JP5504390B2 - ナタリズマブを用いて炎症性疾患及び自己免疫疾患を治療する方法 - Google Patents
ナタリズマブを用いて炎症性疾患及び自己免疫疾患を治療する方法 Download PDFInfo
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Description
[001] 本出願は、2006年3月3日に出願された米国特許仮出願第60/779,190号に基づく優先権を主張し、その全内容がこれによって本明細書に援用される。
[002] 本発明は、組換え型抗体を用いて炎症性疾患及び自己免疫疾患を治療する方法に関する。これらの方法は、患者におけるIgG4抗体に基づいて用量を調節することによって、治療の安全性を改善する。
[003] 血液脳関門を越える抹消血からのリンパ球の遊走が、いくつかの中枢神経系(CNS)炎症性疾患の発症を引き起こすと報告されている。CNS中へのリンパ球の侵入は、細胞接着分子によって仲介される(O'Neill et al., Immunology 72:520-525 (1991); Raine et al., Lab. Invest. 63:476-489 (1990); Yednock et al., Nature 356:63-66 (1992); Baron et al., J. Exp. Med. 177:57-68 (1993); Steffen et al., Am. J. Path. 145:189-201 (1994); Christensen et al., J. Immunol. 154:5293-5301 (1995))。
[015] 本発明は、ナタリズマブを使用して、炎症性疾患及び自己免疫疾患の患者を治療する、より安全な方法を提供する。
定義
[037] 本明細書において使用される用語は、以下に説明するような一般的な意味を有し、そして本明細書の文脈の中でさらに理解することができる。
[039] “治療”とは、疾患のための医療のあらゆる施しまたは適用を意味し、そして、例えば、回復をもたらすこと、若しくは、失われた機能、損なわれた機能、若しくは障害のある機能を修復若しくは直すことによって、または非効率な工程を刺激することによって、疾患を妨げること、疾患の発症を阻止すること、及び疾患を軽減することが含まれる。
[002] “用量”とは、患者に投与されるナタリズマブの量を意味する。
[003] “投与期間”とは、ある用量の投与と次に続くある用量の投与との間の期間を意味する。投与期間は、1以上のさらに続く用量(単数または複数)とともに変えることができ、または一定のままにすることができる。
これらの抗体は、これらの文書中に開示された方法によって、哺乳類細胞の発現系によって、及び、例えばトランスジェニックヤギといった、トランスジェニック動物の発現系によって、調製することができる。
[007] “セロコンバージョン”は、陰性から陽性への血清学試験の変化であり、抗体の生成を表す。
IgG4抗体
[009] 抗体は免疫系によって用いられるタンパク質であり、そして細菌やウイルスのような外来物を同定または中和する。それぞれの抗体は、その標的に特有な特定の抗原を認識する。
免疫グロブリンは、抗体として機能する、免疫グロブリンスーパーファミリーの中の糖タンパク質である。それらは、免疫系のB細胞に由来する形質細胞によって、合成及び分泌される。B細胞はその特異的抗原に結合する際に活性化され、そして形質細胞に分化する。いくつかの場合、B細胞とヘルパーT細胞の相互作用もまた必要である。
[019] ナタリズマブは、α4-インテグリンであるα4β1及びα4β7に対して作られた、組換え型ヒト化IgG4κモノクローナル抗体である。ナタリズマブは、ヒト骨格領域及びa4-インテグリンに結合するマウス抗体の相補性決定領域を含む。ナタリズマブの分子量は149キロダルトンである。
[022] 多発性硬化症患者へ300 mg用量のナタリズマブを繰り返し静脈内投与した後の、平均の最大観測血清濃度は98±34μg/mLであった。投与期間を通じた平均の定常状態ナタリズマブ濃度は、約30μg/mLであった。16±5 mL/hのクリアランスにおいて、11±4日の平均半減期が観測された。5.7±1.9 Lの分布容積は、血漿容積と一致した。
[030] ナタリズマブの医薬組成物は、静脈内に投与されるだろう。投与されるナタリズマブの用量及び投与期間は、全ての患者またはあるクラスの患者にわたって固定されてもよいし、または患者の体重に基づいて決定されてもよい。例えば、ある態様において、ナタリズマブは、静脈内注入によって体重1 kgあたり1から5 mgの用量で投与される。あるいは、固定された用量のナタリズマブが、患者の体重とは無関係に、全ての患者またはあるクラスの患者に対して投与されてもよい。例えば、ある態様において、ナタリズマブ静脈内注入による300 mgの用量で投与される。
全ナタリズマブ及び二価ナタリズマブのELISAアッセイ
[035] 例えば血漿または血清などの生体液といった、溶液中の全ナタリズマブの量は、酵素結合免疫吸着アッセイ(ELISA)を用いて測定することができる。本発明は、一価及び二価ナタリズマブの両方を測定するELISAアッセイを提供する。具体的には、本発明は、全ナタリズマブの濃度及び二価ナタリズマブの濃度を測定するための、固相サンドイッチELISAを提供する。大まかにいうと、本明細書で説明するELISAアッセイは、ナタリズマブに特異的な抗イディオタイプ抗体及びIgG4抗体のFc領域に対する酵素結合抗体を利用する。
[041] ナタリズマブの安全性は、MS、クローン病、及び関節リウマチについての臨床試験におけるナタリズマブを用いた3919の被検体の治療の結果に基づき、本明細書において示されるものであり、結果として5505患者・年(patient-years)のナタリズマブ曝露を行った。ナタリズマブを用いた治療は、概して十分に耐容性であった。全てのナタリズマブのプログラムの中で、治療により発生した死が18例起こった。試験中に直面した一般的及び重篤な有害事象は、ナタリズマブ治療患者及び対照において同様であった。ナタリズマブの中断に至った有害事象は、5.8%のナタリズマブ治療MS患者及び4.8%のプラセボ治療MS患者において起こり、ナタリズマブ治療患者において最も一般的な中断の原因はじんましんであった(1.2%)。
[044] 臨床試験中におきた18例の死のうち、5例がプラセボ対照のMS試験において起こり、それらには患者のうちナタリズマブを投与されていた2例及びプラセボを投与されていた3例が含まれた。ナタリズマブを投与されていた患者は、アルコール依存症及び転移性悪性メラノーマで死亡した。プラセボを投与されていた患者は、心不全、呼吸不全、及び急性の胸膜癌腫症で死亡した。4例の死が盲検MS試験において起こり、それらは呼吸窮迫症、PML、自殺、及びMSによる発作を原因とした。
[048] プラセボ対照試験において、1617人のナタリズマブ治療MS患者のうち251人(15.5%)が、そして1135人のプラセボ治療患者のうち214人(18.9%)が、少なくとも1つの重篤な有害事象に直面した。器官系と分類される、最も一般的な重篤な有害事象は、神経系障害であった(5.9%ナタリズマブ、10.2%プラセボ)。MSの再発は、この発生率に顕著に寄与した(4.7%ナタリズマブ、9.0%プラセボ)。二番目に一般的な重篤な有害事象は、感染及び侵入であり(2.4%ナタリズマブ、2.2%プラセボ)、虫垂炎及び***症(両集団で<1%)が最も一般的であった。
[051] PMLの3つの確定症例が同定され、そのうち2例は致死であった。2つの症例はMS患者において起こり、そして1つはクローン病の患者において起こった。両MS患者は、AVONEX(登録商標)に加え、2年間に渡ってナタリズマブを投与されていた。クローン病患者は、18ヶ月間に渡って8用量のナタリズマブを投与され、そして持続性白血球減少によって認められた通り、慢性的アザチオプリンの使用によって免疫抑制された。3人のPML患者は全て、その疾患過程の初期にわずかな臨床上の変化を示しており、それらは患者または患者の家族によって気づかれていた。
[069] ナタリズマブ療法の中止の影響は、フェーズ2の研究において慎重に評価され、この研究には、プラセボ、3 mg/kgのナタリズマブ、または6 mg/kgのナタリズマブの注入を月ごとに6ヶ月間受けるように無作為化された213人の患者が関与した。患者は、最後の注入の後7ヶ月間追跡された。その間、再発及び他の有害事象が記録され、そしてナタリズマブの最後の投与後4ヶ月目及び7ヶ月目にMRIスキャンを実行した。比較は、プラセボ群及び2つのナタリズマブ投与群の間で行った。予想通り、再発を経験した患者の割合及び再発の頻度は、研究薬の中断後、ナタリズマブ群において、プラセボ群のレベルと同程度まで上昇した。その上、活性MRIスキャンの割合は、療法の中断後、ナタリズマブ群においてプラセボ群のレベルと同程度まで徐々に増えた。よって、ナタリズマブ治療の中断は有効性を失う結果をもたらすが、もしナタリズマブを用いた治療が無かった場合に予想される疾患活性を超えて、疾患活性が上昇する証拠はなく、すなわち、リバウンド効果は観察されなかった。したがって、ナタリズマブ療法を中断するMS患者は、疾患活性が著しく増加するリスクの上昇を有さない。
[070] プラセボ対照MS研究において、AVONEX(登録商標)の投与は、集中的な薬物動態のサンプリングを実施した小集団におけるナタリズマブの血清濃度の増加に関与しているようであった。しかし、薬物動態解析集団からの平均事後パラメーター推定の比較に基づいて、定常期クリアランス及び半減期の値は、AVONEX(登録商標)を同時に併用した患者及びナタリズマブ単剤治療の患者の間で異なったが、それは約5%のみの違いであり、そして臨床上有意でないと考えられた。加えて、ナタリズマブは、120週までAVONEX(登録商標)と併用して589人の患者に投与された場合、十分に耐容性であった。同時にAVONEX(登録商標)を投与された患者において、MSデータベース中にPMLの報告が2例生じたことに注意すべきである。よって、ナタリズマブ治療に伴うPMLのリスクは、インターフェロンβを用いた併用治療によって増加する可能性があるが、これは単なる偶然によって併用療法における2人の患者において起こったのかもしれない(p = 0.23)。
多発性硬化症
[072] MSは脳及び脊髄の慢性疾患である。合衆国のような温帯では、MSの発症率は1年あたり約1/100000から5/100000であり(US National MS Society; NMSS)、合衆国の患者数は350000から400000人と推定されている。MSは若年の、主として女性の疾患であり、疾患の発症が典型的には20から40歳の間に起こる。MSの最初の臨床的兆候は、普通、視神経(視神経炎)、脊髄(横断性脊髄炎)、または脳幹/小脳に影響するような、臨床上単離される症状の形態をとる(Runmarker and Anderson, Brain 116:117-134 (1993))。結果的にMSを発症し始める患者数の推定値は大きくばらつくが、視神経炎の症例では、発病時のMRIでのMS様病変の存在は、10年以内に臨床上確実なMSを発症する確率が80%より大きいことを示す(O'Riordan et al., Brain 121 :495-503 (1998); Sailer et al., Neurology 52:599-606 (1999))。
[085] これらの単剤治療研究の結果により、ナタリズマブが再発寛解型MSのための単剤治療として効果的な治療であることが示された。ナタリズマブ治療は、再発率、障害の進行、及び全てのMRI測定値、研究の一次評価項目及び二次評価項目に対して顕著な影響をもたらした。カプラン・マイヤー曲線の解析により、再発率及び障害の進行に対する影響が治療開始後の早期に明らかにみられ、そして患者集団は治療期間の間ずっと維持され
、最終時点で発散し続けた。さらに、これらの結果は、小集団を超えて一致していた。さらなる正の作用が、再発の重症度及び生活の質の測定値に対して見られた。
[087] 現在認可されている療法を受けている非常に多くの患者は、臨床的に及びMRIによって測定された場合に、疾患活性を経験し続けた。これは、これらの部分的に有効な認可医薬の予想された結果であり、それらそれぞれは、再発率について30%の減少を導いた(IFNB MS Study Group, Neurology 43:655-661 (1993); Jacobs et al., Ann. Neurol 39:285-289 (1996); PRISMS Study Group, Lancet 352:1498-1504 (1998); Johnson et al., Neurology 45:1268-1276 (1995))。MSの治療のためのβ-インターフェロンのフェーズ3試験からのデータは、インターフェロン治療にも関わらず、62%から75%の患者がこの2年間の試験中に少なくとも1回の再発を経験していたことを示す(IFNB MS Study Group, Neurology 43:655-661 (1993); Jacobs et al., Ann. Neurol. 39:285-289 (1996); PRISMS Study Group, Lancet 352:1498-1504 (1998))。同様に、酢酸グラチラマーのフェーズ3のMS試験において66%の被検体は、2年間に少なくとも1回の再発を経験し、その数はプラセボとの有意な違いがなかった(Johnson et al., Neurology 45:1268-1276 (1995))。さまざまな治療戦略を臨床診療において現在使用して、治療中に治療効果を打破する疾患を管理しているが(例えば、切り替え療法、インターフェロンの用量及び頻度の変化、併用療法)、これらの診療は、これらの取り組みの効果を評価する無作為化比較試験が存在しないので、概して経験的なものになる。
[091] PMLは、希突起膠細胞のJCV感染によって引き起こされる、中枢神経系の感染性疾患である。JCVは、幼い頃に大部分の健康個体に感染すると考えられているヒトポリオーマウイルスである。健康個体における抗JCV抗体の血清陽性率は、試験手法に依存して20%から80%の範囲と推定されている(Knowles et al., J. Med. Virol. 71:115-123 (2003)); Knowles and Sasnauskas, J. Virol. Methods. 109:47-54 (2003))。
[0102] JCVは、ヒトポリオーマウイルスの分類の一員であり、小さく、エンベロープを持たず、閉環状二本鎖DNA鎖ゲノムを有する、Papovaviridae科に属す。ポリオーマウイルスは、そのより小さなビリオンサイズ及び異なるゲノムサイズとゲノム構成によって、パピローマウイルスと区別することができる。ポリオーマウイルスは、自然界のどこにでも存在し、そして多くの種から単離することができる。JCVは、進行性多巣性白質脳症(PML)の患者の脳組織から最初に単離された。JCVは、BKヒトポリオーマウイルス(BKV)と75%の核酸配列相同性を共有し、BKVは術後尿管狭窄を有する腎臓移植患者の尿から単離された。BKV及びJCVは、それぞれSV40と70%の相同性を共有する。これら2種は、血清学的に交差反応性ではなく、抗体についての血清学的試験は、BKVとJCVを区別することができる(Demeter, in Mandell et al., eds., Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases, 4th edition, Vol. 2. New York, NY: Churchill Livingstone; 1995:1400-1406)。
[0108] 適切な患者選択は、ナタリズマブのベネフィット−リスク特性の最大化を助ける。ナタリズマブは、最近臨床上の疾患活性がある(例えば、研究に入る前の年に一回の再発)軽度から中程度の障害(EDSS 0から5.0)の未治療患者に対する有効性を示した。ナタリズマブはまた、β-インターフェロンを用いた治療にも関わらず、疾患活性が続いている(例えば、AVONEX(登録商標)を投与されているが、研究に入る前の年に一回の再発)軽度から中程度の障害の患者に対する有効性も示している。
[0119] 実施例は、発明の単なる例示を意図し、そしてしたがって、どんな形であれ発明を限定すると解されるべきではなく、また上述の本発明の側面及び態様を記載しそして詳述する。実施例は、以下の実験が実施された全ての実験または唯一の実験であることを示すわけではない。使用される数字(例えば、量、温度など)に関して正確性を確かにするための努力が払われたが、いくらかの実験誤差及び偏差が含まれているはずである。そうでないと示されていない限り、部分は重量部、分子量は重量平均分子量、温度は摂氏、そして圧力は大気圧またはそれに近い圧力である。
[0120] 2年間にわたるナタリズマブの有効性が、二つのフェーズ3試験において示されている(Polman et al., N. Engl. J. Med. in press (2006); Rudick et al. N. Engl. J. Med. in press (2006))。一方の研究において、ナタリズマブは未治療のMS患者に対して単剤治療として投与され、そしてその有効性がプラセボと比較された。他方の研究では、ナタリズマブは、併用のAVONEX(登録商標)療法にもかかわらず再発を経験した患者に投与され、そしてその有効性がAVONEX(インターフェロンβ-1a)にプラセボを加えたものの有効性と比較された。2年にわたるデータは利点を裏付け、1年の迅速認可を導いた。これらのデータは、障害の持続的進行が始まる時期を遅らせること、年再発率を減少させること、MRI病変を緩和すること、及びプラセボ及び活性AVONEX(登録商標)対照群の両方と比較して患者の生活の質を改善することについて、ナタリズマブは高い効果があることを示す。
Claims (33)
- (a) 第一の用量のナタリズマブを投与する第一の投与期間中に患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量をモニタリングする工程;および
(b) 観測された二価ナタリズマブのレベルに基づいて、第二の投与期間にわたって投与されるナタリズマブの第二の用量を算出する工程、ここで、第二の用量は第二の投与期間の間の治療の安全性及び/または有効性を向上させるものである;
を含み、
ここで、モニタリングにより、第一の投与期間中、患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量が既定のレベル以上のままであることが示される場合、第二の投与期間を通じて投与されるナタリズマブの第二の用量が、第二の投与期間の少なくとも一期間、第二の投与期間中のナタリズマブのレベルを既定のレベル未満まで減少させることを達成するように算出され、そして
モニタリングにより、第一の用量の投与後規定の期間内の第一の投与期間中に、患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量が既定のレベル未満に落ちることが示される場合、第二の投与期間を通じて投与されるナタリズマブの第二の用量が、既定のレベルより高くナタリズマブのレベルを維持するように算出される、
ナタリズマブを用いて炎症性疾患または自己免疫疾患の患者を治療する際の、第二の投与期間にわたり投与されるナタリズマブの第二の用量を算出する方法。 - モニタリングにより、第一の投与期間中、患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量が既定のレベルより多いままであることを示し、第二の投与期間を通じて投与されるナタリズマブの第二の用量が、第二の投与期間の少なくとも一期間、第二の投与期間中のナタリズマブのレベルを既定のレベル未満まで減少させることを達成するように算出される、請求項1の方法。
- 第二の用量が第一の用量より少ない、請求項2の方法。
- 第二の投与期間が第一の投与期間より長い、請求項2の方法。
- 第二の用量が第一の用量より少なく、そして第二の投与期間が第一の投与期間より長い、請求項2の方法。
- 第一の用量が静脈内注入よって投与される300 mgであり、そして第一の投与期間が4週間である、請求項2の方法。
- 既定のレベルが1μg/mlであって、そして第二の用量が静脈内注入によって投与される300 mg未満であり、第二の投与期間が4週間より長い、請求項6の方法。
- 既定のレベルが0.5μg/mlであって、そして第二の用量が静脈内注入によって投与される300 mg未満であり、第二の投与期間が4週間より長い、請求項6の方法。
- 既定のレベルが0.1μg/mlであって、そして第二の用量が静脈内注入によって投与される300 mg未満であり、第二の投与期間が4週間より長い、請求項6の方法。
- モニタリングにより、第一の用量の投与後既定の期間内の第一の投与期間中に、患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量が既定のレベル未満に落ちることが示され、そして第二の投与期間を通じて投与されるナタリズマブの第二の用量が、既定のレベルより高くナタリズマブのレベルを維持するように算出される、請求項1の方法。
- 疾患が多発性硬化症である、請求項1の方法。
- 疾患が炎症性腸疾患または関節リウマチである、請求項1の方法。
- 重篤感染症の指標について患者をモニタリングする工程をさらに含む、請求項1の方法。
- 進行性多巣性白質脳症の指標について患者をモニタリングする工程をさらに含む、請求項1の方法。
- モニタリングにより、患者から得られた尿サンプル、血液サンプル、及び/または脳脊髄液サンプル中のJCVを検出する、請求項14の方法。
- モニタリングにより、進行性多巣性白質脳症の臨床的症状及び/または放射線学的症状について検査する工程を含む、請求項14の方法。
- (a) 患者から得られた血漿サンプルまたは血清サンプル中のIgG4の量を決定する工程;
(b) 第一の用量のナタリズマブを投与する第一の投与期間中に患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブのレベルをモニタリングする工程;及び
(c) 患者から得られた血漿サンプルまたは血清サンプル中のIgG4の量及び患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブのレベルに基づいて、ナタリズマブの第二の用量及び第二の投与期間を算出する工程;
を含み、
ここで、モニタリングにより、第一の投与期間中、患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量が既定のレベル以上のままであることが示される場合、第二の投与期間を通じて投与されるナタリズマブの第二の用量が、第二の投与期間の少なくとも一期間、第二の投与期間中のナタリズマブのレベルを既定のレベル未満まで減少させることを達成するように算出され、そして
モニタリングにより、第一の用量の投与後規定の期間内の第一の投与期間中に、患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量が既定のレベル未満に落ちることが示される場合、第二の投与期間を通じて投与されるナタリズマブの第二の用量が、既定のレベルより高くナタリズマブのレベルを維持するように算出される、
ナタリズマブを用いて炎症性疾患または自己免疫疾患の患者を治療する際の、第二の投与期間にわたり投与されるナタリズマブの第二の用量を算出する方法。 - モニタリングにより、第一の投与期間中、患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量が既定のレベルより多いままであることを示し、第二の投与期間を通じて投与されるナタリズマブの第二の用量が、第二の投与期間の少なくとも一期間、第二の投与期間中のナタリズマブのレベルを既定のレベル未満まで減少させることを達成するように算出される、請求項17の方法。
- ナタリズマブの第一の用量が、4週間の第一の投与期間に静脈内注入によって投与される300 mgである、請求項18の方法。
- 既定のレベルが1μg/mlである、請求項19の方法。
- 既定のレベルが0.5μg/mlである、請求項19の方法。
- 既定のレベルが0.1μg/mlである、請求項19の方法。
- 補正された用量が第一の用量より少ないか、または第二の投与期間が第一の投与期間より長いか、または補正された用量が第一の用量より少なくそして第二の投与期間が第一の投与期間より長い、請求項19の方法。
- モニタリングにより、第一の用量の投与後既定の期間内の第一の投与期間中に、患者から得られた血漿サンプルまたは血清サンプル中の二価ナタリズマブの量が既定のレベル未満に落ちることが示され、そして第二の投与期間を通じて投与されるナタリズマブの第二の用量が、第二の投与期間中の第二の用量の投与後、少なくとも既定の期間まで、既定のレベルより高くナタリズマブのレベルを維持するように算出される、請求項17の方法。
- 重篤感染症の指標について患者をモニタリングする工程をさらに含む、請求項18の方法。
- 重篤感染症が進行性多巣性白質脳症である、請求項25の方法。
- 患者から得られた血液サンプル中のIgG4の量が200μg/ml未満であり、そして算出されたナタリズマブの用量が静脈内注入による300 mg未満である、請求項19の方法。
- 患者から得られた血液サンプル中のIgG4の量が200μg/ml未満であり、そして算出された投与期間が4週間より長い、請求項19の方法。
- 患者から得られた血液サンプル中のIgG4の量が200μg/ml未満であり、算出されたナタリズマブの用量が静脈内注入による300 mg未満であり、そして算出された投与期間が4週間より長い、請求項19の方法。
- 患者から得られた血液サンプル中のIgG4の量が100μg/ml未満であり、そして算出されたナタリズマブの用量が静脈内注入による300 mg未満である、請求項19の方法。
- 患者から得られた血液サンプル中のIgG4の量が100μg/ml未満であり、そして算出された投与期間が4週間より長い、請求項19の方法。
- 患者から得られた血液サンプル中のIgG4の量が100μg/ml未満であり、算出されたナタリズマブの用量が静脈内注入による300 mg未満であり、そして算出された投与期間が4週間より長い、請求項19の方法。
- ナタリズマブの標準的用量が300 mgの静脈内注入であり、そして標準的投与期間が4週間である、請求項19の方法。
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CA2644110A1 (en) | 2007-09-13 |
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ZA200807346B (en) | 2009-09-30 |
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EP1991267B1 (en) | 2017-12-20 |
EP1991267A2 (en) | 2008-11-19 |
EA200801933A1 (ru) | 2009-04-28 |
WO2007103112A3 (en) | 2007-11-29 |
EP3360900A1 (en) | 2018-08-15 |
JP2009529043A (ja) | 2009-08-13 |
US20230082238A1 (en) | 2023-03-16 |
AU2007224228B2 (en) | 2013-09-19 |
SG170058A1 (en) | 2011-04-29 |
EA016626B1 (ru) | 2012-06-29 |
US10466251B2 (en) | 2019-11-05 |
US20070231319A1 (en) | 2007-10-04 |
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JP5883377B2 (ja) | 2016-03-15 |
JP2013067640A (ja) | 2013-04-18 |
US20200166521A1 (en) | 2020-05-28 |
CN101437541A (zh) | 2009-05-20 |
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