WO2012151159A1 - Methods of modulating pla2g12a levels and treating disorders associated therewith - Google Patents

Abstract

Compositions and methods for modulating levels of PLA2G12A are provided. Methods for treating various conditions, such as conditions that are associated with or that result in reduced muscle function and/or muscle mass, are provided. Methods for modulating glucose and/or insulin levels in glucose metabolism disorders are provided.

Description

METHODS OF MODULATING PLA2G12A LEVELS AND TREATING DISORDERS

ASSOCIATED THEREWITH

CROSS-REFERENCE

[0001] This application claims the benefit of U.S. Provisional Patent Application No.

61/481,436, filed May 2, 2011, and U.S. Provisional Patent Application No. 61/481,439, filed May 2, 2011, which applications are incorporated herein by reference in their entirety.

INTRODUCTION

[0001] High blood glucose levels stimulate the secretion of insulin by pancreatic beta-cells.

Insulin in turn stimulates the entry of glucose into muscles and adipose cells, leading to the storage of glycogen and triglycerides and to the synthesis of proteins. Activation of insulin receptors on various cell types diminishes circulating glucose levels by increasing glucose uptake and utilization, and by reducing hepatic glucose output. Disruptions within this regulatory network can result in diabetes and associated pathologic syndromes that affect a large and growing percentage of the human population.

[0002] Patients who have a glucose metabolism disorder can suffer from hyperglycemia,

hyperinsulinemia, and/or glucose intolerance. An example of a disorder that is often associated with the aberrant levels of glucose and/or insulin is insulin resistance, in which liver, fat, and muscle cells lose their ability to respond to normal blood insulin levels.

[0003] Muscle wasting is associated with a number of diseases and conditions. Currently there are few effective treatments for such disorders.

[0004] There is a need in the art for therapy that can modulate glucose and/or insulin levels in a patient and enhance the biological response to fluctuating glucose levels; and for methods of increasing muscle function and/or mass, in the context of disorders, diseases, and conditions that are associated with or that result in reduced muscle function and/or muscle mass. SUMMARY

[0005] The present disclosure provides compositions that find use in modulating levels of

PLA2G12A. The present disclosure provides methods for treating various conditions, such as conditions that are associated with or that result in reduced muscle function and/or muscle mass. The present disclosure provides methods for modulating glucose and/or insulin levels in glucose metabolism disorders.

[0006] The present disclosure provides compositions that find use in modulating glucose and/or insulin levels in glucose metabolism disorders. The present methods involve using an isolated protein PLA2G12A for modulating glucose metabolism. The protein may be used as therapy to treat various glucose metabolism disorders, such as diabetes mellitus, and/or obesity. The subject proteins encompass those expressed by PLA2G12A genes, and homologues thereof, and are useful for treating one or more of the following conditions: diabetes mellitus (e.g. diabetes type I ,diabetes type II and gestational diabetes), insulin resistance, hyperinsulinemia, glucose intolerance, hyperglycemia or metabolic syndrome.

[0007] The present disclosure provides compositions and methods for increasing levels and/or activity of PLA2G12A. The present disclosure provides compositions and methods for increasing muscle function and/or muscle mass. The present methods involve use of an isolated PLA2G12A polypeptide. Subject compositions and methods are useful for treating various conditions and disorders characterized by loss of muscle function and/or muscle mass.

BRIEF DESCRIPTION OF THE DRAWINGS

[0008] Figure 1 shows body weight of mice that were injected with an adeno-associated virus (AAV) vector expressing a protein of the present disclosure or a control virus and then placed on a high fat diet. Lean, chow-fed mice are included as an additional control (n = 7 mice per group).

[0009] Figure 2 shows blood glucose of mice that were injected with an AAV vector expressing a protein of the present disclosure or a control virus and then placed on a high fat diet. Lean, chow-fed mice are included as an additional control (n = 7 mice per group).

[0010] Figure 3 shows insulin levels of mice that were injected with an AAV vector expressing a protein of the present disclosure or a control virus and then placed on a high fat diet for 4 weeks. Lean, chow-fed mice are included as an additional control (n = 7 mice per group).

[0011] Figure 4 shows the level of glucose in mice over a 60 minute period post injection of lg/kg of glucose. Glucose tolerance was monitored in mice that were injected with an AAV vector expressing a protein of the present disclosure or a control virus and then placed on a high fat diet for 6 weeks. Lean, chow-fed mice are included as an additional control (n = 7 mice per group).

[0012] Figure 5 shows forelimb grip strength of 14 week old mice that were injected with an adeno-associated virus (AAV) expressing a protein of the present disclosure (mouse ortholog) at day 1-3 by intraperitoneal injection compared to those of mice injected with a control virus (n=10 per group).

[0013] Figure 6 shows body weight, lean mass, and fat mass of 14 week old mice that were injected with AAV expressing a protein of the present disclosure (mouse ortholog) at day 1-3 by intraperitoneal injection compared to those of mice injected with a control virus (n=10 per group).

[0014] Figure 7 shows Tibialis Anterior (TA), Quadriceps (Quad), Triceps (Tricep), Biceps (Bicep) muscle mass of 14 week old mice that were injected with AAV expressing a protein of the present disclosure (mouse ortholog) at day 1-3 by intraperitoneal injection compared to those of mice injected with a control virus (n=5 per group).

[0015] Figure 8 shows tetanic force generated by Tibialis Anterior muscle of mdx mice that were injected with AAV expressing a protein of the present disclosure (mouse ortholog) at week 11 by intramuscular injection compared to those of mice injected with a control virus (n=5 per group).

[0016] Figure 9 shows levels of message RNA of Embryonic Myosin Heavy Chain (MHC), MyoD and Myogenin in Tibialis Anterior muscle 3 days following intramuscular injection of Cardiotoxin (CTX) in 14 week old mice that were pre-injected as 1-3 day old neonates with AAV expressing a protein of the present disclosure (mouse ortholog) or control GFP virus (n=5 per group). Additional controls include groups of mice injected with AAV expressing a protein of the present disclosure, or GFP control virus, without CTX injection (n=5 per group).

[0017] Figure 10 shows an alignment of various amino acid sequences of PLA2G12A. [0018] Before the present invention is further described, it is to be understood that this invention is not limited to particular embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.

[0019] Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limit of that range and any other stated or intervening value in that stated range, is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included in the smaller ranges, and are also encompassed within the invention, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the invention.

[0020] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can also be used in the practice or testing of the present invention, the preferred methods and materials are now described. All publications mentioned herein are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited.

[0021] It must be noted that as used herein and in the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to "the protein" includes reference to one or more proteins, and so forth. It is further noted that the claims may be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as "solely," "only" and the like in connection with the recitation of claim elements, or use of a "negative" limitation.

[0022] The publications discussed herein are provided solely for their disclosure prior to the filing date of the present application. Nothing herein is to be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed. DETAILED DESCRIPTION

OVERVIEW

[0023] The present disclosure provides compositions and methods for increasing levels and/or activity of PLA2G12A. The compositions and methods find use in increasing muscle function and/or muscle mass. The compositions and methods find use in modulating glucose and/or insulin levels in glucose metabolism disorders.

Modulating glucose and/or insulin levels

[0024] The present disclosure provides compositions that find use in modulating glucose and/or insulin levels in glucose metabolism disorders. The compositions encompass

PLA2G12A (also known as PLA2G12, phospholipase A2, group XIIA, or group XII sPLA2, FKSG38, or UNQ2519/PRO6012) genes and/or proteins encoded thereby, and are useful for conditions of glucose metabolism dysregulation such as, but not limited to, diabetes mellitus (e.g. diabetes type I, diabetes type II, and gestational diabetes). In a diet-induced obesity model (mice on a high fat diet), the glucose and insulin levels are higher than those in a subject on a regular lean diet. However, when the proteins of the present disclosure are administered (as exemplified by expression from an AAV vector), the subject on the high fat diet regains the ability to regulate glucose levels, to an extent seen in subjects on a regular lean diet. Accordingly, the proteins of the present disclosure may be used in restoring glucose homeostasis in subjects with a dysfunctional glucose metabolism, including subjects who may be overweight, obese, and/or on a high fat diet. Methods of increasing muscle mass and/or function

[0025] The proteins targeted by the methods and compositions of the present disclosure

encompass PLA2G12A, PLA2G12A genes and/or proteins encoded thereby, and are useful for treating individuals having a deficiency in muscle function and/or having reduced muscle mass, e.g., for treating disorders, diseases, and conditions in which reduced muscle function and/or mass is a result, a sequela, or a symptom of the disorder, disease, or condition. When PLA2G12A protein was administered (as exemplified by expression from an AAV vector) to wild-type mice, increased grip strength was observed. In the mdx mouse model of Duchenne muscular dystrophy, administration of PLA2G12A protein (as exemplified by expression from an AAV vector) resulted in increased tetanic force in the tibialis anterior muscle. Furthermore, in a cardiotoxin- induced model of muscle injury, administration of PLA2G12A protein (as exemplified by expression from an AAV vector) led to muscle repair, as evidenced by increases in levels of myosin heavy chain mRNA, and in levels of differentiation- specific muscle transcription factors (MyoD and Myogenin) mRNA. Accordingly, administering a PLA2G12A protein, to increase circulating and/or tissue levels of PLA2G12A and/or to increase PLA2G12A activity, can be used to increase muscle function and/or muscle mass in an individual. Administering a PLA2G12A protein can be used to treat disorders, diseases, and conditions in which reduced muscle function (e.g., muscle weakness) and/or reduced muscle mass is a result, a sequela, or a symptom of the disorder, disease, or condition.

DEFINITIONS

[0026] The terms "patient" or "subject" as used interchangeably herein in the context of

therapy, refer to a human and non-human animal, as the recipient of a therapy or preventive care.

[0027] The phrase "in a sufficient amount to effect a change in" means that there is a detectable difference between a level of an indicator measured before and after administration of a particular therapy. In the context of modulating glucose and/or insulin levels, indicators include but are not limited to glucose and insulin. In the context of increasing muscle mass and/or function, indicators include but are not limited to muscle mass and muscle strength.

[0028] The phrase "glucose tolerance", as used herein, refers to the ability of a subject to

control the level of plasma glucose and/or plasma insulin when glucose intake fluctuates. For example, glucose tolerance encompasses the ability to reduce the level of plasma glucose back to a level before the intake of glucose within about 120 minutes or so.

[0029] The phrase "pre-diabetes", as used herein, refers to a condition that may be determined using either the fasting plasma glucose (FPG) test or the oral glucose tolerance test (OGTT). Both require a person to fast overnight. In the FPG test, a person's blood glucose is measured first thing in the morning before eating. In a healthy individual, a normal test result of FPG would indicate a glucose level of below about 100 mg/dl. A subject with pre-diabetes would have a FPG level between about 100 and about 125 mg/dl. If the blood glucose level rises to about 126 mg/dl or above, the subject is determined to have "diabetes". In the OGTT, the subject's blood glucose is measured after a fast and 2 hours after drinking a glucose-rich beverage. Normal blood glucose in a healthy individual is below about 140 mg/dl 2 hours after the drink. In a pre-diabetic subject, the 2-hour blood glucose is about 140 to about 199 mg/dl. If the 2-hour blood glucose rises to 200 mg/dl or above, the subject is determined to have "diabetes".

[0030] "PLA2G12A" (also known as PLA2G12, phospholipase A2, group XIIA, or group XII sPLA2, FKSG38, or UNQ2519/PRO6012) encompasses murine and human proteins that are encoded by gene PLA2G12A or a gene homologue of PLA2G12A. PLA2G12A is found in many mammals (e.g. human, non-human primates, canines, and mouse). See Figure 10 for alignments of various amino acid sequences of PLA2G12A.

[0031] As used herein, "homologues" or "variants" refers to protein or DNA sequences that are similar based on their amino acid or nucleic acid sequences, respectively. Homologues or variants encompass naturally occurring DNA sequences and proteins encoded thereby and their isoforms. The homologues also include known allelic or splice variants of a protein/gene. Homologues and variants also encompass nucleic acid sequences that vary in one or more bases from a naturally-occurring DNA sequence but still translate into an amino acid sequence that correspond to the naturally-occurring protein due to degeneracy of the genetic code. Homologues and variants may also refer to those that differ from the naturally- occurring sequences by one or more conservative substitutions and/or tags and/or conjugates.

[0032] The terms "polypeptide," "peptide," and "protein", used interchangeably herein, refer to a polymeric form of amino acids of any length, which can include genetically coded and non-genetically coded amino acids, chemically or biochemically modified or derivatized amino acids, and polypeptides having modified peptide backbones. The term includes fusion proteins, including, but not limited to, fusion proteins with a heterologous amino acid sequence, fusions with heterologous and homologous leader sequences, with or without N-terminal methionine residues; immunologically tagged proteins; and the like.

[0033] It will be appreciated that throughout this present disclosure reference is made to amino acids according to the single letter or three letter codes. For the reader's convenience, the single and three letter amino acid codes are provided below:

G Glycine Gly P Proline Pro

A Alanine Ala V Valine Val L Leucine Leu I Isoleucine He

M Methionine Met c Cysteine Cys

F Phenylalanine Phe Y Tyrosine Tyr

W Tryptophan Trp H Histidine His

K Lysine Lys R Arginine Arg

Q Glutamine Gin N Asparagine Asn

E Glutamic Acid Glu D Aspartic Acid Asp

S Serine Ser T Threonine Thr

[0034] The terms "nucleic acid molecule" and "polynucleotide" are used interchangeably and refer to a polymeric form of nucleotides of any length, either deoxyribonucleotides or ribonucleotides, or analogs thereof. Non-limiting examples of polynucleotides include linear and circular nucleic acids, messenger RNA (mRNA), cDNA, recombinant polynucleotides, vectors, probes, and primers.

[0035] The term "heterologous" refers to two components that are defined by structures derived from different sources. For example, where "heterologous" is used in the context of a polypeptide, where the polypeptide includes operably linked amino acid sequences that can be derived from different polypeptides (e.g., a first component consisting of a recombinant peptide and a second component derived from a native PLA2G12A polypeptide). Similarly, "heterologous" in the context of a polynucleotide encoding a chimeric polypeptide includes operably linked nucleic acid sequence that can be derived from different genes (e.g., a first component from a nucleic acid encoding a peptide according to an embodiment disclosed herein and a second component from a nucleic acid encoding a carrier polypeptide). Other exemplary "heterologous" nucleic acids include expression constructs in which a nucleic acid comprising a coding sequence is operably linked to a regulatory element (e.g., a promoter) that is from a genetic origin different from that of the coding sequence (e.g., to provide for expression in a host cell of interest, which may be of different genetic origin relative to the promoter, the coding sequence or both). For example, a T7 promoter operably linked to a polynucleotide encoding a PLA2G12A polypeptide or domain thereof is said to be a heterologous nucleic acid. "Heterologous" in the context of recombinant cells can refer to the presence of a nucleic acid (or gene product, such as a polypeptide) that is of a different genetic origin than the host cell in which it is present. [0036] The term "operably linked" refers to functional linkage between molecules to provide a desired function. For example, "operably linked" in the context of nucleic acids refers to a functional linkage between nucleic acids to provide a desired function such as transcription, translation, and the like, e.g., a functional linkage between a nucleic acid expression control sequence (such as a promoter, signal sequence, or array of transcription factor binding sites) and a second polynucleotide, wherein the expression control sequence affects transcription and/or translation of the second polynucleotide. "Operably linked" in the context of a polypeptide refers to a functional linkage between amino acid sequences (e.g., of different domains) to provide for a described activity of the polypeptide.

[0037] As used herein in the context of the structure of a polypeptide, "N-terminus" and "C- terminus" refer to the extreme amino and carboxyl ends of the polypeptide, respectively, while "N-terminal" and "C-terminal" refer to relative positions in the amino acid sequence of the polypeptide toward the N-terminus and the C-terminus, respectively, and can include the residues at the N-terminus and C-terminus, respectively. "Immediately N-terminal" or "immediately C-terminal" refers to a position of a first amino acid residue relative to a second amino acid residue where the first and second amino acid residues are covalently bound to provide a contiguous amino acid sequence.

[0038] "Derived from" in the context of an amino acid sequence or polynucleotide sequence (e.g., an amino acid sequence "derived from" a PLA2G12A polypeptide) is meant to indicate that the polypeptide or nucleic acid has a sequence that is based on that of a reference polypeptide or nucleic acid (e.g., a naturally occurring PLA2G12A

polypeptide or PLA2G12A-encoding nucleic acid), and is not meant to be limiting as to the source or method in which the protein or nucleic acid is made.

[0039] "Isolated" refers to a protein of interest that, if naturally occurring, is in an environment different from that in which it may naturally occur. "Isolated" is meant to include proteins that are within samples that are substantially enriched for the protein of interest and/or in which the protein of interest is partially or substantially purified. Where the protein is not naturally occurring, "isolated" indicates the protein has been separated from an environment in which it was made by either synthetic or recombinant means.

[0040] "Enriched" means that a sample is non-naturally manipulated (e.g., by an

experimentalist or a clinician) so that a protein of interest is present in a greater concentration (e.g., at least a three-fold greater, at least 4-fold greater, at least 8-fold greater, at least 64-fold greater, or more) than the concentration of the protein in the starting sample, such as a biological sample (e.g., a sample in which the protein naturally occurs or in which it is present after administration), or in which the protein was made (e.g., as in a bacterial protein and the like).

[0041] "Substantially pure" indicates that an entity (e.g., polypeptide) makes up greater than about 50% of the total content of the composition (e.g., total protein of the composition) and typically, greater than about 60% of the total protein content. More typically, "substantially pure" refers to compositions in which at least 75%, at least 85%, at least 90% or more of the total composition is the entity of interest (e.g. 95%, or more, of the total protein). In some embodiments, the protein will make up greater than about 90%, and in some embodiments, greater than about 95% of the total protein in the

composition.

PLA2G12A

[0042] The subject proteins find use in increasing the level and/or activity of PLA2G12A in an individual.

[0043] For example, the subject proteins find use in regulating levels of glucose and insulin in a subject; and in increasing muscle mass and/or function in a subject. Such proteins find use in treating and/or preventing aberrant levels of glucose and insulin, even if the subject has or has been on a high-fat diet. As another example, the subject proteins find use in methods of increasing muscle function and/or muscle mass in a patient.

[0044] The present disclosure provides the use of proteins encompassing naturally-occurring full-length and/or fragments of an amino acid sequence of a PLA2G12A polypeptide and homologues from different species, and use of such proteins in preparation of formulation for therapy and in treatment methods (e.g., modulating glucose and/or insulin levels; and increasing muscle mass and/or function). Exemplary embodiments of such are described below.

[0045] "PLA2G12A", as used in the method of the present disclosure is also known as

PLA2G12, phospholipase A2, group XIIA, or group XII sPLA2, FKSG38, or

UNQ2519/PRO6012. PLA2G12A encompasses murine and human variants that are encoded by the PLA2G12A gene or a gene homologous to PLA2G12A. [0046] PLA2G12A refers to PLA2G12A proteins or PLA2G12A DNA sequences, which encompass their naturally occurring isoforms and/or allelic/splice variants. A

PLA2G12A protein also refers to proteins that have one or more alteration in the amino acid residues (e.g. at locations that are not conserved across variants and/or species) while retaining the conserved domains and having the same biological activity as the naturally-occurring PLA2G12A. PLA2G12A also encompasses nucleic acid sequences that vary in one or more bases from a naturally-occurring DNA sequence but still translate into an amino acid sequence that correspond to the a naturally-occurring protein due to degeneracy of the genetic code. For example, PLA2G12A may also refer to those that differ from the naturally- occurring sequences of PLA2G12A by one or more conservative substitutions and/or tags and/or conjugates.

[0047] Proteins used in a method of the present disclosure contain contiguous amino acid

residues of a length derived from PLA2G12A. A sufficient length of contiguous amino acid residues may vary depending on the specific naturally-occurring amino acid sequence from which the protein is derived. For example, the protein may be at least 100 amino acids to 150 amino acid residues in length, or at least 150 amino acids up to the full-length protein (e.g., 180 amino acids, 185 amino acids, 190 amino acids, 195 amino acids). For example, the protein may be of about 189 amino acid residues in length when derived from a human PLA2G12A protein, or of about 192 amino acid residues in length when derived from a mouse PLA2G12A protein.

[0048] A protein containing an amino acid sequence that is substantially similar to the amino acid sequence of a PLA2G12A polypeptide includes a polypeptide comprising an amino acid sequence having at least about 72%, at least about 75%, at least about 80%, at least about 85%, at least about 89%, at least about 90%, at least about 95%, at least about 98%, or at least about 99%, amino acid sequence identity to a contiguous stretch of from about 100 amino acids (aa) to about 150 aa, from about 150 aa to about 175 aa, or from about 175 aa to about 190 aa, up to the full length of a naturally occurring PLA2G12A polypeptide. For example, a PLA2G12A polypeptide suitable for use in a subject method can comprise an amino acid sequence having at least about 72%, at least about 75%, at least about 80%, at least about 85%, at least about 89%, at least about 90%, at least about 95%, at least about 98%, or at least about 99%, amino acid sequence identity to a contiguous stretch of from about 100 amino acids (aa) to about 150 aa, from about 150 aa to about 175 aa, or from about 175 aa to about 190 aa, up to the full length (e.g., up to 195 aa), of the human PLA2G12A polypeptide amino acid sequence (SEQ ID NO: l) depicted in Figure 10.

[0049] In some cases, a suitable PLA2G12A polypeptide lacks a signal peptide. For example, in some cases, a PLA2G12A polypeptide suitable for use in a subject method can comprise an amino acid sequence having at least about 72%, at least about 75%, at least about 80%, at least about 85%, at least about 89%, at least about 90%, at least about 95%, at least about 98%, or at least about 99%, amino acid sequence identity to amino acids 23- 189 of a human PLA2G12A polypeptide (e.g., as shown in Figure 10), where the PLA2G12A polypeptide lacks a signal peptide (e.g., where the signal peptide of the human PLA2G12A polypeptide shown in Figure 10 is amino acids 1-22).

[0050] The protein may lack at least 5, at least 10, up to at least 50 or more aa relative to a

naturally-occurring full-length PLA2G12A polypeptide. For example, the protein may not contain the signal sequence based on the amino acid sequence of a naturally- occurring PLA2G12A polypeptide. The protein may also contain the same or similar glycosylation pattern as those of a naturally-occurring PLA2G12A polypeptide, may contain no glycosylation, or the glycosylation pattern of host cells used to produce the protein.

[0051] Many DNA and protein sequences of PLA2G12A are known in the art and certain

sequences are discussed below.

[0052] The proteins used in the method of the present disclosure include those containing

contiguous amino acid sequences of any naturally- occurring PLA2G12A, as well as those having 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 usually no more than 20, 10, or 5 amino acid substitutions, where the substitution is usually a conservative amino acid substitution. By "conservative amino acid substitution" generally refers to substitution of amino acid residues within the following groups:

1) L, I, M, V, F;

2) R, K;

3) F, Y, H, W, R;

4) G, A, T, S;

5) Q, N; and

6) D, E.

[0053] Conservative amino acid substitutions in the context of a peptide or a protein disclosed herein are selected so as to preserve putative activity of the protein. Such activity may be preserved by substituting with an amino acid with a side chain of similar acidity, basicity, charge, polarity, or size to the side chain of the amino acid being replaced. Guidance for substitutions, insertion, or deletion may be based on alignments of amino acid sequences of different variant proteins or proteins from different species. For example, according to the alignment shown in Figure 10, at certain residue positions that are fully conserved (*), substitution, deletion or insertion may not be allowed while at other positions where one or more residues are not conserved, an amino acid change can be tolerated. Residues that are semi-conserved (. or :) may tolerate changes that preserve charge, polarity, and/or size.

[0054] The present disclosure provides any of the PLA2G12A polypeptides described above.

The protein may be isolated from a natural source, e.g., is in an environment other than its naturally-occurring environment. The subject protein may also be recombinantly made, e.g., in a genetically modified host cell (e.g., bacteria; yeast; Pichia; insect;

mammalian cells; and the like), where the genetically modified host cell is genetically modified with a nucleic acid comprising a nucleotide sequence encoding the subject protein. The subject protein encompasses synthetic polypeptides, e.g., a subject synthetic polypeptide is synthesized chemically in a laboratory (e.g., by cell-free chemical synthesis). Methods of productions are described in more detail below.

Nucleic acid and protein sequences

[0055] The subject polypeptide may be generated using recombinant techniques to manipulate nucleic acids of different PLA2G12A known in the art to provide constructs encoding a protein of interest. It will be appreciated that, provided an amino acid sequence, the ordinarily skilled artisan will immediately recognize a variety of different nucleic acids encoding such amino acid sequence in view of the knowledge of the genetic code.

[0056] For production of subject protein derived from naturally-occurring polypeptides, it is noted that nucleic acids encoding a variety of different PLA2G12A polypeptides are known and available in the art. Nucleic acid (and amino acid sequences) for various PLA2G12A are also provided in GenBank as accession nos.: 1) Homo sapiens: amino acid sequence AAG50243; nucleotide sequence: AF306567; 2) Mus musculus: amino acid sequence AAH26812; nucleotide sequence BC026812; 3) Gallus gallus: amino acid sequence XP_001235270.1; nucleotide sequence XM_001235269.1. Exemplary amino acid sequences are depicted in Figure 10. Several sequences and further information on the nucleic acid and protein sequences can also be found in the Example section below.

[0057] It will be appreciated that the nucleotide sequences encoding the protein may be

modified so as to optimize the codon usage to facilitate expression in a host cell of interest (e.g., Escherichia coli, and the like). Methods for production of codon optimized sequences are known in the art.

Protein modifications

[0058] The proteins used in the present disclosure can be provided as proteins that are modified relative to the naturally-occurring protein. Purposes of the modifications may be to increase a property desirable in a protein formulated for therapy (e.g. serum half-life), to raise antibody for use in detection assays, and/or for protein purification, and the like.

[0059] One way to modify a subject protein is to conjugate (e.g. link) one or more additional elements at the N- and/or C-terminus of the protein, such as another protein (e.g. having an amino acid sequence heterologous to the subject protein) and/or a carrier molecule. Thus, an exemplary protein can be provided as fusion proteins with a polypeptide(s) derived from a PLA2G12A polypeptide.

[0060] Conjugate modifications to proteins may result in a protein that retains the desired

activity, while exploiting properties of the second molecule of the conjugate to impart and/or enhances certain properties (e.g. desirable for therapeutic uses). For example, the polypeptide may be conjugated to a molecule, e.g., to facilitate solubility, storage, half- life, reduction in immunogenicity, controlled release in tissue or other bodily location (e.g., blood or other particular organs, etc.).

[0061] Other features of a conjugated protein may include one where the conjugate reduces toxicity relative to unconjugated protein. Another feature is that the conjugate may target a type of cell or organ more efficiently than an unconjugated material. The protein can optionally have attached a drug to further counter the causes or effects associated with disorders of glucose metabolism (e.g., drug for high cholesterol), and/or can optionally be modified to provide for improved pharmacokinetic profile (e.g., by PEGylation, hyperglycosylation, and the like).

[0062] Modifications that can enhance serum half-life of the subject proteins are of interest. A subject protein may be "PEGylated", as containing one or more poly(ethylene glycol) (PEG) moieties. Methods and reagents suitable for PEGylation of a protein are well known in the art and may be found in US Pat. No. 5,849,860, disclosure of which is incorporated herein by reference. PEG suitable for conjugation to a protein is generally soluble in water at room temperature, and has the general formula R(0-CH₂-CH₂)_nO-R, where R is hydrogen or a protective group such as an alkyl or an alkanol group, and where n is an integer from 1 to 1000. Where R is a protective group, it generally has from 1 to 8 carbons.

[0063] The PEG conjugated to the subject protein can be linear. The PEG conjugated to the subject protein may also be branched. Examples of branched PEG derivatives include those described in U.S. Pat. No. 5,643,575, "star-PEG's" and multi-armed PEG's such as those described in Shearwater Polymers, Inc. catalog "Polyethylene Glycol Derivatives 1997-1998." Star PEGs are described in the art including, e.g., in U.S. Patent No.

6,046,305.

[0064] Where the proteins are to be incorporated into a liposome, carbohydrate, lipid moiety, including N-fatty acyl groups such as N-lauroyl, N-oleoyl, fatty amines such as dodecyl amine, oleoyl amine, and the like (e.g., see US 6,638,513) may also be used to modify the subject proteins.

[0065] Where the subject proteins are used to raise antibodies specific for the subject protein, elements that may be conjugated include large, slowly metabolized macromolecules such as: proteins; polysaccharides, such as sepharose, agarose, cellulose, cellulose beads and the like; polymeric amino acids such as polyglutamic acid, polylysine, and the like; amino acid copolymers; inactivated virus particles; inactivated bacterial toxins such as toxoid from diphtheria, tetanus, cholera, leukotoxin molecules; liposomes; inactivated bacteria; dendritic cells; and the like.

[0066] Additional suitable carriers used in eliciting antibodies are well known in the art, and include, e.g., thyroglobulin, albumins such as human serum albumin, tetanus toxoid; Diphtheria toxoid; polyamino acids such as poly(D-lysine:D-glutamic acid); VP6 polypeptides of rotaviruses; influenza virus hemagglutinin, influenza virus

nucleoprotein; hepatitis B virus core protein, hepatitis B virus surface antigen; purified protein derivative (PPD) of tuberculin from Mycobacterium tuberculosis; inactivated Pseudomonas aeruginosa exotoxin A (toxin A); Keyhole Limpet Hemocyanin (KLH); filamentous hemagglutinin (FHA) of Bordetella pertussis; T helper cell (Th) epitopes of tetanus toxoid (TT) and Bacillus Calmette-Guerin (BCG) cell wall; recombinant 10 kDa, 19 kDa and 30-32 kDa proteins from M. leprae or from M. tuberculosis, or any combination of these proteins; and the like. See, e.g., U.S. Patent No. 6,447,778 for a discussion of carriers, and for methods of conjugating peptides to carriers.

[0067] Where the subject protein is to be isolated from a source, the subject protein can be conjugated to moieties that facilitate purification, such as members of specific binding pairs, e.g., biotin (member of biotin-avidin specific binding pair), an antibody, a lectin, and the like. A subject protein can also be bound to (e.g., immobilized onto) a solid support, including, but not limited to, polystyrene plates or beads, magnetic beads, test strips, membranes, and the like.

[0068] Where the proteins are to be detected in an assay, the subject proteins may also contain a detectable label, e.g., a radioisotope (e.g., 125 I; 35 S, and the like), an enzyme which generates a detectable product (e.g., luciferase, β-galactosidase, horse radish peroxidase, alkaline phosphatase, and the like), a fluorescent protein, a chromogenic protein, dye (e.g., fluorescein isothiocyanate, rhodamine, phycoerythrin, and the like); fluorescence emitting metals, e.g., 152 Eu, or others of the lanthanide series, attached to the protein through metal chelating groups such as EDTA; chemiluminescent compounds, e.g., luminol, isoluminol, acridinium salts, and the like; bioluminescent compounds, e.g., luciferin; fluorescent proteins; and the like. Indirect labels include antibodies specific for a subject protein, wherein the antibody may be detected via a secondary antibody; and members of specific binding pairs, e.g., biotin-avidin, and the like.

[0069] Any of the above elements that are used to modify the subject proteins may be linked to the polypeptide via a linker, e.g. a flexible linker. Where a subject protein is a fusion protein comprising a PLA2G12A polypeptide and a heterologous fusion partner polypeptide, a subject fusion protein can have a total length that is equal to the sum of the PLA2G12A polypeptide and the heterologous fusion partner polypeptide.

[0070] Linkers suitable for use in modifying the proteins of the present disclosure include

"flexible linkers". If present, the linker molecules are generally of sufficient length to allow some flexible movement between the protein and the carrier. The linker molecules are generally about 6-50 atoms long. The linker molecules may also be, for example, aryl acetylene, ethylene glycol oligomers containing 2-10 monomer units, diamines, diacids, amino acids, or combinations thereof. Other linker molecules which can bind to polypeptides may be used in light of this disclosure. [0071] Suitable linkers can be readily selected and can be of any suitable length, such as from 1 amino acid (e.g., Gly) to 20 amino acids, from 2 amino acids to 15 amino acids, from 3 amino acids to 12 amino acids, including 4 amino acids to 10 amino acids, 5 amino acids to 9 amino acids, 6 amino acids to 8 amino acids, or 7 amino acids to 8 amino acids, and may be 1, 2, 3, 4, 5, 6, or 7 amino acids.

[0072] Exemplary flexible linkers include glycine polymers (G)_n, glycine- serine polymers

(including, for example, (GS)_n, GSGGS_n (SEQ ID NO:5) and GGGS_n (SEQ ID NO:6), where n is an integer of at least one), glycine- alanine polymers, alanine-serine polymers, and other flexible linkers known in the art. Glycine and glycine- serine polymers are of interest since both of these amino acids are relatively unstructured, and therefore may serve as a neutral tether between components. Glycine polymers are of particular interest since glycine accesses significantly more phi-psi space than even alanine, and is much less restricted than residues with longer side chains (see Scheraga, Rev. Computational Chem. 11173-142 (1992)). Exemplary flexible linkers include, but are not limited GGSG (SEQ ID NO:7), GGSGG (SEQ ID NO:8), GSGSG (SEQ ID NO:9), GSGGG (SEQ ID NO: 10), GGGSG (SEQ ID NO: 11), GSSSG (SEQ ID NO: 12), and the like. The ordinarily skilled artisan will recognize that design of a peptide conjugated to any elements described above can include linkers that are all or partially flexible, such that the linker can include a flexible linker as well as one or more portions that confer less flexible structure.

Methods of Production

[0073] The proteins of the present disclosure can be produced by any suitable method, including recombinant and non-recombinant methods (e.g., chemical synthesis). Where a polypeptide is chemically synthesized, the synthesis may proceed via liquid-phase or solid-phase. Solid-phase synthesis (SPPS) allows the incorporation of unnatural amino acids and/or peptide/protein backbone modification. Various forms of SPPS, such as Fmoc and Boc, are available for synthesizing peptides of the present disclosure. Details of the chemical synthesis are known in the art (e.g. Ganesan A. 2006 Mini Rev. Med Chem. 6:3-10 and Camarero JA et al. 2005 Protein Pept Lett. 12:723-8). Briefly, small insoluble, porous beads are treated with functional units on which peptide chains are built. After repeated cycling of coupling/deprotection, the free N-terminal amine of a solid-phase attached peptide is coupled to a single N-protected amino acid unit. This unit is then deprotected, revealing a new N-terminal amine to which a further amino acid may be attached. The peptide remains immobilized on the solid-phase and undergoes a filtration process before being cleaved off.

[0074] Where the protein is produced using recombinant techniques, the proteins may be

produced as an intracellular protein or as a secreted protein, using any suitable construct and any suitable host cell, which can be a prokaryotic or eukaryotic cell, such as a bacterial (e.g. Escherichia coli) or a yeast host cell, respectively.

[0075] Other examples of eukaryotic cells that may be used as host cells include insect cells, mammalian cells, and/or plant cells. Where mammalian host cells are used, the cells may include one or more of the following: human cells (e.g. HeLa, 293, H9 and Jurkat cells); mouse cells (e.g., NIH3T3, L cells, and C127 cells); primate cells (e.g. Cos 1, Cos 7 and CV1) and hamster cells (e.g., Chinese hamster ovary (CHO) cells).

[0076] A wide range of host- vector systems suitable for the expression of the subject protein may be employed according standard procedures known in the art. See for example, Sambrook et al. 1989 Current Protocols in Molecular Biology Cold Spring Harbor Press, New York and Ausubel et al. 1995 Current Protocols in Molecular Biology, Eds. Wiley and Sons.

[0077] Methods for introduction of genetic material into host cells include, for example,

transformation, electroporation, conjugation, calcium phosphate methods and the like. The method for transfer can be selected so as to provide for stable expression of the introduced PLA2G12A-encoding nucleic acid. The polypeptide-encoding nucleic acid can be provided as an inheritable episomal element (e.g., plasmid) or can be genomically integrated. A variety of appropriate vectors for use in production of a polypeptide of interest are available commercially.

[0078] Vectors can provide for extrachromosomal maintenance in a host cell or can provide for integration into the host cell genome. The expression vector provides transcriptional and translational regulatory sequences, and may provide for inducible or constitutive expression, where the coding region is operably linked under the transcriptional control of the transcriptional initiation region, and a transcriptional and translational termination region. In general, the transcriptional and translational regulatory sequences may include, but are not limited to, promoter sequences, ribosomal binding sites,

transcriptional start and stop sequences, translational start and stop sequences, and enhancer or activator sequences. Promoters can be either constitutive or inducible, and can be a strong constitutive promoter (e.g., T7, and the like).

[0079] Expression constructs generally have convenient restriction sites located near the

promoter sequence to provide for the insertion of nucleic acid sequences encoding proteins of interest. A selectable marker operative in the expression host may be present to facilitate selection of cells containing the vector. In addition, the expression construct may include additional elements. For example, the expression vector may have one or two replication systems, thus allowing it to be maintained in organisms, for example in mammalian or insect cells for expression and in a prokaryotic host for cloning and amplification. In addition the expression construct may contain a selectable marker gene to allow the selection of transformed host cells. Selectable genes are well known in the art and will vary with the host cell used.

[0080] Isolation and purification of a protein can be accomplished according to methods known in the art. For example, a protein can be isolated from a lysate of cells genetically modified to express the protein constitutively and/or upon induction, or from a synthetic reaction mixture, by immunoaffinity purification, which generally involves contacting the sample with an anti- protein antibody, washing to remove non-specifically bound material, and eluting the specifically bound protein. The isolated protein can be further purified by dialysis and other methods normally employed in protein purification methods. In one embodiment, the protein may be isolated using metal chelate

chromatography methods. Protein of the present disclosure may contain modifications to facilitate isolation, as discussed above.

[0081] The subject proteins may be prepared in substantially pure or isolated form (e.g., free from other polypeptides). The protein can present in a composition that is enriched for the polypeptide relative to other components that may be present (e.g., other

polypeptides or other host cell components). Purified protein may be provided such that the protein is present in a composition that is substantially free of other expressed proteins, e.g., less than 90%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, or less than 5%, of the composition is made up of other expressed proteins. COMPOSITIONS

[0082] The present disclosure provides compositions comprising a subject protein, which may be administered to a subject in need thereof (e.g., a subject in need of restoring glucose homeostasis; a subject in need of increasing muscle mass and/or function).

[0083] A subject protein composition can comprise, in addition to a subject protein, one or more of: a salt, e.g., NaCl, MgCl₂, KC1, MgS0₄, etc.; a buffering agent, e.g., a Tris buffer, N- (2-Hydroxyethyl)piperazine-N'-(2-ethanesulfonic acid) (HEPES), 2-(N- Morpholino)ethanesulfonic acid (MES), 2-(N-Morpholino)ethanesulfonic acid sodium salt (MES), 3-(N-Morpholino)propanesulfonic acid (MOPS), N- tris[Hydroxymethyl]methyl-3-aminopropanesulfonic acid (TAPS), etc.; a solubilizing agent; a detergent, e.g., a non-ionic detergent such as Tween-20, etc.; a protease inhibitor; glycerol; and the like.

[0084] Compositions comprising a subject protein may include a buffer, which is selected

according to the desired use of the protein, and may also include other substances appropriate to the intended use. Those skilled in the art can readily select an appropriate buffer, a wide variety of which are known in the art, suitable for an intended use.

METHODS OF MODULATING GLUCOSE AND/OR INSULIN LEVELS

[0085] The present disclosure provides methods for modulating glucose and/or insulin levels in a subject. A subject method involves administering a subject protein to an individual who has hyperglycemia, hyperinsulinemia, and/or glucose intolerance. The methods of the present disclosure include administering PLA2G12A (polypeptide or nucleic acid) in the context of a variety of conditions including glucose metabolism disorders, including the examples provided herein (in both prevention and post-diagnosis therapy).

[0086] Subjects having, suspected of having, or at risk of developing a glucose metabolism

disorder are contemplated for therapy as described herein.

[0087] By "treatment" it is meant that at least an amelioration of the symptoms associated with the condition afflicting the host is achieved, where amelioration refers to at least a reduction in the magnitude of a parameter, e.g. symptom, associated with the condition being treated. As such, treatment includes situations where the condition, or at least symptoms associated therewith, are reduced or avoided. Thus treatment includes: (i) prevention, that is, reducing the risk of development of clinical symptoms, including causing the clinical symptoms not to develop, e.g., preventing disease progression to a harmful or otherwise undesired state; (ii) inhibition, that is, arresting the development or further development of clinical symptoms, e.g., mitigating or completely inhibiting an active disease (e.g., so as to decrease level of insulin and/or glucose in the bloodstream, to increase glucose tolerance so as to minimize fluctuation of glucose levels, and/or so as to protect against diseases caused by disruption of glucose homeostasis).

[0088] In the methods of the present disclosure, protein compositions described herein can be administered to a subject (e.g. a human patient) to, for example, achieve and/or maintain glucose homeostasis, e.g., to reduce glucose level in the bloodstream and/or to reduce insulin level to a range found in a healthy individual. Subjects for treatment include those having a glucose metabolism disorder as described herein. For example, protein composition finds use in facilitating glucose homeostasis in subjects with a glucose metabolism disorder resulting from obesity.

[0089] The methods relating to disorders of glucose metabolism contemplated herein include, for example, use of protein described above for therapy alone or in combination with other types of therapy. The method involves administering to a subject the subject protein (e.g. subcutaneously or intravenously). As noted above, the methods are useful in the context of treating or preventing a wide variety of disorders related to glucose metabolism.

Formulations

[0090] An isolated PLA2G12A polypeptide can be provided in a pharmaceutical composition, for administration to an individual in need thereof.

[0091] A composition comprising an isolated PLA2G12A polypeptide can comprise a

pharmaceutically acceptable excipient, a variety of which are known in the art and need not be discussed in detail herein. Pharmaceutically acceptable excipients have been amply described in a variety of publications, including, for example, "Remington: The Science and Practice of Pharmacy", 19^th Ed. (1995), or latest edition, Mack Publishing Co; A. Gennaro (2000) "Remington: The Science and Practice of Pharmacy", 20th edition, Lippincott, Williams, & Wilkins; Pharmaceutical Dosage Forms and Drug Delivery Systems (1999) H.C. Ansel et al., eds 7^th ed., Lippincott, Williams, & Wilkins; and Handbook of Pharmaceutical Excipients (2000) A.H. Kibbe et al., eds., 3 rd ed. Amer. Pharmaceutical Assoc. [0092] A subject pharmaceutical composition can include a purified PLA2G12A polypeptide; and a pharmaceutically acceptable excipient. In some cases, the purified PLA2G12A polypeptide is present in a subject pharmaceutical composition in an amount effective to lower blood glucose in an individual, e.g., the purified PLA2G12A polypeptide is present in an amount effective to lower blood glucose levels (e.g., to lower an elevated blood glucose level) in an individual (e.g., in an individual having a glucose metabolism disorder) by at least about 10%, at least about 20%, at least about 25%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, or more than 80%, compared to an elevated level of blood glucose in the individual not treated with the protein.

[0093] In some cases, the purified PLA2G12A polypeptide is present in a subject

pharmaceutical composition in an amount effective to increase insulin sensitivity in an individual, e.g., in an individual having a glucose metabolism disorder.

[0094] A pharmaceutical composition of the present disclosure is suitable for use in a method of reducing blood glucose levels in an individual, e.g., where the individual has elevated blood glucose, compared to a normal control level. Thus, the present disclosure provides a pharmaceutical composition for use in a method of treating a glucose metabolism disorder, where the composition comprises a purified PLA2G12A polypeptide in an amount effective to reduce blood glucose levels (e.g., reduce an elevated blood glucose level) and/or to increase insulin sensitivity in an individual having a glucose metabolism disorder, and to treat the glucose metabolism disorder.

[0095] The protein compositions may comprise other components, such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharin, talcum, cellulose, glucose, sucrose, magnesium, carbonate, and the like. The compositions may contain pharmaceutically acceptable auxiliary substances as required to approximate physiological conditions such as pH adjusting and buffering agents, toxicity adjusting agents and the like, for example, sodium acetate, sodium chloride, potassium chloride, calcium chloride, sodium lactate, hydrochloride, sulfate salts, solvates (e.g., mixed ionic salts, water, organics), hydrates (e.g., water), and the like.

[0096] For example, compositions may include aqueous solution, powder form, granules,

tablets, pills, suppositories, capsules, suspensions, sprays, and the like. The composition may be formulated according to the different routes of administration described later below.

[0097] Where the protein is administered as an injectable (e.g. subcutaneously,

intraperitoneally, and/or intravenously) directly into a tissue, a formulation can be provided as a ready-to-use dosage form, or as non-aqueous form (e.g. a reconstitutable storage-stable powder) or aqueous form, such as liquid composed of pharmaceutically acceptable carriers and excipients. The protein-containing formulations may also be provided so as to enhance serum half-life of the subject protein following administration. For example, the protein may be provided in a liposome formulation, prepared as a colloid, or other conventional techniques for extending serum half-life. A variety of methods are available for preparing liposomes, as described in, e.g., Szoka et al. 1980 Ann. Rev. Biophys. Bioeng. 9:467, U.S. Pat. Nos. 4,235,871, 4,501,728 and 4,837,028. The preparations may also be provided in controlled release or slow-release forms.

[0098] Other examples of formulations suitable for parenteral administration include isotonic sterile injection solutions, anti- oxidants, bacteriostats, and solutes that render the formulation isotonic with the blood of the intended recipient, suspending agents, solubilizers, thickening agents, stabilizers, and preservatives. The formulations can be presented in unit-dose or multi-dose sealed containers, such as ampules and vials, and can be stored in a freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid excipient, for example, water, for injections, immediately prior to use. Extemporaneous injection solutions and suspensions can be prepared from sterile powders, granules, and tablets of the kind previously described.

[0099] The concentration of the subject proteins in a formulation can vary widely (e.g., from less than about 0.1%, usually at or at least about 2% to as much as 20% to 50% or more by weight) and will usually be selected primarily based on fluid volumes, viscosities, and patient-based factors in accordance with the particular mode of administration selected and the patient's needs.

Routes of administration

[00100] In practicing the methods, routes of administration (path by which a subject

protein is brought into a subject) may vary. A subject protein above can be delivered by a route that provides for delivery of the protein to the bloodstream (e.g., by parenteral administration, such as intravenous administration, intramuscular administration, and/or subcutaneous administration). Injection can be used to accomplish parenteral administration.

Dosages

[00101] In the methods, a therapeutically effective amount of a subject protein is

administered to a subject in need thereof. For example, a subject protein causes the level of plasma glucose and/or insulin to return to a normal level relative to a healthy individual when the subject protein is delivered to the bloodstream in an effective amount to a patient who previously did not have a normal level of glucose/insulin relative to a healthy individual prior to being treated. The amount administered varies depending upon the goal of the administration, the health and physical condition of the individual to be treated, age, the degree of resolution desired, the formulation of a subject protein, the activity of the subject proteins employed, the treating clinician's assessment of the medical situation, the condition of the subject, and the body weight of the subject, as well as the severity of the dysregulation of glucose/insulin and the stage of the disease, and other relevant factors. The size of the dose will also be determined by the existence, nature, and extent of any adverse side-effects that might accompany the administration of a particular protein.

[00102] It is expected that the amount will fall in a relatively broad range that can be determined through routine trials. For example, the amount of subject protein employed to restore glucose homeostasis is not more than about the amount that could otherwise be irreversibly toxic to the subject (i.e., maximum tolerated dose). In other cases, the amount is around or even well below the toxic threshold, but still in an effective concentration range, or even as low as threshold dose.

[00103] Also, suitable doses and dosage regimens can be determined by comparisons to indicators of glucose metabolism. Such dosages include dosages which result in the stabilized levels of glucose and insulin, for example, comparable to a healthy individual, without significant side effects. Dosage treatment may be a single dose schedule or a multiple dose schedule (e.g., including ramp and maintenance doses). As indicated below, a subject composition may be administered in conjunction with other agents, and thus doses and regimens can vary in this context as well to suit the needs of the subject.

[00104] Individual doses are typically not less than an amount required to produce a measurable effect on the subject, and may be determined based on the pharmacokinetics and pharmacology for absorption, distribution, metabolism, and excretion ("ADME") of the subject protein or its by-products, and thus based on the disposition of the composition within the subject. This includes consideration of the route of

administration as well as dosage amount, which can be adjusted for enteral (applied via digestive tract for systemic or local effects when retained in part of the digestive tract) or parenteral (applied by routes other than the digestive tract for systemic or local effects) applications. For instance, administration of a subject protein is typically via injection and often intravenous, intramuscular, or a combination thereof.

[00105] By "therapeutically effective amount" is meant that the administration of that amount to an individual, either in a single dose, as part of a series of the same or different protein compositions, is effective to help restore homeostasis of glucose metabolism as assessed by glucose and/or insulin levels in a subject. As noted above, the therapeutically effective amount can be adjusted in connection with dosing regimen and diagnostic analysis of the subject's condition (e.g., monitoring for the levels of glucose and/or insulin in the plasma) and the like.

[00106] As an example, the effective amount of a dose or dosing regimen can be gauged from the ED₅₀ of a protein for inducing an action that leads to clearing glucose from the bloodstream or lowering of insulin levels. By "ED₅₀" (effective dosage) is the intended dosage which induces a response halfway between the baseline and maximum after some specified exposure time. The ED₅₀ of a graded dose response curve therefore represents the concentration of a subject protein where 50% of its maximal effect is observed. ED₅₀ may be determined by in vivo studies (e.g. animal models) using methods known in the art.

[00107] An effective amount may not be more than 100X the calculated ED 50. For

instance, the amount of protein that is administered is less than about 100X, less than about 50X, less than about 40X, 35X, 30X, or 25X and many embodiments less than about 20X, less than about 15X and even less than about 10X, 9X, 8X, 7X, 6X, 5X, 4X, 3X, 2X or IX than the calculated ED₅₀. In one embodiment, the effective amount is about IX to 30X of the calculated ED₅₀, and sometimes about IX to 20X, or about IX to 10X of the calculated ED₅₀. In other embodiments, the effective amount is the same as the calculated ED₅₀, and in certain embodiments the effective amount is an amount that is more than the calculated ED₅₀. [00108] An effective amount of a protein may also be an amount that is effective, when administered in one or more doses, to reduce in an individual a level of plasma glucose and/or plasma insulin that is elevated relative to that of a healthy individual by at least about 10%, at least about 20%, at least about 25%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, or more than 80%, compared to an elevated level of plasma glucose/insulin in the individual not treated with the protein.

[00109] Further examples of dose per administration may be at less than 10 μg, less than

2 μg, or less than 1 μg. Dose per administration may also be more than 50 μg, more than 100 μg, more than 300 μg up to 600 μg or more. An example of a range of dosage per weight is about 0.1 μg/kg to about 1 μg/kg, up to about 1 mg/kg or more. Effective amounts and dosage regimen can readily be determined empirically from assays, from safety and escalation and dose range trials, individual clinician-patient relationships, as well as in vitro and in vivo assays known in the art.

[00110] The term "unit dosage form," as used herein, refers to physically discrete units suitable as unitary dosages for human and animal subjects, each unit containing a predetermined quantity of proteins of the present disclosure calculated in an amount sufficient to produce the desired effect in association with a pharmaceutically acceptable diluent, carrier or vehicle. The specifications for the novel unit dosage forms depend on the particular protein employed and the effect to be achieved, and the pharmacodynamics associated with each protein in the host.

Combination therapy

[00111] Any of a wide variety of therapies directed to regulating glucose metabolism, and any glucose metabolism disorders, and/or obesity, for example, can be combined in a composition or therapeutic method with the subject proteins. The subject proteins can also be administered in combination with a modified diet and/or exercise regimen to promote weight loss.

[00112] "Combination," as used herein in the context of treatment of glucose metabolism disorders, is meant to include therapies that can be administered separately, e.g.

formulated separately for separate administration (e.g., as may be provided in a kit), or undertaken as a separate regime (as in exercise and diet modifications), as well as for administration in a single formulation (i.e., "co-formulated"). Examples of agents that may be provided in a combination therapy include those that are normally administered to subjects suffering from symptoms of hyperglycemia, hyperinsulinemia, glucose intolerance, and disorders associated with those conditions. Examples of agents that may be provided in a combination therapy include those that promote weight loss.

[00113] The present disclosure contemplates combination therapy for the treatment of glucose metabolism disorders with numerous agents (and classes thereof), including 1) insulin, insulin mimetics and agents that entail stimulation of insulin secretion, including sulfonylureas (e.g., chlorpropamide, tolazamide, acetohexamide, tolbutamide, glyburide, glimepiride, glipizide) and meglitinides (e.g., repaglinide (PRANDIN) and nateglinide (STARLIX)); 2) biguanides (e.g., metformin (GLUCOPHAGE)) and other agents that act by promoting glucose utilization, reducing hepatic glucose production and/or diminishing intestinal glucose output; 3) alpha-glucosidase inhibitors (e.g., acarbose and miglitol) and other agents that slow down carbohydrate digestion and consequently absorption from the gut and reduce postprandial hyperglycemia; 4) thiazolidinediones (e.g., rosiglitazone (AVANDIA), troglitazone (REZULIN), pioglitazone (ACTOS), glipizide, balaglitazone, rivoglitazone, netoglitazone, troglitazone, englitazone, ciglitazone, adaglitazone, darglitazone that enhance insulin action (e.g., by insulin sensitization), thus promoting glucose utilization in peripheral tissues; 5) glucagon-like- peptides including dipeptidyl peptidase-IV (DPP-IV) inhibitors (e.g., vildagliptin (GALVUS) and sitagliptin (JANUVIA)) and Glucagon-Like Peptide- 1 (GLP-1) and GLP-1 agonists and analogs (e.g., exenatide (BYETTA)); and 6) DPP-IV-resistant analogs (incretin mimetics). Also suitable for use in a subject combination therapy method are peroxisome proliferator- activated receptor gamma (PPAR gamma) agonists, dual-acting PPAR agonists, pan-acting PPAR agonists, protein tyrosine phosphatase IB (PTP1B) inhibitors, sodium-dependent glucose transporter (SGLT) inhibitors, insulin secretagogues, retinoic X receptor (RXR) agonists, glycogen synthase kinase-3 inhibitors, immune modulators, beta-3 adrenergic receptor agonists, Ι ΐβ-hydroxysteroid dehydrogenase type 1 (1 lbeta-HSDl) inhibitors, and amylin analogs.

[00114] In addition, the present disclosure contemplates pharmacological combination therapy to effect weight loss with any appropriate agent, including agents such as sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, sertraline, bupropion, topiramate, and zonisamide. [00115] Where the subject protein is administered in combination with one or more other therapies, the combination can be administered anywhere from simultaneously to up to 5 hours or more, e.g., 10 hours, 15 hours, 20 hours or more, prior to or after administration of a subject protein. In certain embodiments, a subject protein and other therapeutic intervention are administered or applied sequentially, e.g., where a subject protein is administered before or after another therapeutic treatment. In yet other embodiments, a subject protein and other therapy are administered simultaneously, e.g., where a subject protein and a second therapy are administered at the same time, e.g., when the second therapy is a drug it can be administered along with a subject protein as two separate formulations or combined into a single composition that is administered to the subject. Regardless of whether administered sequentially or simultaneously, as illustrated above, the treatments are considered to be administered together or in combination for purposes of the present disclosure.

[00116] Additional standard therapeutics for glucose metabolism disorders that may or may not be administered in conjunction with a subject protein, include but not limited to any of the combination therapies described above, hormonal therapy, immunotherapy, chemotherapeutic agents and surgery.

[00117] Examples of various weight-loss surgical procedures that can be used in

combination with the subject proteins include gastric bypass surgery, laparoscopic adjustable gastric banding (LAGB), gastric sleeve procedure, and biliopancreatic diversion with duodenal switch procedure.

Patient Populations

[00118] The present disclosure provides a method to treat a patient suffering from

hyperglycemia, hyperinsulinemia, and/or glucose intolerance. Such conditions are also commonly associated with many other glucose metabolism disorders. As such, patients of glucose metabolism disorders can be candidates for therapy according to the subject methods.

[00119] The phrase "glucose metabolism disorder" encompasses any disorder

characterized by a clinical symptom or a combination of clinical symptoms that are associated with an elevated level of glucose and/or an elevated level of insulin in a subject relative to a healthy individual. Elevated levels of glucose and/or insulin may be manifested in the following disorders and/or conditions: type II diabetes (e.g. insulin- resistance diabetes), gestational diabetes, insulin resistance, impaired glucose tolerance, hyperinsulinemia, impaired glucose metabolism, pre-diabetes, metabolic disorders (such as metabolic syndrome which is also referred to as syndrome X), obesity, obesity-related disorder.

[00120] An example of a suitable patient may be one who is hyperglycemic and/or

hyperinsulinemic and who is also diagnosed with diabetes mellitus (e.g. Type II diabetes). "Diabetes" refers to a progressive disease of carbohydrate metabolism involving inadequate production or utilization of insulin and is characterized by hyperglycemia and glycosuria.

[00121] "Hyperglycemia", as used herein, is a condition in which an elevated amount of glucose circulates in the blood plasma relative to a healthy individual and can be diagnosed using methods known in the art. For example, hyperglycemia can be diagnosed as having a fasting blood glucose level between 5.6 to 7 mM (pre-diabetes), or greater than 7mM (diabetes).

[00122] "Hyperinsulinemia", as used herein, is a condition in which there are elevated levels of circulating insulin while blood glucose levels may either be elevated or remain normal. Hyperinsulinemia can be caused by insulin resistance which is associated with dyslipidemia such as high triglycerides, high cholesterol, high low-density lipoprotein (LDL) and low high-density lipoprotein (HDL), high uric acids, polycystic ovary syndrome, type II diabetes and obesity. Hyperinsulinemia can be diagnosed as having a plasma insulin level higher than about 2 μυ/mL.

[00123] A patient having any of the above disorders may be a suitable candidate in need of a therapy in accordance with the present method so as to receive treatment for hyperglycemia, hyperinsulinemia, and/or glucose intolerance. Administering the subject protein in such an individual can restore glucose homeostasis and may also decrease one or more of symptoms associated with the disorder.

[00124] Candidates for treatment using the subject method may be determined using diagnostic methods known in the art, e.g. by assaying plasma glucose and/or insulin levels. Candidates for treatment include those who have exhibited or are exhibiting higher than normal levels of plasma glucose/insulin. Such patients include patients who have a fasting blood glucose concentration (where the test is done after 8 to 10 hour fast) of higher than about 100 mg/dL, e.g., higher than about 110 mg/dL, higher than about 120 mg/dL, about 150 mg/dL up to about 200 mg/dL or more. Individuals suitable to be treated also include those who have a 2 hour postprandial blood glucose concentration or a concentration after a glucose tolerance test (e.g. 2 hours after ingestion of a glucose- rich drink), in which the concentration is higher than about 140 mg/dL, e.g., higher than about 150 mg/dL up to 200 mg/dL or more. Glucose concentration may also be presented in the units of mmol/L, which can be acquired by dividing mg/dL by a factor of 18.

METHODS OF INCREASING MUSCLE MASS AND/OR FUNCTION

[00125] The present disclosure provides methods of increasing levels and/or activity of

PLA2G12A in an individual. The present disclosure provides methods for increasing muscle function and/or muscle mass in an individual having a deficiency in muscle function and/or having reduced muscle mass, e.g., in an individual having a condition, disease, or disorder in which reduced muscle function and/or reduced muscle mass is a result, a sequela, or a symptom of the disorder, disease, or condition. A subject method generally involves administering to an individual an effective amount of an isolated PLA2G12A protein.

[00126] Administration of an isolated PLA2G12A protein can provide for an increase in circulating and/or tissue levels of PLA2G12A protein. For example, administration of an isolated PLA2G12A protein to an individual in need thereof can increase circulating levels of PLA2G12A polypeptide in the individual by at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90%, at least about 2-fold, at least about 2.5-fold, at least about 5-fold, or greater than 5-fold, compared to the circulating level of PLA2G12A polypeptide in the individual not treated with the PLA2G12A polypeptide. In some cases, administration of an isolated PLA2G12A polypeptide to an individual increases circulating levels of PLA2G12A polypeptide in the individual to a normal control level. Circulating levels of PLA2G12A include serum levels. Circulating levels of PLA2G12A polypeptide can be readily determined, using any known method, e.g., an immunological method employing anti-PLA2G12A antibody. Suitable immunological methods include, e.g., an enzyme- linked immunosorbent assay (ELISA), a radioimmunoassay (RIA), and the like. [00127] Administration of an isolated PLA2G12A protein can provide for an increase in tissue levels of PLA2G12A protein. For example, administration of an isolated

PLA2G12A protein to an individual in need thereof can increase tissue levels of PLA2G12A polypeptide in the individual by at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90%, at least about 2-fold, at least about 2.5-fold, at least about 5-fold, or greater than 5- fold, compared to the tissue level of PLA2G12A polypeptide in the individual not treated with the PLA2G12A polypeptide. In some cases, administration of an isolated PLA2G12A polypeptide to an individual increases tissue levels of PLA2G12A polypeptide in the individual to a normal control level. Tissue levels of PLA2G12A include levels in muscles, including levels in particular muscle groups.

[00128] Increasing PLA2G12A levels and/or activity can provide for increasing muscle function and/or muscle mass in an individual, and can be used to treat a disease, disorder, or condition resulting in or associated with reduced muscle function and/or muscle mass. As such, the present disclosure provides methods for increasing muscle function and/or muscle mass in an individual in need thereof, e.g., an individual having a deficiency in muscle function and/or reduced muscle mass. "Increasing muscle mass" includes: a) an increase in muscle mass that results from generation of new muscle tissue; and b) an increase in muscle mass that results from repair of existing muscle tissue that has been damaged (e.g., due to disease or injury).

[00129] A subject method involves administering an isolated PLA2G12A polypeptide to a subject who has a disease, disorder, or condition resulting in or associated with reduced muscle function and/or reduced muscle mass (e.g., a disease, disorder, or condition in which reduced muscle function and/or reduced muscle mass is a result, a sequela, or a symptom of the disorder, disease, or condition). Subjects having, suspected of having, or at risk of developing a disease, disorder, or condition resulting in or associated with reduced muscle function and/or muscle mass are contemplated for therapy described herein.

[00130] By "treatment" is meant that at least an amelioration of the symptoms associated with the condition afflicting the host is achieved, where amelioration refers to at least a reduction in the magnitude of a parameter, e.g. symptom, associated with the condition being treated. As such, treatment includes situations where the condition, or at least symptoms associated therewith, are reduced or avoided. Thus treatment includes: (i) prevention, that is, reducing the risk of development of clinical symptoms, including causing the clinical symptoms not to develop, e.g., preventing disease progression to a harmful or otherwise undesired state; (ii) inhibition, that is, arresting the development or further development of clinical symptoms, e.g., mitigating or completely inhibiting an active disease (e.g., so as to increase muscle function and/or muscle mass).

[00131] In the methods of the present disclosure, a PLA2G12A polypeptide described herein can be administered to a subject (e.g. a human patient) to, for example, increase muscle function to a range found in a healthy individual. Subjects for treatment include those having a disease, disorder, or condition resulting in or associated with reduced muscle function and/or mass, as described herein.

[00132] In some embodiments, an effective amount of an isolated PLA2G12A

polypeptide is an amount that is effective to reduce muscle atrophy, e.g., an effective amount of an isolated PLA2G12A polypeptide reduces muscle atrophy by at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, or at least about 80%, or more than 80%, compared to the degree of atrophy in the absence of treatment with the isolated PLA2G12A polypeptide.

[00133] In some embodiments, an effective amount of an isolated PLA2G12A

polypeptide is an amount that is effective to increase muscle mass (e.g., skeletal muscle mass), e.g., an effective amount of an isolated PLA2G12A polypeptide increases muscle mass by at least about 10%, at least about 25%, at least about 50%, at least about 75%, at least about 2-fold, at least about 2.5-fold, or at least about 5-fold, or more than 5-fold, compared to the muscle mass in the absence of treatment with the isolated PLA2G12A polypeptide. As noted above, "increasing muscle mass" includes: a) an increase in muscle mass that results from generation of new muscle tissue; and b) an increase in muscle mass that results from repair of existing muscle tissue that has been damaged (e.g., due to disease or injury).

[00134] Whether atrophy is reduced, and whether muscle mass is increased, can be

determined using any known method, including, e.g., magnetic resonance imaging (MRI), dual energy x-ray absorptiometry (DEXA), and computed tomography (CT). [00135] As noted above, a method of the present disclosure can provide for improved muscle function, where muscle function includes, e.g., muscle endurance, muscle strength, muscle force, muscle fatigability, etc. "Improved" muscle function includes increased muscle endurance, increased muscle strength, increased muscle force, and decreased muscle fatigability. Thus, for example, in some embodiments, treatment with an isolated PLA2G12A polypeptide results in an increase in one or more of muscle endurance, muscle strength, and muscle force of at least about 10%, at least about 25%, at least about 50%, at least about 75%, at least about 2-fold, at least about 2.5-fold, or at least about 5-fold, or more than 5-fold, compared to the muscle endurance, muscle strength, or muscle force in the absence of treatment with the isolated PLA2G12A polypeptide.

[00136] In some cases, treatment with an isolated PLA2G12A polypeptide results in a decrease in muscle fatigability, e.g., results in an increase in the amount of time to reach a fatigued state, such that muscle fatigability is reduced by at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, or more than 80%, compared to the muscle fatigability in the absence of treatment with the isolated PLA2G12A polypeptide.

[00137] Muscle strength can be measured using any known method, including, e.g., a grip strength test. See, e.g., Geere et al. ((2007) BMC Musculoskelet. Disord. 8: 114), and references cited therein. A field test, such as the one-repetition maximum (1-RM) test, can also be used. The 1-RM test measures dynamic strength by determining how much weight an individual can lift during a single repetition. The amount can be divided by body weight to give 1-RM/BW. Muscle strength and function can be assessed by standard performance tests such as knee flexor and extensor strength, repeated sit-to- stand test, and timed up & go (TUG). Muscle strength can be measured as knee extensor and flexor in Newtons (kiloponds). TUG is a measure of functional mobility including muscle strength, gait speed, and balance and is assessed in seconds. The repeated sit-to- stand is a functional test and measured in seconds.

[00138] Muscle force, expressed as tetanic force, can be measured using any known

method. Various types of contractions can be measured, including isotonic contraction, concentric contraction, eccentric contraction, and isometric contraction. Methods of measuring muscle contraction are known in the art, and any such method can be used to measure muscle contraction. Suitable methods include, e.g., mechanomyography, ultrasound myography, acoustic myography, electromyography, and the like.

[00139] Muscle fatigability and muscle endurance can be measured in humans using a treadmill test, e.g., where the treadmill is inclined or is horizontal. Muscle fatigability and muscle endurance can be measured in rodents (e.g., mice, rats, etc.) using a rotarod test or a wire hang test. For example, in the rotarod test, mice (or rats) are placed on an elevated accelerating rod and the rod is rotated at a certain speed (e.g., 4 rotations per minute (rpm) to 40 rpm). The rodents are then scored for their latency (e.g., in seconds) to fall. An increase in the time to fall is an indication of an increase in muscle endurance or a reduction in muscle fatigability.

[00140] As noted above, a method of the present disclosure can provide for repair of muscle tissue, e.g., in the context of muscle injury. Thus, for example, in some embodiments, treatment with an isolated PLA2G12A polypeptide results in repair of muscle tissue such that the amount of muscle tissue is increased by at least about 10%, at least about 25%, at least about 50%, at least about 75%, at least about 2-fold, at least about 2.5-fold, or at least about 5-fold, or more than 5-fold, compared to the amount of muscle tissue present after muscle injury and in the absence of treatment with the isolated PLA2G12A polypeptide. Muscle repair can be evidenced by an increase in the mRNA and/or protein levels of myosin heavy chain (MHC) in the muscle tissue (e.g., in the muscle tissue undergoing repair). Muscle repair can be evidenced by an increase in the mRNA and/or protein levels of a differentiation-specific muscle transcription factor such as myogenin or myoD in the muscle tissue (e.g., in the muscle tissue undergoing repair). Whether mRNA levels of MHC, myogenin, or myoD are increased can be determined using standard methods, including, e.g., quantitative polymerase chain reaction (qPCR), e.g., using specific primer pairs. Protein levels of MHC, myogenin, or myoD can be determined using an immunological assay, such as an ELISA or an RIA, with antibody specific for the MHC, myogenin, or myoD protein.

Formulations

[00141] An isolated PLA2G12A polypeptide can be provided in a pharmaceutical

composition, for administration to an individual in need thereof. [00142] A composition comprising an isolated PLA2G12A polypeptide can comprise a pharmaceutically acceptable excipient, a variety of which are known in the art and need not be discussed in detail herein. Pharmaceutically acceptable excipients have been amply described in a variety of publications, including, for example, "Remington: The Science and Practice of Pharmacy", 19^th Ed. (1995), or latest edition, Mack Publishing Co; A. Gennaro (2000) "Remington: The Science and Practice of Pharmacy", 20th edition, Lippincott, Williams, & Wilkins; Pharmaceutical Dosage Forms and Drug Delivery Systems (1999) H.C. Ansel et al., eds 7^th ed., Lippincott, Williams, & Wilkins; and Handbook of Pharmaceutical Excipients (2000) A.H. Kibbe et al., eds., 3 rd ed. Amer. Pharmaceutical Assoc.

[00143] A subject pharmaceutical composition can include a purified PLA2G12A

polypeptide; and a pharmaceutically acceptable excipient. In some cases, the purified PLA2G12A polypeptide is present in a subject pharmaceutical composition in an amount effective to increase muscle mass and/or increase muscle function in an individual, e.g., the purified PLA2G12A polypeptide is present in an amount effective to increase muscle mass and/or increase muscle function in an individual (e.g., in an individual having a deficiency in muscle mass and/or function) by at least about 10%, at least about 25%, at least about 50%, at least about 75%, at least about 2-fold, at least about 2.5-fold, or at least about 5-fold, or more than 5-fold, compared to the muscle mass and/or muscle function in the individual not treated with the protein.

[00144] A pharmaceutical composition of the present disclosure is suitable for use in a method of increasing muscle mass and/or muscle function in an individual, e.g., where the individual has a deficiency in muscle mass and/or muscle function. Thus, the present disclosure provides a pharmaceutical composition for use in a method of treating a deficiency in muscle mass and/or muscle function, where the composition comprises a purified PLA2G12A polypeptide in an amount effective to increase muscle mass and/or muscle function in an individual having a deficiency in muscle mass and/or muscle function, and to treat the deficiency in muscle mass and/or muscle function.

[00145] A subject pharmaceutical composition can comprise an isolated PLA2G12A

polypeptide, and a pharmaceutically acceptable excipient. In some cases, a subject pharmaceutical composition will be suitable for injection into a subject, e.g., will be sterile. For example, in some embodiments, a subject pharmaceutical composition will be suitable for injection into a human subject, e.g., where the composition is sterile and is free of detectable pyrogens and/or other toxins.

[00146] The protein compositions may comprise other components, such as

pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharin, talcum, cellulose, glucose, sucrose, magnesium, carbonate, and the like. The compositions may contain pharmaceutically acceptable auxiliary substances as required to approximate physiological conditions such as pH adjusting and buffering agents, toxicity adjusting agents and the like, for example, sodium acetate, sodium chloride, potassium chloride, calcium chloride, sodium lactate, hydrochloride, sulfate salts, solvates (e.g., mixed ionic salts, water, organics), hydrates (e.g., water), and the like.

[00147] For example, compositions may include aqueous solution, powder form,

granules, tablets, pills, suppositories, capsules, suspensions, sprays, and the like. The composition may be formulated according to the different routes of administration described later below.

[00148] Where the protein is administered as an injectable (e.g. subcutaneously,

intraperitoneally, and/or intravenously) directly into a tissue, a formulation can be provided as a ready-to-use dosage form, or as non-aqueous form (e.g. a reconstitutable storage-stable powder) or aqueous form, such as liquid composed of pharmaceutically acceptable carriers and excipients. The protein-containing formulations may also be provided so as to enhance serum half-life of the subject protein following administration. For example, the protein may be provided in a liposome formulation, prepared as a colloid, or other conventional techniques for extending serum half-life. A variety of methods are available for preparing liposomes, as described in, e.g., Szoka et al. 1980 Ann. Rev. Biophys. Bioeng. 9:467, U.S. Pat. Nos. 4,235,871, 4,501,728 and 4,837,028. The preparations may also be provided in controlled release or slow-release forms.

[00149] Other examples of formulations suitable for parenteral administration include isotonic sterile injection solutions, anti-oxidants, bacteriostats, and solutes that render the formulation isotonic with the blood of the intended recipient, suspending agents, solubilizers, thickening agents, stabilizers, and preservatives. The formulations can be presented in unit-dose or multi-dose sealed containers, such as ampules and vials, and can be stored in a freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid excipient, for example, water, for injections, immediately prior to use. Extemporaneous injection solutions and suspensions can be prepared from sterile powders, granules, and tablets of the kind previously described.

[00150] The concentration of the subject proteins in a formulation can vary widely (e.g., from less than about 0.1%, usually at or at least about 2% to as much as 20% to 50% or more by weight) and will usually be selected primarily based on fluid volumes, viscosities, and patient-based factors in accordance with the particular mode of administration selected and the patient's needs.

Routes of administration

[00151] In practicing a method of the present disclosure, routes of administration may vary. An isolated PLA2G12A polypeptide can be delivered by a route that provides for delivery of the agent to the bloodstream (e.g., by parenteral administration, such as intravenous administration, intramuscular administration, and/or subcutaneous administration) or to a specific tissue (e.g., muscle tissue). Injection can be used to accomplish parenteral administration. In some embodiments, an isolated PLA2G12A polypeptide is delivered by a route that provides for delivery of the polypeptide directly into affected muscle tissue, e.g., by intramuscular injection.

Dosages

[00152] In the methods, a therapeutically effective amount of an isolated PLA2G12A polypeptide is administered to a subject in need thereof. For example, an isolated PLA2G12A polypeptide can increase muscle function and/or muscle mass, and can in some cases cause a return to a normal level of muscle function and/or muscle mass relative to a healthy individual when the isolated PLA2G12A polypeptide is delivered to the bloodstream or directly into muscle tissue in an effective amount to a patient who, prior to being treated with the PLA2G12A polypeptide, did not have a normal level of muscle function and/or muscle mass relative to a healthy individual.

[00153] The amount administered varies depending upon the goal of the administration, the health and physical condition of the individual to be treated, age, the degree of resolution desired, the formulation of a subject protein, the activity of the subject protein employed, the treating clinician's assessment of the medical situation, the condition of the subject, and the body weight of the subject, as well as the severity of the disease, disorder, or condition, and other relevant factors. The size of the dose will also be determined by the existence, nature, and extent of any adverse side-effects that might accompany the administration of a particular polypeptide.

[00154] It is expected that the amount will fall in a relatively broad range that can be determined through routine trials. For example, the amount of an isolated PLA2G12A polypeptide employed to increase muscle mass and/or muscle strength or other muscle function is not more than about the amount that could otherwise be irreversibly toxic to the subject (i.e., maximum tolerated dose). In other cases, the amount is around or even well below the toxic threshold, but still in an effective concentration range, or even as low as threshold dose.

[00155] Also, suitable doses and dosage regimens can be determined by comparisons to indicators of normal muscle mass and/or function. Such dosages include dosages which result in increased muscle mass and/or function, for example, comparable to a healthy individual, without significant side effects. Dosage treatment may be a single dose schedule or a multiple dose schedule (e.g., including ramp and maintenance doses). As indicated below, a subject composition may be administered in conjunction with other agents, and thus doses and regimens can vary in this context as well to suit the needs of the subject.

[00156] Individual doses are typically not less than an amount required to produce a measurable effect on the subject, and may be determined based on the pharmacokinetics and pharmacology for absorption, distribution, metabolism, and excretion ("ADME") of the subject isolated PLA2G12A polypeptide or its by-products, and thus based on the disposition of the composition within the subject. This includes consideration of the route of administration as well as dosage amount, which can be adjusted for enteral (applied via digestive tract for systemic or local effects when retained in part of the digestive tract) or parenteral (applied by routes other than the digestive tract for systemic or local effects) applications. For instance, administration of a subject isolated

PLA2G12A polypeptide can be via injection, e.g., via intravenous injection,

intramuscular injection, or a combination thereof.

[00157] By "therapeutically effective amount" is meant that the administration of that amount to an individual, either in a single dose, as part of a series of the same or different protein compositions, is effective to increase muscle mass and/or muscle function in a subject. As noted above, the therapeutically effective amount can be adjusted in connection with dosing regimen and diagnostic analysis of the subject's condition (e.g., monitoring muscle mass, monitoring muscle function) and the like.

[00158] As an example, the effective amount of a dose or dosing regimen can be gauged from the ED₅₀ of an isolated PLA2G12A polypeptide for inducing an action that leads to an increase in muscle mass by a certain amount and/or an increase in muscle function by a certain degree. By "ED₅₀" (effective dosage) is the intended dosage which induces a response halfway between the baseline and maximum after some specified exposure time. The ED₅₀ of a graded dose response curve therefore represents the concentration of an agent (e.g., a subject isolated PLA2G12A polypeptide) where 50% of its maximal effect is observed. ED₅₀ may be determined by in vivo studies (e.g. animal models) using methods known in the art.

[00159] An effective amount may not be more than 100X the calculated ED 50. For

instance, the amount of an agent (e.g., an isolated PLA2G12A polypeptide) that is administered is less than about 100X, less than about 50X, less than about 40X, 35X, 30X, or 25X and many embodiments less than about 20X, less than about 15X and even less than about 10X, 9X, 9X, 7X, 6X, 5X, 4X, 3X, 2X or IX than the calculated ED₅₀. In one embodiment, the effective amount is about IX to 30X of the calculated ED₅₀, and sometimes about IX to 20X, or about IX to 10X of the calculated ED₅₀. In other embodiments, the effective amount is the same as the calculated ED₅₀, and in certain embodiments the effective amount is an amount that is more than the calculated ED₅₀.

[00160] An effective amount of an agent (e.g., an isolated PLA2G12A polypeptide) may also an amount that is effective, when administered in one or more doses, to increase muscle function and/or muscle mass by at least about 10%, at least about 20%, at least about 25%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, or more than 80%, compared to the level of muscle function and/or the muscle mass in the individual not treated with the agent.

[00161] Further examples of dose per administration may be at less than 10 μg, less than

2 μg, or less than 1 μg. Dose per administration may also be more than 50 μg, more 100 μg, more than 300 μg up to 600 μg or more. An example of a range of dosage per weight is about 0.1 μg/kg to about 1 μg/kg, up to about 1 mg/kg or more. Effective amounts and dosage regimen can readily be determined empirically from assays, from safety and escalation and dose range trials, individual clinician-patient relationships, as well as in vitro and in vivo assays known in the art.

[00162] The term "unit dosage form," as used herein, refers to physically discrete units suitable as unitary dosages for human and animal subjects, each unit containing a predetermined quantity of an isolated PLA2G12A polypeptide, calculated in an amount sufficient to produce the desired effect in association with a pharmaceutically acceptable diluent, carrier or vehicle. The specifications for the novel unit dosage forms depend on the particular protein employed and the effect to be achieved, and the

pharmacodynamics associated with each active agent in the host.

Combination therapy

[00163] Any of a variety of therapies directed to increasing muscle function and/or

muscle mass can be combined in a composition or therapeutic method with an isolated PLA2G12A polypeptide. A subject protein can also be administered in combination with a modified diet and/or exercise regimen to promote muscle strength and/or muscle mass.

[00164] "Combination," as used herein in the context of methods of increasing muscle function and/or mass, is meant to include therapies that can be administered separately, e.g. formulated separately for separate administration (e.g., as may be provided in a kit), or undertaken as a separate regime (as in exercise and diet modifications), as well as for administration in a single formulation (i.e., "co-formulated").

[00165] Second therapeutic agents that can be administered in combination therapy with an isolated PLA2G12A polypeptide include, but are not limited to, follistatin (see, e.g., Kota et al. (2009) Sci. Transl. Med. I:6ral5; and U.S. Patent Publication No.

2010/0178348); a follistatin domain-containing protein other than follistatin (see, e.g., U.S. Patent Publication No. 2011/0020372); a corticosteroid; a myostatin inhibitor (see, e.g., U.S. Patent Publication No. 2010/0330072); an anti-activin receptor IIB antibody (see, e.g., U.S. Patent Publication No. 2010/0272734); a truncated activin receptor IIB (see, e.g., U.S. Patent Publication No. 2011/0034372); and the like.

[00166] Where a subject isolated PLA2G12A polypeptide is administered in combination with one or more other therapies, the combination can be administered anywhere from simultaneously to up to 5 hours or more, e.g., 10 hours, 15 hours, 20 hours or more, prior to or after administration of a subject protein. In certain embodiments, a subject isolated PLA2G12A polypeptide and other therapeutic intervention are administered or applied sequentially, e.g., where a subject isolated PLA2G12A polypeptide is administered before or after another therapeutic treatment. In yet other embodiments, a subject isolated PLA2G12A polypeptide and other therapy are administered simultaneously, e.g., where an isolated PLA2G12A polypeptide and a second therapy are administered at the same time, e.g., when the second therapy is a drug it can be administered along with a subject isolated PLA2G12A polypeptide as two separate formulations or combined into a single composition that is administered to the subject. Regardless of whether administered sequentially or simultaneously, as illustrated above, the treatments are considered to be administered together or in combination for purposes of the present disclosure.

Patient populations

[00167] Individuals suitable for treatment with a subject method of increasing muscle function and/or muscle mass include individuals having a deficiency in muscle function and/or having reduced muscle mass. Individuals suitable for treatment with a subject method of increasing muscle function and/or muscle mass include individuals having a disease, disorder, or condition associated with or resulting in reduced muscle function and/or muscle mass, e.g., a disease, disorder, or condition in which reduced muscle function and/or muscle mass is a symptom or a sequela of the disease, disorder, or condition. Such diseases, disorders, or conditions include immobilization, chronic disease, cancer, and injury (e.g., muscle injury).

KITS

[00168] Also provided by the present disclosure are kits for using the compositions

disclosed herein and for practicing the methods, as described above. The kits may be provided for administration of the subject protein in a subject in need of restoring glucose homeostasis. The kits may be provided for administration of the subject protein in a subject in need of an increase in muscle mass and/or function.

[00169] The kit can include one or more of the proteins disclosed herein, which may be provided in a sterile container, and can be provided in formulation with a suitable pharmaceutically acceptable excipient for administration to a subject. The proteins can be provided with a formulation that is ready to be used as it is or can be reconstituted to have the desired concentrations. Where the proteins are provided to be reconstituted by a user, the kit may also provide buffers, pharmaceutically acceptable excipient, and the like, packaged separately from the subject protein. The proteins of the present kit may be formulated separately or in combination with other drugs.

[00170] In addition to above-mentioned components, the kits can further include

instructions for using the components of the kit to practice the subject methods. The instructions for practicing the subject methods are generally recorded on a suitable recording medium. For example, the instructions may be printed on a substrate, such as paper or plastic, etc. As such, the instructions may be present in the kits as a package insert, in the labeling of the container of the kit or components thereof (i.e., associated with the packaging or subpackaging) etc. In other embodiments, the instructions are present as an electronic storage data file present on a suitable computer readable storage medium, e.g. CD-ROM, diskette, etc. In yet other embodiments, the actual instructions are not present in the kit, but means for obtaining the instructions from a remote source, e.g. via the internet, are provided. An example of this embodiment is a kit that includes a web address where the instructions can be viewed and/or from which the instructions can be downloaded. As with the instructions, this means for obtaining the instructions is recorded on a suitable substrate.

EXAMPLES

[00171] The following examples are put forth so as to provide those of ordinary skill in the art with a complete disclosure and description of how to make and use the present invention, and are not intended to limit the scope of what the inventors regard as their invention nor are they intended to represent that the experiments below are all or the only experiments performed. Efforts have been made to ensure accuracy with respect to numbers used (e.g. amounts, temperature, etc.) but some experimental errors and deviations should be accounted for. Unless indicated otherwise, parts are parts by weight, molecular weight is weight average molecular weight, temperature is in degrees Celsius, and pressure is at or near atmospheric. Standard abbreviations may be used, e.g., bp, base pair(s); kb, kilobase(s); pi, picoliter(s); s or sec, second(s); min, minute(s); h or hr, hour(s); aa, amino acid(s); nt, nucleotide(s); i.m., intramuscular(ly); i.p.,

intraperitoneal(ly); s.c, subcutaneous(ly); and the like. EXAMPLES 1-3; MATERIALS AND METHODS

[00172] The following methods and materials were used in Examples 1-3, below.

[00173] Animals. Mice were purchased from the Charles River Laboratory (Wilmington,

MA). Mice were kept in accordance with welfare guidelines and project license restrictions under controlled light (12 hr light and 12 hr dark cycle, dark 6:30 pm-6:30 am), temperature (22±4°C) and humidity (50 +20 ) conditions. They had free access to water (autoclaved distilled water) and were fed ad libitum on a commercial diet (Harlan laboratories, Irradiated 2018 Teklad Global 18% Protein Rodent Diet) containing 17 kcal% fat, 23 kcal% protein and 60 kcal% carbohydrate. Alternatively, mice were maintained on a high-fat diet (D 12492, Research Diets, New Brunswick, NJ. USA) containing 60 kcal% fat, 20 kcal% protein and 20 kcal% carbohydrate. All animal studies were approved by the NGM Institutional Animal Care and Use Committee for NGM-5- 2008 entitled "Characterization Of Biologies, Compounds And Viral Vectors For Treatment Of Diabetes Using Rodent Model".

[00174] DNA and amino acid sequences.

[00175] cDNA of ORF encoding murine PLA2G12A (GenBank Accession No.

BC026812)

ATGGTGACTCCGCGGCCCGCGCCCGCCCGGGGCCCCGCGCTCCTCCTCCTCC TGCTGCTGGCCACTGCGCGCGGGCAGGAACAGGACCAGACCACCGACTGGA GGGCCACCCTCAAGACCATCCGCAACGGCATCCACAAGATAGACACGTACC TCAACGCCGCGCTGGACCTGCTGGGCGGGGAGGACGGGCTCTGCCAGTACA AGTGCAGCGACGGATCGAAGCCTGTTCCACGCTATGGATATAAACCATCTCC ACCAAATGGCTGTGGCTCTCCACTGTTTGGCGTTCATCTGAACATAGGTATC CCTTCCCTGACCAAGTGCTGCAACCAGCACGACAGATGCTATGAGACCTGCG GGAAAAGCAAGAACGACTGTGACGAGGAGTTCCAGTACTGCCTCTCCAAGA TCTGCAGAGACGTGCAGAAGACGCTCGGACTATCTCAGAACGTCCAGGCAT GTGAGACAACGGTGGAGCTCCTCTTTGACAGCGTCATCCATTTAGGCTGCAA GCCATACCTGGACAGCCAGCGGGCTGCATGCTGGTGTCGTTATGAAGAAAA AACAGATCTATAA (SEQ ID NO: 13).

[00176] Protein sequence encoded by the cDNA (GenBank Accession No. AAH26812)

[00177] MVTPRPAPARSPALLLLLLLATARGQEQDQTTDWRATLKTIRNGIHKIDT YLNAALDLLGGEDGLCQYKCSDGSKPVPRYGYKPSPPNGCGSPLFGVHLNIGIPS LTKCCNQHDRC YETCGKS KNDCDEEFQ YCLS KICRD VQKTLGLS QN VQ ACETTV ELLFDSVIHLGCKPYLDSQRAACWCRYEEKTDL (SEQ ID NO:2).

[00178] PLA2G12A open reading frame (ORF) was amplified with polymerase chain reaction (PCR) using recombinant DNA (cDNA) prepared from mouse testes. PCR reagent kits with Phusion high-fidelity DNA polymerase were purchased from New England BioLabs (F-530L, Ipswich, MA). The following primers were used: forward PCR primer: 5' ATGGTGACTCCACGACCAGCACCCGCCCGG (SEQ ID NO: 14) and reverse PCR primer: 5' TTATAGATCTGTCTTCTCCTCATAACGACACC (SEQ ID NO: 15).

[00179] PCR. PCR reactions were set up according to manufacturer's instruction,

amplified DNA fragment was digested with restriction enzymes Spe I and Not I (the restriction sites were included in the 5' or 3' PCR primers, respectively), and the amplification product was then ligated with AAV transgene vectors that had been digested with the same restriction enzymes. The vector used for expression contained a selectable marker and an expression cassette composed of a strong eukaryotic promoter 5' of a site for insertion of the cloned coding sequence, followed by a 3' untranslated region and bovine growth hormone polyadenylation tail. The expression construct is also flanked by internal terminal repeats at the 5' and 3' ends.

[00180] Production and purification of AAV. AAV 293 cells (obtained from Agilent Technologies, Santa Clara, CA) were cultured in Dulbecco's Modification of Eagle's Medium (DMEM, Mediatech, Inc. Manassas, VA) supplemented with 10% fetal bovine serum and lx antibiotic-antimycotic solution (Mediatech, Inc. Manassas, VA). The cells were plated at 50% density on day 1 in 150 mm cell culture plates and transfected on day 2, using calcium phosphate precipitation method, with the following 3 plasmids (20 μg/plate of each): AAV transgene plasmid, pHelper plasmids (Agilent Technologies) and AAV2/9 plasmid (Gao et al (2004) J. Virol. 78:6381). 48 hours after transfection, the cells were scraped off the plates, pelleted by centrifugation at 3000xg and resuspended in buffer containing 20 mM Tris pH 8.5, 100 mM NaCl and 1 mM MgCl₂. The suspension was frozen in an alcohol dry ice bath and was then thawed in 37°C water bath. The freeze and thaw cycles were repeated for a total of three times; benzonase (Sigma- Aldrich, St. Louis, MO) was added to 50 units/ml; deoxycholate was added to a final concentration of 0.25%. After an incubation at 37°C for 30 min, cell debris was pelleted by centrifugation at 5000 x g for 20 min. Viral particles in the supernatant were purified using a

discontinuous iodixanol (Sigma- Aldrich, St. Louis, MO) gradient as previously described (Zolotukhin S. et al (1999) Gene Ther. 6:973). The viral stock was concentrated using Vivaspin 20 (MW cutoff 100,000 Dalton, Sartorius Stedim Biotech, Aubagne, France) and re-suspended in phosphate buffered saline (PBS) with 10% glycerol and stored at -80 °C. To determine the viral genome copy number, 2 μΐ of viral stock was incubated in 6 μΐ of solution containing 50 units/ml benzonase, 50 mM Tris-HCl pH 7.5, 10 mM Mg Cl₂ and 10 mM Ca Cl₂ for at 37°C for 30 minutes.

[00181] Afterwards, 15 μΐ of the solution containing 2 mg/ml of Proteinase K, 0.5%

sodium dodecyl sulfate (SDS) and 25 mM ethylendiaminetetraacetic acid (EDTA) were added and the mixture was incubated for additional 20 min at 55 °C to release viral DNA. Viral DNA was cleaned with mini DNeasy Kit (Qiagen, Valencia, CA) and eluted with 40 μΐ of water. Viral genome copy (GC) was determined by using quantitative PCR.

[00182] Viral stock was diluted with PBS to the desired GC/ml. 200 μΐ of viral working solution was delivered into mice via tail vein injection.

[00183] Blood glucose assay. Blood glucose in mouse tail snip was measured using

ACCU-CHEK Active test strips read by an ACCU-CHEK Active meter (Roche

Diagnostics, Indianapolis, IN) following manufacturer's instruction.

[00184] Serum insulin assay. Whole blood (about 50 μΐ/mouse) from mouse tail snips was collected into plain capillary tubes (BD Clay Adams SurePrep, Becton Dickinson and Co. Sparks, MD). Serum and blood cells were separated by spinning the tubes in an Autocrit Utra 3 (Becton Dickinson and Co. Sparks, MD). Insulin levels in serum were determined using insulin EIA kits (80-Insums-E01, Alpco Diagnostics, Salem, NH) by following manufacturer's instruction.

[00185] Glucose tolerance test (GTT). Mice fasted for 16 hours received glucose (1 g/kg) in PBS via intra-peritoneal injection. Blood glucose levels were determined as described above at the time points indicated.

[00186] Insulin Tolerance test (ITT). Mice fasted for 4 hours receive 0.75 units/kg of insulin (Humulin R Eli Lilly and Co. Indianapolis, IN) via intra-peritoneal injection. Blood glucose is determined as described above.

[00187] Statistics. Statistical analysis was performed with Student's t-Test with 2-tailed distribution. EXAMPLE 1: EFFECT OF IN VIVO PLA2G12A EXPRESSION ON BLOOD GLUCOSE LEVELS

IN MICE WITH DIET-INDUCED OBESITY

[00188] To identify secreted proteins that have an effect on glucose metabolism, selected genes were overexpressed in mice using adeno-associated virus (AAV) as the gene delivery vehicle. The anti-diabetic effects of the gene products were evaluated in diet- induced obesity (DIO) model. Eight week old male mice received a one-time tail vein injection of recombinant AAV (rAAV), and starting at the time of virus injection were subjected to 60% kcal fat diet. The mice were then followed for eight weeks during which time body weight, blood glucose and serum insulin were determined. Glucose tolerance tests were also performed to help assess the effect of rAAV on glucose clearance. rAAV-mediated PLA2G12A expression significantly reduced blood glucose levels as well as body weight in DIO mice (Figures 1 and 2). Results of the glucose tolerance test indicated improvement of glucose disposal in these animals (Figure 4).

[00189] The ability of murine PLA2G12A to regulate the level of plasma glucose was tested as follows. rAAV expressing PLA2G12A was injected through tail vein into mice, and starting at the time of virus injection the mice were subjected to 60% kcal fat diet. Before and two, four, and eight weeks after the injection, 4-hour fasting blood glucose levels were determined in tail blood. In Figure 2, "Chow" refers to mice on chow (lean) diet, "GFP" to DIO mice that were injected with 5 x 10¹¹ genome copies ("5E+11" "GC") of the control rAAV expressing green fluorescent protein (GFP), and "PLA2G12A" to mice injected with 5E+11GC of rAAV expressing PLA2G12A (n = 7 mice per group). As seen in Figure 2, recombinant AAV expressing murine PLA2G12A reduced blood glucose in DIO mice to levels comparable to mice on chow diet.

EXAMPLE 2: EFFECT OF PLA2G12A EXPRESSION ON SERUM INSULIN LEVELS IN MICE

WITH DIET-INDUCED OBESITY

[00190] The ability of murine PLA2G12A to relieve hyperinsulinemia in mice with diet- induced obesity was tested. rAAV expressing PLA2G12A was injected through tail vein into mice, and starting at the time of virus injection the mice were subjected to 60% kcal fat diet. At the four week time point after the AAV injection, tail blood was collected from mice that had been fasting for four hours, and serum insulin were determined by enzyme-linked immunosorbent assay (ELISA). In Figure 3, "Chow" refers to mice on chow (lean) diet; "GFP" to DIO mice that were injected with 5E+11 GC of rAAV expressing green fluorescent protein, and "PLA2G12A" to mice injected with 5E+11 GC of rAAV expressing PLA2G12A (n = 7 mice per group). As seen in Figure 3, recombinant AVV expressing murine PLA2G12A reduced hyperinsulinemia in DIO mice.

EXAMPLE 3: EFFECT OF PLA2G12A EXPRESSION ON GLUCOSE TOLERANCE IN MICE

WITH DIET-INDUCED OBESITY

[00191] The ability of murine PLA2G12A to improve glucose tolerance of mice with diet- induced obesity was evaluated as follows. rAAV expressing PLA2G12A was injected through tail vein into mice, and starting at the time of virus injection the mice were subjected to 60% kcal fat diet. At the six week time point after the AAV injection, a glucose tolerance test was performed. Mice fasted overnight received lg/kg of glucose in PBS via intraperitoneal (i.p.) injection. Blood glucose levels were determined at times indicated. In Figure 4, "Chow" refers to mice on chow (lean) diet, "GFP" to DIO mice that were injected with 5E+11 GC of rAAV expressing green fluorescent protein, and "PLA2G12A" to mice injected with 5E+11 GC of rAAV expressing PLA2G12A (n = 7 mice per group). As seen in Figure 4, recombinant AAV expressing murine PLA2G12A was able to improve glucose tolerance significantly in DIO mice.

EXAMPLE 4: CLONING OF THE HUMAN GENE

[00192] The cloning of the human gene encoding PLA2G12A is carried out by using the

PCR method as previously set forth for the cloning of the mouse gene. Briefly, the human PLA2G12A gene can be cloned out by PCR from cDNA library using the following pair of primers, and then cloned into AAV transgene vector as described above for efficacy evaluation. Forward PCR primer: 5' ATGGCCCTGCTCTCGCGCCCC (SEQ ID NO: 16). Reverse PCR primer: 5' TTAAAGATCAGTTTTTTCTTC (SEQ ID NO: 17).

[00193] The nucleic acid sequences, and the encoded amino acid sequence, for human

PLA2G12A are provided below:

[00194] Human PLA2G12A variant 1 ORF (GenBank Accession No. NM_030821)

[00195] ATGGCCCTGCTCTCGCGCCCCGCGCTCACCCTCCTGCTCCTCCTCATG GCCGCTGTTGTCAGGTGCCAGGAGCAGGCCCAGACCACCGACTGGAGAGCCA CCCTGAAGACCATCCGGAACGGCGTTCATAAGATAGACACGTACCTGAAC GCCGCCTTGGACCTCCTGGGAGGCGAGGACGGTCTCTGCCAGTATAAATG CAGTGACGGATCTAAGCCTTTCCCACGTTATGGTTATAAACCCTCCCCAC CGAATGGATGTGGCTCTCCACTGTTTGGTGTTCATCTTAACATTGGTATC CCTTCCCTGACAAAGTGTTGCAACCAACACGACAGGTGCTATGAGACCTG TGGCAAAAGCAAGAATGACTGTGATGAAGAATTCCAGTATTGCCTCTCCA AGATCTGCCGAGATGTACAGAAAACACTAGGACTAACTCAGCATGTTCAG GCATGTGAAACAACAGTGGAGCTCTTGTTTGACAGTGTTATACATTTAGG TTGTAAACCATATCTGGACAGCCAACGAGCCGCATGCAGGTGTCATTATG AAGAAAAAACTGATCTTTAA (SEQ ID NO: 18).

[00196] Human PLA2G12A-variant 1 189 amino acid residues (GenBank Accession No.

NP_110448).

[00197] MALLS RPALTLLLLLMAAVVRCQEQAQTTDWRATLKTIRNGVHKIDTYL

NA ALDLLGGEDGLCQ YKCS DGS KPFPR YG YKPS PPNGCGS PLFG VHLNIGIPS LT KCCNQHDRCYETCGKS KNDCDEEFQYCLS KICRD VQKTLGLTQH VQACETTVEL LFDSVIHLGCKPYLDSQRAACRCHYEEKTDL (SEQ ID NO: l).

[00198] Human PLA2G12A-variant 2 187 amino acid residues (GenBank Accession No.

EAX06249).

[00199] MALLS RPALTLLLLLMAAVVRCQEQAQTTDWRATLKTIRNGVHKIDTYL

NAALDLLGGEDGLCQYKCSDGSKPFPRYGYKPSPPNGCGSPLFGLNIGIPSLTKCC NQHDRC YETCGKS KNDCDEEFQYCLS KICRD VQKTLGLTQH VQACETTVELLFD SVTHLGCKPYLDSQRAACRCHYEEKTDL (SEQ ID NO: 19).

EXAMPLE 5: TREATMENT OF MICE WITH DIET-INDUCED OBESITY WITH AAV

EXPRESSING HUMAN PLA2G12A

[00200] The human gene encoding PLA2G12A will be cloned into AAV transgene

vector. Recombinant AAV expressing the corresponding proteins will be generated as described above in Materials and Methods.

[00201] The ability of human PLA2G12A (hPLA2G12A) to regulate the level of plasma glucose can be tested as follows. rAAV is injected through tail vein into mice that have been on high fat diet for eight weeks. Two weeks after the injection, 4-hour fasting blood glucose levels are determined in tail bleed using a glucometer. Mice to be tested can include a lean group of mice on chow diet ("Chow"), a "GFP" group of DIO mice that are injected with 1E+12 GC of rAAV expressing green fluorescent protein, and a "hPLA2G12A" group of DIO mice injected with 1E+12GC of rAAV expressing hPLA2G12A (n = 5 mice per group). [00202] The ability of hPLA2G12A to relieve hyperinsulinemia in mice with diet- induced obesity can also be tested. rAAV is injected through tail vein into mice that have been on high fat diet for eight weeks. Before, and two and four weeks after the AAV injection, tail blood is collected from mice that have been fasting for four hours, and serum insulin is determined by enzyme-linked immunosorbent assay (ELISA). Groups of mice tested can include a lean group of mice on chow diet ("Chow"), a "GFP" group of DIO mice that are injected with 1E+12 GC of rAAV expressing green fluorescent protein, and a "hPLA2G12A" group of DIO mice injected with 1E+12 GC of rAAV expressing hPLA2G12A (n = 5 mice per group).

[00203] The ability of hPLA2G12A to improve glucose tolerance of mice with diet- induced obesity can be evaluated as follows. rAAV is injected through tail vein into mice that have been on high fat diet for eight weeks. Glucose tolerance test is performed three weeks after the AAV injection. Mice fasted overnight are injected with lg/kg of glucose in PBS via intraperitoneal injection (i.p.). Blood glucose levels are determined at various timed intervals. Groups of mice under evaluation include a group of lean mice on chow diet ("Chow"), a "GFP" group of DIO mice that are injected with ΪΕ+Ϊ2 GC of rAAV expressing green fluorescent protein, and a"hPLA2G12A" group of DIO mice injected with 1E+12GC of rAAV expressing hPLA2G12A (n = 5 mice per group).

EXAMPLE 6: EXPRESSION OF RECOMBINANT MURINE AND HUMAN PLA2G12A.

[00204] For recombinant protein expression in the mammalian expression systems, the cDNA sequence encoding the murine or human PLA2G12A is cloned into Nhel/Mlul or Nhel/Xbal sites of a modified pCDNA3.1 vector, so that the expressed protein is tagged with either 6xHis or human Fc. After sequence confirmation, the plasmid is tested for expression and secretion by transient transfection of the plasmids into suspension-, serum-free adapted 293T, 293-F, and CHO-S cells using FreeStyle MAX transfection reagent (Invitrogen). The identity of the secreted protein is confirmed by anti-His, Anti- hFc, and/or available gene-specific antibodies. The cell line revealing the highest level of the protein secretion is then selected for large-scale transient production of the protein in spinners and/or Wave Bioreactor® System for 5-7 days. The recombinant protein in the supernatant from the transient production is purified by Ni-NTA beads or Protein A- Sepharose affinity chromatography using AKTAexplorer™ (GE Healthcare), and followed by other purification methods, if needed. The purified protein is then dialyzed against PBS, concentrated to ~1 mg/ml or higher concentrations, and stored at -80°C until use.

[00205] For recombinant protein expression in the bacterial expression system, the cDNA sequence encoding the PLA2G12A protein is cloned into Ndel/Hind III or Kpnl/Hind III sites of pET30(+) vector, so that the expressed protein is tagged with 6 x His. The sequencing confirmed plasmid is transformed into BL21(DE3) cells. The protein expression is induced by adding IPTG in the culture and confirmed with anti-His or gene- specific antibodies. If the expressed protein is in the soluble fraction, it will be purified by Ni-NTA affinity chromatography followed by other purification methods if needed. If the expressed protein is in inclusion bodies, the inclusion bodies will be isolated first. The protein in the inclusion bodies is denatured using urea or other denaturing reagents, purified by Ni-NTA beads, refolded, and further purified using other methods if needed. Endotoxin level in the purified protein is then examined, and removed by different methods until the endotoxin level is within the acceptable range. The protein is then dialyzed, concentrated and stored as described above.

EXAMPLE 7: TREATMENT OF MICE WITH DIET-INDUCED OBESITY WITH HUMAN

PLA2G12A RECOMBINANT PROTEIN

[00206] The ability of murine and human PLA2G12A to regulate the level of plasma glucose can be tested as follows. Recombinant murine or human PLA2G12A protein and control protein dissolved in PBS is injected into mice on high-fat diet at 30, 10, and 3 mg/kg via intraperitoneal, subcutaneous, or intravenous injection once a day for two weeks. Body weight, 4-hour fasting blood glucose levels are determined one and two weeks after the initiation of injections. Glucose tolerance test is performed in week 2 and serum insulin is also determined in week 2. Assays are performed as described above in Examples 1-3.

EXAMPLE 8: EFFECT OF IN VIVO HUMAN PLA2G12A EXPRESSION ON BLOOD GLUCOSE

LEVELS IN MICE WITH DIET-INDUCED OBESITY

[00207] The anti-diabetic effect of human PLA2G12A can be evaluated in the DIO

mouse model described above. Eight- week-old male C57BL/6 mice are subjected to 60% kcal fat diet for eight weeks before they receive a one-time tail vein injection of rAAV comprising a nucleotide sequence encoding human PLA2G12A. Body weight, blood glucose, and serum insulin levels in the mice are determined. Glucose tolerance and insulin tolerance tests are performed to help the assessment of effect of rAAV on glucose clearance and insulin sensitivity.

[00208] The ability of human PLA2G12A to regulate the level of plasma glucose is tested as follows. rAAV expressing human PLA2G12A is injected through tail vein into mice that have been on high fat diet for eight weeks. Two weeks after the injection, 4-hour fasting blood glucose levels are determined in tail blood.

EXAMPLE 9: EFFECT OF HUMAN PLA2G12A EXPRESSION ON SERUM INSULIN LEVELS

IN MICE WITH DIET-INDUCED OBESITY

[00209] The ability of human PLA2G12A to relieve hyperinsulinemia in mice with diet- induced obesity can be tested. rAAV expressing human PLA2G12A is injected through tail vein into mice that have been on high fat diet for eight weeks. At the two and four week time points after the AAV injection, tail blood is collected from mice that had been fasting for four hours, and serum insulin is determined by ELISA.

EXAMPLE 10: EFFECT OF HUMAN PLA2G12A EXPRESSION ON GLUCOSE TOLERANCE

IN MICE WITH DIET-INDUCED OBESITY

[00210] The ability of human PLA2G12A to improve glucose tolerance of mice with diet-induced obesity can be evaluated as follows. rAAV expressing human PLA2G12A is injected through tail vein into mice that have been on high fat diet for eight weeks. A glucose tolerance test is performed three weeks after the AAV injection. Mice fasted overnight receive lg/kg of glucose in phosphate buffered saline (PBS) via intraperitoneal (i.p.) injection. Blood glucose levels are determined before, and 30 and 60 minutes after glucose injection.

EXAMPLE 11: EFFECT OF HUMAN PLA2G12A EXPRESSION ON INSULIN SENSITIVITY IN

MICE WITH DIET-INDUCED OBESITY

[00211] The ability of human PLA2G12A to improve insulin sensitivity of mice with diet-induced obesity can be evaluated as follows. rAAV expressing human PLA2G12A is injected through tail vein into mice that have been on high fat diet for eight weeks. An insulin tolerance test is performed five weeks after the AAV injection. Glucose levels are monitored after an intraperitoneal injection of insulin (0.75 units/kg). Response to insulin is compared among DIO mice injected with AAV expressing human PLA2G12A and GFP by measuring blood glucose levels before, and 20, 40, and 60 minutes after insulin injection. EXAMPLE 12: EFFECT OF HUMAN PLA2G12A-IMMUNOGLOBULIN FC FUSION PROTEIN

EXPRESSION ON BODY WEIGHT, BLOOD GLUCOSE LEVELS, SERUM INSULIN LEVELS, GLUCOSE TOLERANCE, AND INSULIN SENSITIVITY IN MICE WITH DIET-INDUCED

OBESITY

[00212] Using the methods described in Examples 8-11, above, the effect of an rAAV expressing a human PLA2G12A-human immunoglobulin Fc fusion protein on body weight, blood glucose levels, serum insulin levels, glucose tolerance, and insulin sensitivity can be tested in the DIO mouse model. An rAAV comprising a nucleotide sequence encoding a fusion protein comprising human PLA2G12A fused at its carboxyl terminus to human immunoglobulin Fc is constructed. The rAAV is injected into the DIO mouse model, as described in Examples 8-11.

EXAMPLE 13: INCREASING MUSCLE MASS AND/OR FUNCTION

MATERIALS AND METHODS

Animals

[00213] Timed -pregnant C57BL/6 mice were purchased from the Charles River

Laboratory (Wilmington, MA). Mice were kept in accordance with welfare guidelines and project license restrictions under controlled light (12 hr light and 12 hr dark cycle, dark 6:30 pm-6:30 am), temperature (22+4°C) and humidity (50 +20 ) conditions. The mice had free access to water (autoclaved distilled water) and were fed ad libitum on a commercial diet (Harlan laboratories, Irradiated 2018 Teklad Global 18% Protein Rodent Diet) containing 17 kcal% fat, 23 kcal% protein and 60 kcal% carbohydrate. 3- day old neonates were injected with adeno-associated virus (AAV). The injected mice were weaned 3 weeks later and were maintained on 2018 Teklad Global diet containing 2000mg/kg of doxycycline (DOX) to induce gene expression (Harlan Laboratories). In addition, mdx mice were purchased from Jackson Laboratory (Bar Harbor, ME). The mdx mice were kept and maintained in similar conditions and diet as non-injected C57BL6 mice. All animal studies were approved by the NGM Institutional Animal Care and Use Committee for NGM- 12-2009 entitled "Characterization of Biologies,

Compounds and Viral Vectors for Treatment of Muscle Wasting Using Rodent Models". DNA Sequence

[00214] cDNA of ORF encoding murine PLA2G12A (GenBank Accession No.

BC026812) [00215] atggtgactccgcggcccgcgcccgcccggggccccgcgctcctcctcctcctgctgctggccactgcgcgcgg gcaggaacaggaccagaccaccgactggagggccaccctcaagaccatccgcaacggcatccacaagatagacacgtacc tcaacgccgcgctggacctgctgggcggggaggacgggctctgccagtacaagtgcagcgacggatcgaagcctgttccac gctatggatataaaccatctccaccaaatggctgtggctctccactgtttggcgttcatctgaacataggtatcccttccctgacca agtgctgcaaccagcacgacagatgctatgagacctgcgggaaaagcaagaacgactgtgacgaggagttccagtactgcct ctccaagatctgcagagacgtgcagaagacgctcggactatctcagaacgtccaggcatgtgagacaacggtggagctcctct ttgacagcgtcatccatttaggctgcaagccatacctggacagccagcgggctgcatgctggtgtcgttatgaagaaaaaacag atctataa (SEQ ID N0: 13)

[00216] The PLA2G12A open reading frame (ORF) was amplified with a polymerase chain reaction (PCR) using recombinant DNA (cDNA) prepared from mouse testes. PCR reagent kits with Phusion high-fidelity DNA polymerase were purchased from New England BioLabs (F-530L, Ipswich, MA). The following primers were used: forward PCR primer: 5' ATGGTGACTCCACGACCAGCACCCGCCCGG (SEQ ID NO: 14) and reverse PCR primer: 5' TTATAGATCTGTCTTCTCCTCATAACGACACC (SEQ ID NO: 15).

PCR

[00217] PCR reactions were set up according to manufacturer' s instruction, amplified

DNA fragment was digested with restriction enzymes Spe I and Not I (the restriction sites were included in the 5' or 3' PCR primers, respectively), and the amplification product was then ligated with AAV transgene vectors that had been digested with the same restriction enzymes. The vector used for expression contained a selectable marker and an expression cassette composed of tetracycline response elements flanked by minimal cytomegalovirus (CMV) promoter 5' of a site for insertion of the cloned coding sequence, followed by a 3' untranslated region and bovine growth hormone

polyadenylation tail. The expression construct was also flanked by internal terminal repeats at the 5' and 3' ends. Alternatively, another vector was also used for tissue- selective expression containing the same regulatory elements and a muscle- specific promoter.

Production and Purification of AAV

[00218] AAV 293 cells (obtained from Agilent Technologies, Santa Clara, CA) were cultured in Dulbecco's Modification of Eagle's Medium (DMEM, Mediatech, Inc.

Manassas, VA) supplemented with 10% fetal bovine serum and lx antibiotic - antimycotic solution (Mediatech, Inc. Manassas, VA). The cells were plated at 50% density on day 1 in 150 mm cell culture plates and transfected on day 2, using calcium phosphate precipitation method, with the following 3 plasmids (20 μg/plate of each): AAV transgene plasmid, pHelper plasmids (Agilent Technologies) and AAV2/9 or AAV2/6 plasmid (Gao et al (2004) J. Virol. 78:6381). 48 hours after transfection, the cells were scraped off the plates, pelleted by centrifugation at 3000xg and resuspended in buffer containing 20 mM Tris pH 8.5, 100 mM NaCl and 1 mM MgCl₂. The suspension was frozen in an alcohol dry ice bath and was then thawed in 37°C water bath. The freeze and thaw cycles were repeated for a total of three times; benzonase (Sigma-Aldrich, St. Louis, MO) were added to 50 units/ml; and deoxycholate was added to a final concentration of 0.25%. After an incubation at 37°C for 30 min, cell debris was pelleted by centrifugation at 5000 x g for 20 min. Viral particles in the supernatant were purified using a discontinuous iodixanol (Sigma-Aldrich, St. Louis, MO) gradient as previously described (Zolotukhin S. et al (1999) Gene Ther. 6:973). The viral stock was concentrated using Vivaspin 20 (MW cutoff 100,000 Dalton, Sartorius Stedim Biotech, Aubagne, France) and re-suspended in phosphate buffered saline (PBS) with 10% glycerol and stored at -80°C.

[00219] To determine the viral genome copy (GC) number, 2 μΐ of viral stock was

incubated in 6 μΐ of solution containing 50 units/ml benzonase, 50 mM Tris-HCl pH 7.5, 10 mM MgCl₂ and 10 mM CaCl₂ for at 37°C for 30 minutes. Afterwards, 15 μΐ of the solution containing 2 mg/ml of Proteinase K, 0.5% sodium docecyl sulfate (SDS) and 25 mM ethylenediaminetetraacetic acid (EDTA) were added and the mixture was incubated for additional 20 min at 55°C to release viral DNA. Viral DNA was cleaned with mini DNeasy Kit (Qiagen, Valencia, CA) and eluted with 40 μΐ of water. Viral genome copy (GC) was determined by using quantitative PCR (qPCR). Viral stock was diluted with PBS to the desired GC/ml. 50 μΐ of viral working solution was delivered into neonates via intraperitoneal injection or in adult mice via intramuscular injection.

Grip Strength Test

[00220] Grip strength measurements were performed in adult mice at 6, 10 and 14 weeks of age. Briefly, each mouse was held by the tail and allowed to grasp the metallic mesh of the digital grip strength meter (Columbus Instruments International Corporation, Columbus OH, USA). After the mouse grip had been established, the tail was gently pulled away from the mesh until the test animal's grip was broken. The force measured upon release was recorded as peak tension in grams. The test was repeated 10 consecutive times for the same mouse. Data are represented as the average peak tension per test animal. All test subjects were blinded prior to test administration.

Magnetic Resonance Imaging

[00221] Body composition measurements were performed in adult mice at 6, 10, and 14 weeks of age using the Echo magnetic resonance imaging (MRI) whole body

composition analyzer (Echo Medical Systems, Houston, TX, USA). Briefly, a mouse was individually placed in a designated holder. The holder was then inserted into the MRI device for analyses. Following ~ 1 minute reading time, the mouse was then released and the test was complete. Each mouse in a group of 10 was analyzed. Data collected for these analyses included total body weight, lean mass and fat mass.

Muscle Physiology

[00222] Intrinsic contractile properties of the skeletal muscle were evaluated using

muscle physiology assay performed using 1305 5N In Situ Muscle Test System (Aurora Scientific Incorporated, Aurora, ON, Canada). One of the assays used was the measurement of maximum tetanic force generated by specific skeletal muscle group in live animals. Briefly, the mouse injected with control virus or virus expressing the target protein was placed under inhaled isofluorane. The hind leg designated for this study was shaved and disinfected. The mouse was placed on a heated platform contained within the physiology apparatus that is capable of maintaining body temperature. In addition, a thermometer was placed in the test mouse to closely monitor its body temperature throughout the procedure. The animal was secured by keeping the knee stationary and the foot firmly fixed to a footplate. The knee was secured by inserting a 25 gauge needle directly underneath the knee bone. The inserted needle was firmly fixed onto a clamp ensuring the stability of the knee throughout the procedure. Muscle contraction on the secured hind leg of the test animal was elicited by electrical stimulation of the common peroneal nerve. To access the common peroneal nerve, a Teflon coated monopolar electrode was externally inserted through the skin on either side of the tibialis anterior muscle (TA). The proximal end of the wire was connected to an electrical stimulator. To determine the maximum tetanic force generated by the TA muscle, the nerve was stimulated at lHz (twitch), 10Hz, 20Hz, 40Hz, 60Hz, 80Hz, 100Hz and 150Hz for 500ms with 30 second pause between tetanus. Data per n=5 are represented as force (N.cm) at various frequency from twitch (lHz) until 150Hz, the frequency where full tetanization was achieved.

Cardiotoxin-Induced Injury

[00223] The effect of PLA2G12A on skeletal muscle upon damage was determined by inducing local muscle injury. Local skeletal muscle damage was induced by a one-time single dose of 0.1 ml of 10 μΜ cardiotoxin (CTX) stock (Calbiochem,CA) solution directly into the tibialis anterior muscle using a 0.5 ml U-100 insulin syringe. As non- injected control, PBS was injected into the other tibialis anterior muscle of the same mouse. Three days following CTX injection, the effects of PLA2G12A on injured skeletal muscle were determined by measuring gene expression levels for

differentiation- specific muscle transcription factors (MyoD, Myogenin) and for specific muscle gene (such as embryonic myosin heavy chain3, MHC) by quantitative PCR. Briefly, total RNA was isolated from skeletal muscle following manufacturer' s RNA protocol for using Trizol reagent (Invitrogen, Carlsbad, CA, USA). Reverse transcription reaction was performed following the protocol outlined from iScript cDNA synthesis kit from Biorad (Hercules, CA, USA). The primer pairs for MyoD, Myogenin and

Embryonic Myosin Heavy Chain3 were obtained from Applied Biosystems (Carlsbad, CA, USA) as FAM labeled Gene Expression Assay kit (Cat#: Mm01203489_gl, Mm00446195_gl and Mm01332475_gl respectively). A primer pair for

glyceraldehyde-3-phosphate dehydrogenase (Gapdh) was purchased as VIC labeled Gene Expression Assay kit (Cat#: 4352339E) from Applied Biosystems. 384-well Q- PCR reactions were set-up using 2x QuantiTect Multiplex RT-PCR Master Mix (Qiagen, Valencia, CA, USA) and performed on a 7900HT Fast Real-Time PCR System from Applied Biosystems (Carlsbad, CA, USA). Data are represented as fold expression relative to Gapdh control.

RESULTS

[00224] The results are shown in Figures 5-9.

[00225] In Figure 5, "GFP" refers to wild-type mice injected with lxlOEl 1 GC of

recombinant AAV (rAAV) vector expressing green fluorescent protein (GFP) via neonate intraperitoneal gene delivery, and "PLA2G12A" to wild- type mice injected with lxlOEl l GC of rAAV expressing mouse PLA2G12A via neonate intraperitoneal gene delivery (n = 10 mice per group). To assess the overall effect of PLA2G12A over- expression, grip strength tests were performed in adult mice, 11 weeks after the induction of PLA2G12A over-expression. Mice performance in the grip strength test showed a marked increase in peak tension upon PLA2G12A over-expression when compared to GFP injected mice.

[00226] In Figure 6, "GFP" refers to wild-type mice injected with lxlOEl 1 GC of rAAV expressing green fluorescent protein via neonate intraperitoneal gene delivery, and "PLA2G12A" to wild-type mice injected with lxlOEl l GC of rAAV expressing mouse PLA2G12A via neonate intraperitoneal gene delivery (n = 10 mice per group). To further characterize additional phenotypes associated with PLA2G12A over-expression, body composition measurements by magnetic resonance imaging (MRI) were also performed at 11 weeks post- PLA2G12A over-expression. The parameters measured in this procedure include total body weight as well as total lean tissue and total fat tissue mass. Over-expression of PLA2G12A does not change overall lean mass, fat-mass and body weight when compared to GFP-injected mice.

[00227] In Figure 7, "GFP" refers to wild-type mice injected with lxlOEl 1 GC of

rAAV expressing green fluorescent protein via neonate intraperitoneal gene delivery, and "PLA2G12A" to wild-type mice injected with lxlOEl 1 GC of rAAV expressing mouse PLA2G12A via neonate intraperitoneal gene delivery (n = 10 mice per group). To evaluate the effects of PLA2G12A over-expression on skeletal muscle which comprise most of the lean tissue mass, tibialis anterior (TA), Quadriceps (Quad), Triceps (Tricep), Biceps (Bicep) muscles were isolated and weighed. These analyses showed that the gross Quadriceps muscle weights from mice over-expressing PLA2G12A are heavier when compared to age-matched GFP- injected controls. Tibialis anterior (TA), Triceps (Tricep) and Biceps (Bicep) weights, however, showed no significant difference when compared to age-matched GFP- injected controls.

[00228] In Figure 8, "GFP" refers to mdx 10-12 week old mice that were intramuscularly injected with 5xlOE10 GC of rAAV expressing green fluorescent protein, and

"PLA2G12A" to mdx intramuscularly injected with 5xlOE10 GC of rAAV expressing mouse PLA2G12A (n = 5 mice per group). To evaluate the potential effects of

PLA2G12A on skeletal muscle, the maximum force generated by the tibialis anterior (TA) muscle was measured by tetanic force stimulation in situ. This analysis showed that PLA2G12A directly contributes to the increase in maximum tetanic force generated by TA muscle. No significant difference was observed between PLA2G12A and GFP groups at low frequency stimulations. Interestingly, at a higher stimulation frequencies (60Hz, 80Hz, 100Hz and 150Hz), PLA2G12A expression results in increased tetanic force (represented by N.cm) generated by TA muscle. Thus, PLA2G12A over- expression directly impacts skeletal muscle contraction and/or function.

[00229] In Figure 9, "GFP" refers to wild-type mice injected with lxlOEl 1 GC of rAAV expressing green fluorescent protein via neonate intraperitoneal gene delivery, and "PLA2G12A" to wild-type injected with lxlOEl l GC of rAAV expressing mouse PLA2G12A via neonate intraperitoneal gene delivery (n = 5 mice per group). For each mouse, PBS was injected into the right TA and Cardiotoxin (CTX) was injected into the left TA. CTX injection is a reproducible method to induce muscle damage and also useful approach to study the skeletal muscle response to injury. In particular, CTX injection creates a rapid and local muscle injury resulting in proliferation and

differentiation of muscle progenitors called satellite cells. The skeletal muscle response to injury is marked by distinct temporal expression of transcription factors and specific muscle gene products.

[00230] To determine the effects of PLA2G12A over-expression following CTX-induced injury, TA muscles were collected from both PBS and CTX injection sites. The mRNA levels for differentiation- specific muscle transcription factors (MyoD and Myogenin) and for specific muscle gene (Embryonic Myosin Heavy Chain (MHC)) were determined by quantitative PCR. This analysis revealed a significant elevation of MHC, MyoD and Myogenin expression levels in muscles where PLA2G12A is over-expressed, compared to age-matched GFP- injected controls following CTX-induced injury. This observation may suggest that PLA2G12A over-expression in skeletal muscle improves the tissue response to injury.

[00231] While the present invention has been described with reference to the specific embodiments thereof, it should be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the true spirit and scope of the invention. In addition, many modifications may be made to adapt a particular situation, material, composition of matter, process, process step or steps, to the objective, spirit and scope of the present invention. All such modifications are intended to be within the scope of the claims appended hereto.

Claims

CLAIMS What is claimed is:

1. A method of treating a subject comprising:

administering to said subject having a glucose metabolism disorder a therapeutically effective amount of a protein comprising at least 72% amino acid sequence identity to an amino acid sequence of human PLA2G12A, wherein said administering is effective to treat a symptom of a glucose metabolism disorder.

2. The method of Claim 1, wherein said glucose metabolism disorder comprises hyperglycemia and wherein said administering reduces plasma glucose in said subject.

3. The method of Claim 1, wherein said glucose metabolism disorder comprises hyperinsulinemia and wherein said administering reduces plasma insulin in said subject.

4. The method of Claim 1, wherein said glucose metabolism disorder comprises glucose intolerance and wherein said administering increases glucose tolerance in said subject.

5. The method of Claim 1, wherein said glucose metabolism disorder comprises diabetes mellitus.

6. The method of Claim 1, wherein said subject is obese.

7. The method of Claim 1, wherein said glucose metabolism disorder is diet- induced.

8. The method of Claim 1, wherein said subject is human.

9. The method of Claim 1, wherein said administering is by parenteral injection.

10. The method of Claim 9, wherein said parenteral injection is subcutaneous.

11. A pharmaceutical composition comprising:

a) a purified PLA2G12A polypeptide comprising an amino acid sequence having at least 72% amino acid sequence identity to an amino acid sequence of human PLA2G12A, wherein said purified PLA2G12A polypeptide is present in the composition in an amount effective to lower blood glucose and/or increase insulin sensitivity in a subject; and

b) a pharmaceutically acceptable excipient.

12. The composition of claim 11, wherein the excipient is an isotonic injection solution.

13. The composition of claim 11, wherein the composition is suitable for human administration.

14. The composition of claim 11, wherein the PLA2G12A polypeptide is present in a fusion protein comprising a human immunoglobulin Fc region fused to the carboxyl terminus of the PLA2G12A polypeptide.

15. A sterile container comprising the composition of claim 11.

16. The container of claim 15, wherein the container is a syringe.

17. A kit comprising the sterile container of claim 15.

18. A pharmaceutical composition for use in a method of treating a glucose metabolism disorder in a subject, wherein the composition comprises:

a) a purified PLA2G12A polypeptide comprising an amino acid sequence having at least 72% amino acid sequence identity to an amino acid sequence of human PLA2G12A, wherein said purified PLA2G12A polypeptide is present in the composition in an amount effective to lower blood glucose and/or increase insulin sensitivity in a subject, and to treat the glucose metabolism disorder; and

b) a pharmaceutically acceptable excipient.

19. A method of treating a subject, the method comprising:

administering to a subject having a deficiency in muscle function and/or reduced muscle mass a therapeutically effective amount of a protein comprising at least 72% amino acid sequence identity to an amino acid sequence of human PLA2G12A, wherein said administering is effective to increase muscle function and/or muscle mass in the subject.

20. The method of claim 19, wherein the deficiency in muscle function and/or reduced muscle mass is a sequela of immobilization, chronic disease, cancer, or injury.

21. The method of claim 19, wherein said subject is human.

22. The method of claim 19, wherein said administering is by parenteral injection.

23. The method of claim 22, wherein said parenteral injection is intramuscular, intravenous, or subcutaneous injection.

24. A pharmaceutical composition comprising:

a) a purified PLA2G12A polypeptide comprising an amino acid sequence having at least 72% amino acid sequence identity to an amino acid sequence of human PLA2G12A, wherein said purified PLA2G12A is present in the composition in an amount effective to increase muscle function and/or muscle mass in a subject; and

b) a pharmaceutically acceptable excipient.

25. The composition of claim 24, wherein the excipient is an isotonic injection solution.

26. The composition of claim 24, wherein the composition is suitable for human administration.

27. The composition of claim 24, wherein the PLA2G12A polypeptide is present in a fusion protein comprising a human immunoglobulin Fc region fused to the carboxyl terminus of the PLA2G12A polypeptide.

28. A sterile container comprising the composition of claim 24.

29. The container of claim 28, wherein the container is a syringe.

30. A kit comprising the sterile container of claim 28.

31. A pharmaceutical composition for use in a method of treating a deficiency in muscle mass and/or muscle function in a subject, wherein the composition comprises:

a) a purified PLA2G12A polypeptide comprising an amino acid sequence having at least 72% amino acid sequence identity to an amino acid sequence of human PLA2G12A, wherein said purified PLA2G12A polypeptide is present in the composition in an amount effective to increase muscle mass and/or muscle function, and to treat the deficiency in muscle mass and/or muscle function; and

b) a pharmaceutically acceptable excipient.