for human IgG, for example). The moles of PMB/mole IgG were calculated by dividing the number of unique DAB residues detected by 6 (the number of DAB residues/PMB).

The results show that the 3:1 SPDP conjugate possessed the highest degree of conjugation (avg. 3.7 PMB molecules per IgG molecule). This is consistent with this conjugate possessing the highest LPS-binding activity as measured by ELISA (see (b) above). The 3:1 SPDP conjugate contained, on average, twice the number of PMB molecules than the 2: 1 SPDP conjugate, which would explain the two-fold greater activity of the 3: 1 SPDP conjugate in the LPS-binding ELISA. The periodate Ig-PMB is also well conjugated and it exhibited the highest degree of antibacterial activity. It appears that the SPDP linkage affords the highest degree of LPS-binding activity while the periodate linkage provides greater antibacterial activity. This may reflect steric differences in the way PMB is attached to the IgG and/or the different effects of the two conjugation chemistries on PMB activity.

EXAMPLE 15

The Use Of IgG-PMB Conjugates As A Diagnostic: Cross- Reactivity Of Different Gram-Negative LPS Antigens with IgG-PMB

Since the IgG-PMB conjugates exhibited binding to E. coli Oi l 1 :B4 LPS, and this species is only one of many potential gram-negative agents of endotoxemia and bacteremia, it was of interest to determine whether the IgG-PMB conjugate was capable of detecting other species of LPS in a diagnostic format using a competitive ELISA. The example involved: (a) coating of E. coli 011 1:B4 LPS to microtiter wells; (b) incubation of IgG-PMB conjugates with different concentrations of several species of LPS; and (c) assay of conjugate binding to E. coli 0111 :B4 LPS in the presence of competitor.

a) Coating of E. coli 01 11 :B4 LPS to the wells of 96-well microtiter ELISA plates was performed as described in Example 1, (100 μl/well of pyrogen-free PBS containing 1 mM EDTA and 2 μg of LPS was coated onto the wells and allowed to incubate overnight

at 4°C). The wells were washed with PBS-0.05% Tween 20 and blocked with PBS containing 10 mg/ml endotoxin-free BSA at 37°C for 90 minutes.

TABLE 21

Amino Acid Composition Of Ig-PMB Conjugates

b) Incubation of IgG-PMB conjugates with different concentrations of LPS purified from E. coli 0111 :B4 (control standard) Salmonella typhimurium, Pseudomonas aeruginosa, Vibrio cholerae, Shigella flexneri, Klebsiella pneumoniae, Salmonella enteritidis, Serratia marcescens, and Rhodobacter sphaeroides (all

from Sigma, except the Rhodobacter, which was obtained from List Biologicals Laboratory, Campbell, CA) was carried out by adding 250 μl of a 7.2 μg/ml solution of IgG-PMB conjugate prepared with a 3:1 molar ratio of SPDP:PMB (Example 13) to 250 μl of PBS- 0.05%) Tween 20 containing 1 mg/ml BSA followed by incubation at 37°C; 100 μl of these mixtures was added per well.

c) Assay of conjugate binding to E. coli 01 1 1 :B4 LPS in the presence of competitor was measured by incubating 100 μl of the mixtures from (b) above at 37°C for 1 hour. The plates were then washed and the wells incubated with alkaline phosphate- conjugated goat anti-human IgG (Sigma) diluted 1 :500 in PBS with 0.05% Tween 20 containing 1 mg/ml BSA, incubated 37°C for 1 hour, washed again and incubated in p- nitrophenyl phosphate for 30 minutes and read at 410 nm, as described in Example 1. The results are shown in Figure 9 and demonstrate that LPS antigens from all nine species representing four different orders of gram-negative bacteria compete effectively for IgG-PMB binding to E. coli 0111 :B4 LPS. These results show that IgG-PMB conjugates can be used to detect and quantitate a LPS from a variety of bacterial species, and suggest that the IgG-PMB conjugate will be therapeutically effective against a broad spectrum of gram-negative organisms and endotoxins.

EXAMPLE 16

Neutralization Of The In Vivo Effects Of Endotoxin By IgG-PMB

Endotoxin (LPS) can trigger a lethal reaction in vivo. In order to determine whether

IgG-PMB conjugate is capable of neutralizing the lethal effects of endotoxin, a well- characterized and accepted murine model of endotoxic shock was utilized. [C. Galanos et al, Proc. Natl. Acad. Sci. USA 76:5939-5943 (1979).] The example involved: (a) determination of a minimum lethal dose of endotoxin in galactosamine-sensitized mice; and (b) neutralization of endotoxin lethality by premixture with Ig-PMB.

a) Determination of a minimum lethal dose of endotoxin in galactosamine- sensitized mice was performed by administering different doses of E. coli 0111 :B4 LPS to

C57B1/6 mice that were co-administered 20 mg of D-galactosamine-HCl in 400 μl of PBS.

The latter compound is a specific hepatotoxic agent that increases the sensitivity of experimental animals to endotoxin several thousand-fold. [C. Galanos et al, Proc. Natl. Acad. Sci. USA 76:5939-5943 (1979).] To accomplish this determination, 1-500 ng of E. coli 01 11 :B4 LPS (List Biological Laboratories, Campbell, CA) in PBS was injected intraperitoneally, along with 20 mg of D-galactosamine (Sigma). It was found that 10-25 ng of endotoxin was usually sufficient to kill most or all mice within 24 hr. The variability in endotoxin lethality may be related to the different ages of the mice used. Since 10 ng was the minimal effective lethal dose, this amount of LPS was utilized in neutralization experiments.

b) Neutralization of endotoxin lethality by premixture with Ig-PMB was performed by incubating 50 ng of E. coli 011 1 :B4 LPS with 5 mg of periodate conjugated IgG-PMB (prepared as described in Example 14), or 5 mg of unconjugated control human IgG (Sigma) and 100 mg D-galactosamine in PBS and injecting a portion of each mixture intraperitoneally into C57BL/6 mice. The results are shown in Table 22. Survival was assessed 24 hours later.

TABLE 22

Neutralization Of Endotoxin Lethality By IgG-PMB (Therapeutic Prophylactic)

Since the number of animals used in this experiment was small, the trial was repeated using: a) 12 mice in the control group treated with endotoxin, D-galactosamine, and normal human IgG and b) 12 mice in the experimental group that received endotoxin, D- galactosamine, and the periodate IgG-PMB. The per mouse dosage of each component was the same as above and the experiment was repeated exactly as above. The results are shown in Table 23.

TABLE 23

Neutralization Of Endotoxin Lethality By IgG-PMB

The results of these two trials prove that IgG-PMB neutralizes the lethal effect of endotoxin in vivo and suggest that Ig-PMB conjugates will be useful in preventing or treating sepsis due to gram-negative bacteria.

EXAMPLE 17 Prevention Of Endotoxin Lethality By

Prophylactic Administration Of IgG-PMB Conjugate

In the previous example, the ability of IgG-PMB conjugate to neutralize endotoxin lethality in vivo was investigated by mixing conjugate or control IgG with endotoxin and administering the mixture with D-galactosamine into mice. The results showed that the conjugate neutralized the endotoxin. A more strenuous test of the ability of the conjugate to neutralize endotoxin lethality is to administer the conjugate at a separate time and via a separate route than that used to administer endotoxin. In addition, to demonstrate its prophylactic value, lower doses of conjugate were utilized. The Example involved the intravenous administration of IgG-PMB or control IgG followed 1 hr later by the intraperitoneal administration of a lethal dose of endotoxin and D-galactosamine.

Twenty (20) CS7BL/6 mice weighing twenty (20) grams each were administered 200 μg (5 mice) or 400 μg (8 mice) of IgG-PMB conjugate (periodate conjugate prepared as in Example 14) or 400 μg control human IgG (7 mice) in 100 μl of PBS through their tail vein. Ninety (90) minutes later, each mouse received 10 ng E. coli 01 11 :B4 endotoxin and 20 mg D-galactosamine in 200 μl of PBS administered intraperitoneally. After 24 hrs, the number of mice surviving in each group was recorded. The results are shown in Table 24.

TABLE 24

Prophylaxis Against Endotoxin In Challenge With IgG-PMB Conjugate

The results show that a 10-20 mg/kg dose of IgG-PMB administered intravenously is sufficient to protect against a subsequent lethal challenge of endotoxin administered intraperitoneally. These findings suggest that the IgG-PMB conjugate given prophylactically will prevent endotoxin-mediated effects and that the conjugate is capable of neutralizing endotoxin outside of the vascular compartment.

EXAMPLE 18

Preservation Of IgG Effector Functions In IgG-PMB Conjugates: Fc Receptor Binding

One bf the functions of IgG is to opsonize and facilitate clearance of organisms, toxins, antigens, etc. by phagocytic cells. In order to determine whether this property of IgG, which is facilitated by the Fc region of the native molecule, remains intact in IgG conjugates that have been prepared with SPDP or periodate, the binding of IgG-PMB to human monocyte/macrophage cells was examined in a competition assay. This assay is similar to that employed to examine the Fc receptor binding activity of hybrid recombinant antibody fragments fused to cell surface viral receptors. [D.J. Capon et al, Nature 337:525-531 (1989); A. Traunecker et al. Nature, 339:68-70 (1989).] The example involved: (a) preparation of a control conjugate of PMB to human albumin (a non-Fc receptor binding human protein-PMB conjugate); and (b) assay of IgG-PMB conjugate binding to Fc receptors of the human U937 monocyte/macrophage cell line.

a) In order to compare the specific properties of IgG-PMB conjugates with other protein-PMB conjugates, human albumin was conjugated with PMB using the SPDP chemistry of Example 7 (because albumin is not glycosylated, the periodate chemistry of Example 5 was not applicable to albumin). Conjugation of albumin with PMB was carried out in three steps similar to the scheme described in Example 7. The first step involved derivatization of 10 mg of PMB in 50 mM sodium borate, 300 mM NaCl, pH 9.0 with 2:1 mg of SPDP dissolved in 50 μl of dimethylsulfoxide for 30 minutes at room temperature. The free cross-linker was removed on a 15 ml Swift desalting column as described in Example 7. Ten (10) mg of human serum albumin was derivatized with 1.2 mg of SPDP (in 25 μl

DMSO), dissolved in 1 ml of 50 mM sodium borate, 300 mM NaCl, pH 9.0, and mixed for 30 minutes at room temperature. The free cross-linker was removed by gel filtration on a 15 ml Swift desalting column equilibrated with PBS-EDTA, pH 7.5 and the peak fractions containing SPDP-albumin were collected, pooled and concentrated on a Centriprep-30 concentrator. The pH of the sample was raised to 8.0 with 10 μl of ION NaOH, and reduced with 15.4 mg dithiothreitol dissolved in 200 μl of pyrogen-free water for 30 minutes at room temperature. The reduced, derivatized albumin was purified by gel filtration on a 15 ml desalting column and concentrated on a Centriprep-30 concentrator.

The reduced, derivatized albumin was conjugated with SPDP-PMB by mixing the two solutions prepared above and incubating overnight at room temperature. The conjugate was separated from SPDP-PMB by gel filtration on a 50 ml P- 10 column.

b) IgG-PMB conjugate binding to Fc receptors of the human U937 monocyte/macrophage cell line was assayed in a manner similar to that described by Capon el al. [Nature 337:525-531 (1989).] First, a saturation curve of the binding of ^,25 I-labelled human IgG [the ^I25 I-IgG stock concentration was 16 μg/ml = 1.07 x 10 ^"7 M] (New England Nuclear, Boston, MA) was performed by incubating 1 x 10 ^"8 M to 1 x 10 ^"12 M ¹²⁵ I-IgG with 2 x 10 ⁵ U937 cells in 0.5 ml of PBS containing 2 mg/ml BSA and 0.1% sodium azide. The cell suspensions were incubated for 60 minutes at 37°C, centrifuged for 3 minutes at 1500 x g and washed three times with incubation buffer. The cell pellets were then counted for radioactivity with a Bioscan "Quick Count" benchtop radioisotope counter (Bioscan, Inc.,

Washington D.C). The binding was found to saturate at 1 x 10 ^"8 M ¹²⁵ I-Ig so this concentration was used for the competition assay described below.

For the competition experiment, a constant quantity of ^l25 I-IgG (1 x 10 ^"8 M) was incubated with 2 x 10 ⁵ U937 cells in 0.5 ml of PBS containing 2 mg/ml BSA, 0.1% sodium azide and varying concentrations of the unlabelled competitor proteins: human IgG, IgG-PMB (SPDP), IgG-PMB (periodate), and human albumin-PMB from (a) above. The cells were incubated, washed, and the amount of bound radioactive ^{, 5} I-IgG was quantitated as described above. In the absence of any of the human competitor proteins, 12,029 cpm of labelled IgG was bound to the cells. The results of the competitor assay are plotted in Figure 10. It is clear that human IgG and both IgG-PMB conjugates have similar binding properties to the U937 cells in that all three compete comparably well at 10 ^"8 M and 10 ^"6 M. This result shows that the modification of the IgG with SPDP and PMB or by periodate oxidation of the carbohydrate side chains does not impair the ability of IgG to bind to Fc receptors. This suggests that the conjugates can facilitate Fc receptor-mediated opsonization of antigen/organisms by phagocytic cells. As expected, the human albumin-PMB exhibited no competitive binding activity at concentrations up to 10 ^"6 (data not shown) and is therefore unable to facilitate opsonization.

EXAMPLE 19

Preparation Of An Antibody-Antibiotic Conjugate With Activity Against Gram-Positive Bacteria: IgG-Bacitracin

Gram-positive organisms are responsible for approximately one-third of sepsis cases. It would be desirable to have IgG-antibiotic conjugates with activity against these organisms. To this end, conjugates were made between IgG and bacitracin and vancomycin, two surface- active gram-positive antibiotics. The example involved: (a) periodate activation of IgG; and (b) conjugation to bacitracin and vancomycin.

a) Periodate activation of IgG was carried out as described in Example 5(b), using 30 mg of human IgG and 50 mM sodium periodate in 1 ml of 50 mM NaPO ₄ , pH 7.2 for 30 minutes at room temperature. The activated IgG was purified on a 15 ml Swift desalting column (Pierce) and the peak fractions pooled.

b) Conjugation to bacitracin and vancomycin was carried out by adding 18.6 mg of bacitracin to 7.1 mg of activated IgG and 19.7 mg of vancomycin to 7.1 mg of activated IgG and each solution was incubated overnight at 4°C The mixtures were then clarified by centrifugation to remove any precipitates formed during incubation. The reaction mixtures were adjusted to pH 6.5 with 1.0 N HCI, and 10 μl of a NaCNBH ₃ solution (10 mg/ml) was added and incubated for 4 hours at room temperature. The conjugate was then purified on a 15 ml Swift desalting column equilibrated in PBS-EDTA, pH 7.2.

EXAMPLE 20

Antibacterial Activity Of IgG- Antibiotic Conjugate On Gram-Positive Bacteria

To determine if the conjugates prepared in Example 19 possessed anti-bacterial activity, the MIC and MBC of these conjugates was assayed against Staphylococcus epidermidis obtained from Dr. Edward Balish, Department of Medical Microbiology, University of Wisconsin. The strain is gram- positive, DNase negative, mannitol salt negative, coagulase negative and novobiocin sensitive. The example involved:

(a) preparation of an S. epidermidis inoculum; and (b) determination of the MIC and MBC of free and conjugated antibiotics.

a) Preparation of an S. epidermidis inoculum was carried out by plating organisms on TSA overnight at 37°C, and suspending bacteria at 5 x 10 ⁵ organisms/ml in TSB.

b) Determination of the MIC and MBC of the free and conjugated antibiotics was carried out by mixing 0.5 ml of the S. epidermidis inoculum with 0.5 ml of solutions containing 0.3125 to 10 μg/ml of free antibiotic or 12.5 to 250 μg/ml of each conjugate. The MIC was defined as the minimum concentration of the compounds that inhibited visible growth and the MBC defined as the concentration that killed 99.9% or more of the initial organisms present in the inoculum (measured by plating those solutions that do not exhibit visible growth; see Example 10). The results are shown in Table 25.

TABLE 25

MIC And MBC Of Free And IgG-Conjugated Antibiotics On S. epidermidis

The results show that the IgG-bacitracin conjugate was indeed active against S. epidermidis and suggest that this compound could be useful in the prevention and treatment of gram-positive sepsis.

EXAMPLE 21

Treatment Of Persons Susceptible To Gram-Negative Sepsis And Endotoxemia With An Antibody-Antibiotic Conjugate

As noted earlier, studies have suggested a causal relationship between a person's humoral immune status and the susceptibility to gram-negative infections. The present invention contemplates screening for patients having a poor immune status for determining a subpopulation having the greatest need for antibodiotics. The example involves: (a) assay of patient total IgG and IgM levels; (b) assay of patient endotoxin core antigen-specific IgG and IgM levels; (c) comparison of patient immunoglobulin levels to healthy normal controls; (d) administration of immunoglobulin and/or immunoglobulin-antibiotic conjugate to patients with significant deficiencies in total or core antigen-specific immunoglobulin levels.

(a) Assay of patient total IgG and IgM levels is performed by nephelometry using the Beckman Automated immunochemistry system (Beckman Instruments, Inc., Brea, CA) as described by Stoll et al, Serodiagnosis and Immunotherapy 1 :21-31 (1987).

(b) Assay of endotoxin in core-antigen specific IgG and IgM levels is performed by ELISA. Plasma or sera are diluted and the level of binding of different sample dilutions to purified E. coli J5 endotoxin and Salmonella minnesota R595 endotoxin are quantitated and compared with known standards of purified anti-endotoxin antibodies. [B.J. Stoll et al, Serodiagnosis and Immunotherapy 1 :21-31 (1987); and M. Pollack et al, J. Clin. Invest. 72:1874-1881 (1983).]

c) Comparison of patient immunoglobulin levels to healthy controls is performed by analyzing the total IgG and IgM levels (as mg/ml of sample) in the patient vs. the control group and the endotoxin core antigen-specific IgG and IgM levels (as μg/ml of sample) between these same two groups. Patients with < 80% of the normal control level of total IgG and/or < 60% of the normal control level of endotoxin core antigen-specific IgG and IgM are defined as at risk for gram-negative infection and endotoxemia.

d) Administration of immunoglobulin and/or immunoglobulin antibiotic conjugate to patients with significant deficiencies in total or core antigen-specific immunoglobulin levels is carried out to restore normal or near normal total and antigen-specific humoral defenses. To restore normal IgG levels, a 3% solution of intravenously injectable immunoglobulin (available from Sandoz Forschungsinstitut, Vienna, Austria; Hyland Therapeutics, Duarte, CA; or Cutter Laboratories, Berkeley, CA) is administered twice daily until immunoglobulin levels rise to within 10%> of normal levels. Because the IgG-PMB conjugates of the present invention comprise a population of antibody molecules all of which are capable of binding to endotoxin, much less IgG-PMB conjugate is required than total IgG to restore or increase levels antigen-specific antibody. A single intravenous dose consisting of 1-20 mg of IgG-PMB conjugate per kg of body weight is administered to restore endotoxin-specific antibody levels to > 100% of normal levels.

EXAMPLE 22

Treatment Of Persons Susceptible To Gram-Negative Sepsis, Endotoxemia, And Gram-Positive Sepsis With A Cocktail Of Antibody-Antibiotic Conjugates

Since there is a causal relationship between a person's humoral status and their susceptibility to infection, there is also a need to restore antibody levels against gram-positive organisms as well as the levels against gram-negative organisms and endotoxin. This is achieved by administration of a cocktail of antibody-antibiotic conjugates with activity against both classes of bacteria as well as endotoxin. The example involves: (a) identification of persons at risk of infection; and (b) administration of a cocktail of antibody-antibiotic conjugates and, if necessary, total pooled human immunoglobulin to restore antigen-specific and total immunoglobulin levels.

a) Identification of persons at risk of infection is carried out by the means defined in Example 21.

b) Administration of a cocktail of antibody-antibiotic conjugates and, if necessary, total pooled human immunoglobulin to restore antigen-specific and total immunoglobulin levels is carried out by injecting a single intravenous dose of IgG-PMB (1-20 mg/kg) and a single intravenous dose of IgG-bacitracin conjugate (1-20 mg/kg) to increase the levels of gram-negative and gram-positive-reactive antibodies, respectively. If total immunoglobulin levels are also < 80% of normal, a 3% solution of intravenously injectable immunoglobulin (available from Sandoz Forschunginstitut, Vienna, Austria; Hyland Therapeutics, Duarte, CA; or Cuter Laboratories, Berkeley, CA) is administered twice daily until immunoglobulin levels rise to within 10% of normal levels.

EXAMPLE 23

Long-Term Prophylaxis Against Endotoxin Lethality By IgG-PMB Conjugates

The long-term prophylactic effect of the IgG-PMB conjugate was examined in the

D-galactosamine-sensitized mouse model. [C. Galanos et al, Proc. Natl. Acad. Sci.

76:5939-5943 (1979); V. Lehmann et al, J. Exp. Med. 165:657-663 (1987); and

M.A. Freudenberg and C Galanos, Infect. Immun. 56:1352-1357 (1988).] One mg of human IgG-PMB conjugate in PBS (prepared as described in Example 14) was given intravenously to each of 10 male C57B1/6 mice. Ten control mice received 1 mg of unconjugated human IgG in PBS, again intravenously. Both the conjugate and control IgG solutions were at 8 mg/ml, the injection volumes were therefore 125 μl/mouse.

The in vivo experiments described in Examples 16 and 17 showed that as little as 25 μg of the IgG-PMB conjugate could provide complete protection when administered intravenously 1 hour prior to endotoxin challenge. Here, we investigated the protective window at 24 hours. Twenty-four hours after the administration of PMB-conjugated or control IgG, both groups of mice were challenged intraperitoneally with a lethal dose of E. coli Oi l 1 :B4 endotoxin (# 201 ; List Biological Laboratories, Campbell, CA), prepared as described below. A 1 mg/ml stock solution of endotoxin was sonicated for 2 minutes in a Branson 2000 water bath sonicator and diluted 100-fold in PBS to make a 10 ng/μl working solution. Two hundred and forty mg of D-galactosamine hydrochloride (# G-1639; Sigma Chemical Co., St. Louis, MO) was weighed into 2 siliconized Reacti-vials (Pierce) and dissolved in 2.4 ml of PBS containing 0.1 mg/ml bovine serum albumin (BSA) as a carrier protein. Twelve μl of the 10 ng/μl endotoxin solution (120 ng) was added to each vial, and the solutions were mixed for 15 minutes at room temperature. Each vial contained enough solution for twelve 200 μl injections, consisting of 10 ng endotoxin and 20 mg galactosamine/injection. Each mouse in both groups was injected intraperitoneally with 200 μl of the mixture. The mice were given food and water ad libitum, and observed for 24 hours, using mortality as the endpoint. The results were analyzed by Fisher's exact method for estimating probabilities [F. Mosteller, et al, in Probabilty With Statistical Applications, Addison Wesley, Reading, MA (1970)]; significant protection was defined as a p value <0.05 when the experimental and control groups were compared.

The results of the prophylactic study are summarized in Table 26.

TABLE 26

These results show that the IgG-PMB conjugate can be given intravenously as a prophylactic, and significant protection from endotoxin lethality can be obtained for at least 24 hours after administration of the conjugate.

EXAMPLE 24

Determination Of The Relative Half-Life Of PMB-HlgG Conjugate And HIgG In Rabbits

This example describes experiments to determine if there was any effect on the half-life of HIgG in rabbits when conjugated to PMB. The pharmacokinetic study was conducted using male New Zealand White rabbits (10 lb, 12 months old). Two rabbits each received a single dose of 3 mg of PMB-HlgG conjugate in 10 mM phosphate buffer (pH 7.1) containing 150 mM sodium chloride intravenously on day 0. At the same time, two control rabbits received intravenous injections of 3 mg of HIgG in the same buffer. Both the test samples and control samples were tested and found to be pyrogen-free. Rabbits were bled at one hour and 5 hours after the initial injection and then at days 1, 2, 3, 4, 7, 10, and 14 after the initial injection. Serum samples were collected and stored at -70°C until tested for the presence of HIgG.

A sandwich ELISA was developed in order to detect the presence of HIgG in rabbit serum samples. Each well of a microtiter plate (Coming) was coated with 100 μl of a solution containing 25 μg/ml of goat-anti human IgG (Sigma) in 50 mM carbonate buffer, pH 9.5. After an overnight incubation at 4°C, the coating solutions were removed and all wells were washed three times with PBS-Tween-20 (.05% Tween-20 in PBS). The remaining antigen binding sites were blocked by the addition of PBS containing 10 mg/ml BSA (Sigma) for one hour at 37°C

The test serum samples, which were stored at -70°C, were thawed just prior to assay and diluted 1 :10 in PBS-Tween-20 containing 0.1% BSA. All samples were added (200 μl/well) as duplicate aliquots to wells of the microtiter plate. Negative control wells were prepared by adding 200 μl/well of 1 :10 diluted normal rabbit serum in the same diluent as used with the test serum samples. As a positive control, normal HIgG was diluted in the same diluent at 20 μg/ml and subsequently underwent eight serial 1 :4 dilutions up to 0.00031 μg/ml. The corresponding O.D. values were used to generate a standard curve from which corresponding HIgG levels from test serum samples were determined. Plates were incubated at 37°C for 1 hour and washed three times in PBS-Tween-20. Alkaline phosphatase conjugated goat anti-human IgG (Sigma), diluted 1 :500 in 0.1 % BSA in PBS-Tween-20 was added to the wells and incubated at 37°C for one hour. After washing the wells four times with PBS-T, 100 μl of 1 mg/ml p-nitrophenylphosphate (Sigma) in 50 mM Na ₂ CO ₃ , pH 9.5, and 1 mM MgCl ₂ was added to all wells. Plates were shielded from light and allowed to develop at room temperature for 20-30 minutes. Absorbance at 410 nm was determined using a Dynatech MR 700 microplate reader.

The absorbances of duplicate wells were averaged and corrected for background by subtracting the absorbance of the blank wells, which contained only conjugate and substrate. A standard curve of absorbance versus log concentration of HIgG was plotted. Absorbances from test samples were quantified from the linear portion of the standard curve. The serum clearance curve for PMB-HlgG (R3 and R4)and HIgG (Rl and R2) are shown in Figures 11 and 12. The absorbance at 410 nm which directly corresponds to the concentration of HIgG is plotted against days in Figure 11. Figure 12 shows a graph of HIgG in μg/ml serum over time. From both Figures 1 1 and 12, it is clear that the serum half life of PMB-HlgG is similar to that of unconjugated human IgG. Since the half-life of human IgG in humans is on the order of 21 days, these experiments suggest that the conjugate half-life will be long. Therefore, in this Example, we have demonstrated that active conjugate is still detectable in rabbit sera two weeks after conjugate administration.

EXAMPLE 25

Detection Of LPS-Binding Of The PMB-HlgG Conjugate After Two Weeks Of Circulation In Rabbits

This example describes an experiment to determine if PMB-HlgG LPS-binding activity is still present after two weeks of circulation in rabbits. The study was conducted using male New Zealand White rabbits (10 lb, 12 months old). Two rabbits each received a single dose of 3 mg of PMB-HlgG conjugate in 50 mM phosphate buffer containing 150 mM sodium chloride intravenously on day 0. At the same time, two control rabbits received intravenous injections of 3 mg of HIgG in the same buffer. Both the test samples and control samples were tested and found to be pyrogen-free. Rabbits were bled at one hour and 5 hours after the initial injection and then at days 1, 2, 3, 4, 7, 10, and 14 after the initial injection. Serum samples were collected and stored at -70°C until tested for the activity of PMB-HlgG conjugate.

In order to detect the activity of PMB-HlgG conjugate from rabbit serum (i.e., ability to bind to LPS), a simple indirect binding assay was utilized. Each well of a 96-well microtiter plate (Coming) was coated with 100 μl of a 20 μg/ml solution of LPS from E.coli Ol 1 :B4 (Sigma) in PBS. Control wells were coated with PBS only (no LPS). After an overnight incubation at 4°C, the coating solutions were removed and all wells were washed 3 times with PBS-Tween-20. The remaining antigen binding sites were blocked by the addition of PBS containing 10 mg/ml BSA (Sigma, tissue culture grade) for 1 hour at 37°C The blocking solution was removed and test rabbit serum samples diluted 1 :10 in PBS-Tween-20 were added. As a positive control PMB-HlgG conjugate was also diluted in 10% normal rabbit serum and added to the wells. Samples were incubated in duplicate at 37°C for 1 hour and the plates were washed three times with PBS-Tween-20. In order to detect bound antibodies, the wells were incubated with 100 μl of a 1 :500 dilution of goat anti -human IgG-alkaline phosphatase labeled antibody (Sigma) and incubated for 1 hour at 37°C After removing the secondary antibody solutions, the wells were washed 4 times with PBS-Tween-20. Substrate [p-nitrophenylphophate (Sigma)] at 1 mg/ml in 50 mM Na ₂ CO ₃ , and 10 mM MgCl ₂ was added to each well. The color developed after 15-20 minutes of incubation at room temperature was measured at 410 nm using a Dynatech MR700 microplate reader.

The results of the LPS binding assay are as shown in Table 27. The conjugate from rabbit sera collected on day 14 bound to the LPS coated wells indicating that the conjugate was still active after circulating for two weeks in rabbits.

TABLE 27

Binding Of PMB-HlgG Conjugate From Rabbit Serum To LPS

EXAMPLE 26

PMB-IgG Conjugates Do Not Elicit An Immune Response When Administered Intravenously Into Rabbits

This example describes an experiment to determine if anti-PMB antibodies are elicited in rabbits by conjugate administration. Two rabbits were each given 3 mg of PMB-HlgG conjugate intravenously on day 0. These rabbits received additional injections (boosts) at 2 weeks, 4 weeks and 7 weeks. As a control, 2 rabbits each received 3 mg of HIgG alone at the same scheduled day and time as with the experimental group. All rabbits were bled every two weeks after receiving either conjugate or IgG alone. Sera were collected and stored at -70°C until tested for anti-PMB antibodies. In order to detect anti-PMB antibodies in rabbit serum, a simple indirect binding assay was developed. Each well of a 96-well microtiter plate (Coming) was coated with 100 μl of a 200 μg/ml solution of PMB (Sigma) in endotoxin-free PBS. Control wells were coated with PBS only (no PMB). After an overnight incubation at 4°C, the coating solutions were removed and all wells were washed 3 times with endotoxin-free PBS-Tween-20. The remaining antigen binding sites were blocked by the addition of PBS containing 10 mg/ml

BSA (Sigma, tissue culture grade) for 1 hour at 37°C The blocking solution was removed and test rabbit serum samples diluted in 2% normal rabbit serum at dilutions of 1 :10, 1 :100,

1 :1000 and 1 :10,000 were added. A positive control antiserum (chicken anti-PMB

immunoglobulin, Ophidian Pharmaceuticals Inc., Madison, WI) was also diluted as for the test rabbit serum samples. Samples were incubated in duplicate at 37°C for 1 hour. Following this incubation, the plates were washed three times with PBS-Tween-20.

In order to detect bound antibodies, the wells incubated with rabbit serum were incubated with 100 μl of a 1 :500 dilution of goat anti-rabbit IgG-alkaline phosphatase labeled antibody (Sigma) and the wells incubated with chicken antibody were incubated with 100 μl of 1 :500 dilution of goat anti-chicken IgG (whole molecule)-alkaline phosphatase conjugate (Sigma) for 1 hour at 37°C After removing the secondary antibody solutions, the wells were washed 4 times with PBS-Tween-20 and p-nitrophenylphosphate (Sigma) at 1 mg/ml in 50 mM Na ₂ CO ₃ , 10 mM MgCl ₂ was added to each well. The color developed after 15-20 minutes of incubation at room temperature was measured at 410 nm using a Dynatech MR700 microplate reader.

The results in Table 28 show that the positive control antibody, as expected, bound to PMB. This validates that the design of ELISA is capable of detecting PMB-binding antibodies. The results in Table 29 (shown as A ₄₁₀ readings of duplicate samples) indicate that none of the rabbit se m samples bound to PMB, indicating the absence of anti-PMB antibodies. These results demonstrate that PMB is not immunogenic, even on an heterologous protein carrier with repeated injections when given intravenously.

The lack of immunogenicity of this peptide may be related to its D-amino acid content, as these residues may not be recognized by the immune system.

TABLE 28

Binding Of Chicken Antibodies To PMB

EXAMPLE 27

IgG PMB Is Not Toxic

In order to investigate the safety with which IgG-PMB conjugate can be utilized, a toxicity study was performed. Female Sprague-Dawley rats (Harlan Sprague- Dawley) weighing 250-300 g were given 2 relatively high doses of conjugate (approximately 16 mg/kg) intravenously. Serum samples, taken at various times during the study, and major organs were then analyzed for any indication of pathology.

TABLE 29

Binding Of Rabbit Antiserum To PMB Coated Wells As Determined By ELISA

The study consisted of 5 groups, 3 rats per group. After a 7 day acclimation period, rats in groups 1, 2, and 3 received intravenous injections of 4 mg of rat IgG conjugated to PMB (see (E) below for conjugation of PMB to rat IgG) on day 0 and again on day 2; group

4 rats received 4 mg of unconjugated rat IgG intravenously on day 0 (IgG control); and group

5 rats served as a normal control (no injection of either conjugate nor normal rat IgG). The rats were bled by cardiac puncture and sacrificed for organ pathology as indicated in Table 30.

TABLE 30 Study Design

Immediately following cardiac puncture, blood smears (2 slides/rat) were prepared and stained with Diff-Quik (Baxter Healthcare, McGaw Park, IL) for white blood cell differential counts. The remaining blood (2-7 mis) was allowed to clot at 2-8°C The clot was pelleted by centrifugation at 2000 rpm for 10 minutes, and the serum was removed and frozen at

-70°C in 2 aliquots for blood chemistry analysis (SMAC 12) and measurement of complement activation by the CH ₅₀ Complement assay (Diamedix Coφoration; Miami, FL). The organs

of interest (kidney, liver, and spleen) were removed from each rat as indicated in Table 30, and fixed immediately in phosphate buffered formalin (50 mM sodium phosphate, 10% formaldehyde) until sections were made for histopathology slides.

A. Biochemical Serum Analysis For Liver And Kidney Function All rat serum samples (18 total: 3 from groups 1, 2, 4, and 5; and 6 from group 3) were analyzed on the DuPont Dimension AR (DuPont Co., Wilmington, DE) for the following 12 tests (SMAC 12): glucose, blood urea nitrogen (BUN), creatinine, uric acid, calcium, albumin, total protein, cholesterol, total bilirubin, alkaline phosphatase, aspartate transferase (SGOT/AST), and lactate dehydrogenase (LDH). The values for each group were averaged (Table 31) and the experimental groups (1, 2, and 3) were compared with the control groups (4 and 5) to detect any significant differences. The laboratory results were also compared to the normal ranges for each assay, determined by analyzing laboratory data for 20 female Sprague-Dawley rats (data provided by Harlan Sprague-Dawley).

The standard laboratory tests for liver disease include measurement of serum levels of bilimbin, AST, alkaline phosphatase, LDH, albumin, and, to a lesser extent, glucose. Kidney function can be assessed by measuring plasma levels of urea, creatinine, and calcium. [J. F. Zilva, P.R. Pannall, Clinical Chemistry in Diagnosis and Treatment, Yearbook Medical Publishers, Chicago, IL (1984).] With the exception of the lactate dehydrogenase value (LDH), which will be discussed below, Table 31 shows no significant differences when the values for the experimental groups 1, 2, and 3 are compared with the control groups 4 and 5. Furthermore, all the values are within or close to the normal ranges for each assay for this strain of rat.

The values for LDH vary considerably from group to group, and most of the values also exceed the normal range for rat semm LDH (data from Harlan Sprague-Dawley). Lactate dehydrogenase is found in high concentrations in the liver, heart, skeletal muscle, brain, kidney and in erythrocytεs. Elevated values of particular isozymes can indicate liver or cardiac muscle damage, however in this study the control rats also show elevated LDH values, suggesting the elevated LDH values are not associated with the IgG-PMB conjugate. Hemolysis, which may have occurred in vitro (as the blood samples were being drawn, or if the serum was not separated from the blood cells soon enough), also increases serum LDH

values (J. F. Zilva and P. R. Pannall, Clinical Chemistry in Diagnosis and Treatment, supra) . and may explain the elevated values in this study.

It is also worth noting that the measurements for serum samples drawn on day 5 (3 days after the second injection), day 7 (5 days after the second injection) and day 14 (12 days after the second injection) show no significant differences that can be attributed to the administration of the IgG-PMB conjugate. In other words, the day 5, 7 and 14 values for all of the serum components measured are within or close to their respective normal ranges (except LDH) and show little or no significant change over time, as would be expected if the conjugate brought about any acute changes in the condition of the test rats.

TABLE 31

Blood Chemistry Analysis*

The Value For Each Measurement Represents The Average For All 3 Rats In Each Group.

B. White Blood Cell Differential

Blood smears from each rat were examined under oil immersion (1000X) to determine the white blood cell differential. At least one hundred white blood cells were counted on each slide, and the percentages of each cell type (lymphocyte, monocyte, neutrophil, eosinophil, and basophil) were calculated to determine the white blood cell differential for each rat. The differentials for rats in each group were averaged and differentials from groups 1 , 2, and 3 were compared with the differentials from groups 4 and 5, to detect any significant differences in white blood cell populations. In addition, the red blood cells on each slide were examined for moφhology, and a crude estimate of the number of platelets present was made. The results of the differential cell counts are summarized in Table 32.

TABLE 32

White Blood Cell Differentials*

Numbers Given Represent The Percentage For Each Cell Type (Mean Values for Each Group).

Table 32 shows no significant differences in the percentages of each cell type from group to group. The differentials do show some variation from the normal reference values for rats obtained from Harlan Sprague-Dawley (about 5-10% more lymphocytes and 5-10 % fewer neutrophils than expected), however this is found in both the normal control and experimental groups, suggesting this finding is not related to the administration of the

IgG-PMB conjugate. The red blood cell moφhology appeared normal, and platelets were abundant on all slides examined.

C. Organ Histopathology

The organs of interest were removed and fixed in phosphate buffered formaldehyde. Sections were made as described below and stained with hematoxylin and eosin. Kidney: Full length mid-longitudinal section through center Liver: Transverse section through hepatic lobule Spleen: Transverse section The slides were examined for organ pathology and no abnormalities were found.

D. Analysis Of Serum Complement Activity

Immunoglobulin and immunoglobulin complexes have the potential to activate the complement system. Complement activation of this type, mediated by IgG-PMB conjugates, would exacerbate the inflammatory response to endotoxemia or bacteremia. In addition, inhibition of normal complement function would impair complement-mediated host defense mechanisms. In this example, the in vivo effect of IgG-PMB conjugate on serum complement activity was investigated.

Rat serum samples were analyzed for total hemolytic complement activity (CH ₅₀ ) using the EZ Complement CH ₅₀ Assay (Diamedix Coφ., Miami, FL). In order to determine the effect of the conjugate on complement activity, the resulting CH ₅₀ values obtained from untreated control rats were compared to the CH ₅₀ values obtained from the IgG and IgG-PMB conjugate-treated rats.

TABLE 33

Analysis Of Serum Complement Activity"

Each Measurement Represents The Mean CH ₅₀ Value Determined For The 3 Rats In Each Group.

Referring to Table 33 above, there were no significant differences in the CH ₅₀ values between any of the groups tested. If IgG-PMB conjugate-mediated complement activation was occurring in vivo, this effect would have been reflected as a decrease in the CH ₅₀ values of the conjugate-treated rats (groups 1, 2, and 3), as compared against the untreated control rats (group 5), due to depletion of complement components in the treated animals. Similarly, inhibition of normal complement function would have been indicated by a decrease in CH ₅₀ values in the conjugate-treated groups as compared with the untreated control group. Unconjugated IgG was also found to have no effect on serum complement activity (group 4). Therefore, these results show that intravenous administration of IgG-PMB conjugate has no adverse effect on serum complement activity.

E. Conjugation Of PMB Rat IgG Using Periodate Oxidation Of IgG In NaPO ₄

PMB was conjugated to rat IgG using periodate oxidation of IgG. This involved a) periodate oxidation of IgG in phosphate buffer followed by conjugation of PMB to the periodate-oxidized IgG.

a) Periodate oxidation of IgG in phosphate buffer was achieved by dissolving 25 mg rat IgG (Sigma) in 1 ml of 50 mM NaPO ₄ , pH 7.2 buffer and adding 10.7 mg of sodium

metaperiodate (final concentration 50 mM ). After 30 minutes of incubation at room temperature with gentle vortexing every 5 minutes, the periodate was removed by gel filtration on a 15 ml Swift desalting column (Pierce) equilibrated with 50 mM NaPO ₄ , pH 7.2 buffer. The peak fractions containing highest amount of antibody as monitored by A _28ϋ absorbance were pooled.

b) Conjugation of periodate-oxidized IgG with PMB was carried out by adding 75 mg PMB to oxidized IgG at 4°C overnight with gentle shaking followed by reduction with 0.1 mg/ml of NaBH ₃ CN in 20 mM NaPO ₄ , pH 6.5 for 2-3 hours at room temperature. The PMB-IgG was separated from the rest of the reaction products by gel filtration on a 15 ml Swift desalting column equilibrated with 50 mM phosphate containing 150 mM NaCl, pH 7.5 (PBS).

The activity of PMB-rat IgG conjugate was determined by LPS binding assay as described previously. Results in Table 34 indicate that PMB-rat IgG conjugate had excellent LPS binding activity.

TABLE 34

LPS Binding Activity Of PMB-Rat IgG Conjugate As Determined By ELISA (A ₂₈₀ )

EXAMPLE 28

Demonstration Of Opsonophagocytic Activity Of IgG-PMB Conjugates

Opsonic IgG class antibodies mediate an important immune effector function by enhancing the phagocytic clearance of extracellular bacteria [Raff, et al. , J. Infect. Dis. 163:346-354 (1991).] In this way, opsonic IgG plays a critical role in host defense mechanisms against bacterial pathogens. [Rozenberg-Arska, et al. J. Med. Microbiol. 22:143-149 (1991).] The pinpose of this example was to investigate whether the IgG component of IgG-PMB conjugates retains this important effector function. This was done by assessing whether the pre-treatment of E. coli organisms with IgG-PMB conjugate potentiates phagocytic uptake (opsonophagocytosis) by the human monocytic cell line U937.

Opsonophagocytosis assays provide a useful means by which the potential therapeutic efficacy of immunoglobulin preparations, used for the treatment of bacterial infection, can be assessed. [Hill, et al. Am. J. Med. 61-66 (1984).] This example involved (a) Assay for opsonophagocytic activity of IgG-PMB conjugate, and (b) Determination of the minimum effective concentration of IgG-PMB conjugate.

A. Assay For Opsonophagocytic Activity Of IgG-PMB Conjugate

Opsonophagocytic activity of IgG-PMB conjugates was measured using an assay procedure which was modified from published methods. [Gemmell, et al. , J. Clin. Invest. 67:1249-1256 (1981) and Bohnsack, et al, J. Immunol. 143(10):3338-3342 (1989).] E. coli strain HB101 was grown for approximately 20 hours at 37°C on TSA (BBL). The organisms were then suspended in PBS, pH 7.2, at a concentration of 1 x 10 ⁸ CFU./ml. Aliquots of 1.0 ml volumes of this suspension were placed into separate microfuge tubes and the tubes centrifuged at approximately 14,000 x g for 5 min. at 4°C Each of the resulting pellets was then resuspended in a 1.0 ml volume of one of the following opsonin or control solutions:

1. IgG-PMB Conjugate (prepared by periodate oxidation, as described in Example 14(a)) at the MIC for E. coli HB101 (0.062mg/ml) (The MIC was determined as described in Example 12).

2. IgG-PMB Conjugate (same as above) at 2x the MBC for E. coli HB101 (0.25 mg/ml) (The MBC was determined as described in Example 12).

3. IgG Control (unconjugated) at 0.062mg/ml (control for #1 above; this was the same IgG as that used for production of the conjugate).

4. IgG Control (unconjugated) at 0.25mg/ml (control for #2 above).

5. PBS Control (no IgG or conjugate). PBS, pH 7.2 only. The five suspensions were opsonized by incubation at 37°C for 60 min. with periodic mixing. Following opsonization, the suspensions were centrifuged as above, and the resulting pellets were each resuspended in 0.5ml of RPMI 1640 medium which was supplemented with 10% FCS (this will be referred to as "medium" for the remainder of this example). Into each of 5 separate polypropylene culture tubes (S/P) was placed 1.0 ml of a U937 cell suspension, which was prepared in medium, and contained 1 x 10 ⁶ U937 cells/ml. To each tube, 0.1ml of one of the opsonized E. coli suspensions prepared above was also added. A sixth control group was also prepared which contained 1.0 ml of the U937 cell suspension and 0.1 ml of PBS (PBS control). At this point, each tube contained 1 x 10 ⁶ U937 cells, and 2 x 10 ⁷ E. coli organisms, thus providing an E. coli to U937 cell ratio of 20:1. The 6 tubes were then incubated at 37°C for 60 min. with constant shaking, in order to allow phagocytosis to occur. Following incubation, the tubes were placed on ice for several minutes to prevent further phagocytosis. The 6 tubes were then centrifuged for 10 min. at 500 x g at 4°C The resulting pellets were washed three times (centrifuging as in the previous step) with chilled PBS, to remove extracellular E. coli organisms. The final pellets were each resuspended in 0.2 ml of chilled PBS, and smears were prepared by applying 40 μl volumes of the suspensions to glass microscope slides. The smears were allowed to air-dry, and were then fixed by immersion in 100% methanol for 5 sec. and again allowed to air-dry.

The smears were stained using a modified version of the Sowter-McGee staining procedure [Sowter and McGee. J. Clin. Pathol. 29:433-437 (1976)], which chromatically differentiates between intracellular bacteria and the surrounding cytoplasm of the host cells. The slides were hydrated by immersion in water for approximately 60 sec, and were then placed in a methyl green-pyronin (MGP) solution (Sigma) for 5 min. The slides were washed in water for 15-20 sec. and then immersed in light green counterstain (0.25% Sigma Light Green SF Yellowish in distilled H ₂ O) for 3-5 sec. Following a 15-20 sec. rinse in water, the slides were dipped in 100%) ethanol for 5 sec, and then in xylene for 5 sec. The slides were allowed to air-dry, and were then mounted with glass coverslips.

Scoring of opsonophagocytosis was performed in a blind manner, by light microscopy .. For each experimental group, a total of 100 U937 cells were randomly counted to determine the percentage of those cells which contained one or more intracellular E. coli organisms.

The results of this study are presented in Table 35.

TABLE 35

Treatment of E. coli organisms with IgG-PMB conjugates at concentrations that were equivalent to the MIC and 2x the MBC for that organism resulted in the phagocytic uptake of the organisms by greater than 50% of the U937 cells. Treatment of the organisms with comparable concentrations of the unconjugated form of the same IgG resulted in minimal to no uptake. In the absence of IgG-PMB conjugate or IgG, no phagocytic uptake of the E. coli organisms occurred (PBS control group). These results demonstrate that the IgG portion of the IgG-PMB conjugate retains opsonic effector function, and that IgG-PMB conjugates potentiate the phagocytic clearance of bacterial organisms.

B. Determination Of The Minimum Effective Concentration Of IgG-PMB Conjugate

The minimum concentration of IgG-PMB required to mediate opsonophagocytosis was determined by testing the conjugate at the MIC and at fractional concentrations of the MIC (sub-MIC). As an additional control, a parallel series of albumin-PMB (Alb-PMB) conjugate

solutions were also tested at concentrations comparable to the IgG-PMB conjugate. The following conjugate and control solutions were assayed for opsonophagocytic activity by the procedure described in part (a) of this example:

1. IgG-PMB Conjugate (same as that used in part (a) of this Example) at the MIC for E. coli HB101 (0.062 mg/ml). ,

2. IgG-PMB Conjugate (same as above) at 1/2 the MIC for E. coli HB101 (0.031 mg/ml).

3. IgG-PMB Conjugate (same as above) at 1/4 the MIC for E. coli HB101 (0.0155 mg/ml). 4. IgG-PMB Conjugate (same as above) at 1/8 the MIC for E. coli

HB101 (7.75 μg/ml).

5. Alb-PMB Conjugate (prepared as described in Example 18(a)) at 0.062 mg/ml (this group served as a control for #1 above).

6. Alb-PMB Conjugate (same as above) at 0.031 mg/ml (this group served as a control for #2 above).

7. Alb-PMB Conjugate (same as above) at 0.0155 mg/ml (this group served as a control for #3 above).

8. Alb-PMB Conjugate (same as above) at 7.75 μg/ml (this group served as a control for #4 above). 9. IgG Control (unconjugated) at 0.062 mg/ml.

10. PBS Control (no IgG or conjugate). PBS, pH 7.2 only. The results of this study are presented in Table 36.

TABLE 36

Treatment of E. coli organisms with IgG-PMB conjugates, using concentrations at or below the MIC for the conjugate, resulted in the increased phagocytic uptake of the organisms by the U937 cells at all IgG-PMB concentrations tested. The parallel series of Alb-PMB conjugate concentrations tested did not demonstrate significant levels of opsonophagocytic activity, nor did the unconjugated IgG control. These results demonstrate that IgG-PMB conjugates possess significant levels of opsonophagocytic activity at clinically-relevant, sub-MIC concentrations, and that both the functional PMB and IgG portions of the conjugate are required simultaneously in order for the conjugate to be capable of mediating opsonophagocytosis.

EXAMPLE 29

Antimicrobial Activity Of IgG-PMB Conjugates Against Clinically-Relevant Bacterial Strains

MIC and MBC values were determined for IgG-PMB conjugate and native PMB control against bacterial strains which are known to be human pathogens (see Example 29 below). This example involved (a) Preparation of the Conjugate, (b) Preparation of the Bacterial Inocula, and (c) Determination of the MIC and MBC.

A. Preparation Of The Conjugate

The IgG-PMB conjugate was prepared by periodate oxidation as described in Example 14(a) with the following modification, which was performed in order to more effectively remove free (unconjugated) PMB from the final conjugate preparation. The final conjugate solution was adjusted to contain 1.0% Tween-20, and then was chromatographed on a P- 10 column using PBS containing 0.1 % Tween-20 as the eluent. The material in the void volume was concentrated and then further purified by column chromatography as described in the previous sentence.

B. Preparation Of The Bacterial Inocula

Organisms were grown, and separate inocula were prepared for the following test organisms, as described in Example 12 (a): E. coli strain EC 5; Pseudomonas aeruginosa strain ATCC 27312; Pseudomonas aeruginosa strain Strong; and Pseudomonas aeruginosa strain 3.

C. Determination Of The MIC And MBC

The MIC and MBC of IgG-PMB conjugate and native PMB control were determined for each of the test organisms, as described in Examples 12(b) and 12(c). The results of the MIC determination are shown in Table 37.

TABLE 37

The results of the MBC determinations are shown Table 38.

TABLE 38

The bacteriostatic and bactericidal activity of IgG-PMB conjugates against pathogenic bacterial strains demonstrate that these compounds may be effective for the prophylaxis and/or treatment of bacteremia.

EXAMPLE 30

Prophylactic Administration Of IgG-PMB Conjugate Protects Rats Against An Escherichia coli Bacteremia

Gram negative bacteremia and endotoxic shock can trigger a lethal reaction in vivo.

Indeed, overwhelming gram negative bacteremia has become a leading cause of death from infection in the hospital. [S.M. Wolf, N. Eng. J. Med. 307;1267-1268 (1982).] In particular,

E. coli sepsis continues to be associated with an unacceptably high mortality rate, despite the availability of potent antibiotics. E. coli strains with the Kl capsular type have been

identified as the etiologic agent in up to 24% of blood culture isolates [G. W. Count and M. Turck, J. Clin. Microbiol. 5:490 (1977)], 80% of the cases of neonatal meningitis. [L.D. Sarff et al, Lancet 1 :1099 (1975).] It is the most frequent cause of nosocomial gram negative bacteremia in adults [M.P. Weinstein et al, Rev. Infect. Dis. 5:35-53 (1983)] and pyelonephritis in children. [G.H. McCracken et al, Hosp. Pract. 9:57 (1974).] In addition to the Kl type, human blood E. coli isolates also possess an O antigen serotype, with 018 lipopolysaccharide being most frequently associated with bacteremia. [A.S. Cross et al, J. Infect. Dis. 149:184-193 (1984).] E. coli serotype O18:Kl is a very virulent human pathogen, as defined by either D. Rowley, Br. J. Εxp. Pathol. 35:528-538 (1954) or H. Smith, J. Gen. Microbiol. 136:377-383 (1990), they can grow in vivo from a small inoculum, evade host defenses and cause extraintestinal infections.

To test the IgG-PMB conjugate for in vivo efficacy against bacteremia caused by a virulent bacterium such as E. coli O18:Kl, the established animal infection model described by D.Ε. Schiff et al, Infect. Immun. 61 :975-980 (1993) was utilized. This model fulfills many criteria important in evaluating the toxicity, efficacy and safety of immunotherapeutics, some of which have been outlined by A.S. Cross et al, Infect. Immun. 61:2741-2747 (1993). Specifically, the model is an infection rather than an intoxication model in which rats are challenged with low doses of a virulent bacteria instead of using large doses of an avirulent strain. Experimental evidence indicates that models of infection, in contrast to intoxication models, more accurately reflect the course of human sepsis. Infection models: a) use bacteria that cause human sepsis possessing an invasive phenotype with vimlent factors (i.e., a particular K antigen or smooth LPS antigen) [I. Orskov and F. Orskov, J. Hyg. Camp. 95:551-575 (1985)]; b) mimic the normal progression of sepsis from a focal site to colonization; c) generate levels of circulating bacteria consistent with clinical bacteremia [D.E. Dietzman et al, J. Pediatr. 85:128-131 (1974)]; and d) produce endotoxin levels and induce physiological cytokine responses such as triggering TNF kinetics similar to the clinical experience. [Reviewed by A.S. Cross et al, Infect. Immun. 61 :2741-2747 (1993).]

In this Example, we tested whether the prophylactic treatment of neonatal rats with IgG-PMB could protect against bacteremia and death caused by E. coli O18:Kl. This example involved: (a) determination of the lethal dosage of E. coli O18:Kl in rat pups; and (b) in vivo protection against E. coli O18:Kl using IgG-PMB.

A. Determination Of Lethal Dosage Of E. coli O18.K1 In Newborn Rats

Five day old pathogen-free Sprague-Dawley rats (Charles River Laboratories, Wilmington, MA) were inoculated subcutaneously with different doses of E. coli O18:Kl . The E. coli (strain designation C5) obtained from K.S. Kim, Children's Hospital (Los

Angeles, CA), was isolated from the cerebrospinal fluid of a child. An overnight culture of E. coli C5 in brain heart infusion (BHI) medium was diluted 1 :40 in fresh medium and grown to early log phase to an OD ₆₂₀ of 0.25 which represents approximately 1 x 10 ⁸ bacteria/ml. The cells were washed twice by centrifugation with sterile saline (0.9% NaCl) and diluted to different cell densities in saline. Each dilution was streaked onto a BHI agar plate and incubated at 37°C to determine actual cell number.

Approximately 370 to 2620 bacteria in 100 μl of sterile saline were inoculated subcutaneously into the rats. A typical lethal infection with E. coli O18:Kl produced a bacteremia within 18 hours, and death within 24-72 hours post-infection. We found that about 300 bacteria represented an LD ₅₀ and killed about 50% of the pups, whereas, 1500 bacteria was usually sufficient to kill most or all rats. Since between 1500-2500 bacteria represent the minimal effective lethal dose, this concentration of E. coli was utilized in the in vivo bacteremia protection studies using IgG-PMB.

B. In vivo Protection Against E. coli O18.K1 (C5) Using IgG-PMB Conjugate

To determine if the administration of IgG-PMB conjugate can protect in vivo, rat pups were pretreated with IgG-PMB or control IgG followed by an administration of a lethal dose of E. coli C5. The IgG used as the carrier in the conjugate and as the control was a human myeloma protein which was shown to be unreactive to the E. coli C5 by ELISA. The myeloma IgG was used as the carrier to produce the PMB-conjugate, in order to ensure the reactivity between the E. coli and IgG-PMB conjugate was exclusively due to binding between PMB and lipopolysaccharide.

Eleven to twelve 4-5 day-old Sprague-Dawley rats (weighing 10 gm) in each group were given 30 μg, 100 μg or 300 μg of an IgG-PMB conjugate or control IgG in 100 μl of endotoxin-free PBS intraperitoneally. An untreated group was given only PBS (conjugate diluent). Two hours later, each rat received approximately 2560 E. coli C5 bacteria in 100 μl

of PBS subcutaneously behind the head. After 24 hours post-infection, the number of survivors, survivors with focal lesions and dead were recorded. The results are shown in Table 39. The focal lesions appeared very hemorrhagic and were located at or near the site of inoculation. All pups displaying focal lesions were found to be bacteremic and subsequently died within 24-48 hours of appearance of the lesion. Bacteremia was detected by collecting blood from the tail vein, diluted 20-fold in BHI broth and 20 μl aliquots were plated onto (5% sheep red cells) blood agar plates.

The results show that 30 μg of IgG-PMB conjugate/pup or a 300μg/Kg dose was sufficient to completely protect all the animals against the generation of a focal lesion or death by E. coli for 24 hours post-infection. In contrast, no protection was afforded by doses of 30 or 100 μg of IgG/pup compared to the untreated group. Pups treated with IgG at the highest dose (300 μg) were protected (probably representing a nonspecific phenomenon).

These findings demonstrate that IgG-PMB conjugate given prophylactically can prevent the progression of sepsis due to E. coli. This was shown by the prevention of death in the pups and also the protection against focal lesions. These results imply that the conjugate is capable of systemic distribution throughout the body to regions outside the vascular compartment and inhibiting infection.

EXAMPLE 31

Derivatization Of 7- Aminocephalosporanic Acid With Sulfo-MBS

This example describes the attachment of a heterobifunctional crosslinking agent to an antibiotic precursor. This example outlines the derivatization of 7-aminocephalosporanic acid, an antibiotic precursor exhibiting no significant anti-microbial properties, with m- Maleimidobenzoyl-N-hydroxysulfosuccinimide ester ("sulfo-MBS").

For the derivatization of 7-aminocephalosporanic acid, 2.9 mg of 7- aminocephalosporanic acid (Sigma) were dissolved in 1.0 ml of 50 mM phosphate buffer (pH 6.65) and 10.7 μl of 1.0 N NaOH were added during mixing to return the pH to 6.65. Then 4.6 mg of sulfo-MBS (Pierce) were added and dissolved with mixing. The mixture was incubated at ambient temperature with agitation for 4.5 hours. 10 mg of ethanolamine were added and the incubation was continued for 17 additional minutes.

The reaction mixture (0.5 ml) was applied to a 1.5 x 20 cm column of Bio-Rad P2 resin. The eluent was 50 mM phosphate buffer (pH 6.65) flowing at 0.5 ml/minute. The eluate (i.e. the liquid collected at the bottom of the column) was monitored for absorbance at 280 nm. 0.5 ml fractions were collected. Two major absorbance peaks were evident - one centered at 42 minutes and the other at 47.5 minutes (aminocephalosporanic acid and reaction products, respectively). Fractions corresponding to the leading edge of the first peak were pooled (2.0 ml, 3.42 A 280). 1.4 μl of 100% beta-mercaptoethanol was added to the mixture which was then filtered using a sterile Whatman 0.45 micron Puradisc The MIC of the putative S-

TABLE 39

Protection Against A Lethal E. coli O18:Kl Bacteremia Using IgG-PMB Conjugate Treatment

hydroxyethylthio-maleimidobenzoyl-N-aminocephalosporanic acid ester was determined to be 0.86 A _2g0 with Staph. aureus compared to 3.7 A ₂₈₀ for 7-aminocephalosporanic acid.

Controls were also tested for the above derivatizated precursor. Sulfo-MBS, beta- mercaptoethanol and ethanolamine were prepared at concentrations used above and assessed for activity against S. aureus. The compounds were inactive.

EXAMPLE 32

Derivatization Of 6-Aminopenicillanic Acid With Sulfo-MBS

This example describes the attachment of the heterobifunctional crosslinking agent of Example 31 to a different antibiotic precursor. This example outlines the derivatization of 6- aminopenicillanic acid, an antibiotic precursor exhibiting no significant anti-microbial properties, with sulfo-MBS.

For the derivatization of 6-aminopenicillanic acid, 12.1 mg of 6-aminopenicillanic acid (ICN) was dissolved in 2.5 ml of 50 mM phosphate buffer (pH 6.65). The solution was continuously mixed with a stir bar and magnetic stirrer and the pH was monitored. Sulfo- MBS (24.1 mg, Prochem, Inc.) was added and the pH was adjusted to 6.85 with a 1.0 N sodium hydroxide solution. The mixture was incubated at ambient temperature for 2.5 hours. The reaction mixture was applied to a 1.5 x 20 cm column of Whatman LRP-2 resin (C18 reverse phase), equilibrated with 10% medianol in water. The column was developed at 1.0 ml/min. with 10% methanol for 5 min., followed by a linear, 30 min. gradient of 10 to 90%) methanol in water. The eluate containing the last peak of material absorbing at 280 nm (eluted at 26 min.) was collected and concentrated to dryness under reduced pressure using a Labconco Centravap concentrator. The derivatized aminopenicillanic acid was dissolved in 1.0 ml of 50 mM phosphate buffer plus 1.0 mM EDTA, pH 6.65. The MIC of the derivatized aminopenicillanic acid was determined to be 8 μg/ml against S. aureus, compared to 250 μg/ml for the native aminopenicillanic acid.

Purified human IgG (40 mg, Sigma) was dissolved in 2.5 ml of 50 mM triethanolamine, 1.0 mM EDTA, pH 8.0 and continuously stirred with a magnetic stir bar and stirrer. 100 μl of 13 mg/ml iminothiolane (Traut's Reagent, Prochem) in water was added. The pH was monitored and adjusted to 8.0 with 1.0 N. sodium hydroxide. The mixture was incubated at ambient temperature for 2 hours. The mixture was then applied to a 2.5 X 20 cm column of Spectra Gel ACA 202 (Spectrum). The column was eluted at 2.0 ml/min with 50 mM sodium phosphate buffer, 1.0 mM EDTA, pH 6.5. The absorbance at 280 nm was monitored. The material in the void volume, containing iminothiolated IgG, was collected and pooled. The concentration of the iminothiolated IgG was 5.0 mg/ml.

The derivatized aminopenicillanic acid (0.5 ml, 9.0 mg/ml) was mixed with 1.75 ml of iminothiolated IgG and incubated at ambient temperature for 10 min with mixing and then at 2-8°C overnight. The mixture was transferred to ambient temperature and incubated with agitation. After 20 minutes, 146 μl of 10 mM N-ethylmaleimide (Pierce) was added and the incubation was continued for 4 hours. The reaction mixture was passed through a Unifio-Plus filter (S&S) and applied to a 2.5 X 20 cm column of Spectra/Gel ACA 202 (Spectrum). The column was eluted at 2.0 ml/min with 50 mM sodium phosphate buffer, pH 6.5. The absorbance at 280 nm was monitored. The material in the void volume, containing MBS aminopenicillanic acid:IgG was collected, pooled, concentrated using a Centricon concentrator (Amicon) and passed through a Unifio-Plus filter (S&S). The MBS aminopenicillanic acid:IgG was found to be inactive at 0.65 mg/ml against S. aureus.

Controls were also tested for the above derivatizated precursor. Sulfo-MBS, beta- mercaptoethanol and ethanolamine were prepared at concentrations used above and assessed for activity against S. aureus. The compounds were inactive.

EXAMPLE 33

Derivatization Of Amoxicillin with Sulfo SMCC

This example outlines the derivatization of amoxicillin, an antibiotic exhibiting significant anti-microbial properties, with sulfo-SMCC. For the derivatization of amoxicillin, 23 mg of amoxicillin trihydrate (ICN) was added to 2.5 ml of 50 mM phosphate buffer (pH 6.65). The suspension was continuously mixed with a stir bar and magnetic stirrer and the pH was monitored. Sulfo SMCC (23 mg, Prochem, Inc.) was added and the pH was adjusted to 7.0 (and periodically readjusted to 7.0) with 1.0 N sodium hydroxide. The mixture was incubated at ambient temperature for 4 hours. (The reaction mixture was initially turbid due to suspended amoxicillin, but the mixture became clear with time.) The reaction mixture was applied to a 1.5 X 20 cm column of Whatman LRP-2 resin

(C18 reverse phase), equilibrated with 10% methanol in water. The column was developed at

1.0 ml/min. with 10% methanol for 5 min., followed by a linear, 30 min. gradient of 10 to

90% methanol in water. The eluate containing the last peak of material absorbing at 280 nm

(eluted at 27.5 min.) was collected and concentrated to dryness under reduced pressure in a Labconco Centravap concentrator. This derivatized amoxicillin was dissolved in 1.0 ml of 50

mM phosphate buffer plus 1.0 mM EDTA, pH 6.65. The MIC of the derivitized amoxicillin was determined to be 8 ug/ml against S. aureus, compared to 250 ug/ml for native amoxicillin

EXAMPLE 34

Derivatization Of Cefadroxil With Sulfo-SMCC

In the following example, cefadroxil, an antibiotic active against gram-positive bacteria, was reacted with the crosslinking agent sulfosuccinimidyl 4-(N- maleimidomethyl)cyclohexane-l -carboxylate ("sulfo-SMCC").

Cefadroxil (Sigma) was dissolved at 3.0 mg/ml in 50 mM phosphate (pH 6.65). sulfo- SMCC was added and dissolved at 2.6 mg/ml. After a 1 hour and 55 minute incubation at ambient temperature with agitation, ethanolamine was added at 3.4 mg/ml and the incubation was continued for an additional 42 minutes.

The reaction mixture (0.5 ml) was applied to a 1.5 X 13 cm column of Sephadex G10 resin (Pharmacia). The eluent was 50 mM phosphate buffer, pH 6.65, flowing at 0.5 ml/minute. The eluate was monitored for absorbance at 280 nm. 1.0 ml fractions were collected. Two major absorbance peaks were evident - one centered at 22 minutes and the other at 36 minutes (reaction products and cefadroxil, respectively). Fractions corresponding to the leading edge of the first peak were pooled (3.0 ml, 3.5 A 280). 300 μl of 100 mM beta-mercaptoethanol was added to the mixture which was then filtered using a sterile Whatman 0.45 micron Puradisc The MIC of the putative S-hydroxyethylthio maleimidomethyl cyclohexane carboxyl-N-cefadroxil ester was determined to be 1.6 A ₂₈₀ against Staph. aureus compared to a MIC of 0.028 A ₂₈₀ for native cefadroxil. Thus, the derivatized cefadroxil was relatively inactive.

EXAMPLE 35

Derivatization Of Vancomycin With Sulfo-LC-SPDP, Sulfo-MBS, Sulfo-SIAB, And Sulfo- SMPB.

In the following example vancomycin, an antibiotic active against gram-positive bacteria, was reacted with four different heterobifunctional crosslinking agents.

Vancomycin in phosphate buffer was reacted with each of the following compounds: sulfosuccinimidyl 6-[3-(2-pyridyldithio) propionamide] hexanoate ("sulfo- LC- SPDP"), m- maleimidobenzoyl-N-hydroxysulfosuccinimide ester ("sulfo-MBS"), sulfosuccinimidyl (4- iodoacetyl) aminobenzoate ("sulfo-SIAB"), and sulfosuccinimidyl 4-(p-maleimidophenyl) butyrate ("sulfo-SMPB"). All four crosslinking agents react with a primary amino group on the vancomycin molecule, resulting in the formation of an amide bond. Vancomycin derivatized by sulfo-LC-SPDP possesses a sulfhydryl group which can be exposed under the proper conditions and can be reacted with a maleimide on derivatized IgG. Vancomycin derivatized by sulfo-MBS possesses a maleimide group which can react with a sulfhydryl group on either reduced IgG or derivatized IgG, by addition to the maleimide's carbon-carbon double bond. Finally, vancomycin derivatized by sulfo-SIAB posesses an iodo group, which can also react with a sulfhydryl group on either reduced IgG or derivatized IgG, by nucleophilic substitution for the iodo group. Sulfo MBS, sulfo SIAB, sulfo SMPB or sulfo SMCC (Pierce) were dissolved with mixing at a concentration of 20 mM in a solution of 10 mM vancomycin (ICN) in 50 mM sodium phosphate buffer, pH 7.15. The mixtures were incubated with agitation at ambient temperature. Precipitates formed in all four mixtures and the products of the reaction were not further pursued.

EXAMPLE 36

Conjugation Of Vancomycin To IgG With Iminothiolane And Sulfosuccinimidyl 4-(N- maleimidomethyl)cyclohexane- 1 -carboxylate

Because of the unsatisfactory results of the previous example in obtaining a soluble derivatized vancomycin suitable for further conjugation to immunoglobulin, an alternative crosslinking method was investigated using iminothiolane ("Traut's Reagent") to derivatize the vancomycin and sulfosuccinimidyl 4-(N-maleimidomethyl)cyclohexane-l -carboxylate ("sulfo- SMCC") to derivatize the IgG. The reaction proceeds in three steps which are outlined below. First, vancomycin is derivatized with Traut's Reagent. Second, non-specific immunoglobulin is derivatized with sulfo-SMCC. Third, the derivatized vancomycin and the derivatized IgG are reacted with each other forming a conjugate.

a) Reaction Of Vancomycin With Iminothiolane

33.4 mg of vancomycin (ICN) was dissolved in 2.0 ml of freshly degassed 50 mM triethanolamine, 1.0 mM EDTA, pH 8.0 buffer. 34.5 mg of Traut's Reagent (Pierce) was dissolved, and N ₂ gas was blown into the vial which was then tightly capped. The vial was incubated with agitation for 1 hour and 15 minutes.

The mixture (0.5 ml) was applied to a 1.5 x 13 cm column of Sephadex G10 (Pharmacia). The eluent was freshly degassed 50 mM phosphate, 1.0 mM EDTA, pH 6.65 buffer flowing at 0.5 ml/min. 1.0 ml fractions were collected and the fractions in the first peak (void volume of column) were pooled (3.0 ml). The pool from the G10 column was applied to a 4 ml, 1.0 cm diameter column of

Bio-Rad Affi-Gel 501, an organomercury resin. The 501 resin had been previously washed with 25 ml 50 mM sodium acetate, pH 5.0 (acetate buffer), 25 ml of 4.0 mM mercuric acetate in acetate buffer, 25 ml of acetate buffer and the equilibrated to 50 mM phosphate, 1.0 mM EDTA, 0.5% Tween 20, pH 6.65. The pool was applied at 0.2 ml/min using 50 mM phosphate, 1.0 mM EDTA, 0.5% Tween 20, pH 6.65 to wash the column. The flow was increased to 1.0 ml/min after 13 minutes. Washing continued for a total time of 85 minutes to remove native, nonthiolated vancomycin. Thiolated vancomycin was eluted from the Affi- Gel 501 resin at 1.0 ml/min using freshly prepared 10 mM beta-mercaptoethanol in 50 mM phosphate, 1.0 mM EDTA, 0.5% Tween 20, pH 6.65. The first 5 fractions, 1.0 ml each, had A ₂₈₀ significantly greater than baseline and were pooled (0.1 16 A ₂₈₀ or 29 ug/ml, 5.0 ml). The MIC for the putative iminothiolated vancomycin was determined to be 2.4 ug/ml with S. aureus. The MIC of vancomycin is 1-2 μg/ml.

The derivatized vancomycin was concentrated on a Labconco Centravap, 1.0 ml of water was added, and the material was applied to a 1.5 X 13 cm column of Sephadex G10 (Pharmacia). The column was eluted with 50 mM sodium phosphate buffer, 1.0 mM EDTA, 0.5% TWEEN 20, pH 6.65. The material in the void volume was collected and pooled.

b) Reaction Of IgG With Sulfo-SMCC

In general, 15 moles of sulfo-SMCC were used per mole of IgG. Higher molar ratios of crosslinker than this resulted in precipitation of IgG. 40 mg human IgG (Sigma, Cat # 14506, Lot # 063H-8875I) was dissolved in 2 ml of 50 mM phosphate pH 7.1 buffer and 1.6 mg sulfo-SMCC (Prochem, Cat # CL207, Lot # 03092) was added with mixing. The mixture

was incubated at room temperature for 45 min and excess crosslinker was removed by chromatography on an AcA 202 gel filtration column. A 2 ml sample was applied to a 2.5 x 20 cm ACA 202 gel filtration column (Spectrum) equilibrated and eluted with 50 mM MES, 0.5%) Tween-20, pH 6.5 buffer. The first peak corresponding to the activated IgG was collected and absorbance at 280 nm was monitored.

c) Conjugation Of Derivatized Vancomycin And Derivatized IgG For the final conjugation of the derivatized vancomycin and the derivatized IgG, 2.95 ml of 4.4 mg/ml SMCCIgG (from step b above) was added to 14 ml of 0.74 mg/ml iminothiolated vancomycin (from step a above). The solution was incubated at ambient temperature on a rotary shaker at 200 φm. After one hour and five minutes, 100 μl of 3.5 mg/ml 2-mercaptoethanol was added and the incubation was continued for an additional 25 minutes. The solution was concentrated to approximately 2 ml using an Amicon Centricon 30.

The sample was loaded onto a 2.5 x 20 cm column of Spectra Gel ACA 202 resin (Spectmm) and eluted, at 1.0 ml/min, with PBS plus 0.1 % Tween 20. 1.5 ml fractions were collected. The fractions in the void volume were pooled and sterile filtered. The activity of the conjugate was determined by standard MIC testing against S. aureus. The conjugate against S. aureus was found to be inactive at 1.1 mg/ml.

EXAMPLE 37 Conjugation Of Vancomycin To IgG With S-Acetyl Mercapto Succinic Anhydride

("SAMSA") And Sulfosuccinimidyl 4-(N-Maleimidomethyl)cyclohexane-l -Carboxylate

("Sulfo-SMCC")

Because of the unsatisfactory results of the previous example in obtaining a vancomycin-IgG conjugate with antibacterial activity, an alternative crosslinking method was investigated using S-acetyl mercapto succinic anhydride ("SAMSA") to derivatize the vancomycin and sulfosuccinimidyl 4-(N-maleimidomethyl)cyclohexane-l -carboxylate ("sulfo- SMCC") to derivatize the IgG. The reaction proceeds in five steps which are outlined below. First, vancomycin is derivatized with SAMSA. Second, both derivatized vancomycin and free unreacted vancomycin are separated from any unreacted crosslinking agent. Third, the

derivatized vancomycin is separated from the free unreacted vancomycin. Fourth, non¬ specific immunoglobulin is derivatized with sulfo-SMCC. Fifth, the purified derivatized vancomycin and the derivatized IgG are reacted with each other forming a conjugate.

a) Reaction Of Vancomycin With SAMSA 20.4 mg vancomycin (Sigma, Cat # V2002, Lot # 43H1090) [14 μmoles] was dissolved in 200 μl of water. 1.2 ml of saturated sodium succinate was added slowly with stirring and this mixture was cooled to 4°C by placing the reaction mixture on ice. The mixture appeared slightly cloudy. To this mixture was added 121.8 mg of SAMSA (Sigma, Cat # A1251, Lot 3 # 120H5017) dissolved in 200 μl of dimethyl sulfoxide (DMSO, Mallinckrodt, Cat # 5507, Lot # 5507 KLDL). The pH was monitored. The beginning pH was 8.1, and after addition of the SAMSA, it was 6.8. The reaction mixture was incubated at 4°C for one hour followed by another one hour incubation at room temperature, while stirring constantly.

b) Separation Of Excess Crosslinker To remove excess crosslinker from modified and unmodified vancomycin, the mixture was applied to a G-10 column (2.5 x 20 cm, Pharmacia) equilibrated with 50 mM sodium phosphate, pH 7.1. The first peak which contained both modified and unmodified vancomycin was collected and stored at 4°C

c) Purification Of Modified Vancomycin From Unmodified Vancomycin By Affinity Chromatography On Organomercurical Column

A 5ml Affi Gel 501 Organomercurial agarose column (Bio-Rad) was prepared according to the manufacturer's instmctions. The column was equilibrated with 50 mM phosphate, pH 7.1. SAMSA modified vancomycin contains protected sulfhydryl groups which were deprotected with hydroxylamine hydrochloride before applying to the column. Hydroxylamine hydrochloride was added to the modified vancomycin solution to a final concentration of 0.2 M and the mixture was incubated at room temperature for five minutes. The sample was applied to the Affi Gel 501 column at a flow rate of 0.5 ml/min and the column was then washed with 10 mM 2-(N-Mθφholino) ethane sulfonic acid, 1 mM EDTA, 0.5%) Tween-20, pH 6.5 buffer until the baseline A ₂₈₀ was obtained. The bound modified

vancomycin was eluted with the same wash buffer containing 20 mM 2-mercaptoethanol. The activity of the modified vancomycin was determined to be 2.6 μg/ml by MIC testing against S. aureus.

d) Reaction Of IgG With Sulfo-SMCC This reaction was carried out as described in example 35, step b (above).

e) Conjugation Of Derivatized Vancomycin And Derivatized IgG

Modified vancomycin was in a buffer containing 20 mM 2-mercaptoethanol which was removed by dialysis, using benzoylated dialysis tubing (Sigma Cat # D7884, Lot # 43H7085). 750 μg vancomycin (-0.5 μmole) and 7.5 mg (0.05 μmole) maleimide activated IgG was used. The mixture was incubated at room temperature for one hour. Unreacted maleimide sites were blocked by adding 30 moles of 2-mercapto ethyl amine per mole of IgG and incubating the mixture at room temperature for 20 min. The conjugate was purified from excess 2- mercapto ethyl amine and unreacted vancomycin by gel filtration chromatography. The sample was applied to a AcA 202 gel filtration column (2.5 x 20 cm, Spectrum) equilibrated with 0.01 M phosphate buffered saline, pH 7.2 with 0.1 % Tween-20. Absorbance at 280 nm was monitored. The first peak containing vancomycin-IgG conjugate was collected. The activity of the conjugate was determined by MIC testing against S. aureus. MIC of this conjugate against S. aureus was found to be 0.438 mg/ml. This example demonstrates that conjugation of vancomycin derivatized by SAMSA with IgG derivatized by sulfo-SMCC results in an active conjugate. This conjugate was found to be an effective anti-microbial agent when tested against S. aureus.

EXAMPLE 38

Conjugation Of Limulus Antilipopolysaccharide Factor to IgG By Periodate Oxidation of IgG

This example describes the conjugation of Limulus antilipopolysaccharide factor (LALF) to human immunoglobulin by periodate oxidation of the IgG. LALF is a single chain peptide known to bind and neutralize endotoxin. See H.S. Waver et al. Infection and Immunity 60:2506 (1992). The sequence of the peptide is shown in Figure 13. After conjugation of the LALF to the IgG was accomplished, the conjugate was tested for binding

to both E.coli 0111 :B4 lipopolysaccharide (LPS) and E.coli HB101. The binding of LALF and PMB conjugates to LPS was also compared.

a) Preparation of LALF-IgG Conjugate

Purification is achieved by using a spectrophotometric LAL assay to monitor inhibition of LPS-induced lysate activation. Briefly, amoebocytes from L. polyphemus are collected under endotoxin-free conditions, lysed by the addition of distilled water, and centrifuged at 5,000 x g for 30 min. The pellet is extracted with 3 M urea. The extract is filtered through a membrane with a 30,000-Da cutoff and concentrated by a membrane with a

8,000-Da cutoff. The retentate is applied to a cation exchange column (CM Sepharose) equilibrated with 3 M urea- 10 mM ammonium acetate (pH 5.5) and step eluted with NaCl at

0.15, 0.25, 0.5M. The 0.5 M NaCl peak is directly applied to a C-4 reversed-phase column

(Vydac, Hesperia, Calif.) equilibrated with water-0.2% trifluoroacetic acid. The column is step eluted with 25, 35, and 50% isopropanol containing 0.2% trifluoroacetic acid. The 50% isopropanol peak is lyophilized and reconstituted immediately before use. The final product is typically found to be >95% pure by reversed-phase high-performance liquid chromatography and SDS-PAGE.

In this case, purified LALF was obtained from Associates of Cape Cod. Lyophilized

LALF was dissolved at 15 mg/ml in 50 mM sodium acetate, pH 5.0. The MIC of this native

LALF against E. coli HB101 was found to be 16 ug/ml. 10 mg of purified, human IgG (Sigma) was dissolved in 1.0 ml of 50 mM sodium phosphate, pH 7.1. 10.7 mg of sodium meta-periodate was added to the IgG solution and dissolved with mixing. The mixture was incubated at ambient temperature on a rotary shaker at 180 φm for 30 minutes.

The mixture was applied to a 2.5 x 20 cm column of Spectra-Gel ACA 202 (Spectmm) resin and eluted at 2.0 ml/min with 50 mM sodium phosphate, pH 6.7. The absorbance at 280 nm was monitored and 2.0 ml fractions were collected. The fractions corresponding to the void volume of the column (oxidized IgG) were collected.

0.66 ml of the above 15 mg/ml LALF solution was added dropwise with mixing to 1.3 ml of the oxidized IgG (2.1 mg/ml). The mixture was incubated on a rotary shaker at 180 φm for approximately 18 hours. 39 μl of 1.0 N HCI was added with mixing. The mixture was incubated at 180 φm for 3.0 hours at ambient temperature.

The mixture was applied to a 1.5 x 20 cm column of Spectra-Gel ACA 202 resin and was eluted at 1.0 ml/min. with PBS plus 0.1%) Tween 20. The eluent corresponding to the void volume, containing the LALF:IgG conjugate, was collected. The MIC of the LALF:IgG conjugate against E. coli HB101 was determined to be 300 mg/ml.

b) Assay of LPS and E. coli HB101 Binding of LALF-IgG Conjugate

E. coli 0111 :B4 lipopolysaccaride (LPS) was obtained from Sigma and was dissolved at 0.02 mg/ml in PBS plus 0.005% thimerosol. E. coli HB101 was diluted to 10,000,000 CFU/ml in PBS. 100 μl aliquots of LPS solution, E. coli HB101 suspension or PBS were added to wells of Falcon Pro-Bind 96 well microtiter plates. The plates were incubated for 18 hours at 2-8°C . The wells were washed 3 times with PBS. 100 μl of PBS plus 5 mg/ml BSA (Sigma Chemical Co.) was added to each well of the plates and the plates were incubated for 2.0 hours at room temperature. The plates were decanted and 100 μl of sample (e.g. conjugate, antibody, etc.) was added per well and the plates were incubated at ambient temperature for 2.0 hours. The wells were washed 6 times with BBS (0.125 sodium borate, 1.0 M NaCl, pH 8.3) plus 0.5% Tween 20, 3 times with 50 mM sodium carbonate, pH 9.5. Three Sigma 104 phosphatase substrate tablets were dissolved in 15 ml of 50 mM sodium carbonate buffer plus 10 mM MgCl ₂ and added at 100 ml per well. After approximately 20 minutes at ambient temperature, the absorbance at 410 nm of each well was determined. The results are shown in Table 40.

Table 40 Absorbance at 410 nm.

et ₄₁₀ = A ₄₁₀ amp e - ₄₁₀ o oate ate

Another LALF:IgG and a PMB:IgG conjugate were prepared as described above. Binding data for PMB:IgG, LALF:IgG and control IgG to LPS-coated and uncoated (PBS) plates is given in the table below. The binding of both conjugates to the LPS-coated plates is significant, with greater binding of the LALF:IgG to LPS at 4 and 0.8 μg/ml. The LALF:IgG and PMB:IgG conjugates bind LPS in a specific manner, since binding of control unconjugated IgG to LPS-coated plates and binding of both conjugates to PBS-coated plates are low. Thus, binding is mediated by the LALF and PMB portions of the conjugates.

Table 41

Binding of Conjugates to LPS

Conjugate

EXAMPLE 39

Neutralization of the in Vivo Effects of Endotoxin by LALF-IgG

In order to determine whether LALF-IgG conjugate is capable of neutralizing the lethal effects of endotoxin, the murine model of endotoxic shock discussed in Example 16 (see above) was utilized. Neutralization of endotoxin lethality was assessed by LALF-IgG. The minimal effective lethal dose of endotoxin was 15 ng, and the injection volume was 200 μl per mouse.

E. coli Ol l l :B4 endotoxin (Sigma) was prepared as described in Example 23 (see above), except that the diluent used was PBS and .0.1% Tween-20 (without BSA). The

endotoxin and variable amounts of LALF-IgG were incubated in varying amounts as in Example 16(b) (see above). The results are shown in Table 42. As shown in Table 42, the LALF-IgG conjugate was 100% effective at 5 μg per mouse in neutralizing the lethal dose of 15 ng endotoxin per mouse.

Table 42 Results of In Vivo Neutralization of Endotoxin

CLAIMS

I . An antibiotic-antibody conjugate, comprising antibiotic covalently bound to non-specific immunoglobulin, wherein said conjugate is capable of binding to bacteria via said antibiotic.

2. The conjugate of Claim 1 , wherein said immunoglobulin is IgG having an Fc region.

3. The conjugate of Claim 2, wherein said IgG is capable of binding to phagocytic cells via said Fc region.

4. The conjugate of Claim 1 , wherein said conjugate is bacteriostatic.

5. The conjugate of Claim 1, wherein said conjugate is bactericidal.

6. The conjugate of Claim 1, wherein said bacteria are gram positive bacteria.

7. The conjugate of Claim 1, wherein said bacteria are gram negative bacteria.

8. The conjugate of Claim 7, wherein said conjugate is capable of binding lipopolysaccharide on said gram negative bacteria.

9. The conjugate of Claim 7, wherein said conjugate is also capable of binding free endotoxin.

10. The conjugate of Claim 9, wherein said conjugate is capable of neutralizing free endotoxin.

I I . The conjugate of Claim 10, wherein said antibiotic is a polymyxin.

12. The conjugate of Claim 11, wherein said polymyxin is polymyxin B.

13. An antibiotic-antibody conjugate, comprising an endotoxin-binding compound covalently bound to non-specific immunoglobulin.

14. The conjugate of Claim 13, wherein said immunoglobulin is IgG having an Fc region.

15. The conjugate of Claim 14, wherein said IgG is capable of binding to phagocytic cells via said Fc region.

16. The conjugate of Claim 13, wherein said conjugate is capable of binding to gram negative bacteria.

17. The conjugate of Claim 16, wherein said conjugate is bacteriostatic.

18. The conjugate of Claim 16, wherein said conjugate is bactericidal.

19. The conjugate of Claim 13, wherein said endotoxin-binding compound is a polymyxin.

20. The conjugate of Claim 19, wherein said polymyxin conjugate is also capable of binding free endotoxin.

21. A therapeutic preparation, comprising surface-active antibiotic covalently bound to non-specific immunoglobulin, wherein said preparation is bactericidal for both gram- positive and gram-negative organisms.

22. The therapeutic preparation of Claim 21, wherein said antibiotic is selected from the group consisting of cephalosporins and penicillins.

23. The therapeutic preparation of Claim 21, further comprising: i) a first conjugate consisting of a first antibiotic covalently bound to non¬ specific immunoglobulin; and

ii) a second conjugate consisting of a second antibiotic covalently bound to non-specific immunoglobulin.

24. The therapeutic preparation of Claim 23, wherein said first antibiotic is polymyxin and said second antibiotic is bacitracin.

25. The therapeutic preparation of Claim 21, wherein two different antibiotics are covalently bound to the same immunoglobulin molecule.

26. The therapeutic preparation of Claim 25, wherein one of said antibiotics is capable of binding to gram-positive organisms and the other of said antibiotics is capable of binding to gram-negative organisms.

27. A method of treatment, comprising: a) providing a mammal for treatment; b) providing a therapeutic preparation, comprising an surface-active antibiotic compound covalently bound to non-specific lg; and c) administering said preparation to said mammal prior to any symptoms of bacterial infection.

28. The method of Claim 27, wherein said endotoxin binding compound is a polymyxin.

29. The method of Claim 27, wherein said protein is non-specific immunoglobulin.

30. The method of Claim 27, wherein said immunoglobulin is IgG.

31. The method of Claim 27, wherein said administering is intravenous.

32. A method of treatment, comprising: a) providing a mammal at risk for developing sepsis;

b) providing a therapeutic preparation, comprising an antibiotic capable of binding to a microorganism, covalently bound to a non-specific immunoglobulin; and c) administering said preparation to said mammal, prior to the onset of any symptoms of sepsis.

33. The method of Claim 32, wherein said mammal at risk of developing sepsis is selected from the group comprising neonatal calves and foals.

34. The method of Claim 32, wherein said mammal at risk of developing a sepsis is selected from the group comprising surgical patients, and trauma and bum victims.

35. The method of Claim 32, wherein said mammal at risk of developing a sepsis is an immunocompromised patient.

36. The method of Claim 32, wherein said administering is intravenous.

37. The method of Claim 32, wherein said mammal is at risk of developing sepsis due to potential exposure to gram-negative bacteria.

38. The method of Claim 32, wherein said antibiotic is comprised of D-amino acids.

39. The method of Claim 38, wherein said antibiotic comprises a polymyxin.

40. The method of Claim 39 wherein said polymyxin is polymyxin B.

41. The method of Claim 38 wherein said non-specific immunoglobulin is immunoglobulin G.

42. The method of Claim 32, wherein said mammal is at risk of developing sepsis due to potential exposure to gram-positive bacteria.

43. The method of Claim 42, wherein said therapeutic preparation is capable of binding to gram-positive bacteria.

44. The method of Claim 43, wherein said therapeutic preparation comprises bacitracin covalently bound to non-specific immunoglobulin.

45. The method of Claim 32, wherein said mammal is at risk of developing sepsis due to potential exposure to gram-negative and gram-positive bacteria.

46. The method of Claim 45, wherein said therapeutic preparation comprises an antibiotic which is bactericidal for both gram-positive and gram-negative bacteria.

47. The method of Claim 46, wherein said antibiotic is selected from the group consisting of cephalosporins and penicillins.

48. The method of Claim 46, wherein said therapeutic preparation comprises a mixture of a first conjugate comprising an antibiotic capable of reacting with a surface component present on a gram-positive bacteria covalently bound to a non-specific immunoglobulin and a second conjugate comprising an antibiotic capable of reacting with a surface component present on a gram-negative bacteria covalently bound to a non-specific immunoglobulin.

49. A method of diagnosis, comprising: a) providing: i) an antigen associated with the surface of a pathogenic organism immobilized to a solid support; ii) a conjugate comprising a surface-active antibiotic covalently bound to a non-specific immunoglobulin; and iii) a competitor comprising said surface antigen present in solution; b) incubating said immobilized antigen with said conjugate in the presence of said competitor;

c) washing said immobilized surface antigen to remove unbound conjugate and competitor; and d) detecting the presence of said conjugate bound to said immobilized surface antigen.

50. The method of Claim 49, wherein said immobilization of said surface antigen is achieved by the attachment of said surface antigen to the well of a microtiter plate.

51. The method of Claim 50 wherein said surface antigen is isolated from bacterial organisms.

52. The method of Claim 51 wherein said bacterial organisms are gram negative bacteria.

53. The method of Claim 52 wherein said gram negative bacteria comprises Escherichia coli.

54. The method of Claim 49 wherein said surface antigen comprises lipopolysaccharide isolated from Escherichia coli.

55. The method of Claim 54 wherein said competitor is a lipopolysaccharide isolated from gram negative bacteria.

56. The method of Claim 55 wherein said gram negative bacteria is selected from the group consisting of Escherichia coli, Salmonella typhimurium, Pseudomonas aeruginosa, Vibrio cholerae, Shigella flexneri, Klebsiella pneumoniae, Salmonella enteritiditis, Serratia marcescens and Rhodobacter sphaeroides.

57. A method of synthesizing a conjugate comprising the steps of: a) reacting an antibiotic with a crosslinking agent, to form a derivatized antibiotic; and

b) reacting said derivatized antibiotic with non-specific immunoglobulin, to form a conjugate.

58. The method of claim 57, wherein said antibiotic binds to the surface of microorganisms.

59. The method of claim 58, wherein said antibiotic is a peptide.

60. The method of claim 59, wherein said peptide is Limulus antilipopolysaccharide factor

61. The method of claim 59, wherein said peptide is a D-amino acid-containing pepti

62. The metiiod of claim 61, wherein said peptide binds endotoxin.

63. The method of claim 62, wherein said antibiotic is a polymyxin.

64. The method of claim 63, wherein said polymyxin is polymyxin B.

65. The method of claim 64, wherein said antibiotic is bactericidal to gram- negative bacteria.

66. The method of claim 57, wherein said antibiotic is bactericidal to gram-positive bacteria.

67. The method of claim 66, wherein said antibiotic is vancomycin.

68. The method of claim 67, wherein said non-specific immunoglobulin consists of an Fc region.

69. A method of synthesizing a conjugate comprising the steps of:

a) reacting a non-specific immunoglobulin with a first modifying reagent to form an oxidized immunoglobulin preparation;and b) reacting said oxidized immunoglobulin preparation with an antibiotic and a second modifying reagent to form an antibiotic-immunoglobulin conjugate.

70. The method of claim 69, wherein said immunoglobulin consists of an Fc region.

71. The method of claim 69, wherein said first modifying reagent is an oxidizing agent.

72. The method of claim 71, wherein said oxidizing agent is periodate.

73. The method of claim 69, wherein said second modifying reagent is a reducing agent.

74. The method of claim 73, wherein said reducing agent is sodium borohydride.

75. A method of synthesizing a conjugate comprising the steps of: a) reacting an antibiotic precursor with a first crosslinking agent, said antibiotic precursor possessing limited bactericidal activity to form a derivatized antibiotic precursor, said derivatized antibiotic precursor possessing increased bactericidal activity; b) reacting non-specific immunoglobulin with a second crosslinking agent, to form a derivatized immunoglobulin; and c) reacting said derivatized antibiotic precursor with said derivatized immunoglobulin to form a covalent bond between said derivatized antibiotic precursor with said derivatized immunoglobulin to form a conjugate.

76. The method of claim 75, wherein said antibiotic precursor is selected from the group consisting of 7-aminocephalosporanic acid and 6-aminopenicillanic acid.

77. The method of claim 76, wherein said first crosslinking agent is bifunctional.

78. The method of claim 77, wherein said first bifunctional crosslinking agent is m-Maleimidobenzoyl-N-hydroxysulfosuccinimide ester.

79. The method of claim 75, wherein said second crosslinking agent is bifunctional.

80. The method of claim 79, wherein said second bifunctional crosslinking agent is iminothiolane.