NZ717550B2 - Methods of treating or preventing cholesterol related disorders - Google Patents

Abstract

Disclosed and claimed is a method of lowering serum LDL cholesterol in a patient comprising administering at least one anti-PCSK9 antibody to the patient in need thereof at a dose of about 105-280mg wherein said dose is to be administered at a frequency of from once per week to once every four weeks, and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about 15%. Wherein PCSK9 comprises the amino acids of SEQ ID NO 1 and the antibody is defined by 90% identity to SEQ Id NO: 23 and 49 or by the CDRs therein. , and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about 15%. Wherein PCSK9 comprises the amino acids of SEQ ID NO 1 and the antibody is defined by 90% identity to SEQ Id NO: 23 and 49 or by the CDRs therein.

Description

(12) Granted patent specificaon (19) NZ (11) 717550 (13) B2 (47) Publicaon date: 2021.12.24 (54) METHODS OF TREATING OR PREVENTING CHOLESTEROL RELATED DISORDERS (51) Internaonal Patent Classificaon(s): A61K 39/395 C07K 16/40 A61P 3/06 (22) Filing date: (73) Owner(s): 2012.05.10 AMGEN INC. (23) Complete specificaon filing date: (74) Contact: 2012.05.10 Spruson & Ferguson Pty Ltd (62) Divided out of 618300 (72) Inventor(s): CHAN, Joyce Chi Yee (30) Internaonal Priority Data: GIBBS, John P.

US 61/484,610 2011.05.10 DIAS, Clapton S.

US 61/562,303 2011.11.21 WASSERMAN, Scott US 61/595,526 2012.02.06 SCOTT, Robert Andrew Donald US 61/614,417 2012.03.22 CLOGSTON, Christi L.

US 61/642,363 2012.05.03 OSSLUND, Timothy David STEIN, Evan, A. (57) Abstract: Disclosed and claimed is a method of lowering serum LDL cholesterol in a paent comprising administering at least one an-PCSK9 anbody to the paent in need thereof at a dose of about 105-280mg wherein said dose is to be administered at a frequency of from once per week to once every four weeks, and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about 15%. Wherein PCSK9 comprises the amino acids of SEQ ID NO 1 and the anbody is defined by 90% identy to SEQ Id NO: 23 and 49 or by the CDRs therein.

NZ 717550 B2 an elevated total serum cholesterol, elevated LDL, elevated triglycerides, elevated VLDL, and/or low HDL. Hypercholesterolemia is, in fact, an established risk factor for coronary heart disease (CHD) in humans. Lowering of low-density lipoprotein cholesterol (LDL-C) results in a reduction of cardiovascular risk and is a primary goal in pharmacotherapy for CHD. Statins (hydroxymethylglutaryl coenzyme A [HMG CoA] reductase inhibitors) are currently the treatment of choice for hypercholesterolemia. However, emerging data indicate that more aggressive treatment of hypercholesterolemia is associated with lower risk for CHD events. In addition, a subset of patients are intolerant to, or do not respond adequately to, statin therapy. Thus, novel therapies that can be used alone or in combination with existing agents to more effectively reduce LDL-C may be useful.

It is well established that recycling of the hepatic cell surface low-density lipoprotein receptor (LDLR) plays a critical role in the maintenance of cellular and whole body cholesterol balance by regulating plasma LDL-C levels. More recently it has been shown that proprotein convertase subtilisin/kexin type 9 (PCSK9) plays an important role in the recycling and regulation of LDLR. PCSK9 is a member of the subtilisin family of serine proteases and is expressed predominantly in the liver. Following secretion, it causes post- translational down regulation of hepatic cell surface LDLR by a mechanism that involves direct binding to the LDLR. Down regulation of hepatic LDLR in turn leads to increased levels of circulating LDL-C. Thus PCSK9 may represent a target for inhibition by novel therapeutics in the setting of hypercholesterolemia. Strong rationale for such an approach is available from studies in preclinical models and from findings that humans with PCSK9 loss- of-function mutations have cholesterol levels lower than normal and reduced incidence of CHD.

SUMMARY OF VARIOUS EMBODIMENTS According to a first aspect, the present invention provides use of at least one monoclonal antibody that specifically binds to PCSK9, or a fragment of said monoclonal antibody that specifically binds to PCSK9, wherein PCSK9 comprises the amino acids of SEQ ID NO 1, in the manufacture of a medicament for lowering serum LDL cholesterol level in a patient in need thereof and/or treating or preventing a cholesterol related disorder in a patient, wherein said medicament is to be administered to said patient at a dose of about 105 mg to about 280 mg of said monoclonal antibody or said fragment, wherein said dose is to be administered at a frequency of from once per week to once every four weeks, and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about %, wherein said monoclonal antibody or said fragment comprises: (a) a light chain variable region that comprises an amino acid sequence that is at least 90% identical to that of SEQ ID NO:23 and a heavy chain variable region that comprises an amino acid sequence that is at least 90% identical to that of SEQ ID NO:49; or (b) a light chain complementarity determining region (CDR) of the CDRL1 sequence in SEQ ID NO:23, a CDRL2 of the CDRL2 sequence in SEQ ID NO:23, and a CDRL3 of the CDRL3 sequence in SEQ ID NO:23, and a heavy chain complementarity determining region (CDR) of the CDRH1 sequence in SEQ ID NO:49, a CDRH2 of the CDRH2 sequence in SEQ ID NO:49, and a CDRH3 of the CDRH3 sequence in SEQ ID NO:49; In some aspects of the invention a stable formulation comprising at least one monoclonal antibody that specifically binds to PCSK9, wherein PCSK9 comprises the amino acids of SEQ ID NO 1, the monoclonal antibody in an amount of about 40 mg/ml to about 300 mg/ml, and a pharmaceutically acceptable buffer in an amount of about .05 mM to about 40 mM, and a pharmaceutically acceptable surfactant in an amount that is about .01% w/v to about 20% w/v, and at least one pharmaceutically acceptable stabilizer of about 0.5% w/v to about 10% w/v, wherein the stable formulation has a pH of between about 4.0 to about 6.0 is provided. In some embodiments the above stable formulation comprises a pharmaceutically acceptable buffer chosen from thee group consisting of glutamate, phosphate, phosphate buffered saline, sodium acetate, sodium citrate, and Tris buffer. In particular embodiments the pharmaceutically acceptable buffer of the above stable formulation is present in an amount of 10-20 mM. In a particular embodiment the pharmaceutically acceptable buffer is sodium acetate in the amount of 10-20 mM. In some embodiments, the pharmaceutically acceptable surfactant is present in an amount of about 0.004% w/v to about 0.01% w/v. In particular embodiments the pharmaceutically acceptable surfactant of the above stable formulation is polysorbate 80 or polysorbate 20. In further embodiments the e.g. e.g.

See, e.g., et al. Virology et al. supra et al. Basic Methods in Molecular Biology et al. Gene e.g. e.g. i.e.

Computational Molecular Biology et al.SIAM J. Applied Math. et al. Nucl. Acid Res. see et al.

Atlas of Protein Sequence and Structure et al. Proc. Natl. Acad. Sci. U.S.A et al. J. Mol. Biol. et al.supra e.g.

Immunology--A Synthesis et al.

See, e.g., et al. e.g. e.g. e.g., in vivo see infra See, e.g., Clin. Exp. Immunol. et al. J.

Immunol. e.g. i.e.

See, e.g., Fundamental Immunology et al.

See, e.g., See, e.g., et al. et al.

See, e.g., et al. ab initio et al. Ab Initio See, e.g., et al., See, e.g., et al. et al. e.g. in vitro e.g. e.g. e.g. e.g. e.g. see, e.g., et al. Methods in Enzymology see, e.g., et al.

J. Immunol. see, e.g., Antibodies, A Laboratory Manual see, e.g., et al.

Molec. Immunol. see, e.g., et al. Virology et al. Scand.

J. Immunol. e.g. e.g. e.g.

See, e.g., et al. Molecular Cloning: A Laboratory Manual et al. et al. inter alia, e.g. e.g. in vitro 1 nM, 1000pM to 500pM, 500 pM to 200 pM, less than 200 pM, 200 pM to 150 pM, 200 pM to 100 pM, 100 pM to 10 pM, 10 pM to 1 pM.

One example of an IgG2 heavy chain constant domain of an anti-PCSK9 antibody of the present invention has the amino acid sequence as shown in SEQ ID NO: 154, K.

One example of an IgG4 heavy chain constant domain of an anti-PCSK9 antibody of the present invention has the amino acid sequence as shown in SEQ ID NO: 155, K.

One example of a kappa light chain constant domain of an anti-PCSK9 antibody has the amino acid sequence as shown in SEQ ID NO: 157, K.

One example of a lambda light chain constant domain of an anti-PCSK9 antibody has the amino acid sequence as shown in SEQ ID NO: 156, K.

Variable regions of immunoglobulin chains generally exhibit the same overall structure, comprising relatively conserved framework regions (FR) joined by three hypervariable regions, more often called “complementarity determining regions” or CDRs.

The CDRs from the two chains of each heavy chain/light chain pair mentioned above typically are aligned by the framework regions to form a structure that binds specifically with a specific epitope on the target protein (e.g., PCSK9). From N-terminal to C-terminal, naturally-occurring light and heavy chain variable regions both typically conform with the following order of these elements: FR1, CDR1, FR2, CDR2, FR3, CDR3 and FR4. A numbering system has been devised for assigning numbers to amino acids that occupy positions in each of these domains. This numbering system is defined in Kabat Sequences of Proteins of Immunological Interest (1987 and 1991, NIH, Bethesda, MD), or Chothia & Lesk, 1987, J. Mol. Biol. 196:901-917; Chothia et al., 1989, Nature 342:878-883.

Various heavy chain and light chain variable regions are provided herein and are depicted in FIGs. 2A-3JJ and 3LL-3BBB. In some embodiments, each of these variable regions can be attached to the above heavy and light chain constant regions to form a complete antibody heavy and light chain, respectively. Further, each of the so generated heavy and light chain sequences can be combined to form a complete antibody structure.

Specific examples of some of the variable regions of the light and heavy chains of the antibodies that are provided and their corresponding amino acid sequences are summarized in TABLE 2.

TABLE 2: Exemplary Heavy and Light Chain Variable Regions Antibody Light/Heavy SEQ ID NO 30A4 5/74 3C4 7/85 23B5 9/71 25G4 10/72 31H4 12/67 27B2 13/87 25A7 15/58 27H5 16/52 26H5 17/51 31D1 18/53 20D10 19/48 27E7 20/54 30B9 21/55 19H9 22/56 26E10 23/49 21B12 23/49 17C2 24/57 23G1 26/50 13H1 28/91 9C9 30/64 9H6 31/62 31A4 32/89 1A12 33/65 16F12 35/79 22E2 36/80 27A6 37/76 28B12 38/77 28D6 39/78 31G11 40/83 13B5 42/69 31B12 44/81 3B6 46/60 5H5 421/419 24F7 425/423 22B11 429/427 30F1 433/431 24B9.1 437/435 24B9.2 441/439 20A5.1 445/443 20A5.2 449/447 20E5.1 453/451 20E5.2 457/455 8A3 461/459 11F1 465/463 12H11 469/467 11H4 473/471 11H8 477/475 11G1 481/479 8A1 485/483 Again, each of the exemplary variable heavy chains listed in Table 2 can be combined with any of the exemplary variable light chains shown in Table 2 to form an antibody. Table 2 shows exemplary light and heavy chain pairings found in several of the antibodies disclosed herein. In some instances, the antibodies include at least one variable heavy chain and one variable light chain from those listed in Table 2. In other instances, the antibodies contain two identical light chains and two identical heavy chains. As an example, an antibody or antigen binding protein can include a heavy chain and a light chain, two heavy chains, or two light chains. In some embodiments the antigen binding protein comprises (and/or consists) of 1, 2, and/or 3 heavy and/or light CDRs from at least one of the sequences listed in Table 2 (CDRs for the sequences are outlined in FIGs. 2A-3D, and other embodiments in FIGs. 3CCC-3JJJ and 15A-15D). In some embodiments, all 6 CDRs (CDR1-3 from the light (CDRL1, CDRL2, CDRL3) and CDR1-3 from the heavy (CDRH1, CDRH2, and CDRH3)) are part of the ABP. In some embodiments, 1, 2, 3, 4, 5, or more CDRs are included in the ABP. In some embodiments, one heavy and one light CDR from the CDRs in the sequences in Table 2 is included in the ABP (CDRs for the sequences in table 2 are outlined in FIGs. 2A-3D). In some embodiments, additional sections (e.g., as depicted in -2D, 3A-3D, and other e.g. e.g., e.g. e.g. e.g. e.g.

See, e.g., See, e.g., See, e.g., et al.

See, e.g.,et al. et al. et al. .

See, e.g., et al. Mol Immunol et al. et al. et al. e.g. i.e. e.g. e.g. see, e.g., Journal of Molecular Biology see, e.g. Sequences of Proteins of Immunological Interest et al., et al. et al. et al. et al.

See et al. et al., et al. et al., et al. et al. supra , supra Proteins, Structures and Molecular Principles Introduction to Protein Structure et al. e.g. e.g.

See, e.g., See, e.g., e.g.

See, e.g., et al. et al. J Mol Biol See, e.g., et al., et al. e.g. e.g. in vitro e.g. See, e.g., et al., et al., See, e.g., et al., et al.

See, e.g., et al., See, e.g., et al.

See, e.g., et al., et al.

See also et al. e.g.

See also et al. et al.

See also See further et al. et al. et al. et al. et al. et al. et al. et al. et al in vitro e.g.

Pichia Spodoptera frugiperda Autographa californica Spodoptera frugiperda Trichoplusia S. frugiperda Trichoplusia See, e.g., et al. et al.

See, e.g., et al. supra See, e.g., et al. e.g. et al J. Biol. Chem et al J. Biol. Chem. e.g. e.g. e.g. e.g. e.g. e.g.

Remington's Pharmaceutical Sciences Remington's Pharmaceutical Sciences supra in vivo in vivo i.e.

Remington's Pharmaceutical Sciences supra e.g. et al. et al. al. supra See, e.g., et al. in vivo e.g. e.g.

Proinflammatory and Anti-Inflammatory Cytokines in Rheumatoid Arthritis: A Primer for Clinicians e.g.

See, e.g. et al. J. Immunol. e.g. in vitro e.g. et al. Nucleic Acids Res. see Molecular Biology and Evolution

Claims (23)

WHAT IS CLAIMED IS:

1. Use of at least one monoclonal antibody that specifically binds to PCSK9, or a fragment of said monoclonal antibody that specifically binds to PCSK9, wherein PCSK9 comprises the amino acids of SEQ ID NO 1, in the manufacture of a medicament for lowering serum LDL cholesterol level in a patient in need thereof and/or treating or preventing a cholesterol related disorder in a patient, wherein said medicament is to be administered to said patient at a dose of about 105 mg to about 280 mg of said monoclonal antibody or said fragment, wherein said dose is to be administered at a frequency of from once per week to once every four weeks, and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about 15%, wherein said monoclonal antibody or said fragment comprises: (a) a light chain variable region that comprises an amino acid sequence that is at least 90% identical to that of SEQ ID NO:23 and a heavy chain variable region that comprises an amino acid sequence that is at least 90% identical to that of SEQ ID NO:49; or (b) a light chain complementarity determining region (CDR) of the CDRL1 sequence in SEQ ID NO:23, a CDRL2 of the CDRL2 sequence in SEQ ID NO:23, and a CDRL3 of the CDRL3 sequence in SEQ ID NO:23, and a heavy chain complementarity determining region (CDR) of the CDRH1 sequence in SEQ ID NO:49, a CDRH2 of the CDRH2 sequence in SEQ ID NO:49, and a CDRH3 of the CDRH3 sequence in SEQ ID NO:49.

2. The use according to claim 1, wherein said medicament is capable of lowering said serum LDL cholesterol level by an amount selected from the group consisting of a) at least about 30%, b) at least about 40%, c) at least about 50%, and d) at least about 60%.

3. The use according to claim 1, wherein the cholesterol related disorder is selected from the group consisting of familial hypercholesterolemia including heterozygous familial hypercholesterolemia and homozygous familial hypercholesterolemia, non-familial hypercholesterolemia, elevated lipoprotein A, heart disease, metabolic syndrome, diabetes, coronary heart disease, stroke, cardiovascular disease, peripheral arterial disease, hyperlipidemia and dyslipidemia.

4. The use according to any one of claims 1 to 3, wherein said monoclonal antibody or said fragment comprises a light chain variable region that comprises the amino acid sequence of SEQ ID NO:23 and a heavy chain variable region that comprises the amino acid sequence of SEQ ID NO:49.

5. The use according to any one of claims 1 to 4, wherein the said monoclonal antibody or said fragment comprises: (a) a light chain complementarity determining region (CDR) of the CDRL1 sequence in SEQ ID NO:23, a CDRL2 of the CDRL2 sequence in SEQ ID NO:23, and a CDRL3 of the CDRL3 sequence in SEQ ID NO:23, and a heavy chain complementarity determining region (CDR) of the CDRH1 sequence in SEQ ID NO:49, a CDRH2 of the CDRH2 sequence in SEQ ID NO:49, and a CDRH3 of the CDRH3 sequence in SEQ ID NO:49; or (b) a light chain complementarity determining region (CDR) CDRL1 comprising the amino acid sequence of SEQ ID NO: 158, a CDRL2 comprising the amino acid sequence of SEQ ID NO: 162, a CDRL3 comprising the amino acid sequence of SEQ ID NO: 395; a heavy chain complementarity determining region (CDR) CDRH1 comprising the amino acid sequence of SEQ ID NO: 368, a CDRH2 comprising the amino acid sequence of SEQ ID NO: 175, a CDRH3 comprising the amino acid sequence of SEQ ID NO: 180.

6. The use according to any one of claims 1 to 5, wherein said medicament is to be administered to said patient at a dose of said monoclonal antibody or said fragment selected from the group consisting of: a) about 105 mg to about 140 mg, b) about 140 mg to about 280 mg, c) about 120 mg to about 200 mg, d) about 140 mg to about 200 mg, e) about 105 mg, f) about 120 mg, g) about 140 mg, h) about 210 mg, and i) about 280 mg.

7. The use according to any one of claims 1 to 6, wherein said medicament is to be administered to said patient on a schedule selected from the group consisting of: (1) once a week, (2) once every two weeks, and (3) once a month.

8. The use according to any one of claims 1 to 7 wherein said medicament is to be administered to said patient subcutaneously.

9. The use according to any one of claims 1 to 7, wherein said medicament is to be administered to said patient parenterally.

10. The use according to any one of claims 1 to 7, wherein said medicament is to be administered to said patient intravenously.

11. The use according to any one of claims 1 to 10, wherein said medicament is to be administered to said patient on a schedule selected from the group consisting of: (a) about 105 mg to about 280 mg once every 2 weeks (Q2W); (b) about 140 mg to about 280 mg once every two weeks (Q2W); and (c) at least about 140 mg once every two weeks (Q2W).

12. The use according to any one of claims 1 to 10, wherein said medicament is to be administered to said patient at a dose of said monoclonal antibody or said fragment of about 105 mg to about 280 mg once every two weeks, and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about 30-50% for about 7-14 days.

13. The use according to any one of claims 1 to 10, wherein said medicament is to be administered to said patient at a dose of said monoclonal antibody or said fragment of about 120 mg.

14. The use according to any one of claims 1 to 10, wherein said medicament is to be administered to said patient at a dose of said monoclonal antibody or said fragment of about 140 mg.

15. The use according to any one of claims 1 to 10, wherein said medicament is to be administered to said patient at a dose of said monoclonal antibody or said fragment of about 160 mg.

16. The use according to any one of claims 1 to 10, wherein said medicament is to be administered to said patient at a dose of said monoclonal antibody or said fragment of about 140 mg once every two weeks, and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about 30-50% for about 7-14 days.

17. The use according to any one of claims 1 to 8, wherein said medicament is to be administered to said patient at a dose of said monoclonal antibody or said fragment of about 140 mg subcutaneously once every two weeks, and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about 30-50% for about 7-14 days.

18. The use according to any one of claims 1 to 17, wherein said medicament is to be administered to said patient before, after or with at least one other cholesterol-lowering agent.

19. The use according to claim 18, wherein the at least one other cholesterol lowering agent is selected from the group consisting of: statins, including, atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin, Nicotinic acid, Fibric acid, Bile acid sequestrants, Cholesterol absorption inhibitor, lipid modifying agents, PPAR gamma agonists, PPAR alpha/gamma agonists, squalene synthase inhibitors, CETP inhibitors, anti-hypertensives, anti-diabetic agents, including sulphonyl ureas, insulin, GLP-1 analogs, DDPIV inhibitors, ApoB modulators, MTP inhibitors and /or arteriosclerosis obliterans treatments, oncostatin M, estrogen, berbine and a therapeutic agent for an immune-related disorder.

20. The use according to claim 1, wherein said medicament is to be administered to said patient at a dose of said monoclonal antibody or said fragment of about 140 mg subcutaneously once every two weeks and wherein said medicament is capable of lowering said serum LDL cholesterol level by at least about 30%.

21. The use according to claim 20, wherein said monoclonal antibody comprises: a light chain variable region that comprises the amino acid sequence SEQ ID NO: 23 and a heavy chain variable region that comprises the amino acid sequence of SEQ ID NO:49.

22. Use according to any one of claims 1 to 21, wherein the monoclonal antibody or said fragment is in a stable formulation, wherein the stable formulation comprises: (a) about 10 mM to about 20 mM sodium acetate; (b) about 2.0% to about 3.0% w/v proline; (c) about 0.01% w/v polysorbate 20 or polysorbate 80, and and wherein the pH of the formulation is about 5.0.

23. Use according to claim 22, wherein stable formulation comprises about 100mg/ml to about 200mg/ml of the monoclonal antibody or said fragment thereof.