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1. (WO2019043192) TLR-9 AGONISTS FOR MODULATION OF TUMOR MICROENVIRONMENT
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CLAIMS

A TLR-9 agonist for use in the treatment of a tumor disease, preferably of colon cancer, in a subject in need thereof, said TLR-9 agonist comprises

i. an oligodeoxyribonucleotide comprising at least one unmethylated CG dinucleotide, wherein C is deoxycytidine and G is deoxyguanosine and ii. at least one stretch of at least three, in particular of four, consecutive deoxyguanosines,

the deoxyribose moieties of the oligodeoxyribonucleotide are linked by phosphodiester bonds, and the oligodeoxyribonucleotide comprises at least one nucleotide in L-configuration, preferably the at least one nucleotide in L- configuration is comprised within the terminal five nucleotides of at least one end of the oligodeoxyribonucleotide, preferably within the terminal five nucleotides of the 3' end of the oligodeoxyribonucleotide, wherein the treatment with said TLR-9 agonist stimulates the infiltration of CD3+ T cells into the tumor and/or stimulates the infiltration of macrophages, preferably M1 macrophages, into the tumor and/or leads to an increased ratio of M1 macrophages to M2 macrophages within the tumor.

The TLR-9 agonist for use according to claim 1 , wherein the infiltration of the tumor by the CD3+ T cells and/or by the macrophages, preferably M1 macrophages, is stimulated compared with the infiltration without the treatment of the TLR-9 agonist and/or the ratio of M1 macrophages to M2 macrophages within the tumor is increased compared to the ratio of M1 macrophages to M2 macrophages without the treatment of the TLR-9 agonist.

The TLR-9 agonist for use according to claim 1 or 2, wherein the CD3+ T cells are CD4+ or CD8+ T cells, preferably CD8+ T cells.

The TLR-9 agonist for use according to claim 3, wherein the treatment with said TLR-9 agonist leads to an increased frequency of cytotoxic effector T cells (CD8+ CD69+ Granzyme B+) within the CD8+ T cell population in the tumor and/or to an increased ratio of CD8+ T cells, preferably of cytotoxic effector T cells (CD8+ CD69+ Granzyme B+), to regulatory T cells.

5. The TLR-9 agonist for use according to any of the preceding claims, wherein the tumor is infiltrated in its periphery and/or its center, preferably in its center.

6. The TLR-9 agonist for use according to any of the preceding claims, wherein the tumor is a solid tumor, preferably colon cancer, and the subject to be treated is a human.

7. The TLR-9 agonist for use according to any of the preceding claims, wherein the TLR-9 agonist is administered intratumorally or subcutaneously.

8. The TLR-9 agonist for use according to any of the preceding claims, wherein the at least one CG dinucleotide is part of a sequence N N2CGN3N4, wherein N N2 is AA, TT, GG, GT, GA or AT and N3N4 is CT, TT, TG or GG and C is deoxycytidine, G is deoxyguanosine, A is deoxyadenosine, and T is deoxythymidine.

9. The TLR-9 agonist for use according to any of the preceding claims, wherein the oligodeoxyribonucleotide comprises at least three CG dinucleotides.

10. The TLR-9 agonist for use according to any of the preceding claims, wherein the oligodeoxyribonucleotide is single-stranded and/or partially or completely double-stranded.

1 1 . The TLR-9 agonist for use according to any of the preceding claims having the sequence of any of SEQ ID NO: 5 to SEQ ID NO: 14, preferably of SEQ ID NO: 5.

12. The TLR-9 agonist for use according to any of the preceding claims, wherein the subject to be treated has previously received and/or subsequently receives another cancer treatment, preferably a chemotherapeutic and/or a checkpoint inhibitor.

13. The TLR-9 agonist for use according to any of the preceding claims, wherein the treatment with said TLR-9 agonist leads to a conversion of a cold tumor into a hot tumor.

14. A TLR-9 agonist for converting a cold tumor into a hot tumor, wherein the TLR- 9 agonist comprises

i. an oligodeoxyribonucleotide comprising at least one unmethylated CG dinucleotide, wherein C is deoxycytidine and G is deoxyguanosine and

ii. at least one stretch of at least three, in particular of four, consecutive deoxyguanosines,

the deoxyribose moieties of the oligodeoxyribonucleotide are linked by phosphodiester bonds and the oligodeoxyribonucleotide comprises at least one nucleotide in L-configuration, preferably the at least one nucleotide in L- configuration is comprised within the terminal five nucleotides of at least one end of the oligodeoxyribonucleotide, preferably within the terminal five nucleotides of the 3' end of the oligodeoxyribonucleotide, and wherein the tumor is preferably colon cancer.

15. A method for increasing the infiltration of CD3+ T cells, preferably CD8+ T cells, into a tumor, preferably colon cancer, and/or for increasing the frequency of cytotoxic effector T cells (CD8+ CD69+ Granzyme B+) within the CD8+ T cell population in the tumor and/or for increasing the ratio of CD8+ T cells, preferably of cytotoxic effector T cells (CD8+ CD69+ Granzyme B+), to regulatory T cells and/or for increasing the infiltration of macrophages, preferably M1 macrophages, into the tumor and/or for increasing a ratio of M1 macrophages to M2 macrophages within the tumor comprising administering a TLR-9 agonist to a patient in need thereof, wherein the TLR-9 agonist comprises

i. an oligodeoxyribonucleotide comprising at least one unmethylated CG dinucleotide, wherein C is deoxycytidine and G is deoxyguanosine and

ii. at least one stretch of at least three, in particular of four, consecutive deoxyguanosines,

the deoxyribose moieties of the oligodeoxyribonucleotide are linked by phosphodiester bonds and the oligodeoxyribonucleotide comprises at least one nucleotide in L-configuration, preferably the at least one nucleotide in L- configuration is comprised within the terminal five nucleotides of at least one end of the oligodeoxyribonucleotide, preferably within the terminal five nucleotides of the 3' end of the oligodeoxyribonucleotide.

16. Use of a TLR-9 agonist for increasing the infiltration of CD3+ T cells, preferably CD8+ T cells, into a tumor, preferably colon cancer, and/or for increasing the frequency of cytotoxic effector T cells (CD8+ CD69+ Granzyme B+) within the CD8+ T cell population in the tumor and/or for increasing the ratio of CD8+ T cells, preferably of cytotoxic effector T cells (CD8+ CD69+ Granzyme B+), to regulatory T cells and/or for increasing the infiltration of macrophages, preferably M1 macrophages, into the tumor and/or for increasing a ratio of M1 macrophages to M2 macrophages within the tumor, wherein the TLR-9 agonist comprises

i. an oligodeoxyribonucleotide comprising at least one unmethylated CG dinucleotide, wherein C is deoxycytidine and G is deoxyguanosine and

ii. at least one stretch of at least three, in particular of four, consecutive deoxyguanosines,

the deoxyribose moieties of the oligodeoxyribonucleotide are linked by phosphodiester bonds and the oligodeoxyribonucleotide comprises at least one nucleotide in L-configuration, preferably the at least one nucleotide in L- configuration is comprised within the terminal five nucleotides of at least one end of the oligodeoxyribonucleotide, preferably within the terminal five nucleotides of the 3' end of the oligodeoxyribonucleotide.

17. Composition comprising a TLR-9 agonist and a chemotherapeutic and/or a checkpoint inhibitor for use in the treatment of a tumor disease, preferably of colon cancer, in a subject in need thereof, said TLR-9 agonist comprises

i. an oligodeoxyribonucleotide comprising at least one unmethylated CG dinucleotide, wherein C is deoxycytidine and G is deoxyguanosine and

ii. at least one stretch of at least three, in particular of four, consecutive deoxyguanosines,

the deoxyribose moieties of the oligodeoxyribonucleotide are linked by phosphodiester bonds and the oligodeoxyribonucleotide comprises at least one nucleotide in L-configuration, preferably the at least one nucleotide in L- configuration is comprised within the terminal five nucleotides of at least one end of the oligodeoxyribonucleotide, preferably within the terminal five nucleotides of the 3' end of the oligodeoxyribonucleotide, wherein the treatment with said TLR-9 agonist stimulates the infiltration of CD3+ T cells into the tumor and/or stimulates the infiltration of macrophages, preferably M1 macrophages, into the tumor and/or leads to an increased ratio of M1 macrophages to M2 macrophages within the tumor.

1 8. A pharmaceutical composition comprising 1 mg/ml to 30 mg/ml, preferably 1 0 mg/ml to 20 mg/ml, of a TLR-9 agonist comprising at least one nucleotide in L- configuration in glucose in a salt solution.