Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/001—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof by chemical synthesis
• • 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
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/04—Inotropic agents, i.e. stimulants of cardiac contraction; Drugs for heart failure
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/005—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from viruses
  • C07K14/08—RNA viruses
  • C07K14/15—Retroviridae, e.g. bovine leukaemia virus, feline leukaemia virus human T-cell leukaemia-lymphoma virus
  • C07K14/155—Lentiviridae, e.g. human immunodeficiency virus [HIV], visna-maedi virus or equine infectious anaemia virus
  • C07K14/16—HIV-1 ; HIV-2
  • C07K14/163—Regulatory proteins, e.g. tat, nef, rev, vif, vpu, vpr, vpt, vpx
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K7/00—Peptides having 5 to 20 amino acids in a fully defined sequence; Derivatives thereof
  • C07K7/04—Linear peptides containing only normal peptide links
  • C07K7/08—Linear peptides containing only normal peptide links having 12 to 20 amino acids
• • 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
  • C07K2319/00—Fusion polypeptide
  • C07K2319/01—Fusion polypeptide containing a localisation/targetting motif
  • C07K2319/10—Fusion polypeptide containing a localisation/targetting motif containing a tag for extracellular membrane crossing, e.g. TAT or VP22

Definitions

• the present invention relates to peptides which bind the L-type Ca 2+ channel and use thereof to prevent and treat myocardial damage, including cardiac hypertrophy.
• the invention provides methods to treat, prevent or ameliorate the effects of myocardial damage, by administration of peptides and therapeutic compositions comprising peptides.
• Pathological cardiac hypertrophy may arise in a human or another animal as a response to stress; disease such as hypertension; heart muscle injury including myocardial infarction; neurohormones; or pollution causing hypoxia due to atmospheric carbon monoxide.
• HCM hypertrophic cardiomyopathy
• Cardiac troponin is a sarcomeric protein complex that consists of three subunits (cTnT, cTnl and cTnC), and plays a critical role in regulating cardiac contraction and relaxation.
• the entire cTn complex is anchored to tropomyosin via TnT.
• Tnl regulates contraction in response to changes in intracellular calcium.
• Tnl inhibits actin-myosin interaction.
• Tnl undergoes a conformational change that allows actin-myosin interaction, and as a result, contraction.
• Mutations in the cTnl gene TNNI3 account for approximately 3-5% of genotyped families with HCM.
• Human HCM causing cTnl mutation Gly203Ser is characterized by apical and ventricular hypertrophy, and in some cases supraventricular and ventricular arrhythmias.
• HCM is characterized by myocyte remodelling, myofibril disarray and altered energy metabolism.
• Mutations in the MYH7 gene, specifically the alphaMHCArg403Ser mutation is also known to account for approximately 40% of HCM cases.
• Drug therapy used to manage the symptoms of people with HCM may include calcium channel antagonists, p-blockers, calcium channel blockers, amiodarone (Pacerone) or disopyramide (Norpace). Diltiazem, a calcium channel blocker, is used to treat symptoms of HCM such as angina, and heart arrhythmias.
• these drugs can cause negative inotropic (contractile) effects and a decrease in blood pressure leading to heart failure.
• Antiarrhythmic drug therapy includes amiodarone, disopyramide, angiotensin receptor blockers, propafenone, angiotensin-converting enzyme (ACE) inhibitors and perhexilline. These drugs are ineffective in the prevention of arrhythmias. While surgical insertion of an implantable cardioverter defibrillator therapy can prevent sudden death, the socioeconomic and psychological cost to the patient is substantial.
• Cardiac hypertrophy also presents in patients that do not suffer from HCM. Patients that present with cardiac hypertrophy as a result of complete or partial occlusion of a coronary artery are commonly treated with reperfusion therapy, for example using thrombolytic therapy, percutaneous coronary intervention (PCI), or bypass surgery.
• reperfusion therapy when blood supply returns to cardiac tissue after a period of ischemia, reperfusion injury can result.
• the absence of nutrients and oxygen from blood during the period of ischemia causes a condition in which restoration of circulation results in inflammation and oxidative damage. This occurs as a result of the increase in oxidative stress rather than restoration of normal function.
• the long- or L-type Ca 2+ channel is the main route for calcium influx into cardiac myocytes producing the invaluable muscle contraction for the pumping heart. Increases in intracellular calcium and oxidative stress are involved in the pathophysiology of cardiac hypertrophy with increased influx through the L-type Ca 2+ channel or over-expression of the alpha subunit of the channel inducing the hypertrophy.
• the primary structure of the pore-forming L-type Ca 2+ channel alpha- 1 (ai) subunit is composed of 4 homologous repeating motifs ( I— I V), each of which consists of 6 putative transmembrane segments (S1-S6) ( Figure 1 ). Cytoplasmic loops between the transmembrane segments are named according to the motifs they link. There are also 02, 5 and y subunits which are extracellular subunits linked to the alpha subunit via a disulphide bridge, and the L-type Ca 2+ channel beta-2 (P2) subunit which is entirely intracellular. The structure of the P2 subunit may be expressed as any of four beta subunit isoforms (P1-P4).
• All isoforms are hydrophilic, nonglycosylated, and intracellular with no membrane-spanning region.
• the P2 isoform is tightly bound to a highly conserved motif in the cytoplasmic linker between repeats I and II of all cloned high voltage-activated 01 subunit isoforms, called the alpha-interaction domain (AID).
• the L-type Ca 2+ channels also play an important role in regulating mitochondrial function, and this involves both calcium-dependent and calcium-independent mechanisms.
• Activation of the L-type Ca 2+ channel with voltage-clamp of the plasma membrane or with DHP receptor agonist BayK(-) is sufficient to increase intracellular and mitochondrial calcium, NADH production, superoxide production and metabolic activity in wt cardiac myocytes, in a calcium-dependent manner.
• Activation of the L-type Ca 2+ channel also causes an increase in mitochondrial membrane potential ( ⁇ Pm), in a calcium-independent manner.
• the L-type Ca 2+ channel influences mitochondrial function through a structural-functional communication between the L-type Ca 2+ channel and mitochondria via the cytoskeletal network, following conformational changes in L-type Ca 2+ channel that occur on a beat-to-beat basis.
• Patients with HCM exhibit altered communication between the L-type Ca 2+ channel and mitochondria and altered metabolic activity.
• cTnl-G203S myocytes exhibit a faster L-type Ca 2+ channel inactivation rate, and increased and mitochondrial metabolic activity (consistent with the human condition) in response to activation of the L-type Ca 2+ channel.
• These alterations also occur in myocytes isolated from hearts of cTnl-G203S mice that have not yet developed the cardiomyopathy, indicating that alterations in the L-type Ca 2+ channel kinetics and metabolic activity precede development of the cardiomyopathy.
• the alpha subunit of the channel has been the target of a number of therapies which aim to protect the cardiac muscle during reperfusion and calcium overload.
• these therapies include monoclonal antibodies to the alpha subunit; Ca2+ channel antagonists such as the Dihydropyridines, the Benzothiazepines and the Phenylalkylamines.
• Ca2+ channel blockers bind specifically to regions of the a1C subunit of the L-type Ca2+ channel, these drugs have been found to have limited success because they can induce myocardial depression and heart failure.
• WO/2013/1 13060 the inventors made the observation that restricting the movement of the p 2 subunit of the L-type Ca 2+ channel with a peptide derived against AID prevented interaction of p 2 and Qi subunits.
• the l-ll loop of the ai subunit contains an endoplasmic reticulum retention signal that restricts cell surface expression.
• the p 2 subunit reverses the inhibition imposed by the retention signal and is able to modulate the biophysical properties of the L-type Ca 2+ channels ai subunit, producing a leftward shift of the current-voltage relationship, which is consistent with the involvement of the S4 region of the ai subunit voltage-sensor region.
• a peptide of sequence QQLEEDLKGYLDWITQAE (SEQ ID NO: 1 ), (AID peptide) that interacts with the BID of a L-type Ca 2+ channel p 2 subunit in a heart muscle cell, thereby preventing interaction of that p 2 subunit with the AID of an L-type Ca 2+ channel ai subunit.
• the peptide-bound p 2 subunit is unable to reverse the inhibition on the ai subunit imposed by the endoplasmic reticulum retention signal which restricts cell surface expression of the ai subunit. This results in a restriction on the activation of the L-type Ca 2+ channel and decreases mitochondrial energy consumption.
• AID peptide is dependent on the composition of the peptide.
• the inventors have identified that limited substitution of the third and seventh amino acid in the AID peptide sequence has an unexpected impact on the disruptive capacity that this peptide creates in the interaction of the p 2 subunit with the AID of an L-type Ca 2+ .
• the invention provides a peptide comprising the amino acid sequence:
• QQX1EEDX2KGYLDWITQAE (SEQ ID NO: 2) wherein Xi is an amino acid selected from the group comprising: Q, E or R; and wherein X 2 is an amino acid selected from the group comprising: L or E or a variant thereof.
• the peptide does not consist of SEQ ID NO: 1 .
• the invention provides a peptide comprising the amino acid sequence: QQXi EEDX2KGYLDWITQAE wherein Xi is an amino acid selected from the group comprising: Q, E or R; and wherein X2 is an amino acid selected from the group comprising: L or E; or a variant thereof, wherein the peptide does not consist of SEQ ID NO: 1 .
• the peptide binds to the BID of a L-type Ca 2+ channel p 2 subunit. More preferably, the peptide binds to the BID of a human L-type Ca 2+ channel p 2 subunit.
• the invention provides a peptide comprising any one of the amino acid sequences of SEQ ID NO: 4 - 7 or a variant thereof, wherein the peptide does not consist of SEQ ID NO: 1.
• the peptide binds to the BID of a L-type Ca 2+ channel P2 subunit. More preferably, the peptide binds to the BID of a human L-type Ca 2+ channel p 2 subunit.
• the invention provides a peptide comprising: a peptide portion comprising the amino acid sequence of SEQ ID NO: 2; and a peptide portion comprising the amino acid sequence of:
• RKKRRQRRRZaa (SEQ ID NO: 3) wherein Zaa is a 6-amino hexanoic acid or a variant thereof.
• the peptide binds to the BID of a L-type Ca 2+ channel p 2 subunit. More preferably, the peptide binds to the BID of a human L-type Ca 2+ channel p 2 subunit.
• the peptide of the invention comprises an amino acid sequence selected from the group of at least 75%; at least 80%; at least 85%; at least 90%; at least 95%; at least 96%; at least 97%; at least 98%; and at least 99% sequence homology to a peptide comprising SEQ ID NO: 2. More preferably, the peptide of the invention comprises an amino acid sequence comprising one or more conservative amino acid substitutions to SEQ ID NO: 2 selected from the suitable amino acid substitutions set out in Table 3.
• the invention provides a method for modulating movement of a beta subunit of the L-type Ca 2+ channel in a cardiac cell of a subject, comprising administering to the subject a peptide of the invention.
• the invention provides a method for modulating binding of a beta subunit of the L-type Ca 2+ channel in a cardiac cell of a subject, comprising administering to the subject a peptide of the invention.
• the peptide prevents interaction between the beta subunit of the L-type Ca 2+ channel and an alpha subunit of the L-type Ca 2+ channel in a cardiac cell of a subject and therefore activation of the channel.
• the invention provides a method for modulating a L-type Ca 2+ channel in a cardiac cell of a subject, comprising the step of administering to the subject a peptide of the invention.
• the invention provides a method for treating, preventing or reducing myocardial damage and/or oxidative stress in the heart of a subject, comprising the step of administering to the subject a peptide of the invention.
• the myocardial damage comprises cardiac hypertrophy.
• cardiac hypertrophy and/or oxidative stress is reduced.
• intracellular Ca 2+ levels in a cardiac cell in the heart of the subject are slightly reduced or substantially maintained in a cardiac cell in the heart of the subject.
• the subject is preferably a mammal and is more preferably a human. Most preferably, the subject suffers from hypertrophic cardiomyopathy.
• the invention provides a method for treating or preventing cardiac hypertrophy in a subject comprising the step of administering to the subject a peptide of the invention.
• the subject Preferably, the subject suffers from hypertrophic cardiomyopathy.
• the invention provides a use of a peptide of the invention for modulating movement of a beta subunit of the L-type Ca 2+ channel in a cardiac cell in the heart of a subject.
• the invention provides a use of a peptide of the invention for modulating a L-type Ca 2+ channel in a cardiac cell of a subject.
• the invention provides a use of a peptide of the invention for treating, preventing or reducing myocardial damage and/or oxidative stress in the heart of a subject.
• the use is during and/or following reperfusion.
• the invention provides a polynucleotide encoding a peptide of the invention described herein.
• the invention provides the use of the peptide of the invention for the manufacture of a medicament to treat, prevent, or ameliorate myocardial damage and/or oxidative stress in the heart of a subject.
• the myocardial damage is cardiac hypertrophy.
• the invention provides a pharmaceutical, prophylactic or therapeutic composition
• a pharmaceutical, prophylactic or therapeutic composition comprising the peptide of the invention; and one or more pharmaceutically acceptable carriers and/or diluents.
• the invention provides a method for slowing the progression of myocardial fibrosis in a subject comprising the step of administering to the subject a peptide of the invention.
• the invention provides the use of a peptide of the invention for slowing the progression of myocardial fibrosis in a subject
• the invention provides a kit to treat, prevent or ameliorate the effects of myocardial damage and/or oxidative stress in the heart of a subject, wherein the kit comprises at least a peptide of the invention, packaged in a suitable container, together with instructions for its use.
• the invention provides a use of a peptide of the invention for modulating binding to a L-type Ca 2+ channel alpha-interacting domain in a cardiac cell of a subject.
• the invention provides the use of the peptide of the invention for the manufacture of a medicament to treat, prevent, or ameliorate reperfusion injury in the heart of a subject. .
• Figure 1 presents an illustration of the primary structure of the pore-forming L-type Ca 2+ channel alpha-1 (ai) subunit which is composed of 4 homologous repeating motifs ( I— I V), each of which consists of 6 putative transmembrane segments (S1-S6).
• 02b consists of a transmembrane protein (5) and extracellular 02 protein linked via a disulfide bond (S-S).
• P2 is an intracellular protein bound to the linker between motifs 1 and 2 of cue via the a-interacting domain (AID).
• Figure 2 presents the results of a competitive binding assay demonstrating mean binding affinity (K 0.5 ) of each mutant peptide, the full-length AID peptide and diltiazem for the p subunit.
• Figure 3 illustrates the effect of mutant peptides on oxidative stress responses in wild type cardiac myocytes.
• Figure 4 presents the effect of mutant peptides on flavoprotein oxidation, a measure of metabolic activity and oxygen consumption in wt myocytes.
• Figure 5 presents the effect of mutant peptides on flavoprotein oxidation, a measure of metabolic activity and oxygen consumption in myocytes isolated from cTnl-G203S mutant mouse hearts that are hypertrophic.
• Figure 6 presents the effect of mutant peptides on the release of CK and LDH (indication of necrosis), and oxidative stress measured as the ratio of reduced glutathione to oxidised glutathione (GSH:GSSG) in hearts exposed to no-flow ischemia for 20 min ex vivo.
• Figure 7 presents a table of sequences referenced in this application.
• Figure 8 presents the echocardiographic parameters of cTnl-G203S mice administered with 10 pM AID(S)-TAT or AID-TAT.
• Figure 9 presents the results of a competitive binding assay demonstrating mean binding affinity (K0.5) of each mutant peptide, the full-length AID peptide and diltiazem for the p subunit following exposure to 0, 10 nM, 100 nM, 1 pM, 10 pM and 100 pM of peptide.
• Figure 10 illustrates that the in vitro exposure of cTnl.2 (wt) and cTnl-G203S (mutant) cardiomyocytes to variant peptides are more efficacious at restoring metabolic activity than original AID-TAT assessed as changes in flavoprotein oxidation.
• Figure 11 illustrates that the in vitro exposure of cTnl.2 (wt) and cTnl-G203S (mutant) cardiomyocytes to variant peptides are more efficacious at restoring metabolic activity than original AID-TAT assessed as changes in JC-1 fluorescence.
• Figure 12 illustrates that the in vivo treatment of cTnl-G203S (mutant) mice with AID-TAT variant peptides does not alter blood pressure.
• Figure 13 illustrates that the in vivo treatment of cTnl-G203S mice with AID-TAT variant peptides are not toxic.
• Figure 14 illustrates that the in vivo treatment of cTnl-G203S mice with AID-TAT variant peptides slows the progression of fibrosis.
• Figure 15 illustrates the echocardiographic parameters of mice exposed to 10 pM AID(S), 10 pM AID-TAT, 5 pM AID P7 -TAT, 5 pM AID P I 4 -TAT, 5 pM AID P I 5 -TAT or 5 pM AID P I 6 -TAT.
• Figure 16 illustrates that the in vivo treatment of cTnl-G203S mice with AID-TAT variant peptides slows the progression of hypertrophy.
• the invention described herein may include one or more range of values (for example, size, displacement and field strength etc.).
• a range of values will be understood to include all values within the range, including the values defining the range, and values adjacent to the range which lead to the same or substantially the same outcome as the values immediately adjacent to that value which defines the boundary to the range.
• the present invention provides a peptide comprising the amino acid sequence:
• QQXI EEDX 2 KGYLDWITQAE (SEQ ID NO: 2) wherein Xi is an amino acid selected from the group comprising: Q, E or R; and wherein X 2 is an amino acid selected from the group comprising: L or E
• the peptide binds to the BID of a L-type Ca 2+ channel p 2 subunit. More preferably, the peptide binds to the BID of a human L-type Ca 2+ channel p 2 subunit. Most preferably, the peptide binds to the BID of a L-type Ca 2+ channel p 2 subunit with greater affinity compared with SEQ ID NO: 1 .
• the present invention provides an isolated peptide comprising variants to the highly conserved AID motif of the human L-type Ca 2+ channel ai subunit (SEQ ID NO:1 ).
• the inventors have identified a number of variants to specific amino acids in the original AID-peptide that improve the binding affinity of the peptide to BID of a L-type Ca 2+ channel p 2 subunit.
• the improvements in binding affinity result in improved functionality of the peptide in vitro and/or in vivo.
• the peptides of the invention can further slow the inactivation rate of the L-type Ca 2+ channel in comparison to the original-AID peptide.
• the peptides of the invention can be administered at a lower dose to the subject in comparison to the original-AID peptide to produce the same effect in vitro or in vivo.
• the inventors have identified specific variations at positions Xi and X 2 are effective at increasing the binding affinity of the peptide to BID in comparison with the original-AID peptide.
• the original AID-peptide has hydrophobic amino acid leucine at position Xi, but in some embodiments, variations at position Xi to a negative (e.g. glutamic acid), positive (e.g. arginine) or polar uncharged (e.g. glutamine) amino acids, each increase binding affinity of the peptide to BID in comparison with the original-AID peptide.
• Binding affinity of the peptides of the invention to the BID can be measured by a number of techniques that are well known in the art, including SDS-PAGE assays.
• the peptide is provided in a pharmaceutically acceptable form.
• the peptide is not QQLEEDLKGYLDWITQAE (SEQ ID NO: 1 ).
• the peptide is not toxic. Most preferably, the peptide does not exhibit kidney toxicity and/or liver toxicity. Kidney toxicity can be measured by methods known in the art, including by assessing urea and creatinine concentrations using the Quantichrom Urea assay kit (BioAssay Systems, Hayward, CA) and Quantichrom Creatinine assay kit (BioAssay Systems, Hayward, CA), respectively.
• Liver toxicity can be measured by methods known in the art including by assessing alanine transaminase (ALT) and aspartate transaminase (AST) concentrations using the Alanine Transaminase assay kit (BioAssay Systems, Hayward, CA) and Aspartate Transaminase assay kit (BioAssay Systems, Hayward, CA), respectively.
• ALT alanine transaminase
• AST aspartate transaminase
• the present invention further and more preferably provides a peptide comprising the amino acid sequence of SEQ ID NO: 4 - 7 as set out in the table below: Table 2:
• a peptide of the present invention may be recombinant, natural or synthetic.
• a peptide of the invention may be mixed with diluents, adjuvants or carriers (including nanoparticles) that will not interfere with the intended purpose of the peptide.
• a peptide of the invention may also be in a substantially purified form, in which case it will generally comprise the peptide in a preparation in which at least 90%, 95%, 98% or 99% of the protein in the preparation is a peptide of the invention.
• the term ‘peptide’ as used herein may be used interchangeably with the term ‘polypeptide’ as referring to a chain of at least two amino acid monomers.
• the peptides of the invention comprise one or more repeats of a peptide portion comprising SEQ ID NO:2 or a variant thereof.
• the present invention further includes variants of; (1 ) the amino acid sequence of SEQ ID NO: 2; or (2) the amino acid sequence of SEQ ID NO: 2 and SEQ ID NO: 3.
• the variant binds to the BID of a L-type Ca 2+ channel p 2 subunit. More preferably, the peptide binds to the BID of a human L-type Ca 2+ channel p 2 subunit. Most preferably, the variant binds with a higher affinity to the BID of a L-type Ca 2+ channel p 2 subunit compared with SEQ ID NO: 1.
• the variant has an amino acid sequence homology to (1 ) the amino acid sequence of SEQ ID NO: 2; or (2) the amino acid sequence of SEQ ID NO: 2 and SEQ ID NO: 3 selected from the group consisting of: at least 75% sequence homology; at least 80%; at least 85%; at least 90%; at least 95%; at least 96%; at least 97%; at least 98%; and at least 99%.
• the variant is not QQLEEDLKGYLDWITQAE.
• % sequence homology may for example be calculated as follows.
• the query sequence is aligned to the target sequence using the CLUSTAL W algorithm (Thompson et al, Nucleic Acids Research, 22: 4673-4680 (1994)).
• a comparison is made over the window corresponding to one of the aligned sequences, for example the shortest.
• the window may in some instances be defined by the target sequence. In other instances, the window may be defined by the query sequence.
• the amino acid residues at each position are compared, and the percentage of positions in the query sequence that have identical correspondences in the target sequence is reported as % sequence homology.
• Variants of (1 ) the amino acid sequence of SEQ ID NO: 2; and (2) the amino acid sequence of SEQ ID NO: 2 and SEQ ID NO: 3 include a polypeptide substantially homologous to (1 ) the amino acid sequence of SEQ ID NO: 2; or (2) the amino acid sequence of SEQ ID NO: 2 and SEQ ID NO: 3 but which has an amino acid sequence different from that of (1 ) the amino acid sequence of SEQ ID NO: 2; or (2) the amino acid sequence of SEQ ID NO: 2 and SEQ ID NO: 3 sequence because one or more amino acids have been chemically modified or substituted by amino acids analogs.
• any changes to the sequence to create a variant of (1 ) the amino acid sequence of SEQ ID NO: 2; or (2) the amino acid sequence of SEQ ID NO: 2 and SEQ ID NO: 3 can also include, in addition to amino acid substitutions, amino acid deletions and/or amino acid additions.
• Amino acid substitutions are preferably conservative amino acid substitutions known to those skilled in the art.
• the person skilled in the art may perform an amino acid substitution by selecting an amino acid from within the same class of amino acid that is shared with the specific amino acid that is identified for substitution. Examples of suitable amino acid substitutions are presented in Table 3 below.
• Peptide variants of the present invention also include fusion to further peptides, for example, where an additional peptide sequence is fused to a peptide of the invention to aid in extraction and purification.
• additional fusion peptide partners include glutathione-S- transferase (GST), hexahistidine, GAL4 (DNA binding and/or transcriptional activation domains) and p-galactosidase. It may also be convenient to include a proteolytic cleavage site between the additional peptide partner and the peptide of the invention to allow removal of additional peptide sequences.
• the additional peptide will not hinder binding of the peptide of the invention to the BID of a L-type Ca 2+ channel P2 subunit.
• the invention further provides a peptide comprising: a peptide portion comprising the amino acid sequence of SEQ ID NO: 2; and a peptide portion comprising the amino acid sequence:
• RKKRRQRRRZaa (SEQ ID NO: 3) wherein Zaa is 6-amino hexanoic acid or a variant thereof.
• the peptide portion of the peptide of the invention comprising the amino acid sequence of SEQ ID NO: 3 encodes a TAT peptide.
• Trans-activating transcriptional activator (TAT) from Human Immunodeficiency Virus 1 is a cell-penetrating peptide which is known in the art to deliver attached molecules such as peptides into cells.
• TAT transcriptional activator
• the TAT peptide portion in the peptide of the invention facilitates transport of the peptide into cardiac cells via endocytosis or by direct translocation across the plasma membrane.
• the nuclear localisation signal found within the domain, GRKKR (SEQ ID NO: 8) mediates further translocation of TAT into the cell nucleus. The biological role of this domain and exact mechanism of transfer is currently unknown.
• the amino acid sequence of the protein transduction domain is YGRKKRRQRRR (SEQ ID NO: 9).
• the peptide of the invention may comprise other or additional peptide portions which assist or facilitate in the transport of the peptide into cardiac or other cells, or provide some other benefit, for example, amongst others, identifying the location of a peptide of the invention within a cell.
• the peptides of the invention comprise one or more repeats of a peptide portion comprising SEQ ID NO:2 and a peptide portion comprising SEQ ID NO: 3 or a variant thereof.
• the present invention also provides an isolated polynucleotide encoding a peptide of the present invention as described herein including peptides comprising SEQ ID No: 2 - 7. It will be understood by a skilled person that due to the degeneracy of the amino acid code, numerous different polynucleotides can encode the same peptide as a result of the degeneracy of the genetic code. In addition, it is to be understood that skilled persons may, using routine techniques, make nucleotide substitutions that do not affect the peptide sequence encoded by the polynucleotides of the invention to reflect the codon usage of any particular host organism in which the polypeptides of the invention are to be expressed.
• Polynucleotides of the present invention may be in the form of RNA, such as mRNA, or in the form of DNA, including, for instance, cDNA and genomic DNA obtained by cloning or produced synthetically.
• the DNA may be double-stranded or single-stranded.
• Single-stranded DNA or RNA may be the coding strand, also known as the sense strand, or it may be the non-coding strand, also referred to as the anti-sense strand.
• They may also be polynucleotides that include within them synthetic or modified nucleotides. A number of different types of modification to oligonucleotides are known in the art.
• polynucleotides described herein may be modified by any method available in the art. Such modifications may be carried out in order to enhance the in vivo activity or life span of polynucleotides of the invention.
• both strands of the duplex are encompassed by the present invention.
• the polynucleotide is single-stranded, it is to be understood that the complementary sequence of that polynucleotide is also included within the scope of the present invention.
• references to "isolated" polynucleotide(s) means a polynucleotide, DNA or RNA, which has been removed from its native environment.
• recombinant DNA molecules contained in a vector are considered isolated for the purposes of the present invention.
• Further examples of isolated DNA molecules include recombinant DNA molecules maintained in heterologous host cells or purified (partially or substantially) DNA molecules in solution.
• Isolated RNA molecules include in vivo or in vitro RNA transcripts of the DNA molecules of the present invention. Isolated peptides of the present invention further include such molecules produced synthetically.
• the polynucleotides of the present invention that encode a peptide of the present invention include, but are not limited to, those peptides encoded by the amino acid sequences of SEQ ID No: 2 and 4-7. Rather the polynucleotides of the present invention may comprise the coding sequence for the peptides and additional sequences, such as those encoding a leader or secretory sequence, such as a pre-, or pro- or prepro- protein sequence; the coding sequence of the peptide, with or without the aforementioned additional coding sequences, together with additional, non-coding sequences, including for example, but not limited to introns and non-coding 5' and 3' sequences, such as the transcribed, non-translated sequences that play a role in transcription, mRNA processing, including splicing and polyadenylation signals, for example ribosome binding and stability of mRNA; an additional coding sequence which codes for additional amino acids, such as those which provide additional functionalities
• the present invention further relates to variants of the nucleic acid molecules of the present invention, which encode variants of the peptides of the present invention.
• variants include those produced by nucleotide substitutions, deletions or additions that may involve one or more nucleotides.
• Non-naturally occurring variants may be produced using mutagenesis techniques known to those in the art.
• the variants may be altered in coding regions, non-coding regions, or both. Alterations in the coding regions may produce conservative or non-conservative amino acid substitutions, deletions or additions. Especially preferred among these are silent substitutions, additions and deletions, which do not alter the properties and activities of the encoded peptide. Also especially preferred in this regard are conservative substitutions.
• a nucleic acid molecule encoding the amino acid sequence of a peptide of the invention may be inserted into an appropriate expression vector using standard ligation techniques.
• the vector is typically selected to be functional in the particular host cell employed (/.e., the vector is compatible with the host cell machinery such that amplification of the nucleic acid molecule and/or expression of the nucleic acid molecule can occur).
• a nucleic acid molecule encoding the amino acid sequence of a peptide of the invention may be amplified/expressed in prokaryotic, yeast, insect (baculovirus systems), and/or eukaryotic host cells. Selection of the host cell will depend in part on whether the peptide is to be post-translationally modified (e.g., glycosylated and/or phosphorylated). If so, yeast, insect, or mammalian host cells are preferable.
• expression vectors used in any of the host cells will contain sequences for plasmid maintenance and for cloning and expression of exogenous nucleotide sequences.
• sequences collectively referred to as “flanking sequences” in certain embodiments, will typically include one or more of the following nucleotide sequences: a promoter, one or more enhancer sequences, an origin of replication, a transcriptional termination sequence, a complete intron sequence containing a donor and acceptor splice site, a sequence encoding a leader sequence for secretion of the peptide, a ribosome binding site, a polyadenylation sequence, a polylinker region for inserting the nucleic acid encoding the peptide to be expressed, and a selectable marker element.
• Preferred vectors for practicing this invention are those that are compatible with bacterial, insect, and mammalian host cells.
• Such vectors include, inter alia, pCRII, pCR3, and pcDNA3.1 (Invitrogen Company, Carlsbad, CA), pBSII (Stratagene Company, La Jolla, CA), pET15 (Novagen, Madison, Wl), pGEX (Pharmacia Biotech, Piscataway, NJ), pEGFP-N2 (Clontech, Palo Alto, CA), pETL (BlueBacll; Invitrogen), pDSR-alpha (PCT Publication No. WO 90/14363) and pFastBacDual (Gibco/BRL, Grand Island, NY).
• Additional suitable vectors include, but are not limited to, cosmids, plasmids or modified viruses, but it will be appreciated that the vector system must be compatible with the selected host cell.
• Such vectors include, but are not limited to, plasmids such as Bluescript plasmid derivatives (a high copy number ColE1 -based phagemid, Stratagene Cloning Systems Inc., La Jolla CA), PCR cloning plasmids designed for cloning Taq-Taq-amplified PCR products (e.g., TOPOTM TA Cloning® Kit, PCR2.1 plasmid derivatives, Invitrogen, Carlsbad, CA), and mammalian, yeast, or virus vectors such as a baculovirus expression system (pBacPAK plasmid derivatives, Clontech, Palo Alto, CA).
• plasmids such as Bluescript plasmid derivatives (a high copy number ColE1 -based phagemid, Stra
• the completed vector may be inserted into a suitable host cell for amplification and/or fusion protein expression.
• the transformation of an expression vector for a peptide of the invention into a selected host cell may be accomplished by well-known methods including transfection, infection, calcium chloride, electroporation, microinjection, lipofection or the DEAE-dextran method or other known techniques. The method selected will in part be a function of the type of host cell to be used. These methods and other suitable methods are well known to the skilled artisan, and are set forth, for example, in Sambrook et al., supra.
• Host cells may be prokaryotic host cells (such as E. coli) or eukaryotic host cells (such as a yeast cell, an insect cell or a vertebrate cell).
• the host cell when cultured under appropriate conditions, synthesizes the peptide that can subsequently be collected from the culture medium (if the host cell secretes it into the medium) or directly from the host cell producing it (if it is not secreted).
• the selection of an appropriate host cell will depend upon various factors, such as desired expression levels, peptide modifications that are desirable or necessary for activity, such activity (such as glycosylation or phosphorylation), and ease of folding into a biologically active molecule.
• a number of suitable host cells are known in the art and many are available from the American Type Culture Collection (ATCC), 10801 University Boulevard, Manassas, VA 201 10-2209. Examples include, but are not limited to, mammalian cells, such as Chinese hamster ovary cells (CHO) (ATCC No. CCL61 ); CHO DHFR-cells (Urlaub et al., Proc. Natl. Acad. Sci. USA, 97:4216-4220 (1980)); human embryonic kidney (HEK) 293 or 293T cells (ATCC No. CRL1573); or 3T3 cells (ATCC No. CCL92).
• CHO Chinese hamster ovary cells
• CHO DHFR-cells Urlaub et al., Proc. Natl. Acad. Sci. USA, 97:4216-4220 (1980)
• human embryonic kidney (HEK) 293 or 293T cells ATCC No. CRL1573)
• 3T3 cells ATCC
• suitable mammalian host cells are the monkey COS- 1 (ATCC No. CRL1650) and COS-7cell lines (ATCC No. CRL1651 ) cell lines, and the CV-1 cell line (ATCC No. CCL70).
• suitable mammalian cell lines are the monkey COS- 1 (ATCC No. CRL1650) and COS-7cell lines (ATCC No. CRL1651 ) cell lines, and the CV-1 cell line (ATCC No. CCL70).
• Further exemplary mammalian host cells include primate cell lines and rodent cell lines, including transformed cell lines. Normal diploid cells, cell strains derived from in vitro culture of primary tissue, as well as primary explants, are also suitable.
• Candidate cells may be genotypically deficient in the selection gene or may contain a dominantly acting selection gene.
• mammalian cell lines include, but are not limited to, mouse neuroblastoma N2A cells, HeLa, mouse L-L-929 cells, 3T3 lines derived from Swiss, Balb-c or NIH mice, BHK or HaK hamster cell lines, which are available from the ATCC. Each of these cell lines is known by and available to those skilled in the art of protein expression.
• E. coli e.g., HB101 , (ATCC No. 33694) DH5a, DH10, and MC1061 (ATCC No. 53338)
• HB101 ATCC No. 33694
• DH5a DH5a
• DH10 DH10
• MC1061 ATCC No. 533378
• B. subtilis Pseudomonas spp.
• B. subtilis Pseudomonas spp.
• Streptomyces spp. and the like may also be employed in this method.
• yeast cells Many strains of yeast cells known to those skilled in the art are also available as host cells for the expression of peptides of the present invention.
• Preferred yeast cells include, for example, Saccharomyces cerivisae and Pichia pastoris.
• insect cell systems may be utilized in the methods of the present invention. Such systems are described for example in Kitts et al., Biotechniques, 14:810-817 (1993); Lucklow, Curr. Opin. Biotechnol., 4:564-572 (1993); and Lucklow et al. (J. al., J. Virol., 67:4566-4579 (1993).
• Preferred insect cells are Sf-9 and Hi5 (Invitrogen, Carlsbad, CA).
• transgenic animals to express glycosylated peptides of the invention.
• a transgenic milk-producing animal a cow or goat, for example
• plants to produce peptides of the invention.
• the glycosylation occurring in plants is different from that produced in mammalian cells, and may result in a glycosylated product which is not suitable for human therapeutic use.
• compositions are within the scope of the present invention.
• Peptides of the invention can be combined with various components to produce compositions of the invention.
• Such compositions can comprise a therapeutically effective amount of a peptide or nucleotide of the invention in admixture with a pharmaceutically or physiologically acceptable formulation agent selected for suitability with the mode of administration.
• Pharmaceutical compositions may also comprise a therapeutically effective amount of one or more peptide of the invention in admixture with a pharmaceutically or physiologically acceptable formulation agent selected for suitability with the mode of administration.
• the compositions are combined with a pharmaceutically acceptable carrier or diluent to produce a pharmaceutical composition (which may be for human or animal use).
• Suitable carriers and diluents include isotonic saline solutions, for example phosphate-buffered saline.
• pharmaceutically acceptable carrier includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents and the like. The use of such media and agents for pharmaceutically active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions is contemplated. Supplementary active ingredients can also be incorporated into the compositions. See, e.g., Remington's Pharmaceutical Sciences, 19th Ed. (1995, Mack Publishing Co., Easton, Pa.) which is herein incorporated by reference.
• the pharmaceutical composition can contain formulation materials for modifying, maintaining or preserving, for example, the pH, osmolarity, viscosity, clarity, colour, isotonicity, odour, sterility, stability, rate of dissolution or release, adsorption or penetration of the composition.
• Suitable formulation materials include, but are not limited to, amino acids (such as glycine, glutamine, asparagine, arginine or lysine); antimicrobials; antioxidants (such as ascorbic acid, sodium sulphite or sodium hydrogen-sulphite); buffers (such as borate, bicarbonate, Tris- HCI, citrates, phosphates or other organic acids); bulking agents (such as mannitol or glycine); chelating agents (such as ethylenediamine tetraacetic acid (EDTA)); complexing agents (such as caffeine, polyvinylpyrrolidone, beta-cyclodextrin or hydroxypropyl-beta-cyclodextrin), fillers; monosaccharides, disaccharides; and other carbohydrates (such as glucose, mannose, or dextrins); proteins (such as serum albumin, gelatin or immunoglobulins); colouring, flavouring and diluting agents; emulsifying agents; hydro
• compositions prepared according to the invention may be administered by any means that leads to the peptides of the invention coming in contact with a causative agent of a disease or disorder as herein described including cardiac hypertrophy or oxidative stress.
• the primary vehicle or carrier in a pharmaceutical composition may be either aqueous or non-aqueous in nature.
• a suitable vehicle or carrier may be water for injection, physiological saline solution, solution or artificial cerebrospinal fluid, possibly supplemented with other materials common in compositions for parenteral administration.
• Neutral buffered saline or saline mixed with serum albumin are further exemplary vehicles.
• Other exemplary pharmaceutical compositions comprise Tris buffer of about pH 7.0-8.5, or acetate buffer of about pH 4.0-5.5, which may further include sorbitol or a suitable substitute therefor.
• compositions may be prepared for storage by mixing the selected composition having the desired degree of purity with optional formulation agents in the form of a lyophilized cake or an aqueous solution.
• the peptide product may be formulated as a lyophilizate using appropriate excipients such as sucrose.
• compositions can be capable of parenteral delivery.
• compositions may be capable of delivery through the digestive tract, such as orally.
• the preparation of such pharmaceutically acceptable compositions is within the skill of the art.
• the formulation components are present in concentrations that are acceptable to the site of administration.
• buffers are used to maintain the composition at physiological pH or at a slightly lower pH, typically within a pH range of from about 5 to about 8.
• the therapeutic compositions for use in this invention may be in the form of a pyrogen-free, parenterally acceptable aqueous solution comprising the desired peptide of the invention in a pharmaceutically acceptable vehicle.
• a particularly suitable vehicle for parenteral injection is sterile distilled water in which the active agent is formulated as a sterile, isotonic solution, properly preserved.
• Yet another preparation can involve the formulation of the desired molecule with an agent, such as injectable microspheres, bio-erodible particles, polymeric compounds (such as polylactic acid, acid or polyglycolic acid), or beads or liposomes, that provides for the controlled or sustained release of the product which may then be delivered as a depot injection.
• Hyaluronic acid may also be used, and this may have the effect of promoting sustained duration in the circulation.
• Other suitable means for the introduction of the desired molecule include implantable drug delivery devices.
• peptides of the present invention that are administered in this fashion can be formulated with or without those carriers customarily used in the compounding of solid dosage forms such as tablets and capsules.
• a capsule may be designed to release the active portion of the formulation at the point in the gastrointestinal tract when bioavailability is maximized, and pre-systemic degradation is minimized.
• Additional agents can be included to facilitate absorption of the active agent. Diluents, flavourings, low melting point waxes, vegetable oils, lubricants, suspending agents, tablet disintegrating agents, and binders may also be employed.
• Another pharmaceutical composition may involve an effective quantity of a peptide of the invention in a mixture with non-toxic excipients that are suitable for the manufacture of tablets.
• excipients include, but are not limited to, inert diluents, such as calcium carbonate, sodium carbonate or bicarbonate, lactose, or calcium phosphate; or binding agents, such as starch, gelatin, or acacia; or lubricating agents such as magnesium stearate, stearic acid, or talc.
• sustained- or controlled-delivery formulations include formulations involving a peptide of the invention in sustained- or controlled-delivery formulations.
• Techniques for formulating a variety of other sustained- or controlled-delivery means such as liposome carriers, bio-erodible microparticles or porous beads and depot injections, are also known to those skilled in the art. See for example, PCT Application No. PCT/US93/00829 that describes the controlled release of porous polymeric microparticles for the delivery of pharmaceutical compositions.
• sustained-sustained-release preparations include semipermeable polymer matrices in the form of shaped articles, for example, films, or microcapsules.
• Sustained release matrices may include polyesters, hydrogels, polylactides, copolymers of L-glutamic acid and gamma ethyl-L-glutamate, ethylene vinyl acetate or poly-D(-)-3-hydroxybutyric acid.
• Sustained-release compositions may also include liposomes, which can be prepared by any of several methods known in the art.
• the pharmaceutical composition to be used for in vivo administration typically must be sterile. This may be accomplished by filtration through sterile filtration membranes. Where the composition is lyophilized, sterilization using these methods may be conducted either prior to, or following, lyophilization and reconstitution.
• the composition for parenteral administration may be stored in lyophilized form or in a solution.
• parenteral compositions generally are placed into a container having a sterile access port, for example, an intravenous solution bag or vial having a stopper pierceable by a hypodermic injection needle.
• the pharmaceutical composition may be stored in sterile vials as a solution, suspension, gel, emulsion, solid, or as a dehydrated or lyophilized powder.
• Such formulations may be stored either in a ready-to-use form or in a form (e.g., lyophilized) requiring reconstitution prior to administration.
• the effective amount of the active agent in the pharmaceutical composition to be employed therapeutically will depend, for example, upon the therapeutic context and objectives.
• One skilled in the art will appreciate that the appropriate dosage levels for treatment will thus vary depending, in part, upon the molecule delivered, the indication for which the active agent is being used, the route of administration, and the size (body weight, body surface or organ size) and condition (the age and general health) of the patient. Accordingly, the clinician may titre the dosage and modify the route of administration to obtain the optimal therapeutic effect.
• a typical dosage may range from about 0.1 .g/kg to up to about 100 mg/kg or more, depending on the factors mentioned above.
• the dosage may range from 0.1 p.g/kg up to about 100 mg/kg; or 1 .g/kg up to about 100 mg/kg; or 5 p.g/kg up to about 100 mg/kg.
• the frequency of dosing will depend upon the pharmacokinetic parameters of the active agent and the formulation used. Typically, a clinician will administer the composition until a dosage is reached that achieves the desired effect. The composition may therefore be administered as a single dose, or as two or more doses (which may or may not contain the same amount of the desired molecule) over time, or as a continuous infusion via an implantation device or catheter. Further refinement of the appropriate dosage is routinely made by those of ordinary skill in the art and is within the ambit of tasks routinely performed by them. Appropriate dosages may be ascertained through use of appropriate dose-response data.
• the peptide or pharmaceutical composition comprising the peptide can be administered to the subject in a range of treatment regimens.
• the peptide or pharmaceutical composition can be administered hourly, three times daily, twice daily, once daily, once every two days, once every three days, once weekly, once every two weeks, once monthly, once every two months, once every six months, and once yearly.
• the appropriate regimen can be determined by the person skilled in the art based on the nature of the condition to be treated.
• the peptide or pharmaceutical composition comprising the peptide can be administered three times per week.
• the route of administration of the pharmaceutical composition is in accord with known methods, e.g., orally, through injection by intravenous, intracoronary, intraperitoneal, intracerebral (intra-parenchymal), intracerebroventricular, intramuscular, intra-ocular, intraarterial, intraportal, or intralesional routes; by sustained release systems or by implants.
• the compositions may be administered by bolus injection or continuously by infusion, or by implantation device.
• the composition may be administered locally via implantation of a membrane, sponge or another appropriate material on to which the desired molecule has been absorbed or encapsulated.
• the device may be implanted into any suitable tissue or organ, and delivery of the desired molecule may be via diffusion, timed-release bolus, or continuous administration.
• compositions herein in an ex vivo manner.
• cells, tissues, or organs that have been removed from the patient are exposed to the pharmaceutical compositions after which the cells, tissues and/or organs are subsequently implanted back into the patient.
• nanoparticles may be employed as carriers for delivery of peptides of the invention.
• the nanoparticles may be spherical polymeric nanoparticles. Nanoparticles have been shown to overcome some limitations of conventional therapeutic delivery such as nonspecific biodistribution and targeting, and lack of water solubility, amongst others. Thus, nanoparticles may be used for delivering peptides of the invention to cardiac cells for treatment of a patient with the peptides.
• the peptides of the invention are delivered through the use of dendronized polymers.
• the peptides of the invention are delivered through the use of linear dendronized polymers (denpols).
• the peptides of the invention are complexed with linear deondronized polymers to form polymer-peptide nanoparticles.
• the polymer-peptide nanoparticles can be delivered intracellularly.
• the invention provides a use of a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or the amino acid sequence of SEQ ID NO: 2 and SEQ ID NO: 3, or variants thereof; for modulating binding to a L-type Ca 2+ channel alpha-interacting domain. This preferably occurs intracellularly in a cardiac cell.
• the invention provides a use of a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or the amino acid sequence of SEQ ID NO: 2 and SEQ ID NO: 3, or variants thereof; for modulating movement of a L-type Ca 2+ channel p 2 subunit in a cardiac cell such as a myocyte in the heart of a subject.
• the invention also provides a method for modulating movement of a L-type Ca 2+ channel p 2 subunit in a cardiac cell such as a myocyte in the heart of a subject, comprising administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or SEQ ID NO: 2 and SEQ ID NO: 3, or variants thereof.
• Binding of the peptide to the alpha-interacting domain can prevent movement of the p 2 subunit during activation and inactivation of the L-type Ca 2+ channel. Since the p 2 subunit is proposed to facilitate inactivation of the alpha subunit, this can result in a delay in inactivation of the current.
• a subject that can be treated with a peptide of the invention will include humans as well as other mammals and animals.
• the invention provides the use of a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof; for modulating a L-type Ca 2+ channel in a cardiac cell such as a myocyte in the heart of a subject.
• the invention also provides a method for modulating a L-type Ca 2+ channel in a cardiac cell such as a myocyte in the heart of a subject, comprising the step of administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof.
• the invention provides the use of a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof; for preventing or reducing myocardial damage and/or oxidative stress in the heart of a subject.
• the invention also provides a method for preventing or reducing myocardial damage and/or oxidative stress in the heart of a subject, comprising the step of administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof.
• the myocardial damage may include cardiac hypertrophy.
• cardiac hypertrophy is reduced or prevented but intracellular Ca 2+ levels are reduced or substantially maintained in the heart of the subject. Substantially maintained indicates Ca 2+ levels which are the same or close to what is observed normally in the subject such as before cardiac hypertrophy.
• the invention provides uses and methods for the peptides of the invention as a treatment to prevent or reduce damage and/or oxidative stress in myocardial cells in a subject by modulating L-type Ca 2+ channel activity.
• the peptides of the invention may be administered to treat or prevent cardiac hypertrophy in patients that have developed or are at risk of developing cardiac hypertrophy.
• the peptides of the invention can also be administered to reduce damage and/or oxidative stress to ischemic myocardial cells following a myocardial infarction in a subject during and after reperfusion therapy.
• the peptides may be administered before, after or during reperfusion.
• the invention also provides a use of a peptide comprising: the amino acid sequence of SEQ ID NO: 2; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3; in the preparation of a medicament for treating, preventing or ameliorating myocardial damage to a patient.
• the invention also provides a use of a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof; in the manufacture of a medicament for treating, preventing or ameliorating myocardial damage to a patient, and/or oxidative stress in myocardial cells.
• peptides of the invention may be preferable to administer in combination with other therapeutic agents that are useful for treating cardiac hypertrophy or HCM in a subject, or other agents which assist in reducing myocardial damage and/or oxidative stress.
• therapeutic agents may include, as some non-limiting examples, Antioxidants such as N-acetylcysteine, reduced glutathione, TAT-conju gated catalase or TAT-conjugated superoxide dismutase.
• the peptides may be administered via a variety of methods, for example, as a therapeutic depending on the particular circumstances and as deemed appropriate by a medical practitioner.
• a peptide of the invention may be administered via the coronary arteries by a cardiologist/physician at the time of angiography or angioplasty in a hospital after admission with chest pain and diagnosis of coronary occlusion (myocardial infarction).
• a peptide of the invention may be administered to HCM patients prior to the development of cardiomyopathy.
• the peptide of the invention may be administered via intraperitoneal injection or via the coronary arteries to patients at risk of developing cardiomyopathy.
• Prevention of the development of cardiomyopathy may be measured by a decrease in intraventricular septal thickness or posterior wall thickness, and increase in left ventricular end diastolic dimension on echocardiography.
• the peptide of the invention may be administered about 3 times a week, on the basis that the half-life of the peptides of the invention in the body is likely to be approximately 3 to 4 days, consistent with the turnover rate of Cav1 .2 channel protein (as described in Catalucci et al., The Journal of Cell Biology 184, 923-933 (2009)).
• the effect of the administered therapeutic composition can be monitored by standard diagnostic procedures.
• effectiveness of the peptide may be monitored by echocardiography (ultrasound analysis of cardiac function) in one example. Size of damage could be assessed by release of muscle enzymes into the blood and by changes on electrocardiography (ECG).
• ECG electrocardiography
• the present invention provides a method for modulating movement of a beta subunit of the L-type Ca 2+ channel in a cardiac cell in the heart of a subject, comprising administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3.
• the present invention further provides a method for modulating binding of a beta subunit of the L-type Ca 2+ channel in a cardiac cell in the heart of a subject, comprising administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3.
• the peptide prevents interaction between the beta subunit of the L-type Ca2+ channel and an alpha subunit of the L- type Ca2+ channel in a cardiac cell of a subject.
• the present invention further provides a method for modulating a L-type Ca 2+ channel in a cardiac cell in the heart of a subject, comprising the step of administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or the amino acid sequence of SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof.
• the present invention further provides a method for reducing myocardial damage and/or oxidative stress in the heart of a subject, comprising the step of administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or a peptide comprising the amino acid SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof.
• the method of the invention may reduce cardiac hypertrophy but substantially maintain intracellular Ca 2+ levels in the heart of the subject.
• the method of treatment or use does not cause vasodilatory effects or negative inotropic effects as can occur with treatment with calcium channel antagonists.
• the invention provides a method of preventing cardiac hypertrophy in the heart of a subject, comprising the step of administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or a peptide comprising the amino acid SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof.
• the subject suffers from HCM.
• the invention provides a method or use for slowing the progression of myocardial fibrosis in a subject, comprising administering to the subject a peptide comprising: the amino acid sequence of SEQ ID NO: 2, or variants thereof; or a peptide comprising the amino acid SEQ ID NO: 2, and SEQ ID NO: 3, or variants thereof.
• the invention provides a method or use for modulating binding of a beta subunit of the L-type Ca 2+ channel in a cardiac cell of a subject, comprising administering to the subject a peptide of this invention, wherein the method is more effective at modulating the binding of a beta subunit of the L-type Ca 2+ channel in a cardiac cell of a subject compared to a method of administering QQLEEDLKGYLDWITQAE (SEQ ID NO:1 ).
• the invention provides a method or use for modulating a L- type Ca 2+ channel in a cardiac cell of a subject, comprising the step of administering to the subject a peptide of this invention, wherein the method is more effective at modulating the L- type Ca 2+ channel in a cardiac cell of a subject compared to a method of administering QQLEEDLKGYLDWITQAE (SEQ ID NO:1 ).
• the invention provides a method or use for reducing myocardial damage and/or oxidative stress in the heart of a subject, comprising the step of administering to the subject a peptide of this invention, wherein the method is more effective at reducing the myocardial damage and/or oxidative stress in the heart of a subject compared to a method of administering QQLEEDLKGYLDWITQAE (SEQ ID NO:1 ).
• the term “subject” generally includes mammals such as: humans; farm animals such as sheep, goats, pigs, cows, horses, llamas; companion animals such as dogs and cats; primates; birds, such as chickens, geese and ducks; fish; and reptiles.
• the subject is preferably human.
• compositions of the present invention for the treatment of the above described conditions vary depending upon many different factors, including means of administration, target site, physiological state of the patient, whether the patient is human or an animal, and other medications administered. Treatment dosages need to be titrated to optimize safety and efficacy.
• a peptide corresponding to the a1C-p2a interaction domain (AID) within the cytoplasmic l-ll linker of the cardiac a1C subunit was synthesized by using the amino acid sequence, QQLEEDLKGYLDWITQAE (SEQ ID NO:1).
• a scrambled (inactive) control peptide (AID[S]) was also synthesized with the sequence, QKILGEWDLAQYTDQELE (SEQ ID NO: 10).
• a cell-penetrating TAT sequence was tethered to AID or AID(S) via 6- aminohexanoic acid (6-Ahx) (RKKRRQRRR) (SEQ ID NO: 3), to yield AID-TAT and AID(S)-TAT peptides.
• variant AID-peptides were also synthesised as listed in Table 4. Based on the original AID-TAT sequence, variant sequences were generated by truncating the amino end and/or carboxyl end of the original sequence or by inducing point mutations in amino acids.
• the beads were incubated in Quench Buffer (100 mM Tris-HCI, 150 mM NaCI, pH 8.0) at room temperature for 1 hour. After washing the cardiac lysate was added to increasing concentrations of the variant peptide to allow for competitive binding with the AID bound beads in the concentrations showed in Table 5.
• Quench Buffer 100 mM Tris-HCI, 150 mM NaCI, pH 8.0
• Table 5 Sample preparation for pre-binding the AID/variant peptide to the P2 subunit in whole heart lysate at varying concentrations.
• the AID-peptide bound beads were split into 5 aliquots for the 5 samples prepared in Table 5.
• the whole heart lysate added to each of the peptide-bound beads to allow competitive binding for 2 hours at room temperature.
• the membranes were placed in blocking buffer (5% BSA) for 1 hour, before overnight incubation with Rabbit Anti-Cavp2 polyclonal primary antibody (Alomone Labs #ACC-105) at 4°C.
• the membrane was washed three times for 10 minutes each with TBST before incubation with Goat Anti-Rabbit IgG (H+L)-HRP Conjugate secondary antibody (Abeam #ab97080, preabsorbed) in 5% BSA at room temperature for 1 hour.
• Goat Anti-Rabbit IgG (H+L)-HRP Conjugate secondary antibody Abeam #ab97080, preabsorbed
• Luminata Crescendo Western HRP Substrate (Merck Millipore) and ChemiDoc imager (Biorad) with ImageLab software. Densitometric analysis performed using Imaged software to quantify the intensity of the bands on the membrane corresponding to the Cavp2.
• Hearts were then perfused with KHB supplemented with 2.4 mg/ml collagenase B for 3 min, then 8 min perfusion in the presence of 40 pM calcium. Following perfusion, aorta and atria were removed, and ventricles gently teased apart and triturated to dissociate myocytes into suspension.
• HBS calcium free HEPES-Buffered Solution
• Intracellular calcium was monitored in cardiac myocytes using the fluorescent indicator Fura-2 AM (Fura-2, 1 pM, ex 340/380 nm, em 510 nm, Molecular Probes). Oxidative stress was induced by applying a non-necrotic/non-apoptotic concentration of H2O2 (30 pm) to the myocytes for 5 min followed by 10U/ml catalase. Fluorescence at 340/380nm excitation and 510nm emission were measured at 1 minute intervals with an exposure of 50ms before and after exposure to 30pM H2O2 (5min) and 10U/ml catalase (5min). Ratiometric 340/380nm signal was quantified and reported as a percentage from the baseline pre-treatment average.
• Fura-2 AM Fluorescence at 340/380nm excitation and 510nm emission were measured at 1 minute intervals with an exposure of 50ms before and after exposure to 30pM H2O2 (5min) and 10U/ml cata
• Figure 3(a) demonstrates the effects of the peptides on an increase in intracellular calcium induced by a hydrogen peroxide insult (H2O2). Only P7 altered the increase in Fura 2 following H2O2. The mutant P7 was more effective at decreasing H2O2 induced increases in intracellular Ca 2+ (Fura 2) and superoxide production (DHE) than AID-TAT and had a similar effect on mitochondrial membrane potential (JC-1 ) as AID- TAT.
• H2O2 hydrogen peroxide insult
• Mitochondrial membrane potential was monitored in cardiac myocytes by assessing alterations in 5,5',6,6'-tetrachloro- 1 ,T,3,3'-tetraethylbenzimidazolylcarbocyanine iodide fluorescence (JC-1 : 200 nM, ex 480 nm, em 580/535 nm, Molecular Probes).
• Myocytes were incubated in calcium-free HBS (0 mM calcium, supplemented with 3 mM EGTA) for at least 3 h prior to measuring changes in 'Pm.
• mutant peptides P6-TAT, P7-TAT, P14-TAT and P15-TAT
• AID-TAT peptide The results show that P7, P14 and P15 presented a statistically significant reduction in flavoprotein oxidation in comparison with AID-TAT peptide in HCM hearts, and that P7 presented a statistically significant reduction in flavoprotein oxidation in comparison with AID-TAT peptide in wild type hearts.
• Perfusates were collected 20 and 25 min pre-ischemia and 20 and 30 min following reperfusion.
• a single dose of 0.5-1 OpM AID(S)-TAT, AID-TAT, peptide 6 or peptide 7 was added to Ca 2+ -containing KHB solution just prior to reperfusion.
• Creatine Kinase (CK) and Lactate Dehydrogenase (LDH) activity was measured in perfusates collected pre- and post-ischemia, and post-ischemia values normalized to pre-ischemia values.
• CK enzyme reagent CK NAC-activated diagnostic kit, Randox Laboratories
• rate of increase in absorbance recorded over 15 min at 30°C using a spectrophotometer (PowerWave XS, BioTek, 340 nm).
• LDH activity was calculated according to the equation: 3 x (dilution factor) ac ivi y /m ) -
• GSH GSH/GSSG ratio detection assay kit as per manufacturer’s instructions. 8 Total glutathione and GSH were measured using a FLUOstar OPTIMA (BMG Labtech, ex 485- 12 nm, em 520 nm). GSSG was calculated by subtracting GSH from total glutathione.
• 10pM AID-TAT was administered to cTnlG203S mutant mice by intraperitoneal injection 3 times per week prior to the development of hypertrophic cardiomyopathy, for 5 weeks.
• the peptide was dissolved in phosphate buffered saline solution (PBS), and the total amount of the 10
• Administration prevented the development of the hypertrophy as evidenced by a decrease in intraventricular septal thickness and increase in left ventricular end diastolic dimension on echocardiography. Fractional shortening also improved.
• the results are presented in Figure 8.
• the AID-TAT peptide was administered 3 times per week because it was hypothesised that the bound AID- TAT peptide lasts 3-4 days, consistently with the turnover rate of the Cav1 .2 channel protein.
• Example 9 In vitro binding to the l Ca -L 6? subunit demonstrates increased binding affinity of AID P7 , AIDpi4, AIDpi5 and AIDpi6
• Biotinylation of original AID (no TAT): For each reaction (a dose-response curve consisted of 6 reactions), 0.02 nM AID-TAT was incubated in biotinylation solution (0.1 M MES buffer containing 1 nM amine-PEGn-biotin and 0.2nM EDC) for 2 hrs at room temperature with agitation (400rpm). Affinity beads (Dynabeads M-280 Streptavidin, ThermoFisher Scientific) were then incubated with biotinylated AID peptide for 30 min at room temperature with agitation (400rpm).
• AID mutant peptides were serially diluted (0, 10 nM, 100 nM, 1 pM, 10 pM, 100 pM) and incubated with 100 pg of Cavp2 subunit from cardiac homogenate and cytoplasmic protein preparation for 2 hrs at room temperature with agitation (400rpm) as previously described (Haase H, Podzuweit T, Lutsch G, Hohaus A, Kostka S, Lindschau C, et al.
• beta-adrenoceptor to L-type calcium channel: identification of a novel cardiac protein kinase A target possessing similarities to AHNAK. FASEB J. 1999;13(15):2161 -72; Hohaus A, Poteser M, Romanin C, Klugbauer N, Hofmann F, Morano I, et al. Modulation of the smooth-muscle L-type Ca2+ channel alphal subunit (alphal C- b) by the beta2a subunit: a peptide which inhibits binding of beta to the l-ll linker of alphal induces functional uncoupling. Biochem J.
• Example 10 In vitro exposure of cTnl-G203S cardiomyocytes to AID-TAT variants are more efficacious in restoring ip m and flavoprotein oxidation
• JC-1 mitochondrial membrane potential (i m )as previously described (Viola HM, Arthur PG, Hool LC. Transient exposure to hydrogen peroxide causes an increase in mitochondria-derived superoxide as a result of sustained alteration in L-type Ca2+ channel function in the absence of apoptosis in ventricular myocytes. Circ Res. 2007;100(7) :1036-44). The fluorescence signal was measured on a Hamamatsu Orca ER digital camera attached to an inverted Nikon TE2000-U microscope.
• Flavoprotein autofluorescence was used to measure flavoprotein oxidation based on previously described methods (Yaniv Y, Juhaszova M, Lyashkov AE, Spurgeon HA, Sollott SJ, Lakatta EG. Ca2+- regulated-cAMP/PKA signaling in cardiac pacemaker cells links ATP supply to demand. J Mol Cell Cardiol. 2011 ;51 (5):740-8). Fluorescence at excitation 480 nm and emission 535 nm was measured on a Hamamatsu Orca ER digital camera attached to an inverted Nikon TE2000-U microscope. Fluorescent images were acquired at 1 min intervals with 200ms exposure.
• Metamorph 6.3 (Version 7.10.3) was used to quantify the signal by manually tracing myocytes. An equivalent region not containing cells was used as background and was subtracted. Fluorescence values recorded over 5 min before and 5 min after addition of drugs were averaged and alterations in fluorescent ratios reported as the percentage increase from the basal average. FCCP (50 pM) and NaCN (40 mM) was added at the end of each experiment to achieve a respective maximal and minimal fluorescence value indicative of maximal and minimal flavoprotein oxidation.
• BayK(-) The l C a- L agonist BayK(-) was used to activate the channel and assess mitochondrial function. Consistent with previous findings, in the presence of 10 pM inactive scrambled peptide (AID(S)-TAT), BayK(-) induced an increase in flavoprotein oxidation that was comparable to the response elicited with application of BayK(-) alone (Figure 10A-C) ( Viola HM, Shah AA, Johnstone VPA, Cserne Szappanos H, Hodson MP, Hool LC. Characterization and validation of a preventative therapy for hypertrophic cardiomyopathy in a murine model of the disease. Proc Natl Acad Sci U S A.
• Figure 10 presents the mean +/- SEM of flavoprotein fluorescence from cTnl.2 wt and cTnl-G203S mutant myocytes before and after exposure to 10 pM BayK(-) in the presence of 1 pM AID(S)-TAT, and increasing concentrations of variant peptides as indicated.
• N no. of animals
• n no. of cardiomyocytes.
• Figure 11 presents the mean +/- SE of JC-1 fluorescence from cTnl.2 wt and cTnl-G203S mutant myocytes before and after exposure to 10 pM BayK(-) in the presence of 1 pM AID(S)-TAT, and 0.5 pM of variant peptides as indicated.
• N no. of animals
• n no. of cardiomyocytes.
• Example 11 In vivo treatment of cTnl-G203S mice with AID-TAT variants does not alter blood pressure
• mice Twenty to thirty week-old male mice expressing the human cTnl gene encoding the human disease-causing cTnl-G203Swere generated and used for the in vivo studies.
• the mice develop hallmark features of HCM between 20 and 25 weeks (Viola H, Johnstone V, Cserne Szappanos H, Richman T, Tsoutsman T, Filipovska A, et al.
• the L-type Ca(2+) channel facilitates abnormal metabolic activity in the cTnl-G203S mouse model of hypertrophic cardiomyopathy. J Physiol.
• mice expressing the normal human troponin I gene were used as controls and indicated as wild-type (wt).
• 20-week old cTnl-G203S mice were treated with 10 pM AID(S)-TAT (2 mg/kg) or 5 pM AID-TAT mutant peptides via intraperitoneal injection, 3 times per week for a total duration of 5 weeks.
• the peptide was dissolved in phosphate buffered saline solution (PBS), and the total amount of the 10pM AID-TAT mutant peptides administered over 5 weeks was 0.9mg.
• the total amount of the 5pM AID-TAT mutant peptides administered over 5 weeks was 0.45mg
• Male mice were utilized to eliminate potential differences in responses due to gender. The number of mice used is indicated by N.
• Blood pressure was assessed prior to commencing the treatment regime, 1 hr after initial injection (acute) and following completion of the 5-week treatment regime.
• Blood pressure measurements of mice were obtained via the CODA non-invasive blood pressure system (Tail- Cuff Method, Kent Scientific Corporation). Conscious mice were placed into an appropriate size restrainer based on body weight and pre-set parameters to assess blood pressure (SOFTWARE details from Henrietta) were run for a total of 15 cycles (the first 5 cycles are undertaken for acclimatisation). An average of 10 measurements was used.
• the fluorescent indicator propidium iodide (P4170; Sigma Aldrich) was used to assess AID-TAT mutant peptide toxicity in vitro in cardiac myocytes. Fluorescence at excitation 480 nm and emission 580 nm was measured on a Hamamatsu Orca ER digital camera attached to an inverted Nikon TE2000-U microscope.
• Fluorescent images were acquired after initial 20 min pre-incubation with 1 pM AID P7 -TAT (P7-TAT), AID P I 4 -TAT (P14-TAT), AID P I 5 -TAT (P15-TAT), or AID P 16-TAT (P16-TAT), and after 5 min incubation with the dye, using 50 ms exposure. No evidence of toxicity was observed.
• Example 13 In vivo treatment of cTnl-G203S mice with AID-TAT variants is not toxic
• mice were treated with 5pM AID(S)-TAT, AID P7 -TAT (P7-TAT), AID P I 4 -TAT (P14- TAT) or AID P I 5 -TAT (P15-TAT) or AID P 16-TAT 3x/wk/5wk (equalling 15 doses).
• the peptide was dissolved in phosphate buffered saline solution (PBS), and the total amount of the 5pM AID- TAT mutant peptides administered over 5 weeks was 0.45mg. Body weight was recorded prior to administration of each peptide dose.
• mice were anesthetised and terminal blood collected. Blood was left to coagulate in a Lithium-Heparin tube at room temperature for 20 min. Plasma was separated using centrifugation at 3000 g for 10 min at 4°C. To measure kidney toxicity, urea and creatinine concentrations were assessed using Quantichrom Urea assay kit (BioAssay Systems, Hayward, CA) and Quantichrom Creatinine assay kit (BioAssay Systems, Hayward, CA), respectively.
• alanine transaminase (ALT) and aspartate transaminase (AST) concentrations were measured using Alanine Transaminase assay kit (BioAssay Systems, Hayward, CA) and Aspartate Transaminase assay kit (BioAssay Systems, Hayward, CA), respectively. Assays were performed as per manufacturer’s instructions, using a spectrophotometer (CLARIOstar, BMG LABTECH).
• Figure 13 presents the mean ⁇ SEM of urea (A) and ALT (B) concentrations from plasma from wt and cTnl-G203S mice treated with 10 pM AID(S)-TAT, 5pM AID P7 -TAT or 5 pM AID P I 4 -TAT or AID P I 5 -TAT or AID P I 6 -TAT (3x/wk/5wk) as indicated.
• N number of mice.
• P ns as determined by ANOVA and Kruskal- Wallis tests (A-B).
• Example 14 In vivo treatment of cTnl-G203S mice with AID-TAT variants slows the progression of fibrosis
• mice were extracted and prepared for Masson’s Trichchrome staining based on previously described methods with minor modifications (Van De Vlekkert D, Machado E, d'Azzo A. Analysis of Generalized Fibrosis in Mouse Tissue Sections with Masson's Trichrome Staining. Bio Protoc. 2020;10(10):e3629). Hearts were washed in PBS and fixed overnight in 10% buffered formalin saline (FSAL-5L; Hurst Scientific, AUS). After fixation, hearts were washed 3 x 10min in PBS and incubated overnight in 30% sucrose solution (in PBS).
• myocardial fibrosis is a characteristic feature of HCM (O'Connell TD, Rodrigo MC, Simpson PC. Isolation and culture of adult mouse cardiac myocytes. Methods Mol Biol. 2007;357:271 -96).
• Myocardial fibrosis is the collagen-rich extracellular matrix that is significantly increased in hypertrophic hearts (Haase H, Striessnig J, Holtzhauer M, Vetter R, Glossmann H. A rapid procedure for the purification of cardiac 1 ,4-dihydropyridine receptors from porcine heart. Eur J Pharmacol. 1991 ;207(1 ):51 -9).
• Echocardiographic assessment of cTnl-G203S mice reveal the development of HCM characteristics from approximately 21 weeks of age (Viola H, Johnstone V, Cserne Szappanos H, Richman T, Tsoutsman T, Filipovska A, et al.
• the L-type Ca(2+) channel facilitates abnormal metabolic activity in the cTnl-G203S mouse model of hypertrophic cardiomyopathy. J Physiol. 2016;594(14):4051 -70; Viola HM, Shah AA, Johnstone VPA, Cserne Szappanos H, Hodson MP, Hool LC. Characterization and validation of a preventative therapy for hypertrophic cardiomyopathy in a murine model of the disease.
• Figure 15 presents: LVEDd, left ventricular end diameter during diastole; LVEDs, left ventricular end diameter during systole; FS, fractional shortening; EF, ejection fraction; LVPWd, left ventricular posterior wall in diastole; LVPWs, left ventricular posterior wall in systole; IVDd, intraventricular septum in diastole; IVDs, intraventricular septum in systole; HR, heart rate.
• N number of mice. Values reported as mean ⁇ SEM; P values compared with cTnl-G203S Al D(S)- TAT as determined by the Kruskal-Wallis test.
• Figure 16 presents the mean ⁇ SEM of heart weight to body weight ratio measurements from wt and cTnl-G203S mice treated with 10 pM AID(S)-TAT, 10 pM AID-TAT, 5 pM AIDP -TAT, 5 pM AIDPU- TAT, 5 pM AIDPU-TAT or 5 pM AIDPI6-TAT.
• n number of mice as indicated.

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