Classifications

• • 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
  • A61K38/22—Hormones
• • 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
  • A61K38/22—Hormones
  • A61K38/2264—Obesity-gene products, e.g. leptin
• • 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
  • A61K38/22—Hormones
  • A61K38/23—Calcitonins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/04—Anorexiants; Antiobesity agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
  • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P5/00—Drugs for disorders of the endocrine system
  • A61P5/24—Drugs for disorders of the endocrine system of the sex hormones
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • C07K14/575—Hormones

Definitions

• the disclosure is in the field of medicine, including the use of amylin agonist compounds to treat estrogen-deficient mammals.
• Estrogen is the female sex hormone responsible for ovulation. Estrogen has been found to influence body fat distribution. The results of a number of medical studies indicate that menopause is associated with a progressive increase in weight, and a redistribution of body fat to the abdominal region. Animal studies have shown that a lack of estrogen leads to excessive weight gain.
• Hormone replacement therapy has been used to improve the quality of life for postmenopausal women to alleviate the symptoms associated with estrogen deficiency and to slow the progression of diseases associated with estrogen deficiency.
• hormone replacement therapies are available to help alleviate the deleterious physical and physiological changes associated with menopause.
• Such regimens include monotherapy, such as estrogen, and combination therapy, such as estradiol and progesterone/progestin.
• Estrogen is widely known to influence energy balance and body weight homeostasis through effects on feeding behavior and metabolism (1, 2).
• the absence of estrogen for example, through experimental removal of the ovaries (OVX), leads to increased caloric consumption and subsequent accelerated body weight and fat mass gain (3, 4).
• OVX ovaries
• the induction of hyperphagia and rapid weight gain post-OVX can be reversed by estrogen replacement (3, 4).
• pharmacological and neurobiological studies comparing the responsiveness of intact and OVX rodents to neurohormonal signals have elucidated mechanisms whereby estrogen modulates the central control of energy balance.
• CCK CCK
• adiposity e.g., leptin, insulin (4, 7)
• orexigenic signals e.g., melanin concentrating hormone, neuropeptide Y, ghrelin (8- 11)
• These pre-clinical findings have potential clinical significance, as many of the aforementioned neurohormonal signals have been, or are currently being pursued as potential anti-obesity targets, and post-menopausal women make up a high percentage of the obese population for whom these agents are ultimately prescribed (12).
• amylin which has been advocated as a potent satiety signal (13).
• amylin acts via its receptors in the area postrema (AP) of the brainstem to inhibit gastric emptying and food intake (14).
• AP area postrema
• sustained peripheral infusion of amylin to diet-induced obese (DIO) rats reduces food intake and body weight in a fat-specific manner (15).
• Administration of the synthetic amylin analog, pramlintide, to human subjects likewise reduced food intake and body weight (16, 17).
• exemplary methods described herein include (i) treating obesity in estrogen-deficient mammals; (ii) treating overweight in estrogen-deficient mammals; (iii) reducing weight in estrogen- deficient mammals; (iv) reducing body fat in estrogen-deficient mammals; (v) reducing body fat while maintaining lean muscle mass in estrogen-deficient mammals; (vi) increasing satiety in estrogen-deficient mammals; (vii) reducing appetite in estrogen-deficient mammals; (viii) delaying gastric emptying in estrogen-deficient mammals; (ix) reducing gastric motility in estrogen-deficient mammals; (x) reducing ovariectomized weight gain and/or body fat in female mammals; (xi) treating ovariectomized obesity or overweight in female mammals; (xii) reducing menopausal weight gain and/
• the methods described herein may further comprise improving glycemic control in the estrogen-deficient mammals by administering to the estrogen-deficient mammals therapeutically effective amounts of amylin agonist compounds or pharmaceutical compositions comprising amylin agonist compounds. Improving glycemic control includes lowering blood glucose levels, reducing hemoglobin AIc (HbAIc) levels, and the like.
• the estrogen- deficient mammals have diabetes, such as type 2 diabetes, and are overweight or obese.
• the estrogen-deficient mammals may be further administered an effective amount of leptin or a leptin analog.
• leptin or leptin analog such as metreleptin
• the leptin or leptin analog can be administered in the same pharmaceutical composition as the amylin agonist compound or can be administered in a separate pharmaceutical composition.
• the estrogen-deficient mammals may be further administered an effective amount of a GLP-I receptor agonist or analog thereof (e.g., GLP-l(7-37) or an analog thereof; exendin-4 or an analog thereof); PYY or an analog thereof; GIP or an analog thereof.
• GLP-I receptor agonist or analog thereof e.g., GLP-l(7-37) or an analog thereof; exendin-4 or an analog thereof
• PYY or an analog thereof e.g., PYY or an analog thereof
• GIP GIP or an analog thereof.
• Bdnf brain-derived neurotrophic factor
• the patient can be a mammal, such as a human.
• the human may be male or female.
• the patient need not have an estrogen-deficiency for this method.
• the patient in need of increased levels of brain-derived neurotrophic factor may have WAGR syndrome.
• amylin agonist compounds may be any known in the art or described herein, such as 25 ' 28 ' 29 Pro-human-amylin (SEQ ID NO:20) or a pharmaceutically acceptable salt thereof, KCNTATCVLGRLSQELHRLQTYPRTNTGSNTY (SEQ ID NO: 137) or a pharmaceutically acceptable salt thereof, and the like.
• the amylin agonist compounds may be in the form of a pharmaceutically acceptable salt and/or may be amidated.
• Figures 1A-1C show the effects on body weight in three groups of diet-induced obese (DIO) female rats treated with rat amylin (SEQ ID NO: 15).
• Ovariectomized (OVX) female rats treated with amylin (Figure IB) exhibited a sustained weight loss that was about twice as great as that of intact female rats treated with amylin ( Figure IA) and that of OVX female rats treated with amylin and estrogen (Figure 1C).
• Figures 2A-2C show the effects on food intake in three groups of DIO female rats treated with rat amylin (SEQ ID NO: 15).
• OVX female rats treated with amylin Figure 2B
• Figure 2C exhibited a sustained reduction in food intake that was about twice as great as that of intact female rats treated with amylin ( Figure 2A) and that of OVX female rats treated with amylin and 17- ⁇ estradiol (Figure 2C).
• Figures 3A- 3C shows the change in adiposity ( Figures 3A and 3B) and change in percent lean mass (Figure 3C) of DIO female rats treated with vehicle or with rat amylin (SEQ ID NO: 15).
• Figure 3A depicts vehicle-corrected change in adiposity.
• OVX female rats treated with amylin exhibited a vehicle-corrected change in adiposity that was about 40% greater than that of intact female rats treated with amylin (Sham) and that of OVX female rats treated with amylin and estrogen (0VX+E).
• Figure 3B depicts non-vehicle corrected change in adiposity dataset that is depicted in Figure 3A.
• Figures 4A-4C show the effects of three additional, exemplary amylin agonists on body weight in SHAM-operated and OVX female rats.
• Figure 4 A depicts effects when the indicated animals are treated with a 50 ⁇ g/kg/day infusion of SEQ ID NO: 20.
• Figure 4B depicts effects when the indicated animals are treated with a 2 ⁇ g/kg/day infusion of SEQ ID NO: 137.
• Figure 4C depicts effects when the indicated animals are treated with a 5 ⁇ g/kg/day infusion of SEQ ID NO: 142. *p ⁇ 0.05 vs. vehicle control.
• Figures 5A-5F depict exaggerated amylin-induced changes in metabolism in estrogen- deficient DIO rats.
• Rate of oxygen consumption Figures 5 A and 5B
• substrate utilization Figures 5C and 5D
• locomotor activity in the X-axis Figures 5E and 5F
• Figures 5A, 5C, and 5E are presented in either longitudinal form over ⁇ 48 hrs ( Figures 5A, 5C, and 5E) or represented as means during light and dark phases ( Figures 5B, 5D, and 5F) for DIO sham-operated (SHAM) controls or ovariectomized (OVX) rats continuously infused with either vehicle or rat amylin (50 ⁇ g/kg/d).
• SHAM DIO sham-operated
• OVX ovariectomized rats continuously infused with either vehicle or rat amylin (50 ⁇ g/kg/d).
• VO 2 rate of oxygen consumption, a marker of metabolic rate
• RQ respiratory quotient. Shaded grey areas indicate periods of darkness. To improve clarity of the graphs error bars were removed from data presented in longitudinal form. *p ⁇ 0.05 vs. SHAM - vehicle; #p ⁇ 0.05 vs. SHAM - amylin; ⁇ p ⁇ 0.05 vs. OVX - vehicle.
• Figure6A-6F indicates that reduced food consumption does not explain all of amylin' s effects on body weight in OVX rats.
• Rate of oxygen consumption Figures 6 A and ⁇ B
• substrate utilization Figures 6C and 6D
• locomotor activity in the X-axis Figures 6E and 6F
• Figures 6A, 6C, and 6E are presented in either longitudinal form over -120 hrs ( Figures 6A, 6C, and 6E) or represented as overall means ( Figures 6B, 6D, and 6F) for DIO OVX rats continuously infused with either vehicle or rat amylin (50 ⁇ g/kg/d), or vehicle but restricted to the mean food intake of amylin- treated animals (yoked-fed).
• VO 2 rate of oxygen consumption, a marker of metabolic rate
• RER respiratory quotient. Shaded grey areas indicate periods of darkness. To improve clarity of the graphs error bars were removed from data presented in longitudinal form. *p ⁇ 0.05 vs. OVX - vehicle; ⁇ p ⁇ 0.05 vs. OVX - amylin.
• Figures 7A-7J BrdU staining in the area postrema ( Figures 7A, 7C, 7E, and 7G; 1OX magnification) or the nucleus of the solitary tract ( Figures 7B, 7D, 7F, and 7H; 2OX magnification) of OVX ( Figures 7A, 7C, 7B, and 7D) and SHAM ( Figures 7E, 7G, 7F, and 7H) animals continuously infused with either vehicle or rat amylin (50 ⁇ g/kg/d). Average cell counts in the AP ( Figure 71) or NTS ( Figure 7J). *p ⁇ 0.05 vs.SHAM vehicle; ⁇ p ⁇ 0.05 vs. SHAM amylin, SHAM vehicle and OVX vehicle. Counts of the NTS are unilateral.
• Figures 8A-8C depict BrdU staining results in the hippocampus.
• Figure 8A depicts BrdU staining with DAB in the hippocampus of an OVX/amylin-treated animal (1OX magnification).
• Figure 8B depicts average cell counts of the hippocampus with DAB staining of OVX and SHAM animals continuously infused with either vehicle or rat amylin (50 ⁇ g/kg/d); *p ⁇ 0.05 vs. OVX vehicle. All cell counts of the hippocampus are unilateral.
• Figure 8C depicts BrdU/NeuN staining in the hippocampus of an OVX/amylin-treated animal (2OX magnification); BrdU label is green, NeuN label is red, colocalized cells appear yellow.
• Figures 9A-9H depict enhancement of amylin-mediated body weight loss in estrogen- deficient ZDF rats.
• Percent vehicle-corrected Figures 9A and 9B
• overall change in body weight Figures 9C and 9D
• cumulative food intake Figures 9E and 9F
• change in body composition parameters Figures 9G and 9H
• of obese, diabetic sham-operated (SHAM) or ovariectomized (OVX) ZDF rats Figures 9A, 9C, 9E, and 9G
• intact lean ZDF controls Figures 9B, 9D, 9F, and 9H
• *p ⁇ 0.05 vs. SHAM - vehicle or vs. vehicle controls for lean rats
• #p ⁇ 0.05 vs. SHAM - amylin ⁇ p ⁇ 0.05 vs. OVX - vehicle.
• Estrogen deficiency refers to a mammal having less estrogen circulating in her blood than a typical healthy female of the same species at reproductive age. Estrogen deficiency may be caused by menopause, perimenopause, post-menopause, ovarian dysfunction, an ovariectomy, a hysterectomy, and the like. Estrogen deficiency may generally be diagnosed in a female human when estradiol levels are about 30 or below and follicle stimulating hormone (FSH) levels are about 30 or above. All post-menopausal female mammals are considered to have an estrogen deficiency. Perimenopausal female mammals may also have an estrogen deficiency caused by the fluctuation in estrogen levels and the cessation of ovarian function.
• FSH follicle stimulating hormone
• estrogen includes, for example, estradiols, estrones, estriols, and combinations of two or more thereof.
• Hormone replacement therapy refers to the administration of hormones to estrogen- deficient mammals, such as menopausal or postmenopausal females.
• the hormones may include estrogen (including analogs and derivatives thereof), progesterone (including analogs and derivatives thereof), testosterone (including analogs and derivatives thereof), and combinations of two or more thereof.
• Hormone replacement therapy includes monotherapy and combination therapy. A mammal being administered a therapeutically effective amount of hormone replacement therapy would not be estrogen deficient.
• “Obesity” and “overweight” refer to mammals having a weight that is greater than what they should have, and may be determined by, e.g., physical appearance, body mass index (BMI), waist-to-hip circumference ratios, skinfold thickness, and waist circumference.
• BMI body mass index
• the Centers for Disease Control and Prevention define overweight as an adult human having a BMI of 25 to 29.9; and define obese as an adult human having a BMI of 30 or higher.
• BMI is a calculation based on a person's sex, weight, and height.
• the Centers for Disease Control and Prevention state that a person with a waist-to-hip ratio greater than 1.0 is overweight.
• Lean body mass refers to the fat- free mass of the body, i.e., total body weight minus body fat weight is lean body mass. Lean body mass can be measured by methods such as hydrostatic weighing, computerized chambers, dual-energy X-ray absorptiometry, skin calipers, magnetic resonance imaging (MRI) and bioelectric impedance analysis (BIA).
• MRI magnetic resonance imaging
• BIOA bioelectric impedance analysis
• body fat or “whole body fat” is meant deposited lipid or lipids as it may occur or be found throughout the body.
• fat distribution means the location of fat deposits in the body. Such locations of fat deposition include, for example, subcutaneous, visceral and ectopic fat depots.
• subcutaneous fat is meant the deposit of lipids just below the skin's surface.
• the amount of subcutaneous fat in an estrogen-deficient mammal can be measured using any method available for the measurement of subcutaneous fat. Methods of measuring subcutaneous fat are known in the art, for example, those described in U.S. Patent No. 6,530,886, the entirety of which is incorporated herein by reference.
• visceral fat is meant the deposit of fat as intra-abdominal adipose tissue. Visceral fat surrounds vital organs and can be metabolized by the liver to produce blood cholesterol. Visceral fat has been associated with increased risks of conditions such as polycystic ovary syndrome, metabolic syndrome and cardiovascular diseases.
• ectopic fat storage is meant lipid deposits within and around tissues and organs that constitute the lean body mass (e.g., skeletal muscle, heart, liver, pancreas, kidneys, blood vessels). Generally, ectopic fat storage is an accumulation of lipids outside classical adipose tissue depots in the body.
• “Mammal” refers to warm-blooded animals that generally have fur or hair, that give live birth to their progeny, and that feed their progeny with milk. Mammals include female humans; companion animals (e.g., dogs, cats); farm animals (e.g., cows, horses, sheep, pigs, goats); wild animals; and the like. In one embodiment, the mammal is a female. In one embodiment, the mammal is a female human. In one embodiment, the mammal is a cat or dog. In one embodiment, the mammal is a diabetic mammal, e.g., a female human having type 2 diabetes.
• the mammal is an obese diabetic mammal, e.g., an obese female human having type 2 diabetes.
• Reduced nutrient availability is meant to include any means by which the body reduces the nutrients available to the body to store as fat.
• reducing nutrient availability may be by means that include, but are not limited to, reducing appetite, increasing satiety, affecting food choice/taste aversion, increasing metabolism, and/or decreasing or inhibiting food absorption.
• Exemplary mechanisms that may be affected include delayed gastric emptying or decreased absorption of food in the intestines.
• Increased nutrient availability is meant to include any means by which the body increases the nutrients available to the body to store as fat.
• increasing nutrient availability may be by means that include, but are not limited to, increasing appetite, decreasing satiety, affecting food choice, decreasing taste aversion, decreasing metabolism, and/or increasing food absorption.
• Exemplary mechanisms that may be affected include decreasing gastric hypomotility or increasing absorption of food in the intestines.
• Amylin agonist compounds include native amylin peptides, amylin analog peptides, and other compounds (e.g., small molecules) that have amylin agonist activity.
• the "amylin agonist compounds” can be derived from natural sources, can be synthetic, or can be derived from recombinant DNA techniques.
• Amylin agonist compounds have amylin agonist receptor binding activity and may comprise amino acids (e.g., natural, unnatural, or a combination thereof), peptide mimetics, chemical moieties, and the like. The skilled artisan will recognize amylin agonist compounds using amylin receptor binding assays or by measuring amylin agonist activity in soleus muscle assays.
• amylin agonist compounds will have an IC50 of about 200 or less, about 100 or less, or about 50 or less, in an amylin receptor binding assay, such as that described herein, in US Patent No. 5,686,411, and US Publication No. 2008/0176804, the disclosures of which are incorporated by reference herein.
• amylin agonist compounds will have an EC50 of about 20 or less, about 15 or less, about 10 or less, or about 5 or less in a soleus muscle assay, such as that described herein and in US Patent No. 5,686,411, the disclosure of which is incorporated by reference herein.
• the amylin agonist compound has at least 90% or 100% sequence identity to
• the amylin agonist compound is a peptide chimera of amylin (e.g., human amylin (SEQ ID NO:1), rat amylin (SEQ ID NO:15), and the like) and calcitonin (e.g., human calcitonin (SEQ ID NO: 140), salmon calcitonin (SEQ ID NO: 141), and the like).
• the amylin agonist compound has at least 90% or 100% sequence identity to SEQ ID NO: 137. Suitable and exemplary amylin agonist compounds are also described in US Publication No. 2008/0274952, the disclosure of which is incorporated by reference herein in its entirety.
• an analog refers to a compound that has properties that are as good as or better than the parent compound.
• the analog may have superior stability, solubility, efficacy, half-life, and the like.
• an analog is a compound that has at least 75% sequence identity to the parent compound, at least 80% sequence identity, at least 85% sequence identity, at least 90% sequence identity, or at least 95% sequence identity to the parent compound.
• a leptin analog may have at least 75% sequence identity to human leptin
• an exendin analog may have at least 75% sequence identity to exendin-4
• a GLP-l(7-37) analog may have at least 75% sequence identity to GLP-l(7-37), and the like.
• 18 Arg 25 ' 28 Pro-h-amylin refers to a peptide based on the amino acid sequence of human amylin (i.e., h-amylin) and which has the following substitutions: Arg replaces His at position 18 in h-amylin; Pro replaces Ala at position 25 in h- amylin; and Pro replaces Ser at position 28 in h-amylin.
• des ⁇ Lys-h-amylin refers to a peptide based on the amino acid sequence of human amylin (i.e., h-amylin) except that the Lys at position 1 (i.e., 1 LyS) in h-amylin is deleted (i.e., des-) from the amino acid sequence.
• amylin agonist peptide is a compound of Formula (I) or a pharmaceutically acceptable salt thereof:
• At least one of Xaa 2 s, Xaa 28 , and Xaa 2 g is proline. In one embodiment for the compounds of Formula (I), at least two of Xaa 2 s, Xaa 2 g, and Xaa 2 g are proline.
• Exemplary compounds of Formula (I) include human amylin (SEQ ID NO: 1); (IeS- 1 LyS- h-amylin (SEQ ID NO: 2); 17 Ile 18 Arg 23 Leu-h-amylin (SEQ ID NO: 3);
• exemplary compounds of Formula (I) include monkey amylin (SEQ ID NO: 12); cat amylin (SEQ ID NO: 13); dog amylin (SEQ ID NO: 14); rat amylin (SEQ ID NO: 15); mouse amylin (SEQ ID NO: 16); hamster amylin SEQ ID NO: 17); guinea pig amylin (SEQ ID NO: 18); degu amylin (SEQ ID NO: 19); and pharmaceutically acceptable salts of any of these compounds.
• amylin agonist peptide is a compound of Formula (II) or a pharmaceutically acceptable salt thereof:
• Xaai is Lys, Ala, Ser, or hydrogen (preferably Lys or hydrogen);
• Xaa 2 is Ser, Asp, GIu, Lys, ornithine (Orn), or Cys, wherein the amino acid is optionally linked to the amino acid at Xaa 7 to form an intramolecular linkage (e.g., Cys forming a disulfide bond with the Cys at Xaa 7 ; Ser forming a bond with Ser at Xaa 7 ; Asp or Lys forming a bond with Lys or Asp, respectively, at Xaa 7 );
• Xaa 7 is Ser, Asp, GIu, Lys, Orn, or Cys, wherein the amino acid is optionally linked to the amino acid at Xaa 2 to form an intramolecular linkage (e.g., Cys forming a disulfide bond with the Cys at Xaa 2 ; Ser forming a bond with Ser at Xaa 2
• Xaa 2 and Xaa 7 may form an intramolecular linkage such as disulfide bond; amide bond; alkyl acids and alkyl amines which may form cyclic lactams; alkyl aldehydes or alkyl halides and alkylamines which may condensed and be reduced to form an alkyl amine or imine bridge; or side chains which may be connected to form an alkyl, alkenyl, alkynyl, ether or thioether bond.
• Alkyl chains may include lower alkyl groups having from about 1 to about 6 carbon atoms.
• the intramolecular linkage may be a disulfide, amide, imine, amine, alkyl and alkene bond.
• Xaa 2 and Xaa 7 are independently selected from Ser, Asp, GIu, Lys, Orn, or Cys.
• Xaa 2 and Xaa 7 are Cys and Cys.
• Xaa 2 and Xaa 7 are Ser and Ser.
• Xaa 2 and Xaa 7 are Asp and Lys or Lys and Asp.
• the amino acid residues at Xaa 2 and Xaa 7 do not form an intramolecular linkage.
• the amylin agonist compound of Formula (II) is 25 ' 28 ' 29 Pro-h-amylin having the formula: KCNTATCATQRLANFLVHSSNNFGPILPPTNVGSNTY-NH 2 (SEQ ID NO:20), where 2 CyS and 7 CyS form a disulfide bond; or a pharmaceutically acceptable salt thereof.
• the compound is an acetate salt of 25 ' 28 ' 29 Pro-h-amylin.
• exemplary compounds of Formula (II) include: des- Lys- ' ' Pro-h-amylin (SEQ ID NO: 21); 18 Arg 25 ' 28 ' 29 Pro-h-amylin (SEQ ID NO: 22); des- 1 LyS- 18 Arg 25 ' 28 ' 29 Pro-h-amylin (SEQ ID NO: 23); 25 Pro 26 Val 28 ' 29 Pro-h-amylin (SEQ ID NO: 24); 17 Ile 25 ' 28 ' 29 Pro-h-amylin (SEQ ID NO: 25); 23 Leu 25 Pro 26 Val 28 ' 29 Pro-h-amylin (SEQ ID NO: 26); 18 Arg 23 Leu 25 ' 28 ' 29 Pro-h-amylin (SEQ ID NO: 27); 17 Ile 23 Leu 25 ' 28 ' 29 Pro-h-amylin (SEQ ID NO: 28); des- 1 Lys- 17 Ile 23 Leu 25 ' 28 ' 29 Pro-h-amy
• amylin agonist peptide is a compound of Formula (III) or a pharmaceutically acceptable salt thereof:
• Xaai is Lys, Ala, Ser, or hydrogen (preferably Lys or hydrogen);
• Xaa 2 is Ser, Asp,
• Xaa 7 is Ser, Asp, GIu, Lys, Orn, or Cys, wherein the amino acid is optionally linked to the amino acid at Xaa 7 to form an intramolecular linkage (e.g., Cys forming a disulfide bond with Cys at Xaa 7 ; Ser forming a bond with Ser at Xaa 7 ; Asp or Lys forming a bond with Lys or Asp, respectively, at Xaa 7 );
• Xaa 7 is Ser, Asp, GIu, Lys, Orn, or Cys, wherein the amino acid is optionally linked to the amino acid at Xaa 2 to form an intramolecular linkage (e.g., Cys forming a disulfide bond with Cys at Xaa 2 ; Ser forming a bond with Ser at Xaa 2 ; Asp or Lys forming a bond with Lys or Asp, respectively, at Xaa 2 );
• Xaa 3 i is Asn, Asp, or GIn (preferably Asn or Asp); and Z is OH or NH 2 (preferably NH 2 ).
• Xaa 2 and Xaa 7 may form an intramolecular linkage such as disulfide bond; amide bond; alkyl acids and alkyl amines which may form cyclic lactams; alkyl aldehydes or alkyl halides and alkylamines which may condensed and be reduced to form an alkyl amine or imine bridge; or side chains which may be connected to form an alkyl, alkenyl, alkynyl, ether or thioether bond.
• Alkyl chains may include lower alkyl groups having from about 1 to about 6 carbon atoms.
• the intramolecular linkage may be a disulfide, amide, imine, amine, alkyl and alkene bond.
• Xaa 2 and Xaa 7 are independently selected from Ser, Asp, GIu, Lys, Ornithine, or Cys.
• Xaa 2 and Xaa 7 are Cys and Cys.
• Xaa 2 and Xaa 7 are Ser and Ser.
• Xaa 2 and Xaa 7 are Asp and Lys or Lys and Asp.
• the amino acid residues at Xaa 2 and Xaa 7 do not form an intramolecular linkage.
• Exemplary compounds of Formula (III) include: 18 Arg 25 ' 28 Pro-h-amylin (SEQ ID NO: 32); des ⁇ Lys- ⁇ Arg ⁇ ' ⁇ Pro-h-amylin (SEQ ID NO: 33); 18 Arg 23 Leu 25 ' 28 Pro-h-amylin (SEQ ID NO: 34); 23 Leu 25 Pro 26 Val 28 Pro-h-amylin (SEQ ID NO: 35); des- 1 Lys- 23 Leu 25 Pro 26 Val 28 Pro-h- amylin (SEQ ID NO: 36); 18 Arg 23 Leu 25 Pro 26 Val 28 Pro-h-amylin (SEQ ID NO: 37); 25 ' 28 Pro-h- amylin (SEQ ID NO: 38); and pharmaceutically acceptable salts of these peptides.
• amylin agonist peptide is a compound of Formula (IV) or a pharmaceutically acceptable salt thereof:
• Xaai is Lys, Ala, Ser, or hydrogen (preferably Lys or hydrogen);
• Xaa 2 is Ser, Asp, GIu, Lys, Orn, or Cys, wherein the amino acid is optionally linked to the amino acid at Xaa 7 to form an intramolecular linkage (e.g., Cys forming a disulfide bond with Cys at Xaa 7 ; Ser forming a bond with Ser at Xaa 7 ; Asp or Lys forming a bond with Lys or Asp, respectively, at Xaa 7 );
• Xaa 7 is Ser, Asp, GIu, Lys, Orn, or Cys, wherein the amino acid is optionally linked to the amino acid at Xaa 2 to form an intramolecular linkage (e.g., Cys forming a disulfide bond with Cys at Xaa 2 ; Ser forming a bond with Ser at Xaa 2 ; Asp or
• Xaa 2 and Xaa 7 may form an intramolecular linkage such as disulfide bond; amide bond; alkyl acids and alkyl amines which may form cyclic lactams; alkyl aldehydes or alkyl halides and alkylamines which may condensed and be reduced to form an alkyl amine or imine bridge; or side chains which may be connected to form an alkyl, alkenyl, alkynyl, ether or thioether bond.
• Alkyl chains may include lower alkyl groups having from about 1 to about 6 carbon atoms.
• the intramolecular linkage may be a disulfide, amide, imine, amine, alkyl and alkene bond.
• Xaa 2 and Xaa 7 are independently selected from Ser, Asp, GIu, Lys, Orn, or Cys.
• Xaa 2 and Xaa 7 are Cys and Cys.
• Xaa 2 and Xaa 7 are Ser and Ser.
• Xaa 2 and Xaa 7 are Asp and Lys or Lys and Asp.
• the amino acid residues at Xaa 2 and Xaa 7 do not form an intramolecular linkage.
• Exemplary compounds of Formula (IV) include Thr Arg His Leu ' Pro Asp-h- amylin (SEQ ID NO: 39), 28 ' 29 Pro-h-amylin (SEQ ID NO:138 ), and pharmaceutically acceptable salts thereof.
• SEQ ID NO: 39 Thr Arg His Leu ' Pro Asp-h- amylin
• SEQ ID NO:138 28 ' 29 Pro-h-amylin
• amylin agonist peptide is a compound of Formula (V) or a pharmaceutically acceptable salt thereof:
• Xaai is Lys, Ala, Ser, or hydrogen (preferably Lys or hydrogen);
• Xaa 2 is Ser, Asp, GIu, Lys, Orn, or Cys, wherein the amino acid is optionally linked to the amino acid at Xaa 7 to form an intramolecular linkage (e.g., Cys forming a disulfide bond with Cys at Xaa 7 ; Ser forming a bond with Ser at Xaa 7 ; Asp or Lys forming a bond with Lys or Asp, respectively, at Xaa 7 );
• Xaa 7 is Ser, Asp, GIu, Lys, Orn, or Cys, wherein the amino acid is optionally linked to the amino acid at Xaa 2 to form an intramolecular linkage (e.g., Cys forming a disulfide bond with Cys at Xaa 2 ; Ser forming a bond with Ser at Xaa 2 ; Asp or
• Xaa 2 and Xaa 7 may form an intramolecular linkage such as disulfide bond; amide bond; alkyl acids and alkyl amines which may form cyclic lactams; alkyl aldehydes or alkyl halides and alkylamines which may condensed and be reduced to form an alkyl amine or imine bridge; or side chains which may be connected to form an alkyl, alkenyl, alkynyl, ether or thioether bond.
• Alkyl chains may include lower alkyl groups having from about 1 to about 6 carbon atoms.
• the intramolecular linkage may be a disulfide, amide, imine, amine, alkyl and alkene bond.
• Xaa 2 and Xaa 7 are independently selected from Ser, Asp, GIu, Lys, Orn, or Cys.
• Xaa 2 and Xaa 7 are Cys and Cys.
• Xaa 2 and Xaa 7 are Ser and Ser.
• Xaa 2 and Xaa 7 are Asp and Lys or Lys and Asp.
• the amino acid residues at Xaa 2 and Xaa 7 do not form an intramolecular linkage.
• amylin agonist compound of Formula (V) is 25 ' 29 Pro-h-amylin (SEQ ID NO: 139) or a pharmaceutically acceptable salt thereof.
• amylin agonist peptide is a compound of Formula (VI) or a pharmaceutically acceptable salt thereof:
• Exemplary compounds of Formula (VI) are SEQ ID NOs:40-137.
• the compound of Formula (VII) is: KCNTATCVLGRLSQELHRLQTYPATNTGSNTY (SEQ ID NO: 137), which may optionally be amidated, or a pharmaceutically acceptable salt thereof.
• the amylin agonist peptide has at least 87% sequence identity to the amino acid sequence of SEQ ID NO: 137.
• Such amylin agonist peptides include SEQ ID NOs: 51, 52, 76, 88, and 117.
• the amylin agonist peptide has at least 90% sequence identity to the amino acid sequence of SEQ ID NO: 137.
• Such amylin agonist peptides include SEQ ID NOs: 44, 45, 49, 58, 66, 71, 75, 86, 108, 110, 113, 115, 116, 120, 122, 123, 124, 131, or 132.
• the amylin agonist peptide has at least 93% sequence identity to the amino acid sequence of SEQ ID NO: 137.
• Such amylin agonist peptides include SEQ ID NOs: 55, 67, 70, 73, 82, 83, 84, 89, 94, 100, 103, 106, 107, 111, 112, 125, and 133.
• the amylin agonist peptide has at least 96% sequence identity to the amino acid sequence of SEQ ID NO:137.
• amylin agonist peptides include SEQ ID NOs: 40, 42, 43, 46, 47, 48, 54, 64, 65, 68, 69, 74, 78, 79, 80, 81, 85, 90, 91, 92, 93, 95, 96, 97, 98, 99, 101, 102, 109, 118, 119, 121, 130, and 137.
• the amylin agonist peptide may be any one of SEQ ID NOs: 40-137 or a pharmaceutically acceptable salt thereof; or an amylin agonist peptide having at least 87%, 90%, 93%, or 96% sequence identity to the amino acid sequence of any one of SEQ ID NOs: 40- 137 or a pharmaceutically acceptable salt thereof.
• the amylin agonist peptide may optionally be amidated.
• amylin agonist peptides of SEQ ID NOs:40-137 are:
• SEQ ID NO:50 isocaproyl-STAVLGRLSQELHRLQTYPRTNTGSNTY
• SEQ ID NO:60 Isocaproyl-STAVLG[K(For)]LSQELH[K(For)]LQTYPRTNTGSGTP
• SEQ ID NO:61 Isocaproyl-STAVL(Aib)[K(For)]LSQEL(Aib)[K(For)]LQTYPRTNTGSNTY
• SEQ ID NO:62 Isocaproyl-STAVL(Aib)[K(For)]LSQEL(Aib)[K(For)]LQTYPRTNVGSNTY
• Ac is acetyl; Agy is (S)-2- Amino-2-methyl-pent-4-enoic acid; Aib is alpha-methylalanine; 4Abu is 4-aminobutyric acid; dAh is (R)-2-amino-3-hydroxy-3 -methyl-butyric acid; Ahp is (S)-2-amino-3-hydroxy-4-methyl- pentanoic acid; Ahb is (S)-2-amino-3-hydroxy-3 -methyl-butyric acid; Hse is homoserine; Cit is citrulline; Orn is ornithine; 9Anc is H 2 N(CH 2 ) S CONH 2 ; and PEG5000 is polyethylene glycol having a molecular weight of about 5,000.
• the amylin agonist compounds useful in the methods described herein comprise at least a loop region, an ⁇ helix region, and a C-terminal tail.
• the loop region comprises an amino sequence comprising the formula X-(Xaai sequence)-Y, where X and Y are capable of forming a bond and are independently selected residues having side chains which are chemically bonded to each other to form an intramolecular linkage such as disulfide bonds; amide bond; alkyl acids and alkyl amines which may form cyclic lactams; alkyl aldehydes or alkyl halides and alkylamines which may condensed and be reduced to form an alkyl amine or imine bridge; or side chains which may be connected to form an alkyl, alkenyl, alkynyl, ether or thioether bond.
• Alkyl chains may include lower alkyl groups having from about 1 to about 6 carbon atoms.
• the intramolecular linkage may be a disulfide, amide, imine, amine, alkyl and alkene bond.
• X and Y are independently selected from Ser, Asp, GIu, Lys, Orn, or Cys.
• X and Y are Cys and Cys.
• X and Y are Ser and Ser.
• X and Y are Asp and Lys or Lys and Asp.
• the Xaai sequence comprises an amino acid sequence of 3, 4, 5, or 6 amino acids between X and Y.
• the Xaai sequence comprises an amino acid sequence having a region with one or more substituted or unsubstituted hydroxyl-containing residues next to Y.
• the hydroxyl containing residue region may have at least 2 of the 3 amino acids adjacent Y that are either Ser or Thr.
• the other amino acids in the Xaai sequence may be any amino acid.
• the Xaai sequence is 3 amino acids.
• the Xaai sequence is 4 amino acids.
• the Xaai sequence is 5 amino acids.
• the Xaai sequence is 6 amino acids. Accordingly, Xaai can be represented by Xaa 2 Xaa 3 Xaa 4 Xaa 5 Xaa 6 Xaa 7 . In certain embodiments, Xaa 2 , Xaa 3 , and/or Xaa 4 may absent. In certain embodiments, Xaa 5 , Xaa 6 , and Xaa 7 comprise the hydroxy-containing residue region. As such, at least two of the three amino acids can be a Ser, hSer, Thr, alloThr, d-Thr, or other unnatural analogs thereof.
• Xaa 2 can be any amino acid or absent
• Xaa 3 can be any amino acid or absent
• Xaa 4 can be any amino acid or absent
• Xaas can be any amino acid if Xaa 6 is a Ser or Thr and Xaa 7 is a Ser or Thr
• Xaa 6 can be any amino acid if Xaa 5 is a Ser or Thr and Xaa 7 is a Ser or Thr
• Xaa 7 can be any amino acid if Xaa 5 is Ser or Thr and Xaa 6 is Ser or Thr.
• Xaai can be represented as Xaa 2 absent, Xaa 3 is Ala, GIy, Ser, Asp or absent, Xaa 4 is Asn, Ala, Asp, GIy or absent; Xaas is Ala, Leu, Thr, or Ser; Xaa 6 is Ala, Ser, or Thr; and Xaa 7 is Ala, Ser, VaI, Hse, (S)-2-amio-3-hydroxy- methylbutanoic acid (Ahb), (2S,3R)-2-amino-3hydroxy-methylpentanoic acid (Ahp), D-Thr, Thr, or a derivative thereof.
• Xaai can be represented as Xaa 2 is absent, Xaa 3 is Ser, GIy, or absent, Xaa 4 is Asn or Asp, Xaas is Ala, Ser, Thr or Leu, Xaa 6 is Ala, Thr or Ser, and Xaa 7 is Ser, D-Thr, alloThr or Thr.
• the loop region comprises the above-described representations of Xaai wherein Xaa 3 is Ala, wherein Xaa 3 is Ser or wherein Xaa 3 is GIy.
• the loop region comprises the above described representations of Xaai wherein Xaa 4 is Ala, wherein Xaa 4 is Asn, wherein Xaa 4 is Asp, or wherein Xaa 4 is GIy.
• the loop region comprises the above- described representations of Xaai wherein Xaas is Ala, wherein Xaas is Thr, or wherein Xaas is Leu.
• the loop region comprises the above described representations of Xaai wherein Xaa 6 is Ser or wherein Xaa 6 is Ala.
• the loop region comprises the above-described representations of Xaai wherein Xaa 7 is Thr or wherein Xaa 7 is D-Thr. It is further contemplated that no more than one, two, or three modifications such as substitutions, insertions, deletions, and/or derivatizations may be made to the loop region.
• loop region examples include, but are not limited to, C-N-T-A-T-C; C-A-T- A-T- C; C-D-T-A-T-C; C-G-T-A-T-C; C-N-A-A-T-C; C-N-T-S-T-C; C-N-T-A-dThr-C; C-N-T-A- T(OPO 3 H 2 )-C; C-N-T-A-S-C; C-N-T-A-A-C; C-N-T-A-V-C; C-N-T-A-Hse-C; C-N-T-A-Ahb- C; C-N-T-A-Ahp-C; C-S-N-L-S-T-C; C-G-N-L-S-T-C; C-A-N-L-S-T-C; C-S-A-L-S-T-C; C-S-
• the loop region may further comprise modifications or additional amino acids at the N- terminal end.
• modifications include the addition of compounds such as Lys, Ala, Phe, He, Ser, Octylglycine, Isocap, Fmoc-3,6-dioxyoctanoic acid, Fmoc-l-amino-4,7,10-trioxa-13- tridecanamine succinimic acid, acetyl, and/or groups for solubility, delivery, signaling.
• Exemplary modified loops include the addition of Lys the sequence of Xaai or the addition of He to the sequence of Xaai.
• the modified loop region may be K-C-N-T-A-T-C.
• the additions and/or modifications at the N-terminal end of the loop region may change the loop region.
• the loop region may be modified as follows: cyclo(2,7) 1-7 bAmylin, cyclo(Asp 2 Lys 7 ) 1-7 hAmylin, N-isocaproyl 1-7 hAmylin, N-3,6 dioxaoctanoyl 1-7 hAmylin, L-Octylglycine 1-7 hAmylin, Acetyl (Agy 2 ,Agy 7 ) 1-7 hAmylin wherein Agy is Allylglycine, Acetyl (Ala 1 ) 1-7 hAmylin, (Thr 1 , Asp 3 ) 1-7 hAmylin, Isocap (Ala 7 ) 5-7 sCT, Acetyl (Agy 2 ,Agy 7 ) 1-7 sCT, and cyclo
• certain embodiments comprise a modification at the N- terminal region of the loop region such that amino acids Xaa 2 to Xaa 5 are absent.
• the amino acid sequences may be referred to as amino acids at position a to position b adjacent to a reference peptide.
• the reference peptides are human amylin (hAmylin) (SEQ ID NO:1); rat amylin (rAmylin) (SEQ ID NO: 15); salmon calcitonin (sCT) CSNLSTCVLGKLSQELHKLQTYPRTNTGSGTP (SEQ ID NO: 141); and human calcitonin (hCT) CGNLSTCMLGTYTQDFNKFHTFPQTAIGVGAP (SEQ ID NO: 140).
• 1-7 hAmylin refers to the amino acid sequence from position 1 to position 7, inclusive, of human amylin (SEQ ID NO:1). Modification to the reference peptide may be shown as: position of modification adjacent to the modification.
• (Asp 2 ,Lys 7 ) 1-7 hAmylin represents the amino acid sequence at positions 1 to 7 of human amylin with a modification of a Cys to Asp at position 2 and a modification of a Cys to Lys at position 7.
• the ⁇ helix region of the compound may be about 8 to 23 amino acids in length.
• the ⁇ helix region is amphiphatic.
• the ⁇ helix region comprises about 3 to 6 helical turns.
• the ⁇ helix region comprises 3, 4, 5, or 6 helical turns.
• the ⁇ helix region is a rigid structure equivalent to about 3, 4, 5, or 6 helical turns.
• An example of an idealized helix is LLQQLQKLLQKLKQY.
• the ⁇ helix is an ampliphatic structure. Accordingly, characteristics of desirable amino acids that would provide this type of structure may be selected.
• the calcitonin ⁇ helix region a combination of an amylin and a calcitonin ⁇ helix region, or parts thereof, and/or some CGRP elements are desirable in the ⁇ helix region of the peptides. It is contemplated that, as with the loop region, the ⁇ helix region can be from any amylin or calcitonin, and analogs thereof. Accordingly, in certain embodiments, the ⁇ helix region is at least a portion of an ⁇ helix region of calcitonin or calcitonin analog.
• the ⁇ helix region is at least a portion of an ⁇ helix region of calcitonin or calcitonin analog and at least a portion of an ⁇ helix of an amylin or amylin analog.
• the ⁇ helix region of the novel compounds contain elements of CGRP. It is further contemplated that novel compounds may have no more than one, two, three, four, or five further modifications such as substitutions, insertions, deletions, and/or derivatizations.
• the ⁇ helix region may comprise amino acids from position 8 of sCT to position 18, 19, 20, 21, 22, 23, 24, 25, 26, or 27 of sCT.
• the ⁇ helix region may comprise more than one portion of a calcitonin or calcitonin analog ⁇ helix region of the same or different species, for example 8-21 sCT 19-27 sCT; 8-21 sCT 18-27 sCT; or 8-16 hCT 17-27 sCT; or (Arg 11 ) 8-16 hCT (Arg 18 ) 17-27 sCT.
• the above described ⁇ helix of 8-18 sCT to 8-27 sCT may further comprise the substitutions of one or more of (Aib 10 ), (Arg 11 ), (Orn 11 ), (hArg 11 ), (Cit 11 ), (hLys 11 ), (Lys(for) ⁇ ), (Aib 17 ), (Arg 18 ), (Orn 18 ), (hArg 18 ), (Cit 18 ), (hLys 18 ), (Lys(for) 18 ), (Lys(PEG5000) 18 ), (Leu 22 ), (Pro 24 ) or any combination thereof.
• an ⁇ helix region can be represented by ( ⁇ helix region type I) Ri- VaI Leu Xaa 10 Xaa ⁇ Leu Ser GIn Xaais Leu XaaiXaaig Leu GIn Thr Xaa 22 Pro Xaa 24 Thr Asn Thr-Pvi, wherein Xaa i0 is GIy or Aib; Xaa ⁇ is Lys, Arg, Orn, hArg, Cit, hLys, or Lys(for); Xaa i5 is GIu or Phe; Xaa ⁇ is His or Aib; Xaaig is Lys, Arg, Orn, hArg, Cit, hLys,Lys(for), Lys(PEG 5000); Xaa 22 is Try or Leu; Xaa 24 is Arg or Pro; or Ri is absent or comprises 1-4 additional amino acids.
• Examples of an ⁇ helix region type I include 8-18 sCT, 8-21 sCT, 8-24 sCT, 8-27 sCT, (Arg 11 ) 8-18 sCT, (Arg 18 ) 8-18 sCT, (Arg 11 Arg 18 ) 8-18 sCT, (1 lOrn 18Orn) 8-18 sCT, (Arg 11 18Cit) 8-18 sCT, (l lhArg 18hArg) 8-18 sCT, (Arg 11 Orn 18 ) 8-18 sCT, (11 Cit Arg 18 ) 8-18 sCT, (l lCit 18Cit) 8-18 sCT, (l lhLys 18hLys) 8-18 sCT, (lOAib HArg 17Aib Arg 18 ) 8-18 sCT, (l lLys(for) 18Lys(for)) 8-18 sCT, (lOAib l lLys(for) 17Aib 18Lys(for))
• the ⁇ helix region may comprise a portion of an ⁇ helix region of amylin or amylin analog and a portion of an ⁇ helix region of calcitonin or calcitonin analog.
• the ⁇ helix region may comprise amino acids from position 8 of hAmylin to 11, 12, 13, 14, 15, 16, 17, 18 or 19 of hAmylin and amino acids from position 13, 14, 15, 16, 17, 18, and 19 of sCT to position 18, 19, 20, 21, 22, 23, 24, 25, 26, or 27 of sCT.
• the above described ⁇ helix region of amylin and calcitonin may further comprise the substitutions of one or more of (8VaI), (9Leu), (9Met), (10GIy), (lOHis), (12Thr), (13Thr), (13Asn), (13Phe), (13Tyr), (14Arg), (14AIa), (14Asp), (14GIu), (14GIn), (14Thr), (14GIy), (15Leu), (15Ser), (15GIu), (15AIa), (15Tyr), (16Asp), (17Ser), (17Phe), (17Arg), (17Aib), (Arg 18 ), (18Orn), (18hArg), (18Cit), (18hLys), (18Lys(for)), (18Lys(PEG5000)), (19Phe), (20His), (21Asn), (22Met), (22VaI), (22Phe), (22Leu), (24Pro), or any combination thereof.
• the number of amino acids in the ⁇ helix region is at least 10 amino acids. In other embodiments, the number of amino acids in the ⁇ helix region is 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, or 23. In other embodiments, the number of amino acids in the ⁇ helix region is 24 or more.
• an ⁇ helix region can be represented by ( ⁇ helix region type II) Ri - Xaag Xaag Xaaio R Xaai2 Xaai3 Xaai4 Xaais Xaai6 Xaa ⁇ Xaaig Xaaig Xaa 2 o Xaa 2 i Xaa 22 P Xaa 24 TNT -Ri wherein Xaag is Ala or VaI; Xaag is Thr, Met or Leu; Xaaio is GIn, GIy, His; Xaai 2 is Leu, or Thr; Xaa ⁇ is Ala, Thr, Asn, Phe, Tyr, Ser, or Thr; Xaai 4 is Asn, Arg, Ala, Asp, GIu, GIn, Thr, or GIy; Xaais is Phe, Leu, Ser, GI
• Examples of an ⁇ helix region of type II include, but is not limited to (8VaI 9Leu 1 OGIy) 11-15 hAmylin 16-27 sCT, (8VaI 9Leu 10GIy) 11-15 hAmylin (18Arg) 16-27 sCT, 8-12 hAmylin (18Arg) 13-27 sCT, 8-18 hAmylin 19-23 sCT, 8-18 HAmylin 19-27 sCT, (15GIu 18 Arg) 8-18 hAmylin 19-24 sCT, (14Arg 15 Ser) 8-18 hAmylin 19-22 sCT, (13AIa 14AIa 15AIa) 8-18 hAmylin 19-27 sCT, (13AIa 14Asp 15AIa) 8-18 hAmylin 19-22 sCT, (13AIa 14Asp) 8-18 hAmylin 19-23 sCT, (13AIa 14Asp) 8-18 hAmy
• novel compounds include variations of the above exemplary compounds with the ⁇ helix terminating at corresponding to 22, 23, 24, 25, 26 or 27 of sCT.
• compound 8-18 hAmylin 19-24 sCT is also specifically described as this compound is merely 8-18 hAmylin 19-27 sCT described above truncated to position 24.
• compound (13AIa 14Asp 15AIa) 8-18 hAmylin 19-23 is specifically described because of the above language applied to (13AIa 14Asp 15AIa) 8-18 hAmylin 19-22.
• the C-terminal tail comprises amino acids from position 27, 28, 29, 30, 31, 32, or 33 to position 36 or 37 of hAmylin. In other embodiments, the C-terminal tail comprises amino acids from position 27 or 28 to position 32 of sCT; however, when the loop region is from a calcitonin or calcitonin analog and the ⁇ helix region is from a calcitonin or calcitonin analog, the last position of the C-terminal tail is not Pro, Hyp, homoSerine (Hse) or derivatives of Hse.
• the above described ⁇ helix of amylin and calcitonin may further comprise the substitutions of one or more of (27Tyr) hAmylin, (29Arg) hAmylin, (32VaI) hAmylin, (32Thr) hAmylin, (34GIu) hAmylin, (35Lys) hAmylin, (36Phe) hAmylin, (36AIa) hAmylin, (37Phe) hAmylin, (30Asn) sCT, (32Tyr) sCT, or any combination thereof.
• a C-terminal tail can be represented by Xaa 2 g Xaa 2 g Xaa3o Xaa 3 i Xaa 32 Xaa 33 G Xaa 35 Xaa 36 Xaa 37 Xaa 38 , wherein Xaa 28 is Lys, Tyr, or absent; Xaa 29 is Ser, Pro, or absent; Xaa 3 o is Ser, Pro, Arg, or absent; Xaa 3 i is Thr, or absent; Xaa 32 is Asn or absent; Xaa 33 is VaI, Thr, or absent; Xaa 3 s is Ser, GIu; Xaa 36 is Asn, Lys, or GIy; Xaa 37 is Thr, Phe, or Ala; Xaa 3 g is Tyr, Phe, Pro, or absent; with the proviso that when the loop region is from a calcitonin or calcitonin analog and the
• the C-terminal tail examples include, but is not limited to, 27-37 rAmylin, (27Tyr 29Arg 32Thr) 27-37 rAmylin, (29Arg 32Thr) 28-37 rAmylin, 30-37 hAmylin, (32Thr) 30-37 hAmylin, (35Lys 36AIa 37Phe) 30-37 hAmylin, 30-36 hAmylin, (32VaI) 30-36 hAmylin, (34GIu 36Phe) 30-36 hAmylin, 31-37 hAmyin, 31-36 hAmylin, 33-36 hAmylin, 33-7 hAmylin, 28-32 sCT, (30Asn 32Tyr) 28-32 sCT, and 27-32 sCT.
• the C-terminal tail comprises the amino acid sequence KSNFVPTN or SNFVPTNV.
• the C-terminal tail of the novel compounds may further comprise modifications or additional amino acids at the C-terminal end.
• modifications include the addition of compounds such as Lys, up to 4 Lys, L- Octylglycine, 4ABU (4- Aminobutyric acid), 9Anc (9-Amiononanoic acid), and/or groups for solubility, stability, or delivery. Examples include 33-37 hAmylin L-octylglycine, 33-37 hAmylin 4ABU, and 33-37 hAmylin 9Anc.
• peptides may be used in the methods described herein including peptides that comprise an amino acid sequence of Formula (VII): Xaal X Xaa3 Xaa4 Xaa5 Xaa6 Y Xaa8 Xaa9 XaalO Xaal 1 Xaal2 Xaal3 Xaal4 Xaal5 Xaal6 Xaal7 Xaal8 Xaal9 Xaa20 Xaa21 Xaa22 Xaa23 Xaa24 Xaa25 Xaa26 Xaa27 Xaa28 Xaa29 Xaa30 Xaa31 Xaa32, wherein Xaal is A, C, hC, D, E, F, I, L, K, hK, R, hR, S, Hse(homoSER), T, G, Q, N, M, Y, W, P
• Alkyl chains may include lower alkyl groups having from about 1 to about 6 carbon atoms.
• the intramolecular linkage may be a disulfide, amide, imine, amine, alkyl and alkene bond.
• X and Y are independently selected from Ser, Asp, GIu, Lys, Orn, or Cys.
• X and Y are Cys and Cys.
• X and Y are Ser and Ser.
• X and Y are Asp and Lys or Lys and Asp.
• the peptides may comprise an amino acid sequence of Formula (VIII): Xaal Xaa2 Xaa3 Xaa4 Xaa5 Xaa6 Xaa7 Xaa8 Xaa9 XaalO Xaal 1 Xaal2 Xaal3 Xaal4 Xaal5 Xaal 6 Xaal 7 Xaal 8 Xaal 9 Xaa20 Xaa21 Xaa22 Xaa23 Xaa24 Xaa25 Xaa26 Xaa27 Xaa28 Ser Xaa30 Xaa31 Xaa32, wherein Xaal is A, C, D, F, I, K, S, T, or absent; Xaa2 is C, D, S, or absent; Xaa3 is A, D, N, or absent; Xaa4 is A, L, T, or absent; Xaa5
• compounds comprise an amino acid sequence of Formula (IX): Xaal Xaa2 Xaa3 Xaa4 Xaa5 Xaa6 Xaa7 Xaa8 Xaa9 XaalO Xaal 1 Leu Xaal3 Xaal4 Xaal5 Leu Xaal7 Xaal8 Xaal9 Xaa20 Xaa21 Xaa22 Pro Xaa24 Thr Asn Xaa27 GIy Ser Xaa30 Xaa31 Xaa32, wherein Xaal is A, C, F, I, K, S, or absent; Xaa2 is C, D, or S; Xaa3 is A, D or N; Xaa4 is A, L or T; Xaa5 is A or S; Xaa6 is T; Xaa7 is C or K; Xaa8 is A or V; X
• sequences of Formula (VII), (VIII), or (IX) further comprises 1, 2, 3, 4, 5 or more modifications of substitutions, insertions, deletions, elongations and/or derivatizations.
• the squence of formula I, II, or III comprises a VaI is inserted between amino acids at positions 22 and 23.
• the sequence of formula I, II, or II comprises a GIn is inserted between positions 22 and 23.
• the sequence of formula I, II, or III comprises a sequence of GlnThrTyr between positions 22 and 23.
• the sequence of formula I, II, or III comprises a sequence of Leu-Gln-Thr-Tyr between positions 22 and 23.
• the modifications of formula I, II, or III may be at the N-terminal end.
• the N-terminal portion of formula I, II, or III has an added octylglycine .
• the N-terminal portion of formula I, II or III has an added isocap.
• suitable peptides comprise an amino acid sequence of Formula (X): Xaal Xaa2 Xaa3 Xaa4 Xaa5 Xaa6 Xaa7 Xaa8 Xaa9 XaalO Xaal 1 Xaal2 Xaal3 Xaal4 Xaal5 Xaal ⁇ Xaal 7 Xaal 8 Xaal 9 Xaa20 Xaa21 Xaa22 Pro Xaa24 Thr Asn Xaa27 GIy Ser Xaa30 Xaa31 Xaa32, wherein Xaal is A, C, D, F, K, T, or absent; Xaa2 is A, C, D, S, or absent; Xaa3 is A, D, N, or absent; Xaa4 is A, L, T, or absent; Xaa5 is A or S; Xaa6 is A, S, T
• suitable peptides comprise an amino acid sequence comprising: (a) a loop region comprising Xaai; (b) an ⁇ helix loop type I; and (c) a C-terminal tail; wherein Xi comprises an amino sequence of X Xaa 2 Xaa 3 Xaa 4 Xaas Xaa 6 Xaa 7 Y, wherein Xaa 2 is any amino acid or absent; Xaa 3 is Ala, GIy, Ser, Asp or absent; Xaa 4 is Asn, Ala, Asp, GIy or absent; Xaas is Ala, Leu, Thr, or Ser; Xaa 6 is Ala, Ser, or Thr; and Xaa 7 is Ala, Ser, VaI, Hse, (S)-2-amio-3-hydroxy-methylbutanoic acid (Ahb), (2S,3R)-2-amino-3hydroxy- methylpentanoic acid (Ahb),
• suitable peptides comprise an amino acid sequence comprising (a) a loop region comprising Xaai; (b) an ⁇ helix loop type II; and (c) a C-terminal tail; wherein loop region Xaai comprises an amino sequence of X Xaa2 Xaa3 Xaa4 Xaa5 Xaa6 Xaa7 Y wherein, Xaa2 is any amino acid or absent; Xaa3 is Ala, GIy, Ser, Asp or absent; Xaa4 is Asn, Ala, Asp, GIy or absent; Xaa5 is Ala, Leu, Thr, or Ser; Xaa6 is Ala, Ser, or Thr; and Xaa7 is Ala, Ser, VaI, Hse, (S)-2-amio-3-hydroxy-methylbutanoic acid (Ahb), (2S,3R)-2- amino-3hydroxy-methylpentanoic acid (Ahb),
• the compounds described herein can form pharmaceutically acceptable salts with various inorganic acids, organic acids, and bases.
• Exemplary salts prepared with organic and inorganic acids include HCl, HBr, H 2 SO 4 , H3PO4, trifluoroacetic acid, acetic acid, formic acid, methanesulfonic acid, toluenesulfonic acid, maleic acid, fumaric acid, camphorsulfonic acid, and the like.
• Exemplary salts prepared with bases include ammonium salts, alkali metal salts (such as sodium and potassium salts) and alkali earth salts (such as calcium and magnesium salts).
• the pharmaceutically acceptable salt is an acetate salt, a hydrochloride salt, or a trifluoroacetate salt.
• the pharmaceutically acceptable salts may be formed by conventional means, as by reacting the free acid or base forms of the compounds with one or more equivalents of the appropriate base or acid in a solvent or medium in which the salt is insoluble, or in a solvent such as water, which is then removed in vacuo or by freeze-drying, or by exchanging the ions of an existing salt for another ion on a suitable ion exchange resin.
• the peptides described herein may be prepared using conventional coupling reactions known in the art.
• the peptides may be prepared by successively adding the desired amino acid to a growing peptide chain.
• an alpha-N-carbamoyl protected amino acid and an amino acid attached to the growing peptide chain on a resin support are reacted at room temperature in an inert solvent such as N-methylpyrrolidone, dimethylformamide or methylene chloride in the presence of coupling agents such as dicyclohexylcarbodiimide 1- hydroxybenzotriazole in the presence of a base such as diisopropylethylamine.
• the alpha-N- carbamoyl protecting group is removed from the resultant peptide with a reagent such as trifluoroacetic acid or piperidine, and the coupling reaction repeated with the next desired N- protected amino acid.
• a reagent such as trifluoroacetic acid or piperidine
• Suitable N-protecting groups are known in the art, with t- butyloxycarbonyl herein preferred.
• Suitable coupling conditions include use of a solvent system which maximizes swelling of the solid support, minimizes secondary structure elements of the peptide chain during synthesis cycles, and minimizes intrapeptide and interpeptide hydrogen bonding.
• the synthesis cycle includes a capping step after the coupling step(s) wherein unreacted alpha-amino groups of the peptide chain are rendered unreactive.
• the synthesis cycle is successively repeated using appropriate protected alpha-amino acids to give amylin or an amylin analog of specified sequence.
• the peptides are cleaved from the solid support. It is preferred that the cysteine residues of the peptide chain are selectively deprotected and an intramolecular disulfide bond is formed before cleaving the peptide bond from the solid support.
• Peptides may be purified by RP-HPLC (preparative and analytical) using a Waters Delta Prep 3000 system.
• a C4, C8 or C18 preparative column (lO ⁇ , 2.2 x 25 cm; Vydac, Hesperia, Calif.) may be used to isolate peptides, and purity may be determined using a C4, C8 or Cl 8 analytical column (5 ⁇ , 0.46 x 25 cm; Vydac).
• Amino acid analyses may be performed on the Waters Pico Tag system and processed using the Maxima program.
• Peptides may be hydrolyzed by vapor- phase acid hydrolysis (115 0 C, 20-24 h). Hydrolysates may be derivatized and analyzed by standard methods (Cohen, et al., The Pico Tag Method: A Manual of Advanced Techniques for Amino Acid Analysis, pp. 11-52, Millipore Corporation, Milford, Mass. (1989)).
• Fast atom bombardment analysis may be carried out by M-Scan, Incorporated (West Chester, Pa.).
• Mass calibration may be performed using cesium iodide or cesium iodide/glycerol. Plasma desorption ionization analysis using time of flight detection may be carried out on an Applied Biosystems Bio-Ion 20 mass spectrometer.
• each synthesis cycle comprises: (i) treating the growing peptide chain under ⁇ -amino deprotecting conditions to remove an ⁇ -amino group; (ii) activating the ⁇ -carboxyl group of the ⁇ -amino protected designated amino acid; (iii) contacting the growing peptide chain and the designated amino acid under coupling conditions to form a peptide linkage between the free ⁇
• peptides described herein may also be prepared using recombinant DNA techniques, using methods now known in the art, such as those described in Sambrook et al., Molecular Cloning: A Laboratory Manual, 2d Ed., Cold Spring Harbor (1989).
• the compounds described herein can be linked to one or more polymers to provide additional beneficial biological properties.
• additional beneficial biological properties may include, e.g., providing additional therapeutic activity to the compound; increasing the in vivo half life of the compound, decreasing the rate of clearance of the compound by the kidney, decreasing the immunogenicity of the compound, decreasing the proteolysis rate of the compound, or increasing the stability of the compound.
• Exemplary polymers that can be linked to the amylin agonist compounds include peptides, saccharides, polyethylene glycols, albumin, fatty acids, polyamino acids, dextran, gelatin, polyvinyl pyrrolidone, polyvinyl alcohol, N-(2- hydroxypropyl)-methacrylamide, and the like.
• the amylin agonist compounds are linked to peptides, saccharides, polyethylene glycols, albumin, fatty acids, and polyamino acids.
• amylin agonist compounds described herein are linked to peptides that have different therapeutic activity and/or that target different receptors than the amylin agonist compound.
• exemplary peptides include GLP-I receptor agonists (e.g., exendins, exendin analogs, GLP- 1(7-37), GLP- 1(7-37) analogs); PYY; PYY analogs; leptin; leptin analogs; GIP; GIP analogs, and the like.
• Amylin agonist compounds linked (e.g., directly or through amino acid(s) and/or chemical moiety linkers) to another peptide may be referred to as hybrid peptides. Examples of hybrid peptides comprising amylin agonist peptides linked to other therapeutic peptides are described, for example, in WO 2005/077072 and WO 2007/022123, the disclosures of which are incorporated by reference herein.
• the compounds described herein are linked to saccharides (e.g., N- acetyl-galactosamine, N-acetyl-glucosamine, galactose, sialic acid, glucose, fucose, mannose, and the like) to produce glycans.
• saccharides e.g., N- acetyl-galactosamine, N-acetyl-glucosamine, galactose, sialic acid, glucose, fucose, mannose, and the like
• Such compounds may be referred to as glycosylated peptides.
• the amylin agonist peptides can be glycosylated (e.g., N-linked glycosylation, 0-linked glycosylation) at, e.g., an Asn amino acid residue, a Ser amino acid residue, a Thr amino acid residue, or any combination of two or more thereof.
• Methods for the glycosylation of amino acids are known in
• the compounds described herein are linked to one or two polyethylene glycols, preferably one polyethylene glycol.
• the polyethylene glycol can have a molecular weight from about 5,000 daltons to about 40,000 daltons.
• the compounds described herein are linked to a polyamino acid.
• Exemplary polyamino acids include poly-lysine (e.g., poly-D-lysine and/or poly-L-lysine), poly-aspartic acid, poly-serine, poly- glutamic acid, and the like.
• the compounds described herein are linked to a fatty acid.
• the fatty acid may be a C4-C28 fatty acid chain that is saturated or unsaturated, and branched or linear.
• any linking group known in the art can be used.
• the linking group may comprise any chemical group(s) suitable for linking the compound to the polymer.
• Exemplary linking groups include amino acids, maleimido groups, dicarboxylic acid groups, succinimide groups, or a combination of two or more thereof.
• the compound can be directly attached to the polymer without any linking group.
• Methods for linking compounds to one or more polymers are known in the art and described, for example, in US Patent No. 6,329,336; US Patent No. 6,423,685; US Patent No. 6,924,264; WO 2007/022123; WO 2007/053946; WO 2008/058461; and WO 2008/082274, the disclosures of which are incorporated by reference herein.
• the compounds may have other chemical modification that may involve adding chemical moieties, creating new bonds, and removing chemical moieties.
• Examplary modifications at amino acid side groups include acylation of lysine ⁇ -amino groups, N-alkylation of arginine, histidine, or lysine, alkylation of glutamic or aspartic carboxylic acid groups, and deamidation of glutamine or asparagine.
• Exemplary modifications of the terminal amino group include the desamino, N-lower alkyl, N-di-lower alkyl, and N-acyl modifications, such as alkyl acyls, branched alkylacyls, alkylaryl-acyls.
• terminal carboxy group examples include the amide, lower alkyl amide, dialkyl amide, arylamide, alkylarylamide and lower alkyl ester modifications.
• Lower alkyl is Ci_4 alkyl.
• one or more side groups, or terminal groups may be protected by protective groups known to the skilled artisan.
• the ⁇ -carbon of an amino acid may be mono- or dimethylated.
• compositions containing the amylin agonist compounds described herein may be provided in the form of solutions suitable for peripheral administration, including parenteral (including intravenous, intraarterial, intramuscular, subcutaneous), nasal, or oral administration.
• Pharmaceutical compositions containing the amylin agonist compounds described herein can be prepared following the teachings in, for example, US Patent No. 5,998,367 and US Patent No. 6,410,511, the disclosures of which are incorporated by reference herein.
• Other references for preparing pharmaceutical compositions containing compounds can be considered, including, for example, Remington's Pharmaceutical Sciences by Martin; and Wang et al, Journal of Parenteral Science and Technology, Technical Report No. 10, Supp. 42:2S (1988), the disclosures of which are incorporated by reference herein.
• the pharmaceutical formulations may be stabilized at neutral pH. Since the amylin agonist compounds are amphoteric they may be utilized as free bases, as acid addition salts, or as metal salts.
• a wide variety of pharmaceutically acceptable acid addition salts are available, as described above. These include those prepared from both organic and inorganic acids, preferably mineral acids. Typical acids which may be mentioned by way of example include acetic, citric, succinic, lactic, hydrochloric and hydrobromic acids. Such products are readily prepared by procedures well known in the art.
• amylin agonist compounds will normally be provided as parenteral compositions for injection or infusion. They can, for example, be suspended in an inert oil, suitably a vegetable oil such as sesame, peanut, or olive oil. Alternatively, they can be suspended in an aqueous isotonic buffer solution at a pH of about 5.6 to 7.4. Useful buffers include sodium citrate-citric acid and sodium phosphate-phosphoric acid. A form of repository or "depot" slow release preparation may be used so that therapeutically effective amounts of the preparation are delivered into the bloodstream over many hours or days following parenteral injection.
• the desired isotonicity of the formulations may be accomplished using sodium chloride or other pharmaceutically acceptable agents such as dextrose, boric acid, sodium tartrate, propylene glycol, polyols (such as mannitol and sorbitol), or other inorganic or organic solutes.
• sodium chloride is preferred for buffers containing sodium ions.
• solutions of the above compositions may be thickened with a thickening agent such as methylcellulose. They may be prepared in emulsified form, either water in oil or oil in water. Any of a wide variety of pharmaceutically acceptable emulsifying agents may be employed including, for example, acacia powder, a non-ionic surfactant, or an ionic surfactant, such as alkali polyether alcohol sulfates or sulfonates.
• compositions may be prepared by mixing the ingredients following generally accepted procedures.
• the selected components may be simply mixed in a blender or other standard device to produce a concentrated mixture which may then be adjusted to the final concentration and viscosity by the addition of water or thickening agent and possibly a buffer to control pH or an additional solute to control tonicity.
• Typical therapeutically effective amounts of the amylin agonist compounds for use in parenteral formulations are from about 1 ⁇ g to about 5 mg; from about 10 ⁇ g to about 3 mg; from about 50 ⁇ g to about 2 mg; or from about 100 ⁇ g to about 1 mg.
• the dosages may be administered daily (e.g., BID or TID), weekly, or monthly.
• the therapeutically effective amount of the amylin agonist compound will depend on the formulation and frequency of administration (e.g., immediate release, sustained release).
• the therapeutically effective amount of the amylin agonist compounds for use in nasal or oral formulations may be about 5 -fold to 15 -fold greater than the amount used in parenteral formulations. Therapeutic methods and Uses
• exemplary methods described herein include (i) treating obesity in estrogen-deficient mammals; (ii) treating overweight in estrogen-deficient mammals; (iii) reducing weight in estrogen-deficient mammals; (iv) reducing body fat in estrogen-deficient mammals; (v) reducing body fat while maintaining lean muscle mass in estrogen-deficient mammals; (vi) increasing satiety in estrogen-deficient mammals; (vii) reducing appetite in estrogen-deficient mammals; (viii) delaying gastric emptying in estrogen-deficient mammals; (ix) reducing gastric motility in estrogen-deficient mammals; (x) reducing ovariectomized weight gain and/or body fat in female mammals; (xi) treating ovariectomized obesity or overweight in female mammals; (xii) reducing menopausal weight
• the methods described herein may further comprise improving glycemic control in the estrogen-deficient mammals by administering to the estrogen-deficient mammals therapeutically effective amounts of amylin agonist compounds or pharmaceutical compositions comprising amylin agonist compounds. Improving glycemic control includes lowering blood glucose levels, reducing hemoglobin AIc (HbAIc) levels, and the like.
• the estrogen- deficient mammals have diabetes, such as type 2 diabetes, and are overweight or obese.
• the methods disclosed herein are used to increase the metabolic rate in an estrogen-deficient mammal, decrease a reduction in the metabolic rate in an estrogen- deficient mammal, or preserve the metabolic rate in an estrogen-deficient mammal.
• the metabolic rate may involve the preferential use of the body's fat as an energy source over lean body tissue.
• lean body mass is not decreased following administration of an amylin agonist as provided herein.
• a reduction in the lean body mass is lessened or prevented following administration of amylin agonist as provided herein.
• lean body mass is increased following administration of an amylin agonist as provided herein.
• Such preference for fat as the energy source may be determined by comparing the amount of fatty tissue to lean body tissue, ascertained by measuring total body weight and fat content at the beginning and end of the treatment period.
• An increase in metabolic rate is a higher level of the use of calories or another energy source by an estrogen- deficient mammal over a period of time compared with the level of use of calories or other energy source by the estrogen-deficient mammal over another period of time under substantially similar or identical conditions without administration of an amylin agonist as provided herein.
• the metabolic rate is increased at least about 5% in an estrogen-deficient mammal, in other embodiments, the metabolic rate is increased at least about 10%, 15%, 20% 25%, 30%, or 35% in an estrogen-deficient mammal compared with the level of use of calories or other energy source by the estrogen-deficient mammal over another period of time under substantially similar or identical conditions without administration of an amylin agonist as provided herein.
• the increase in metabolic rate can be measured using a respiratory calorimeter, for example.
• the methods provided are effective to elicit a reduction of a decrease in metabolic rate in a an estrogen deficient mammal.
• a decrease in metabolic rate can be the primary result of estrogen deficiency experienced by an estrogen-deficient mammal, or may also be a secondary result from a nutritional or physical regimen engaged in by such an estrogen-deficient mammal, which leads to a reduction in metabolic rate, for example, due to a reduced calorie diet, a restricted diet, or weight loss.
• a restricted diet includes allowances or prohibitions, or both on the types of food or the amounts of food or both permitted in a diet, not necessarily based on calories. For example, as in individual diets, the body compensates with a reduced metabolic rate based on the lower caloric intake.
• a method is provided to reduce the loss of metabolic rate in an estrogen-deficient mammal, where the loss of metabolic rate is the result of a reduced calorie diet or weight loss.
• the estrogen- deficient mammal's reduction in metabolic rate is decreased by at least about 10%, 15%, 20% 25%, 30%, 35%, 40%, 50%, 60%, 70%, 80%, 90%, or 95%.
• administration of an amylin agonist as provided herein is commenced before the condition or nutritional or physical regimen is initiated.
• metabolic rate is measured using a respiratory calorimeter.
• a method comprises administering an effective amount an amylin agonist as provided herein to such an estrogen-deficient mammal.
• the estrogen-deficient mammal is losing weight, or has lost weight, for example, due to a reduced calorie diet, increased exercise or a combination thereof.
• metabolic plateau is meant time intervals of steady metabolic rate while the body adjusts to changes in caloric or energy input. Changes in caloric input or expenditure can be the result of, for example, reduced calorie diets or increased physical activity. Such plateaus can be observed, for example, during a weight loss regimen when weight loss slows or stops.
• a method of the present invention reduces the duration of a metabolic plateau in an estrogen-deficient mammal compared with the duration of metabolic plateaus in an otherwise identical subject over the same period of time under substantially similar or identical conditions without administration of an amylin agonist as provided herein.
• a method of the present invention reduces the frequency of metabolic plateaus compared with the frequency of metabolic plateaus in an otherwise identical estrogen-deficient mammal over the same period of time under substantially similar or identical conditions without administration of an amylin agonist as provided herein.
• a method of the present invention delays the onset of a metabolic plateau compared with the onset of a metabolic plateau in an otherwise identical estrogen- deficient mammal over the same period of time under substantially similar or identical conditions without administration of an amylin agonist as provided herein.
• metabolic plateaus are identified by charting periods of reduced or no weight loss.
• at least one metabolic plateau is reduced.
• at least two, three, four, five, six, seven, eight, nine, or ten metabolic plateaus are reduced.
• metabolic plateaus are delayed one day as compared to an estrogen-deficient mammal not administered an amylin agonist as provided herein under identical or similar conditions.
• metabolic plateaus are delayed 2 days, 3 days, 4 days, 5 days, 6 days, 1 week, 10 days, 2 weeks or 3 weeks in an estrogen-deficient mammal.
• a method is provided to preserve the metabolic rate in an estrogen-deficient mammal.
• the estrogen-deficient mammal may be at risk of losing metabolic rate, for example, due to the initiation of a reduced calorie diet, restricted diet, or anticipated weight loss.
• a preservation of metabolic rate is a maintenance of the level of the use of calories or another energy source by an estrogen-deficient mammal over a period of time compared with the level of use of calories or other energy source by an otherwise identical estrogen-deficient mammal over the same period of time under substantially similar or identical conditions without administration of an amylin agonist as provided herein.
• the metabolic rate is maintained within 15% of the estrogen-deficient mammal's metabolic rate prior to the initiation of the event that results in the decrease in metabolic rate. In other aspects, the metabolic rate is maintained within 10%, within 7%, within 5%, within 3% or less of the estrogen-deficient mammal's metabolic rate. In one aspect, an amylin agonist as provided herein is administered at the initiation of a reduced calorie diet, restricted diet, or exercise regimen.
• Metabolic rates can be assessed using any method available for determining such rates, for example by using a respiratory calorimeter. Such methods and devices for assaying metabolic rates are known in the art and are described, for example, in U.S. Patent Nos. 4,572,208, 4,856,531, 6,468,222, 6,616,615, 6,013,009, and 6,475,158.
• the metabolic rate of an animal can be assessed by measuring the amount of lean tissue versus fatty tissue catabolized by the animal following the diet period. Thus, total body weight and fat content can be measured at the end of the dietary period.
• a frequently used method to determine total body fat is to surgically remove and weigh the retroperitoneal fat pad, a body of fat located in the retroperitoneum, the area between the posterior abdominal wall and the posterior parietal peritoneum.
• the pad weight is considered to be directly related to percent body fat of the animal. Since the relationship between body weight and body fat in rats is linear, obese animals have a correspondingly higher percent of body fat and retroperitoneal fat pad weight.
• methods for reducing fat mass by increasing the metabolic rate in an estrogen-deficient mammal comprising administering an amylin agonist as provided herein in an amount effective to reduce fat mass by increasing the estrogen-deficient mammal's metabolic rate.
• Fat mass can be expressed as a percentage of the total body mass.
• the fat mass is reduced by at least 1%, at least 5%, at least 10%, at least 15%, at least 20%, or at least 25% over the course of treatment.
• the estrogen-deficient mammal's lean mass is not decreased over the course of the treatment.
• the estrogen-deficient mammal's lean mass is maintained or increased over the course of the treatment.
• the estrogen-deficient mammal is on a reduced calorie diet or restricted diet.
• reduced calorie diet is meant that the estrogen- deficient mammal is ingesting fewer calories per day than compared to the same estrogen- deficient mammal's normal diet.
• the estrogen-deficient mammal is consuming at least 50 fewer calories per day.
• the estrogen-deficient mammal is consuming at least 100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, or 1000 fewer calories per day.
• a method for altering the fat distribution in an estrogen-deficient mammal comprising administering an amylin agonist as provide herein in an amount effective to alter fat distribution in the estrogen-deficient mammal.
• the alteration results from an increased metabolism of visceral or ectopic fat, or both in the estrogen-deficient mammal.
• the method involves the metabolism of visceral or ectopic fat or both at a rate of at least about 5%, 10%, 15%, 20%, 25%, 30%, 40%, or 50% greater than for subcutaneous fat.
• the methods result in a favorable fat distribution.
• favorable fat distribution is an increased ratio of subcutaneous fat to visceral fat, ectopic fat, or both.
• the method involves an increase in lean body mass, for example, as a result of an increase in muscle cell mass.
• methods for reducing the amount of subcutaneous fat in an estrogen-deficient mammal comprising administering, to an estrogen-deficient mammal in need thereof, an amylin agonist as provided herein in an amount effective to reduce the amount of subcutaneous fat in the estrogen-deficient mammal.
• the amount of subcutaneous fat is reduced in an estrogen-deficient mammal by at least about 5%.
• the amount of subcutaneous fat is reduced by at least about 10%, 15%, 20%, 25%, 30% 40%, or 50% compared to the estrogen-deficient mammal prior to administration of an amylin agonist as provided herein.
• the methods described herein can be used to reduce the amount of visceral fat in an estrogen-deficient mammal.
• the visceral fat is reduced in an estrogen-deficient mammal by at least about 5%. In other instances, the visceral fat is reduced in the estrogen- deficient mammal by at least about 10%, 15%, 20%, 25%, 30% 40%, or 50% compared to the estrogen-deficient mammal prior to administration of an amylin agonist as provided herein.
• Visceral fat can be measured through any means available to determine the amount of visceral fat in an estrogen-deficient mammal. Such methods include, for example, abdominal tomography by means of CT scanning and MRI. Other methods for determining visceral fat are described, for example, in U.S. Patent Nos. 6,864,415, 6,850,797, and 6,487,445.
• a method for preventing the accumulation of ectopic fat or reducing the amount of ectopic fat in an estrogen-deficient mammal comprises administering, to an estrogen-deficient mammal in need thereof, an amylin agonist as provided herein in an amount effective to prevent accumulation of ectopic fat or to reduce the amount of ectopic fat in the estrogen-deficient mammal.
• the amount of ectopic fat is reduced in an estrogen-deficient mammal by at least about 5% compared to the estrogen-deficient mammal prior to administration of an amylin agonist as provided herein.
• the amount of ectopic fat is reduced in a estrogen-deficient mammal by at least about 10%, or by at least about 15%, 20%, 25%, 30% 40%, or 50%.
• the amount of ectopic fat is proportionally reduced 5%, 10%, 15%, 20%, 25%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100% in comparison to subcutaneous fat in an estrogen-deficient mammal.
• Ectopic fat can be measured in an estrogen-deficient mammal using any method available for measuring ectopic fat.
• methods for producing a more favorable fat distribution in an estrogen-deficient mammal, where the method comprises administering to an estrogen-deficient mammal an amylin agonist as provided hereinin amounts effective to produce a favorable fat distribution.
• administration of an amylin agonist as provided herein reduces the amount of visceral fat or ectopic fat, or both, in an estrogen-deficient mammal.
• Such methods result in a higher ratio of subcutaneous fat to visceral fat or ectopic fat.
• Such improved ratios may result in a reduced risk of the development of cardiovascular diseases, polycystic ovary syndrome, metabolic syndrome, or any combinations thereof.
• ectopic or visceral fat is metabolized at a rate 5% greater than subcutaneous fat. In other embodiments, ectopic or visceral fat is metabolized at a rate at least 10% 15%, 20%, 25%, 30% 50%, 60%, 70%, 80%, 90%, or 100% greater than subcutaneous fat.
• Methods for reducing an estrogen-deficient mammal's weight to below that of morbid obesity include reducing caloric intake, increasing physical activity, drug therapy, bariatric surgery, such as gastric bypass surgery, or any combinations of the preceeding methods.
• administering an amylin agonist as provided herein further reduces the weight of the estrogen- deficient mammal.
• methods are provided for reducing the body mass index in an estrogen-deficient mammal having a body mass index of 40 or less by administering an amylin agonist as provided hereinin effective amounts to further reduce the estrogen-deficient mammal's weight.
• reducing weight it is meant that the estrogen-deficient mammal loses a portion of his/her total body weight over the course of treatment, whether the course of treatment be days, weeks, months or years.
• reducing weight can be defined as a decrease in proportion of fat mass to lean mass (in other words, the estrogen-deficient mammal has lost fat mass, but maintained or gained lean mass, without necessarily a corresponding loss in total body weight).
• An effective amount of an amylin agonist as provided herein in these embodiments is an amount effective to reduce an estrogen-deficient mammal's body weight over the course of the treatment, or alternatively an amount effective to reduce the estrogen-deficient mammal's percentage of fat mass over the course of the treatment.
• the estrogen- deficient mammal's body weight is reduced, over the course of treatment, by at least about 1%, by at least about 5%, by at least about 10%, by at least about 15%, or by at least about 20%.
• the estrogen-deficient mammal's percentage of fat mass is reduced, over the course of treatment, by at least 1%, at least 5%, at least 10%, at least 15%, at least 20%, or at least 25%.
• methods of reducing nutrient availability, e.g., reducing weight, in an estrogen-deficient mammal comprise administering to the estrogen-deficient mammal an effective amount of an amylin agonist as provided herein in a bolus dose one or more times a day.
• a bolus dose is an intermittent dosage of medicine (as opposed to a continuous infusion).
• An estrogen-deficient mammal can be administered one or more bolus doses per day.
• the bolus dose can be the same no matter when it is administered to the estrogen-deficient mammal, or can be adjusted such that the estrogen-deficient mammal is administered a larger bolus dose at certain times of the day as compared to others.
• a bolus dose can be administered less frequently, for example, once every three days, once per week, twice a month, once every month. Furthermore, the time between bolus doses is preferably long enough to allow the drug administered in the previous bolus dose to clear the estrogen-deficient mammal's blood stream.
• methods of reducing nutrient availability, e.g., reducing weight, in an estrogen-deficient mammal comprise administering to the estrogen-deficient mammal an effective amount of an amylin agonist as provided herein in continuous doses.
• continuous dose it is intended to mean the continuous infusion of the drug by, for example, intravenous injection or a transdermal patch.
• a continuous dose can be administered orally in the form of a controlled release capsule or tablet which releases the drug into the estrogen- deficient mammal's system over a period of time.
• the drug is released over a period of about 1 hour, in some cases the drug is released over a period of about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 18, or 24 hours.
• the present invention is yet further directed to methods of increasing oxidative metabolism in an estrogen-deficient mammal, the method comprising administering to an estrogen-deficient mammal in need thereof an effective amount of an amylin agonist as provided herein.
• Oxidative metabolism is the process by which oxygen is used to make energy from carbohydrates (sugars).
• a method of inducing a feeling of fullness in an estrogen-deficient mammal comprises administering an effective amount of an amylin agonist as provided herein to said estrogen-deficient mammal.
• a method of controlling hunger in an estrogen-deficient mammal comprises administering an effective amount of an amylin agonist as provided herein to said estrogen-deficient mammal.
• a method of prolonging a feeling of satiation in an estrogen- deficient mammal comprises administering an effective amount of an amylin agonist as provided herein to said estrogen-deficient mammal.
• a method of reducing caloric intake of an estrogen-deficient mammal by reducing the size of a meal comprises administering an effective amount of an amylin agonist as provided herein to said estrogen-deficient mammal.
• a method of controlling food intake of an estrogen-deficient mammal comprising administering an effective amount of an amylin agonist as provided herein to said estrogen-deficient mammal.
• a method for ensuring or assisting in compliance of an estrogen- deficient mammal with a reduced calorie or restrictive diet comprises administering an effective amount of an amylin agonist as provided herein to said estrogen-deficient mammal.
• a method of adjusting an estrogen-deficient mammal's set point so that the body's propensity for homeostasis is adjusted to a healthier set point comprises administering an effective amount of an amylin agonist as provided herein to said estrogen-deficient mammal.
• a method for maintaining weight loss or maintaining the weight lost in an estrogen-deficient mammal which has experienced or undergone or is undergoing a weight-reducing treatment therapy or regimen, wherein the method comprises administering an effective amount of an amylin agonist as provided herein to said estrogen-deficient mammal.
• the weight loss is maintained by re-setting the estrogen-deficient mammal's set point.
• methods of the invention are of use in treating and/or preventing metabolic conditions or disorders that benefit from a reduction in nutrient availability in an estrogen-deficient mammal in need of such treatment or prevention. Accordingly, these methods may be useful in treating and/or preventing of obesity, diabetes (e.g., type 2 or non- insulin dependent diabetes, type 1 diabetes, and gestational diabetes), eating disorders, insulin- resistance syndrome, and cardiovascular disease.
• diabetes e.g., type 2 or non- insulin dependent diabetes, type 1 diabetes, and gestational diabetes
• eating disorders e.g., type 1 diabetes, and gestational diabetes
• insulin- resistance syndrome e.g., obesity, obesity, diabetes (e.g., type 2 or non- insulin dependent diabetes, type 1 diabetes, and gestational diabetes), eating disorders, insulin- resistance syndrome, and cardiovascular disease.
• methods of use in altering fat distribution, reducing fat mass, or both in an estrogen-deficient mammal are provided. Accordingly, subjects for whom altering body composition is of benefit can also benefit from the present methods.
• Altered body composition includes loss or maintenance of body fat, with minimization of loss, maintenance, or gain of lean body mass. In such situations, weight may increase as well as decrease. Accordingly, subjects may be lean, overweight, or obese as these terms are generally used in the art.
• Methods of the invention may also include reducing fat in non-adipose tissue while sparing lean mass. Uses for this method include treating diseases such as nonalcoholic steatohepatitis (NASH) or lipodystrophy.
• NASH nonalcoholic steatohepatitis
• the estrogen-deficient mammal may further be administered an effective amount of leptin or a leptin analog.
• the leptin or leptin analog may be administered in the same pharmaceutical composition as the amylin agonist compound or may be administered in a separate pharmaceutical composition.
• the leptin or leptin analog is metreleptin.
• the leptin and leptin analogs that may be employed in the methods disclosed herein are describe in, for example, U.S. Patent Nos.
• Murine leptin VPIQKVQDDTKTLIKTIVTRINDISHT-Xaa-
• Bovine leptin VPICKVQDDTKTLIKTIVTRINDISHT-Xaa- SVSSKQRVTGLDFIPGLHPLLSLSKMDQTLAIYQQILTSLPSRNVVQISNDLENLRDLLHL LAASKSCPLPQVRALESLESLGVVLEASLYSTEVVALSRLQGSLQDMLRQLDLSPGC , wherein Xaa at position 28 is Q or absent (SEQ ID NO: 16).
• Xaa at position 27 is T or A ; and Xaa at position 28 is Q or absent (SEQ ID NO: 2).
• Rat leptin VPIHKVQDDTKTLIKTIVTRINDISHTQSVSARQRVTGLDFIP GLHPILSLSKMDQTLAWQQILTSLPSQNVLQIAHDLENLRDLLHLLAFSKSCSLPQTRGL QKPESLDGVLEASLYSTEVVALSRLQGSLQDILQQLDLSPEC (SEQ ID NO: 4).
• Platypus leptin The mature playpus leptin sequence follows:
• Leptin A200 is an Fc antibody fragment condensation product with leptin, as known in the art. See e.g., Lo et ah, 2005, Protein Eng. Design & Selection, 18:1-10 (SEQ ID NO: 7).
• Leptin A300 is metreleptin with substitutions WlOlQ and W139Q (N- terminal *Met counted as residue 1): MVPIQKVQDDTKTLIKTIVTRINDISHTQSVSSKQKVTGLDFIPGLHPILTLSKMDQTLAV YQQILTSMPSRNVIQISNDLENLRDLLHVLAFSKSCHLPQ ASGLETLDSLGGVLEASGYST EVVALSRLQGSLQDMLQQLDLSPGC (SEQ ID NO:6).
• Leptin A500 Research by a number of investigators including the inventors have focused on the effects on aggregation of residue substitution in leptin. See e.g., Ricci et al., 2006. "Mutational approach to improve physical stability of protein therapeutics susceptible to aggregation: Role of altered conformation in irreversible precipitation," Book Chapter. In: Misbehaving Proteins: Protein (Mis)Folding, Aggregation, and Stability. Murphy RM, Tsai AM, Eds. New York. Springer, pp. 331-350, which is incorporated herein by reference and for all purposes. Accordingly, leptin A500 with sequence following has been used in the compounds and methods described herein:
• Embodiment 1 A method for treating estrogen deficiency in a mammal in need thereof comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 2 A method for treating obesity in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 3 A method for treating overweight in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 4 A method for reducing weight in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 5 A method for reducing body fat in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 6 A method for reducing body fat while maintaining lean muscle mass in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 7 A method for reducing weight and/or body fat while maintaining lean muscle mass in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 8 A method for maintaining weight in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 9 A method for delaying gastric emptying in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 10 A method for reducing gastric motility in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 11 A method for reducing appetite in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 12 A method for increasing satiety in an estrogen-deficient mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 13 A method for reducing ovariectomized weight gain in a female mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 14 A method for treating ovariectomized obesity and/or overweight in a female mammal comprising administering to the estrogen-deficient mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 15 A method for reducing menopausal weight gain and/or body fat in a female mammal comprising administering to the menopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 16 A method for reducing menopausal weight gain and/or body fat while maintaining lean muscle mass in a female mammal comprising administering to the menopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 17 A method for reducing postmenopausal weight gain and/or body fat in a female mammal comprising administering to the postmenopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 18 A method for reducing postmenopausal weight gain and/or body fat while maintaining lean muscle mass in a female mammal comprising administering to the postmenopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 19 A method for reducing perimenopausal weight gain and/or body fat in a female mammal comprising administering to the perimenopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 20 A method for reducing perimenopausal weight gain and/or body fat while maintaining lean muscle mass in a female mammal comprising administering to the perimenopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 21 A method for treating menopausal obesity or overweight in a female mammal comprising administering to the menopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 22 A method for treating postmenopausal obesity or overweight in a female mammal comprising administering to the postmenopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 23 A method for treating perimenopausal obesity or overweight in a female mammal comprising administering to the perimenopausal female mammal a therapeutically effective amount of an amylin agonist compound.
• Embodiment 24 A method for increasing Bdnf levels in an estrogen-deficient mammal in need thereof comprising administering to the estrogen-deficient mammal in need of increased Bdnf levels a therapeutically effective amount of an amylin agonist compound.
• Embodiment 25 A method of increasing Bdnf levels in a mammal in need thereof comprising administering to the mammal in need of increased Bdnf levels a therapeutically effective amount of an amylin agonist compound.
• Embodiment 26 The method of any one of Embodiments 1-25 further comprising administering an effective amount of leptin or a leptin analog.
• Embodiment 27 The method of any one of Embodiments 1-25 further comprising administering an effective amount of metreleptin.
• Embodiment 28 The method of any one of Embodiments 1-25 further comprising administering an effective amount of a GLP-I receptor agonist or an analog thereof; PYY or an analog thereof; GIP or an analog thereof; or CCK or an analog thereof.
• Embodiment 29 The method of Embodiment 28, wherein the GLP-I receptor agonist is GLP- 1(7-37) or exendin-4.
• Embodiment 30 The method of any one of Embodiments 1-25, wherein the mammal is a female human.
• Embodiment 31 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (I).
• Embodiment 32 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (II).
• Embodiment 33 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (III).
• Embodiment 34 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (IV).
• Embodiment 35 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (V).
• Embodiment 36 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (VI).
• Embodiment 37 The method of any one of Embodiments 1-25, wherein the amylin agonist compound comprises the amino acid sequence of any one of SEQ ID NOs: 1-139 or a pharmaceutically acceptable salt thereof.
• Embodiment 38 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has at least 90% sequence identity to the amino acid sequence of any one of SEQ ID NOs:l-139.
• Embodiment 39 The method of any one of Embodiments 1-25, wherein the amylin agonist compound comprises the amino acid sequence of any one of SEQ ID NOS: 1-11, 20-39, 138, and 139.
• Embodiment 40 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has at least 90% sequence identity to the amino acid sequence of any one of SEQ ID NOS: 1-11, 20-39, 138, and 139.
• Embodiment 41 The method of any one of Embodiments 1-25, wherein the amylin agonist compound comprises the amino acid sequence of SEQ ID NO:20 or a pharmaceutically acceptable salt thereof.
• Embodiment 42 The method of any one of Embodiments 1-25, wherein the amylin agonist compound comprises the amino acid sequence of any one of SEQ ID NOS:40-137 or a pharmaceutically acceptable slat thereof.
• Embodiment 43 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has at least 90% sequence identity to the amino acid sequence of any one of SEQ ID NOS:40-137.
• Embodiment 44 The method of any one of Embodiments 1-25, wherein the amylin agonist compound comprises the amino acid sequence of SEQ ID NO: 137.
• Embodiment 45 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is peripherally administered to the mammal.
• Embodiment 46 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is parenterally administered to the mammal.
• Embodiment 47 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is subcutaneously administered to the mammal.
• Embodiment 48 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is intravenously administered to the mammal.
• Embodiment 49 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is intramuscularly administered to the mammal.
• Embodiment 50 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is intraarterial administered to the mammal.
• Embodiment 51 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is nasally administered to the mammal.
• Embodiment 52 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has an IC 50 of about 200 or less in an amylin receptor binding assay.
• Embodiment 53 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has an IC 50 of about 100 or less in an amylin receptor binding assay.
• Embodiment 54 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has an IC 50 of about 50 or less in an amylin receptor binding assay.
• Embodiment 55 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has an EC50 of about 20 or less in soleus muscle assay.
• Embodiment 56 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has an EC50 of about 15 or less in soleus muscle assay.
• Embodiment 57 The method of any one of Embodiments 1-25, wherein the amylin agonist compound has an EC 50 of about 5 or less in soleus muscle assay.
• Embodiment 58 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is linked to a peptide, a carbohydrate, a saccharide, polyethylene glycol, albumin, a fatty acid, a polyamino acid, dextran, gelatin, a polyvinyl pyrrolidone, a polyvinyl alcohol, an N- (2-hydroxypropyl)-methacrylamide, or a combination of two or more thereof.
• Embodiment 59 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is linked to a peptide, a carbohydrate, a saccharide, a polyethylene glycol, albumin, a fatty acid, or a polyamino acid.
• Embodiment 60 The method of Embodiment 58 or 59, wherein the peptides is an exendin, an exendin analog, a GLP-I, a GLP-I analog, a CCK, a CCK analog, a PYY, a PYY analog, a GIP, or a GIP analog.
• Embodiment 61 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is glycosylated at one, two, three, or four, amino acid residues.
• Embodiment 62 The method of any one of Embodiments 1-25, wherein the mammal is not being administered hormone replacement therapy.
• Embodiment 63 The method of any one of Embodiments 1-25, wherein the mammal is perimenopausal.
• Embodiment 64 The method of any one of Embodiments 1-25, wherein the mammal is menopausal.
• Embodiment 65 The method of any one of Embodiments 1-25, wherein the mammal is postmenopausal.
• Embodiment 66 The method of any one of Embodiments 1-25, wherein the mammal has an ovarian dysfunction, or has had an overectomy or a hysterectomy.
• Embodiment 67 The method of any one of Embodiments 30, wherein the female human has an estradiol level of about 30 or less and a follicle stimulating hormone level of about 30 or more.
• Embodiment 68 The method of any one of Embodiments 1-25 wherein the therapeutically effective amount of the amylin agonist compound is from 1 ⁇ g to 5 mg.
• Embodiment 69 The method of any one of Embodiments 1-25 wherein the therapeutically effective amount of the amylin agonist compound is from 1 ⁇ g/day to 5 mg/day.
• Embodiment 70 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist compound is from 1 ⁇ g/week to 5 mg/week.
• Embodiment 71 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist compound is from 1 ⁇ g/month to 5 mg/month.
• Embodiment 72 The method of any one of Embodiments 1-25 wherein the therapeutically effective amount of the amylin agonist compound is from 10 ⁇ g to 3 mg.
• Embodiment 73 The method of any one of Embodiments 1-25 wherein the therapeutically effective amount of the amylin agonist compound is from 10 ⁇ g/day to 3 mg/day.
• Embodiment 74 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist analog is from 10 ⁇ g/week to 3 mg/week.
• Embodiment 75 The method of any one of Embodiments 25, wherein the therapeutically effective amount of the amylin agonist analog is from 10 ⁇ g/month to 3 mg/month.
• Embodiment 76 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist compound is from 50 ⁇ g to 2 mg.
• Embodiment 77 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist compound is from 50 ⁇ g/day to 2 mg/day.
• Embodiment 78 The method of any one of Embodiments 1-25 wherein the therapeutically effective amount of the amylin agonist compound is from 50 ⁇ g/week to 2 mg/week.
• Embodiment 79 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist compound is from 50 ⁇ g/month to 2 mg/month.
• Embodiment 80 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist compound is from 100 ⁇ g to 1 mg.
• Embodiment 81 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist compound is from 100 ⁇ g/day to 1 mg/day.
• Embodiment 82 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist analog is administered daily in a single or divided dose.
• Embodiment 83 The method of any one of Embodiments 1-60 wherein the therapeutically effective amount of the amylin agonist analog is from 100 ⁇ g/week to 1 mg/week.
• Embodiment 84 The method of any one of Embodiments 1-60 wherein the therapeutically effective amount of the amylin agonist analog is from 100 ⁇ g/month to 1 mg/month.
• Embodiment 85 The method of any one of Embodiments 1-25, wherein the therapeutically effective amount of the amylin agonist analog provides at least a therapeutically effective minimum plasma level of the amylin agonist compound.
• Embodiment 86 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (VII).
• Embodiment 87 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (VIII).
• Embodiment 88 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (IX).
• Embodiment 89 The method of any one of Embodiments 1-25, wherein the amylin agonist compound is a compound of Formula (X).
• Embodiment 90 The method of any one of Embodiments 1-25, wherein the amylin agonist compound comprises a fragment of a human amylin amino acid sequence, a fragment of a rat amino acid sequence, a fragment of a salmon calcitonin amino acid sequence, a fragment of a human calcitonin sequence, or a combination of two or more thereof.
• Embodiment 91 The method of any one of Embodiments 1-25, wherein the amylin agonist compound comprises (a) a loop region; (b) an ⁇ helix loop type I; and (c) a C-terminal tail.
• Embodiment 92 The method of any one of Embodiments 1-25, wherein the amylin agonist compound comprises (i) an amylin peptide fragment and (ii) a calcitonin peptide fragment.
• Embodiment 93 The method of Embodiment 92, wherein the amylin is human amylin or rat amylin; and the calcitonin is human calcitonin or salmon calcitonin.
• Embodiment 94 The method of any one of Embodiments 1-25, wherein the mammal has diabetes.
• Embodiment 95 The method of any one of Embodiments 1-14 and 94, which further comprises improving glycemic control in the estrogen-deficient mammal in need thereof.
• Embodiment 96 The method of Embodiment 95, wherein the method of improving glycemic control is a method of lowering blood glucose levels or reducing hemoglobin AIc (HbAIc) levels.
• HbAIc hemoglobin AIc
• Embodiment 97 The method of any one of Embodiments 15-24 and 94, which further comprises improving glycemic control in the menopausal, postmenopausal, or perimenopausal female mammal in need thereof.
• Embodiment 98 The method of Embodiment 97, wherein the method of improving glycemic control is a method of lowering blood glucose levels or reducing hemoglobin AIc (HbAIc) levels.
• HbAIc hemoglobin AIc
• Embodiment 99 The method of any one of Embodiments 1-98, wherein the amylin agonist compound comprises the amino acid sequence of SEQ ID NO: 142 or a pharmaceutically acceptable salt thereof.
• amylin receptor binding assay a competition assay that measures the ability of compounds to bind specifically to membrane-bound amylin receptors, is described in US Patent No. 5,686,411 (e.g., Example 18), the disclosure of which is incorporated by reference herein.
• a preferred source of the membrane preparations used in the assay is the basal forebrain which comprises membranes from the nucleus accumbens and surrounding regions. Compounds being assayed compete for binding to these receptor preparations with 125 I Bolton Hunter rat amylin.
• Assays of biological activity of amylin agonist compounds in the soleus muscle may be performed using methods described in US Patent No. 5,686,411 (e.g., Example 19), the disclosure of which is incorporated by reference herein, in which amylin agonist activity may be assessed by measuring the inhibition of insulin- stimulated glycogen synthesis.
• an exemplary method includes soleus muscle strips prepared from 12-h fasted male Wistar rats. The tendons of the muscles are ligated before attachment to stainless steel clips.
• Muscle strips are pre -incubated in Erlenmeyer flasks containing 3.5 ml Krebs-Ringer bicarbonate buffer, 7mM N-2-hydroxyethyl-peperazine-N'-2-ethane-sulphonic acid, pH 7.4, and 5.5 mM pyruvate. Flasks are sealed and gassed continuously with O 2 and CO 2 in the ratio 19:1 (v/v). After pre-incubation of muscles in this medium for 30 min at 37°C in an oscillating water bath, the muscles strips are transferred to similar vials containing identical medium (except pyruvate) with added [U- 14 C] glucose (0.5 ⁇ Ci/ml) and insulin (100 ⁇ U/ml).
• the flasks are sealed and re-gassed for an initial 15 min in a 1-h incubation. At the end of the incubation period, muscles are blotted and rapidly frozen in liquid N 2 .
• the concentration of lactate in the incubation medium can be determined spectrophotometrically and [U- 14 C] glucose incorporation in glycogen measured. All studies described in the Examples below were approved by the Institutional Animal Care and Use Committee at Amylin Pharmaceuticals, Inc., in accordance with Animal Welfare Act guidelines. Animals were housed in standard caging at 22 0 C on a 12-hour light, 12-hour dark cycle. Additionally, all data were analyzed using a one- or two-way analysis of variance (ANOVA) with Neuman-Keuls or Bonferroni post hoc analyses respectively. Statistical significance was assumed for p ⁇ 0.05. Graphs were generated using Prism 4 for Windows (Graphpad Software, San Diego, CA). All data are presented as mean ⁇ SEM.
• OVX bilateral ovariectomy surgery
• SHAM sham surgery
• OVX+E 2 ug ⁇
• Body weight gain in grams over the 28 day treatment period was: SHAM - vehicle, 18.5 ⁇ 2.3 g; OVX - vehicle, 30.2 ⁇ 3.3 g; and OVX+E - vehicle, 22.2 ⁇ 4.2 g (p ⁇ 0.05 for OVX vs. SHAM, but not OVX+E, at week 4; not shown).
• Amylin infusion in these rats was associated with reduced cumulative food intake relative to vehicle controls across all surgical groups. Specifically: the SHAM rats that received amylin infusion experienced a reduction in cumulative food intake of 10.9 ⁇ 3.4% relative to SHAM rats that received vehicle only (Figure 2A); the OVX rats that received amylin infusion experienced a reduction of cumulative food intake of 23.0 ⁇ 2.0% relative to OVX rats that received vehicle only ( Figure 2B); and the OVX+E rats that received amylin infusion experienced a reduction in cumulative food intake of approximately 15% relative to OVX+E rats that received vehicle only (Figure 2C).
• OVX vehicle-treated animals consumed more food than both SHAM vehicle-treated animals and OVX+E vehicle treated animals at week 4 (SHAM vehicle -treated, 329 ⁇ 7 g; OVX vehicle-treated, 354 ⁇ 11 g; OVX+E vehicle-treated, 326 ⁇ 7 g; p ⁇ 0.05 for OVX vs. SHAM and OVX+E groups at week 4); however, there was no difference in cumulative food intake between amylin-treated groups.
• Amylin treatment was also associated with significant reductions in adiposity (percent fat mass) as depicted in Figures 3A (vehicle corrected) and 3B (not vehicle corrected).
• adiposity percent fat mass
• Figures 3A (vehicle corrected) and 3B (not vehicle corrected) amylin infusion induced a reduction in adiposity of about 7.5 ⁇ 0.6% compared to vehicle.
• amylin infusion induced a reduction in adiposity of about 4.7% compared to vehicle.
• Each group of rats was administered either vehicle or one of the following amylin agonists: 50 ⁇ g/kg/day of SEQ ID NO: 20; 2 ⁇ g/kg/day of SEQ ID NO: 137; or 5 ⁇ g/kg/day of SEQ ID NO: 142.
• these exemplary amylin agonists at least attenuate typical weight gain that is associated with estrogen deficiency and can even elicit enhanced weight loss in the setting of estrogen deficiency relative to the SHAM contrils, which have normal estrogen levels.
• Rats were housed in the metabolic chambers for 2 nights and rates of oxygen consumption (VO 2 ), a proxy for metabolic rate, and carbon dioxide production (VCO 2 ) were measured using a high-speed Oxymax indirect calorimetry system (Columbus Instruments, Columbus, OH). Metabolic rate was normalized for initial body weight of the animal. Respiratory quotient (RQ) was calculated as VCO 2 AVO 2 . Total physical activity in the X-axis (laser beam breaks) was also measured throughout the experiment. An automated feeding system apparatus allowed accurate continuous monitoring of food intake. After two nights, rats were returned to home caging and utilized for assessment of neurogenesis (described below).
• VO 2 oxygen consumption
• VCO 2 carbon dioxide production
• Rats were housed in the metabolic chambers for 5 nights and VO 2 and VCO 2 normalized to initial body weight were measured using a high-speed Oxymax indirect calorimetry system (Columbus Instruments). Total physical activity in the X-axis (laser beam breaks) was also measured.
• An automated feeding system restricted the amount of food allowed to half the vehicle group such that they consumed the mean amount of food consumed by the amylin-treated animals every 30 mins. In effect, this control group is therefore truly food-matched, or yoked-fed, as they consumed the same amount of food at approximately the same time as the test (amylin-treated) group, rather than in a traditional pair-fed group where animals consume their daily allotment of food quickly after presentation.
• OVX was associated with reduced metabolic rate and reduced preference for utilizing fat relative to SHAM controls, and amylin administration to OVX females exerted pro-metabolic consequences including increasing metabolic rate and fat oxidation, as well as physical activity, that likely contribute to the overall enhanced weight loss observed in this model.
• OVX - vehicle controls 82.0 ⁇ 3.9 g
• body weight was reduced by amylin treatment and yoked feeding: OVX - vehicle, 25.0 ⁇ 2.4 g; OVX - amylin, 4.5 ⁇ 6.6 g; OVX - YF, -3.2 ⁇ 2.3 g (p ⁇ 0.05 for amylin and YF groups vs. vehicle).
• amylin administration had no significant effect on VO 2 levels, however OVX - YF rats demonstrated reduced VO 2 compared to OVX - vehicle and OVX - amylin groups ( Figures 6 A and 6B).
• Immunohistochemistry was performed on free-floating sections. For c-Fos, blocking was performed with 1% bovine serum albumin (BSA). Rabbit polyclonal antibody against amino acids 210-335 of human c-Fos protein that are not cross-reactive with FosB, Fra-1, and Fra-2 (Santa Cruz Biotechnology, Santa Cruz, CA) were used in a dilution of 1 :4,000. Sections were incubated overnight at 4 0 C. The next day tissue was incubated with goat anti-rabbit Alexa-Fluor 488 secondary antibody (1 :250, Molecular Probes, Eugene, OR) in PBS/Triton for 2 hr in the dark.
• BSA bovine serum albumin
• Tissue from these rats was subsequently double labeled for BrdU along with NeuN, a marker for mature neurons, so that the type of cell could be accurately determined.
• the protocol was identical to that described above, except that sections were also incubated with mouse monoclonal primary anti-NeuN, ( i :100, Chemicon international), and then with goat anti-mouse AJoxa-Fluor 594 secondary antibody Cl :250, Molecular Probed.
• Ovariectomy is known to decrease neurogenesis in the hippocampus, a deficit that can be corrected with estrogen replacement (18).
• BrdU-immunoreactivity was measured within the area postrema (AP), the nucleus of the solitary tract (NTS) and the hippocampus, specific brain regions known to show spontaneous neurogenesis (19, 20).
• OVX treatment reduced neurogenesis below baseline and sustained infusion of amylin was able to restore it (p ⁇ 0.05) (depicted quantitatively by graph in Figure 8B; BrdU staining with DAB in hippocampous of an OVX/amylin-treated animal illustrated in Figure 8 A; BrdU/neuN staining in the hippocampus of a different OVX/amylin-treated animal illustrated in Figure 8C).
• amylin significantly increased the number of BrdU-positive cells above that of OVX- vehicle, and both SHAM groups (p ⁇ 0.05) (depicted quantitatively by graph in Figure 71; see, e.g., Figures 7B, 7D, 7F, and 7H).
• Example 7 Invesitgation of a role for amylin-dependent increase in leptin sensitivity as a mediator of amylin 's improved efficacy in estrogen-deficient rats. Materials and methods.
• Plasma metabolite analyses Plasma metabolite analyses. Terminal plasma insulin (Crystal Chem Inc., Downer's Grove, IL), and leptin, total adiponectin and total ghrelin (Millipore, Billerica, MD) levels were measured using commercially available ELISA. Plasma glucose, triglyceride, and total cholesterol levels were measured using an Olympus bioanalyzer (Olympus America Diagnostics, Center Valley, PA). Plasma amylin levels were measured using an internal IEMA.
• the OVX state is known to profoundly increase body weight as well as body fat mass and corresponding plasma leptin levels.
• Plasma triglycerides were reduced in OVX rats compared to SHAM ZDF controls and, unlike in lean animals where amylin infusion reduced plasma triglycerides, there was no effect of amylin (Table 3).
• Total cholesterol levels were reduced in SHAM ZDF rats, but were overall increased by OVX, with no change in lean animals (Table 3).
• i p ⁇ 0.05 vs. vehicle control within surgical group; ⁇ p ⁇ 0.05 vs. SHAM within drug treatment; ⁇ p ⁇ 0.05 vs. OVX within treatment.
• OVX has been associated with reduced brown adipose tissue expression of uncoupling protein- 1 mRNA, a common marker of metabolism, suggesting that metabolic rate was suppressed by OVX (28).
• Reduced metabolism and fat utilization in OVX rats could contribute significantly to the overall enhanced weight and adipose tissue gain in this model.
• amylin agonism to SHAM rats maintained, but did not increase, metabolic rate and reduced RQ.
• amylin significantly increased, but did not fully normalize, metabolic rate and also reduced RQ and increased dark phase locomotor activity.
• the synergistic weight loss is fat-specific and reflective of recaptured leptin sensitivity in a previously leptin-resistant model: enhanced metabolic rate and increased fat utilization, and greater fat loss, relative to pair-fed controls (32).
• amylin reduced body weight to a greater extent in OVX rats by increasing sensitivity to endogenous leptin by infusing amylin to SHAM or OVX ZDF rats that exhibit an obesity syndrome due to a non- functioning leptin receptor.
• SEQ ID NO:50 isocaproyl-STAVLGRLSQELHRLQTYPRTNTGSNTY
• KCNTASCVLGRLSQELHRLQTYPRTNTGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 32 Tyr is optionally amidated.
• KCNTAVCVLGRLSQELHRLQTYPRTNTGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 32 Tyr is optionally amidated.
• KCNTATCVLGRLSQELHRYPRTNTGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 29 Tyr is optionally amidated.
• KCNTATCVLGK(For)LSQELHK(For)LQTYPRTNTGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and the C-terminal Tyr is optionally amidated.
• KCNTATCVLGRLSQELHRLQTLQTYPRTNTGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 35 Tyr is optionally amidated.
• KCNTATCVLGRLSQELHRLQTLLQTYPRTNTGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 35 Tyr is optionally amidated.
• KCNTSTCVLGRLSQELHRLQTYPRTNTGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 32 Tyr is optionally amidated.
• KCNTATCATQRLSQELHRLQTYPRTNTGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 32 Tyr is optionally amidated.
• KCNTATCATQRLSQELHRLQTYPRTNVGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 32 Tyr is optionally amidated.
• KCNTSTCATQRLANELVRLQTYPRTNVGSNTY Where 2 CyS and 7 CyS are optionally linked by a disulfide bond; and 32 Tyr is optionally amidated.
• Cys and Cys are optionally linked by a disulfide bond; and Tyr is optionally amidated.
• CyS and 7 CyS are optionally linked by a disulfide bond; and 32 Pro is optionally amidated.
• CyS and 7 CyS are optionally linked by a disulfide bond; and 32 Pro is optionally amidated.
• CyS and 49 CyS are optionally linked by a disulfide bond; and 32 Pro is optionally amidated.

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• 2010
  • 2010-04-09 WO PCT/US2010/030625 patent/WO2010118384A2/en not_active Ceased
  • 2010-04-09 EP EP20100762535 patent/EP2416797A4/en not_active Withdrawn
  • 2010-04-09 JP JP2012504907A patent/JP2012523434A/ja active Pending
  • 2010-04-09 US US13/263,070 patent/US20120071401A1/en not_active Abandoned

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