WO2021154216A1 - Protéines de fusion et procédés de traitement d'une dysrégulation du complément à l'aide de celles-ci - Google Patents

Protéines de fusion et procédés de traitement d'une dysrégulation du complément à l'aide de celles-ci Download PDF

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Publication number
WO2021154216A1
WO2021154216A1 PCT/US2020/015466 US2020015466W WO2021154216A1 WO 2021154216 A1 WO2021154216 A1 WO 2021154216A1 US 2020015466 W US2020015466 W US 2020015466W WO 2021154216 A1 WO2021154216 A1 WO 2021154216A1
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compound
seq
fusion protein
amino acid
acid sequence
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PCT/US2020/015466
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English (en)
Inventor
Julian Chandler
Christian COBAUGH
Keith BOUCHARD
Jeffrey Hunter
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Alexion Pharmaceuticals, Inc.
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Priority to PCT/US2020/015466 priority Critical patent/WO2021154216A1/fr
Publication of WO2021154216A1 publication Critical patent/WO2021154216A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/02—Immunomodulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • C07K14/46—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
    • C07K14/47—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • C07K14/46—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
    • C07K14/47—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
    • C07K14/4701—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals not used
    • C07K14/472—Complement proteins, e.g. anaphylatoxin, C3a, C5a
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • C07K14/705—Receptors; Cell surface antigens; Cell surface determinants
    • C07K14/70596—Molecules with a "CD"-designation not provided for elsewhere
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2319/00—Fusion polypeptide
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2319/00—Fusion polypeptide
    • C07K2319/30—Non-immunoglobulin-derived peptide or protein having an immunoglobulin constant or Fc region, or a fragment thereof, attached thereto

Definitions

  • the complement system plays a central role in the clearance of immune complexes and in immune responses to infectious agents, foreign antigens, virus-infected cells, and tumor cells.
  • Complement activation occurs primarily by three pathways: the classical pathway, the lectin pathway, and the alternative pathway.
  • the alternative pathway of complement activation is in a constant state of low-level activation. Uncontrolled activation or insufficient regulation of the alternative complement pathway can lead to systemic inflammation, cellular injury, and tissue damage. Thus, the alternative complement pathway has been implicated in the pathogenesis of a number of diverse diseases.
  • fusion proteins that include fragments of complement factor H (FH) fused to Fc domains, such as Fc receptor binding domains; fragments of FH and complement receptor 2 (CR2) fused to Fc domains, such as Fc receptor binding domains; and variants thereof.
  • FH complement factor H
  • CR2 complement receptor 2
  • the fusion proteins can be used to treat patients with diseases associated with alternative complement pathway dysregulation.
  • a fusion protein having the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 includes a fragment of complement factor FI (FH) (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and 135) and/or a fragment of CR2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94-107, and 136-141); L1 is absent or is an amino acid sequence of at least one amino acid; Fc is an Fc domain; L2 is absent or is an amino acid sequence of at least one amino acid; and D2 includes a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 136, and 137) and/or a fragment of CR2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94-107)
  • the fragment of FH of D1 includes one or more FH short consensus repeat (SCR) domains and/or the fragment of FH of D2 includes one or more FH SCR domains.
  • the one or more SCR domains are selected from the group consisting of SCR 1 , 2, 3, 4, 5, 19, and 20.
  • the FH SCR domains are SCRs 1-4 (e.g., a fragment of FH of SEQ ID NO: 1
  • the FH SCR domains are SCRs 1 -5 (e.g., a fragment of FH of SEQ ID NO: 108). In one embodiment, the FH SCR domains are SCRs 1 -4, 19, and 20 (e.g., a fragment of FH of SEQ ID NO: 134). In one embodiment, the FH SCR domains are SCRs 1 -5, 19, and 20 (e.g., a fragment of FH of SEQ ID NO: 135). In one embodiment, the FH SCR domains are SCRs 19 and 20 (e.g., a fragment of FH of SEQ ID NO: 110).
  • the fragment of CR2 of D1 includes one or more CR2 SCR domains and/or the fragment of CR2 of D2 includes one or more CR2 SCR domains.
  • the one or more SCR domains of CR2 are selected from the group consisting of SCR 1 , 2, 3, and 4.
  • the CR2 SCR domains are SCRs 1 -2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 95 and 102-107).
  • the CR2 SCR domains are SCRs 1 -3 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 136-141 ).
  • the CR2 SCR domains are SCRs 1 -4 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94 and 96-101 ).
  • D1 or D2 further includes a fragment of FH fused by a linker (L3) to a fragment of FH.
  • L3 is an amino acid sequence of at least one amino acid.
  • the fragment of FH includes SCR domains 19 and 20 (e.g., a fragment of FH of SEQ ID NO: 110).
  • D1 or D2 further includes a fragment of FH fused by a linker (L3) to a fragment of CR2.
  • L3 is an amino acid sequence of at least one amino acid.
  • the fragment of CR2 includes SCR domains 1 -2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 95 and 102-107).
  • L3 is G 4 A, (G 4 A) 2 G 4 S, (G 4 A) 2 G 3 AG 4 S, G 4 AG 3 AG 4 S, G 4 SDA, G 4 SDAA , G 4 S, (G 4 S) 2 , (G 4 S) 3 , (G 4 S) 4 , (G 4 S)S, (G 4 S) 6 , EAAAK, (EAAAK) 3 , PAPAP, G 4 SPAPAP, PAPAPG 4 S, GSTSGKSSEGKG, (GGGDS) 2 , (GGGES) 2 , GGGDSGGGGS, GGGASGGGGS, GGGESGGGGS, ASTKGP, ASTKGPSVFPLAP, G 3 P, G 7 P, PAPNLLGGP, G 12 , APELPGGP, SEPQPQPG, (G 3 S2) 3 , GGGGGGGGGSGGGS, GGGGSGGGGGGGGGS, (GGSSS) 3 , (GS4) 3 , G 4 A(
  • L3 is (G 4 A) 2 G 4 S, G 4 SDAA, GGGGAGGGGAGGGGS, GGGGSGGGGSGGGGS, G 4 S, (G 4 S) 2 , (G 4 S) 3 , (G 4 S) 4 , (G 4 S) 5 , (G 4 S) 6 , (EAAAK) 3 , PAPAP, G 4 SPAPAP, PAPAPG 4 S, GSTSGKSSEGKG, (GGGDS) 2 , (GGGES) 2 , GGGDSGGGGS, GGGASGGGGS, GGGESGGGGS, ASTKGP, ASTKGPSVFPLAP, G 3 P, G 7 P, PAPNLLGGP, G 6 , G 12 , APELPGGP, SEPQPQPG, (G 3 S2) 3 , GGGGGGGGGSGGGS, GGGGSGGGGGGGGGS, (GGSSS) 3 , (GS4) 3 , G 4 A(G 4 S) 2 , G 4 SG
  • L3 is (G 4 A) 2 G 4 S. In some embodiments, L3 is G 4 SDAA. In some embodiments, L3 is (G 4 S)4. In some embodiments, L3 is G 4 SDA. In some embodiments, L3 is G 4 A. In some embodiments, L3 is (G 4 A) 3 .
  • SCR2 of the fragment of CR2 includes an N101Q substitution, an N107Q substitution, and/or a S109A substitution.
  • the Fc domain includes a fragment crystallizable (Fc) domain.
  • the Fc domain includes an Fc domain from a human immunoglobulin, or is a chimeric Fc domain.
  • the human immunoglobulin is IgG 1 , lgG2, lgG 3 , or lgG4.
  • the chimeric Fc domain is lgG2/4.
  • the Fc domain can preferably bind an Fc receptor (e.g., FcRn, FcyRI, FcyRII, or FcyRIII).
  • the fusion protein forms a dimer.
  • L1 and L2 have the same or different amino acid sequences.
  • L1 and L2 can be selected from the group consisting of: DAA, G 4 A, (G 4 A) 2 G 4 S, (G 4 A) 2 G 3 AG 4 S, G 4 AG 3 AG 4 S, G 4 SDA, G 4 SDAA , G 4 S, (G 4 S) 2 , (G 4 S) 3 , (G 4 S) 4 , (G 4 S)S, (G 4 S) 6 , EAAAK, (EAAAK) 3 , PAPAP, G 4 SPAPAP, PAPAPG 4 S, GSTSGKSSEGKG, (GGGDS) 2 , (GGGES) 2 , GGGDSGGGGS, GGGASGGGGS, GGGESGGGGS, ASTKGP, ASTKGPSVFPLAP, G 3 P, G 7 P, PAPNLLGGP, G 12 , APELPGGP, SEPQPQPG, (G 3 S2) 3 , GGGGGGGGGGGS
  • L1 and L2 can be selected from the group consisting of: (G 4 A) 2 G 3 AG 4 S, G 4 SDAA, (G 4 A) 2 G 4 S, G 4 AG 3 AG 4 S, GGGGAGGGGAGGGGS, GGGGSGGGGSGGGGS, G 4 S, (G 4 S) 2 , (G 4 S) 3 , (G 4 S) 4 , (G 4 S)S, (G 4 S) 6 , (EAAAK) 3 , PAPAP, G 4 SPAPAP, PAPAPG 4 S, GSTSGKSSEGKG, (GGGDS) 2 , (GGGES) 2 , GGGDSGGGGS, GGGASGGGGS, GGGESGGGGS, ASTKGP, ASTKGPSVFPLAP, G 3 P, G 7 P, PAPNLLGGP, G 6 , G 12 , APELPGGP, SEPQPQPG, (G 3 S2) 3 , GGGGGGGGGGGSGGGS, GGGGSGGGGGGGGGGGG
  • L1 and L2 are (G 4 A) 2 G 4 S. In some embodiments, L1 and L2 are G 4 SDAA. In some embodiments, L1 and L2 are (G 4 S) 4 . In some embodiments, L1 is (G 4 A) 2 G 3 AG 4 S. In some embodiments, L2 is (G 4 A) 2 G 3 AG 4 S. In some embodiments, L1 is G 4 SDAA. In some embodiments, L2 is G 4 SDAA. In some embodiments, L1 is G 4 AG 3 AG 4 S. In some embodiments, L2 is G 4 AG 3 AG 4 S.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 is or includes CR2 domains 1-2, wherein CR2 SCR 2 includes an N107Q substitution; L1 is or includes G 4 SDAA; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1-4.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 148, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 148.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 is or includes CR2 domains 1-2, wherein CR2 SCR 2 includes an N107Q substitution; L1 is or includes G 4 SDAA; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1-5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 147, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 147.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 is or includes CR2 SCR domains 1 and 2, wherein CR2 SCR 2 includes an N107Q substitution; L1 is or includes G 4 SDAA; Fc is or includes a FLG2-G 4 Fc domain (e.g., having the sequence of SEQ ID NO: 111 ); L2 is or includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1 -4.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 155, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 155.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 is or includes FH SCR domains 19 and 20; L1 is absent; Fc is or includes an lgG2- G 4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is absent; and D2 is or includes FH SCRs 1-5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 144, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 144.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes FH SCR domains 1-5; L1 is absent; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is absent; and D2 is or includes FH SCRs 19 and 20.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 145, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 145.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes FH SCR domains 1-5; L1 is or includes (G 4 A) 2 G 4 S; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is absent; and D2 is or includes FH SCRs 19 and 20.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 152, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 152.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes FH SCR domains 1-5; L1 is absent; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 4 S; and D2 is or includes FH SCRs 19 and 20.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 153, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 153.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes FH SCR domains 1-5; L1 is or includes (G 4 A) 2 G 4 S; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 4 S; and D2 is or includes FH SCRs 19 and 20.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 154, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 154.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 includes CR2 SCR domains 1 -4; L1 includes (G 4 A) 2 G 4 S; Fc includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 includes (G 4 A) 2 G 4 S; and D2 includes FH SCRs 1 -5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 132, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 132.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 includes CR2 SCR domains 1-4, wherein CR2 SCR 2 includes an N107Q substitution; L1 includes (G 4 A) 2 G 4 S; Fc includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 includes (G 4 A) 2 G 4 S; and D2 includes FH SCRs 1-5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 121 , or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 121 .
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 includes CR2 SCR domains 1-4, wherein CR2 SCR 2 includes a S109A substitution; L1 includes (G 4 A) 2 G 4 S; Fc includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 includes (G 4 A) 2 G 4 S; and D2 includes FH SCRs 1-5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 122, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 122.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 includes CR2 SCR domains 1-4; L1 includes G 4 SDAA; Fc includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 includes (G 4 S) 4 ; and D2 includes FH SCRs 1- 5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 114, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 114.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 includes CR2 SCR domains 1-4; L1 includes G 4 SDAA; Fc includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 includes (G 4 S) 2 ; and D2 includes FH SCRs 1- 5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 118, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 118.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1-L1- Fc-L2-D2, wherein D1 includes CR2 SCR domains 1-4; L1 includes G 4 SDAA; Fc includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 includes G 4 S; and D2 includes FH SCRs 1-5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 119, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 119.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 includes CR2 SCR domains 1 -4; L1 is absent; Fc includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is absent; and D2 includes FH SCRs 1 -5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 116, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 116.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 includes CR2 SCR domains 1 -4; L1 is absent; Fc includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 includes (G 4 A) 2 G 4 S; and D2 includes FH SCRs 1 -5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 124, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 124.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 115, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 115.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 117, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 117.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 120, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 120.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 123, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 123.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes CR2 SCR domains 1 -4; L1 is or includes G 4 SDAA; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1 -5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 209, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence with at least 85% (e.g., at least 90%, at least 95%, at least 97%, or at least 99%) sequence identity to SEQ ID NO: 209.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes CR2 SCR domains 1 -4, wherein CR2 SCR 2 includes an N107Q substitution; L1 is absent; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1 -5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 210, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence with at least 85% (e.g., at least 90%, at least 95%, at least 97%, or at least 99%) sequence identity to SEQ ID NO: 210.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes CR2 SCR domains 1 -2, wherein CR2 SCR 2 includes an N107Q substitution; L1 is absent; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1 -5.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 211 , or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence with at least 85% (e.g., at least 90%, at least 95%, at least 97%, or at least 99%) sequence identity to SEQ ID NO: 211 .
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes CR2 SCR domains 1 -4, wherein CR2 SCR 2 includes an N107Q substitution; L1 is or includes G 4 SDA; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1 -4.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 212, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence with at least 85% (e.g., at least 90%, at least 95%, at least 97%, or at least 99%) sequence identity to SEQ ID NO: 212.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes CR2 SCR domains 1 -4, wherein CR2 SCR 2 includes an N107Q substitution; L1 is absent; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1 -4.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 213, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence with at least 85% (e.g., at least 90%, at least 95%, at least 97%, or at least 99%) sequence identity to SEQ ID NO: 213.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes CR2 SCR domains 1 -2, wherein CR2 SCR 2 includes an N107Q substitution; L1 is absent; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 3 AG 4 S; and D2 is or includes FH SCRs 1 -4.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 214, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence with at least 85% (e.g., at least 90%, at least 95%, at least 97%, or at least 99%) sequence identity to SEQ ID NO: 214.
  • the fusion protein has the structure, from N-terminus to C-terminus: D1 -L1 - Fc-L2-D2, wherein D1 is or includes FH SCR domains 19-20; L1 is or includes (G 4 A) 2 G 4 S; Fc is or includes an lgG2-G4 Fc domain (e.g., having the sequence of SEQ ID NO: 88); L2 is or includes (G 4 A) 2 G 4 S; and D2 is or includes FH SCRs 1 -4.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 215, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence with at least 85% (e.g., at least 90%, at least 95%, at least 97%, or at least 99%) sequence identity to SEQ ID NO: 215.
  • a fusion protein including (a) a moiety including a fragment of complement receptor 2 (CR2); (b) an anti-albumin VHH domain; and (c) a moiety including a fragment of complement factor H (FH).
  • the fusion protein has the structure, from N-terminus to C-terminus: (a)-(b)-(c).
  • the fusion protein has the structure (a)-L1 -(b)-L2-(c), in which L1 and L2, independently, may be absent or a linker of at least one amino acid.
  • L1 and L2 can have the sequence selected from those shown above.
  • one or more, or all, of (a), (b), and/or (c) are fused by a linker.
  • fusion protein includes from N-terminus to C-terminus: FH SCR domains 1 -5 (e.g., a fragment of FH of SEQ ID NO: 108) fused to an anti-albumin VHH domain, with or without a linker.
  • FH SCR domains 1 -5 e.g., a fragment of FH of SEQ ID NO: 108 fused to an anti-albumin VHH domain, with or without a linker.
  • the fusion protein includes from N-terminus to C-terminus: CR2 SCR domains 1 -4 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94 and 96-101 ) fused to the anti albumin VHH domain fused to FH SCR domains 1 -5 (e.g., a fragment of FH of SEQ ID NO: 108).
  • the fusion protein has the amino acid sequence of SEQ ID NO: 125, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 125.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 126, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 126.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 127, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 127.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 128, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 128.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 129, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 129.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 130, or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 130.
  • the fusion protein has the amino acid sequence of SEQ ID NO: 131 , or a variant thereof having up to 10 (e.g., 10 or fewer, 9 or fewer, 8 or fewer, 7 or fewer, 6 or fewer, 5 or fewer, 4 or fewer, 3 or fewer, 2 or fewer, or 1 or fewer) amino acid substitutions, additions, or deletions.
  • the fusion protein has an amino acid sequence having at least 85% (e.g., at least 85%, at least 90%, at least 95%, or at least 99%) sequence identity to SEQ ID NO: 131 .
  • the fusion protein has an increased half-life relative to the fusion protein lacking the Fc domain.
  • the fusion protein is formulated in a pharmaceutical composition, with at least one pharmaceutically acceptable carrier.
  • the at least one pharmaceutically acceptable carrier is saline.
  • nucleic acid or polynucleotide encoding a fusion protein described herein.
  • Also provided is a method of treating a disease mediated by alternative complement pathway dysregulation including administering an effective amount of a pharmaceutical composition including a fusion protein described herein to a subject in need thereof.
  • Also provided is a method of treating a disease mediated by alternative complement pathway dysregulation including administering an effective amount of a polynucleotide encoding a fusion protein described herein to a subject in need thereof.
  • Also provided is a method of treating a disease mediated by alternative complement pathway dysregulation including administering an effective amount of a host cell including a nucleic acid encoding a fusion protein described herein to a subject in need thereof.
  • Also provided is a method of producing a fusion protein described herein including the steps of culturing one or more host cells including one or more nucleic acid molecules capable of expressing the fusion protein under conditions suitable for expression of the fusion protein.
  • the method further includes the step of obtaining the fusion protein from the cell culture or culture medium.
  • a method of treating a disease mediated by alternative complement pathway dysregulation including administering an effective amount of a fusion protein described herein to a subject in need thereof.
  • the fusion protein is formulated in a pharmaceutical composition, with at least one pharmaceutically acceptable carrier, and is, preferably, rehydrated prior to administration.
  • the composition is lyophilized.
  • the at least one pharmaceutically acceptable carrier is saline.
  • the fusion protein is formulated for daily, weekly, or monthly administration. In some embodiments, the fusion protein is formulated for intravenous, subcutaneous, intramuscular, oral, nasal, sublingual, intrathecal, or intradermal administration. In some embodiments, the fusion protein is formulated for administration at a dosage of between about 0.1 mg/kg to about 150 mg/kg. In some embodiments, the fusion protein is formulated for administration in combination with an additional therapeutic agent.
  • the disease is paroxysmal nocturnal hemoglobinuria (PNH). In some embodiments, the disease is atypical hemolytic uremic syndrome (aHUS). In some embodiments, the disease is IgA nephropathy. In some embodiments, the disease is lupus nephritis. In some embodiments, the disease is C3 glomerulopathy (C3G). In some embodiments, the disease is dermatomyositis. In some embodiments, the disease is systemic sclerosis. In some embodiments, the disease is demyelinating polyneuropathy. In some embodiments, the disease is pemphigus. In some embodiments, the disease is dense deposit disease (DDD).
  • DDD dense deposit disease
  • the disease is age related macular degeneration (AMD). In some embodiments, the disease is thrombic thrombocytopenic purpura (TTP). In some embodiments, the disease is membranous nephropathy. In some embodiments, the disease is focal segmental glomerular sclerosis (FSGS). In some embodiments, the disease is membranous nephropathy. In some embodiments, the disease is bullous pemphigoid. In some embodiments, the disease is membranous nephropathy. In some embodiments, the disease is epidermolysis bullosa acquisita (EBA). In some embodiments, the disease is ANCA vasculitis.
  • AMD age related macular degeneration
  • TTP thrombic thrombocytopenic purpura
  • TTP thrombic thrombocytopenic purpura
  • TTP thrombic thrombocytopenic purpura
  • the disease is membranous nephropathy.
  • FSGS focal segmental
  • the disease is membranous nephropathy. In some embodiments, the disease is hypocomplementemic urticarial vasculitis. In some embodiments, the disease is immune complex small vessel vasculitis. In some embodiments, the disease is an autoimmune necrotizing myopathy.
  • the disease is rejection of a transplanted organ.
  • the disease is antiphospholipid (aPL) Ab syndrome.
  • the disease is glomerulonephritis.
  • the disease is asthma.
  • the disease is systemic lupus erythematosus (SLE).
  • the disease is rheumatoid arthritis (RA).
  • the disease is multiple sclerosis (MS).
  • the disease is traumatic brain injury (TBI).
  • the disease is ischemia reperfusion injury.
  • the disease is preeclampsia.
  • the subject is a mammal. In some embodiments, the mammal is a human.
  • kits including a fusion protein described herein.
  • the kit further includes instructions for administering an effective amount of the fusion protein to a subject in need thereof.
  • a construct consisting of CR2 SCR 1 -4 directly fused to FH SCR 1 -5 (CR2I-4-FHI- 5 ), as described in WO2007/14567.
  • FIG. 1 A is a schematic diagram illustrating exemplary complement factor H (FH) fusion proteins.
  • FIG. 1B are sequences of CR2 fragments A-F, corresponding to SEQ ID NOs: 99, 97, 98, 96,
  • Fragments A and C include an S109A mutation.
  • Fragments D and F include an N107Q mutation.
  • Mutated residues are denoted by an asterisk above the residue. Shaded, underlined residues indicate N-glycosylation motifs. Shaded residues with a “+” above the residue denote positively charged residues within the N- glycosylation motifs. Shaded, non-underlined residues indicate positively charged amino acids, none of which were mutated.
  • FIGS. 2A-2C are a series of SDS-PAGE gels showing the expression of the factor H fusion protein variants from harvested cell culture supernatants.
  • the accompanying tables indicate the predicted molecular weight (MW) in kilodaltons (kDa) of the major band, as well as the yield in ⁇ g/mL.
  • FIGS. 3A-3B are representative SE HPLC chromatograms (280nm) and SDS-PAGE gels of purified CR2-FH-Fc fusion protein N-linked glycosylation variants.
  • FIGS. 4A-4D are a series of graphs showing alternative pathway hemolytic activity of fusion proteins containing FH or fusion proteins including CR2 and FH.
  • FIG. 4E is a schematic diagram illustrating the complement factor H (FH) fusion proteins tested for hemolytic activity (see FIGS. 4C and 4D).
  • FIG. 5A is a schematic diagram illustrating exemplary FH anti-albumin-VHH fusion proteins with glycosylation variants.
  • FIG. 5B is an SDS-PAGE gel showing the expression of the factor H anti-albumin-VHH fusion protein variants from harvested cell culture supernatants.
  • the accompanying table indicates the predicted molecular weight (MW) in kilodaltons (kDa) of the major band, as well as the yield in ⁇ g/mL.
  • FIG. 5C is an SDS-PAGE gel purifying factor H anti-albumin-VHH fusion proteins from harvested cell culture supernatants fractionated from MEP HYPERCELTM or CAPTOTM Adhere ImpRes resins.
  • FIG. 5D is an SDS-PAGE gel determining elution pH profile of the factor H anti-albumin-VHH fusion proteins from harvested cell culture supernatants using MEP HYPERCELTM or CAPTOTM Adhere ImpRes resin, purified along a pH gradient.
  • FIG. 5E is a graph showing the yield of the factor H anti-albumin-VHH fusion protein (Compound O) isolated using various small scale purification schemes.
  • FIG. 5F is a SE HPLC chromatogram showing the purity of the factor H anti-albumin-VHH fusion protein (Compound O) isolated using MEP HYPERCELTM resin at pH 4.7.
  • FIG. 5G is a SE HPLC chromatogram showing the purity of the factor H anti-albumin-VHH fusion protein (Compound O) isolated using CAPTOTM Adhere ImpRes resin at pH 4.46.
  • FIG. 5H is a graph showing the alternative pathway hemolytic activity of the factor H anti-albumin- VHH fusion proteins (Compound O) isolated using MEP HYPERCELTM resin.
  • FIG. 51 is a graph showing the alternative pathway hemolytic activity of the factor H anti-albumin- VHH fusion proteins (Compound O) isolated using CAPTOTM Adhere ImpRes resin.
  • FIG. 5J is an SDS-PAGE gel showing the overall purity of the factor H anti-albumin-VHH fusion protein isolated in a large scale purification scheme using a HITRAP CAPTOTM Adhere ImpRes Column.
  • FIG. 6A is a schematic diagram illustrating Compound X.
  • FIG. 6B is a pair of SDS-PAGE gels showing the fragmentation of Compound X under reducing or non-reducing conditions.
  • FIG. 6C is a schematic diagram illustrating exemplary FH fusion proteins evaluated in the structure function analysis studies.
  • FIG. 7 is a spectra showing the ESI-ToF mass spectrometry of protein A-purified Compound X.
  • FIG. 8A is a schematic diagram illustrating Compound AC.
  • FIG. 8B is pair of SDS-PAGE gels showing the fragmentation of Compound AC under reducing or non-reducing conditions.
  • FIG. 8C is a spectra showing ESI-ToF mass spectrometry of Compound AC.
  • FIG. 9 is a graph showing inhibition of alternative pathway hemolytic activity of fusion proteins Compound AC and Compound AD.
  • FIG. 10 is a graph showing inhibition of alternative pathway hemolytic activity of fusion proteins containing FH or fusion proteins including CR2 and FH. Molecular descriptions and IC 50 values are shown in the accompanying table.
  • FIG. 11 is a graph showing inhibition of alternative pathway hemolytic activity of non-targeted FH- Fc fusion proteins. Molecular descriptions and IC 50 values are shown in the accompanying table.
  • FIG. 12 is a graph showing association of Compound AC (dark blue trace), Compound AP (red trace), or Compound AQ (light blue trace) with immobilized C3d by Octet BLI detection.
  • FIG. 13 is an SDS PAGE of Compound H indicating fragmentation under non-reducing or reducing conditions.
  • FIG. 14 is a graph showing the PK of compounds X, H, and AC in wild-type mice.
  • FIG. 15 is a graph showing inhibition of mouse alternative pathway hemolysis in mice treated with Compounds X, H, or AC.
  • FIG. 16 is a graph showing PK and suppression of AP hemolytic activity in wild-type mice following administration of 25 mg/kg Compound AB.
  • FIG. 17 is a graph showing PK and suppression of AP hemolytic activity in wild-type mice following administration with 25 mg/kg Compound AC.
  • FIG. 18 is a graph showing the profile of Compound AC when administered as a single 25 mg/kg IV dose to wild-type and FH -/- mice.
  • FIG. 19 is series of immunohistochemical images showing human factor H (Compound AC) localized to kidney glomeruli of FH-/- mice administered a single 25 mg/kg IV dose of Compound AC.
  • Each frame provides a representative image from an individual animal.
  • the PBS treatment group had 5 individual animals. Three animals were analyzed on day 1 and day 3, and five animals were analyzed on days 7 and 14.
  • FIG. 20 is a graph showing quantitation of mean fluorescence intensity of glomerular human factor H staining (Compound AC) in FH-/- mice treated with Compound AC.
  • the human factor H-positive pixel count mean signal intensity was calculated as an average from 20 glomeruli for each animal.
  • Statistical significance was determined by one-way ANOVA using the Kruskal-Wallis test for multiple comparisons. An asterisk indicates statistical significance between the treatment group at a given timepoint and the non-treated (PBS) control. NS is not significant.
  • FIG. 21 is a series of immunohistochemical images of mouse C3 deposited on the glomeruli of FH-/- mice treated with either Compound AC or PBS. Each frame provides a representative image from an individual animal.
  • FIG. 22 is a graph showing quantitation of mean fluorescence intensity of glomerular C3 staining in FH-/- mice treated with Compound AC.
  • the C3 positive pixel count mean signal intensity was calculated as an average from 20 glomeruli for each animal.
  • Statistical significance was determined by one-way ANOVA using the Kruskal-Wallis test for multiple comparisons. An asterisk indicates statistical significance between the treatment group at a given timepoint and the non-treated (PBS) control. NS is not significant.
  • FIG. 23 is a series of immunohistochemical images showing deposition of properdin on the glomeruli of FH-/- mice treated with either Compound AC or PBS. Each frame provides a representative image from an individual animal.
  • FIG. 24 is a graph showing plasma C3 levels of FH-/- mice treated with Compound AC.
  • FIG. 25 is a graph showing plasma C5 levels in FH-/- and in wild-type control mice treated with Compound AC.
  • FIG. 26 is a graph showing a reduction in the KLH-specific IgM response in immunized animals administered cyclophosphamide, Compound AA, or Compound AJ.
  • FIG. 27 is a graph showing a near complete suppression of the KLH-specific IgG response in immunized animals administered cyclophosphamide, Compound AA, or Compound AJ.
  • fusion protein refers to a composite polypeptide made up of two (or more) distinct, heterologous polypeptides.
  • the heterologous polypeptides can either be full-length proteins, or fragments of full-length proteins. Fusion proteins herein can be prepared by either synthetic or recombinant techniques known in the art.
  • the term “antibody” refers to an immunoglobulin molecule that specifically or substantially specifically binds to, or is immunologically reactive with, a particular antigen.
  • the antibody can be, for example, a natural or artificial mono- or polyvalent antibody including, but not limited to, a polyclonal, monoclonal, multi-specific, human, humanized, or chimeric antibody.
  • An antibody may be a genetically engineered or otherwise modified form of an antibody, including but not limited to, heteroconjugate antibodies (e.g., bi-, tri-, and tetra-specific antibodies, diabodies, triabodies, and tetrabodies), and antigen binding fragments of antibodies, including, for example, single domain, Fab', F(ab') 2 , Fab, Fv, rlgG and scFv fragments.
  • heteroconjugate antibodies e.g., bi-, tri-, and tetra-specific antibodies, diabodies, triabodies, and tetrabodies
  • antigen binding fragments of antibodies including, for example, single domain, Fab', F(ab') 2 , Fab, Fv, rlgG and scFv fragments.
  • single domain antibody defines molecules where the antigen binding site is present on, and formed by, a single immunoglobulin domain.
  • Single domain antibodies include antibodies whose complementary determining regions (“CDFts”) are part of a single domain polypeptide.
  • Single domain antibodies include an antibody or antigen binding fragment thereof that specifically binds a single antigen.
  • the antigen binding site of an immunoglobulin single variable domain is formed by no more than three CDRs.
  • the single variable domain may, for example, include a light chain variable domain sequence (a VL sequence) or a suitable fragment thereof; or a heavy chain variable domain sequence (e.g., a VH sequence or VHH sequence), or a suitable fragment thereof; as long as it is capable of forming a single antigen binding unit (i.e ., a functional antigen binding unit that essentially is the single variable domain, such that the single antigen binding domain does not need to interact with another variable domain to form a functional antigen binding unit).
  • a single antigen binding unit i.e ., a functional antigen binding unit that essentially is the single variable domain, such that the single antigen binding domain does not need to interact with another variable domain to form a functional antigen binding unit.
  • Such antibodies can be derived, for example, from antibodies raised in Camelidae species, for example, in a camel, dromedary, llama, alpaca, or guanaco.
  • Additional antibodies include, for example, immunoglobulin new antigen receptor (IgNAR) of cartilaginous fishes (e.g., sharks, e.g., nurse sharks).
  • IgNAR immunoglobulin new antigen receptor
  • Other species besides Camelidae and cartilaginous fishes may produce antibodies whose CDRs are part of a single polypeptide.
  • Antibodies can be prepared by either synthetic or recombinant techniques known in the art.
  • affinity refers to the strength of an interaction between binding moiety and its target.
  • an Fc domain such as an Fc receptor binding domain, interacts through non-covalent forces with an Fc receptor (e.g., FcRn, FcyRI, FcyRII, or FcyRIII).
  • FcRn FcRn
  • FcyRI FcyRII
  • FcyRIII FcyRIII
  • high affinity for an Fc receptor binding domain or fragment thereof (e.g., an Fc domain) refers to an Fc domain having a KD of 10 -8 M or less, 10 -9 M or less, 10 -10 M or less, 10 -11 M or less, 10 -12 M or less, or 10 -13 M or less for an Fc receptor.
  • low affinity for an Fc receptor binding domain or fragment thereof (e.g., an Fc domain) refers to an Fc domain having a KD of 10 -7 M or more
  • Fc domain refers to an antibody (e.g., a monoclonal antibody), or fragment thereof, such as a fragment crystallizable (Fc) region of an antibody.
  • exemplary Fc domains include an Fc domain comprising the second and third constant domain of a human immunoglobulin (CFI2 and CH3), or the hinge, CH2 and CH3.
  • the immunoglobulin may be an IgG (e.g., human IgG 1 , lgG4 , lgG2/4, or lgG4 proline stabilized construct).
  • An Fc domain may also comprise an Fc receptor binding domain.
  • Fc receptor binding domain refers to a polypeptide or antibody fragment that directly binds to an Fc receptor (e.g., FcRn, FcyRI, FcyRII, or FcyRIII), including to a mammalian Fc receptor (e.g., a human Fc receptor).
  • Antibody fragments capable of binding to an Fc receptor include fragment crystallizable (Fc) domains from an antibody, such as an IgG (e.g., human IgG 1 , lgG4 , lgG2/4, or lgG4 proline stabilized construct).
  • Fc receptor refers to a protein on the surface of immune cells, such as natural killer cells, macrophages, neutrophils, and mast cells.
  • An Fc receptor can bind to an Fc (Fragment, crystallizable) region of an antibody that is attached to infected cells or invading pathogens and this binding can stimulate phagocytic or cytotoxic cells to destroy microbes, or infected cells by antibody-mediated phagocytosis or antibody-dependent cell-mediated cytotoxicity.
  • FcRn refers to the neonatal Fc receptor that binds IgG.
  • FcRn is similar in structure to MHC class I protein, which, in humans, is encoded by the FCGRT gene.
  • An Fc receptor binding domain that binds directly to FcRn includes an antibody Fc domain.
  • Regions capable of binding to a polypeptide such as albumin or IgG, which has human FcRn-binding activity can indirectly bind to human FcRn via albumin, IgG, or such.
  • a human FcRn-binding region may be a region that binds to a polypeptide having human FcRn-binding activity.
  • Other Fc receptors include FcyRI, FcyRII, and FcyRIII.
  • fused refers to the combination or attachment of two or more elements, components, or protein domains, e.g., polypeptides, by means including chemical conjugation, recombinant means, and chemical bonds, e.g., disulfide bonds and amide bonds.
  • two single polypeptides can be joined to form one contiguous protein structure through recombinant expression, chemical conjugation, a chemical bond, a peptide linker, or any other means of covalent linkage.
  • linker refers to a linkage between two elements, e.g., polypeptides or protein domains.
  • a linker can be a covalent bond.
  • a linker can also be a molecule of any length that can be used to couple, for example, a factor H fragment and/or a CR2 fragment with an Fc domain, such as an Fc receptor binding domain.
  • a linker also refers to a moiety (e.g., a polyethylene glycol (PEG) polymer) or an amino acid sequence (e.g., a 1 -200 amino acid, 1 -150 amino acid, 1 -100, a 5-50, or a 1 - 10 amino acid sequence, particularly amino acids with smaller side chains and/or flexible amino acid sequences) occurring between two polypeptides or polypeptide domains to provide space and/or flexibility between the two polypeptides or polypeptide domains.
  • An amino acid linker may be part of the primary sequence of a polypeptide (e.g., joined to the linked polypeptides or polypeptide domains via the polypeptide backbone). Non-limiting examples include (G 4 A) 2 G 4 S, G 4 SDAA, (G 4 S), and (G 4 A) 2 G 3 AG 4 S. (SEQ ID NOs: 14-16, and 79).
  • host cell refers to any kind of cellular system that can be engineered to generate the fusion proteins described herein.
  • Non-limiting examples of host cells include HEK, HEK293, HT-1080, CHO, Pichia pastoris, Saccharomyces cerevisiae, and transformable insect cells such as High Five, Sf9, and Sf21 cells.
  • operatively linked in the context of a polynucleotide fragment means that the two polynucleotide fragments are joined such that the amino acid sequences encoded by the two polynucleotide fragments remain in-frame.
  • alternative complement pathway refers to one of three pathways of complement activation (the others being the classical pathway and the lectin pathway).
  • alternative complement pathway dysregulation refers to any aberration in the ability of the alternative complement pathway to provide host defense against pathogens and clear immune complexes and damaged cells and for immunoregulation.
  • Alternative complement pathway dysregulation can occur in the fluid phase and at the cell surface and can lead to excessive complement activation or insufficient regulation, both causing tissue injury.
  • Vector H refers to a protein component of the alternative complement pathway encoded by the complement factor H gene (“FH;” NM000186; GenelD:3075; UniProt ID P08603;
  • Factor H is translated as a 1 ,213 amino acid precursor polypeptide that is processed by removal of an 18 amino acid signal peptide, resulting in the mature factor H protein (amino acids 19-1231 ).
  • Factor H consists of 20 short complement regulator (SCR) domains.
  • Amino acids 1 -18 comprise the signal peptide
  • residues 21 -80 comprise SCR1 (SEQ ID NO: 1
  • residues 85-141 comprise SCR 2 (SEQ ID NO: 2)
  • residues 146-205 comprise SCR3 (SEQ ID NO: 3)
  • residues 201 -262 comprise SCR 4 (SEQ ID NO: 4)
  • residues 267-320 comprise SCR 5 (SEQ ID NO: 5)
  • residues 1107-1165 comprise SCR 19 (SEQ ID NO:6)
  • residues 1167-1230 comprise SCR 20 (SEQ ID NO: 7).
  • Factor H regulates complement activation on self-cells by possessing both cofactor activity for the factor l-mediated C3b cleavage, and decay accelerating activity against the alternative pathway C3 convertase, C3bBb.
  • Complement receptor 2 or “CR2” refers to human complement receptor 2, also referred to as CD21 (CR2/CD21 ), is a 145 kD transmembrane protein of the C3 binding protein family comprising 15 or 16 short consensus repeat (SCR) domains, structural units characteristic of such proteins.
  • SCR domains have a typical framework of highly conserved residues including four cysteines, two prolines, one tryptophan, and several other partially conserved glycines and hydrophobic residues. These SCR domains are separated by short sequences of variable length that serve as spacers.
  • Amino acids 1 -20 comprise the leader peptide
  • amino acids 23-82 comprise SCR1 (SEQ ID NO: 8)
  • amino acids 91 -146 comprise SCR2 (SEQ ID NO: 9)
  • amino acids 154-210 comprise SCR3 (SEQ ID NO: 10)
  • amino acids 215-271 comprise SCR4 (SEQ ID NO: 11 ).
  • the active site (C3d binding site) is located in SCR1 -2 (the first two N-terminal SCR domains).
  • CR2 is expressed on mature B cells and follicular dendritic cells, and plays an important role in humoral immunity. J. Hannan et al ., Biochem. Soc. Trans. (2002) 30:983-989; K. A. Young et al., J. Biol.
  • CR2 protein does not bind intact C3 protein, but binds its breakdown products, including the C3b, iC3b, and C3d cleavage fragments, via a binding site located within the first two amino-terminal SCR domains (“SCRs 1 - 2”) of the CR2 protein. Consequently, the SCRs 1 -2 of CR2 discriminate between cleaved (i.e. , activated) forms of C3 generated during complement activation and intact circulating C3. While the affinity of CR2 for C3d is only 620-658 nM (J. Hannan et al., Biochem. Soc. Trans.
  • Cleavage of C3 results initially in the generation and deposition of C3b on the activating cell surface.
  • the C3b fragment is involved in the generation of enzymatic complexes that amplify the complement cascade.
  • C3b is rapidly converted to inactive iC3b, particularly when deposited on a host surface containing regulators of complement activation (i.e., most host tissue).
  • regulators of complement activation i.e., most host tissue.
  • iC3b is subsequently digested to the membrane-bound fragments C3dg and then C3d by factor I and other proteases and cofactors, but this process is relatively slow.
  • the C3 ligands for CR2 are relatively long lived once they are generated and are present in high concentrations at sites of complement activation.
  • a “functional fragment” or a “biologically active fragment” refers to a fragment, or portion, of a protein having some or all of the activities of the full-length protein.
  • a functional or biologically active fragment of factor H refers to any fragment of a factor H protein having some or all of the activities of factor H, e.g., alternative complement pathway regulatory activity of the full-length factor H protein. Examples include, but are not limited to, factor H fragments, joined from N-terminus to C terminus, containing the following SCRs: [1 -4], [1 -5], [1 -7], [1 -20], [19-20], [1 -4 and 19-20], and [1 -5 and 19-20].
  • a functional fragment or a “biologically active fragment” of CR2 protein is one having some or all of the activities of CR2, e.g., alternative complement pathway regulatory activity of the full-length CR2 protein.
  • Examples include, but are not limited to, CR2 fragments, from N-terminus to C-terminus, containing the following SCRs: [1 -2], [1 -3], or [1 -4],
  • fragment refers to less than 100% of the amino acid sequence or a full-length reference protein (e.g., 99%, 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%, of the full- length sequence etc.), but including, e.g., 20, 25, 30, 35, 40, 45, 50, 100, 150, 200, 250, 300, 350, or more amino acids.
  • a fragment can be of sufficient length such that a desirable function of the full-length protein is maintained. For example, the regulation of the alternative complement pathway in the fluid phase by fragments of, for example, factor H, is maintained. Such fragments are “biologically active fragments.”
  • short complement regulator As used herein, the terms “short complement regulator”, or “SCR”, also known as “short consensus repeat”, “sushi domains,” or “complement control protein” or “CCP,” describe domains found in all regulators of complement activation (RCA) gene clusters that contribute to their ability to regulate complement activation in the blood or on the cell surface to which they specifically bind. SCRs typically are composed of about 60 amino acids, with four cysteine residues disulfide bonded in a 1-3, 2-4 arrangement and a hydrophobic core built around an almost invariant tryptophan residue. SCRs are found in proteins including, but not limited to, factor H and CR2.
  • Percent (%) sequence identity is defined as the percentage of nucleic acids or amino acids in a candidate sequence that are identical to the nucleic acids or amino acids in the reference polynucleotide or polypeptide sequence, after aligning the sequences and introducing gaps, if necessary, to achieve the maximum percent sequence identity. Alignment for purposes of determining percent nucleic acid or amino acid sequence identity can be achieved in various ways that are within the capabilities of one of skill in the art, for example, using publicly available computer software, such as BLAST, BLAST-2, or Megalign software.
  • percent sequence identity values may be generated using the sequence comparison computer program BLAST.
  • percent sequence identity of a given nucleic acid or amino acid sequence, A, to, with, or against a given nucleic acid or amino acid sequence, B, (which can alternatively be phrased as a given nucleic acid or amino acid sequence, A that has a certain percent sequence identity to, with, or against a given nucleic acid or amino acid sequence, B) is calculated as follows:
  • disease refers to an interruption, cessation, or disorder of body functions, systems, or organs.
  • Disease(s) or disorders of interest include those that would benefit from treatment with a fusion protein or method described herein.
  • Non-limiting examples of diseases or disorders to be treated herein resulting from the dysregulation of the alternative complement pathway activation include, but are not limited to, kidney disorders, cutaneous disorders, and neurological disorders; for example, paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS), IgA nephrology, lupus nephritis, C3 glomerulopathy (C3G), dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, focal segmental glomerular sclerosis (FSGS), bullous pemphigoid, epidermolysis bullosa acquisita (EBA), ANCA va
  • PNH paroxy
  • treatment refers to therapeutic treatment, in which the object is to inhibit or lessen an undesired physiological change or disorder or to promote a beneficial phenotype in a patient.
  • treatment refers to clinical intervention in an attempt to alter the natural course of an individual’s affliction, disease, or disorder.
  • the terms include, for example, prophylaxis before or during the course of clinical pathology.
  • Desirable effects of treatment include, but are not limited to, preventing occurrence or recurrence of disease, alleviation of symptoms, diminishment of any direct or indirect pathological consequences of the disease, decreasing the rate of disease progression, amelioration, or palliation of the disease state, and improved prognosis.
  • fusion proteins are used to control the cellular and clinical manifestations of kidney disorders, cutaneous disorders, and neurological disorders, such as PNH, aHUS, IgA nephrology, lupus nephritis, C3G, dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, FSGS, bullous pemphigoid, epidermolysis bullosa acquisita (EBA), ANCA vasculitis, hypocomplementemic urticarial vasculitis, immune complex small vessel vasculitis, an autoimmune necrotizing myopathy, rejection of a transplanted organ, antiphospholipid (aPL) Ab syndrome, glomerulonephritis, asthma, DDD, AMD, SLE, RA, MS, TBI, ischemia reperfusion injury, preeclampsia, and TTP.
  • PNH kidney disorders
  • aHUS IgA n
  • administering refers refer to any method of providing a pharmaceutical preparation to a subject.
  • Fusion proteins may be administered by any method known to those skilled in the art. Suitable methods for administering the fusion protein may be, for example, orally, by injection (e.g., intravenously, intraperitoneally, intramuscularly, intravitreally, and subcutaneously), drop infusion preparations, inhalation, intranasally, and the like. In particular, administrations is via intravenous and/or subcutaneous infusions.
  • Fusion proteins prepared as described herein may be administered in various forms, depending on the disorder to be treated and the age, condition, and body weight of the subject, as is known in the art.
  • a preparation can be administered prophylactically; that is, administered to decrease the likelihood of developing a disease or condition.
  • the term “effective amount” refers to an amount that is sufficient to achieve the desired result or to have an effect on an undesired condition.
  • an “effective amount” refers to an amount that is sufficient to achieve the desired therapeutic result.
  • the specific therapeutically effective dose for any particular patient will depend upon a variety of factors including the disorder being treated and the severity of the disorder; the specific composition employed; the age, body weight, general health, sex, and diet of the patient; the time of administration; the route of administration; the rate of excretion of the specific compound employed; the duration of the treatment; drugs used in combination or coincidental with the specific compound employed, and like factors known in the art.
  • Dosage can vary, and can be administered in one or more dose administrations daily, weekly, monthly, or yearly, for one or several days.
  • the term “patient in need thereof” or “subject in need thereof,” refers to the identification of a subject based on need for treatment of a disease or disorder.
  • a subject can be identified, for example, as having a need for treatment of a disease or disorder (e.g., PNH, aHUS, IgA nephrology, lupus nephritis, C3G, dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, FSGS, bullous pemphigoid, epidermolysis bullosa acquisita (EBA), ANCA vasculitis, hypocomplementemic urticarial vasculitis, immune complex small vessel vasculitis, an autoimmune necrotizing myopathy, rejection of a transplanted organ, antiphospholipid (aPL) Ab syndrome, glomerulonephritis, asthma, DDD, AMD, SLE, RA, MS, TBI, ischemia reperfusion injury, preeclampsia, and TTP), based upon an earlier diagnosis by a person of skill in the art (e
  • Described herein are alternative complement pathway-specific C3 and C5 convertase inhibitors that regulate alternative complement pathway activity. Diseases mediated by complement dysregulation are often a result of complement overactivity both in the fluid phase and at the cell surface. Described herein are compositions and methods for treating diseases mediated by complement dysregulation.
  • disorders mediated by alternative complement pathway dysregulation include, for example, kidney disorders, cutaneous disorders, and neurological disorders, such as paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS), IgA nephrology, lupus nephritis, C3 glomerulopathy (C3G), dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, focal segmental glomerular sclerosis (FSGS), bullous pemphigoid, epidermolysis bullosa acquisita (EBA), ANCA vasculitis, hypocomplementemic urticarial vasculitis, immune complex small vessel vasculitis, an autoimmune necrotizing myopathy, rejection of a transplanted organ, antiphospholipid (aPL) Ab syndrome, glomerulonephritis, asthma, dense deposit disease (DDD), age related macular degeneration (
  • compositions and methods described herein feature fusion proteins that include a fragment of complement factor H (FH) fused to an Fc domain (e.g., a monoclonal antibody, or fragment thereof (e.g., an Fc domain)).
  • FH complement factor H
  • the fusion proteins may also contain a fragment of CR2.
  • Exemplary fusion proteins for use in the methods of the invention include, but are not limited to, Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185,
  • the fusion protein is Compound AB, Compound AC, or Compound AJ (e.g., a fusion protein having an amino acid sequence of any one of SEQ ID NO: 147, 148, or 155, or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NO: 192, 193, or 200).
  • the fusion protein or fusion proteins according to the disclosure herein regulate(s) alternative complement pathway activity, by attenuating C3 and C5 convertase activity.
  • the Fc domain increases the serum half-life of the fusion protein, may stabilize the fusion protein overall, and aids in manufacturing, i.e., via protein A affinity chromatography.
  • the overall design targets the alternative complement pathway and leaves activation (protection) via classical and lectin pathways intact.
  • fusion proteins that include a fragment of factor FI and an Fc domain (e.g., an IgG or a functional fragment thereof, e.g., an Fc domain, such as an Fc domain that binds an Fc receptor) can be used as therapeutic agents to treat diseases mediated by alternative complement pathway dysregulation.
  • an Fc domain e.g., an IgG or a functional fragment thereof, e.g., an Fc domain, such as an Fc domain that binds an Fc receptor
  • RCA regulator of complement activation
  • the best studied members of the RCA family are factor H, FHL-1 , CR1 , DAF, MCP, and C4b-binding protein (C4BP).
  • the members are organized in tandem structural units termed short consensus repeats (SCRs), which are present in multiple copies in the protein.
  • SCR consists of 60-70 highly conserved amino acids, including 4 cysteines.
  • the portion of the fusion protein suitable for inhibiting activity of the alternative complement pathway is fused with a larger polypeptide, e.g., human albumin, an antibody, an antibody fragment, or Fc, for increased duration of effect.
  • a larger polypeptide e.g., human albumin, an antibody, an antibody fragment, or Fc
  • the portion of the fusion protein suitable for inhibiting activity of the alternative complement pathway includes a fragment of factor H.
  • the fragment of factor H may include at least the first four N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, and 4).
  • the fragment of factor H includes at least the first five N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, and 5) (also known as the cofactor and decay accelerating domains).
  • the fragment of factor H may also include at least the first four or five N-terminal SCRs and the last two N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, 19, and 20 or SCRs 1 , 2, 3, 4, 5, 19, and 20).
  • the fusion protein may include, in addition to a fragment of factor H, a fragment of complement receptor 2 (CR2).
  • the fragment of factor H in the fusion protein may include at least the first four or five N-terminal SCR domains of factor H and the fragment of CR2 in the fusion protein may include at least the first two N-terminal SCR domains of CR2 (e.g., SCRs 1 and 2).
  • the fragment of CR2 may include at least the first three or four N-terminal SCR domains of CR2 (e.g., SCRs 1 , 2 and 3 or SCRs 1 , 2, 3, and 4).
  • the fragment of factor H includes at least the first five N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, and 5), and the fragment of CR2 includes at least the first two N-terminal SCR domains of CR2 (e.g., SCRs 1 and 2). In certain embodiments, the fragment of factor H includes at least the first five N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, and 5), and the fragment of CR2 includes at least the first three N-terminal SCR domains of CR2 (e.g., SCRs 1 , 2 and 3).
  • the fragment of factor H includes at least the first five N-terminal SCR domains of factor H (e.g., FH SCRs 1 , 2, 3, 4, and 5), and the fragment of CR2 includes at least the first four N- terminal SCR domains of CR2 (e.g., CR2 SCRs 1 , 2, 3, and 4).
  • the fragment of factor H includes at least the first four and the last two N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, 19, and 20), and the fragment of CR2 includes at least the first two N-terminal SCR domains of CR2 (e.g., SCRs 1 and 2).
  • the fragment of factor H includes at least the first four and the last two N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, 19, and 20), and the fragment of CR2 includes at least the first three N-terminal SCR domains of CR2 (e.g., SCRs 1 , 2 and 3).
  • the fragment of factor H includes at least the first four and the last two N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, 19, and 20), and the fragment of CR2 includes at least the first four N-terminal SCR domains of CR2 (e.g., SCRs 1 , 2, 3, and 4).
  • the fragment of factor H includes at least the first five and last two N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, 5, 19, and 20), and the fragment of CR2 includes at least the first two N-terminal SCR domains of CR2 (e.g., SCRs 1 and 2). In certain embodiments, the fragment of factor H includes at least the first five and last two N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, 5, 19, and 20), and the fragment of CR2 includes at least the first three N-terminal SCR domains of CR2 (e.g., SCRs 1 , 2 and 3).
  • the fragment of factor H includes at least the first five and last two N-terminal SCR domains of factor H (e.g., SCRs 1 , 2, 3, 4, 5, 19, and 20), and the fragment of CR2 includes at least the first four N-terminal SCR domains of CR2 (e.g., SCRs 1 , 2, 3, and 4).
  • the fragment of factor H portion of the fusion protein is a functional fragment of wild-type factor H.
  • the factor H, or fragment thereof portion of the fusion protein is derived from a substituted (e.g., conservatively substituted) factor H or an engineered factor H (e.g., a factor H engineered to increase stability, activity, and/or other desirable properties of the protein, as determined by a predictive model or assay known to one of skill in the art, such as described herein).
  • the fragment of CR2 portion of the fusion protein is a functional fragment of wild-type CR2.
  • the CR2 or fragment thereof portion of the fusion protein composition is derived from a substituted (e.g., conservatively substituted) CR2 or an engineered CR2 (e.g., aCR2 engineered to increase stability, activity, and/or other desirable properties of the protein, as determined by a predictive model or assay known to one of skill in the art, such as an assay described herein).
  • amino acid substitutions can be introduced into the fusion proteins described herein to improve functionality.
  • amino acid substitutions can be introduced into the fragment of factor H or CR2, wherein an amino acid substitution increases binding affinity of fragment of factor H or CR2 for its ligand(s).
  • amino acid substitutions can be introduced into the fragment of factor H, CR2, or the Fc, or fragment thereof, to increase functionality and/or to improve the pharmacokinetics of the fusion protein.
  • the N107 residue of CR2 SCR 2 is changed to Gin (N107Q).
  • the S109 residue of CR2 SCR 2 is changed to Ala (S109A).
  • the N107 residue of CR2 SCR 2 is changed to Gin (N107Q) and the S109 residue of CR2 SCR 2 is changed to Ala (S109A).
  • the S103 residue of CR2 SCR 2 is changed to Ala (S103A).
  • the N101 residue of CR2 SCR 2 is changed to Gin (N101Q).
  • the first or the second, or both, N-linked glycosylation consensus sequences may be mutated to eliminate the consensus sequence so that it is no longer glycosylated.
  • the fusion proteins described herein can be fused with another compound, such as a compound to increase the half-life of the polypeptide and/or to reduce potential immunogenicity of the fusion protein (for example, polyethylene glycol (PEG)).
  • PEG polyethylene glycol
  • PEG can be used to improve water solubility, reduce the rate of kidney clearance, and reduce immunogenicity of the fusion protein (see, e.g., U.S. Pat. No. 6,214,966, the disclosure of which is incorporated herein by reference).
  • the fusion proteins described herein can be PEGylated by any means known to one skilled in the art.
  • the fragment of factor H and/or CR2 may be prepared by a number of synthetic methods of peptide synthesis by fragment condensation of one or more amino acid residues, according to conventional peptide synthesis methods known in the art (Amblard, M. etai, Mot. Biotechnol., 33:239-54, 2006).
  • a fragment of factor H and/or CR2 may be produced by expression in a suitable prokaryotic or eukaryotic system.
  • a DNA construct may be inserted into a plasmid vector adapted for expression in a suitable host cell (such as E. coif) or a yeast cell (such as S. cerevisiae or P. pastoris), or into a baculovirus vector for expression in an insect cell, or a viral vector for expression in a mammalian cell.
  • Suitable mammalian cells for recombinant expression include, e.g., a human embryonic kidney cell (HEK) (e.g., HEK 293), a Chinese Hamster Ovary (CHO) cell, L cell, C127 cell, 3T3 cell, BHK cell, or COS-7 cell.
  • HEK human embryonic kidney cell
  • CHO Chinese Hamster Ovary
  • L cell L cell
  • C127 cell C127 cell
  • 3T3 cell BHK cell
  • COS-7 COS-7 cell.
  • Suitable expression vectors include the regulatory elements necessary and sufficient for expression of the DNA in the host cell.
  • a leader or secretory sequence or a sequence that is employed for purification of the fusion protein can be included in the fusion protein.
  • the fragment of factor H and/or CR2 produced by gene expression in a recombinant prokaryotic or eukaryotic system may be purified according to methods known in the art (See, e.g., Structural Genomics Consortium, Nat. Methods, 5:135-46, 2008).
  • the fusion protein has the structure, from N-terminus to C-terminus, of Formula I:
  • D1 is a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and 135) and/or a fragment of CR2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94-107 and 136-141);
  • L1 is absent (e.g., is a covalent bond between D1 and Fc), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between D1 and Fc;
  • Fc is an Fc domain, such as an Fc receptor binding domain (e.g., the Fc domain has the sequence of any one of SEQ ID NOs: 88 and 111-113, and, preferably, the sequence of SEQ ID NO: 88);
  • L2 is absent (e.g., is a covalent bond between Fc and D2), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between Fc and D2; and
  • D2 is a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and 135) and/or a fragment of CR2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94-107 and 136-141).
  • D1 and D2 do not both comprise a fragment of CR2.
  • the fragment of FH of D1 includes one or more FH SCR domains, preferably wherein the one or more SCR domains are selected from the group consisting of SCR 1 , 2, 3, 4, 5, 19, and 20, and/or the fragment of FH of D2 includes one or more FH SCR domains, preferably wherein the one or more SCR domains are selected from the group consisting of SCR 1 , 2, 3, 4, 5, 19, and 20.
  • the FH SCR domains are selected from the group consisting of SCR [1 -4] (e.g., a fragment of FH of SEQ ID NO: 109); [1 -5] (e.g., a fragment of FH of SEQ ID NO: 108); [1-4, 19, and 20] (e.g., a fragment of FH of SEQ ID NO: 134); [1-5, 19, and 20] (e.g., a fragment of FH of SEQ ID NO: 135); and [19 and 20] (e.g., a fragment of FH of SEQ ID NO: 110).
  • SCR [1 -4] e.g., a fragment of FH of SEQ ID NO: 109
  • [1 -5] e.g., a fragment of FH of SEQ ID NO: 108
  • [1-4, 19, and 20] e.g., a fragment of FH of SEQ ID NO: 134
  • [1-5, 19, and 20] e.g.,
  • the fragment of CR2 of D1 includes one or more CR2 SCR domains, preferably wherein the one or more SCR domains are selected from the group consisting of SCR 1 , 2, 3, and 4, and/or the fragment of CR2 of D2 includes one or more CR2 SCR domains, preferably wherein the one or more SCR domains are selected from the group consisting of SCR 1 , 2, 3, and 4.
  • the CR2 SCR domains are selected from the group consisting of: SCR [1-2] (e.g., a fragment of CR2 of any one of SEQ ID NOs: 95 and 102-107), [1 -3] (e.g., a fragment of CR2 of any one of SEQ ID NOs: 136-141), and [1-4] (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94 and 96-101).
  • D1 or D2 is a fragment of FH fused by L3 to a fragment of FH, wherein L3 is an amino acid sequence of at least one amino acid.
  • the fragment of FH includes SCR domains 19 and 20 (e.g., a fragment of FH of SEQ ID NO: 110).
  • D1 or D2 is a fragment of FH fused by L3 to a fragment of CR2, wherein L3 is an amino acid sequence of at least one amino acid (e.g., the linker of any one of SEQ ID NOs 13- 87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238).
  • the fragment of FH comprises SCR domains 19 and 20
  • the fragment of CR2 comprises SCR domains 1-2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 95 and 102-107).
  • L1 , L2, and L3 may be linkers of the same type and/or sequence or of a different type and/or sequence.
  • the fusion protein has the structure, from N-terminus to C-terminus, of
  • D1 is a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and 135);
  • L1 is absent (e.g., is a covalent bond between D1 and Fc), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between D1 and Fc;
  • Fc is an Fc domain, such as an Fc receptor binding domain (e.g., the Fc domain has the sequence of any one of SEQ ID NOs: 88 and 111-113, and, preferably, the sequence of SEQ ID NO: 88);
  • L2 is absent (e.g., is a covalent bond between Fc and D2), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between Fc and D2; and D2 is a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and
  • the fusion protein has the structure, from N-terminus to C-terminus, of
  • D1 is a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and 135);
  • L1 is absent (e.g., is a covalent bond between D1 and Fc), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, and 169, and preferably, of any one of SEQ ID NOs:14, 15, 16, 79, and 163) between D1 and Fc;
  • Fc is an Fc domain, such as an Fc receptor binding domain (e.g., the Fc domain has the sequence of any one of SEQ ID NOs: 88 and 111 -113, and, preferably, the sequence of SEQ ID NO: 88);
  • L2 is absent (e.g., is a covalent bond between Fc and D2), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between Fc and D2; and
  • D2 is a fragment of CR2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94-107 and 136-
  • the fusion protein has the structure, from N-terminus to C-terminus, of
  • D1 is a fragment of CR2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94-107 and 136-141 );
  • L1 is absent (e.g., is a covalent bond between D1 and Fc), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between D1 and Fc;
  • Fc is an Fc domain, such as an Fc receptor binding domain (e.g., the Fc domain has the sequence of any one of SEQ ID NOs: 88 and 111 -113, and, preferably, the sequence of SEQ ID NO: 88);
  • L2 is absent (e.g., is a covalent bond between Fc and D2), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between Fc and D2; and
  • D2 is a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and
  • the fusion protein has the structure, from N-terminus to C-terminus, of
  • D1 is a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and 135);
  • L1 is absent (e.g., is a covalent bond between D1 and Fc), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between D1 and Fc;
  • Fc is an Fc domain, such as an Fc receptor binding domain (e.g., the Fc domain has the sequence of any one of SEQ ID NOs: 88 and 111 -113, and, preferably, the sequence of SEQ ID NO: 88);
  • L2 is absent (e.g., is a covalent bond between Fc and D2), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between Fc and D2; and
  • D2 is a polypeptide having the structure, from N-terminus to C-terminus, CR2-L3-FH, wherein CR2 is a fragment of CR2 comprising CR2 SCR domains 1 -2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 95 and 102-107), L3 is an amino acid sequence of at least one amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238), and FH is a fragment of FH comprising FH SCR domains 19-20 (e.g., a fragment of FH of SEQ ID NO: 110).
  • CR2 is a fragment of CR2 comprising CR2 SCR domains 1 -2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 95 and
  • the fusion protein has the structure, from N-terminus to C-terminus, of
  • D1 is a polypeptide having the structure, from N-terminus to C-terminus, CR2-L3-FH, wherein CR2 is a fragment of CR2 comprising CR2 SCR domains 1 -2 (e.g., a fragment of CR2 of any one of SEQ ID NOs: 95 and 102-107), L3 is an amino acid sequence of at least one amino acid, and FH is a fragment of FH comprising FH SCR domains 19-20 (e.g., a fragment of FH of SEQ ID NO: 110);
  • L1 is absent (e.g., is a covalent bond between D1 and Fc), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between D1 and Fc;
  • Fc is an Fc domain, such as an Fc receptor binding domain (e.g., the Fc domain has the sequence of any one of SEQ ID NOs: 88 and 111 -113, and, preferably, the sequence of SEQ ID NO: 88);
  • L2 is absent (e.g., is a covalent bond between Fc and D2), or is a linker of an amino acid sequence of at least 1 amino acid (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238) between Fc and D2; and
  • D2 is a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and
  • a fragment of FH is fused to an Fc which is fused to a fragment of FH. In some embodiments, a fragment of FH is fused to an Fc which is fused to a fragment of CR2. In some embodiments, a fragment of FH is fused to a fragment of FH, which is fused to an Fc, which is fused to a fragment of FH. In some embodiments, a fragment of CR2 is fused to a fragment of FH, which is fused to an Fc, which is fused to a fragment of FH. In some embodiments, a fragment of FH is fused to an Fc, which is fused to a fragment of FH, fused to a fragment of FH. In some embodiments, a fragment of FH is fused to an Fc, which is fused to a fragment of CR2, fused to a fragment of FH.
  • fusion proteins for use in the methods as described herein are found in Tables 1 -4, below.
  • Factor H fusion proteins include either a fragment of factor H fused to an Fc domain or a fragment of factor H and a fragment of CR2 fused to an Fc domain.
  • the Fc domain is an antibody, or a functional fragment thereof, such as an Fc receptor binding domain.
  • the Fc domain may be from an IgA, IgD, IgE, IgG, or IgM antibody, or a fragment thereof.
  • the fusion proteins described herein may utilize a wide variety of antibodies or antibody fragments containing an Fc domain.
  • the Fc domain includes a complete monoclonal antibody (e.g., an IgG).
  • the Fc domain includes only the fragment crystallizable (Fc) domain of an antibody.
  • the full length antibody (e.g., an IgG molecule) may comprise a constant region, or a portion thereof, from any type of antibody isotype, including, for example, IgG (including lgG1 , lgG2, lgG3 , and lgG4), or a hybrid constant region, or a portion thereof (e.g., a chimera), such as a G2/G4 hybrid constant region (see e.g., Burton DR and Woof JM, Adv.
  • Exemplary Fc domains include an Fc region comprising the second and third constant domain of a human immunoglobulin (CH2 and CH3), or the hinge, CH2, and CH3.
  • An Fc domain may or may not include a hinge region (e.g., residues ERKCC of the human lgG2 upper hinge region).
  • the Fc domain may be an IgG 2/4 Fc domain having the sequence VECPPCPAPPVAGPSVFLFPPKPKDTLMISRTPEVTCVVV DVSQEDPE VQFNWYVDGVEVHNAKTKPR EEQFNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKGLPSSIEKTISKAKGQPREPQVYTLPPSQEEMTKN QVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSRLTVDKSRWQEGNVFSCSVMH EALHNHYTQKSLSLSLGK (SEQ ID NO: 88) or
  • Additional exemplary Fc domains include a proline- stabilized hinge, CH2, and CH3 of lgG4 having the sequence
  • the Fc domain may be that from an IgG (e.g., human IgG 1 , e.g., of the hinge, CH2, and CH3 regions of lgG1 having the sequence of EPKSADKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEV HNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPS RDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVF SCSVMHEALHNHYTQKSLSLSPGK (SEQ ID NO: 113)).
  • the factor H fusion protein including an Fc domain has an increased half- life relative to a fusion protein lacking the Fc domain.
  • the fusion protein may also have a serum-binding peptide, which can improve the pharmacokinetics of the fusion protein.
  • the serum-binding peptide may replace the Fc domain of the fusion protein or the serum protein-binding peptide may be added as an additional domain to the fusion protein.
  • the serum-binding peptide may be an albumin-binding peptide.
  • the albumin-binding peptide may have the sequence DICLPRWGCLW (SEQ ID NO: 12). Different variants of albumin-binding peptides can be constructed and attached to the fusion protein.
  • the fusion protein includes (a) a moiety including a fragment of complement receptor 2 (CR2) (e.g., a fragment of CR2 of any one of SEQ ID NOs: 94-107 and 136-141);
  • CR2 complement receptor 2
  • a moiety including a fragment of complement factor H (FH) e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and 135); and (c) an anti-albumin VHH domain, wherein optionally (a), (b), and/or
  • (c) may be fused by a linker (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238).
  • Fusion proteins can also include albumin binding peptides that can be attached to the N- or C-terminus of the fusion protein.
  • a serum-binding peptide e.g., an albumin binding peptide
  • an Fc domain such as an Fc receptor binding domain
  • a fragment of factor H such as an Fc receptor binding domain
  • a fragment of CR2 such as an Fc receptor binding domain
  • the fusion protein includes (a) a moiety including a fragment of FH (e.g., a fragment of FH of any one of SEQ ID NOs: 108-110, 134, and 135), and (b) an anti-albumin VHH domain, wherein optionally (a) and (b) may be fused by a linker (e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238).
  • a linker e.g., the linker of any one of SEQ ID NOs 13-87, 142, 143, 163, 169, and 226-238, and preferably, of any one of SEQ ID NOs: 14, 15, 16, 79, 163, and 226-238.
  • Albumin binding peptides and human serum albumin can be fused genetically to a regulator of the alternative complement pathway or through chemical means, e.g., chemical conjugation.
  • a linker can be inserted between the fragment of factor H, Fc domain, such as an Fc receptor binding domain, and the albumin binding peptide.
  • a linker can be inserted between the fragment of CR2, Fc domain, such as an Fc receptor binding domain, and the albumin binding peptide.
  • the L1 , L2, and L3 domains of the fusion proteins described herein are linkers.
  • a linker is used to create a linkage or connection between, for example, polypeptides, or protein domains.
  • a fragment of factor H may be linked directly to an Fc domain (e.g., an IgG, or a functional fragment thereof, e.g., an Fc domain) by one or more suitable linkers.
  • a linker can be a simple covalent bond, e.g., a peptide bond, a synthetic polymer, e.g., a PEG polymer, or any kind of bond created from a chemical reaction, e.g., chemical conjugation.
  • the peptide linker can be, for example, a linker of one or more amino acid residues inserted or included at the transition between the two domains (e.g., a fragment of the FH domain and an Fc receptor binding domain).
  • the identity and sequence of amino acid residues in the linker may vary depending on the desired secondary structure. For example, glycine, serine, and alanine are useful for linkers given their flexibility. Any amino acid residue can be considered as a linker in combination with one or more other amino acid residues, which may be the same as or different from the first amino acid residue, to construct larger peptide linkers as necessary depending on the desired length and/or properties.
  • linkers can be used to fuse two or more protein domains together (e.g., a fragment of factor FI and an Fc domain).
  • Linkers may be flexible, rigid, or cleavable.
  • Linkers may be structured or unstructured.
  • the residues for the linker may be selected from naturally occurring amino acids, non-naturally occurring amino acids, and modified amino acids.
  • the linker may include at least 1 or more, 2 or more, 5 or more, 10 or more, 15 or more, or 20 or more amino acid residues.
  • Peptide linkers can include, but are not limited to, glycine linkers, glycine-rich linkers, serine-glycine linkers, and the like.
  • a glycine-rich linker includes at least about 50% glycine.
  • the linker(s) used confer one or more other favorable properties or functionality to the polypeptide(s) described herein, and/or provide one or more sites for the formation of derivatives and/or for the attachment of functional groups.
  • linkers containing one or more charged amino acid residues can provide improved hydrophilic properties
  • linkers that form or contain small epitopes or tags can be used for the purposes of detection, identification, and/or purification.
  • a skilled artisan will be able to determine the optimal linkers for use in a specific polypeptide.
  • linkers When two or more linkers are used for a polypeptide, the linkers may be the same or different.
  • Linkers can contain motifs, e.g., multiple or repeating motifs.
  • the linker has the amino acid sequence GS, or repeats thereof (Huston, J. et al., Methods Enzymol., 203:46-88, 1991).
  • the linker includes the amino acid sequence EK, or repeats thereof (Whitlow, M. et al., Protein Eng., 6:989-95, 1993).
  • the linker includes the amino acid sequence GGS, or repeats thereof.
  • the linker includes the amino acid sequence GGGGS (SEQ ID NO: 243), or repeats thereof. In certain embodiments, the linker contains more than one repeat of GGS or GGGGS (US Pat. No. 6,541 ,219, the entire contents of which are herein incorporated by reference).
  • the peptide linker may be rich in small or polar amino acids, such as G and S, but can contain additional amino acids, such as T and A, to maintain flexibility, as well as polar amino acids, such as K and E, to improve solubility.
  • Exemplary linkers include, but are not limited to: G 4 A (SEQ ID NO: 13), (G 4 A) 2 G 4 S (SEQ ID NO: 14), (G 4 A) 2 G 3 AG 4 S (SEQ ID NO: 79), G 4 AG 3 AG 4 S (SEQ ID NO: 163), G 4 SDA (SEQ ID NO: 164), G 4 SDAA (SEQ ID NO: 15), G 4 S (SEQ ID NO: 16), (G 4 S) 2 (SEQ ID NO: 17), (G 4 S) 3 (SEQ ID NO: 18), (G 4 S) 4 (SEQ ID NO: 19), (G 4 S) 5 (SEQ ID NO: 20), (G 4 S) 6 (SEQ ID NO: 21), EAAAK (SEQ ID NO: 142), (EAAAK) 3 (SEQ ID NO: 22), PAPAP (SEQ ID NO: 23), G 4 SPAPAP (SEQ ID NO: 24), PAPAPG 4 S (SEQ ID NO: 25), GSTSGKSSEGKG (SEQ
  • Exemplary rigid linkers include but are not limited to A(EAAAK)A (SEQ ID NO: 143), A(EAAAK) n A (SEQ ID NO: 64), wherein n can be any number, or (XP)n wherein n can be any number, with X designating any amino acid.
  • Exemplary in vivo cleavable linkers include, for example, LEAGCKNFFPRSFTSCGSLE (SEQ ID NO: 65), GSST (SEQ ID NO: 66), and CRRRRRREAEAC (SEQ ID NO: 67).
  • a linker can contain 2 to 12 amino acids including motifs of GS, e.g., GS, GSGS (SEQ ID NO: 68), GSGSGS (SEQ ID NO: 69), GSGSGSGS (SEQ ID NO: 70), GSGSGSGSGSGS (SEQ ID NO: 71 ), or GSGSGSGSGSGSGSGS (SEQ ID NO: 72).
  • a linker can contain 3 to 12 amino acids including motifs of GGS, e.g., GGS, GGSGGS (SEQ ID NO: 73), GGSGGSGGS (SEQ ID NO: 74), and GGSGGSGGSGGS (SEQ ID NO: 75).
  • a linker can contain 4 to 12 amino acids including motifs of GGSG, e.g., GGSG (SEQ ID NO: 76), GGSGGGSG (SEQ ID NO: 77), or GGSGGGSGGGSG (SEQ ID NO: 78).
  • a linker can contain motifs of GGGGS (SEQ ID NO: 243).
  • a linker can also contain amino acids other than glycine and serine, e.g., GENLYFQSGG (SEQ ID NO: 80), SACYCELS (SEQ ID NO: 81 ), RSIAT (SEQ ID NO: 82), RPACKIPNDLKQKVMNH (SEQ ID NO: 83), GGSAGGSGSGSSGGSSGASGTGTAGGTGSGSGTGSG (SEQ ID NO: 84), AAANSSIDLISVPVDSR (SEQ ID NO: 85), GGSGGGSEGGGSEGGGSEGGGSEGGGSEGGGSGGGS (SEQ ID NO: 86), GGGGAGGGGAGGGGS (SEQ ID NO: 87), GGGGAGGGGAGGGGAGGGGS (SEQ ID NO: 89), DAAGGGGSGGGGSGGGGSGGGGSGGGGS (SEQ ID NO: 90), GGGGAGGGGAGGGGA (SEQ ID NO: 91 ), GGGGAGGGGAGGGAGGGGS (SEQ ID NO: 91
  • the linker is a cleavable linker, such as an enzymatically cleavable linker. Inclusion of a cleavable linker can aid in detection of the fusion protein.
  • An enzymatically cleavable linker can be cleavable, for example, by trypsin, Human Rhinovirus 3C Protease (3C), enterokinase (Ekt),
  • FXa Factor Xa
  • TSV Tobacco Etch Virus protease
  • Thr thrombin
  • Cleavage sequences for each of these enzymes are well known in the art. For example, trypsin cleaves peptides on the C-terminal side of lysine and arginine amino acid residues. If a proline residue is on the carboxyl side of the cleavage site, the cleavage will not occur. If an acidic residue is on either side of the cleavage site, the rate of hydrolysis has been shown to be slower.
  • linkers are examples of linkers that can be excised using trypsin: K(G 4 A) 2 G 3 AG 4 SK (SEQ ID NO:226), R(G 4 A) 2 G 3 AG 4 SR (SEQ ID NO:227), K(G 4 A) 2 G 3 AG 4 SR (SEQ ID NO:228), R(G 4 A) 2 G 3 AG 4 SK (SEQ ID NO:229), K(G 4 A) 2 G 4 SK (SEQ ID NO:230), K(G 4 A) 2 G 4 SR (SEQ ID NO:231 ), R(G 4 A) 2 G 4 SK (SEQ ID NO:232), and R(G 4 A) 2 G 4 SR (SEQ ID NO:233).
  • a particular example of a protease cleavage site that can be included in an enzymatically cleavable linker is a tobacco etch virus (TEV) protease cleavage site, e.g., ENLYTQS (SEQ ID NO: 234), where the protease cleaves between the glutamine and the serine.
  • TSV tobacco etch virus
  • Another example of a protease cleavage site that can be included in an enzymatically cleavable linker is an enterokinase cleavage site, e.g., DDDDK (SEQ ID NO: 235), where cleavage occurs after the lysine residue.
  • protease cleavage site that can be included in an enzymatically cleavable linker is a thrombin cleavage site, e.g., LVPR (SEQ ID NO: 236).
  • the cleavage site is LEVLFQGP (SEQ ID NO: 237) where cleavage occurs between the glutamine and glycine residues.
  • the preferred cleavage site for Factor Xa protease is IEDGR (SEQ ID NO: 238), where cleavage occurs between the glutamic acid and aspartic acid residues.
  • the inclusion of the cleavable linker is useful in that it has a sequence of amino acids that is unique from other peptides in the human proteome that are generated with the above mentioned enzymes. As such this excised linker may serve as a unique identifying peptide of the fusion protein when administered as a pharmaceutical preparation to humans. In this way the cleavable linker may be detected and quantitated by mass spectrometry and be used to monitor the pharmacokinetics of the fusion protein.
  • the linker is a polymeric or oligomeric glycine linker, and can include a lysine at the N-terminus, the C-terminus, or both the N-and the C-termini.
  • the C-terminus of D1 may be linked to the N-terminus of
  • the C-terminus of Fc may be linked to the N-terminus of D2. In a certain embodiment, the C-terminus of FH may be linked to the N-terminus of FH. In a certain embodiment, the C-terminus of FH may be linked to the N-terminus of CR2. In a certain embodiment, the C-terminus of CR2 may be linked to the N-terminus of FH. In a certain embodiment, the C-terminus of FH may be linked to the N-terminus of Fc. In a certain embodiment, the C-terminus of CR2 may be linked to the N- terminus of Fc. In a certain embodiment, the C-terminus of Fc may be linked to the N-terminus of FH. In a certain embodiment, the C-terminus of Fc may be linked to the N-terminus of Fc may be linked to the N-terminus of FH. In a certain embodiment, the C-terminus of Fc may be linked to the N-terminus of CR2.
  • Table 1 Exemplary Fusion Proteins having the sequence, from N-terminus to C-terminus, of D1-L1-FC-L2-D2 indicates the absence of a feature.
  • Table 2 Exemplary Fusion Proteins having the sequence, from N-terminus to C-terminus, of D1-L1-FC-L2-D2
  • Table 3 Exemplary Fusion Proteins having the sequence, from N-terminus to C-terminus, of D1-L1-VHH-L2-D2
  • Table 4 Exemplary Fusion Proteins having the sequence, from N-terminus to C-terminus, of D1-L1-VHH-L2-D2
  • the nucleic acid molecule can be operably linked to a suitable control sequence to form an expression unit encoding the protein.
  • An exemplary signal peptide (leader sequence) is that of mouse Ig heavy chain V region 102 (SEQ ID NO: 223; UniProt Accession Number P01750).
  • the expression unit is used to transform a suitable host cell, and the transformed host cell is cultured under conditions that allow the production of the recombinant protein.
  • the recombinant protein is isolated from the medium or from the cells; recovery and purification of the protein may not be necessary in some instances where some impurities may be tolerated.
  • Additional residues may be included at the N- or C-terminus of the protein- coding sequence to facilitate purification (e.g., a histidine tag).
  • a His Tag can be added to the FH or CR2 domain of a construct (e.g., the His Tag can be added to the N- or C-terminus of FH; see, e.g., SEQ ID NO: 242, which is the sequence of FH, in which a His Tag, consisting of consecutive histidine residues, are added to the C-terminus of FH 1-5).
  • the fusion proteins of the present disclosure may include naturally-occurring or a non-naturally- occurring components; preferably at least one component is non-naturally occurring, e.g., with respect to its structure (e.g., sequence) and/or its association (e.g., how it is linked to other components).
  • non-naturally occurring refers to any molecule, e.g., fusion protein, produced with the aid of human manipulation, including, without limitation, molecules produced by genetic engineering using random mutagenesis or rational design and molecules produced by chemical synthesis.
  • Non-limiting examples of non-naturally occurring molecules include, e.g., conservatively substituted variants, non- conservatively substituted variants, and active hybrids (e.g., chimeras) or fragments.
  • Non-natural molecules further include natural molecules that have been modified, e.g., post-translationally, e.g., via addition of chemical moieties, tags, ligands.
  • non-natural molecules include the fusion proteins of the present disclosure.
  • the fusion protein can be expressed from a single polynucleotide that encodes the entire fusion protein or as multiple (e.g., two or more) polynucleotides that may be expressed by suitable expression systems or may be co-expressed.
  • Polypeptides encoded by polynucleotides that are co-expressed may associate through, e.g., disulfide bonds or other means to form a functional fusion protein.
  • the light chain portion of monoclonal antibody may be encoded by a separate polynucleotide from the heavy chain portion of a monoclonal antibody. When co-expressed in a host cell, the heavy chain polypeptides will associate with the light chain polypeptides to form the monoclonal antibody.
  • any and all polynucleotide molecules that can encode the fusion proteins disclosed in the present specification can be useful, including, without limitation naturally-occurring and non-naturally-occurring DNA molecules and naturally-occurring and non-naturally-occurring RNA molecules.
  • Non-limiting examples of naturally-occurring and non-naturally-occurring DNA molecules include single-stranded DNA molecules, double-stranded DNA molecules, genomic DNA molecules, cDNA molecules, vector constructs, such as, e.g., plasmid constructs, phagemid constructs, bacteriophage constructs, retroviral constructs and artificial chromosome constructs.
  • Non-limiting examples of naturally-occurring and non-naturally-occurring RNA molecules include single-stranded RNA, double stranded RNA and mRNA.
  • the present disclosure also provides synthetic nucleic acids, e.g., non-natural nucleic acids, comprising nucleotide sequence encoding one or more of the aforementioned fusion proteins. Included herein are nucleic acids encoding the fusion proteins, including the complementary strand thereto, or the RNA equivalent thereof, or a complementary RNA equivalent thereof.
  • a nucleic acid encoding the desired fusion protein is generated using molecular cloning methods, and is generally placed within a vector, such as a plasmid constructs, phagemid constructs, bacteriophage constructs, retroviral constructs and artificial chromosome constructs.
  • a vector such as a plasmid constructs, phagemid constructs, bacteriophage constructs, retroviral constructs and artificial chromosome constructs.
  • Non-limiting examples of naturally- occurring and non-naturally-occurring RNA molecules include single-stranded RNA, double stranded RNA and mRNA.
  • the vector is used to transform the nucleic acid into a host cell appropriate for the expression of the fusion polypeptide. Representative methods are disclosed, for example, in Maniatis et al. (Cold Springs Harbor Laboratory, 1989).
  • Host cells can include, e.g., a Human Embryonic Kidney (HEK) (e.g., HEK 293) cell, Chinese Hamster Ovary (CHO) cell, L cell, C127 cell, 3T3 cell, BHK cell, COS-7 cell, or any other suitable host cell known in the art.
  • HEK Human Embryonic Kidney
  • CHO Chinese Hamster Ovary
  • prokaryotic cells including, without limitation, strains of aerobic, microaerophilic, capnophilic, facultative, anaerobic, gram-negative and gram-positive bacterial cells such as those derived from, e.g., Escherichia coli, Bacillus subtilis, Bacillus licheniformis, Bacteroides fragilis, Clostridia perfringens, Clostridia difficile, Caulobacter crescentus, Lactococcus lactis, Methylobacterium extorquens, Neisseria meningirulls, Neisseria meningitidis, Pseudomonas fluorescens and Salmonella typhimurium ; and eukaryotic cells including, without limitation, yeast strains, such as, e.g., those derived from Pichia pastoris, Pichia methanolica, Pichia angusta, Schizosaccharomyces pombe, Saccharomyces cere
  • Codon optimization for expression in a host cell e.g., bacteria such as E. coli or insect Hi5 cells, may be performed using Codon Optimization Tool (CODONOPT), available freely from Integrated DNA Technologies, Inc., Coralville, Iowa, USA.
  • CODONOPT Codon Optimization Tool
  • a nucleic acid or polynucleotide encoding the fusion protein is provided.
  • a vector including a nucleic acid or polynucleotide encoding the fusion protein is provided.
  • a host cell including one or more polynucleotides encoding the fusion protein is provided.
  • a host cell including one or more fusion expression vectors is provided.
  • the fusion proteins can be produced by expression of a nucleotide sequence in any suitable expression system known in the art. Any expression system may be used, including yeast, bacterial, animal, plant, eukaryotic, and prokaryotic systems. In some embodiments, yeast systems that have been modified to reduce native yeast glycosylation, hyper-glycosylation or proteolytic activity may be used. Furthermore, any in vivo expression systems designed for high level expression of recombinant proteins within organisms known in the art can be used for producing the fusion proteins specified herein.
  • the factor H fusion protein as described herein, is produced by culturing one or more host cells including one or more nucleic acid molecules capable of expressing the fusion protein under conditions suitable for expression of the fusion protein. In some embodiments, the factor H fusion protein is obtained from the cell culture or culture medium.
  • the fusion protein can also be produced using chemical methods to synthesize the desired amino acid sequence, in whole or in part.
  • polypeptides can be synthesized by solid phase techniques, cleaved from the resin, and purified by preparative high performance liquid chromatography (e.g., Creighton (1983) Proteins: Structures And Molecular Principles, WH Freeman and Co, New York N.Y.).
  • the composition of the synthetic polypeptides can be confirmed by amino acid analysis or sequencing.
  • the amino acid sequence of a fusion protein or any part thereof can be altered during direct synthesis and/or combined using chemical methods with a sequence from other subunits, or any part thereof, to produce a variant polypeptide.
  • Secreted, biologically active fusion proteins described herein, such as those described in Tables 1 -4, may be purified by techniques such as high performance liquid chromatography, ion exchange chromatography, gel electrophoresis, affinity chromatography, e.g., protein A affinity chromatography, size exclusion chromatography, and the like.
  • affinity chromatography e.g., protein A affinity chromatography, size exclusion chromatography, and the like.
  • the conditions used to purify a particular protein depend, in part, on factors such as net charge, hydrophobicity, hydrophilicity etc., as would be apparent to a skilled artisan.
  • the fusion proteins described herein were assessed for activity using a complement pathway hemolysis assay, which measures complement-mediated lysis of rabbit erythrocytes secondary to activation of the alternative pathway on a cell surface.
  • Rabbit erythrocytes generally activate complement-mediated lysis in mouse or human serum. As serum C3 is activated, C3 convertases, C3 activation fragments, and C5 convertases are deposited on rabbit RBCs.
  • Serum alternative complement pathway activity in the presence of a fusion protein comprising a fragment of factor FI and an Fc domain (e.g., an IgG, or a functional fragment thereof, e.g., an Fc receptor binding domain) or a fragment of factor H, a fragment of CR2, and an Fc (e.g., an IgG, or a functional fragment thereof, e.g., an Fc receptor binding domain; see, e.g., the fusion proteins of Tables 1-4), for example, were evaluated in a concentration-dependent manner in human or mouse serum supplemented with Mg++ and EGTA as Ca sequestrant, thus favoring the alternative pathway of complement activation.
  • an Fc domain e.g., an IgG, or a functional fragment thereof, e.g., an Fc receptor binding domain
  • Fusion proteins of the disclosure may exhibit a half maximal inhibitory concentration (ICso) of between about 9 nM to about 65 nM (e.g., between about 9 nM to about 50 nM, between about 9 nM to about 40 nM, between about 9 nM to about 30 nM, between about 9 nM to about 20 nM, between about 30 nM to about 60 nM, between about 40 nM to about 60 nM, or between about 50 nM to about 60 nM .
  • ICso half maximal inhibitory concentration
  • Compound AB may have an ICso of between about 9 nM to about 11 nM (e.g., 10.82 nM), Compound AC may have an IC 50 of between about 10 nM to about 12 nM (e.g., 11 .4 nM).
  • the fusion proteins described herein can be evaluated for alternative complement pathway activity can be evaluated in the fluid phase using an alternative complement pathway assay kit, for example, Complement system Alternative Pathway WIESLAB ® , Lund, Sweden.
  • an alternative complement pathway assay kit for example, Complement system Alternative Pathway WIESLAB ® , Lund, Sweden.
  • This method combines principles of the hemolytic assay for complement activation with the use of labeled antibodies specific for a neoantigen produced as a result of complement activation. The amount of neoantigen generated is proportional to the functional activity of the alternative pathway.
  • wells of the plate are coated with specific activators of the alternative pathway. Serum is diluted in diluent containing specific blockers to ensure that only the alternative pathway is activated.
  • Anti-properdin VHH for example, can be spiked into the patient’s blood in a concentration-dependent manner.
  • complement is activated by the specific coating.
  • the wells are then washed and C5b-9 is detected with a specific alkaline phosphatase-labelled antibody to the neoantigen as a result of complement activation.
  • the amount of complement activation correlates with the color intensity and is measured in terms of absorbance (optical density (OD)) at 405nm.
  • OD optical density
  • the fusion proteins described herein can be incorporated into pharmaceutical compositions suitable for administration to a subject.
  • Pharmaceutical compositions including factor H fusion proteins described herein can be formulated for administration at individual doses ranging, e.g., from 0.01 mg/kg to 500 mg/kg.
  • the pharmaceutical composition may contain, e.g., from 0.1 ⁇ g/0,5 mL to 1 g/ 5mL of the fusion protein.
  • compositions including factor H fusion proteins can also be formulated for either a single or multiple dosage regimens.
  • Doses can be formulated for administration, e.g., hourly, bihourly, daily, bidaily, twice a week, three times a week, four times a week, five times a week, six times a week, weekly, biweekly, monthly, bimonthly, or yearly.
  • doses can be formulated for administration, e.g., twice, three times, four times, five times, six times, seven times, eight times, nine times, ten times, eleven times, or twelve times per day.
  • the pharmaceutical compositions including factor H fusion proteins can be formulated according to standard methods.
  • Pharmaceutical formulation is a well-established art, and Is further described in, e.g., Gennaro (2000) Remington: The Science and Practice of Pharmacy, 20th Edition, Lippincott, Williams & Wilkins (ISBN: 0683306472); Ansel et al. (1999) Pharmaceutical Dosage Forms and Drug Delivery Systems, 7th Edition, Lippincott Williams & Wilkins Publishers (ISBN: 0683305727); and Kibbe (2000) Handbook of Pharmaceutical Excipients, American Pharmaceutical Association, 3rd Edition (ISBN: 091733096X).
  • the pharmaceutical composition can include the fusion protein and at least one pharmaceutically acceptable carrier.
  • pharmaceutically acceptable carrier includes any and ail solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like that are physiologically compatible.
  • pharmaceutically acceptable carrier excludes tissue culture medium including bovine or horse serum.
  • Pharmaceutically acceptable carriers or adjuvants by themselves, do not induce the production of antibodies harmful to the individual receiving the composition nor do they elicit protection. Therefore, pharmaceutically acceptable carriers are inherently non-toxic and nontherapeutic, and are known to the person skilled in the art.
  • Examples of pharmaceutically acceptable carriers include one or more of water, saline, phosphate buffered saline, dextrose, glycerol, ethanol and the like, as well as combinations thereof. In many cases, it will be preferable to include isotonic agents, for example, sugars, polyalcohols such as mannitol, sorbitol, or sodium chloride in the composition. Pharmaceutically acceptable substances include minor amounts of auxiliary substances such as wetting or emulsifying agents, preservatives, or buffers, which enhance the shelf life or effectiveness of the antibody.
  • compositions described herein may be prepared in a variety of forms. These include, for example, liquid, semi-solid, and solid dosage forms, such as liquid solutions (e.g., Injectable and infusible solutions), dispersions or suspensions, tablets, pills, powders, liposomes and suppositories.
  • liquid solutions e.g., Injectable and infusible solutions
  • dispersions or suspensions tablets, pills, powders, liposomes and suppositories.
  • Such formulations can be prepared by methods known in the art such as, e.g., the methods described in Epstein et al. (1985) Proc Natl Acad Sci USA 82:3688; Hwang et al. (1980) Proc Natl Acad Sci USA 77:4030; and U.S. Patent Nos. 4,485,045 and 4,544,545.
  • Liposomes with enhanced circulation time are disclosed in, e.g., U.S. Patent No. 5,013,556.
  • compositions including factor H fusion proteins can also be formulated with a carrier that will protect the composition (e.g., a factor H fusion protein) against rapid release, such as a controlled release formulation, including implants and microencapsulated delivery systems.
  • a carrier that will protect the composition (e.g., a factor H fusion protein) against rapid release
  • a carrier that will protect the composition (e.g., a factor H fusion protein) against rapid release
  • a carrier e.g., a factor H fusion protein
  • a carrier e.g., a factor H fusion protein
  • a carrier e.g., a carrier that will protect the composition (e.g., a factor H fusion protein) against rapid release
  • 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. Many methods for
  • compositions are in the form of injectable or infusible solutions, such as compositions simiiar to those used for passive immunization of humans with other antibodies.
  • the composition(s) can delivered by, for example, parenteral injection (e.g., intravenous, subcutaneous, intraperltoneal, intramuscular).
  • the pharmaceutical compositions can be provided in a sterile form and stable under the conditions of manufacture and storage.
  • the composition can be formulated as a solution, microemulsion, dispersion, liposome, or other ordered structure suitable to high drug concentration.
  • Sterile Injectable solutions can be prepared by incorporating the fusion protein in the required amount in an appropriate solvent with one or a combination of Ingredients enumerated above, as required, followed by filter sterilization.
  • dispersions are prepared by Incorporating the fusion protein into a sterile vehicle that contains a basic dispersion medium and the required other ingredients from those enumerated above.
  • the preferred 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 proper fluidity of a solution 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.
  • Prolonged absorption of injectable compositions can be brought about by including in the composition a reagent that delays absorption, for exampie, monostearate salts, and gelatin. The preferred form depends, in part, on the intended mode of administration and therapeutic application.
  • compositions intended for systemic or local delivery can be in the form of injectable or infusible solutions.
  • the composition can be formulated, for example, as a buttered solution at a suitable concentration and suitable tor storage at 2- 8°C (e.g., 4°C).
  • a composition can also be formulated tor storage at a temperature below 0°C (e.g., - 20°C or -80°C).
  • a composition can further be formulated for storage for up to 2 years (e.g., one month, two months, three months, four months, five months, six months, seven months, eight months, nine months, 10 months, 11 months, 1 year, 11 ⁇ 2 years, or 2 years) at 2-8°C (e.g., 4°C).
  • the compositions described herein can be stable in storage for at least 1 year at 2-8°C (e.g., 4°C).
  • the fusion proteins described herein can be administered by a variety of methods known in the art, although for many therapeutic applications, the preferred route/mode of administration is intravenous injection or infusion.
  • the fusion proteins can also be administered by intramuscular or subcutaneous injection.
  • the route and/or mode of administration will vary depending upon the desired results.
  • the fusion protein may be prepared with a carrier that will protect the antibody against rapid release, such as a controlled release formulation, including implants, transdermal patches, and microencapsulated delivery systems.
  • a carrier that will protect the antibody against rapid release, such as a controlled release formulation, including implants, transdermal patches, and microencapsulated delivery systems.
  • Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, and polyglycol aiccid. Prolonged absorption of injectable compositions can be attained by including in the composition an agent that delays absorption, for example, monostearate salts and gelatin. Many methods for the preparation of such formulations are known to those skilled in the art (e.g., Sustained and Controlled Release Drug Delivery Systems, J. R. Robinson, ed., Marcel Dekker, Inc,, New York, 1978). Additional methods applicable to the controlled or extended release of fusion proteins disclosed herein are described, for example, in WO 2016081884, the entire contents of which are incorporated herein by reference.
  • the pharmaceutical composition(s) may have a pH of about 5.6-10.0, about 6.0-8.8, or about 6.5- 8.0.
  • the pH may be about 6.2, 6.5, 6.75, 7,0, or 7,5.
  • the pharmaceutical compositions may be formulated for oral, sublingual, intranasal, intraocular, rectal, transdermal, mucosal, topical, intravitreal, or parenteral administration.
  • Parenteral administration may include intradermal, subcutaneous (s.c, s.q., sub-Q, Hypo), intramuscular (i.m.), intravenous (i,v,), intraperitoneal (i.p.), intra-arterial, intramedulary, intracardiac, intravitreai (eye), intra-articular (joint), intrasynovial (joint fluid area), intracranial, intraspinai, and intrathecal (spinal fluids) injection or infusion. Any device suitable for parenteral injection or Infusion of drug formulations may be used for such administration.
  • the pharmaceutical composition may be contained in a sterile pre-filled syringe.
  • a fusion protein is co-formuiated with and/or co-administered with one or more additional therapeutic agents.
  • the compositions can be co-formulated with the second agent, or the compositions can be formulated separately from the second agent formulation.
  • the respective pharmaceutical compositions can be mixed, e.g,, just prior to administration, and administered together or can be administered separately, e.g., at the same or different times.
  • a fusion protein can be co-formulated and/or co-administered with one or more additional antibodies that bind other targets (e.g., antibodies that bind regulators of the alternative complement pathway).
  • compositions described herein can be co-formulated or co-administered 'with other therapeutic agents to ameliorate side effects of administering the compositions described herein (e.g., therapeutic agents that minimize risk of Infection in an immunocompromised environment, for example, anti-bacterial agents, anti-fungal agents and anti-viral agents).
  • compositions containing factor H fusion proteins can be provided to a subject in combination with pharmaceutically acceptable sterile aqueous or non-aqueous solvents, suspensions, or emulsions.
  • non-aqueous solvents are propylene glycol, polyethylene glycol, vegetable oil, fish oil, and injectable organic esters.
  • Aqueous carriers include water, water-alcohol solutions, emulsions, or suspensions, including saline and buffered medical parenteral vehicles including sodium chloride solution, Ringer's dextrose solution, dextrose plus sodium chloride solution, Ringer's solution containing lactose, or fixed oils.
  • Intravenous vehicles can include fluid and nutrient replenishers, electrolyte replenishers, such as those based upon Ringer's dextrose, and the like.
  • Pharmaceutically acceptable salts can be included therein, for example, mineral acid salts such as hydrochlorides, hydrobromides, phosphates, sulfates, and the like; and the salts of organic acids such as acetates, propionates, malonates, benzoates, and the like.
  • auxiliary substances such as wetting or emulsifying agents, pH buffering substances, and the like, can be present in such vehicles.
  • a thorough discussion of pharmaceutically acceptable carriers is available in Remington's Pharmaceutical Sciences (Mack Pub. Co., N.J. 1991 ).
  • the pharmaceutical compositions can include a “therapeutically effective amount” or a “prophylactically effective amount” of a fusion protein
  • a “therapeutically effective amount” refers to an amount effective, at dosages, and for periods of time necessary, to achieve the desired therapeutic resuit.
  • a therapeutically effective amount of the antibody can vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the fusion protein to elicit a desired response in the individual.
  • a “prophylacticaliy effective amount” refers to an amount effective, at dosages, and for periods of time necessary, to achieve the desired prophylactic result.
  • a prophylactic dose is used in subjects prior to or at an earlier stage of disease where the prophylacticaliy effective amount will be less than the therapeutically effective amount.
  • Dosage regimens may be adjusted to provide the optimum desired response (e.g., a therapeutic or prophylactic response). For example, a single bolus may be administered, several divided doses may be administered over time, or the dose may be proportionally reduced or increased as indicated by the exigencies of the therapeutic situation, it is advantageous to formulate parenteral compositions in dosage unit form for ease of administration and uniformity of dosage.
  • Dosage unit form as used herein refers to physically discrete units suited as unitary dosages for the mammalian subjects to be treated; each unit containing a predetermined quantity of active compound calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier. It is to be noted that dosage values can vary with the type and severity of the condition to be alleviated. It is to be further understood that for any particular subject, specific dosage regimens should be adjusted over time according to the Individual need and the professional judgment of the administering clinician.
  • the efficacy of treatment with a fusion protein as described herein can be assessed based on an improvement In one or more symptoms or indicators of the disease state or disorder being treated.
  • An Improvement of at least 10% (increase or decrease, depending upon the indicator being measured) in one or more clinical indicators is considered “effective treatment,” although greater Improvements are preferred, such as 20%, 30%, 40%, 50%, 75%, 90%, or even 100%, or, depending upon the indicator being measured, more than 100% (e.g., two-fold, three-fold, ten-fold, etc., up to and Including attainment of a disease-free state.
  • the complement factor H fusion proteins described herein can be used to treat diseases mediated by alternative complement pathway dysregulation by inhibiting the alternative complement pathway activation in a mammal (e.g., a human).
  • the fusion protein(s) described herein can be used to treat a variety of alternative complement pathway-associated disorders.
  • Such disorders include, without limitation, paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS), IgA nephrology, lupus nephritis, C3 glomerulopathy (C3G), dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, focal segmental glomerular sclerosis (FSGS), bullous pemphigoid, epidermolysis bullosa acquisita (EBA), ANCA vasculitis, hypocomplementemic urticarial vasculitis, immune complex small vessel vasculitis, an autoimmune necrotizing myopathy, rejection of a transplanted organ, antiphospholipid (aPL) Ab syndrome, glomerulonephritis, asthma, dense deposit disease (DDD), age related macular degeneration (AMD), systemic lupus erythematosus (SLE),
  • a therapeutically effective amount of a complement factor H fusion protein as disclosed herein (e.g., a fusion protein having the sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152- 155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), is administered to a mammalian subject in need of such treatment.
  • the preferred subject is a human patient.
  • the amount administered should be sufficient to inhibit complement activation and/or restore normal alternative complement pathway regulation.
  • an effective human dose will be in the range of 0.01 mg/kg-150 mg/kg ((e.g., from 0.05 mg/kg to 500 mg/kg, from 0.1 mg/kg to 20 mg /kg, from 5 mg/kg to 500 mg/kg, from 0.1 mg/kg to 100 mg/kg, from 10 mg/kg to 100 mg/kg, from 0.1 mg/kg to 50 mg/kg, from 0.5 mg/kg to 25 mg/kg, from 1 .0 mg/kg to 10 mg/kg, from 1 ,5 mg/kg to 5 mg/kg, or from 2.0 mg/kg to 3.0 mg/kg) or from 1 ⁇ g/kg to 1 ,000
  • jg/kg e.g., from 5 ⁇ g/kg to 1 ,000 ⁇ g/kg, from 1 ⁇
  • the methods proteins described herein are particularly useful for treating renal lesions characterized histologically by predominant C3 accumulation the glomerular basement membrane in the absence of significant deposition of immunoglobulin (Nester, C. & Smith, R., Curr. Opin. Nephrol. Hypertens., 22:231-7, 2013) from aberrant regulation of the alternative pathway of complement, also known as C3 glomerulopathy (C3G).
  • C3G C3 glomerulopathy
  • DDD dense deposit disease
  • DDD is a rare kidney disease leading to persisting proteinuria, hematuria, and nephritic syndrome.
  • Factor FI deficiency and dysfunction in DDD has been reported in several cases. For example, mutations in factor H have been found in human patients with DDD.
  • Symptoms of DDD include, e.g., one or both of hematuria and proteinuria; acute nephritic syndrome; drusen development and/or visual impairment; acquired partial lipodystrophy and complications thereof; and the presence of serum C3 nephritic factor (C3NeF), an autoantibody directed against C3bBb, the C3 convertase of the alternative complement pathway (Appel, G. et al., J. Am. Soc. Nephrol., 16:1392-404, 2005).
  • Targeting factor H to complement activation sites has therapeutic effects on an individual having DDD.
  • administering an effective dose to the individual a composition including a fusion molecule described herein is effective in treating DDD.
  • the route of administration may affect the recommended dose. Repeated systemic doses are contemplated to maintain an effective level, e.g., to attenuate or inhibit complement activation in a patient's system, depending on the mode of administration adopted.
  • compositions and methods described herein are particularly useful for treatment of renal inflammation caused by systemic lupus erythematosus (SLE), such as lupus nephritis.
  • SLE systemic lupus erythematosus
  • Lupus glomerulonephritis includes diverse and complex morphological lesions, depending on the proportion of glomeruli affected by active or chronic lesions, the degree of interstitial inflammation or fibrosis, as well as vascular lesions (Weening, J. etal., J. Am. Soc. Nephrol., 15:241-50, 2004).
  • Lupus nephritis is a serious complication that occurs in a subpopulation of patients with SLE.
  • SLE is the prototypic autoimmune disease resulting in multi-organ involvement. This anti-self response is characterized by autoantibodies directed against a variety of nuclear and cytoplasmic cellular components. These autoantibodies bind to their respective antigens, forming immune
  • Complement pathways including the alternative complement pathway
  • fusion proteins are thus useful for treating lupus nephritis.
  • AMD refers to age-related deterioration or breakdown of the eye's macula, resulting in the loss of integrity of the histoarchitecture of the cells and/or extracellular matrix of the normal macula and/or the loss of function of the cells of the macula. It is clinically characterized by progressive loss of central vision that occurs as a result of damage to the photoreceptor cells in an area of the retina called the macula.
  • AMD encompasses all stages of AMD, including Category 2 (early stage), Category 3 (intermediate), and Category 4 (advanced) AMD.
  • a wet form and a dry form are also encompassed.
  • the proteins of the alternative complement pathway are central to the development of age-related macular degeneration (Zipfel, P. et al., Adv. Exp. Med. Biol., 703:9-24, 2010).
  • Analysis of ocular deposits in AMD patients has shown a large number of inflammatory proteins including amyloid proteins, coagulation factors, and proteins of the complement pathway.
  • a genetic variation in the complement factor H substantially raises the risk of AMD, suggesting that uncontrolled complement activation underlies the pathogenesis of AMD (Edwards, A. etal., Science, 308:421-4, 2005; Haines, J.
  • methods of treating AMD include, but are not limited to, formation of ocular drusen, inflammation in the eye or eye tissue, loss of photoreceptor cells, loss of vision (including for example visual acuity and visual field), neovascularization (such as choroidal neovascularization or CNV), and retinal detachment.
  • compositions and methods described herein are particularly useful for treatment of PNH.
  • PNH is a consequence of clonal expansion of one or more hematopoietic stem cells with mutant PIG-A.
  • the extent to which the PIG-A mutant clone expands varies widely among patients.
  • Another feature of PNH is its phenotypic mosaicism based on the PIG-A genotype that determines the degree of GPI-AP deficiency. For example, PNH III cells are completely deficient in GPI-APs, PNH II cells are partially (-90%) deficient, and PNH I cells, which are progeny of residual normal stem cells, express GPI-AP at normal density.
  • Classic PNH is characterized by a large population of GPI-AP deficient PMNs, cellular marrow with erythroid hyperplasia and normal or near-normal morphology and frequent or persistent florid macroscopic hemoglobinuria.
  • PNH in the setting of another bone marrow failure is characterized by a relatively small percentage ( ⁇ 30%) of GPI-AP deficient PMNs, evidence of a concomitant bone marrow failure syndrome and intermittent or absent mild to moderate macroscopic hemoglobinuria.
  • Subclinical or latent PNH is characterized by a small ( ⁇ 1%) population of GPI-AP deficient PMNs, evidence of a concomitant bone marrow failure syndrome and no clinical or biochemical evidence of intravascular hemolysis.
  • Complement pathways are implicated in the pathology of PNH, and thus fusion proteins provided herein are thus useful for treating PNH.
  • compositions and methods described herein are particularly useful for treatment of aHUS, an extremely rare disease characterized by low levels of circulating red blood cells due to their destruction (hemolytic anemia), low platelet count (thrombocytopenia) due to their consumption and inability of the kidneys to process waste products from the blood and excrete them into the urine (acute kidney failure), a condition known as uremia.
  • Complement pathways including the alternative complement pathway
  • fusion proteins provided herein are thus useful for treating aHUS.
  • compositions and methods described herein are particularly useful for treatment of dermatomyositis, a group of acquired muscle diseases called inflammatory myopathies which are characterized by chronic muscle inflammation accompanied by muscle weakness.
  • the cardinal symptom is a skin rash that precedes or accompanies progressive muscle weakness.
  • Dermatomyositis may occur at any age, but is most common in adults in their late 40s to early 60s, or children between 5 and 15 years of age.
  • Complement pathways including the alternative complement pathway
  • fusion proteins provided herein are thus useful for treating dermatomyositis.
  • compositions and methods described herein are particularly useful for treatment of systemic scleroderma.
  • diffuse scleroderma or systemic sclerosis it is a chronic disease characterized by diffuse fibrosis and vascular abnormalities in the skin, joints, and internal organs (especially the esophagus, lower Gl tract, lungs, heart, and kidneys). Common symptoms include Raynaud phenomenon, polyarthralgia, dysphagia, heartburn, and swelling and eventually skin tightening and contractures of the fingers.
  • Complement pathways are implicated in the pathology of systemic scleroderma, and thus fusion proteins provided herein are thus useful for treating systemic scleroderma.
  • compositions and methods described herein are particularly useful for treatment of demyelinating polyneuropathy, a neurological disorder characterized by progressive weakness and impaired sensory function in the legs and arms.
  • the disorder which is sometimes called chronic relapsing polyneuropathy, is caused by damage to the myelin sheath of the peripheral nerves.
  • Complement pathways including the alternative complement pathway
  • fusion proteins provided herein are thus useful for treating demyelinating polyneuropathy
  • compositions and methods described herein are particularly useful for treatment of pemphigus, a group of rare autoimmune skin disorders that cause blisters and sores on the skin or mucous membranes, such as in the mouth or on the genitals.
  • Complement pathways including the alternative complement pathway
  • fusion proteins provided herein are thus useful for treating pemphigus.
  • TTP thrombotic thrombocytopenic purpura
  • TTP features numerous microscopic clots, or thromboses, in small blood vessels throughout the body. Red blood cells are subjected to shear stress that damages their membranes, leading to intravascular hemolysis. The resulting reduced blood flow and endothelial injury results in organ damage, including brain, heart, and kidneys.
  • TTP is clinically characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurological changes, renal failure, and fever.
  • TTP is caused by autoimmune or hereditary dysfunctions that activate the coagulation cascade or the complement system (George, J., N. Engl. J. Med., 354:1927-35, 2006).
  • TTP may arise from genetic or acquired inhibition of the enzyme ADAMTS13, a metalloprotease responsible for cleaving large multimers of von Willebrand factor (vWF) into smaller units, ADAMTS13 inhibition or deficiency ultimately results in increased coagulation (Tsai, H., J. Am. Soc. Nephrol., 14:1072-81 , 2003).
  • Patients suffering from TTP typically present in the emergency room with one or more of the following; purpura, renal failure, low platelets, anemia, and/or thrombosis, including stroke.
  • Thrombocytopenia can be diagnosed by a medical professional as one or more of: (i) a platelet count that is less than 150,000/mm 3 (e.g., less than 60,000/mm 3 ); (ii) a reduction in platelet survival time, reflecting enhanced platelet disruption in the circulation; and (iii) giant platelets observed in a peripheral smear, which is consistent with secondary activation of thrombocytopoiesis. Because TTP is a disorder that arises from dysregulation of alternative complement pathway activation, treatment with fusion proteins described herein to inhibit the alternative complement pathway activation may aid in stabilizing and/or correcting the disease.
  • compositions and methods described herein are particularly useful for treatment of Membranous nephropathy (MN), a glomerular disease and the most common cause of idiopathic nephrotic syndrome in nondiabetic white adults. If untreated, about one-third of MN patients progress to end stage renal disease over 10 years. The incidence of ESRD due to MN in the United States is about 1 .9/million per year. Most cases of PMN (70%) have circulating pathogenic lgG4 autoantibodies to the podocyte membrane antigen PLA2R. Complement components including C3, C4d, and C5b-9 are also commonly present, but not C1q, indicating that the lectin and potentially the alternative pathways of complement activation are involved.
  • MN Membranous nephropathy
  • C5b-9 Complement components including C3, C4d, and C5b-9 are also commonly present, but not C1q, indicating that the lectin and potentially the alternative pathways of complement activation are involved.
  • compositions and methods described herein are particularly useful for treatment of focal segmental glomerulosclerosis (FSGS).
  • FSGS focal segmental glomerulosclerosis
  • FSGS is characterized by obliteration of glomerular capillary tufts with increased matrix deposition and scarring (D'Agati VD, Fogo AB, Bruijn JA, Jennette JC Pathologic classification of focal segmental glomerulosclerosis: a working proposal. Am J Kidney Dis. 2004 Feb; 43(2):368-82.).
  • the incidence of FSGS has increased over the past decades and it is one of the leading causes of nephrotic syndrome in adults (Korbet SM Treatment of primary FSGS in adults. J Am Soc Nephrol. 2012 Nov; 23(11 ):1769-76).
  • ESRD end-stage renal disease
  • Primary FSGS is responsible for 3.3% of all the cases of end-stage renal disease (ESRD) resulting from primary kidney disease in the United States.
  • the complement system has been shown to be activated in patients with primary FSGS and elevated levels of plasma Ba, indicative of activation of the alternative pathway, correlates with disease severity. Patients with low serum C3 had a significantly higher percentage of interstitial injury.
  • C5b-9 In the experimental focal segmental glomerulosclerosis, the intratubular formation of C5b-9 was found to promote peritubular myofibroblast accumulation. Myofibroblasts may act as sentinel inflammatory cells and deposit extracellular matrix. These cells may also constrict kidney tubules leading to atubular glomeruli. By this mechanism, complement activation may contribute to tubulointerstitial injury and fibrosis in FSGS. (Rangan GK, Pippin JW, Couser WG. C5b-9 regulates peritubular myofibroblast accumulation in experimental focal segmental glomerulosclerosis. Kidney Int. 2004;66:1838-1848).
  • Complement activation contributes to both glomerular and tubulointerstitial damage in adriamycin nephropathy in mice. J Immunol. 2006 Sep 15; 177(6):4094-102. Furthermore, complement factor H deficient mice display higher C3b glomerular deposition and more severe kidney damage than wild-type controls. (Morigi M, Locatelli M, Rota C, Buelli S, Corna D, Rizzo P, Abbate M, Conti D, Perico L, Longaretti L, Benigni A,
  • the method involves treating a subject having systemic lupus erythromatosus by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encode
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having lupus nephritis by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having membranous nephropathy by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the group consisting of
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having FSGS by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having bullous pemphigoid by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nu
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having epidermolysis bullosa acquisita by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having ANCA vasculitis by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucle
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having hypocomplementemic urticarial vasculitis by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encode
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having immune complex small vessel vasculitis by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucle
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having rheumatoid arthritis by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the group consisting of
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having aPL by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having glomerulonephritis by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nu
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having PNH syndrome by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having C3G by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having dermatomyositis by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nu
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having autoimmune necrotizing myopathies by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucle
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having systemic sclerosis by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having demyelinating polyneuropathy by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nu
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having pemphigus by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having inflammation by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having organ transplantation by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having intestinal and renal l/R injury by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nu
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having asthma by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having spontaneous fetal loss by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having DDD by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having IgA nephropathy by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nu
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having HUS by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having aHUS by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having macular degeneration by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the method involves treating a subject having TTP by administering to the subject a therapeutically effective amount of fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ).
  • the method involves administering to the subject a therapeutically effective amount of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 e.g., a fusion protein having at least 85% sequence identity to any one of SEQ
  • the disclosure further relates to a composition comprising the fusion proteins, as provided above, for use in treatment of a disease selected from the group consisting of PNH, aHUS, IgA nephrology, lupus nephritis, C3G, dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, FSGS, bullous pemphigoid, epidermolysis bullosa acquisita (EBA), ANCA vasculitis, hypocomplementemic urticarial vasculitis, immune complex small vessel vasculitis, an autoimmune necrotizing myopathy, rejection of a transplanted organ, antiphospholipid (aPL) Ab syndrome, glomerulonephritis, asthma, DDD, AMD, SLE, RA, MS, TBI, ischemia reperfusion injury, preeclampsia, and TTP; preferably, SLE, lupus
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of SLE.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of SLE.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of lupus nephritis.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of membranous nephropathy.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of membranous
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of IgA nephropathy.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of IgA ne
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of FSGS.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of FSGS.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of Pemphigus.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of Pemphigus.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of bullous pemphigoid.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of bullous pemphigo
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of epidermolysis bullosa acquisita.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of systemic sclerosis.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of systemic sclerosis.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of ANCA vasculitis.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of ANCA vasculitis
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of hypocomplementemic urticarial vasculitis.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of immune complex small vessel vasculitis.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of immune complex small vessel vas
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of PNH.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of PNH.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of AHUS.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of AHUS.
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • the disclosure relates to a composition
  • a composition comprising Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of dermatomyositis.
  • Compound AB SEQ ID NO: 147
  • Compound AC SEQ ID NO: 148
  • Compound AJ SEQ ID NO: 155
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155
  • a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of dermatomyo
  • the disclosure further relates to a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177
  • Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200 for use in treatment of autoimmune necrotizing myopathies.
  • the disclosure relates to a pharmaceutical composition for treating PNH, aHUS, IgA nephrology, lupus nephritis, C3G, dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, FSGS, bullous pemphigoid, epidermolysis bullosa acquisita (EBA), ANCA vasculitis, hypocomplementemic urticarial vasculitis, immune complex small vessel vasculitis, an autoimmune necrotizing myopathy, rejection of a transplanted organ, antiphospholipid (aPL) Ab syndrome, glomerulonephritis, asthma, DDD, AMD, SLE, RA, MS, TBI, ischemia reperfusion injury, preeclampsia, or TTP, or preferably, SLE, lupus nephritis, membranous nephropathy, I
  • the disclosure relates to a pharmaceutical composition for treating SLE, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 114
  • the disclosure relates to a pharmaceutical composition for treating SLE, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195
  • the disclosure relates to a pharmaceutical composition for treating lupus nephritis, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152- 155, and 209-215; or a fusion protein encoded by the nucle
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 as an active ingredient.
  • the disclosure relates to a pharmaceutical composition for treating lupus nephritis, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of S
  • the disclosure relates to a pharmaceutical composition for treating membranous nephropathy, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX,
  • fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145,
  • the disclosure relates to a pharmaceutical composition for treating membranous nephropathy, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID
  • the disclosure relates to a pharmaceutical composition for treating IgA nephropathy, containing a fusion protein selected from the group consisting of Compound A, Compound
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 as an active ingredient.
  • the disclosure relates to a pharmaceutical composition for treating IgA nephropathy, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NO
  • the disclosure relates to a pharmaceutical composition for treating FSGS, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound
  • the disclosure relates to a pharmaceutical composition for treating FSGS, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194,
  • the disclosure relates to a pharmaceutical composition for treating Pemphigus, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS,
  • Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152- 155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs:
  • the disclosure relates to a pharmaceutical composition for treating Pemphigus, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO:
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155, or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200.
  • the disclosure relates to a pharmaceutical composition for treating bullous pemphigoid, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS,
  • a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z
  • Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152- 155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs:
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 as an active ingredient.
  • the disclosure relates to a pharmaceutical composition for treating bullous pemphigoid, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NO
  • the disclosure relates to a pharmaceutical composition for treating epidermolysis bullosa acquisita, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucle
  • the disclosure relates to a pharmaceutical composition for treating epidermolysis bullosa acquisita, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of
  • the disclosure relates to a pharmaceutical composition for treating systemic sclerosis, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR,
  • fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145,
  • the disclosure relates to a pharmaceutical composition for treating systemic sclerosis, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 19
  • the disclosure relates to a pharmaceutical composition for treating ANCA vasculitis, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS,
  • Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152- 155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs:
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 as an active ingredient.
  • the disclosure relates to a pharmaceutical composition for treating ANCA vasculitis, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NO
  • the disclosure relates to a pharmaceutical composition for treating hypocomplementemic urticarial vasculitis, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ) as an active ingredient.
  • the disclosure relates to a pharmaceutical composition for treating hypocomplementemic urticarial vasculitis, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one
  • the disclosure relates to a pharmaceutical composition for treating immune complex small vessel vasculitis, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ) as an active ingredient.
  • the disclosure relates to a pharmaceutical composition for treating immune complex small vessel vasculitis, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NO
  • the disclosure relates to a pharmaceutical composition for treating PNH, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 114
  • the disclosure relates to a pharmaceutical composition for treating PNH, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195
  • the disclosure relates to a pharmaceutical composition for treating AHUS, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs:
  • the disclosure relates to a pharmaceutical composition for treating AHUS, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194,
  • the disclosure relates to a pharmaceutical composition for treating dermatomyositis, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX,
  • fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145,
  • the disclosure relates to a pharmaceutical composition for treating dermatomyositis, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NO
  • the disclosure relates to a pharmaceutical composition for treating autoimmune necrotizing myopathies, containing a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ,
  • Compound AR Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114- 132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 ) as an active ingredient.
  • the disclosure relates to a pharmaceutical composition for treating autoimmune necrotizing myopathies, containing a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200).
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NO
  • the disclosure relates to use of a composition comprising a fusion protein, as provided above, for the manufacture of a medicament for treating a disease selected from the group consisting of PNH, aHUS, IgA nephrology, lupus nephritis, C3G, dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, FSGS, bullous pemphigoid, epidermolysis bullosa acquisita (EBA), ANCA vasculitis, hypocomplementemic urticarial vasculitis, immune complex small vessel vasculitis, an autoimmune necrotizing myopathy, rejection of a transplanted organ, antiphospholipid (aPL) Ab syndrome, glomerulonephritis, asthma, DDD, AMD, SLE, RA, MS, TBI, ischemia reperfusion injury, preeclampsia, and TTP;
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for SLE.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for SLE.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of S
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 for the manufacture of a medicament for lupus nephritis.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for lupus nephritis.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO:
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) for the manufacture of a medicament for membranous nephropathy.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for IgA nephropathy.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encode
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for FSGS.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for FSGS.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for Pemphigus.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for Pemphigus.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for bullous pemphigoid.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for bullous pemphigoid.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encode
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO:
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) for the manufacture of a medicament for epidermolysis bullosa acquisita.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for systemic sclerosis.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for systemic sclerosis.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for ANCA vasculitis.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for ANCA vasculitis.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21 for the manufacture of a medicament for hypocomplementemic urticarial vasculitis.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for hypocomplementemic urticarial vasculitis.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for immune complex small vessel vasculitis.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for immune complex small vessel vasculitis.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encode
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for PNH.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for PNH.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of S
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a variant thereof e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for AHUS.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for AHUS.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-21, for the manufacture of a medicament for dermatomyositis.
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for dermatomyositis.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encode
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound A, Compound B, Compound C, Compound D, Compound E, Compound F, Compound G, Compound H, Compound I, Compound M, Compound N, Compound O, Compound P, Compound Q, Compound R, Compound S, Compound T, Compound U, Compound X, Compound Y, Compound Z, Compound AB, Compound AC, Compound AG, Compound AH, Compound Al, Compound AJ, Compound AR, Compound AS, Compound AT, Compound AU, Compound AV, Compound AW, and Compound AX, (e.g., a fusion protein having the amino acid sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165
  • the disclosure relates to use of a composition comprising a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encoded by any one of SEQ ID NOs: 194, 195, or 200) ), for the manufacture of a medicament for autoimmune necrotizing myopathies.
  • a fusion protein selected from the group consisting of Compound AB (SEQ ID NO: 147), Compound AC (SEQ ID NO: 148), or Compound AJ (SEQ ID NO: 155), or a variant thereof (e.g., a fusion protein having at least 85% sequence identity to any one of SEQ ID NOs: 147, 148, or 155), or a fusion protein encode
  • CR2 SCR domains 1 -4 inhibit auto-antibodies, bind to C3b/C3d, and are useful for increasing the B cell activation threshold.
  • FH SCR domains 1 -5 bind to C3b and can inhibit the alternative complement pathway (AP).
  • FH SCR domains 19-20 can interact with the negatively-charged extracellular matrix components on host cell surfaces, and can bind to C3b. The Fc domain allows for prolonged stability and pharmacokinetics properties.
  • the amino acid sequence of human complement receptor 2 (CR2) (Genbank accession number NP 001006659.1 ) encompassing short consensus repeats (SCRs) 1 -4 was added to the N-terminus of the human lgG2/lgG4 hybrid heavy chain constant region at position 4 of the hinge region.
  • the amino acid sequence of human complement factor H (Genbank accession number NP_000177.2) SCRs 1 -5 was added to the C-terminus of the hybrid human lgG2/lgG4 heavy chain constant region.
  • variants were constructed with peptide linkers having the sequence (G 4 S)4, (G 4 A) 2 G 4 S, G 4 SDA, or G 4 SDAA inserted between the CR2 region and the Fc region. Additional variants had (G 4 SK (G 4 A)3G 4 S, or (G 4 A) 2 G 4 S linker sequences inserted between the IgG region and the human complement factor H region. Some variants had linkers in both positions.
  • N-linked glycosylation sites of CR2 eliminated by introducing either an N107Q or S109A mutation (amino acid residue numbering according to mature CR2, excluding the 20 amino acid signal peptide) ( Figure 1 B).
  • This glycosylation site is known to be variably occupied by heterogeneous high mannose glycans in a fusion protein comprising the first four SCR domains of factor H and the first 4 domains of CR2 in the absence of an Fc domain (CR21-4FH1-5).
  • the amino acid sequences of the constructs shown in Figure 1 A were provided to GeneArt (ThermoFisher) for codon optimization and gene synthesis.
  • Nucleotide sequences encoding the polypeptides of the compounds shown in Table 1 were cloned into an expression vector for production in mammalian cells. Plasmid DNA was then transiently transfected into human HEK293 cells. After 4-5 days, supernatants were harvested. The concentration of fusion proteins were determined by SDS- PAGE and densitometry. Fusion proteins were purified by Protein A chromatography. The concentrations of purified fusion proteins were determined by UV spectroscopy absorbance at 280nm corrected for molar extinction coefficient. Purity was assessed by SDS-PAGE and size-exclusion HPLC.
  • CR2-FH-Fc fusion proteins expressed well in transiently transfected HEK293 cells.
  • Exemplary SDS PAGE gels of harvested cell culture supernatants are shown in Figures 2A-2C. These fusion proteins were readily purified by Protein A chromatography to high levels of purity (See Figures 3A-3B).
  • the N-linked glycosylation site at position 107 of CR2 SCR2 can be removed without compromising expression levels, however the N107Q variant appeared to be more prone to aggregation than the S109A variant ( Figure 2C).
  • Fusion proteins were tested for their ability to inhibit the alternative pathway using the AP-specific hemolytic assay. Briefly, rabbit red blood cells were washed and added to 10% human serum containing Mg 2+ and EGTA. Serial dilutions of inhibitors were added and the cells were incubated for 30 min at 37°C. Cells were removed by centrifugation and the amount of cell lysis was determined by measuring the absorbance of the supernatant at 415 nm.
  • Factor H fusion proteins including an Fc domain and a fragment of CR2 were at least 4 times more potent than CR21-4FH1-5 in the AP hemolytic assay ( Figures 4A and 4B).
  • CR2 increased the potency when incorporated into a fusion protein containing factor H SCRs 1-4 or 1-5.
  • CR2 alone had no effect on AP hemolysis ( Figure 4A).
  • Fusion proteins containing FH SCRs 19-20 in addition to FH SCRs 1-4 appeared to be equipotent to fusion proteins containing factor H and CR2 ( Figure 4C).
  • CR2 SCRs 3- 4 and FH SCR 5 can be excluded from the fusion proteins without a loss of potency ( Figure 4D).
  • a variety of constructs including the first 5 N-terminal SCR domains of FH and/or the first four N- terminal SCR domains of CR2, and anti-human serum albumin (a-HSA) VHH were designed in silico, and is illustrated in Figure 5A.
  • FH SCR domains 1 -5 bind to C3b and can inhibit the alternative complement pathway (AP).
  • CR2 SCR domains 1-4 inhibit auto-antibodies, bind to C3b/C3d, and are useful for increasing the B cell activation threshold.
  • the a-HSA-VHH allows for prolonged stability and pharmacokinetics properties. Expression was accomplished similarly to Example 1 .
  • the FHi-5-a-HSA-VHH and CR2i-4-a-HSA-VHH-FHi-s fusion proteins were purified from cell supernatant using MEP HYPERCELTM or CAPTOTM Adhere ImpRes resin at a variety of pH conditions. The yield and purity from these purification conditions are shown in Figures 5B-5G.
  • Fusion proteins were tested for inhibition of the alternative pathway using the AP-specific hemolytic assay. Briefly, rabbit red blood cells were washed and added to 10% human serum containing Mg 2+ and EGTA. Serial dilutions of inhibitors were added and the cells were incubated for 30 min at 37°C. Cells were removed by centrifugation and the amount of cell lysis was determined by measuring the absorbance of the supernatant at 415 nm. All fractions purified using MEP HYPERCELTM or CAPTOTM Adhere ImpRes resin at a variety of pH conditions retained similar inhibition activity ( Figures 5H and 51).
  • HiTrap CAPTOTM Adhere ImpRes was used for a large scale purification. The final product eluted at pH 4.5 and was isolated to 99% purity (Figure 5J).
  • Compound X (SEQ ID NO: 132) was designed ( Figure 6A), expressed transiently in CHO cells, and purified by protein A chromatography, as described above. As indicated by the multiple bands in the reduced and non-reduced SDS-PAGE analysis ( Figure 6B), the fusion protein was determined to be susceptible to fragmentation.
  • Compound X was then enzymatically de-glycosylated by PNGase F treatment and analyzed by electrospray ionization time-of-flight (ESI-ToF) mass spectrometry. Following deconvolution of the mass spectra, three major species were observed with m/z values corresponding to masses of 177,324.4 Da,
  • Compound X was then modified in the following manner: (1 ) shorten the CR2 SCRs to delete SCRs 3-4; (2) change the linker from (G 4 A) 2 (G 4 S) to GGGGSDAA; (3) modify the FH to exclude SCR5 (i.e. , use SCR1 -4 vs. SCR1 -5); and (4) other modifications such as C-terminal modification of SCR4 to add Serine (S); and (5) further optional modification to substitute N107Q ( Figure 8A).
  • the resultant fusion protein (Compound AC), was assessed by SDS PAGE. Human CR2 contains two consensus N- linked glycosylation sites at positions 101 and 107.
  • CR2 produced in E.coli cells which do not add N-linked glycans to proteins, was shown to bind similarly to its ligands as CR2 produced in mammalian cells. Therefore, the N107Q substitution was not expected to negatively impact the binding properties of the CR2 domain.
  • Compound AD contains the hinge, CH2, and CH3 regions of a human lgG1 Fc region fused via a flexible linker to FH SCRs 1 -5 at the C-terminus. Both compounds were tested for inhibition of the human complement alternative pathway in a rabbit red blood cell hemolysis assay. Briefly, rabbit red blood cells were incubated with titrations of both inhibitors for 30 minutes in 10% complement preserved human serum supplemented with 10 mM EGTA and 2 mM MgCI 2+ in gelatin veronal buffer (GVB).
  • GVB gelatin veronal buffer
  • SCRs 19 and 20 of complement factor H function to localize the molecule to cellular surfaces and extracellular matrix.
  • Factor H SCRs 19-20 were therefore included in certain compounds as targeting domains in place of CR2. Additionally, the position of the targeting domains and factor H domains at the N-or C-terminus was investigated by generating variants containing these domains at either termini of a human Fc region. As a control, compounds with no targeting domain were included and the complement regulatory domains of FH were fused to either the N- or C-terminus of a human Fc region. These compounds were tested for inhibition of the human complement alternative pathway in a rabbit red blood cell hemolysis assay.
  • Figure 11 provides the dose-response curves for compounds Compound AD, Compound AE, and Compound AF. As shown in the dose response curve, non-targeted compounds in which the FH domain is attached to the C-terminus of the Fc region are active in this assay (Compound AD and Compound AE) while Compound AF having the FH domain attached to the N-terminus of the Fc region was not active at the concentrations tested.
  • a single dose of a factor H fusion protein (e.g., a CR2-FH-Fc fusion protein, a FH19-20-FC-FH1-5 fusion protein; a fusion protein having the sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222) can be administered to a mouse model of complement activity (e.g., C47BL/6J male mice) to test the pharmacokinetic properties of the fusion protein.
  • Plasma samples can be collected at various time points following administration.
  • Pharmacokinetic properties of the factor H fusion proteins can be assessed by testing the plasma samples using an enzyme-linked immunosorbent assay (ELISA).
  • ELISA enzyme-linked immunosorbent assay
  • AP alternative pathway hemolytic activity can be monitored in the collected plasma samples using methods known in the art.
  • the effects of the fusion protein in the mouse model can be compared to effects with an isotype- matched control antibody, and can be measured as a function of dose and exposure. Sustained inhibition of plasma complement alternative pathway hemolytic activity is indicative of fusion protein efficacy and sustained bioavailability.
  • the pharmacokinetics (PK) and pharmacodynamics (PD) of compounds described herein were evaluated in single dose studies in wild-type C57 black 6 (C57BL/6) mice.
  • Compound X was selected because it was found to be susceptible to fragmentation and it has both N-linked glycosylation sites present in the CR2 domain.
  • Compound H was selected because it has the N107Q mutation which eliminated the second N-linked glycosylation site of CR2.
  • Compound H contains a longer (G 4 A) 2 G 4 S linker between the CR2 domain and the Fc region and thus is susceptible to fragmentation.
  • Figure 13 provides the SDS-PAGE analysis of Compound H expressed in CHO cells and purified by protein A chromatography. Fragmentation is evident by the presence of multiple bands on the reduced and non-reduced SDS-PAGE.
  • Compound AC was also evaluated for PK and PD effects in wild-type mice as it contains the shorter linker between the CR2 domain and the Fc and thus has minimal fragmentation. Compound AC also has the N107Q mutation that eliminates the second N-linked glycosylation site of CR2.
  • mice Male C57BI/6 mice were administered single 25 mg/kg IV doses of either Compound X, Compound H, or Compound AC. Blood samples were taken at 30 minutes, 1 day, 2 days, 4 days, 5 days, and 7 days after dosing. The serum concentrations of the compounds were determined using an immuno-assay in which the compounds were captured using either an anti-human CR2 monoclonal antibody (clone 1148) or an anti-human IgG polyclonal antibody (Jackson ImmunoResearch, catalog number 109-065-088). The compounds were detected using an anti-human factor H antibody (Quidel, catalog number A254). Similar results were obtained when either the anti-CR2 or the anti-human IgG antibody was used to capture the compounds.
  • Figure 14 provides the PK data.
  • Compound X being susceptible to fragmentation and having the second-N-linked glycosylation site present in CR2, had the poorest PK.
  • Compound H which was susceptible to fragmentation but does not contain the second N- linked glycosylation site had better PK, and compound AC, having no fragmentation and the second N- linked glycosylation site of CR2 eliminated had the most favorable PK.
  • Compound AB is identical to Compound AC except for the inclusion of SCR5 in the FH domain.
  • Figure 16 provides the PK and PD data for Compound AB and
  • Figure 17 provides the PK and PD data of Compound AC. Note that the PD data are expressed as percent lysis or the remaining hemolytic activity present in the serum of treated animals.
  • a single dose of Compound AC was found to suppress alternative pathway hemolysis more effectively than Compound AB.
  • a single dose of a factor H fusion protein (e.g., a CR2-FH-Fc fusion protein, a FH19-20-FC-FH1-5 fusion protein; a fusion protein having the sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165-173, 177-185, 188-190, 192, 193, 197-200, and 216-222) can be administered to factor H deficient mice, and plasma samples can be collected at various time points following administration.
  • a factor H fusion protein e.g., a CR2-FH-Fc fusion protein, a FH19-20-FC-FH1-5 fusion protein; a fusion protein having the sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155
  • Pharmacokinetic and pharmacodynamic properties of the factor H fusion proteins can be assessed by testing the plasma samples using an ELISA.
  • C3 and factor B levels can be assessed by ELISA and/or western blot.
  • Glomeruli C3 deposition can be examined by immunohistochemistry (IHC).
  • Normalization and/or restoration of plasma levels of complement components, such as C3 and factor B, to levels observed in factor H sufficient littermates, elimination of glomerular C3 deposits, and/or sustained prevention of glomerular C3 deposition can be indicative of fusion protein efficacy and prolonged bioavailability.
  • in vivo mechanistic studies were performed by administering Compound AC to factor H deficient C57BL/6 mice. Both alleles encoding complement factor H are inactivated in this strain using CRISPR technology. These mice exhibit uncontrolled AP activation of complement resulting in depletion of plasma C3 and C5 and deposition of C3 fragments and properdin along the glomerular basement membrane in kidneys. Factor H deficient mice have been shown to develop membranoproliferative glomerulonephritis and are predisposed to developing renal injury caused by immune complexes. In this experiment, a single 25 mg/kg IV dose of Compound AC was administered to FH-/- mice on day 0.
  • Serum was sampled on days 1 , 3, 7, 10, and 14 for PK and to measure levels of complement C3 and C5.
  • PK was determined by an immunoassay in which Compound AC was captured using a polyclonal anti-human IgG antibody and detected with an anti-human FH antibody.
  • Plasma levels of complement C3 were determined by an immunoassay using the Gyros xPlore system (Gyros Protein Technologies, Uppsala, Sweden).
  • Mouse C3 was captured using a biotinylated rat monoclonal anti-C3 antibody, clone 11 H9 (Novus Biologicals catalog number NB200-5408) and detected with Alexa Fluor 647 labeled goat anti-mouse C3 polyclonal antibody (MP Biomedicals catalog number 55463).
  • Mouse C3 (Complement Technologies catalog number M113) was used as a standard.
  • Plasma C5 levels were determined by ELISA using anti-mouse C5 monoclonal antibody BB5.1 (Alexion Pharmaceuticals, Inc,) and detected with Alexa Fluor-647 labeled anti-mouse C5 monoclonal antibody ATM587 (Alexion Pharmaceuticals, Inc,). Recombinant mouse C5 was used as a standard.
  • the PK profile of Compound AC was different when administered to FH-/- mice as compared to wild-type mice.
  • plasma levels of Compound AC decreased more rapidly, presumably due to the localization of Compound AC to tissues such as the kidney glomeruli where C3 deposition had occurred.
  • Figure 18 provides the PK profile form wild-type and FH-/- mice administered a single 25 mg/kg IV dose of Compound AC.
  • Compound AC was found to localize to the kidneys of FH-/- mice. Fluorescence detection of Compound AC was statistically significant at the day 1 and day 3 time-point.
  • Figure 19 provides the IHC of human factor H (Compound AC) on the glomerular basement membrane of FH-/- mice administered a single 25 mg/kg IV dose.
  • Figure 20 provides the mean fluorescence intensity and statistical analysis for the localization of Compound AC.
  • Complement C3 forms deposits along the glomerular basement membrane in the kidneys of FH- /- mice.
  • a single 25 mg/kg dose of Compound AC dramatically reduced C3 deposition by day 1 post dosing and remained significantly reduced for 7 days ( Figures 21 and 22).
  • FIG. 25 provides the plasma C5 levels of FH-/- mice treated with Compound AC.
  • Plasma C5 levels of normal mouse serum (NMS) at day zero and PBS-treated control FH-/- mice at day 10 and day 14 are also shown. C5 levels were significantly elevated from day 1 to day 14 when compared to the day 10 PBS control group using Dunnett’s test for multiple comparisons.
  • NMS normal mouse serum
  • Plasma and urine samples can be collected at various time points following administration.
  • C3 and factor B levels can be assessed by ELISA and/or western blot. Glomeruli C3, IgG, and C1q deposition can be examined by immunohistochemistry (IHC). Levels of anti-dsDNA autoantibodies and/or immune complexes can be assessed by ELISA. Proteinuria and biological urea nitrogen (BUN) levels can be assessed according to routine methods known in the art.
  • IHC immunohistochemistry
  • the reduction and/or prevention of glomerular C3 deposition, normalization of plasma C3 and factor B levels, reduction and/or prevention of glomerular IgG and C1q deposition, reduction in circulating anti-dsDNA autoantibodies and/or immune complexes, and/or restoration of kidney function as indicated by amelioration of proteinuria and normalization of BUN can be indicative of fusion protein efficacy in this model.
  • C57BL/6J and DBA Ia1/j mice can be immunized with bovine collagen type II with Freund’s incomplete/M tuberculosis adjuvant to trigger collagen-induced arthritis.
  • a booster injection can be administered after three weeks.
  • Clinical disease activity can be determined by gross examination of the mice; the extent of inflammation, joint ankylosis, and loss of function can be used to generate a clinical disease activity score 35 days post collagen immunization booster.
  • a factor H fusion proteins e.g., a CR2-FH-Fc fusion protein, a FH19-20-FC-FH1-5 fusion protein; a fusion protein having the sequence of any one of SEQ ID NOs: 114-132, 144, 145, 147, 148, 152-155, and 209-215; or a fusion protein encoded by the nucleic acid sequence of any one of SEQ ID NOs: 165- 173, 177-185, 188-190, 192, 193, 197-200, and 216-222) can be administered prophylactically, or immediately following, the second administration of bovine collagen II, with weekly administrations thereafter.
  • a CR2-FH-Fc fusion protein e.g., a CR2-FH-Fc fusion protein, a FH19-20-FC-FH1-5 fusion protein
  • the efficacy of the factor H fusion protein therapy can be assessed by monitoring changes in clinical disease activity, examination of complement activation, and monitoring of anti-collagen antibody titers.
  • Clinical disease activity e.g., inflammation, joint ankylosis, and loss of function
  • Complement activation and/or complement-mediated inflammation in the joints can be assessed by quantifying C3 deposition in knee joint, ankle, and paw by IHC, and histopathological changes including inflammation, pannus, and cartilage and bone damage.
  • the levels of anti-collagen antibodies can be quantified by ELISA performed on plasma samples.
  • a reduction in clinical disease activity as determined by gross examination, prevention of complement activation and/or inflammation in the joints (e.g., prevention of C3 deposition in the knee joint, ankle, and/or paw), prevention of histological changes (e.g., inflammation, pannus, and/or cartilage and bone damage), and/or a reduction in the formation of anti-collagen antibodies in plasma can be indicative of therapeutic efficacy of the fusion protein in this model.
  • EXAMPLE 10 Suppression of B-cell activation and antibody formation in the mouse KLH immunization model
  • Complement receptor 2 (CD21) is expressed on mature B-lymphocytes, T cells and follicular dendritic cells.
  • the binding of CR2 on mature B-cells to C3d-opsonized antigens stabilizes a signaling complex composed of CR2, CD81 , Leu-13 and CD19. This complex amplifies the signal transmitted by the B-cell receptor upon binding to its specific antigen.
  • the binding of CR2 to C3d-opsonized antigens reduces the threshold of antigen required for B-cell activation and antibody formation, expressed on B-cells may facilitate the internalization of C3d-obsonized antigens, which may then be presented by B-cells on HLA/ MHC class II molecules.
  • a fusion protein consisting of SCRs 1-2 of CR2 fused to the N-terminus of the heavy chain of an antibody has been previously shown to suppress the antibody response in mice immunized with keyhole limpet hemocyanin (KLH).
  • Factor H deficient mice have enhanced B-cell receptor activation, germinal center hyperactivity and increased double-stranded autoantibodies, caused by increased exposure of splenic B-cells to activated C3 fragments. Therefore, administration of factor H may reduce B-cell activation and autoantibody formation by inhibiting alternative pathway C3 convertases. Additionally, the pathology of certain diseases such as membranous nephropathy, IgA nephropathy, lupus, epidermolysis bullosa acquisita, dermatomyositis, and others involve the formation of autoantibodies that bind to self-structures, form immune complexes and activate complement. The alternative pathway can further contribute to tissue damage by amplifying complement activation. Therefore, a therapeutic that can reduce alternative complement pathway activation and limit the complement-mediated stimulation of autoreactive B-cells may be effective in these diseases.
  • diseases such as membranous nephropathy, IgA nephropathy, lupus, epidermolysis bullo
  • mice were immunized with 0.5 mg KLH in 0.2 mL PBS by intraperitoneal injection (I.P.). On the day of immunization, mice were administered a single, 25 mg/kg I.P. dose of compounds AA and AJ. As a positive control for inhibition of B-cell activation, one group of immunized mice received a 50 mg/kg dose of cyclophosphamide on the day of immunization and a second dose seven days later.
  • Cyclophosphamide has been shown to reduce autoantibody formation in patients with lupus nephritis.
  • One group of animals was immunized with KLH alone.
  • As a negative control one group of animals was sham-immunized with PBS. Serum samples were collected before immunization, 1 hour after immunization/dosing, on day 7 and on day 14.
  • KLH specific IgM (early antibody response) and IgG (later response following class switching and affinity maturation) levels were determined by ELISA using KLH as the capture reagent.
  • KLH immune serum from non-treated KLH immunized mice was used as a positive control in the ELISA.
  • a subject diagnosed as having a disease associated with alternative complement pathway dysregulation can be treated with a fusion protein containing a fragment of factor H and an Fc domain, or a fragment of factor H, a fragment of CR2, and an Fc domain (e.g., a fusion protein having the sequence of any one of SEQ ID NO: 1
  • the fusion protein can be administered at an effective dose to treat the subject diagnosed with disease associated with alternative complement pathway dysregulation (e.g., kidney disorders, cutaneous disorders, and neurological disorders, such as PNH, aHUS, IgA nephropathy, lupus nephritis, C3G, dermatomyositis, systemic sclerosis, demyelinating polyneuropathy, pemphigus, membranous nephropathy, FSGS, bullous pemphigoid, epidermolysis bullosa acquisita, ANCA vasculitis, hypocomplementemic urticarial vasculitis, immune complex small vessel vasculitis, DDD, AMD, or TTP).
  • alternative complement pathway dysregulation e.g., kidney disorders, cutaneous disorders, and neurological disorders, such as PNH, aHUS, IgA nephropathy, lupus nephritis, C3G, dermatomyositis, systemic
  • the subject When effectively treated, the subject shows normal levels of biomarkers of dense deposit disease (e.g., urinary protein, serum creatinine, plasma C5b-9 for dense deposit disease, or e.g., urinary protein, 51 Cr- EDTA renal clearance, plasma C5b-9 for C3 glomerulonephritis) following treatment.
  • biomarkers of dense deposit disease e.g., urinary protein, serum creatinine, plasma C5b-9 for dense deposit disease, or e.g., urinary protein, 51 Cr- EDTA renal clearance, plasma C5b-9 for C3 glomerulonephritis
  • the subject can be diagnosed prior to treatment by a variety of diagnostic methods known in the art.
  • a subject can be diagnosed as having dense deposit disease from electron microscopy analysis of biopsied tissue.
  • a subject may exhibit plasma complement C3 lower than the normal range found in a healthy individual.
  • the subject may exhibit nephrotic-range proteinuria, presented as elevated urinary protein excretion during a 24 hour time period.
  • the subject may show elevated C3 nephritic factor, an autoantibody that stabilizes the alternative pathway C3 convertase activity.
  • Genetic screening of the subject may reveal a tyrosine-402-histidine (Y402H) of factor H, or other mutation in a regulator of the alternative complement pathway that is associated with dense-deposit disease.
  • a low level of plasma C5, combined with a high level of the terminal complement complex sC5b-9 and C5b-9 glomerular deposits can indicate abnormally high levels of alternative complement pathway activation.
  • a subject may be diagnosed with C3 glomerulonephritis by a renal biopsy.
  • the renal biopsy of a subject may demonstrate expansion of the mesangial matrix and increased glomerular cellularity, segmental capillary wall thickening and focal tubular atrophy.
  • Electron microscopy may show sub-endothelial and mesangial electron dense deposits with infrequent sub-epithelial deposits.
  • the biopsy may show positive staining for complement C3.
  • the subject may exhibit proteinuria and renal impairment.
  • the subject may have a family history of renal disease.
  • GGTCTGCCG GAAAGGCGAGTGGGTTGCCCTGAATCCTCTGAGAAAGTGCCAGAAGAGGCCTTGCG

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  • Chemical Kinetics & Catalysis (AREA)
  • General Chemical & Material Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Cell Biology (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • Peptides Or Proteins (AREA)

Abstract

L'invention concerne des protéines de fusion qui comprennent deux fragments du facteur H, un fragment du facteur H et un domaine Fc, ou un fragment du facteur H, un fragment de CR2 et un domaine Fc. L'invention concerne également l'utilisation de ces protéines dans des procédés de traitement de maladies médiées par une dysrégulation de la voie alterne du complément.
PCT/US2020/015466 2020-01-28 2020-01-28 Protéines de fusion et procédés de traitement d'une dysrégulation du complément à l'aide de celles-ci WO2021154216A1 (fr)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20150377899A1 (en) * 2012-12-27 2015-12-31 National Institute Of Advanced Industrial Science And Technology Molecule library constructed on the basis of backbone structure of microprotein
WO2019243586A1 (fr) * 2018-06-22 2019-12-26 Universität Ulm Inhibiteurs du complément et utilisations de ceux-ci
WO2020041644A1 (fr) * 2018-08-22 2020-02-27 Alexion Pharmaceuticals, Inc. Peptides et méthodes de traitement d'affections liées à la dystrophie les utilisant

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20150377899A1 (en) * 2012-12-27 2015-12-31 National Institute Of Advanced Industrial Science And Technology Molecule library constructed on the basis of backbone structure of microprotein
WO2019243586A1 (fr) * 2018-06-22 2019-12-26 Universität Ulm Inhibiteurs du complément et utilisations de ceux-ci
WO2020041644A1 (fr) * 2018-08-22 2020-02-27 Alexion Pharmaceuticals, Inc. Peptides et méthodes de traitement d'affections liées à la dystrophie les utilisant

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
DATABASE UniProtKB [online] 15 March 2017 (2017-03-15), "Vannielia litorea", XP055845136, retrieved from UniProt Database accession no. A0A1N6FLV0 *

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