WO2015195509A2 - Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases - Google Patents
Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases Download PDFInfo
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- A61K31/573—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
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- A61K31/575—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of three or more carbon atoms, e.g. cholane, cholestane, ergosterol, sitosterol
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- A61K38/22—Hormones
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- 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
- C07K14/50—Fibroblast growth factor [FGF]
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- C07K2319/00—Fusion polypeptide
Definitions
- the invention relates, in part, to the treatment or prevention of bile acid-related and associated disorders with variants of fibroblast growth factor 19 (FGF19) proteins and peptide sequences (and peptidomimetics) and fusions of FGF19 and/or fibroblast growth factor 21 (FGF21) proteins and peptide sequences (and peptidomimetics), and variants of fusions of FGF19 and/or FGF21 proteins and peptide sequences (and peptidomimetics) in combination with one or more additional therapeutic agents.
- FGF19 fibroblast growth factor 19
- FGF21 fibroblast growth factor 21
- Bile acids steroid acids that are found predominantly in the bile of mammals, regulate cholesterol, triglyceride, glucose and energy homeostasis, and facilitate digestion and absorption of lipids in the small intestine.
- bile acid production occurs primarily in the perivenous hepatocytes through a series of enzymatic reactions that convert cholesterol into the two primary bile acids, cholic acid and chenodeoxycholic acid.
- the primary bile acids are synthesized by two distinct pathways.
- the primary bile acids are produced by hydroxylation of cholesterol through catalysis by the cytochrome P450 enzyme cholesterol 7a-hydroxylase (CYP7A1), which catalyzes the first and rate-limiting step.
- CYP7A1 cholesterol 7a-hydroxylase
- the conversion of cholesterol to bile acids is primarily effected by this pathway. See, e.g., Inagaki et ah, Cell Metabolism 2:217-25 (Oct 2005).
- CYP7A1 activity is down-regulated by cholic acid and up-regulated by cholesterol; thus, CYP7A1 is regulated by bile acids themselves.
- repression of CYP7A1 results in the decreased synthesis of bile acids from intrahepatic cholesterol in response to the daily feeding- fasting cycle.
- CYP27A1 is not regulated by bile acids.
- bile acids are potentially toxic to cells, and the size of the bile acid pool is tightly regulated within the liver and intestine to prevent cytotoxic accumulation.
- FXR nuclear receptors
- intestinal FXR activation due to transintestinal bile acid flux after a meal induces the expression of the hormone FGF19, which is released by small intestinal epithelial cells and circulates to bind to hepatocyte FGF receptor 4 (FGFR4) receptors.
- the FGFR4 receptors signal a reduction in bile acid synthesis via c-Jun NH 2 -terminal kinase (JNK) pathway activation.
- Cholestasis is a condition characterized by a reduction or cessation of bile flow from the liver to the small intestine (principally the duodenum).
- Primary biliary cirrhosis (PBC) is the most common cholestatic liver disease and is the fifth most common cause of liver transplant in the United States.
- PBC is a progressive hepatic disease that primarily results from autoimmune destruction of the bile ducts that transport bile acids out of the liver. As the disease progresses, persistent toxic build-up of bile acids causes progressive liver damage marked by chronic inflammation and fibrosis.
- a majority of PBC patients are asymptomatic at the time of initial diagnosis, but most develop symptoms, such as fatigue and pruritus, over time. Jaundice may result from advanced disease.
- the invention is based, in part, on the use of variants of FGF19 peptide sequences, fusions of FGF19 and/or FGF21 peptide sequences and variants of fusions (chimeras) of FGF19 and/or FGF21 peptide sequences having one or more activities associated with the treatment and/or prevention of bile acid-related disorders, in combination with other therapeutic agents and/or treatment modalities.
- variants and fusions (chimeras) of FGF19 and/or FGF21 peptide sequences include sequences that do not substantially increase or induce hepatocellular carcinoma (HCC) formation or HCC tumorigenesis and/or do not induce a substantial elevation or increase in lipid profile.
- HCC hepatocellular carcinoma
- FGF19 and/or FGF21 peptide sequences further include those sequences disclosed in PCT Pub. No. WO 2013/006486 and US Pub. No. 2013/0023474, published January 20, 2013 and January 24, 2013, respectively; as well as PCT Publ. No. WO 2014/085365, published June 5, 2014.
- compositions and mixtures comprising certain peptide sequences, including subsequences, variants and modified forms of the exemplified peptide sequences (including the FGF19 and FGF21 variants and subsequences listed in the Sequence Listing or Table 1, and the FGF19/FGF21 fusions and chimeras listed in the Sequence Listing or Table 1), and one or more pharmaceutically acceptable carriers or excipients.
- Combinations such as one or more peptide sequences in a pharmaceutically acceptable carrier or excipient, with one or more therapeutic agents or treatment modalities useful in the treatment and/or prevention of a bile acid-related disease, disorder, or condition are also provided.
- Such combinations of peptide sequence(s) provided herein with one or more additional agents or modalities are useful in accordance with the methods and uses provided herein.
- a use or method of treatment of a subject includes administering a chimeric peptide or peptide sequence provided herein to a subject having, or at risk of having, a disorder of bile acid homeostasis treatable by a peptide sequence provided herein, in an amount effective for treating the disorder, in combination with at least one additional agent or treatment modality having an additive, synergistic or complementary effect.
- the additional agent or treatment modality may also confer one or more further benefits, such as, but not limited to, the ability to lower the dose of one or more of the peptide sequence(s) provided herein or the additional agent(s) in order to favorably impact one or more of the adverse effects experienced by the subject (e.g., decreasing the frequency or severity of an adverse effect).
- a method or use of modulating bile acid homeostasis or treating a bile-acid related or associated disorder includes: a) administering a chimeric peptide sequence, comprising: i) an N-terminal region comprising at least seven amino acid residues, the N- terminal region having a first amino acid position and a last amino acid position, wherein the N- terminal region comprises DSSPL (SEQ ID NO: 121) or DASPH (SEQ ID NO: 122), and ii) a C- terminal region comprising a portion of SEQ ID NO:99 (FGF19), the C-terminal region having a first amino acid position and a last amino acid position, wherein the C-terminal region comprises amino acid residues 16-29 of SEQ ID NO:99 (FGF19), WGDPIRLRHLYTSG (SEQ ID
- a method or use of modulating bile acid homeostasis or treating a bile-acid related or associated disorder includes: a) administering a chimeric peptide sequence, comprising: i) an N-terminal region comprising a portion of SEQ ID NO: 100
- FGF21 the N-terminal region having a first amino acid position and a last amino acid position, wherein the N-terminal region comprises amino acid residues GQV, and wherein the V residue corresponds to the last amino acid position of the N-terminal region
- a method or use of modulating bile acid homeostasis or treating a bile-acid related or associated disorder includes: a) administering a chimeric peptide sequence, comprising: ii) an N-terminal region comprising a portion of SEQ ID NO: 100
- FGF21 the N-terminal region having a first amino acid position and a last amino acid position, wherein the N-terminal region comprises at least 5 contiguous amino acids of SEQ ID NO: 100 (FGF21) including the amino acid residues GQV, and wherein the V residue corresponds to the last amino acid position of the N-terminal region
- a method or use of modulating bile acid homeostasis or treating a bile-acid related or associated disorder includes: administering a) peptide sequence, comprising or consisting of any of: i) a FGF19 sequence variant having one or more amino acid substitutions, insertions or deletions compared to a reference or wild type FGF19, ii) a FGF21 sequence variant having one or more amino acid substitutions, insertions or deletions compared to a reference or wild type FGF21, iii) a portion of an FGF19 sequence fused to a portion of an FGF21 sequence, or iv) a portion of an FGF19 sequence fused to a portion of an FGF21 sequence, wherein the FGF19 and/or FGF21 sequence portion(s) have one or more amino acid substitutions, insertions or deletions compared to a reference or wild type FGF19 and/or FGF21; and b) administering at least one additional agent effective
- a chimeric peptide sequence has an N-terminal region with at least 6 contiguous amino acids of SEQ ID NO: 100 (FGF21) including the amino acid residues GQ; or has an N-terminal region with at least 7 contiguous amino acids of SEQ ID NO: 100 (FGF21) including the amino acid residues GQV.
- a peptide sequence has amino -terminal amino acids 1-16 of SEQ ID NO: 100 (FGF21) fused to carboxy-terminal amino acids 21-194 of SEQ ID NO:99 (FGF19), or the peptide sequence has amino-terminal amino acids 1-147 of SEQ ID NO:99 (FGF19) fused to carboxy-terminal amino acids 147-181 of SEQ ID NO: 100 (FGF21) (M41), or the peptide sequence has amino-terminal amino acids 1-20 of SEQ ID NO:99
- FGF19 fused to carboxy-terminal amino acids 17-181 of SEQ ID NO: 100 (FGF21) (M44), or the peptide sequence has amino-terminal amino acids 1-146 of SEQ ID NO: 100 (FGF21) fused to carboxy-terminal amino acids 148-194 of SEQ ID NO:99 (FGF19) (M45), or the peptide sequence has amino-terminal amino acids 1-20 of SEQ ID NO: 99 (FGF19) fused to internal amino acids 17-146 of SEQ ID NO: 100 (FGF21) or fused to carboxy-terminal amino acids 148- 194 of SEQ ID NO:99 (FGF19) (M46).
- a peptide sequence has at least one amino acid substitution to amino acid residues 125-129 of SEQ ID NO:99 (FGF19), EIRPD; at least one amino acid substitution to amino acid residues 126-128 of SEQ ID NO:99 (FGF19), IRP; or at least one amino acid substitution to amino acid residues 127-128 of SEQ ID NO:99 (FGF19), RP, or at least one amino acid substitution to amino acid residues 1-124 of SEQ ID NO:99 (FGF19) and/or to amino acid residues 130-194 of SEQ ID NO:99 (FGF19).
- the amino acid sequence of the peptide comprises at least one amino acid substitution in the Loop-8 region of FGF19, or the corresponding FGF19 sequence thereof in a variant peptide provided herein.
- the amino acid sequence of the peptide comprises one amino acid substitution to the EIRPD (amino acids 2-6 of SEQ ID NO:99 (FGF19), IRP, wherein at least one amino acid substitution is R127L or P128E.
- the amino acid sequence of the peptide comprises at least one amino acid substitution in the Loop-8 region of FGF19, or the corresponding FGF19 sequence thereof in a variant peptide provided herein.
- the amino acid sequence of the peptide comprises one amino acid substitution to the EIRPD (amino acids 2-6 of SEQ ID NO:
- the amino acid sequence of the peptide comprises two amino acid substitutions to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In other embodiments, the amino acid sequence of the peptide comprises three amino acid substitutions to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In certain embodiments, the amino acid sequence of the peptide comprises four amino acid substitutions to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19.
- the amino acid sequence of the peptide comprises five amino acid substitutions to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In certain embodiments, the amino acid sequence of the peptide comprises one amino acid substitution to the IRP (amino acids 3-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In some embodiments, the amino acid sequence of the peptide comprises two amino acid substitutions to the IRP (amino acids 3-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19.
- the amino acid sequence of the peptide comprises three amino acid substitutions to the IRP (amino acids 3-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In certain embodiments, the amino acid sequence of the peptide comprises one amino acid substitution to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In some embodiments, the amino acid sequence of the peptide comprises two amino acid substitutions to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19.
- the amino acid substitution to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19 is an Arg (R) to Leu (L) substitution.
- the substitution to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19 is a Pro (P) to Glu (E) substitution.
- the substitutions to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19 is an Arg (R) to Leu (L) substitution and a Pro (P) to Glu (E) substitution.
- the foregoing substitution(s) in the Loop-8 region of FGF19 is in the corresponding FGF19 sequence thereof in a variant peptide provided herein. That is, said substitutions within a corresponding FGF19 sequence (e.g., EIRPD, IRP or RP) of a peptide variant provided herein is also contemplated.
- a corresponding FGF19 sequence e.g., EIRPD, IRP or RP
- Methods and uses provided herein can be practiced using a peptide or chimeric sequence, as set forth herein.
- the peptide sequence includes or consists of any sequence set forth in Table 1.
- a peptide or chimeric sequence of any suitable length can be practiced using a peptide or chimeric sequence of any suitable length.
- the N-terminal or C-terminal region of the peptide or chimeric sequence is from about 20 to about 200 amino acid residues in length.
- a peptide or chimeric sequence has 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or more amino acid deletions from the amino terminus, the carboxy-terminus or internally.
- a peptide or chimeric sequence has an N-terminal region, or a C-terminal region that includes or consists of an amino acid sequence of about 5 to 10, 10 to 20, 20 to 30, 30 to 40, 40 to 50, 60 to 70, 70 to 80, 80 to 90, 90 to 100 or more amino acids.
- a peptide or chimeric sequence has an FGF19 sequence portion, or an FGF21 sequence portion that includes or consists of an amino acid sequence of about 5 to 10, 10 to 20, 20 to 30, 30 to 40, 40 to 50, 50 to 60, 60 to 70, 70 to 80, 80 to 90, 90 to 100 or more amino acids of FGF19 or FGF21.
- a peptide sequence or a chimeric peptide sequence has a WGDPI (SEQ ID NO: 170) sequence motif corresponding to the WGDPI (SEQ ID NO: 170) sequence of amino acids 16-20 of SEQ ID NO:99 (FGF19); has a substituted, mutated or absent WGDPI (SEQ ID NO: 170) sequence motif corresponding to FGF19 WGDPI (SEQ ID NO: 170) sequence of amino acids 16-20 of FGF19; has a WGDPI (SEQ ID NO: 170) sequence with one or more amino acids substituted, mutated or absent.
- the peptide sequence is distinct from an FGF19 variant sequence having any of GQV, GDI, WGPI (SEQ ID NO : 171 ), WGDPV (SEQ ID NO : 172), WGDI (SEQ ID NO : 173), GDPI (SEQ ID NO : 174), GPI, WGQPI (SEQ ID NO: 175), WGAPI (SEQ ID NO: 176), AGDPI (SEQ ID NO: 177), WADPI (SEQ ID NO: 178), WGDAI (SEQ ID NO: 179), WGDPA (SEQ ID NO: 180), WDPI (SEQ ID NO : 181 ), WGDI (SEQ ID NO : 182), WGDP (SEQ ID NO : 183) or FGDPI (SEQ ID NO : 184) substituted for the FGF19 WGDPI (SEQ ID NO: 170) sequence at amino acids 16-20.
- a peptide sequence or a chimeric peptide sequence has N- terminal region comprises amino acid residues VHYG (SEQ ID NO: 101), wherein the N- terminal region comprises amino acid residues DASPHVHYG (SEQ ID NO: 102), or the N- terminal region comprises amino acid residues DSSPLVHYG (SEQ ID NO: 103). More particularly, in one aspect the G corresponds to the last position of the N-terminal region.
- the N-terminal region comprises amino acid residues DSSPLLQ (SEQ ID NO: 104), where the Q residue is the last amino acid position of the N- terminal region, or comprises amino acid residues DSSPLLQFGGQV (SEQ ID NO: 105), where the V residue corresponds to the last position of the N-terminal region.
- an N-terminal region comprises or consists of (or further comprises or consists of): RHPIP (SEQ ID NO: 106), where R is the first amino acid position of the N-terminal region; or HPIP (SEQ ID NO: 107), where H is the first amino acid position of the N-terminal region; or RPLAF (SEQ ID NO: 108), where R is the first amino acid position of the N-terminal region; or PLAF (SEQ ID NO: 109), where P is the first amino acid position of the N- terminal region; or R, where R is the first amino acid position of the N-terminal region.
- RHPIP SEQ ID NO: 106
- HPIP SEQ ID NO: 107
- H the first amino acid position of the N-terminal region
- RPLAF SEQ ID NO: 108
- PLAF SEQ ID NO: 109
- a peptide or chimeric sequence has: amino acid residues HPIP (SEQ ID NO: 107), which are the first 4 amino acid residues of the N-terminal region.
- a peptide or chimeric sequence has: an R residue at the first position of the N-terminal region, or the first position of the N-terminal region is an M residue, or the first and second positions of the N-terminal region is an MR sequence, or the first and second positions of the N-terminal region is an RM sequence, or the first and second positions of the N- terminal region is an RD sequence, or the first and second positions of the N-terminal region is an DS sequence, or the first and second positions of the N-terminal region is an MD sequence, or the first and second positions of the N-terminal region is an MS sequence, or the first through third positions of the N-terminal region is an MDS sequence, or the first through third positions of the N-terminal region is an RDS sequence, or the first through
- a peptide or chimeric sequence has at the N- terminal region first amino acid position an "M” residue, an "R” residue, a “S” residue, a “H” residue, a “P” residue, a “L” residue or an “D” residue.
- a peptide or chimeric sequence peptide sequence does not have a "M” residue or an "R” residue at the first amino acid position of the N-terminal region.
- a peptide or chimeric sequence has an N-terminal region with any one of the following sequences: MDSSPL (SEQ ID NO: l 10), MSDSSPL (SEQ ID NO: 1 1 1), SDSSPL (SEQ ID NO: 1 12), MSSPL (SEQ ID NO: 1 13) or SSPL (SEQ ID NO:
- a peptide or chimeric sequence has a residue at the last position of the C-terminal region that corresponds to about residue 194 of SEQ ID NO:99 (FGF19).
- a peptide sequence or a chimeric peptide sequence an addition of amino acid residues 30-194 of SEQ ID NO:99 (FGF19) at the C-terminus, resulting in a chimeric polypeptide having at the last position of the C-terminal region that corresponds to about residue 194 of SEQ ID NO: 99 (FGF19).
- a chimeric peptide sequence or peptide sequence comprises all or a portion of an FGF19 sequence (e.g., SEQ ID NO:99), positioned at the C-terminus of the peptide, or where the amino terminal "R" residue is deleted from the peptide.
- FGF19 sequence e.g., SEQ ID NO:99
- a chimeric peptide sequence or peptide sequence comprises or consists of any of M1-M98 variant peptide sequences, or a subsequence or fragment of any of the M1-M98 variant peptide sequences.
- Methods and uses provided herein can also be practiced using a peptide or chimeric sequence, as set forth herein.
- a peptide sequence comprises or consists of any one of the following sequences:
- RHPIPD S SPLLQFGGQ VRLRHL YT S GPHGLS S CFLRIRADG V VD C ARGQ S AHSLLEIKAV ALRTVAIKGVHSVRYLCMGADGKMQGLLQYSEEDCAFEEEIRPDGYNVYRSEKHRLPV SLSSAKQRQLYKNRGFLPLSHFLPMLPMVPEEPEDLRGHLESDMFSSPLETDSMDPFGLV TGLEAVRSPSFEK (M5) (SEQ ID NO:5);
- the R terminal residue (R residue at the N-terminus) is deleted.
- the peptide comprises or consists of:
- the N-terminal R residue is deleted.
- the peptide comprises or consists of:
- GLVTGLEAVRSPSFEK (M201) (SEQ ID NO: 198); or a subsequence or fragment thereof In one embodiment, the N-terminal R residue is deleted.
- the peptide comprises or consists of:
- GLVTGLEAVRSPSFEK (M202) (SEQ ID NO: 199); or a subsequence or fragment thereof In one embodiment, the N-terminal R residue is deleted.
- the peptide comprises or consists of:
- EAVRSPSFEK (M203) (SEQ ID NO:200); or a subsequence or fragment thereof.
- the N-terminal R residue is deleted.
- the peptide comprises or consists of:
- the N-terminal R residue is deleted.
- the peptide comprises or consists of:
- EAVRSPSFEK (M205) (SEQ ID NO:202); or a subsequence or fragment thereof.
- the N-terminal R residue is deleted.
- the peptide comprises or consists of: RHPIPD S SPLLQFGGQ VRLRHL YT S GPHGLS S CFLRIRADG V VD C ARGQ S AHSLLEIKAV
- TGLEAVRSPSFEK (M206) (SEQ ID NO:203); or a subsequence or fragment thereof.
- the N-terminal R residue is deleted.
- the peptide comprises or consists of:
- the peptide is a variant peptide designated M139.
- the peptide comprises an amino acid sequence set forth in SEQ ID NO: 193.
- the peptide consists of an amino acid sequence set forth in SEQ ID NO: 193.
- the peptide is a variant peptide designated Ml 40.
- the peptide comprises an amino acid sequence set forth in SEQ ID NO: 194.
- the peptide consists of an amino acid sequence set forth in SEQ ID NO: 194. In some embodiments, the peptide is a variant peptide designated M141. In some embodiments, the peptide comprises an amino acid sequence set forth in SEQ ID NO: 195. In other embodiments, the peptide consists of an amino acid sequence set forth in SEQ ID NO: 195. In some
- the peptide is a variant peptide designated Ml 60.
- the peptide comprises an amino acid sequence set forth in SEQ ID NO: 196.
- the peptide consists of an amino acid sequence set forth in SEQ ID NO: 196.
- the peptide is a variant peptide designated M200.
- the peptide comprises an amino acid sequence set forth in SEQ ID NO: 197.
- the peptide consists of an amino acid sequence set forth in SEQ ID NO: 197.
- the peptide is a variant peptide designated M201.
- the peptide comprises an amino acid sequence set forth in SEQ ID NO: 198.
- the peptide consists of an amino acid sequence set forth in SEQ ID NO: 198.
- the peptide is a variant peptide designated M202. In some embodiments, the peptide comprises an amino acid sequence set forth in SEQ ID NO: 199. In other embodiments, the peptide consists of an amino acid sequence set forth in SEQ ID NO: 199. In certain embodiments, the peptide is a variant peptide designated M203. In some embodiments, the peptide comprises an amino acid sequence set forth in SEQ ID NO:200. In other embodiments, the peptide consists of an amino acid sequence set forth in SEQ ID NO:200. In some embodiments, the peptide is a variant peptide designated M204. In some embodiments, the peptide comprises an amino acid sequence set forth in SEQ ID NO:201.
- the peptide consists of an amino acid sequence set forth in SEQ ID NO:201. In another embodiment, the peptide is a variant peptide designated M205. In some embodiments, the peptide comprises an amino acid sequence set forth in SEQ ID NO:202. In other embodiments, the peptide consists of an amino acid sequence set forth in SEQ ID NO:202. In other embodiments, the peptide is a variant peptide designated M206. In some embodiments, the peptide comprises an amino acid sequence set forth in SEQ ID NO:203. In other embodiments, the peptide consists of an amino acid sequence set forth in SEQ ID NO:203. In yet other embodiments, the peptide is a variant peptide designated M207. In some embodiments, the peptide comprises an amino acid sequence set forth in SEQ ID NO:204. In other embodiments, the peptide consists of an amino acid sequence set forth in SEQ ID NO:204.
- the N-terminus of the peptide sequence includes or consists of any of:
- HPIPD S SPLLQFGGQ VRLRHL YT S G (M5-R) (amino acids 1-25 of SEQ ID NO: 160);
- DSSPLLQFGGQVRLRHLYTSG (M6-R) (amino acids 2-22 of SEQ ID NO:6);
- RPLAFSDSSPLLQFGGQ VRLRHL YTSG (amino acids 1-27 of SEQ ID NO:7);
- HPIPDSSPLLQWGDPIRLRHLYTSG (M8-R) (amino acids 2-26 of SEQ ID NO:8);
- HPIPDSSPLLQFGWGDPIRLRHLYTSG (M9-R) (amino acids 2-28 of SEQ ID NO:9);
- HPIPDSSPHVHYGWGDPIRLRHLYTSG (M10-R) (amino acids 2-28 of SEQ ID NO: 10); RPLAFSDAGPLLQWGDPIRLRHLYTSG (Mi l) (amino acids 1-27 of SEQ ID NO: l 1);
- RPLAFSDAGPLLQFGWGDPIRLRHLYTSG (M12) (amino acids 1-29 of SEQ ID NO: 12); RPLAFSDAGPLLQFGGQVRLRHLYTSG (M13) (amino acids 1-27 of SEQ ID NO: 13); HPIPDSSPHVHYGGQVRLRHLYTSG (M14-R) (amino acids 2-26 of SEQ ID NO: 14);
- RPLAFSDAGPHVHYGGQVRLRHLYTSG (Ml 5) (amino acids 1-27 of SEQ ID NO: 15); RPLAFSDAGPHVHWGDPIRLRHLYTSG (Ml 6) (amino acids 1-27 of SEQ ID NO: 16); RPLAFSDAGPHVGWGDPIRLRHLYTSG (M17) (amino acids 1-27 of SEQ ID NO: 17); RPLAFSDAGPHYGWGDPIRLRHLYTSG (Ml 8) (amino acids 1-27 of SEQ ID NO: 18); RPLAFSDAGPVYGWGDPIRLRHLYTSG (M19) (amino acids 1-27 of SEQ ID NO: 19); RPLAFSDAGPVHGWGDPIRLRHLYTSG (M20) (amino acids 1-27 of SEQ ID NO:20); RPLAFSDAGPVHYWGDPIRLRHLYTSG (M21) (amino acids 1-27 of SEQ ID NO:21); RPLAFSDAGPH
- RHPIPDSSPLLQFGDQVRLRHLYTSG (M32) (amino acids 1-26 of SEQ ID NO:32);
- RHPIPDSSPLLQFGPQVRLRHLYTSG (M33) (amino acids 1-26 of SEQ ID NO:33);
- RHPIPD S SPLLQFGG A VRLRHL YT S G (M34) (amino acids 1-26 of SEQ ID NO:34);
- RHPIPDSSPLLQFGGEVRLRHLYTSG (M35) (amino acids 1-26 of SEQ ID NO:35);
- RHPIPD S SPLLQFGGN VRLRHL YT S G (M36) (amino acids 1-26 of SEQ ID NO:36);
- RHPIPD S SPLLQFGGQ ARLRHL YT S G (M37) (amino acids 1-26 of SEQ ID NO:37);
- RHPIPDSSPLLQFGGQIRLRHLYTSG (amino acids 1-26 of SEQ ID NO:38);
- RHPIPDSSPLLQFGGQTRLRHLYTSG (M39) (amino acids 1-26 of SEQ ID NO:39);
- RHPIPD S SPLLQFG WGQP VRLRHL YT S G (M40) (amino acids 1-28 of SEQ ID NO:40); DAGPHVHYG WGDPIRLRHL YT S G (M74-R) (amino acids 2-24 of SEQ ID NO:74);
- VHYGWGDPIRLRHLYTSG (M75-R) (amino acids 2-19 of SEQ ID NO:75);
- RLRHLYTSG (M77-R) (amino acids 2-10 of SEQ ID NO:77);
- RHPIPDSSPLLQFGWGDPIRLRHLYTSG (M9) (amino acids 1-28 of SEQ ID NO:9);
- RHPIPDSSPLLQWGDPIRLRHLYTSG (M8) (amino acids 1-26 of SEQ ID NO:8);
- RPLAFSDAGPLLQFGWGDPIRLRHLYTSG (Ml 2) (amino acids 1-29 of SEQ ID NO: 12); RHPIPD S SPH VHYG WGDPIRLRHL YT S G (M10) (amino acids 1-28 of SEQ ID NO: 10); RPLAFSDAGPLLQFGGQVRLRHLYTSG (M13) (amino acids 1-27 of SEQ ID NO: 13); RHPIPDSSPHVHYGGQ VRLRHL YTSG (M14) (amino acids 1-26 of SEQ ID NO: 14); RPLAFSDAGPHVHYGGDIRLRHLYTSG (M43) amino acids 1-27 of SEQ ID NO:43); or RDSSPLLQFGGQVRLRHLYTSG (M6) (amino acids 1-22 of SEQ ID NO:6);
- the peptide comprises or consists of any of:
- HPIPDS SPLLQFGGQVRLRHLYTSG (M5-R) (amino acids 1-25 of SEQ ID NO: 160);
- RPLAFSDSSPLLQFGGQVRLRHLYTSG (amino acids 1-27 of SEQ ID NO:7);
- HPIPDSSPLLQWGDPIRLRHLYTSG (M8-R) (amino acids 2-26 of SEQ ID NO:8);
- HPIPDSSPLLQFGWGDPIRLRHLYTSG (M9-R) (amino acids 2-28 of SEQ ID NO:9);
- HPIPDSSPHVHYGWGDPIRLRHLYTSG (M10-R) (amino acids 2-28 of SEQ ID NO: 10); RPLAFSDAGPLLQWGDPIRLRHLYTSG (Ml 1) (amino acids 1-27 of SEQ ID NO: l 1); RPLAFSDAGPLLQFGWGDPIRLRHLYTSG (M12) (amino acids 1-29 of SEQ ID NO: 12); RPLAFSDAGPLLQFGGQ VRLRHL YTSG (M13) (amino acids 1-27 of SEQ ID NO: 13); HPIPDSSPHVHYGGQVRLRHLYTSG (M14-R) (amino acids 2-26 of SEQ ID NO: 14);
- RPLAFSDAGPHVHYGGQVRLRHLYTSG (M15) (amino acids 1-27 of SEQ ID NO: 15); RPLAFSDAGPHVHWGDPIRLRHLYTSG (M16) (amino acids 1-27 of SEQ ID NO: 16); RPLAFSDAGPHVGWGDPIRLRHLYTSG (M17) (amino acids 1-27 of SEQ ID NO: 17); RPLAFSDAGPHYGWGDPIRLRHLYTSG (M18) (amino acids 1-27 of SEQ ID NO: 18); RPLAFSDAGPVYGWGDPIRLRHLYTSG (M19) (amino acids 1-27 of SEQ ID NO: 19); RPLAFSDAGPVHGWGDPIRLRHLYTSG (M20) (amino acids 1-27 of SEQ ID NO:20); RPLAFSDAGPVHYWGDPIRLRHLYTSG (M21) (amino acids 1-27 of SEQ ID NO:21); RPLAFSDAGPHVHGWG
- RPLAFSDSSPHVHWGDPIRLRHLYTSG (M27) (amino acids 1-27 of SEQ ID NO:27); RPLAFSDAGPHVWGDPIRLRHLYTSG (M28) (amino acids 1-26 of SEQ ID NO:28);
- RPLAFSDAGPHVHYWGDPIRLRHLYTSG (amino acids 1-28 of SEQ ID NO:29);
- RPLAFSDAGPHVHYAWGDPIRLRHLYTSG (M30) (amino acids 1-29 of SEQ ID NO:30);
- RHPIPDSSPLLQFGAQ VRLRHL YTSG (M31) (amino acids 1-26 of SEQ ID NO:31);
- RHPIPDSSPLLQFGDQVRLRHLYTSG (M32) (amino acids 1-26 of SEQ ID NO:32); RHPIPDSSPLLQFGPQVRLRHLYTSG (M33) (amino acids 1-26 of SEQ ID NO:33); RHPIPDSSPLLQFGGAVRLRHLYTSG (M34) (amino acids 1-26 of SEQ ID NO:34);
- RHPIPDSSPLLQFGGEVRLRHLYTSG (M35) (amino acids 1-26 of SEQ ID NO:35);
- RHPIPDSSPLLQFGGNVRLRHLYTSG (amino acids 1-26 of SEQ ID NO:36);
- RHPIPDSSPLLQFGGQARLRHLYTSG (M37) (amino acids 1-26 of SEQ ID NO:37);
- RHPIPDSSPLLQFGGQIRLRHLYTSG (amino acids 1-26 of SEQ ID NO:38);
- RHPIPDSSPLLQFGGQTRLRHLYTSG (M39) (amino acids 1-26 of SEQ ID NO:39);
- RHPIPDSSPLLQFGWGQPVRLRHLYTSG (amino acids 1-28 of SEQ ID NO:40);
- DAGPHVHYGWGDPIRLRHLYTSG (M74-R) (amino acids 2-24 of SEQ ID NO:74);
- VHYGWGDPIRLRHLYTSG (M75-R) (amino acids 2-19 of SEQ ID NO:75);
- RLRHLYTSG (M77-R) (amino acids 2-10 of SEQ ID NO:77);
- RHPIPDSSPLLQFGWGDPIRLRHLYTSG (M9) (amino acids 1-28 of SEQ ID NO:9);
- RHPIPDSSPLLQWGDPIRLRHLYTSG (M8) (amino acids 1-26 of SEQ ID NO:8);
- RPLAFSDAGPLLQFGWGDPIRLRHLYTSG (M12) (amino acids 1-29 of SEQ ID NO: 12);
- RHPIPDSSPHVHYGWGDPIRLRHLYTSG (amino acids 1-28 of SEQ ID NO: 10);
- RPLAFSDAGPLLQFGGQVRLRHLYTSG (M13) (amino acids 1-27 of SEQ ID NO: 13);
- RHPIPDSSPHVHYGGQVRLRHLYTSG (amino acids 1-26 of SEQ ID NO: 14);
- RPLAFSDAGPHVHYGGDIRLRHLYTSG (M43) amino acids 1-27 of SEQ ID NO:43); or RDSSPLLQFGGQVRLRHLYTSG (M6) (amino acids 1-22 of SEQ ID NO:6).
- the peptide comprise one of the foregoing sequences. In another embodiment, the peptide consists of one of the foregoing sequences. In some embodiments, the peptide comprises a C-terminal region comprising a portion of SEQ ID NO: 99 (FGF19), the C-terminal region having a first amino acid position and a last amino acid position,
- the C-terminal region comprises amino acid residues 16-29 of SEQ ID NO:99 (FGF19), WGDPIRLRHLYTSG (SEQ ID NO: 169), wherein the W residue corresponds to the first amino acid position of the C-terminal region.
- a peptide sequence includes or consists of: HPIPDSSPLLQFGGQVRLRHLYTSGPHGLSSCFLRIRADGVVDCARGQSAHSLLEIKAVA LRTVAIKGVHSVRYLCMGADGKMQGLLQYSEEDCAFEEEIRPDGYNVYRSEKHRLPVS LSSAKQRQLYKNRGFLPLSHFLPMLPMVPEEPEDLRGHLESDMFSSPLETDSMDPFGLVT GLEAVRSPSFEK (SEQ ID NO: 160); DSSPLLQFGGQVRLRHLYTSGPHGLSSCFLRIRADGVVDCARGQSAHSLLEIKAVALRTV AIKGVHSVRYLCMGADGKMQGLLQYSEEDCAFEEEIRPDGYNVYRSEKHRLPVSLSSA KQRQLYKNRGFLPLSHFLPMLPMVPEEPEDLRGHLESDMFSSPLETDSMDPFGLVTGLE AVRSPSFEK (SEQ ID NO: 138 or 16
- the R terminal residue is deleted.
- a peptide sequence comprises or consists of:
- TGLEAVRSPSFEK (M70) (SEQ ID NO:70), or a subsequence or fragment thereof.
- a peptide sequence includes the addition of amino acid residues 30-194 of SEQ ID NO:99 (FGF19) at the C-terminus, resulting in a chimeric polypeptide.
- a peptide sequence has at least one amino acid substitution to amino acid residues 125-129 of SEQ ID NO:99 (FGF19), EIRPD. In other embodiments, the peptide sequence has at least one amino acid substitution to amino acid residues 126-128 of SEQ ID NO:99 (FGF19), EIRPD. In other embodiments, the peptide sequence has at least one amino acid substitution to amino acid residues 126-128 of SEQ ID NO:99 (FGF19), EIRPD. In other embodiments, the peptide sequence has at least one amino acid substitution to amino acid residues 126-128 of SEQ
- the peptide sequence has at least one amino acid substitution to amino acid residues 127-128 of SEQ ID NO:99 (FGF19), RP. In other embodiments, the peptide sequence has at least one amino acid substitution to amino acid residues 1-124 of SEQ ID NO:99 (FGF19) and/or to amino acid residues 130-194 of SEQ ID NO:99 (FGF19).
- a peptide sequence comprises substitution to one of amino acid residues 127-128 of SEQ ID NO:99 (FGF19), RP, wherein at least one amino acid substitution is R127L or P128E.
- the peptide comprises both a R127L and P128E substitution to amino acid residues 127-128 of SEQ ID NO:99 (FGF19), RP, or the
- the amino acid sequence of the peptide comprises at least one amino acid substitution in the Loop-8 region of FGF19, or the corresponding FGF19 sequence thereof in a variant peptide provided herein.
- the amino acid sequence of the peptide comprises one amino acid substitution to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19.
- the amino acid sequence of the peptide comprises two amino acid substitutions to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19.
- the amino acid sequence of the peptide comprises three amino acid substitutions to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In certain embodiments, the amino acid sequence of the peptide comprises four amino acid substitutions to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In some embodiments, the amino acid sequence of the peptide comprises five amino acid substitutions to the EIRPD (amino acids 2-6 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19.
- the amino acid sequence of the peptide comprises one amino acid substitution to the IRP (amino acids 3-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In some embodiments, the amino acid sequence of the peptide comprises two amino acid substitutions to the IRP (amino acids 3-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In other embodiments, the amino acid sequence of the peptide comprises three amino acid substitutions to the IRP (amino acids 3-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19.
- the amino acid sequence of the peptide comprises one amino acid substitution to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In some embodiments, the amino acid sequence of the peptide comprises two amino acid substitutions to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19. In certain embodiments, the amino acid substitution to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19 is an Arg (R) to Leu (L) substitution.
- the substitution to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19 is a Pro (P) to Glu (E) substitution.
- the substitutions to the RP (amino acids 4-5 of SEQ ID NO: 190) amino acid sequence in the Loop-8 region of FGF19 is an Arg (R) to Leu (L) substitution and a Pro (P) to Glu (E) substitution.
- the foregoing substitution(s) in the Loop-8 region of FGF19 is in the corresponding FGF19 sequence thereof in a variant peptide provided herein. That is, said substitutions within a corresponding FGF19 sequence (e.g., EIRPD, IRP or RP) of a peptide variant provided herein is also contemplated.
- Peptide or chimeric sequences provided herein can be of any suitable length.
- the N-terminal or C-terminal region of the peptide or chimeric sequence is from about 20 to about 200 amino acid residues in length.
- a chimeric peptide sequence or peptide sequence has at least one amino acid deletion.
- a peptide or chimeric sequence has 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or more amino acid deletions from the amino terminus, the carboxy- terminus or internally.
- the amino acid substitution, or deletion is at any of amino acid positions 8-20 of FGF19 (AGPHVHYGWGDPI) (SEQ ID NO: 187).
- a peptide or chimeric sequence has an N-terminal region, or a C- terminal region that comprises or consists of an amino acid sequence of about 5 to 10, 10 to 20, 20 to 30, 30 to 40, 40 to 50, 60 to 70, 70 to 80, 80 to 90, 90 to 100 or more amino acids.
- a peptide or chimeric sequence has an FGF19 sequence portion, or an FGF21 sequence portion that comprises or consists of an amino acid sequence of about 5 to 10, 10 to 20, 20 to 30, 30 to 40, 40 to 50, 50 to 60, 60 to 70, 70 to 80, 80 to 90, 90 to 100 or more amino acids of FGF19 or FGF21.
- a peptide or chimeric sequence has an amino acid substitution, an addition, insertion or is a subsequence that has at least one amino acid deleted.
- Such amino acid substitutions, additions, insertions and deletions of a peptide sequence can be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more amino acid residues (10-20, 20-30, 30-40, 40-50, etc.), for example, at the N- or C-terminus, or internal.
- the amino acid substitution, or deletion is at any of amino acid positions 8-20 of FGF19 (AGPHVHYGWGDPI) (SEQ ID NO: 187).
- a peptide or chimeric sequence includes all or a portion of an FGF19 sequence set forth as:
- a peptide or chimeric sequence has a function or activity greater or less than a comparison sequence.
- chimeric peptide sequences and peptide sequences have particular functions or activities.
- a chimeric peptide sequence or peptide sequence maintains or increases a fibroblast growth factor receptor 4 (FGFR4) mediated activity.
- FGFR4 fibroblast growth factor receptor 4
- a chimeric peptide sequence or peptide sequence binds to FGFR4 or activates FGFR4, or does not detectably bind to FGFR4 or activate FGFR4, or binds to FGFR4 with an affinity less than, comparable to or greater than FGF19 binding affinity for FGFR4, or activates FGFR4 to an extent or amount less than, comparable to or greater than FGF19 activates FGFR4.
- a chimeric peptide sequence or peptide sequence provided herein activates FGFR4 to an extent or amount less than the extent or amount that FGF19 activates FGFR4.
- a chimeric peptide sequence or peptide sequence provided herein activates FGFR4 to an extent or amount comparable to the extent or amount that FGF19 activates FGFR4. In some embodiments, a chimeric peptide sequence or peptide sequence provided herein activates FGFR4 to an extent or amount greater than the extent or amount that FGF19 activates FGFR4.
- a chimeric peptide sequence or peptide sequence provided herein maintains an FGFR4 mediated activity. In one embodiment, a chimeric peptide sequence or peptide sequence provided herein increases an FGFR4 mediated activity. In some embodiments, a chimeric peptide sequence or peptide sequence provided herein binds to FGFR4 with an affinity less than FGF19 binding affinity for FGFR4. In some embodiments, a chimeric peptide sequence or peptide sequence provided herein binds to FGFR4 with an affinity comparable to FGF19 binding affinity for FGFR4.
- a chimeric peptide sequence or peptide sequence provided herein binds to FGFR4 with an affinity greater than FGF19 binding affinity for FGFR4. In some embodiments, a chimeric peptide sequence or peptide sequence provided herein does not detectably bind to FGFR4.
- a chimeric peptide sequence or peptide sequence has reduced HCC formation compared to FGF19, or an FGF19 variant sequence having any of GQV, GDI, WGPI (SEQ ID NO : 171 ), WGDPV (SEQ ID NO : 172), WGDI (SEQ ID NO : 173), GDPI (SEQ ID NO: 174), GPI, WGQPI (SEQ ID NO: 175), WGAPI (SEQ ID NO: 176), AGDPI (SEQ ID NO: 177), WADPI (SEQ ID NO: 178), WGDAI (SEQ ID NO: 179), WGDP A (SEQ ID NO: 180), WDPI (SEQ ID NO : 181 ), WGDI (SEQ ID NO : 182), WGDP (SEQ ID NO : 183) or FGDPI (SEQ ID NO: 184) substituted for the WGDPI (SEQ ID NO: 170) sequence at amino acids 16-20 of F
- a peptide or chimeric sequence has a function or activity greater or less than a comparison sequence.
- the comparison sequence is FGF19.
- the comparison sequence is FGF19 variant sequence having any of GQV, GDI, WGPI (SEQ ID NO : 171 ), WGDPV (SEQ ID NO : 172), WGDI (SEQ ID NO : 173), GDPI (SEQ ID NO: 174), GPI, WGQPI (SEQ ID NO: 175), WGAPI (SEQ ID NO: 176), AGDPI (SEQ ID NO: 177), WADPI (SEQ ID NO: 178), WGDAI (SEQ ID NO: 179), WGDPA (SEQ ID NO: 180), WDPI (SEQ ID NO: 181), WGDI (SEQ ID NO: 182), WGDP (SEQ ID NO: 183) or FGDPI (SEQ ID NO: 184) substituted for the WGDPI (SEQ ID NO:
- a peptide or chimeric peptide sequence provided herein has greater glucose lowering activity compared to a comparison sequence. In another embodiment, a peptide or chimeric peptide sequence provided herein has less lipid increasing activity compared to a comparison sequence. In other embodiment, a peptide or chimeric peptide sequence provided herein has lower or reduced lipid ⁇ e.g., triglyceride, cholesterol, non- HDL) activity compared to a comparison sequence. In other embodiments, a peptide or chimeric peptide sequence provided herein has more HDL increasing activity as compared to a comparison sequence. In other embodiment, a peptide or chimeric peptide sequence provided herein has less lean mass reducing activity compared to a comparison sequence or FGF21.
- a peptide or chimeric sequence includes one or more L-amino acids, D-amino acids, non-naturally occurring amino acids, or amino acid mimetic, derivative or analogue.
- a peptide or chimeric sequence has an N-terminal region, or a C-terminal region, or a FGF19 sequence portion, or an FGF21 sequence portion, joined by a linker or spacer.
- Non-limiting exemplary bile acid related or associated disorders treatable according to the methods and uses provided herein include: cholestasis, including, for example diseases of intrahepatic cholestasis ⁇ e.g., primary biliary cirrhosis (PBC), primary familial intrahepatic cholestasis (PFIC) ⁇ e.g., progressive PFIC), primary sclerosing choangitis (PSC), pregnancy intrahepatic cholestasis (PIC), neonatal cholestasis, and drug-induced cholestasis (e.g., estrogen)), and diseases of extrahepatic cholestasis (e.g., bile cut compression from tumor, bile duct blockade by gall stones); bile acid malabsorption and other disorders involving the distal small intestine, including ileal resection, inflammatory bowel diseases (e.g., Crohn's disease and ulcerative colitis), short bowel syndrome
- bile acid diarrhea BAD
- GI symptoms GI, liver, and/or biliary cancers (e.g., colon cancer and hepatocellular cancer); and/or bile acid synthesis abnormalities, such as those contributing to non-alcoholic
- NASH steatohepatitis
- cirrhosis cirrhosis
- portal hypertension e.g., in mammals, such as humans.
- Additional bile acid-related disorders include metabolic syndrome; a lipid or glucose disorder; cholesterol or triglyceride metabolism; type 2 diabetes.
- the bile acid related or associated disorder is bile acid malabsorption. In another particular embodiment, the bile acid related or associated disorder is diarrhea. In a still further particular embodiment, the bile acid related or associated disorder is cholestasis (e.g., intrahepatic or extrahepatic cholestasis), and in another further particular embodiment, the bile acid related or associated disorder is primary billiary cirrhosis (PBC). In other particular embodiments, the bile acid related or associated disorder is primary sclerosing cholangitis. In another embodiment, the bile acid related or associated disorder is PFIC (e.g., progressive PFIC).
- PBC primary billiary cirrhosis
- the at least one additional agent effective in modulating bile acid homeostasis or treating a bile-acid related or associated disorder is: a glucocorticoid; CDCA; UDCA; insulin, an insulin secretagogues, an insulin mimetic, a sulfonylurea and a meglitinide; a biguanide; an alpha-glucosidase inhibitors; a DPP-IV inhibitor, GLP-1 , a GLP-1 agonists and a GLP-1 analog; a DPP-IV-resistant analogue; a PPAR gamma agonist, a dual- acting PPAR agonist, a pan-acting PPAR agonist; a PTP1B inhibitor; an SGLT inhibitor; an RXR agonist; a glycogen synthase kinase-3 inhibitor; an immune modulator; a beta-3 adrenergic receptor agonist; an 1 lbe
- the at least one additional agent effective in modulating PBC is UDCA, an FXR agonist, OCA, an ASBT inhibitor, an autoimmune agent, an anti-IL-12 agent, an anti-CD80 agent, an anti-CD20 agent, a CXCL10 neutralizing antibody, a ligand for CXCR3, a fibrate, fish oil, colchicine, methotrexate, azathioprine, cyclosporine, or an anti-retroviral therapy.
- the at least one additional agent effective in modulating PBC is UDCA, OCA, an ASBT inhibitor, an anti-IL-12 agent, an anti-CD20 agent, or a fibrate.
- the combination of a chimeric peptide sequence or a peptide sequence described herein and at least one additional therapeutic agent or treatment modality is assessed to ensure that it does not cause untoward adverse effects in the subject.
- the combination of a chimeric peptide sequence or a peptide sequence described herein and at least one additional therapeutic agent or treatment modality is assessed to ensure that it does not induce HCC in the subject.
- assessments may be performed before initiation of therapy (e.g., in a dose escalation study), during therapy, (e.g. , by evaluating a marker correlating with HCC activity), or subsequent to termination of therapy (e.g., by performing a liver biopsy).
- the assessment is performed in a suitable test environment (e.g. , a validated animal model).
- a suitable test environment e.g. , a validated animal model.
- a suitable test environment e.g. , a validated animal model.
- PBC bile acid-related disorder
- chimeric and peptide sequences that modulate bile acid homeostasis in combination with one or more additional therapeutic agents or treatment modalities that are useful in the treatment and/or prevention of bile acid- related or associated disorders.
- the invention is based, in part, on the use of variants of FGF19 peptide sequences, fusions of FGF19 and/or FGF21 peptide sequences and variants of fusions (chimeras) of FGF19 and/or FGF21 peptide sequences having one or more activities associated with the treatment and/or prevention of a bile acid-related disorder (e.g., PBC), in combination with other therapeutic agents and/or treatment modalities.
- Such variants and fusions (chimeras) of FGF19 and/or FGF21 peptide sequences include sequences that do not substantially increase or induce HCC formation or HCC tumorigenesis and/or do not induce a substantial elevation or increase in lipid profile.
- a chimeric peptide sequence includes or consists of an N- terminal region having at least seven amino acid residues and the N-terminal region having a first amino acid position and a last amino acid position, where the N-terminal region has a DSSPL (SEQ ID NO: 121) or DASPH (SEQ ID NO: 122) sequence; and a C-terminal region having a portion of FGF19 and the C-terminal region having a first amino acid position and a last amino acid position, where the C-terminal region includes amino acid residues 16-29 of FGF19 (WGDPIRLRHLYTSG; SEQ ID NO: 169) and the W residue corresponds to the first amino acid position of the C-terminal region.
- the variant is M70:
- a chimeric peptide sequence includes or consists of an N- terminal region having a portion of FGF21 and the N-terminal region having a first amino acid position and a last amino acid position, where the N-terminal region has a GQV sequence and the V residue corresponds to the last amino acid position of the N-terminal region; and a C- terminal region having a portion of FGF19 and the C-terminal region having a first amino acid position and a last amino acid position where the C-terminal region includes amino acid residues 21-29 of FGF19 (RLRHLYTSG; SEQ ID NO: 185) and the R residue corresponds to the first position of the C-terminal region.
- modifications to the Loop-8 region of FGF19 are disclosed herein that possess favorable metabolic parameters without exhibiting substantial tumorigenicity.
- FGF19 residues 127-129 are defined as constituting the Loop-8 region, although in the literature the Loop-8 region is sometimes defined as including or consisting of other residues (e.g., residues 125-129).
- Certain combinations of R127L and P128E substitutions to the FGF19 framework had an unexpectedly positive effect on HCC formation. Even more surprisingly, a combination of R127L and P128E substitutions and a substitution of Gin (Q) for Leu (L) in the FGF19 core region had an even more significant effect on preventing HCC formation.
- variants of FGF19 Loop-8 region are included since they can reduce or eliminate substantial, measurable or detectable HCC formation. Furthermore, the effect of reducing HCC formation may be enhanced by modifications to amino acid residues outside of the Loop 8 region (e.g., substitutions of amino acid residues in the core region).
- a peptide sequence includes or consists of a FGF19 variant having one or more amino acid substitutions, insertions or deletions compared to a reference or wild type FGF19.
- a peptide sequence includes or consists of a FGF21 sequence variant having one or more amino acid substitutions, insertions or deletions compared to a reference or wild type FGF21.
- a peptide sequence includes or consists of a portion of an FGF19 sequence fused to a portion of an FGF21 sequence.
- a peptide sequence includes or consists of a portion of an FGF19 sequence fused to a portion of an FGF21 sequence, where the FGF19 and/or FGF21 sequence portion(s) have one or more amino acid substitutions, insertions or deletions compared to a reference or wild type FGF19 and/or FGF21.
- Examples of such sequences are disclosed in PCT Pub. No. WO 2013/006486 and US Pub. No. 2013/0023474, as well as PCT Publ. No. WO 2014/085365, published June 5, 2014. Table 1 and the Sequence Listing also sets forth representative sequences that may be used in the methods provided herein.
- peptide protein
- polypeptide sequence are used interchangeably herein to refer to two or more amino acids, or “residues,” including chemical modifications and derivatives of amino acids, covalently linked by an amide bond or equivalent.
- the amino acids forming all or a part of a peptide may be from among the known 21 naturally occurring amino acids, which are referred to by both their single letter abbreviations and their common three- letter abbreviation.
- conventional amino acid residues have their conventional meaning. Thus, “Leu” is leucine, "He” is isoleucine, "Nle” is norleucine, and so on.
- conventional amino acids and their corresponding three letter and single letter abbreviations are as follows:
- a peptide or chimeric sequence provided herein has at the N-terminal region first amino acid position an "M” residue, an "R” residue, a “S” residue, a “H” residue, a “P” residue, a “L” residue or an “D” residue.
- a peptide or chimeric sequence peptide sequence does not have a "M” residue or an "R” residue at the first amino acid position of the N-terminal region.
- the number of amino acids or residues in a peptide sequence provided herein will total less than about 250 (e.g., amino acids or mimetics thereof).
- the number of residues comprise from about 20 up to about 200 residues (e.g. , amino acids or mimetics thereof).
- the number of residues comprise from about 50 up to about 200 residues (e.g., amino acids or mimetics thereof).
- the number of residues comprise from about 100 up to about 195 residues (e.g., amino acids or mimetics thereof) in length.
- Amino acids or residues can be linked by amide or by non-natural and non-amide chemical bonds including, for example, those formed with glutaraldehyde, N- hydroxysuccinimide esters, bifunctional maleimides, or N, N'-dicyclohexylcarbodiimide (DCC).
- Non-amide bonds include, for example, ketomethylene, aminomethylene, olefin, ether, thioether and the like (see, e.g. , Spatola in Chemistry and Biochemistry of Amino Acids, Peptides and Proteins, Vol. 7, pp 267-357 (1983), "Peptide and Backbone Modifications," Marcel Decker, NY).
- a peptide provided herein includes a portion of an FGF19 sequence and a portion of an FGF21 sequence, the two portions need not be joined to each other by an amide bond, but can be joined by any other chemical moiety or conjugated together via a linker moiety.
- subsequences, variants and modified forms of the exemplified peptide sequences include the FGF19 and FGF21 variants and subsequences listed in the Sequence Listing, or Table 1), so long as the foregoing retains at least a detectable or measureable activity or function.
- certain exemplified variant peptides for example, those having all or a portion of FGF21 sequence at the amino-terminus, have an "R" residue positioned at the N-terminus, which can be omitted.
- certain exemplified variant peptides include an "M" residue positioned at the N-terminus, which can be appended to or further substituted for an omitted residue, such as an "R” residue. More particularly, in various embodiments peptide sequences at the N-terminus include any of: RDSS (SEQ ID NO: l 15), DSS, MDSS (SEQ ID NO: 116) or MRDSS (SEQ ID NO: 117).
- peptide sequences include those with the following residues at the N-terminus: MDSSPL (SEQ ID NO: 119), MSDSSPL (SEQ ID NO: 120) (cleaved to SDSSPL (SEQ ID NO: l 12)) and MSSPL (SEQ ID NO: l 13) (cleaved to SSPL (SEQ ID NO: 114)).
- modified peptide sequences, nucleic acids and other compositions may have greater or less activity or function, or have a distinct function or activity compared with a reference unmodified peptide sequence, nucleic acid, or other composition, or may have a property desirable in a protein formulated for therapy (e.g. serum half-life), to elicit antibody for use in a detection assay, and/or for protein purification.
- a protein formulated for therapy e.g. serum half-life
- a peptide sequence provided herein can be modified to increase serum half-life, to increase in vitro and/or in vivo stability of the protein, etc.
- Particular examples of such subsequences, variants and modified forms of the peptide sequences exemplified herein ⁇ e.g. , a peptide sequence listed in the Sequence Listing or Table 1) include substitutions, deletions and/or insertions/additions of one or more amino acids, to or from the amino-terminus, the carboxy-terminus or internally.
- substitutions, deletions and/or insertions/additions of one or more amino acids to or from the amino-terminus, the carboxy-terminus or internally.
- One example is a substitution of an amino acid residue for another amino acid residue within the peptide sequence.
- Another is a deletion of one or more amino acid residues from the peptide sequence, or an insertion or addition of one or more amino acid residues into the peptide sequence.
- the number of residues substituted, deleted or inserted/added are one or more amino acids ⁇ e.g., 1-3, 3-5, 5-10, 10-20, 20-30, 30-40, 40-50, 50-60, 60-70, 70-80, 80-90, 90-100, 100- 1 10, 1 10-120, 120-130, 130-140, 140-150, 150-160, 160-170, 170-180, 180-190, 190-200, 200- 225, 225-250, or more) of a peptide sequence.
- an FGF19 or FGF21 sequence can have few or many amino acids substituted, deleted or inserted/added ⁇ e.g., 1-3, 3-5, 5-10, 10-20, 20- 30, 30-40, 40-50, 50-60, 60-70, 70-80, 80-90, 90-100, 100-110, 1 10-120, 120-130, 130-140, 140- 150, 150-160, 160-170, 170-180, 180-190, 190-200, 200-225, 225-250, or more).
- an FGF19 amino acid sequence can include or consist of an amino acid sequence of about 1-3, 3-5, 5-10, 10-20, 20-30, 30-40, 40-50, 50-60, 60-70, 70-80, 80-90, 90-100, 100-1 10, 1 10-120, 120- 130, 130-140, 140-150, 150-160, 160-170, 170-180, 180-190, 190-200, 200-225, 225-250, or more amino acids from FGF21 ; or an FGF21 amino acid or sequence can include or consist of an amino acid sequence of about 1-3, 3-5, 5-10, 10-20, 20-30, 30-40, 40-50, 50-60, 60-70, 70-80, 80-90, 90-100, 100-1 10, 1 10-120, 120-130, 130-140, 140-150, 150-160, 160-170, 170-180, 180- 190, 190-200, 200-225, 225-250, or more amino acids from FGF19.
- substitutions include substituting a D residue for an L-residue. Accordingly, although residues are listed in the L-isomer configuration, D-amino acids at any particular or all positions of the peptide sequences provided herein are included, unless a D- isomer leads to a sequence that has no detectable or measurable function.
- a "conservative substitution” is a replacement of one amino acid by a biologically, chemically or structurally similar residue.
- Biologically similar means that the substitution is compatible with a biological activity, e.g., activity that improves PBC and/or the manifestations thereof.
- Structurally similar means that the amino acids have side chains with similar length, such as alanine, glycine and serine, or having similar size, or the structure of a first, second or additional peptide sequence is maintained.
- Chemical similarity means that the residues have the same charge or are both hydrophilic and hydrophobic.
- Particular examples include the substitution of one hydrophobic residue, such as isoleucine, valine, leucine or methionine, for another, or the substitution of one polar residue for another, such as the substitution of arginine for lysine, glutamic for aspartic acids, or glutamine for asparagine, serine for threonine, etc.
- Routine assays can be used to determine whether a subsequence, variant or modified form has activity, e.g., activity that improves PBC and/or the manifestations thereof.
- Particular examples of subsequences, variants and modified forms of the peptide sequences exemplified herein have 50%-60%, 60%-70%, 70%-75%, 75%-80%, 80%-85%, 85%- 90%, 90%-95%, or 96%, 97%, 98%, or 99% identity to a reference peptide sequence.
- identity and “homology” and grammatical variations thereof mean that two or more referenced entities are the same. Thus, where two amino acid sequences are identical, they have the identical amino acid sequence.
- “Areas, regions or domains of identity” mean that a portion of two or more referenced entities are the same. Thus, where two amino acid sequences are identical or homologous over one or more sequence regions, they share identity in those regions.
- BLAST ⁇ e.g., BLAST 2.0
- search algorithm see, e.g., Altschul et al, J. Mol. Biol. 215:403 (1990), publicly available through NCBI
- BLAST 2.0 BLAST 2.0
- search parameters as follows: Mismatch -2; gap open 5; gap extension 2.
- a BLASTP algorithm is typically used in combination with a scoring matrix, such as PAM100, PAM 250, BLOSUM 62 or BLOSUM 50.
- FASTA e.g., FASTA2 and FASTA3
- SSEARCH sequence comparison programs are also used to quantitate the extent of identity (Pearson et al, Proc. Natl. Acad. Sci. USA 85:2444 (1988); Pearson, Methods Mol Biol. 132: 185 (2000); and Smith et al, J. Mol. Biol. 147: 195 (1981)).
- Programs for quantitating protein structural similarity using Delaunay-based topological mapping have also been developed (Bostick et al, Biochem Biophys Res Commun. 304:320 (2003)).
- an “amino acid” or “residue” includes conventional alpha- amino acids as well as beta-amino acids; alpha, alpha disubstituted amino acids; and N- substituted amino acids, wherein at least one side chain is an amino acid side chain moiety as defined herein.
- An “amino acid” further includes N-alkyl alpha-amino acids, wherein the N- terminus amino group has a Ci to C 6 linear or branched alkyl substituent.
- amino acid therefore includes stereoisomers and modifications of naturally occurring protein amino acids, non-protein amino acids, post-translationally modified amino acids (e.g., by glycosylation, phosphorylation, ester or amide cleavage, etc.), enzymatically modified or synthesized amino acids, derivatized amino acids, constructs or structures designed to mimic amino acids, amino acids with a side chain moiety modified, derivatized from naturally occurring moieties, or synthetic, or not naturally occurring, etc. Modified and unusual amino acids are included in the peptide sequences provided herein (see, for example, in Synthetic Peptides: A User's Guide; Hruby et al, Biochem. J. 268:249 (1990); and Toniolo C, Int. J. Peptide Protein Res. 35:287 (1990)).
- amino acid side chain moiety includes any side chain of any amino acid, as the term “amino acid” is defined herein. This therefore includes the side chain moiety in naturally occurring amino acids. It further includes side chain moieties in modified naturally occurring amino acids as set forth herein and known to one of skill in the art, such as side chain moieties in stereoisomers and modifications of naturally occurring protein amino acids, non-protein amino acids, post-translationally modified amino acids, enzymatically modified or synthesized amino acids, derivatized amino acids, constructs or structures designed to mimic amino acids, etc. For example, the side chain moiety of any amino acid disclosed herein or known to one of skill in the art is included within the definition.
- a "derivative of an amino acid side chain moiety" is included within the definition of an amino acid side chain moiety.
- a single amino acid including stereoisomers and modifications of naturally occurring protein amino acids, non-protein amino acids, post-translationally modified amino acids, enzymatically-synthesized amino acids, non-naturally occurring amino acids including derivatized amino acids, an alpha, alpha disubstituted amino acid derived from any of the foregoing (i.e. , an alpha, alpha disubstituted amino acid, wherein at least one side chain is the same as that of the residue from which it is derived), a beta-amino acid derived from any of the foregoing (i.e.
- a beta-amino acid which, other than for the presence of a beta-carbon, is the same as the residue from which it is derived) etc., including all of the foregoing can be referred to herein as a "residue.”
- Suitable substituents, in addition to the side chain moiety of the alpha- amino acid, include Ci to C 6 linear or branched alkyl.
- Aib is an example of an alpha, alpha disubstituted amino acid.
- alpha, alpha disubstituted amino acids can be referred to using conventional L- and D-isomeric references, it is to be understood that such references are for convenience, and that where the substituents at the alpha-position are different, such amino acid can interchangeably be referred to as an alpha, alpha disubstituted amino acid derived from the L- or D-isomer, as appropriate, of a residue with the designated amino acid side chain moiety.
- (S)-2-Amino-2-methyl-hexanoic acid can be referred to as either an alpha, alpha disubstituted amino acid derived from L-Nle (norleucine) or as an alpha, alpha disubstituted amino acid derived from D-Ala.
- Aib can be referred to as an alpha, alpha
- alpha disubstituted amino acid derived from Ala. Whenever an alpha, alpha disubstituted amino acid is provided, it is to be understood as including all (R) and (S) configurations thereof.
- N-substituted amino acid includes any amino acid wherein an amino acid side chain moiety is covalently bonded to the backbone amino group, optionally where there are no substituents other than H in the alpha-carbon position.
- Sarcosine is an example of an N- substituted amino acid.
- sarcosine can be referred to as an N-substituted amino acid derivative of Ala, in that the amino acid side chain moiety of sarcosine and Ala is the same, i.e., methyl.
- covalent modifications of the peptide sequences including subsequences, variants and modified forms of the peptide sequences exemplified herein are provided.
- An exemplary type of covalent modification includes reacting targeted amino acid residues with an organic derivatizing agent that is capable of reacting with selected side chains or the N- or C-terminal residues of the peptide.
- Derivatization with bifunctional agents is useful, for instance, for cross-linking peptide to a water-insoluble support matrix or surface for use in the method for purifying anti-peptide antibodies, and vice-versa.
- cross linking agents include, e.g., l,l-bis(diazoacetyl)-2-phenylethane, glutaraldehyde, N-hydroxysuccinimide esters, for example, esters with 4-azidosalicylic acid, homobifunctional imidoesters, including disuccinimidyl esters such as 3,3'-dithiobis(succinimidylpropionate), bifunctional maleimides such as bis-N-maleimido-l,8-octane and agents such as methyl-3-[(p- azidophenyl)dithio]propioimidate.
- Exemplified peptide sequences, and subsequences, variants and modified forms of the peptide sequences exemplified herein can also include alterations of the backbone for stability, derivatives, and peptidomimetics.
- peptidomimetic includes a molecule that is a mimic of a residue (referred to as a "mimetic"), including but not limited to piperazine core molecules, keto-piperazine core molecules and diazepine core molecules.
- an amino acid mimetic of a peptide sequence provided herein includes both a carboxyl group and amino group, and a group corresponding to an amino acid side chain, or in the case of a mimetic of Glycine, no side chain other than hydrogen.
- these would include compounds that mimic the sterics, surface charge distribution, polarity, etc. of a naturally occurring amino acid, but need not be an amino acid, which would impart stability in the biological system.
- Proline may be substituted by other lactams or lactones of suitable size and substitution;
- Leucine may be substituted by an alkyl ketone, N-substituted amide, as well as variations in amino acid side chain length using alkyl, alkenyl or other substituents, others may be apparent to the skilled artisan.
- the essential element of making such substitutions is to provide a molecule of roughly the same size and charge and configuration as the residue used to design the molecule.
- binding when used in reference to a peptide sequence, means that the peptide sequence interacts at the molecular level. Specific and selective binding can be distinguished from non-specific binding using assays known in the art ⁇ e.g. , competition binding, immunoprecipitation, ELISA, flow cytometry, Western blotting).
- Peptides and peptidomimetics can be produced and isolated using methods known in the art. Peptides can be synthesized, in whole or in part, using chemical methods (see, e.g., Caruthers (1980). Nucleic Acids Res. Symp. Ser. 215; Horn (1980); and Banga, A.K.,
- Peptide synthesis can be performed using various solid-phase techniques (see, e.g., Roberge Science 269:202 (1995); Merrifield, Methods
- Enzymol. 289:3 (1997)) and automated synthesis may be achieved, e.g., using the ABI 431A Peptide Synthesizer (Perkin Elmer) in accordance with the manufacturer's instructions.
- Peptides and peptide mimetics can also be synthesized using combinatorial methodologies. Synthetic residues and polypeptides incorporating mimetics can be synthesized using a variety of procedures and methodologies known in the art (see, e.g., Organic Syntheses Collective
- Modified peptides can be produced by chemical modification methods (see, for example, Belousov, Nucleic Acids Res. 25:3440 (1997); Frenkel, Free Radic. Biol. Med. 19:373 (1995); and Blommers, Biochemistry 33:7886 (1994)). Peptide sequence variations, derivatives, substitutions and modifications can also be made using methods such as oligonucleotide -mediated (site-directed) mutagenesis, alanine scanning, and PCR-based mutagenesis. Site-directed mutagenesis (Carter et al, Nucl. Acids Res., 13:4331 (1986); Zoller et al, Nucl. Acids Res. 10:6487 (1987)), cassette
- a "synthesized" or “manufactured” peptide sequence is a peptide made by any method involving manipulation by the hand of man. Such methods include, but are not limited to, the aforementioned, such as chemical synthesis, recombinant DNA technology, biochemical or enzymatic fragmentation of larger molecules, and combinations of the foregoing.
- Peptide sequences provided herein including subsequences, sequence variants and modified forms of the exemplified peptide sequences ⁇ e.g., sequences listed in the Sequence Listing or Table 1), can also be modified to form a chimeric molecule.
- peptide sequences that include a heterologous domain can be added to the amino-terminus or at the carboxyl-terminus of the peptide sequence.
- Heterologous domains can also be positioned within the peptide sequence, and/or alternatively flanked by FGF19 and/or FGF21 derived amino acid sequences.
- peptide also includes dimers or multimers (oligomers) of peptides.
- dimers or multimers (oligomers) of the exemplified peptide sequences are provided herein, as well as subsequences, variants and modified forms of the exemplified peptide sequences, including sequences listed in the Sequence Listing or Table 1.
- a peptide sequence provided herein comprises an amino acid sequence set forth in Table 1. In other embodiments, a peptide sequence provided herein consists of an amino acid sequence set forth in Table 1. Table 1
- HPIPDSSPLLQFGGQVRLRHLYTSGPHGLSSCFLRIRADGVVDCARGQSAHSLLEIK AVALRTVAIKGVHSVRYLCMGADGKMQGLLQYSEEDCAFEEEIRPDGYNVYRSE KHRLPVSLSSAKQRQLYKNRGFLPLSHFLPMLPMVPEEPEDLRGHLESDMFSSPLE TDSMDPFGLVTGLEAVRSPSFEK
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: l . In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:2. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:3. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:4. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:5. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:6. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:7.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:8. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:9. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 10. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 1 1. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 12. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 13. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 14. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 15.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 16. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 17. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 18. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 19. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:20. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:21. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:22. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:23.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:24. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:25. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:26. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:27. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:28. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:29. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:30.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:31. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:32. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:33. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:34. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:35. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:36. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:37.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:38. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:39. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:40. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:41. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:42. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:43. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:44.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:45. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:46. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:47. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:48. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:49. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:50. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:51.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:52. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:53. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:54. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:55. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:56. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:57. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:58.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:59. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 60. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:61. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 62. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 63. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 64. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:65.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 66. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 67. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:68. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 69. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 70. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:71. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 72.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 73. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 74. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 75. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 76. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:77. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:78. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 79.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:80. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:81. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 82. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 83. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 84. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 85. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:86.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:87. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 88. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:89. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 90. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:91. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 92. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 93.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 94. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:95. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 96. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 97. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:98. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 138. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 139.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 140. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 141. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 142. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 143. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 144. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 145. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 146.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 147. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 148. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 149. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 150. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 151. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 152. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 153.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 154. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 155. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 156. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 157. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 158. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 159. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 160.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 161. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 162. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 163. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 164. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 165. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 166. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 167.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 168. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 192. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 193. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 194. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 195. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 196. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 197.
- the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 198. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO: 199. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:200. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:201. In other embodiments, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:202. In one embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:203. In another embodiment, the peptide sequence comprises an amino acid sequence set forth in SEQ ID NO:204.
- the R residue at the N-terminus is deleted.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 1.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:2.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:3.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:4.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:5.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:6.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:7. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:8. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:9. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 10. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 11. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 12. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 13.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 14. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 15. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 16. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 17. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 18. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 19. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:20.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:21. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:22. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:23. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:24. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:25. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:26. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:27.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:28. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:29. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:30. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:31. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:32. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:33. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:34.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:35. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:36. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:37. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:38. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:39. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:40. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:41.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:42. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:43. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:44. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:45. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:46. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:47. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:48.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:49. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:50. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:51. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:52. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:53. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:54. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:55.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:56. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:57. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:58. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:59. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 60. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:61. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 62.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 63. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 64. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 65. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 66. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 67. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:68. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 69.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 70. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:71. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 72. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 73. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 74. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 75. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 76.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 77. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:78. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 79. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:80. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:81. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 82. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 83.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 84. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 85. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:86. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:87. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 88. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:89. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 90.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:91. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 92. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 93. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 94. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 95. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 96. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 97.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:98. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 138. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 139. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 140. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 141. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 142. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 143.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 144. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 145. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 146. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 147. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 148. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 149. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 150.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 151. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 152. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 153. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 154. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 155. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 156. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 157.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 158. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 159. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 160. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 161. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 162. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 163. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 164.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 165. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 166. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 167. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 168. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 192. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 193. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 194.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 195. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 196. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 197. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 198. In other embodiments, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO: 199. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:200. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:201.
- the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:202. In one embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:203. In another embodiment, the peptide sequence consists of an amino acid sequence set forth in SEQ ID NO:204. In certain embodiments of the various peptide sequences provided herein, the R residue at the N-terminus is deleted.
- nucleic acid molecules encoding peptide sequences provided herein, including subsequences, sequence variants and modified forms of the sequences listed in the Sequence Listing (and in PCT Pub. No. WO 2013/006486 and US Pub. No. 2013/0023474, as well as PCT Publ. No. WO 2014/085365) or Table 1 , and vectors that include nucleic acid encoding the peptides used in the methods described herein.
- nucleic acids include those that encode the exemplified peptide sequences disclosed herein, as well as those encoding functional subsequences, sequence variants and modified forms of the exemplified peptide sequences, so long as the foregoing retain at least detectable or measureable activity or function useful in the treatment or prevention of a bile acid-related disorder (e.g., PBC).
- a bile acid-related disorder e.g., PBC
- Nucleic acid which can also be referred to herein as a gene, polynucleotide, nucleotide sequence, primer, oligonucleotide or probe, refers to natural or modified purine- and pyrimidine-containing polymers of any length, either polyribonucleotides or
- nucleic acid including deoxyribonucleic acid (DNA) and ribonucleic acid (RNA).
- the nucleic acids can be single strand, double, or triplex, linear or circular.
- Nucleic acids include genomic DNA and cDNA.
- RNA nucleic acid can be spliced or unspliced mRNA, rRNA, tRNA or antisense. Nucleic acids include naturally occurring, synthetic, as well as nucleotide analogs and derivatives.
- nucleic acid molecules provided herein include sequences degenerate with respect to nucleic acid molecules encoding the peptide sequences useful in the methods provided herein.
- degenerate nucleic acid sequences encoding peptide sequences including subsequences, variants and modified forms of the peptide sequences exemplified herein (e.g., in the Sequence Listing or Table 1), are provided.
- Nucleic acid can be produced using any of a variety of known standard cloning and chemical synthesis methods, and can be altered intentionally by site-directed mutagenesis or other recombinant techniques known to one skilled in the art. Purity of polynucleotides can be determined through, for example, sequencing, gel electrophoresis, and UV spectrometry.
- Nucleic acids may be inserted into a nucleic acid construct in which expression of the nucleic acid is influenced or regulated by an "expression control element," referred to herein as an "expression cassette.”
- expression control element refers to one or more nucleic acid sequence elements that regulate or influence expression of a nucleic acid sequence to which it is operatively linked.
- An expression control element can include, as appropriate, promoters, enhancers, transcription terminators, gene silencers, a start codon (e.g., ATG) in front of a protein-encoding gene, etc.
- An expression control element operatively linked to a nucleic acid sequence controls transcription and, as appropriate, translation of the nucleic acid sequence.
- the term "operatively linked” refers to a juxtaposition wherein the referenced components are in a relationship permitting them to function in their intended manner.
- expression control elements are juxtaposed at the 5' or the 3' ends of the genes but can also be intronic.
- Expression control elements include elements that activate transcription
- control elements sufficient to render gene expression controllable for specific cell types or tissues (i.e., tissue-specific control elements). Typically, such elements are located upstream or downstream (i.e., 5' or 3') of the coding sequence. Promoters are generally positioned 5' of the coding sequence. Promoters, produced by recombinant DNA or synthetic techniques, can be used to provide for transcription of the polynucleotides provided herein.
- a "promoter” typically means a minimal sequence element sufficient to direct transcription.
- Nucleic acids may be inserted into a plasmid for transformation into a host cell and for subsequent expression and/or genetic manipulation.
- a plasmid is a nucleic acid that can be stably propagated in a host cell; plasmids may optionally contain expression control elements in order to drive expression of the nucleic acid.
- a vector is synonymous with a plasmid. Plasmids and vectors generally contain at least an origin of replication for propagation in a cell and a promoter.
- Plasmids and vectors may also include an expression control element for expression in a host cell, and are therefore useful for expression and/or genetic manipulation of nucleic acids encoding peptide sequences, expressing peptide sequences in host cells and organisms, or producing peptide sequences, for example.
- transgene means a polynucleotide that has been introduced into a cell or organism by artifice.
- the transgene has been introduced by genetic manipulation or "transformation” of the cell.
- a cell or progeny thereof into which the transgene has been introduced is referred to as a "transformed cell” or “transformant.”
- the transgene is included in progeny of the transformant or becomes a part of the organism that develops from the cell. Transgenes may be inserted into the
- chromosomal DNA or maintained as a self-replicating plasmid, YAC, minichromosome, or the like.
- Bacterial system promoters include T7 and inducible promoters such as pL of bacteriophage ⁇ , plac, ptrp, ptac (ptrp-lac hybrid promoter) and tetracycline -responsive promoters.
- Insect cell system promoters include constitutive or inducible promoters (e.g., ecdysone).
- Mammalian cell constitutive promoters include SV40, RSV, bovine papilloma virus (BPV) and other virus promoters, or inducible promoters derived from the genome of mammalian cells (e.g.
- expression systems further include vectors designed for in vivo use.
- adenoviral vectors U.S. Patent Nos. 5,700,470 and 5,731,172
- adeno-associated vectors U.S. Patent No. 5,604,090
- herpes simplex virus vectors U.S. Patent No.
- Vectors include those that deliver genes to cells of the intestinal tract, including the stem cells (Croyle et al, Gene Ther. 5:645 (1998); S.J. Henning, Adv. Drug Deliv. Rev. 17:341 (1997), U.S. Patent Nos. 5,821,235 and 6,110,456). Many of these vectors have been approved for human studies.
- Yeast vectors include constitutive and inducible promoters (see, e.g., Ausubel et al, In: Current Protocols in Molecular Biology, Vol. 2, Ch. 13, ed., Greene Publish. Assoc. & Wiley Interscience, 1988; Grant et al Methods in Enzymology, 153:516 (1987), eds. Wu & Grossman; Bitter Methods in Enzymology, 152:673 (1987), eds. Berger & Kimmel, Acad. Press, N.Y.; and, Strathern et al, The Molecular Biology of the Yeast Saccharomyces (1982) eds. Cold Spring Harbor Press, Vols.
- a constitutive yeast promoter such as ADH or LEU2 or an inducible promoter such as GAL may be used (R. Rothstein In: DNA Cloning, A Practical Approach, Vol.11, Ch. 3, ed. D.M. Glover, IRL Press, Wash., D.C., 1986).
- Vectors that facilitate integration of foreign nucleic acid sequences into a yeast chromosome, via homologous recombination for example, are known in the art.
- Yeast artificial chromosomes YAC are typically used when the inserted polynucleotides are too large for more conventional vectors ⁇ e.g., greater than about 12 Kb).
- Expression vectors also can contain a selectable marker conferring resistance to a selective pressure or identifiable marker ⁇ e.g., beta-galactosidase), thereby allowing cells having the vector to be selected for, grown and expanded.
- a selectable marker can be on a second vector that is co-transfected into a host cell with a first vector containing a nucleic acid encoding a peptide sequence.
- Selection systems include, but are not limited to, herpes simplex virus thymidine kinase gene (Wigler et al, Cell 11 :223 (1977)), hypoxanthine-guanine phosphoribosyltransferase gene (Szybalska et al, Proc.
- neomycin gene which confers resistance to aminoglycoside G-418 (Colberre-Garapin et al, J. Mol. Biol. 150: 1(1981)); puromycin; and hygromycin gene, which confers resistance to hygromycin (Santerre et al, Gene 30: 147 (1984)).
- Additional selectable genes include trpB, which allows cells to utilize indole in place of tryptophan; hisD, which allows cells to utilize histinol in place of histidine (Hartman et al, Proc. Natl. Acad. Sci.
- a transformed cell(s) in vitro, ex vivo and in vivo and host cells that produce a variant or fusion of FGF19 and/or FGF21 as set forth herein, where expression of the variant or fusion of FGF19 and/or FGF21 is conferred by a nucleic acid encoding the variant or fusion of FGF19 and/or FGF21.
- a "transformed" or "host” cell is a cell into which a nucleic acid is introduced that can be propagated and/or transcribed for expression of an encoded peptide sequence. The term also includes any progeny or subclones of the host cell.
- Transformed and host cells that express peptide sequences provided herein typically include a nucleic acid that encodes the peptide sequence.
- a transformed or host cell is a prokaryotic cell.
- a transformed or host cell is a eukaryotic cell.
- the eukaryotic cell is a yeast or mammalian (e.g., human, primate, etc.) cell.
- Transformed and host cells include but are not limited to microorganisms such as bacteria and yeast; and plant, insect and mammalian cells.
- bacteria transformed with recombinant bacteriophage nucleic acid, plasmid nucleic acid or cosmid nucleic acid expression vectors yeast transformed with recombinant yeast expression vectors
- plant cell systems infected with recombinant virus expression vectors e.g., cauliflower mosaic virus, CaMV; tobacco mosaic virus, TMV
- recombinant plasmid expression vectors e.g., Ti plasmid
- insect cell systems infected with recombinant virus expression vectors e.g., baculovirus
- animal cell systems infected with recombinant virus expression vectors e.g., retroviruses, adenovirus, vaccinia virus, or transformed animal cell systems engineered for transient or stable propagation or expression.
- a transformed cell can be in a subject.
- a cell in a subject can be transformed with a nucleic acid that encodes a peptide sequence as set forth herein in vivo.
- a cell can be transformed in vitro with a transgene or polynucleotide, and then transplanted into a tissue of subject in order to effect treatment.
- a primary cell isolate or an established cell line can be transformed with a transgene or polynucleotide that encodes a variant of FGF19 and/or FGF21 or a fusion/chimeric sequence (or variant) thereof, such as a chimeric peptide sequence including all or a portion of FGF19, or including all or a portion of FGF21, and then optionally transplanted into a tissue of a subject.
- a transgene or polynucleotide that encodes a variant of FGF19 and/or FGF21 or a fusion/chimeric sequence (or variant) thereof, such as a chimeric peptide sequence including all or a portion of FGF19, or including all or a portion of FGF21, and then optionally transplanted into a tissue of a subject.
- Non-limiting target cells for expression of peptide sequences include pancreas cells (islet cells), muscle cells, mucosal cells and endocrine cells.
- pancreas cells islet cells
- muscle cells can provide inducible production (secretion) of a variant of FGF19 and/or FGF21, or a fusion/chimeric sequence (or variant) thereof, such as a chimeric peptide sequence including all or a portion of FGF19, or including all or a portion of FGF21.
- Additional cells to transform include stem cells or other multipotent or pluripotent cells, for example, progenitor cells that differentiate into the various pancreas cells (islet cells), muscle cells, mucosal cells and endocrine cells. Targeting stem cells provides longer term expression of peptide sequences provided herein.
- the term "cultured,” when used in reference to a cell, means that the cell is grown in vitro.
- a particular example of such a cell is a cell isolated from a subject, and grown or adapted for growth in tissue culture.
- Another example is a cell genetically manipulated in vitro, and transplanted back into the same or a different subject.
- isolated when used in reference to a cell, means a cell that is separated from its naturally occurring in vivo environment. "Cultured” and “isolated” cells may be manipulated by the hand of man, such as genetically transformed. These terms include any progeny of the cells, including progeny cells that may not be identical to the parental cell due to mutations that occur during cell division. The terms do not include an entire human being.
- Nucleic acids encoding peptide sequences provided herein can be introduced for stable expression into cells of a whole organism. Such organisms, including non-human transgenic animals, are useful for studying the effect of peptide expression in a whole animal and therapeutic benefit. For example, as disclosed herein, production of a variant of FGF19 and/or FGF21 or a fusion/chimeric sequence (or variant) thereof, such as a chimeric peptide sequence including all or a portion of FGF19, or including all or a portion of FGF21 as set forth herein, in mice.
- mice strains that develop or are susceptible to developing a particular disease are also useful for introducing therapeutic proteins as described herein in order to study the effect of therapeutic protein expression in the disease- susceptible mouse.
- Transgenic and genetic animal models that are susceptible to particular disease or physiological conditions such as streptozotocin (STZ)-induced diabetic (STZ) mice, are appropriate targets for expressing variants of FGF19 and/or FGF21, fusions/chimeric sequences (or variant) thereof, such as a chimeric peptide sequence including all or a portion of FGF19, or including all or a portion of FGF21, as set forth herein.
- STZ streptozotocin
- non-human transgenic animals that produce a variant of FGF19 and/or FGF21, or a fusion/chimeric sequence (or variant) thereof, such as a chimeric peptide sequence including all or a portion of FGF19, or including all or a portion of FGF21, the production of which is not naturally occurring in the animal which is conferred by a transgene present in somatic or germ cells of the animal.
- transgenic animal refers to an animal whose somatic or germ line cells bear genetic information received, directly or indirectly, by deliberate genetic manipulation at the subcellular level, such as by microinjection or infection with recombinant virus.
- transgenic further includes cells or tissues (i.e., "transgenic cell,” “transgenic tissue”) obtained from a transgenic animal genetically manipulated as described herein.
- a transgenic animal does not encompass animals produced by classical crossbreeding or in vitro fertilization, but rather denotes animals in which one or more cells receive a nucleic acid molecule.
- Transgenic animals provided herein can be either heterozygous or homozygous with respect to the transgene.
- mice including mice, sheep, pigs and frogs
- transgenic animals including mice, sheep, pigs and frogs
- U.S. Patent Nos. 5,721,367, 5,695,977, 5,650,298, and 5,614,396 are well known in the art (see, e.g., U.S. Patent Nos. 5,721,367, 5,695,977, 5,650,298, and 5,614,396) and, as such, are additionally included.
- transformed host cells expressing peptide sequences include isolated and purified forms.
- isolated when used as a modifier of a composition provided herein, means that the composition is separated, substantially, completely, or at least in part, from one or more components in an environment.
- compositions that exist in nature, when isolated are substantially free of one or more materials with which they normally associate with in nature, for example, one or more protein, nucleic acid, lipid, carbohydrate or cell membrane.
- isolated does not exclude alternative physical forms of the composition, such as variants, modifications or derivatized forms, fusions and chimeras, multimers/oligomers, etc., or forms expressed in host cells.
- isolated also does not exclude forms ⁇ e.g., pharmaceutical compositions, combination compositions, etc.) in which there are combinations therein, any one of which is produced by the hand of man.
- An “isolated” composition can also be “purified” when free of some, a substantial number of, or most or all of one or more other materials, such as a contaminant or an undesired substance or material.
- the term "recombinant,” when used as a modifier of peptide sequences, nucleic acids encoding peptide sequences, etc., means that the compositions have been manipulated (i.e., engineered) in a fashion that generally does not occur in nature (e.g., in vitro).
- a particular example of a recombinant peptide would be where a peptide sequence provided herein is expressed by a cell transfected with a nucleic acid encoding the peptide sequence.
- a particular example of a recombinant nucleic acid would be a nucleic acid (e.g., genomic or cDNA) encoding a peptide sequence cloned into a plasmid, with or without 5', 3' or intron regions that the gene is normally contiguous within the genome of the organism.
- a recombinant peptide or nucleic acid is a hybrid or fusion sequence, such as a chimeric peptide sequence comprising a portion of FGF19 and a portion of FGF21.
- Improvements of physical properties include, for example, modulating immunogenicity; methods of increasing solubility, bioavailability, serum half-life, and/or therapeutic half-life; and/or modulating biological activity. Certain modifications may also be useful to, for example, raise of antibodies for use in detection assays (e.g., epitope tags) and to provide for ease of protein purification. Such improvements must generally be imparted without adversely impacting the bioactivity of the treatment modality and/or increasing its
- Pegylation of is one particular modification contemplated herein, while other modifications include, but are not limited to, glycosylation (N- and O-linked); polysialylation; albumin fusion molecules comprising serum albumin (e.g., human serum albumin (HSA), cyno serum albumin, or bovine serum albumin (BSA)); albumin binding through, for example a conjugated fatty acid chain (acylation); and Fc-fusion proteins.
- serum albumin e.g., human serum albumin (HSA), cyno serum albumin, or bovine serum albumin (BSA)
- Fc-fusion proteins Fc-fusion proteins
- Pegylation The clinical effectiveness of protein therapeutics is often limited by short plasma half-life and susceptibility to protease degradation.
- Studies of various therapeutic proteins e.g. , filgrastim
- conjugating or linking the protein to any of a variety of nonproteinaceous polymers, e.g., polyethylene glycol (PEG), polypropylene glycol, or polyoxyalkylenes. This is frequently effected by a linking moiety covalently bound to both the protein and the nonproteinaceous polymer, e.g., a PEG.
- PEG-conjugated biomolecules have been shown to possess clinically useful properties, including better physical and thermal stability, protection against susceptibility to enzymatic degradation, increased solubility, longer in vivo circulating half-life and decreased clearance, reduced immunogenicity and antigenicity, and reduced toxicity.
- pegylation itself may enhance activity.
- PEGs suitable for conjugation to a polypeptide sequence are generally soluble in water at room temperature, and have the general formula R(0-CH 2 -CH 2 ) n O-R, where R is hydrogen or a protective group such as an alkyl or an alkanol group, and where n is an integer from 1 to 1000. When R is a protective group, it generally has from 1 to 8 carbons.
- R is hydrogen or a protective group such as an alkyl or an alkanol group, and where n is an integer from 1 to 1000. When R is a protective group, it generally has from 1 to 8 carbons.
- the PEG conjugated to the polypeptide sequence can be linear or branched. Branched PEG derivatives, "star-PEGs" and multi-armed PEGs are contemplated by the present disclosure.
- a molecular weight of the PEG used in embodiments provided herein is not restricted to any particular range, and examples are set forth elsewhere herein; by way of example, certain embodiments have molecular weights between 5kDa and 20kDa, while other embodiments have molecular weights between 4kDa and lOkDa.
- Such compositions can be produced by reaction conditions and purification methods know in the art. Cation exchange chromatography may be used to separate conjugates, and a fraction is then identified which contains the conjugate having, for example, the desired number of PEGs attached, purified free from unmodified protein sequences and from conjugates having other numbers of PEGs attached.
- Pegylation most frequently occurs at the alpha amino group at the N-terminus of the polypeptide, the epsilon amino group on the side chain of lysine residues, and the imidazole group on the side chain of histidine residues. Since most recombinant polypeptides possess a single alpha and a number of epsilon amino and imidazole groups, numerous positional isomers can be generated depending on the linker chemistry.
- PEG may be bound to a polypeptide provided herein via a terminal reactive group (a "spacer” or "linker”) which mediates a bond between the free amino or carboxyl groups of one or more of the polypeptide sequences and polyethylene glycol.
- a terminal reactive group a "spacer” or "linker”
- the PEG having the spacer which may be bound to the free amino group includes N-hydroxysuccinylimide polyethylene glycol which may be prepared by activating succinic acid ester of polyethylene glycol with N- hydroxysuccinylimide.
- Another activated polyethylene glycol which may be bound to a free amino group is 2,4-bis(0-methoxypolyethyleneglycol)-6-chloro-s-triazine, which may be prepared by reacting polyethylene glycol monomethyl ether with cyanuric chloride.
- the activated polyethylene glycol which is bound to the free carboxyl group includes
- Conjugation of one or more of the polypeptide sequences provided herein to PEG having a spacer may be carried out by various conventional methods.
- the conjugation reaction can be carried out in solution at a pH of from 5 to 10, at temperature from 4°C to room temperature, for 30 minutes to 20 hours, utilizing a molar ratio of reagent to protein of from 4: 1 to 30: 1.
- the reaction is terminated by acidifying the reaction mixture and freezing at, e.g., -20°C.
- Pegylation of various molecules is discussed in, for example, U.S. Pat. Nos. 5,252,714; 5,643,575; 5,919,455; 5,932,462; and 5,985,263.
- PEG mimetics also provided herein are uses of PEG mimetics.
- Recombinant PEG mimetics have been developed that retain the attributes of PEG ⁇ e.g., enhanced serum half- life) while conferring several additional advantageous properties.
- simple polypeptide chains comprising, for example, Ala, Glu, Gly, Pro, Ser and Thr
- XTEN technology a polypeptide or protein drug of interest
- This obviates the need for an additional conjugation step during the manufacturing process.
- established molecular biology techniques enable control of the side chain composition of the polypeptide chains, allowing optimization of immunogenicity and manufacturing properties.
- Glycosylation is meant to broadly refer to the enzymatic process by which glycans are attached to proteins, lipids or other organic molecules.
- the use of the term “glycosylation” herein is generally intended to mean adding or deleting one or more carbohydrate moieties (either by removing the underlying glycosylation site or by deleting the glycosylation by chemical and/or enzymatic means), and/or adding one or more glycosylation sites that may or may not be present in the native sequence.
- the phrase includes qualitative changes in the glycosylation of the native proteins involving a change in the nature and proportions of the various carbohydrate moieties present.
- Glycosylation can dramatically affect the physical properties ⁇ e.g., solubility) of polypeptides and can also be important in protein stability, secretion, and subcellular
- Glycosylated polypeptides may also exhibit enhanced stability or may improve one or more pharmacokinetic properties, such as half-life.
- solubility improvements can, for example, enable the generation of formulations more suitable for pharmaceutical
- Addition of glycosylation sites can be accomplished by altering the amino acid sequence.
- the alteration to the polypeptide may be made, for example, by the addition of, or substitution by, one or more serine or threonine residues (for O-linked glycosylation sites) or asparagine residues (for N-linked glycosylation sites).
- the structures of N-linked and O-linked oligosaccharides and the sugar residues found in each type may be different.
- One type of sugar that is commonly found on both is N-acetylneuraminic acid (hereafter referred to as sialic acid).
- sialic acid is usually the terminal residue of both N-linked and O-linked oligosaccharides and, by virtue of its negative charge, may confer acidic properties to the glycoprotein.
- a particular embodiment comprises the generation and use of N-glycosylation variants.
- polypeptide sequences provided herein may optionally be altered through changes at the nucleic acid level, particularly by mutating the nucleic acid encoding the polypeptide at preselected bases such that codons are generated that will translate into the desired amino acids.
- Polysialylation in certain embodiments, also provided herein is the use of polysialylation, the conjugation of polypeptides to the naturally occurring, biodegradable a- (2 ⁇ 8) linked polysialic acid ("PSA") in order to improve the polypeptides' stability and in vivo pharmacokinetics .
- PSA biodegradable a- (2 ⁇ 8) linked polysialic acid
- Albumin Fusion Additional suitable components and molecules for conjugation include albumins such as human serum albumin (HSA), cyno serum albumin, and bovine serum albumin (BSA).
- HSA human serum albumin
- BSA bovine serum albumin
- albumin is conjugated to a drug molecule (e.g., a polypeptide described herein) at the carboxyl terminus, the amino terminus, both the carboxyl and amino termini, and internally (see, e.g., US Pat Nos. 5,876,969 and 7,056,701).
- a drug molecule e.g., a polypeptide described herein
- albumin secretion pre-sequences and variants thereof, fragments and variants thereof, and HSA variants. Such forms generally possess one or more desired albumin activities.
- fusion proteins are provided herein comprising a polypeptide drug molecule fused directly or indirectly to albumin, an albumin fragment, an albumin variant, etc., wherein the fusion protein has a higher plasma stability than the unfused drug molecule and/or the fusion protein retains the therapeutic activity of the unfused drug molecule.
- the indirect fusion is effected by a linker, such as a peptide linker or modified version thereof.
- fusion of albumin to one or more polypeptides provided herein can, for example, be achieved by genetic manipulation, such that the nucleic acid coding for HSA, or a fragment thereof, is joined to the nucleic acid coding for the one or more polypeptide sequences.
- albumin binding through a conjugated fatty acid chain (acylation) and fusion proteins which comprise an albumin binding domain (ABD) polypeptide sequence and the sequence of one or more of the polypeptides described herein.
- Conjugation with Other Molecules include, for example, thyroglobulin; tetanus toxoid; Diphtheria toxoid;
- polyamino acids such as poly(D-lysine:D-glutamic acid); VP6 polypeptides of rotaviruses;
- influenza virus hemagglutinin, influenza virus nucleoprotein; Keyhole Limpet Hemocyanin (KLH); and hepatitis B virus core protein and surface antigen; or any combination of the foregoing.
- KLH Keyhole Limpet Hemocyanin
- conjugation of one or more additional components or molecules at the N- and/or C-terminus of a polypeptide sequence such as another polypeptide (e.g., a polypeptide having an amino acid sequence heterologous to the subject polypeptide), or a carrier molecule is also contemplated.
- another polypeptide e.g., a polypeptide having an amino acid sequence heterologous to the subject polypeptide
- a carrier molecule e.g., an exemplary polypeptide sequence can be provided as a conjugate with another component or molecule.
- a polypeptide may also be conjugated to large, slowly metabolized macromolecules such as proteins; polysaccharides, such as sepharose, agarose, cellulose, or cellulose beads;
- polymeric amino acids such as polyglutamic acid, or polylysine; amino acid copolymers;
- inactivated virus particles inactivated virus particles
- inactivated bacterial toxins such as toxoid from diphtheria, tetanus, cholera, or leukotoxin molecules
- inactivated bacteria inactivated bacteria
- dendritic cells dendritic cells
- Fc-fusion Molecules In certain embodiments, the amino- or carboxyl- terminus of a polypeptide sequence provided herein can be fused with an immunoglobulin Fc region (e.g., human Fc) to form a fusion conjugate (or fusion molecule).
- Fc fusion conjugates have been shown to increase the systemic half-life of biopharmaceuticals, and thus the biopharmaceutical product may require less frequent administration.
- Fc binds to the neonatal Fc receptor (FcRn) in endothelial cells that line the blood vessels, and, upon binding, the Fc fusion molecule is protected from degradation and re -released into the circulation, keeping the molecule in circulation longer.
- FcRn neonatal Fc receptor
- Fc binding is believed to be the mechanism by which endogenous IgG retains its long plasma half-life. More recent Fc- fusion technology links a single copy of a biopharmaceutical to the Fc region of an antibody to optimize the pharmacokinetic and pharmacodynamic properties of the biopharmaceutical as compared to traditional Fc-fusion conjugates.
- Additional suitable components and molecules for conjugation include those suitable for isolation or purification.
- Particular non-limiting examples include binding molecules, such as biotin (biotin-avidin specific binding pair), an antibody, a receptor, a ligand, a lectin, or molecules that comprise a solid support, including, for example, plastic or polystyrene beads, plates or beads, magnetic beads, test strips, and membranes.
- Purification methods such as cation exchange chromatography may be used to separate conjugates by charge difference, which effectively separates conjugates into their various molecular weights.
- the cation exchange column can be loaded and then washed with ⁇ 20 mM sodium acetate, pH ⁇ 4, and then eluted with a linear (0 M to 0.5 M) NaCl gradient buffered at a pH from 3 to 5.5, such as at pH ⁇ 4.5.
- the content of the fractions obtained by cation exchange chromatography may be identified by molecular weight using conventional methods, for example, mass spectroscopy, SDS-PAGE, or other known methods for separating molecular entities by molecular weight.
- a fraction is then identified which contains the conjugate having the desired number of PEGs attached, purified free from unmodified protein sequences and from conjugates having other numbers of PEGs attached.
- a peptide sequence provided herein is linked to a chemical agent (e.g., an immunotoxin or chemotherapeutic agent), including, but are not limited to, a cytotoxic agent, including taxol, cytochalasin B, gramicidin D, mitomycin, etoposide, tenoposide, vincristine, vinblastine, colchicin, doxorubicin, daunorubicin, and analogs or homo logs thereof.
- cytotoxic agent including taxol, cytochalasin B, gramicidin D, mitomycin, etoposide, tenoposide, vincristine, vinblastine, colchicin, doxorubicin, daunorubicin, and analogs or homo logs thereof.
- Other chemical agents include, for example, antimetabolites (e.g., methotrexate, 6-mercaptopurine, 6- thioguanine, cytarabine, 5-fluorouracil de
- alkylating agents e.g., mechlorethamine, carmustine and lomustine, cyclothosphamide, busulfan, dibromomannitol, streptozotocin, mitomycin C, and cisplatin
- antibiotics e.g., bleomycin
- anti-mitotic agents e.g., vincristine and vinblastine.
- Cytotoxins can be conjugated to a peptide provided herein using linker technology known in the art and described herein.
- suitable components and molecules for conjugation include those suitable for detection in an assay.
- Particular non-limiting examples include detectable labels, such as a
- radioisotope e.g. , I; S, P; P
- an enzyme which generates a detectable product e.g., luciferase, ⁇ -galactosidase, horse radish peroxidase and alkaline phosphatase
- a fluorescent protein e.g., a chromogenic protein, dye (e.g., fluorescein isothiocyanate); fluorescence emitting metals (e.g., 152 Eu); chemiluminescent compounds (e.g., luminol and acridinium salts);
- bioluminescent compounds e.g., luciferin
- fluorescent proteins Indirect labels include labeled or detectable antibodies that bind to a peptide sequence, where the antibody may be detected.
- a peptide sequence provided herein is conjugated to a radioactive isotope to generate a cytotoxic radiopharmaceutical (radioimmunoconjugates) useful as a diagnostic or therapeutic agent.
- radioactive isotopes include, but are not limited to, iodine 131 , indium 111 , yttrium 90 and lutetium 177 .
- radioimmunoconjugates are known to the skilled artisan. Examples of radioimmunoconjugates that are commercially available include ibritumomab, tiuxetan, and tositumomab.
- Linkers Linkers and their use have been described above. Any of the foregoing components and molecules used to modify the polypeptide sequences provided herein may optionally be conjugated via a linker. Suitable linkers include "flexible linkers" which are generally of sufficient length to permit some movement between the modified polypeptide sequences and the linked components and molecules. The linker molecules are generally about 6-50 atoms long. The linker molecules may also be, for example, aryl acetylene, ethylene glycol oligomers containing 2-10 monomer units, diamines, diacids, amino acids, or combinations thereof.
- Suitable linkers can be readily selected and can be of any suitable length, such as 1 amino acid (e.g., Gly), 2, 3, 4, 5, 6, 7, 8, 9, 10, 10-20, 20-30, 30-50 or more than 50 amino acids.
- Exemplary flexible linkers include glycine polymers (G) n , glycine-serine polymers (for example, (GS) soir, GSGGS slope (SEQ ID NO:206) and GGGS slope (SEQ ID NO:207), where n is an integer of at least one), glycine-alanine polymers, alanine-serine polymers, and other flexible linkers.
- Glycine and glycine-serine polymers are relatively unstructured, and therefore may serve as neutral tethers between components.
- Exemplary flexible linkers include, but are not limited to, GGSG (SEQ ID NO:208), GGSGG (SEQ ID NO:209), GSGSG (SEQ ID NO:210), GSGGG (SEQ ID NO:211), GGGSG (SEQ ID NO: 189), and GSSSG (SEQ ID NO:212).
- bile acid-related disorder when used in reference to a condition of a subject, means a disruption of bile acid homeostasis, which may manifest itself as, for example, an acute, transient or chronic abnormal level of a bile acid or one or more bile acids.
- the condition can be caused by inhibition, reduction or a delay in bile acid synthesis, metabolism or absorption such that the subject exhibits a bile acid level not typically found in normal subjects.
- the methods include administering a peptide sequence, such as an FGF19 or FGF21 variant, fusion or chimera disclosed herein ⁇ e.g., in the Sequence Listing or Table 1), or a subsequence, a variant or modified form of an FGF19 or FGF21 variant, fusion or chimera disclosed herein ⁇ e.g., the Sequence Listing or Table 1), to a subject in an amount effective for treating a bile acid-related disorder, in combination with an additional therapeutic agent(s) and/or treatment modalities ⁇ e.g., an agent useful in the treatment and/or prevention of PBC).
- the additional therapeutic agent(s) can be administered before, with, or following administration of the peptides described herein.
- a method provided herein for, for example, modulating bile acid homeostasis or treating a bile-acid related or associated disorder includes contacting or administering i) one or more peptides provided herein (e.g., a variant or fusion of FGF19 and/or FGF21 as set forth in the Sequence Listing or Table 1) in an amount effective to modulate bile acid homeostasis or treat a bile-acid related or associated disorder, and ii) at least one additional therapeutic agent or treatment modality that is useful in the treatment or prevention of a bile acid related disorder (e.g., PBC).
- one or more peptides provided herein e.g., a variant or fusion of FGF19 and/or FGF21 as set forth in the Sequence Listing or Table 1
- at least one additional therapeutic agent or treatment modality that is useful in the treatment or prevention of a bile acid related disorder (e.g., PBC).
- subject refers to an animal.
- the animal is a mammal that would benefit from treatment with a peptide sequence provided herein.
- Particular examples include primates (e.g., humans), dogs, cats, horses, cows, pigs, and sheep.
- Subjects include those having a disorder, e.g., a bile acid related or associated disorder, such as cholestasis, including, for example diseases of intrahepatic cholestasis (e.g., PBC, PFIC, PSC, PIC, neonatal cholestasis, and drug induced cholestasis (e.g., estrogen)), and diseases of extrahepatic cholestasis (e.g., bile cut compression from tumor, bile duct blockade by gall stones); bile acid malabsorption and other disorders involving the distal small intestine, including ileal resection, inflammatory bowel diseases (e.g., Crohn's disease and ulcerative colitis), short bowel syndrome, disorders impairing absorption of bile acids not otherwise characterized (idiopathic)) leading to diarrhea (e.g., BAD) and GI symptoms, and GI, liver, and/or biliary cancers (e.g.,
- Additional bile acid-related disorders that may be treated or prevented with the peptide sequences provided herein in combination with one or more additional therapeutic agents or treatment modalities include metabolic syndrome, a lipid or glucose disorder, cholesterol or triglyceride metabolism, diabetes (e.g., type 2 diabetes), other hyperglycemic-related disorders, including kidney damage (e.g., tubule damage or nephropathy), liver degeneration, eye damage (e.g., diabetic retinopathy or cataracts), and diabetic foot disorders, and dyslipidemias and their sequelae such as, for example, atherosclerosis, coronary artery disease, cerebrovascular disorders and the like.
- metabolic syndrome e.g., a lipid or glucose disorder, cholesterol or triglyceride metabolism
- diabetes e.g., type 2 diabetes
- other hyperglycemic-related disorders including kidney damage (e.g., tubule damage or nephropathy), liver degeneration, eye damage (e.g., diabetic retinopathy or cataract
- Other conditions which may be associated with metabolic syndrome such as obesity and elevated body mass (including the co-morbid conditions thereof such as, but not limited to, nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), and polycystic ovarian syndrome (PCOS)), and also include thromboses, hypercoagulable and prothrombotic states (arterial and venous), hypertension (including portal hypertension (defined as a hepatic venous pressure gradient (HVPG) greater than 5 mm Hg), cardiovascular disease, stroke and heart failure; Disorders or conditions in which inflammatory reactions are involved, including atherosclerosis, chronic inflammatory bowel diseases (e.g., Crohn's disease and ulcerative colitis), asthma, lupus erythematosus, arthritis, or other inflammatory rheumatic disorders;
- disorders of cell cycle or cell differentiation processes such as adipose cell tumors, lipomatous carcinomas including, for example, liposarcomas, solid tumors, and neoplasms;
- Neurodegenerative diseases and/or demyelinating disorders of the central and peripheral nervous systems and/or neurological diseases involving neuroinflammatory processes and/or other peripheral neuropathies including Alzheimer's disease, multiple sclerosis, Parkinson's disease, progressive multifocal leukoencephalopathy and Guillian-Barre syndrome; Skin and
- dermatological disorders and/or disorders of wound healing processes including erythemato- squamous dermatoses; and Other Disorders such as syndrome X, osteoarthritis, and acute respiratory distress syndrome.
- Treatment of a bile acid-related disorder may have the benefit of alleviating or abolishing a disorder secondary thereto.
- a subject suffering from NASH may also have depression or anxiety due to NASH; thus, treating the subject's NASH may also indirectly treat the depression or anxiety.
- the use of the therapies disclosed herein to target such secondary disorders is also contemplated in certain embodiments.
- the subject has or is at risk of having PBC. In other particular embodiments, the subject has or is at risk of having NASH. In one embodiment, the subject has PBC. In one embodiment, the subject is at risk of having PBC. In other words, the subject has or is at risk of having PBC. In other words, the subject has or is at risk of having PBC. In other words, the subject has or is at risk of having PBC. In other words, the subject has or is at risk of having PBC.
- the subject has NASH. In other embodiments, the subject is at risk of having NASH.
- Subjects at risk of developing a bile acid-related or associated disorder include, for example, those who may have a family history or genetic predisposition toward such disorder, as well those whose diet may contribute to development of such disorders.
- treatment methods include contacting or administering a peptide as set forth herein (e.g., a variant or fusion of FGF19 and/or FGF21 as set forth in the Sequence Listing or Table 1) in an amount effective to achieve a desired outcome or result in a subject.
- a treatment that results in a desired outcome or result includes decreasing, reducing or preventing the severity or frequency of one or more symptoms of the condition in the subject, e.g., an improvement in the subject's condition or a "beneficial effect” or "therapeutic effect.”
- treatment can decrease or reduce or prevent the severity or frequency of one or more symptoms of the disorder, stabilize or inhibit progression or worsening of the disorder, and in some instances, reverse the disorder, transiently (e.g., for 1-6, 6-12, or 12-24 hours), for medium term (e.g., 1-6, 6-12, 12-24 or 24-48 days) or long term (e.g., for 1-6, 6-12, 12-24, 24-48 weeks, or greater than 24-48 weeks).
- transiently e.g., for 1-6, 6-12, or 12-24 hours
- medium term e.g., 1-6, 6-12, 12-24 or 24-48 days
- long term e.g., for 1-6, 6-12, 12-24, 24-48 weeks, or greater than 24-48 weeks.
- treatment can lower or reduce one or more symptoms or effects of the bile acid-related or associated disorders described above.
- Treatment methods also include contacting or administering one or more additional agents or therapeutic modalities useful in the treatment or prevention of a bile acid related disorder, such as those agents or therapeutic modalities described herein, in an amount effective to achieve a desired outcome or result in a subject.
- a treatment that results in a desired outcome or result includes decreasing, reducing or preventing the severity or frequency of one or more symptoms of the condition in the subject, e.g., an improvement in the subject's condition or a "beneficial effect” or "therapeutic effect.” Therefore, treatment can decrease or reduce or prevent the severity or frequency of one or more symptoms of the disorder, stabilize or inhibit progression or worsening of the disorder, and in some instances, reverse the disorder, transiently (e.g., for 1-6, 6-12, or 12-24 hours), for medium term (e.g., 1-6, 6-12, 12-24 or 24-48 days) or long term (e.g., for 1-6, 6-12, 12-24, 24-48 weeks, or greater than 24-48 weeks).
- treatment with a peptide provided herein in combination with another therapeutic agent can lower or reduce one or more symptoms or effects of the bile acid-related or associated disorders described above.
- an "effective amount” or a "sufficient amount” for use and/or for treating a subject refers to an amount that provides, in single or multiple doses, alone, or in combination with one or more other agents, treatments, protocols, or therapeutic regimens, a detectable response of any duration of time (transient, medium or long term), a desired outcome in or an objective or subjective benefit to a subject of any measurable or detectable degree or for any duration of time (e.g., for hours, days, months, years, in remission or cured).
- Such amounts typically are effective to ameliorate a disorder, or one, multiple or all adverse symptoms, consequences or complications of the disorder, to a measurable extent, although reducing or inhibiting a progression or worsening of the disorder, is considered a satisfactory outcome.
- the term “ameliorate” means an improvement in the subject's disorder, a reduction in the severity of the disorder, or an inhibition of progression or worsening of the disorder (e.g., stabilizing the disorder).
- a bile acid-related or associated disorder such as those described above, including cholestasis (e.g. , PBC), disorders impairing absorption of bile acids leading to diarrhea (e.g. , BAD) and bile acid synthesis abnormalities (e.g., NASH)
- an improvement can be a lowering or a reduction in one or more symptoms or effects of the disorder.
- a therapeutic benefit or improvement therefore need not be complete ablation of any one, most or all symptoms, complications, consequences or underlying causes associated with the disorder or disease.
- a satisfactory endpoint is achieved when there is a transient, medium or long term, incremental improvement in a subject's condition, or a partial reduction in the occurrence, frequency, severity, progression, or duration, or inhibition or reversal, of one or more associated adverse symptoms or complications or consequences or underlying causes, worsening or progression (e.g. , stabilizing one or more symptoms or complications of the condition, disorder or disease), of the disorder or disease, over a duration of time (hours, days, weeks, months, etc.).
- the amount of the peptide and the additional agent sufficient to ameliorate a disorder will depend on the type, severity and extent, or duration of the disorder, the therapeutic effect or outcome desired, and can be readily ascertained by the skilled artisan. Appropriate amounts will also depend upon the individual subject (e.g. , the
- a transient, or partial, restoration of normal bile acid homeostasis in a subject can reduce the dosage amount or frequency of the peptides and agents described herein in order to treat the bile acid-related or associated disorders described previously even though complete freedom from treatment has not resulted.
- An effective amount can be ascertained, for example, by measuring one or more relevant physiological effects.
- Methods and uses provided herein for treating a subject are applicable for prophylaxis to prevent or reduce the likelihood of a disorder in a subject, such as a bile acid-related or associated disorder. Accordingly, methods and uses provided herein for treating a subject having, or at risk of developing, a bile acid-related disorder or associated disorder can be practiced prior to, substantially contemporaneously with, or following administration or application of another agent useful for the treatment or prevention of a bile acid-related or associated disorder, and/or can be supplemented with other forms of therapy.
- Supplementary therapies include other glucose lowering treatments, such as insulin, an insulin sensitivity enhancer and other drug treatments, a change in diet (low sugar, fats, etc.), weight loss surgery- deducing stomach volume by gastric bypass, gastrectomy), gastric banding, gastric balloon, gastric sleeve, etc.
- a method or use provided herein for treating a hyperglycemic or insulin resistance disorder can be used in combination with drugs or other pharmaceutical compositions that lower glucose or increase insulin sensitivity in a subject.
- PBC Primary biliary cirrhosis
- cholestatic liver disease is a progressive hepatic disease that primarily results from autoimmune destruction of the bile ducts that transport bile acids out of the liver. As the disease progresses, persistent toxic build-up of bile acids causes progressive liver damage marked by chronic inflammation and fibrosis.
- combination therapy with the variants of FGF19 peptide sequences, fusions of FGF19 and/or FGF21 peptide sequences and variants of fusions (chimeras) of FGF19 and/or FGF21 peptide sequences described herein is of particular import, as such sequences do not induce, or do not substantially increase, HCC formation or HCC tumorigenesis.
- patients with PBC are often asymptomatic at the time of initial diagnosis, most present, or subsequently develop, one or more of the following: pruritus; fatigue; jaundice; xanthoma; disorders associated with an extrahepatic autoimmune disorder ⁇ e.g., Sjogren's Syndrome and rheumatoid arthritis); and complications that result from cirrhosis or portal hypertension ⁇ e.g., ascites, esophageal varices and hepatic encephalopathy).
- Diagnostic blood tests include deranged liver function tests (gamma-glutamyl transferase and alkaline phosphatase) and the presence of particular antibodies
- AMA antimitochondrial antibody
- ANA antinuclear antibody
- Antinuclear antibodies are believed to be prognostic indicators of PBC.
- a liver biopsy is frequently performed to confirm disease.
- Endoscopic retrograde cholangiopancreatography (ERCP) an endoscopic evaluation of the bile duct, may also be employed to confirm disease.
- Stage 1 is characterized by portal inflammation and mild bile duct damage
- Stage 2 Periportal Stage
- Stage 3 is characterized by active and/or passive fibrous septa
- Stage 4 Breast Cirrhosis
- Liver biopsy is required to determine the stage of disease.
- Serum bilirubin is an indicator of PBC progression and prognosis. Patients with a serum bilirubin level of 2-6 mg/dL have a mean survival time of 4.1 years, patients with a serum bilirubin level of 6-10 mg/dL have a mean survival time of 2.1 years, and patients with a serum bilirubin level above 10 mg/dL have a mean survival time of 1.4 years. Liver transplantation is an option in advanced cases of PBC, although the recurrence rate may be as high as 18% at 5 years, and up to 30% at 10 years.
- one aspect pertains to the use of one or more current therapies in combination with variants of FGF19 peptide sequences, fusions of FGF19 and/or FGF21 peptide sequences and variants of fusions (chimeras) of FGF19 and/or FGF21 peptide sequences having one or more activities associated with the treatment and/or prevention of PBC and associated diseases, disorders and conditions.
- the most commonly used and/or promising agents for combination therapy are set forth hereafter, although it is to be understood that these agents are illustrative, and not exclusionary.
- UDCA bile acid ursodeoxycholic acid
- UDCA therapy is helpful in reducing the cholestasis and improving the liver function tests in PBC patients; however, it does not demonstrably improve symptoms and has a questionable impact on prognosis.
- UDCA has been shown to reduce mortality, adverse events and the need for transplantation in PBC.
- UDCA is considered the first-line therapy, approximately one -third of patients may be non-responsive and remain at risk of progressive liver disease and are candidates for alternative or additive therapy.
- Farnesoid-X-receptor agonists represent a promising class of agents that may be used in combination therapy.
- CYP7A1 hydroxylase- 1
- Obeticholic acid (OCA; Intercept Pharmaceuticals, NY) is a bile acid analog and FXR agonist derived from the primary human bile acid chenodeoxycholic acid, or CDCA.
- OCA is currently being evaluated for patients having an inadequate therapeutic response to ursodiol or who are unable to tolerate ursodiol.
- Inhibitors of the apical sodium-dependent bile acid transporter represent another class of agents that may be used in combination with the variants of FGF19 peptide sequences, fusions of FGF19 and/or FGF21 peptide sequences and variants of fusions (chimeras) of FGF19 and/or FGF21 peptide sequences described herein for the treatment and/or prevention of PBC and associated diseases.
- ASBT a member of the sodium/bile-salt co-transport family coded by gene SLC10A2
- SLC10A2 a member of the sodium/bile-salt co-transport family coded by gene SLC10A2
- Bile acid sequestrants also find use in the treatment of PBC. Cholestyramine and colestipol are the best known bile acid sequestrants. However, their use is sometimes limited because they are only available in powder form and are not tolerated by many patients, often because of the poor texture and taste of the resin powder. The bile acid sequestrant colesevelam is available in tablet form and is often better tolerated. All bile acid sequestrants are capable of binding other compounds, including the fat-soluble vitamins A, D, E and K, and deficiencies of these vitamins many necessitate supplementation. Importantly, the PBC patient population inherently has poor lipid-dependent absorption of vitamins A, D, E and K, and thus patients taking bile acid sequestrants are at particular risk for deficiency of those vitamins.
- Agents associated with immune and inflammatory function are candidates for combination therapy with the variants of FGF19 peptide sequences, fusions of FGF19 and/or FGF21 peptide sequences and variants of fusions (chimeras) of FGF19 and/or FGF21 peptide sequences having one or more activities associated with the treatment and/or prevention of PBC and associated diseases, disorders and conditions.
- the interleukin IL-12 is linked with autoimmunity. Data indicate that the IL-12 signaling pathway plays a key role in the effector mechanisms that lead to biliary destruction. Targeting the p40 subunit of IL-12 has also been shown to ameliorate experimental immune- mediated cholangiopathy.
- anti-IL-12 agents e.g., monoclonal Ab inhibitors
- CD80 polymorphisms in CD80 have been identified as conferring an increased susceptibility to PBC
- blockade of co-stimulation between T cells and antigen-presenting cells through CD80 by use of an anti-CD80 agent could represent an important therapeutic approach for the treatment of PBC.
- improvement in IgM titre and an increase in intrahepatic regulatory T-cell number using the anti-CD20 antibody rituximab (RITUXAN) have shown promise.
- the immune-mediated destruction of small-sized bile ducts in PBC is predominantly cell-mediated, characterized by Thl cells, CD8+ T cells, NK cells and NKT cells which express CXCR3. Therefore, neutralizing antibodies to CXCL10, a ligand for CXCR3, may offer the possibility to interfere with one of the key inflammatory processes and contribute to immune- mediated biliary destruction in PBC.
- blockade of co-stimulatory signals between T cells expressing CD28 and antigen-presenting cells expressing CD80 might represent an important approach for the treatment of autoimmune diseases.
- variants of FGF19 peptide sequences, fusions of FGF19 and/or FGF21 peptide sequences and variants of fusions (chimeras) of FGF19 and/or FGF21 peptide sequences described herein can be used in combination with other agents for the treatment and/or prevention of those bile acid-related disorders referenced herein that have an immune and/or inflammatory component, including, but not limited to, PBC and associated diseases, disorders and conditions.
- agents for the treatment and/or prevention of those bile acid-related disorders referenced herein that have an immune and/or inflammatory component including, but not limited to, PBC and associated diseases, disorders and conditions.
- examples of such other agents include, for example, non-steroidal antiinflammatory drugs (NSAID); steroids; cytokine suppressive anti-inflammatory drug(s)
- CSAIDs antibodies to, or antagonists of, other human cytokines or growth factors (e.g., IL-2, IL-6, or PDGF); TNF antagonists (e.g., agents such as REMICADE, p75TNFRIgG (ENBREL) or p55TNFRlgG (LENERCEPT)); interferon-pia (AVONEX); interferon-pib (BETASERON); and immune checkpoint inhibitors, including PD1 (associated agents include the antibodies nivolumab and lambrolizumab), PDL1 , BTLA, CTLA4 (associated agents include the fully humanized CTLA4 monoclonal antibody ipilimumab (YERVOY), TIM3, LAG3, and A2aR.
- TNF antagonists e.g., agents such as REMICADE, p75TNFRIgG (ENBREL) or p55TNFRlgG (LENERCEPT)
- interferon-pia AVONE
- Fibrates have been shown to improve various aspects of PBC, including liver function tests, both as monotherapy and in combination with UDCA non-responders.
- a fibrate is a member selected from the group of bezafibrate (BEZALIP), ciprofibrate (MODALIM), gemfibrozil (LOPID), clofibrate, and fenofibrate (TRICOR).
- BEZALIP bezafibrate
- MODALIM ciprofibrate
- LPID gemfibrozil
- clofibrate clofibrate
- fenofibrate TriCOR
- corticosteroids such as budesonide may improve liver histology and biochemistry, particularly when used in combination with UDCA.
- Colchicine has been shown to improve liver function tests (e.g., AST and ALP) and represents another alternative treatment for PBC.
- Non-alcoholic steatohepatitis considered part of a spectrum of non-alcoholic fatty liver diseases (NAFLD), causes inflammation and accumulation of fat and fibrous tissue in the liver.
- NASH non-alcoholic fatty liver diseases
- risk factors include central obesity, type-2 diabetes mellitus, insulin resistance (IR) and dyslipidemia;
- Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in the United States, and the estimated prevalence of NAFLD is 20-30% and for NASH it is estimated at 3.5-5%.
- tamoxifen e.g., piroxifen, amiodarone and steroids
- prednisone e.g., prednisone and hydrocortisone
- Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in the United States, and the estimated prevalence of NAFLD is 20-30% and for NASH it is estimated at 3.5-5%.
- NASH frequently presents with no overt symptoms, complicating its diagnosis.
- Liver function tests generally begin the diagnostic process, with levels of AST (aspartate
- ALT aminotransferase
- Other blood tests are often used for ruling out other causes of liver disease, such as hepatitis.
- Imaging tests ⁇ e.g., ultrasound, CT scan, or MRI
- a liver biopsy is required to confirm NASH.
- NASH ursodeoxycholic acid
- Other agents being evaluated, currently approved for different indications, include losartan and telisartan, exenatide, GLP-1 agonists, DPP IV inhibitors, and carbamazepine.
- Bile acid replacement is used in inborn errors of bile acid biosynthesis, usually with a mixture of chenodeoxycholic Acid (CDCA) or Ursodeoxycholic Acid (UDCA) and cholic acid, to suppress the synthesis of cytotoxic bile acid precursors and restore the input of primary bile acids into the enterohepatic circulation.
- CDCA chenodeoxycholic Acid
- UDCA Ursodeoxycholic Acid
- combination therapy with numerous additional agents is also contemplated, including, but not limited to, 1) insulin e.g., bolus and basal analogs), insulin mimetics and agents that entail stimulation of insulin secretion, including sulfonylureas (e.g., chlorpropamide, tolazamide, acetohexamide, tolbutamide, glyburide, glimepiride, glipizide) and meglitinides (e.g., repaglinide (PRANDIN) and nateglinide (STARLIX)); 2) biguanides (e.g., metformin (GLUCOPHAGE)) and other agents that act by promoting glucose utilization, reducing hepatic glucose production and/or diminishing intestinal glucose output; 3) alpha-glucosidase inhibitors (e.g., acarbose and miglitol) and other agents that slow down
- sulfonylureas e.g., chlorpropamide,
- rosiglitazone AVANDIA
- troglitazone REZULIN
- pioglitazone ACTOS
- glipizide balaglitazone
- rivoglitazone netoglitazone
- troglitazone englitazone
- ciglitazone adaglitazone
- darglitazone that enhance insulin action (e.g., by insulin sensitization), thus promoting glucose utilization in peripheral tissues;
- DPP-4 dipeptidyl peptidase-4
- bromocriptine formulations e.g. and bile acid sequestrants (e.g., colesevelam)
- SGLT-2 inhibitors e.g., glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, glycerol, g., g., bile acid sequestrants (e.g., colesevelam), and SGLT-2 inhibitors.
- Appetite suppression drugs are also well known and can be used in combination with the compositions and methods provided herein.
- Supplementary therapies can be administered prior to, contemporaneously with or following methods and uses provided herein.
- Peptide sequences provided herein including subsequences, sequence variants and modified forms of the exemplified peptide sequences (e.g., sequences listed in the Sequence Listing or Table 1), may be formulated in a unit dose or unit dosage form.
- a peptide sequence is in an amount effective to treat a subject in need of treatment, e.g., due to abnormal or aberrant bile acid homeostasis, such as metabolic syndrome; a lipid- or glucose-related disorder; cholesterol or triglyceride metabolism; type 2 diabetes; cholestasis, including, for example diseases of intrahepatic cholestasis (e.g., PBC, PFIC, PSC, PIC, neonatal cholestasis, and drug induced cholestasis (e.g., estrogen)), and diseases of extrahepatic cholestasis (e.g., bile cut compression from tumor, bile duct blockade by gall stones); bile acid malabsorption and other disorders involving the distal small intestine, including ileal resection, inflammatory bowel diseases (e.g., Crohn's disease and ulcerative colitis), disorders impairing absorption of bile acids not otherwise characterized (
- Exemplary unit doses range from about 25-250, 250-500, 500-1000, 1000-2500 or 2500-5000, 5000-25,000, 25,000-50,000 ng; from about 25-250, 250-500, 500- 1000, 1000-2500 or 2500-5000, 5000-25,000, 25,000-50,000 ⁇ g; and from about 25-250, 250- 500, 500-1000, 1000-2500 or 2500-5000, 5000-25,000, 25,000-50,000 mg.
- Peptide sequences provided herein including subsequences, sequence variants and modified forms of the exemplified peptide sequences can be administered to provide the intended effect as a single dose or multiple dosages, for example, in an effective or sufficient amount.
- Exemplary doses range from about 25-250, 250-500, 500-1000, 1000-2500 or 2500-5000, 5000-25,000, 25,000-50,000 pg/kg; from about 50-500, 500-5000, 5000-25,000 or 25,000-50,000 ng/kg; and from about 25-250, 250-500, 500-1000, 1000-2500 or 2500-5000, 5000-25,000, 25,000-50,000 ⁇ g/kg.
- Single or multiple doses can be administered, for example, multiple times per day, on consecutive days, alternating days, weekly or intermittently (e.g., twice per week, once every 1, 2, 3, 4, 5, 6, 7 or 8 weeks, or once every 2, 3, 4, 5 or 6 months).
- Peptide sequences provided herein including subsequences, variants and modified forms of the exemplified peptide sequences can be administered and methods may be practiced via systemic, regional or local administration, by any route.
- a peptide sequence can be administered parenterally (e.g., subcutaneously, intravenously, intramuscularly, or intraperitoneally), orally (e.g., ingestion, buccal, or sublingual), inhalation, intradermally, intracavity, intracranially, transdermally
- compositions can be administered via a (micro)encapsulated delivery system or packaged into an implant for administration.
- a particular non-limiting example of parenteral (e.g., subcutaneous) administration entails the use of Intarcia's subcutaneous delivery system (Intarcia Therapeutics, Inc.; Hayward, CA).
- the system comprises a miniature osmotic pump that delivers a consistent amount of a therapeutic agent over a desired period of time.
- the system can be used with formulations that maintain the stability of proteinaceous therapeutic agents at human body temperature for extended periods of time.
- compositions which include a peptide sequence (or sequences) provided herein, including subsequences, variants and modified forms of the exemplified peptide sequences (e.g., sequences listed in the Sequence Listing or Table 1), and one or more pharmaceutically acceptable or physiologically acceptable diluents, carriers or excipients; in combination with, or separate from, one or more additional agents for the treatment of a bile acid-related disease, disorder or condition, or a composition comprising such one or more additional agents and one or more pharmaceutically acceptable or physiologically acceptable diluents, carriers or excipients.
- a peptide sequence or sequences and an additional agent(s) are present in a therapeutically acceptable amount.
- the pharmaceutical compositions may be used in accordance with the methods and uses provided herein.
- the pharmaceutical compositions can be administered ex vivo or in vivo to a subject in order to practice treatment methods and uses provided herein.
- compositions provided herein can be formulated to be compatible with the intended method or route of administration; exemplary routes of administration are set forth herein.
- compositions may further comprise other therapeutically active agents or compounds disclosed herein (e.g. , bile acid stabilizing agents or drugs) or known to the skilled artisan which can be used in the treatment or prevention of various bile acid diseases and disorders as set forth herein.
- other therapeutically active agents or compounds disclosed herein e.g. , bile acid stabilizing agents or drugs
- known to the skilled artisan which can be used in the treatment or prevention of various bile acid diseases and disorders as set forth herein.
- therapeutically active agents or compounds may be present in a separate pharmaceutical composition(s). Exemplary dosing parameters and regimens are described herein.
- compositions typically comprise a therapeutically effective amount of at least one of the peptide sequences provided herein, including subsequences, variants and modified forms of the exemplified peptide sequences (e.g., sequences listed in the Sequence Listing or Table 1) and/or one or more additional agents described herein, and one or more pharmaceutically and physiologically acceptable formulation agents.
- Suitable pharmaceutically acceptable or physiologically acceptable diluents, carriers or excipients include, but are not limited to, antioxidants (e.g., ascorbic acid and sodium bisulfate), preservatives (e.g., benzyl alcohol, methyl parabens, ethyl or n-propyl, p-hydroxybenzoate), emulsifying agents, suspending agents, dispersing agents, solvents, fillers, bulking agents, buffers, vehicles, diluents, and/or adjuvants.
- a suitable vehicle may be physiological saline solution or citrate buffered saline, possibly supplemented with other materials common in pharmaceutical compositions for parenteral administration.
- Neutral buffered saline or saline mixed with serum albumin are further exemplary vehicles.
- Typical buffers include, but are not limited to pharmaceutically acceptable weak acids, weak bases, or mixtures thereof.
- Buffer components also include water soluble materials such as phosphoric acid, tartaric acids, lactic acid, succinic acid, citric acid, acetic acid, ascorbic acid, aspartic acid, glutamic acid, and salts thereof.
- a primary solvent in a vehicle may be either aqueous or non-aqueous in nature.
- the vehicle may contain other pharmaceutically acceptable excipients for modifying or maintaining the pH, osmolarity, viscosity, sterility or stability of the pharmaceutical
- the pharmaceutically acceptable vehicle is an aqueous buffer.
- a vehicle comprises, for example, sodium chloride and/or sodium citrate.
- compositions provided herein may contain still other
- composition agents for modifying or maintaining the rate of release of a peptide and/or an additional agent, as described herein.
- formulation agents include those substances known to artisans skilled in preparing sustained-release formulations.
- pharmaceutically and physiologically acceptable formulation agents see, for example, Remington's Pharmaceutical Sciences, 18th Ed. (1990, Mack
- a pharmaceutical composition may be stored in a sterile vial as a solution, suspension, gel, emulsion, solid, or dehydrated or lyophilized powder. Such compositions may be stored either in a ready to use form, a lyophilized form requiring reconstitution prior to use, a liquid form requiring dilution prior to use, or other acceptable form.
- a pharmaceutical composition is provided in a single-use container (e.g. , a single-use vial, ampoule, syringe, or autoinjector (similar to, e.g., an EpiPen®)), whereas a multi-use container (e.g., a multi-use vial) is provided in other embodiments.
- Any drug delivery apparatus may be used to deliver peptides and the other agents described herein, including implants (e.g., implantable pumps) and catheter systems, both of which are known to the skilled artisan.
- Depot injections which are generally administered subcutaneously or intramuscularly, may also be utilized to release peptides and/or other agents described herein over a defined period of time. Depot injections are usually either solid- or oil-based and generally comprise at least one of the formulation components set forth herein. The skilled artisan is familiar with possible formulations and uses of depot injections.
- a pharmaceutical composition can be formulated to be compatible with its intended route of administration.
- pharmaceutical compositions include carriers, diluents, or excipients suitable for administration by routes including parenteral (e.g., subcutaneous (s.c), intravenous, intramuscular, or intraperitoneal), intradermal, oral (e.g., ingestion), inhalation, intracavity, intracranial, and transdermal (topical).
- parenteral e.g., subcutaneous (s.c), intravenous, intramuscular, or intraperitoneal
- intradermal e.g., oral (e.g., ingestion), inhalation, intracavity, intracranial, and transdermal (topical).
- compositions may be in the form of a sterile injectable aqueous or oleagenous suspension.
- This suspension may be formulated using suitable dispersing or wetting agents and suspending agents disclosed herein or known to the skilled artisan.
- the sterile injectable preparation may also be a sterile injectable solution or suspension in a non-toxic parenterally-acceptable diluent or solvent, for example, as a solution in 1 ,3-butane diol.
- Acceptable diluents, solvents and dispersion media include water, Ringer's solution, isotonic sodium chloride solution, Cremophor ELTM (BASF, Parsippany, NJ) or phosphate buffered saline (PBS), ethanol, polyol (e.g., glycerol, propylene glycol, and liquid polyethylene glycol), and suitable mixtures thereof.
- sterile, fixed oils are conventionally employed as a solvent or suspending medium.
- any bland fixed oil may be employed, including synthetic mono- or diglycerides.
- fatty acids such as oleic acid find use in the preparation of injectables. Prolonged absorption of particular injectable formulations can be achieved by including an agent that delays absorption (e.g., aluminum monostearate or gelatin).
- compositions may be in a form suitable for oral use, for example, as tablets, capsules, troches, lozenges, aqueous or oily suspensions, dispersible powders or granules, emulsions, hard or soft capsules, or syrups, solutions, microbeads or elixirs.
- compositions intended for oral use may be prepared according to any method known to the art for the manufacture of pharmaceutical compositions.
- Such compositions may contain one or more agents such as sweetening agents, flavoring agents, coloring agents and preserving agents in order to provide pharmaceutically elegant and palatable preparations.
- Tablets containing a peptide provided herein may be in admixture with non-toxic
- excipients suitable for the manufacture of tablets.
- excipients include, for example, diluents, such as calcium carbonate, sodium carbonate, lactose, calcium phosphate or sodium phosphate; granulating and disintegrating agents, for example, corn starch, or alginic acid; binding agents, for example starch, gelatin or acacia, and lubricating agents, for example magnesium stearate, stearic acid or talc.
- Tablets, capsules and the like suitable for oral administration may be uncoated or they may be coated by known techniques to delay disintegration and absorption in the gastrointestinal tract and thereby provide a sustained action over a longer period.
- a time delay material such as glyceryl monostearate or glyceryl distearate may be employed. They may also be coated by techniques known in the art to form osmotic therapeutic tablets for controlled release.
- Additional agents include biodegradable or biocompatible particles or a polymeric substance such as polyesters, polyamine acids, hydrogel, polyvinyl pyrrolidone, polyanhydrides, polyglycolic acid, ethylene-vinylacetate, methylcellulose, carboxymethylcellulose, protamine sulfate, or lactide/glycolide copolymers, polylactide/glycolide copolymers, or
- the oral agent can be entrapped in microcapsules prepared by coacervation techniques or by interfacial polymerization, by the use of hydroxymethylcellulose or gelatin- microcapsules or poly (methylmethacrolate) microcapsules, respectively, or in a colloid drug delivery system.
- Colloidal dispersion systems include macromolecule complexes, nano- capsules, microspheres, microbeads, and lipid-based systems, including oil-in-water emulsions, micelles, mixed micelles, and liposomes. Methods of preparing liposomes are described in, for example, U.S. Patent Nos. 4,235,871, 4,501,728, and 4,837,028. Methods for the preparation of the above-mentioned formulations will be apparent to those skilled in the art.
- Formulations for oral use may also be presented as hard gelatin capsules wherein the active ingredient is mixed with an inert solid diluent, for example, calcium carbonate, calcium phosphate, kaolin or microcrystalline cellulose, or as soft gelatin capsules wherein the active ingredient is mixed with water or an oil medium, for example peanut oil, liquid paraffin, or olive oil.
- an inert solid diluent for example, calcium carbonate, calcium phosphate, kaolin or microcrystalline cellulose
- water or an oil medium for example peanut oil, liquid paraffin, or olive oil.
- Aqueous suspensions contain the active materials in admixture with excipients suitable for the manufacture thereof.
- excipients are suspending agents, for example sodium carboxymethylcellulose, methylcellulose, hydroxy-propylmethylcellulose, sodium alginate, polyvinyl-pyrrolidone, gum tragacanth and gum acacia; dispersing or wetting agents may be a naturally-occurring phosphatide, for example lecithin, or condensation products of an alkylene oxide with fatty acids, for example polyoxy-ethylene stearate, or condensation products of ethylene oxide with long chain aliphatic alcohols, for example heptadecaethyleneoxycetanol, or condensation products of ethylene oxide with partial esters derived from fatty acids and a hexitol such as polyoxyethylene sorbitol monooleate, or condensation products of ethylene oxide with partial esters derived from fatty acids and hexitol anhydrides, for example polyethylene sorbitan monooleate.
- Oily suspensions may be formulated by suspending the active ingredient in a vegetable oil, for example arachis oil, olive oil, sesame oil or coconut oil, or in a mineral oil such as liquid paraffin.
- the oily suspensions may contain a thickening agent, for example beeswax, hard paraffin or cetyl alcohol. Sweetening agents such as those set forth above, and flavoring agents may be added to provide a palatable oral preparation.
- Dispersible powders and granules suitable for preparation of an aqueous suspension by addition of water provide the active ingredient in admixture with a dispersing or wetting agent, suspending agent and one
- compositions provided herein may also be in the form of oil-in-water emulsions.
- the oily phase may be a vegetable oil, for example olive oil or arachis oil, or a mineral oil, for example, liquid paraffin, or mixtures of these.
- Suitable emulsifying agents may be naturally-occurring gums, for example, gum acacia or gum tragacanth; naturally-occurring phosphatides, for example, soy bean, lecithin, and esters or partial esters derived from fatty acids; hexitol anhydrides, for example, sorbitan monooleate; and condensation products of partial esters with ethylene oxide, for example, polyoxyethylene sorbitan monooleate.
- compositions can also include carriers to protect the composition against rapid degradation or elimination from the body, such as a controlled release formulation, including implants, liposomes, hydrogels, prodrugs and microencapsulated delivery systems.
- a time delay material such as glyceryl monostearate or glyceryl stearate alone, or in combination with a wax, may be employed.
- Prolonged absorption of injectable pharmaceutical compositions can be achieved by including an agent that delays absorption, for example, aluminum monostearate or gelatin.
- Prevention of the action of microorganisms can be achieved by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, and the like.
- peptides and/or one or more additional agents described herein in the form of suppositories for rectal administration can be prepared by mixing a peptide and/or one or more additional agents described herein with a suitable non- irritating excipient which is solid at ordinary temperatures but liquid at the rectal temperature and will therefore melt in the rectum to release the drug.
- suitable non- irritating excipient include, but are not limited to, cocoa butter and polyethylene glycols.
- a method includes: providing a candidate peptide sequence; administering the candidate peptide sequence to a test animal; measuring bile acid levels of the animal after administration of the candidate peptide sequence, to determine if the candidate peptide sequence favorably modulates bile acid homeostasis; and analyzing the candidate peptide sequence for induction of HCC in the animal, or expression of a marker correlating with HCC activity.
- a candidate peptide that modulates bile acid homeostasis but does not have substantial HCC activity thereby identifies a peptide sequence that modulates bile acid homeostasis without substantial HCC activity.
- bile acids and precursors such as 7 alpha- hydroxy-4-cholesten-3-one
- a sample e.g., serum
- Another non-limiting examples is a two reaction method (Randox Laboratories, Ltd.) using serum or heparinized plasma.
- bile acids are oxidized by 3-a-hydroxysteroid dehydrogenase with the subsequent reduction of Thio-NAD to Thio-NADH.
- oxidized bile acids are reduced by the same enzyme with the subsequent oxidation of NADH to NAD.
- the rate of formation of Thio-NADH is determined by measuring the specific absorbance change at 405 nm.
- Indicators for HCC include detection of a tumor maker such as elevated alpha-fetoprotein (AFP) or des-gamma carboxyprothrombin (DCP) levels.
- AFP alpha-fetoprotein
- DCP des-gamma carboxyprothrombin
- a number of different scanning and imaging techniques are also helpful, including ultrasound, CT scans and MRI.
- evaluation of whether a peptide (e.g., a candidate peptide) exhibits evidence of inducing HCC may be determined in vivo by, for example, quantifying HCC nodule formation in an animal model, such as db/db mice, administered a peptide, compared to HCC nodule formation by wild type FGF19.
- liver cancer may be nodular, where the tumor nodules (which are round-to-oval, grey or green, well circumscribed but not encapsulated) appear as either one large mass or multiple smaller masses.
- HCC may be present as an infiltrative tumor which is diffuse and poorly circumscribed and frequently infiltrates the portal veins.
- Methods provided herein may further include assessing a hepatic tissue sample from an in vivo animal model (e.g., a db/db mouse) useful in HCC studies in order to determine whether a peptide sequence exhibits evidence of inducing HCC.
- an in vivo animal model e.g., a db/db mouse
- a pathologist can determine whether one of the four general architectural and cytological types (patterns) of HCC are present (i.e., fibrolamellar, pseudoglandular (adenoid), pleomorphic (giant cell) and clear cell).
- the techniques, assays and the like described in this section are applicable to identifying an additional agent described herein having desired properties and/or characteristics. Moreover, the techniques, assays and the like described in this section are applicable to identifying a peptide in combination with an additional agent described herein, for example, a composition comprising a peptide in combination with an additional agent described herein that has at least one favorable characteristic; or a treatment regimen comprising a peptide provided herein in combination with an additional agent described herein that has at least one favorable characteristic.
- antibodies As used herein, the terms “antibodies” (Abs) and “immunoglobulins” (Igs) refer to glycoproteins having the same structural characteristics. While antibodies exhibit binding specificity to an antigen, immunoglobulins include both antibodies and other antibody-like molecules which may lack antigen specificity.
- antibody includes intact monoclonal antibodies, polyclonal antibodies, multispecific antibodies (e.g., bispecific antibodies) formed from at least two intact antibodies, and antibody binding fragments including Fab and F(ab)' 2 , provided that they exhibit the desired biological activity.
- the basic antibody structural unit comprises a tetramer, and each tetramer is composed of two identical pairs of polypeptide chains, each pair having one "light” chain (about 25 kDa) and one "heavy” chain (about 50-70 kDa).
- the amino-terminal portion of each chain includes a variable region of about 100 to 110 or more amino acids primarily responsible for antigen recognition.
- each chain defines a constant region primarily responsible for effector function.
- Human light chains are classified as kappa and lambda light chains, whereas human heavy chains are classified as mu, delta, gamma, alpha, or epsilon, and define the antibody's isotype as IgM, IgD, IgA, and IgE, respectively.
- Binding fragments are produced by recombinant DNA techniques, or by enzymatic or chemical cleavage of intact antibodies. Binding fragments include Fab, Fab', F(ab') 2 , Fv, and single-chain antibodies.
- Each heavy chain has at one end a variable domain (VH) followed by a number of constant domains.
- Each light chain has a variable domain at one end (VL) and a constant domain at its other end; the constant domain of the light chain is aligned with the first constant domain of the heavy chain, and the light chain variable domain is aligned with the variable domain of the heavy chain.
- the variable and constant regions are joined by a "J" region of about 12 or more amino acids, with the heavy chain also including a "D" region of about 10 more amino acids.
- the antibody chains all exhibit the same general structure of relatively conserved framework regions (FR) joined by three hyper- variable regions, also called complementarity-determining regions or CDRs.
- both light and heavy chains comprise the domains FR1, CDR1, FR2, CDR2, FR3, CDR3 and FR4.
- bispecific or bifunctional antibodies is an artificial hybrid antibody having two different heavy/light chain pairs and two different binding sites.
- Bispecific antibodies can be produced by a variety of methods including fusion of hybridomas or linking of Fab' fragments.
- the term "monoclonal antibody” refers to an antibody obtained from a population of substantially homogeneous antibodies, that is, the individual antibodies comprising the population are identical except for possible naturally occurring mutations that may be present in minor amounts. Monoclonal antibodies are highly specific, being directed against a single antigenic site. In contrast to polyclonal antibody preparations which include different antibodies directed against different determinants (epitopes), each monoclonal antibody is directed against a single determinant on the antigen.
- a “neutralizing antibody” is an antibody molecule that is able to eliminate or significantly reduce an effector function of a target antigen to which it binds.
- Antibody binding fragments may be produced by enzymatic or chemical cleavage of intact antibodies. Digestion of antibodies with the enzyme papain results in two identical antigen-binding fragments, also known as "Fab" fragments, and an "Fc" fragment which has no antigen-binding activity. Digestion of antibodies with the enzyme pepsin results in a F(ab') 2 fragment in which the two arms of the antibody molecule remain linked and comprise two- antigen binding sites. The F(ab') 2 fragment has the ability to crosslink antigen.
- Fab refers to a fragment of an antibody that comprises the constant domain of the light chain and the CHI domain of the heavy chain.
- Fv when used herein refers to the minimum fragment of an antibody that retains both antigen-recognition and antigen-binding sites. In a two-chain Fv species, this region consists of a dimer of one heavy- chain and one light-chain variable domain in non-covalent association. In a single-chain Fv species, one heavy-chain and one light-chain variable domain can be covalently linked by a flexible peptide linker such that the light and heavy chains can associate in a "dimeric" structure analogous to that in a two-chain Fv species.
- variable domain interacts to define an antigen-binding site on the surface of the VH-VL dimer. While the six CDRs, collectively, confer antigen-binding specificity to the antibody, even a single variable domain (or half of an Fv comprising only three CDRs specific for an antigen) has the ability to recognize and bind antigen.
- CDRs complementarity determining regions
- hypervariable region refers to the amino acid residues of an antibody which are responsible for antigen-binding.
- the hypervariable region generally comprises amino acid residues from a “complementarity determining region” or “CDR” and/or those residues from a “hypervariable loop”.
- epitope refers to binding sites for antibodies on protein antigens.
- Epitopic determinants usually consist of chemically active surface groupings of molecules such as amino acids or sugar side chains, as well as specific three dimensional structural and charge characteristics.
- An antibody is said to bind an antigen when the dissociation constant is ⁇ 1 ⁇ , such as ⁇ 100 nM or ⁇ 10 nM.
- An increased equilibrium constant means that there is less affinity between the epitope and the antibody, whereas a decreased equilibrium constant means that there is a higher affinity between the epitope and the antibody.
- An antibody with a KD of "no more than” a certain amount means that the antibody will bind to the epitope with the given K D or more strongly.
- K D describes the binding characteristics of an epitope and an antibody
- potency describes the effectiveness of the antibody itself for a function of the antibody. There is not necessarily a correlation between an equilibrium constant and potency; thus, for example, a relatively low KD does not automatically mean a high potency.
- the term "selectively binds" in reference to an antibody does not mean that the antibody only binds to a single substance, but rather that the K D of the antibody to a first substance is less than the KD of the antibody to a second substance.
- An antibody that exclusively binds to an epitope only binds to that single epitope.
- antibodies that contain rodent (murine or rat) variable and/or constant regions are sometimes associated with, for example, rapid clearance from the body or the generation of an immune response by the body against the antibody.
- rodent-derived antibodies In order to avoid the utilization of rodent-derived antibodies, fully human antibodies can be generated through the introduction of human antibody function into a rodent so that the rodent produces fully human antibodies.
- human and “fully human” antibodies can be used interchangeably herein. The term “fully human” can be useful when distinguishing antibodies that are only partially human from those that are completely, or fully human. The skilled artisan is aware of various methods of generating fully human antibodies.
- Chimeric or otherwise humanized antibodies can be utilized. Chimeric antibodies have a human constant region and a murine variable region, and, as such, human anti-chimeric antibody responses may be observed in some patients. Therefore, it is advantageous to provide fully human antibodies against multimeric enzymes in order to avoid possible human anti-mouse antibody or human anti-chimeric antibody responses.
- Fully human monoclonal antibodies can be prepared, for example, by the generation of hybridoma cell lines by techniques known to the skilled artisan. Other preparation methods involve the use of sequences encoding particular antibodies for transformation of a suitable mammalian host cell, such as a CHO cell. Transformation can be by any known method for introducing polynucleotides into a host cell, including, for example, packaging the
- polynucleotide in a virus or into a viral vector
- transducing a host cell with the virus (or vector) or by transfection procedures known in the art Methods for introducing heterologous polynucleotides into mammalian cells are well known in the art and include dextran-mediated transfection, calcium phosphate precipitation, polybrene -mediated transfection, protoplast fusion, electroporation, encapsulation of the polynucleotide(s) in liposomes, and direct microinjection of the DNA into nuclei.
- Mammalian cell lines available as hosts for expression are well known in the art and include, but are not limited to CHO cells, HeLa cells, and human hepatocellular carcinoma cells.
- Antibodies can be used diagnostically and/or therapeutically.
- the antibodies can be used as a diagnostic by detecting the level of one or more peptides provided herein in a subject, and either comparing the detected level to standard control level or to a baseline level in a subject determined previously (e.g., prior to any illness).
- the antibodies can be used as a therapeutic to modulate the activity of one or more peptides provided herein and/or one or more additional agents described herein, thereby having an effect on a condition or disorder.
- kits including, but not limited to, peptide sequences provided herein and/or one or more additional agents for the treatment of a bile acid-related disease, disorder or condition, or a composition comprising the foregoing, and one or more pharmaceutically acceptable or physiologically acceptable diluents, carriers or excipients, optionally in further combination with one or more therapeutic agents distinct from those described above, compositions and pharmaceutical compositions thereof, packaged into suitable packaging material.
- a kit may include a label or packaging insert including a description of the components or instructions for use in vitro, in vivo, or ex vivo, of the components therein.
- Exemplary instructions include instructions for treatment and/or prevention of a bile acid related or associated disorder, such as cholestasis, including, for example diseases of intrahepatic cholestasis ⁇ e.g., PBC, PFIC, PSC, PIC, neonatal cholestasis, and drug induced cholestasis ⁇ e.g., estrogen)), and diseases of extrahepatic cholestasis ⁇ e.g., bile cut compression from tumor, bile duct blockade by gall stones); bile acid malabsorption and other disorders involving the distal small intestine, including ileal resection, inflammatory bowel diseases ⁇ e.g., Crohn's disease and ulcerative colitis), disorders impairing absorption of bile acids not otherwise characterized (idiopathic)) leading to diarrhea ⁇ e.g., BAD) and GI symptoms, and GI, liver, and/or biliary cancers ⁇ e.g., colon cancer and
- packaging material refers to a physical structure housing the components of the kit.
- the packaging material can maintain the components sterilely, and can be made of material commonly used for such purposes ⁇ e.g., paper, corrugated fiber, glass, plastic, foil, ampules, vials, tubes, etc.).
- Kits provided herein can include labels or inserts.
- Labels or inserts include "printed matter," e.g., paper or cardboard, separate or affixed to a component, a kit or packing material ⁇ e.g., a box), or attached to, for example, an ampule, tube or vial containing a kit component.
- Labels or inserts can additionally include a computer readable medium, such as a disk ⁇ e.g., hard disk, card, memory disk), optical disk such as CD- or DVD-ROM/RAM, DVD, MP3, magnetic tape, or an electrical storage media such as RAM and ROM or hybrids of these such as magnetic/optical storage media, FLASH media or memory type cards.
- Labels or inserts can include, among other things, identifying information of one or more components therein, dosing parameters, and/or information on the clinical pharmacology of the active ingredient(s), including mechanism of action, pharmacokinetics and
- Labels or inserts can include information identifying manufacturer information, lot numbers, manufacturer location and date.
- Labels or inserts can include information on a condition, disorder, disease or symptom for which a kit component may be used.
- Labels or inserts can include instructions for the clinician or for a subject for using one or more of the kit components in a method, treatment protocol or therapeutic regimen. Instructions can include dosage amounts, frequency or duration, and instructions for practicing any of the methods, treatment protocols or therapeutic regimens set forth herein. Exemplary instructions include instructions for treatment or use of a peptide sequence as set forth herein and/or the use of an additional agent or treatment modality useful in treating a bile acid-related or associated disorder or a disorder of bile acid homeostasis. Kits provided herein therefore can additionally include labels or instructions for practicing any of the methods and uses provided herein, including treatment methods and uses.
- Labels or inserts can include information on any benefit that a component may provide, such as a prophylactic or therapeutic benefit. Labels or inserts can include information on potential adverse side effects, such as warnings to the subject or clinician regarding situations where it would not be appropriate to use a particular composition. Adverse effects could also occur when the subject has, will be, or is currently taking one or more other medications that may be incompatible with the composition, or the subject has, will be, or is currently undergoing another treatment protocol or therapeutic regimen which would be incompatible with the composition and, therefore, instructions could include information regarding such
- Kits provided herein can additionally include other components. Each component of the kit can be enclosed within an individual container and all of the various containers can be within a single package. In certain embodiments, kits are designed for cold storage. Kits provided herein can further be designed to contain peptide sequences provided herein, or that contain nucleic acids encoding peptide sequences. Kits provided herein can also be designed to contain, either separately or in combination with the peptide sequences provided herein, one or more additional agents useful in the treatment or prevention of a bile acid-related disease or disorder. Any cells in the kit can be maintained under appropriate storage conditions until ready to use.
- reference to a range of 90-100% includes 91-99%, 92-98%, 93-95%, 91-98%, 91-97%, 91-96%, 91-95%, 91- 94%, 91-93%, and so forth.
- Reference to a range of 90-100% also includes 91%, 92%, 93%, 94%, 95%, 96%, 97%, etc., as well as 91.1%, 91.2%, 91.3%, 91.4%, 91.5%, etc., 92.1%, 92.2%, 92.3%, 92.4%, 92.5%, etc., and so forth.
- reference to a range of 25-250, 250-500, 500- 1000, 1000-2500, 2500-5000, 5000-25,000, or 5000-50,000 includes any numerical value or range within or encompassing such values, e.g., 25, 26, 27, 28, 29...250, 251, 252, 253,
- a series of ranges are disclosed throughout this document.
- the use of a series of ranges includes combinations of the upper and lower ranges to provide another range. This construction applies regardless of the breadth of the range and in all contexts throughout this patent document.
- reference to a series of ranges such as 5-10, 10-20, 20-30, 30-40, 40-50, 50-75, 75-100, 100-150, includes ranges such as 5-20, 5-30, 5-40, 5-50, 5-75, 5- 100, 5-150, and 10-30, 10-40, 10-50, 10-75, 10-100, 10-150, and 20-40, 20-50, 20-75, 20-100, 20-150, and so forth.
- the invention is generally disclosed herein using affirmative language to describe the numerous embodiments.
- the invention also specifically includes embodiments in which particular subject matter is excluded, in full or in part, such as substances or materials, method steps and conditions, protocols, procedures, assays or analysis.
- the invention is generally not expressed herein in terms of what the invention does not include, aspects that are not expressly included in the invention are nevertheless disclosed herein.
- FACS fluorescence-activated cell sorting
- mice Animals. Mice can be purchased from The Jackson Laboratory (Bar Harbor, ME) and used in various models, assays and the like familiar to the skilled artisan. By way of example, db/db mice (The Jackson Laboratory) can be kept in accordance with welfare guidelines under controlled light (12 hr light and 12 hr dark cycle, dark 6:30 pm-6:30 am), temperature (22 ⁇ 4°C) and humidity (50% ⁇ 20%) conditions.
- mice can have free access to water (autoclaved distilled water) and can be fed ad libitum on a commercial diet (Harlan Laboratories, Indianapolis, IN, Irradiated 2018 Teklad Global 18% Protein Rodent Diet) containing 17 kcal% fat, 23 kcal% protein and 60 kcal% carbohydrate. All animal studies can be approved by the NGM Institutional Animal Care and Use Committee.
- FGF19 ORF can be amplified with polymerase chain reaction (PCR) using recombinant DNA (cDNA) prepared from human small intestinal tissue.
- PCR reagent kits with
- Phusion® high-fidelity DNA polymerase can be purchased from New England BioLabs (F-1)
- forward PCR primer 530L, Ipswich, MA.
- forward PCR primer 530L, Ipswich, MA.
- Amplified DNA fragment can be digested with restriction enzymes Spe I and Not I (the restriction sites are frequently not included in the 5 ' or 3 ' PCR primers, respectively) and then ligated with AAV transgene vectors that have been digested with the same restriction enzymes.
- the vector that can be used for expression can contain a selectable marker and an expression cassette comprising a strong eukaryotic promoter 5 ' of a site for insertion of the cloned coding sequence, followed by a 3 ' untranslated region and a bovine growth hormone polyadenylation tail.
- the expression construct can also be flanked by internal terminal repeats at the 5' and 3' ends.
- CYP7A1 Repression Assay in Primary Human Hepatocytes Primary human hepatocytes can be plated on collagen-coated plates (Becton Dickinson Biosciences) in Williams E media (Invitrogen) supplemented with 100 nM dexamethasone (Sigma) and 0.25 mg/ml MatriGelTM (Becton Dickinson Biosciences). Cells can be treated with FGF19 or variants at 37°C for 6 hours. CYP7A1 expression can be evaluated in triplicate by quantitative RT-PCR (TaqMan® ABI PRISM 7700, Applied Biosystems) and normalized to GAPDH expression.
- CYP7A1 In vivo Repression Assay Nine-week-old male db/db mice (Jackson Laboratories) can be injected intraperitoneally with recombinant proteins FGF19 or FGF21 at 0.1 mg/kg, 1 mg/kg, and 10 mg/kg. Animals can be euthanized 5 hours post-injection. Livers can be harvested and homogenized in TRIzol® reagent (Invitrogen). Total RNA can be extracted and treated with DNase (Ambion) followed by quantitative RT-PCR analysis and normalized to GAPDH expression.
- AAV293 cells (which can be obtained from Agilent Technologies, Santa Clara, CA) can be cultured in Dulbeco's Modification of Eagle's Medium (DMEM, Mediatech, Inc. Manassas, VA) supplemented with 10% fetal bovine serum and lx antibiotic-antimycotic solution (Mediatech, Inc. Manassas, VA).
- DMEM Dulbeco's Modification of Eagle's Medium
- fetal bovine serum fetal bovine serum
- lx antibiotic-antimycotic solution Mediatech, Inc. Manassas, VA
- the cells can be plated at 50% density on day 1 in 150 mm cell culture plates and can be transfected on day 2, using calcium phosphate precipitation method with the following 3 plasmids (20 ⁇ g/plate of each): AAV transgene plasmid, pHelperTM plasmids (Agilent Technologies) and AAV2/9 plasmid (Gao et ah, J. Virol. 78:6381 (2004)). Forty-eight (48) hours after transfection, the cells can be scraped off the plates, pelleted by centrifugation at 3000xg and resuspended in buffer containing 20 mM Tris pH 8.5, 100 mM NaCl and 1 mM MgCl 2 .
- the suspension can be frozen in an alcohol dry ice bath and then thawed in a 37°C water bath.
- the freeze and thaw cycles can be repeated three times; Benzonase® (Sigma-aldrich, St. Louis, MO) can be added to 50 units/ml; deoxycholate can be added to a final concentration of 0.25%.
- cell debris can be pelleted by centrifugation at 5000 x g for 20 min.
- Viral particles in the supernatant can be purified using a gradient comparable to discontinued iodixanal (Sigma- aldrich, St. Louis, MO) gradient as previously described (Zolotukhin S. et al (1999) Gene Ther.
- the viral stock can be concentrated using Vivaspin® 20 (MW cutoff 100,000 Dalton, Sartorius Stedim Biotech, Aubagne, France) and re-suspended in phosphate -buffered saline (PBS) with 10%) glycerol and stored at -80°C.
- PBS phosphate -buffered saline
- 2 ⁇ of viral stock can be incubated in 6 ⁇ of solution containing 50 units/ml Benzonase®, 50 mM Tris-HCl pH 7.5, 10 mM MgCl 2 and 10 mM CaCl 2 at 37°C for 30 minutes.
- Viral DNA can be cleaned with mini DNeasy® Kit (Qiagen, Valencia, CA) and eluted with 40 ⁇ of water.
- Viral genome copy (GC) can be determined by using quantitative PCR.
- Viral stock can be diluted with PBS to desirable GC/ml, and viral working solution (200 ⁇ ) can be delivered into mice via tail vein injection.
- HCC Assay Liver specimens can be harvested from db/db mice 24 weeks after AAV injection. HCC scores can be recorded as the number of HCC nodules on the surface of the entire liver from variants-injected mice divided by the number of HCC nodules from wild- type FGF19-injected mice.
- Serum FGF19/FGF21/V ariants Exposure Level Assay Whole blood (about 50 ⁇ /mouse) from mouse tail snips can be collected into plain capillary tubes (BD Clay Adams SurePrepTM, Becton Dickenson and Co. Sparks, MD). Serum and blood cells can be separated by spinning the tubes in an AutocritTM Ultra 3 (Becton Dickinson and Co. Sparks, MD). FGF19, FGF21, and variant exposure levels in serum can be determined using EIA kits (Biovendor) by following the manufacturer's instructions.
- FGFR4 Binding and Activity Assays Solid phase ELISA (binding) and ERK phosphorylation assay can be performed using purified recombinant proteins.
- FGFR binding assay can be conducted using solid phase ELISA. Briefly, a 96-well plate can be coated with 2 ⁇ g/ml anti-hFc antibody and can be incubated with 1 ⁇ g/ml FGFRl-hFc or FGFR4-hFc.
- Binding to FGF19 variants in the presence of 1 ⁇ g/ ml soluble ⁇ -klotho and 20 ⁇ g/ml heparin can be detected by biotinylated anti- FGF19 antibodies (0.2 ⁇ g/mL), followed by streptavidin- HRP incubation (100 ng/mL).
- biotinylated anti- FGF19 antibodies 0.2 ⁇ g/mL
- streptavidin- HRP incubation 100 ng/mL
- Hep3B cells can be stimulated with FGF19 variants for 10 minutes at 37°C, then can be immediately lysed and assayed for ERK phosphorylation using a commercially available kit from Cis-Bio.
- Example 1 Through assessment of wild-type FGF 19 and FGF21, this example illustrates how the peptides (e.g. , M70) provided herein can be evaluated for inhibition of CYP7A1 expression.
- peptides e.g. , M70
- mice can be dosed intraperitoneally with either recombinant FGF 19 (0.1 mg/kg; 1 mg/kg; 10 mg/kg) or recombinant FGF21 (0.1 mg/kg; 1 mg/kg; 10 mg/kg).
- FGF 19 0.1 mg/kg; 1 mg/kg; 10 mg/kg
- FGF21 0.1 mg/kg; 1 mg/kg; 10 mg/kg
- livers can be harvested, RNA extracted, and CYP7A1 expression determined by real-time PCR (QPCR) using GADPH as a normalization control.
- QPCR real-time PCR
- CYP7A1 expression values for the various FGF 19 and FGF21 concentrations can be compared to mice dosed with PBS vehicle control.
- Example 2 Using the assays described above (e.g., in vitro cell-based assay
- Invention Peptides that retain Cyp7al repression activity can be further evaluated in the HCC assay (or other relevant assay or model) described above to identify variants that can be useful for modulating bile acid metabolism and/or for treating bile acid-related diseases (e.g., PBC, NASH, and bile acid diarrhea) without causing induction of HCC.
- HCC assay or other relevant assay or model
- Example 3 Invention Peptides can be analyzed for lipid elevating activity and tumorigenesis using the above-described methods or any methods familiar to the skilled artisan. If a positive correlation is observed between lipid elevation and tumorigenesis, as determined by HCC formation in db/db mice, lipid elevating activity can be used as an indicator and/or predictor of HCC formation in animals.
- Example 4 The teachings of this example can be used to determine whether administration of Invention Peptides to human patients can result in suppression of 7a-hydroxy- 4-cholsten-3-one (C4), a marker of bile acid synthesis.
- C4 7a-hydroxy- 4-cholsten-3-one
- Study Subjects Healthy adults in the age range 18-65 years and with normal body weight (body mass index, BMI 20-35) can be enrolled in the study.
- the study protocol can be approved by the Human Research Ethics Committee in Australia, and written informed consent can be obtained from each subject.
- each subject can be required to be in good health as determined by no clinically significant findings from medical history, physical exam, 12-lead ECG, clinical laboratory findings, and vital signs at screening.
- Subjects with a history or clinical manifestation of any significant metabolic, allergic, dermatological, hepatic, renal, hematological, pulmonary, cardiovascular, GI, neurological, or psychiatric disorder can be excluded from enrollment.
- Study Design The study can be a randomized, double-blind, placebo-controlled design. Prescreening of subjects can be performed 7-30 days prior to entry, and baseline evaluations can be performed before treatment. Each subject can be given a SC injection of 3 mg/day in a single bolus dose daily for 7 days of one or more Invention Peptides. Blood samples can be collected into heparinized tubes through an indwelling catheter. Blood samples taken on Day 1 and Day 7 at 4.5 hrs or 24 hrs after administration of one or more Invention Peptides or placebo can be analyzed. Serum levels of 7a-hydroxy-4-cholesten-3-one (C4) can be used to monitor CYP7A1 enzymatic activity (bile acid synthesis). They can be analyzed from individual serum samples after sample extraction followed by high-pressure liquid chromatography (HPLC) as described previously (Galman et al. (2003) J Lipid Res. 2003; 44(4):859-66).
- HPLC high-pressure liquid chromatography
- Example 5 The previously described assays for FGFR4 binding and activity can be used to assess whether Invention Peptides show activation of mouse FGFR4- -klotho signaling in a rat myoblast cell line
- ELK luciferase assay can be performed in L6 cells transiently transfected with mouse FGFR4, b-klotho, and reporter constructs containing 5xUAS luciferase and GAL4-DNA-binding domain (DBD) fused to ELK1.
- DBD GAL4-DNA-binding domain
- luciferase activity is regulated by the endogenous phosphorylated extracellular signal-regulated kinase (ERK).
- ERK extracellular signal-regulated kinase
- a cell-based receptor activation assay can be used to evaluate the ability of mouse FGFR4 to mediate ligand-dependent signaling in the presence of ⁇ -klotho.
- a rat L6 myoblast cell line which lacks endogenous expression of these proteins, can be transfected with DNAs encoding FGFR4 and ⁇ -klotho from mouse, as well as plasmids containing an Elk 1 -dependent chimeric transcription factor-based reporter system.
- concentration response of ligand-dependent luciferase expression can be analyzed in whole-cell lysates in the presence of luciferin substrate.
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Abstract
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| EP15810176.6A EP3155005A4 (en) | 2014-06-16 | 2015-06-15 | Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases |
| US15/316,108 US10456449B2 (en) | 2014-06-16 | 2015-06-15 | Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases |
| CA2951153A CA2951153A1 (en) | 2014-06-16 | 2015-06-15 | Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases |
| AU2015277438A AU2015277438B2 (en) | 2014-06-16 | 2015-06-15 | Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases |
| US16/600,139 US11241481B2 (en) | 2014-06-16 | 2019-10-11 | Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases |
| US17/562,732 US20220241373A1 (en) | 2014-06-16 | 2021-12-27 | Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases |
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| US16/600,139 Continuation US11241481B2 (en) | 2014-06-16 | 2019-10-11 | Methods and uses for modulating bile acid homeostasis and treatment of bile acid disorders and diseases |
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2015
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- 2015-06-15 EP EP15810176.6A patent/EP3155005A4/en not_active Withdrawn
- 2015-06-15 CA CA2951153A patent/CA2951153A1/en active Pending
- 2015-06-15 AU AU2015277438A patent/AU2015277438B2/en not_active Ceased
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2019
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2021
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| Publication number | Publication date |
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| US20170182123A1 (en) | 2017-06-29 |
| US11241481B2 (en) | 2022-02-08 |
| US20220241373A1 (en) | 2022-08-04 |
| CA2951153A1 (en) | 2015-12-23 |
| EP3155005A2 (en) | 2017-04-19 |
| US10456449B2 (en) | 2019-10-29 |
| EP3155005A4 (en) | 2018-07-11 |
| AU2015277438A1 (en) | 2016-12-22 |
| AU2015277438B2 (en) | 2020-02-27 |
| WO2015195509A3 (en) | 2016-02-11 |
| US20200197489A1 (en) | 2020-06-25 |
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