Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies

Definitions

• the invention relates to diastolic dysfunction and related conditions and to antibody compositions and vaccines and therapeutic uses of same.
• Diastole is the part of the cardiac cycle that includes the isovolumetric relaxation phase and the filling phases and has passive and active components. The filling of the left ventricle
• LV is divided into rapid filling during early diastole, diastasis, and a rapid filling phase late in diastole that corresponds with atrial contraction.
• LV relaxation an essential characteristic of normal diastole, is an energy-dependent process.
• adenosine triphosphate ATP
• ATP adenosine triphosphate
• ATP production is limited, for example where there has been an impairment in the cardiac uptake of glucose and/or impairments in mitochondrial metabolism, this may result in a slower rate of isovolumic relaxation and reduced distensibility of the LV.
• LVDD Left ventricular diastolic dysfunction
• preload volume an adequate end diastolic volume
• LVDD is generally a consequence of abnormalities during diastole.
• impaired LV relaxation, high filling pressure, and increased LV operating stiffness are underlying mechanisms in LVDD.
• Cardiac impairments that represent LVDD include reduced E:A ratio and increased deceleration time. These impairments can lead to concentric hypertrophy and associated cardiomyopathy, and heart failure.
• Asymptomatic diastolic dysfunction may be present for significant periods before it develops into a symptomatic clinical event.
• pulmonary pressures increase abnormally during exercise, producing reduced exercise tolerance.
• filling pressures increase further, clinical signs of heart failure appear.
• atrial fibrillation diastolic dysfunction may rapidly lead to overt diastolic heart failure.
• the asymptomatic phase of diastolic dysfunction represents a potential time to intervene to prevent symptomatic heart failure. Suggesting the success of possible interventions, a mortality benefit has been observed in those whose diastolic dysfunction improved compared with those whose diastolic dysfunction remained the same or worsened.
• Patients with LVDD are generally older, more often female, and have a high prevalence of CVD and other morbid conditions, such as obesity, metabolic syndrome, diabetes mellitus type 2, salt- sensitive hypertension, atrial fibrillation, COPD, anemia, and/or renal dysfunction.
• HFPeF preserved ejection fraction
• HFPeF normal ejection fraction is observed, but only at the expense of increased LV filling pressure.
• HFPeF is sometimes referred to as 'diastolic heart failure ' or 'backward heart failure ' .
• LVDD is an important precursor to many different cardiovascular diseases. It represents the dominant mechanism (2/3 of patients) in the development of HFPeF. HFPeF shows a rising prevalence in the older population. By 2020, more than 8% of people over 65 are estimated to have HFPEF and is associated with a poor prognosis .
• W02010/035261A2 discusses polypeptides, compositions, and methods of use thereof for optimized treatment of diseases or disorders associated with amyloid beta protein ( ⁇ ) accumulation in a subject.
• W02009/052125A2 discusses a human anti-amyloid antibody, including isolated nucleic acids that encode at least one anti- amyloid antibody, amyloid, vectors, host cells, transgenic animals or plants, and methods of making and using thereof, including therapeutic compositions, methods and devices.
• WO20Q5/028511A2 discusses an anti-amyloid antibody, including isolated nucleic acids that encode at least one anti-amyloid antibody, amyloid, vectors, host cells, transgenic animals or plants, and methods of making and using thereof, including therapeutic compositions, methods and devices.
• W02008/002893A2 discusses antibodies, including specified portions or variants, specific for at least one beta-amyloid (amyloid) protein or fragment thereof, as well as anti-idiotype antibodies, and nucleic acids encoding such anti-amyloid antibodies, complementary nucleic acids, vectors, host cells, and methods of making and using thereof, including therapeutic formulations, administration and devices.
• W02007/068412A2 discusses methods and compositions for the therapeutic and diagnostic use in the treatment of diseases and disorders which are caused by or associated with amyloid or amyloid-like proteins including amyloidosis, a group of disorders and abnormalities associated with amyloid protein such as Alzheimer's disease.
• AD Alzheimer disease
• No.22 discusses if amyloid beta ( ⁇ ) protein aggregates are present in the hearts of patients with a primary diagnosis of AD, affecting myocardial function.
• No. 1 discusses an overview of cardiovascular links to
• the invention relates to methods of treating, preventing, or ameliorating diastolic dysfunction or conditions associated with or arising from same, and to pharmaceutical compositions and kits for providing antibodies that bind to ⁇ 42 in an individual for treating or preventing diastolic dysfunction or conditions associated with or arising from same.
• the invention provides a method for preventing or treating diastolic dysfunction or condition associated with same in an individual including providing in an individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• the invention further provides a composition comprising a therapeutically effective amount of an anti-A ⁇ 42 antibody for use in preventing or treating diastolic dysfunction or condition associated with same in an individual.
• the invention further provides a use of a composition comprising an anti-A ⁇ 42 antibody in the manufacture of a medicament for preventing or treating diastolic dysfunction or condition associated with same.
• the invention further provides a method for preventing or treating diastolic dysfunction or condition associated with same in an individual comprising: assessing or having assessed, a sample, preferably a plasma sample obtained from an individual for whom diastolic dysfunction is to be prevented or treated to determine the amount of ⁇ 42 in the sample; and where the individual has an amount of ⁇ 42 that is greater than that observed in a control describing the amount of ⁇ 42 in an individual who does not develop, or does not have diastolic dysfunction; o providing an anti-A ⁇ 42 antibody in the individual; thereby preventing or treating diastolic dysfunction or condition associated with same in the individual.
• the invention further provides a method for determining likelihood of an individual having or developing diastolic dysfunction comprising: assessing or having assessed, a sample, preferably a plasma sample obtained from an individual for whom the likelihood of having or developing diastolic dysfunction is to be determined to determine the amount of ⁇ 42 in the sample; determining that the individual has a higher likelihood of developing or having diastolic dysfunction where the amount of ⁇ 42 is greater than that observed in a control describing the amount of ⁇ 42 in an individual who does not develop, or does not have diastolic dysfunction; determining that the individual has a lower likelihood of developing or having diastolic dysfunction where the amount of ⁇ 42 is the same as that observed in the control; thereby determining the likelihood of an individual having or developing diastolic dysfunction.
• the invention further provides a kit comprising: an anti-A ⁇ 42 antibody and/or a vaccine or immune-stimulating composition for producing an anti-A ⁇ 42 antibody in an individual; written instructions for use of the kit in an enumerated embodiment described below.
• the invention further provides a pharmaceutical formulation comprising:
• an anti-A ⁇ 42 antibody preferably Bapineuzumab wherein the antibody is provided in an amount of about 1 to 250 mg/ml of the formulation, more preferably about 10 to 200 mg/ml of the formulation, more preferably about 40 to 80 mg/ml of the formulation, preferably 80mg/ml of the formulation, or preferably 150 to 200mg/ml for sub-cutaneous or intramuscular administration, optionally wherein the formulation does not comprise a salt, or does not comprise a buffer.
• Embodiment 1 A method for preventing or treating diastolic dysfunction in an individual, preferably an obese, or pre- diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• a therapeutically effective amount of an anti- ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 2 A method for preventing or treating heart failure, more preferably HFpEF in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• a therapeutically effective amount of an anti- ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 3 A method for preventing or treating concentric hypertrophy in an individual, preferably an obese, or pre- diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• an anti- ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 4 A method for preserving or decreasing left ventricle deceleration time in an individual, preferably in an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• an anti- ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 5 A method for preserving or preventing intra- ventricular septal thickening in an individual, preferably in an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• an anti- ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 6 A method for preserving or preventing an increase in left ventricular mass in an individual, preferably in an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• an anti- ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 7 A method for preventing or treating cardiomyopathy, more preferably diabetic cardiomyopathy, or hypertrophic cardiomyopathy, or ischemic cardiomyopathy, or hypertensive cardiomyopathy in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• cardiomyopathy more preferably diabetic cardiomyopathy, or hypertrophic cardiomyopathy, or ischemic cardiomyopathy, or hypertensive cardiomyopathy in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma
• Embodiment 8 A method for preventing the reduction of cardiac glucose uptake, or for preventing the accumulation of cardiac tri-acyl glycerol in an individual, preferably an obese, or pre- diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• Embodiment 9 A method for preventing or treating obesity - associated cardiomyopathy in an individual, more preferably in an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• a therapeutically effective amount of an anti- ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 10 A method for preventing or treating diastolic dysfunction in an individual, preferably in an obese, or pre- diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune-stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti-i ⁇ 42 antibody.
• Embodiment 11 A method for preventing or treating heart failure, more preferably HFpEF in an individual, preferably in an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune- stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti- ⁇ 42 antibody.
• Embodiment 12 A method for preventing or treating concentric hypertrophy in an individual, preferably an obese, or pre- diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune-stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• Embodiment 13 A method for preserving or decreasing left ventricle deceleration time in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune- stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• Embodiment 14 A method for preserving or preventing intra- ventricular septal thickening in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune- stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• Embodiment 15 A method for preserving or preventing an increase in left ventricular mass in an individual, preferably in an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune- stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• Embodiment 16 A method for preventing or treating cardiomyopathy, more preferably diabetic cardiomyopathy, or hypertrophic cardiomyopathy, or ischemic cardiomyopathy, or hypertensive cardiomyopathy in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune- stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• Embodiment 17 A method for preventing the reduction of cardiac glucose uptake, or for preventing the accumulation of cardiac tri-acyl glycerol in an individual, preferably an obese, or pre- diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune-stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti- ⁇ 42 antibody.
• Embodiment 18 A method for preventing or treating obesity - associated cardiomyopathy in an individual, more preferably in an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising administering a vaccine or immune-stimulating composition to the individual to produce in the individual a therapeutically effective amount of an anti- ⁇ 42 antibody.
• Embodiment 19 A composition for use in preventing or treating diastolic dysfunction in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• Embodiment 20 A composition for use in preventing or treating heart failure, more preferably HFpEF in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti-A ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• an anti-A ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 21 A composition for use preventing or treating concentric hypertrophy in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• an anti- ⁇ 42 antibody more preferably Bapineuzumab
• Embodiment 22 A composition for use in preserving or decreasing left ventricle deceleration time in an individual in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti-A ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• Embodiment 23 A composition for use in preserving or preventing intra-ventricular septal thickening in an individual preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti-A ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• Embodiment 24 A composition for use in preserving or preventing an increase in left ventricular mass in an individual preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• Embodiment 25 A composition for use preventing or treating cardiomyopathy, more preferably diabetic cardiomyopathy, or hypertrophic cardiomyopathy, or ischemic cardiomyopathy, or hypertensive cardiomyopathy in an individual preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti- ⁇ 42 antibody, preferably an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• cardiomyopathy more preferably diabetic cardiomyopathy, or hypertrophic cardiomyopathy, or ischemic cardiomyopathy, or hypertensive cardiomyopathy in an individual preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably
• Embodiment 26 A composition for use in preventing the reduction of cardiac glucose uptake, or for preventing the accumulation of cardiac tri-acyl glycerol in an individual preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• Embodiment 27 A composition for use in preventing or treating obesity -associated cardiomyopathy in an individual, more preferably in an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a therapeutically effective amount of an anti- ⁇ 42 antibody, more preferably Bapineuzumab to the individual, preferably in an amount of about 0.1mg/kg to 15mg/kg, preferably once every 14 days.
• Embodiment 28 A composition for use in preventing or treating diastolic dysfunction in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of an anti- ⁇ 42 antibody.
• Embodiment 29 A composition for use in preventing or treating heart failure, more preferably HFpEF, in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of an anti- ⁇ 42 antibody.
• Embodiment 30 A composition for use in preventing or treating concentric hypertrophy in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• Embodiment 31 A composition for use in preserving or decreasing left ventricle deceleration time in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of an anti- ⁇ 42 antibody.
• Embodiment 32 A composition for use in preserving or preventing intra-ventricular septal thickening in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of an anti- ⁇ 42 antibody.
• Embodiment 33 A composition for use in in preserving or preventing an increase in left ventricular mass in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• Embodiment 34 A composition for use in preventing or treating cardiomyopathy, more preferably diabetic cardiomyopathy, or hypertrophic cardiomyopathy, or ischemic cardiomyopathy, or hypertensive cardiomyopathy, in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of anti- ⁇ 42 antibody.
• Embodiment 35 A composition for use in preventing the reduction of cardiac glucose uptake, or for preventing the accumulation of cardiac tri-acyl glycerol in an individual, preferably an obese, or pre-diabetic, or diabetic or elderly individual, more preferably an obese individual, or an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of an anti-A ⁇ 42 antibody.
• Embodiment 36 A composition for use in preventing or treating obesity -associated cardiomyopathy in an individual, more preferably in an individual having an elevated amount of ⁇ 42, more preferably an elevated amount of plasma ⁇ 42, comprising a vaccine or immune-stimulating composition for producing in the individual a therapeutically effective amount of an ⁇ - ⁇ 42 antibody.
• Embodiment 37 A pharmaceutical formulation, preferably a formulation for sub-cutaneous injection, the formulation comprising:
• an anti-A ⁇ 42 antibody preferably Bapineuzumab a surfactant
• the antibody is provided in an amount of about 1 to 250 mg/ml of the formulation, more preferably about 10 to 200 mg/ml of the formulation, more preferably about 40 to 80 mg/ml of the formulation, preferably 80mg/ml of the formulation, or from 50 to 200mg/ml of the formulation for sub cutaneous or intra muscular administration, optionally wherein the formulation does not comprise a salt, or does not comprise a buffer.
• Embodiment 38 A method for determining the likelihood of an individual having or developing diastolic dysfunction comprising: assessing or having assessed a sample, preferably a plasma sample, obtained from an individual for whom the likelihood of having or developing diastolic dysfunction is to be determined, to determine the amount of ⁇ 42 in the sample; determining that the individual has a higher likelihood of developing or having diastolic dysfunction where the amount of ⁇ 42 is greater than that observed in a control describing the amount of ⁇ 42 in an individual who does not develop, or does not have diastolic dysfunction; determining that the individual has a lower likelihood of developing or having diastolic dysfunction where the amount of ⁇ 42 is the same as that observed in the control; preferably wherein the individual is overweight or obese, preferably wherein the control describes an amount of ⁇ 42 in an individual who does not develop, or does not have diastolic dysfunction and who is not elderly, preferably of an age of from 20 to 40 years old, and having a body mass index in the normal range, thereby
• the isovolumetric relaxation phase is an essential phase of normal diastole. It is energy dependent, and aberrations of the relaxation phase, as observed in LVDD and related clinical manifestations such as concentric hypertrophy and later heart failure, occur where there is an impairment in availability of ATP, for example as occurring where there is reduced cardiac glucose uptake.
• Amyloid beta denotes peptides of 36-43 amino acids, preferably ⁇ 42 that are crucially involved in Alzheimer's disease as the main component of the amyloid plaques found in the brains of Alzheimer patients.
• the peptides derive from the amyloid precursor protein (APP), which is cleaved by beta secretase and gamma secretase to yield ⁇ .
• APP amyloid precursor protein
• ⁇ molecules can aggregate to form flexible soluble oligomers which may exist in several forms.
• an anti-amyloid beta antibody or "anti- ⁇ antibody” or “anti- Abeta antibody” refers to an immunoglobulin molecule or fragment thereof, such as a CDR, variable domain or fragment thereof, Fab, Dab fragment or whole antibody.
• An anti- ⁇ antibody may be of any isotype or subtype and may be xenogeneic, allogeneic or syngeneic.
• An anti- ⁇ antibody may bind to any ⁇ protein or peptide or molecule comprising same such as APP.
• An anti- ⁇ antibody may bind to ⁇ or a fragment thereof in soluble form (i.e. when partially or wholly soluble in plasma) or in insoluble form, for example when presented as a plaque.
• An anti- ⁇ antibody may bind to ⁇ and thereby enable depletion of ⁇ from plasma and excretion from the body; or may enable neutralisation of ⁇ , for example thereby minimising a toxic effect of ⁇ such as cardiomyocyte inflammation.
• diastolic dysfunction generally refers to a condition characterised by the inability of the left ventricle to fill an adequate end diastolic volume at a physiologically normal or acceptable pressure.
• E/A ratio generally refers to the ratio of the E wave to the A wave.
• E the peak velocity of blood flow across the mitral valve during early diastolic filling corresponds to the E wave.
• atrial contraction corresponds to the A wave. From these findings, "the E/A ratio” is calculated. Under normal conditions, E is greater than A and the E/A ratio is approximately 1.5.
• Concentric hypertrophy generally refers to a form of cardiac hypertrophy associated with increased left ventricular wall thickness, or associated with an increase in LV mass without dilation of the LV, for example as measured by LVIDd.
• Concentric hypertrophy differs from "eccentric hypertrophy", the latter being characterised by dilatation of the left ventricular chamber and is observed in, or associated with valvular defects or endurance training.
• Eccentric hypertrophy may develop from concentric hypertrophy.
• An individual with diastolic dysfunction, in particular, an individual with early stage diastolic dysfunction may or may not have detectable concentric hypertrophy.
• HFpEF heart failure with preserved ejection fraction
• Cardiomyopathy generally refers to a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction, which usually (but not invariably) exhibit inappropriate ventricular hypertrophy or dilatation.
• Cardiomyopathy may be a primary cardiomyopathy, which is confined to the heart, preferably an acquired cardiomyopathy, more preferably an obesity-associated cardiomyopathy.
• An obesity-associated cardiomyopathy is defined myocardial disease in obese individuals that cannot be explained by diabetes mellitus, hypertension, coronary artery disease or other etiologies. The presentation of this disease can vary from asymptomatic left ventricular dysfunction to overt dilated cardiomyopathy and heart failure.
• yielderly individual refers to an individual over 60 years of age, more preferably 65 or 70 or 75 years of age.
• the term "pharmaceutically acceptable” means a nontoxic material that does not interfere with the effectiveness of the biological activity of the active ingredient(s).
• the term “treat”, “treating” or “treatment” in connection to a disease or disorder refers in one embodiment, to ameliorating the disease or disorder (i.e •9 slowing or arresting or reducing the development of the disease or at least one of the clinical symptoms thereof).
• “treat”, “treating” or “treatment” refers to alleviating or ameliorating at least one physical parameter including those which may not be discernible by the patient.
• “treat”, “treating” or “treatment” refers to modulating the disease or disorder, either physically, ⁇ e.g •9 stabilization of a discernible symptom), physiologically, ⁇ e.g •9 stabilization of a physical parameter), or both.
• the term “therapeutically effective amount” refers to an amount of the compound of the invention, e.g. anti- ⁇ 42 antibody; or vaccine or immunostimulating composition for producing same; which is sufficient to achieve the stated effect. Accordingly, a therapeutically effective amount of an anti- ⁇ 42 antibody; or vaccine or immunostimulating composition for producing same; will be an amount sufficient for the treatment or prevention of the condition mediated by or associated with ⁇ 42 plasma expression or production.
• therapeutic regimen is meant the pattern of treatment of an illness, e.g •9 the pattern of dosing used during the treatment of the disease or disorder.
• a subject is "in need of” a treatment if such subject would benefit biologically, medically or in quality of life from such treatment.
• Figure 2 - Chronic ⁇ 42 administration alters cardiac function.
• Figure 3 Administration of anti - ⁇ 42 antibodies preserves diastolic function in development of obesity.
• Figure 5 Administration of anti - ⁇ 42 antibodies preserves diastolic function in established obesity.
• Figure 6 Chronic ⁇ 40 administration does not alter cardiac function.
• An individual to whom the methods of the invention are applied is mammalian, preferably a human being.
• An individual may not have diastolic dysfunction at the time of treatment.
• Such an individual may be at risk for diastolic dysfunction i.e. may have one or more risk factors for diastolic dysfunction.
• the individual may be pre diabetic or diabetic, overweight or obese, female, have Alzheimer's disease or other neural disease with ⁇ involvement, or elderly.
• the individual may have an elevated amount of ⁇ 42, preferably an elevated amount of plasma ⁇ 42.
• the invention may be applied to such an individual to prevent the development of diastolic dysfunction, or to prevent diastolic dysfunction.
• an individual may have diastolic dysfunction at the time of treatment.
• Such an individual may be asymptomatic for diastolic dysfunction, or symptomatic for diastolic dysfunction.
• the invention may be applied to such an individual to treat or ameliorate or alleviate diastolic dysfunction.
• the individual to be administered an anti- ⁇ 42 antibody or immune-stimulation composition is obese and has an elevated amount of plasma ⁇ 42 and may or may not have diastolic dysfunction.
• Such an individual may have obesity associated cardiomyopathy, or may be at risk for same.
• Stages of diastolic dysfunction have been classified according to various grading systems. For example, four basic echocardiographic patterns of diastolic dysfunction, (graded I to IV) according to the American Society of Echocardiography and the European Association of Cardiovascular Imaging are described:
• the E/A ratio is ⁇ 0.8 and deceleration time is >200ms, while the E/e' ratio, a measure of the filling pressure, is within normal limits at ⁇ 10. This pattern may develop normally with age in some patients, and many grade I patients will not have any clinical signs or symptoms of heart failure.
• Grade II diastolic dysfunction is called "pseudonormal filling dynamics", with the E/A ratio between 0.8 and 2.0, and a reduction in deceleration time to between 160 and 220ms. This is considered moderate diastolic dysfunction and is associated with elevated left atrial filling pressures, with an E/e' ratio between 10 and 14. These patients more commonly have symptoms of heart failure, and many have left atrial enlargement due to the elevated pressures in the left heart.
• Class III diastolic dysfunction patients have an E/A ratio >2 and E/e' ratio >14. They will demonstrate reversal of their diastolic abnormalities on echocardiogram when they perform the Valsalva maneuver. This is referred to as "reversible restrictive diastolic dysfunction".
• Grade III and IV diastolic dysfunction are called "restrictive filling dynamics". These are both severe forms of diastolic dysfunction, and patients tend to have advanced heart failure symptoms .
• an individual having Grade I diastolic dysfunction as described above, preferably having an elevated plasma amount of ⁇ 42 is provided with anti-A ⁇ 42 antibodies to prevent the development of more severe diastolic dysfuction, or otherwise to preserve diastolic function.
• an individual having Grade II, III or IV diastolic dysfunction preferably having an elevated plasma amount of ⁇ 42 is provided with anti-A ⁇ 42 antibodies to treat or reverse diastolic dysfuction, or to treat or reverse one or more symptoms or characters of diastolic dysfunction.
• an individual may have concentric hypertrophy.
• An individual in need of treatment may have a normal left ventricle diameter and may have a normal cardiac weight.
• An individual in need of treatment may have an increased LV deceleration time.
• An individual in need of treatment may have a cardiomyopathy, especially an ischemic or hypertrophic cardiomyopathy.
• An individual in need of treatment may have a systolic condition in addition to diastolic dysfunction.
• An individual the subject of treatment may be symptomatic for heart failure and may be symptomatic for HFPpEF or may be asymptomatic for heart failure or HFpEF.
• Symptoms of heart failure generally include shortness of breath including exercise induced dyspnea, paroxysmal nocturnal dyspnea and orthopnea, exercise intolerance, fatigue, elevated jugular venous pressure, and edema.
• Patients with HFpEF poorly tolerate stress, particularly hemodynamic alterations of ventricular loading or increased diastolic pressures. Often there is a more dramatic elevation in systolic blood pressure in HFpEF.
• An individual who is asymptomatic or symptomatic for heart failure may or may not be obese or overweight, diabetic or pre- diabetic, have Alzheimer's disease or other neural disease with ⁇ involvement, or elderly.
• an individual may be selected for treatment or prevention of LVDD, or screened for LVDD, or assessed for risk of developing LVDD by assessing or measuring the plasma amount of ⁇ and optionally comparing with a normal control describing an amount of ⁇ in plasma in an individual not having, or not at risk of having diastolic dysfunction, for example, an individual who is not overweight or obese, or not pre-diabetic or diabetic, or who does not have Alzheimer's disease or who is not elderly.
• a control may be an age matched control. Where the individual to be assessed is elderly, the control may describe an amount of ⁇ 42 in plasma that is consistent with that found in a normal individual having an age of about 20 to 40 years old. In one embodiment a control describes the amount of ⁇ 42 in plasma from an individual having a body mass index in the normal range, from about 18.5 to 24.9 kg/m 2 .
• a control describing the amount of ⁇ 42 in plasma may be may be derived from a single individual. In another embodiment, a control may be derived from a cohort of individuals .
• diastolic dysfunction is induced by administration of an amount of about 0.04mg/kg of ⁇ 42 peptide per day.
• individuals on a high fat diet may develop a plasma amount of ⁇ 42 peptide of about 3 fold above controls.
• an individual to be selected for treatment may have a plasma amount of ⁇ 42 peptide of about 10 to lOOpM, or about 1 to at least 10 fold the amount of ⁇ 42 peptide in a control.
• a control may provide a reference point against which a determination regarding implementation of subsequent prophylaxis or therapy can be made. The determination may be made on the basis of the comparison between test sample obtained from the individual being assessed for prophylaxis or treatment and the control.
• control may be provided in the form of data that has been derived by another party, and/or prior to assessment of the subject for treatment.
• control may be derived from a commercial database or a publically available database.
• the individual is selected for treatment or prevention of LVDD, or screened for LVDD, or assessed for risk of developing LVDD, where the individual has an amount of ⁇ or fragment thereof, preferably ⁇ 42 that is greater than the amount of ⁇ or fragment thereof, preferably ⁇ 42 in a normal control.
• the samples to be tested are body fluids such as blood, serum, plasma, urine, tears, saliva, CSF and the like.
• the sample from the individual may require processing prior to detection of the levels of ⁇ 42.
• the sample may be centrifuged or diluted to a particular concentration or adjusted to a particular pH prior to testing. Conversely, it may be desirable to concentrate a sample that is too dilute, prior to testing.
• ⁇ 42 may be measured, or peptides or complexes that comprise ⁇ 42 may be measured.
• fragments of ⁇ 42 comprising the ⁇ 42 C- terminal sequences that distinguish ⁇ 42 from ⁇ 40 may be measured.
• the above described methods may be combined with the following diagnostic procedures for detecting, assessing or measuring diastolic dysfunction or related heart failure such as HFPeF, or the following procedures may be used without assessment of plasma amount of ⁇ 42.
• Two-dimensional echocardiography with Doppler flow measurements is commonly used to assess diastolic dysfunction.
• Exercise may be required to clearly demonstrate diastolic functional changes.
• blood flows through the mitral valve when the LV relaxes, causing an early diastolic mitral velocity (E), and then additional blood is pumped through the valve when the left atrium contracts during late diastole (A).
• E early diastolic mitral velocity
• A late diastole
• the E/A ratio can be altered in diastolic dysfunction.
• Tissue Doppler imaging is an echocardiographic technique that measures the velocity of the mitral annulus. This velocity has been shown to be a sensitive marker of early myocardial dysfunction. With abnormal active relaxation, mitral annulus velocity during early diastole (E) is decreased while mitral annulus velocity during late diastole (A) is increased, resulting in a lowered E/A ratio. In animal models, tissue Doppler imaging has been validated as a reliable tool for the evaluation of diastolic dysfunction. The E- and A-wave velocities are affected by blood volume, mitral valve anatomy, mitral valve function, and atrial fibrillation, making standard echocardiography less reliable.
• tissue Doppler imaging is useful for measuring mitral annular motion (a measure of transmitral flow that is independent of the aforementioned factors). Cardiac catheterization remains the preferred method for diagnosing diastolic dysfunction.
• two-dimensional echocardiography with Doppler is the best noninvasive tool to confirm the diagnosis.
• radionuclide angiography is used for patients in whom echocardiography is technically difficult.
• LV inflow propagation velocity (VP) by color M-mode Doppler is another relatively preload-insensitive index of LV relaxation. It has been shown to correlate well with the time constant of isovolumic relaxation ( ⁇ ), both in animals and humans.
• STE speckle tracking echocardiography
• CMR Cardiac magnetic resonance
• Myocardial tagging allows the labeling of specific myocardial regions. Following these regions during diastole enables them to be analyzed in a manner similar to STE.
• the rapid diastolic untwisting motion followed by CMR tagging is directly related to isovolumic relaxation and can be used as an index of the rate and completeness of relaxation.
• Biomarkers may also be assessed for diagnosis of LVDD.
• B-type natriuretic peptide (BNP) and Tnl have been used as HF biomarkers and exhibit strong association with hospitalization. Nevertheless, they are nonspecific and not well correlated with diastolic dysfunction.
• BNP B-type natriuretic peptide
• Tnl Tnl
• cMyBP-C could be a new biomarker releases from damaged myofilaments.
• elevated S-glutathionylated cMyBP-C level can be detected in the blood of patients with diastolic dysfunction.
• cMyBP-C a cardiac contractile protein, which leads to impaired relaxation
• modified cMyBP- C in the blood may represent a circulating biomarker for diastolic dysfunction.
• Anti- ⁇ antibodies for use in the invention generally bind to plasma or extracellular associated ⁇ 42, especially oligomeric ⁇ 42. Without wanting to be bound by hypothesis, it is believed that the administration of anti- ⁇ antibodies either depletes, binds or neutralises plasma or extracellular associated ⁇ 42 peptide, resulting in a minimisation of diastolic dysfunction, preferably through a minimisation of ⁇ 42 induced or associated cardiomyocyte inflammation and/or reduced cardiac glucose uptake.
• the anti- ⁇ antibodies may bind to any one of the following epitopes on ⁇ 42 peptide shown in Table 1:
• the anti- ⁇ antibodies may bind to monomeric ⁇ 42 or to oligomeric ⁇ 42 peptide.
• the anti- ⁇ antibodies may bind to an amyloid fibril.
• the anti- ⁇ antibodies may bind to an amyloid protofibril.
• Selective anti-A ⁇ 42 antibodies i.e. antibodies that bind to ⁇ 42 but not to ⁇ 40
• selective anti-A ⁇ 40 antibodies i.e. antibodies that bind to ⁇ 40 but not to ⁇ 42, and their methods of synthesis are known in the art. See for example: Ida N. et al. J. Biol. Chem. 1996 271: 22908-22914; Axelsen T V et al.
• an anti- ⁇ antibody may be a selective anti ⁇ 42 antibody.
• the anti- ⁇ antibodies may be human, humanized, chimeric, murine or derived from another mammalian species, or avian.
• the anti- ⁇ antibodies may be of any isotype or subtype.
• the anti- ⁇ antibodies may be IgG, IgM, IgA, IgE or IgD.
• the antibody is IgG, more preferably of subtype IgGl, IgG2 or IgG4.
• the anti- ⁇ antibodies may be whole antibodies, i.e comprising all of the domains common to the relevant isotype or subtype, or the anti- ⁇ antibodies may be a fragment of a whole antibody comprising at least CDR and framework regions for enabling binding of the anti- ⁇ antibodies to an epitope on ⁇ peptide.
• the anti- ⁇ antibodies may be in the form of a Fab, Dab.
• the anti- ⁇ antibodies may be selected from the group consisting of Bapineuzumab, Solanezumab, Gantenerumab, Crenezumab,
• Bapineuzumab (AAB-001; Pfizer Inc., New York, NY, and Janssen Pharmaceuticals, Inc., Raritan, NJ), is a humanized immunoglobulin (Ig) G1 anti- ⁇ mAb, that binds the five N- terminal residues and clears both fibrillar and soluble ⁇ .
• Ig immunoglobulin
• Solanezumab (LY2062430; Eli Lilly and Company, Indianapolis, IN), is a humanized IgGl mAb that binds the mid-domain of ⁇ (residues 16-26) and increases clearance of monomers.
• Gantenerumab (Hoffman-La Roche, Basel, Switzerland), the first fully human IgGl anti- ⁇ mAb, binds a conformational epitope expressed on ⁇ fibrils.
• This epitope encompasses both N- terminal (3-12) and central (18-27) amino acids of ⁇ and thus requires that the peptide be folded with the midregion near the N-terminus.
• Crenezumab (MABT5102A; Genentech, Inc •, South San Francisco, CA) is an antibody engineered on an IgG4 backbone to minimize the activation of Fc gamma receptors. Crenezumab prefers the mid- domain of the ⁇ peptide (residues 13-24) and binds multiple conformations of ⁇ (monomers, oligomers, fibrils), with a 10- fold higher affinity for oligomers versus monomers. The epitope recognized by crenezumab overlaps that of solanezumab, explaining their observed crossreactivity but not their different binding profiles for various species of ⁇ .
• crenezumab and solanezumab actually target slightly different epitopes (residues 13-24 vs. 16-26, respectively) and suggested that solanezumab -bound ⁇ possesses an alpha-helical structure between residues 21 and 26, whereas crenezumab-bound ⁇ has a random coil structure between residues 21 and 24. It has been proposed that the alpha-helical epitope is present in monomeric ⁇ but absent from aggregated species, potentially explaining solanezumab ' s preference for monomers but crenezumab ' s recognition of multiple species, including oligomers .
• Aducanumab (BIIB037; Biogen, Inc •, Cambridge, MA) is a fully human IgGl mAb that selectively reacts with ⁇ aggregates, including soluble oligomers and insoluble fibrils. It binds the N-terminus (residues 3-6) and recognizes a conformational epitope present on aggregated species of ⁇ but absent from monomers .
• MEDI1814 (Medlmmune, UK and Astra Zeneca UK) is a fully human IgG ⁇ monoclonal antibody engineered for selective, high-affinity binding of ⁇ -42 ( ⁇ 42) peptides as well as to have a greatly reduced effector function by introducing a triple mutation into the Fc region.
• MEDI1814 binds specifically all forms of ⁇ 42 peptides but not ⁇ 40 peptides.
• rats and cynomolgous monkeys MEDI1814 increases total and decreases free CSF ⁇ 42 levels, but does not affect total CSF ⁇ 40 levels.
• An anti- ⁇ antibody may be provided in the form of a pharmaceutical composition including a therapeutically effective amount of an anti- ⁇ antibody and a pharmaceutically acceptable carrier.
• a pharmaceutical composition may be in solid or liquid form and may be, inter alia, in a form of powder, tablet, solution or aerosol.
• a pharmaceutical composition comprises a pharmaceutically acceptable carrier and/or diluent.
• suitable pharmaceutical carriers, excipients and/or diluents are well known in the art and include phosphate buffered saline solutions, water, emulsions, such as oil/water emulsions, various types of wetting agents, sterile solutions etc.
• Compositions comprising such carriers can be formulated by well known conventional methods.
• Preparations for parenteral administration include sterile aqueous or non-aqueous solutions, suspensions, and emulsions.
• non-aqueous solvents are propylene glycol, polyethylene glycol, vegetable oils such as olive oil, and injectable organic esters such as ethyl oleate.
• Aqueous carriers include water, alcoholic/aqueous solutions, emulsions or suspensions, including saline and buffered media.
• Parenteral vehicles include sodium chloride solution, Ringer's dextrose, dextrose and sodium chloride, lactated Ringer's, or fixed oils.
• Intravenous vehicles include fluid and nutrient replenishers, electrolyte replenishers (such as those based on Ringer's dextrose), and the like. Preservatives and other additives may also be present such as, for example, antimicrobials, anti- oxidants, chelating agents, and inert gases and the like. 3.4 Antibody administration
• An anti- ⁇ antibody may be administered by any known route enabling systemic accumulation of a therapeutically effective amount of antibody.
• the antibody is administered parenterally . It is particularly preferred that the administration is carried out by injection for example by intravenous (i.v.), subcutaneous (s.c), intraperitoneal (i.p.), intramuscular (i.m.), intradermal (i.d.) injection, or by intranasal or intrabronchial delivery.
• Other parenteral routes of administration of therapeutic antibody are known to the skilled worker.
• the dosage regimen will be determined by the attending physician and clinical factors. As is well known in the medical arts, dosages for any one patient depends upon many factors, including the patient's size, body surface area, age, the particular compound to be administered, sex, time and route of administration, general health, and other drugs being administered concurrently. Proteinaceous pharmaceutically active matter may be present in amounts between 1 ng and 15 mg/kg body weight per dose; however, doses below or above this exemplary range are envisioned, especially considering the aforementioned factors. If the regimen is a continuous infusion, it should also be in the range of 1 ⁇ g to 10 mg units per kilogram of body weight per minute. Progress can be monitored by periodic assessment. The compositions of the invention may be administered locally or systemically.
• the antibody is administered in an amount of 0.1 to 15 mg/kg, preferably 0.5 mg/kg to 10m /kg, preferably about 5mg/kg.
• the antibody may be administered i.v.
• the antibody may be administered once every 2 to 4 weeks.
• the antibody is administered in an amount of 0.5 to 5 mg/kg by i.v. administration every 10 to 15 weeks.
• the antibody is administered in an amount of 100 to 500 mg, preferably about 400mg (irrespective of body weight) by i.v. administration every 4 weeks.
• the antibody is administered in an amount of from 100 to 300 mg by s.c. injection once every 4 weeks.
• the administration of the antibody enables the reduction of the amount or activity of ⁇ 42 in plasma to an amount that is the same as, or that approximates that observed in a normal individual, as described above.
• anti - ⁇ 42 formulations ⁇ ti- ⁇ 42 antibodies may be provided in the form of high protein content formulations in which the antibody component is from 1 to 250mg/mL, preferably 10 to 100 mg/ml of the formulation, more preferably about 40 to 80 mg/ml of the formulation, preferably 80mg/ml of the formulation, or preferably 150 to 200mg/ml for sub-cutaneous or intramuscular administration.
• High antibody content formulations are particularly useful for management or for prevention or treatment of diastolic dysfunction, as they enable larger doses of antibody, and smaller volumes of the formulation to be administered. This minimises the pain incurred during self parenteral administration, in particular administration by self sub-cutaneous injection.
• the anti-A ⁇ 42 formulations of the invention are adapted to have improved stability and solubility, minimised aggregation, and minimised viscosity at high protein content of antibody. These improvements may arise from the incorporation of a surfactant/and or a polyol.
• a surfactant may be selected from the group consisting of nonionic surfactants such as polysorbates or poloxamers.
• a surfactant may be a poloxamer, e.g., Poloxamer 188, Poloxamer 407; polyoxyethylene alkyl ethers, e.g., Brij 35, Cremophor A25, Sympatens ALM/230.
• a polysorbate may be Polysorbate 20 (Tween 20), Polysorbate 80 (Tween 80), Mirj, and Poloxamers, e.g., Poloxamer 188.
• a polyol may be selected from the group consisting of fructose, mannose, maltose, lactose, arabinose, xylose, ribose, rhamnose, galactose, glucose, sucrose, trehalose, sorbose, melezitose, raffinose, mannitol, xylitol, erythritol, threitol, sorbitol, glycerol, L-gluconate and metallic salts thereof.
• the polyol is sorbitol or mannitol, more preferably mannitol.
• Polyols may be included in an amount of about 1 to 50mg/mL of the formulation.
• the formulation does not require the use of a buffer such as acetate, succinate, gluconate, histidine, methionine, citrate, phosphate, citrate / phosphate, imidazole, combinations thereof, and other organic acid buffers.
• a buffer such as acetate, succinate, gluconate, histidine, methionine, citrate, phosphate, citrate / phosphate, imidazole, combinations thereof, and other organic acid buffers.
• an injectable aqueous pharmaceutical formulation comprising an anti-A ⁇ 42 antibody, preferably Bapineuzemab, o wherein the antibody is provided in an amount of about 1 to 250mg/mL, preferably 150 to 250 mg/ml of the formulation, more preferably about 200 mg/ml of the formulation; a surfactant, preferably polysorbate 80 in an amount of about 0.1- 1.5 mg/ml of the formulation;
• a polyol preferably mannitol in an amount of about 1 to 50mg/mL of the formulation wherein the formulation does not contain a buffer selected from the group consisting of acetate, succinate, gluconate, histidine, methionine, citrate, phosphate, citrate / phosphate, imidazole, combinations thereof, and other organic acid buffers.
• a buffer selected from the group consisting of acetate, succinate, gluconate, histidine, methionine, citrate, phosphate, citrate / phosphate, imidazole, combinations thereof, and other organic acid buffers.
• Anti- ⁇ antibodies may be provided in an individual for prevention, treatment or amelioration of diastolic dysfunction or related condition by administering an ⁇ immuno-stimulating compositions or vaccine to the individual.
• a vaccine or immune-stimulating composition for producing anti- ⁇ antibodies may comprise a peptide immunogen as an immunogenic component for production of anti- ⁇ antibodies in the individual, generally antibodies that can bind to oligomeric ⁇ 42.
• a peptide immunogen for producing anti- ⁇ 42 antibodies may be synthetic or may be derived from a natural source.
• a peptide immunogen for producing anti- ⁇ 42 antibodies may form an ⁇ epitope.
• the epitope may be as shown in Table 1, or as discussed in Ida supra; Axelsen supra; Miller supra.
• An alternative active immunization approach is the DNA ⁇ immunization in which not the peptide itself but a DNA encoding ⁇ is injected. The injected DNA is translated in the immunized individual to produce ⁇ peptide which then triggers respective immune responses against ⁇ .
• a vaccine or immune-stimulating for generating anti- ⁇ antibodies may comprise a nucleic acid for encoding an immunogenic peptide for producing anti- ⁇ antibodies, especially antibodies that bind to oligomeric ⁇ 42.
• the nucleic acid may be DNA, in which case the vaccine is a DNA vaccine .
• the vaccine comprises a full length DNA encoding a ⁇ trimer vaccine.
• the full length DNA ⁇ trimer vaccine may contain B- and T-cell epitopes.
• the full-length DNA ⁇ vaccine has the advantage that it is open to a wider anti- ⁇ response with a broader variety of antibody epitopes.
• a vaccine or immune-stimulating composition described herein are administered by any appropriate standard routes of administration.
• the composition may be administered by topical, oral, rectal, nasal or parenteral (for example, intravenous, subcutaneous, or intramuscular) routes.
• the composition or vaccine is administered by parenteral, particularly by i.p•, i.v•, s.c. or i.m injection.
• a gene gun may be used for i.m or s.c injection using techniques known to the skilled worker.
• the frequency of injection can be varied depending on the patient response.
• the frequency of administration can varied by the attending physician depending on the patient's response and corresponding antibody titers. For example, a patient who is a low responder may require more frequent administration, while a patient who is a high responder may require less frequent administration in order to elicit and/or maintain the same antibody titer.
• the frequency of injection can include, but is not limited to, 1 to 10 administrations per year, e.g. 2 to 8 per year, e.g. 6 administrations per year.
• the composition or vaccine is administered to human patients in need thereof about every 4 to 8 weeks, preferably about every 5 to 7 weeks, in particular about every 6 weeks.
• Such a dosing regimen may last about 12 to 16 weeks, e.g. to about 12 weeks.
• the composition or vaccine is administered at 0, 6, 12 weeks.
• the delay between subsequent administrations may be extended.
• the invention provides a dosing regimen of (a) two or more administrations at intervals of about 6 weeks, followed by (b) two or more administrations at intervals of about 12 weeks.
• the invention provides a dosing regimen of (a) three administrations at intervals of about 6 weeks (e.g. at weeks 0, 6 and 12) followed by (b) two or more administrations (e.g. 3, 4, 5 or more) at intervals of about 12 weeks (e.g. at weeks 24, 36, 48 and 60).
• about 5 to 600 ⁇ g of a peptide immunogen or DNA encoding same can be administered in human patients, for example about 5 to 550 g, about 50 to 500 ⁇ g, about 100 to 500 ⁇ g, e.g. about 75 to 300 ⁇ g, e.g. about 50 to 150 ⁇ g, e.g. about 15 to 125 ⁇ g, e.g. about 25 to 100 ⁇ g, e.g. about 50 ⁇ g, 75 ⁇ g, lOO ⁇ g, 150 ⁇ g, 200 ⁇ g, 300 ⁇ g, 400 ⁇ g or 450 ⁇ g.
• the composition or vaccine may contain one of these amounts per dose.
• the composition of the invention comprises about 150 ⁇ g or about 50 ⁇ g of the peptide immunogen or DNA encoding same per dose.
• mice were resuspended in 1% NH 4 OH and aliquoted at 200ng/ml in H 2 O and stored at -80°C for no longer than 4 weeks.
• Male C57BL6 mice were obtained from the Animal Resource Centre (Perth, WA) at 4 weeks of age and housed with 4 mice per cage on a 12hr light/dark cycle at a temperature of 22°C and a constant humidity with a normal rodent diet. At 12 weeks of age, mice were grouped according to body mass and composition, determined by EchoMRI.
• An i.p. glucose tolerance test (GTT) was performed on the final treatment day following an overnight fast.
• Mice were administered 2g/kg lean mass of glucose including radioactive glucose tracers, prepared as follows. 100 ⁇ l of 1 ⁇ Ci/ ⁇ l glucose analogue, [ 3 H]-2-deoxyglucose (2-DOG), and 500 ⁇ l of 200 ⁇ Ci/mL U- 14 C glucose were evaporated to dryness before redissolving the radioactive tracers in 1 mL of 50% glucose.
• mice 50 ⁇ l of the supernatant was diluted in 500 ⁇ l of distilled water and then suspended in 4 mL of Ultima Gold XR scintillation fluid (Packard Bioscience). Blood radioactivity was determined at each time point by performing liquid scintillation counting on each solution using the Beckman scintillation counter (LS6000 SC). At the conclusion of the GTT, mice were killed via cervical dislocation. Blood was obtained immediately following by cardiac puncture and the heart, and other tissues were immediately removed. Hearts were washed in ice cold PBS and weighed prior to being snap frozen in liquid nitrogen. The heart (30mg), epididymal fat pad (30mg and quadriceps skeletal muscle (30mg) were homogenised in 1.5 ml of distilled water.
• the homogenate was centrifuged at 3000 rpm for 10 min at 4°C. 400 ⁇ l of the supernatant was diluted into 1.6 mL of distilled water and then suspended in 14 mL of Ultima Gold XR scintillation fluid (Packard Bioscience). The radioactivity of each sample (from both [ 3 H]- 2-DOG6P and [ 3 H]-2-DOG) was determined by liquid scintillation counting using the Beckman scintillation counter (LS6000 SC). The 3 H radioactivity was used to measure glucose uptake into each tissue.
• the amount of U- 14 C glucose clearance into the lipid fraction was measured by suspending 100 ⁇ l of the triglyceride solution in 5 mL of Ultima Gold XR scintillation fluid (Packard Bioscience), followed by scintillation counting using the Beckman scintillation counter (LS6000 SC). Total triglyceride content was measured using an enzymatic fluorometric assay (BioVision) as per manufacturers' instructions. Lipoprotein lipase was used in an enzymatic reaction to yield fatty acid and glycerol. Quantified glycerol was used as an indirect measure of triglyceride and was 49ndividual to tissue weight.
• Total mRNA from the tissues was extracted by homogenizing ⁇ 20- 30 milligrams of tissue in 1 ml of Trizol followed by incubation at room temperature (RT) for 5min. 200 ⁇ L of chloroform was added to the homogenate, shaken for 15 seconds and incubated for 1min at RT before centrifuging at 12,OOOg for lOmin at 4 °C for extracting the upper aqueous phase. An equal volume (350 ⁇ l for cell lysate/450 ⁇ L for tissue) of 70% ethanol was added to cell/tissue samples and they were further purified with Rneasy spin columns (the Rneasy®min I Kit, Qiagen).
• cDNA Complementary DNA
• cDNA was synthesised using the SuperscriptTM III transcription system (Invitrogen).
• cDNA was quantified by OliGreen assay (Quant-iTTM OliGreen® ssDNA Assay Kit; Invitrogen). All primers were designed in-house using the Beacon Primer Designer program software and synthesised by Gene Works (Adelaide, Australia). Primer sequence efficiency was tested over a wide concentration range.
• Gene expression levels were quantified using the FastStart Universal SYBR Green Master (ROX; Roche Applied- Science) on the MX3005PTM Multiplex Quantitative PCR (QPCR) system (Stratagene). Log-transformed CT values were normalised to cDNA concentration to determine relative gene expression levels.
• Doppler imaging was also utilised to measure the velocity of blood flow through the aortic valve. The measurements were then used to calculate the ejection time, peak aortic flow and heart rate.
• M-mode imaging of the left ventricle was used to measure the thickness of the inter-ventricular septum (IVS), left ventricular internal diameter (LVID) and left ventricular posterior wall (LVPW) in both diastole (d) and end-systole (s) as well as systolic measures such as ejection fraction and fractional shortening.
• IVRS inter-ventricular septum
• LVID left ventricular internal diameter
• LVPW left ventricular posterior wall
• An estimation of LV mass was calculated from the m-mode imaging by using the formula (1.05[LVIDd + LVPWd + IVSd] 3 - [LVIDd] 3 ) by Troy et al. (1972). Mice were humanely killed by cervical dislocation 1 week later. Blood was obtained immediately following by cardiac puncture and the
• IVS inter-ventricular septum
• LVID left ventricular internal diameter
• LVPW left ventricular posterior wall
• mice were then placed on a high fat diet (HFD) with 43% of calories from fat (23.5% by weight; SF04-001 High Fat Rodent Diet Based on D12451, Specialty Feeds, Glen Forrest, WA) for 13 weeks. At 12 weeks of age, mice were also administered 0.75 mg/kg bodyweight of either the ⁇ 42 neutralising antibody 3D6 (#TAB-0809CLV, Creative
• mice were selected based on fat mass, body weight and lean mass to match these variables as closely as possible between groups. Each cage contained 2 mice from each group.
• mice After 10 weeks of the treatment period, mice underwent an oral glucose tolerance test (OGTT). Following a 5 hour fast, baseline readings of blood glucose were collected via a tail bleed of the mice using a hand-held glucometer (AccuCheck Performa). Mice were then administered 50mg of glucose via oral gavage and blood glucose was measured 15, 30, 45, 60- and 90-minutes post administration. An additional 30pL of blood was collected at baseline and 15, 30- and 60-minutes post administration in heparinised tubes for analysis of serum insulin concentration. Blood was centrifuged at 10,OOOg for 10 minutes at 4°C and plasma was collected by removing the supernatant. Plasma from the OGTT was analysed for insulin content using the Mouse Ultrasensitive Insulin ELISA (ALPCO, Salem, NH). An insulin tolerance test
• ITT 11 weeks into the treatment period. Following a 5 hour fast, baseline readings of blood glucose were collected via a tail bleed of mice using a hand-held glucometer (AccuCheck Performa). Mice were administered of 53ndivid via i.p. injection and blood glucose was measured 20, 40, 60, 90- and 120-minutes post administration. Echocardiography was then performed 12 weeks into the treatment period, as described above, to obtain post-treatment measures of cardiac function. Changes in cardiac function parameters were expressed as a percentage of the baseline measure. Mice were sacrificed following 13 weeks of the treatment period. At the conclusion of the treatment period, mice were killed via cervical dislocation following a 5-hr fasting period. Blood was obtained immediately following by cardiac puncture and the heart, and other tissues were immediately removed. Hearts were washed in ice cold PBS and weighed prior to being snap frozen in liquid nitrogen.
• HFD High Fat Diet
• mice were humanely killed via cervical dislocation and blood was immediately obtained via cardiac puncture and stored in a heparinised tube.
• the heart was 151 blotted prior to being weighed and all tissues were snap frozen in liquid nitrogen and stored at - 80°C.
• Plasma ⁇ 42 was measured using a high sensitivity ELISA kit (Wako Diagnostics) and plasma that was diluted 1:10 with assay buffer. Cardiac TAG was measured using using a triglyceride GPO-PAP kit (Roche Diagnostics) after extraction by KOH hydrolysis.
• mice Male C57BL6 mice were obtained from the Animal Resource Centre (Perth, WA) at 4 weeks of age and housed with 4 mice per cage on a 12hr light/dark cycle at a temperature of 22°C and a constant humidity with a normal rodent diet. At 12 weeks of age, mice were grouped according to body mass and composition, determined by EchoMRI.
• cardiac function was assessed by echocardiography as follows. Mice were anaesthetised with inhalation of 1.5% isoflurane anaesthesia and echocardiography was performed using the Phillips HD15 diagnostic ultrasound system with a 15 MHz linear-array transducer by an experienced veterinarian. The velocity of blood flow through the mitral valve was analysed using Doppler mode imaging. These results were used to calculate the deceleration time and E:A ratio. Doppler imaging was also utilised to measure the velocity of blood flow through the aortic valve.
• M-mode imaging of the left ventricle was used to measure the thickness of the inter-ventricular septum (IVS), left ventricular internal diameter (LVID) and left ventricular posterior wall (LVPW) in both diastole (d) and end- systole (s) as well as systolic measures such as ejection fraction and fractional shortening.
• IVS inter-ventricular septum
• LVID left ventricular internal diameter
• LVPW left ventricular posterior wall
• An estimation of LV mass was calculated from the m-mode imaging by using the formula (1.05[LVIDd + LVPWd + IVSd] 3 - [LVIDd] 3 ) by Troy et al. (1972). Mice were humanely killed by cervical dislocation 1 week later.
• Plasma ⁇ 40 was measured using a high sensitivity ELISA kit (Wako Diagnostics) and plasma that was diluted 1:10 with assay buffer.
• mice were administered Scr ⁇ 42 or ⁇ 42 for five weeks prior to echocardiography. Hearts were also collected for morphological analysis (Figure 2). Administration of ⁇ 42 had no effect on gross heart weight (Figure 2A) or of internal dimensions of the left ventricle (LVIDd; Figure 2B). However, indices of diastolic dysfunction were evident in mice administered ⁇ 42, including reduced E:A ratio ( Figure 2C) and increased deceleration time ( Figure 2D). There was no significant difference between groups when the peak blood flow velocity into the left ventricle during the relaxation phase in early dystole I was normalised by the relaxation time (isovolumetric relaxation time; IVRT)( Figure 2E).
• IVRT isovolumetric relaxation time
• Example 4 - Administration of anti - ⁇ 42 antibodies preserves diastolic function in development of obesity.
• Echocardiography Doppler imaging of the mitral valve was used to assess the deceleration time, a critical measure of diastolic function (Figure 3).
• mice administered the control antibody had an increase in deceleration time (Figure 3A), indicating deterioration of diastolic function.
• mice administered the 3D6 antibody showed either preserved or decreased deceleration time ( Figure 3A).
• mice administered the control antibody had a statistically significant ⁇ 30% increase in deceleration time (Figure 3B), indicative of diastolic dysfunction.
• deceleration time in mice administered the 3D6 antibody did not change from baseline levels (Figure 3B).
• the relative change in deceleration time from baseline was significantly different between control and 3D6 antibody administered groups ( Figure 3B).
• Example 5 Administration of anti - ⁇ 42 antibodies prevents concentric hypertrophy in development of obesity.
• Echocardiographic M-mode imaging was used to characterise the morphology of the left ventricle ( Figure 4).
• Mice administered control antibody tended to have an increased intraventricular septum thickness at end-diastole (IVSd), a measure of hypertrophy, following the development of obesity, which was not observed in mice administered 3D6 antibody ( Figure 4A).
• IVSd intraventricular septum thickness at end-diastole
• Figure 4B Expressed relative to pre high fat diet values, IVSd siginificantly increased 115% in mice administered control antibody, while in mice administered 3D6 antibody this value was 95% (Figure 4B).
• the relative change in IVSd from pre high fat diet values was significantly different between control and 3D6 antibody administered groups ( Figure 4B).
• mice administered control antibody significantly increased calculated left ventricular mass, a measure of hypertrophy, throughout the development of obesity, which was not observed in mice administered 3D6 antibody ( Figure 4E).
• left ventricular mass siginificantly increased 138% in mice administered control antibody ( Figure 4F).
• the relative change in left ventricular mass from pre high fat diet values was significantly different between control and 3D6 antibody administered groups ( Figure 4F).
• Example 6 Administration of anti - ⁇ 42 antibodies preserves diastolic function and reduces cardiac TAGs in established obesity.
• Example 7 - ⁇ 40 chronic administration does not alter cardiac function
• mice were administered ⁇ 40 or scrambled ⁇ 40 (Scr ⁇ 42) at l ⁇ g/day by i.p. injection for 5 weeks, prior to echocardiography (Figure 6).
• Administration of ⁇ 40 significantly increased plasma ⁇ 40 ( Figure 6A).
• administration of ⁇ 40 did not have any effect on indices of diastolic function, including E:A ratio ( Figure 6B) and DT ( Figure 6C), nor any effect on indices of systolic function, including fractional shortening (Figure 6D) and ejection fraction (Figure 6E).
• ⁇ 40 administration had no effect on cardiac morphology measures, including IVSd ( Figure 6F), LVIDd ( Figure 6G) and LV mass ( Figure 6H).
• ⁇ 42 alters cardiac metabolism and function and has particular impact on diastole. Without being bound by hypothesis, it is believed that the alteration or reprogramming of cardiac metabolism may arise from an ⁇ 42 mediated or associated inflammatory response.
• Administration of ⁇ 42 to mice reduced cardiac glucose uptake and shunted glucose into TAG synthesis, leading to TAG accumulation.
• Reduced glucose uptake and utilisation increases the reliance on fatty acid oxidation, which reduces cardiac efficiency. This is due to the greater O2 cost to produce ATP from beta oxidation, which impairs ATP production and results in impaired cardiac relaxation.
• diastolic relaxation phase has large energetic and ATP requirements,as Ca2+ reuptake and normalisation of membrane ion balances is ATP dependent. Further, the relaxation phase is much longer than systole. Hence the increased reliance on fatty acid oxidation leads to the observed diastolic dysfunction.
• ⁇ 42 antibodies could be used to prevent diastolic dysfunction and halt progression to heart failure in obesity and conditions in individuals having a higher than normal plasma amount of ⁇ 42.
• Vaccination to generate ⁇ 42 antibodies is utilised to prevent obesity-associated cardiomyopathy or cardiomyopathy where circulating ⁇ 42 is elevated.
• CADI06 may be administered in a single administration of the immunizing peptide in PBS at doses of 2.5-250mg/kg via subcutaneous injection.
• the vaccination protocol could also include additional intramuscular administrations of the immunizing peptide 1, 2 and 3 months after the initial immunization.

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