Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/18—Growth factors; Growth regulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
  • A61K38/08—Peptides having 5 to 11 amino acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0043—Nose
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia

Definitions

• the present invention relates to sex- specific treatments of diseases associated with an aberrant functionality of activity-dependent neuroprotective protein (ADNP) or tightly linked with microtubule (cy to skeletal) function, such as the treatment of females suffering from progressive supranuclear palsy, males suffering from schizophrenia or amnestic mild cognitive impairment.
• ADNP activity-dependent neuroprotective protein
• microtubule cy to skeletal
• NAP Neuroprotective peptide site of activity -dependent neuroprotective protein
• ADNP activity -dependent neuroprotective protein
• NAP and pipeline products protect nerve cells by associating with microtubule end binding proteins (EB 1/EB3), through the SxIP motif (NAPVSIPQ), thus enhancing microtubule dynamics and Tau -micro tubule interaction, protecting the synapse.
• EB 1/EB3 microtubule end binding proteins
• NAPVSIPQ SxIP motif
• NAP further enhances ADNP-EB 1/EB3, interactions, protecting against ADNP deficits
• NAPVISP homology 3 domain-ligand association site in NAP
• PSP Progressive supranuclear palsy
• DMT disease modifying therapy
• Symptoms include changes to speech, balance, walking, swallowing, vision, cognition, autonomic functioning as well as Parkinson’s like symptoms, such as, tremor, stiffness and slowness.
• PSP is a rapidly progressive, neurodegenerative disease, a tauopathy caused by abnormal folding of the protein Tau in brain cells.
• tauopathy The most prevalent tauopathy is Alzheimer’s disease while other less frequent tauopathies exist as well. Tauopathy can also be found in other brain diseases, including, but not limited to amyotrophic lateral sclerosis (ALS) and autism. All these diseases are currently lacking disease modifying therapeutics.
• ALS amyotrophic lateral sclerosis
• progressive supranuclear palsy PSP
• corticobasal degeneration CBD
• MSA multiple system atrophy
• PSP progressive supranuclear palsy
• CBD corticobasal degeneration
• MSA multiple system atrophy
• PSP, CBD and MSA are considered rare, especially compared to the more common neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease. However, only about 25% of people with PSP, CBD and MSA are accurately diagnosed.
• Davunetide (NAP) treatment has shown cognitive score enhancement in amnestic mild cognitive (aMCI) (Morimoto et al. Dementia and geriatric cognitive disorders 2013; 35(5-6): 325-336) and protection of daily living activities in schizophrenia patients (Javitt et al., Schizophrenia research 2012; 136(1-3): 25-31.; Gozes I. Frontiers in neurology 2020; 11: 608444).
• aMCI amnestic mild cognitive
• the choice of aMCI as a therapeutic target for davunetide is obvious as it protects against tauopathy and cell death, with aMCI being the precursor of Alzheimer’s disease, the major tauopathy.
• ADNP regulates the autophagy process, interacting with the autophagy-controlling proteins, e.g. microtubule-associated protein 1 light chain 3 (LC3) and regulating beclin 1 expression, with NAP (davunetide) enhancing/replacing deficient ADNP deficits and providing neuroprotection (Sragovich S, Merenlender- Wagner A, Gozes I. Bioessays. 2017;39(l 1)).
• LC3 microtubule-associated protein 1 light chain 3
• Tauopathies can be categorized by the presence of tau aggregates containing 3 (3R) and/or 4 (4R) microtubulebinding domain repeats (determined by inclusion/exclusion of MAPT exon 10) and by inclusion/exclusion of exons 2 and 3 translated to two N-terminal Tau domains, with the accumulation of 1N4R isoforms in PSP and ON isoforms in the Alzheimer’ s disease temporal cortex.
• NAP dexavunetide
• ADNP enhances Tau microtubule association
• ADNP is directly interacting with the splicing machinery, possibly to suppress exon 10 inclusion.
• the davunetide trial in the pure 4-repeat Tau, PSP a potentially ideal population target for davunetide protection, was deemed negative (Boxer et al.,), retrospectively, part of the negative result was attributed to NAP preferential enhancement of the dynamic 3-repeat Tau (containing 3 microtubule interaction sites) vs. the 4-repeat Tau microtubule interaction (Ivashko-Pachima et al., PLoS One 2019; 4(3)):e0213666).
• PSP and other neurodegenerative diseases still have no treatment and there is an urgent need for providing such.
• cognitive impairments in schizophrenia are not adequately addressed and developmental disorders, including, but not limited to, autism spectrum disorders, Alzheimer's disease are an unmet medical need.
• the present invention is based on an unexpected observation that males and females suffering from PSP react differently to the treatment by NAP peptide (also called davunetide).
• NAP peptide also called davunetide
• NAP peptide reduced the increase in the size of brain ventricles caused by neurodegeneration in females. This was not observed in males.
• Finding that NAP protein may be used in treating PSP contradicts the previous statements of e.g., Boxer et al., (The Lancet Neurology 2014; 13(7): 676-685) explicitly stating that Davunetide is not an effective treatment for PSP.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence SEQ ID NO: 1 (NAPVSIPQ; NAP peptide) and a pharmaceutically acceptable carrier, for use in a sex-specific treatment or inhibition of the development of a disease or disorder associated with an aberrant functionality of activity -dependent neuroprotective protein (ADNP) in a subject.
• the disease or disorder is selected from a neurodegenerative disease, neurodevelopmental disease or mental disease, and tauopathy.
• the disease is taupathy.
• the disease or disorder is selected from progressive supranuclear palsy (PSP), schizophrenia, Alzheimer's disease, amnestic mild cognitive impairment (aMCI), ADNP syndrome, autism and muscle disease.
• PSP progressive supranuclear palsy
• aMCI amnestic mild cognitive impairment
• ADNP syndrome autism and muscle disease.
• the disease is progressive supranuclear palsy (PSP) and the use comprises treating or inhibiting the development of PSP in a female subject.
• the treatment or prevention of the development of PSP comprises preventing or inhibiting the increase in the size of brain ventricles.
• the use comprises administering from 1 to 80 mg/day of the NAP peptide.
• the use comprises administering from 40 to 80 mg/day of the NAP peptide.
• the disease is progressive supranuclear palsy (PSP) and use comprises treating PSP in a male subject comprising administering to said subject from 1 to 50 mg/day of the NAP
• the disease is schizophrenia and the use comprises treating schizophrenia in a male subject, wherein the use comprises administering to said male subject from 10 to 80 mg/day of the NAP peptide. According to some embodiments, the use comprises administering to said male subject from 20 to 80 mg/day of the NAP peptide.
• the disease is schizophrenia and the use comprises treating schizophrenia in a female subject, wherein the use comprises administering to said subject from 1 to 4 mg/day of the NAP peptide.
• the disease is amnestic mild cognitive impairment (aMCI) and the use comprises treating amnestic aMCI in a male subject, wherein the use comprises administering to said subject from 10 to 80 mg/day or from 25 to 80 mg/day of the NAP peptide.
• aMCI amnestic mild cognitive impairment
• the disease is amnestic mild cognitive impairment (aMCI) and the use comprises treating amnestic aMCI in a female subject, wherein the use comprises administering to said subject from 35 to 80 mg/day of the NAP peptide.
• aMCI amnestic mild cognitive impairment
• the use comprises sex-specific treatment or prevention of Alzheimer's disease.
• the use comprises treatment or prevention at the prodromal stage of the disease.
• Alzheimer's disease is characterized by the presence in a biological sample of at least one of the followings: (i) of aberrant P53 protein; (ii) P-tau217; (iii) P-tau231 and (iii) P-taul81 and (iv) change in ADNP expression.
• the use comprises treating a female subject and comprises administering from 1 to 80 mg/day, from 1 to 10 mg/day, from 20 to 40 mg/day or from 40 to 80 mg/day of the NAP.
• the use comprises treating a male subject and comprises administering from 1 to 80 mg/day, from 1 to 10 mg/day, from 20 to 40 mg/day or from 40 to 80 mg/day of the NAP.
• the present invention provides a method for treating or inhibiting the development of a disease or disorder associated with an aberrant functionality of activity-dependent neuroprotective protein (ADNP) in a subject comprising administering to said subject a peptide comprising the amino acid sequence SEQ ID NO: 1 (NAPVSIPQ; NAP peptide) in a sex-specific way/manner.
• ADNP activity-dependent neuroprotective protein
• the present invention provides a method for treating or inhibiting the development of PSP in a female subject comprising administering to said female subject a peptide comprising the amino acid sequence SEQ ID NO: 1.
• the method comprises administering from 40 to 80 mg/day of the NAP peptide.
• the present invention provides a method for treating or inhibiting the development of PSP in a male subject comprising administering to said subject from 1 to 50 mg/day of the NAP
• the present invention provides a method for treating schizophrenia in a male subject, comprising administering to said male subject from 10 to 80 mg/day of the NAP peptide.
• the method comprises administering to said male subject from 20 to 80 mg/day of the NAP peptide.
• the present invention provides a method for treating schizophrenia in a female subject, wherein the use comprises administering to said subject from 1 to 4 mg/day of the NAP peptide.
• the present invention provides a method for treating amnestic mild cognitive impairment (aMCI) comprising treating amnestic aMCI in a male subject, wherein the use comprises administering to said subject from 10 to 80 mg/day or from 25 to 80 mg/day of the NAP peptide.
• aMCI amnestic mild cognitive impairment
• the present invention provides a method for treating amnestic aMCI in a female subject, wherein the use comprises administering to said subject from 35 to 80 mg/day of the NAP peptide.
• the present invention provides a method for treating or preventing of Alzheimer's disease in a subject in need thereof in sex-specific manner. According to some embodiments, treatment or prevention is at the prodromal stage of the disease.
• Alzheimer's disease is characterized by the presence in a biological sample of at least one of the followings: (i) of aberrant P53 protein; (ii) P-tau217; (iii) P-tau231 and (iii) P-taul81 and (iv) change in ADNP expression.
• the method comprises treating a female subject and comprises administering from 1 to 80 mg/day, from 1 to 10 mg/day, from 20 to 40 mg/day or from 40 to 80 mg/day of the NAP.
• the method comprises treating a male subject and comprises administering from 1 to 80 mg/day, from 1 to 10 mg/day, from 20 to 40 mg/day or from 40 to 80 mg/day of the NAP.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ and a pharmaceutically acceptable carrier for use in ameliorating and/or preventing side effects of an anti-amyloid-P therapy, wherein the therapy comprises anti- amyloid- P antibodies.
• the composition is administered in a sex-specific mode.
• the composition is administered to a female subject, e.g., in a dose of from 1 to 70 mg/day or from 50 to 70 mg/day of the NAP.
• the composition is administered to a male subject, e.g. in a dose of from 1 to 70, from 1 to 50 or from 50 to 70 mg/day of the NAP.
• the anti-amyloid-P therapy comprises aducanumab or lecanemab.
• the NAP peptide or the pharmaceutical composition comprising NAP peptide is administered intranasally.
• the sex- specific treatment comprises inhibiting neurodegeneration in the subject.
• Fig. 1 shows baseline demographics (Fig. 1A - weight; Fig. IB - height; Fig. 1C - age; Fig. ID - brain ventricle volume; Fig. IE - SEADL; Fig. IF - PSPRS) for PSP- suffering subjects treated with placebo or NAP and divided by sex: for that at the baseline, the tested population differed by weight, height and ventricular volumes, with obvious higher male values.
• Fig. 2 shows linear regressions separating males and females, davunetide and placebo-treated as measured by MRI, percent of baseline change in ventricular volume at 52 weeks of treatment, correlating with age.
• Fig. 3 shows linear regressions separating males and females, davunetide and placebo-treated as measured by MRI, change in ventricular volume at 52 weeks of treatment, correlating with ventricular baseline ventricular volume (mm).
• Fig. 4 shows total Tau (Fig. 4A) and phosphorylated Tau (Fig. 4B) reduction in the cerebrospinal fluid (CSF) of the davunetide-treated female patients compared to placebo.
• Fig. 5 shows correlations plot r values employing percent change compared to baseline at 52 week davunetide vs. placebo treatment results including the study primary endpoints, PSPRS and SEADL, the secondary end point of brain ventricular volume change as well as age. Significance is denoted by: * P ⁇ 0.05; **P ⁇ 0.01; ***P ⁇ 0.001. denotes #P ⁇ 0.1 and >0.05.
• Fig. 6 shows linear regression plots comparing, the male and female placebo groups change over the 52 weeks trial (Fig. 6A) PSPRS, (Fig. 6B) limb motor domain of the PSPRS, (Fig. 6C) SEADL, (Fig. 6D) table showing statistically significant accelerated deterioration in the davunetide-treated males. *indicates significance and #P ⁇ 0.1 and >0.05, compared to placebo as detailed on the figure.
• Fig. 7 shows linear regression plots comparing, female davunetide vs. placebo change over the 52 week trial (Fig. 7A) PSPRS, (Fig. 7B) behavior domain of the PSPRS, (Fig. 7C) bulbar domain of the PSPRS, (Fig. 7D) SEADL. *indicates significance compared to placebo, as detailed on the figure.
• Fig. 8 shows the exploratory endpoint GDS change from baseline to 52 weeks of davunetide vs. placebo treatment results in females (Fig. 8A) and males (Fig. 8B).
• Fig. 9 shows the effect of davunetide vs. placebo treatment on the change in elderly patients suffering from amnestic mild cognitive impairment (aMCI), on the CANTAB DMTS scale from baseline to 16 weeks.
• the DMTS scale measured the change in percentage right recognition of the object after 12-second delay (short-term visual and verbal working memory).
• Patients were treated with two doses of davunetide: 5mg/day and 30 mg/day (15mg/bid) over the 12-week trial with every 4-week assessments including an additional assessment 4 weeks after cessation of treatment.
• the change in the DMTS scale from baseline was measured and presented as follows: Fig. 9A - women, 5mg/day; Fig.
• Fig. 10 shows the effect davunetide vs. placebo treatment on the change in UPS A scale from week 1 in patients diagnosed as suffering from schizophrenia. Patients were treated with two doses of davunetide: 5mg/day and 30 mg/day (15mg/bid) over the 6-week trial or the 12 week trial. The change in the UPSA scale from week 1 was measured and presented as follows: Fig. 10A - women, 5mg/day; Fig.
• FIG. 11 shows opposite gene regulation in male and female mice with ADNP syndrome.
• a complete RNA sequencing of brain hippocampal samples shows an opposite regulation in ADNP mutated HTR males and HTR females compared to control wild type (WT), treated with vehicle (saline) or NAP as depicted for the Hacel gene/mRNA intron retention event (aberrant alternative splicing) in males, corrected by NAP.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAP peptide and a pharmaceutically acceptable carrier for use in a sex-specific treatment, inhibition of the development or prevention of a disease or disorder associated with an aberrant functionality of activity-dependent neuroprotective protein (ADNP) in a subject.
• ADNP activity-dependent neuroprotective protein
• the disease or disorder is selected from a neurodegenerative disease, neurodevelopmental disease or mental disease, and tauopathy According to some embodiments, the wherein the disease or disorder is a tauopathy.
• tauopathy refers to neurodegenerative disorders characterized by the deposition of abnormal tau protein in the brain. Tauopathy is a major outcome of ADNP- deficiency or ADNP aberrant functionality.
• ADNP activity-dependent neuroprotective protein
• ADNP activity-dependent neuroprotective protein
• Bassan et al.; Zamostiano et al., J Biol Chem. 2001;276(l):708-14 The protein has neurotrophic/neuroprotective activity as measured e.g., with in vitro cortical neuron culture assays described by, e.g., Gozes et al., (Proc. Natl. Acad. Sci. USA 93, 427- 432, 1996; Bassan et al.) and reviewed in Gozes. Book Chapter 13, in Neuroprotection in Alzheimer’s Disease, 1st Edition - December 30, 2016, Gozes, Ed., Academic Press).
• Non-limiting example is Hacel as shown in Example 5.
• Hacel HECT Domain And Ankyrin Repeat Containing E3 Ubiquitin Protein Ligase 1 associated with ataxia (Bellamy et al., PLoS One. 2022;17(l):e0261845), Huntington disease (Ehrnhoefer et al., Hum Mol Genet. 2018;27(2):239-253.
• OMIM severe neurodevelopmental disorder
• OMIM severe neurodevelopmental disorder
• OMIM severe neurodevelopmental disorder
• Alzheimer’s disease Na et al., J Alzheimers Dis. 2018;64(4): 1149-1161).
• NAP peptide refers to peptides comprising the amino acid sequence NAPVSIPQ and to any derivative or analog of the peptide comprising the amino acids NAPVSIPQ or related sequences and having the same biological activity, e.g., as peptides defined in W02008084483, W02006099739, US2012208763 and US20150141345 and incorporated herein by reference in their entirety.
• the term NAP refers to one of the NAP's derivatives having an amino acid sequence selected from amino acid sequences SEQ ID NO: 2-49 and to NAP alpha-aminoisobutyric acid analog, or SKIP, (Ivashko-Pachima et al., J Mol Neurosci. 2021 Aug;71(8):1515-1524) or Ac-SKIP (Ivashko-Pachima and Gozes (Front Cell Neurosci. 2019 Oct 1;13:435. doi: 10.3389/fncel.2019.00435).
• the methods of treatment of the present invention include use of other compounds that have an activity that is similar to that of NAP, i.e.
• NAP vasoactive intestinal peptide
• PACAP pituitary adenylate cyclase-activating polypeptide
• VIP vasoactive intestinal peptide
• PACAP pituitary adenylate cyclase-activating polypeptide
• Sragovich et al Translational Psychiatry volume 9, Article number: 235 (2019); SNV described in Eger et al., (Front Pharmacol. 2021 May 5; 12:638128. doi: 10.3389/fphar.2O21.638128), or ketamine (Brown et al., Neuroscience. 2015 Apr 2;290:31-40).
• NAP activity should also be considered in combination with other drugs such as anti-psychotic drugs including but not limited to risperidone or clozapine.
• treating refers to taking steps to obtain beneficial or desired results, including clinical results.
• beneficial or desired clinical results include, but are not limited to, or ameliorating abrogating, substantially inhibiting, slowing or reversing the progression of a disease, condition or disorder, substantially ameliorating or alleviating clinical or esthetical symptoms of a condition, substantially preventing the appearance of clinical or esthetical symptoms of a disease, condition, or disorder, and protecting from harmful or annoying symptoms.
• Treating further refers to accomplishing one or more of the following: (a) reducing the severity of the disorder; (b) limiting the development of symptoms characteristic of the disorder(s) being treated; (c) limiting worsening of symptoms characteristic of the disorder(s) being treated; (d) limiting recurrence of the disorder(s) in patients that have previously had the disorder(s); and/or (e) limiting recurrence of symptoms in patients that were previously asymptomatic for the disorder(s).
• the term treating refers to inhibiting the progression of the disease or disorder.
• the term refers to reversing and diminishing the course of progression of the disease or disorder.
• the term refers also to preventing the disease.
• the term “preventing” when used in relation to a condition refers to the administration of a composition which reduces the frequency of, or delays the onset of, symptoms of a medical condition in a subject relative to a subject who does not receive the composition.
• the main essence of the present invention is that the treatment of the diseases described herein is sex-specific.
• the term "sex-specific treatment” has the meaning that the treatment of males and females is different in the terms of doses, regime, and outcome. As such, the treatment may be effective to one sex and ineffective to the opposite sex, the dose that is effective to one sex is ineffective or even harmful to the opposite sex etc.
• the terms “sex-specific” and “gender- specific” may be used interchangeably.
• the term “sex” refers to the biologic sex of the subject defined by genetics as well known in the art.
• the terms "male”, “males", “man” and “men” are used herein interchangeably.
• composition refers to a composition comprising at least one active agent as disclosed herein optionally formulated together with one or more pharmaceutically acceptable carriers. Formulation of the pharmaceutical composition may be adjusted according to applications. In particular, the pharmaceutical composition may be formulated using a method known in the art so as to provide rapid, continuous or delayed release of the active ingredient after administration to mammals.
• the formulation may be any one selected from among plasters, granules, lotions, liniments, lemonades, aromatic waters, powders, syrups, ophthalmic ointments, liquids and solutions, aerosols, extracts, elixirs, ointments, fluidextracts, emulsions, suspensions, decoctions, infusions, ophthalmic solutions, tablets, suppositories, injections, spirits, capsules, creams, troches, tinctures, pastes, pills, and soft or hard gelatin capsules.
• compositions may contain other active compounds providing supplemental, additional, or enhanced therapeutic functions, solid carriers or excipients such as, for example, lactose, starch or talcum or liquid carriers such as, for example, water, fatty oils or liquid paraffins.
• the pharmaceutical composition of the present invention may be administered in any known method.
• the term "administering” or “administration of’ a substance, a compound or an agent to a subject can be carried out using one of a variety of methods known to those skilled in the art.
• a compound or an agent can be administered, intravenously, arterially, intradermally, intramuscularly, intraperitoneally, intravenously, subcutaneously, ocularly, sublingually, orally (by ingestion), intranasally (by inhalation), intraspinally, intracerebrally, and transdermally (by absorption, e.g., through a skin duct).
• a compound or agent can also appropriately be introduced by rechargeable or biodegradable polymeric devices or other devices, e.g., patches and pumps, or formulations, which provide for the extended, slow or controlled release of the compound or agent.
• Administering can also be performed, for example, once, a plurality of times, and/or over one or more extended periods.
• the composition is administered 1, 2, 3, 4, 5 or 6 times a day.
• the composition is administered 1, 2, 3, 4, 5 or 6 times a month.
• the administration includes both a direct administration, including self-administration, and indirect administration, including the act of prescribing a drug.
• a physician who instructs a patient to self-administer a drug, or to have the drug administered by another and/or who provides a patient with a prescription for a drug is administering the drug to the patient.
• the administration of the pharmaceutical composition of the present invention is intranasal.
• the disease or disordered treated in a sex-specific manner is a disease or disorder associated with an aberrant functionality of ADNP.
• diseases are progressive supranuclear palsy (PSP) and related diseases (CBD, MSA), schizophrenia and related mental disorders including depression, Alzheimer's disease, amnestic mild cognitive impairment (aMCI), Parkinson’s disease, neurodevelopmental disorders, including but not limited to, ADNP syndrome, Phelan McDermid syndrome, Dravet syndrome, Rett syndrome, Angelman syndrome, idiopathic or genetic autism spectrum disorder, Down syndrome, amyotrophic lateral disorder (ALS), ataxia, Huntington disease and muscle disease associated with aberrant functionality of ADNP, including, but not limited to natural aging, Duchene muscular dystrophy and Pompe disease. All these diseases or disorders are associated with or mediated by aberrant functionality of ADNP/cytoskeleton, such as aberrant expression, missense, non-sense and frameshift mutations resulting in aberrant length or structure
• the disease is progressive supranuclear palsy (PSP).
• PSP progressive supranuclear palsy
• the term "progressive supranuclear palsy” or “PSP” refers to a neurologic disorder of unknown origin that gradually destroys cells in many areas of the brain and the accumulation of abnormal aggregates of the microtubule-associated protein Tau, resulting in insoluble paired helical filaments, including the gradual deterioration of neurons and glial cells in the midbrain and frontal cortex that display insoluble helical filaments of Tau proteins as described e.g. in Shi et al., Nature 2021; 598:359-363.
• PSP starts with a pre-symptomatic phase during which there is an increase in neuropathological abnormalities.
• patients develop isolated symptoms that are suggestive of PSP (soPSP).
• PSP can be classic PSP- Richardson's syndrome (PSP-RS), PSP-Parkinsonism (PSP-P), PSP-corticobasal syndrome (PSP-CBS), PSP- progressive non-fluent aphasia (PSP-PNFA), or PSP-pure akinesia with gait freezing (PSP- PAGF) (Ling et al., J. Mov. Discord. 9(1):3-13, 2016). After onset, symptoms of PSP become rapidly and progressively worse.
• PSP Planar palidus .
• Symptoms of PSP usually first appear at the age of 60 and worsen until death. People with PSP commonly die from pneumonia, choking or other complications caused by the loss of functional brain cells, resulting in loss of autonomic and motor function (e.g. the ability to swallow).
• Signs and symptoms of PSP include movement, cognitive and psychiatric disorders. Voluntary movement can be impaired in PSP and include pseudobulbar palsy (i.e. inability to control facial movements), bradykinesia (i.e. slow or abnormal muscle movement), neck and trunk rigidity, impaired gait, impaired balance, posture instability and difficulty with speech and swallowing. The most obvious, outward sign of the disease is an inability to coordinate and move the eyes normally, resulting in a vertical gaze palsy.
• Cognitive impairments include loss of executive functions (e.g. attention control, inhibitory control, working memory, cognitive flexibility, reasoning, problem solving and planning) and diminished fluency.
• Associated psychiatric symptoms include depression, feelings of irritability, sadness or apathy, insomnia, fatigue and loss of energy.
• a subject can be identified as having PSP using the MDS PSP Diagnostic Criteria (as described in, e.g., Hoglinger et al., Mov. Disord. 31 :644-652, 2016).
• a subject can be identified as having an increased risk of developing PSP or identified as having PSP (e.g., any of the types of PSP described herein), e.g., at least in part, by detecting tau protein deposits (e.g., 4-repeat tau protein deposits), detecting of atrophy of the midbrain and/or superior cerebellar peduncles (e.g., using any of the imaging techniques described herein or known in the art, e.g., magnetic resonance imaging (MRI) or positron emission tomography (PET) scans), and/or detecting of hypometabolism in the frontal cortex, caudate, and/or thalamus in the subject (e.g., using any of the imaging techniques described herein or known in the art, e.g., MRI, CT scan, or PET scan).
• tau protein deposits e.g., 4-repeat tau protein deposits
• detecting of atrophy of the midbrain and/or superior cerebellar peduncles e.g.,
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier, for use in a sex-specific treating or inhibiting the development or progression of the PSP in a subject.
• the subject is a female.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating or inhibiting the development of progressive supranuclear palsy (PSP) in a female subject.
• NAPVSIPQ amino acid sequence NAPVSIPQ
• the female subject is 50 years old or more. According to some embodiments, the female subject is 55 years old or more. According to some embodiments, the female subject is 60 years old or more. According to some embodiments, the female subject is 65 years old or more. According to some embodiments, the female subject is 70, 75, 80, 85 or 90 years old or more.
• the female subject is administered from 1 to 100 mg/day of the NAP peptide. According to some embodiments, the subject is administered from 1 to 70 mg/day of the NAP peptide. According to some embodiments, the female subject is administered from 2 to 65 mg/day, from 5 to 60 mg/day, of the NAP peptide. According to some embodiments, the female subject is administered from 10 to 50 mg/day, from 15 to 45 mg/day, from 20 to 40 mg/day or from 25 to 35 mg/day, or about 30 mg/day of the NAP peptide.
• the female subject is administered from 40 to 80 mg/day, from 45 to 75 mg/day, from 50 to 70 mg/day, from 55 to 65 mg/day or about 60 mg/day of the NAP peptide.
• the administration may be performed in one dose or split into several doses, e.g. 2, 3, or 4 doses.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating or inhibiting the development of progressive supranuclear palsy (PSP) in a male subject.
• the male subject is 50 years old or more.
• the male subject is 55 years old or more.
• the male subject is 60 years old or more.
• the male subject is 65 years old or more.
• the male subject is 70, 75, 80, 85 or 90 years old or more.
• the male subject is administered from 1 to 50 mg/day of the NAP peptide.
• the subject is administered from 1 to 45 mg/day of the NAP peptide.
• the male subject is administered from 2 to 40 mg/day, or from 3 to 35 mg/day, of the NAP peptide.
• the male subject is administered from 1 to 30, from 5 to 35 mg/day, from 10 to 40 mg/day or from 10 to 35 mg/day of the NAP peptide.
• the male subject is administered from 10 to 50 mg/day, from 15 to 45 mg/day, from 20 to 40 or from 25 to 35 mg/day, or about 30 mg/day of the NAP peptide.
• the male subject is administered from 1 to 15 mg/day, from 2 to 10 mg/day, from 3 to 10 mg/day, from 1 to 5 mg/day or from 2 to 4 mg/day of the NAP peptide.
• the administration may be performed in one dose or split in several doses, e.g., 2, 3, or 4 doses.
• the efficacy of the treatment may be assessed by measuring any known symptom or parameter associated with the disease.
• the treatment results in improving one or more of said symptoms of parameters.
• the treatment comprises an improvement in at least one of the following symptoms associated with PSP: behavior, bulbar, dysarthria, ocular motor, limb motor and gait.
• the treatment comprises an improvement in the score of Geriatric Depression Scale and/or Clinical Global Impression of Disease Severity.
• the treatment comprises an improvement in the score of the Schwab and England Activities of Daily Living scale (SEADL).
• SEADL Schwab and England Activities of Daily Living scale
• the term "improved" when referring to symptoms or parameters of any one of the diseases described in the application may be quantitative and qualitative as known in the art. The improvement is measured/assessed in comparison to a subject that does not receive the treatment, i.e. a control. Thus, the term may have the meaning of improvement of at least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 50%, 60%, 70%, 80%, 90%, or 95% in symptoms and/or parameters for a treated individual or a patient population compared to an individual or patient population not receiving the therapeutic agent. According to a further embodiment, the improvement is at least 1.5, at least 2, at least 2.5 at least 3, at least 5 or at least 10 folds compared to an individual or patient population not receiving the therapeutic agent.
• the disease is schizophrenia.
• schizophrenia refers to a mental disorder as known in the art and described e.g. in DSM- IV-TR.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in a sex-specific treating schizophrenia in a subject.
• the subject is female. Therefore, in some embodiments, the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating schizophrenia in a female subject.
• the female subject is administered from 1 to 20 mg/day of the NAP peptide.
• the subject is administered from 1 to 15 mg/day of the NAP peptide.
• the female subject is administered from 2 to 10 mg/day, from 3 to 8 mg/day, of the NAP peptide.
• the female subject is administered from 1 to 4, from 1 to 3, or from 2 to 4 mg/day of NAP peptide.
• the female subject is administered about 1, about 1.5, about 2, about 2.5, about 3, about 3.5 or about 4 mg/day of NAP peptide. According to some embodiments, the female subject is administered about 1, about 1.5, about 2, about 2.5, about 3, about 3.5 or about 4 mg of NAP peptide b.i.d. According to some embodiments, the female subject is administered from 4 to 5 mg/day or about 5 mg/day of the NAP peptide. According to any one of the above embodiments, the administration may be performed in one dose or split in several doses, e.g. 2, 3, or 4 doses.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating schizophrenia in a male subject.
• the male subject is administered from 10 to 80 mg/day of the NAP peptide.
• the male subject is administered from 15 to 75 mg/day of the NAP peptide.
• the male subject is administered from 15 to 70 mg/day, from 20 to 60 mg/day, of the NAP peptide.
• the male subject is administered with from 20 to 40, or from 25 to 35 mg/day.
• the male subject is administered with from 25 to 60 mg/day or from 30 to 50 mg/day of the NAP peptide. According to some embodiments, the male subject is administered with from 40 to 80 mg/day, from 50 to 70 mg/day, or from 55 to 65 of the NAP peptide. According to some embodiments, the male subject is administered with about 30, about 40, about 50, or about 60 mg/day of the NAP peptide. According to any one of the above embodiments, the administration may be performed in one dose or split in several doses, e.g. 2, 3, or 4 doses.
• Amnestic mild cognitive impairment (aMCI)
• the disease is amnestic mild cognitive impairment (aMCI).
• aMCI amnestic mild cognitive impairment
• the term "amnestic mild cognitive impairment” refers to a mild cognitive impairment with memory loss as the predominant symptom and is frequently seen as a prodromal stage of Alzheimer's disease. For example, a person may start to forget important information that he or she would previously have recalled easily, such as appointments, conversations or recent events.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in a sex-specific treating aMCI in a subject.
• the subject is female. Therefore, in some embodiments, the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating aMCI in a female subject.
• the female subject is administered from 20 to 80 mg/day of the NAP peptide, once or twice daily.
• the female subject is administered from 25 to 70 mg/day or from 30 to 70 mg/day of the NAP peptide.
• the female subject is administered from 35 to 75 mg/day, from 40 to 70 mg/day, or from 40 to 65 of the NAP peptide.
• the female subject is administered from 40 to 80 mg/day, from 50 to 70 mg/day, or from 55 to 65 of the NAP peptide. According to some embodiments, the female subject is administered with about 30, about 35, about 40, about 45, about 50, about 55, or about 60 mg/day of the NAP peptide.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating aMCI in a male subject.
• the male subject is administered from 10 to 80 mg/day of the NAP peptide.
• the male subject is administered from 15 to 75 mg/day of the NAP peptide.
• the male subject is administered from 15 to 70 mg/day, from 20 to 60 mg/day, of the NAP peptide.
• the male subject is administered with from 20 to 40, or from 25 to 35 mg/day.
• the male subject is administered from 25 to 70 mg/day or from 30 to 70 mg/day of the NAP peptide. According to some embodiments, the male subject is administered from 35 to 75 mg/day, from 40 to 70 mg/day, or from 40 to 65 of the NAP peptide. According to some embodiments, the male subject is administered from 40 to 80 mg/day, from 50 to 70 mg/day, or from 55 to 65 of the NAP peptide. According to some embodiments, the male subject is administered with about 30, about 35, about 40, about 45, about 50, about 55, or about 60. According to any one of the above embodiments, the administration may be performed in one dose or split in several doses, e.g. 2, 3, or 4 doses.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in the sex-specific prevention of Alzheimer’s disease.
• the disease is Alzheimer's disease.
• Alzheimer's disease refers to a progressive neurologic disease of the brain that leads to the irreversible loss of neurons and dementia.
• the clinical hallmarks of Alzheimer's disease are progressive impairment in memory, judgment, decision making, orientation to physical surroundings, and language.
• the present invention provides a pharmaceutical composition
• a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in a sex-specific treating Alzheimer's disease in a subject.
• the subject is female. Therefore, in some embodiments, the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating Alzheimer's disease in a female subject.
• the female subject is administered from 1 to 80 mg/day of the NAP peptide.
• the subject is administered from 1 to 70 mg/day of the NAP peptide.
• the female subject is administered from 2 to 65 mg/day, from 5 to 60 mg/day, of the NAP peptide.
• the female subject is administered from 10 to 50 mg/day, from 15 to 45 mg/day, from 20 to 40 mg/day or from 25 to 35 mg/day of the NAP peptide or about 30 35 mg/day of the NAP peptide.
• the female subject is administered from 40 to 80 mg/day, from 45 to 75 mg/day, from 50 to 70 mg/day, from 55 to 65 mg/day or about 60 mg/day of the NAP peptide.
• the female subject is administered from 1 to 20 mg/day of the NAP peptide.
• the subject is administered from 1 to 15 mg/day of the NAP peptide.
• the female subject is administered from 2 to 10 mg/day, from 3 to 8 mg/day, of the NAP peptide. According to some embodiments, the female subject is administered from 4 to 5 mg/day or about 5 mg/day of the NAP peptide. According to any one of the above embodiments, the administration may be performed in one dose or split in several doses, e.g. 2, 3, or 4 doses. According to one embodiment, the dose of the NAP peptide is about 5 mg once daily or about 15 mg twice daily.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating Alzheimer's disease in a male subject.
• the male subject is administered from 5 to 30 mg/day of the NAP peptide.
• the male subject is administered from 1 to 80 mg/day of the NAP peptide.
• the subject is administered from 1 to 70 mg/day of the NAP peptide.
• the female subject is administered from 2 to 65 mg/day, from 5 to 60 mg/day, of the NAP peptide.
• the female subject is administered from 10 to 50 mg/day, from 15 to 45 mg/day, from 20 to 40 mg/day or from 25 to 35 mg/day of the NAP peptide. According to some embodiments, the female subject is administered from 40 to 80 mg/day, from 45 to 75 mg/day, from 50 to 70 mg/day, from 55 to 65 mg/day or about 60 mg/day of the NAP peptide. According to some embodiments, the female subject is administered from 1 to 20 mg/day of the NAP peptide. According to some embodiments, the subject is administered from 1 to 15 mg/day of the NAP peptide. According to some embodiments, the female subject is administered from 2 to 10 mg/day, from 3 to 8 mg/day, of the NAP peptide. According to some embodiments, the female subject is administered from 4 to 5 mg/day or about 5 mg/day of the NAP peptide.
• the Alzheimer's disease is at the early stage of the disease.
• the subject is at the prodromal stage of the disease.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in sex-specific prevention of Alzheimer's disease in a male subject.
• the subject is pre-or post- Alzheimer’s disease onset and is characterized by the presence in a biological sample of least one of the following biomarkers (i) of aberrant P53 protein; (ii) P- tau217; (iii) P-tau231 and (iii) P-taul81and (iv) change in ADNP expression as described e.g. in US2010303785.
• biomarkers i) of aberrant P53 protein; (ii) P- tau217; (iii) P-tau231 and (iii) P-taul81and (iv) change in ADNP expression as described e.g. in US2010303785.
• biomarkers i) of aberrant P53 protein
• P- tau217 e.g. P-tau231
• P-taul81and iv
• change in ADNP expression e.g. in US2010303785.
• biological sample encompasses a variety of sample types obtained from an organism
• the term specifically encompasses a clinical sample and includes serum, plasma, urine, biological fluids including aqueous humour and vitreous for eyes samples, and tissue samples.
• the term also encompasses samples that have been manipulated in any way after procurement, such as treatment with reagents, solubilization, or enrichment for certain components.
• the biological sample could be a blood or serum sample.
• the treatment according to some embodiments is commenced before the clinical signs of Alzheimer's disease appear.
• the treatment comprises an improvement in the score of Geriatric Depression Scale of a subject suffering from Alzheimer's disease
• the disease or disorder is autism.
• the disease or disorder is muscle disease associated with or mediated by aberrant functionality of ADNP.
• the present invention provides a pharmaceutical composition comprising NAP and a pharmaceutically acceptable carrier for use in treating the disease or disorder in a female subject.
• the female subject is administered from 1 to 80 mg/day of the NAP peptide.
• the subject is administered from 1 to 70 mg/day of the NAP peptide.
• the female subject is administered from 2 to 65 mg/day, from 5 to 60 mg/day, of the NAP peptide.
• the female subject is administered from 10 to 50 mg/day, from 15 to 45 mg/day, from 20 to 40 mg/day or from 25 to 35 mg/day of the NAP peptide. According to some embodiments, the female subject is administered from 40 to 80 mg/day, from 45 to 75 mg/day, from 50 to 70 mg/day, from 55 to 65 mg/day or about 60 mg/day of the NAP peptide. According to some embodiments, the female subject is administered from 1 to 20 mg/day of the NAP peptide. According to some embodiments, the subject is administered from 1 to 15 mg/day of the NAP peptide. According to some embodiments, the female subject is administered from 2 to 10 mg/day, from 3 to 8 mg/day, of the NAP peptide.
• the female subject is administered from 4 to 5 mg/day or about 5 mg/day of the NAP peptide.
• the present invention provides a pharmaceutical composition comprising a peptide comprising the amino acid sequence NAPVSIPQ (NAP peptide) and a pharmaceutically acceptable carrier for use in treating the disease or disorder in a male subject.
• the male subject is administered from 1 to 80 mg/day of the NAP peptide.
• the male subject is administered from 1 to 70 mg/day of the NAP peptide.
• the male subject is administered from 2 to 65 mg/day, from 5 to 60 mg/day, of the NAP peptide.
• the male subject is administered from 10 to 50 mg/day, from 15 to 45 mg/day, from 20 to 40 mg/day or from 25 to 35 mg/day of the NAP peptide. According to some embodiments, the male subject is administered from 40 to 80 mg/day, from 45 to 75 mg/day, from 50 to 70 mg/day, from 55 to 65 mg/day or about 60 mg/day of the NAP peptide. According to some embodiments, the female subject is administered from 1 to 20 mg/day of the NAP peptide. According to some embodiments, the male subject is administered from 1 to 15 mg/day of the NAP peptide.
• the male subject is administered from 2 to 10 mg/day, from 3 to 8 mg/day, of the NAP peptide.
• the male subject is administered from 4 to 5 mg/day or about 5 mg/day of the NAP peptide
• the administration may be performed in one dose or split in several doses, e.g. 2, 3, or 4 doses.
• the present invention provides a pharmaceutical composition comprising a NAP peptide and a pharmaceutically acceptable carrier for use in ameliorating and/or preventing side effects of an anti-amyloid-P therapy, wherein the therapy comprises anti-amyloid-P antibodies.
• anti-amyloid-P antibodies refer to antibodies that bind specifically to amyloid-P and are used for treatment of Alzheimer's disease.
• the anti-amyloid-P therapy is selected from aducanumab, bupineuzuman, gantenerumab, gantenerumab, lecanemab, and solanezumab.
• the anti-amyloid-P therapy is aducanumab.
• the composition is administered in a sex-specific mode.
• the subject is a female.
• the composition is administered to a female subject.
• the female subject is administered from 1 to 80 mg/day of the NAP peptide.
• the subject is administered from 1 to 70 mg/day of the NAP peptide.
• the female subject is administered from 2 to 65 mg/day, from 5 to 60 mg/day, of the NAP peptide.
• the female subject is administered from 10 to 50 mg/day, from 15 to 45 mg/day, from 20 to 40 mg/day or from 25 to 35 mg/day of the NAP peptide.
• the female subject is administered from 40 to 80 mg/day, from 45 to 75 mg/day, from 50 to 70 mg/day, from 55 to 65 mg/day or about 60 mg/day of the NAP peptide.
• the female subject is administered from 1 to 20 mg/day of the NAP peptide.
• the subject is administered from 1 to 15 mg/day of the NAP peptide.
• the female subject is administered from 2 to 10 mg/day, from 3 to 8 mg/day, of the NAP peptide.
• the female subject is administered from 4 to 5 mg/day or about 5 mg/day of the NAP peptide.
• the subject is a male.
• the pharmaceutical composition comprising the NAP peptide is administered to a male subject.
• the male subject is administered from 1 to 80 mg/day of the NAP peptide.
• the male subject is administered from 1 to 70 mg/day of the NAP peptide.
• the male subject is administered from 2 to 65 mg/day, from 5 to 60 mg/day, of the NAP peptide.
• the male subject is administered from 10 to 50 mg/day, from 15 to 45 mg/day, from 20 to 40 mg/day or from 25 to 35 mg/day of the NAP peptide.
• the male subject is administered from 40 to 80 mg/day, from 45 to 75 mg/day, from 50 to 70 mg/day, from 55 to 65 mg/day or about 60 mg/day of the NAP peptide. According to some embodiments, the male subject is administered from 1 to 20 mg/day of the NAP peptide. According to some embodiments, the male subject is administered from 1 to 15 mg/day of the NAP peptide. According to some embodiments, the male subject is administered from 2 to 10 mg/day, from 3 to 8 mg/day, of the NAP peptide.
• the male subject is administered from 4 to 5 mg/day or about 5 mg/day of the NAP peptide
• the administration may be performed in one dose or split in several doses, e.g. 2, 3, or 4 doses.
• the use comprises administering the pharmaceutical composition for at least one day before starting anti-amyloid-P therapy.
• the use comprises administering the pharmaceutical composition for at least 2, 3, 4, 5, 6 or 7 days before starting anti-amyloid-P therapy.
• the use comprises administering the pharmaceutical composition for at least 2, 3, 4, 5, 6, 7 or 8 weeks or 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 or 12 months before starting anti-amyloid-P therapy.
• the use comprises administering the pharmaceutical composition in combination with the anti-amyloid-P therapy.
• the present invention provides a method of treating or inhibiting the development or progression of a disease or disorder associated with an aberrant functionality of activity -dependent neuroprotective protein (ADNP) in a subject, wherein the treatment is gender specific.
• ADNP activity -dependent neuroprotective protein
• the present invention provides a method of treating or inhibiting the development or progression of progressive supranuclear palsy (PSP) in a female subject, the method comprises administering a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1).
• the present invention provides a method of treating or inhibiting the development or progression of progressive supranuclear palsy (PSP) in a male subject, the method comprises administering from 1 to 50 mg/day of a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1).
• the present invention provides a method of treating schizophrenia in a male subject, the method comprises administering from 10 to 80 mg/day of a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1).
• the present invention provides a method of treating or inhibiting the development or progression of aMCI in a male subject, the method comprises administering from 20 to 80 mg/day of a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1).
• the present invention provides a method of treating or inhibiting the development or progression of aMCI in a female subject, the method comprises administering from 35 to 80 mg/day of a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1).
• the present invention provides a method of preventing the development of Alzheimer's disease, preferably in a sex-specific manner/mode.
• the present invention provides a method of treating schizophrenia in a female subject, the method comprises administering from 1 to 4 mg/day of a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1).
• the present invention provides use of a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1) for preparing a medicament for sex-specific treating or inhibiting the development or progression of a disease or disorder associated with an aberrant functionality of activity-dependent neuroprotective protein (ADNP) in a subject.
• a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1) for preparing a medicament for sex-specific treating or inhibiting the development or progression of a disease or disorder associated with an aberrant functionality of activity-dependent neuroprotective protein (ADNP) in a subject.
• ADNP activity-dependent neuroprotective protein
• the present invention provides use of a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1) for preparing a medicament for treating or inhibiting the development or progression of progressive supranuclear palsy (PSP) in a female subject.
• the present invention provides use of a peptide comprising the amino acid sequence NAPVSIPQ (SEQ ID NO: 1) for preparing a medicament for treating schizophrenia in a male subject, wherein the treating comprises administering medicament comprise administering from 15 to 80 mg/day of the peptide.
• the treatment using NAP may be combined with any treatment commonly used for the corresponding disease.
• a and/or B includes, (A and B) and (A or B).
• the term “comprising the amino acid sequence” encompasses the term “consisting of the amino acid sequence” and may be replaced by it.
• the term “consisting of’ excludes any component, step or procedure not specifically delineated or listed.
• the term “consisting essentially of’ means that the composition or component may include additional ingredients, but only if the additional ingredients do not materially alter the basic and novel characteristics of the claimed compositions or methods.
• Example 1 NAP for sex-specific treatment of Progressive supranuclear palsy
• a secondary outcome was brain ventricular volume as measured with boundary shift integral analysis of T1 -weighted magnetic resonance imaging (MRI) scans, mostly collected at week 0 and 52.
• MRI magnetic resonance imaging
• selected patients were also subjected to lumbar puncture and assessment of Tau content and Tau hyperphosphorylation in the cerebrospinal fluid (CSF). Boxer et al concluded that Davunetide is not an effective treatment for PSP and that clinical trials of disease-modifying treatment are feasible in patients with PSP and should be pursued with other promising tau- directed treatments.
• the cohort was composed of female and male PSP patients treated with davunetide or placebo (sample sizes for sex-treatment groups at 52 weeks of treatment: 48-55), outcome variables included ventricular volume (will be referred to as volume), PSPRS and SEADL assessed at study initiation and follow up to 52 weeks after twice daily treatment.
• Fig. 1 reveals that at the baseline, the tested population differed by weight and height, with obvious higher male values. Furthermore, on average, the randomized female davunetide group showed significantly increased weight compared to the placebo group. Age- wise, there were no differences.
• Davunetide treatment provides significant neuroprotection against age/brain ventricular volume-dependent increases in PSP woman patients
• Davunetide neuroprotection is significantly correlated with the study primary endpoints: SEADL and PSPRS [0137]
• Fig. 5 depicts correlation plots of percent change compared to baseline at 52-week davunetide vs. placebo treatment results including the study primary endpoints, PSPRS and SEADL, the secondary end point of brain ventricular volume change as well as age.
• the PSPRS measures disability across 28 items in six domains: daily activities (by history), behavior, bulbar, ocular motor, limb motor and gait/midline.
• CGIds Clinical Global Impression of Disease Severity
• GDS Geriatric Depression scale
• RBANS Repeatable Battery for the Assessment of Neuropsychological Disease Severity
• ADNP eukaryotic linear motif
• Caspases represent key players in apoptosis, development and differentiation. Caspases recognize the respective substrates by specific cleavage motifs. There are five amino acids of the substrate around the caspase cleavage site, named (N- to C-terminal): P4, P3, P2, Pl, P-1. The scissile bond between the essential aspartate at Pl and P-1, usually a small amino acid, is cleaved by caspase-3 and -7, whereas positions P4 to P-1 are important for substrate specificity and recognition.
• ADNP residues 734-738 contain the motif DDSDS which is a recognition motif for caspase-3 and caspase-7. Cleavage of the caspase substrates results in characteristic morphological features of apoptotic cell death, including membrane blebbing, pyknotic nuclei, cell rounding, and formation of apoptotic vesicles. Thus, activated caspase- 3, a major enzyme in the apoptotic pathway, is often used as a marker for apoptotic cells. The length of the ADNP protein after the caspase cleavage is 737aa.
• ADNP autism/intellectual disability causing de novo mutations in ADNP in p.Arg730*, closely located near the caspase cleavage site.
• p.Arg730Thrfs*4 which is one of the pathogenic mutations in ADNP that is correlated to aging/ Alzheimer’s disease, truncates ADNP length to a protein of 734aa.
• PCSKs PCSKs mammalian subtilisin/kexin isozymes
• SKIs subtilisin-like proprotein convertases
• PCS KI proprotein convertase 1, NEC1
• PCSK2 proprotein convertase 2, NEC2
• PCS KI proprotein convertase 1, NEC1
• PCSK2 proprotein convertase 2, NEC2
• ADNP residues 367-371 KQLLP include the cleavage motif recognized by the members of the subtilisin-like family.
• the length of ADNP after cleavage in this site is 367aa.
• the length of ADNP after the truncating mutation p.Ile359Thrfs*8 is 367aa, found in the post mortem Alzheimer’s brain.
• PACE4 paired basic amino acid cleaving system 4, SPC4
• SPC4 paired basic amino acid processing sites
• substrates include transforming growth factor beta-related proteins, proalbumin, and von Willebrand factor and assorted neuropeptides.
• paired basic amino acids are found in ADNP.
• ADNP a short active motif within ADNP
• ADNP Alzheimer’s disease
• SIRT1 sirtuin 1
• FOXO3 Forkhead box 03
• ADNP directed therapy in susceptible individuals exhibiting one or more of the modified P53 biomarker, P-tau217 and Phosphorylated Tau, identified in body fluids and by imaging.
• a suggested therapy would be nasal NAP (davunetide) administration with previous human experience and cognitive score protection/enhancement in amnestic mild cognitive impairment (aMCI) patients.
• ADNP the parent protein of the NAP peptide
• RNA sequencing results Wang et al., J Clin Invest. 2022;132(2):el49904
• FDR False Discovery Rate for the temporal cortices indicated a very high significance (0.0008) for a higher ADNP expression in the Alzheimer’s disease samples compared to controls.
• Example 3 Sex-specific treatment of amnestic mild cognitive impairment.
• DMTS is a test of delayed and recognition memory using simultaneous and delayed visual matching to sample.
• the subject is shown a complex visual pattern on a screen and after a delay (simultaneous, 0, 4 or 12 s), 4 patterns are displayed.
• the subject’s task is to select the pattern that matches the original sample, here depicted after a 12 s interval.
• subjects suffering from aMCI were treated with either 5mg daily or 15mg twice daily (BID) by intranasal davunetide administration (1 or three puffs of the same strength davunetide solution). Treatment was for 12 weeks and testing was at baseline and every four weeks, including also 4 weeks after cessation of treatment.
• the 5mg daily dose was beneficial for women as detected after 6 and 12 weeks of treatment. While the same low dose was effective in men as well (Fig. 10C) especially after 6 weeks of treatment, the 15mg/twice-daily treatment showed surprising significant results only in men, treated for 12 weeks (Fig. 10 D). This is contrary to Javitt's statements that 15mg/bid is not significantly effective on UPSA.
• Hacel HECT Domain And Ankyrin Repeat Containing E3 Ubiquitin Protein Ligase 1).
• Hacel is associated with ataxia and Huntington disease and is also involved in depression and Alzheimer’s disease.
• NAP protection (Fig. 11) further attests to sexdependent treatments of the diseases associated or mediated with Hacel.

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