GB2456562A - Treatment of HIV/AIDS - Google Patents
Treatment of HIV/AIDS Download PDFInfo
- Publication number
- GB2456562A GB2456562A GB0800970A GB0800970A GB2456562A GB 2456562 A GB2456562 A GB 2456562A GB 0800970 A GB0800970 A GB 0800970A GB 0800970 A GB0800970 A GB 0800970A GB 2456562 A GB2456562 A GB 2456562A
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- GB
- United Kingdom
- Prior art keywords
- lymphocytes
- hiv
- infected
- compound
- necrosis
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
- A61K38/12—Cyclic peptides, e.g. bacitracins; Polymyxins; Gramicidins S, C; Tyrocidins A, B or C
- A61K38/13—Cyclosporins
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
- A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
- A61K38/19—Cytokines; Lymphokines; Interferons
- A61K38/20—Interleukins [IL]
- A61K38/208—IL-12
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
- A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
-
- 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
- A61K47/6801—Drug-antibody or immunoglobulin conjugates defined by the pharmacologically or therapeutically active agent
- A61K47/6803—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates
- A61K47/6811—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates the drug being a protein or peptide, e.g. transferrin or bleomycin
- A61K47/6817—Toxins
-
- 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
- A61K47/6835—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 the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site
- A61K47/6849—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 the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site the antibody targeting a receptor, a cell surface antigen or a cell surface determinant
-
- 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
- A61P31/12—Antivirals
- A61P31/14—Antivirals for RNA viruses
- A61P31/18—Antivirals for RNA viruses for HIV
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Engineering & Computer Science (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Chemical & Material Sciences (AREA)
- Medicinal Chemistry (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Pharmacology & Pharmacy (AREA)
- Public Health (AREA)
- Animal Behavior & Ethology (AREA)
- Immunology (AREA)
- Epidemiology (AREA)
- Gastroenterology & Hepatology (AREA)
- Proteomics, Peptides & Aminoacids (AREA)
- Molecular Biology (AREA)
- Mycology (AREA)
- Virology (AREA)
- Microbiology (AREA)
- Tropical Medicine & Parasitology (AREA)
- Zoology (AREA)
- AIDS & HIV (AREA)
- Toxicology (AREA)
- Cell Biology (AREA)
- Communicable Diseases (AREA)
- Oncology (AREA)
- Chemical Kinetics & Catalysis (AREA)
- General Chemical & Material Sciences (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Organic Chemistry (AREA)
- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
- Medicines Containing Antibodies Or Antigens For Use As Internal Diagnostic Agents (AREA)
Abstract
Methods for the treatment of Human Immunodeficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are disclosed. Specifically, the treatment comprises inducing necrosis of HIV-infected lymphocytes. This is achieved by administration of an antibody, a toxin or a drug. Preferably the drug is conjugated to material that is able to specifically bind to HIV-infected lymphocytes. Suitable compounds include antithymocyte globulin, cyclosporine and cytotoxic monoclonal antilymphocytic antibodies. Also disclosed is use of a compound able to induce necrosis and a compound able to promote proliferation of lymphocytes in the treatment of HIV/AIDS. An example of a compound able to promote proliferation of lymphocytes is Interleukin-12.
Description
2456562
- 1 -
TREATMENT OP HIV/AIDS
Field of invention
5 The current invention relates to methods for the treatment of Human Immunodeficiency Virus infection and Acquired Immunodeficiency Syndrome.
Background
10
Infection by Human Immunodeficiency virus (HIV) and the subsequent development of Acquired Immunodeficiency Syndrome (AIDS) is a worldwide problem, currently without cure.
Current drug treatment regimes are based on suppression of HIV replication by either inhibiting entry into cells or preventing the production of a protein needed to make an HIV particle. These can be classified into the following five groups:
• Entry and Fusion Inhibitors
• Integrase Inhibitors
• Non-nucleoside Reverse Transcriptase Inhibitors
• Nucleoside Reverse Transcriptase Inhibitors
• Protease Inhibitors
Current clinical practice involves treatment with a combination (or 'cocktail') of a of number the above drugs. Ideally, prophylactic treatment should begin shortly after 30 exposure to the virus.
15
20
25
- 2 -
Treatments for side effects and opportunistic diseases resulting from reduced immunity are also prescribed,
although these do not aid clearance of the HIV infection itself.
5
Currently, no vaccine for HIV exists and AIDS remains an incurable condition.
Thus, it is an object of the present invention to provide a 10 treatment for HIV infection and/or AIDS, or at least to provide the public and the medical community with a useful alternative.
Summary of invention
15
The present invention relates to a method of treatment of HIV infection and/or AIDS in an individual in need thereof, wherein the method comprises inducing necrosis of HIV-infected lymphocytes.
20
Preferably, the lymphocytes are T-cells. More preferably, the lymphocytes are CD4+ T-cells. Most preferably, the lymphocytes are HIV-infected CD4+ T-cells.
25 In certain embodiments, necrosis is induced by administration of an antibody, a drug or a toxin.
In one embodiment, necrosis is induced by the administration of immunosuppressive agents. Appropriate immunosuppressive 30 agents include, but are not limited to antithymocyte globulin, cyclosporine and cytotoxic monoclonal antilymphocytic antibodies.
- 3 -
Where an antibody is used, the ability of the antibody to elicit an immune response could be utilised to cause necrosis.
5
Where a drug or a toxin is used, it is preferentially conjugated to a compound able to bind specifically to particular cell types, such as lymphocytes, T-cells, CD4+ T-cells or HIV-infected CD4+ T-cells. Such a compound may, for 10 example, be an antibody, antibody fragment, receptor, ligand or lectin that binds specifically to cell surface components found on the desired cell type. Such compounds may be administered locally or systemically.
15 Chemotherapy and radiotherapy may also be used in the method of the invention.
In a further embodiment of the current invention, in addition to inducing necrosis of HIV-infected lymphocytes 20 the treatment may include promotion of lymphocyte proliferation. The treatment may include administration of one or more additional agents that promote lymphocyte proliferation. Appropriate lymphocyte proliferative agents include, but are not limited to, interleukin-12 and anti-25 interleukin-10.
Lymphocyte proliferation treatment may be co-administered or administered at a different time point. Co-administration may involve administration of a combined formulation 30 containing both an agent which induces necrosis of HIV-
infected lymphocytes and an agent which promotes lymphocyte proliferation, or administration of the two agents in
- 4 -
separate formulations, either simultaneously or sequentially.
In another embodiment, in addition to inducing necrosis of 5 HIV-infected lymphocytes the treatment may include inhibition of apoptosis. The treatment may include the administration of one or more additional agents that inhibit apoptosis. Appropriate agents include, but are not limited to, antioxidants.
10
Apoptosis inhibition treatment may be co-administered or administered at a different time point. Co-administration may involve administration of a combined formulation containing both an agent which induces necrosis of HIV-15 infected lymphocytes and an agent which inhibits apoptosis or administration of the two agents in separate formulations, either simultaneously or sequentially. Appropriate administration routes include, but are not limited to, oral, parenteral, sublingual, nasal, pulmonary 20 and topical. Parenteral administration may include intravenous, intraarterial, intramuscular, intracardiac, subcutaneous, intraosseous infusion, intradermal,
intrathecal and intraperitoneal administration. Oral administration may be in the form of tablets, capsules, 25 suspensions, solutions any other form known in the art.
In a further embodiment, the current invention provides for the use of a compound able to induce necrosis of HIV-infected lymphocytes in the treatment of HIV infection 30 and/or AIDS.
- 5 -
Preferably, the compound induces necrosis of lymphocytes that are infected with HIV.
Preferably, the lymphocytes are T-cells. More preferably, 5 the lymphocytes are CD4+ T-cells. Most preferably, the lymphocytes are HIV-infected CD4+ T-cells.
In one embodiment, the compound is an immunosuppressive agent. Appropriate immunosuppressive agents include, but 10 are not limited to antithymocyte globulin, cyclosporine and cytotoxic monoclonal antilymphocytic antibodies..
In a further embodiment, the compound is administered together with one or more agents able to promote lymphocyte 15 proliferation. Appropriate lymphocyte proliferative agents include, but are not limited to, interleukin-12 and anti-interleukin-10.
The agent able to promote lymphocyte proliferation may be 20 co-administered or administered at a different time point. Co-administration may involve administration of a combined formulation containing both an agent which induces necrosis of HIV-infected lymphocytes and an agent which promotes lymphocyte proliferation, or administration of the two 25 agents in separate formulations, either simultaneously or sequentially.
In one embodiment , the compound is administered together with one or more agents able to inhibit apoptosis. Appropriate agents include, but are not limited to, 30 antioxidants.
- 6 -
The agent able to able to inhibit apoptosis may be coadministered or administered at a different time point. Co-administration may involve administration of a combined formulation containing both an agent which induces necrosis 5 of HIV-infected lymphocytes and an agent able to inhibit apoptosis, or administration of the two agents in separate formulations, either simultaneously or sequentially.
Detailed Description
10 It is well-established that the primary site of HIV
replication is within lymphocytes, specifically CD4+ T-cells. Budding of new virus particles from infected cells causes death of these cells by apoptosis. It is the reduction in serum levels of CD4+ T-cells and the
15 accompanying chronic weakening of the immune system that leads to the eventual development of AIDS.
The immune system attempts to control the infection by inducing apoptosis of infected cells. During apoptosis,
20 viral nucleic acids and proteins are incorporated into apoptotic bodies along with other cellular components. Apoptotic bodies are phagocytosed by phagocytes such as macrophages.
25 Antigen presentation by the phagocyte following phagocytosis may result in the activation of naive T-cells that may go on to become CD8+ T-cells able to specifically target and kill infected CD4+ T-cells.
30 As noted above, current treatments for HIV concentrate on the inhibition of the virus life-cycle, thereby halting or slowing the rate of virus replication and subsequent spread.
- 7 -
Such treatments are hindered by the nature of HIV, which has a high rate of genomic mutation. Thus, new strains and subtypes emerge that are resilient to antiretroviral treatment.
5
The current inventors propose a novel treatment route that does not suffer from the drawbacks of existing antiretroviral drugs. Surprisingly, by inducing the death of HIV-infected lymphocytes by necrosis, it is possible to 10 elicit a stronger immune response to HIV than that which occurs during the normal course of HIV infection. This improved immune system response results in significantly reduced viral load and even total viral clearance.
15 Necrosis is the uncontrolled death of a cell, resulting in total disintegration of the cell and release of the cellular contents. This excludes programmed cell-death (apoptosis), which is characterised by cell blebbing and the formation of apoptotic bodies. The phrase "inducing necrosis" is 20 intended to include any process by which a cell can be caused to die by necrosis or similar processes resulting in the uncontrolled release of cellular contents.
If a lymphocyte is killed by necrosis, then the internal 25 cellular components (including viral components in infected cells) are not packaged into apoptotic bodies for phagocytosis. Clearance of the cellular debris by the reticuloendothelial system results in antigen presentation and activation of the adaptive immune system.
30
The current method is contrary to established thinking on HIV/AIDS treatment, since it will result in a temporary
- 8 -
reduction in lymphocyte levels. Currently, all treatment routes focus on preservation of lymphocyte levels. Without wishing to be bound by any particular theory, the inventors propose that any non-infected T-lymphocytes that are 5 destroyed will be naturally replaced by the body.
Destruction of all T-lymphocytes, including non-infected T-lymphocytes, has potential additional advantages since sites for virus replication are removed.
10 The method of the invention involves treating an HIV-
positive individual, who may or may not exhibit symptoms of full-blown AIDs, in order to induce necrosis of (at least) HIV-infected lymphocytes. Included with the invention are methods which specifically induce necrosis of HIV-infected 15 (T)lymphocytes only (and do not result in substantial killing of non-HIV infected (T) lymphocytes), and also methods which result in necrosis of HIV-infected and non-infected lymphocytes.
20 In one embodiment the method of the invention induces necrosis of HIV-infected T-lymphocytes. More preferably, the lymphocytes are HIV-infected CD4+ T-cells.
As will be appreciated by those of skill in the relevant 25 art, the method of necrosis induction may take a number of different forms. This may involve administration of a chemical agent, such as a drug or toxin. For example, a necrotic toxin may be directed to a target cell by conjugation to a compound able to bind specifically to the 30 target HIV-infected cell type (in which necrosis is to be induced), i.e. HIV-infected lymphocytes, T-cells, CD4+ T-cells. Such a compound may, for example, be an antibody,
- 9 -
antibody fragment, receptor, ligand or lectin that binds specifically to at least one cell surface component found on the target cell type. Such compounds may be administered locally or systemically at a suitable dose.
5
In other embodiments, induction of necrosis in HIV-infected lymphocytes may be achieved by non-chemical means. In one embodiment, necrosis of HIV-infected lymphocytes is induced by the use of scalar waves. This embodiment is largely non-10 invasive and may involve exposure of a whole patient to the scalar wave.
In certain embodiments, induction of lymphocyte necrosis occurs in vivo. Alternatively, induction of lymphocyte 15 necrosis may occur in vitro and the resulting debris returned to the body for clearance by the reticuloendothelial system.
- 10 -
Claims (24)
1. A method of treating HIV infection and/or AIDS in an individual in need thereof, wherein the method
5 comprises inducing necrosis of HIV-infected lymphocytes.
2. The method of claim 1, wherein the lymphocytes are T-lymphocytes.
10
3. The method of claim 2, wherein the lymphocytes are CD4+ T-lymphocytes.
4. The method of any one of claims 1 to 3, wherein 15 necrosis is induced by a chemical agent.
5. The method of claim 4 wherein the chemical agent is an antibody, a drug, or a toxin.
20
6. The method of claim 5, wherein the drug or toxin is conjugated to a compound able to bind specifically to HIV-infected lymphocytes, preferably HIV-infected T-lymphocytes, more preferably HIV-infected CD4+ T lymphocytes.
25
7. The method of claim 6, wherein the compound able to bind specifically to HIV-infected lymphocytes, preferably HIV-infected T-lymphocytes, more preferably HIV-infected CD4+ T lymphocytes is an antibody, 30 antibody fragment, receptor, ligand or lectin.
- 11 -
8. The method of claim 1, wherein necrosis is induced by a scalar wave.
9. The method of claim 1, wherein necrosis is induced 5 specifically in HIV-infected lymphocytes.
10. The method of claim 1, wherein necrosis is induced in HIV-infected and non-infected lymphocytes.
10
11. The method of claim 1, wherein necrosis of HIV-
infected lymphocytes is induced by administration of an immunosuppressive agent.
12. The method of claim 11, wherein the
15 immunosuppressive agent is selected from the group consisting of antithymocyte globulin, cyclosporine and cytotoxic monoclonal antilymphocytic antibodies.
13. Use of a compound able to induce necrosis of HIV-
20 infected lymphocytes in the treatment of HIV infection and/or AIDS.
14. The use of claim 13, wherein the lymphocytes are T-lymphocytes.
25
15. The use of claim 14, wherein the T-cells are CD4+ T-lymphocytes.
16. The use of claim 13, wherein the compound is an 30 immunosuppressive agent.
- 12 -
17. The use of claim 13, wherein the compound is selected from the group consisting of antithymocyte globulin, cyclosporine and cytotoxic monoclonal antilymphocytic antibodies.
5
18. Use of a compound able to induce necrosis of HIV-infected lymphocytes and a compound able to promote proliferation of lymphocytes in the treatment of HIV infection and/or AIDS.
0
19. The use of claim 18, wherein the compound able to promote proliferation of lymphocytes is interleukin-12 or anti-interleukin-10.
15 20. The use of claim 18, wherein the compound able to induce necrosis of HIV-infected lymphocytes and the compound able to promote proliferation of lymphocytes are co-administered, either simultaneously or sequentially.
20
21. The use of claim 18, wherein the compound able to induce necrosis of HIV-infected lymphocytes and the compound able to promote proliferation of lymphocytes are administered at different time-points.
25
22. Use of a compound able to induce necrosis of HIV-infected lymphocytes and a compound able to inhibit apoptosis in the treatment of HIV infection and/or AIDS.
30
23. The use of claim 18, wherein the compound able to induce necrosis of HIV-infected lymphocytes and the
- 13 -
compound able to inhibit apoptosis are co-administered, either simultaneously or sequentially.
24. The use of claim 18, wherein the compound able to 5 induce necrosis of HIV-infected lymphocytes and the compound able to inhibit apoptosis are administered at different time-points.
10 868162; NLW, NLW
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| GB0800970A GB2456562A (en) | 2008-01-18 | 2008-01-18 | Treatment of HIV/AIDS |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| GB0800970A GB2456562A (en) | 2008-01-18 | 2008-01-18 | Treatment of HIV/AIDS |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| GB0800970D0 GB0800970D0 (en) | 2008-02-27 |
| GB2456562A true GB2456562A (en) | 2009-07-22 |
Family
ID=39166020
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| GB0800970A Withdrawn GB2456562A (en) | 2008-01-18 | 2008-01-18 | Treatment of HIV/AIDS |
Country Status (1)
| Country | Link |
|---|---|
| GB (1) | GB2456562A (en) |
Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US7125866B1 (en) * | 1999-04-30 | 2006-10-24 | Regents Of The University Of Michigan | Therapeutic applications of pro-apoptotic benzodiazepines |
-
2008
- 2008-01-18 GB GB0800970A patent/GB2456562A/en not_active Withdrawn
Patent Citations (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US7125866B1 (en) * | 1999-04-30 | 2006-10-24 | Regents Of The University Of Michigan | Therapeutic applications of pro-apoptotic benzodiazepines |
Non-Patent Citations (2)
| Title |
|---|
| Clin.Pharm.Therapeut. Vol.73 No.2, 2003. Cukiernik et al. "Sulfamethoxazole hydroxylamine (SMX-HA): Induces increased necrotic versus apoptotic cell death in sensitive lymphocytes." p.P11. * |
| Peptides Vol.20 No.11, 1999. Plymale et al. "Concentration-dependent differential induction of necrosis or apoptosis by HIV-1 lytic peptide 1." pp.1275-83. See Results and Discussion especially. * |
Also Published As
| Publication number | Publication date |
|---|---|
| GB0800970D0 (en) | 2008-02-27 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| WAP | Application withdrawn, taken to be withdrawn or refused ** after publication under section 16(1) |