Treatment of Knee Osteoarthritis via Intra-articular Delivery of an Immunosuppressive Enzyme

Project Summary
In osteoarthritis (OA), intra-articular inflammation is a key mediator of joint destruction and chronic joint pain.
Unfortunately, current strategies to control joint inflammation have largely failed. To address this challenge, our
team is developing an innovative metabolic reprogramming strategy for the treatment of knee OA. In our strategy,
indoleamine 2,3-dioxygenase (IDO), an immunosupressive enzyme, will be intra-articularly delivered to
catabolize tryptophan into kynurenines. Based on IDO’s effect in other tissues, this redirection of tryptophan
metabolism will likely drive the polarization of joint-level immune cells toward an anti-inflammatory state.
Importantly, our strategy differs from other intra-articular delivery strategies for protein and synthetic drugs, as
our enzyme will continuously produce anti-inflammatory metabolites in the OA-affected joint and thereby create
prolonged anti-inflammatory effects that potentially reset immune homeostasis in the joint. However, while IDO
can continuously produce anti-inflammatory metabolites, free IDO is subject to joint clearance. To address this
challenge, we will also fuse IDO to a carbohydrate-binding protein, thereby extending IDO’s joint residence time
via a novel tissue anchoring approach. Morever, because tissue-anchored IDO does not need to release to
generate anti-inflammatory signals, the anchored IDO will continue to produce anti-inflammatory kyneurenines
without the need for our ‘drug’ (IDO) to release and bind a specific target. Our preliminary data demonstrate that
tryptophan metabolism is altered in both human OA and rodent models, our tissue anchoring strategy can extend
the residence time of an enzyme from a few days to over 4 weeks, and that intra-articular delivery of an IDO
fusion protein can shift tryptophan metabolism, reduce inflammation, and reverse pain-related behaviors in a rat
knee OA model. As such, this R01 proposal seeks to evaluate intra-articular delivery of an IDO fusion protein as
a therapeutic strategy to control joint inflammation and reduce OA-related pathological remodeling after trauma
(Aim 1) and after the onset of chronic OA symptoms (Aim 2). To achieve these aims, our team will integrate
expertise in metabolic profiling, immune engineering, joint histology, and rodent behavioral analyses.
Specifically, this R01 will address the following scientific questions: 1) How is joint metabolism altered by intra-
articular delivery of an IDO fusion protein? 2) How is the local regulation of the immune system within the joint
altered by an intra-articular injection of an IDO fusion protein? 3) Do IDO-induced metabolic shifts affect other
joint tissues as well? 4) Can intra-articular injection of an IDO fusion protein stall the onset of post-traumatic OA
after medial meniscus injury? and, 5) Can intra-articular delivery of an IDO fusion protein reverse OA-related
pain and disability, even in the context of irreparable joint damage? Answering these questions will be important
for understanding the translational risks of our IDO fusion protein, as well as for refining metabolic reprogramming
strategies for OA treatment in the future.

Grant Number: 5R01AR079874-05
NIH Institute/Center: NIH
Principal Investigator: Kyle Allen