CA2142881A1 - Detection and therapy of lesions with biotin/avidin conjugates - Google Patents

Detection and therapy of lesions with biotin/avidin conjugates

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Publication number
CA2142881A1
CA2142881A1 CA002142881A CA2142881A CA2142881A1 CA 2142881 A1 CA2142881 A1 CA 2142881A1 CA 002142881 A CA002142881 A CA 002142881A CA 2142881 A CA2142881 A CA 2142881A CA 2142881 A1 CA2142881 A1 CA 2142881A1
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Prior art keywords
composition
targeting
detection
targeted
conjugate
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CA002142881A
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French (fr)
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David Milton Goldenberg
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Immunomedics Inc
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Individual
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    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B82—NANOTECHNOLOGY
    • B82Y—SPECIFIC USES OR APPLICATIONS OF NANOSTRUCTURES; MEASUREMENT OR ANALYSIS OF NANOSTRUCTURES; MANUFACTURE OR TREATMENT OF NANOSTRUCTURES
    • B82Y5/00—Nanobiotechnology or nanomedicine, e.g. protein engineering or drug delivery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
    • A61K47/6891—Pre-targeting systems involving an antibody for targeting specific cells
    • A61K47/6893—Pre-targeting systems involving an antibody for targeting specific cells clearing therapy or enhanced clearance, i.e. using an antibody clearing agents in addition to T-A and D-M
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
    • A61K47/6891—Pre-targeting systems involving an antibody for targeting specific cells
    • A61K47/6897—Pre-targeting systems with two or three steps using antibody conjugates; Ligand-antiligand therapies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K49/00—Preparations for testing in vivo
    • A61K49/06—Nuclear magnetic resonance [NMR] contrast preparations; Magnetic resonance imaging [MRI] contrast preparations
    • A61K49/08—Nuclear magnetic resonance [NMR] contrast preparations; Magnetic resonance imaging [MRI] contrast preparations characterised by the carrier
    • A61K49/10—Organic compounds
    • A61K49/14—Peptides, e.g. proteins
    • A61K49/16—Antibodies; Immunoglobulins; Fragments thereof
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
    • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
    • A61K51/04—Organic compounds
    • A61K51/08—Peptides, e.g. proteins, carriers being peptides, polyamino acids, proteins
    • A61K51/10—Antibodies or immunoglobulins; Fragments thereof, the carrier being an antibody, an immunoglobulin or a fragment thereof, e.g. a camelised human single domain antibody or the Fc fragment of an antibody
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
    • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
    • A61K51/04—Organic compounds
    • A61K51/08—Peptides, e.g. proteins, carriers being peptides, polyamino acids, proteins
    • A61K51/10—Antibodies or immunoglobulins; Fragments thereof, the carrier being an antibody, an immunoglobulin or a fragment thereof, e.g. a camelised human single domain antibody or the Fc fragment of an antibody
    • A61K51/1018—Antibodies or immunoglobulins; Fragments thereof, the carrier being an antibody, an immunoglobulin or a fragment thereof, e.g. a camelised human single domain antibody or the Fc fragment of an antibody against material from animals or humans
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K51/00—Preparations containing radioactive substances for use in therapy or testing in vivo
    • A61K51/02—Preparations containing radioactive substances for use in therapy or testing in vivo characterised by the carrier, i.e. characterised by the agent or material covalently linked or complexing the radioactive nucleus
    • A61K51/04—Organic compounds
    • A61K51/08—Peptides, e.g. proteins, carriers being peptides, polyamino acids, proteins
    • A61K51/10—Antibodies or immunoglobulins; Fragments thereof, the carrier being an antibody, an immunoglobulin or a fragment thereof, e.g. a camelised human single domain antibody or the Fc fragment of an antibody
    • A61K51/1093—Antibodies or immunoglobulins; Fragments thereof, the carrier being an antibody, an immunoglobulin or a fragment thereof, e.g. a camelised human single domain antibody or the Fc fragment of an antibody conjugates with carriers being antibodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/04—Antibacterial agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A61P35/02—Antineoplastic agents specific for leukemia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G01N33/531—Production of immunochemical test materials
    • G01N33/532—Production of labelled immunochemicals
    • G01N33/534—Production of labelled immunochemicals with radioactive label
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01R—MEASURING ELECTRIC VARIABLES; MEASURING MAGNETIC VARIABLES
    • G01R33/00—Arrangements or instruments for measuring magnetic variables
    • G01R33/20—Arrangements or instruments for measuring magnetic variables involving magnetic resonance
    • G01R33/44—Arrangements or instruments for measuring magnetic variables involving magnetic resonance using nuclear magnetic resonance [NMR]
    • G01R33/48—NMR imaging systems
    • G01R33/54—Signal processing systems, e.g. using pulse sequences ; Generation or control of pulse sequences; Operator console
    • G01R33/56—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution
    • G01R33/5601—Image enhancement or correction, e.g. subtraction or averaging techniques, e.g. improvement of signal-to-noise ratio and resolution involving use of a contrast agent for contrast manipulation, e.g. a paramagnetic, super-paramagnetic, ferromagnetic or hyperpolarised contrast agent
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2123/00—Preparations for testing in vivo

Abstract

Uses of compositions in methods for detecting and/or treating targeted lesions in a patient are provided. The compositions used are comprised of a targeting composition comprising a biotin and targeting protein conjugate or an avidin and targeting protein conjugate; optionally, a clearing composition comprised of avidin, when the targeting composition is a biotin conjugate, or biotin, when the targeting composition is an avidin conjugate; a detection or therapeutic composition comprised of a conjugate of avidin or biotin with a targeting protein and detection or therapeutic agent; and, optionally, another detection or therapeutic composition comprised of avidin or biotin conjugated to a detection or therapeutic agent. The compositions, methods of use, and kits for use are also provided.

Description

2 1 4 2 ~ 8 i PCI'/US93/07754 IMPROVED DETEt:TION AND THE~APY OF LESIONS
Wlq~I B}OTIN/AVIDIN CONJU&ATES

BAC~GROIJN~ OF THE INV~IQ~t 1- Field of the Invention The present invention relates to improved uses of compositions containing biotin and avidin in methods for detecting and treating pathological conditions with a multi-step process.

2- Description of the Prior Art j .

Antibodies against different determinants associated with pathological and normal cells, as well as associated with pathogenic microorganisms, have been used for the detection and treatment of a wide variety of pathological conditions, or lesions. The targeting antibody is 15 conjugated to an appropr~ate detecting or therapeutic agent according to processes well known and readily available to one of ordinary s~cill in the art, as described, for example, in Hansen et al., U.S. Patent No.
3,927,193 and Goldenberg, -U.S. -: ~at. Nos. 4,331,647, ~0 4,348,376, 4,361,544, 4,468,457,- i,4ii,744, 4,460,459,
4,460,S61, 4,624,846 and 4,818,709.
When detecting a lesion, a high signal-to-background ratio needs to be achieved. Therapy also requires a high ab~olute accretion of the therapeutic agent in the 25 lesion; as well as a raasonably~Iong duration of uptake and ~ina~ ng. High background levels of non-targeting antibody have long been recognized as a major impediment to high tarqet: background ratios being achie~red. To overcome this impediment, various methods have been 30 developed, such as th08e described in the above-21~2881 referenced Goldenberg patents.
Still other methods have been developed to increase the target:background ratios of the detection or therapeutic agents, such as pre-targeting and biotin/avidin approaches, as described, for example, in Goodwin et al., U.S. Patent ~o. 4,863,713; Goodwin et al., J. Nucl. Med. 29:226, 1988; Hnatowich et al., J.
Nucl. Med. 28:1294, 1987; Oehr et al., J. Nucl. Med.
29:728, 1988; Klibanov et al.~ J. Nucl. Med. 29:1951, 1988; Sinitsyn et ~1., J. Nucl. Med. 30:66, 1989;
Xalofonos et al., J. Nucl. Med. 31:1791, 1990; Schechter et al., Int. J. Cancer 48:167, 1g91; P~ganelli et al., Cancer Res. 51:S960, 1991; Paganelli et al., Nucl. Med.
Commun. 12:2Il, 1~91; Stickney et al., Cancer Res.
51 6650, 1991; and Yuan et al., Cancer Res. 51:3119, 1991~.
,~ ~
~ Avidin, found in egg whites, has a very high binding affinity~ for biotin, which is a B-complex vitamin (Wilcheck et al., Anal. Biochem, 171:1, 1988).
20 ~ Streptavidin, derived from streptomyces avidinii, is s~i~ilar~ to avidin, but has lower non-specific tissue bindln~g,~and th-r-rore often is used in p}ace of avidin.
Both avidin~ and ~treptavidin have a tetravalency for b1otin, thus permitting ~ampllfication when the former ; 25 bin* to-biotin. ~ ~`
In a;prior-art 2-step procedure, a targeting antibody con~ugated -wi~h ~either avidin or biotin and then is - in~ected into a patient, thus localizing the avidin or -l ~ b~otin at a ~umor of interest. Thereafter, eibher biotin ; ~ 30 or~ avidin (depending on which was coupled to the target~ng ~antibody), bearing an imaging isotope, is inj-cted--~n~ is localiz-d at the Qite of the primary antibody by binding to avidin or biotin, resFec~ively.
~ Timing of the second injection after the first one - 35 is very critical. Injecting the radiolabeled avidin or biotin too early will increase the avidin/biotin conjugates in the bloodstream and nontargeted tissues, while injecting very late ~ay decrease the amount ;

W094/04702 2 1 4 2 ~ ~ 1 PCT/US93/077~4 targeted to the tumor because of reduced retention of the primary antibody at the tumor.
Paganelli et al. (Int. J. Cancer 2:121, 1988) and Kalofonos et al. (J. Nucl. Med. 31:1791, lsso) demonstrated the feasibility of the above approach (the former used biotinylated antibody; the latter used streptavidin-conjugated antibody for tumor localization).
In work reported by Kalofonos et al. (ibid.), 3 of lO
patients showed improved imaging. However, the patients also showed that labeled biotin alone (without antibody pretargeting) could detect tumors in 8 of lO patients.
Paganelli et al. (J. Nucl. Med. 31:735, 1990 and Cancer Res. 51:5960, 1991) disclose a 3-step approach wherein a biotinyIated antibody is administered, followed by cold, i.e., non-labeled and non-conjugated, avidin to clear nontargeted antibody, and then a radiolabeled b~iotin is given which bind~ to the avidin retained in the body;,~pr-sumably~where the aYidin has complexed to the biotinylated~antibody. By this method, Paganelli et al.
were~able to show, with the exception of the kidneys, high tumor:normal organ ratios. By further examining this 3-step procedure, however, the pre~ent`inventor has found th~t cold avidin can reduce the amount of biotin (in thè~biotiny~lated antibody) contained in tumor.
~ Further, many of the above-cited studies have demonstrated that avidin is immunogenic-,-resulting in anti-avidin antibodies which preclude- -repeated administrations of this agent (and thereby repeated dqtecting or therapy courses). Nany of these 2- and 3-stQp approaches using biotin or avidin~immunoconjugateshave shown improved target:background ratios; however, - the administration of a clearing ag~ntr such as avidin, a~ter a biotinylated targeting antibody-is first given, not only reduces circulating biotinylated antibody, but al~o reducQs the amount of biotinylated antibody in the - target lesion.
Therefore, a need exists for better uses of co~positions in methods which will allow for higher and W094/~702 2 1 ~ 2 8 8 1 4 PCT/US93/077 - more selective tar~eting and retaining detection and therapeutic a~ents to and at pathological lesions and for retaining higher amounts of biotin with the original antibody.

OBJECTS_OF ~FHE I~VENTION

The principal object of the present invention is to provide a composition for use in a method of delivering higher amounts and higher target:nontarget ratios of detection or therapeutic agents to targeted leæions.
Another objective of the invention is to provide a composition for use in a method of increasing the amount of primary targeting-antibody present in a lesion to be detected or treated.
Still another object of the invention is to provide a compo~ition for use in a 3- or multiple-step procedure which delivers higher amounts of a detection or therapeutic agent to a lesion.
Yet another object of the invention is to provide composition for u~e in a method of restoring any cleared primary antibody and/or detection or therapeutic agent from a lesion in a later targeting step.
A further o~jèct of the invention is to provide a composition for u~e in a method of decreasing the immunogenicity of-the-targeting agents.
Yet another object of the invention is to provide a plurality of uses for these detection or therapeutic agents.
Upon further study of the specification and appended claLms, further objects and advantages of this invention will become apparent to those skilled in the art.
, .
S~MM~Y OF TEE INVENTION

In its broadest embodiment, the invention provides a composition for use in a method of detecting and/or treating le~ions in a patient. The method comprises the W094/~702 PCT/US93/07754
- 5 - ~

steps of (a) parenterally injecting a subject with a targeting composition comprised of (i) a biotin-protein conjugate or (ii) an avidin-protein conjugate, wherein the protein preferentially binds to a marker substance produced or associated with the targeted lesion, and allowing the protein conjugate to preferentially accrete at the targeted lesion; (b) then, optionally, parenterally injecting a clearing composition comprised of (i) avidin, when the targeting composition is a biotin-prote~in conjugate, or (ii) biotin, when the targeting composition is an avidin-protein conjugate, and allowing the clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion; (c)-parenterally injecting a detection or therapeutic composition comprised of a conjugate of (i) avidin, protein and detection or therapeutic agent, or (ii) biotin, protein and detection or therapeutic agent, wherein the protein preferentially binds to a mark r sub~tance produced by or a~sociated with the targeted lesion and wherein the protein may be the same as the protein of the targQting composition, and allowing the composition to accrete at the targeted lesion; and (d) parenterally inject.ing, either prior or subse~uent to ~'th- co~posit1on of (c), another detection or therapeutic ~; co position comprised of (i) avidin conjugated-to a d~tection;or therapeutic agent, or (ii)biotin-conjugated to a detection or therapeutic agent, wherein the de~ection or therapeutic agent may be the s~me a~ the d~tection on therap~utic agent of step (c),''and allowing the con~ugate to accr~te at the targeted }e~ion, wherein (i) step (d) is optional if a clearing co~position has b~en ad~inistered, (ii) the d~tection-'or- therapeutic compositions o~ step (c3 and (d) containing avidin are ~ad~inistQred as the nQxt step after the administration of a composition containing biotin or of a clearing ~; ' composition containing avidin, (iii) detection or th~rapeutic co~po~ition~ of step (c) and (d) containing W094/~702 2 1 ~ S ~ i PCT/US93/077~ ~
- 6 -biotin are ~dministered as the next step after the administration of a composition containing avidin or of a clearing composition containing biotin.
In variations of the above;embodimen~, the following compositions are used in each step.
In a three-stage embodiment, first the targeting composition comprised of a biotin-protein conjugate is injected, and no clearing composition is administered;
then a detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent is injected and then a detection or therapeutic composition comprised of a con~ugate of biotin, protein and detection or therapeutic agent is injected.
In a four-step embodiment, a targeting composition 1~ comprised of a biotin-protein conjugate is first injected, then a clearing composition comprised of avidin is injected, then a detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent is injected, and, lastly, a detection or therapeutic compo~ition comprised of a conjugate of biotin, protein and detection or therapeutic agent is injected.
In another four-step embodiment, a targeting composition comprised of a biotin-protein conjugate is injected, then a clearing composition comprised of avidin is injected, then a det-ection or therapeutic composition comprised of a conjugate of biotin, protein and detection or therapeutic agent is injected, and, lastly, another detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent is injected.
In another-~-~four-step embodiment, a targeting compo~ition comprised of a bi~tin-protein conjugate is in~ected, then a clearing composition comprised of avidin is injected, then a detection or t~erapeutic composition comprised of biotin conjugated to a detection or thexapeutic agent is injected, and, lastly, a detection or therapeutic composition comprised of a conjuga~e of 21~28~
- 7 -avidin, protein and detection or-therapeutic agent is injected.
In another three-step embodiment, a tar~eting composition comprised of a biotin-protein conjugate is injected, then a clearing composition comprised of avidin is injected, and, lastly, a detection or therapeutic composition comprised of a conjugate of biotin, protein and ~etection or therapeutic agent is injected.
In another four-step embodiment, a targeting composition comprised of a biotin-protein conjugate is injected, then a clearing composition comprised of avidin is injected, then a detection or therapeutic composition comprised of a conjugate of avidin, protein and detection or therapeutic agent is injected, and, lastly, another detection or thorapeutic composition comprised of biotin conjugated to a detection or therapeu~ic agent is injected.
In another three-step embodiment, a subject is first inj-cted with a targeting compo~ition comprised of an avidin-protein conjugate, then the subject is injected with a detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent, -and, la~st}y, the~subject is injected with a detection or th~rapeutic composition comprised of a conjugate of - 25 a~idin, protein and detection or therapeutic agent.
In another ~four-step embodiment, -a--~argeting composition compri~ed of an avidin-protein conjugate is injected, then a clearing composition compri~ed Qf biotin is, injected~ then;a detection or therapeutic composition compri~ed of biotin conjugated to a dQtection or therapeutic ag-nt is inje¢ted, and, lastly, a detection or thesapeutic composition compri~ed-of--~ conjugate of avidir., protein and detection or therapeutic agent is in~e¢ted.
, ~
In another four-step embodiment, an avidin-protein ¢on~uga*e i~ injected, then a clearing composition :
¢omprised of biotin is injected, then a detection or th ap~utic ¢ompo~ition comprised of a conjugate of WO 94/04702 2 1 !; 2 ~ 8 ' PCI /US93/07754 ~
-- 8 -- :

-avidin, protein and detection or therapeutic agent is ;~
injected, and, lastly, another detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent is in~ected.
SIn another four-step embodiment, a targeting compo~ition comprised of an avidin-protein conjugate is injected, then a clearing composition comprised of biotin is injected, then a detection or therapeutic composition comprised of avidin conjugated to a detection or 10therapeutic agent is injected, and, lastly, another detection or therapeutic composition comprised of biotin, protein and detection or therapeutic agent is injected.
In another three-step em~odiment, a targeting composition comprised of an avidin-protein conjugate is 15injected, then a cl~aring composition comprised of biotin is injected, and, lastly, a detection or therapeutic composition comprised of a conjugate of avidin, protein and detection or therapeutic agent is injected.
In another four-stQp embodiment, a targeting 20compo~ition comprised of an avidin-protein conjugate is injected, then a clearing compo6ition comprised of biotin !
is injected, then a detection or therapeutic composition compri~ed of a conjugate of biotin, protein and detection or therapeutic agent is injected, and, lastly, another detection or therapeutic composition comprised of avidin conjugated to a--det~c~ion or therapeutic agent is injected. ~

DETAILED DISCUSSION
. .
It has now been found that the use of the compositions ~isc~o~ed herein in 3- and 4-step procedures of the pre~ent invention is more advantageous for selective detection and therapy of lesions than the uses disclo~ed in the prior art.
In a more preferred embodiment o~ this invention involving a 3-step approach, a biotinylated targeting antibody or fragment i8 injected, followed by the W094/04702 2 1 ~ 2 8 8 I PCT/US93/07754 application of avidin as a clearing agent Then, as a third step, instead of administering biotin-conjugated isotope or drug as taught in the prior art, a lesion-targeting antibody or fragment conjugate is administered The antibody or fragment is either the same as that of the first step or another such targeting antibody or fragment, and is conjugated with biotin and with a detection or therapeutic agent Using the lesion-targeting antibody or fragment conjugate forms another lattice of complexation of biotin-avidin-biotin, with the added advantage of targeting to the lesion with the antibody or fragment -The more preferred 4-step embodiments have two basic approaches In both, the first step is the injection of a biotinylated antibody or fragment and the second step is the injection of an avidin chaæe The third step ~- involve~ the iniection of either avidin conjugated with a detection or theràpeutic agent, or, alternatively, a biotin conjugated with a detection or therapeutic agent - 20 When the third step use~ an avidin conjugate, the fourth st-p i8 an injection of a biotinylated anti-lesion antibody or frag- nt conjugatQd with a detection or therap-utic agent When the~third step involves biotin con~ugated with a detection or therapeuti-c agent, the 25~ fourth~ st p re~ ires the injection of an anti-lesion antibody or fragment conjugated with avidin_and with a d~taction~or~therapeutic agent Each of these 4-step approaches is an improvement, ~-in~terms of ab-olute amount of detection or therapeutic agent delivered and retained at the site-of the lesion, co~pared to th~ prior~ art 2- and- 3--step procedures *hich~did not contemplate the U~Q of a-biotinylated or av~din-coniuga*Qd~antibody o ~ra~c nt bQaring additional detection or therapQutic ag-nts for enhance~ent of the ~- 35 e~fect~as a l-~t step or~ cours-, if desired, the ~equence can be repeated for additional accumulation of the agents, as needed Furth r, the preferred lesion-loc~lizing antibody can be W094/04702 2 1 ~ 2 ~ ~ 1 PCT/US93/07754 -- 10 -- !

a bispecific or hybrid antibody, whereby at least 2 antibody arms are directed against different epitopes of the same antigen or against different substances associated with the lesion. This is preferred in order to achieve higher levels of accretion and binding in the lesion.
These uses of the compositions of the present invention provide the following improved results over other sequences reported earlier by others:
1. increased binding and retention of primary antibody in the lesion;
2. higher lesion:normal organ ~including kidney) ratios;
3. increased targeting of detection and therapeutic agentC to the lesion; and 4. improved lesion detection or therapy. -The detectionltherapeutic agents used in the present invention can be any or multiples of the following:
A- diagnostic or therapeutic radionuclides (e.g.,alpha-, beta-, gamma-, positron-, x-ray-and fluorescence-emitters; electron- and neutron-capturing agents);
B- photoactivated dyes for detection or therapy;
C- cytotoxic agents (e.g., drugs, toxins, hormones, ~ ytokines, hormone ` antagonists, receptor an~agonists);
D- differentiation agents (e.g., vitamins, cytokines! autocrines, certain hormones and drugs).
The composit~ons of the present invention can be used to detect (eith~r-by internal procedures or by external imaging) and-~or~ treat lesions, including cancers, infec~ious diseases, cardiovascular diseases and other pathological condit~ons.
Internal detection procedures include intraoperative, intravascular or endoscopic, including laparoscopic, techniques, both surgically invasive and W094/W702 2 1 ~ 2 8 8 1 PCT/US93/07754 non-invasive.
Avidins are a family of proteins functionally defined by their ability to bind biotin with high affinity and specificity. Avidins are fairly small oligomeric S proteins, made up of four identical subunits, each bearing a single binding site for biotin. Avidins can - therefore bind up to four moles of biotin per mole of avidin. ~ v Avidins include proteins (a) produced by amphibians, reptiles and avians, which are present in their eggs and known as avidin, and (b) produced by a streptomyces, Streptomyces ~id~nii, and known as streptavidin. As used herein ~avidin~ includes all of the above proteins.
Proteins are known which preferentially bind marker - ;~
substances that are produced by or associated with lesions. For example, antibodies can be used against cancer-associated substances, as well as against any p~thological l-sion that shows an increas-d or unique antigenic~marker, such a~ against substances associated 2~0 ~ ~with~;c~r4iovas¢ular~ 1Q8ionS, such as, vascular clots - incIuding thrombi and emboli, myocardial infarctions and `` oth-r organ in~arcts, atherosclerotic plaques;
inflar~atory ~ lesion8; and infectious~ and parasitic agents.~ Examples of appropriate ~applications are 25~ y ovided~in~the~abov -referenc-d Goldenberg patents and applications. ~ = - -;
- - .
The~canoer ~t~te8~ include carci~omas;, -melanomas, -~ sarcomas, neuroblastomas, leukemias, lymphomas, gliomas an~ myQlomas.
The infectious diseasQs include those caused by invading ~microbes~ or parasites. ;As used herein, ` H~icrobe" d-notes viru~, bacteria~-- rickettsia, ~ycoplasm~, protozoa, fungi and like-~microorganis~c~
par~-ite" denotes infectious, generally microscopic or ~v ry ~ ll multicellular invertebrates, or ova or uvenile forms thereof, which are susceptible to antibody-induced clearance or lytic or phagocytic d-struction, e.g., malarial parasites, spirochetes and , .

- 21~28~ i the like, i-ncluding helminths, while "infectious agent"
or ~pathogen~ denotes both microbes and parasites.
The protein substances useful in the present invention include protein, peptide, polypeptide, glycoprotein, lipoprotein, or the like, e.g. hormones, lymphokines, growth factors, albumin, cytokines, enzymes, immune modulators, receptor proteins, antibodies and antibody fragments.
The protein substance of particular interest in the preeent invention are antibodies and antibody fragments.
By "antibodies and antibody fragments" is meant generally immunoglobulins or fragments thereof that specifically bind to antigens to form immunè c~mplexes.
The antibody may be whole immunoglobulin of any cla~s, e.g., IgG, IgM, IgA, IgD, IgE, chimeric or hybrid antibodies with dual or multiple antigen or epitope specif~icitiQc. It can bo a polyclonal antibody, pre$erably an affinity-purified antibody from a human or an appropriate animal, e.g., a primate, goat, rabbit, mou~o or the like. Monoclonal antibodies are also suit~ble for u-e in the pre-ent invention, and are preferred b~cause o~ their high spec~ficities. They are r-adily~prepar~d by what are now con~idered conventional procedures of i~ unization of mammals with immunogenic sntigen prep~r~tion, fusion of immune lymph or spleen cells with an im~ort~l-myeloma cell line, and isolation .
of ~pecific hybrid-oma --clonQs. More unconvention~l m thods of proparing monoclonal antibodies are not ex~luded, ~uch as interspQcios fu~ions and genetic engineoring manipulationQ of hyporvariablo regions, since it i~ pri~arily tho antig n sp-cificity of the antibodies that af~-ct~l_tho1r utility in the present invention. It will bo approciatod that n~wer techniquos for production of monoclonals can ~lso b~ used, e.g., human monoclonals, inter~peci~ monoclonal~, ch~Qric ~o.g., human/mou~e) monoclonals, genetically engineerod ant~bodies and the like.
Antibody fragm-nt~ usoful in the pro~ont invention 21~2881 :
W094/~702 PCT/US93/07754 include F(ab')2, F(ab)2, Fab', Fab, Fv and the like inc~uding hybrid fragments. Preferred fragments are Fab', F(ab~ )2~ Fab, and F(ab)2. Also useful are any subfragments retaining the hypervariable, antigen-binding region of an immunoglobulin and ha~ing a size similar to or smaller than a Fab' fragment. Th~s will include genetically engineered and/or recombinant proteins, ~`
whether single-chain or multiple-chain, which incorporate an antigen-binding site and otherwi6e function in vivo as targeting vehicles in substantially the same way as natural immunoglobulin fragments. Such single-chain binding molecules known in the art, and are disclosed in U.S.Patent 4,946,778. Fab' antibody fragments may be conveniently made by reductive cleavage of F(ab' )2 frag~ents, which themselves may be made by pepsin digestion of intact immunoglobulin. Fab antibody ~-fra~e:nts may be made by papain digestion of intact i~munoglobulin, under reducing conditions, or by cleavage of~ F(;ab)~2~ fr~gments which rasult from careful papain 20- digestion of whole im~unoglobulin. The fragments may also b- produced by genetic engineering.
It hould be noted that mixtures of antibodies and - i unoglobulin cla---s can be used, as can hybrid antibodi-s. Multisp-cific, including bispecific and hybrid,~antibodies~and antibody fragments are especially pref-rr-d in the present invention for- detecting and treat~ng le~ions and are comprised of at~l~a~t two different sub~tantially monospecific antibodies or antibody frag~ent~, wherein at ~least two of said antibodies or antibody fragments specifically bind to at least two dif~erent antigens produced or associated with th- targ-ted le-ion or ~t least two di-~f~rent epitopes or molecule~ o~ ~ ~arker substance prod~uced or associated with the targeted le~ion. Multisp~cific antibodies and anti~ody ragm~nts with dual ~p~cificitie~ c~n be prep~rQd analogously to the anti-tu~or marker hybrids ~ ~ di~clo~ed in U~S. Pat. No. 4,361,544. Other techni~ues - ~ for pr-paring hybrid antibodies are disclo~ed in, e.g., :
:~ .

2~ 12881 ''''J' ' ' '' W094/0470t PCT/US93/077 - U.S. Pat. No. 4,474,893 and 4,479,895, and in Milstein et al., Immunol. Today, 5,299t1984).
Preferred are proteins having a specific immunoreactivity to a marker substance of at least 60%
- 5 and a cross-reactivity to other antigens or non-targeted substances of les~ than 35%.
As di~clo~ed above, antibodies against tumor antigens and against pathogens are known. For example, antibodies and antibody fragments which specifically bind markers produced by or associated with tumors or infectious le~ions, including viral, bacterial, fungal and parasitic infection , and antigens and products associated with such microorganisms have been disclosed, inter alia, in Hansen et al., U.S. Patent 3,927,193 and Goldenberg U.S.
Patents 4,331,647, 4,348,376, 4,361,544, 4,468,457, 4,444,744, 4,818,709 and 4,624,846. In particular, antibodies against an antigen, e.g., a gastrointestinal, lung, br st, prostate, ovarian, testicular, brain or ~; 1 W hatic; tumor, a sarcoma or a melanoma, are advantageously u~ed.
A wide vari~ty of monoclonal antibodies against infectious~dis-ase agents ha~e been develop~d, and are summarized in a review by Polin, in Eur. J. Clin.
, ~ . .
~MicrobioL., 3(5)~387-398, 1g84, showing ready 2S ~availability. These include monoclonal antibodies (MAbs) against p~thog-ns- and- their antigens such as the ; following~
.

1, ' ' ' A=O ~ ~e~ ~ I Y~
Streptococcus-agaiact-tae L4gionella pneumophilia Streptococcu&--pyog~nes ~; E~cherichia-col~~ ~
-~ Neisseria gonorrho~ae Neiss ia ~cningitidis 3S Pneumococcus H~mophili~ influenzae B
Trepon-ma pallidu~

21~2881 W094/~702 PCT/US93/07754 Lyme disease spirochetes Pseudomonas aeruginosa Mycobacterium leprae Brucella abortus Mycobacterium tuberculosis Tetanus toxin "~
~nti-viral MAbs HrV-l, -2, -3 Hepatitis A, B, C, D
Rabies visus Influenza virus Cytomegalovirus Herpes simplex I and II
Human serum parvo-like virus Respiratory syncytial virus .
Varicella-Zoster virus Hepatitis B virus Meas1 s virus :~ Adenovirus ,~
:20 Human T-cell leukemia viruses Epstein-Barr visus Murine leukemia visus*
Nu~ps virus : ~ I
: V-~icular stomatitis virus ! `
~:25 Sindbis~visus ` ~
:; ~ Ly-phocytic choriomeningitis virus -- -Wast virus .
Blue tongue virus Sendai virus ~
F-line 1eukeuia viru~* i-`
Reo virus ~ .
~ Polio virus ~--~~--- --~ : Si~ian virus 40* :
Mouse mam~asy tumor visus* ~
~: 3~5 D ngu~ visu~ . : Rubella visus *~an~mal ViSU8 wo g4,04702 2 1 1 2 8 8 i PCTtUS93/07754 Anti-Drotozoan MAbs --Plaæmodium falciparum Plasmodium vivax Toxoplasma gohdii S Trypano~o~a rangeli Trypanosoma cruzi Trypanosoma rhodesien~ei - Trypano-oma brucei ~S¢histo80~a m~nsoni 5c~i~to~o~ japanicum Bab~ia bovis El~ria t~nella Onchocerca volvulus LeiEhm~nia tropica Trichin-lla -pir~l~s theilelria~parva hyd~tig-na Ta~nia ovis~
~Taenia-~agin~t~- 20 Echinococcu- granulo~u~
ocestoide~ corti ntimvco~la~L MAbs ~
Mycopl~8~ rthritid1c M~ hyorhinis 25~ N~or~
M ~arginini;~
; Achol~plas-a laidlawii MJ s~livarium M pneu~oni~

30~ AdditionaL -x~nple--= of---MAbs g~nerat-d against inr - c~ious~ organi~s thst h~v been described in the liter~tur~ are~noted below MAbs~gainst the gpl20 glycoprotein antigen of human ounodefici-ncy virus 1 (HrV-l) are known, and certain of~such antibodie~ can have an immunoprotective role in hu~ans S-e, Q.g., ~o~si et al , Proc N~tl~ Acad Sci :; :
~: :
:

21 12~8 1 ~

USA, 8S:8055-8058, 1990. Other MAbs against viral antigens and viral induced antigens are al50 known. This shows that proper selection of the epitope can distinguish between a therapeutic and non-therapeutic target.
NAbs aqainst malaria parasites can be directed against the sporozoite, merozoite, schizont and gametocyte stag@s. Monoclonal antibodies have been generated against sporozoites (circumsporozoite antigen), and have been shown to neutralize sporozoites in vitro and in rodents (N. Yoshida et al., Science 207:71-73, 1980).
Several groups have developed M~bs to T. gondii, the protozoan para~ite involved in toxoplasmosis (Kasper et al., J. Immunol. 129:1694-1699, 1982; Id., 130:2407-2412, 1983).
MAbs have been developed against schistosomular surface antigens and have been found to act against schistosomulae in vivo or in vitro (Simp~on et al., Parasitology, 83:163-177, 1981; Smith et al., Parasitology, 84:83-91, 1982; Gryzch et al., J. Immunol., 129:2739-2743, 1982; Zodda et al., J. Immunol. 129:2326-2328, 1982; Dissous et al., J. Immunol., 129:2232-2234, 1982).
Trypanosoma cruzi is the causative agent of Chagas' disease, and is transmitted by blood-sucking reduviid - - -insects. A NAb has been generated that specifically -inhibits the differentiation of one form of the parasite to another (epimastigote to trypomastigote stage) in vitro, and which reacts with a call-surface glycoprotein;~
however, th~s antigen is absQnt from the mammalian (bloodstream) forms of the parasite (Sher et al., Nature~
300:639-640, 1982). -~
Suitable MAbs have been developed against most of the microorganisms (bacteria, viruses, protozoa, ~ otherparasites) responsible for the majority of infections in humans, and many have been used previously for in vitro diagnostic purposQs. The~e antibodies, and newer MAbs wos4/o47o2 2 1 f~ 2 ~ i PCT/US93/07754 that can be generated by- conventional methods, are appropriate for use in the present invention.
Proteins useful for detecting and treating cardiovascular lesions include fibrin-specific proteins, for example, fibrinogen,. solub~e fibrin, antifibrin antibodies and fragments, fra~ment E~ (a 60 ~Da fragment of human fibrin made by controlled pla~min digestion of cros~linked fibrin), plasmin (an enzyme in the blood respon~ible for the dissolution of fre~h thrombi), plasminogen activators (e.g., urokinase, streptokinase and tissue plasminogen activator), heparin, and fibronectin (an adhesive plasma glycoprotein of 450 kDa) and platelet-directed proteins, for example, platelets, antiplatelet antibodies and antibody fragments, anti-activated platelet antibodies, and anti-activated-platelet factors, which h~ve been.reviewed by Koblik et al., se~in. Nucl . Med ., 19:221-237 (1989).
Among the radionuclides u~eful in the present invéntion, gamma-emitters, po~tron-emitters, x-ray :e~itters: and fiuorescence-emitters are suitable for Iocalization and/or therapy, while beta- and alpha-emitters and electron- and neutron-capturing agents also . can be used for therapy.
Suitable radioisotop-~ for ~use in the. present -25 invention include: Astat~ne-211, Iodine-123, Iodine-125, : Iodine-126, Iodine-131, Iodine-13.3.~B- smuth-212, Bromine-: 77, Indium-l:ll, Indlum-113m, Gallium-67, Gallium-68, ;
Ruthenium-95,Rutheniu~-97, Ruthenium-103,Ruthenium-105, !: . Mercury-107, Mercury-203, Rhenium-186~.~Rhenium-188, Tellurium-l~lm, Tellurium-122m, Tellurium-125m, Thulium-165, Thulium-167, Thuliu~-168, T-chnetiu~-99m, Fluorine-~ 18, Silv~r-lll, Platinu~-197~ F~lladium-109, copper-67, :: Phosphorus-32, Phosphorus-33, -Y~t~ ~-go, Scandium-47, S~marium-153, ~utetium-177, Rhodium-105, Praseodymium-142, Pra-~odymiu~-143, Terbium-161, Holmium-166, Gold-199, Cobalt-57, Cobalt-58, Chromiu~-51, Iron-59, Selenium-75, Thalliu~-201, and Ytterbium-169. Preferably the radioisotope will emit in the 10 - 5,000 kev range, i .

W094/04702 2 1 ~ 2 8 8 i PCr/US93/077s4 -- 19 -- ' `

more preferably 50 - 1,500 kev, most preferably-50 - ~00 kev.
Isotopes preferred for external imaging include:Iodine-123, Iodine-131, Indium-111, Gallium-67, Ruthenium-97, Technetium-99m, Cobalt-57, Cobalt-58, Chromium-51, Iron-S9, Selenium-75, Thallium-201, and Ytterbium-169.
Isotopes most preferred for internal detection include:
10 Iodine-125, Iodine-123, Iodine-131, Indium-lll, Technetium-99m and Gallium-67.
Isotopes preferred for therapeutic use include:
Iodine-125, Iodine-131, Rhenium-186, Rhenium-188, Sil~er-111, Platinum-197, Palladium-109, Copper-67, Phosphorus-15 32, Phosphorus-33, Yttrium-90, Scandium-47, Samarium-153, Lutetium-177, Rhodium-105, Praseodymium-142, Praseodymium-143, Terbium-161, Holmium-166, and Gold-l99.
Nany drugs and toxins are known which have cytotoxic effects on cells. They are to be found in compendia of 20 drug~ and toxins, such as the Nerck Index, Goodman and Gilman, and the like, and in the references cited above.
Any such drug can be conjugated to or loaded onto the antibody by conventional means well know in t~e art, and illustrated by analogy to those described above.~~
The present invention also contemplates dyes used, for example, in photodynamic therapy, conjugated to proteins, biotin or avidin and used in conjunction with appropriate nonionizing radiation.
~ , The use; of light and porphyrins in the present invention i8 alBo contemplated and their use in cancer therapy is readily avail~le to one of ordinary sk~ll in the are, as revi~wed by van den Bergh (Chemi~t~y~in Britain, May 1~86; Vol. 22, pp. 430-437). ~
Examples of known cytotoxic agents useful in the present invent~on are listed in Goodman et al., "The ~harmacological Basis of Therapeutics," Sixth Edition, A.G. Gilman et al, ed~./ Macmillan Publishing Co. New York, 1980. These include taxol, nitrogen mustards, such W094/04702 2 ~ PCT/US93/077~4 as mechlorethamine, cyclophosphamide, melphalan, uracil mustard and chlorambucil; ethylenimine derivatives, such as thiotepa; alkyl sulfonates, such as busulfan;
nitrosoureas, such as carmustine, lomustine, semustine and streptozocin; triazenes, such as dacarbazine; folic acid analogs, such as methotrexate; pyrimidine analogs, such as fluorouracil, cytarabine and azaribine; purine analogs, such as mercaptopurine and thio~uanine; vinca alkaloids, such as vinblastine and vincristine;
antibiotics, such as dactinomycin, daunorubicin, doxorubicin, bleomycin, mithramycin and mitomycin;
enzymes, such as L-asparaginase; platinum coordination complexes, such as cisplatin; substituted urea, such as hydroxyurea; methyl hydrazine derivatives, such as procarbazine; adrenocortical suppressants, such as mitotane; hormones and antagonists, such as adrenocortisteroids (prednisone), progestins (hydroxyprogesterone caproate, medroprogesterone acetate and megestrol acetate), estrogens (diethylstilbestrol and ethinyl e~tradiol), antiestrogens (tamoxifen), and androgens (testosterone propionate and fluoxymesterone).
Drugs that interfere w~th intracellular protein ; synthe~is can also be u~ed in the methods of the present invention; such drugs are known to these skilled in the art and include puromycin, cycloheximide, and ribonuclease. ~~
Toxins can also be used in the methods of the present invention. Toxins useful as therapeutics are known to !. those skilled in the art and include plant and bacterial -toxins, such a6, abrin, alpha toxin, diphtheria toxin, ~xotoxin, gelonin, pok~weed antiviral protein, ricin, and saporin.
Toxin~ in their nativè fosm require a minimum of thsee diffesent biochemical functions to kill cells: a cell binding function, a cytotoxic function, and a function to tran~locate the toxic activity into the cells.
Th~ modified toxin~ u eful in the present invention 21 12881; ~
W094/~702 PCT/US93/07754 differ from native toxins in t~at the domain providing the cell binding function of the native toxin is nonfunctioning because the domain is missing partially or totally. I
Other therapeutic agents useful in the present invention include anti-DMA, anti-RNA, anti-protein and anti-chromatin cytotoxic or antimicrobial agents. -The proteins useful in the present invention may be labeled or conjugated by a variety of methods known in ~
the art. Many of these methods are disclosed in the ``
a~ove-referenced U.S. Patents and Patent Applications.
See also, Rayudu, op. cit.; and Childs et al., J. Nuc. I ;~
Med., ~, 293(1985). Any conventional method of -~
radiolabeling which is suitable for labeling isotopes for ~-in vi~o use will be generally suitable for labeling , -~
detection agents according to the present invention. ¦
The avidin/streptavidin, biotin or proteins may be conjugated to therapeutic agents such as drugs, toxins, -boron addends, isotopes, fluorescent dyes activated by `;~
nonionizing radiation, hormones, autocrines, cytokines, cytoprotective agents, etc., by methods known to those ~``
skilled in the art. US Patent 5,057,313, Shih et al, teaches one such method.
Other examples are conjugating avldin/streptavldin 2S to (a) iodine by the chloramine-T or Bolton-Hunter procedures, (b) technetium/rhenium by procedures --- -described by Griffiths et al. (Cancer Res. 51:4594, l991)- ~
or Fritzberg et al. (U.S. Pat. No. 5,120,526) and (c) metallic nuclides through bifunctional chelating agents a~ described by Meares et al. (Br. J. Cancer 62:21, 1990). Additionally avidin/streptavidin/biotin can be bound to dendrimers by procedures described for amino---containing proteins as dQscribed by ~na~owich et al. tJ.-Nucl. Med. 28:1294, 1987).
Biotin can be readily conjugated to proteins (including antibodies and their fragments) via t~e proteins' lysine and cysteine residues, and, if available, their oxidized carbohydrate groups.

W094/04702 2 1 '1 2 S 8 I PCT/US93/077~
- 22 - ~

The detection or therapeutic agents may be treated by methods, known to those skilled in the art, to permit the agents to be more easily conjugated to biotin, avidin~streptavidin or targeting protein as required.
Loading of drugs onto a carrier, as disclosed in U.S.
Patent 5,057,313, will depend upon the potency of the drug, the efficiency of the antibody targeting and the efficacy of the conjugate once it reaches its target. In most ca~es, it is desirable to load at least 20, preferably 50 and often 100 or more molecules of a drug on a carrier. The ability to partially or completely detoxify a drug as a conjugate, while it is circulation, can reduce systemic side effects of the drug and permit its use when systemic administration of the unconjugated drug would be unacceptable.
Toxins will often be lec~ heavily loaded than drugs, but it will still be advantageous to load at least 1, preferab}y 5, and in some cases 10 or more molecules of toxin on a carrier-and load at lQast one carrier chain on the~antibody for targeted delivery.
~ In addition to conjugating radioisotopes to biotin - (or to streptavidin) for targeting to tumors (or other lesions), it is possible to conjugate drugs to avidin, for example via a dextran spacer molecule (Sch~chter et al., Int. J.~ Cancer 48:167, 1991) for delivery of a cytotoxic ag nt~to tu~ors in animals. --Neth~ds for treating toxin~ and, in particular, ~odified Psuedomonas exotoxin , are well known in the art ; and are disclosed~, for example, in Batkra et al.,Proc.
Natl. A¢ad. Sci. USA, Vol. 86, pp. 8545-8549, 1989;
Seethar~m et al., J. 8iol. Chem., Vol 266, no. 26, pp.
17376-17381, 1991; and Pa~tan~--4t-al., and U.S. Patent 4,892,827. - -~
When con~ugating the foregoing guantity of antibody or antibody fragment, the anount of drug or toxin is generally about 0.25 to 5 times, preferably 1-3 times, the amount of antibody or antibody fragment, and the time of r-action is about 10 to 120 minutes, preferably 30-90 2 1 4 288 ~ ~`

- 23 ~

minutes. --A physiological solution of the protein conjugate isadvantageously metered into sterile vials, e.g., zt a unit dosage of about 1.0 - 500 mg protein conjugate/vial, and the vials are either stoppered, sealed and stored at -- - low temperature, or lyophilized, stoppered, sealed and stored. Variations and modifications of these formulations will be readily apparent to the ordinary - skilled artisan, as a function of the individual needs of ~- ~ 10 the patient or treatment regimen, as well as of variations in the form in which the radioisotopes may be - - provided or may become available.
-The present invention includes~ uses of the compositions wherein there is a reduction of the i~munogenicity of (a) avidin (b) the therapeutic agent moiety of a conjugate, e.g., the toxin, or (c) the targeting composition, by coupling the immunogenic agent with a carbohydrate polymer or polyol groups. Examples of useful carbohydrates or polyol groups include dextran, polysaccharides, polyethylene glycol (PEG), and the like.
The use of a dextran or another polymer for ,................................................................. .,~.
attachment of the therapeutic agents to avidin, or a dextran or another polymer coupled directly to a~idin or streptavidin is desirous to decrease the immunogenicity of the conjugates involving avidin. This then permits repeated applications of avidin alone or as a conju`gate,-~in the tr~atment courses. I~ the avidin used in the clearing composition is ~o coupled then more time may be needed for the clearing composition to fulfill its functions.
In an embodiment of the 3-stQp improved detection or therapeutic protoco~ of the present invention~ -t~e biotinylated or avidin (streptavidin) lesion-targeting protein can be injected parentally, usually at a protein dose of 0.5 to 50 mg, more preferably within a dose range of 1.0 to 20.0 mg, and still more preferably at 2.0 to 10.0 mg. This can be administered as a single injection or in divided do~es. After 1-5 days, more preferably at wo94/n4702 2 1 ~ 2 ~ i PCT/US93/077 le~s than ~ days and ~-ven at less than 1 day when the first agent involves~ a small and rapidly targeting molecule, such as-an-antibody fragment or subfragment, a do~e of unlabele~ ~iearing agent, such as 2.0 to 200.0 mg s avidin (more preferably about a ratio of 2.5:1 to 10:1 of avidin to b-iot-inylated protein) when a biotinylated lesion-targeting protein is u~ed as the first agent, is administered parenterally. The clearing agent can be given as a single injection or in divided doses, wherein administering the clearing agent in 2 doses is preferred in certain circumstances. The third step involves injection of:the --~iotinylated (or avidin-conjugated) lesion-targeting -protein, as in the first step, but conjugated to a detection or therapeutic agent. The lesion-targeting protein can be identical to that of the first step, or another protein capable of similarly targeting the lesion, such as a second targeting antibody. The third step~s reagents can be administered parenterally within 24 hrs of the 2nd step, but also at up to 3 days later. In one detection embodiment, the third step involves lll-In conjugated to biotin attached to a le~ion-targeting antibody or antibody fragment.
Within 24 hrs of the last in~ection, more preferably within 4 hrs, planar and singlë-photon emission computed tomography scans are made with a gamma camera equipped with the appropriate col-lima~or and selecting the a~ppropriate energy windows -for~the det~ction isotope being u~ed, such as 173 keV and 247 keV for lll-In.
1 In an embodiment of a 4-step ~detection or therapy protocol of the pre~ent invention, the biotinylated or avidin (~treptavidin) l--ion-targeting protein can be - in~ected parenterally, ~ua-~ly at a protein do~e of 2 to 200 mg, more preferably within a dose ~nge of 5 to 50 mg, more preferably at 2.0 to lO.o mg. This can be administered a~ a single or as divided injections. After 1-5 dayg, more preferably at less than 2 days and even at le~ than 1 day when the first agent involves a small and rapidly targeting molecule, s~ch as an antibody fragment W0~4/04702 2 1 4 2 ~ 1 PCT/US93tO7754 or subfragment, a dose of unlabeled clearing agen~, such as 2.S- to 10-times the dose of the first step's protain (which can be determined also by measuring the amount of first agent's protein circulating in-the blood at the time of the second step's injection), is given parenterally. The longer the delay af-ter~~the first step, the lower the amount (and ratio) of clearing agent given.
The clearing agent can be gi~en as a single injection or in divided doses, dividing the-administration of the lo clearing agent into at le~8t 2 ~doses may be preferable, usually within a short period, such as within 2 hrs. In the third step of one em~odiment of the invention, a dose of 2 to 200 mg protein, more preferably 5 to 50 mg, of biotin conjugated with a detection or therapeutic agent, as appropriate, is administered parenterally either as a single dose or in divided doses. A fourth step involves !
the parenteral administration of avidin (or streptaYidin) conjugated to a lesion-targeting agent, which can be the same or different from the first lesion-targeting agent, to which a detection or therapeutic agent, as appropriate, is also attached.
In another embodiment, the third step can involve the biotinylated lesion-targeting protein conjugated with a detection or therapeutic agent, as appropriate, and the 2S fourth step the detection or therapeutic agent, as appropriate, conjugated to avidin (or streptavidin). The - -third step's reagents can be administered within 24 hrs --of the 2nd step, but also at up to 7 days or more later, depending upon t~e targeting time and clearance involvlng the first two steps. The fourth step can be initiatëd within 24 hrs of the third step, but also up to 7 d~ys or mors later.
Route~ of ~dminis~ration include intravenous,~
intraarterial, intrapleural, intraperitoneal, intrathecal, subcutaneous or by perfusion.~
An appl~cation of the lesion-specific or lesion-a~sociated protein disclosad hereinabove is for magnetic re~onance imaging (mri). In this case, for example, a W094t~702 2 1 ~1 2 ~ S ~ PCT/US93/07754 suitably - radiolabeled -antibody/fragment or an antibody/fragment bearing a mr image enhancing agent is administered with the intention of obtaining an image of --f I the lesion.
The uses of compositions in methods according to the invention can be practiced either with scintigraphic or-- -magnetic resonance imaging agents. A combination of these imaging agents can also be used, although this requires more complex instrumentation and~~ data~
processing. ~~
Scintigraphic imaging according to the method of the inv;ention is effected by obtaining a scintigram of the --lesion of interest.
The scintigram is normally taken by a gamma imaging camera having one or more windows for detection of energies in the 50-500 keV range. Use of radioisotopes with higher energy, beta, or positron emissions would entail use of imaging cameras with the appropriate detectors, all of which are conventional in the art.
The scintigraphic data can be stored in a computer for later processing.
Methods useful for internal detection and/or treatment of tumors and/or other lesions are readily available to those skilled in the art, and are disclosed, for example, in U.S. Patent 4,782,840; U.S.Patent 4,932,412; and copending U.S. -Application 07/879,857.
The uses of compositions according to the present invention can enhance the methods disclosed in these reference~.
Magnetic resonance imaging (mri) is effected in an analogou~ manner to scintigraphic im~ging except that the i~aging agents will contain--~magnetic resonance (mr) ~nhancing 6pecies rather than radioisotopes. It will be !
appreciated that the magnetic re~onance phenomenon 3S opsrates on a different principle from scintigraphy.
Normally, the signal generated is correlated with the relaxation time~ of the magnetic mo~ents of protons in the nuclei of the hydrogen atoms of water molecules in W094/~4702 2 1 4 2 ~ 8 I PCT/US93/07754 ~

the region to be imaged. The magnetic resonance image enhancing agent acts by incre~sing the rate of relaxation, thereby increasing the contrast between water molecules in the region where the imaging agent accretes and water molecules elsewhere in the body. However, the effect of the agent is to decrease both T~ and T2, the former resulting in greater contrast while the latter results in lesser contrast. Accordingly, the phenomenon is concentration-dependent, and there is normally an opti~um concentration of a paramagnetic species for maximum efficacy. Thi optimal concentration will vary with the particular agent used, the locus of imaging, the mode of imaging, i.e., spin-echo, saturation-recovery, inversion-recovery and/or various other strongly T~-dependent or T2-dependent imaging techniques, and the composition of the medium in which the agent is dissolved or suspended. The~e factors, and their relative importance are known in the art. See, e.g., Pykett, Scientific American, 246, 78(1982); Runge et al., ~m. J.
R~diol., ~1, 1209(1983).
The mr image enhancing agent must be present in sufficient amounts to enable detection by an external camera, using magnetic field strengths which are reasonably attainable and compatible with patient safety and instrumen~al design~ The requirements for such agents are well known in the art for those agents which h~ve their effect upon water molecules in the medium, and are di~closed, in~er 31i~, in Pykett, o~. cit., and Runge eti al., OD. . Cit-Preparation of prot~in, biotin or avidin/streptavidin (molecule) conjugated to a magnetic re~onance image enhancing agent can be effected by a variety of methods~
In order to load a molecule with a la-~e number of paramagnetic ion~, it may be necessary to react it with a reagent having a long tail to which are attached a multiplicity of chelating groups for binding the ions.
Such a tail c~n be a polymer such as a polylysine, polysaccharide, or other derivatized or derivatizable W094/04702 2 1 ~ 2 ~ ~ ~. PCT/US93/077~

chain having pendant groups to wh~ch can be bound chelating groups such as, e.g., ethylenediaminetetra-acetic acid (EDTA), diethylenetriaminepentaacetic acid (DTPA), porphyrins, polyamines, crown ethers, bis-thio-semicar~azones, polyoximes, and like groups known to be useful for this purpose. The chelate is normally linked to the molecule by a group which enables formation of a bond to the molecule with minimal 1068 of immunore~ctivity and minimal aggregation and/or internal cross-linking. Other, more unusual, methods and reagents for conjugating chelates to antibodies are disclosed in U.S. Patent 4,824,659 to Hawthorne, entitled ~Antibody ¦' Conjugates", issued April 25, 1989.
MRI contrast agents are well known in the art and include, for ex~mple, Gadolinium, Iron, Manganese, "
Rhenium, Europium, Lanthanium, Holmium, and Ferbium.
The ~r scans are stored in a computer and the images processed analogou~ly to the scintigraphic data. i Without further elaboration, it is believed that one skill-d in th~ art can, u~ing the preceding description, I
utilize th~ pr~sent invention to it~ fullest extent. The , following pre-ferred ~pQGif iC e~bodim~nts are, therefore, ~- to be construed as merely illustrative, and not -~ Ii~itative of th- remainder of the-disclosure in any way ~~
2-5 whatsoever. In the following examples, all temperatures are s~t forth uncorrected in- d~grees-~Celsius; unless - _ otherwi~e indicated, all parts and 'percentages are by ~'' ~-weight. ' , Accordingly, thes~ e~bodlments con~tltute improved compo~itions and u--~ ther-of for a~plification of - -protein, e~pecially antibody' nd antibody fragments, ' targeting for det~cting and thera~y of cancer and other _~ --pathological con~1t~o~. ' ~` '--- -- -, ..
rEs ~ , ~ ' ~iotin ~ia Lvsine.

W094~04702 2 1 4 2 8 8 i - PCT/US93/07754 " - 29 - !

An antibody or antibody fragment at a concentration-of 1-20 mg/ml in a non-amine containing buffer (e.g.,borate, phosphate, etc.), at a suitable concentration (0.05-0.5 M), at a slightly elevated pH
(7.0-9.5), is mixed with a 1-lOO molar excess of the activated ester (succinimide or sulfosuccinimide are preferred) of D-biotin or D-biotin incorporating a spacer arm (such as succinimido-6-~biotinamido]hexanoate). A
co-solvent, such as dimethylformamide (DMF) or dimethylsulfoxide (DMSO), may be added to provide a final concentration of up to 20% to facilitate reactant solubility. The reaction solution is stirred for 1-24 ho~rs and kept at a temperature of 4C to 37C. At the end of the reaction period, the modified protein is separated from unbound biotin and other low molecular weight contaminants by size-exclusion chromatography and/or dialysis.

Exam~le 2 - Con~uaatina Ant~Po~y or AntibodY Fragment to Biotin via_Cysteine, An antibody or antibody fragmen~ at a concantration of 5-20 mg/ml in 0.1-O.5 M tris buffer, pH 8.7, is made 0.5-5 mg~/ml in 2-mercaptoethanol. The reaction solution is let stand 5-120 min. at a temperature of 4-37C. The reduced protein is separated from unreacted thiol by size-exclusion chromatography in 50 mN acetate buffer, pH
4.5-. Protein concentration and the number of thiol groups per antibody molecule may be determined at this time. The reduced antibody at a concentration of 1-20 mglml in a non-aminQ containing bu~fer (Q.g., phosphate) at a neutral pH (5.0-7.0) is mixed with a 1-lOO molar exces~ of biotin-malei~ide ~N-biotinyl-N-~6-maleimido hexanoyl~hydrazide) (Sigma Chem. Co). A co-solvent, e.g., DMF or DMSO, may be added to provide a final concent~ation of up to 20% to facilitate reactant solubility. The reaction solution i8 stirred for 1-24 hour~ at a temperature between 4-37C. At the end of the W094/04702 21 Ll 2 ~ 8 1 PCT/US93/07754 reaction period,~the biotinyl-ated protein is separated from unbound biotin and other low molecular weight contaminants by size-exclusion chromatography and/or dialysis.

Example 3 - Coniuaatina Antibody or ~ntibody Fraqments ~o Biotin ~ia a Carbohvdrate.
Antibody at a concentration of 1-20 mg/ml is treated with sodium metaperiodate to a final concentration of 0.1-10 mg/ml in phosphate buffered sal~ne at room temperature for 1-4 hours. Ethylene glycol is added to decompose the remaining periodate. The oxidized IgG is purified from low molecular weight contaminants by size-exclusion chromatography in phosphate buffer. The oxidized anti~ody (1-20 mg/ml) is reacted with a 1-100 molar excess of biotin-hydrazide ~Pierce Ch~mical Co.) in a non-amine buffer (e.g., phosphate, carbonate, etc.) at neutral pH (5.0-8.0) for 1-48 hours at 4-37C. After the optimum time for coupling, the formed hydrazones are reduced by the addition of sodium cyanoborohydride with pH adjustment to >7. The biotinylated antibody is -~ purified by size-exclusion chromatography and/or ~ dialy3is.

Exam~le 4 - Coniuaatina Antibodv or AntibodY Fraoments to iotin via addended Thiol GrouDs ~
An antibody or antibody fragment at a~concentration of 1-20 mg/ml in a non-amine containing buffer (e.g., b~rate, carbonate, etc.) at a suitable concentration (0.05-0.5M) and pH (7-10)-is mixed with a 1-100 molar ;
excess of 2-iminothiolane hydrochloride tPierce Chemical Co.). The reaction mixture i~ made -1-lOo mM in EDTA to help prevent disulflde bond formation and h~id at 4-37 for from 1-4 hours. The modified protein is purified by size-exalusion chromatography in a neutral ~o slightly acidic buf~er (e.g., acetate, citrate, etc.) pH 5.0-7Ø
The purified s~lfhydryl substituted antibody ~1-20 mg/ml) is mixed with a 1-100 molar excess of biotin maleimide.

W094~04702 2 1 ~ 2 ,~ 8 1 PcT/us93/07754 A co-solvent, e.g., DMF or DMS0, may be added to a f~nal concentration of up to 20~ to facilitate reactant solubility. The reaction solution is stirred for 1-24 hours at a temperature between 4-37C. At the end of the reaction period, the biotinylated protein is separated from unbound biotin and other low molecular weight contaminants by size-exclusion chromatography and/or dialysis.

Exam~le S - Coniuaatina Biotin and Fab' Fraoments .
~ 10An antibody F(ab' )2 fragment (obtained by pepsin digestion of the intact antibody) at a concentration of 5-20 mg/ml in phosphate buffer at-pH 6-8 is treated w~th a freshly prepared solution of L-cysteine to give a final cy6teine concentration of 1-50 mg/ml. The reaction is ¦-15allowed to proceed for 1-4 hours at 25-37C. At the end of this period, the Fab' fragment is purified from low lecular weight contaminants by size-exclusion chromatography in an acidic buffer (e.g., acetate, etc.) at pH 4.0-6Ø The Fab' fragment i8 reacted with a 1-100 molar eXcess of biotin-maleimide at pH 5.0-7Ø A co-solvent, e.g.,- DMF or DMS0, may be added to a final concentration of up to 20% to facilitate reactant solubility. The reaction i stirred for 1-24 hours at a temperature between 4-37C. At the end of the reaction period, the biotinylated antibody fragment is separated from unbound biotin and other low molecular weight contaminants by size-exclusion chromatography and/or dialysis . ........................................................... .

kxample 6 - Determinatio~ of Extent of Biotinylat~on of--~ -roteins - -~
A small amount of biotinylated antibody is heated to ~-56 in 0. lM pho~phate buffer for 10 minutes and enzymatically dige~ted with ~mall volumes of 1% pronase (Sigma Chemical Co.). The dige~tion is allowed to proceed overnight. The digest i8 analyzed with a 10 uN

W094/04702 2 1 'i Z ~ ~ 1 PCT/US93/077s4 ¦ - solution of-avidin saturated-with a 100 uM solution of 2-j (4'-hydroxyazobenzene)-benzoic acid (HAB~) in O.lM
¦ ~ - phosphate buffer, pH 7Ø The avidin-HABA solution is ~-- titrated with increa~ing volume~ of digested biotinylated - 5 antibody as well as a standard biotin solution containing 10 mM of biotin. The change in absorbance at 500 nM
for each i8 determined, and the concentration of biotin in the pronase digested biotinylated antibody calculated ~-- - from reference to the standard curve of the titration of :
biotin with avidin-HABA.
i .
-- Exam~le 7 - Cancer Imaaina with Three-Step Procedure A patient diagno~ed by sigmoidoscopy to have a colonic neopla~m is injected i.v. with 1.0 mg. of a biotinylated MN-14 monoclonal antibody IgG against ~i 15 carcinoe~bryonic antigen ~CEA). Two days later, 5 mg of ~ ;
unlabeled avidin (in two divided do~es, 20 min apart) is injected i~.v. The next d~y, 1 mg of biotinylated Mu-9 ¦ antibody IgG against colon-specific antigen-p (CSAp) ! labeled with lll-In (4 mCi) is injected i.v. The patient is scanned with a ga~a camera 2 hrs later, and a focus ~ of increased radioactivity is dstected in the region of - ~ the~ sigmoid ~olon, in agreement with the sigmoidoscopy i finding~. I
; : "
ExamDle 8 - Atherosclerotic rmaainor with Three-Ste~
i~Y~ C ~ ~~
A pat~ent with suspected atherosclerotic plaques in various arteries is injected i.v. with 2.0 mg of the biotinylated LLl monoclonal antibody F(ab')2 against macrophage. One day later, 6 ~g of unlabeled avidin (in two dividQd dosQs, lS min apartt--is- injected i.v. one d~u later, 1 mg Or biotinylated LLl IgG conjugated with 5 mCi of 11~-ln is in~ected i.v., and the patient scanned with~ a ga~ma ca~era 3 hours later. Foci of abnormal radioacti~ity is found in a tibial artery, the abdominal aorta, and possibly in a right cerebral ve~sel.
.

W094/~702 2 1 4 ~ ~ 8 ~ PCT/US93/077~ ~

Example 9 - Cancer Radioimmunotherapy with a Four-Ste~
Procedure A patient with several small colonic carcinoma metastase~ to the liver is injected i.v. with a dose of 10 mg of a first composition comprised of biotinylated MN-14 anti-CEA IgG monoclonal antibody. Two days later, a clearing composition of 25 mg avidin is injected i.v.
(in two divided doee~, 30 min apart). After another 2 dayc, a do~e of lO mg of a second composition of biotin having 25 mCi 90-Y is injected i.v. Two weeks later, a second therapy dose of a third composition of 20 mCi 90-Y
conjugated to avidin-labeled MN-14 anti-CEA IgG (10 mg) i8 given i.v. Based upon liver CT scans and plasma CEA
titers performed 8 weeks later, significant regression of the liver tumor lesions is observed.

Examole 10 - Cancer Chemoimmunotherapy with a Four-SteD
- ~ Procedure ~ patient with a right lung adenocarcinoma is injected with biotinylated "RS7" anti-lung-cancer IgG
i.v. Four day~ later, avidin is injected i.v. (in two divid~ed do~es, 60 minute~ apart). After another 2 days, a do~e of biotinylated RS7 conjugated with aminodextran-doxorubicin, according to the methods described in the Shih patent (USP 4,699,784), is administered i.v. Five-~ 25 days later, a dose of streptavidin conjugated with~
a~inodextran-doxorubicin is administered i.v. Four weeks-later, chest CT indicates that the right lung lesion is decreased in size by about 50 percent.
.. , The preceding example~ can be repeated with similar 3 0 SUCCQS8 by substituting the generically or specifical-Iy-described reactants and/or opQrating condit.i~ns of~t~-is invention for those used in the preceding examples.
Fro~ the foregoing descriptions, one skilled in the art can easily ascertain the es~ential characteristics of t~is in~ention and, without departing from the spiri~ and scope thereof, can make various changes and modifications W094/04702 21,.1~8~- - 34 - PC~/US93/07754 of the invention to adapt it to vari~ a~e~
condition~ .

Claims (65)

1. Use of a composition comprising:
(A) a targeting composition comprising a targeting protein that preferentially binds to a marker substance produced by or associated with a lesion compared to non-lesion sites, covalently conjugated to biotin or avidin, wherein said targeting composition preferentially accretes at the targeted lesion;
(B) optionally, a clearing composition that is capable both of clearing said tageting composition from said non-lesion sites and binding to said targeting composition accreted at said lesion, said clearing composition comprising avidin when said targeting composition contains biotin and comprising biotin when said targeting composition contains avidin;
(C) a first detection or therapeutic composition comprising a conjugate composed of avidin-targeting protein detection or therapeutic agent covalently linked, when said targeting composition contains avidin, and comprised of biotin-targeting protein detection or therapeutic agent when said targeting composition contains biotin, wherein said targeting protein may be the same or different than that of (A) above, and said composition accretes at the targeted lesion;
(D) optionally, a second detection or therapeutic composition comprising a covalent conjugate of avidin-detection or therapeutic agent when said targeting composition of (A) above contains biotin and of biotin-detection or therapeutic agent when said targeting composition of (A) above contains avidin, and said composition accretes at the target lesion;
in a method of amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is injected parenterally with:
(a) targeting composition (A);
(b) then, optionally clearing composition (B);
(c) detection or therapeutic composition (C); and (d) detection or therapeutic composition (D);

wherein step (d) is either prior to or subsequent to step (c) and step (d) is optional if a clearing composition has been administered.
2. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a first detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent; and (C) a second detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A);
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is injected parenterally with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, detection or therapeutic composition (B), and the conjugate of said composition (B) is allowed to accrete at the targeted lesion; and (c) then, detection or therapeutic composition (C), and said composition (C) is allowed to accrete at the targeted lesion.
3. The use of a composition according to claim 1, wherein the targeting protein composition comprises:
(A) a targeting composition comprised of a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of avidin;

(C) a first detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent; and (D) a second detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A);
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is injected parenterally with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion;
(c) then, detection or therapeutic composition (C), and the conjugate of said composition (C) is allowed to accrete at the targeting protein targeted lesion; and (d) then, detection or therapeutic composition (D), and said composition (D) is allowed to accrete at the targeted lesion.
4. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of avidin;
(C) a first detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A); and (D) a second detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent;
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, a patient is injected parenterally with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion;
(c) then, detection or therapeutic composition (C), and said composition (C) is allowed to accrete at the targeted lesion; and (d) then, detection or therapeutic composition (D), and the conjugate of said composition (D) is allowed to accrete at the targeted lesion.
5. The use of a composition according to claim 1, wherein the composition-comprises:
(A) a targeting composition comprising a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of avidin;
(C) a first detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent; and (D) a second detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A);

in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, a patient is injected parenterally with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion;
(c) then, detection or therapeutic composition (C), and the conjugate of said composition (C) is allowed to accrete at the targeted lesion; and (d) then, detection or therapeutic composition (D), and said composition (D) is allowed to accrete at the targeted lesion.
6. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced or associated with the targeted lesion;
(B) a clearing composition comprised of avidin; and (C) a detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced- by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A);
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is parenterally injected with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion; and (c) then, detection or therapeutic composition (C), and said composition (C) is allowed to accrete at the targeted lesion.
7. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of avidin;
(C) a first detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A); and (D) a second detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent;
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is injected parenterally with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion;
(c) then, detection or therapeutic composition (C), and said composition (C) is allowed to accrete at the targeted lesion; and (d) then, detection or therapeutic composition (D), and the conjugate of said composition (D) is allowed to accrete at the targeted lesion.
8. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a first detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent; and (C) a second detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A);
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is parenterally injected with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, first detection or therapeutic composition (B), and the conjugate of said composition (B) is allowed to accrete at the targeted lesion; and (c) then, second detection or therapeutic composition (C), and said composition (C) is allowed to accrete at the targeted lesion.
9. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of biotin;
(C) a first detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent; and (D) a second detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A);
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is parenterally injected with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion;
(c) then, first detection or therapeutic composition (C), and the conjugate of said composition (C) is allowed to accrete at the targeted lesion; and (d) then, second detection or therapeutic composition (D), and said composition (D) is allowed to accrete at the targeted lesion.
10. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of biotin;
(C) a first detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A); and (D) a second detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent;
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is parenterally injected with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion;
(c) then, first detection or therapeutic composition (C), and said composition (C) is allowed to accrete at the targeted lesion; and (d) then, second detection or therapeutic composition (D), and the conjugate of said composition (D) is allowed to accrete at the targeted lesion.
11. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of biotin;
(C) a first detection or therapeutic composition comprised-of avidin conjugated to a detection or therapeutic agent; and (D) a second detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A);
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is parenterally injected with:

(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion;
(c) then, first detection or therapeutic composition (c), and the conjugate of said composition (C) is allowed to accrete at the targeted lesion; and (d) then, second detection or therapeutic composition (D), and said composition (D) is allowed to accrete at the targeted lesion.
12. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of biotin; and (C) a detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A);
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is parenterally injected with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion; and (c) then, detection or therapeutic composition (C), and said composition (c) is allowed to accrete at the targeted lesion.
13. The use of a composition according to claim 1, wherein the composition comprises:
(A) a targeting composition comprising an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion;
(B) a clearing composition comprised of biotin;
(C) a first detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of said targeting composition (A); and (D) a second detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent;
in a method for amplifying the detection or treatment of targeted lesions in a patient, wherein, in the method, the patient is parenterally injected with:
(a) targeting composition (A), and the targeting protein conjugate of said composition (A) is allowed to preferentially accrete at the targeted lesion;
(b) then, clearing composition (B), and said composition (B) is allowed to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at the targeted lesion;
(c) then, a first detection or therapeutic composition (C), and said composition (C) is allowed to accrete at the targeted lesion; and (d) then, a second detection or therapeutic composition (D), and the conjugate of said composition (D) is allowed to accrete at the targeted lesion.
14. A method of amplifying the detection or treatment of lesions in a subject, comprising the steps of:

a) parenterally injecting into said subject a targeting composition comprising a targeting protein that preferentially binds to a marker substance produced or associated with said lesion compared to non-lesion sites, covalently conjugated to biotin or avidin, and allowing said targeting composition to preferentially accrete at the targeted lesions;
b) optionally parenterally injecting into said subject a clearing composition that is capable both of clearing said targeting composition from said non-lesion sites and binding to said targeting composition accreted at said lesion, said clearing composition comprising avidin when said targeting composition contains biotin and comprising biotin when said targeting composition contains avidin;
c) parenterally injecting into said subject a first detection or therapeutic composition comprising a conjugate composed of avidin-targeting protein detection or therapeutic agent covalently linked, when said targeting composition contains avidin, and composed of biotin-targeting protein detection or therapeutic agent when said targeting composition contains biotin, wherein said targeting protein may be the same or different than that of a) above, and allowing said detection or therapeutic composition to accrete at said lesion;
d) parenterally injecting into said subject, either prior or subsequent to the composition of c) above, a second detection or therapeutic composition comprising a covalent conjugate of avidin-detection or therapeutic agent when said targeting composition of a) above contains biotin and of biotin-detection or therapeutic agent when said targeting composition of a) above contains avidin;
wherein step d) above is optional if a clearing composition has been administered.
15. The method of claim 14 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then, parenterally injecting a detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion; and (c) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing the composition to accrete at said targeted lesion.
16. The method of claim 14 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then, parenterally injecting a clearing composition comprised of avidin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion;
(c) then, parenterally injecting a detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion; and (d) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of biotin, and a detection or therapeutic agent, wherein the preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing said detection or therapeutic composition to accrete at said targeted lesion.
17. The method of claim 14 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then, parenterally injecting a clearing composition comprised of avidin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion;
(c) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing the composition to accrete at said targeted-lesion, and (d) then, parenterally injecting another detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion.
18. The method of claim 14 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then, parenterally injecting a clearing composition comprised of avidin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion;
(c) then, parenterally injecting a detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion; and (d) then, parenterally injecting a detecting or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing said detecting or therapeutic composition to accrete at said targeted lesion.
19. The method of claim 14 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then, parenterally injecting a clearing composition comprised of avidin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion; and (c) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing the composition to accrete at said targeted lesion.
20. The method of claim 14 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of a biotin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion, (b) then, parenterally injecting a clearing composition comprised of avidin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion;
(c) then, parenterally injecting a detection or-therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing said detection or therapeutic composition to accrete at said targeted lesion; and (d) then, parenterally injecting another detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion.
21. The method of claim 14 for amplifying the detection or treatment of lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then, parenterally injecting a detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion; and (c) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing the composition to accrete at said targeted lesion.
22. The method of claim 14 for amplifying the detection or treatment of lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then parenterally injecting a clearing composition comprised of biotin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion;
(c) then, parenterally injecting a detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion; and (d) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing said detection or therapeutic composition to accrete at said targeted lesion.
23. The method of claim 14 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then, parenterally injecting a clearing composition comprised of biotin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion;
(c) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing said detection or therapeutic composition to accrete at the targeted lesion; and (d) then, parenterally injecting another detection or therapeutic composition comprised of biotin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion.
24. The method of claim 14 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then parenterally injecting a clearing composition comprised of biotin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion;
(c) then, parenterally injecting a detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion; and (d) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing said detection or therapeutic composition to accrete at said targeted lesion.
25. The method of claim 1 for amplifying the detection or treatment of targeted lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;

(b) then, parenterally injecting a clearing composition comprised of biotin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion; and (c) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of avidin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing said detection or therapeutic composition to accrete at said targeted lesion.
26. The method of claim 14 for amplifying the detection or treatment of lesions in a patient, the method comprising the steps of:
(a) parenterally injecting a subject with a targeting composition comprised of an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion, and allowing the targeting protein conjugate to preferentially accrete at said targeted lesion;
(b) then, parenterally injecting a clearing composition comprised of biotin, and allowing said clearing composition to substantially clear the targeting composition from non-targeted sites and to bind to the targeting composition accreted at said targeted lesion;
(c) then, parenterally injecting a detection or therapeutic composition comprised of a conjugate of biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with said targeted lesion and may be the same as the targeting protein of said targeting composition, and allowing said detection or therapeutic composition to accrete at said targeted lesion; and (d) then, parenterally injecting another detection or therapeutic composition comprised of avidin conjugated to a detection or therapeutic agent, and allowing the conjugate to accrete at said targeted lesion.
27. The use or method of any of claims 1 or 14, wherein the lesion is cancerous, cardiovascular, infectious or inflammatory.
28. The use or method of claim 27, wherein the cardiovascular lesion is a thrombus, embolus, infarct or atherosclerotic plaque.
29. The use or method of claim 27, wherein the cancerous lesion is a carcinoma, melanoma, sarcoma, neuroblastoma, leukemia, lymphoma, glioma or myeloma.
30. The use or method of claim 27, wherein the lesion is infectious or inflammatory.
31. The use or method of any of claims l or 14, wherein the targeting protein is a peptide, polypeptide, hormone, lymphokine, growth factor, albumin, cytokine, enzyme, immune modulator, receptor protein, antibody or antibody fragment.
32. The use or method of any of claims 1 or 14, wherein the targeting protein of the targeting composition and the detection for therapeutic composition are the same.
33. The use or method of any of claims 1 or 14, wherein the targeting protein of the targeting composition and the detection or therapeutic composition are different.
34. The use or method of claim 33, wherein the different targeting proteins preferentially bind to differing epitopes or molecules of the same marker substance.
35. The use or method of claim 31, wherein the targeting protein is a monoclonal antibody, or a specific binding fragment thereof.
36. The use or method of claim 35, wherein the fragment is a Fv, single chain antibody, Fab, Fab', F(ab)2 or F(ab')2.
37. The use or method of claim 36, wherein the fragment is Fab, Fab', F(ab)2 or F(ab')2.
38. The use or method of claim 35, wherein the antibody is multispecific.
39. The use or method of claim 38, wherein the antibody is multispecific to differing epitopes or molecules of a marker substance.
40. The use or method of claim 31, wherein the targeting protein has a specific immunoreactivity to a marker substance of at least 60% and a cross-reactivity to other antigens or non-target substances of less than 35%.
41. The use or method of any of claims 1 or 14, wherein the method is for detection of a lesion.
42. The use or method of claim 41, wherein the method further comprises external imaging or internal detection.
43. The use or method of claim 42, wherein internal detection is during an operative, intravascular or endoscopic procedure.
44. The use or method of claim 41, wherein the detection agent is a radionuclide, mri enhancing agent, photoactivated dye or differentiation agent.
45. The use or method of claim 44, wherein the radionuclide is a gamma-, positron-, x-ray or fluorescence-emitter.
46. The use or method of claim 44, wherein the differentiation agent is a vitamin, cytokine, autocrine, hormone or drug.
47. The use or method of claim 44, wherein the radionuclide has an energy between 10 and 5000 keV.
48. The use or method of claim 47, wherein the radionuclide has an energy between 50 and 500 keV.
49. The use or method of claim 44, wherein the radionuclide used for imaging is Iodine-123, Iodine-131, Indium-111, Gallium-67, Ruthenium-97, Technetium-99m, Cobalt-57, Cobalt-58, Chromium-51, Iron-59, Selenium-75, Thallium-201, or Ytterbium-169.
50. The use or method of claim 43, wherein the radionuclide used is Iodine-125, Iodine-123, Iodine-131, Indium-111, Technetium-99m or Gallium-67.
51. The use or method of claim 44, wherein the mri enhancing agent is a species of Gadolinium, Iron, Manganese, Rhenium, Europium, Lanthanium, Holmium, or Fermium.
52. The use or method of any of claims 1 or 14, wherein the method is for treating a lesion.
53. The use or method of claim 52, wherein the therapeutic agent is an isotope, drug, toxin, fluorescent dye activated by nonionizing radiation, hormone, hormone antagonist, receptor antagonist, autocrine or cytokine.
54. The use or method of claim 52, wherein the therapeutic agent is an electron- or neutron-capturing agent.
55. The use or method of claim 53, wherein the isotope is Iodine-125, Iodine-131, Rhenium-186, Rhenium-188, Silver-111, Platinum-197, Palladium-109, Copper-67, Phosphorus-32, Phosphorus-33, Yttrium-90, Scandium-47, Samarium-153, Lutetium-177, Rhodium-105, Praseodymium-142, Prasaodymium-143, Terbium-161, Holmium-166, or Gold-199.
56. The use or method of claim 52, wherein the therapeutic agent is an anti-DNA, anti-RNA, anti-protein or anti-chromatin cytotoxic or antimicrobial agent.
57. The use or method of claim 53, wherein the drug is taxol, mechlorethamine, cyclophosphamide, melphalan, uracil mustard, chlorambucil, thiotepa, busulfan, carmustine, lomustine, semustine, streptozocin, dacarbazine, methotrexate, fluorouracil, cytarabine, azaribine, mercaptopurine, thioguanine, vinblastine, vincristine, dactinomycin, daunorubicin, doxorubicin, bleomycin, mithramycin, mitomycin, L-asparaginase, cisplatin, hydroxyurea, procarbazine,mitotane,prednisone, hydroxyprogesteronecaproate, medroprogesteroneacetate, diethylstilbestrol, ethinylestradiol, tamoxifen, testosterone propionate or fluoxymesterone.
58. The use or method of claim 53, wherein the toxin is abrin, alpha toxin, diphtheria toxin, exotoxin, gelonin, pokeweed antiviral protein, ricin or saporin.
59. The use or method of claim 53, wherein the drug is puromycin, cycloheximide or ribonuclease.
60. A composition for use in a method for reducing immunogenicity of avidin, wherein the composition comprises avidin coupled with a carbohydrate polymer or polyol groups, which makes the parenterally injected composition less immunogenic.
61. The composition of claim 60, wherein the carbohydrate polymer or polyol groups are dextran, polysaccharides, or polyethylene glycol (PEG).
62. The use or method of any of claims 1 or 14, wherein the immunogenicity of avidin or of the therapeutic agent conjugate is reduced by coupling the avidin or therapeutic moiety of the conjugate with carbohydrate polymer or polyol groups.
63. The use or method of any of claims 1 or 14, wherein the immunogenicity of the targeting composition is reduced by coupling with a carbohydrate polymer or polyol groups.
64. A sterile injectable composition for human use comprising a detection or therapeutic composition comprised of a conjugate of (i) avidin, targeting protein and a detection or therapeutic agent, or (ii) biotin, targeting protein and a detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with a targeted lesion.
65. A kit suitable for use in a method of detecting or treating targeted lesions in a human, the kit comprising:
(a) a vial containing a sterile injectable preparation of a targeting composition comprised of (i) a biotin-targeting protein conjugate, or (ii) an avidin-targeting protein conjugate, wherein the targeting protein preferentially binds to a marker substance produced or associated with the targeted lesion;
(b) optionally, a vial containing a sterile injectable preparation of a clearing composition comprised of (i) avidin, when the targeting composition is a biotin-targeting protein conjugate, or (ii) biotin, when the targeting composition is an avidin-targeting protein conjugate;
(c) a vial containing a sterile injectable preparation of a detection or therapeutic composition which when administered to the human is comprised of a conjugate of (i) avidin, targeting protein and detection or therapeutic agent, or (ii) biotin, targeting protein and detection or therapeutic agent, wherein the targeting protein preferentially binds to a marker substance produced by or associated with the targeted lesion and may be the same as the targeting protein of the targeting composition; and (d) optionally, a vial containing a sterile injectable preparation containing another detection or therapeutic composition which when administered to the human is comprised of (i) avidin conjugated to a detection or therapeutic agent, or (ii)biotin conjugated to a detection or therapeutic agent.
CA002142881A 1992-08-21 1993-08-20 Detection and therapy of lesions with biotin/avidin conjugates Abandoned CA2142881A1 (en)

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