Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/22—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against growth factors ; against growth regulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
  • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
  • A61K39/3955—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against proteinaceous materials, e.g. enzymes, hormones, lymphokines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
  • A61P21/06—Anabolic agents
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
  • C07K16/46—Hybrid immunoglobulins
  • C07K16/468—Immunoglobulins having two or more different antigen binding sites, e.g. multifunctional antibodies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
  • A61K2039/507—Comprising a combination of two or more separate antibodies
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/30—Immunoglobulins specific features characterized by aspects of specificity or valency
  • C07K2317/31—Immunoglobulins specific features characterized by aspects of specificity or valency multispecific
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
  • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
  • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
  • C07K2317/565—Complementarity determining region [CDR]
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
  • C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding

Definitions

• the present invention relates to compositions and methods for increasing muscle mass and muscle strength in a subject. More specifically, the invention relates to compositions thai specifically bind GDF8 and Activin A and the use of such compositions to treat diseases and disorders characterized by decreased muscle mass or strength.
• GDF8 also known as myostatin
• TGF-p transforming growth faetor-p
• GDF8 plays a central role in the development and maintenance of skeletal muscle, acting as a negative regulator of muscle mass. While the myostatin null mouse phenotype demonstrates the importance of GDF8 in the control of muscle size during development, muscle hypertrophy can also be elicited in adult muscle through inhibition of GDF8 with neutralizing antibodies, decoy receptors, or other antagonists. Administration of GDF8 neutralizing antibodies has been reported to result in muscle mass increases of between 10 and 30%.
• the increased muscle mass seen is due to increased fiber diameter as opposed to myofiber hyperplasia (fiber number).
• a number of studies have also reported increases in muscle strength or performance commensurate with increased size including twitch and tetanic force.
• Use of a cleavage resistant version of the GDF8 propeptide also leads to increased muscle size.
• GDF8 antagonists have been used in adult mice with significant effects on skeletal muscle mass. These include the extracellular portion of the Type I! GDF8 receptor, ActR!iB, stabilized by fusion to an IgG Fc domain ("ActRliB-Fc").
• ActR!iB Type I! GDF8 receptor
• ActRliB-Fc IgG Fc domain
• ACE- 031 The clinical molecule "ACE- 031" is an exampl of an AetRI!B-Fc molecule.
• ActRIIB-Fc has been shown to increase muscle mass in experimental animals, in human clinical trials this molecule was shown to cause various adverse side effects.
• administration of ACE-031 to postmenopausal women in a Phase lb ascending dose study was shown to cause undesired increases in hemoglobin and decreases in FSH levels
• a Phase !! study of ACE-031 in pediatric patients with muscular dystrophy was discontinued due to adverse effects including nose and gum bleeding. Dilated blood vessels are also observed in patients treated with ActR!IB-Fc.
• ActRiSB-Fc e.g., enhanced skeletal muscle growth
• desired therapeutic effects of ActRiSB-Fc e.g., enhanced skeletal muscle growth
• ActRiiB iigands e.g., GDF11 , BMP9, BMP 10, etc.
• a composition comprising a GDF8-specific binding protein and an Activin A-specific binding protein.
• the GDF8-specific binding protein is an anti-GDF6 antibody and/or the Activin A- specific binding protein is an anti-Acfivin A antibody.
• an antigen-binding molecule is provided comprising a GDFB-specific btndtng domain and an Activin A-speeific binding domain.
• the antigen-binding molecule is a bispecifse antibody comprising a first variable domain that specifically binds GDF8 and a second variable domain that specifically binds Activin A,
• the present invention provides methods for increasing muscle mass or strength in a subject by administering to the subject an Activin A-specific binding protein.
• the present invention also provides methods for increasing muscle mass or strength in a subject by administering to the subject a GDFS-spectfic binding protein and an Activin A-specific binding protein, or by administering to the subject an antigen-binding molecule comprising a GDF8- specific binding domain and an Activin A-specific binding domain.
• the methods according to this aspect of the invention are useful for treating diseases or disorders associated with decreased muscle mass, strength or power, including, e.g. , cachexia, sarcopenia and other muscle-wasting conditions.
• the present invention relates to compositions comprising antigen-specific binding proteins. More specifically, the present invention provides a composition comprising a GDF8- speeific binding protein and an Activin A-specific binding protein.
• antigen-specific binding protein means a protein comprising at !east one domain which specifically binds a particular antigen.
• exemplary categories of antigen-specific binding proteins include antibodies, antigen-binding portions of antibodies, peptides that specifically interact with a particular antigen (e.g., pepfibodies), receptor molecules that specifically interact with a particular antigen, and proteins comprising a iigand-binding portion of a receptor that specifically binds a particular antigen.
• the present invention includes antigen-specific binding proteins that specifically bind GDF8, i.e., "GDFS-speeific binding proteins".
• GDFB ⁇ also referred to as “growth and differentiation factor- ⁇ ” and “myostatin” means the protein having the amino acid sequenc of SEQ iD NO:25 ⁇ mature protein).
• GDFS-specific binding proteins specifically bind GDF8 but do not bind other ActRi!B ligands such as GDF3, BMP2, 8MP4, B P7, BMP8, BMP1G, GDF11 , Activi A, Activin 8, Activin AS, Nodal, etc.
• the present invention also includes antigen-specific binding proteins that specifically bind Activin A, i.e., "Activin A-specific binding proteins", Activins are homo- and heter-dimeric molecules comprising pA and/or j3B subunits.
• the ⁇ subunit has the amino acid sequence of SEQ iD NQ:26 and the ⁇ subunit has the amino acid sequence of SEQ iD NO;28,
• Activin A is a homodimer of two ⁇ subunits;
• Activin B is a homodimer of two ⁇ subunits; and
• Activin AB is a heferodimer of one j3A subunit and one ⁇ subunit.
• An Activin A-specific binding protein may be an antigen-specific binding protein that specifically binds the ⁇ subunit. Since the pA subunit is found in both Activin A and Activin AB molecules, an "Activin A-specific binding protein" can be an antigen-specific binding protein that specifically binds Activin A as we!! as Activin AB (by virtue of its interaction with the ⁇ su unit).
• an Activin A-specific binding protein specifically binds Activin A, or Activin A and Activin AB, but does not bind other ActRI IB Iigands such as Activin B, GDF3, GDF8, BMP2, BMP4, BMP7, BMP9, SMP10, GDF11 , Nodal, etc.
• moiecuies such as ActR!iB-Fc (e.g. , "ACE- 031"), which comprise the Sigand-binding portion of the ActRlSB receptor, are not considered "GDF8- specific binding proteins” or "Activin A-specific binding proteins” because such moiecuies bind multiple Iigands besides GDFS, Activin A and Activin AB.
• the present invention also includes antigen-binding moiecuies comprising two different antigen-specific binding domains.
• the present invention includes antigen-binding moiecuies comprising a GDFS-specific binding domain and an Activin A-specific binding domain.
• the term "antigen-specific binding domain,” as used herein, includes poiypeptides comprising or consisting of: (i) an antigen-binding fragment of an antibody molecule, (ii) a peptide that specifically interacts with a particular antigen (e.g., a peptibody). and/or (I) a ligand-binding portion of a receptor that specifically binds a particular antigen.
• the present invention includes bispecific antibodies with one arm comprising a first heavy chain variable region/light chain variable region (HCVR/LCVR) pair that specifically binds GDFS and another arm comprising a second HCVR/LCVR pair that specifically binds Activin A.
• HCVR/LCVR heavy chain variable region/light chain variable region
• an antigen-specific binding protein or an antigen-specific binding domain includes molecules that bind a particular antigen (e.g. , GDFS, or Activin A and/or AB) or a portion thereof with a , of less than about 500 pM, less than about 400 pM, less than about 300 M, iess than about 200 pM, less than about 100 pM, iess than about 90 pM.
• a particular antigen e.g. GDFS, or Activin A and/or AB
• an antigen-specific binding protein or antigen-specific binding domain "does not bind" to a specified molecule (e.g., “does not bind GDF1 V, “does not bind BMP9", “does not bind BMP 10", etc.) it the protein or binding domain, when tested for binding to the molecule at 2S°C in a surface piasmon resonance assay, exhibits a K ⁇ - ; of greater than 1000 pM, or fails to exhibit any binding in such an assay or equivalent thereof.
• surface piasmon resonance refers to an optical phenomenon that allows for the analysis of real-time interactions by detection: of alterations in protein concentrations within a biosensor matrix, for example using the SIAcoreTM system (Biacore Life Sciences division of GE Healthcare, Piscataway, NJ).
• K means the equilibrium dissociation constant of a particular protein-protein interaction (e.g., antibody-antigen interaction). Unless indicated otherwise, the K D values disclosed herein refer to K 0 values determined by surface piasmon resonance assay at 25°C.
• an antigen-specific binding protein can comprise or consist of an antibody or antigen-binding fragment of an antibody.
• antigen-binding molecules comprising two different antigen-specific binding domains
• one or both of the antigen-specific binding domains may comprise or consist of an antigen-binding fragment of an antibody.
• antibody is intended to refer to immunoglobulin molecules comprising four polypeptide chains, two heavy (H) chains and two light (L) chains interconnected by disulfide bonds, as well as mu!timers thereof (e.g., !givl).
• Each heavy chain comprises a heavy chain variable region (abbreviated herein as HCV or VH) and a heavy chain constant region.
• the heavy chain constant region comprises three domains, (3 ⁇ 41 , CM2 and C H 3.
• Each light chain comprises a light chain variable region (abbreviated herein as LCVR or V'J and a light chain constant region.
• the light chain constant region comprises one domain
• the VH and Vs . regions can be further subdivided into regions of hypervariabi!ity, termed
• each V M and V L is composed of three CDRs and four FRs, arranged from amsno-terminus to carboxy-terminus in the following order; FR1 , CDR1 , FR2, CDR2, FR3, CDR3, FR4.
• the FRs of the antibodies of the invention may be identical to the human germiine sequences, or may be naturally or artificially modified.
• An amino acid consensus sequence may be defined based on a side-by-side analysis of two or more CDRs.
• antibody/' also includes antigen-binding fragments of full antibody mo!ecuies.
• antigen-binding portion of an antibody, “antigen-binding fragment” of an antibody, and the like, as used herein:, include any naturally occurring, enzymaticaily obtainabie, synthetic, or genetically engineered polypeptide or glycoprotein that specifically binds an antigen to form a comp!ex.
• Antigen-binding fragments of an antibody may be derived, e.g... from full antibody molecules using any suitable standard techniques such as proteolytic digestion or recombinant genetic engineering techniques involving the manipulation and expression of DNA encoding antibody variable and optionally constant domains.
• DNA is known and/or is readily available from, e.g., commercial sources, DNA libraries (including, e.g., phage-antibody libraries ⁇ , or can be synthesized.
• the DNA may be sequenced and manipulated chemically or by using molecular biology techniques, fo example, to arrange one or more variabie and/or constant domains into a suitable configuration, or to introduce eodons, create cysteine residues, modify, add or delete amino acids, etc.
• Non-limiting examples of antigen-binding fragments include; (i) Fab fragments; (is) F ⁇ ab')2 fragments; ⁇ $) Fd fragments; ⁇ iv) Fv fragments; (v) single-chain Fv (scFv) moiecuies; (vt) dAb fragments; and (vii) minimal recognition units consisting of the amino acid residues that mimic the hypervariab!e region of an antibody (e.g., an isolated complementarity determining regio (CDR) such as a CDR3 peptide), or a constrained FR3-CD 3-FR4 peptide.
• CDR complementarity determining regio
• engineered molecules such as domain-specific antibodies, single domain antibodies, domain- deleted antibodies, chimeric antibodies, CDR-grafted antibodies, diabodies, triabodies, tetrabodies, minibodies, nanobodies ⁇ e.g. monovalent nanobodses, bivalent nanobodses, etc.), smal! modular immunQpharrnaceuiica!s (SM!Ps), and shark variable IgNAR domains, are also encompassed within the expression "antigen-binding fragment," as used herein.
• variable domain An antigen-binding fragment of an antibody will typically comprise at least one variable domain.
• the variable domain may be of any size or amino acid composition and wi!l generally comprise at least one CDR which is adjacent to or in frame with one or more framework sequences, in antigen-binding fragments having a V H domain associated with a V L domain, the VH and VL domains may be situated relative to one another in any suitable arrangement.
• the variable region may be dimeric and contain VH-VH, VR-V l or V L -VY dimers.
• the antigen-binding fragment of an antibody may contain a monomelic V H or V L domain.
• an antigen-binding fragment of an antibody may contain at least one variable domain covended!y linked to at least one constant domain.
• Non-limiting, exemplary configurations of variabie and constant domains that may be found within an antigen- binding fragment of an antibody of the present invention include: (j) VH-CK1 ; (ii) VH-C H 2; (i) V H - C H 3; (iv) VH-C H 1-CH2; (V) VH-C H 1 -C H 2-C H 3; (vi) V h -3 ⁇ 42-CH3; (vii) V H -C,.; (viii) VL-C H 1 ; (ix) VL-CB2; (x) V L -CH3: (xi) V L -CH1 -C H 2; (xii) V L -CH1 -C H 2-CH3; (xiii) V L -C H 2-C H 3; and (xiv) V L
• variable and constant domains may be either direetiy linked to one another or may be linked by a full or partiai hinge or linker region.
• a hinge region may consist of at ieast 2 ⁇ e.g., 5, 10, 15, 20, 40, 80 or more) amino acids which resu!t in a flexible or semi-flexible linkage between adjacent variable and/or constant domains in a single polypeptide molecule.
• an antigen-binding fragment of an antibody of the present invention may comprise a horno-dimer or hetero-dimef (or other mutii er) of any of the variable and consiani domain configurations listed above in non-covending association with one another and/or with one or more monomeric V'H or Vs. domain ⁇ e.g., by disulfide bondfs)),
• the molecules of the present invention may comprise or consist of human antibodies and/or recombinant human antibodies, or fragments thereof.
• human antibody includes antibodies having variable and constant regions derived from human germline immunoglobulin sequences. Human antibodies may nonetheless include amino acid residues not encoded by human germline immunoglobulin sequences (e.g., mutations introduced by random or site-specific mutagenesis in vitro or by somatic mutation n vivo), for example in the CDRs and in particular CDR3.
• the term "human antibody”, as used herein is not intended fo include antibodies in which CDR sequences derived from the germline of another mammalian species, such as a mouse, have been grafted onto human framework sequences.
• the molecules of the present invention may comprise or consist of recombinant human antibodies or antigen-binding fragments thereof.
• recombinant human antibody is intended to include all human antibodies that are prepared, expressed, created or isolated by recombinant means, such as antibodies expressed using a recombinant expression vector Iran sfected into a host eel (described further below), antibodies isolated from a recombinant, combinatorial human antibody library (described further below), antibodies isolated from an animal (e.g., a mouse) that is transgenic for human immunoglobulin genes ⁇ see e.g. , Taylor et al, (1992 ⁇ Nuc!, Acids Res.
• Such recombinant human antibodies have variable and constant regions derived from human germline immunoglobulin sequences. In certain embodiments, however, such recombinant human antibodies are subjected to in vitro mutagenesis (or, when an animal transgenic for human ig sequences is used, in vivo somatic mutagenesis) and thus the amino acid sequences of the V3 ⁇ 4 and V ; . regions of the recombinant antibodies are sequences that, while derived from and related to human germline V H and V L sequences, may not naturally exist within the human antibody germline repertoire in vivo,
• the GDF8-specific binding protein, or the GDFS-specific binding domain comprises or consists of an anti-GDFS aritibody or antigen-binding fragment thereof .
• Anti-GDFS antibodies are mentioned in, e.g., US Patent Nos. 6,098,506; 7,320,789; 7,261 ,893; 7,807,159; 7,888,488; 7,635,760; 7,632,499; in US Patent AppL Pubi. Nos. 2007/0178095; 2010/0166764; 2009/0148436; and international Patent Appi. Pub!. No. WO 20 0/070094.
• Anti-GDFS antibodies are also described in US Patent Appi, No.
• Table 1 sets fort the sequence identifiers of the HCVRs, LCVRs, and CDRs of certain non-limiting, exemplary anti-GDFS antibodies that can be used in the context of the present invention.
• the Activin A-specific binding protein, or the Activin A-specific binding domain comprises or consists of an antibody or antigen-binding fragment thereof that specifically hinds Activin A.
• the Activin A-specific binding protein specifically binds the 8A subunit.
• An antigen-specific binding protein that specifically binds the [3 ⁇ 4A subunit may recognize both Activin A ( ⁇ / ⁇ homodimer) and Activin AB ( ⁇ / ⁇ heterodimer).
• an Activin A ⁇ specific binding protein may bind both Activin A and Activin AB (but not Activin B),
• Anti-Activin A antibodies are mentioned in, e.g., US Patent Appi. Publ. No 2009/0234106.
• a particular anti- Activin A antibody is designated "MAB3381 ,” and is a ailable commercially from R&D Systems, inc. Minneapolis, MM MAB3381 specifically binds Activin A ⁇ homodimer ⁇ as well as Activin AB (heterodimer).
• anfi-Activin A antibodies or antigen-binding fragments thereof, can be used in the context of the present invention, so long as such antibodies and/or antigen-binding fragments "specifically bind" Activin A and/or Activin AB, as defined herein.
• the present invention includes pharmaceutical compositions comprising a GDFS- specific binding protein and an Activin A-specific binding protein.
• the present invention also includes pharmaceutical compositions comprising an antigen-binding molecule comprising a GDFS-specifie binding domain and an Aetivin A-speeific inding domain.
• the pharmaceutical compositions of the invention are formulated with suitable carriers, excipients, and other agents that provide suitable transfer, delivery, tolerance, and the like. A multitude of appropriate formulations can be found in, e.g.. Remington's Pharmaceutical Sciences.
• Suitable formulations include, for example, powders, pastes, ointments, jeies, waxes, oils, lipids, lipid ⁇ caiionic or anionic) containing vesicles (such as LIPOFECT!NTM ⁇ , DMA conjugates, anhydrous absorption pastes, oii-irt-water and water-in-oil emulsions, emulsions carbovvax (polyethylene glycols of various molecula weights), semi-solid gels, and semi-solid mixtures containing carbowax. Additional suitabl formulations are also describee! in Powell et a!. "Compendium of excipients for parenteral formulations" PDA (1998) J Pbarm Sci Techno! 52:238-311.
• compositions of the present invention e.g. , encapsulation in liposomes, micropartic!es, microcapsules, recombinant cells capable of expressing the mutant viruses, receptor mediated endocytosis (see, e.g., Wu et al., 1987, J. Biol. Chem. 282:4429-4432).
• compositions include, but are not limited to, intradermal, intramuscular, intraperitoneal, intravenous, subcutaneous, intranasal, epidural, and oral routes.
• the compositions may be administered by an convenient route, for example by infusion or bolus injection, by absorption through epithelial or mucocutaneous linings (e.g., oral mucosa, rectal and intestinal mucosa, etc.) and may be administered together with other biologically active agents.
• a pharmaceutical composition of the present invention can be delivered
• a pen delivery device readily has applications in delivering a
• Such a pen delivery device can be reusable or disposable.
• a reusable pen delivery device generally utilizes a replaceable cartridge that contains a pharmaceutical composition. Onc ail of the pharmaceutical composition within the cartridge has been administered and the cartridge is empty, the empty cartridge can readily be discarded and replaced with a new cartridge that contains the pharmaceutical composition. The pen delivery device can then be reused.
• a disposable pen delivery device there is no replaceable cartridge. Rather, the disposable pen deiivery device comes prefilled with the pharmaceutical composition held in a reservoir within the device. Once the reservoir is emptied of the pharmaceutical composition, the entire device is discarded.
• DiSETRONICTM pen (Disetronic Medical Systems, Bergdorf, Switzerland ⁇ , BUMAtOG Mix 75/25TM pen, HUMALGGTM pen, HUMALIN 70/30 w pen ⁇ Eli Lilly and Co., Indianapolis, IN), NOVOPENTM !, If and Hi (Novo Nordisk, Copenhagen., Denmark ⁇ , OVOPEN JUNIORTM (Novo Nordisk, Copenhagen, Denmark). SDTM pen (Becton Dickinson, Franklin Lakes, NJ),
• OPT! PENTM, OPTiPEN PROTM, OPTiPEN STARLETTM, and OPT!CLSKTM isanofi-aventis, Frankfurt, Germany), to name only a few.
• disposable pen delivery devices having applications in subcutaneous delivery of a pharmaceutical composition of the present Invention include, but are not limited to the SOLOSTARTM pen ⁇ sanofi-aveniis), the FLEXPENTM (Novo Nordisk), and the KWIKPENTM (Eil Lilly), the SURECLICKTM Autoinjector (Amgen, Thousand Oaks, CA), the PENLETTM (Haselmeier, Stuttgart, Germany), the EPIPE (Dey, LP.), and the HUMIRATM Pen (Abbott Labs, Abbott Park it), to name only a few.
• compositions of the present invention can be delivered in a controlled release system.
• a pump may be used (see
• a control !ed release system can be placed In proximity of the composition's target, thus requiring oniy a fraction of the systemic dose (see, e.g., Goodson, 19S4, in Medical Applications of Controlled Release, supra, vol 2, p, 115-138), Other controlled re!ease systems are discussed in the review by Langer, 1990, Science 249:1527-1533.
• T e Injectable preparations may include dosage forms for intravenous, subcutaneous, intracutaneous and intramuscular injections, drip infusions, etc. These injectable preparations ma be prepared by known methods.
• the injectable preparations may be prepared, e.g... by dissolving, suspending or emulsifying the antibody or its salt described above in a sterile aqueous medium or an oily medium convention-ally used for injections.
• aqueous medium for injections there are, for example, physiological saline, an isotonic solution containing glucose and other auxiliary agents, etc..
• an appropriate solubiiizing agent such as an alcohol (e.g., ethanoi), a poiyalcoho! (e.g., propylene glycol, polyethylene glycol), a nonionic surfactant [e.g., poiysorbate 80, HCO-50
• oily medium there are employed, e.g., sesame oil, soybean oil, etc., which may be used in combination with a solubiiizing agent such as benzyl benzoate, benzyl alcohol, etc.
• a solubiiizing agent such as benzyl benzoate, benzyl alcohol, etc.
• the pharmaceutical compositions for oral or parenteral use described above are prepared into dosage forms in a unit dose suited to fit a dose of the active ingredients.
• dosage forms In a unit dose include, for example, tablets, pills, capsules, injections (ampoules), suppositories, etc.
• the amount of active ingredient (e.g., anti-GDF8 antibodies and anti-Activin A antibodies) that can be administered to a subject is, generally, a therapeutically effective amount.
• therapeutically effective amount' 1 means a ciose of antigen-specific binding proteins and/or antigen-binding molecules that results in a detectable increase in one or more of the following parameters: body weight, muscle mass ⁇ e.g. , tibialis anterior [TAJ muscle mass, gastrocnemius [GAJ muscle mass, quadriceps [Quad] muscle mass, etc.), muscle strength/power, and/or muscle function.
• A-specific binding protein includes, e. g., an amount of GDFS-specific binding protein and/or Activin A-specific binding protein that, when administered to a test subject, causes an increase in TA or GA muscle mass of at feast 2%. 5%, 10%, 15%. 20%, 25%, 30%, 40%, 50%. 60% or more, compared to control treated subjects, e.g., as illustrated in Example 1 , herein.
• a therapeutically effective amount can be from about 0.05 mg to about 600 mg; e.g., about 0.05 mg, about 0.1 mg, about 1 .0 mg, about 1.5 mg, about 2.0 mg, about 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 80 mg, about 70 mg, about 80 mg, about 90 mg, about 100 mg, about 1 10 mg, about 120 mg, about 130 mg, about 140 mg, about 150 mg, about 160 mg, about 170 mg, about 180 mg, about 190 mg, about 200 mg, about 210 mg, about 220 mg, about 230 mg, about 240 mg, about 250 mg, about 260 mg, about 270 mg, about 280 mg, about 290 mg, about 300 mg, about 310 mg, about 320 mg, about 330 mg, about 340 mg, about 350
• the amount of antibody of the present invention (e.g., anti ⁇ GDF8 antibodies, anti- Activin A antibodies, or bispecific antibodies that specifically bind GDF8 and Activin A) contained within the individual doses may be expressed in terms of milligrams of antibody per kilogram of patient body weight ⁇ i.e., mg/kg).
• the anti ⁇ GDF8, anti-Activin A and/or anti- GDF8/anfi-Activin A bispecific antibodies of the present invention may be administered to a patient at a dose of about 0,0001 to about 50 mg kg of patient body weight (e.g.
• compositions of the present invention may comprise equal amounts of GDFS- specific binding protein and Activin A-specific binding protein.
• the amount of GDFS-specific binding protein in the composition may be less than or greater than the amount of Activin A-specific binding protein.
• the present invention includes methods of treating conditions or afflictions which can be cured, alleviated or improved by increasing muscle strength/power and/or muscle mass and/or muscle function in an individual, or by favorably altering metaboiism (carbohydrate, iipid and protein processing) by specifically binding GDF8, and/or Activin A, and/or Activin AS, and not binding other ActRIIB ligands.
• the present invention includes methods for increasing muscle strength/power and/or muscle mass and/or museie function in a subject, or for treating a disease or disorder characterized by decreased museie mass or strength in a subject, by administering to the subject an Activin A-specific binding protein.
• the present invention also includes methods for increasing muscle strength/power and/or muscle mass and/or muscle function in a subject, or for treating a disease or disorder characterized by decreased muscle mass or strength in a subject, by administering to the subject a GDFS- specific binding protein and an Activin A-specific binding protein.
• a GDFS-specific binding protein and an Activin A-specific binding protein Any of the GDFS-specific binding proteins and/or Activin A-specific binding proteins disclosed or referred to herein can be used in the context of these aspects of the invention ,
• the therapeutic methods of the present invention include administering to a subject an anti-GDFS antibody and/or an antt- Activin A antibody.
• the GDFS-specific binding protein and the Activin A-specific binding protein may be administered to the subject at the same or substantially the same time, e.g., in a single therapeutic dosage, or i two separate dosages which are administered simultaneously or within less than about 5 minutes of one another.
• the GDFS-specific binding protein and the Activin A-specific binding protein may be administered to the subject at the same or substantially the same time, e.g., in a single therapeutic dosage, or i two separate dosages which are administered simultaneously or within less than about 5 minutes of one another.
• the GDFS-specific binding protein and the Activin A-specific binding protein may be
• the present invention also includes methods for increasing muscle strength/power and/or muscle mass and/or muscle function in a subject, or for treating a disease or disorder characterized by decreased museie mass or strength in a subject, b administering to the subject an antigen-binding molecule comprising a GDF8-specific binding domain and an Activin A-specific binding domain.
• an antigen-binding molecule comprising a GDF8-specific binding domain and an Activin A-specific binding domain.
• the therapeutic methods of the present invention include administering to a subject a bispecific antibody comprising a first variable domain comprising a HCVR/LCVR pair that specifically binds GDF8 and a second variable domain comprising a HCVR/LCVR pair that specifically binds Activin A.
• compositions of the present invention may be administered to a subject along with one or more additional therapeutic agents, including, e.g., growth factor inhibitors,
• immunosuppressants anti-inflammatory agents, metabolic inhibitors, enzyme inhibitors, and cytotoxic/cytostatic agents.
• the additional therapeutic agent(s) may be administered prior to, concurrent with, or after the administration of the GDF8- and Activin A-speeific binding proteins of the present invention.
• compositions of the present invention include, but are not limited to, sa copenia, cachexia ⁇ either idiopathic or secondary to other conditions : e.g., cancer, chronic reoai failure, or chronic obstructive pulmonary disease), muscie injury, muscie wasting and muscle atrophy, e.g., muscie atrophy or wasting caused by or associated with disuse, immobilization, bed rest, injury, medical treatment or surgical intervention ⁇ e.g. , hip fracture, hip replacement, knee replacement, etc.) or by necessit of mechanical ventilation.
• sa copenia cachexia ⁇ either idiopathic or secondary to other conditions : e.g., cancer, chronic reoai failure, or chronic obstructive pulmonary disease
• muscie injury e.g., muscie wasting and muscle atrophy, e.g., muscie atrophy or wasting caused by or associated with disuse, immobilization, bed rest, injury, medical treatment or
• compositions of the invention may also be used to treat, prevent or ameliorate diseases such as cancer, obesity, diabetes, arthritis, multiple sclerosis, muscular dystrophy, amyotrophic lateral sclerosis, Parkinson's disease, osteoporosis, osteoarthritis, osteopenia, metabolic syndromes (including, but not limited to diabetes, obesity, nutritional disorders, organ atrophy, chronic obstructive pulmonary disease, and anorexia).
• diseases such as cancer, obesity, diabetes, arthritis, multiple sclerosis, muscular dystrophy, amyotrophic lateral sclerosis, Parkinson's disease, osteoporosis, osteoarthritis, osteopenia, metabolic syndromes (including, but not limited to diabetes, obesity, nutritional disorders, organ atrophy, chronic obstructive pulmonary disease, and anorexia).
• the present invention includes methods for increasing muscie strength/power and/or muscie mass and/or muscle function in a subject, or for treating a disease or disorder characterized by decreased muscle mass or strength in a subject, without causing adverse side effects associated with the administration of mo!ecuies which bind multiple ⁇ e.g., 3 or more) ActRi!B ligands.
• the clinical molecule referred to as AC £-031 (Aceeleron Pharma, inc., Cambridge, MA) is a mu!timer consisting of the extracellular portion of ActR!iB fused to an igG Fc domain ⁇ this molecule is also referred to herein as "ActRiiB-Fc").
• ActRliB-Fc binds GDF8 as well as other Act HB ligands such as, e.g., Activin A, Activin B, GDF11 , 8 P9,
• compositions of the present invention may be administered to a subject over a defined time course.
• the methods according to this aspect of the invention comprise sequentially administering to a subject muitip!e doses of the compositions of the present invention .
• sequentially administering means thai each dose of the compositions of the present invention are administered to the subject at a different point in time, e.g., on different days separated by a predetermined interval ⁇ e.g.
• the present invention includes methods which comprise sequentially administering to the patient an initial dose of a composition of the present invention, followed by one or more secondary doses of the composition, and optionally followed by one or more tertiary doses of the composition.
• the terms “initial dose,” “secondary doses,” and “tertiary doses,” refer to the temporal sequence of administration of the compositions of the present invention.
• the “initial dose” is the dose which is administered at the beginning of the treatment regimen ⁇ also referred to as the “baseline dose”);
• the “secondary doses” are the doses which are administered after the initial dose;
• the “tertiary doses' 1 are the doses which are administered after the secondary doses.
• the initial, secondary, and tertiary doses may all contain the same amount of active ingredient(s), but will generally differ from one another in terms of frequency of administration, in certain embodiments, however, the amount of active ingredients) contained in the initial, secondary and/or tertiary doses will vary from one another ⁇ e.g., adjusted up o down as appropriate) during the course of treatment.
• each secondary and/or tertiary dose is administered 1 to 30 (e.g., 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 14, I S, 18, 17, 18, 19, 20, 21 , 22, 23, 24, 25, 28, 27, 28, 29, 30, or more) days after the immediately preceding dose.
• the phrase "the immediately preceding dose,” as used herein, means, in a sequence of multiple administrations, the dose(s) of the compositions of the present invention which are administered to a subject prior to the administration of the very next dose in the sequence with no intervening doses.
• the methods according to this aspect of the invention may comprise administering to a patient any number of secondary and/or tertiary doses of the compositions of the present invention.
• any number of secondary and/or tertiary doses of the compositions of the present invention may comprise administering to a patient any number of secondary and/or tertiary doses of the compositions of the present invention.
• only a single secondary dose is administered to the patient.
• two or more (e.g., 2, 3, 4, 5, 8, 7, 8, or more) secondary doses are administered to the patient.
• two or more (e.g., 2, 3, 4, 5, 6 ; 7, 8, or more) tertiary doses are administered to the patient.
• eac secondary dose may be administered at the same frequency as the other secondary doses.
• each secondary dose may he administered to the patient 1 to 29 days after the immediately preceding dose.
• each tertiary dose may be administered at the same frequency as the other tertiary doses.
• each tertiary dose may be administered to the patient 1 to 60 days after the immediately preceding dose.
• the frequency at which the secondary and/or tertiary doses are administered to a patient can vary over the course of the treatment regimen.
• the frequency of administration may also be adjusted during the course of treatment by a physician depending on the needs of the individual patient following clinical examination,
• ActRSIB-Fc is a GDFS antagonist consisting of the extracellular portion of the ActRiSB receptor, stabilized by fusion to an SgG Fc domain.
• ActRi!B-Fc has been shown to increase muscle mass in mice to a greater extent than anti-GDP8 antibodies.
• the present Example was designed to determine whether specific inhibition of GDFS and Activin A can increase skeletal muscle mass to an extent that is at least equivalent to the increase observed using ActRIIB-Fc.
• the extent of skeletal muscle hypertrophy induced by administration of AetR!lB-Fc was compared to the effect of administration of a GDFS-specific antibody, an Activin A specific antibody, or a combination of an anti-GDF8 + anti-Activin A antibody.
• the ActRilB-Fc construct used in this Example has the amino acid sequence of SEQ ID NO:27,
• the anti-GDFS antibody used in this Example is the antibody designated H4H1857N2 (see Tabie 1 ).
• the artii-Activin A antibody used in this Example is the antibody designated MA83381 (available from R&D Systems, inc., Minneapolis, N).
• An isotype-matched ChigG4) antibody was used as negative control
• mice 25 male CB1 SOD mice at approximately 10 weeks of age, were divided evenly according to body weight into 5 groups based on treatment (isotype Control rrsAb, ActRllB-Fc, H4H1657N2, MAB3381 , or H4H1657N2 + MAB3381), Reagents were administered subcutaneous!y at a dose of 10 mg/kg twice for the first week (on day 0 and day 3 ⁇ and once a week for the following three weeks ⁇ on day 7, day 14 and day 21 ⁇ . On day 28, mice were euthanized and weighed, and the tibialis anterior (TA) muscles, and the gastrocnemius (GA) muscles, were dissected and weighed. Tissues were normalized to starting bod weight, and percent change in weight over the isotype-matched (higG4) control antibody was calculated. Results are summarized in Table 2 and are expressed as percent increase over negative control ⁇ standard error of the mean.
• mice treated with AetRlSB-Fc showed a significant increase in red blood ceil distribution width (RDVV), which reflects the extent of size variation of red blood ceils in a sample.
• RDVV red blood ceil distribution width
• mice treated with anti-GDFS antibody, anti-Activin A antibody, or the combination of anti-GDFS + anti-Acttvin A antibodies did not exhibit an appreciable degree of increase in % RDW as compared to isotype control-treated mice.
• Microarray analysis was conducted on skeletal muscle samples from mice treated with isotype control, ActRi!B-Fe, and H4H1657N2 (anti-GDF8). From these experiments, a set of genes was identified that is uniquely affected by AcfRi!B-Fc. Of particular interest was the up- reguiation of Endoglin rnRNA levels in skeletal muscle in samples from ActRliB-Fc-treated subjects. Endoglin is a transmembrane protein expressed primarily in endothelial ceils and interacts and promotes signaling through receptors of the TGFp family (ALK > in response to TGFp, BMP , or BMP10.
• HHT Hereditary Haemorrhagic Telangiectasia
• the present inventors have surprisingly discovered that treatment with a GDF8-specifte binding protein, or an Activin A-specific binding protein, or a combination of a GDFS-specific binding protein and an Activin A-specific binding protein provide highly efficaoious methods for increasing muscl mass and strength that avoid the adverse side effects caused by ActRf lB-Fc.
• agents which function to increase muscle mass and strength have utility in settings in which patients have undergone surgery (or will undergo surgery), e.g. , for joint replacement or repair, etc. As such, agents that are administered to promote the rescue of muscle mass would ideally not interfere with other aspects of surgical recovery such as wound healing.
• H4H1657N2, AB3381 , or H4H1657N2 + MAB3381 were administered at 10 mg/kg every 3-4 days. The first dose was given the day before wounding the animals, and the last one was given two days before terminating the study on day 14. Digital images of the wound were taken on day 0 (day of wounding), 8, 9, 12, and 14, and the excision wound size change was measured and compared to the isotype control group. Results are summarized in Table 5. All data are expressed as mean total wound size ⁇ the standard error of the mean.

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