Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/177—Receptors; Cell surface antigens; Cell surface determinants
  • A61K38/179—Receptors; Cell surface antigens; Cell surface determinants for growth factors; for growth regulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
  • A61K47/6801—Drug-antibody or immunoglobulin conjugates defined by the pharmacologically or therapeutically active agent
  • A61K47/6803—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates
  • A61K47/6811—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates the drug being a protein or peptide, e.g. transferrin or bleomycin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/12—Antihypertensives
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • C07K14/705—Receptors; Cell surface antigens; Cell surface determinants
  • C07K14/71—Receptors; Cell surface antigens; Cell surface determinants for growth factors; for growth regulators
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2319/00—Fusion polypeptide
  • C07K2319/30—Non-immunoglobulin-derived peptide or protein having an immunoglobulin constant or Fc region, or a fragment thereof, attached thereto
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2319/00—Fusion polypeptide
  • C07K2319/32—Fusion polypeptide fusions with soluble part of a cell surface receptor, "decoy receptors"

Definitions

• the present invention generally relates to the field of medicine and
• compositions and methods aimed at reducing or otherwise favorably modulating such binding and signaling can be useful.
• the TGF- ⁇ superfamily includes a number of ligands of biological
• TGF- ⁇ and Activin play important pathogenic roles in many diseases, including the progression of cancer and uncontrolled fibrosis, such as kidney, lung and liver fibrotic diseases.
• Myostatin/GDF8 is another important ligand, which is related to Activin, and which shares binding to the same Type II receptor (ActivinRIIb).
• Myostatin is a powerful inhibitor of skeletal muscle growth and is a validated therapeutic target for muscle wasting diseases such as muscular dystrophy.
• Additional ligands in the TGF- ⁇ family include bone morphogenetic proteins (BMP), which have been implicated in cardiovascular diseases. For example, high levels of both BMP2 and BMP4 have been found in calcified atherosclerotic plaques and diseased aortic valves.
• BMP bone morphogenetic proteins
• ⁇ -ED greatly enhances the antagonist potency of ⁇ -ED (De Crescenzo et al., 2004, J. Biol, Chem. 279: 26013).
• a significant disadvantage of the coiled-coil fused dimer is that the non-covalent nature of the dimerization domain limits its potency, i.e. it dissociates at low concentrations such that a large portion of the coil- fused receptor ectodomain will be acting as a monomer rather than a dimer.
• Use of the Fc domain of IgG provides a covalent interaction, but at the cost of large size.
• composition including a TGF- ⁇ ligand trap.
• the TGF- ⁇ ligand trap is a soluble recombinant TGF- ⁇ type II receptor Fc-fusion protein (TGFBRII-Fc).
• TGFBRII-Fc soluble recombinant TGF- ⁇ type II receptor Fc-fusion protein
• the TGFBRII-Fc fusion protein comprises or consists of an amino acid sequence that is at least 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99% or 100% identical to the amino acid sequence of SEQ ID NO: 1.
• Various embodiments of the present invention describe a method for treating, preventing, or reducing the progression rate of pulmonary hypertension (PH) in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of PH in the subject.
• Various embodiments of the present invention describe a method of treating, preventing, or reducing the progression rate of pulmonary vascular remodeling in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of pulmonary vascular remodeling in the subject.
• Various embodiments of the present invention describe a method of treating, preventing, or reducing the progression rate of pulmonary fibrosis in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of pulmonary fibrosis in the subject.
• Various embodiments of the present invention describe a method of treating, preventing, or reducing the progression rate of right ventricular hypertrophy in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of right ventricular hypertrophy in the subject.
• Various embodiments of the present invention describe a method of treating, preventing, or reducing the progression rate of a disease associated with excessive TGF- ⁇ signaling in a subject.
• the method includes
• TGF- ⁇ ligand trap administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• Various embodiments of the present invention describe a method of treating, preventing, or reducing the progression rate of a disease associated with excessive GDF15 signaling in a subject.
• the method includes
• TGF- ⁇ ligand trap administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• Various embodiments of the present invention describe a method of treating, preventing, or reducing the progression rate of a disease associated with excessive PAI-1 signaling in a subject.
• the method includes
• TGF- ⁇ ligand trap administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• Various embodiments of the present invention describe a method of reducing right ventricular systolic pressure in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby reducing right ventricular systolic pressure in the subject.
• imaging/detecting TGF- ⁇ ligand in a subject including administering a quantity of a TGF- ⁇ ligand trap linked to an imaging molecule to the subject.
• Figures 1A to IE are graphs that demonstrate, in accordance with an
• MCT monocrotaline
• RVSP right ventricular systolic pressure
• RVH right ventricular hypertrophy
• RVSP was measured by right ventricular catheterization
• FIG. 2A -2C demonstrate, in accordance with an embodiment of the invention, TGFBRII-Fc selectively inhibits the signaling of TGFpi, TGFP3, and GDF15 in human pulmonary artery smooth muscle cells (PASMC).
• PASMC pulmonary artery smooth muscle cells
• BMP4 BMP4, TGFpi, TGFP2, TGFP3, and GDF15 ligands at various concentrations for 30 minutes.
• Western blot and qPCR were performed to assess the ability of TGFBRII-Fc to modulate signaling activity in vitro.
• FIG. 2D-2F demonstrate, in accordance with an embodiment of the invention, TGFBRII-Fc selectively inhibits TGFpi and GDF15 signaling in vascular smooth muscle cells.
• Fig. 2D Human aortic smooth muscle cells were deprived of serum overnight, and then incubated with BMP4, TGFpi, TGFP2, or GDF15 at indicated concentrations for 30 min, and analyzed by
• FIG. 2E-Fig. 2F HASMCs were deprived of serum, pretreated with TGFBRII-Fc (2000 ng/ml) or vehicle followed by incubation with TGFpi (1 ng/ml), TGFP2 (1 ng/ml), or GDF15 (30 ng/ml) for 2 hours.
• Figures 3A to 3D are graphs that demonstrate, in accordance with an
• low dose TGFBRII-Fc treatment causes a trend towards reduced right ventricular systolic pressure (RVSP), a trend towards reduced right ventricular hypertrophy, and significantly reduced pulmonary vascular remodeling.
• RVSP right ventricular systolic pressure
• rats were analyzed in a blinded fashion by catheterization under anesthesia with pentobarbital and intratracheal intubation to determine RVSP (Fig. 3 A), systemic arterial pressures (not shown), and euthanized. The degree of RVH was assessed in a blinded fashion based on measurement of Fulton's ratio
• Figures 4A to 4D show graphs that demonstrate, in accordance with an
• high dose TGFBRII-Fc treatment attenuates right ventricular systolic pressure (RVSP), right ventricular hypertrophy, and prevents pulmonary vascular remodeling.
• RVSP right ventricular systolic pressure
• Figures 5A to 5D show graphs that demonstrate, in accordance with an
• TGFBRII-Fc attenuates echocardiographic RV hypertrophy.
• MCT 40 mg/kg SC
• rats were treated with vehicle or TGFBRII-Fc (15 mg/kg, twice per week) starting 24 hours after MCT.
• Two weeks following MCT rats were analyzed under anesthesia with 1.5% isoflurane by small animal ultrasonography to measure right ventricular thickness and diastolic dimension (Fig. 5A & Fig. 5B), pulmonary flow acceleration time (PAT, Fig. 5C), and pulmonary ejection time (PET, Fig. 5D).
• Figures 6A to 6F are graphs that demonstrate, in accordance with an
• TGFBRII-Fc inhibited TGFP-mediated transcription in PH lung tissues.
• MCT-induced PH was correlated with a modest increase in TGFpi and a significant decrease in TGFP2 mRNA expression (Fig. 6A-Fig. 6C).
• Figures 7A to 7C are graphs that demonstrate, in accordance with an
• treatment with TGFBRII-Fc following establishment of PH is associated with partial rescue of PH and mortality in accordance with various embodiments of the present invention.
• MCT 40 mg/kg SC
• rats were treated in a delayed fashion starting on day 17 after the establishment of PH with TGFBRII-FC (15 mg/kg three times weekly).
• RVSP RVSP among animals treated with TGFBRII-Fc
• C RVH
• Figures 8 A and 8B show the amino acid sequences of human IgGl, IgG2, IgG3 and IgG4 hinge (Fig. 8 A) and Fc (Fig. 8B) domains.
• IgGl hinge domain SEQ ID NO:65
• IgG2 hinge domain SEQ ID NO:66
• IgG3 hinge domain SEQ ID NO: 67
• IgG4 hinge domain SEQ ID NO: 68
• Fig. 8B is shown in same order as Fig. 8A: IgGl Fc domain (SEQ ID NO:69), i.e. first line of aa's; IgG2 Fc domain (SEQ ID NO:70) i.e.
• IgG3 Fc domain SEQ ID NO: 71
• IgG4 Fc domain SEQ ID NO: 72
• the amino acid residues shown in Fig.8A and Fig.8B are numbered according to the numbering system of Kabat EU. Isotype sequences are aligned with the IgGl sequence by placing the first and last cysteine residues of the respective hinge regions, which form the inter-heavy chain S--S bonds, in the same positions.
• Figures 9 A to 9B show tissue sections demonstrating the lack of mitral valve remodeling, degeneration or abnormalities in response to TGFBRII-Fc treatment.
• Figure 9A control.
• Figure 9B TGFBRII-Fc-treated.
• “Beneficial results” may include, but are in no way limited to, lessening or alleviating the severity of the disease condition, preventing the disease condition from worsening, curing the disease condition, preventing the disease condition from developing, lowering the chances of a patient developing the disease condition and prolonging a patient's life or life expectancy.
• the disease condition is pulmonary hypertension, pulmonary vascular remodeling, pulmonary fibrosis, right ventricular hypertrophy, diseases associated with excessive TGF- ⁇ signaling, diseases associated with excessive GDF15 signaling, and diseases associated with excessive PAI-1 signaling.
• Treatment and “treating”, as used herein refer to both therapeutic treatment and prophylactic or preventative measures, wherein the object is to slow down (lessen) the targeted pathologic condition, prevent the pathologic condition, pursue or obtain beneficial results, or lower the chances of the individual developing the condition even if the treatment is ultimately unsuccessful.
• Those in need of treatment include those already with the condition as well as those prone to have the condition or those in whom the condition is to be prevented.
• PH Pulmonary hypertension
• pulmonary artery pulmonary arterial hypertension
• pulmonary vein pulmonary vein
• pulmonary capillaries together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, leg swelling and other symptoms.
• PH can be a severe disease with a markedly decreased exercise tolerance and heart failure.
• PH can be one of at least five different possible types, including: arterial, venous, hypoxic, thromboembolic or miscellaneous.
• TGF- ⁇ ligand trap refers to a protein that is capable of trapping a TGF- ⁇ ligand, even if only transiently, thereby modulating the ligand's ability to interact with one or more additional molecules.
• the TGF- ⁇ ligand can mean a ligand selected from
• TGF- ⁇ TGF- ⁇ , TGF-P2, TGF-P3, and GDF 15.
• TGF- ⁇ ligand trap includes, but is in no way limited to, a soluble recombinant TGF- ⁇ receptor Fc-fusion protein, which includes the TGF- ⁇ ligand binding domain of a TGF- ⁇ receptor and the Fc domain of an immunoglobin.
• a method of treating, preventing, or reducing the progression rate of a pulmonary hypertension (PH) in a subject comprises administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of a PH in the subject, wherein the TGF- ⁇ ligand trap comprises 1) a TGF- ⁇ ligand binding domain of a TGF ⁇ receptor and 2) a Fc domain of an immunoglobulin, and 3) optionally a linker (an immunoglobulin linker or other linker) between the ligand binding domain and the Fc domain.
• the TGF- ⁇ ligand binding domain of a TGF ⁇ receptor comprises SEQ ID NO: 63, or portion thereof, or variant thereof: TIPPHVQKSV NNDMIVTDNN GAVKFPQLCK FCDVRFSTCD NQKSCMSNCS ITSICEKPQE VCVAVWRKND ENITLETVCH DPKLPYHDFI LEDAASPKCI MKEKKKPGET FFMCSCSSDE CNDNIIFSEE YNTSNPD (SEQ ID NO: 63).
• the TGF- ⁇ ligand binding domain of a TGF ⁇ receptor comprises SEQ ID NO: 3, or SEQ ID NO; 4, or SEQ ID NO: 5, or portion thereof, or variant thereof:
• the Fc domain comprises SEQ ID NO: 64, or
• SEQ ID NO: 64 ECPPCPAP PVAGPSVFLF PPKPKDTLMI SRTPEVTCVV VDVSHEDPEV QFNWYVDGVE VHNAKTKPRE EQFNSTFRVV SVLTWHQDW LNGKEYKCKV SNKGLPAPIE KTISKTKGQP REPQVYTLPP SREEMTKNQV SLTCLVKGFY PSDIAVEWES NGQPENNYKT TPPMLDSDGS FFLYSKLTVD KSRWQQGNVF SCSVMHEALH NHYTQKSLSL SPGK (SEQ ID NO: 64)
• exemplary Fc domains are described in Fig IB, e.g. SEQ ID NO:'s 69, 70, 71 and 72.
• the Fc domain comprises SEQ ID NO: 69, SEQ ID NO: 70, SEQ ID NO: 71, or SEQ ID NO: 72, or comprise a fragment of SEQ ID NO: 69, SEQ ID NO: 70, SEQ ID NO: 71, or SEQ ID NO: 72, or a variant of SEQ ID NO: 69, SEQ ID NO: 70, SEQ ID NO: 71, or SEQ ID NO: 72.
• the binding domains may be selected from the ectodomains of the TGF- ⁇ type II and TGF- ⁇ type I receptors.
• TGF- ⁇ type II and TGF- ⁇ type I receptors include a soluble recombinant TGF- ⁇ type II receptor Fc-fusion protein (TGFBRII-Fc).
• the natural receptors from which the polypeptide binding domain is designed may be TpR-I-ED or TpR-II-ED.
• the TGF- ⁇ ligand binding domain of a TGF ⁇ receptor comprises a sequence of the TGF- ⁇ type I receptor ectodomain, or portion of ectodomain, for example SEQ ID NO: 73, or portion thereof.
• SEQ ID NO: 73 or portion thereof.
• SEQ ID NO: 74 or fragment/portion thereof, EDPSLDRPFI SEGTTLKDLI YDMTTSGSGS GLPLLVQRTI ARTIVLQESI GKGRFGEVWR GKWRGEEVAV KIFSSREERS WFREAEIYQT VMLRHENILG FIAADNKDNG TWTQLWLVSD YHEHGSLFDY LNRYTVTVEG MIKLALSTAS GLAHLHMEIV GTQGKPAIAH RDLKSKNILV KKNGTCCIAD LGLAVRHDSA TDTIDIAPNH RVGTKRYMAP EVLDDSINMK HFESFKRADI YAMGLVFWEI ARRCSIGGIH EDYQLPYYDL VPSDPSVEEM RKVVCEQKLR PNIPNRWQSC EALRVMAKIM RECWYANGAA RLTALRIKKT LSQLSQQEGI KM (SEQ ID NO: 74)(Chain A, Cytoplasmic Domain Of Un
• the TGF- ⁇ ligand binding domain of a TGF ⁇ receptor comprises a sequence of the TpR-III-ED, or portion of SEQ ID NO: 75; 1
• TGF- ⁇ Transforming Growth Factor- ⁇
• the complete cDNA of human T ⁇ RII was used as the template for PCR amplification of the coding sequence of the extracellular domain of T ⁇ RII (nucleotides 1-477 including the signal sequence). PCR was performed using the sense primer, 5'-
• SEQ ID NO: 78 is an example of Type II Transforming Growth Factor- ⁇ (TGF- ⁇ ) Receptor extracellular domain: MGRGLLRGLW PLHIVLWTRI ASTIPPHVQK SVNNDMIVTD
• TGF beta traps the binding of ligand can be confirmed using standard ligand binding assays, well known to those of skill in the art, e.g. radio ligand binding assays (See e.g. Sittampalam, G. S.; Kahl, S. D.; Janzen, W. P. High-throughput screening: Advances in assay technologies, 1997, Current Opinion in Chemical Biology 1 (3): 384-391; and De Jong, L. A. A.; et al. Receptor-ligand binding assays: Technologies and Applications, 2005, Journal of Chromatography B 829 (1-2): 1-25).
• TGFBRII-Fc refers to a fusion protein including the TGF- ⁇ ligand binding domain of a TGF- ⁇ type II receptor or a variant or biologically active portion thereof and the Fc domain of an immunoglobin.
• a linker can be included between the TGF- ⁇ ligand binding domain and the Fc domain.
• a fusion protein can include the entire extracellular portion of a TGF- ⁇ type II receptor or a variant thereof and the Fc domain of an immunoglobin.
• a fusion protein can include part of the extracellular portion of a TGF- ⁇ type II receptor or a variant thereof and the Fc domain of an immunoglobin.
• variants can include, but are not limited to, those that include conservative amino acid mutations, SNP variants, and splicing variants.
• One non-limiting example is the lib splicing variant of the TGF- ⁇ type II receptor.
• the TGF- ⁇ ligand binding domain and/or the Fc domain may be modified, for example, to facilitate purification, so long as such modifications do not reduce the functions of these domains to unacceptable level.
• the TGF- ⁇ type II receptor can be from a mammal.
• the receptor is from a human, monkey, ape, dog, cat, cow, horse, goat, sheep, pig, rabbit, mouse, or rat.
• the immunoglobin can be from a mammal. Merely by way of example, it can be from a human, monkey, ape, dog, cat, cow, horse, goat, sheep, pig, rabbit, mouse, or rat.
• Amino acids from the variable regions of the mature heavy and light chains of immunoglobulins are designated by the position of an amino acid in the chain. Kabat described numerous amino acid sequences for antibodies, identified an amino acid consensus sequence for each subgroup, and assigned a residue number to each amino acid. Rabat's numbering scheme is extendible to antibodies not included in his compendium by aligning the antibody in question with one of the consensus sequences in Kabat by reference to conserved amino acids. This method for assigning residue numbers has become standard in the field and readily identifies amino acids at equivalent positions in different antibodies, including chimeric or humanized variants. For example, an amino acid at position 50 of a human antibody light chain occupies the equivalent position to an amino acid at position 50 of a mouse antibody light chain.
• Fc region As used herein, the term "Fc region,” “Fc domain” or analogous terms are used to define CH2/CH3 C-terminal region of an IgG heavy chain.
• An example of the amino acid sequence containing the human IgGl is shown in FIG. 8B. Although boundaries may vary slightly, as numbered according to the Kabat system, the Fc domain extends from amino acid 231 to amino acid 447 (amino acid residues in FIG. 8B are numbered according to the Kabat system: See Kabat et al., "Sequences of Proteins of Immunological Interest", 5th Ed. Public Health Service, NIH, MD (1991), which is herein incorporated by reference in its entirety.).
• FIG. 8B also provides examples of the amino acid sequences of the Fc regions of IgG isotypes IgGl, IgG2, IgG3, and IgG4.
• the Fc region of an IgG comprises two constant domains, CH2 and CH3.
• the CH2 domain of a human IgG Fc region usually extends from amino acids 231 to amino acid 341 according to the numbering system of Kabat (FIG. 8B).
• the CH3 domain of a human IgG Fc region usually extends from amino acids 342 to 447 according to the numbering system of Kabat (FIG. 8B).
• the CH2 domain of a human IgG Fc region (also referred to as "Cy2" domain) is unique in that it is not closely paired with another domain. Rather, two N-linked branched carbohydrate chains are interposed between the two CH2 domains of an intact native IgG.
• TGFBRII-Fc examples include, but are not limited to, a protein having the sequence set forth in SEQ ID NO: 1 or a variant thereof.
• a variant of SEQ ID NO: l includes a sequence with at least 80%, 85%, 90%, 95%, 98%, or 99% sequence identity to SEQ ID NO: 1.
• amino acids 1-137 are a TGF- ⁇ ligand binding domain
• amino acids 138-141 are a linker
• amino acids 142 - 364 are an Fc domain.
• This exemplar TGFBRII-Fc can be expressed by a nucleic acid that includes a nucleotide sequence set forth in SEQ ID NO:2, or a degenerate variant thereof.
• a "degenerate variant” as used herein refers to a variant that has a mutated nucleotide sequence, but still encodes the same polypeptide due to the redundancy of the genetic code.
• the "hinge region” or “hinge domain” of a heavy chain IgG is generally
• the linker between the ligand binding domain and the Fc domain comprises a hinge region, e.g. any of SEQ ID NO: 65-68 (See Figure 8A).
• the linker comprises TGG G (SEQ ID NO: 79).
• the linker comprises any of SEQ ID NO's: 6-48 (See Example 3).
• substantially identical peptides to those specifically described herein are contemplated and may include one or more conservative amino acid mutations. It is known in the art that one or more conservative amino acid mutations to a reference peptide may yield a mutant peptide with no substantial change in physiological, chemical, or functional properties, compared to the reference peptide; and in such a case, the reference and mutant peptides would be considered "substantially identical" polypeptides.
• a conservative amino acid mutation may include the addition, deletion, or substitution of an amino acid.
• a conservative amino acid substitution is defined herein as the substitution of an amino acid residue for another amino acid residue with similar chemical properties (e.g. size, charge, or polarity).
• a conservative mutation may be an amino acid substitution.
• Such a conservative amino acid substitution may substitute a basic, neutral, hydrophobic, or acidic amino acid for another of the same group.
• basic amino acid includes hydrophilic amino acids having a side chain pKa value of greater than 7, which are typically positively charged at physiological pH.
• Basic amino acids include histidine (His or H), arginine (Arg or R), and lysine (Lys or K).
• neutral amino acid also “polar amino acid” means hydrophilic amino acids having a side chain that is uncharged at physiological pH, but in which at least one bond in which the pair of electrons shared in common by two atoms is held more closely by one of the atoms.
• Polar amino acids include serine (Ser or S), threonine (Thr or T), cysteine (Cys or C), tyrosine (Tyr or Y), asparagine (Asn or N), and glutamine (Gin or Q).
• hydrophobic amino acid also “non-polar amino acid” is meant to include amino acids exhibiting a hydrophobicity of greater than zero according to the normalized consensus hydrophobicity scale of Eisenberg (1984).
• Hydrophobic amino acids include proline (Pro or P), isoleucine (He or I), phenylalanine (Phe or F), valine (Val or V), leucine (Leu or L), tryptophan (Trp or W), methionine (Met or M), alanine (Ala or A), and glycine (Gly or G).
• “Acidic amino acid” refers to hydrophilic amino acids having a side chain pKa value of less than 7, which are typically negatively charged at physiological pH. Acidic amino acids include glutamate (Glu or E), and aspartate (Asp or D).
• Sequence identity is used to evaluate the similarity of two sequences; it is determined by calculating the percent of residues that are the same when the two sequences are aligned for maximum correspondence between residue positions. Any known method may be used to calculate sequence identity; for example, computer software is available to calculate sequence identity. By way of non-limiting example, sequence identity can be calculated by software such as BLAST-P, Blast-N, or FASTA-N, or any other appropriate software that is known in the art. The
• substantially identical sequences of the present invention may be at least 80% identical. In other examples, the substantially identical sequences may be at least 80%, 85%o, 90%o, 95%), or 100% identical at the amino acid level to sequences described herein.
• linker there may be a linker.
• the linker is an unstructured and flexible polypeptide sequence.
• the linker region provides a segment that is distinct from the structured ligand binding and Fc domains and thus can be used for conjugation to accessory molecules (for example, molecules useful in increasing stability such as PEGylation moieties) or cargo molecules such as contrast agents for imaging and toxins without having to chemically modify the ligand binding and Fc domains.
• Conjugation methodologies are somewhat diverse, but typically can be performed using commercial kits that enable conjugation via common reactive groups such as primary amines, succinimidyl (NHS) esters and sulfhydral-reactive groups.
• Some non-limiting examples are: Alexa Fluor 488 protein labeling kit (Molecular Probes, Invitrogen detection technologies) and PEGylation kits (Pierce Biotechnology Inc.).
• the linker may include an unstructured amino acid sequence that may be either the same as or derived from conservative modifications to the sequence of a natural unstructured region in the extracellular portion of the receptor for the ligand of interest or another receptor in the TGF- ⁇ superfamily.
• such linkers may be entirely artificial in composition and origin but will contain amino acids selected to provide an unstructured flexible linker with a low likelihood of encountering electrostatic or steric hindrance complications when brought into close proximity to the ligand of interest.
• the length of the linker is considered to be the number of amino acids
• Linker length will be considered acceptable when it permits binding domains to bind their natural binding sites on their natural ligand. Examples of natural and artificial linker sequences of varying length are given in Table 2. For example, and without wishing to be limiting in any manner, the linker length may be between about 18-80 amino acids, 25-60 amino acids, 35-45 amino acids, or any other suitable length.
• the linker may be modified in length and composition based on atomic-level simulations and knowledge-based design in order to improve binding affinity, specificity, immunogenicity and stability. This is applicable to a wide range of molecular systems exhibiting homomeric, heteromeric, dimeric and multimeric ligand-receptor structural characteristics. Additional different binding domains can be incorporated to generate multivalent traps with even higher binding potency.
• Linkers may be designed to facilitate purification of the linker and/or ligand binding trap. The exact purification scheme chosen will determine what
• linker may include regions to facilitate the addition of cargo or accessory molecules.
• purification "tags” such as His tags
• the linker may include regions to facilitate the addition of cargo or accessory molecules.
• Polypeptides of the invention can be useful as therapeutic agents that
• the present invention also encompasses nucleotide sequences encoding
• polypeptides of the invention are polypeptides of the invention. These nucleotide sequences can be cloned and inserted into any suitable vector (including expression vector) and therefore are very amenable to production of polypeptides of the invention.
• vector refers to a carrier nucleic acid molecule into which a nucleic acid sequence can be inserted for introduction into a cell where it can be replicated.
• a nucleic acid sequence can be "exogenous,” which means that it is foreign to the cell into which the vector is being introduced or that the sequence is homologous to a sequence in the cell but in a position within the host cell nucleic acid in which the sequence is ordinarily not found.
• Vectors include plasmids, cosmids, viruses (bacteriophage, animal viruses, and plant viruses), and artificial chromosomes (e.g., YACs).
• viruses bacteria, animal viruses, and plant viruses
• artificial chromosomes e.g., YACs.
• One of skill in the art would be well equipped to construct a vector through standard recombinant techniques (see, for example, Maniatis et al., 1988 and Ausubel et al., 1994, both of which are incorporated herein by reference).
• expression vector refers to any type of genetic construct
• Expression vectors can contain a variety of "control sequences," which refer to nucleic acid sequences necessary for the transcription and possibly translation of an operably linked coding sequence in a particular host cell. In addition to control sequences that govern transcription and translation, vectors and expression vectors may contain nucleic acid sequences that serve other functions as well and are described infra.
• polypeptide or "protein,” as used herein, means a polymer of amino acids joined in a specific sequence by peptide bonds.
• amino acid refers to either the D or L stereoisomer form of the amino acid, unless otherwise specifically designated.
• a "biologically active" portion of a molecule refers to a
• a biologically active portion of a protein is any portion of a protein which retains the ability to perform one or more biological functions of the full-length protein (e.g. binding with another molecule, phosphorylation, etc.), even if only slightly.
• the ligand binding domain is a biological portion of a TGFP receptor.
• a therapeutic dose is administered at an interval from every day to every month via the subcutaneous, intrathecal, convection-enhanced, intravenous or intra-arterial route at a dose ranging from 0.05 mg to 50mg/kg of body weight, and optionally 1.0 mg to 10 mg/kg of body weight or 0.3 mg to 3.0 mg/kg of body weight.
• the TGF- ⁇ ligand trap is administered to the subject 1-7 times per week or once weekly, or once every two, three or four weeks. In various embodiments, the TGF- ⁇ ligand trap is administered to the subject for 1-5 days, 1-5 weeks, 1-5 months, or 1-5 years.
• any suitable route of administration of a TGF- ⁇ ligand trap may be adapted, and therefore the routes of administration described herein are not intended to be limiting.
• Routes of administration may including but are not limited to, intravenous, oral, buccal, intranasal, inhalation, topical application to a mucosal membrane or injection, including intradermal, intrathecal, intracisternal, intralesional or any other type of injection. Administration can be effected continuously or intermittently and will vary with the subject and the condition to be treated.
• TGF- ⁇ ligand trap or compositions would allow for a TGF- ⁇ ligand trap or compositions to be delivered on, in, or near the pulmonary disease locations or targeted cells.
• routes of administration described herein will allow for a TGF- ⁇ ligand trap and compositions described herein to be delivered to a region in the vicinity of diseased tissues, organs, or individual cells to be treated. "In the vicinity" can include any tissue or bodily fluid in the subject that is in sufficiently close proximity to or in sufficient communication with diseased tissues, organs, or individual cells such that at least a portion of the TGF- ⁇ ligand trap or compositions administered to the subject reach their intended targets and exert their therapeutic effects.
• compositions [00078]
• the present invention provides a pharmaceutical composition that includes a TGF- ⁇ ligand trap described herein.
• the pharmaceutical composition is formulated for modified release, sustained release, or controlled release, or a combination thereof.
• the pharmaceutical composition is formulated for oral, via inhalation, nasal, sublingual, buccal, subcutaneous, intradermal, intramuscular, intravenous, intraperitoneal, or parenteral administration.
• the pharmaceutical composition further includes at least one pharmaceutically acceptable excipient.
• excipients include but are not limited to starches, sugars, microcrystalline cellulose, diluents, granulating agents, lubricants, binders, disintegrating agents, wetting agents, emulsifiers, coloring agents, release agents, coating agents, sweetening agents, flavoring agents, perfuming agents, preservatives, antioxidants, plasticizers, gelling agents, thickeners, hardeners, setting agents, suspending agents, surfactants, humectants, carriers, stabilizers, and combinations thereof.
• the pharmaceutical composition further includes at least one pharmaceutically acceptable carrier.
• pharmaceutically acceptable carriers are well known in the art and include aqueous solutions such as physiologically buffered saline or other solvents or vehicles such as glycols, glycerol, vegetable oils (e.g., olive oil) or injectable organic esters.
• a pharmaceutically acceptable carrier can be used to administer the compositions of the invention to a cell in vitro or to a subject in vivo.
• a pharmaceutically acceptable carrier can contain a physiologically acceptable compound that acts, for example, to stabilize the composition or to increase the absorption of the agent.
• a physiologically acceptable compound can include, for example, carbohydrates, such as glucose, sucrose or dextrans, antioxidants, such as ascorbic acid or glutathione, chelating agents, low molecular weight proteins or other stabilizers or excipients.
• Other physiologically acceptable compounds include wetting agents, emulsifying agents, dispersing agents or preservatives, which are particularly useful for preventing the growth or action of microorganisms.
• Various preservatives are well known and include, for example, phenol and ascorbic acid.
• a pharmaceutically acceptable carrier including a physiologically acceptable compound, depends, for example, on the route of administration of the polypeptide.
• a physiologically acceptable compound such as aluminum monosterate or gelatin is particularly useful as a delaying agent, which prolongs the rate of absorption of a pharmaceutical composition administered to a subject.
• carriers stabilizers or adjutants can be found in Martin, Remington's Pharm. Sci., 15th Ed. (Mack Publ. Co., Easton, 1975), incorporated herein by reference.
• Other examples of carriers include, but are not limited to, a nanoparticle- based carrier (e.g. a polymer N-(2-hydorxylpropyl)methacrylamide (HPMA), glutamic acid, PEG, dextran) and a nanocarrier (e.g., nanoshell, liposome,
• the present invention provides a method of treating, preventing, or reducing the progression rate of pulmonary hypertension (PH) in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of PH in the subject.
• the method can further include mixing a pharmaceutically acceptable carrier with the TGF- ⁇ ligand trap prior to administering a therapeutically effective amount of the TGF- ⁇ ligand trap to the subject.
• Pulmonary arterial hypertension is a type of pulmonary hypertension that may be particularly amenable to treatment with a TGF- ⁇ ligand trap. Accordingly, in some embodiments, the method includes administering a
• TGF- ⁇ ligand trap therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of pulmonary arterial
• pulmonary arterial hypertension in the subject, including any of the following subcategories of pulmonary arterial hypertension.
• Pulmonary arterial hypertension can arise secondary to other conditions or a as a primary or idiopathic pulmonary arterial hypertension.
• certain types of familial pulmonary arterial hypertension are associated with decreased expression or function of the bone morphogenetic protein receptor type II (BMPRII), which is thought to result in excessive signaling by TGF- ⁇
• BMPRII bone morphogenetic protein receptor type II
• Pulmonary hypertension can be of five major types, thus a series of tests is performed to distinguish pulmonary arterial hypertension from venous, hypoxic, thromboembolic, or miscellaneous varieties. These generally include pulmonary function tests; blood tests to exclude HIV, autoimmune diseases, and liver disease; electrocardiography (ECG); arterial blood gas measurements; X-rays of the chest (followed by high-resolution CT scanning if interstitial lung disease is suspected); and ventilation-perfusion or V/Q scanning to exclude chronic thromboembolic pulmonary hypertension. Diagnosis of PAH requires the presence of pulmonary hypertension. Although pulmonary arterial pressure can be estimated on the basis of
• pulmonary hypertension e.g. Clinical improvement is often measured by a "six- minute walk test", i.e. the distance a patient can walk in six minutes. Stability and improvement in this measurement correlate with better survival. Blood BNP level is also being used now to follow progress of patients with pulmonary hypertension. Improvement of symptoms can also be monitored by assaying arterial pressure. For example, normal pulmonary arterial pressure in a person living at sea level has a mean value of 8-20 mm Hg (1066-2666 Pa) at rest. Pulmonary hypertension is present when mean pulmonary artery pressure exceeds 25 mm Hg (3300 Pa) at rest.
• mPAP Mean pulmonary artery pressure
• sPAP systolic pulmonary artery pressure
• the present invention provides a method of treating, preventing, or reducing the progression rate of pulmonary vascular remodeling in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of pulmonary vascular remodeling in the subject.
• the method can further include mixing a pharmaceutically acceptable carrier with the TGF- ⁇ ligand trap prior to administering a therapeutically effective amount of the TGF- ⁇ ligand trap to the subject.
• the present invention provides a method of treating, preventing, or reducing the progression rate of vascular remodeling in the heart of a subject.
• the method can further include mixing a
• the methods of the invention reduce mitral valve degeneration, or e.g. mitral valve prolapse. Beneficial effects can be monitored by echocardiography.
• the present invention provides a method of treating, preventing, or reducing the progression rate of pulmonary fibrosis in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of pulmonary fibrosis in the subject.
• the method can further include mixing a pharmaceutically acceptable carrier with the TGF- ⁇ ligand trap prior to administering a therapeutically effective amount of the TGF- ⁇ ligand trap to the subject.
• the present invention provides a method of treating, preventing, or reducing the progression rate of right ventricular hypertrophy in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of right ventricular hypertrophy in the subject.
• the method can further include mixing a pharmaceutically acceptable carrier with the TGF- ⁇ ligand trap prior to administering a therapeutically effective amount of the TGF- ⁇ ligand trap to the subject.
• the present invention provides a method of treating, preventing, or reducing the progression rate of a pulmonary disease associated with excessive TGF- ⁇ signaling in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• the method can further include mixing a
• the TGF- ⁇ can be TGF- ⁇ , TGF ⁇ 3, or a
• the present invention provides a method of treating, preventing, or reducing the progression rate of a pulmonary disease associated with excessive GDF15 signaling in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• the method can further include mixing a
• the present invention provides a method of treating, preventing, or reducing the progression rate of a pulmonary disease associated with excessive PAI-1 signaling in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• the method can further include mixing a
• the present invention provides a method of reducing right ventricular systolic pressure in a subject.
• the method includes administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby reducing right ventricular systolic pressure in the subject.
• the method can further include mixing a pharmaceutically acceptable carrier with the TGF- ⁇ ligand trap prior to administering a therapeutically effective amount of the TGF- ⁇ ligand trap to the subject.
• the subjects in the examples described above are mammals.
• the subject is a human, monkey, ape, dog, cat, cow, horse, goat, sheep, pig, rabbit, mouse, or rat.
• the TGF- ⁇ is TGF- ⁇ , TGF ⁇ 3, or a combination thereof.
• the amount of TGF- ⁇ ligand trap administered to the subject is 0.05 mg to 50mg/kg of body weight, and optionally 1.0 mg to 10 mg/kg of body weight or 0.3 mg to 3.0 mg/kg of body weight.
• the TGF- ⁇ ligand trap is administered to the subject 1-7 times per week or once weekly, or once every two, three or four weeks.
• the TGF- ⁇ ligand trap is administered to the subject for 1-5 days, 1-5 weeks, 1-5 months, or 1-5 years.
• TGF- ⁇ ligand trap may be administered by any route used for protein therapeutics, including but not limited to subcutaneous, intravenous or intramuscular administration.
• the TGF- ⁇ ligand trap is
• the TGF- ⁇ ligand trap is administered before, during, or after the subject develops a disease condition, including but not limited to pulmonary hypertension, pulmonary vascular remodeling, pulmonary fibrosis, right ventricular hypertrophy, pulmonary diseases associated with excessive TGF- ⁇ signaling, pulmonary diseases associated with excessive GDF15 signaling, and pulmonary diseases associated with excessive PAI-1 signaling.
• the TGF- ⁇ ligand trap is part of a pharmaceutical composition.
• the pharmaceutical composition is formulated for modified release, sustained release, or controlled release, or a combination thereof.
• the pharmaceutical composition is formulated for oral, via inhalation, nasal, sublingual, buccal, subcutaneous, intradermal, intramuscular, intravenous, intraperitoneal, or parenteral administration.
• the pharmaceutical composition further includes at least one pharmaceutically acceptable excipient.
• excipients include but are not limited to starches, sugars, microcrystalline cellulose, diluents, granulating agents, lubricants, binders, disintegrating agents, wetting agents, emulsifiers, coloring agents, release agents, coating agents, sweetening agents, flavoring agents, perfuming agents, preservatives, antioxidants, plasticizers, gelling agents, thickeners, hardeners, setting agents, suspending agents, surfactants, humectants, carriers, stabilizers, and combinations thereof.
• Paragraph 1 A method of treating, preventing, or reducing the progression rate of pulmonary hypertension (PH) in a subject, comprising: administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of PH in the subject.
• Paragraph 2 The method of paragraph 1, wherein PH is mediated by excessive TGF- ⁇ signaling.
• Paragraph 3 The method of any of paragraphs 1-2, wherein the subject is a human.
• Paragraph 4 The method of any of paragraphs 1-3, wherein the TGF- ⁇ ligand trap comprises 1) a TGF- ⁇ ligand binding domain of a TGF receptor and 2) a Fc domain of an immunoglobulin.
• Paragraph 5 The method of paragraph 4, wherein the TGF- ⁇ ligand trap further comprises a linker between the TGF- ⁇ ligand binding domain of a TGF receptorand the Fc domain.
• Paragraph 6. The of any of paragraphs 1-5, wherein the TGF- ⁇ ligand trap is a soluble recombinant TGF- ⁇ type II receptor Fc-fusion protein (TGFBRII-Fc).
• Paragraph 7 The method of any of paragraphs 1-6, wherein the TGFBRII-Fc consists of the sequence set forth in SEQ ID NO: 1 or a variant thereof.
• Paragraph 8 The method of any of paragraphs 1-6, wherein the TGFBRII-Fc comprises the sequence set forth in SEQ ID NO: 1 or a variant thereof.
• Paragraph 10 The method of any of paragraphs 1-6, wherein the TGFBRII-Fc is encoded by a nucleic acid comprising a nucleotide sequence set forth in SEQ ID NO:
• Paragraph 11 The method of any of paragraphs 1-10, wherein the amount of
• TGF- ⁇ ligand trap administered to the subject is 0.1-10 mg/kg of body weight.
• Paragraph 12 The method of any of paragraphs 1-11, wherein the TGF- ⁇ ligand trap is administered to the subject 1-7 times per month.
• Paragraph 13 The method of any of paragraphs 1-12, wherein the TGF- ⁇ ligand trap is administered to the subject for 1-5 days, 1-5 weeks, 1-5 months, or 1-5 years.
• Paragraph 14 The method of any of claims 1-13, wherein the TGF- ⁇ ligand trap is administered to the subject orally, via inhalation, nasally, sublingually, buccally, subcutaneously, intradermally, intramuscularly, intravenously, intraperitoneally, or parenterally.
• Paragraph 15 The method of any of paragraphs 1-14, wherein the TGF- ⁇ ligand trap is administered before, during, or after the subject develops PH.
• Paragraph 16 The method of any of paragraphs 1-15, further comprising mixing a pharmaceutically acceptable carrier with the TGF- ⁇ ligand trap prior to administering a therapeutically effective amount of the TGF- ⁇ ligand trap to the subject.
• Paragraph 17 The method of any of paragraphs 1-16, wherein the TGF- ⁇ ligand trap is part of a pharmaceutical composition.
• Paragraph 18 The method of paragraph 17, wherein the pharmaceutical composition is formulated for modified release, sustained release, or controlled release, or a combination thereof.
• Paragraph 19 The method of paragraph 17, wherein the pharmaceutical composition is formulated for oral, via inhalation, nasal, sublingual, buccal, subcutaneous, intradermal, intramuscular, intravenous, intraperitoneal, or parenteral administration.
• Paragraph 20 The method of paragraph 17, wherein the pharmaceutical composition further comprises at least one pharmaceutically acceptable excipient.
• Paragraph 21 The method of paragraph 17, wherein the pharmaceutical composition further comprises at least one pharmaceutically acceptable carrier.
• Paragraph 22 A method of treating, preventing, or reducing the progression rate of pulmonary vascular remodeling in a subject, comprising: administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of pulmonary vascular remodeling in the subject.
• Paragraph 23 A method of treating, preventing, or reducing the progression rate of pulmonary fibrosis in a subject, comprising: administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of pulmonary fibrosis in the subject.
• Paragraph 24 The method of claim 23, using the TGF- ⁇ ligand trap of any of paragraphs 4-10.
• Paragraph 25 A method of treating, preventing, or reducing the progression rate of right ventricular hypertrophy in a subject, comprising: administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of right ventricular hypertrophy in the subject.
• Paragraph 26 The method of claim 25, using the TGF- ⁇ ligand trap of any of paragraphs 4-10.
• Paragraph 27 A method of treating, preventing, or reducing the progression rate of a pulmonary disease associated with excessive TGF- ⁇ signaling in a subject, comprising: administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• Paragraph 28 The method of claim 27, using the TGF- ⁇ ligand trap of any of paragraphs 4-10.
• Paragraph 29 The method of any of claims 1-28, wherein the TGF- ⁇ is TGF- ⁇ , TGF-P3, or a combination thereof.
• Paragraph 30 A method of treating, preventing, or reducing the progression rate of a pulmonary disease associated with excessive GDF15 signaling in a subject, comprising: administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• Paragraph 31 The method of claim 30, using the TGF- ⁇ ligand trap of any of paragraphs 4-10.
• Paragraph 32 A method of treating, preventing, or reducing the progression rate of a pulmonary disease associated with excessive PAI-1 signaling in a subject, comprising: administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby treating, preventing, or reducing the progression rate of the disease in the subject.
• Paragraph 33 The method of claim 32, using the TGF- ⁇ ligand trap of any of paragraphs 4-10
• Paragraph 34 A method of reducing right ventricular systolic pressure in a subject, comprising: administering a therapeutically effective amount of a TGF- ⁇ ligand trap to the subject, thereby reducing right ventricular systolic pressure in the subject.
• Paragraph 35 The method of claim 34, using the TGF- ⁇ ligand trap of any of paragraphs 4-10.
• TGF- ⁇ Transforming Growth Factor-
• ALK5 TGFP type I receptor
• TGFBRII-Fc When administered prophylactically following MCT, TGFBRII-Fc treatment reduced right ventricular systolic pressure, right ventricular hypertrophy, and attenuated pulmonary vascular remodeling. Elevated mRNA levels of TGFP transcriptional target PAI-1 in lungs of MCT rats were corrected by TGFBRII-Fc, consistent with attenuating of TGFP signaling. When administered 2.5 weeks after MCT, TGFpRII-Fc partially rescued established PH with a trend towards improved survival at 5 weeks. Of note, no cardiac structural or valvular abnormalities were found in association with treatment with TGFBRII-Fc at any dose. Collectively, the data disclosed herein supports the conclusion that a TGFP ligand trap could be an effective and acceptably safe strategy for correcting TGFP- mediated pulmonary vascular remodeling and PH.
• nucleic acid sequences encoding each of the above linkers and binding domains.
• mice purchased from Charles River Laboratory. All protocols and surgical procedures were approved by the local animal care committee. Animals were housed at 24°C in a 12-hour light-dark cycle. Food and water were accessible ad libitum. To induce PAH, rats received a single subcutaneous injection of monocrotaline (MCT, 40 mg/kg). Mortality and total number of rats included in the present study are summarized in Table 3.
• Prophylaxis protocol At 24 hours after PAH induction, rats were randomized into TGFBRII-Fc (5 or 15 mg/kg, twice per week) or vehicle groups. Rats were treated for 21 days. At day 14, ventricular function and RV remodeling were examined by echocardiogram. At day 21, rats were subjected to hemodynamics and right ventricular hypertrophy measurements.
• RVH right ventricular hypertrophy
• Rats were mechanically ventilated using a rodent ventilator and hemodynamic assessment using a fluid- filled catheter through the right ventricular (RV) apex, as described previously (Megalou, A. J., Glava, C, Vilaeti, A. D., Oikonomidis, D. L., Baltogiannis, G. G., Papalois, A., Vlahos, A. P., and Kolettis, T. M. (2012) Pulm Circ 2, 461-469). Lungs were perfused with PBS and one right lobe was excised and snap frozen for RNA and protein extraction.
• RV right ventricular
• Lungs were further perfused with 1% paraformaldehyde (PFA) into the pulmonary artery, followed by trachea for 1 minute. Left lobes were embedded in paraffin.
• PFA paraformaldehyde
• RVH right ventricular hyperplasia
• the heart was removed and the RV free wall dissected from the left ventricle plus septum (LV+S) and weighted separately. Degree of RVH was determined from the ration RV/(LV+S).
• Monocrotaline was purchased from Oakwood Products, Inc.
• Recombinant human BMP4, TGFpi, TGFP2 and GDF15 were obtained from R&D Systems.
• vascular remodeling quantification were performed in a blinded manner. Data were presented as mean ⁇ SEM and compared between group using t test. P ⁇ 0.05 was considered statistically significant.
• Figures 9 A to 9B show heart tissue sections demonstrating the lack of mitral valve remodeling, degeneration or abnormalities in response to TGFBRII-Fc treatment.
• Figure 9A control.
• Figure 9B TGFBRII-Fc-treated.

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