WO2020010308A1 - Multi-specific wnt surrogate molecules and uses thereof - Google Patents

Multi-specific wnt surrogate molecules and uses thereof Download PDF

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Publication number
WO2020010308A1
WO2020010308A1 PCT/US2019/040687 US2019040687W WO2020010308A1 WO 2020010308 A1 WO2020010308 A1 WO 2020010308A1 US 2019040687 W US2019040687 W US 2019040687W WO 2020010308 A1 WO2020010308 A1 WO 2020010308A1
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Prior art keywords
fzd
wnt
binding
wnt surrogate
surrogate molecule
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English (en)
French (fr)
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Yang Li
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Surrozen Inc
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Surrozen Inc
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Priority to ES19830971T priority Critical patent/ES3058239T3/es
Priority to US17/257,817 priority patent/US20210292422A1/en
Priority to DK19830971.8T priority patent/DK3820906T3/da
Priority to CN202510662154.5A priority patent/CN120623353A/zh
Priority to CA3104526A priority patent/CA3104526A1/en
Priority to EP19830971.8A priority patent/EP3820906B1/en
Priority to JP2021500040A priority patent/JP2021529796A/ja
Priority to PL19830971.8T priority patent/PL3820906T3/pl
Application filed by Surrozen Inc filed Critical Surrozen Inc
Priority to CN201980052601.8A priority patent/CN112566940B/zh
Priority to EP25208409.0A priority patent/EP4733325A2/en
Priority to AU2019297522A priority patent/AU2019297522B2/en
Publication of WO2020010308A1 publication Critical patent/WO2020010308A1/en
Anticipated expiration legal-status Critical
Priority to JP2023186681A priority patent/JP2024001292A/ja
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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
    • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
    • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
    • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
    • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
    • C07K16/2863—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against receptors for growth factors, growth regulators
    • 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
    • C07K2317/30—Immunoglobulins specific features characterized by aspects of specificity or valency
    • C07K2317/35—Valency
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/52—Constant or Fc region; Isotype
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/52—Constant or Fc region; Isotype
    • C07K2317/524—CH2 domain
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/52—Constant or Fc region; Isotype
    • C07K2317/526—CH3 domain
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/55—Fab or Fab'
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/60—Immunoglobulins specific features characterized by non-natural combinations of immunoglobulin fragments
    • C07K2317/62—Immunoglobulins specific features characterized by non-natural combinations of immunoglobulin fragments comprising only variable region components
    • C07K2317/622—Single chain antibody (scFv)
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/60—Immunoglobulins specific features characterized by non-natural combinations of immunoglobulin fragments
    • C07K2317/64—Immunoglobulins specific features characterized by non-natural combinations of immunoglobulin fragments comprising a combination of variable region and constant region components
    • 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
    • C07K2317/71—Decreased effector function due to an Fc-modification
    • 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
    • C07K2317/75—Agonist effect on antigen
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/90—Immunoglobulins specific features characterized by (pharmaco)kinetic aspects or by stability of the immunoglobulin
    • C07K2317/92—Affinity (KD), association rate (Ka), dissociation rate (Kd) or EC50 value
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2319/00—Fusion polypeptide
    • C07K2319/20—Fusion polypeptide containing a tag with affinity for a non-protein ligand
    • C07K2319/21—Fusion polypeptide containing a tag with affinity for a non-protein ligand containing a His-tag

Definitions

  • the present disclosure relates generally to Wnt signaling pathway agonist molecules, compositions, and methods of using the same. Such molecules are useful, for example, in modulating Wnt signaling pathways.
  • Wnt (“Wingless-related integration site” or“Wingless and lnt-1” or “Wingless-lnt”) ligands and their signals play key roles in the control of
  • Wnt signaling As a therapeutic is the existence of multiple Wnt ligands and Wnt receptors, Frizzled 1 -10 (Fzd1- 10), with many tissues expressing multiple and overlapping Fzds.
  • Canonical Wnt signals also involve Low-density lipoprotein (LDL) receptor-related protein 5 (LRP5) or Low-density lipoprotein (LDL) receptor-related protein 6 (LRP6) as co- receptors, which are broadly expressed in various tissues, in addition to Fzds. Ratios of Fzd to LRP binding moieties have not been previously explored to modulate signaling levels, and to confer tissue and/or functional specificity.
  • LRP5 Low-density lipoprotein
  • LRP6 Low-density lipoprotein receptor-related protein 6
  • the Wnt signaling pathway is subdivided into canonical (b-catenin dependent) and non-canonical (b-catenin independent) pathways.
  • the non- canonical pathway can be further divided into two distinct branches - the Planar Cell Polarity (PCP) pathway and the Wnt/Ca 2+ pathway. Binding of certain Wnt ligands with certain Fzd receptors, or combinations of Fzd receptors can trigger the different pathways, and/or confer tissue and functional specificity.
  • PCP Planar Cell Polarity
  • binding moieties that specifically bind to one or more Fzd, LRP5, or LRP6 to modulate the different Wnt signaling pathways. Also a need exists to create binding moieties with certain ratios of co-receptors (e.g., Fzd and LRP receptors) to modulate signaling levels, and to confer tissue and/or functional specificity.
  • co-receptors e.g., Fzd and LRP receptors
  • the present disclosure provides Wnt surrogate molecules and related uses thereof.
  • the present disclosure provides a multispecific Wnt surrogate molecule, wherein the Wnt surrogate molecule comprises: (i) a plurality of regions that each specifically bind to a set of one or more Fzd receptor epitopes (Fzd binding regions), wherein at least two Fzd binding regions bind to the same or different sets of one or more Fzd receptor epitopes; and (ii) one or more regions that specifically bind to a Low-density lipoprotein (LDL) receptor-related protein 5 (LRP5) and/or a LDL receptor-related protein 6 (LRP6) (LRP5/6 binding regions).
  • LDL Low-density lipoprotein
  • LRP6 LDL receptor-related protein 6
  • at least two Fzd binding regions bind to different sets of one or more Fzd receptors, different sets of one or more epitopes within the same set of one or more Fzd receptors, or a combination thereof.
  • each Fzd binding region binds to one or more of Frizzled 1 (Fzd1 ), Frizzled 2 (Fzd2), Frizzled 3 (Fzd3), Frizzled 4 (Fzd4),
  • Frizzled 5 Frizzled 5
  • Frizzled 6 Frizzled 6
  • Frizzled 7 Frizzled 7
  • Frizzled 8 Frizzled 8
  • Frizzled 9 Frizzled9
  • Frizzled 10 Frizzled 10
  • At least one Fzd binding region binds to: (i) Fzd1 , Fzd2, Fzd7, and Fzd9; (ii) Fzd1 , Fzd2, and Fzd7; (iii) Fzd5 and Fzd8; (iv) Fzd5, Fzd7, and Fzd8; (v) Fzd1 , Fzd4, Fzd5, and Fzd8; (vi) Fzd1 , Fzd2, Fzd5, Fzd7, and Fzd8; (vii) Fzd4 and Fzd9; (viii) Fzd9 and Fzd10; (ix) Fzd5, Fzd8, and Fzd10; (x) Fzd4, Fzd5, and Fzd8; or (xi) Fzd1 , Fzd5, Fzd7, and Fzd8.
  • the plurality of Fzd binding regions comprises: (i) a first Fzd binding region that binds to a first set of one or more Fzd receptors, and (ii) a second Fzd binding region that binds to a second, different set of one or more Fzd receptors.
  • the first Fzd binding region binds to one or more of Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, and
  • Fzd10 and the second Fzd binding region binds to one or more of Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, and Fzd10.
  • the first Fzd binding region binds to Fzd4 and the second Fzd binding region binds to Fzd9.
  • the plurality of Fzd binding regions comprises: (i) a first Fzd binding region that binds to a first set of one or more epitopes within a set of one or more Fzd receptors, and (ii) a second Fzd binding region that binds to a second, different set of one or more epitopes within the same set of one or more Fzd receptors.
  • the Wnt surrogate binds to at least one Fzd receptor that induces non-canonical Wnt signaling; and the second Fzd binding region binds to at least one Fzd receptor that induces canonical Wnt signaling.
  • the Wnt surrogate binding to the first Fzd receptor and second Fzd receptor results in canonical Wnt signaling; or non-canonical Wnt signaling.
  • at least one Fzd binding region binds monospecifically to a single Fzd receptor.
  • the at least one Fzd binding region binds monospecifically to Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, or Fzd10.
  • At least one Fzd binding region binds to a region of a Fzd receptor that (i) does not include the cysteine rich domain (CRD) of the Fzd receptor or (ii) includes less than the entire CRD of the FZD receptor or iii) partially overlap with the CRD of the FZD receptor.
  • CRD cysteine rich domain
  • the at least one Fzd binding region binds to a hinge region of the Fzd receptor.
  • the hinge region comprises an amino acid sequence having at least 90% identity, at least 95% identity, or at least 98% identity to any of the sequences set forth in SEQ ID
  • the at least one Fzd binding region binds to an N-terminal region upstream of the CRD of the Fzd receptor.
  • the N-terminal region comprises an amino acid sequence having at least 90% identity, at least 95% identity, or at least 98% identity to SEQ ID NO:
  • At least one of the Fzd binding regions comprises one or more antigen-binding fragments of an antibody.
  • the one or more antigen-binding fragments are selected from the group consisting of: IgG, scFv, Fab, and VHH or sdAbs.
  • the one or more antigen-binding fragments are humanized.
  • At least one Fzd binding region comprises an amino acid sequence having at least 90% identity to any of the sequences set forth in Table 1A, Table 1 B, SEQ ID NOs: 1 -73, or an antigen-binding fragment thereof.
  • the one or more LRP5/6 binding regions comprises one or more antigen-binding fragments of an antibody.
  • the one or more antigen-binding fragments are selected from the group consisting of: IgG, scFv, Fab, and VHH or sdAbs.
  • the one or more antigen-binding fragments are humanized.
  • the one or more LRP5/6 binding regions comprise an amino acid sequence having at least 90% identity to any of the sequences set forth in Table 2A, Table 2B, or SEQ ID NOs: 74-97, or an antigen-binding fragment thereof.
  • the Wnt surrogate molecule comprises two or more LRP5/6 binding regions.
  • the Fzd binding regions and the LRP5/6 binding regions are in a ratio of Fzd:LRP5/6.
  • the Fzd binding regions and the LRP5/6 binding regions are in a ratio of Fzd n :LRP5/6 n (F n :L n ), wherein F and L are integers between 1 and 9, inclusive, and n is an integer between 1 and 4 inclusive.
  • the Fzd binding regions and the LRP5/6 binding regions are in a ratio of Fzd:LRP5/6 selected from the group consisting of: 1 : 1 , 2: 1 , 3: 1 , 4: 1 , 5: 1 , 6: 1 , 2: 1 2:3, 2:5, 2:7, 7:2, 5:2, 3:2, 3:4, 3:5, 3:7, 3:8, 8:3, 7:3, 5:3, 4:3, 4:5, 4:7, 4:9, 9:4, 7:4, 5:4, 6:7, 7:6, 1 :2, 1 :3, 1 :4, 1 :5, 1 :6, 2: 1 (with two Fzd binders and one LRP binder), 1 :2 (with one Fzd binder and two LRP binders), 2: 1 : 1 (with two different LRP binders), 1 : 1 :2 (with two different Fzd binders), 1 : 1 : 1 (two different Fzd binders), 1 :
  • the ratio of Fzd binding regions to LRP5/6 binding regions comprises 2 Fzd binding regions and 2 LRP5/6 binding regions; 2 Fzd binding regions and 1 LRP5/6 binding region; or 1 Fzd binding region and 2 LRP5/6 binding regions.
  • the ratio of Fzd binding regions to LRP5/6 binding regions comprises a first Fzd binding region, a second Fzd binding region, and 1 LRP5/6 binding region; or a first Fzd binding regions, a second Fzd binding regions, a first LRP5/6 binding region, and a second LRP5/6 binding region.
  • the first Fzd and second Fzd binding regions bind to different Fzd receptors, or bind to the same Fzd receptor on different regions/epitope, and the first LRP5/6 and second LRP5/6 binding regions bind to different epitopes or to different LRP proteins.
  • the LRP binding regions comprise a first LRP binding region that binds to a first set of one or more LRP receptors, and a second LRP binding region that binds to a second, different set of one or more LRP receptors.
  • the Wnt surrogate molecule comprises a structural format selected from the group consisting of: hetero-lg, diabody (DART), tandem diabody (DART), diabody-Fc, Fabs-in-tandem, Fabs-in-tandem IgG (FIT- Ig), Fv-lgG, and tandem scFv.
  • the Wnt surrogate molecule comprises: (i) a first light chain and a first heavy chain forming a first Fzd binding region, and (ii) a second light chain and a second heavy chain forming a second Fzd binding region, wherein the first and second Fzd binding regions bind to different sets of one or more Fzd receptor epitopes.
  • the Wnt surrogate molecule comprises a first LRP5/6 binding region fused to an N-terminus of the first light chain, a C-terminus of the first light chain, an N-terminus of the first heavy chain, or a C-terminus of the first heavy chain.
  • the Wnt surrogate molecule comprises second LRP5/6 binding region fused to an N-terminus of the second light chain, a C-terminus of the second light chain, an N-terminus of the second heavy chain, or a C-terminus of the second heavy chain.
  • the first and second heavy chains are connected to each other.
  • the first heavy chain comprises a first CH3 domain
  • the second heavy chain comprises a second CH3 domain
  • the first and second CH3 domains are connected to each other.
  • the first and second CH3 domains are connected to each other via knobs-into-holes mutations.
  • the first heavy chain and/or the second heavy chain comprise an amino acid sequence having at least 90% identity, at least 95% identity, or at least 98% identity to any of the sequences set forth in SEQ ID NOs:110, 112, 114, 116, 118, 120, or 122 (or shown in Table 5 or Table 6A)
  • the first light chain and/or the second light chain comprise an amino acid sequence having at least 90% identity to any of the sequences set forth in SEQ ID NOs:109, 111 , 113, 115, 117, 119, or 121 (or shown in Table 5 or Table 6A).
  • the Wnt surrogate molecule comprises one or more sequences (e.g., two or three sequences) having at least 90%, at least 95%, at least 98% or at least 99% sequence identity to a sequence disclosed in Table 5 or Table 6A.
  • the Wnt surrogate molecule comprises the sequences set forth for any Wnt surrogate molecule disclosed in Table 5 or Table 6A, or sequences having at least 90%, at least 95%, at least 98%, or at least 99% identity to such sequences.
  • the Wnt surrogate molecule has a structure as set forth in Table 6B.
  • the Wnt surrogate molecule modulates a Wnt signaling pathway in a cell, optionally a mammalian cell. In some embodiments, the Wnt surrogate molecule increases signaling via the Wnt signaling pathway in the cell. In some embodiments, the Wnt signaling pathway is a canonical Wnt signaling pathway. In some embodiments, the Wnt signaling pathway is a non- canonical Wnt signaling pathway.
  • the present disclosure provides a pharmaceutical composition
  • a pharmaceutical composition comprising a pharmaceutically acceptable excipient, diluent, or carrier, and a Wnt surrogate molecule according to any of the embodiments herein.
  • the present disclosure provides a method for agonizing a Wnt signaling pathway in a cell, comprising contacting the cell with a Wnt surrogate molecule according to any of the embodiments herein, wherein the Wnt surrogate molecule is an agonist of a Wnt signaling pathway.
  • the present disclosure provides a method for treating a subject having a disease or disorder, comprising administering to the subject an effective amount of a pharmaceutical composition of any of the embodiments herein, wherein the Wnt surrogate molecule is an agonist of a Wnt signaling pathway.
  • the disease or disorder is associated with reduced or impaired Wnt signaling, and/or wherein the subject would benefit from increased Wnt signaling.
  • the disease or disorder is selected from the group consisting of: bone fractures, stress fractures, vertebral
  • osteonecrosis osseointegration of implants or orthopedic devices, osteogenesis imperfecta, bone grafts, tendon repair, tendon-bone integration, tooth growth and regeneration, maxillofacial surgery, dental implantation, periodontal diseases, maxillofacial reconstruction, osteonecrosis of the jaw, hip or femoral head, avascular necrosis, alopecia, hearing loss, vestibular hypofunction, macular degeneration, age-related macular degeneration (AMD), vitreoretinopathy, retinopathy, diabetic retinopathy, diseases of retinal degeneration, Fuchs’ dystrophy, cornea diseases, stroke, traumatic brain injury, Alzheimer's disease, multiple sclerosis, muscular dystrophy, muscle atrophy caused by sarcopenia or chachexia, diseases affecting blood brain barrier (BBB), spinal cord injuries, spinal cord diseases
  • NASH nonalcoholic steatohepatitis
  • NAFLD nonalcoholic fatty liver disease
  • the disease or disorder is a bone disease or disorder.
  • the Wnt surrogate molecule binds: (i) Fzd1 , Fzd2, and Fzd7; or (ii) Fzd1 , Fzd2, Fzd5, Fzd7, and Fzd8.
  • FIG. 1 Schematic diagrams of illustrative formats of Wnt surrogate molecules. Different VHH, Fv, or scFv, Diabody, or Fabs containing various VL and VH regions directed against different Fzd receptors and Lrp receptors are combined in various ratios. The different colors represent different binders (which can bind to the same target or different targets).
  • FIG. 2A Schematic diagram of a Fzd receptor including a cysteine rich domain (CRD), hinge region, and N-terminal region.
  • CCD cysteine rich domain
  • FIG. 2A Schematic diagram of a Fzd receptor including a cysteine rich domain (CRD), hinge region, and N-terminal region.
  • FIG. 2B Schematic diagram of a Wnt surrogate molecule with binding specificity for the Fzd receptor hinge region.
  • FIG. 2C Binding kinetics of 1791 -3 and 1291 -3 Wnt surrogate molecules.
  • FIG. 2D In vitro activity of 1791 -3 and 1291 -3 Wnt surrogate molecules.
  • FIG. 3A Schematic diagrams of monospecific and multispecific Wnt surrogate molecules.
  • FIG. 3B In vitro activity of Wnt surrogate molecules in 293STF cells.
  • FIG. 3C In vitro activity of Wnt surrogate molecules in 293STF cells overexpressing Fzd4 (293STF Fzd40E).
  • FIG. 3D In vitro activity of Wnt surrogate molecules in 293STF cells overexpressing Fzd9 (293STF Fzd90E).
  • FIG. 3C In vitro activity of Wnt surrogate molecules in 293STF cells overexpressing Fzd4 and Fzd9 (293STF Fzd40E + Fzd90E).
  • FIGS. 4A-4E show sequence alignments of the hinge region of various Fzds (SEQ ID NOs: 2251 -2260).
  • FIGS. 5A-5C show the structure of heterologous molecules
  • FIGS. 6A-6E show the structures of Wnt surrogate molecules with different ratios of Fzd to Lrp binders and their impact on Wnt3a activation of beta- catenin-dependent signaling.
  • FIGS. 7A-7D show structures containing heterodimerizion of two different Lrp binders together with Fzd binders and their in vitro activity in 293STF cells.
  • FIGS. 8A-8J show 1 :1 bivalent bispecific L1/F1 tandem scFv molecules are not efficient in activating b-catenin dependent WNT signaling.
  • A Diagram of 1 :1 bivalent bispecific L1/F1 tandem scFv constructs. Each circle represents a scFv domain, the thin black line at the end of each molecule represent the 6xHis tag.
  • B Ni resin purified tandem scFv molecules were separated on 4-15% SDS-PAGE gel. Left panel, from left to right: L1 -F1 tandem scFv with 5-mer, 10-mer and 15-mer linkers under reducing (R, lanes 1 -3) or nonreducing (NR, lanes 4-6) conditions.
  • FIG. 9. 1 :1 bivalent bispecific L1/F1 tandem scFv molecules are not efficient in activating b-catenin dependent WNT signaling.
  • the dose dependent STF activity of the tandem scFvs purified either from Ni column alone or additionally purified from SEC column, with L1 fused to the N-terminus of F1 and F1 fused to the N-terminus of L1 comparing to recombinant WNT3A and the surrogate WNT, 18R5-DKK1 c.
  • These data are identical to Fig. 1 C-1 F, except with the positive control molecule data included.
  • FIGS. 10A-10F Increasing the valency of L1 and F1 tandem scFv by fusing to a Fc domain significantly increased the activity in Wnt signal.
  • E-F The dose dependent STF activity of the tandem scFv-Fc molecules from the protein peak fractions corresponding to the monomeric forms of the molecules from SEC column.
  • FIGS. 11 A-11 B The STF activity and Octet binding profiles of the 2:2 tetravalent bispecific F1/L1 molecules.
  • FIGS. 12A-12E The 2:2 tetravalent bispecific molecules, consisting of the two F1 and two L2 binding arms, are highly potent in inducing Wnt signaling.
  • B-C The dose dependent STF activities of the 2:2 tetravalent bispecific molecules consisting of F1 and L2 binding arms in both orientations, from the protein peak fractions corresponding to the monomeric forms of each molecules from SEC column.
  • FIGS. 13A-13B 1 :1 bivalent bispecific L2/F1 tandem scFv molecules are not efficient in activating b-catenin dependent WNT signaling.
  • the molecular format diagrams are also shown on top. The arrows in each panel indicate the position of the
  • FIGS. 14A-14I The 2:2 tetravalent bispecific molecules, consisting of the two F2 and two L1 or L2 binding arms, activate Wnt signaling.
  • the F2-L2 orientation does not appear to be active while the reverse L2-F2 orientation seems to be active in the 1 : 1 format.
  • the arrows in each panel indicate the position of the monomeric forms of the proteins.
  • F) and FI The 2:2 tetravalent bispecific molecular formats and STF activities across SEC column fractions for molecules consisting of F2 and L2 combinations in both orientations.
  • the arrows in each panel indicate the position of the monomeric forms of the proteins.
  • G) and I) The dose dependent STF activities of the 2:2 tetravalent bispecific L2/F2 molecules of F) and FI) from the protein peak fractions corresponding to the monomeric forms of each molecules from SEC column.
  • FIGS. 15A-15B FZD specific profile of F1 , F2, F3, and the STF activities of the 1 :1 bivalent bispecific F2/L1 molecules.
  • the molecular format diagrams are also shown on top. The arrows in each panel indicate the position of the monomeric forms of the proteins.
  • the 1 :1 bivalent bispecific format is ineffective in inducing Wnt/b- catenin signaling.
  • FIGS 16A-16D The 2:2 tetravalent bispecific molecules, consisting of the two F3 and two L1 or L2 binding arms, activate Wnt signaling.
  • FIG. 17 The 1 :1 bivalent bispecific L1/F3 or L2/F3 tandem scFv molecules are not efficient in activating b-catenin dependent WNT signaling.
  • the molecular format diagrams are also shown on top. The arrows in each panel indicate the position of the monomeric forms of the proteins.
  • the 1 :1 bivalent bispecific format is ineffective in inducing Wnt/p-catenin signaling.
  • FIGS. 18A-18B The 2:2 tetravalent bispecific dumbbell format has similar activity to the 2:2 tetravalent bispecific tandem scFv-Fc format.
  • the surrogate WNT agonists tested here are the combination of F1 and L1 in the 2:2 tetravalent bispecific dumbbell format. This format is active, however, show a much lower efficacy compare to WNT3A. There is a preference for L1 to be on the N-terminus of Fc.
  • the surrogate WNT agonists tested here are the combination of F1 and L2 in the 2:2 tetravalent bispecific dumbbell format. There is also a preference for L2 to be on the N-terminus of Fc.
  • FIGS. 19A-19C Various 1 :1 bivalent bispecific tandem scFv molecules show little to no activity.
  • FIG 20A-20B Various 1 :1 bispecific scFv molecules show little to no activity.
  • A,D The diagrams of molecules with different stoichiometries between FZD and LRP binders, such as 2 FZD binders and 1 LRP binders (2:1 ) or 1 FZD and 2 LRP binders (1 :2).
  • B,C Dose response of molecules in A) in STF reporter assays.
  • E,F Dose response of molecules in D) in STF reporter assays.
  • G Molecular formats of 2:2 tetravalent trispecific molecule where the two FZD binders are of different FZD specificity (1 :1 :2).
  • H Dose response of molecules in G) in STF reporter assays.
  • the present disclosure relates to multispecific Wnt surrogate molecules that specifically bind to a plurality of different Fzd receptors and epitopes and to LRP5 and/or LRP6 in order to modulate a Wnt signaling pathway.
  • the Wnt surrogate molecules activate a Wnt signaling pathway or increase signaling via a Wnt signaling pathway.
  • the Wnt surrogate molecules of the present disclosure have: (i) a plurality of regions that each specifically bind to a set of one or more Frizzled (Fzd) receptors and/or epitopes, referred to herein as“Fzd binding regions;” and (ii) one or more regions that specifically bind to a LRP5 and/or a LRP6, referred to herein as“LRP5/6 binding regions.”
  • Certain embodiments encompass specific structural formats or arrangements of the Fzd binding regions and the LRP5/6 binding regions that are advantageous in modulating Wnt signaling pathways and related biological effects, e.g., for the treatment of diseases and disorders associated with Wnt signaling.
  • the Wnt surrogate molecules disclosed herein include multiple Fzd binding regions with binding specificities for different Fzd receptors and/or epitopes.
  • a Wnt surrogate molecule may include at least two Fzd binding regions that each bind to different sets of one or more Fzd receptors, different sets of one or more epitopes within the same set of one or more Fzd receptors, or a combination thereof.
  • Each Fzd binding region may be monospecific, bispecific, trispecific, etc. for a different Fzd receptor epitope or plurality of Fzd receptor epitopes.
  • Such multispecific Wnt surrogate molecules are capable of selectively activating specific combinations of Fzd receptors, while reducing or eliminating activation of non-targeted Fzd receptors.
  • Embodiments of the present disclosure are advantageous for selectively modulating Wnt signaling in a target cell type and/or for the treatment of a specific disease or disorder, e.g., by reducing off-target effects.
  • Embodiments of the invention pertain to the use of Wnt surrogate molecules for the diagnosis, assessment and treatment of diseases and disorders associated with Wnt signaling pathways.
  • the subject Wnt surrogate molecules are used to modulate a Wnt signaling pathway in a cell or tissue.
  • the subject Wnt surrogate molecules are used in the treatment or prevention of diseases and disorders associated with aberrant or deregulated (e.g., reduced) Wnt signaling, or for which modulating, e.g.,
  • a and/or B encompasses one or more of A or B, and combinations thereof such as A and B.
  • oligonucleotide synthesis oligonucleotide synthesis, and tissue culture and transformation (e.g.,
  • Enzymatic reactions and purification techniques may be performed according to manufacturer's specifications or as commonly accomplished in the art or as described herein. These and related techniques and procedures may be generally performed according to conventional methods well known in the art and as described in various general and more specific references that are cited and discussed throughout the present specification. Unless specific definitions are provided, the nomenclature utilized in connection with, and the laboratory procedures and techniques of, molecular biology, analytical chemistry, synthetic organic chemistry, and medicinal and pharmaceutical chemistry described herein are those well-known and commonly used in the art. Standard techniques may be used for recombinant technology, molecular biological, microbiological, chemical syntheses, chemical analyses, pharmaceutical preparation, formulation, and delivery, and treatment of subjects. Embodiments of the present disclosure relate to antibodies and antigen-binding fragments thereof that bind to one or more Fzd receptors.
  • CDRs complementarity determining regions
  • Embodiments of the present disclosure relate to antibodies and antigen-binding fragments thereof that bind to LRP5 and/or LRP6. Sequences of illustrative antibodies, or antigen-binding fragments, or complementarity
  • CDRs determining regions (CDRs) thereof, are set forth in SEQ ID NOs:74-97, Tables 2A and 2B, and Table 5.
  • an antibody is an immunoglobulin molecule capable of specific binding to a target, such as a carbohydrate, polynucleotide, lipid, polypeptide, etc., through at least one epitope recognition site, located in the variable region of the immunoglobulin molecule.
  • a target such as a carbohydrate, polynucleotide, lipid, polypeptide, etc.
  • the term encompasses not only intact polyclonal or monoclonal antibodies, but also fragments thereof (such as dAb, Fab, Fab', F(ab')2, Fv), single chain (scFv), Nanobodies® (Nabs; also referred to as VHH or single-domain antibodies
  • sdAbs synthetic variants thereof, naturally occurring variants, fusion proteins comprising an antibody or an antigen-binding fragment thereof, humanized antibodies, chimeric antibodies, and any other modified configuration of the immunoglobulin molecule that comprises an antigen-binding site or fragment (epitope recognition site) of the required specificity.
  • “Diabodies,” multivalent or multispecific fragments constructed by gene fusion WO94/13804; P. Holliger et al. , Proc. Natl. Acad. Sci. USA 90 6444-6448, 1993
  • Minibodies comprising a scFv joined to a CFI3 domain are also included herein (S.
  • antigen-binding fragment refers to a polypeptide fragment that contains at least one CDR of an immunoglobulin heavy and/or light chain, or of a VHH or sdAb, that binds to the antigen of interest, in particular to one or more Fzd receptors, or to LRP5 and/or LRP6.
  • an antigen-binding fragment of the herein described antibodies may comprise 1 , 2, 3, 4, 5, or all 6 CDRs of a VH and VL sequence set forth herein from antibodies that bind one or more Fzd receptors or LRP5 and/or LRP6.
  • an antigen-binding fragment may comprise all three VFI CDRs or all three VL CDRs.
  • an antigen-binding fragment thereof may comprise all three CDRs of a VHH or sdAb.
  • An antigen-binding fragment of a Fzd-specific antibody is capable of binding to a Fzd receptor.
  • An antigen-binding fragment of a LRP5/6- specific antibody is capable of binding to a LRP5 and/or LRP6 receptor.
  • the term encompasses not only isolated fragments but also polypeptides comprising an antigen-binding fragment of an antibody disclosed herein, such as, for example, fusion proteins comprising an antigen-binding fragment of an antibody disclosed herein, such as, e.g., a fusion protein comprising a VHH or sdAb that binds one or more Fzd receptors and a VHH or sdAb that binds LRP5 and/or LRP6.
  • a binding agent e.g., a Wnt surrogate molecule or binding region thereof
  • a Wnt surrogate molecule or binding region thereof is said to specifically bind an antigen when it preferentially recognizes its target antigen in a complex mixture of proteins and/or macromolecules.
  • a Wnt surrogate molecule or binding region thereof e.g., an antibody or antigen-binding fragment thereof
  • the equilibrium dissociation constant may be ⁇ 10 9 M or ⁇ 10 10 M.
  • antibodies and antigen-binding fragments thereof as described herein include a heavy chain and a light chain CDR set, respectively interposed between a heavy chain and a light chain framework region (FR) set which provide support to the CDRs and define the spatial relationship of the CDRs relative to each other.
  • CDR set refers to the three hypervariable regions of a heavy or light chain V region. Proceeding from the N-terminus of a heavy or light chain, these regions are denoted as “CDR1 ,” “CDR2,” and “CDR3" respectively.
  • An antigen-binding site therefore, includes six CDRs, comprising the CDR set from each of a heavy and a light chain V region.
  • a polypeptide comprising a single CDR (e.g., a CDR1 , CDR2 or CDR3) is referred to herein as a "molecular recognition unit.” Crystallographic analysis of a number of antigen-antibody complexes has demonstrated that the amino acid residues of CDRs form extensive contact with bound antigen, wherein the most extensive antigen contact is with the heavy chain CDR3. Thus, the molecular recognition units are primarily responsible for the specificity of an antigen-binding site.
  • FR set refers to the four flanking amino acid sequences which frame the CDRs of a CDR set of a heavy or light chain V region. Some FR residues may contact bound antigen; however, FRs are primarily responsible for folding the V region into the antigen-binding site, particularly the FR residues directly adjacent to the CDRs. Within FRs, certain amino residues and certain structural features are very highly conserved. In this regard, all V region sequences contain an internal disulfide loop of around 90 amino acid residues. When the V regions fold into a binding-site, the CDRs are displayed as projecting loop motifs which form an antigen-binding surface.
  • immunoglobulin CDRs and variable domains may be determined by reference to Kabat, E. A. et al. ,
  • A“monoclonal antibody” refers to a homogeneous antibody population wherein the monoclonal antibody is comprised of amino acids
  • Monoclonal antibodies are highly specific, being directed against a single epitope.
  • monoclonal antibodies encompasses not only intact monoclonal antibodies and full-length monoclonal antibodies, but also fragments thereof (such as Fab, Fab', F(ab')2, Fv), single chain (scFv), VHH or sdAbs, variants thereof, fusion proteins comprising an antigen-binding fragment of a monoclonal antibody, humanized monoclonal antibodies, chimeric monoclonal antibodies, and any other modified
  • the immunoglobulin molecule that comprises an antigen- binding fragment (epitope recognition site) of the required specificity and the ability to bind to an epitope, including Wnt surrogate molecules disclosed herein. It is not intended to be limited as regards the source of the antibody or the manner in which it is made (e.g., by hybridoma, phage selection,
  • the term includes whole immunoglobulins as well as the fragments etc. described above under the definition of "antibody”.
  • the proteolytic enzyme papain preferentially cleaves IgG molecules to yield several fragments, two of which (the F(ab) fragments) each comprise a covalent heterodimer that includes an intact antigen-binding site.
  • the enzyme pepsin is able to cleave IgG molecules to provide several fragments, including the F(ab')2 fragment which comprises both antigen-binding sites.
  • An Fv fragment for use according to certain embodiments of the present disclosure can be produced by preferential proteolytic cleavage of an IgM, and on rare occasions of an IgG or IgA immunoglobulin molecule. Fv fragments are, however, more commonly derived using recombinant techniques known in the art.
  • the Fv fragment includes a non- covalent VH: :VL heterodimer including an antigen-binding site which retains much of the antigen recognition and binding capabilities of the native antibody molecule.
  • single chain Fv or scFV antibodies are contemplated.
  • Kappa bodies III et al., Prot. Eng. 10: 949-57 (1997)); minibodies (Martin et al., EMBO J 13: 5305-9 (1994)); diabodies (Holliger et al., PNAS 90: 6444-8 (1993)); or Janusins (Traunecker et al., EMBO J 10: 3655-59 (1991 ) and Traunecker et al., Int. J. Cancer Suppi 1: 51 -52 (1992)), may be prepared using standard molecular biology techniques following the teachings of the present application with regard to selecting antibodies having the desired specificity.
  • bispecific or chimeric antibodies may be made that encompass the ligands of the present disclosure.
  • a chimeric antibody may comprise CDRs and framework regions from different antibodies, while bispecific antibodies may be generated that bind specifically to one or more Fzd receptors through one binding domain and to a second molecule through a second binding domain.
  • These antibodies may be produced through recombinant molecular biological techniques or may be physically conjugated together.
  • a single chain Fv (scFv) polypeptide is a covalently linked VH: :VL heterodimer which is expressed from a gene fusion including VH- and Vi_-encoding genes linked by a peptide-encoding linker. Fluston et al. (1988) Proc. Nat. Acad. Sci. USA 85 ⁇ 16):5879-5883.
  • a number of methods have been described to discern chemical structures for converting the naturally aggregated— but chemically separated— light and heavy polypeptide chains from an antibody V region into an scFv molecule which will fold into a three dimensional structure substantially similar to the structure of an antigen-binding site. See, e.g., U.S. Patent Nos.
  • an antibody as described herein is in the form of a diabody.
  • Diabodies are multimers of polypeptides, each polypeptide comprising a first domain comprising a binding region of an immunoglobulin light chain and a second domain comprising a binding region of an immunoglobulin heavy chain, the two domains being linked (e.g., by a peptide linker) but unable to associate with each other to form an antigen binding site: antigen binding sites are formed by the association of the first domain of one polypeptide within the multimer with the second domain of another polypeptide within the multimer (WO94/13804).
  • a dAb fragment of an antibody consists of a VH domain (Ward, E. S. et al., Nature 341 , 544-546 (1989)).
  • bispecific antibodies may be conventional bispecific antibodies, which can be manufactured in a variety of ways (Holliger, P. and Winter G., Current Opinion Biotechnol. 4, 446-449 (1993)), e.g., prepared chemically or from hybrid hybridomas, or may be any of the bispecific antibody fragments mentioned above.
  • Diabodies and scFv can be constructed without an Fc region, using only variable domains, potentially reducing the effects of anti-idiotypic reaction.
  • Bispecific diabodies as opposed to bispecific whole antibodies, may also be particularly useful because they can be readily constructed and expressed in E. coli.
  • Diabodies (and many other polypeptides such as antibody fragments) of appropriate binding specificities can be readily selected using phage display (WO94/13804) from libraries. If one arm of the diabody is to be kept constant, for instance, with a specificity directed against antigen X, then a library can be made where the other arm is varied and an antibody of appropriate specificity selected.
  • Bispecific whole antibodies may be made by knobs-into-holes engineering (J. B. B. Ridgeway et al., Protein Eng., 9, 616-621 (1996)).
  • the antibodies described herein may be provided in the form of a UniBody®.
  • a UniBody® is an lgG4 antibody with the hinge region removed (see GenMab Utrecht, The Netherlands; see also, e.g., US20090226421 ). This proprietary antibody technology creates a stable, smaller antibody format with an anticipated longer therapeutic window than current small antibody formats. lgG4 antibodies are considered inert and thus do not interact with the immune system. Fully human lgG4 antibodies may be modified by eliminating the hinge region of the antibody to obtain half-molecule fragments having distinct stability properties relative to the corresponding intact lgG4
  • UniBody® that can bind to cognate antigens (e.g ., disease targets) and the
  • UniBody® therefore binds univalently to only one site on target cells.
  • the antibodies of the present disclosure may take the form of a VHH or sdAb.
  • VHH or sdAb technology was originally developed following the discovery and identification that camelidae (e.g., camels and llamas) possess fully functional antibodies that consist of heavy chains only and therefore lack light chains.
  • camelidae e.g., camels and llamas
  • These heavy-chain only antibodies contain a single variable domain(VHH) and two constant domains (CH2, CH3).
  • the cloned and isolated single variable domains have full antigen binding capacity and are very stable.
  • These single variable domains, with their unique structural and functional properties form the basis of“VHH or sdAbs”.
  • VHH or sdAbs are encoded by single genes and are efficiently produced in almost all prokaryotic and eukaryotic hosts, e.g., E. coli (see, e.g., U.S. Pat. No. 6,765,087), molds (for example Aspergillus or
  • VHH or sdAbs may be formulated as a ready-to-use solution having a long shelf life.
  • Nanoclone® method is a proprietary method for generating VHH or sdAbs against a desired target, based on automated high- throughput selection of B-cells.
  • VHH or sdAbs are single-domain antigen-binding fragments of camelid-specific heavy-chain only antibodies.
  • VHH or sdAbs typically have a small size of around 15 kDa.
  • the antibodies or antigen-binding fragments thereof as disclosed herein are humanized.
  • the antigen-binding site may comprise either complete variable domains fused onto constant domains or only the CDRs grafted onto appropriate framework regions in the variable domains.
  • Epitope binding sites may be wild type or modified by one or more amino acid substitutions.
  • variable regions of both heavy and light chains contain three complementarity-determining regions (CDRs) which vary in response to the epitopes in question and determine binding capability, flanked by four framework regions (FRs) which are relatively conserved in a given species and which putatively provide a scaffolding for the CDRs.
  • CDRs complementarity-determining regions
  • FRs framework regions
  • humanized antibodies preserve all CDR sequences (for example, a humanized mouse antibody which contains all six CDRs from the mouse antibodies). In other embodiments, humanized
  • antibodies have one or more CDRs (one, two, three, four, five, six) which are altered with respect to the original antibody, which are also termed one or more CDRs "derived from" one or more CDRs from the original antibody.
  • the antibodies of the present disclosure may be chimeric antibodies.
  • a chimeric antibody is comprised of an antigen-binding fragment of an antibody operably linked or otherwise fused to a heterologous Fc portion of a different antibody.
  • the heterologous Fc domain is of human origin. In other embodiments, the
  • heterologous Fc domain may be from a different Ig class from the parent antibody, including IgA (including subclasses lgA1 and lgA2), IgD, IgE, IgG (including subclasses lgG1 , lgG2, lgG3, and lgG4), and IgM.
  • the heterologous Fc domain may be comprised of CFI2 and CFI3 domains from one or more of the different Ig classes.
  • the antigen-binding fragment of a chimeric antibody may comprise only one or more of the CDRs of the antibodies described herein (e.g., 1 , 2, 3, 4, 5, or 6 CDRs of the antibodies described herein), or may comprise an entire variable domain (VL, VFI or both).
  • Wnt surrogate molecules that bind both one or more Fzd receptors and one or both of LRP5 and/or LRP6.
  • Wnt surrogate molecules may also be referred to as“Wnt surrogates” or“Wnt mimetics.”
  • the Wnt surrogate molecules bind one or more human Fzd receptors and one or both of a human LRP5 and/or a human LRP6.
  • a Wnt surrogate molecule is capable of modulating or modulates Wnt signaling events in a cell contacted with the Wnt surrogate molecule.
  • the Wnt surrogate molecule increases Wnt signaling, e.g., via the canonical Wnt/ -catenin pathway.
  • the Wnt surrogate molecule specifically modulates the biological activity of a human Wnt signaling pathway.
  • Wnt surrogate molecules of the present disclosure are biologically active in binding to one or more Fzd receptors and to one or more of LRP5 and LRP6, and in activation of Wnt signaling, i.e. , the Wnt surrogate molecule is a Wnt agonist.
  • Wnt agonist activity refers to the ability of an agonist to mimic the effect or activity of a Wnt protein binding to an Fzd receptor and/or LRP5 or LRP6.
  • the ability of the Wnt surrogate molecules and other Wnt agonists disclosed herein to mimic the activity of Wnt can be confirmed by a number of assays.
  • Wnt agonists typically initiate a reaction or activity that is similar to or the same as that initiated by the receptor's natural ligand.
  • the Wnt agonists disclosed herein activate, enhance or increase the canonical Wnt/ -catenin signaling pathway.
  • the term "enhances" refers to a measurable increase in the level of Wnt/ -catenin signaling compared with the level in the absence of a Wnt agonist, e.g., a Wnt surrogate molecule disclosed herein.
  • the increase in the level of Wnt/ -catenin signaling is at least 10%, at least 20%, at least 50%, at least two-fold, at least five-fold, at least 10-fold, at least 20-fold, at least 50-fold, or at least 100-fold as compared to the level of Wnt/ -catenin signaling in the absence of the Wnt agonist, e.g., in the same cell type.
  • Methods of measuring Wnt/ -catenin signaling are known in the art and include those described herein.
  • Wnt surrogate molecules disclosed herein are multispecific, i.e., they specifically bind to two or more different epitopes.
  • At least one epitope is within one or more Fzd receptors and at least one epitope binds to LRP5 and/or LRP6.
  • multispecific Wnt surrogate molecules are multispecific with respect to Fzd receptor binding, i.e., they specifically bind to two or more different types of Fzd receptors, two or more different epitopes within a single type of Fzd receptor, or a combination thereof.
  • a multispecific Wnt surrogate molecule may bind to two or more of Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, and Fzd10.
  • a multispecific Wnt surrogate molecule binds to: (i) Fzd1 , Fzd2,
  • Fzd7, and Fzd9 Fzd7, and Fzd9; (ii) Fzd1 , Fzd2, and Fzd7; (iii) Fzd5 and Fzd8; (iv) Fzd5, Fzd7, and Fzd8; (v) Fzd1 , Fzd4, Fzd5, and Fzd8; (vi) Fzd1 , Fzd2, Fzd5, Fzd7, and Fzd8; (vii) Fzd4 and Fzd9; (viii) Fzd9 and Fzd10; (ix) Fzd5, Fzd8, and Fzd10; (x) Fzd4, Fzd5, and Fzd8; or (xi) Fzd1 , Fzd5, Fzd7 and Fzd8.
  • a Wnt surrogate molecule that is
  • the multispecific with respect to Fzd binding includes at least one Fzd binding region that binds to a plurality of different Fzd receptor epitopes, e.g., epitopes within different Fzd receptors, different epitopes within the same Fzd receptor, or combinations thereof.
  • the Wnt surrogate molecule may include at least one Fzd binding region that binds to two or more Fzd receptors, e.g., two or more of Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, and Fzd10.
  • the Wnt surrogate molecule may include at least one Fzd binding region that binds to: (i) Fzd1 , Fzd2, Fzd7 and Fzd9; (ii) Fzd1 , Fzd2 and Fzd7; (iii) Fzd5 and Fzd8; (iv) Fzd5, Fzd7 and Fzd8; (v) Fzd1 , Fzd4, Fzd5 and Fzd8; (vi) Fzd1 , Fzd2, Fzd5, Fzd7 and Fzd8; (vii) Fzd4 and Fzd9; (viii) Fzd9 and Fzd10; (ix) Fzd5, Fzd8 and Fzd10; (x) Fzd4, Fzd5 and Fzd8; or (xi) Fzd1 , Fzd5, Fzd7 and Fzd8.
  • a Wnt surrogate that is multispecific with respect to Fzd binding includes at least two Fzd binding regions that each bind to different sets of one or more Fzd receptor epitopes, e.g., epitopes within different Fzd receptors, different epitopes within the same Fzd receptor, or combinations thereof.
  • a set of one or more Fzd receptor epitopes may include one, two, three, four, five, six, seven, eight, nine, ten, or more Fzd receptor epitopes, such that each Fzd binding region may be
  • a multispecific Wnt surrogate includes two or more Fzd binding regions, wherein one or more of these Fzd binding regions specifically binds only one Fzd receptor or receptor epitope.
  • two or more, three or more, or four or more Fzd binding regions within the mutispecific Wnt surrogate each specifically bind only one Fzd receptor or receptor epitope, wherein at least two or more, at least three or more, or at least four or more of the Fzd binding regions specifically bind different Fzd receptors and/or receptor epitopes.
  • the Wnt surrogate molecule includes a first Fzd binding region that binds to a first set of one or more Fzd receptor epitopes, and a second Fzd binding region that binds to a second, different set of one or more Fzd receptor epitopes.
  • the first Fzd binding region may bind to a first set of one or more Fzd receptors
  • the second Fzd binding region may bind to a second, different set of one or more Fzd receptors.
  • the first Fzd binding region may bind to a first set of one or more epitopes within a set of one or more Fzd receptors, and the second Fzd binding region may bind to a second, different set of one or more epitopes within the same set of one or more Fzd receptors.
  • the first Fzd binding region binds to one or more of Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, and Fzd10.
  • the second Fzd binding region binds to one or more of Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, and Fzd10.
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein: the first Fzd binding region binds to Fzd1 and the second Fzd binding region binds to Fzd2; the first Fzd binding region binds to Fzd1 and the second Fzd binding region binds to Fzd3; the first Fzd binding region binds to Fzd1 and the second Fzd binding region binds to Fzd4; the first Fzd binding region binds to Fzd1 and the second Fzd binding region binds to Fzd5; the first Fzd binding region binds to Fzd1 and the second Fzd binding region binds to Fzd6; the first Fzd binding region binds to Fzd1 and the second Fzd binding region binds to Fzd7; the first Fzd binding region binds to Fzd1 and the second Fzd binding region binds to Fzd7
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein: the first Fzd binding region binds to Fzd2 and the second Fzd binding region binds to Fzd3; the first Fzd binding region binds to Fzd2 and the second Fzd binding region binds to Fzd4; the first Fzd binding region binds to Fzd2 and the second Fzd binding region binds to Fzd5; the first Fzd binding region binds to Fzd2 and the second Fzd binding region binds to Fzd6; the first Fzd binding region binds to Fzd2 and the second Fzd binding region binds to Fzd7; the first Fzd binding region binds to Fzd2 and the second Fzd binding region binds to Fzd8; the first Fzd binding region binds to Fzd2 and the second Fzd binding region binds to Fzd8
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein: the first Fzd binding region binds to Fzd3 and the second Fzd binding region binds to Fzd4; the first Fzd binding region binds to Fzd3 and the second Fzd binding region binds to Fzd5; the first Fzd binding region binds to Fzd3 and the second Fzd binding region binds to Fzd6; the first Fzd binding region binds to Fzd3 and the second Fzd binding region binds to Fzd7; the first Fzd binding region binds to Fzd3 and the second Fzd binding region binds to Fzd8; the first Fzd binding region binds to Fzd3 and the second Fzd binding region binds to Fzd9; or the first Fzd binding region binds to Fzd3 and the second Fzd binding region binds to Fzd
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein: the first Fzd binding region binds to Fzd4 and the second Fzd binding region binds to Fzd5; the first Fzd binding region binds to Fzd4 and the second Fzd binding region binds to Fzd6; the first Fzd binding region binds to Fzd4 and the second Fzd binding region binds to Fzd7; the first Fzd binding region binds to Fzd4 and the second Fzd binding region binds to Fzd8; the first Fzd binding region binds to Fzd4 and the second Fzd binding region binds to Fzd9; or the first Fzd binding region binds to Fzd4 and the second Fzd binding region binds to Fzd10.
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein: the first Fzd binding region binds to Fzd5 and the second Fzd binding region binds to Fzd6; the first Fzd binding region binds to Fzd5 and the second Fzd binding region binds to Fzd7; the first Fzd binding region binds to Fzd5 and the second Fzd binding region binds to Fzd8; the first Fzd binding region binds to Fzd5 and the second Fzd binding region binds to Fzd9; or the first Fzd binding region binds to Fzd5 and the second Fzd binding region binds to Fzd10.
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein: the first Fzd binding region binds to Fzd6 and the second Fzd binding region binds to Fzd7; the first Fzd binding region binds to Fzd6 and the second Fzd binding region binds to Fzd8; the first Fzd binding region binds to Fzd6 and the second Fzd binding region binds to Fzd9; or the first Fzd binding region binds to Fzd6 and the second Fzd binding region binds to Fzd10.
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein: the first Fzd binding region binds to Fzd7 and the second Fzd binding region binds to Fzd8; the first Fzd binding region binds to Fzd7 and the second Fzd binding region binds to Fzd9; or the first Fzd binding region binds to Fzd7 and the second Fzd binding region binds to Fzd 10.
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein: the first Fzd binding region binds to Fzd8 and the second Fzd binding region binds to Fzd9; or the first Fzd binding region binds to Fzd8 and the second Fzd binding region binds to Fzd10.
  • the Wnt surrogate molecule includes a first Fzd binding region and a second Fzd binding region, wherein the first Fzd binding region binds to Fzd9 and the second Fzd binding region binds to Fzd10.
  • the first or second binding region may specifically bind only the indicated Fzd, or it may also bind additional Fzds.
  • the first Fzd binding region may specifically bind only Fzd1 , or it may also bind to one or more other Fzds in addition to Fzd1.
  • the second Fzd binding region may specifically bind only Fzd2, or it may also bind to one or more other Fzds in addition to Fzd2.
  • the first and second Fzd binding regions bind to different sets of Fzd receptors.
  • the first and second binding regions may specifically bind to different epitopes within the same Fzd receptor.
  • the first binding region may bind to a first epitope in Fzd1
  • the second binding region may bind to a second, different epitope in Fzd1.
  • the first binding region may bind to a first epitope in Fzd2, and the second binding region may bind to a second, different epitope in Fzd2.
  • the first binding region may bind to a first epitope in Fzd3, and the second binding region may bind to a second, different epitope in Fzd3.
  • the first binding region may bind to a first epitope in Fzd4, and the second binding region may bind to a second, different epitope in Fzd4.
  • the first binding region may bind to a first epitope in Fzd5, and the second binding region may bind to a second, different epitope in Fzd5.
  • the first binding region may bind to a first epitope in Fzd6, and the second binding region may bind to a second, different epitope in Fzd6.
  • the first binding region may bind to a first epitope in Fzd7, and the second binding region may bind to a second, different epitope in Fzd7.
  • the first binding region may bind to a first epitope in Fzd8, and the second binding region may bind to a second, different epitope in Fzd8.
  • the first binding region may bind to a first epitope in Fzd9, and the second binding region may bind to a second, different epitope in Fzd9.
  • the first binding region may bind to a first epitope in Fzd10, and the second binding region may bind to a second, different epitope in Fzd10.
  • the first or second binding regions may specifically bind only the indicated epitope, or may also bind additional epitopes.
  • the first binding region may specifically bind only the first epitope in Fzd1 , or it may also bind to one or more other epitopes in Fzd1 or other Fzd receptors.
  • the second Fzd binding region may specifically bind only the second epitope in Fzd1 , or it may also bind to one or more other epitopes in Fzd1 or other Fzd receptors.
  • the first and second binding regions specifically bind to the same Fzd receptor or receptors
  • the first and second binding regions bind to different epitopes within the same receptor(s).
  • multispecific Wnt surrogate molecules are multispecific with respect to LRP5/6 binding, i.e. , they specifically bind to two or more different epitopes within LRP5 and/or LRP6.
  • a multispecific Wnt surrogate molecule includes a first LRP5/6 binding region that binds to a first epitope within LRP5 and/or LRP6, and a second LRP5/6 binding region that binds to a second, different epitope within LRP5 and/or LRP6.
  • the first or second binding regions may specifically bind only the indicated epitope, or may also bind additional epitopes.
  • the first binding region binds to a first epitope in LRP5E1 E2
  • the second binding region binds to a second, different epitope in LRP5E1 E2
  • the first binding region may specifically bind only the first epitope in LRP5E1 E2, or it may also bind to one or more other epitopes in LRP5E1 E2 or other LRP receptors.
  • the second LRP binding region may specifically bind only the second epitope in LRP5E1 E2, or it may also bind to one or more other epitopes in LRP5E1 E2 or other LRP receptors.
  • multispecific Wnt surrogate molecules are multispecific with respect to both Fzd binding and LRP5/6 binding.
  • a Wnt surrogate molecule may include a plurality of Fzd binding regions that each specifically bind to a different set of one or more Fzd receptors, and a plurality of LRP5/6 binding regions that each specifically bind to a different epitope within LRP5 and/or LRP6. It shall be appreciated that the various embodiments of Fzd binding regions and LRP5/6 binding regions disclosed herein may be combined in many ways to generate multispecific Wnt surrogate molecules with any desired combination of Fzd and LRP5/6 binding specificity.
  • Wnt surrogate molecules disclosed herein are multivalent, e.g., they comprise two or more regions that each specifically bind to the same epitope, e.g., two or more regions that bind to an epitope within one or more Fzd receptors and/or two or more regions that bind to an epitope within LRP5 and/or LRP6. In particular embodiments, they comprise two or more regions that bind to an epitope within one or more Fzd receptors and two or more regions that bind to an epitope within LRP5 and/or LRP6.
  • Wnt surrogate molecule comprise Fzd binding regions and LRP5/6 binding regions in a ratio of Fzd n :LRP5/6 n (F n :L n ), wherein F and L are integers between 1 and 9, inclusive, and n is an integer between 1 and 4 inclusive.
  • Wnt surrogate molecules comprise a ratio of the number of regions that bind one or more Fzd receptors to the number of regions that bind LRP5 and/or LRP6 of or about: 1 : 1 , 2: 1 , 3: 1 , 4: 1 , 5: 1 , 6: 1 , 2: 1 2:3, 2:5, 2:7, 7:2, 5:2, 3:2, 3:4, 3:5, 3:7, 3:8, 8:3, 7:3, 5:3, 4:3, 4:5, 4:7, 4:9, 9:4, 7:4, 5:4, 6:7, 7:6, 1 :2, 1 :3, 1 :4, 1 :5, 1 :6, 2:1 (with two Fzd binders and one LRP binder), 1 :2 (with one Fzd binder and two LRP binders), 2:1 :1 (with two different LRP binders), 1 :1 :2 (with two different Fzd binders), 1 :1 :1 (with two different F
  • Wnt surrogate molecules disclosed herein may have any of a variety of different structural formats or configurations.
  • Wnt surrogate molecules may comprise polypeptides and/or non-polypeptide binding moieties, e.g., small molecules.
  • Wnt surrogate molecules comprise both a polypeptide region and a non-polypeptide binding moiety.
  • Wnt surrogate molecules may comprise a single polypeptide, or they may comprise two or more, three or more, or four or more polypeptides.
  • the Wnt surrogates comprises one, two, three, or four polypeptides, e.g., linked or bound to each other or fused to each other.
  • the Wnt surrogate molecules may be a fusion protein comprising one or more Fzd binding regions (also referred to herein as“Fzd binding domains”) and one or more LRP5/6 binding regions (also referred to herein as“LRP5/6 binding domains”).
  • the binding regions may be directly fused or they may be connected via a linker, e.g., a polypeptide or chemical linker, including but not limited to any of those disclosed herein.
  • the Wnt surrogate molecules comprise two or more polypeptides
  • the polypeptides may be linked via covalent bonds, such as, e.g., disulfide bonds, and/or noncovalent interactions.
  • covalent bonds such as, e.g., disulfide bonds
  • noncovalent interactions For example, heavy chains of human immunoglobulin IgG interact at the level of their CFI3 domains directly, whereas, at the level of their CFI2 domains, they interact via the carbohydrate attached to the asparagine (Asn) N84.4 in the DE turn.
  • Wnt surrogate polypeptides may be engineered to facilitate binding between two polypeptides.
  • knobs-into-holes amino acid modifications may be introduced into two different polypeptides to facilitate their binding.
  • Knobs- into-holes amino acid (AA) changes is a rational design strategy developed in antibody engineering, used for heterodimerization of the heavy chains, in the production of bispecific IgG antibodies. AA changes are engineered in order to create a knob on the CFI3 of the heavy chains from a first antibody and a hole on the CFI3 of the heavy chains of a second antibody.
  • the knob may be represented by a tyrosine (Y) that belongs to the 'very large' IMGT volume class of AA, whereas the hole may be represented by a threonine (T) that belongs to the 'small' IMGT volume class.
  • Y tyrosine
  • T threonine
  • Other means of introducing modifications into polypeptides to facilitate their binding are known and available in the art. For example, specific amino acids may be introduced and used for cross-linking, such as Cysteine to form an intermolecular disulfide bond.
  • the Wnt surrogate molecules comprise one or more binding regions derived from an antibody or antigen-binding fragment thereof, e.g., antibody heavy chains or antibody light chains or fragments thereof.
  • one or more polypeptides of a Wnt surrogate molecule are antibodies or antigen-binding fragments thereof.
  • Wnt surrogates comprise two antibodies or antigen-binding fragments thereof, e.g., one that binds one or more Fzd receptors and one that binds LRP5 and/or LRP6.
  • Wnt surrogates comprise three antibodies or antigen-binding fragments thereof, e.g., one that binds a first set of one or more Fzd receptor epitopes, one that binds a second, different set of one or more Fzd receptor epitopes, and one that binds LRP5 and/or LRP6.
  • Wnt surrogates comprise four antibodies or antigen-binding fragments thereof, e.g., one that binds a first set of one or more Fzd receptor epitopes, one that binds a second, different set of one or more Fzd receptor epitopes, one that binds a first epitope within LRP5 and/or LRP6, and one that binds a second, different epitope within LRP5 and/or LRP6.
  • a Wnt surrogate molecule includes a polypeptide comprising two antibody heavy chain regions (e.g., hinge regions) bound together via one or more disulfide bond.
  • a Wnt surrogate molecule includes a polypeptide comprising an antibody light chain region (e.g., a CL region) and an antibody heavy chain region (e.g., a CH1 region) bound together via one or more disulfide bonds.
  • Wnt surrogate molecules may have a variety of different structural formats, including but not limited to those shown in FIG. 1.
  • a Wnt surrogate molecule comprises an scFv or antigen-binding fragment thereof fused to a VHH or sdAb or antigen-binding fragment thereof.
  • the scFv specifically binds one or more Fzd receptor epitopes
  • the VHH or sdAb specifically binds LRP5 and/or LRP6.
  • the scFv specifically binds LRP5 and/or LRP6, and the VHH or sdAb specifically binds one or more Fzd receptor epitopes.
  • the scFv or antigen-binding fragment thereof is fused directly to the VHH or sdAb or antigen-binding fragment thereof, whereas in other embodiments, the two binding regions are fused via a linker moiety.
  • the VHH or sdAb is fused to the N-terminus of the scFV, while in other
  • the VHH or sdAb is fused to the C-terminus of the scFv.
  • the scFv is described herein or comprises any of the CDR sets described herein.
  • the VHH or sdAb is described herein or comprises any of the CDR sets disclosed herein.
  • a Wnt surrogate molecule comprises one or more Fabs or antigen-binding fragment thereof and one or more VHH or sdAbs or antigen-binding fragment thereof (or alternatively, one or more scFvs or antigen-binding fragment thereof).
  • the Wnt surrogate comprises two or more Fabs, each of which specifically binds to different sets of one or more Fzd receptor epitopes, and the VHH or sdAb (or scFv) specifically binds LRP5 and/or LRP6.
  • the Wnt surrogate comprises a Fab that specifically binds LRP5 and/or LRP6, and two or more VHH or sdAb (or scFv), each of which specifically binds to different sets of one or more Fzd receptor epitopes.
  • the VHH or sdAbs (or scFvs) are fused to the N-terminus of the Fab, while in some embodiments, the VHH or sdAbs (or scFvs) are fused to the C- terminus of the Fab.
  • the Fab is present in a full IgG format, and the VHH or sdAbs (or scFvs) are fused to the N-terminus and/or C- terminus of the IgG light chain.
  • the Fab is present in a full IgG format, and the VHH or sdAbs (or scFvs) are fused to the N-terminus and/or C-terminus of the IgG heavy chain.
  • two or more VHH or sdAbs (or scFvs) are fused to the IgG at any combination of these locations, where each of the two or more VHH or sdAbs (or scFvs) bind different sets of Fzds.
  • Fabs may be converted into a full IgG format that includes both the Fab and Fc fragments, for example, using genetic engineering to generate a fusion polypeptide comprising the Fab fused to an Fc region, i.e. , the Fab is present in a full IgG format.
  • the Fc region for the full IgG format may be derived from any of a variety of different Fes, including but not limited to, a wild-type or modified lgG1 , lgG2, lgG3, lgG4 or other isotype, e.g., wild-type or modified human lgG1 , human lgG2, human lgG3, human lgG4, human lgG4Pro (comprising a mutation in core hinge region that prevents the formation of lgG4 half molecules), human IgA, human IgE, human IgM, or the modified lgG1 referred to as lgG1 LALAPG.
  • a wild-type or modified lgG1 , lgG2, lgG3, lgG4 or other isotype e.g., wild-type or modified human lgG1 , human lgG2, human lgG3, human lgG4, human lgG4Pro (
  • the L234A, L235A, P329G (LALA-PG) variant has been shown to eliminate complement binding and fixation as well as Fc-g dependent antibody- dependent cell-mediated cytotoxity (ADCC) in both murine lgG2a and human lgG1.
  • ADCC Fc-g dependent antibody- dependent cell-mediated cytotoxity
  • the IgG comprises one or more of the following amino acid substitutions: N297G, N297A, N297E, L234A, L235A, or P236G.
  • Non-limiting examples of bivalent and bispecific Wnt surrogate molecules that are bivalent towards both the one or more Fzd receptor epitopes and the LRP5 and/or LRP6 are provided as the top four structures depicted in FIG.
  • VHH or sdAbs or scFvs are depicted as single solid ovals in red, blue or yellow , and the Fab or IgG is depicted in blue.
  • the VHH or sdAbs (or scFvs) may be fused to the N-termini of both light chains, to the N-termini of both heavy chains, to the C-termini of both light chains, or to the C-termini of both heavy chains.
  • VHH or sdAbs could be fused to both the N-termini and C-termini of the heavy and/or light chains, to the N- termini of the light chains and the heavy chains, to the C-termini of the heavy and light chains, to the N-termini of the heavy chains and C-termini of the light chains, or to the C-termini of the heavy chains and the N-termini of the light chains.
  • two or more VHH or sdAbs (or scFvs) may be fused together, optionally via a linker moiety, and fused to the Fab or IgG at one or more of these locations.
  • the two or more VHH or sdAbs (or scFvs) may each bind to a different set of one or more Fzd receptor epitopes.
  • the Wnt surrogate molecule has a hetero-lg format, whereas the Fab is present as a half antibody, and one or more VHH or sdAb (or scFv) is fused to one or more of the N-terminus of the Fc, the N-terminus of the Fab, the C-terminus of the Fc, or the C-terminus of the Fab.
  • two or more VHH or sdAbs are fused to the N-terminus of the Fc, the N-terminus of the Fab, the C-terminus of the Fc, or the C-terminus of the Fab, wherein each of the VHH or sdAbs (or scFvs) binds a different set of one or more Fzd receptor epitopes.
  • a bispecific but monovalent to each receptor version of this format is depicted in FIG. 1 C, 1 D, 1 E, 1 F, which may be modified to include two or more Fzd binding regions, wherein at least two of the Fzd binding regions bind to different sets of one or more Fzd receptor epitopes.
  • the Fab or antigen-binding fragment (or IgG) thereof is fused directly to the VHH or sdAb (or scFv) or antigen-binding fragment thereof, whereas in other embodiments, the binding regions are fused via a linker moiety.
  • the Fab is described herein or comprises any of the CDR sets described herein.
  • the VHH or sdAbs or scFvs are described herein or comprises any of the CDR sets disclosed herein.
  • a Wnt surrogate molecule comprises one or more Fabs or antigen-binding fragment thereof that binds one or more Fzd receptor epitopes and one or more Fabs or antigen-binding fragment thereof that binds LRP5 and/or LRP6. In certain embodiments, it comprises two Fab or antigen-binding fragments thereof that bind different sets of one or more Fzd receptor epitopes and/or two Fab or antigen-binding fragments thereof that bind LRP5 and/or LRP6.
  • one or more of the Fabs are present in a full IgG format, and in certain embodiments, both Fabs are present in a full IgG format.
  • the Fabs in full IgG format specifically binds one or more Fzd receptor epitopes
  • the other Fabs specifically binds LRP5 and/or LRP6.
  • the Fabs specifically bind different sets of one or more Fzd receptor epitopes
  • the Fabs in full IgG format specifically binds LRP5 and/or LRP6.
  • the Fabs specifically binds LRP5 and/or LRP6, and the Fabs in full IgG format specifically bind different sets of one or more Fzd receptor epitopes.
  • the Fab is fused to the N-terminus of the IgG, e.g., to the heavy chain or light chain N-terminus, optionally via a linker.
  • the Fab is fused to the N-terminus of the heavy chain of the IgG and not fused to the light chain.
  • the two heavy chains can be fused together directly or via a linker.
  • An example of such a bispecific and bivalent with respect to both receptors is shown in FIG. 1V, 1 W, 1X and 1 AA.
  • two or more VHH or sdAbs may be fused together, optionally via a linker moiety, and fused to the Fab or IgG at one or more of these locations.
  • the Wnt surrogate molecule has a hetero-lgG format, whereas one of the Fab is present as a half antibody, and the other Fab is fused to one or more of the N-terminus of the Fc, the N-terminus of the Fab, or the C-terminus of the Fc.
  • a bispecific but monovalent to each receptor version of this format is depicted in FIG.
  • 1 D which may be modified to includes one or more additional Fab, wherein two or more Fab bind to different sets of Fzd receptor epitopes.
  • the Fab or antigen-binding fragment thereof is fused directly to the other Fab or IgG or antigen-binding fragment thereof, whereas in other embodiments, the binding regions are fused via a linker moiety.
  • the one or both of the two Fabs are described herein or comprise any of the CDR sets described herein.
  • Wnt surrogate molecules have a format as described in PCT Application Publication No. WO2017/136820, e.g., a Fabs-in- tandem IgG (FIT -IG) format. Shiyong Gong, Fang Ren, Danqing Wu, Xuan Wu & Chengbin Wu (2017).
  • FIT -IG also include the formats disclosed in“Fabs-in-tandem immunoglobulin is a novel and versatile bispecific design for engaging multiple therapeutic targets” mAbs, 9:7, 1118-1128, DOI:
  • FIT-IGs combine the functions of two antibodies into one molecule by re-arranging the DNA sequences of two parental monoclonal antibodies into two or three constructs and co- expressing them in mammalian cells. Examples of FIT -IG formats and constructs are provided in FIGS. 1 A and 1 B and FIGS. 2A and 2B of PCT Application Publication No. WO2017/136820. In certain embodiments, FIT-IGs require no Fc mutation, no scFv elements, and no linker or peptide connector.
  • Wnt surrogates comprises a Fab and an IgG.
  • the Fab binder LC is fused to the HC of the IgG, e.g., by a linker of various length in between.
  • the Fab binder HC can be fused or unfused to the LC of the IgG. A variation of this format has been called Fabs-in-tandem IgG (or FIT-lg).
  • the FIT-lg comprises two or more Fzd binding domains, wherein at least two or the Fzd binding regions bind to different sets of one or more Fzd receptor epitopes, e.g., different sets of one or more Fzd receptors or different sets of one or more epitopes within the same Fzd receptor(s).
  • Wnt surrogate molecules comprise two or more VHH or sdAbs (or scFvs), including at least one that binds one or more Fzd receptor epitopes and at least one that binds LRP5 and/or LRP6.
  • one of the binding regions is a VHH or sdAb and the other is an scFv.
  • the Wnt surrogate molecules comprises three or more VHH or sdAbs (or scFvs), including at least two that binds different sets of one or more Fzd receptor epitopes and at least one that binds LRP5 and/or LRP6.
  • Wnt surrogate molecules comprising two or more VHH or sdAbs (or scFvs) may be formatted in a variety of configurations, including but not limited to those depicted in FIG. 1 K, 1 L, 1 M, 1 N, 10, 1 P, 1 Q, 1 S, 1T.
  • two or more VHH or sdAbs (or scFvs) are fused in tandem or fused to two different ends of an Fc, optionally via one or more linkers.
  • the linker and its length may be the same or different between the VHH or sdAb (or scFv) and the other VHH or sdAb (or scFv), or between the VHH or sdAb and Fc.
  • the VHH or sdAb is fused to the N-terminus and/or C-terminus of the IgG heavy chain.
  • two or more VHH or sdAbs are fused to the IgG at any combination of these locations.
  • Non- limiting examples of bivalent and bispecific Wnt surrogate molecules of this format are depicted as the structures depicted in FIG. 1 K, 1 L, 1M, 1 N, 10, 1 P, 1 Q.
  • both VHH or sdAbs may be fused to the N-termini of the Fc, to the C-termini of the Fc, or one or more VHH or sdAb may be fused to either or both of an N-terminus or C-terminus of the Fc.
  • the Wnt surrogate molecule has a hetero-lgG format, whereas one VHH or sdAb is present as a half antibody, and the other is fused to the N-terminus of the Fc or the C-terminus of the Fc.
  • a bispecific but monovalent to each receptor version of this format is depicted in FIG. 1 E.
  • the VHH or sdAb is fused directly to the other VHH or sdAb, whereas in other embodiments, the binding regions are fused via a linker moiety.
  • the VHH or sdAbs are described herein or comprises any of the CDR sets described herein.
  • any of these formats may comprise one or more scFvs in place of one or more VHH or sdAbs.
  • a Wnt surrogate molecule is formatted as a diabody.
  • the binders against Fzd and LRP can also be linked together in a diabody (or DART) configuration.
  • the diabody can also be in a single chain configuration. If the diabody is fused to an Fc, this will create a bivalent bispecific format. Without fusion to Fc, this would be a monovalent bispecific format.
  • a diabody is a noncovalent dimer scFv fragment that consists of the heavy-chain variable (VH) and light-chain variable (VL) regions connected by a small peptide linker.
  • diabody is a single-chain (Fv)2 in which two scFv fragments are covalently linked to each other.
  • the diabody comprises two or more Fzd binding regions, wherein at least two of the Fzd binding regions bind to different sets of one or more Fzd receptor epitopes.
  • two or more diabodies, scFvs, and/or VHH or sdAbs can be fused in tandem in a multivalent format, with or without being fused to an Fc (FIG. 1 A, 1 B, 1 F, 1 U).
  • Fc Fc
  • at least one of the diabodies, scFvs, and/or VHH or sdAbs binds one or more Fzd receptor epitopes
  • at least one of the diabodies, scFvs, and/or VHH or sdAbs binds LRP5 and/or LRP6.
  • a Wnt surrogate molecule comprises two or more Fabs or antigen- binding fragments thereof that each bind a different set of one or more Fzd receptor epitopes, and one or more VHH or sdAbs or antigen-binding fragments thereof (or, alternatively or in combination, one or more scFvs or antigen-binding fragments thereof), e.g., that bind LRP5/6.
  • a first Fab specifically binds a first set of one or more Fzd receptor epitopes
  • a second Fab specifically binds a second, different set of one or more Fzd receptor epitopes
  • the VHH or sdAb (or scFv) specifically binds LRP5 and/or LRP6.
  • the VHH or sdAb (or scFv) is fused to the N-terminus of the Fabs, while in some embodiments, the VHH or sdAb (or scFv) is fused to the C-terminus of the Fabs.
  • the Wnt surrogate molecule has a hetero- Ig format, as depicted in FIG. 1 G, 1 H, 1AG in which the first and second Fabs are each present as a half antibody, and one or more VHH or sdAbs (or scFvs) are fused to one or more of the N-terminus of the Fc, the N-terminus of the Fab, the C- terminus of the Fc (e.g., FIG. 1Y), or the C-terminus of the Fab.
  • the first and second Fabs may be connected to each other via knobs-into-holes mutations in their respective Fes, e.g., within the CH3 domain.
  • Wnt surrogate molecules in various embodiments, comprise one or more antibodies or antigen-binding fragments thereof disclosed herein.
  • a Wnt surrogate comprises two
  • each polypeptide comprises an VHH or sdAb or scFv that binds LRP5/6 and an VHH or sdAb or scFv that binds one or more Fzd receptor epitopes, optionally wherein one of the binding domains is an scFv and the other is an VHH or sdAb.
  • each polypeptide comprises a Fzd binding region that binds a different set of one or more Fzd receptor epitopes.
  • a Wnt surrogate comprises three polypeptides, wherein the first polypeptide comprises an antibody heavy chain and the second polypeptide comprises an antibody light chain, wherein the antibody heavy chain and light chain bind LRP5/6 or one or more Fzd receptor epitopes, and wherein the third polypeptide comprises a VHH or sdAb fused to a heavy chain Fc region, wherein the VHH or sdAb binds to either LRP5/6 or one or more Fzd receptor epitopes.
  • Wnt polypeptides comprise four polypeptides, including two heavy chain polypeptides and two light chain polypeptides, wherein the two heavy chains and two light chains bind LRP5/6 or one or more Fzd receptor epitopes, and further comprise one or more VHH or sdAb or scFv fused to one or more of the heavy chains and/or light chains, wherein the VHH or sdAb or scFv binds to LRP5/6 or one or more Fzd receptor epitopes.
  • a Wnt surrogate comprises at least four polypeptides, including two heavy chain polypeptides and two light chain polypeptides that bind either LRP5/6 or one or more Fzd receptor epitopes, wherein the Wnt surrogate further comprises a Fab that binds either LRP5/6 or one or more Fzd receptor epitopes.
  • the Fab may comprise two polypeptides, each fused to one of the two heavy chain polypeptides, and two polypeptides, each fused to one of the two light chain polypeptides, or it may comprise two polypeptides each fused to one of the two heavy chain polypeptides and two additional polypeptides, each bound to one of the two polypeptides fused to the heavy chain polypeptides, thus making a second Fab.
  • Other configurations may be used to produce the Wnt surrogates disclosed herein. In particular embodiments of any of these formats, they comprise at least two or more Fzd binding regions, which each bind to a different set of Fzd receptor epitopes.
  • the differing ratios of Fzd binding regions to LRP binding regions is represented in FIG. 1AB, 1AC, 1AD, 1AE, 1AF, 1AG, 1 AH, 1AI, 1AJ, 1AK, 1AL, 1AM.
  • one or more Fabs bind to one or more Fzd receptors or to different epitopes in the same Fzd receptor, and one or more VHH or sdAbs (or scFvs) bind to one or more LRP receptors or different epitopes in the same LRP receptor.
  • a Wnt surrogate molecule includes a first light chain and first heavy chain forming a first Fzd binding region, and a second light chain and second heavy chain forming a second Fzd binding region, with the first and second Fzd binding regions binding to different sets of one or more Fzd receptor epitopes.
  • the first and second heavy chains are connected to each other.
  • the first heavy chain may include a first CH3 domain
  • the second heavy chain may include a second CH3 domain
  • the first and second CH3 domains may be connected to each other, e.g., via knobs- into-holes mutations.
  • the first heavy chain and/or the second heavy chain comprise an amino acid sequence having at least 90%, at least 95%, at least 98%, or at least 99% identity to any of the sequences set forth in SEQ ID NOs:110, 112, 114, 116, 118, 120, and 122.
  • the first light chain and/or the second light chain comprise an amino acid sequence having at least 90%, at least 95%, at least 98%, or at least 99% identity to any of the sequences set forth in SEQ ID NOs: 109, 111 , 113, 115, 117, 119, and 121.
  • one or more heavy chain comprises an amino acid sequence having at least 90%, at least 95%, at least 98%, or at least 99% identity to any of the sequences disclosed in Table 5.
  • one or more light chain comprises an amino acid sequence having at least 90%, at least 95%, at least 98%, or at least 99% identity to any of the sequences disclosed in Table 5.
  • the Wnt surrogate molecule includes a first LRP5/6 binding region and/or a second LRP5/6 binding region, each of which may be or include a Fab or scFv.
  • the first and second LRP5/6 binding regions may bind to the same epitope within LRP5/6, or may bind to different epitopes within
  • the first LRP5/6 binding region may be fused to an N-terminus of the first light chain, a C-terminus of the first light chain, an N-terminus of the first heavy chain, or a C-terminus of the first heavy chain.
  • the second LRP5/6 binding region may be fused to an N-terminus of the second light chain, a C-terminus of the second light chain, an N-terminus of the second heavy chain, or a C-terminus of the second heavy chain.
  • a Wnt surrogate molecule comprises an Fzd binding region, e.g., an anti-Fzd antibody, or antigen-binding fragment thereof, fused or bound to a polypeptide that specifically binds to one or more Fzd receptors.
  • the polypeptide that specifically binds to one or more Fzd receptors is an antibody or antigen-binding fragment thereof. In certain embodiments, it is an antibody or antigen-binding fragment thereof disclosed herein or in U.S. Provisional Patent Application No. 62/607,877, titled, “Anti-Frizzled antibodies and Methods of Use,” Attorney Docket No. SRZN- 004/00US, filed on December 19, 2017, which is incorporated herein by reference in its entirety.
  • At least one Fzd binding region of a Wnt surrogate molecule includes one or more antigen-binding fragments of an antibody.
  • the one or more antigen-binding fragments may be or be derived from an IgG, scFv, Fab, or VFIFI or sdAb.
  • the one or more antigen-binding fragements are humanized.
  • the Fzd binding region comprises the three heavy chain CDRs and/or the three light chain CDRs disclosed for any of the illustrative antibodies or fragments thereof that bind to one or more Fzd receptors provided in Table 1A.
  • the Fzd binding region comprises the three heavy chain CDRs and/or the three light chain CDRs disclosed for any of the illustrative antibodies or fragments thereof that bind to one or more Fzd receptors provided in Table 1A, wherein the CDRs collectively comprise one, two, three, four, five, six, seven, or eight amino acid modifications, e.g., substitutions, deletions, or additions.
  • the Fzd binding region is a VHH or sdAb or was derived from a VHH or sdAb, so Table 1 A only includes the three heavy chain CDRs.
  • the Fzd binding region comprises the three CDR HC sequences provided in Table 1 A or variants wherein the CDRs collectively comprise one, two, three, four, five, six, seven or eight amino acid modifications.
  • the Fzd binding region comprises the heavy chain fragment and/or light chain fragment of any of the illustrative antibodies or fragments thereof that bind to one or more Fzd receptors provided in Table 1 B or SEQ ID NOs: 1 -73 (or an antigen-binding fragment or variant of either).
  • the Fzd binding region is a Fab or was derived from a Fab, so the heavy chain of Table 1 B includes VFI and CH1 sequences, but not CFI2 or CFI3 sequences.
  • the Fzd binding region is a VHH or sdAb or was derived from a VHH or sdAb, so Table 1 B includes the VHH domain.
  • the Fzd binding region is a polypeptide, e.g., an antibody or antigen-binding fragment thereof, that competes with any of these antibodies for binding to one or more Fzd receptors.
  • the Fzd binding region includes an amino acid sequence having at least 90%, at least 95%, at least 98%, or at least 99% identity to any of the sequences set forth in Table 1A, Table 1 B, or SEQ ID NOs: 1 - 73, or an antigen-binding fragment thereof. Binding characteristics of clones listed in Table 1 B were determined and are shown in Table 1 B. Heavy chain CDRs are designated CDRH1 , CDRH2 and CDRH3, and light chain CDRs are designated CDRL1 , CDRL2, and CDRL3.
  • Table 1 B Anti-Fzd Antibody Clone IDs, Heavy Chain (HC) and Light Chain (LC)
  • the Fzd binding region may be selected from any binding domain that binds an Fzd receptor epitope with an affinity of, e.g., a KD of at least about 1 x 10 4 M, at least about 1 x 10 5 M, at least about 1 x 10 6 M, at least about 1 x 10 7 M, at least about 1 x 10 8 M, at least about 1 x 10 9 M, at least about 1 x 10 10 M, at least about 1 x 10 11 M, at least about 1 x 10 12 M, at least about 1 x 10 13 M, at least about 1 x 10 14 M, or at least about 1 x 10 15 M.
  • a KD of at least about 1 x 10 4 M, at least about 1 x 10 5 M, at least about 1 x 10 6 M, at least about 1 x 10 7 M, at least about 1 x 10 8 M, at least about 1 x 10 9 M, at least about 1 x 10 10 M, at least about 1 x 10 11 M, at least about 1
  • the Fzd binding region may be selected from any binding domain that binds one or more Fzd receptor epitopes at high affinity, e.g., a KD of less than about 1 x 10- 7 M, less than about 1 x 10 8 M, less than about 1 x 10 9 M, less than about 1 x 10 10 M, less than about 1 x 10 11 M, less than about 1 x 10 12 M, less than about 1 x 10 13 M, less than about 1 x 10 14 M, or less than about 1 x 10 15 M.
  • the Fzd binding region may be selected from any binding domain that binds an Fzd receptor epitope at high affinity, e.g.
  • Suitable Fzd binding regions include, without limitation, de novo designed Fzd binding proteins, antibody derived binding proteins, e.g. scFv, Fab, etc. and other portions of antibodies that specifically bind to one or more Fzd proteins, VHH or sdAb derived binding domains, knottin-based engineered scaffolds, norrin and engineered binding fragments derived therefrom, naturally occurring Fzd binding domains, and the like.
  • An Fzd binding domain may be affinity selected to enhance binding to a desired Fzd protein or plurality of Fzd proteins, e.g. to provide tissue selectivity.
  • the Fzd binding region binds to one, two, three, four, five or more different frizzled proteins, e.g., one or more of human frizzled proteins Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, and Fzd10.
  • the Fzd binding region binds to Fzd1 , Fzd2, and Fzd 7.
  • the Fzd binding region binds to Fzd1 , Fzd2, Fzd5, Fzd7, and Fzd8.
  • the Fzd binding region is selective for one or more frizzled protein of interest, e.g.
  • the Fzd binding region comprises the six CDR regions of the pan specific frizzled antibody OMP-18R5 (vantictumab). In certain embodiments, the Fzd binding region is an scFv comprising the six CDR regions of the pan-specific frizzled antibody OMP-18R5 (vantictumab). See, for example, U.S. Patent No. 8,507,442, herein specifically incorporated by reference.
  • the CDR sequences of OMP-18R5 include (i) a heavy chain CDR1 comprising GFTFSFIYTLS (SEQ ID NO:270), a heavy chain CDR2 comprising VISGDGSYTYYADSVKG (SEQ ID NO:677), and a heavy chain CDR3 comprising NFIKYVFAN (SEQ ID NO:1033), and (ii) a light chain CDR1 comprising
  • the Fzd binding region is an antibody or derivative thereof, including without limitation scFv, minibodies, VHH or sdAbs and various antibody mimetics comprising any of these CDR sequences.
  • these CDR sequences comprise one or more amino acid modifications.
  • the Fzd binding region comprises the six CDR regions of anti-FZD7-1791 or anti-FZD7-1291.
  • Anti-FZD7-1791 and anti- FZD7-1291 are antibodies that bind to different epitopes within the hinge region of Fzd7, as described in PCT Patent Publication Nos. WO2016/205551 and
  • the Fzd binding region is an scFv comprising the six CDR regions of anti-FZD7-1791 or anti-FZD7-1291.
  • the CDR sequences of anti- FZD7-1791 include (i) a heavy chain CDR1 comprising TYAMFI (SEQ ID NO: 1)
  • a heavy chain CDR2 comprising RIRSKSNNYAKNYDDSVKD (SEQ ID NO:2193), and a heavy chain CDR3 comprising ENYGGRFDY (SEQ ID NO:2196), and (ii) a light chain CDR1 comprising KASENVLNYVS (SEQ ID NO:2199), a light chain CDR2 comprising GASNRYT (SEQ ID NO:2202), and a light chain CDR3 comprising GQSYRYP (SEQ ID NO:2205).
  • the heavy chain sequence of anti- FZD7-1791 includes SEQ ID NQ:70 and the light chain sequence of anti-FZD7- 1791 includes SEQ ID NO:71.
  • the CDR sequences of anti- FZD7-1291 include (i) a heavy chain CDR1 comprising SYAMS (SEQ ID NO:
  • a heavy chain CDR2 comprising TISDGGSYTRYPDKLKG (SEQ ID NO:2194), and a heavy chain CDR3 comprising VGGRRDYFDY (SEQ ID NO:2194).
  • the heavy chain sequence of anti-FZD7-1291 includes SEQ ID NO:72 and the light chain sequence of anti-FZD7-1291 includes SEQ ID NO:73.
  • the Fzd binding region is an antibody or derivative thereof, including without limitation scFv, minibodies, VHH or sdAbs and various antibody mimetics comprising any of these CDR sequences. In certain embodiments, these CDR sequences comprise one or more amino acid modifications.
  • the Fzd binding region comprises a variable region sequence, or the CDRs thereof, from any of a number of frizzled specific antibodies, which are known in the art and are commercially available, or can be generated de novo. Any of the frizzled polypeptides can be used as an immunogen or in screening assays to develop an antibody.
  • frizzled binding domains include antibodies available from Biolegend, e.g., Clone
  • CFI3A4A7 specific for human frizzled 4 CD344
  • Clone W3C4E11 specific for human Fzd9 CD349
  • antibodies available from Abeam e.g., ab64636 specific for Fzd7; ab83042 specific for human Fzd4; ab77379 specific for human Fzd7;
  • the Fzd binding region of a Wnt surrogate molecule may be an engineered protein that is selected for structural homology to the frizzled binding region of a Wnt protein.
  • Such proteins can be identified by screening a structure database for homologies.
  • the initial protein thus identified, for example the microbial Bh1478 protein.
  • the native protein is then engineered to provide amino acid substitutions that increase affinity, and may further be selected by affinity maturation for increased affinity and selectivity in binding to the desired frizzled protein.
  • frizzled binding moieties include the Fz27 and Fz27-B12 proteins.
  • a Wnt surrogate molecule comprises an LRP5/6 binding region, e.g., an anti-LRP5/6 antibody, or antigen-binding fragment thereof, fused to a polypeptide that specifically binds to one or more Fzd receptor epitopes.
  • the polypeptide that specifically binds to LRP5/6 is an antibody or antigen-binding fragment thereof. If certain embodiments, it is an antibody or antigen-binding fragment thereof disclosed in the U.S.
  • At least one LRP5/6 binding region of a Wnt surrogate molecule includes one or more antigen-binding fragments of an antibody.
  • the one or more antigen-binding fragments may be or be derived from an IgG, scFv, Fab, or VFIFI or sdAb.
  • the one or more antigen-binding fragments are humanized.
  • the LRP5/6 binding region comprises the three heavy chain CDRs and/or the three light chain CDRs disclosed for any of the illustrative antibodies or fragments thereof that bind to LRP5 and/or LRP6 provided in Table 2A.
  • the LRP5/6 binding region comprises the three heavy chain CDRs and/or the three light chain CDRs disclosed for any of the illustrative antibodies or fragments thereof that bind to LRP5 and/or LRP6 provided in Table 2A, wherein the CDRs collectively comprise one, two, three, four, five, six, seven, or eight amino acid modifications, e.g., substitutions, deletions, or additions.
  • the LRP5/6 binding region is a VHH or sdAb or was derived from a VHH or sdAb, so Table 2A only includes the three heavy chain CDRs.
  • the LRP5/6 binding region comprises the three heavy chain CDRs shown in Table 2A or variants wherein the CDRs collectively comprise one, two, three, four, five, six, seven or eight amino acid modifications.
  • the LRP5/6 binding region comprises the heavy chain fragment and/or light chain fragment of any of the illustrative antibodies or fragments thereof that bind to LRP5 and/or LRP6 provided in Table 2B or SEQ ID NOs:74-97 (or an antigen-binding fragment or variant of either).
  • the LRP5/6 binding region is a Fab or was derived from a Fab, so Table 2B includes VFI and CH1 sequence, but not CFI2 or CFI3 sequences.
  • the LRP5/6 binding region is a VHH or sdAb or was derived from a VHH or sdAb, so Table 2B includes the VHH domain.
  • the LRP5/6 binding region is a polypeptide, e.g., an antibody or antigen-binding fragment thereof, that competes with one of these antibodies for binding to LRP5 and/or LRP6.
  • the LRP5/6 binding region includes an amino acid sequence having at least 90%, at least 95%, at least 98%, or at least 99% identity to any of the sequences set forth in Table 2A, Table 2B, or SEQ ID NOs:74-97, or an antigen-binding fragment thereof. Binding characteristics for clones listed in Table 2B were determined and are shown in Table 2B. Table 2A: Anti-LRP5/6 Antibody Clone IDs and CDR sequences.
  • the LRP5/6 binding region may be selected from any binding domain that binds LRP5 or LRP6 with a KD of less than or equal to about 1 x 10 4 M, less than or equal to about 1 x 10 5 M, less than or equal to about 1 x 10 6 M, less than or equal to about 1 x 10 7 M, less than or equal to about 1 x 10 8 M, less than or equal to about 1 x 10 9 M, less than or equal to about 1 x 10 1 ° M, less than or equal to about 1 x 10 11 M, less than or equal to about 1 x 10 12 M, less than or equal to about 1 x 10 13 M, less than or equal to about 1 x 10 14 M, or less than or equal to 1 x 10 15 M in the context of a Wnt surrogate molecule.
  • the LRP5/6 binding region may be selected from any binding domain that binds LRP5 or LRP6 with a KD of greater than or equal to about 1 x 10 4 M, greater than or equal to about 1 x 10 5 M, greater than or equal to about 1 x 10 6 M, greater than or equal to about 1 x 10 7 M, greater than or equal to about 1 x 10 8 M, greater than or equal to about 1 x 10 9 M, greater than about 1 x
  • the LRP5/6 binding region may be selected from any binding domain that binds LRP5 or LRP6 at high affinity, e.g. a KD of less than about 1 x 10 7 M, less than about 1 x 10 8 M, less than about 1 x 10 9 M, or less than about 1 x 10 1 ° M.
  • LRP5/6 binding region include, without limitation, de novo designed LRP5/6 binding proteins, antibody derived binding proteins, e.g., scFv, Fab, etc., and other portions of antibodies that specifically bind to one or more Fzd proteins; VHH or sdAb derived binding domains; knottin-based
  • a LRP5/6 binding region may be affinity selected to enhance binding.
  • DKK Dickkopf
  • hDKKs 1 -4 contain two distinct cysteine-rich domains in which the positions of 10 cysteine residues are highly conserved between family members.
  • Exemplary sequences of human Dkk genes and proteins are publicly available, e.g., Genbank accession number NM_014419 (soggy-1 ); NM_014420 (DKK4); AF177394 (DKK-1 ); AF177395 (DKK-2); NM_015881
  • the LRP6 binding moiety is a DKK1 peptide, including without limitation the C-terminal domain of human DKK1.
  • the C-terminal domain may comprise the sequence: KMYHTKGQEGSVCLRSSDCASGLCCARHFWSKICKPVLKEGQVCTKHRRKGSH GLEIFQRCYCGEGLSCRIQKDHHQASNSSRLHTCQRH (SEQ ID NO:2249) (see Genbank accession number NP_036374) or a biologically active fragment thereof.
  • NP_055236 may comprise the sequence:
  • LRP5 or LRP6 antibodies that specifically bind to LRP5 or LRP6 are known in the art and are commercially available, or can be generated de novo. LRP5, LRP6 or fragments thereof can be used as an immunogen or in screening assays to develop an antibody. Examples of known antibodies include, without limitation, those described in Gong et al. (2010) PLoS One. 5(9):e12682; Ettenberg et al. (2010) Proc Natl Acad Sci U S A.
  • Wnt surrogate molecules disclosed herein comprise one or more polypeptides comprising two or more binding regions.
  • the two or more binding regions may be two or more Fzd binding regions or two or more LRP5/6 binding regions, or they may comprise one or more Fzd binding regions and one or more LRP5/6 binding regions.
  • the binding regions may be directly joined or contiguous, or may be separated by a linker, e.g. a
  • the length of the linker, and therefore the spacing between the binding domains can be used to modulate the signal strength, and can be selected depending on the desired use of the Wnt surrogate molecule.
  • the enforced distance between binding domains can vary, but in certain embodiments may be less than about 100 angstroms, less than about 90 angstroms, less than about 80 angstroms, less than about 70 angstroms, less than about 60 angstroms, or less than about 50 angstroms.
  • the linker is a rigid linker, in other embodiments the linker is a flexible linker.
  • the linker is a peptide linker
  • it may be from about 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 , 12, 13, 14, 15, 16, 17, 18, 19, 20 21 , 22, 23, 24, 25, 26, 27, 28, 29, 30 or more amino acids in length, and is of sufficient length and amino acid composition to enforce the distance between binding domains.
  • the linker comprises or consists of one or more glycine and/or serine residues.
  • a Wnt surrogate molecule comprises a polypeptide sequence having at least 90%, at least 95%, at least 98% or at least 99% identity to a polypeptide sequence disclosed in any of SEQ ID NOs: 109-124 or 125-157, or having at least 90%, at least 95%, at least 98% or at least 99% identity to an antigen-binding fragment of a polypeptide sequence disclosed in any of SEQ ID NOs: 109-124 or 125-157.
  • the Wnt surrogate molecules comprises or consists of a polypeptide sequence set forth in any of SEQ ID NOs: 109-124 or 125-147, or an antigen-binding fragment thereof.
  • the antigen-binding fragment binds one or more Fzd receptors and also binds LRP5 and/or LRP6.
  • Wnt surrogate molecule can be multimerized, e.g., through an Fc domain, by concatenation, coiled coils, polypeptide zippers, biotin/avidin or streptavidin multimerization, and the like.
  • the Wnt surrogate molecules can also be joined to a moiety such as PEG, Fc, etc., as known in the art to enhance stability in vivo.
  • a Wnt surrogate molecule directly activates canonical Wnt signaling through binding to one or more Fzd proteins and to
  • LRP5/6 particularly by binding to these proteins on a cell surface, e.g., the surface of a human cell.
  • the direct activation of Wnt signaling by a Wnt surrogate molecule is in contrast to potentiation of Wnt signaling, which enhances activity only when native Wnt proteins are present.
  • Wnt surrogate molecules may activate Wnt signaling, e.g., by mimicking the effect or activity of a Wnt protein binding to a frizzled protein.
  • the ability of the Wnt surrogate molecules of the present disclosure to mimic the activity of Wnt can be confirmed by a number of assays.
  • the Wnt surrogate molecules typically initiate a reaction or activity that is similar to or the same as that initiated by the receptor's natural ligand.
  • the Wnt surrogate molecules of the present disclosure enhance the canonical Wnt/ -catenin signaling pathway.
  • the term "enhances" refers to a measurable increase in the level of Wnt/ -catenin signaling compared with the level in the absence of a Wnt surrogate molecule of the present disclosure.
  • Wnt/ -catenin signaling Various methods are known in the art for measuring the level of canonical Wnt/ -catenin signaling. These include, but are not limited to assays that measure: Wnt/ -catenin target gene expression; TCF reporter gene expression; b- catenin stabilization; LRP phosphorylation; Axin translocation from cytoplasm to cell membrane and binding to LRP.
  • the canonical Wnt/ -catenin signaling pathway ultimately leads to changes in gene expression through the transcription factors TCF7, TCF7L1 , TCF7L2 and LEF.
  • the transcriptional response to Wnt activation has been characterized in a number of cells and tissues.
  • TCF reporter assay assesses changes in the transcription of TCF/LEF controlled genes to determine the level of Wnt/b- catenin signaling.
  • a TCF reporter assay was first described by Korinek, V. et al. , 1997. Also known as TOP/FOP this method involves the use of three copies of the optimal TCF motif CCTTTGATC, or three copies of the mutant motif
  • TOPFI_ASFI and pFOPFI_ASFI upstream of a minimal c-Fos promoter driving luciferase expression (pTOPFI_ASFI and pFOPFI_ASFI, respectively) to determine the transactivational activity of endogenous p-catenin/TCF4.
  • pTOPFI_ASFI and pFOPFI_ASFI respectively
  • a higher ratio of these two reporter activities (TOP/FOP) indicates higher -catenin/TCF4 activity, whereas a lower ratio of these two reporter activities indicates lower -catenin/TCF4 activity.
  • These reporters are based on a multimerized TCF binding site, which drives expression of LacZ or GFP, which are readily detectable by methods known in the art.
  • These reporter genes include: TOP-GAL, BAT-GAL, ins-TOPEGFP, ins- TOPGAL, LEF-EGFP, Axin2-LacZ, Axin2-d2EGFP, Lgr5tm1 (cre/ERT2),
  • measuring the level and location of b-catenin in a cell is a good reflection of the level of Wnt/ -catenin signaling.
  • a non-limiting example of such an assay is the "Biolmage b-Catenin Redistribution Assay" (Thermo Scientific) which provides recombinant U20S cells that stably express human b- catenin fused to the C-terminus of enhanced green fluorescent protein (EGFP). Imaging and analysis is performed with a fluorescence microscope or HCS platform allowing the levels and distribution of EGFP-p-catenin to be visualized.
  • EGFP enhanced green fluorescent protein
  • Axin has been shown to bind preferentially to a phosphorylated form of the LRP tail. Visualization of Axin translocation, for example with a GFP-Axin fusion protein, is therefore another method for assessing levels of Wnt/ -catenin signaling.
  • a Wnt surrogate molecule enhances or increases canonical Wnt pathway signaling, e.g., b-catenin signaling, by at least 30%, 35%, 40%, 45%, 50%, 60%, 70%, 75%, 80%, 85%, 90%, 95%, 100%, 110%, 150%, 200%, 250%, 300%, 400% or 500%, as compared to the b-catenin signaling induced by a neutral substance or negative control as measured in an assay described above, for example as measured in the TOPFIash assay. A negative control may be included in these assays.
  • Wnt surrogate molecules may enhance b-catenin signaling by a factor of 2x, 5x, 10x, 100x, 1000x, 10000x or more as compared to the activity in the absence of the Wnt surrogate molecule when measured in an assay described above, for example when measured in the TOPFIash assay, or any of the other assays mentioned herein.
  • a Wnt polypeptide is a native human full length mature Wnt protein.
  • human native sequence Wnt proteins of interest in the present application include the following: Wnt-1 (GenBank Accession No.
  • NM_005430 Wnt-2 (GenBank Accession No. NM_003391 ); Wnt-2B (Wnt-13) (GenBank Accession No. NM_004185 (isoform 1 ), NM_024494.2 (isoform 2)), Wnt-3 (RefSeq.: NM_030753), Wnt3a (GenBank Accession No. NM_033131 ), Wnt-4 (GenBank Accession No. NM_030761 ), Wnt-5A (GenBank Accession No. NM_003392), Wnt-5B (GenBank Accession No. NM_032642), Wnt-6 (GenBank Accession No. NM_006522), Wnt-7A (GenBank Accession No. NM_004625), Wnt- 7B (GenBank Accession No. NM_058238), Wnt-8A (GenBank Accession No.
  • Wnt-8B (GenBank Accession No. NM_003393), Wnt-9A (Wnt- 14) (GenBank Accession No. NM_003395), Wnt-9B (Wnt-15) (GenBank Accession No. NM_003396), Wnt-1 OA (GenBank Accession No. NM_025216), Wnt-10B
  • NM_004626 Wnt- 16 (GenBank Accession No. NM_016087)). Although each member has varying degrees of sequence identity with the family, all encode small (i.e. , 39-46 kD), acylated, palmitoylated, secreted glycoproteins that contain 23-24 conserved cysteine residues whose spacing is highly conserved (McMahon, A P et al., Trends Genet. 1992; 8: 236-242; Miller, J R. Genome Biol. 2002; 3(1 ): 3001.1 - 3001 .15).
  • Wnt polypeptides of interest include orthologs of the above from any mammal, including domestic and farm animals, and zoo, laboratory or pet animals, such as dogs, cats, cattle, horses, sheep, pigs, goats, rabbits, rats, mice, frogs, zebra fish, fruit fly, worm, etc.
  • Wnt pathway signaling or “Wnt signaling” is used herein to refer to the mechanism by which a biologically active Wnt exerts its effects upon a cell to modulate a cell's activity.
  • Wnt proteins modulate cell activity by binding to Wnt receptors, including proteins from the Frizzled (Fzd) family of proteins, proteins from the ROR family of proteins, the proteins LRP5, LRP6 from the LRP family of proteins, the protein FRL1 /crypto, and the protein Derailed/Ryk. Once activated by Wnt binding, the Wnt receptor(s) will activate one or more intracellular signaling cascades.
  • Wnt signaling pathway includes the canonical Wnt signaling pathway; the Wnt/planar cell polarity (Wnt/PCP) pathway; the Wnt-calcium (Wnt/Ca 2+ ) pathway (Giles, RFI et al. (2003) Biochim Biophys Acta 1653, 1 -24; Peifer, M. et al. (1994) Development 120: 369-380; Papkoff, J. et al (1996) Mol. Cell Biol. 16: 2128-2134; Veeman, M. T. et al. (2003) Dev. Cell 5: 367-377); and other Wnt signaling pathways as is well known in the art.
  • Wnt/PCP Wnt/planar cell polarity pathway
  • Wnt/Ca 2+ Wnt-calcium pathway
  • activation of the canonical Wnt signaling pathway results in the inhibition of phosphorylation of the intracellular protein b-catenin, leading to an accumulation of b- catenin in the cytosol and its subsequent translocation to the nucleus where it interacts with transcription factors, e.g.
  • TCF/LEF to activate target genes.
  • Activation of the Wnt/PCP pathway activates RhoA, c-Jun N-terminal kinase (JNK), and nemo-like kinase (NLK) signaling cascades to control such biological processes as tissue polarity and cell
  • Activation of the Wnt/Ca 2+ by, for example, binding of Wnt-4, Wnt-5A or Wnt-1 1 elicits an intracellular release of calcium ions, which activates calcium sensitive enzymes like protein kinase C (PKC), calcium-calmodulin dependent kinase II (CamKII) or calcineurin (CaCN).
  • PKC protein kinase C
  • CaCN calcium-calmodulin dependent kinase II
  • CaCN calcineurin
  • Wnt surrogate molecules may be assessed using a variety of methods known to the skilled person, including e.g., affinity/binding assays (for example, surface plasmon resonance, competitive inhibition assays), cytotoxicity assays, cell viability assays, cell proliferation or differentiation assays in response to a Wnt, cancer cell and/or tumor growth inhibition using in vitro or in vivo models, including but not limited to any described herein.
  • the Wnt surrogate molecules described herein may also be tested for effects on Fzd receptor internalization, in vitro and in vivo efficacy, etc.
  • Such assays may be performed using well-established protocols known to the skilled person (see, e.g., Current Protocols in Molecular Biology (Greene Publ. Assoc. Inc. & John Wiley & Sons, Inc., NY, NY); Current Protocols in Immunology (Edited by: John E. Coligan, Ada M. Kruisbeek, David H. Margulies, Ethan M.
  • an Fzd binding region of a Wnt surrogate molecule comprises one or more of the CDRs of the anti-Fzd antibodies described herein.
  • a LRP5/6 binding region of a Wnt surrogate molecule comprises one or more of the CDRs of the anti-LRP5/6 antibodies described herein.
  • Also disclosed herein is a method for obtaining an antibody or antigen-binding domain specific for a Fzd receptor, the method comprising providing by way of addition, deletion, substitution or insertion of one or more amino acids in the amino acid sequence of a VH domain set out herein or a VH domain which is an amino acid sequence variant of the VH domain, optionally combining the VH domain thus provided with one or more VL domains, and testing the VH domain or VH/VL combination or combinations to identify a specific binding member or an antibody antigen binding domain specific for one or more Fzd receptor and optionally with one or more desired properties.
  • the VL domains may have an amino acid sequence which is substantially as set out herein.
  • An analogous method may be employed in which one or more sequence variants of a VL domain disclosed herein are combined with one or more VH domains.
  • Wnt surrogate molecules are water soluble.
  • water soluble it is meant a composition that is soluble in aqueous buffers in the absence of detergent, usually soluble at a concentration that provides a biologically effective dose of the polypeptide.
  • Compositions that are water soluble form a substantially homogenous composition that has a specific activity that is at least about 5% that of the starting material from which it was purified, usually at least about 10%, 20%, or 30% that of the starting material, more usually about 40%, 50%, or 60% that of the starting material, and may be about 50%, about 90% or greater.
  • Wnt surrogate molecules disclosed herein typically form a substantially homogeneous aqueous solution at concentrations of at least 25 mM and higher, e.g., at least 25 pM, 40 pM, or 50 pM, usually at least 60 pM, 70 pM, 80 pM, or 90 pM, sometimes as much as 100 pM, 120 pM, or 150 pM.
  • Wnt surrogate molecules disclosed herein typically form a substantially homogeneous aqueous solution at concentrations of about 0.1 mg/ml, about 0.5 mg/ml, of about 1 mg/ml or more.
  • an antigen or epitope that "specifically binds” or “preferentially binds” (used interchangeably herein) to an antibody or antigen-binding fragment thereof is a term well understood in the art, and methods to determine such specific or preferential binding are also well known in the art.
  • a molecule e.g., a Wnt surrogate molecule, is said to exhibit "specific binding” or “preferential binding” if it reacts or associates more frequently, more rapidly, with greater duration and/or with greater affinity with a particular cell or substance than it does with alternative cells or substances.
  • a molecule or binding region thereof e.g., a Wnt surrogate molecule or binding region thereof, "specifically binds" or “preferentially binds" to a target antigen, e.g., an Fzd receptor, if it binds with greater affinity, avidity, more readily, and/or with greater duration than it binds to other substances.
  • a Wnt surrogate molecule or binding region thereof that specifically or preferentially binds to the Fzd1 receptor is an antibody that binds to the Fzd1 receptor with greater affinity, avidity, more readily, and/or with greater duration than it binds to other Fzd receptors or non-Fzd proteins.
  • a Wnt surrogate molecule or binding region thereof that specifically or preferentially binds to a first target may or may not specifically or preferentially bind to a second target.
  • “specific binding” or “preferential binding” does not necessarily require (although it can include) exclusive binding.
  • reference to binding means preferential binding.
  • any of the one or more Fzd binding regions of a Wnt surrogate molecule binds to one, two, three, four, five or more different frizzled receptors, e.g., one or more of human frizzled receptors Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, Fzd10.
  • any of the Fzd binding regions binds to Fzd1 , Fzd2, Fzd5, Fzd7 and Fzd8.
  • any of the Fzd binding regions binds to: (i) Fzd1 , Fzd2, Fzd7 and Fzd9; (ii) Fzd1 , Fzd2 and Fzd7; (iii) Fzd5 and Fzd8; (iv) Fzd5, Fzd7 and Fzd8; (v) Fzd1 , Fzd4, Fzd5 and Fzd8; (vi) Fzd1 , Fzd2, Fzd5, Fzd7 and Fzd8; (vii) Fzd4 and Fzd9; (viii) Fzd9 and Fzd10; (ix) Fzd5, Fzd8 and Fzd10; (x) Fzd4, Fzd5 and Fzd8; or (xi) Fzd1 , Fzd5, Fzd7 and Fzd8.
  • the Fzd binding region is selective for one or more Fzd receptors of interest, e.g. having a specificity for the one or more desired Fzd receptors of at least 10-fold, 25-fold, 50-fold, 100-fold, 200-fold or more relative to other Fzd receptors.
  • any of the one or more Fzd binding regions of a Wnt surrogate molecule is multispecific and binds or specifically binds to a plurality of Fzd receptors, e.g., two or more of Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, or Fzd10.
  • any of the one or more Fzd binding regions may be bispecific, trispecific, tetraspecific, and so on.
  • any of the one or more Fzd binding regions of a Wnt surrogate molecule is monospecific and binds or specifically binds to a single Fzd receptor, e.g., only one of Fzd1 , Fzd2, Fzd3, Fzd4, Fzd5, Fzd6, Fzd7, Fzd8, Fzd9, or Fzd10.
  • a monospecific Fzd binding region binds to a region of an Fzd receptor that does not include the cysteine rich domain (CRD) of the Fzd receptor, or includes less than the entire CRD of the FZD receptor.
  • CRD cysteine rich domain
  • sequences within the CRD show strong homology between the 10 Fzd receptors, with homologies being even higher between subfamily members. Accordingly, certain embodiments of the monospecific Fzd binding regions disclosed herein do not bind to the CRD, or bind only to a subset of the CRD.
  • a Fzd binding region binds to an epitope comprising at least a portion of the extracellular domain after the CRD, referred to herein as the“hinge region” of a Fzd receptor (see FIG. 2A).
  • the“hinge region” of a Fzd receptor see FIG. 2A.
  • at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or 100% of the epitope is present within the hinge region of a Fzd receptor.
  • the hinge regions of the extracellular domain of Fzd receptors show highly divergent sequences.
  • the hinge region includes an amino acid sequence having at least 90%, at least 95%, at least 98%, or at least 99% identity to any of the sequences set forth in SEQ ID NOs:98-107.
  • a monospecific Fzd binding region binds to an epitope comprising at least a portion of an N-terminal region upstream of the CRD of the Fzd receptor (FIG. 2A).
  • at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, or 100% of the epitope is present within the N-terminal region of a Fzd receptor.
  • the sequence of an illustrative N-terminal region is set forth in SEQ ID NO: 108 and in Table 4 below.
  • the N-terminal region includes an amino acid sequence having at least 90%, at least 95%, at least 98%, or at least 99% identity to SEQ ID NO: 108.
  • any of the one or more LRP5/6 binding regions of a Wnt surrogate molecule binds to one or both of LRP5/6.
  • LRP5/6 is used to refer collectively to either or both of LRP5 and/or LRP6.
  • Immunological binding generally refers to the non-covalent interactions of the type which occur between an immunoglobulin molecule and an antigen for which the immunoglobulin is specific, for example by way of illustration and not limitation, as a result of electrostatic, ionic, hydrophilic and/or hydrophobic attractions or repulsion, steric forces, hydrogen bonding, van der Waals forces, and other interactions.
  • interactions can be expressed in terms of the dissociation constant (Kd) of the interaction, wherein a smaller Kd represents a greater affinity.
  • Immunological binding properties of selected polypeptides can be quantified using methods well known in the art. One such method entails measuring the rates of antigen-binding site/antigen complex formation and dissociation, wherein those rates depend on the concentrations of the complex partners, the affinity of the interaction, and on geometric parameters that equally influence the rate in both directions.
  • both the "on rate constant" (K on ) and the "off rate constant” (Koff) can be determined by calculation of the concentrations and the actual rates of association and
  • the Wnt surrogate molecules or binding regions thereof described herein have an affinity of less than about 10,000, less than about 1000, less than about 100, less than about 10, less than about 1 , less than about 0.1 , less than about 0.01 , less than about 0.001 , less than about 0.0001 , less than about 0.00001 , or less than about 0.000001 nM, and in some embodiments, the antibodies may have even higher affinity for one or more Fzd receptor epitopes or LRP5 or LRP6 receptor.
  • the constant regions of immunoglobulins show less sequence diversity than the variable regions, and are responsible for binding a number of natural proteins to elicit important biochemical events.
  • IgA which includes subclasses lgA1 and lgA2
  • IgD which includes subclasses lgA1 and lgA2
  • IgE which includes subclasses lgG1 , lgG2, lgG3, and lgG4
  • IgM immunoglobulin M
  • the distinguishing features between these antibody classes are their constant regions, although subtler differences may exist in the V region.
  • the Fc region of an antibody interacts with a number of Fc receptors and ligands, imparting an array of important functional capabilities referred to as effector functions.
  • the Fc region comprises Ig domains CFI2 and CFI3 and the N-terminal hinge leading into CFI2.
  • An important family of Fc receptors for the IgG class are the Fc gamma receptors (FcyRs). These receptors mediate communication between antibodies and the cellular arm of the immune system (Raghavan et al. , 1996, Annu Rev Cell Dev Biol 12:181 -220; Ravetch et al. , 2001 , Annu Rev Immunol 19:275-290).
  • this protein family includes FcyRI (CD64), including isoforms FcyRIa, FcyRIb, and FcyRIc; FcyRII (CD32), including isoforms FcyRIla (including allotypes H 131 and R131 ), FcyRIIb (including FcyRIlb- 1 and FcyRllb-2), and FcyRIIc; and FcyRIII (CD16), including isoforms FcyRIIIa (including allotypes V158 and F158) and FcyRIIIb (including allotypes FcyRIIIb- NA1 and FcyRlllb-NA2) (Jefferis et al., 2002, Immunol Lett 82:57-65).
  • These receptors typically have an extracellular domain that mediates binding to Fc, a membrane spanning region, and an intracellular domain that may mediate some signaling event within the cell. These receptors are expressed in a variety of immune cells including monocytes, macrophages, neutrophils, dendritic cells, eosinophils, mast cells, platelets, B cells, large granular lymphocytes, Langerhans' cells, natural killer (NK) cells, and T cells. Formation of the Fc/FcyR complex recruits these effector cells to sites of bound antigen, typically resulting in signaling events within the cells and important subsequent immune responses such as release of inflammation mediators, B cell activation, endocytosis, phagocytosis, and cytotoxic attack.
  • NK natural killer
  • ADCC antibody dependent cell-mediated cytotoxicity
  • the different IgG subclasses have different affinities for the FcyRs, with lgG1 and lgG3 typically binding substantially better to the receptors than lgG2 and lgG4 (Jefferis et al., 2002, Immunol Lett 82:57-65). All FcyRs bind the same region on IgG Fc, yet with different affinities: the high affinity binder FcyRI has a Kd for lgG1 of 10 8 M 1 , whereas the low affinity receptors FcyRII and FcyRIII generally bind at 10 6 and 10 5 respectively.
  • FcyRIIIa and FcyRIIIb are 96% identical; however, FcyRIIIb does not have an intracellular signaling domain.
  • FcyRI, FcyRIIa/c, and FcyRIIIa are positive regulators of immune complex-triggered activation, characterized by having an intracellular domain that has an immunoreceptor tyrosine-based activation motif (ITAM)
  • FcyRIIb has an immunoreceptor tyrosine-based inhibition motif (ITIM) and is therefore inhibitory.
  • IITAM immunoreceptor tyrosine-based activation motif
  • ITIM immunoreceptor tyrosine-based inhibition motif
  • the receptors also differ in expression pattern and levels on different immune cells.
  • Yet another level of complexity is the existence of a number of FcyR polymorphisms in the human proteome. A particularly relevant polymorphism with clinical significance is
  • V158/F158 FcYRIIIa Fluman lgG1 binds with greater affinity to the V158 allotype than to the F158 allotype. This difference in affinity, and presumably its effect on ADCC and/or ADCP, has been shown to be a significant determinant of the efficacy of the anti-CD20 antibody rituximab (Rituxan®, a registered trademark of IDEC Pharmaceuticals Corporation). Subjects with the V158 allotype respond favorably to rituximab treatment; however, subjects with the lower affinity F158 allotype respond poorly (Cartron et al. , 2002, Blood 99:754-758). Approximately 10-20% of humans are V158/V158 homozygous, 45% are V158/F158
  • the Fc region is also involved in activation of the complement cascade.
  • C1 binds with its C1 q subunits to Fc fragments of IgG or IgM, which has formed a complex with antigen(s).
  • modifications to the Fc region comprise modifications that alter (either enhance or decrease) the ability of a Fzd-specific antibody as described herein to activate the complement system (see e.g., U.S. Patent No. 7,740,847).
  • CDC complement- dependent cytotoxicity
  • the present disclosure provides anti- Fzd antibodies having a modified Fc region with altered functional properties, such as reduced or enhanced CDC, ADCC, or ADCP activity, or enhanced binding affinity for a specific FcyR or increased serum half-life.
  • modified Fc regions contemplated herein are described, for example, in issued U.S. Patent Nos.
  • Wnt surrogate molecules comprise antibody variable domains with the desired binding specificities fused to immunoglobulin constant domain sequences.
  • the fusion is with an Ig heavy chain constant domain, comprising at least part of the hinge, CH2, and CH3 regions.
  • DNAs encoding the immunoglobulin heavy chain fusions and, if desired, the immunoglobulin light chain are inserted into separate expression vectors, and are co-transfected into a suitable host cell. This provides for greater flexibility in adjusting the mutual proportions of the three polypeptide fragments in
  • Wnt surrogate molecules disclosed herein may also be modified to include an epitope tag or label, e.g., for use in purification or diagnostic
  • linking groups known in the art for making antibody conjugates, including, for example, those disclosed in U.S. Patent No. 5,208,020 or EP Patent 0 425 235 B1 , and Chari et al., Cancer Research 52: 127-131 (1992).
  • the linking groups include disulfide groups, thioether groups, acid labile groups, photolabile groups, peptidase labile groups, or esterase labile groups, as disclosed in the above-identified patents, disulfide and thioether groups being preferred.
  • anti-LRP5/6 antibodies and antigen-binding fragments thereof and/or anti-Fzd antibodies and antigen-binding fragments thereof present within a Wnt surrogate molecule are monoclonal. In certain embodiments, they are humanized.
  • the present disclosure further provides in certain embodiments an isolated nucleic acid encoding a polypeptide present in a Wnt surrogate molecule disclosed herein. Nucleic acids include DNA and RNA. These and related embodiments may include polynucleotides encoding antibody fragments that bind one or more Fzd receptors and/or LRP5 or LRP6 as described herein.
  • isolated polynucleotide shall mean a polynucleotide of genomic, cDNA, or synthetic origin, or some combination thereof, which by virtue of its origin, the isolated polynucleotide: (1 ) is not associated with all or a portion of a polynucleotide in which the isolated polynucleotide is found in nature; (2) is linked to a polynucleotide to which it is not linked in nature, or (3) does not occur in nature as part of a larger sequence.
  • An isolated polynucleotide may include naturally occurring and/or artificial sequences.
  • operably linked means that the components to which the term is applied are in a relationship that allows them to carry out their inherent functions under suitable conditions.
  • a transcription control sequence "operably linked" to a protein coding sequence is ligated thereto so that expression of the protein coding sequence is achieved under conditions compatible with the transcriptional activity of the control sequences.
  • control sequence refers to polynucleotide sequences that can affect expression, processing or intracellular localization of coding sequences to which they are ligated or operably linked. The nature of such control sequences may depend upon the host organism. In particular
  • transcription control sequences for prokaryotes may include a promoter, ribosomal binding site, and transcription termination sequence.
  • transcription control sequences for eukaryotes may include promoters comprising one or a plurality of recognition sites for transcription factors, transcription enhancer sequences, transcription termination sequences and polyadenylation sequences.
  • control sequences can include leader sequences and/or fusion partner sequences.
  • polynucleotide as referred to herein means single- stranded or double-stranded nucleic acid polymers.
  • the nucleotides comprising the polynucleotide can be ribonucleotides or
  • deoxyribonucleotides or a modified form of either type of nucleotide.
  • Said modifications include base modifications such as bromouridine, ribose
  • polynucleotide specifically includes single and double stranded forms of DNA.
  • modified nucleotides includes nucleotides with modified or substituted sugar groups and the like.
  • oligonucleotide linkages includes oligonucleotide linkages such as phosphorothioate, phosphorodithioate, phosphoroselenoate,
  • An oligonucleotide can include a detectable label to enable detection of the oligonucleotide or hybridization thereof.
  • vector is used to refer to any molecule (e.g., nucleic acid, plasmid, or virus) used to transfer coding information to a host cell.
  • expression vector refers to a vector that is suitable for transformation of a host cell and contains nucleic acid sequences that direct and/or control expression of inserted heterologous nucleic acid sequences. Expression includes, but is not limited to, processes such as transcription, translation, and RNA splicing, if introns are present.
  • polynucleotides may include genomic sequences, extra-genomic and plasmid-encoded sequences and smaller engineered gene segments that express, or may be adapted to express, proteins, polypeptides, peptides and the like. Such segments may be naturally isolated, or modified synthetically by the skilled person.
  • polynucleotides may be single-stranded (coding or antisense) or double-stranded, and may be DNA (genomic, cDNA or synthetic) or RNA molecules.
  • RNA molecules may include HnRNA molecules, which contain introns and correspond to a DNA molecule in a one-to-one manner, and mRNA molecules, which do not contain introns. Additional coding or non-coding sequences may, but need not, be present within a
  • polynucleotide according to the present disclosure, and a polynucleotide may, but need not, be linked to other molecules and/or support materials.
  • Polynucleotides may comprise a native sequence or may comprise a sequence that encodes a variant or derivative of such a sequence.
  • nucleotide sequences that encodes an antibody as described herein. Some of these polynucleotides bear minimal sequence identity to the nucleotide sequence of the native or original polynucleotide sequence encoding a polypeptide within a Wnt surrogate molecule. Nonetheless, polynucleotides that vary due to differences in codon usage are expressly contemplated by the present disclosure. In certain embodiments, sequences that have been codon-optimized for mammalian expression are specifically contemplated.
  • a mutagenesis approach such as site-specific mutagenesis, may be employed for the preparation of variants and/or derivatives of the polypeptides described herein.
  • site-specific mutagenesis By this approach, specific modifications in a polypeptide sequence can be made through mutagenesis of the underlying polynucleotides that encode them.
  • Site-specific mutagenesis allows the production of mutants through the use of specific oligonucleotide sequences which encode the DNA sequence of the desired mutation, as well as a sufficient number of adjacent nucleotides, to provide a primer sequence of sufficient size and sequence complexity to form a stable duplex on both sides of the deletion junction being traversed. Mutations may be employed in a selected polynucleotide sequence to improve, alter, decrease, modify, or otherwise change the properties of the polynucleotide itself, and/or alter the properties, activity, composition, stability, or primary sequence of the encoded polypeptide.
  • the inventors contemplate the mutagenesis of the polynucleotide sequences that encode a polypeptide present in a Wnt surrogate molecule, to alter one or more properties of the encoded polypeptide, such as the binding affinity, or the function of a particular Fc region, or the affinity of the Fc region for a particular FcyR.
  • the techniques of site-specific mutagenesis are well-known in the art, and are widely used to create variants of both
  • polypeptides and polynucleotides For example, site-specific mutagenesis is often used to alter a specific portion of a DNA molecule.
  • a primer comprising typically about 14 to about 25 nucleotides or so in length is employed, with about 5 to about 10 residues on both sides of the junction of the sequence being altered.
  • site-specific mutagenesis techniques have often employed a phage vector that exists in both a single stranded and double stranded form.
  • Typical vectors useful in site-directed mutagenesis include vectors such as the M13 phage. These phages are readily commercially-available and their use is generally well-known to those skilled in the art.
  • Double-stranded plasmids are also routinely employed in site directed mutagenesis that eliminates the step of transferring the gene of interest from a plasmid to a phage.
  • sequence variants of the selected peptide- encoding DNA segments using site-directed mutagenesis provides a means of producing potentially useful species and is not meant to be limiting as there are other ways in which sequence variants of peptides and the DNA sequences encoding them may be obtained.
  • recombinant vectors encoding the desired peptide sequence may be treated with mutagenic agents, such as hydroxylamine, to obtain sequence variants.
  • mutagenic agents such as hydroxylamine
  • one or more nucleic acids encoding a polypeptide of a Wnt surrogate molecule are introduced directly into a host cell, and the cell incubated under conditions sufficient to induce expression of the encoded polypeptides.
  • the Wnt surrogate polypeptides of this disclosure may be prepared using standard techniques well known to those of skill in the art in combination with the polypeptide and nucleic acid sequences provided herein.
  • the polypeptide sequences may be used to determine appropriate nucleic acid sequences encoding the particular polypeptide disclosed thereby.
  • the nucleic acid sequence may be optimized to reflect particular codon "preferences" for various expression systems according to standard methods well known to those of skill in the art.
  • a recombinant host cell which comprises one or more constructs as described herein, e.g., a vector comprising a nucleic acid encoding a Wnt surrogate molecule or polypeptide thereof; and a method of production of the encoded product, which method comprises expression from encoding nucleic acid therefor.
  • Expression may conveniently be achieved by culturing under appropriate conditions recombinant host cells containing the nucleic acid.
  • an antibody or antigen-binding fragment thereof may be isolated and/or purified using any suitable technique, and then used as desired.
  • Polypeptides, and encoding nucleic acid molecules and vectors may be isolated and/or purified, e.g., from their natural environment, in substantially pure or homogeneous form, or, in the case of nucleic acid, free or substantially free of nucleic acid or genes of origin other than the sequence encoding a polypeptide with the desired function.
  • Nucleic acid may comprise DNA or RNA and may be wholly or partially synthetic. Reference to a nucleotide sequence as set out herein encompasses a DNA molecule with the specified sequence, and encompasses a RNA molecule with the specified sequence in which U is substituted for T, unless context requires otherwise.
  • Suitable host cells include bacteria, mammalian cells, yeast and baculovirus systems.
  • Mammalian cell lines available in the art for expression of a heterologous polypeptide include Chinese hamster ovary cells, HeLa cells, baby hamster kidney cells, NSO mouse melanoma cells and many others.
  • a common, preferred bacterial host is E. coli.
  • polypeptides e.g., antibodies and antigen-binding fragments thereof
  • prokaryotic cells such as E. coli
  • expression in eukaryotic cells in culture is also available to those skilled in the art as an option for production of antibodies or antigen-binding fragments thereof, see recent reviews, for example Ref, M. E. (1993) Curr. Opinion Biotech. 4: 573-576; Trill J. J. et al. (1995) Curr. Opinion Biotech 6: 553-560.
  • Suitable vectors can be chosen or constructed, containing appropriate regulatory sequences, including promoter sequences, terminator sequences, polyadenylation sequences, enhancer sequences, marker genes and other sequences as appropriate.
  • Vectors may be plasmids, viral, e.g., phage, or phagemid, as appropriate.
  • phage e.g., phage
  • phagemid e.g., viral, e.g., phage, or phagemid, as appropriate.
  • Many known techniques and protocols for manipulation of nucleic acid for example in preparation of nucleic acid constructs, mutagenesis, sequencing, introduction of DNA into cells and gene expression, and analysis of proteins, are described in detail in Current Protocols in Molecular Biology, Second Edition, Ausubel et al. eds., John Wiley & Sons, 1992, or subsequent updates thereto.
  • host cell is used to refer to a cell into which has been introduced, or which is capable of having introduced into it, a nucleic acid sequence encoding one or more of the herein described polypeptides, and which further expresses or is capable of expressing a selected gene of interest, such as a gene encoding any herein described polypeptide.
  • the term includes the progeny of the parent cell, whether or not the progeny are identical in morphology or in genetic make-up to the original parent, so long as the selected gene is present.
  • a method comprising introducing such nucleic acid into a host cell.
  • the introduction may employ any available technique.
  • suitable techniques may include calcium phosphate
  • transfection DEAE-Dextran, electroporation, liposome-mediated transfection and transduction using retrovirus or other virus, e.g. vaccinia or, for insect cells, baculovirus.
  • suitable techniques may include calcium chloride transformation, electroporation and transfection using bacteriophage.
  • the introduction may be followed by causing or allowing expression from the nucleic acid, e.g. by culturing host cells under conditions for expression of the gene.
  • the nucleic acid is integrated into the genome (e.g., chromosome) of the host cell. Integration may be promoted by inclusion of sequences which promote recombination with the genome, in accordance-with standard techniques.
  • the present disclosure also provides, in certain embodiments, a method which comprises using a construct as stated above in an expression system in order to express a particular polypeptide such as a Wnt mimetic molecule as described herein.
  • transduction is used to refer to the transfer of genes from one bacterium to another, usually by a phage.
  • Transduction also refers to the acquisition and transfer of eukaryotic cellular sequences by retroviruses.
  • transfection is used to refer to the uptake of foreign or exogenous DNA by a cell, and a cell has been "transfected” when the exogenous DNA has been introduced inside the cell membrane.
  • transfection techniques are well known in the art and are disclosed herein. See, e.g., Graham et al., 1973, Virology 52:456; Sambrook et al.
  • transformation refers to a change in a cell's genetic characteristics, and a cell has been transformed when it has been modified to contain a new DNA.
  • a cell is transformed where it is genetically modified from its native state.
  • the transforming DNA may recombine with that of the cell by physically integrating into a chromosome of the cell, or may be maintained transiently as an episomal element without being replicated, or may replicate independently as a plasmid.
  • a cell is considered to have been stably transformed when the DNA is replicated with the division of the cell.
  • non-naturally occurring or “non-native” when used in connection with biological materials such as nucleic acid molecules, polypeptides, host cells, and the like, refers to materials which are found in nature and are not manipulated by a human.
  • non-naturally occurring or “non-native” as used herein refers to a material that is not found in nature or that has been structurally modified or synthesized by a human.
  • polypeptide protein and “peptide” and “glycoprotein” are used interchangeably and mean a polymer of amino acids not limited to any particular length. The term does not exclude modifications such as myristylation, sulfation, glycosylation, phosphorylation and addition or deletion of signal sequences.
  • polypeptide or protein means one or more chains of amino acids, wherein each chain comprises amino acids covalently linked by peptide bonds, and wherein said polypeptide or protein can comprise a plurality of chains non-covalently and/or covalently linked together by peptide bonds, having the sequence of native proteins, that is, proteins produced by naturally-occurring and specifically non-recombinant cells, or genetically-engineered or recombinant cells, and comprise molecules having the amino acid sequence of the native protein, or molecules having deletions from, additions to, and/or substitutions of one or more amino acids of the native sequence.
  • polypeptide and protein specifically encompass Wnt surrogate molecules, Fzd binding regions thereof, LRP5/6 binding regions thereof, antibodies and antigen-binding fragments thereof that bind to a Fzd receptor or a LRP5 or LRP6 receptor disclosed herein, or sequences that have deletions from, additions to, and/or substitutions of one or more amino acid of any of these polypeptides.
  • a "polypeptide” or a “protein” can comprise one (termed “a monomer”) or a plurality (termed “a multimer”) of amino acid chains.
  • isolated protein “isolated Wnt surrogate molecule or“isolated antibody” referred to herein means that a subject protein, Wnt surrogate molecule, or antibody: (1 ) is free of at least some other proteins with which it would typically be found in nature; (2) is essentially free of other proteins from the same source, e.g., from the same species, (3) is expressed by a cell from a different species; (4) has been separated from at least about 50 percent of polynucleotides, lipids, carbohydrates, or other materials with which it is associated in nature; (5) is not associated (by covalent or noncovalent interaction) with portions of a protein with which the "isolated protein” is associated in nature; (6) is operably associated (by covalent or noncovalent interaction) with a polypeptide with which it is not associated in nature; or (7) does not occur in nature.
  • an isolated protein can be encoded by genomic DNA, cDNA, mRNA or other RNA, or may be of synthetic origin, or any combination thereof.
  • an isolated protein may comprise naturally-occurring and/or artificial polypeptide sequences.
  • the isolated protein is substantially free from proteins or polypeptides or other contaminants that are found in its natural environment that would interfere with its use (therapeutic, diagnostic, prophylactic, research or otherwise).
  • amino acid sequence modification(s) of any of the polypeptides e.g., Wnt surrogate molecules or Fzd binding regions or LRP5/6 binding regions thereof) described herein are contemplated.
  • amino acid sequence variants of a Wnt surrogate molecule may be prepared by introducing appropriate nucleotide changes into a
  • polynucleotide that encodes the antibody, or a chain thereof, or by peptide synthesis.
  • modifications include, for example, deletions from, and/or insertions into and/or substitutions of, residues within the amino acid sequences of the antibody. Any combination of deletion, insertion, and substitution may be made to arrive at the final Wnt surrogate molecule, provided that the final construct possesses the desired characteristics (e.g., high affinity binding to one or more Fzd and/or LRP5/6 receptor).
  • the amino acid changes also may alter post-translational processes of the antibody, such as changing the number or position of
  • a variant has at least 90%, at least 95%, at least 98%, or at least 99% identity to a polypeptide disclosed herein.
  • such variant polypeptides bind to one or more Fzd receptor, and/or to one or more LRP5/6 receptor, at least about 50%, at least about 70%, and in certain
  • Wnt surrogate molecules specifically set forth herein.
  • such variant Wnt surrogate molecules bind to one or more Fzd receptor, and/or to one or more LRP5/6 receptor, with greater affinity than the Wnt surrogate molecules set forth herein, for example, that bind quantitatively at least about 105%, 106%, 107%, 108%, 109%, or 110% as well as an antibody sequence specifically set forth herein.
  • the Wnt surrogate molecule or a binding region thereof may comprise: a) a heavy chain variable region comprising: i. a CDR1 region that is identical in amino acid sequence to the heavy chain CDR1 region of a selected antibody described herein; ii. a CDR2 region that is identical in amino acid sequence to the heavy chain CDR2 region of the selected antibody; and iii. a CDR3 region that is identical in amino acid sequence to the heavy chain CDR3 region of the selected antibody; and/or b) a light chain variable domain comprising: i.
  • a CDR1 region that is identical in amino acid sequence to the light chain CDR1 region of the selected antibody; ii. a CDR2 region that is identical in amino acid sequence to the light chain CDR2 region of the selected antibody; and iii. a CDR3 region that is identical in amino acid sequence to the light chain CDR3 region of the selected antibody; wherein the antibody specifically binds a selected target (e.g., one or more Fzd receptor epitopes or LRP5 or LRP6 receptors).
  • a selected target e.g., one or more Fzd receptor epitopes or LRP5 or LRP6 receptors.
  • the antibody, or antigen-binding fragment thereof is a variant antibody or antigen-binding fragment thereof wherein the variant comprises a heavy and light chain identical to the selected antibody except for up to 8, 9, 10, 11 , 12, 13, 14, 15, or more amino acid substitutions in the CDR regions of the VH and VL regions.
  • the variant comprises a heavy and light chain identical to the selected antibody except for up to 8, 9, 10, 11 , 12, 13, 14, 15, or more amino acid substitutions in the CDR regions of the VH and VL regions.
  • the Wnt surrogate molecule or a binding region thereof may have: a) a heavy chain variable region having an amino acid sequence that is at least 80% identical, at least 95% identical, at least 90%, at least 95% or at least 98% or 99% identical, to the heavy chain variable region of an antibody or antigen-binding fragments thereof described herein; and/or b) a light chain variable region having an amino acid sequence that is at least 80% identical, at least 85%, at least 90%, at least 95% or at least 98% or 99% identical, to the light chain variable region of an antibody or antigen-binding fragments thereof described herein.
  • the amino acid sequence of illustrative antigen-binding fragments thereof are set forth in SEQ ID NOs:1 -97 and 109-157.
  • a polypeptide has a certain percent "sequence identity" to another polypeptide, meaning that, when aligned, that percentage of amino acids are the same when comparing the two sequences. Sequence similarity can be determined in a number of different manners. To determine sequence identity, sequences can be aligned using the methods and computer programs, including BLAST, available over the world wide web at ncbi.nlm.nih.gov/BLAST/. Another alignment algorithm is FASTA, available in the Genetics Computing Group (GCG) package, from Madison, Wis., USA, a wholly owned subsidiary of Oxford Molecular Group, Inc. Other techniques for alignment are described in Methods in Enzymology, vol.
  • GCG Genetics Computing Group
  • the Smith-Waterman is one type of algorithm that permits gaps in sequence alignments. See Meth. Mol. Biol. 70: 173-187 (1997). Also, the GAP program using the Needleman and Wunsch alignment method can be utilized to align sequences. See J. Mol. Biol. 48: 443-453 (1970)
  • the program has default parameters determined by the sequences inputted to be compared.
  • the sequence identity is determined using the default parameters determined by the program. This program is available also from Genetics Computing Group (GCG) package, from Madison, Wis., USA.
  • GCG Genetics Computing Group
  • FastDB is described in Current Methods in Sequence Comparison and Analysis,
  • the Wnt surrogate molecule or a binding region thereof may comprise: a) a heavy chain variable region comprising: i. a CDR1 region that is identical in amino acid sequence to the heavy chain CDR1 region of a selected antibody described herein; ii. a CDR2 region that is identical in amino acid sequence to the heavy chain CDR2 region of the selected antibody; and iii. a CDR3 region that is identical in amino acid sequence to the heavy chain CDR3 region of the selected antibody; and b) a light chain variable domain comprising: i.
  • a CDR1 region that is identical in amino acid sequence to the light chain CDR1 region of the selected antibody; ii. a CDR2 region that is identical in amino acid sequence to the light chain CDR2 region of the selected antibody; and iii. a CDR3 region that is identical in amino acid sequence to the light chain CDR3 region of the selected antibody; wherein the antibody specifically binds a selected target (e.g., a Fzd receptor, such as Fzd1 ).
  • a selected target e.g., a Fzd receptor, such as Fzd1
  • the antibody, or antigen-binding fragment thereof is a variant antibody wherein the variant comprises a heavy and light chain identical to the selected antibody except for up to 8, 9, 10, 11 , 12, 13, 14, 15, or more am ino acid substitutions in the CDR regions of the VFI and VL regions.
  • the variant comprises a heavy and light chain identical to the selected antibody except for up to 8, 9, 10, 11 , 12, 13, 14, 15, or more am ino acid substitutions in the CDR regions of the VFI and VL regions.
  • VMD is a molecular visualization program for displaying, animating, and analyzing large biomolecular systems using 3-D graphics and built-in scripting (see the website for the Theoretical and Computational Biophysics Group,
  • compositions comprising a Wnt surrogate molecule described herein and one or more pharmaceutically acceptable diluent, carrier, or excipient are also disclosed.
  • the pharmaceutical composition further comprises one or more Wnt polypeptides or Norrin
  • compositions comprising a polynucleotide comprising a nucleic acid sequence encoding a Wnt surrogate molecule described herein and one or more pharmaceutically acceptable diluent, carrier, or excipient are also disclosed.
  • a polynucleotide comprising a nucleic acid sequence encoding a Wnt surrogate molecule described herein and one or more pharmaceutically acceptable diluent, carrier, or excipient are also disclosed.
  • composition further comprises one or more polynucleotides comprising a nucleic acid sequence encoding a Wnt polypeptide or Norrin polypeptide.
  • the polynucleotides are DNA or mRNA, e.g., a modified mRNA.
  • the polynucleotides are modified mRNAs further comprising a 5’ cap sequence and/or a 3’ tailing sequence, e.g., a polyA tail.
  • the polynucleotides are expression cassettes comprising a promoter operatively linked to the coding sequences.
  • the nucleic acid sequence encoding the Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same polynucleotide.
  • compositions comprising an expression vector, e.g., a viral vector, comprising a polynucleotide comprising a nucleic acid sequence encoding a Wnt surrogate molecule described herein and one or more pharmaceutically acceptable diluent, carrier, or excipient are also disclosed.
  • the pharmaceutical composition further comprises an expression vector, e.g., a viral vector, comprising a polynucleotide comprising a nucleic acid sequence encoding a Wnt polypeptide or Norrin polypeptide.
  • nucleic acid sequence encoding the Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same polynucleotide, e.g., expression cassette.
  • the present disclosure further contemplates a pharmaceutical composition
  • a pharmaceutical composition comprising a cell comprising an expression vector comprising a polynucleotide comprising a promoter operatively linked to a nucleic acid encoding a Wnt surrogate molecule and one or more pharmaceutically acceptable diluent, carrier, or excipient.
  • the pharmaceutical composition further comprises a cell comprising an expression vector comprising a
  • the polynucleotide comprising a promoter operatively linked to a nucleic acid sequence encoding a Wnt polypeptide or a Norrin polypeptide.
  • the nucleic acid sequence encoding the Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same polynucleotide, e.g., expression cassette and/or in the same cell.
  • the cell is a heterologous cell or an autologous cell obtained from the subject to be treated.
  • the cell is a stem cell, e.g., an adipose-derived stem cell or a hematopoietic stem cell.
  • compositions comprising a first molecule for delivery of a Wnt surrogate molecule as a first active agent and a second molecule for delivery of a Wnt polypeptide or Norrin
  • the first and second molecule may be the same type of molecule or different types of molecules.
  • the first and second molecule may each be independently selected from the following types of molecules: polypeptides, small organic molecules, nucleic acids encoding the first or second active agent (optionally DNA or mRNA, optionally modified RNA), vectors comprising a nucleic acid sequence encoding the first or second active agent (optionally expression vectors or viral vectors), and cells comprising a nucleic acid sequence encoding the first or second active agent (optionally an expression cassette).
  • the subject molecules can be combined with pharmaceutical ly-acceptable carriers, diluents, excipients and reagents useful in preparing a formulation that is generally safe, non-toxic, and desirable, and includes excipients that are acceptable for mammalian, e.g., human or primate, use.
  • excipients can be solid, liquid, semisolid, or, in the case of an aerosol composition, gaseous.
  • carriers, diluents and excipients include, but are not limited to, water, saline, Ringer's solutions, dextrose solution, and 5% human serum albumin.
  • Supplementary active compounds can also be incorporated into the formulations. Solutions or suspensions used for the formulations can include a sterile diluent such as water for injection, saline solution, fixed oils, polyethylene glycols, glycerine, propylene glycol or other synthetic solvents;
  • antibacterial compounds such as benzyl alcohol or methyl parabens
  • antioxidants such as ascorbic acid or sodium bisulfite
  • chelating compounds such as
  • EDTA ethylenediaminetetraacetic acid
  • buffers such as acetates, citrates or phosphates
  • detergents such as Tween 20 to prevent aggregation
  • the pharmaceutical compositions are sterile.
  • compositions may further include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersion.
  • suitable carriers include physiological saline, bacteriostatic water, or phosphate buffered saline (PBS).
  • PBS phosphate buffered saline
  • the composition is sterile and should be fluid such that it can be drawn into a syringe or delivered to a subject from a syringe. In certain embodiments, it is stable under the conditions of manufacture and storage and is preserved against the contaminating action of microorganisms such as bacteria and fungi.
  • the carrier can be, e.g., a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), and suitable mixtures thereof.
  • the proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersion and by the use of surfactants.
  • Prevention of the action of microorganisms can be achieved by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, and the like.
  • isotonic agents for example, sugars, polyalcohols such as mannitol, sorbitol, sodium chloride in the composition.
  • Prolonged absorption of the internal compositions can be brought about by including in the composition an agent which delays absorption, for example, aluminum monostearate and gelatin.
  • Sterile solutions can be prepared by incorporating the anti-Fzd antibody or antigen-binding fragment thereof (or encoding polynucleotide or cell comprising the same) in the required amount in an appropriate solvent with one or a combination of ingredients enumerated above, as required, followed by filtered sterilization.
  • dispersions are prepared by incorporating the active compound into a sterile vehicle that contains a basic dispersion medium and the required other ingredients from those enumerated above.
  • methods of preparation are vacuum drying and freeze-drying that yields a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof.
  • the pharmaceutical compositions are prepared with carriers that will protect the antibody or antigen-binding fragment thereof against rapid elimination from the body, such as a controlled release formulation, including implants and microencapsulated delivery systems.
  • a controlled release formulation including implants and microencapsulated delivery systems.
  • Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate,
  • polyanhydrides polyglycolic acid, collagen, polyorthoesters, and polylactic acid. Methods for preparation of such formulations will be apparent to those skilled in the art. The materials can also be obtained commercially. Liposomal suspensions can also be used as pharmaceutically acceptable carriers. These can be prepared according to methods known to those skilled in the art.
  • Dosage unit form refers to physically discrete units suited as unitary dosages for the subject to be treated; each unit containing a
  • predetermined quantity of active antibody or antigen-binding fragment thereof calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier.
  • the specification for the dosage unit forms are dictated by and directly dependent on the unique characteristics of the antibody or antigen- binding fragment thereof and the particular therapeutic effect to be achieved, and the limitations inherent in the art of compounding such an active antibody or antigen-binding fragment thereof for the treatment of individuals.
  • compositions can be included in a container, pack, or dispenser, e.g. syringe, e.g. a prefilled syringe, together with instructions for administration.
  • compositions of the present disclosure encompass any pharmaceutically acceptable salts, esters, or salts of such esters, or any other compound which, upon administration to an animal comprising a human, is capable of providing (directly or indirectly) the biologically active antibody or antigen-binding fragment thereof.
  • present disclosure includes pharmaceutically acceptable salts of a Wnt surrogate molecule described herein.
  • acceptable salt refers to physiologically and pharmaceutically acceptable salts of the compounds of the present disclosure: i.e. , salts that retain the desired biological activity of the parent compound and do not impart undesired
  • Pharmaceutically acceptable base addition salts are formed with metals or amines, such as alkali and alkaline earth metals or organic amines.
  • Metals used as cations comprise sodium, potassium, magnesium, calcium, and the like.
  • Amines comprise N-N’-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine, dicyclohexylamine, ethylenediamine, N-methylglucamine, and procaine (see, for example, Berge et al. ,“Pharmaceutical Salts,” J. Pharma Sci., 1977, 66, 119).
  • the base addition salts of said acidic compounds are prepared by contacting the free acid form with a sufficient amount of the desired base to produce the salt in the conventional manner.
  • the free acid form may be
  • the free acid forms differ from their respective salt forms somewhat in certain physical properties such as solubility in polar solvents, but otherwise the salts are equivalent to their respective free acid for purposes of the present disclosure.
  • the pharmaceutical composition provided herein comprise a therapeutically effective amount of a Wnt surrogate molecule or pharmaceutically acceptable salt thereof in admixture with a pharmaceutically acceptable carrier, diluent and/or excipient, for example saline, phosphate buffered saline, phosphate and amino acids, polymers, polyols, sugar, buffers,
  • a pharmaceutically acceptable carrier for example saline, phosphate buffered saline, phosphate and amino acids, polymers, polyols, sugar, buffers,
  • amino acids, polymers and sugars and the like are octylphenoxy polyethoxy ethanol compounds, polyethylene glycol monostearate compounds, polyoxyethylene sorbitan fatty acid esters, sucrose, fructose, dextrose, maltose, glucose, mannitol, dextran, sorbitol, inositol, galactitol, xylitol, lactose, trehalose, bovine or human serum albumin, citrate, acetate,
  • this formulation is stable for at least six months at 4° C.
  • the pharmaceutical composition provided herein comprises a buffer, such as phosphate buffered saline (PBS) or sodium phosphate/sodium sulfate, tris buffer, glycine buffer, sterile water and other buffers known to the ordinarily skilled artisan such as those described by Good et al.
  • a buffer such as phosphate buffered saline (PBS) or sodium phosphate/sodium sulfate, tris buffer, glycine buffer, sterile water and other buffers known to the ordinarily skilled artisan such as those described by Good et al.
  • the pH of the buffer may be in the range of 6.5 to 7.75, preferably 7 to 7.5, and most preferably 7.2 to 7.4.
  • the present disclosure also provides methods for using the Wnt surrogate molecules disclosed herein, e.g., to modulate a Wnt signaling pathway, e.g., to increase Wnt signaling, and the administration of a Wnt surrogate molecule disclosed herein in a variety of therapeutic settings.
  • a Wnt surrogate molecule is provided to a subject having a disease involving inappropriate or deregulated Wnt signaling, e.g., reduced Wnt signaling.
  • a Wnt surrogate molecule may be used to agonize a Wnt signaling pathway in a tissue or a cell. Agonizing the Wnt signaling pathway may include, for example, increasing Wnt signaling or enhancing Wnt signaling in a tissue or cell.
  • the present disclosure provides a method for agonizing a Wnt signaling pathway in a cell, comprising contacting the tissue or cell with an effective amount of a Wnt surrogate molecule or pharmaceutically acceptable salt thereof disclosed herein, wherein the a Wnt surrogate molecule is a Wnt signaling pathway agonist.
  • contacting occurs in vitro, ex vivo, or in vivo.
  • the cell is a cultured cell, and the contacting occurs in vitro.
  • the method comprises further contacting the tissue or cell with one or more Wnt polypeptides or Norrin polypeptides.
  • the present disclosure provides a method for agonizing Wnt signaling in a tissue or cell, comprising contacting the tissue or cell with an effective amount of a polynucleotide comprising a Wnt surrogate molecule disclosed herein.
  • the target tissue or cell is also contacted with a polynucleotide comprising a nucleic acid sequence that encodes a Wnt polypeptide or a Norrin polypeptide.
  • the polynucleotides are DNA or mRNA, e.g., a modified mRNA.
  • the polynucleotides are modified mRNAs further comprising a 5’ cap sequence and/or a 3’ tailing sequence, e.g., a polyA tail.
  • the polynucleotides are expression cassettes comprising a promoter operatively linked to the coding sequences.
  • the nucleic acid sequence encoding the Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same polynucleotide.
  • the present disclosure provides a method for agonizing Wnt signaling in a tissue or cell, comprising contacting the tissue or cell with an effective amount of a vector comprising a nucleic acid sequence encoding a Wnt surrogate molecule.
  • the tissue or cell is also contacted with a vector comprising a nucleic acid sequence that encodes a Wnt polypeptide or a Norrin polypeptide.
  • the vector is an expression vector, and may comprise a promoter operatively linked to the nucleic acid sequence.
  • the vector is a viral vector.
  • nucleic acid sequence encoding a Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same vector, e.g., in the same expression cassette.
  • the present disclosure provides a method for agonizing Wnt signaling in a tissue, comprising contacting the tissue with an effective amount of a cell comprising a nucleic acid sequence encoding a Wnt surrogate molecule of the present disclosure.
  • the tissue is also contacted with a cell comprising a nucleic acid sequence that encodes a Wnt polypeptide or Norrin polypeptide.
  • the nucleic acid sequence encoding the Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same cell.
  • the cell is a heterologous cell or an autologous cell obtained from the subject to be treated.
  • the cell was transduced with a vector comprising an expression cassette encoding the Wnt surrogate molecule or the Wnt polypeptide or Norrin polypeptide.
  • the cell is a stem cell, e.g., an adipose-derived stem cell or a hematopoietic stem cell.
  • Wnt surrogate molecules disclosed herein may be used in to treat a disease, disorder or condition, for example, by agonizing, e.g., increasing Wnt signaling in a targeted cell, tissue or organ.
  • agonizing e.g., increasing Wnt signaling in a targeted cell, tissue or organ.
  • the present disclosure provides a method for treating a disease or condition in a subject in need thereof, e.g., a disease or disorder associated with reduced or impaired Wnt signaling, and/or for which increased Wnt signaling would provide a therapeutic benefit, comprising contacting the subject with an effective amount of a disease or condition in need thereof, e.g., a disease or disorder associated with reduced or impaired Wnt signaling, and/or for which increased Wnt signaling would provide a therapeutic benefit, comprising contacting the subject with an effective amount of a
  • the composition is a pharmaceutical composition comprising any of: a Wnt surrogate molecule; a polynucleotide comprising a nucleic acid sequence encoding a Wnt surrogate molecule, e.g., a DNA or mRNA, optionally a modified mRNA; a vector comprising a nucleic acid sequence encoding a Wnt surrogate molecule, e.g., an expression vector or viral vector; or a cell comprising a nucleic acid sequence encoding a Wnt surrogate molecule, e.g., a cell transduced with an expression vector or viral vector encoding a Wnt surrogate molecule.
  • the disease or condition is a pathological disease or disorder, or an injury, e.g., an injury resulting from a wound.
  • the wound may be the result of another therapeutic treatment.
  • the disease or condition comprises impaired tissue repair, healing or regeneration, or would benefit from increased tissue repair, healing or regeneration.
  • contacting occurs in vivo, i.e. , the subject composition is administered to a subject.
  • the method comprises further contacting the subject with a pharmaceutical composition comprising one or more Wnt polypeptides or Norrin polypeptides.
  • a pharmaceutical composition comprising one or more Wnt polypeptides or Norrin polypeptides.
  • the present disclosure contemplates contacting a subject with a first molecule for delivery of a Wnt surrogate molecule as a first active agent and a second molecule for delivery of a Wnt polypeptide or Norrin polypeptide.
  • the first and second molecule may be the same type of molecule or different types of molecules.
  • the first and second molecule may each be independently selected from the following types of molecules: polypeptides, small organic molecules, nucleic acids encoding the first or second active agent (optionally DNA or mRNA, optionally modified RNA), vectors comprising a nucleic acid sequence encoding the first or second active agent (optionally expression vectors or viral vectors), and cells comprising a nucleic acid sequence encoding the first or second active agent (optionally an expression cassette).
  • the present disclosure provides a method for treating a disease or condition, e.g., a disease or disorder associated with reduced Wnt signaling, or for which increased Wnt signaling would provide a therapeutic benefit, comprising contacting a subject in need thereof with a pharmaceutical composition comprising an effective amount of a polynucleotide comprising a nucleic acid sequence encoding a Wnt surrogate molecule disclosed herein.
  • a pharmaceutical composition comprising an effective amount of a polynucleotide comprising a nucleic acid sequence that encodes a Wnt polypeptide or a Norrin polypeptide.
  • the polynucleotides are DNA or mRNA, e.g., a modified mRNA.
  • the polynucleotides are modified mRNAs further comprising a 5’ cap sequence and/or a 3’ tailing sequence, e.g., a polyA tail.
  • the polynucleotides are expression cassettes comprising a promoter operatively linked to the coding sequences.
  • the nucleic acid sequence encoding the Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same polynucleotide.
  • the present disclosure provides a method for treating a disease or condition, e.g., a disease or disorder associated with reduced Wnt signaling, or for which increased Wnt signaling would provide a therapeutic benefit, comprising contacting a subject in need thereof with a pharmaceutical composition comprising an effective amount of a vector comprising a nucleic acid sequence encoding a Wnt surrogate molecule.
  • a pharmaceutical composition comprising an effective amount of a vector comprising a nucleic acid sequence that encodes a Wnt polypeptide or a Norrin polypeptide.
  • the vector is an expression vector, and may comprise a promoter operatively linked to the nucleic acid sequence.
  • the vector is a viral vector.
  • the nucleic acid sequence encoding the Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same vector, e.g., in the same expression cassette.
  • the present disclosure provides a method for treating a disease or condition, e.g., a disease or disorder associated with reduced Wnt signaling, or for which increased Wnt signaling would provide a therapeutic benefit, comprising contacting a subject in need thereof with a pharmaceutical composition comprising an effective amount of a cell comprising a nucleic acid sequence encoding a Wnt surrogate molecule.
  • a pharmaceutical composition comprising an effective amount of a cell comprising a nucleic acid sequence encoding a Wnt surrogate molecule.
  • the subject is also contacted with a cell comprising a nucleic acid sequence that encodes a Wnt polypeptide or a Norrin polypeptide.
  • the nucleic acid sequence encoding the Wnt surrogate molecule and the nucleic acid sequence encoding the Wnt polypeptide or Norrin polypeptide are present in the same cell.
  • the cell is a heterologous cell or an autologous cell obtained from the subject to be treated.
  • the cell was transduced with a vector comprising an expression cassette encoding the Wnt surrogate molecule or the Wnt polypeptide or Norrin polypeptide.
  • the cell is a stem cell, e.g., an adipose-derived stem cell or a hematopoietic stem cell.
  • Wnt signaling plays key roles in the developmental process and maintenance of stem cells. Reactivation of Wnt signals is associated with regeneration and repair of most tissues after injuries and diseases. Wnt surrogate molecule molecules are expected to provide benefit of healing and tissue repair in response to injuries and diseases. Causes of tissue damage and loss include but are not limited to aging, degeneration, hereditary conditions, infection and inflammation, traumatic injuries, toxins/metabolic-induced toxicities, or other pathological conditions. Wnt signals and enhancers of Wnt signals have been shown to activate adult, tissue-resident stem cells. In some embodiments, the compounds of the present disclosure are administered for use in treating diseased or damaged tissue, for use in tissue regeneration and for use in cell growth and proliferation, and/or for use in tissue engineering.
  • compositions of the present disclosure may be used to promote or increase bone growth or regeneration, bone grafting, healing of bone fractures, stress fractures, vertebral compression fractures, treatment of osteoporosis and osteoporotic fractures, spinal fusion, osseointegration of orthopedic devices, tendon-bone integration, tooth growth and regeneration, dental implantation, periodontal diseases, maxillofacial reconstruction, and osteonecrosis of the jaw. They may also be used in the treatment of alopecia; enhancing regeneration of sensory organs, e.g. treatment of hearing loss, treatment of vestibular
  • hypofunction treatment of macular degeneration, treatment of vitreoretinopathy, other diseases of retinal degeneration, Fuchs’ dystrophy, other cornea disease, etc.
  • treatment of stroke traumatic brain injury, Alzheimer's disease, multiple sclerosis, muscular dystrophy, muscle atrophy caused by sarcopenia or cachexia, and other conditions affecting the blood brain barrier
  • treatment of spinal cord injuries other spinal cord diseases.
  • compositions of this present disclosure may also be used in treatment of oral mucositis, treatment of short bowel syndrome, inflammatory bowel diseases (IBD), other gastrointestinal disorders; treatment of metabolic syndrome; treatment of diabetes, dyslipidemia, treatment of pancreatitis, conditions where exocrine or endocrine pancreas tissues are damaged; conditions where enhanced epidermal regeneration is desired, e.g., epidermal wound healing, treatment of diabetic foot ulcers, syndromes involving tooth, nail, or dermal hypoplasia, etc., conditions where angiogenesis is beneficial; treatment of myocardial infarction, coronary artery disease, heart failure; enhanced growth of hematopoietic cells, e.g. enhancement of hematopoietic stem cell transplants from bone marrow, mobilized peripheral blood, treatment of
  • compositions of the present disclosure may also be used in enhanced regeneration of liver cells, e.g. liver regeneration, treatment of cirrhosis, enhancement of liver transplantations, treatment of acute liver failure, treatment of chronic liver diseases with hepatitis C or B virus infection or post- antiviral drug therapies, alcoholic liver diseases, alcoholic hepatitis, non-alcoholic liver diseases with steatosis or steatohepatitis (NASH), and the like.
  • liver regeneration e.g. liver regeneration, treatment of cirrhosis, enhancement of liver transplantations, treatment of acute liver failure, treatment of chronic liver diseases with hepatitis C or B virus infection or post- antiviral drug therapies, alcoholic liver diseases, alcoholic hepatitis, non-alcoholic liver diseases with steatosis or steatohepatitis (NASH), and the like.
  • compositions of this present disclosure may treat diseases and disorders including, without limitation, conditions in which regenerative cell growth is desired.
  • Conditions in which enhanced bone growth is desired may include, without limitation, fractures, grafts, ingrowth around prosthetic devices, osteoporosis, osteoporotic fractures, spinal fusion,
  • Wnt surrogate molecules enhance and promotes Wnt signals which are critical in promoting bone regeneration.
  • Methods for regeneration of bone tissues benefit from administration of the compounds of the present disclosure, which can be systemic or localized.
  • bone marrow cells are exposed to molecules of the present disclosure, such that stem cells within that marrow become activated.
  • bone regeneration is enhanced by contacting a responsive cell population, e.g., bone marrow, bone progenitor cells, bone stem cells, etc. with an effective dose of a Wnt surrogate molecule disclosed herein.
  • a responsive cell population e.g., bone marrow, bone progenitor cells, bone stem cells, etc.
  • Methods for regeneration of bone tissues benefit from administration of the Wnt surrogate molecule which can be systemic or localized.
  • the contacting is performed in vivo. In other such embodiments, the contacting is performed ex vivo.
  • the molecule may be localized to the site of action, e.g. by loading onto a matrix, which is optionally biodegradable, and optionally provides for a sustained release of the active agent.
  • Matrix carriers include, without limitation, absorbable collagen sponges, ceramics, hydrogels, polymeric microspheres, nanoparticles, bone cements, and the like.
  • compositions comprising one or more Wnt surrogate molecule disclosed herein (or a polynucleotide encoding a Wnt surrogate molecule, or a vector or cell comprising a polynucleotide encoding a Wnt surrogate molecule) are used to treat or prevent a bone disease or disorder, including but not limited to any of the following, or to treat or prevent an injury associated with, but not limited to, any of the following: osteoporosis, osteoporotic fractures, bone fractures, non-union fractures, delayed union fractures, spinal fusion,
  • Wnt surrogate molecules that bind Fzd1 , Fzd 2, and Fzd 7, and also LRP5 and/or LRP6, are used to treat or prevent any bone disease or disorder.
  • Wnt surrogate molecules that bind Fzd1 , Fzd 2, Fzd 5, Fzd 7 and Fzd 8, and also LRP5 and/or LRP6, are used to treat or prevent any bone disease or disorder.
  • compositions and methods disclosed herein may be used to: increase bone mineral density, increase bone volume (e.g., tibia and/or femur bone volume), increase cortical thickness (e.g., in trabecular region or in femur mid-diaphysis), increase mineral apposition rate, increase the number of osteblasts and/or decrease the number of osteoclasts (e.g., in bone), increase bone stiffness, increase the ultimate load to fracture point, improve bone resistance to fracture, decrease bone loss associated with osteoporosis, or increase biochemical strength of bone, in a subject.
  • bone volume e.g., tibia and/or femur bone volume
  • cortical thickness e.g., in trabecular region or in femur mid-diaphysis
  • increase mineral apposition rate e.g., in trabecular region or in femur mid-diaphysis
  • increase mineral apposition rate e.
  • Wnt surrogate molecules that bind Fzd1 , Fzd 2, and Fzd 7 are used for any of these indicated uses. In one embodiment, Wnt surrogate molecules that bind Fzd1 , Fzd 2, Fzd 5, Fzd 7 and Fzd 8 are used for any of these indicated uses.
  • compositions comprising one or more Wnt surrogate molecule disclosed herein (or a polynucleotide encoding a Wnt surrogate molecule, or a vector or cell comprising a polynucleotide encoding a Wnt surrogate molecule) can be used for the in vivo treatment of skeletal tissue deficiencies.
  • skeletal tissue deficiency it is meant a deficiency in bone or other skeletal connective tissue at any site where it is desired to restore the bone or connective tissue, no matter how the deficiency originated, e.g. whether as a result of surgical intervention, removal of tumor, ulceration, implant, fracture, or other traumatic or degenerative
  • compositions of the present disclosure can be used as part of a regimen for restoring cartilage function to a connective tissue, for the repair of defects or lesions in cartilage tissue such as degenerative wear and arthritis, trauma to the tissue, displacement of torn meniscus, meniscectomy, a luxation of a joint by a torn ligament, malalignment of joints, bone fracture, or by hereditary disease.
  • a Wnt surrogate molecule may also be used for treatment of periodontal diseases. Periodontal diseases are a leading cause of tooth loss and are linked to multiple systemic conditions.
  • tooth or underlying bone regeneration is enhanced by contacting a responsive cell population.
  • the contacting is performed in vivo.
  • the contacting is performed ex vivo, with subsequent implantation of the activated stem or progenitor cells.
  • the molecule may be localized to the site of action, e.g. by loading onto a matrix, which is optionally biodegradable, and optionally provides for a sustained release of the active agent.
  • Matrix carriers include, without limitation, absorbable collagen sponges, ceramics, hydrogels, bone cements, polymeric microspheres, nanoparticles, and the like.
  • the vestibular organs comprised of the semicircular canals (SSCs), the utricle, and the saccule, also contain sensory hair cells in order to detect head position and motion.
  • Compositions of the present disclosure can be used, for example, in an infusion; in a matrix or other depot system; or other topical application to the ear for enhancement of auditory regeneration.
  • a Wnt surrogate molecule may also be used in regeneration of retinal tissue.
  • Muller glia cells are capable of regenerating retinal cells, including photoreceptors, for example after neurotoxic injury in vivo.
  • Wnt signaling and enhancers of Wnt signals can promote proliferation of Muller glia-derived retinal progenitors after damage or during degeneration.
  • compositions of the present disclosure may also be used in the regeneration of tissues and other cell types in the eye.
  • AMD age-related macular degeneration
  • AMD is characterized by progressively decreased central vision and visual acuity.
  • Fuchs’ dystrophy is characterized by progressive loss of cornea endothelial cells.
  • Wnt signal and enhancing of Wnt signal can promote regeneration of cornea endothelium, retina epithelium, etc. in the eye tissue.
  • compositions of the present disclosure can be used, for example, in an infusion; in a matrix or other depot system; or other topical application to the eye for retinal regeneration and treatment of macular degeneration.
  • compositions comprising a Wnt surrogate molecule disclosed herein (or a polynucleotide encoding a Wnt surrogate molecule, or a vector or cell comprising a polynucleotide encoding a Wnt surrogate molecule) are used to promote liver regeneration, reduce fibrosis, and/or improve liver function.
  • compositions and methods disclosed herein are used to: increase liver weight, increase the liver to body weight ratio, increase the number of PCNA and pH3 positive nuclei in liver, increase expression of Ki67 and/or Cyclin D1 in liver, increase liver cell proliferation and/or mitosis, decrease fibrosis following chronic liver injury, or increase hepatocyte function.
  • compositions of this disclosure may be used in treatment of acute liver failure, acute alcoholic liver injuries, treatment of chronic liver diseases with hepatitis C or B virus infection or post-antiviral drug therapies, chronic alcoholic liver diseases, non-alcoholic fatty liver diseases and non-alcoholic steatohepatitis (NASH), treatment of cirrhosis and severe chronic liver diseases of all causes, and enhanced regeneration of liver cells.
  • Methods for regeneration of liver tissue benefit from administration of the compounds of the present disclosure, which can be systemic or localized. These include, but are not limited to, methods of systemic administration and methods of localized
  • administration e.g. by injection into the liver tissue, by injection into veins or blood vessels leading into the liver, by implantation of a sustained release formulation, and the like.
  • compositions comprising a Wnt surrogate molecule disclosed herein (or a polynucleotide encoding a Wnt surrogate molecule, or a vector or cell comprising a polynucleotide encoding a Wnt surrogate molecule) are used to treat or prevent a liver disease or disorder, including but not limited to, or to treat or prevent a liver injury or disorder resulting from any of the following: acute liver failure (all causes), chronic liver failure (all causes), cirrhosis, liver fibrosis (all causes), portal hypertension, nonalcoholic steatohepatisis
  • NASH nonalcoholic fatty liver disease
  • NAFLD nonalcoholic fatty liver disease
  • HCV hepatitis C virus-induced liver diseases
  • HBV hepatitis B virus-induced liver diseases
  • other viral hepatitis e.g., hepatitis A virus-induced liver diseases (HAV) and hepatitis D virus-induced liver diseases (HDV)
  • primary biliary cirrhosis autoimmune hepatitis
  • livery surgery liver injury, liver transplantation,“small for size” syndrome in liver surgery and transplantation
  • liver injury liver transplantation
  • liver transplantation “small for size” syndrome in liver surgery and transplantation
  • congenital liver disease and disorders any other liver disorder or defect resulting from genetic diseases, degeneration, aging, drugs, or injuries.
  • Various epidermal conditions benefit from treatment with the compounds of the present disclosure. Mucositis occurs when there is a breakdown of the rapidly divided epithelial cells lining the gastro-intestinal tract, leaving the mucosal tissue open to ulceration and infection.
  • the part of the epithelial lining that covers the mouth, called the oral mucosa is one of the most sensitive parts of the body and is particularly vulnerable to chemotherapy and radiation.
  • Oral mucositis is probably the most common, debilitating complication of cancer treatments, particularly chemotherapy and radiation.
  • the compositions of the present disclosure may also benefit treatment of short bowel syndrome,
  • epidermal conditions include epidermal wound healing, diabetic foot ulcers, syndromes involving tooth, nail, or dermal hypoplasia, and the like. Molecules of the present disclosure may be used in all these conditions, where regenerative cells are contacted with compounds of the present disclosure. Methods for regeneration of epithelial tissues benefit from administration of the compounds of the present disclosure, which can be systemic or localized. Contacting can be, for example, topical, including intradermal, subdermal, in a gel, lotion, cream etc.
  • Wnt signals and enhancement and promotion of Wnt signals also play an important role in repair and regeneration of tissues including pancreas, kidney, and lung in preclinical models.
  • a Wnt surrogate molecule may benefit various disease conditions involving exocrine and endocrine pancreas, kidney, or lung.
  • the Wnt surrogate molecules may be used in treatment of metabolic syndrome; treatment of diabetes, treatment of acute or chronic pancreatitis, exocrine pancreatic insufficiency, treatment of acute kidney injuries, chronic kidney diseases, treatment of lung diseases, including but not limited to chronic obstructive pulmonary diseases (COPD), other conditions that cause loss of lung epithelial tissues.
  • COPD chronic obstructive pulmonary diseases
  • hair follicle regeneration is enhanced by contacting a responsive cell population with a molecule of the present disclosure.
  • the contacting is performed in vivo.
  • the contacting is performed ex vivo.
  • the molecule may be localized to the site of action, e.g. topical lotions, gels, creams and the like.
  • BBB blood brain barrier
  • Angiogenesis is critical to ensure the supply of oxygen and nutrients to many tissues throughout the body, and is especially important for the CNS as the neural tissue is extremely sensitive to hypoxia and ischemia.
  • CNS endothelial cells which form the BBB differ from endothelial cells in non-neural tissue, in that they are highly polarized cells held together by tight junctions and express specific transporters. Wnt signaling regulates CNS vessel formation and/or function. Conditions in which the BBB is compromised can benefit from
  • compositions of the present disclosure may also be used in treatment of spinal cord injuries, other spinal cord diseases, stroke, traumatic brain injuries, etc.
  • Wnt signals also play a role in angiogenesis.
  • a Wnt surrogate molecule may benefit conditions where angiogenesis is beneficial, treatment of myocardial infarction, coronary artery disease, heart failure, etc., and conditions from hereditary diseases. Methods for regeneration of these tissues benefit from administration of the compounds of the present disclosure, which can be systemic or localized.
  • methods of the present disclosure promote tissue regeneration, e.g., in a tissue subjected to damage or tissue or cell reduction or loss.
  • the loss or damage can be anything which causes the cell number to diminish, including diseases or injuries.
  • an accident, an autoimmune disorder, a therapeutic side-effect or a disease state could constitute trauma.
  • Tissue regeneration increases the cell number within the tissue and preferably enables connections between cells of the tissue to be re-established, and more preferably the functionality of the tissue to be regained.
  • administering refers to delivery of a composition to a cell, to cells, tissues and/or organs of a subject, or to a subject. Such administering or introducing may take place in vivo, in vitro or ex vivo.
  • a pharmaceutical composition is administered parenterally, e.g., intravenously, orally, rectally, or by injection. In some embodiments, it is administered locally, e.g., topically or intramuscularly.
  • a composition is administered to target tissues, e.g., to bone, joints, ear tissue, eye tissue, gastrointestinal tract, skin, a wound site or spinal cord.
  • Methods of the present disclosure may be practiced in vivo or ex vivo.
  • the contacting of a target cell or tissue with a Wnt surrogate molecule is performed ex vivo, with subsequent implantation of the cells or tissues, e.g., activated stem or progenitor cells, into the subject.
  • the skilled artisan can determine an appropriate site of and route of administration based on the disease or disorder being treated.
  • the dose and dosage regimen may depend upon a variety of factors readily determined by a physician, such as the nature of the disease or disorder, the characteristics of the subject, and the subject's history.
  • a physician such as the nature of the disease or disorder, the characteristics of the subject, and the subject's history.
  • the amount of a Wnt surrogate molecule administered or provided to the subject is in the range of about 0.01 mg/kg to about 50 mg/kg, 0.1 mg/kg to about 500 mg/kg, or about 0.1 mg/kg to about 50 mg/kg of the subject’s body weight.
  • treatment generally mean obtaining a desired pharmacologic and/or physiologic effect.
  • the effect may be prophylactic in terms of completely or partially preventing a disease or symptom thereof, e.g. reducing the likelihood that the disease or symptom thereof occurs in the subject, and/or may be therapeutic in terms of a partial or complete cure for a disease and/or adverse effect attributable to the disease.
  • Treatment covers any treatment of a disease in a mammal, and includes: (a) preventing the disease from occurring in a subject which may be predisposed to the disease but has not yet been diagnosed as having it; (b) inhibiting the disease, i.e. , arresting its development; or (c) relieving the disease, i.e. , causing regression of the disease.
  • the therapeutic agent e.g., a Wnt surrogate molecule
  • the treatment of ongoing disease where the treatment stabilizes or reduces the undesirable clinical symptoms of the patient, is of particular interest. Such treatment is desirably performed prior to complete loss of function in the affected tissues.
  • the subject therapy will desirably be administered during the symptomatic stage of the disease, and in some cases after the symptomatic stage of the disease.
  • the subject method results in a therapeutic benefit, e.g., preventing the development of a disorder, halting the progression of a disorder, reversing the progression of a disorder, etc.
  • the subject method comprises the step of detecting that a therapeutic benefit has been achieved. The ordinarily skilled artisan will appreciate that such measures of therapeutic efficacy will be applicable to the particular disease being modified, and will recognize the appropriate detection methods to use to measure therapeutic efficacy.
  • Wnt surrogate molecules disclosed herein to promote or enhance the growth or proliferation of cells, tissues and organoids, for example, by contacting cells or tissue with one or more Wnt surrogate, optionally in combination with a Norrin or Rspondin
  • the cells or tissue are contacted ex vivo, in vitro, or in vivo.
  • Such methods may be used to generate cells, tissue or organoids for therapeutic use, e.g., to be transplanted or grafted into a subject. They may also be used to generate cells, tissue or organoids for research use.
  • the Wnt surrogate molecules have widespread applications in non-therapeutic methods, for example in vitro research methods.
  • the present disclosure provides a method for tissue regeneration of damaged tissue, such as the tissues discussed above, comprising administering a Wnt surrogate molecule to cells.
  • the Wnt surrogate molecule may be administered directly to the cells in vivo, administered to a subject orally, intravenously, or by other methods known in the art, or administered to ex vivo cells.
  • Wnt surrogate molecule is administered to ex vivo cells
  • these cells may be transplanted into a subject before, after or during administration of the Wnt surrogate molecule.
  • Wnt signaling is a key component of stem cell culture.
  • the stem cell culture media as described in WO2010/090513, WO2012/014076, Sato et al., 2011 (GASTROENTEROLOGY 201 1 ; 141 : 1762-1772) and Sato et al., 2009 (Nature 459, 262-5).
  • the Wnt surrogate molecules disclosed herein are suitable alternatives to Rspondin for use in these stem cell culture media, or may be combined with Rspondin.
  • the disclosure provides a method for enhancing the proliferation of stem cells comprising contacting stem cells with one or more Wnt surrogate molecules disclosed herein.
  • the disclosure provides a cell culture medium comprising one or more Wnt surrogate molecules disclosed herein.
  • the cell culture medium may be any cell culture medium already known in the art that normally comprises Wnt or Rspondin, but wherein the Wnt or Rspondin is replaced (wholly or partially) or supplemented by Wnt surrogate molecule(s) disclosed herein.
  • the culture medium may be as described in as described in WO2010/090513,
  • Stem cell culture media often comprise additional growth factors.
  • This method may thus additionally comprise supplying the stem cells with a growth factor.
  • Growth factors commonly used in cell culture medium include epidermal growth factor (EGF, (Peprotech), Transforming Growth Factor-alpha (TGF-alpha, Peprotech), basic Fibroblast Growth Factor (bFGF, Peprotech), brain-derived neurotrophic factor (BDNF, R&D Systems), Hepatocyte Growth Factor (HGF) and Keratinocyte Growth Factor (KGF, Peprotech, also known as FGF7).
  • EGF epidermal growth factor
  • TeGF-alpha Transforming Growth Factor-alpha
  • bFGF basic Fibroblast Growth Factor
  • BDNF brain-derived neurotrophic factor
  • HGF Hepatocyte Growth Factor
  • KGF Keratinocyte Growth Factor
  • the EGF precursor exists as a membrane- bound molecule which is proteolytically cleaved to generate the 53-amino acid peptide hormone that stimulates cells.
  • EGF or other mitogenic growth factors may thus be supplied to the stem cells.
  • the mitogenic growth factor may be added to the culture medium every second day, while the culture medium is refreshed preferably every fourth day.
  • a mitogenic factor is selected from the groups consisting of: i) EGF, TGF-alpha, and KGF, ii) EGF, TGF-alpha, and FGF7; iii) EGF, TGF-alpha, and FGF; iv) EGF and KGF; v) EGF and FGF7; vi) EGF and a FGF; vii) TGF-alpha and KGF; viii) TGF-alpha, and FGF7; ix) or from TGF-alpha and a FGF.
  • the disclosure includes a stem cell culture media comprising a Wnt surrogate molecule disclosed herein, e.g., optionally in combination with one or more of the growth factors or combinations thereof described herein.
  • the Wnt surrogate molecules are used to enhance stem cell regeneration.
  • Illustrative stem cells of interest include but are not limited to: muscle satellite cells; hematopoietic stem cells and progenitor cells derived therefrom (U.S. Patent No. 5,061 ,620); neural stem cells (see Morrison et al. (1999) Cell 96: 737-749); embryonic stem cells; mesenchymal stem cells;
  • mesodermal stem cells liver stem cells; adipose-tissue derived stem cells, etc.
  • inventions of the present disclosure relate, in part, to diagnostic applications for detecting the presence of cells or tissues expressing one or more Fzd receptors or LRP5 or LRP6 receptors.
  • the present disclosure provides methods of detecting one or more Fzd receptors or LRP5 or LRP6 receptors in a sample, such as detection of cells or tissues expressing Fzd1.
  • ISH immunohistochemistry
  • ICC immunocytochemistry
  • ISH in situ hybridization
  • WISH whole-mount in situ hybridization
  • FISH fluorescent DNA in situ hybridization
  • EIA enzyme immuno-assay
  • ELISA enzyme linked immuno-assay
  • ISH is a type of hybridization that uses a labeled complementary DNA or RNA strand (i.e., primary binding agent) to localize a specific DNA or RNA sequence in a portion or section of a cell or tissue ⁇ in situ), or if the tissue is small enough, the entire tissue (whole mount ISH).
  • primary binding agent i.e., primary binding agent
  • Fluorescent DNA ISH can, for example, be used in medical diagnostics to assess chromosomal integrity.
  • RNA ISH hybridization histochemistry
  • mRNAs and other transcripts are used to measure and localize mRNAs and other transcripts within tissue sections or whole mounts.
  • the Wnt surrogate molecules described herein are conjugated to a detectable label that may be detected directly or indirectly.
  • an antibody “conjugate” refers to a Wnt surrogate molecule that is covalently linked to a detectable label.
  • DNA probes, RNA probes, monoclonal antibodies, antigen-binding fragments thereof, and antibody derivatives thereof, such as a single-chain-variable-fragment antibody or an epitope tagged antibody may all be covalently linked to a detectable label.
  • In“direct detection” only one detectable antibody is used, i.e., a primary detectable antibody. Thus, direct detection means that the antibody that is conjugated to a detectable label may be detected, per se, without the need for the addition of a second antibody (secondary antibody).
  • a “detectable label” is a molecule or material that can produce a detectable (such as visually, electronically or otherwise) signal that indicates the presence and/or concentration of the label in a sample.
  • the detectable label can be used to locate and/or quantify the target to which the specific antibody is directed. Thereby, the presence and/or concentration of the target in a sample can be detected by detecting the signal produced by the detectable label.
  • a detectable label can be detected directly or indirectly, and several different detectable labels conjugated to different specific-antibodies can be used in combination to detect one or more targets. Examples of detectable labels, which may be detected directly, include fluorescent dyes and radioactive substances and metal particles. In contrast, indirect detection requires the application of one or more additional antibodies, i.e.
  • secondary antibodies after application of the primary antibody.
  • the detection is performed by the detection of the binding of the secondary antibody or binding agent to the primary detectable antibody.
  • primary detectable binding agents or antibodies requiring addition of a secondary binding agent or antibody include enzymatic detectable binding agents and hapten detectable binding agents or antibodies.
  • the detectable label is conjugated to a nucleic acid polymer which comprises the first binding agent (e.g., in an ISH, WISH, or FISH process). In other embodiments, the detectable label is conjugated to an antibody which comprises the first binding agent (e.g., in an IHC process).
  • detectable labels which may be conjugated to Wnt surrogate molecules used in the methods of the present disclosure include fluorescent labels, enzyme labels, radioisotopes, chemiluminescent labels, electrochemiluminescent labels, bioluminescent labels, polymers, polymer particles, metal particles, haptens, and dyes.
  • fluorescent labels include 5-(and 6)-carboxyfluorescein, 5- or 6-carboxyfluorescein, 6-(fluorescein)-5-(and 6)-carboxamido hexanoic acid, fluorescein isothiocyanate, rhodamine, tetramethylrhodamine, and dyes such as Cy2, Cy3, and Cy5, optionally substituted coumarin including AMCA, PerCP, phycobiliproteins including R-phycoerythrin (RPE) and allophycoerythrin (APC), Texas Red, Princeton Red, green fluorescent protein (GFP) and analogues thereof, and conjugates of R-phycoerythrin or allophycoerythrin, inorganic fluorescent labels such as particles based on semiconductor material like coated CdSe nanocrystallites.
  • RPE R-phycoerythrin
  • APC allophycoerythrin
  • GFP green fluorescent protein
  • polymer particle labels include micro particles or latex particles of polystyrene, PMMA or silica, which can be embedded with fluorescent dyes, or polymer micelles or capsules which contain dyes, enzymes or substrates.
  • metal particle labels include gold particles and coated gold particles, which can be converted by silver stains.
  • haptens include DNP, fluorescein isothiocyanate (FITC), biotin, and digoxigenin.
  • Examples of enzymatic labels include horseradish peroxidase (HRP), alkaline phosphatase (ALP or AP), b-galactosidase (GAL), glucose-6-phosphate dehydrogenase, b-N- acetylglucosamimidase, b-glucuronidase, invertase, Xanthine Oxidase, firefly luciferase and glucose oxidase (GO).
  • Examples of commonly used substrates for horseradishperoxidase include 3,3'-diaminobenzidine (DAB), diaminobenzidine with nickel enhancement, 3-amino-9-ethylcarbazole (AEC), Benzidine
  • BDHC dihydrochloride
  • HARM Hanker-Yates reagent
  • IB Indophane blue
  • TMB tetramethylbenzidine
  • CN 4-chloro-1 -naphtol
  • CN 4-chloro-1 -naphtol
  • CN 4-chloro-1 -naphtol
  • CN 4-chloro-1 -naphtol
  • Examples of commonly used substrates for Alkaline Phosphatase include Naphthol-AS-B 1 -phosphate/fast red TR (NABP/FR), Naphthol-AS-MX- phosphate/fast red TR (NAMP/FR), Naphthol-AS-B1 -phosphate/- fast red TR (NABP/FR), Naphthol-AS-MX-phosphate/fast red TR (NAMP/FR), Naphthol-AS- B1 -phosphate/new fuschin (NABP/NF), bromochloroindolyl phosphate/nitroblue tetrazolium (BCIP/NBT), 5-Bromo-4-chloro-3-indolyl-b-- d-galactopyranoside (BCIG).
  • NABP/FR Naphthol-AS-B 1 -phosphate/fast red TR
  • NAMP/FR Naphthol-AS-MX- phosphate/fast red TR
  • luminescent labels include luminol, isoluminol, acridinium esters, 1 ,2-dioxetanes and pyridopyridazines. Examples of
  • electrochemiluminescent labels include ruthenium derivatives.
  • radioactive labels include radioactive isotopes of iodide, cobalt, selenium, tritium, carbon, sulfur and phosphorous.
  • Detectable labels may be linked to the antibodies described herein or to any other molecule that specifically binds to a biological marker of interest, e.g., an antibody, a nucleic acid probe, or a polymer.
  • detectable labels can also be conjugated to second, and/or third, and/or fourth, and/or fifth binding agents or antibodies, etc.
  • each additional binding agent or antibody used to characterize a biological marker of interest may serve as a signal amplification step.
  • the biological marker may be detected visually using, e.g., light microscopy, fluorescent microscopy, electron microscopy where the detectable substance is for example a dye, a colloidal gold particle, a luminescent reagent.
  • Visually detectable substances bound to a biological marker may also be detected using a spectrophotometer.
  • the detectable substance is a radioactive isotope detection can be visually by autoradiography, or non-visually using a scintillation counter. See, e.g., Larsson, 1988, Immunocytochemistry: Theory and Practice, (CRC Press, Boca Raton, Fla.); Methods in Molecular Biology, vol. 80 1998, John D. Pound (ed.) (Humana Press, Totowa, N.J.).
  • kits for detecting one or more Fzd or LRP5/6 receptor or cells or tissues expressing one or more Fzd or LRP5/6 receptors in a sample wherein the kits contain at least one antibody, polypeptide, polynucleotide, vector or host cell as described herein.
  • a kit may comprise buffers, enzymes, labels, substrates, beads or other surfaces to which the antibodies of the present disclosure are attached, and the like, and instructions for use.
  • Wnt surrogate molecules representing different configurations were produced, as further described in the following Examples. These included the Wnt surrogate molecules disclosed in Table 5 5 below, which comprise the sequences set forth in SEQ ID NOs: 109-157. The specific Fzd and LRP binding elements used for Wnt surrogate molecules presented in these examples are listed in Tables 1 A and 1 B and 2A and 2B.
  • Receptor Hinge Region Active Wnt surrogate molecules were generated comprising various combinations of Fzd binders that bind the Fzd receptor hinge region (see FIG. 2A) and LRP binders.
  • Fzd binders that bind the Fzd receptor hinge region (see FIG. 2A) and LRP binders.
  • Two antibodies that bind to the hinge region of Fzd7, anti-FZD7-1791 (SEQ ID NOS:70-71 ) and anti-FZD7-1291 (SEQ ID NOS:72-73), have been described in WO2016/205551 and WO2016/205566. These two antibodies were used to
  • Both anti-FZD7-1791 and anti-FZD7-1291 were cloned into human lgG1 framework with LALA-PG mutations in Fc to reduce effector functions.
  • LRP5 binder #3 (008S- D01 ; SEQ ID NO:97) was cloned in frame to the N-termini of the light chains of both antibodies as depicted in FIG. 2B.
  • Both recombinant appended IgG proteins, named 1791 -3 (SEQ ID NOs:113-114) and 1291 -3 (SEQ ID NOs:111-112), respectively, were prepared by transfection of respective expression vectors into Expi293F cells (Thermo Fisher Scientific, Waltham, MA) according to the manufacturer’s instructions. Briefly, four days after the transfection, cell culture medium was collected after spinning down the cell pellet. The media was incubated with Protein A resin (REPLIGEN,
  • Antibodies that bind to the hinge region of Fzd1 and Fzd2 were utilitized to demonstrate that, in addition to the Fzd7 hinge, other Fzd hinge regions also yield active Wnt surrogate molecules.
  • Recombinant Fab fragments of these antibodies were produced from Expi293F cells (Thermo Fisher Scientific, Waltham, MA) via transient transfection. The Fabs were purified from the culture media with Nickel resin and further polished with size exclusion chromatography (SEC).
  • the anti-FZD1 hinge and anti-FZD2 hinge antibodies were cloned into human lgG1 framework with LALA-PG mutations in Fc to reduce effector functions.
  • LRP5 binder #3 (008S-D01 ; SEQ ID NO:97) or LRP5/6 binder #36 (013S-D05; SEQ ID NOs: 91 and 96) were cloned in frame to the N-termini of the light chains of respective antibodies as depicted in FIG. 2B.
  • the recombinant appended IgG proteins were prepared by transfection of respective expression vectors into Expi293F cells (Thermo Fisher Scientific, Waltham, MA) according to the manufacturer’s instructions. Briefly, four days after the transfection, cell culture medium was collected after spinning down the cell pellet. The media was incubated with Protein A resin (REPLIGEN, Waltham,
  • Binding kinetics of 1791 -3 and 1291 -3 to either Fzd7 CRD or Fzd7 CRD with the extracellular hinge region sequences (Fzd7 CRD+hinge) was determined by bio-layer interferometry (BLI) using Octet Red 96 (PALL ForteBio, Fremont, CA) instruments at 30° C, 1000 rpm with streptavidin (SA) biosensors. N-terminal biotinylated Fzd7 CRD and Fzd7 CRD+hinge proteins were captured on the SA biosensor.
  • the SA biosensor with captured biotinylated-Fzd7 was dipped into wells containing the relevant antibodies at 7 different concentrations in running buffer plus a well with only running buffer as a reference channel. KD was determined by global fitting. As shown in FIG. 2C, both of these antibody fusion proteins only bound to the Fzd7 protein with the hinge region, and not to the Fzd7 CRD domain alone.
  • R2M3-3 Another Wnt surrogate molecule, R2M3-3 (Fzd binder 001 S-A04; Lrp binder 008S-D01 ; SEQ ID NOs: 109-110), which can engage Fzd1 , Fzd2, Fzd7, Fzd5, and Fzd8, was also tested. As shown in FIG. 2D, the maximal effect from 1791-3 is approaching that of the multifamily specific R2M3-3.
  • Wnt surrogates comprising antibodies that bind the Fzd1 or Fzd2 hinge regions to activate Wnt signaling was assessed in the 293 STF cell line overexpressing either Fzd1 or Fzd2, where the b-Catenin luciferase reporter plasmid Super TOP Flash (STF) was stably integrated.
  • STF b-Catenin luciferase reporter plasmid Super TOP Flash
  • Sequences from monospecific Wnt surrogate molecules were combined to generate a multispecific Wnt surrogate molecule with a desired combination of Fzd binding specificity.
  • two monospecific Wnt surrogate molecules 4SD1 -3 (Fzd binder 004S-D01 ; Lrp binder 008S-D01 ; SEQ ID NOs:115-116), which binds Fzd4, and 14SB6-3 (Fzd binder 014S-B06; Lrp binder 008S-D01 ; SEQ ID
  • hetero-lg 4SD1 -3+14SB6-3 (SEQ ID NOs: 120 and122 ).
  • Half of the hetero-lg molecule came from 4SD1 -3 with the introduction of the “holes” mutations in the CH3 domain (SEQ ID NO: 120).
  • This half of the molecule contained one binding arm to Fzd4 and one binding arm to LRP5.
  • the other half of the hetero-lg molecule came from 14SB6-3 with the introduction of the“knobs” mutations in the CH3 domain (SEQ ID NO:122).
  • This half of the molecule contained one binding arm to Fzd9 and one binding arm to LRP5.
  • 4SD1 -3 monovalent bispecific SEQ ID NO: 120 and 123
  • 14SB6-3 monovalent bispecific SEQ ID NO: 122 and 124
  • the 4SD1 -3 monovalent bispecific molecule contained the 4SD1-3 half of the hetero-lg with the“holes” mutations (SEQ ID NO: 120) paired with an Fc with “knobs” mutations (SEQ ID NO: 123), but without an Fab arm; therefore, this molecule was bispecific but monovalent against Fzd4 and LRP5.
  • the 14SB6-3 monovalent bispecific contained the 14SB6-3 half of the hetero-lg with the“knobs” mutations SEQ ID NO: 122) paired with an Fc with“holes” mutations SEQ ID NO: 124), but without an Fab arm; therefore, this molecule was bispecific but monovalent against Fzd9 and LRP5.
  • Hetero-lg 4SD1 -3+14SB6-3, 4SD1 -3 monovalent bispecific, and 14SB6-3 monovalent bispecific were purified through a 4-step purification process. Since the Fc containing the“knobs” mutation also contains a FLAG tag, and the Fc containing the “holes” mutation also contains a His tag, these proteins were purified first by protein A and Ni-NTA affinity purification steps, followed by an SEC step; Anti-FLAG M2 beads were used as a final purification step.
  • a retrovirus-based Fzd4 overexpression 293STF stable cell line was generated (293STF Fzd40E).
  • both R2M3-3 and 4SD1 -3 (Fzd4 monospecific) potently activated Wnt signaling, while the hetero-lg 4SD1 -3+14SB6-3 showed very weak activity, and the Fzd9 monospecific molecule, 14SB6-3 was inactive (FIG. 3C).
  • Fzd9 was introduced into the parental 293STF cells through transient transfection to create the 293STF Fzd90E cell line.
  • both R2M3-3 and 14SB6-3 Fzd9 monospecific
  • both R2M3-3 and 14SB6-3 were able to activate Wnt signaling
  • the hetero-lg 4SD1 -3+14SB6-3 showed very weak activity
  • Fzd4 and Fzd9 were co-introduced into 293STF cells through a combination of retroviral Fzd4 delivery and Fzd9 transient transfection to create the 293STF Fzd40E + Fzd90E cell line.
  • R2M3-3, 4SD1-3, 14SB6-3, and hetero-lg 4SD1 -3+14SB6-3 were all fully active (FIG. 3E)
  • Wnt signaling can be mediated through beta-catenin-dependent
  • a multivalent molecule consisting of bivalent binding arms (004S- C10) toward Fzd6, a noncanonical receptor, was combined with bivalent binding arms (3; 004S-D01 ) toward Lrp5.
  • the molecule is named 4SC10-3 (Fig. 5A top panel).
  • Such a format has been shown to activate beta-catenin-dependent signaling when the Fzd binder is directed against a canonical Fzd receptor.
  • Fig. 5A top panel Such a format has been shown to activate beta-catenin-dependent signaling when the Fzd binder is directed against a canonical Fzd receptor.
  • 4SC10-3 was not able to effectively activate beta-catenin-dependent signaling in 293STF reporter cells (in the presence of 20nM R-spondin), in contrast to the positive control molecule R2M3-26 (Fzd binder 001 S-A04; Lrp binder 009S-E04) that engages Fzd1 ,2, 7, 5, 8.
  • a multivalent molecule consisting of 4SC10 and another Fzd binding arm, 1 RC07 (001 S- B03), which binds to Fzd1 ,2,7 (canonical Fzd receptors), was combined with bivalent binding arms (3) toward Lrp5.
  • the molecule is named heterolg 4SC10-3+1 RC07-3 (Fig. 5B top panel), and it activated beta-catenin-dependent signaling in 293STF reporter cells.
  • the 1 RC07-3 monovalent bispecific molecule shown in Fig. 5C top panel was also tested. As shown in Fig. 5C, 1 RC07-3 monovalent bispecific molecule is not able to effectively activate signaling.
  • Multivalent formats produced potent and highly efficacious Wnt signaling activators.
  • Experiments were designed to test the impact of the formats on endogenous Wnt signaling.
  • an inactive surrogate molecule was generated with a null mutant of R2M3, R2M3mut (Y9A), and fused to either Lrp binders 3 or 26, and named R2M3mut-3 or R2M3mut-26, respectively.
  • R2M3, R2M3mut Y9A
  • This format in principle, should lack the ability to synergize with endogenous Wnt ligands via cross-linking of Lrp co-receptors.
  • Fzd binders tested in this structure include R2M3 (001 S-A04), 1 RC07 (001 S- B03), R2M13 (004S- G06), and 5S-H5 (005S-H05)
  • heterodimerized/multimerized Lrp binders directed against two different regions on Lrp may also relieve synergistic effects of bivalent Lrp binder formats on endogenous Wnt ligands was tested. As shown in Fig. 7A, several examples were contstructed in a 2:1 :1 ratio, where two different Lrp binders (one binds to Lrp5E1 E2, the other binds to
  • Lrp6E3E4 were each fused to either the N-terminus of light chain of Fzd binder,
  • a multivalent molecule with two distinct Fzd binding arms and two distinct Lrp binding arms termed 1 : 1 : 1 : 1 format as shown in Fig. 7C was generated.
  • Both the 1 RC07-26+4SD1 -3 (1 : 1 : 1 : 1 ) and R2M9-26+1 RC07-3 (1 : 1 : 1 : 1 ) combinations resulted in strong induction of Wnt signaling (Fig. 7D).
  • R2M9 structure contains the 003S-E07 Fzd binding element.
  • Figs. 5-7 illustrate the various structures for induction of canonical or non-canonical Wnt signaling (or both), as well as the ability to synergize with, antagonize, or leave unaffected signaling via endogenous Wnt ligands within target tissues.
  • This versatile collection of soluble Wnt surrogate ligands could be used for therapies with tailored Wnt signaling that may allow for maximum therapeutic effect and minimal side effects.
  • a surrogate WNT agonist generated by linking a FZD binder (18R5 antibody in scFv format) and the C-terminal portion of Dickkopf (DKK1c) into a single polypeptide chain (18R5-DKK1c) exhibited the ability to activate WNT/p-catenin signaling (Janda et al. , 2017, Nature, 545(7653):234-237). Combination of various FZD and LRP binding antibody fragments were generated based on this concept.
  • F1 , F2, and F3 and LRP scFvs The sequences for Fzd binding scFvs, referred to as F1 , F2, and F3, and LRP scFvs, referred to as L1 and L2, as well as linker sequences used to combine them are shown in Table 6A. Since these molecules have a monovalent binding arm to each target, we refer to this format as bivalent bispecific format (denoted as 1 : 1 to represent the stoichiometry of binding to one FZD and one LRP molecule).
  • LRP binder is a LRP6 E1 E2 domains binder, 1 1 15.3 (US 8,715,941 B2), which is referred herein as L1 .
  • L1 was fused to either the N- or C-terminus of 18R5 scFv (referred herein as F1 ) with 5, 10, or 15 amino acid linkers in between.
  • Multivalent molecules wre produced in a more defined and easily produced format by attaching L1 and F1 tandem scFv fusions to the N-terminus of an Fc fragment as depicted in Fig. 10A to generate a tetravalent bispecific format.
  • FZD/LRP binding molecules as compared to WNT3A and 18R5-DKK1 c are similar to that of the pre-SEC material shown in Fig. 8 (Fig. 11 ).
  • the affinity of the binding arms to their respective receptors in this tetravalent bispecific format was determined using bio-layer interferometry on an Octet instrument.
  • the relative orientation and linker lengths had no impact on the affinity of the respective arms to their target receptors, suggesting that the effects of orientation on the reporter activity is not due to impact of format on binding but rather the geometry of the receptors assembled by the surrogate molecules.
  • DKK1 c predominantly binds LRP E3E4 domain (Ahn et al. , 2011 , Cheng et al., 2011 ).
  • L2 an LRP6E3E4 binder
  • YW211.31.57 US 8,846,041 B2
  • L2 was tested in the 1 : 1 tandem scFv format where L2 was fused to either the N- or C-terminus of F1 scFv with 5, 10, or 15 amino acid linkers in between. While these fusion proteins behaved less well and expressed at lower levels compared to the L1/F1 fusion proteins (Fig. 13A), similar to L1/F1 fusion proteins shown in Fig.
  • the 1 :1 bivalent bispecific tandem scFv format and the 2:2 tetravalent bispecific fusions to Fc were also constructed between F3 and the two LRP binders. Similar to the observation with F1 fusions shown in Fig. 8, no robust activities were observed for the 1 : 1 tandem scFv fusion molecules between F3 and L1 or L2 (Fig. 17). In contrast, 293 STF reporter activities of the fusion molecules between F3, LRP binders, and Fc in the 2:2 tetravalent bispecific format from the SEC column fractions coincided to the protein peak of the monomeric forms of the molecules (Fig. 16A and 16B).

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WO2022130342A1 (en) 2020-12-18 2022-06-23 Antlera Therapeutics Inc. Tetravalent fzd and wnt co-receptor binding antibody molecules and uses thereof
JP7778148B2 (ja) 2020-12-18 2025-12-01 アントラーエイ セラピューティクス インコーポレイテッド 四価ＦＺＤ及びＷＮＴコレセプター（ｃｏ－ｒｅｃｅｐｔｏｒ）結合抗体分子並びにその使用
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DK3820906T3 (da) 2025-12-15
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CN112566940A (zh) 2021-03-26
CN112566940B (zh) 2025-06-13
EP3820906A1 (en) 2021-05-19
CA3104526A1 (en) 2020-01-09
AU2019297522B2 (en) 2026-04-23
JP2024001292A (ja) 2024-01-09
EP4733325A2 (en) 2026-04-29
US20210292422A1 (en) 2021-09-23
EP3820906A4 (en) 2022-04-20
JP2021529796A (ja) 2021-11-04
EP3820906B1 (en) 2025-10-15
PL3820906T3 (pl) 2026-04-13

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