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
  • A61K38/1883—Neuregulins, e.g.. p185erbB2 ligands, glial growth factor, heregulin, ARIA, neu differentiation factor
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
  • A61K47/6801—Drug-antibody or immunoglobulin conjugates defined by the pharmacologically or therapeutically active agent
  • A61K47/6803—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates
  • A61K47/6811—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates the drug being a protein or peptide, e.g. transferrin or bleomycin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
  • A61K47/6835—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site
  • A61K47/6851—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site the antibody targeting a determinant of a tumour cell
• • 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
  • A61P9/06—Antiarrhythmics
• • 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
  • C07K14/475—Growth factors; Growth regulators
  • C07K14/4756—Neuregulins, i.e. p185erbB2 ligands, glial growth factor, heregulin, ARIA, neu differentiation factor
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/32—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against translation products of oncogenes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
  • C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2319/00—Fusion polypeptide

Definitions

• NRG Neuregulin
• HRG glial growth factor
• NDF new differentiation factor
• the NRG protein family has four members: NRG-1, NRG-2, NRG-3 and NRG-4.
• NRG (including NRG-1) plays a particularly important role in the development of the heart.
• NRG-1 directly binds to membrane-bound ErbB3 or ErbB4, inducing dimerization to create ErbB2/ErbB4, ErbB2ZErbB3, ErbB3ZErbB3 and ErbB4ZErbB4 complexes, and subsequent intracellular signaling.
• expression of NRG induces paracrine signaling to promote growth and differentiation in cardiac tissue during embryogenesis, with deletion of any of ErbB2, ErbB4 or NRG-1 leading to embryonic lethality.
• cancer therapies blocking ErbB2 receptor signaling have been shown to have significant cardiotoxicity side-effects, demonstrating in humans that ErbB2-mediated signaling is essential not only for development but also for the homeostasis of healthy cardiac tissue.
• NRG-1 signal transduction plays a part in the development and function of other organ systems, as well as in the pathogenesis of human disease (including schizophrenia and head and neck cancer).
• NRG-1 has many isomers.
• Research in gene mutated mice indicates that isomers with different N terminal regions or EGF- like domains have different in vivo functions.
• the present invention is based on the NRG-ipa2 isoform.
• Endogenous NRG-1 binds to and induces signaling through both ErbB3 (HER3) and ErbB4 (HER4).
• HER3 ErbB3
• HER4 ErbB4
• Numerous pre-clinical and clinical studies have shown the therapeutic potential of NRG-1 across a variety of cardiovascular indications, principally through its interactions with cardiomyocyte-expressed ErbB4 (HER4).
• rhNRG-1 recombinant human NRG-1
• signaling of NRG-1 through HER3 may promote cancer development and/or progression, raising significant concerns for any application requiring chronic administration or without grave cardiovascular (CV) risk factors.
• CV grave cardiovascular
• NRG-1 may disrupt gastrointestinal (GI) epithelial integrity and homeostasis, leading to severe GI toxicity and thus loss of therapeutic window for NRG-1.
• GI gastrointestinal
• both clinical-stage active protein fragments of rhNRG-1 have shown a short half-life, indicating that burdensome dosing and administration schedules may be required to achieve the desired therapeutic levels of exposure.
• burdensome dosing and administration schedules may be required to achieve the desired therapeutic levels of exposure.
• the present invention addresses these needs by providing a recombinant protein comprising a fusion of the rhNRG-1 active domain with a HER3-specific antagonist antibody: HER3 signaling is blocked in a way that mitigates the oncogenic risk and GI toxicity of rhNRG- 1, and at the same time the antibody backbone format confers a molecular half-life of a typical monoclonal antibody, enabling more convenient dosing and administration for the product.
• the disclosure provides methods of treating atrial fibrillation and/or cardiac fibrosis in a subject, comprising administering to the subject a recombinant fusion protein comprising a fragment of neuregulin-1 (NRG-1) fused to a monospecific ErbB3 (HER3) monoclonal antibody (mAb).
• the cardiac fibrosis comprises atrial fibrosis.
• the disclosure provides methods of treating atrial fibrillation in a subject, comprising administering to the subject a recombinant fusion protein comprising a fragment of neuregulin- 1 (NRG-1) fused to a monospecific ErbB3 (HER3) monoclonal antibody (mAb).
• the atrial fibrillation is associated with atrial fibrosis.
• the disclosure provides methods of treating atrial fibrosis in a subject, comprising administering to the subject a recombinant fusion protein comprising a fragment of neuregulin- 1 (NRG-1) fused to a monospecific ErbB3 (HER3) monoclonal antibody (mAb).
• the disclosure provides a recombinant fusion protein comprising a fragment of neuregulin-1 (NRG-1) fused to a monospecific ErbB3 (HER3) monoclonal antibody (mAb) for use in a method of treating atrial fibrillation and/or cardiac fibrosis.
• the cardiac fibrosis comprises atrial fibrosis.
• the NRG-1 fragment comprises an active domain of NRG-1.
• the NRG-1 fragment comprises the ERBB3/4 binding domain.
• the NRG-1 fragment binds to and induces signaling through ErbB4 (HER4).
• the mAb inhibits NRG-1 signaling through ErbB3 (HER3).
• the NRG-1 fragment comprises the NRG-1 B2a isoform.
• the NRG-1 fragment is fused via its N-terminal amino acid to the C-terminus of the antibody heavy chain using a linker.
• the linker comprises at least one copy of a Gly-Gly-Gly-Gly-Ser-Gly-Gly-Gly-Gly-Gly-Ser linker set forth in SEQ ID NO: 5.
• the C-terminus of the antibody heavy chain comprises the Fc domain of the antibody.
• the monoclonal antibody is glycosylated.
• the NRG-1 fragment comprises the amino acid sequence of SEQ ID NO: 4.
• the mAb comprises a heavy chain amino acid sequence of SEQ ID NO: 2.
• the mAb comprises a light chain amino acid sequence of SEQ ID NO: 3.
• the mAb comprises a substitution mutation in at least one of amino acids 234, 239 and 434 of SEQ ID NO: 2.
• the at least one substitution mutation comprises a L234F mutation, a S239A mutation, a N434A mutation, or a combination thereof.
• the recombinant fusion protein comprises the amino acid sequences of SEQ ID NO: 3 and SEQ ID NO: 14.
• the recombinant fusion protein promotes HER2/4 signaling over HER2/3 signaling relative to the signal induction potential of recombinant NRG-1. In some embodiments, the recombinant fusion protein promotes proliferation, differentiation and survival of cardiomyocytes or cardiac tissue in the subject. In some embodiments, the recombinant fusion protein attenuates proliferation of tumor or cancer cells relative to recombinant NRG-1.
• administering the recombinant fusion protein reduces the duration of an atrial fibrillation episode, or reduces the frequency with which atrial fibrillation occurs. In some embodiments, administering the recombinant fusion protein reduces a sign or a symptom of atrial fibrillation or atrial fibrosis. In some embodiments, the symptom of atrial fibrillation comprises irregular heartbeat, heart palpitations, lightheadedness, extreme fatigue, shortness of breath, chest pain or a combination thereof. In some embodiments, the sign of atrial fibrosis comprises collagen deposition, and administering the recombinant fusion protein reduces collagen deposition in atrial tissue.
• the NRG-1 binds to and induces signaling through ErbB4 (HER4).
• the mAb inhibits NRG-1 signaling through ErbB3 (HER3).
• kits comprising an effective amount of a recombinant fusion protein of the invention or pharmaceutical composition comprising a recombinant fusion protein of the invention.
• the disclosure provides a recombinant fusion protein comprising a fragment of neuregulin-1 (NRG-1) fused to a monospecific ErbB3 (HER3) monoclonal antibody (mAb) for use in the manufacture of a medicament for the treatment of atrial fibrillation and/or cardiac fibrosis.
• NSG-1 neuregulin-1
• HER3 monospecific ErbB3
• mAb monoclonal antibody
• FIG. 1 shows the construction of the expression plasmids for expressing the recombinant fusion protein disclosed herein.
• FIG. 2 A illustrates a molecular schematic of an anti-HER.3 mAb/NRG-1 fusion protein of the disclosure.
• FIG. 2B shows representative data generated by SDS-PAGE analysis.
• FIG. 2C shows Western blot results detected by primary antibody specific for the 61- amino acid active fragment of NRG-1 comprising the HER3/4 binding domain (“NRG-1”, R&D Systems, Minneapolis, MN).
• FIG. 2D shows Western blot results detected by primary antibody specific for IgG.
• FIG. 3 illustrates a binding analysis showing that the recombinant fusion protein disclosed herein binds to HER3 protein (Curve 1, Step 2) and can simultaneously bind an anti- NRG-1 antibody (Curve 1, Step 3). Note that Fc mutations were introduced into the recombinant fusion protein disclosed herein to knock out the Fc effector function of the parent antibody sequence encoding a HER3 specific antibody, which may mitigate the undesired cytotoxicity towards normal tissues expressing HER3 receptor.
• FIG. 4A shows the mean relative growth rate in the NCI-N87 gastric cancer cell line.
• FIG. 4B shows the mean relative growth rate in the MCF-7 breast cancer cell line.
• FIG. 4C shows the mean relative growth rate in the RT-112 bladder cancer cell line.
• FIG. 4D shows the mean relative growth rate in the T47D breast cancer cell line.
• the recombinant fusion protein provided herein demonstrates markedly lower activity in promoting cancer cell proliferation.
• FIGS. 5A-5B illustrate that despite reduced cancer cell growth potential, the recombinant fusion protein provided herein fully preserves the ability to induce PI3K/AKT signaling in cardiomyocytes - demonstrating comparable activity to recombinant NRG-1 and GP120 mAb/NRG-1 fusion protein.
• FIG. 5A is a plot showing the relative ratio of phospho- AKT (pAKT) to total AKT (tAKT) versus antibody concentration (in nM) in human cardiomyocytes treated with the recombinant fusion protein of the disclosure and controls.
• FIG. 5B is a Western Blot analysis of AKT phosphorylation in human cardiomyocytes treated with the recombinant fusion protein of the disclosure and controls.
• FIGS. 6A-6C show direct comparison of HER2/4 and HER2/3 dimerization in the presence of the recombinant fusion protein disclosed herein and controls.
• FIG. 6A shows the assay principle for detecting ligand-induced dimerization.
• PathHunter Dimerization Assay developed by Eurofins DiscoverX (Fremont, CA) is used for detecting ligand-induced dimerization of two subunits of a receptor-dimer pair.
• P-gal enzyme is split into two fragments, ProLink (PK) and enzyme receptor (EA).
• the cells have been engineered to co-express target protein 1 fused to enzyme donor PK, and target protein 2 fused to enzyme acceptor EA.
• FIG. 6B is a plot illustrating that the recombinant fusion protein provided herein can induce HER2/HER4 dimerization with potency comparable to NRG-1.
• FIG. 6C is a plot illustrating that the recombinant fusion protein provided herein is significantly less potent than NRG-1 in inducing HER2/HER3 dimerization.
• FIG. 7 illustrates the binding affinity of anti-HER3 mAb/NRG-1 fusion protein of the invention to HER3 antigen across different species including human, monkey, rat and mouse.
• the equilibrium dissociation rate (KD) determined by BIAcore analysis is 3.13xlO' 10 (human), 3.97xlO' 10 (monkey), 2.68xl0' 9 (rat) and 2.77xl0' 9 (mouse), respectively.
• FIG. 8 is a plot that illustrates the effect of the recombinant fusion protein on ejection fraction (EF) in rat model of systolic heart failure induced by coronary artery ligation.
• FIGS. 9A-9F is a series of 6 images that show histopathological changes in cardiac muscle structure in a rat model of systolic heart failure induced by coronary artery ligation. Cardiac tissues next to the surgical site were collected and fixed in 4% formaldehyde, paraffin sections were then prepared and stained with H&E.
• FIG. 9A shows cardiac tissue from a sham surgery control rat.
• FIG. 9B shows cardiac tissue from a systolic heart failure model rat treated with vehicle control.
• FIG. 9C shows cardiac tissue from a systolic heart failure model rat treated with GP120 mAb/NRG-1 (10 mg/kg).
• FIG. 9A-9A shows cardiac tissue from a sham surgery control rat.
• FIG. 9B shows cardiac tissue from a systolic heart failure model rat treated with vehicle control.
• FIG. 9C shows cardiac tissue from a systolic heart failure model rat treated with GP120
• FIG. 9D shows cardiac tissue from a systolic heart failure model rat treated with anti-HER3 mAb/NRG-1 (1 mg/kg).
• FIG. 9E shows cardiac tissue from a systolic heart failure model rat treated with anti-HER3 mAb/NRG-1 (3 mg/kg).
• FIG. 9F shows cardiac tissue from a systolic heart failure model rat treated with anti-HER3 mAb/NRG- 1 (10 mg/kg).
• FIG. 10 is a graph illustrating the evaluation of in vivo anti -turn or activity using a subcutaneous FaDu carcinoma xenograft model in NOD/SCID mice.
• FIG. 11 is a graph illustrating body -weight changes in tumor bearing mice treated with the recombinant fusion protein of the disclosure and controls.
• FIG. 12 is a graph illustrating the pharmacokinetic profile of the recombinant fusion protein in cynomolgus monkeys (macaques).
• FIG. 13 A shows a diagram depicting a fibrotic assay in which fibrosis is induced in rat atrial tissue samples in vitro.
• FIG. 13B shows a graph depicting collagen type I induction in the absence of an exemplary NRG-1/HER3 antibody fusion protein, in the assay depicted in FIG. 13 A.
• the x- axis depicts the day samples were taken.
• the y-axis depicts mRNA expression of collagen type I (collagen type I alpha 1 chain, or Collal, mRNA) expressed as fold change in Collal mRNA present over the level of Collal mRNA present on day 1 of the assay.
• FIG. 13C shows a graph depicting collagen type III induction in the absence of an exemplary NRG-1/HER3 antibody fusion protein, in the assay depicted in FIG. 13 A.
• the x- axis depicts day samples were taken.
• the y-axis depicts mRNA expression of collagen type III (collagen type III alpha chain 1, or Col3ali, mRNA) expressed as fold change in Col3al mRNA present over the level of Col3al mRNA present on day 1 of the assay.
• collagen type III collagen type III alpha chain 1, or Col3ali, mRNA
• FIG. 14A shows a graph depicting the effect of an NRG-1/HER3 antibody fusion protein (NRG-1/HER3) on collagen type I induction, in the assay depicted in FIG. 13 A.
• the x- axis depicts day samples were taken.
• the y-axis depicts mRNA expression of collagen type I expressed as fold change in Collal mRNA present over the level of Collal mRNA present on day 2 of the assay in the absence of NRG-1/HER3.
• FIG. 14B shows a graph depicting the effect of NRG-1/HER3 antibody fusion protein (NRG-1/HER3) on collagen type III induction in the assay depicted in FIG. 13 A.
• the x-axis depicts day samples were taken.
• the y-axis depicts mRNA expression of collagen type III expressed as fold change in Col3al mRNA present over the level of Col3al mRNA present on day 2 of the assay in the absence of NRG-1/HER3.
• FIG. 15 shows a diagram depicting programmed electrical stimulation (PES) with a trans-jugular octapolar catheter used to measure atrial fibrillation (AF) inducibility in the in vivo experimental models depicted in FIG. 16 and FIG. 18.
• FIG. 16 shows a diagram depicting an angiotensin-II (Ang-II)-induced hypertension mouse model to measure atrial fibrillation in vivo.
• PES programmed electrical stimulation
• AF atrial fibrillation
• FIG. 17A shows a graph depicting the effect of the NRG-1/HER3 antibody fusion protein on total AF duration in the model depicted in FIG. 16.
• the x-axis depicts treatment conditions: CTRL, sham treated control; ANG II + Vehicle, vehicle only control, ANG II + NRG-1/HER3, animals with ANG II induced hypertension that were treated with the NRG- 1/HER3 antibody fusion protein.
• the y-axis depicts time in seconds (s).
• FIG. 17B shows a graph depicting the effect of the NRG-1/HER3 antibody fusion protein on AF inducibility in the model depicted in FIG. 16.
• the x-axis depicts treatment.
• the y-axis depicts the percentage of mice with AF.
• FIG. 18 shows a diagram depicting a second atrial fibrillation (AF) model in which mice were fed a high fat diet.
• AF atrial fibrillation
• FIG. 19A shows a graph depicting body weight over time for the three groups of mice in the model depicted in FIG. 18.
• the x-axis depicts time in weeks (W).
• the y-axis depicts body weight.
• CRTL mice not fed a high fat diet, and treated with a vehicle alone control
• HFD + vehicle mice fed a high fat diet and treated with a vehicle alone control
• HFD + NRG- 1/HER3 mice fed a high fat diet and treated with the NRG-1/HER3 antibody fusion protein.
• FIG. 19B shows a graph depicting the effect of the NRG-1/HER3 antibody fusion protein on total body weight over time in the metabolic syndrome model depicted in FIG. 18.
• the x-axis depicts time in weeks (W).
• the y-axis depicts change in body weight.
• FIG. 19C shows a graph depicting the effect of the NRG-1/HER3 antibody fusion protein on glucose tolerance in the model depicted in FIG. 18.
• the x-axis depicts time after 20% glucose injection.
• the y-axis depicts blood glucose concentration in mg/dL.
• FIG. 20A shows a graph depicting the effect of the NRG-1/HER3 antibody fusion protein on total duration of irregular atrial arrhythmia in the metabolic syndrome model depicted in FIG. 18.
• the x-axis depicts the treatment condition: WT, wild type, no high fat diet and injected with vehicle alone; HFD + vehicle: mice fed a high fat diet and treated with a vehicle alone control; HFD + NRG-1/HER3, mice fed a high fat diet and treated with the NRG- 1/HER3 antibody fusion protein.
• the y-axis depicts the time in seconds (s).
• FIG. 20B shows a graph depicting the effect of the NRG-1/HER3 antibody fusion protein on arrhythmia inducibility in the metabolic syndrome model depicted in FIG. 18.
• the x-axis depicts the treatment condition: CRTL: mice not fed a high fat diet, and treated with a vehicle alone control; HFD + vehicle: mice fed a high fat diet and treated with a vehicle alone control; HFD + NRG-1/HER3, mice fed a high fat diet and treated with the NRG-1/HER3 antibody fusion protein.
• the y-axis depicts the percentage of mice with induced AF.
• FIGS. 21A-21F are a series of images that show Collagen I immunohistochemistry staining of cardiac tissue from systolic heart failure (or heart failure with reduced ejection fraction, HFrEF) model rats (Example 7). Rats were treated with sham surgery (FIG. 21A), or with surgery and vehicle alone (FIG. 21B), a GP120-NRG-1 antibody fusion protein (FIG. 21C), 1 mg/kg NRG-1/HER3 antibody fusion protein (FIG. 2 ID), 3 mg/kg NRG-1/HER3 antibody fusion protein (FIG. 21E), or 10 mg/kg NRG-1/HER3 antibody fusion protein (FIG. 21F).
• FIG. 22 is a diagram showing the experimental design for testing the effect of NRG- 1/HER3 antibody fusion protein in an Aachener mini-pig model of deoxycorticosterone acetate ( an aldosterone agonist) induced hypertension and atrial fibrosis.
• FIG. 23 shows a pair of electrocardiograms (ECGs) from a DOCA-model mini-pigs and an equation.
• the top ECG is a representative ECG in which 50 Hz burst pacing induced atrial fibrillation.
• the bottom ECG is a representative ECG in which 50 Hz burst pacing did not induce atrial fibrillation.
• the equation shows how the ECG data was used to calculate atrial fibrillation inducibility.
• FIG. 24 is a plot showing mean atrial pressure (in mmHg, y-axis) for control, DOCA + vehicle (VEH), and DOCA+ NRG-1/HER3 mini-pigs.
• FIG. 25 is a plot showing atrial fibrillation (AF) inducibility in control, DOCA + vehicle, and DOCA+ NRG-1/HER3 mini-pigs. AF inducibility was calculated as shown in FIG. 23.
• FIG. 26 is a plot (left) and three representative images (right) that show the degree of atrial fibrosis in control, DOCA + vehicle, and DOCA+ NRG-1/HER3 mini-pigs.
• the current invention utilizes a recombinant fusion protein comprising a fusion between a monoclonal antibody -fused to an active fragment of a neuregulin-1 protein isoform across a variety of cardiovascular and central nervous system (CNS) indications.
• CNS central nervous system
• Neuroregulin or neuregulin analogs are molecules that can activate ErbB2/ErbB4 or ErbB2/ErbB3 heterodimer protein tyrosine kinases, such as all neuregulin isoforms, neuregulin EGF domain alone, neuregulin mutants, and any kind of neuregulin-like gene products that also activate the above receptors.
• the preferred “neuregulin” used in this invention is a polypeptide fragment of human neuregulin 1 P2 isoform containing the EGF-like domain and the receptor binding domain. In one embodiment, the neuregulin fragment is an active fragment.
• Neuregulin-1 and isoforms thereof are also known in the art as neuregulin 1 (NRG1), glial growth factor (GGF), Heregulin (HGL), HRG, new differentiation factor (NDF), ARIA, GGF2, HRG1, HRGA, SMDF, MST131, MSTP131 and NRG1 intronic transcript 2 (NRG1-IT2).
• the terms “ErbB3”, “ErbB3 (HER3)”, “HER3” refer to the same protein (or the same gene when in reference thereto) and are used interchangeably herein.
• the recombinant fusion comprises a monoclonal antibody portion that is specific for ErbB3.
• ErbB3 (erb-b2 receptor tyrosine kinase 3) is also known in the art as FERLK, LCCS2, ErbB- 3, c-erbB3, erbB3-S, MDA-BF-1, c-erbB-3, pl80-ErbB3, p45-sErbB3 and p85-sErbB3.
• ErbB4 refers to the same protein (or the same gene when in reference thereto) and are used interchangeably herein.
• ErbB4 erb-b2 receptor tyrosine kinase 4
• ALS19 and pl80erbB4 are also known in the art as ALS19 and pl80erbB4.
• ErbB2 refers to the same protein (or the same gene when in reference thereto) and are used interchangeably herein.
• ErbB2 erb-b2 receptor tyrosine kinase 2
• NEU NEU
• NGL NGL
• TKR1 CD340
• HER-2 MLN 19
• HER-2/neu HER-2/neu
• active refers to a fragment having a biological activity or biological function. In some embodiments, the activity is equal to or approximates the activity of the wild-type protein.
• subject includes, but is not limited to, a mammal, including, e.g., a human, non-human primate (e.g., monkey), mouse, pig, cow, goat, rabbit, rat, guinea pig, hamster, horse, monkey, sheep, or other non-human mammal, a non-mammal, including, e.g., a non-mammalian vertebrate, such as a bird (e.g., a chicken or duck) or a fish; and a non- mammalian invertebrate.
• the methods and compositions of the invention are used to treat (both prophylactically and/or therapeutically) non-human animals.
• subject can also refer to patients, i.e. individuals awaiting or receiving medical care.
• composition means a composition suitable for pharmaceutical use in a subject, including an animal or human.
• a pharmaceutical composition generally comprises an effective amount of an active agent (e.g., the recombinant fusion proteins of the invention) and a pharmaceutically acceptable carrier, diluent or excipient (e.g., a buffer, adjuvant, or the like).
• the term “effective amount” means a dosage or amount sufficient to produce a desired result.
• the desired result may comprise an objective or subjective improvement in the recipient of the dosage or amount (e.g., long-term survival, decrease in number and/or size of tumors, effective prevention of a disease state, etc.).
• a “prophylactic treatment” is a treatment administered to a subject who does not display signs or symptoms of a disease, pathology, or medical disorder, or displays only early signs or symptoms of a disease, pathology, or disorder, such that treatment is administered for the purpose of diminishing, preventing, or decreasing the risk of developing the disease, pathology, or medical disorder.
• a prophylactic treatment functions as a preventative treatment against a disease or disorder.
• a “prophylactic activity” is an activity of an agent, such as the recombinant fusion protein of the invention, or composition thereof, that, when administered to a subject who does not display signs or symptoms of a pathology, disease or disorder (or who displays only early signs or symptoms of a pathology, disease, or disorder) diminishes, prevents, or decreases the risk of the subject developing the pathology, disease, or disorder.
• a “prophylactically useful” agent or compound refers to an agent or compound that is useful in diminishing, preventing, treating, or decreasing development of a pathology, disease or disorder.
• a “therapeutic treatment” is a treatment administered to a subject who displays symptoms or signs of pathology, disease, or disorder, in which treatment is administered to the subject for the purpose of diminishing or eliminating those signs or symptoms of pathology, disease, or disorder.
• a “therapeutic activity” is an activity of an agent, such a recombinant fusion protein of the invention, or a composition thereof, that eliminates or diminishes signs or symptoms of a pathology, disease or disorder, when administered to a subject suffering from such signs or symptoms.
• a “therapeutically useful” agent or compound indicates that an agent or compound is useful in diminishing, treating, or eliminating such signs or symptoms of the pathology, disease or disorder.
• treating cancer means reversing, alleviating, inhibiting the progress of, or preventing, either partially or completely, the growth of tumors, tumor metastases, or other cancer-causing or neoplastic cells in a subject.
• treatment refers to the act of treating.
• cardiovascular disease means preventing, inhibiting, suppressing, delaying, reversing, or alleviating, either partially or completely, the onset of a cardiovascular disease or condition in a subject, or the progression of a pre-existing cardiovascular disease or condition, or a symptom thereof, in a subject.
• cardiovascular diseases include chronic heart failure / Congestive heart failure (CHF), acute heart failure / myocardial infarction (MI), left ventricular systolic dysfunction, reperfusion injury associated with MI, chemotherapy-induced cardiotoxicity (adult or pediatric), radiation-induced cardiotoxicity, adjunct to surgical intervention in pediatric congenital heart disease, and atrial fibrosis.
• Non-limiting examples of symptoms of cardiovascular disease include shortness of breath, cough, rapid weight gain, swelling in legs, ankles and abdomen, dizziness, fatigue, weakness, dizziness, chest pain, fainting (syncope), tachychardia, bradychardia and arrhythmia such as atrial fibrillation.
• Methods of determining the progression of cardiovascular disease and the effectiveness of treatment will be readily apparent to one of ordinary skill in the art.
• the progression of various cardiovascular diseases can be determined by ejection fraction, electrocardiogram (ECG), Holter monitoring, echocardiogram, stress test, cardiac catheterization, cardiac computerized tomography (CT) scan and cardiac magnetic resonance imaging (MRI).
• fibrosis refers the immoderate formation and deposition of extracellular matrix (ECM) components, for example collagen.
• ECM extracellular matrix
• Fibrotic ECM compromises tissue homeostasis, and can lead to organ dysfunction due to loss of architectural integrity and aberrant remodeling. Fibrosis is characterized by the proliferation of fibroblasts, which can differentiate into myofibroblasts which secrete ECM proteins.
• Cardiac fibrosis refers to fibrosis of the heart, generally, and includes atrial fibrosis, as well as fibrosis affecting other regions of the heart, such as, but not limited to, the ventricles, myocardium, pericardium, endocardium and valves.
• atrial fibrosis As well as fibrosis affecting other regions of the heart, such as, but not limited to, the ventricles, myocardium, pericardium, endocardium and valves.
• fibrosis In the heart, replacement or reparative fibrosis occurs after cardiac injury, and is associated with cardiomyocyte death and the replacement of necrotic myocardial areas with fibrotic scar tissue. In reactive fibrosis, there is increased deposition of collagen and other ECM proteins in the interstitial space that surrounds cardiac cells and vessels, causing this space to expand, without replacement of injured or dead cardiomyocytes.
• Atrial fibrosis refers to fibrosis of the atrium. Atrial fibrosis is strongly associated with atrial fibrillation (AF), one of the most common arrhythmias in humans. Without wishing to be bound by theory, it is thought that atrial fibrosis causes abnormal electrical conduction through the atrium, leading to atrial fibrillation.
• AF atrial fibrillation
• Fibrosis can be detected by any suitable means known in the art, including, but not limited to DE-MR imaging (MRI), circulating biomarkers (e.g., Galactin-3, MMP-3, MMP-9, high-sensitivity cardiac troponin T, Osteopontin, suppression of tumorigenicity 2, connective tissue growth factor (CTGF), resistin (RETN), Periostin, and midregional pro-atrial natriuretic peptide, as well as microRNAs such as miRNA-15, miR-21, miR-29c, miR-328, miR-30a, miR-214, miR-503 and miR-133a) and electroanatomic voltage mapping.
• MRI DE-MR imaging
• biomarkers e.g., Galactin-3, MMP-3, MMP-9, high-sensitivity cardiac troponin T, Osteopontin, suppression of tumorigenicity 2, connective tissue growth factor (CTGF), resistin (RETN), Periostin, and midregional pro-atrial n
• arrhythmia refers to an irregular heartbeat, and includes both tachycardia (abnormally fast heartbeats) and bradychardia (abnormally slow heartbeats).
• Atrial fibrillation is an irregular and often very rapid heart rhythm that can lead to blood clots in the heart.
• AF Atrial fibrillation
• the normal beating of the atrium is irregular, impeding blood flow from the atria to the ventricles.
• AF may be acute, or chronic.
• AF can be assessed in terms of the duration of AF episodes, and the number of episodes that occur in a given unit of time (e.g. , AF/episodes per day, week or month).
• Paroxysmal AF begins suddenly and ends spontaneously within 7 days. In contrast, persistent AF occurs for longer than 7 days and ends spontaneously or with treatment. Long-standing persistent AF refers to uninterrupted AF for more than a year. Permanent AF refers to AF that persists despite treatment to restore normal sinus rhythm. Symptoms of AF include irregular heartbeat, heart palpitations, lightheadedness, extreme fatigue, shortness of breath and chest pain.
• treating a central nervous system (CNS)-related disease means method of preventing, inhibiting, suppressing, delaying, reversing or alleviating, either partially or completely, the onset of a CNS-related disease or condition in a subject.
• the term “treating a CNS-related disease” also can also mean reversing, slowing or otherwise alleviating a pre-existing CNS-related disease or condition, or a symptom thereof.
• CNS-related disease or conditions that can be treated with the methods of the disclosure include amyotrophic lateral sclerosis (ALS), Parkinson’s disease, Alzheimer's Disease, Bell's Palsy, epilepsy and seizures, Guillain-Barre Syndrome, stroke, traumatic brain injury, multiple sclerosis or a combination.
• Treating CNS- related diseases can improve or prevent symptoms such as tremors, bradykinesia, rigid muscles, loss of balance, impaired posture, speech changes, loss of motor control, paralysis, trouble swallowing, muscle cramps, seizures, memory loss and confusion.
• nucleic acids or polypeptide sequences refer to two or more sequences or subsequences that are the same or have a specified percentage of nucleotides or amino acid residues that are the same, when compared and aligned for maximum correspondence. To determine the percent identity, the sequences are aligned for optimal comparison purposes (e.g., gaps can be introduced in the sequence of a first amino acid or nucleic acid sequence for optimal alignment with a second amino or nucleic acid sequence). The amino acid residues or nucleotides at corresponding amino acid positions or nucleotide positions are then compared.
• the molecules are identical at that position.
• substantially identical in the context of two nucleic acids or polypeptides, refers to two or more sequences or subsequences that have at least 90%, at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98% identity, or at least 99% identity (e.g., as determined using one of the methods set forth infra).
• the term "binds,” “specifically binds to,” or is “specific for” refers to measurable and reproducible interactions such as binding between a target and an antibody, which is determinative of the presence of the target in the presence of a heterogeneous population of molecules including biological molecules.
• an antibody that specifically binds to a target (which can be an epitope) is an antibody that binds this target with greater affinity, avidity, more readily, and/or with greater duration than it binds to other targets.
• the extent of binding of an antibody to an unrelated target is less than about 10% of the binding of the antibody to the target as measured, for example, by a radioimmunoassay (RIA).
• an antibody that specifically binds to a target has a dissociation constant (Kd) of ⁇ 1 pM, ⁇ 100 nM, ⁇ 10 nM, ⁇ 1 nM, or ⁇ 0.1 nM.
• Kd dissociation constant
• an antibody specifically binds to an epitope on a protein that is conserved among the protein from different species.
• specific binding can include, but does not require exclusive binding.
• references to “neuregulin” or “a neuregulin peptide” includes mixtures of such neuregulins, neuregulin isoforms, and/or neuregulin-like polypeptides.
• Reference to “the formulation” or “the method” includes one or more formulations, methods, and/or steps of the type described herein and/or which will become apparent to those persons skilled in the art upon reading this disclosure.
• polypeptide refers to a polymer of amino acids and its equivalent and does not refer to a specific length of a product; thus, “peptides” and “proteins” are included within the definition of a polypeptide. Also included within the definition of polypeptides are “antibodies” as defined herein.
• a “polypeptide region” refers to a segment of a polypeptide, which segment may contain, for example, one or more domains or motifs (e.g., a polypeptide region of an antibody can contain, for example, one or more complementarity determining regions (CDRs)).
• fragment refers to a portion of a polypeptide preferably having at least 20 contiguous or at least 50 contiguous amino acids of the polypeptide.
• a “derivative” is a polypeptide or fragment thereof having one or more non-conservative or conservative amino acid substitutions relative to a second polypeptide (also referred to as a “variant”); or a polypeptide or fragment thereof that is modified by covalent attachment of a second molecule such as, e.g., by attachment of a heterologous polypeptide, or by glycosylation, acetylation, phosphorylation, and the like.
• derivatives for example, polypeptides containing one or more analogs of an amino acid (e.g., unnatural amino acids and the like), polypeptides with unsubstituted linkages, as well as other modifications known in the art, both naturally and non-naturally occurring.
• amino acid e.g., unnatural amino acids and the like
• polypeptides with unsubstituted linkages as well as other modifications known in the art, both naturally and non-naturally occurring.
• An “isolated” polypeptide is one which has been identified and separated and/or recovered from a component of its natural environment. Contaminant components of its natural environment are materials which would interfere with diagnostic or therapeutic uses for the polypeptide, and may include enzymes, hormones, and other proteinaceous or nonproteinaceous solutes.
• An isolated polypeptide includes an isolated antibody, or a fragment or derivative thereof.
• the current invention utilizes a recombinant fusion protein comprising a fusion between a monoclonal antibody-fused to a fragment of a neuregulin-1 protein isoform for use across a variety of cardiovascular and neurologic indications.
• the antibody is specific for ERBB3 (HER3).
• an “antibody” refers to a protein comprising one or more polypeptides substantially or partially encoded by immunoglobulin genes or fragments of immunoglobulin genes.
• the recognized immunoglobulin genes include the kappa, lambda, alpha, gamma, delta, epsilon and mu constant region genes, as well as myriad immunoglobulin variable region genes.
• Light chains are classified as either kappa or lambda.
• Heavy chains are classified as gamma, mu, alpha, delta, or epsilon, which in turn define the immunoglobulin classes, IgG, IgM, IgA, IgD and IgE, respectively.
• a typical immunoglobulin (e.g., antibody) structural unit comprises a tetramer.
• Each tetramer is composed of two identical pairs of polypeptide chains, each pair having one “light” (about 25 kD) and one “heavy” chain (about 50-70 kD).
• the N- terminus of each chain defines a variable region of about 100 to 110 or more amino acids primarily responsible for antigen recognition.
• the terms variable light chain (VL) and variable heavy chain (VH) refer to these light and heavy chains, respectively.
• Antibodies exist as intact immunoglobulins or as a number of well characterized fragments produced by digestion with various peptidases.
• pepsin digests an antibody below the disulfide linkages in the hinge region to produce F(ab')2, a dimer of Fab which itself is a light chain joined to VH-CH1 by a disulfide bond.
• the F(ab')2 may be reduced under mild conditions to break the disulfide linkage in the hinge region thereby converting the F(ab')2dimer into an Fab' monomer.
• the Fab' monomer is essentially a Fab with part of the hinge region (see, Fundamental Immunology, W. E.
• Antibodies include single chain antibodies, including single chain Fv (sFv or scFv) antibodies in which a variable heavy and a variable light chain are joined together (directly or through a peptide linker) to form a continuous polypeptide.
• Antibodies include single domain antibodies, which comprise an antibody fragment consisting of a single monomeric variable antibody domain that is able to bind selectively to an antigen domain.
• Exemplary single domain antibodies include VHH fragments, which were originally isolated from camelids.
• the antibody domain of the fusion protein optionally comprises all or part of an immunoglobin molecule and optionally contains all or part of an immunoglobin variable region (/. ⁇ ., the area of specificity for the disease related antigen) and optionally comprises region(s) encoded by a V gene, and/or a D gene and/or a J gene.
• the antibodies used herein optionally comprise F(ab)2, F(ab')2, Fab, Fab', scFv, single domain antibodies, etc. depending upon the specific requirements of the embodiment.
• Some embodiments utilize fusion proteins comprising IgG domains.
• other embodiments comprise alternate immunoglobins such as IgM, IgA, IgD, and IgE.
• IgGl, IgG2, IgG3, etc. are all possible molecules in the antibody domains of the antibody-immunostimulant fusion proteins used in the invention.
• different embodiments of the invention comprise various hinge regions (or functional equivalents thereof). Such hinge regions provide flexibility between the different domains of the antibody-immunostimulant fusion proteins. See, e.g., Penichet, et al. 2001 “Antibody-cytokine fusion proteins for the therapy of cancer” J Immunol Methods 248:91-101.
• the mAb comprised by the recombinant fusion protein of the invention is monospecific for ErbB3 (HER3)).
• Human HER3 (ErbB-3, ERBB3, c-erbB-3, c-erbB3, receptor tyrosine-protein kinase erbB-3) encodes a member of the epidermal growth factor receptor (EGFR) family of receptor tyrosine kinases which also includes HER1 (also known as EGFR), HER2, and HER4 (Kraus, M.H. et al, PNAS 86 (1989) 9193-9197; Plowman, G.D.
• EGFR epidermal growth factor receptor
• the transmembrane receptor HER3 consists of an extracellular ligand- binding domain (ECD), a dimerization domain within the ECD, a transmembrane domain, an intracellular protein tyrosine kinase domain (TKD) and a C-terminal phosphorylation domain.
• ECD extracellular ligand- binding domain
• TKD transmembrane domain
• This membrane-bound HER3 protein has a Heregulin (HRG) binding domain within the extracellular domain but not an active kinase domain. It therefore can bind this ligand but not convey the signal into the cell through protein phosphorylation.
• HRG Heregulin
• heterodimers with other HER family members which do have kinase activity. Heterodimerization leads to the activation of the receptor-mediated signaling pathway and transphosphorylation of its intracellular domain. Dimer formation between HER family members expands the signaling potential of HER3 and is a means not only for signal diversification but also signal amplification.
• the HER2/HER3 heterodimer induces one of the most important mitogenic signals via the PI3K and AKT pathway among HER family members (Sliwkowski M.X., et al, J. Biol. Chem. 269 (1994) 14661-14665; Alimandi M, et al, Oncogene. 10 (1995) 1813- 1821; Hellyer, N.J., J. Biol. Chem. 276 (2001) 42153-4261; Singer, E., J. Biol.
• the human ERBB3 protein comprises the following amino acid sequence provided in GenBank AAH02706.1 and set forth in SEQ ID NO: 1 :
• the mAb of the recombinant fusion protein provided herein is an anti-Her3 mAb that inhibits NRG-1 signaling through ErbB3 (HER3).
• the mAb comprised by the recombinant fusion protein of the invention comprises an anti-HER3 mAb.
• anti-HER3 antibodies and their sequences, are known in the art and may include, but are not limited to the following: patritumab, seribantumab (fully human mAb), LJM716, KTN3379, AV-203, REGN1400, GSK2849330, or MM-141.
• Such antibodies may be also be selected from any of the following forms, including, chimeric, bi-specific, non-human, fully human, or humanized form, so long as they bind to and inhibit signaling from human ERBB3 (HER3).
• the anti- HER3 antibody is of human origin.
• the term "antibody” encompasses the various forms of antibody structures including, but not being limited to, whole antibodies and antibody fragments.
• the antibody according to the invention is preferably a human antibody, humanized antibody, chimeric antibody, or further genetically engineered antibody as long as the characteristic properties according to the invention are retained.
• Antibody fragments comprise a portion of a full length antibody, preferably the variable domain thereof, or at least the antigen binding site thereof. Examples of antibody fragments include diabodies, single-chain antibody molecules, and multispecific antibodies formed from antibody fragments. scFv antibodies are, e.g., described in Huston, J.S., Methods in Enzymol. 203 (1991) 46-88.
• antibody fragments comprise single chain polypeptides having the characteristics of a VH domain, namely being able to assemble together with a VL domain, or of a VL domain binding to the respective antigen being able to assemble together with a VH domain to a functional antigen binding site and thereby providing the properties of an antibody according to the invention.
• the terms "monoclonal antibody” or “monoclonal antibody composition” as used herein refer to a preparation of antibody molecules of a single amino acid composition.
• a chimeric antibody may be used in the compositions and methods provided herein.
• the term "chimeric antibody” refers to a monoclonal antibody comprising a variable region, /. ⁇ ., binding region, from mouse and at least a portion of a constant region derived from a different source or species, usually prepared by recombinant DNA techniques. Chimeric antibodies comprising a mouse variable region and a human constant region are especially preferred.
• Such rat/human chimeric antibodies are the product of expressed immunoglobulin genes comprising DNA segments encoding rat immunoglobulin variable regions and DNA segments encoding human immunoglobulin constant regions.
• chimeric antibodies encompassed by the present invention are those in which the class or subclass has been modified or changed from that of the original antibody. Such “chimeric” antibodies are also referred to as "cl ass- switched antibodies.” Methods for producing chimeric antibodies involve conventional recombinant DNA and gene transfection techniques now well known in the art. See, e.g., Morrison, S.L., et al, Proc. Natl. Acad Sci. USA 81 (1984) 6851-6855; US 5,202,238 and US 5,204,244.
• a humanized antibody may be used in the compositions and methods provided herein.
• the term "humanized antibody” or “humanized version of an antibody” refers to antibodies in which the framework or "complementarity determining regions” (CDR) have been modified to comprise the CDR of an immunoglobulin of different specificity as compared to that of the parent immunoglobulin.
• the CDRs of the VH and VL are grafted into the framework region of human antibody to prepare the "humanized antibody.” See e.g. Riechmann, L., et al, Nature 332 (1988) 323-327; and Neuberger, M.S., et al, Nature 314 (1985) 268-270.
• the heavy and light chain variable framework regions can be derived from the same or different human antibody sequences.
• the human antibody sequences can be the sequences of naturally occurring human antibodies.
• Human heavy and light chain variable framework regions are listed e.g. in Lefranc, M.-P., Current Protocols in Immunology (2000) - Appendix IP A. IP.1- A.1P.37 and are accessible via IMGT, the international ImMunoGeneTics information system® (http://imgt.cines.fr) or via http://vbase.mrc-cpe.cam.ac.uk.
• the framework region can be modified by further mutations.
• Particularly preferred CDRs correspond to those representing sequences recognizing the antigens noted above for chimeric antibodies.
• humanized antibody as used herein also comprises such antibodies which are modified in the constant region to generate the properties according to the invention, especially in regard to complement component Iq (Clq) binding and/or Fc Receptor (FcR) binding, e.g. by "class switching” i.e. change or mutation of Fc parts (e.g. from IgGl to IgG4 and/or IgGl/IgG4 mutation).
• class switching i.e. change or mutation of Fc parts (e.g. from IgGl to IgG4 and/or IgGl/IgG4 mutation).
• human antibody as used herein, is intended to include antibodies having variable and constant regions derived from human germ line immunoglobulin sequences. Human antibodies are well-known in the state of the art (van Dijk, M.A., and van de Winkel, J.G., Curr. Opin. Chem. Biol.
• Human antibodies can also be produced in transgenic animals (e.g., mice) that are capable, upon immunization, of producing a full repertoire or a selection of human antibodies in the absence of endogenous immunoglobulin production. Transfer of the human germ-line immunoglobulin gene array in such germ-line mutant mice will result in the production of human antibodies upon antigen challenge (see, e.g., Jakobovits, A., et al, Proc. Natl. Acad. Sci. USA 90 (1993) 2551-2555; Jakobovits, A., et al, Nature 362 (1993) 255-258; Brueggemann, M.D., et al., Year Immunol.
• Human antibodies can also be produced in phage display libraries (Hoogenboom, H.R., and Winter, G., J. Mol. Biol. 227 (1992) 381-388; Marks, J.D., et al, J. Mol. Biol. 222 (1991) 581- 597).
• the techniques of Cole, A., et al. and Boerner, P., et al. are also available for the preparation of human monoclonal antibodies (Cole, A., et al., Monoclonal Antibodies and Cancer Therapy, Liss, A.L., p. 77 (1985); and Boerner, P., et al, J. Immunol. 147 (1991) 86-95).
• the term "human antibody” as used herein also comprises such antibodies which are modified in the constant region to generate the properties according to the invention.
• the mAb comprised by the recombinant fusion protein provided herein comprises at least one mutation in the Fc domain or region.
• recombinant human antibody is intended to include all human antibodies that are prepared, expressed, created or isolated by recombinant means, such as antibodies isolated from a host cell, for example a NS0 or CHO cell or from an animal (e.g. a mouse) that is transgenic for human immunoglobulin genes or antibodies expressed using a recombinant expression vector transfected into a host cell.
• recombinant human antibodies have variable and constant regions in a rearranged form.
• the recombinant human antibodies according to the invention have been subjected to in vivo somatic hypermutation.
• the amino acid sequences of the VH and VL regions of the recombinant antibodies are sequences that, while derived from and related to human germ line VH and VL sequences, may not naturally exist within the human antibody germ line repertoire in vivo.
• the terms "which binds to human HER3", “which specifically binds to human HER3", or “anti-HER3 antibody” are interchangeable and refer to an antibody which specifically binds to the human HER3 antigen with a KD-value of about 4.8 lx' 10 mol/L or lower at 25°C.
• the binding affinity is determined with a standard binding assay at 25°C, such as surface plasmon resonance technique (BIAcore®, GE-Healthcare Uppsala, Sweden).
• an "antibody which binds to human HER3" as used herein refers to an antibody or portion thereof specifically which binds to the human HER3 antigen with a binding affinity within a range of KD 1.0 x 1 O' 8 mol/L - 1.0 x 10' 13 mol/L) at 25°C, and preferably with a KD-value of 4.8 lx' 10 mol/L or lower at 25°C.
• an anti-HER3 antibody comprised by the recombinant fusion protein disclosed herein comprises a variable region heavy (VH) chain and a variable region light (VL) chain.
• the antibody comprises the VH and VL sequences in SEQ ID NO: 2 and SEQ ID NO: 3, respectively; and has one or more of the following properties: inhibition of HER3 phosphorylation in tumor cells, inhibition of AKT phosphorylation in tumor cells, inhibition of signaling through ErbB3 (HER3), and inhibition of the proliferation of tumor cells.
• the anti-HER3 mAb provided herein comprises a VH amino acid sequence set forth in SEQ ID NO: 2:
• the anti-HER3 mAb provided herein comprises a VL amino acid sequence of SEQ ID NO: 3:
• the anti-HER3 antibody of the present invention comprises at least one mutation in the Fc region.
• the mature anti-HER3 antibody (i.e.- lacking a signal peptide) of the present invention comprises at least one mutation in amino acids 234, 239, 434, or a combination thereof, where in other embodiments, the amino acid mutations comprise at least one of the following substitution mutations: L234F, S239A, N434A or a combination thereof.
• mutations to amino acids 234 and/or 239 knock down effector functions of the anti-HER3 antibody.
• a mutation to amino acid 434 extends the half-life of the antibody in a subject.
• the one or more mutations in the Fc region reduce effector function.
• the reduced effector function comprises a reduced affinity of the anti-HER.3 antibody for one or more Fc Receptors.
• the FcRs can be FcyRI, FcyRIIa, FcyRIIb, FcyRIIIa (158F), FcyRIIIa (158V) and Clq.
• the reduced affinity comprising an increase in dissociation constant of about 1 order of magnitude or greater.
• introducing one or more Fc mutations increases the KD of the anti-HER3 antibody of fusion protein comprising same for FcyRI from 2.81xl0" 9 M to 1.03x1 O' 8 M.
• introducing one or more Fc mutations increases the KD of the anti-HER3 antibody of fusion protein comprising same for FcyRIIa from 3.95xl0" 7 M to 1.35x1 O' 6 M. In some embodiments, introducing one or more Fc mutations increases the KD of the anti-HER3 antibody of fusion protein comprising same for FcyRIIb from 1.03xl0" 7 M to 1.52x1 O' 6 M. In some embodiments, introducing one or more Fc mutations increases the KD of the anti-HER3 antibody of fusion protein comprising same for FcyRIIIa (158F) from 6.37x10" 8 M to 1.18X10" 7 M. In some embodiments, introducing one or more Fc mutations increases the KD of the anti-HER3 antibody of fusion protein comprising same for FcyRIIIa (158V) from 3.41 xlO" 8 M to 9.10X10" 8 M.
• the anti-HER3 antibody or recombinant fusion protein comprising same binds to FcyRI with an equilibrium dissociation constant (KD) higher than or equal to 1.03xl0" 8 M.
• the anti-HER3 antibody or recombinant fusion protein comprising same comprises one or more Fc mutations and binds to FcyRIIa with a KD higher than or equal to 1.35xl0" 6 M.
• the anti-HER3 antibody or recombinant fusion protein comprising same comprises one or more Fc mutations and binds to FcyRIIb with a KD higher than or equal to 1.5 xlO" 6 M.
• the anti-HER3 antibody or recombinant fusion protein comprising same comprises one or more Fc mutations and binds to FcyRIIIa (158F) with a KD higher than or equal to 1.18xl0" 7 M. In some embodiments, the anti-HER3 antibody or recombinant fusion protein comprising same comprises one or more Fc mutations and binds to FcyRIIIa (158V) with a KD higher than or equal to 9.10xl0" 8 M.
• antibody effector function(s) refers to a function contributed by an Fc region(s) of an Ig. Such function can be affected by, for example, binding of an Fc effector region (s) to an Fc receptor on an immune cell with phagocytic or lytic activity or by binding of an Fc effector region(s) to components of the complement system.
• the anti-HER3 antibody does not induce antibodydependent cellular cytotoxicity (ADCC).
• ADCC antibody-dependent cellular cytotoxicity
• the antibody according to the invention is glycosylated.
• the glycosylation is N-glycosylation. In other embodiments, the glycosylation is O-glycosylation.
• the antibodies comprised by the recombinant fusion protein may be produced via recombinant means.
• Such methods are widely known in the state of the art and comprise protein expression in prokaryotic and eukaryotic cells with subsequent isolation of the antibody polypeptide and usually purification to a pharmaceutically acceptable purity.
• nucleic acids encoding light and heavy chains or fragments thereof are inserted into expression vectors by standard methods. Expression is performed in appropriate prokaryotic or eukaryotic host cells, such as CHO cells, NS0 cells, SP2/0 cells, HEK293 cells, COS cells, yeast, or E.
• the antibodies may be present in whole cells, in a cell lysate, or in a partially purified, or substantially pure form.
• variable domains Cloning of variable domains is described by Orlandi, R., et al, Proc. Natl. Acad. Sci. USA 86 (1989) 3833- 3837; Carter, P., et al, Proc. Natl. Acad. Sci. USA 89 (1992) 4285-4289; Norderhaug, L., et al, J. Immunol. Methods 204 (1997) 77-87.
• a preferred transient expression system (HEK 293) is described by Schlaeger, E.-J. and Christensen, K., in Cytotechnology 30 (1999) 71-83, and by Schlaeger, E.-J., in J. Immunol.
• Monoclonal antibodies are suitably separated from the culture medium by conventional immunoglobulin purification procedures such as, for example, protein A-Sepharose, hydroxylapatite chromatography, gel electrophoresis, dialysis, or affinity chromatography.
• DNA and RNA encoding the monoclonal antibodies is readily isolated and sequenced using conventional procedures.
• the hybridoma cells can serve as a source of such DNA and RNA.
• the DNA may be inserted into expression vectors, which are then transfected into host cells, such as HEK 293 cells, CHO cells, or myeloma cells that do not otherwise produce immunoglobulin protein, to obtain the synthesis of recombinant monoclonal antibodies in the host cells.
• host cells such as HEK 293 cells, CHO cells, or myeloma cells that do not otherwise produce immunoglobulin protein, to obtain the synthesis of recombinant monoclonal antibodies in the host cells.
• the heavy and light chain variable domains according to the invention are combined with sequences of promoter, translation initiation, constant region, 3' untranslated region, polyadenylation, and transcription termination to form expression vector constructs.
• the heavy and light chain expression constructs can be combined into a single vector, cotransfected, serially transfected, or separately transfected into host cells which are then fused to form a single host cell expressing both chains.
• the antibodies are administered to the subject in therapeutically effective amount which is the amount of the subject compound or combination that will elicit the biological or medical response of a tissue, system, animal or human that is being sought by the researcher, veterinarian, medical doctor or other clinician.
• the recombinant fusion protein provided herein comprises a fragment of an NRG-1 protein.
• NRG proteins can bind to the ErbB4 receptor on the surface of myocardial cells, continuously activate the PI3K/AKT signal pathway in the cell, and change the structure of the myocardial cells, thereby improving the function of myocardial cells.
• neuregulin or “NRG” refers to proteins or peptides that can bind and activate ErbB3, ErbB4 or heterodimers or homodimers thereof, including neuregulin isoforms, neuregulin EGF-like domain, polypeptides comprising neuregulin EGF-like domain, neuregulin mutants or derivatives, and any kind of neuregulin-like gene products that can activate the above receptors
• Neuregulin also includes NRG-1, NRG-2, NRG-3 and NRG-4 proteins, peptides, fragments and compounds that have the functions of neuregulin.
• neuregulin is a protein or peptide that can bind to and activate ErbB2ZErbB4 or ErbB2/ErbB3 heterodimers, for example, but not for the purpose of restriction
• peptides of the present invention includes a fragment of the NRG-1P2 isoform, i.e., the 177-237 amino acid fragment, which contains the EGF-like domain having the following amino acid sequence: SHLVKCAEKEKTFCVNGGECFMVKDLSNPSRYLCKCPNEFTGDRCQNYVMASFYK AEELYQ (SEQ ID NO: 4).
• the NRG proteins of the present invention can activate the receptors above and regulate their biological functions, for example, stimulate the synthesis of acetylcholine receptors in skeletal muscle cells, promote the differentiation and survival of cardiomyocytes and DNA synthesis. It is well known to those of skill in this art that a mutation of a single amino acid in a non-critical region generally would not alter the biological activity of the resulting protein or polypeptide (see, e.g., Watson et al., Molecular Biology of the Gene, 4th Edition, 1987, The Bejacmin/Cummings Pub.co.,p. 224).
• the NRG proteins of the invention can be isolated from natural sources, may be modified through recombination technology, artificial synthesis or other means.
• EGF-like domain refers to a polypeptide fragment encoded by the neuregulin gene that binds to and activates ErbB3, ErbB4, or heterodimers or homodimers thereof and including heterodimers with ErbB2, and structurally similar to the EGF receptor binding region as described in WO 00/64400, Holmes et al., Science, 256: 1205-1210 (1992); U.S. Pat. Nos. 5,530,109 and 5,716,930; Hijazi et al., Int. J.
• EGF-like domain binds to and activates ErbB2ZErbB4 or ErbB2ZErbB3 heterodimers.
• EGF-like domain comprises the amino acid sequence of the receptor binding domain of NRG- 1.
• EGF-like domain refers to amino acid residues 177-226, 177-237, or 177-240 of NRG-1.
• EGF- like domain comprises the amino acid sequence of the receptor binding domain of neuregulin- 2 (NRG-2, also known in the art as DONI, HRG2 and NTAK).
• NRG-2 also known in the art as DONI, HRG2 and NTAK.
• an EGF-like domain of NRG-2 comprises a sequence of HARKCNETAKSYCVNGGVCYYIEGINQLSCKCPNGFFGQRCL (SEQ ID NO: 15).
• EGF-like domain comprises the amino acid sequence of the receptor binding domain of neuregulin 3 (NRG-3, also known in the art as HRG3 and pro-NRG3).
• the EGF-like domain of NRG-3 comprises a sequence of HFKPCRDKDLAYCLNDGECFVIETLTGSHKHCRCKEGYQGVRCD (SEQ ID NO: 16).
• EGF-like domain comprises the amino acid sequence of the receptor binding domain of neuregulin 4 (NRG-4, also known in the art as HER4).
• NRG-4 neuregulin 4
• an EGF-like domain of NRG-4 comprises a sequence of HEEPCGPSHKSFCLNGGLCYVIPTIPSPFCRCVENYTGARCE (SEQ ID NO: 17).
• EGF-like domain comprises the amino acid sequence of Ala Glu Lys Glu Lys Thr Phe Cys Vai Asn Gly Glu Cys Phe Met Vai Lys Asp Leu Ser Asn Pro (SEQ ID NO: 18), as described in U.S. Pat. No. 5,834,229.
• the NRG-1 protein provided in the recombinant fusion protein disclosed herein is the NRG-1 B2a isoform.
• the active NRG-1 fragment comprises the ERBB3/4 binding domain.
• the NRG-1 binds to and induces signaling through ErbB4 (HER4).
• the mAb inhibits NRG-1 signaling through ErbB3 (HER3).
• the active protein fragment of NRG-1 comprises the active domain of NRG-1.
• the NRG-1 fragment comprises SEQ ID NO: 4, or a sequence having at least 70%, at least 80%, at least 90% or at least 95% identity thereto, which is capable of binding to and inducing signaling through ErbB4.
• the NRG-1 in the recombinant fusion protein disclosed herein is fused to the C-terminus of the anti-HER3 antibody heavy chain using a linker.
• NRG-1 is attached to the linker via the first (1 st ) amino acid on the N- terminus of NRG-1, which in one embodiment is a Serine (S or Ser) amino acid.
• the specific recombinant fusion protein utilized in the current invention may be optionally obtained or created by any method known in the art (including purchase from commercial sources).
• nucleic acid sequences encoding the appropriate antibody framework are optionally cloned and ligated into appropriate vectors (e.g., expression vectors for, e.g., prokaryotic or eukaryotic organisms).
• appropriate vectors e.g., expression vectors for, e.g., prokaryotic or eukaryotic organisms.
• nucleic acid sequences encoding the NRG-1 B2a isoform molecule are optionally cloned into the same vector in the appropriate orientation and location so that expression from the vector produces an antibody -NRG-1 B2a isoform fusion protein.
• Some optional embodiments also require post-expression modification, e.g., assembly of antibody subunits, etc. The techniques and art for the above (and similar) manipulations are well known to those skilled in the art.
• the antibody domain and NRG-1 B2a isoform are assembled post-expression through, e.g., chemical means.
• the present invention provides a composition, e.g. a pharmaceutical composition comprising the recombinant fusion protein of the present invention.
• the recombinant fusion protein reduces the duration of an atrial fibrillation episode. In one embodiment, the recombinant fusion protein reduces the frequency with which atrial fibrillation occurs. Symptoms of atrial fibrillation include, but are not limited to, irregular heartbeat, heart palpitations, lightheadedness, extreme fatigue, shortness of breath, chest pain, and combinations thereof. In one embodiment, the recombinant fusion protein reduces collagen content or deposition in cardiac tissue.
• the recombinant fusion protein promotes cardiomyocyte proliferation, differentiation, and survival. In another embodiment, the recombinant fusion protein promotes proliferation, differentiation and survival of cardiac tissue. In one embodiment, the recombinant fusion protein promotes cardiomyocyte proliferation, differentiation, and survival without promoting cancer and/or tumor growth. In another embodiment, the recombinant fusion protein promotes proliferation, differentiation and survival of cardiac tissue without promoting cancer or tumor growth.
• the cancer is adrenocortical carcinoma, AIDS-related cancers, AIDS-related lymphoma, anal cancer, anorectal cancer, cancer of the anal canal, appendix cancer, childhood cerebellar astrocytoma, childhood cerebral astrocytoma, basal cell carcinoma, skin cancer (non-melanoma), biliary cancer, extrahepatic bile duct cancer, intrahepatic bile duct cancer, bladder cancer, urinary bladder cancer, bone and joint cancer, osteosarcoma and malignant fibrous histiocytoma, brain cancer, brain tumor, brain stem glioma, cerebellar astrocytoma, cerebral astrocytoma/malignant glioma, ependymoma, medulloblastoma, supratentorial primitive neuroectodermal tumors, visual pathway and hypothalamic glioma, breast cancer, bronchial adenomas/carcin
• the recombinant fusion protein promotes proliferation, differentiation and survival of central nervous system (CNS) cells. In another embodiment, the recombinant fusion protein promotes proliferation, differentiation and survival of central nervous system (CNS) cells without promoting cancer and/or tumor growth. In another embodiment, the recombinant fusion protein has a reduced capacity to induce antibodydependent cell cytotoxicity (ADCC).
• ADCC antibodydependent cell cytotoxicity
• the recombinant fusion protein promotes HER2/4 signaling over HER2/3 signaling relative to the signal induction potential of recombinant NR.G- 1.
• the recombinant fusion protein comprises an anti-HER3mAb fused to or operably linked to the C-terminus of the antibody heavy chain via a GGGGSGGGGS (G4S) linker (SEQ ID NO: 5) to the NRG-1 B2a isoform of SEQ ID NO: 4.
• G4S GGGGSGGGGS
• SEQ ID NO: 5 to the NRG-1 B2a isoform of SEQ ID NO: 4.
• one or more copies of the linker may be used.
• 2, 3, 4, or 5 copies of the G4S linker or any other linker known in the art as being suitable for the composition disclosed herein may be used herein.
• linker is art-recognized and refers to a molecule (including but not limited to unmodified or modified nucleic acids or amino acids) or group of molecules (for example, 2 or more, e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100 or more) connecting two compounds, such as two polypeptides.
• the linker may be comprised of a single linking molecule or may comprise a linking molecule and at least one spacer molecule, intended to separate the linking molecule and a compound by a specific distance.
• a nucleic acid sequence is “operably linked” when it is placed into a functional relationship with another nucleic acid sequence.
• a nucleic acid presequence or secretory leader is operably linked to a nucleic acid encoding a polypeptide if it is expressed as a preprotein that participates in the secretion of the polypeptide;
• a promoter or enhancer is operably linked to a coding sequence if it affects the transcription of the sequence; or a ribosome binding site is operably linked to a coding sequence if it is positioned so as to facilitate translation.
• “operably linked” means that the nucleic acid sequences being linked are contiguous, and, in the case of a secretory leader, contiguous and in reading frame. However, enhancers are optionally contiguous. Linking can be accomplished, for example, by ligation at convenient restriction sites. If such sites do not exist, synthetic oligonucleotide adaptors, linkers or other methods known in the art can be used.
• the “operably linked” also refers to the functional pairing of distinct amino acid sequences, peptides or proteins, as in the pairing of the antibody and NR.G-1 fragment described herein via a linker sequence also described herein.
• the anti-HER3 mAh heavy chain comprised by the recombinant fusion protein provided herein is encoded by SEQ ID NO: 6:
• CTCTTTTTATAAGGCTGAGGAGCTGTACCAGTAA (SEQ ID NO: 6).
• sequence set forth in SEQ ID NO: 6 comprises no Fc mutations.
• SEQ ID NO: 6 is also referred to as “NPCF”.
• the recombinant fusion protein provided herein comprises a heavy chain of an anti-HER3 mAb.
• the anti-HER3 mAb heavy chain is encoded by SEQ ID NO: 7:
• GGGGCACCCTGGTGACAGTGTCTTCCGCCTCTACAAAGGGCCCCTCCGTGTTTCC TCTGGCTCCAAGCTCTAAGAGCACCTCTGGAGGAACAGCCGCTCTGGGATGTCTG
• SEQ ID NO: 7 is also referred to as “NPCFA”.
• SEQ ID NO: 7 comprises one or more mutations that encode for one or more mutations in the constant (Fc) region of the anti-HER3 mAb provided herein.
• the mature anti-HER3 antibody of the present invention comprises at least one mutation in amino acids 234, 239, 434, or a combination thereof.
• the amino acid mutations comprise at least one of the following substitution mutations: L234F, S239A, N434A or a combination thereof.
• the recombinant fusion protein provided herein comprises a light chain sequence of an anti-HER3 mAb.
• the light chain sequence is encoded by (SEQ ID NO: 8): ATGGTGTTGCAGACCCAGGTCTTCATTTCTCTGTTGCTCTGGATCTCTGGTGCCTA CGGGGACATCGAGATGACCCAGTCTCCAGATTCCCTGGCCGTGAGCCTGGGAGA GAGGGCTACAATCAACTGCCGGTCCAGCCAGTCTGTGCTGTACTCTTCCAGCAAC AGGAATTACCTGGCCTGGTATCAGCAGAATCCCGGCCAGCCCCCTAAGCTGCTGA TCTATTGGGCTAGCACCAGAGTCTGGAGTGCCTGACCGCTTCTCTGGATCCGG AAGCGGCACAGACTTCACCCTGACAATCTCTTCCCTGCAGGCCGAGGACGTGGCC GTGTACTATTGCCAGCAGTATTACTCTACCCCTAGGACATTCGGCCAGGGCACCA AGGTGGAGATCAAGCGGACAGTGGCCGCTCCATCCGTGTTCATCTTTCCACCCTC CGACGAGCAGCTGGCTGGATCTGGATCTGGATCCGG AAGCGGCACAG
• the heavy chain of the anti-HER3 antibody comprised by the recombinant fusion protein provided herein comprises the following amino acid sequence: MEFGLSWVFLVAIIKGVQCQVQLQQWGAGLLKPSETLSLTCAVYGGSFSGYYWSWI RQPPGKGLEWIGEINHSGSTNYNPSLKSRVTISVETSKNQFSLKLSSVTAADTAVYYC ARDKWTWYFDLWGRGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFP EPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNT KVDKRVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVS HEDPEVI ⁇ FNWYVDGVEVHNAI ⁇ TI ⁇ PREEQYNSTYRVVSVLTVLHQDWLNGI ⁇ EYI ⁇ C KVSNKALPAP
• the heavy chain of the anti-HER3 antibody comprised by the recombinant fusion protein provided herein comprises the following amino acid sequence: MEFGLSWVFLVAIIKGVQCQVQLQQWGAGLLKPSETLSLTCAVYGGSFSGYYWSWI RQPPGKGLEWIGEINHSGSTNYNPSLKSRVTISVETSKNQFSLKLSSVTAADTAVYYC ARDKWTWYFDLWGRGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFP EPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNT KVDKRVEPKSCDKTHTCPPCPAPEFLGGPAVFLFPPKPKDTLMISRTPEVTCVVVDVS HEDPEVI ⁇ FNWYVDGVEVHNAI ⁇ TI ⁇ PREEQYNSTYRVVSVLTVLHQDWLNGI ⁇ EYI ⁇ C KVSNKALPAP
• the anti-HER3 mAb heavy chain sequence comprises a signal peptide sequence.
• the anti-HER3 mAb heavy chain signal peptide sequence comprises the amino acid sequence of MEFGLSWVFLVAIIKGVQC (SEQ ID NO: 11).
• light chain of the anti-HER3 antibody comprised by the recombinant fusion protein comprises the following amino acid sequence: MVLQTQVFISLLLWISGAYGDIEMTQSPDSLAVSLGERATINCRSSQSVLYSSSNRNY LAWYQQNPGQPPKLLIYWASTRESGVPDRFSGSGSGTDFTLTISSLQAEDVAVYYCQ QYYSTPRTFGQGTKVEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQ WKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSS PVTKSFNRGEC (SEQ ID NO: 12).
• the anti-HER3 mAb light chain sequence comprises a signal peptide sequence.
• the anti-HER3 mAb light chain signal peptide sequence comprises the amino acid sequence of MVLQTQVFISLLLWISGAYG (SEQ ID NO: 13).
• a mature polypeptide such as an antibody heavy chain or light chain amino acid sequence disclosed herein lacks a signal peptide.
• the recombinant fusion protein comprises the following amino acid sequences:
• each of the heavy chain sequence and light chain sequence in the mature recombinant fusion protein lack a signal peptide amino acid sequence.
• the heavy chain of the anti-HER3 antibody provided herein is fused via the C-terminus linker sequence to the NRG-1 B2a isoform provided herein.
• the C-terminus of the antibody heavy chain comprises the Fc domain of the antibody.
• compositions comprising the recombinant fusion protein disclosed herein formulated together with a pharmaceutical carrier.
• the anti-HER3 antibody and the NRG-1 fragment described herein are recombinantly or chemically fused/ operably linked via a linker to form a fusion protein.
• a “fusion protein,” “fusion polypeptide,” “recombinant fusion protein,” or “recombinant polypeptide” refers to a hybrid polypeptide which comprises polypeptide portions from at least two different polypeptides.
• a “fusion protein” as defined herein is a fusion of a first amino acid sequence (protein) comprising, for example an NRG-1 B2a isoform of the invention, joined via a linker to the C-terminus of a second amino acid sequence comprising an heavy chain of an antibody that binds specifically to ERBB3 (HER3).
• the fusion protein is recombinantly encoded and produced.
• the recombinant fusion protein is encoded by a nucleic acid sequence encoding the antibody of the invention that is operably linked via a nucleic acid sequence encoding a linker, to a nucleic acid sequence encoding an NRG-1 B2a isoform of the invention.
• the recombinant fusion protein amino acid sequence is homologous to SEQ ID NO: 14 fused to SEQ ID NO: 3.
• the term “homology” may refer to identity to recombinant fusion protein sequence (e.g. to any of SEQ ID NO: 1-18) of greater than 70%.
• “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 72%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 75%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 78%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 80%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 82%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 83%.
• “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 85%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 87%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 88%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 90%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 92%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 93%.
• “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 95%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 96%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 97%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 98%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of greater than 99%. In another embodiment, “homology” refers to identity to any of SEQ ID NO: 1-18 of 100%. [00146] The determination of percent identity between two sequences can be accomplished using a mathematical algorithm.
• a non-limiting example of a mathematical algorithm utilized for the comparison of two sequences is the algorithm of Karlin and Altschul, 1990, Proc. Natl. Acad. Set. USA 87:2264-2268, modified as in Karlin and Altschul, 1993, Proc. Natl. Acad. Set. 7/5490:5873-5877.
• Such an algorithm is incorporated into the NBLAST and XBLAST programs of Altschul et al., 1990, J. Mol. Biol. 215:403-410.
• Gapped BLAST can be utilized as described in Altschul et al., 1997, Nucleic Acids Res. 25:3389-3402.
• PSI-Blast can be used to perform an iterated search which detects distant relationships between molecules (id.).
• the default parameters of the respective programs e.g., XBLAST and NBLAST
• the default parameters of the respective programs e.g., XBLAST and NBLAST
• a mathematical algorithm utilized for the comparison of sequences is the algorithm of Myers and Miller, CABIOS (1989). Such an algorithm is incorporated into the ALIGN program (version 2.0) which is part of the GCG sequence alignment software package. When utilizing the ALIGN program for comparing amino acid sequences, a PAM120 weight residue table, a gap length penalty of 12, and a gap penalty of 4 can be used. Additional algorithms for sequence analysis are known in the art and include ADVANCE and ADAM as described in Torellis and Robotti, 1994, Comput. Appl. Biosci. 10:3-5; and FASTA described in Pearson and Lipman, 1988, Proc. Natl. Acad. Sci. USA 85:2444-8.
• protein sequence alignment may be carried out using the CLUSTAL W algorithm, as described by Higgins et al., 1996, Methods Enzymol. 266:383-402.
• polynucleotides of the present invention are prepared using PCR techniques using procedures and methods known to one skilled in the art.
• the procedure involves the ligation of two different DNA sequences (See, for example, “Current Protocols in Molecular Biology”, eds. Ausubel et al., John Wiley & Sons, 1992).
• polynucleotides of the present invention are inserted into expression vectors (i.e., a nucleic acid construct) to enable expression of the recombinant polypeptide.
• the expression vector of the present invention includes additional sequences which render this vector suitable for replication and integration in prokaryotes.
• the expression vector of the present invention includes additional sequences which render this vector suitable for replication and integration in eukaryotes.
• the expression vector of the present invention includes a shuttle vector which renders this vector suitable for replication and integration in both prokaryotes and eukaryotes.
• cloning vectors comprise transcription and translation initiation sequences (e.g., promoters, enhancer) and transcription and translation terminators (e.g., polyadenylation signals).
• prokaryotic or eukaryotic cells can be used as host-expression systems to express the polypeptides of the present invention.
• these include, but are not limited to, microorganisms, such as bacteria transformed with a recombinant bacteriophage DNA, plasmid DNA or cosmid DNA expression vector containing the polypeptide coding sequence; yeast transformed with recombinant yeast expression vectors containing the polypeptide coding sequence.
• non-bacterial expression systems are used (e.g., mammalian expression systems such as CHO cells) to express the polypeptide of the present invention.
• the expression vector used to express polynucleotides of the present invention in mammalian cells is pCI-DHFR vector comprising a CMV promoter and a neomycin resistance gene.
• a number of expression vectors can be advantageously selected depending upon the use intended for the polypeptide expressed.
• large quantities of polypeptide are desired.
• vectors that direct the expression of high levels of the protein product, possibly as a fusion with a hydrophobic signal sequence, which directs the expressed product into the periplasm of the bacteria or the culture medium where the protein product is readily purified are desired.
• vectors adaptable to such manipulation include, but are not limited to, the pET series of E. coli expression vectors [Studier et al., Methods in Enzymol. 185:60-89 (1990)].
• yeast expression systems are used.
• a number of vectors containing constitutive or inducible promoters can be used in yeast as disclosed in U.S. Pat. No. 5,932,447.
• vectors which promote integration of foreign DNA sequences into the yeast chromosome are used.
• the expression vectors of the present invention can further include additional polynucleotide sequences that allow, for example, the translation of several proteins from a single mRNA such as an internal ribosome entry site (IRES) and sequences for genomic integration of the promoter-chimeric polypeptide.
• IRS internal ribosome entry site
• the expression vectors of the present invention include elements that increase the expression of the recombinant fusion proteins of the invention. Such features include, but are not limited to, choice of promoter and polyadenylation.
• the polyadenylation sequence is a bovine growth hormone (BGH) polyadenylation sequence.
• the promoter comprises a constitutively active promoter.
• the promoter comprises a cytomegalovirus promoter (pCMV).
• mammalian expression vectors include, but are not limited to, pcDNA3, pcDNA3.1 (+/-), pGL3, pZeoSV2(+/-), pSecTag2, pDisplay, pEF/myc/cyto, pCMV/myc/cyto, pCR3.1, pSinRep5, DH26S, DHBB, pNMTl, pNMT41, pNMT81, which are available from Invitrogen, pCI which is available from Promega, pMbac, pPbac, pBK-RSV and pBK-CMV which are available from Strategene, pTRES which is available from Clontech, and their derivatives.
• expression vectors containing regulatory elements from eukaryotic viruses such as retroviruses are used by the present invention.
• SV40 vectors include pSVT7 and pMT2.
• vectors derived from bovine papilloma virus include pBV-lMTHA, and vectors derived from Epstein Barr virus include pHEBO, and p205.
• exemplary vectors include pMSG, pAV009/A + , pMTO10/A + , pMAMneo-5, baculovirus pDSVE, and any other vector allowing expression of proteins under the direction of the SV-40 early promoter, SV-40 later promoter, metallothionein promoter, murine mammary tumor virus promoter, Rous sarcoma virus promoter, polyhedrin promoter, or other promoters shown effective for expression in eukaryotic cells.
• recombinant viral vectors are useful for in vivo expression of the polypeptides of the present invention since they offer advantages such as lateral infection and targeting specificity.
• lateral infection is inherent in the life cycle of, for example, retrovirus and is the process by which a single infected cell produces many progeny virions that bud off and infect neighboring cells.
• the result is that a large area becomes rapidly infected, most of which was not initially infected by the original viral particles.
• viral vectors are produced that are unable to spread laterally. In one embodiment, this characteristic can be useful if the desired purpose is to introduce a specified gene into only a localized number of targeted cells.
• various methods can be used to introduce the expression vector encoding the recombinant fusion protein of the present invention into cells.
• Such methods are generally described in Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Springs Harbor Laboratory, New York (1989, 1992), in Ausubel et al., Current Protocols in Molecular Biology, John Wiley and Sons, Baltimore, Md. (1989), Chang et al., Somatic Gene Therapy, CRC Press, Ann Arbor, Mich. (1995), Vega et al., Gene Targeting, CRC Press, Ann Arbor Mich. (1995), Vectors: A Survey of Molecular Cloning Vectors and Their Uses, Butterworths, Boston Mass. (1988) and Gilboa et at.
• introduction of nucleic acid by viral infection offers several advantages over other methods such as lipofection and electroporation, since higher transfection efficiency can be obtained due to the infectious nature of viruses.
• the polypeptides of the present invention can also be expressed from a nucleic acid construct administered to the individual employing any suitable mode of administration, described hereinabove (z.e., in-vivo gene therapy).
• the nucleic acid construct is introduced into a suitable cell via an appropriate gene delivery vehicle/method (transfection, transduction, homologous recombination, etc.) and an expression system as needed and then the modified cells are expanded in culture and returned to the individual (z.e., ex-vivo gene therapy).
• the expression construct of the present invention can also include sequences engineered to optimize stability, production, purification, yield or activity of the expressed polypeptide.
• transformed cells are cultured under effective conditions, which allow for the expression of high amounts of recombinant fusion protein or polypeptide.
• effective culture conditions include, but are not limited to, effective media, bioreactor, temperature, pH and oxygen conditions that permit protein production.
• an effective medium refers to any medium in which a cell is cultured to produce the recombinant polypeptide of the present invention.
• a medium typically includes an aqueous solution having assimilable carbon, nitrogen and phosphate sources, and appropriate salts, minerals, metals and other nutrients, such as vitamins.
• cells of the present invention can be cultured in conventional fermentation bioreactors, shake flasks, test tubes, microtiter dishes and petri plates.
• culturing is carried out at a temperature, pH and oxygen content appropriate for a recombinant cell.
• culturing conditions are within the expertise of one of ordinary skill in the art.
• resultant polypeptides of the present invention either remain within the recombinant cell, secreted into the fermentation medium, secreted into a space between two cellular membranes, such as the periplasmic space in E. coli; or retained on the outer surface of a cell or viral membrane.
• the phrase “recovering the recombinant polypeptide” used herein refers to collecting the whole fermentation medium containing the polypeptide and need not imply additional steps of separation or purification.
• polypeptides of the present invention are purified using a variety of standard protein purification techniques, such as, but not limited to, affinity chromatography, ion exchange chromatography, filtration, electrophoresis, hydrophobic interaction chromatography, gel filtration chromatography, reverse phase chromatography, concanavalin A chromatography, chromatofocusing and differential solubilization.
• standard protein purification techniques such as, but not limited to, affinity chromatography, ion exchange chromatography, filtration, electrophoresis, hydrophobic interaction chromatography, gel filtration chromatography, reverse phase chromatography, concanavalin A chromatography, chromatofocusing and differential solubilization.
• the expressed coding sequence can be engineered to encode the polypeptide of the present invention and fused cleavable moiety.
• a fusion protein can be designed so that the polypeptide can be readily isolated by affinity chromatography; e.g., by immobilization on a column specific for the cleavable moiety.
• a cleavage site is engineered between the polypeptide and the cleavable moiety and the polypeptide can be released from the chromatographic column by treatment with an appropriate enzyme or agent that specifically cleaves the fusion protein at this site [e.g., see Booth et al., Immunol. Lett. 19:65-70 (1988); and Gardella et al., J. Biol. Chem. 265: 15854-15859 (1990)].
• polypeptide of the present invention is retrieved in “substantially pure” form.
• the phrase “substantially pure” refers to a purity that allows for the effective use of the protein in the applications described herein.
• polypeptide of the present invention can also be synthesized using in vitro expression systems.
• in vitro synthesis methods are well known in the art and the components of the system are commercially available.
• the recombinant polypeptides are synthesized and purified; their therapeutic efficacy can be assayed in vivo or in vitro.
• the pharmaceutical composition provided herein comprising the recombinant fusion protein of the invention is further formulated with a pharmaceutical carrier.
• pharmaceutical carrier includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like that are physiologically compatible.
• the carrier is suitable for intravenous, intramuscular, subcutaneous, parenteral, spinal or epidermal administration (e.g. by injection or infusion).
• the present invention provides a method of treating a disease or condition in a subject in need thereof, the method comprising administering a therapeutically effective amount of the recombinant fusion protein or the pharmaceutical composition comprising the recombinant fusion protein disclosed herein.
• the present invention provides a method of treating a cardiovascular disease or condition in a subject in need thereof, the method comprising administering a therapeutically effective amount of the recombinant fusion protein or a pharmaceutical composition comprising the same.
• the present invention provides a method of preventing, inhibiting, suppressing or delaying the onset of a cardiovascular disease or condition in a subject, the method comprising administering an effective amount of the recombinant fusion protein or the pharmaceutical composition described herein.
• the cardiovascular disease or condition comprises atrial fibrillation.
• the cardiovascular disease or condition comprises cardiac fibrosis.
• the cardiovascular disease or condition comprises atrial fibrillation and cardiac fibrosis.
• the cardiovascular disease comprises a chronic heart failure / Congestive heart failure (CHF), acute heart failure / myocardial infarction (MI), left ventricular systolic dysfunction, reperfusion injury associated with MI, chemotherapy-induced cardiotoxicity (adult or pediatric), radiation-induced cardiotoxicity, adjunct to surgical intervention in pediatric congenital heart disease.
• CHF chronic heart failure / Congestive heart failure
• MI myocardial infarction
• RV left ventricular systolic dysfunction
• reperfusion injury associated with MI a chronic heart failure / Congestive heart failure
• chemotherapy-induced cardiotoxicity adult or pediatric
• radiation-induced cardiotoxicity adjunct to surgical intervention in pediatric congenital heart disease.
• the wherein the chemotherapy-induced cardiotoxicity results from a subject receiving anthracy clines, alkylating agents, antimicrotubule agents, and antimetabolites agents used as chemotherapy.
• the cardiovascular condition is cardiotoxicity as a result of a subject receiving a cancer therapy.
• the cancer therapy is a HER-2 targeted therapy.
• the HER-2 targeted therapy comprises use of trastuzumab, ado-trastuzumab, emtansine, lapatinib, neratinib, and pertuzumab, any anti-HER2 antibody, any anti-HER2 agent or a combination thereof.
• the invention relates to a method of inducing remodeling of muscle cell sarcomeric and cytoskeleton structures, or cell-cell adhesions, the method comprising treating the cells with the recombinant fusion protein disclosed herein.
• the therapeutic method is directed to treating heart failure resulting from disassociation of cardiac muscle cell-cell adhesion and/or the disarray of sarcomeric structures in the mammal.
• the present invention provides a method for preventing, treating or delaying heart failure with preserved ejection fraction in a human, the method comprising administering a pharmaceutical composition comprising a recombinant fusion protein disclosed herein.
• ejection fraction refers to Ejection fraction (EF), a measurement, typically expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. For example, an ejection fraction of 50 percent means that 50 percent of the total amount of blood in the left ventricle is pushed out with each heartbeat.
• EF Ejection fraction
• the invention is directed to treating subjects with or at risk for development of heart disease and related conditions, e.g., heart failure.
• heart failure is meant an abnormality of cardiac function where the heart does not pump blood at the rate needed for the requirements of metabolizing tissues.
• Heart failure includes a wide range of disease states such as congestive heart failure, myocardial infarction, tachyarrhythmia, familial hypertrophic cardiomyopathy, ischaemic heart disease, idiopathic dilated cardiomyopathy, and myocarditis.
• the heart failure can be caused by any number of factors, including ischaemic, congenital, rheumatic, or idiopathic forms.
• Chronic cardiac hypertrophy is a significantly diseased state which is a precursor to congestive heart failure and cardiac arrest.
• treatment refers to both therapeutic treatment and prophylactic or preventative measures, wherein the object is to prevent or slow down (lessen) heart hypertrophy.
• Those in need of treatment include those already with the disorder as well as those prone to have the disorder or those in which the disorder is to be prevented.
• the heart hypertrophy may be from any cause which is responsive to retinoic acid, including congenital, viral, idiopathic, cardiotrophic, or myotrophic causes, or as a result of ischaemia or ischaemic insults such as myocardial infarction.
• the treatment is performed to stop or slow the progression of hypertrophy, especially after heart damage, such as from ischaemia, has occurred.
• the pharmaceutical composition provided herein is given immediately after the myocardial infarction, to prevent or lessen hypertrophy.
• treating a subject with atrial fibrillation or cardiac fibrosis with the recombinant fusion protein described herein, or a pharmaceutical composition comprising same can result in decreasing a sign or a symptom of the atrial fibrillation or fibrosis.
• treating a subject with the recombinant fusion protein can reduce the duration and/or frequency of atrial fibrillation, or reduce a sign or a symptom of atrial fibrillation, such as reducing irregular heartbeat, heart palpitations, lightheadedness, extreme fatigue, shortness of breath, chest pain or a combination thereof.
• treating a subject with the recombinant fusion protein reduces collagen content or deposition in cardiac tissue, for example in atrial tissue.
• treating a subject with a pharmaceutical composition comprising the recombinant fusion protein provided herein can result in increase in average survival time of a population of treated subjects in comparison to a population receiving monotherapy with a drug that is not a compound of the disclosure, or a pharmaceutically acceptable salt, solvate, analog or derivative thereof.
• the average survival time is increased by more than 30 days; more preferably, by more than 60 days; more preferably, by more than 90, 120, or 365 days; more preferably, by more than 365 days.
• An increase in average survival time of a population may be measured by any reproducible means.
• An increase in average survival time of a population may be measured, for example, by calculating for a population the average length of survival following initiation of treatment with an active compound.
• An increase in average survival time of a population may also be measured, for example, by calculating for a population the average length of survival following completion of a first round of treatment with the pharmaceutical composition disclosed herein.
• treating a subject with a pharmaceutical composition comprising the recombinant fusion protein provided herein can result in a decrease in the mortality rate of a population of treated subjects in comparison to a population receiving carrier alone.
• Treating cancer can result in a decrease in the mortality rate of a population of treated subjects in comparison to an untreated population.
• Treating cancer can result in a decrease in the mortality rate of a population of treated subjects in comparison to a population receiving monotherapy with a drug that is not a compound of the disclosure, or a pharmaceutically acceptable salt, solvate, analog or derivative thereof.
• the mortality rate is decreased by more than 2%; more preferably, by more than 5%; more preferably, by more than 10%; and most preferably, by more than 25%.
• a decrease in the mortality rate of a population of treated subjects may be measured by any reproducible means.
• a decrease in the mortality rate of a population may be measured, for example, by calculating for a population the average number of disease-related deaths per unit time following initiation of treatment with an active compound.
• a decrease in the mortality rate of a population may also be measured, for example, by calculating for a population the average number of disease- related deaths per unit time following completion of a first round of treatment with the pharmaceutical composition disclosed herein.
• the present invention provides a method of treating a central nervous system (CNS)-related disease or condition in a subject in need thereof, the method comprising administering a therapeutically effective amount of the recombinant fusion protein or the pharmaceutical composition described herein.
• CNS central nervous system
• the present invention provides a method of preventing, inhibiting, suppressing or delaying the onset of a CNS-related disease or condition in a subject, the method comprising administering an effective amount of the recombinant fusion protein or the pharmaceutical composition described herein.
• the CNS-related disease or condition is amyotrophic lateral sclerosis (ALS), Parkinson’s disease, Alzheimer's Disease, Bell's Palsy, epilepsy and seizures, Guillain-Barre Syndrome, stroke, traumatic brain injury, multiple sclerosis or a combination.
• ALS amyotrophic lateral sclerosis
• Parkinson’s disease Alzheimer's Disease, Bell's Palsy, epilepsy and seizures
• Guillain-Barre Syndrome traumatic brain injury
• multiple sclerosis or a combination.
• a composition of the present invention can be parenterally administered to a subject in need thereof, or can be administered by a variety of methods known in the art.
• the route and/or mode of administration will vary depending upon the desired results.
• the compound may be administered to a subject in an appropriate carrier, for example, liposomes, or a diluent.
• Pharmaceutically acceptable diluents include saline and aqueous buffer solutions.
• Pharmaceutical carriers include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersion. The use of such media and agents for pharmaceutically active substances is known in the art.
• preparations for administration to subjects include sterile aqueous or non-aqueous solutions, suspensions, and emulsions.
• Some embodiments include non-aqueous solvents such as propylene glycol, polyethylene glycol, vegetable oils (e.g., olive oils), organic esters (e.g., ethyl oleate) and other solvents known to those of skill in the art.
• Physiologically acceptable carriers are optionally used in certain embodiments of the invention. Examples of such include, e.g., saline, PBS, Ringer's solution, lactated Ringer's solution, etc.
• preservatives and additives are optionally added to the compositions to help ensure stability and sterility.
• antibiotics and other bacterioci des, antioxidants, chelating agents, and the like are all optionally present in various embodiments of the compositions herein.
• parenteral administration and “administered parenterally” as used herein means modes of administration other than enteral and topical administration, usually by injection, and includes, without limitation, intravenous, intramuscular, intra-arterial, intrathecal, intracapsular, intraorbital, intracardiac, intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intra-articular, subcapsular, subarachnoid, intraspinal, epidural and intrasternal injection and infusion.
• the compounds of the present invention which may be used in a suitable hydrated form, and/or the pharmaceutical compositions of the present invention, are formulated into pharmaceutically acceptable dosage forms by conventional methods known to those of skill in the art.
• the recombinant fusion protein, or pharmaceutical composition comprising the same are optionally administered to subjects in need of treatment (either therapeutically or prophylactically) in any appropriate sterile pharmaceutical carrier.
• Such pharmaceutical carrier acts to maintain the solubility and action of the fusion protein.
• it may be desired to administer additional components in conjunction with the fusion protein.
• chemotherapeutic agents, antibiotics, additional formulations comprising the recombinant fusion protein of the invention and one or more standard of care agents, etc. are all optionally included with the compositions of the invention.
• combination treatment As used herein, the terms “combination treatment,” “combination therapy,” and “co-therapy” are used interchangeably and generally refer to treatment modalities featuring an recombinant fusion protein or pharmaceutical composition comprising the same as provided herein and an additional therapeutic agent.
• combination treatment modalities are part of a specific treatment regimen intended to provide a beneficial effect from the concurrent action of the therapeutic agent combination.
• the beneficial effect of the combination may include, but is not limited to, pharmacokinetic or pharmacodynamic co-action resulting from the combination of therapeutic agents.
• Administration of these therapeutic agents in combination typically is carried out over a defined time period (usually minutes, hours, days or weeks depending upon the combination selected).
• combination treatment comprises administration of two or more therapeutic agents in a sequential manner, wherein each therapeutic agent is administered at a different time, as well as administration of these therapeutic agents, or at least two of the therapeutic agents, in a substantially simultaneous manner.
• Substantially simultaneous administration can be accomplished, for example, by administering to the subject a single dosage form having a fixed ratio of each therapeutic agent or in multiple, separate dosage forms for the therapeutic agents.
• Sequential or substantially simultaneous administration of each therapeutic agent can be effected by any appropriate route including, but not limited to, oral routes, intravenous routes, intramuscular routes, and direct absorption through mucous membrane tissues.
• the therapeutic agents can be administered by the same route or by different routes.
• the therapeutic agents can be administered according to the same or to a different administration interval.
• a first therapeutic agent of the combination selected may be administered by intravenous injection while the other therapeutic agents of the combination may be administered orally.
• all therapeutic agents may be administered orally or all therapeutic agents may be administered by intravenous injection.
• combination therapy also embraces the administration of the therapeutic agents as described above in further combination with other biologically active ingredients and non-drug therapies (e.g., surgery or radiation treatment).
• the combination therapy further comprises a non-drug treatment
• the non-drug treatment may be conducted at any suitable time so long as a beneficial effect from the co-action of the combination of the therapeutic agents and non-drug treatment is achieved.
• the beneficial effect is still achieved when the non-drug treatment is temporally removed from the administration of the therapeutic agents, perhaps by days or even weeks.
• the additional therapeutic agent is a chemotherapeutic agent (also referred to as an anti -neoplastic agent or anti -proliferative agent), e.g., an alkylating agent; an antibiotic; an anti-metabolite; a detoxifying agent; an interferon; a polyclonal or monoclonal antibody; an EGFR inhibitor; a HER2 inhibitor; a histone deacetylase inhibitor; a hormone; a mitotic inhibitor; an MTOR inhibitor; a multi-kinase inhibitor; a serine/threonine kinase inhibitor; a tyrosine kinase inhibitors; a VEGF/VEGFR inhibitor; a taxane or taxane derivative, an aromatase inhibitor, an anthracycline, a microtubule targeting drug, a topoisomerase poison drug, an inhibitor of a molecular target or enzyme (e.g., a kinase
• an alkylating agent
• Exemplary alkylating agents suitable for use according to the combination treatment modalities provided herein include, but are not limited to, cyclophosphamide (Cytoxan; Neosar); chlorambucil (Leukeran); melphalan (Alkeran); carmustine (BiCNU); busulfan (Busulfex); lomustine (CeeNU); dacarbazine (DTIC-Dome); oxaliplatin (Eloxatin); carmustine (Gliadel); ifosfamide (Ifex); mechlorethamine (Mustargen); busulfan (Myleran); carboplatin (Paraplatin); cisplatin (CDDP; Platinol); temozolomide (Temodar); thiotepa (Thioplex); bendamustine (Treanda); or streptozocin (Zanosar).
• cyclophosphamide Cytoxan; Neosar
• anthracyclines include, but are not limited to, doxorubicin (Adriamycin); doxorubicin liposomal (Doxil); mitoxantrone (Novantrone); bleomycin (Blenoxane); daunorubicin (Cerubidine); daunorubicin liposomal (DaunoXome); dactinomycin (Cosmegen); epirubicin (Ellence); idarubicin (Idamycin); plicamycin (Mithracin); mitomycin (Mutamycin); pentostatin (Nipent); or valrubicin (Valstar).
• doxorubicin Adriamycin
• Doxil doxorubicin liposomal
• mitoxantrone Novantrone
• bleomycin Blenoxane
• daunorubicin Cerubidine
• daunorubicin liposomal DaunoXome
• Exemplary anti-metabolites include, but are not limited to, fluorouracil (Adrucil); capecitabine (Xeloda); hydroxyurea (Hydrea); mercaptopurine (Purinethol); pemetrexed (Alimta); fludarabine (Fludara); nelarabine (Arranon); cladribine (Cladribine Novaplus); clofarabine (Clolar); cytarabine (Cytosar-U); decitabine (Dacogen); cytarabine liposomal (DepoCyt); hydroxyurea (Droxia); pralatrexate (Folotyn); floxuridine (FUDR); gemcitabine (Gemzar); cladribine (Leustatin); fludarabine (Oforta); methotrexate (MTX; Rheumatrex); methotrexate (Trexall); thioguanine
• Exemplary detoxifying agents include, but are not limited to, amifostine (Ethyol) or mesna (Mesnex).
• interferons include, but are not limited to, interferon alfa-2b (Intron A) or interferon alfa-2a (Roferon-A).
• Exemplary polyclonal or monoclonal antibodies include, but are not limited to, trastuzumab (Herceptin); ofatumumab (Arzerra); bevacizumab (Avastin); rituximab (Rituxan); cetuximab (Erbitux); panitumumab (Vectibix); tositumomab/iodine-131 tositumomab (Bexxar); alemtuzumab (Campath); ibritumomab (Zevalin; In-111; Y-90 Zevalin); gemtuzumab (Mylotarg); eculizumab (Soliris) or denosumab.
• Exemplary EGFR inhibitors include, but are not limited to, gefitinib (Iressa); lapatinib (Tykerb); cetuximab (Erbitux); erlotinib (Tarceva); panitumumab (Vectibix); PKL 166; canertinib (CI-1033); matuzumab (EMD 72000) or EKB-569.
• Exemplary HER2 inhibitors include, but are not limited to, trastuzumab (Herceptin); lapatinib (Tykerb) or AC-480.
• Histone Deacetylase Inhibitors include, but are not limited to, vorinostat (Zolinza).
• Exemplary hormones include, but are not limited to, tamoxifen (Soltamox; Nolvadex); raloxifene (Evista); megestrol (Megace); leuprolide (Lupron; Lupron Depot; Eligard; Viadur) ; fulvestrant (Faslodex); letrozole (Femara); triptorelin (Trelstar LA; Trelstar Depot) ; exemestane (Aromasin) ; goserelin (Zoladex) ; bicalutamide (Casodex); anastrozole (Arimidex); fluoxy me sterone (Androxy; Halotestin); medroxyprogesterone (Provera; Depo- Provera); estramustine (Emcyt); flutamide (Eulexin); toremifene (Fareston); degarelix (Firmagon); nilutamide
• Exemplary mitotic inhibitors include, but are not limited to, paclitaxel (Taxol; Onxol; Abraxane); docetaxel (Taxotere); vincristine (Oncovin; Vincasar PFS); vinblastine (Velban); etoposide (Toposar; Etopophos; VePesid); teniposide (Vumon); ixabepilone (Ixempra); nocodazole; epothilone; vinorelbine (Navelbine); camptothecin (CPT); irinotecan (Camptosar); topotecan (Hycamtin); amsacrine or lamellarin D (LAM-D).
• paclitaxel Taxol; Onxol; Abraxane
• docetaxel Taxotere
• vincristine Oncovin
• Vincasar PFS vinblastine
• Velban etop
• Exemplary MTOR inhibitors include, but are not limited to, everolimus (Afinitor) or temsirolimus (Torisel); rapamune, ridaforolimus; or AP23573.
• Exemplary multi-kinase inhibitors include, but are not limited to, sorafenib (Nexavar); sunitinib (Sutent); BIBW 2992; E7080; Zd6474; PKC-412; motesanib; or AP24534.
• Exemplary serine/threonine kinase inhibitors include, but are not limited to, ruboxistaurin; eril/fasudil hydrochloride; flavopiridol; seliciclib (CYC202; Roscovitine); SNS- 032 (BMS-387032); Pkc412; bryostatin; KAI-9803; SF1126; VX-680; Azdl l52; Arry-142886 (AZD-6244); SCIO-469; GW681323; CC-401; CEP-1347 or PD 332991.
• Exemplary tyrosine kinase inhibitors include, but are not limited to, erlotinib (Tarceva); gefitinib (Iressa); imatinib (Gleevec); sorafenib (Nexavar); sunitinib (Sutent); trastuzumab (Herceptin); bevacizumab (Avastin); rituximab (Rituxan); lapatinib (Tykerb); cetuximab (Erbitux); panitumumab (Vectibix); everolimus (Afinitor); alemtuzumab (Campath); gemtuzumab (Mylotarg); temsirolimus (Torisel); pazopanib (Votrient); dasatinib (Sprycel); nilotinib (Tasigna); vatalanib (Ptk787; ZK222584); CEP-701;
• VEGF/VEGFR inhibitors include, but are not limited to, bevacizumab (Avastin), sorafenib (Nexavar), sunitinib (Sutent), ranibizumab, pegaptanib, or vandetinib.
• microtubule targeting drugs include, but are not limited to, paclitaxel, docetaxel, vincristin, vinblastin, nocodazole, epothilones and navelbine.
• topoisomerase poison drugs include, but are not limited to, teniposide, etoposide, adriamycin, camptothecin, daunorubicin, dactinomycin, mitoxantrone, amsacrine, epirubicin and idarubicin.
• Exemplary taxanes or taxane derivatives include, but are not limited to, paclitaxel and docetaxol.
• Exemplary immune checkpoint inhibitors include programmed cell death 1 (PD-1), CD274 molecule (PD-L1) and cytotoxic T-lymphocyte associated protein 4 (CTLA4) inhibitors.
• PD-1 inhibitors include Pembrolizumab, Nivolumab and Cemiplimab.
• Exemplary PD-L1 inhibitors include Atezolizumab, Avelumab and Durvalumab.
• CLTA4 inhibitors include Ipilimumab.
• Exemplary platinum based antineoplastic agents include Cisplatin and Carboplatin.
• Exemplary cyclin dependent kinase (CDK) inhibitors include abemaciclib, palbociclib, and ribociclib.
• Exemplary poly (ADP -ribose) polymerase (PARP) inhibitors include talazoparib, olaparib, rucaparib, niraparib and veliparib.
• Exemplary general chemotherapeutic, anti-neoplastic, anti-proliferative agents include, but are not limited to, altretamine (Hexalen); isotretinoin (Accutane; Amnesteem; Claravis; Sotret); tretinoin (Vesanoid); azacitidine (Vidaza); bortezomib (Velcade) asparaginase (Elspar); levamisole (Ergamisol); mitotane (Lysodren); procarbazine (Matulane); pegaspargase (Oncaspar); denileukin diftitox (Ontak); porfimer (Photofrin); aldesleukin (Proleukin); lenalidomide (Revlimid); bexarotene (Targretin); thalidomide (Thalomid); temsirolimus (Torisel); arsenic trioxide (Hexalen
• combination treatment modalities are provided in which the additional therapeutic agent is a cytokine, e.g., G-CSF (granulocyte colony stimulating factor).
• a pharmaceutical composition provided herein may be administered in combination with radiation therapy. Radiation therapy can also be administered in combination with a pharmaceutical composition provided herein and another chemotherapeutic agent described herein as part of a multi-agent therapy.
• a pharmaceutical composition provided herein may be administered in combination with standard chemotherapy combinations such as, but not restricted to, CMF (cyclophosphamide, methotrexate and 5- fluorouracil), CAF (cyclophosphamide, adriamycin and 5 -fluorouracil), AC (adriamycin and cyclophosphamide), FEC (5 -fluorouracil, epirubicin, and cyclophosphamide), ACT or ATC (adriamycin, cyclophosphamide, and paclitaxel), rituximab, Xeloda (capecitabine), Cisplatin (CDDP), Carboplatin, TS-1 (tegafur, gimestat and otastat potassium at a molar ratio of 1 :0.4: 1), Camptothecin-11 (CPT-11, Irinotecan or CamptosarTM), CHOP (cyclophospham
• a pharmaceutical composition provided herein may be administered with an inhibitor of an enzyme, such as a receptor or non-receptor kinase.
• Receptor and non-receptor kinases are, for example, tyrosine kinases or serine/threonine kinases.
• Kinase inhibitors described herein are small molecules, polynucleic acids, polypeptides, or antibodies.
• Exemplary kinase inhibitors include, but are not limited to, Bevacizumab (targets VEGF), BIBW 2992 (targets EGFR and Erb2), Cetuximab/Erbitux (targets Erbl), Imatinib/Gleevec (targets Bcr-Abl), Trastuzumab (targets Erb2), Gefitinib/Iressa (targets EGFR), Ranibizumab (targets VEGF), Pegaptanib (targets VEGF), Erlotinib/Tarceva (targets Erbl), Nilotinib (targets Bcr-Abl), Lapatinib (targets Erbl and Erb2/Her2), GW- 572016/lapatinib ditosylate (targets HER2/Erb2), Panitumumab/Vectibix (targets EGFR), Vandetinib (targets RET/VEGFR),
• the combination therapy can include administration of a beta blocker (e.g., bisprolol or metoprolol succinate), a calcium channel blocker (e.g., diltiazem or verapamil), digoxin, an anti-arrhythmic medication (e.g., propafenone, flecainide, sotalol, dofetilide, amiodarone, and dronedarone), or a blood thinner (e.g., warfarin, apixabab, dabigatran, edoxaban, or rivaroxaban).
• a beta blocker e.g., bisprolol or metoprolol succinate
• a calcium channel blocker e.g., diltiazem or verapamil
• digoxin e.g., diltiazem or verapamil
• an anti-arrhythmic medication e.g., propafenone, flecainide, sotalol
• the combination therapy can include cardioversion therapy to reset the heart sinus rhythm (e.g., electrical or drug cardioversion).
• the combination therapy can include ablation, e.g. AV node ablation or Maze procedure. Ablation uses a scalpel, or heat or cold to create small scars on the heart that block faulty electrical signals and restore a normal heart rhythm.
• the recombinant fusion protein or pharmaceutical composition comprising the same polypeptide disclosed herein is administered to a subject once a day.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every two days.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every three days.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every four days.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every five days.
• the recombinant fusion protein or pharmaceutical composition comprising the same polypeptide is administered to a subject once every six days. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every week. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every 7-14 days. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every 10-20 days. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every 5-15 days. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject once every 15-30 days.
• a dose of the recombinant fusion protein of the present invention comprises from 0.005 to 0.1 milligrams/kg in an injectable solution. In another embodiment, the dose comprises from 0.005 to 0.5 milligrams/kg of the recombinant fusion protein. In another embodiment, the dose comprises from 0.05 to 0.1 micrograms of the recombinant fusion protein. In another embodiment, the dose comprises from 0.005 to 0.1 milligrams/kg of the recombinant fusion protein in an injectable solution.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.0001 mg to 0.6 mg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.001 mg to 0.005 mg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.005 mg to 0.01 mg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.01 mg to 0.3 mg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.2 mg to 0.6 mg.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 1-100 mcg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 10-80 mcg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 20-60 mcg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 10-50 mcg/kg.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 40-80 mcg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 10-30 mcg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 30-60 mcg/kg.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.1 mcg/kg to 100 mg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.1 mcg/kg to 50 mg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.1 mcg/kg to 25 mg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.1 mcg/kg to 10 mg/kg.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.1 mcg/kg to 5 mg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.1 mcg/kg to 1 mg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.1 mcg/kg to 0.1 mg/kg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 10 mg/kg to 60 mg/kg.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 0.1 mg/kg, 0.2 mg/kg, 0.3 mg/kg, 0.4 mg/kg, 0.5 mg/kg, about 1 mg/kg, about 2 mg/kg, about 3 mg/kg, about 4 mg/kg, about 5 mg/kg, about 6 mg/kg, about 7 mg/kg, about 8 mg/kg, about 9 mg/kg, about 10 mg/kg, about 20 mg/kg, about 30 mg/kg, about 40 mg/kg, about 50 mg/kg, about 60 mg/kg or about 70 mg/kg.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 0.1 mg/kg, 0.2 mg/kg, 0.3 mg/kg, 0.4 mg/kg, 0.5 mg/kg, 0.6 mg/kg, 0.7 mg/kg, 0.8 mg/kg, 0.9 mg/kg or 1 mg/kg.
• the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 0.2 mg to 2 mg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 2 mg to 6 mg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 4 mg to 10 mg. In another embodiment, the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 5 mg and 15 mg.
• a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 10 pg/kg- 1000 pg/kg. In another embodiment, a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 25 pg/kg- 600 pg/kg. In another embodiment, a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose ranging from 50 pg/kg- 400 pg/kg. In another embodiment, a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 25 pg/kg.
• a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 50 pg/kg. In another embodiment, a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 100 pg/kg. In another embodiment, a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 200 pg/kg. In another embodiment, a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 300 pg/kg.
• a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 400 pg/kg. In another embodiment, a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 500 pg/kg. In another embodiment, a recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject in a dose of about 600 pg/kg.
• a single one time dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject.
• a total of two doses are administered to the subject.
• a total of two or more doses are administered to the subject.
• a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject at least once a day. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject at least once every two days. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject at least once a every two or more days. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject every week, biweekly or every three weeks.
• a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject at least once a week. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject at least once every two weeks. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject at least once every three weeks. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject at least once every three or more weeks. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject two or more times a week.
• a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject two or more times a month. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject two or more times a year. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject two or more times every two years. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject two or more times every two or more years. [00241] In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 36 hours.
• a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 48 hours. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 60 hours. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 72 hours. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 84 hours. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 96 hours.
• a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 5 days. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 6 days. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 7 days. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 8-10 days. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 10-12 days.
• a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 12-15 days. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 15-25 days. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 20-30 days.
• a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered to a subject at least once every 1 month. In one embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 2 months. In one embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 3 months. In one embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 4 months. In one embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 5 months.
• a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 6 months. In one embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered at least once every 6-12 months. In another embodiment, a dose of the recombinant fusion protein or pharmaceutical composition comprising the same is administered quarterly. In another embodiment, the dose is administered daily, weekly, biweekly, monthly or annually. In another embodiment, the dose is administered once, twice, or two or more times a day, a week, a month or a year. In another embodiment, the dose is administered every two, three, four, or at least five years.
• repeat administrations (doses) of compositions of this invention may be undertaken immediately following the first course of treatment or after an interval of days, weeks, or years to achieve the desired effect as further provided herein (e.g. to prevent or treat cardiovascular disease or condition, or a CNS-related disease or condition).
• the pharmaceutical compositions are administered by intravenous, intra-arterial, subcutaneous or intramuscular injection of a liquid preparation.
• liquid formulations include solutions, suspensions, dispersions, emulsions, oils and the like.
• the pharmaceutical compositions are administered intravenously, and are thus formulated in a form suitable for intravenous administration.
• the pharmaceutical compositions are administered intra-arterially, and are thus formulated in a form suitable for intra-arterial administration.
• compositions for use in the methods disclosed herein comprise solutions or emulsions, which in some embodiments are aqueous solutions or emulsions comprising a safe and effective amount of the compounds disclosed herein and optionally, other compounds, intended for intravenous or subcutaneous administration.
• kits for conducting/using the methods and/or the compositions of the invention optionally include, e.g., appropriate recombinant fusion protein (and optionally mixtures of a number of such proteins for performing synergistic treatments, see, above), and optionally appropriate disease related antigen(s) as well).
• kits can also comprise appropriate excipients (e.g., pharmaceutically acceptable excipients) for performing therapeutic and/or prophylactic treatments of the invention.
• Such kits optionally contain additional components for the assembly and/or use of the compositions of the invention including, but not limited to, e.g., diluents, etc.
• kits can optionally include such components as, e.g., buffers, reagents, serum proteins, antibodies, substrates, etc.
• prepackaged reagents the kits optionally include pre-measured or pre-dosed amounts that are ready to incorporate into the methods without measurement, e.g., pre-measured fluid aliquots, or pre-weighed or pre-measured solid reagents that can be easily reconstituted by the end-user of the kit.
• kits also typically include appropriate instructions for performing the methods of the invention and/or using the compositions of the invention.
• the components of the kits/packages are provided in a stabilized form, so as to prevent degradation or other loss during prolonged storage, e.g., from leakage.
• a number of stabilizing processes/agents are widely used for reagents, etc. that are to be stored, such as the inclusion of chemical stabilizers (i.e., enzymatic inhibitors, microbicides/bacteriostats, anticoagulants), etc.
• Actual dosage levels of the active ingredients in the pharmaceutical compositions of the present invention may be varied so as to obtain an amount of the active ingredient which is effective to achieve the desired therapeutic response for a particular subject, composition, and mode of administration, without being toxic to the subject.
• the selected dosage level will depend upon a variety of pharmacokinetic factors including the activity of the particular compositions of the present invention employed, the route of administration, the time of administration, the rate of excretion of the particular compound being employed, the duration of the treatment, other drugs, compounds and/or materials used in combination with the particular compositions employed, the age, sex, weight, condition, general health and prior medical history of the subject being treated, and like factors well known in the medical arts.
• the composition must be sterile and fluid to the extent that the composition is deliverable by syringe.
• the carrier preferably is an isotonic buffered saline solution. Proper fluidity can be maintained, for example, by use of coating such as lecithin, by maintenance of required particle size in the case of dispersion and by use of surfactants.
• isotonic agents for example, sugars, polyalcohols such as mannitol or sorbitol, and sodium chloride in the composition.
• Actual dosage levels of the active ingredients in the pharmaceutical compositions of the present invention may be varied so as to obtain an amount of the active ingredient which is effective to achieve the desired therapeutic response for a particular subject, composition, and mode of administration, without being toxic to the subject.
• the selected dosage level will depend upon a variety of pharmacokinetic factors including the activity of the particular compositions of the present invention employed, the route of administration, the time of administration, the rate of excretion of the particular compound being employed, the duration of the treatment, other drugs, compounds and/or materials used in combination with the particular compositions employed, the age, sex, weight, condition, general health and prior medical history of the subject being treated, and like factors well known in the medical arts.
• inventive embodiments may be practiced otherwise than as specifically described and claimed.
• inventive embodiments of the present disclosure are directed to each individual feature, system, article, material, kit, and/or method described herein.
• any combination of two or more such features, systems, articles, materials, kits, and/or methods, if such features, systems, articles, materials, kits, and/or methods are not mutually inconsistent, is included within the inventive scope of the present disclosure.
• references to “A and/or B”, when used in conjunction with open-ended language such as “comprising” can refer, in one embodiment, to A only (optionally including elements 5 other than B); in another embodiment, to B only (optionally including elements other than A); in yet another embodiment, to both A and B (optionally including other elements); etc.
• the phrase “at least one,” in reference to a list of one or more elements, should be understood to mean at least one element selected from any one or more of the elements in the list of elements, but not necessarily including at least one of each and every element specifically listed within the list of elements and not excluding any combinations of elements in the list of elements.
• This definition also allows that elements may optionally be present other than the elements specifically identified within the list of elements to which the phrase “at least one” refers, whether related or unrelated to those elements specifically identified.
• “at least one of A and B” can refer, in one embodiment, to at least one, optionally including more than one, A, with no B present (and optionally including elements other than B); in another embodiment, to at least one, optionally including more than one, B, with no A present (and optionally including elements other than A); in yet another embodiment, to at least one, optionally including more than one, A, and at least one, optionally including more than one, B (and optionally including other elements); etc.
• the present invention further provides a kit for preventing, treating or delaying a cardiovascular disease or condition in a human, wherein the kit comprises one or more doses of pharmaceutical composition comprising a recombinant fusion protein disclosed herein used for preventing, treating or delaying a cardiovascular disease or condition, and instructions on how to use the pharmaceutical preparation or composition.
• the present invention further provides a kit for preventing, treating or delaying a CNS-related disease or condition in a human, wherein the kit comprises one or more doses of pharmaceutical composition comprising a recombinant fusion protein disclosed herein used for preventing, treating or delaying a cardiovascular disease or condition, and instructions on how to use the pharmaceutical preparation or composition.
• the present invention further provides a kit for preventing, treating or delaying heart failure with preserved ejection fraction in a human, wherein the kit comprises one or more doses of pharmaceutical composition comprising a recombinant fusion protein disclosed herein used for preventing, treating or delaying heart failure with preserved ejection fraction, and instructions on how to use the pharmaceutical preparation or composition.
• DNA sequences encoding the recombinant fusion proteins’ heavy chain (named NPCFA and NPCF for the sequences with or without Fc mutations, respectively) and light chain (named PAL) were synthesized by GENEWIZ (Suzhou, China).
• Expression vector pCHOGUN was obtained from Horizon Discovery (Cambridge, UK) under a licensing agreement. Construction of the expression plasmids is carried out as outlined in FIG. 1. Briefly, pCHOGUN vector was linearized by restriction enzyme BfuAI and gene insert fragments such as NPCF, NPCFA, and PAL were purified following double restriction enzyme digestion by Ncol and Asci.
• the linearized pCHOGUN/BfuAI and the purified gene insert fragment were ligated per standard protocol and then transformed into E.coli DH5a competent cells.
• DH5a cells were plated and incubated overnight at 37°C.
• Plasmids pCHOGUN-NPCF, pCHOGUN- NPCFA and pCHOGUN-PAL were isolated and confirmed by restriction enzyme digestion or PCR.
• the plasmid containing the heavy chain insert (pCHOGUN-NPCF or pCHOGUN- NPCFA) was digested with restriction enzymes BspEI and Pcil, whereas the plasmid containing the light chain insert (pCHOGUN-PAL) was digested with restriction enzymes NgoMIV and Pcil.
• the fragments with the heavy or light chain insert were purified, ligated and then transformed into DH5a cells.
• the plasmid constructs containing both the heavy and light chain inserts (pCHOGUN-NPCF+PAL or pCHOGUN-NPCF A+P AL) were identified and confirmed by restriction enzyme digestion and DNA sequencing.
• HD-BIOP3 a glutamine synthetase-null (GS' /_ ) cell line derived from CHO KI cells, was obtained from Horizon Discovery (Cambridge, UK) under a licensing agreement. Plasmid DNA is isolated using commercially available Qiagen Plasmid Kits. Transfection of the plasmid DNA into HD-BI0P3 cells was performed using a commercially available electroporation system from Lonza. The transfected cells were plated in 96-well plates and underwent pool selection using standard procedures. Cells from the selected pools were cultured in 125-mL shake flasks for 10-14 days and the media were harvested for antibody purification. Antibody proteins were purified by protein-A affinity chromatography followed by size-exclusion chromatography and then analyzed with SDS-PAGE and Western blot according to standard protocols.
• FIG. 2A illustrates the schematic structure of the recombinant fusion protein disclosed herein.
• FIG. 2B shows representative data generated by SDS-PAGE analysis.
• Western blot results detected by primary antibody specific for the 61 -amino acid active fragment of NRG-1 comprising the HER3/4 binding domain (“NRG-1”, R&D Systems, Minneapolis, MN) or IgG are shown in FIGS. 2C and 2D, respectively.
• Molecular structure integrity of the recombinant fusion protein disclosed herein is assessed by evaluating its concurrent binding ability to HER3 protein and Anti -NRG-1 antibody. His-tagged HER3 recombinant protein (Sino Biological, Beijing, China) was captured on the sensor chip immobilized with anti-His antibody (Thermo Fisher, Waltham, MA) (Step 1), followed by the injection of samples (including the recombinant fusion protein disclosed herein, the recombinant fusion protein disclosed herein without Fc mutations, anti- HER3 mAb (Step 2), and anti-NRG-1 antibody (R&D Systems, Minneapolis, MN) (Step 3).
• Tumor cells were seeded in 96-well plates at 2,500-20,000 cells per well, depending on the growth kinetics of each cell line. Cells were then treated with the recombinant fusion protein disclosed herein, antibody or control protein in a step-wise 1 :4 serial dilution series for 5 days. Cell viability was assessed using Cell Counting Kit-8 from Dojindo Molecular Technologies (Kumamoto, Japan) according to the manufacturer’s instructions. Data were analyzed with GraphPad Prism software and are presented as the rate of growth relative to the untreated control.
• the recombinant fusion protein disclosed herein demonstrates markedly lower activity in promoting cancer cell proliferation.
• EXAMPLE 5 - Activation of PI3K/AKT Signaling Pathway in Human Cardiomyocytes
• Human cardiomyocytes obtained from Cellular Dynamics (Madison, WI) were seeded in 0.1% gelatin-coated 96-well plates and recovered in the plating medium (Cellular Dynamics) for 4 hours. Cells were then cultured in the maintaining medium (Cellular Dynamics) for 96 hours before used for experimentation.
• FIG. 5 shows AKT phosphorylation in response to stimuli in human cardiomyocytes. Results suggest that the recombinant fusion protein disclosed herein can activate the HER2:HER4 signaling pathway in cardiomyocytes with a potency comparable to NRG-1.
• EXAMPLE 6 Induction of HER2:HER3 Dimerization and HER2:HER4 Dimerization
• PathHunter Dimerization Assay developed by Eurofins DiscoverX (Fremont, CA) detects ligand induced dimerization of two subunits of a receptor-dimer pair. The assay principle is illustrated in FIG. 6A. P-gal enzyme is split into two fragments, ProLink (PK) and enzyme receptor (EA). The cells have been engineered to co-express target protein 1 fused to enzyme donor PK, and target protein 2 fused to enzyme acceptor EA. Binding of ligand to one target protein induces it to interact with the other target protein, forcing complementation of the two enzyme fragments and resulting in the enzyme reaction to release chemiluminescent signal which is detected as Relative Fluorescence Unit or RFU.
• PK ProLink
• EA enzyme receptor
• the recombinant fusion protein disclosed herein can induce HER2/HER4 dimerization with potency comparable to NRG-1; whereas its ability to induce HER2/HER3 dimerization is much weaker.
• As negative controls for the study neither the isotype control antibody GP120 mAb nor the anti-HER3 mAb induced receptor dimerization.
• a Sprague Dawley rat model of myocardial infarction and systolic heart failure was employed.
• a 6-0 silk suture was used to ligate the left anterior descending coronary artery (LAD) 3-4 mm below the left atrial appendage in a surgical procedure.
• LAD left anterior descending coronary artery
• ECG M-mode echocardiography
• mice were divided into five groups of eleven rats each, with an additional ten sham-surgery rats included in a sixth group.
• the study was designed for each group to receive twice-weekly tail vein injections for a period of four weeks, or eight total injections.
• Both the sham surgery group and the negative control of vehicle group received saline, three groups received the recombinant fusion protein at 1, 3, or 10 mg/kg, and the final group received a positive control of GP120 mAb/NRG-1 fusion protein (10 mg/kg).
• mice were euthanized and the cardiac tissues next to the surgical site were collected, fixed in 4% formaldehyde, and embedded in paraffin. Five pm thick paraffin sections of the heart tissues were stained with hematoxylin and eosin dyes, and histopathological changes were observed under a light microscope. As shown in FIGS. 9A-9F, in the sham operation group, the cardiomyocytes were arranged in an orderly fashion and the cytoplasm and the myocardial fibers were evenly stained. No inflammatory cell infiltration was observed in the interstitial spaces and no myocardial necrosis was found.
• the myocardial infarction marginal zone exhibited widened gaps between myocardial cells; the nuclei were condensed and shattered and the myocardial fiber arrangement lost its ordered structure; the cell size was enlarged and the interstitial edema was noticed.
• Treatment with the recombinant fusion protein partially alleviated the pathological changes in the myocardial infarction zone, including significant reduction of necrotic cells, narrowed interstitial spaces between myocardial cells, and recovery of myocardial fiber arrangement towards normal structure.
• EXAMPLE 8 The Recombinant Fusion Protein Attenuated Tumor Growth in Subcutaneous FaDu Carcinoma Xenograft Model in NOD/SCID Mice
• mice Female NOD/SCID mice, age 7-10 weeks, were inoculated subcutaneously in the right flank with FaDu tumor cells (3 x 10 6 ) suspended in 0.1 ml of PBS. When tumors reached approximately 150 mm 3 , mice were randomized and sorted into 6 study groups with 8 animals per group. Test samples were administrated intravenously by tail vein injection twice a week for three consecutive weeks, for a total of 6 treatments. Tumor growth was monitored by caliper measurements. The study was terminated at 21 days post-treatment.
• FIG. 10 The tumor growth in response to different treatments is summarized in FIG. 10.
• Anti- HER3 mAb at 10 mg/kg showed significant anti -turn or activity with a tumor growth inhibition (TGI) of 93.5% at the end of study (p ⁇ 0.001 vs. vehicle group).
• TGI tumor growth inhibition
• the control molecule GP120 mAb/NRG-1 fusion protein showed no anti -tumor activity at either the high or low dose. No animal deaths occurred during the study.
• the safety and tolerability of the recombinant fusion protein was evaluated following four consecutive weekly administrations at dose levels of 3, 10, and 30 mg/kg in comparison to vehicle control, with three males and three females included in each cohort for the main 28-day study period, and an additional two males and two females in the 30 mg/kg and vehicle control cohorts evaluated following a subsequent 28-day recovery period.
• While there was test agent-related vomiting observed in this repeat-dose study clinical observations of vomiting were only associated with infusion reactions, only observed in one animal in the 10 mg/kg cohort (17%) and two animals in the 30 mg/kg cohort (20%), and were transient in nature.
• Diarrhea was observed only in the vehicle control cohort and 30 mg/kg recombinant fusion protein cohort, in only one (10%) and three (30%) animals respectively, and was considered normal for this type of procedure and unrelated to the recombinant fusion protein. Finally, in this repeat-dose study, average body weight was reduced by >10% relative to baseline only at the 10 mg/kg and 30 mg/kg dose levels, and only following the fourth dose in the 10 mg/kg cohort and the third and fourth doses in the 30 mg/kg cohort. In summary, treatment with the recombinant fusion protein did not result in any clinically significant findings related to food intake, vomiting, or diarrhea other than during acute infusion reactions, and gastrointestinal findings had no impact on the determination of the no-adverse event level in either study. These results indicate that the design of the recombinant fusion protein mitigates the adverse effect of NRG- 1 recombinant protein on the gastrointestinal tract.
• Blood samples ( ⁇ 1 ml) were collected from cynomolgus monkeys following singledose administration of 60 mg/kg of the recombinant fusion protein at different time points, and sera were extracted and stored at -80°C until tested.
• concentrations of the recombinant fusion protein in the serum samples were assayed by capture ELISA according to standard procedures. Briefly, 96-well plates were coated with the recombinant human HER3 protein (R&D System), blocked with BSA, and incubated with test samples. After multiple washes, plates were incubated with HRP-conjugated anti-human IgG Fc antibody and then detected with TMB substrate.
• FIG. 12 shows that the pharmacokinetic profile of the recombinant fusion protein is similar to IgG antibody.
• the binding affinity between the recombinant anti-HER3 mAb/NRG-1 fusion protein and Fc receptors were measured using label-free SPR technique.
• a total of six Fc receptors (each fused with a His-tag), including FcyRI (Abeam), FcyRIIa, FcyRIIb, FcyRIIIa (158F), FcyRIIIa (158V), and Clq (Sino Biological), were analyzed against the recombinant fusion protein, the recombinant fusion protein without Fc mutations and anti-HER3 antibody, respectively. All Fc receptors and test samples were purified by affinity chromatography.
• the recombinant fusion protein and all other samples were serially diluted to a total of 6 concentrations, ranging from 0.3 nM to 30 nM, and the serial dilutions were injected in sequence through both flow cells in each channel. Multiple analyses were completed in the same run by simultaneously injecting samples over multiple channels.
• FcyRIIIa 158F
• FcyRIIIa 158V
• Fc mutations led to 2 to 3 -fold reduction in binding affinity for the recombinant fusion protein. Binding to Clq was too weak to be detected for all samples.
• ADCC antibody-dependent cellular cytotoxicity
• Atrial fibrillation results from electrical and structural remodeling of the atria, in which inflammation and fibrosis play a role.
• Current therapy is limited to anti arrhythmic drugs and ablations, but does not target the structural problem.
• neuregulin-1 (NRG1), an epidermal growth factor family member, has anti-fibrotic and anti-inflammatory effects in the myocardium.
• the NRG-1/HER3 antibody fusion protein comprises an NRG-1 active fragment and an antagonistic HER3 (ERBB3) antibody, and electively signals through ERBB4 preferentially over ERBB3.
• ERBB3 antagonistic HER3
• FIG. 13 A An in vitro fibrotic assay, as depicted in FIG. 13 A, was used to induce fibrosis in rat tissue samples in vitro. Atrial samples were harvested from male rats (Wistar Han, 10 weeks old), cut into small pieces (1-2 mm 2 ) and kept in low serum medium in the presence or absence of the NRG-1/HER3 fusion protein (5nM concentration). Col lai and Col3al mRNA was quantified after 24-72 hours, as depicted in FIGS. 14A and 14B, respectively.
• AF inducibility was tested in two models.
• male mice C57BL/6N, 12-15 weeks old
• angiotensin-II Ang-II, 4 weeks, osmotic mini-pumps, 3000 ng/kg/min
• FIG. 16 mice were fed with a high fat diet (HFD, 8 weeks, 60% Kcal fat) inducing severe weight gain (56 ⁇ 3% increase compared to 23 ⁇ 4% with regular chow), as shown in FIG. 19A.
• AF inducibility was tested by 5 runs of programmed electrical stimulation (PES) with a trans-jugular octapolar catheter, as depicted in FIG. 15.
• PES programmed electrical stimulation
• AF inducibility % mice inducible by ⁇ 3 PES-runs
• duration of PES-induced AF AF duration
• the NRG-1/HER3 fusion protein significantly attenuated AF inducibility (from 57% to 0%), shown in FIG. 20B, and AF duration (from 10.9 ⁇ 3.2s to 0.76 ⁇ 0.5s, p ⁇ 0.05), shown in FIG. 20A.
• EXAMPLE 12 NRG-1/HER3 Antibody Fusion Protein Reduces Collagen Type Associated with Myocardial Stiffness
• Example 7 The Sprague Dawley rat model of myocardial infarction and systolic heart failure (also referred to as heart failure with reduced ejection fraction, or HFrEF) employed in Example 7 was used to assay Collagen Type I and Collagen Type III expression.
• cardiac tissue samples were removed, fixed and sectioned as described in Example 7, and stained for Collagen type I or Collagen type III protein expression using immunohi stochemi stry .
• FIGS. 21A-21F Representative results for Collagen Type I are shown in FIGS. 21A-21F.
• NRG-1/HER3 antibody fusion protein administered at 1 mg/kg, 3 mg/kg and 10 mg/k, down-regulated the expression of collagen type I by 6.6%, 37.1%, and 40.5%, respectively, as compared to the vehicle control.
• the Collagen Fill ratio decreased by 4.7%, 40.8%, and 36.6%, respectively, relative to the vehicle control.
• AAA p ⁇ 0.01 denotes statistical significance in comparison to the sham control
• EXAMPLE 13 NRG-1/HER3 Antibody Fusion Protein Prevents Atrial Fibrosis and Atrial Fibrillation Inducibility in a Porcine POCA Model
• Atrial fibrosis is a substrate for re-entry in atrial fibrillation (AF), and higher burdens of fibrosis are associated with resistance to therapy and worse prognosis. The degree of fibrosis predicts prognosis and therapy refractoriness.
• AF atrial fibrillation
• the degree of fibrosis predicts prognosis and therapy refractoriness.
• the NRG-1/HER3 fusion protein is a long-acting neuregulin-fusion protein that has been shown to decrease ventricular fibrosis (z.e., has anti-fibrotic properties) in animal models of heart failure through selective stimulation of the ErbB4 receptor.
• Methods 18 Aachener mini-pigs were randomized into 3 groups: control (CTRL), DOCA + Vehicle (DOCA+VEH) and DOCA+ NRG-1/HER3 fusion protein. The control group did not undergo a therapeutic intervention. A diagram of the experiment is shown in FIG. 22. To induce hypertension and atrial fibrosis, pellets releasing 10 mg/kg DOCA over a period of 60 days were implanted in mini-pigs in the DOCA+VEH and DOCA+ NRG-1/HER3 fusion protein groups.
• the DOCA-implanted animals underwent weekly treatment with the NRG- 1/HER3 fusion protein (0.3 mg/kg; DOCA + NRG-1/HER3 fusion protein) or its vehicle (DOCA + VEH), starting at the day of implantation (total of 9 administrations).
• OAA + VEH the vehicle
• AF inducibility was tested by performing 50 burst pacing episodes and quantified as the percentage of “successful” episodes where an AF run > 5 seconds could be induced after the burst, out of the 50 attempts. Exemplary results of AF inducibility testing are shown in FIG. 23.
• Atrial fibrosis was quantified using Imaged software on Masson tri chrome staining of left atrial specimens, isolated after euthanizing the animals.
• AF inducibility in the DOCA+VEH group was significantly higher than in the CTRL group (66/250 vs. 9/300, p ⁇ 0.001), and the DOCA + NRG-1/HER3 fusion protein group (66/250 vs. 8/300, p ⁇ 0.001).
• NRG-1/HER3 fusion protein prevents atrial fibrosis and AF inducibility in a porcine DOCA model.
• the effect of the NRG-1/HER3 fusion protein is unrelated to effects on blood pressure, but probably related to reduced atrial fibrogenesis.

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