Factor viii-fc chimeric and hybrid polypeptides, and methods of use thereof.
Abstract
The present invention relates to the use of a long-acting Factor VIII (FVIII) polypeptide for the manufacture of a medicament for reducing the incidence of an episode of bleeding in a human subject in need thereof, wherein the medicament is adapted for Be administrable in multiple doses at a dosage interval of three days to seven days between two doses, wherein each of the multiple doses provides 25 IU / kg to 65 IU / kg of the long-acting FVIII polypeptide, wherein The long acting FVIII polypeptide is a FVIIIi dimer monomer hybrid comprising a portion of FVIII and two portions of Fc, wherein one of the portions of Fc is fused to the C-terminal end of the light chain of the FVIII portion .

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Expires 6 December 2030.
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31 claims: 8 independent, 23 dependent
- 1162 REIVINDICACIONES InSÍÍÍUÍO Mexicano Habiéndose descrito la invención como antecede^RjPPropÍetíad Industrial reclama como propiedad lo contenido en las siguientes reivindicaciones:1. Uso de un polipéptido del Factor VIII (FVIII) de acción prolongada para la elaboración de un medicamento para reducir la incidencia de un episodio de sangrado en un sujeto humano en necesidad del mismo, en donde el medicamento está adaptado para ser administrable en dosis múltiples a en un intervalo de dosificación de tres días a siete días entre dos dosis, en donde cada una de las dosis múltiples provee de 25 IU/kg a 65 IU/kg del polipéptido del FVIII de acción prolongada, en donde el polipéptido del FVIII de acción prolongada es un híbrido monómero dímero del FVIIIFc que comprende una porción del FVIII y dos porciones de Fe, en donde una de las porciones de Fe se fusiona al extremo Cterminal de la cadena ligera de la porción del FVIII.
- 2El uso de conformidad con la reivindicación 1, en donde el sujeto tiene hemofilia A.
- 3El uso de conformidad con la reivindicación 1, en donde la reducción de la incidencia de un episodio de sangrado es para la prevención o tratamiento de los episodios de sangrado. 163 Mexicano
- 4El uso de conformidad con la reivindicadífMo ftopledatí Industrial en donde el uso es para la profilaxis del episodio de sangrado o para profilaxis adaptada.
- 5El uso de conformidad con la reivindicación 1, en donde un nivel de concentración mínima de Factor VIII:C de i z plasma en el sujeto después de la administración del medicamento se mantiene por encima de 1 IU/dl.
- 6El uso de conformidad con la reivindicación 1, en donde cada una de las dosis es de 25 IU/kg, 30 IU/kg, 35 IU/kg, 40 IU/kg, 45 IU/kg, 50 IU/kg, 55 IU/kg, 60 IU/kg o 65 IU/kg.
- 7El uso de conformidad con la reivindicación 1, en donde el intervalo de dosificación es de tres días, cuatro días, cinco días, seis días o siete días.
- 8El uso de conformidad con la reivindicación 1, en donde el intervalo de dosificación es dos veces a la semana.
- 9El uso de conformidad con la reivindicación 1, en donde cada una de las dosis es de 65 IU/kg.
- 10El uso de conformidad con la reivindicación 9, en donde el intervalo de dosificación es de cuatro días.
- 11El uso de conformidad con la reivindicación 1, en donde el medicamento está adaptado para ser administrable dos veces por semana, en una primera dosis terapéutica de 25 IU/kg a 65 IU/kg del polipéptido del FVIII de acción 164 prolongada y una segunda dosis terapéutica de 25 iu/kg d· id Propiedad Industrial IU/kg del polipéptido del FVIII de acción prolongada.
- 12El uso de conformidad con la reivindicación 11, en donde el intervalo de dosificación entre la primera dosis y la segunda dosis es de tres días a cinco días.
- 13El uso de conformidad con la reivindicación 1, en donde el medicamento resuelve más de 5-20%, más que 5-15%, más que 5-10%, más que 10-20% o más que 10-15% de episodios de sangrado.
- 14El uso de conformidad con la reivindicación 1, en donde el polipéptido del FVIII de acción prolongada es el Factor VIII pegilado.
- 15El uso de conformidad con la reivindicación 1, en donde la porción del FVIII comprende el factor VIII de longitud completa, factor VIII maduro o el factor VIII con una supresión total o parcial del dominio B.
- 16El uso de conformidad con la reivindicación 1, la cual además exhibe una o más características seleccionadas de:(i) en donde una depuración media (CL) (actividad) en el sujeto es de 2.33 ± 1.08 mL/hora/kg o menos;(ii) en donde un tiempo medio de permanencia (MRT) (actividad) en el sujeto es de 1.5 veces mayor que el MRT de un polipéptido que consiste de 165 la porción de FVIII;(iii) en donde un Ti/ 2 (actividad) en el sujeto es de 1.5 veces mayor que el T1/2 medio (actividad) de un polipéptido que consiste de la porción de FVIII;(iv) en donde una recuperación media incremental (valor K) en el sujeto es de 90% de la recuperación incremental de un polipéptido que consiste de la porción de FVIII;(v) en donde un Vss medio (actividad) en el sujeto es de 37.7 a 79.4 mL/kg;(vi) en donde una AUC/dosis media (actividad) en el sujeto es de 19.2*h/dL por IU/kg a 81.7 IU*h/dL por IU/kg;y (vii) una combinación de los mismos.
- 17El uso de conformidad con la reivindicación 1, en donde cada una de las dosis es de 50 IU/kg a 65 IU/kg.
- 18El uso de conformidad con la reivindicación 11, en donde la primera dosis es de 50 IU/kg y la segunda dosis es de 50 IU/kg.
- 19El uso de conformidad con la reivindicación 18, en donde la segunda dosis del medicamento está adaptada para ser administrable tres días o cuatro días después de la primera dosis.
- 20El uso de conformidad con la reivindicación 11, 166 en donde la primera dosis es de 65 IU/kg y la segundtíeteB®^leclad Industriar es de 65 IU/kg.
- 21El uso de conformidad con la reivindicación 20, en donde la segunda dosis del medicamento está adaptada para ser administrable cinco días o una semana después de la administración de la primera dosis.
- 22El uso de conformidad con la reivindicación 19, en donde un nivel de concentración mínima del Factor VIII:C de plasma en el sujeto después de la administración del medicamento se mantiene por encima de 1 IU/dl.
- 23El uso de conformidad con la reivindicación 21, en donde un nivel de concentración mínima del Factor VIII:C de plasma en el sujeto después de la administración del medicamento se mantiene por encima de 1 IU/dl.
- 24Uso de un polipéptido del FVIII de acción prolongada para la elaboración de un medicamento para el tratamiento profiláctico de un episodio de sangrado espontáneo en un sujeto humano, en donde el medicamento está adaptado para ser administrable en dosis múltiples a un intervalo de dosificación de tres días a siete días entre dos dosis del polipéptido del FVIII de acción prolongada, en donde cada una de las dosis múltiples provee de 25 IU/kg a 65 IU/kg del polipéptido del FVIII de acción prolongada, y 167 Instituto Mexicano en donde el polipéptido del FVIII de aadé-fipPtOpledaci industrio* prolongada es un híbrido monómero dímero del FVIIIFc que comprende una porción del FVIII y dos porciones de Fe, en donde una de las porciones de Fe se fusiona al extremo Cterminal de la cadena ligera de la porción del FVIII.
- 25El uso de conformidad con la reivindicación 24, en donde la porción del FVIII comprende el factor VIII de longitud completa, factor VIII maduro o el factor VIII con una supresión total o parcial del dominio B.
- 26Uso de un polipéptido quimérico que comprende un híbrido monómero dímero del FVIIIFc para la elaboración de un medicamento para reducir la incidencia de un episodio de sangrado en un sujeto humano, en donde el medicamento está adaptado para ser administrabie en dosis múltiples a un intervalo de dosificación de aproximadamente tres a siete días entre dos dosis del polipéptido quimérico, en donde cada una de las dosis múltiples provee de 25 IU/kg a 65 lU/kg del polipéptido quimérico que comprende un híbrido monómero dímero del FVIIIFc, en donde el híbrido monómero dímero del FVIIIFc comprende una porción del FVIII y dos porciones de Fe, en donde una de las dos porciones de Fe se fusiona al extremo extermina! de la cadena ligera de la porción del FVIII, y en donde el medicamento provee una AUC/dosis en el 168 sujeto de 19.2 - 81.7 IU*h/kL por IU/kg, (CL) (actividad) en el sujeto de 1.22 , . „ „. Mexicano una depuración¿^^¿ledad - 5.19 mL/hora/kg JndUlMcrt ambos.
- 27El uso de conformidad con la reivindicación 1, en donde la porción del FVIII comprende una secuencia de aminoácidos al menos 95% idéntica a los aminoácidos 1 a 1438 de la SEQ ID NO:2.
- 28El uso de conformidad con la reivindicación 1, en donde la porción del FVIII comprende los aminoácidos 1 a 1438 de la SEQ ID NO:2.
- 29El uso de conformidad con la reivindicación 1, en donde el polipéptido del FVIII de acción prolongada comprende una secuencia de aminoácidos al menos 95% idéntica a los aminoácidos 1 a 1665 de la SEQ ID NO:2.
- 30El uso de conformidad con la reivindicación 1, en donde el polipéptido del FVIII de acción prolongada comprende los aminoácidos 1 a 1665 de la SEQ ID NO:2.
- 31El uso de conformidad con la reivindicación 24, en donde el híbrido monómero dímero comprende los aminoácidos 1 a 1665 de la SEQ ID NO:2 y los aminoácidos 1 a 227 de la SEQ ID NO: 4. 169 RBSUMEN DB IA INVENCIÓN La presente invención proporciona métodos para administrar el Factor VIII;métodos para administrar polipéptidos quiméricos e híbridos que comprenden el Factor VIII;polipéptidos quiméricos e híbridos que comprenden el Factor VIII;polinucleótidos que codifican tales polipéptidos quiméricos e híbridos;células que comprenden tales polipéptidos;y métodos para producir tales polipéptidos quiméricos e híbridos que usan tales células.
Independent claims31
1,363 paragraphs in 1,207 sections, as filed
i-.
HCiUlARJA DI. KXIWMIA
Institute
Mexican Property
Industrial
PATENT TITLE NO. 336830
Owner (s): BIOGEN IDEC HEMOPHILIA INC.
Address: 9 Fourth Avenue, Waltham, Massachusetts, 02451, USA
Name: HYBRID AND CHEMERIC POLYPEPTIDES OF FACTOR VIII-FC, AND METHODS OF USE OF THE SAME.
Classification:
Inventor (s):
Int.CI.8: A61K38 / 37; A61K47 / 48; A61P7 / 04; C07K14 / 755; C07K16 / 46
JENNIFER A. DUMONT; SUSAN LOW; ALAN J. BITONTI; GLENN PIERCE; ALVIN LUK; HAIYAN JIANG; BYRON MCKINNEY; MATT OTTMER; JURG SOMMER; «AREN NUGENT; LIAN Ll; ROBERT PETERS
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December 9, 2009 December 9, February 4, 20 July 9, November 20, December
61 / 267.070 61 / 285.0 <M 61/301,
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subscribe this to you: Twenty aftis
Vencindento Date:
The reference point is ot jaconfi
Informity with the articulate with da from the date of the presence lo hai: ial de I áón
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Legal property based on the provisions of articles 6 ° sections III and 7 ° bis 2 of the law, before those of the regret in the Property of the request in twenty years imi ¡raffle to keep valid ; and of the 15/1999,
01/26/2004, 06/16/2005, 01/25/2006, 05/06/2009, 06/01/2010, 06/18/2010, 06/28/2010, 01/27/2012 and 09 / 04/2012); Articles 1, 3, section V Subsection a), 4 "and 12" sections l and lll of the Regulations of the Mexican Institute of Industrial Property (DOF 12/14/1999, amended on 07/01/2002, 07/15/2004 , 07/28/2004 and 09/07/2007); Articles 1 ", 3 °, 4", 5 "section V subsection a), 16 sections I and III and 30 of the Organic Statute of the Mexican Institute of Industrial Property (DOF 12/27/1999, amended on 10/10/2002, 07/29/2004, 08/04/2004 and 09/13/2007); 1 “, 3 ° and 5 ° subsection a) of the Agreement that delegates powers to the Deputy General Directors, Coordinator, Divisional Directors, Heads of Regional Offices, Divisional Deputy Directors, Departmental Coordinators and other subordinates of the Mexican Institute of Industrial Property. (DOF 12/15/1999, amended on 02/04/2000, 07/29/2004, 08/04/2004 and 09/13/2007).
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Arenal No. 550, Floor 1,
Col. Pueblo Santa María Tepepan, Xochimílco Delegation,
CP 16020, Mexico City Tel, (55) 53 34 07 00 www.impi.gob.mx
Issue Date: February 3, 2016
DIVISIONAL DIRECTOR OF PATENTS n ·
NAHANNY CANAL REYES
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MX / 2016/8506
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336S3O /
CHEMERIC AND HYBRID POLYPEPTIDES OF FACTOR VIII-FC
METHODS OF USE OF THE SAME
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FIELD OF THE INVENTION
Mexican Property
Industrial
The present invention relates generally to the field of therapeutics for hemostatic disorders.
BACKGROUND OF THE INVENTION
Hemophilia A is an X-linked coagulation disorder caused by mutations and / or deletions in the Factor VIII (FVIII) gene resulting in a deficiency of FVIII activity (Peyvandi et al., 2006). The disease is characterized by spontaneous bleeding and excessive bleeding after trauma. Over time, repeated bleeding into the muscles and joints, which often begins in early childhood, results in hemophilic arthropathy and irreversible joint damage / This damage is progressive and can lead to severely limited joint mobility , muscular atrophy and chronic pain (Rodríguez-Merchán, EC, Semin. Thromb.
Hemost. 29: 87-96 (2003), which is incorporated herein by reference in its entirety).
The A2 domain is necessary for the procoagulant activity of the Factor VIII molecule. Studies show that porcine Factor VIII has a procoagulant activity six times greater than human Factor VIII Ref.:231092
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li stltuto icon
Bioi. jS & Industrial property
266: 12481-12486 (1991)), and that the difference in activity '(Lollar, P., and E.
Parker et al., Coagulant between human and porcine Factor VIII appears to be based on a difference in amino acid sequence between one or more residues in the human and porcine A2 domains (Lollar, P., et al., J. Biol. Chem. 267: 23652-23657 (1992)), which is incorporated herein by reference in its entirety.
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Treatment of hemophilia A is by replacement therapy aimed at restoring FVIII activity to 1 to 5% of normal levels to prevent spontaneous bleeding (Manucci, PM, et al., N. Engl. J. Med. 344: 1773-1779 (2001), which is incorporated herein by reference in its entirety). Recombinant and plasma-derived FVIII products are available to treat bleeding episodes on demand or to prevent bleeding episodes from occurring by prophylactic treatment. Based on the half-life of these products, treatment regimens require frequent intravenous administration. Such frequent administration is painful and uncomfortable.
The reduction in mortality, the prevention of joint damage, and the improvement in quality of life are important achievements due to the development of plasma-derived and recombinant FVIII. Prolonged protection from bleeding
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would represent another key advance in treating '<sup>n</sup>and ^<sup>or</sup>^°
Mexican patients with hemophilia A. However, to date, Industriar has developed products that allow prolonged protection. Therefore, there is a need for improved methods of treating hemophilia due to Factor VIII deficiency that are more tolerable and more effective than current therapies.
BRIEF DESCRIPTION OF THE INVENTION
The present invention provides methods of administration of Factor VIII; methods of administration of chimeric polypeptides comprising Factor VIII and hybrids of these chimeric polypeptides; chimeric polypeptides comprising Factor VIII and hybrids of these chimeric polypeptides; polynucleotides encoding such chimeric and hybrid polypeptides, cells comprising such polynucleotides; and methods for producing such chimeric and hybrid polypeptides by using cells.
The present invention provides a method of administering Factor VIII to a subject in need thereof, which comprises administering to the subject a therapeutic dose of a chimeric Factor VIII polypeptide, for example, a chimeric Factor VIII-Fc polypeptide, in a dosage range at least about one and a half times greater than the dosing interval required for a
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equivalent amount of Factor VIII without the non-Moxíccinc portion of the Project
Factor VIII (a polypeptide consisting of the IndUSIFLOT Factor VIII portion), for example, without the Fe portion.
The dosing range can be at least about one and a half to six times, one and a half to five times, one and a half to four times, one and a half to three times, or one and a half. at two times greater than the required dosage range for an equivalent amount of Factor VIII without the non-Factor VIII portion (a polypeptide consisting of the Factor VIII portion), eg, the Fe portion. The dosing interval can be at least about one and a half, two, two and a half, three, three and a half, four, four and a half, five, five and a half, or six times longer than the required dosing interval for a equivalent amount of Factor VIII without the non-Factor VIII portion (a polypeptide consisting of the Factor VIII portion), eg, the Fe portion. The dosage interval can be approximately every five, six, seven, eight, nine, ten, eleven, twelve, thirteen, or fourteen days or more.
The dosage range can be at least about one and a half to 5, one and a half, 2, 3, 4, or 5 days or more.
The present invention also provides a method of administering Factor VIII to a subject in need of the
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my ism, which includes administering a subject
Industry!
therapeutic use of a chimeric Factor VIII polypeptide, for example, a Factor VIII-Fc chimeric polypeptide, to obtain an area under the curve (AUC) of plasma concentration versus time of at least about one and a quarter times greater than the AUC that is obtained by an equivalent amount of Factor VIII without the non-Factor VIII portion (a polypeptide consisting of the Factor VIII portion), for example without the Fe portion.
The present invention also provides a method of administering Factor VIII to a subject in need thereof, which comprises administering to the subject a therapeutic dose of a polypeptide comprising a Factor VIII and an Fe in a dosage range of approximately every five, six, seven, eight, nine, ten, eleven, twelve, thirteen or fourteen days or more.
The methods of the invention can be practiced on a subject in need of prophylactic treatment or treatment on demand.
On-demand treatment includes treatment for a bleeding episode, hemarthrosis, muscle bleeding, oral bleeding, hemorrhage, muscle bleeding, oral bleeding, trauma, capitis trauma (head trauma), gastrointestinal bleeding, intracranial hemorrhage, intra-abdominal hemorrhage, intrathoracic hemorrhage, bone fracture, central nervous system bleeding
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Property of the retropharyngeal space, bleeding into the retroperitoneal IndUStrtat space, or bleeding into the illiopsoas sheath. The subject may need surgical prophylaxis, perisurgical interventions, or surgical treatment. Surgeries of this type include, for example, minor surgery, major surgery, tooth extraction, tonsillectomy, inguinal herniotomy, synovectomy, total knee replacement, craniotomy, osteosynthesis, trauma surgery, intracranial surgery, intra-abdominal surgery, surgery * intrathoracic, or joint replacement surgery.
For on-demand treatment, the chimeric polypeptide dosage range is
<td>approximately</td><td>once every</td><td> 24-36,</td><td> 24-48, 24-72,</td><td> 24,</td><td> 25,</td><td> 26,</td>
<td> 15 27, 28, 29, 30,</td><td> 31, 32, 33,</td><td> 34, 35,</td><td> 36, 37, 38,</td><td> 39,</td><td> 40,</td><td> 41,</td>
<td> 42, 43, 44, 45,</td><td> 46, 47, 48,</td><td> 49, 50,</td><td> 51, 52, 53,</td><td> 54, .</td><td> 55,</td><td> 56,</td>
57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, or hours or more.
The therapeutic doses that can be used in the methods of the invention are about 10 to about 100 IU / kg, more specifically, about 10-20, 20-30, 3040, 40-50, 50-60, 60-70, 70- 80, 80-90, or 90-100 Ul / kg, and more specifically, about 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85 .90, 95, O 100 IU / kg.
Therapeutic doses that can be used in the methods
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of the invention are approximately 10 aa proximadame ^ e ^
Ul / kg, more specifically, about 100-110,
120-130, 130-140, 140-150 Ul / kg, and more specifically, /
about 110, 115, 120, 125, 130, 135, 140, 145, or 150 IU / kg.
The subject in the methods of the invention can be a human subject or can be a non-human mammal. Non-human mammals include, for example, mice, dogs, primates, monkeys, cats, horses, cows, pigs, and other domestic animals and small animals. Determination of the dosage range and AUC can be carried out in a single subject or in a population of subjects.
Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can be a human Factor VIII, or a non-human Factor VIII, such as porcine, mouse, or canine Factor VIII. Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can have a total or partial deletion of the B domain.
Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can be at least 90% or 95% identical to an amino acid sequence of Factor VIII shown in Table 2 without a signal sequence (amino acids 1 to 1438 of Sec. with ID #: 2; amino acids 1 to 2332 of the seq. with ID #: 6; amino acids 1 to 740 of the seq. with ID #: 8; amino acids 1 to 745 of the sec. with no. of
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amino acids 1 to 684 of sec. with no. by faftítUlo Mexicano
Factor VIII (or the chimeric factor infusfr-. 'Portion) may be identical to an ident sequence: 10; or ident.:12). The one Factor VIII amino acid polypeptide shown in Table 2 without a
<td> 5</td><td>sequence</td><td>signal (amino acids</td>
<td></td><td>ident.:2;</td><td>amino acids 1 a</td>
<td></td><td>ident.:6;</td><td>amino acids 1 a</td>
<td></td><td>ident. : 8,</td><td>amino acids 1 a</td>
<td></td><td>ident.:10;</td><td>or amino acids 1</td>
<td> 10</td><td>ident.:12)</td><td></td>
<td>1 to 1438 of the sec</td><td>. with</td><td>no.</td><td>of</td>
<td>2332 of sec.</td><td>with</td><td>no.</td><td>of</td>
<td>740 of sec.</td><td>with</td><td>no.</td><td>of</td>
<td>745 of sec.</td><td>with</td><td>no.</td><td>of</td>
<td>to 684 of sec.</td><td>with</td><td>no.</td><td>of</td>
Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can be at least 90% or 95% identical to a Factor VIII amino acid sequence shown in
Table 2 with a signal sequence (amino acids -19 to 1438 of seq. With ident no .: 2; amino acids -19 to 2332 of seq.
with no. of ident. : 6; amino acids -19 to 740 of sec. with no. of ident. : 8; amino acids -19 to 745 of sec. with no. of ident. : 10; or amino acids -20 to 684 of sec. with no. Identification number: 12). Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can be identical to a Factor VIII amino acid sequence shown in Table 2 with a
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signal sequence (amino acids -19 to 1438 of seq. no.
of ident. :two; amino acids -19 to 2332 of sec. with no. of ident. : 6, - amino acids -19 to 740 of sec. with no. of ident. : 8; amino acids -19 to 745 of sec. with no. from ident.:10; or amino acids ident.:12).
The Fe (or chimeric) portion can be to the amino acid sequence
-20 to 684 of sec.
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of the Industrial Property the Fe portion of a polypeptide less 90% or 95% identical to that of the Fe shown in Table 2
<td>(amino acids</td><td> 1439</td><td>to 1665 of sec.</td><td>with num</td><td>. from ident.:2;</td>
<td>amino acids</td><td colspan="2">2333 to 2559 of sec.</td><td>with no.</td><td>from ident.:6;</td>
<td>amino acids</td><td>741 a</td><td>967 of sec.</td><td>with no.</td><td>of ident. : 8;</td>
<td>amino acids</td><td>746 to</td><td>972 of sec.</td><td>with no.</td><td>from ident.:10;</td>
<td>amino acids</td><td>685 to</td><td>924 of sec. with</td><td>no. of</td><td>ident.:12). The</td>
<td>Fe portion</td><td>(wave</td><td>Fe portion of a</td><td colspan="2">chimeric polypeptide)</td>
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may be identical to the amino acid sequence of Fe shown in Table 2 (amino acids 1439 to 1665 of sec.
with no. from ident.:2; amino acids 2333 to 2559 of sec. with no. of ident. : 6; amino acids 741 to 967 of sec. with no. of ident. : 8; amino acids 746 to 972 of sec. with no. of ident .: 10; amino acids 685 to 924 of sec. with no. from ident.:12).
The chimeric polypeptide may comprise a sequence at least 90% or 95% identical to the amino acid sequence of the
Fe and Factor VIII shown in Table 2A (i) without a signal sequence (amino acids 1 to 1665 of the seq. ID #: 2) or at least 90% or 95% identical to the amino acid sequence of the Fe and Factor VIII shown in Table 2A (i) with a signal sequence (amino acids -19 to 1665 of the
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sec. with no. of ident.:2). The chimeric polypeptide can ^ Jf¡f<sub>or</sub>fg. 'R $ @ XsC £ SRO comprise a sequence identical to the sequence ^^ pfm¡ @ da € i amino acids of Fe and Factor VIII shown in Table y ^<sup>us</sup>^ at (i) without a signal sequence (amino acids 1 to 1665 of sec.
with no. Ident.:2) or identical to the amino acid sequence of Fe and Factor VIII shown in Table 2A (i) with a signal sequence (amino acids -19 to 1665 of the seq. with Ident No.:2) .
The chimeric polypeptide may be in the form of a hybrid comprising a second polypeptide in association with the chimeric polypeptide, wherein the second polypeptide comprises or consists essentially of an Fe.
The second polypeptide may comprise or consist essentially of a sequence at least 90% or 95% identical to the amino acid sequence shown in Table 2A (ii) without a signal sequence (amino acids 1 to 227 of seq. With ident no. .: 4) or at least 90% or 95% identical to the amino acid sequence shown in Table 2A (ii) with a signal sequence (amino acids -20 to 227 of the seq. With ident no .: 4) . The second polypeptide may comprise or consist essentially of a sequence identical to the amino acid sequence shown in Table 2A (ii) 'without a signal sequence (amino acids 1 to 227 of the seq. ID No.:4) or identical. to the amino acid sequence shown in Table 2A (ii) with a signal sequence (amino acids -20
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to 227 of sec. with no. of ident.:4).
The chimeric or hybrid polypeptide can be administered Industrio! as part of a pharmaceutical composition comprising at least one excipient.
The invention also provides the chimeric and hybrid polypeptides described above, the polynucleotides that encode them, a human embryonic cell culture comprising the polynucleotides, and the methods for producing such chimeric and hybrid polypeptides, and the polypeptides produced by such methods.
BRIEF DESCRIPTION OF THE FIGURES
Figure 1. Schematic representation of the rFVIIIFc monomer.
Figure 2. WBCT of rFVIIIFc compared to ReFacto ”in hemophilia A mice after an intravenous dose of 50 IU / kg (n = 6 mice per group).
Figure 3. Chromogenic activity in the plasma of mice with hemophilia A after a single intravenous dose of 50 IU / kg of rFVIIIFc, ReFacto® and Advate®.
Figures 4A-4B. WBCT of rFVIIIFc and ReFacto® in dogs with hemophilia A rFVIIIFc (Figure 4A). In Figure 4B ReFacto® followed by rFVIIIFc in a crossover study.
Figure 5. Pharmacokinetics of intravenous rFVIIIIFc and ReFacto in dogs with hemophilia A (measured by ELISA).
Figure 6. Activity of rFVIII and ReFacto® after
<img file="MX336830B_D0024.tif" />
a single dose per trial
Institute
Mexican intravenous in dogs with hemophilia A (idfiÜB £ iO | ÍI dad
Industry specific chromogenic activity for the
FVIII).
Figure 7. Group mean plasma concentration 5 of rFVIIIFc and Xyntha over time after a single intravenous dose (125 IU / kg) in cynomolgus monkeys (n = 6, mean ± SD). Plasma concentrations were determined by ELISA.
Figures 8A-8B. Curves of individual plasma concentration of rFVIIIFc and Xyntha as a function of time after a single intravenous dose (125 IU / kg) in cynomolgus monkeys (n = 6, mean ± SD). Plasma concentrations were determined by ELISA. In Figure 8A the rFVIIIFc by ELISA. In Figure 8B the Xyntha by ELISA.
Figure 9. Group mean plasma chromogenic activity after a single intravenous dose (125 IU / kg) of rFVIIIFc and Xyntha in cynomolgus monkeys (n = 6, mean ± SD). FVIII activity was measured using a specific chromogenic activity assay for
FVIII.
Figures 10A-10B. Plasma chromogenic activity versus time curves after a single intravenous dose (125 IU / kg) of rFVIIIFc and Xyntha in cynomolgus monkeys (n = 6, mean + SD). FVIII activity was measured using a chromogenic activity assay
<img file="MX336830B_D0025.tif" />
Specific institute of FVIII. In Figure 10A chromogenic activity Μθχ / οαηο defap<sub>ro</sub>¿<sub>ecfotí</sub> of the rFVIIIFc. In Figure 10B chromogenic activity of IncfUSfrfcjt Xyntha.
Figure 11. Biochemical characterization of rFVIII-Fc: Factor X activation as a function of Factor X concentration.
Figure 12. Biochemical characterization of rFVIII-Fc: Factor X activation as a function of Factor IXa concentration.
Figures 13A-13D. Group mean observed FVIII activity (± SE) (one-step assay, 25 IU / kg in Figure 13A or 65 IU / kg in Figure 13B; and the chromogenic assay, 25,
Ul / kg in Figure 13C or 65 Ul / kg in Figure 13D) as a function of time.
Figures 14A-I4B. Group mean observed FVIII activity (± SE) (a one-step assay in Figure 14A or chromogenic assay in Figure 14B) versus time.
DETAILED DESCRIPTION OF THE INVENTION
The present invention provides a method of treating hemophilia A with Factor VIII by using a longer dosage range and / or higher AUC than is possible with currently known Factor VIII products. The present invention also provides better chimeric Factor VIII polypeptides, chimeric Factor VIII polynucleotides, and methods of
<img file="MX336830B_D0026.tif" />
production.
Treatment of hemophilia A is by replacement therapy aimed at restoring FVIII activity to 1 to 5% of normal levels to prevent spontaneous bleeding (Manucci, PM ,. et al., N. Engl. J. Med 344: 1773-9 (2001), which is incorporated herein by reference in its entirety). Recombinant and plasma-derived FVIII products are available to treat on-demand bleeding episodes or to prevent bleeding episodes from occurring by prophylactic treatment. Based on the half-life of these products (10-12 h) (Whita GC, et al., Thromb. Haemost. 77: 660-7 (1997); Morfini, M., Hemophilia 9 (suppl 1): 94-99 ;
Discussion 100 (2003)), treatment regimens require frequent intravenous administration, commonly two to three times a week for prophylaxis and one to three times a day for on-demand treatment (Manco-Johnson, MJ, and others, N. Engl. J. Med. 357: 535-544 (2007)), each of which is incorporated herein by reference in its entirety. Such frequent administration is painful and uncomfortable.
The present invention provides a method of administering Factor VIII to a subject in need thereof, comprising administering to the subject a therapeutic dose of a chimeric Factor VIII polypeptide, for example, an effe-α ^ piedad indusíriat
<img file="MX336830B_D0027.tif" />
Chimeric polypeptide Institute Factor VIII-Fe, or a hybrid of such a Mejfoano property polypeptide in a dosage range of at least CTF approximately one and a half times greater than the required dosage range for an equivalent amount of Factor VIII without the non-portion. -Factor VIII (a polypeptide consisting of the Factor VIII portion), for example, without the Fe portion.
The dosing interval can be at least about one and a half to six times longer, one and a half to five times longer, one and a half to four times longer, one and a half to three times longer, or one and a half to two times longer, than the dosage range required for an equivalent amount of Factor VIII without the non-Factor VIII portion (a polypeptide consisting of the Factor VIII portion), for example, without the Faith. The dosing interval can be at least approximately one and a half, two, two and a half, three, three and a half, four, four and a half, five, five and a half, or six times longer than the dosing interval required for an equivalent amount of Factor VIII without the non-Factor VIII portion (a polypeptide consisting of the Factor VIII portion), eg, without the Fe portion. The dosage interval can be approximately every five, six, seven, eight, nine, ten, eleven, twelve, thirteen, or fourteen days or more.
<img file="MX336830B_D0028.tif" />
The dosage range can be from about one and a half to 5, one and a half, 2, 3, 4, or 5 days or more.
The present invention also provides a method of administering Factor VIII to a subject in need thereof, comprising administering to the subject a therapeutic dose of a chimeric Factor VIII polypeptide, for example, a chimeric Factor VIII-Fe polypeptide, or a hybrid of such a polypeptide to obtain an area under the plasma concentration versus time curve (AUC) of at least about one and a quarter times greater than the AUC that was obtained for an equivalent amount of Factor VIII without the non-portion. -Factor VIII (a polypeptide consisting of the Factor VIII portion), for example, without the Fe portion.
The present invention also provides a method of administering Factor VIII to a subject in need thereof, which comprises administering to the subject a therapeutic dose of a polypeptide comprising a Factor VIII and an Fe or a hybrid of such a polypeptide at a dosage range of approximately every five, six, seven, eight, nine, ten, eleven, twelve, thirteen, or fourteen days or more.
The methods of the invention can be practiced on a subject in need of prophylactic treatment or treatment on demand.
Administration, as used herein, means
<img file="MX336830B_D0029.tif" />
Institute to give a pharmaceutically acceptable Mexican Property Factor VIII polypeptide of the invention to a subject through a pharmaceutically acceptable Industttat route. The preferred routes of administration are intravenous, eg, injection, intravenous, and intravenous infusion. Additional routes of administration include, for example, subcutaneous, intramuscular, oral, nasal, and pulmonary administration. Chimeric polypeptides and hybrid proteins can be administered as part of a pharmaceutical composition comprising at least one excipient.
Area under the plasma concentration versus time curve (AUC), as used herein, is the same as the term of matter in pharmacology, and is based on the rate and magnitude of Factor VIII absorption, after of the administration. The AUC is determined over a specified period of time, such as 12, 18, 24, 36, 48, or 72 hours, or for infinity using extrapolation based on the slope of the curve. Unless otherwise specified herein, the AUC is determined for infinity. Determination of AUC can be carried out on a single subject, or on a population of subjects for which the mean is calculated.
Domain B of Factor VIII, as used herein, is the same as domain B known in the art which is defined by amino acid sequence identity.
<img file="MX336830B_D0030.tif" />
internal and proteolytic cleavage sites by thrombin, eg, the Ser741-Argl648 residues of full-length human Factor VIII. The other domains of Factor
Human VIII are defined by the following amino acid residues: Al, Alal-Arg372 residues; A2, Ser373 Industrial waste
<td>Arg740;</td><td>A3,</td><td>waste</td><td>Serl690-Ile2032; Cl,</td><td>, waste</td><td>Arg2033-</td>
<td>Asn2172;</td><td>C2,</td><td>waste</td><td>Ser2173-Tyr2332. The</td><td>sequence</td><td>A3-C1-C2</td>
<td>It includes</td><td>the</td><td>waste</td><td>Serl690-Tyr2332. The</td><td>sequence</td><td>remaining,</td>
Glul649-Argl689 residues are generally referred to as the Factor VIII light chain activating peptide. The boundary locations for all domains, including the B domains, for porcine, mouse, and canine Factor VIII are also known in the art. Preferably, the B domain of Factor VIII is deleted (Factor VIII with deleted domain B or BDD FVIII). An example of a BDD FVIII is Refacto (recombinant BDD FVIII), which has the same sequence as the Factor VIII portion of the sequence in Table 2A (i) (amino acids -19 to 1438 or 1 to 1438 of sec. with ID number: 2).
A Factor VIII with domain B deleted may have the partial or total deletions described in US Patent Nos. 6,316,226, 6,346,513,
7,041,635, 5,789,203, 6,060,447, 5,595,886, 6,228,620,
5,972,885, 6,048,720, 5,543,502, 5,610,278, 5,171,844,
<img file="MX336830B_D0031.tif" />
5,112,950, 4,868,112, and 6,458,563, each of which hereby incorporates by reference in its totality some embodiments, a deleted Factor VIII B domain sequence of the present invention comprises any of the deletions described in col. 4, line 4 to col. 5, line 28 and Examples 1-5 of US Patent No. 6,316,226 (also in
6,346,513). In some embodiments, a deleted B domain Factor VIII of the present invention has a deletion described in col. 2, lines 26-51 and the Examples
5-8 of United States Patent No. 5,789,203 (also 6,060,447, 5,595,886, and 6,228,620). In some embodiments, a Factor'VIII with domain B deleted has a deletion described in col. 1, line 25 to col. 2, line 40 of US Patent No. 5,972,885; cabbage. 6, lines 1-22 and Example 1 of US Patent No. 6,048,720, col. 2, lines 17-46 of US Patent No. 5,543,502; cabbage. 4, line 22 to col. 5, line 36 of US Patent No. 5,171,844, col. 2, lines 55-68, Figure 2, and Example 1 of US Patent No. 5,112,950; cabbage. 2, line 2 of col. 19, line 21, and Table 2 of US Patent No. 4,868,112, col. 2, line 1 to col. 3, line 19, col. 3, line 40 to col. 4, line 67, col. 7, line 43 to col. 8, line 26, et al. 11 of line 5 of col. 13, line 39
<img file="MX336830B_D0032.tif" />
of United States patent no. 7,041,635, or col.
4, lines 25-53, of US Patent a »® 6,458,563. In some embodiments, a Factor VIII with domain B deleted has a deletion of most of the B domain, but still contains amino-terminal B domain sequences that are essential for in vivo proteolytic processing of the primary translation product into two polypeptide chains. , as described in WO 91/09122, which is incorporated herein by reference in its entirety. In some embodiments, a Factor VIII with domain B deleted is constructed with a deletion of amino acids 747-1638, that is, virtually a complete deletion of the B domain. Hoeben RC, et al., J. Biol. Chem. 265 (13) :
7318-7323 (1990), which is incorporated herein by reference in its entirety. A Factor VIII with domain B deleted may also contain a deletion of amino acids 771-1666 or amino acids 868-1562 of Factor
VIII. Meulien P., et al. Protein Ing. 2 (4): 301-6 (1988), incorporated herein by reference in its entirety.
Additional deletions of domain B that are part of the invention include, for example: the deletion of amino acids 982 to 1562 or 760 to 1639 (Toole et al.,
Proc. Nati. Acad Sci. United States (1986) 83, 5939-5942)), from 797 to 1562 (Eaton et al., Biochemestry (1986) 25: 83438347)), from 741 to 1646 (Kaufman (published PCT application
<img file="MX336830B_D0033.tif" />
no. WO 87/04187)), of
747 to 1560 (Sarver and (1987) 6: 553-564)), from 741 to 1648 (Pasek (PCTlndUSfffOt application no. 88/00831)), from 816 to 1598 or from 741 to 1689 (Lagner (Behring Inst. Mitt ( 1988) No. 82: 16-25, EP 295597)), each of which is incorporated herein by reference in its entirety. Each of the above deletions can be made in any Factor VIII sequence.
Chimeric polypeptide, as used herein, means a polypeptide that includes within it at least two polypeptides (or subsequences or peptides) from different sources. Chimeric polypeptides can include, for example, two, three, four, five, six, seven or more polypeptides from different sources, such as different genes, different cDNAs, or different animals or other species. Chimeric polypeptides can include, for example, one or more linkers that join the different subsequences. Thus, subsequences can be linked directly or they can be linked indirectly, through linkers, or both, within a single chimeric polypeptide. Chimeric polypeptides can include, for example, additional peptides, such as signal sequences and sequences such as 6His and FLAG that aid in the purification or detection of proteins. In addition, chimeric polypeptides can have amino acid or peptide additions to the N-termini and / or C-termini.
<img file="MX336830B_D0034.tif" />
In some embodiments, the industrial chimeric polypeptide comprises a Factor VIII portion and a non-Factor VIII portion. Examples of non-Factor VIII portions include, for example, Fe, XTEN, and albumin. Examples of chimeric polypeptides of the invention include, for example, Factor VIII-Fc chimeric polypeptides, Factor VIII-XTEN chimeric polypeptides, and Factor VIII chimeric polypeptides.
VIII-albumin.
Examples of Factor VIII-Fe chimeric polypeptides include, for example, secs. with nos. of ident: 2, 6, 8, and 12 (Table 2), with or without their signal sequences and the chimeric polypeptide Fe of sec. with no. of ident: 4 (Table 2).
The chimeric polypeptide may comprise a sequence at least 90% or 95% identical to the amino acid sequence of the
Fe and Factor VIII shown in Table 2A (i) without a signal sequence (amino acids 1 to 1665 of the seq. With ident no .: 2) or at least 90% or 95% identical to the amino acid sequence of the Fe and Factor VIII shown in Table 2A (i) with a signal sequence (amino acids -19 to 1665 of the seq. ID: 2). The chimeric polypeptide may comprise a sequence identical to the amino acid sequence of Fe and Factor VIII shown in Table 2A (i) without a signal sequence (amino acids 1 to 1665 of Seq. Ident. No .: 2) or identical to the sequence of
<img file="MX336830B_D0035.tif" />
amino acids substitute for Fe and Factor VIII shown in Table ^ g ^^ Q ^ Q '? Iq Property (i) with a signal sequence (amino acids -19 to 1665 of | n ^ ¡¡sfp | Qfsec. With ident no .: 2).
As discussed above, examples of chimeric polypeptides include Factor VIII that is fused to one or more XTEN polypeptides. Schellenburger et al. Nat. Biotech. 27: 1186-90 (2009), which is incorporated herein by reference in its entirety. Factor VIII can be fused to either the N-terminus of the XTEN polypeptide or the C-terminus of the XTEN polypeptide, provided that the Factor VIII component of the Factor VIII-XTEN fusion protein can be processed by a protease to yield a polypeptide containing processed Factor VIII. A protease site can be included between the XTEN portion and the Factor VIII portion to allow such treatment. XTEN polypeptides include, for example, those described in WO 2009/023270, WO 2010/091122, WO 2007/103515, US 2010/0189682, and US 2009/0092582, each of which is incorporated herein as reference in its entirety.
As discussed above, examples of chimeric polypeptides also include Factor VIII that is fused to one or more albumin polypeptides. Preferably, the albumin is human albumin. Factor VIII can be fused to either the N-terminal end of the
<img file="MX336830B_D0036.tif" />
Institute
Mexican albumin or at the C-terminal end of albumin, always ^ íftProjÍI @ dctó
Indusfflat the Factor VIII component of the Factor VIII-albumin fusion protein can be processed by an enzymatically active proprotein convertase to produce a processed polypeptide containing Factor VIII. Examples of albumin, eg fragments thereof, that can be used in the present invention are known. For example, US Patent No. 7,592,010; United States Patent No. 6,686,179; and Schulte, Thrombosis Res. 124 Suppl. 2: S6-S8 (2009), each of which is incorporated herein by reference in its entirety.
In some embodiments, a chimeric polypeptide comprising a Factor VIII portion has a longer half-life (tl / 2) than a polypeptide consisting of the same Factor VIII portion without the non-Factor VIII portion. A chimeric Factor VIII polypeptide with increased tl / 2 may be referred to herein as a long-acting Factor VIII. Long-acting Factor VIII chimeric polypeptides include, for example, Factor VIII that fuses to Fe (including, for example, chimeric Factor VIII polypeptides in the form of a hybrid such as a dimer monomeric hybrid of FVIIIFc; see •
Example 1, Figure. 1, and Table 2A. and US Patent Nos. 7,404,956 and 7,348,004), the Factor
<img file="MX336830B_D0037.tif" />
VIII that merges into XTEN, and Factor VIII that is _ Mexican <sup>fusi</sup>e & fe pity the albumin.
Cultivation, cultivating and culturing, as used herein, means incubating cells under in vitro conditions that allow cell growth or division, or keeping cells alive. Cultured cells, as used herein, means that the cells are propagated in vitro.
Factor VIII, as used herein, means Factor VIII polypeptide functional in its normal role in coagulation, unless otherwise specified. Thus, the term Factor VIII includes variant polypeptides that are functional. Preferred Factor VIII proteins are human, porcine, canine, and murine Factor VIII proteins. As described in the Background of the Art section, complete polypeptide and polynucleotide sequences are known, as are many functional fragments, mutants, and modified versions. Examples of human Factor VIII sequences are shown as subsequences in secs. with nos. Identification numbers: 2, 6, 8, 10 and 12 (Table 2). Factor VIII polypeptides include, for example, full-length Factor VIII, full-length Factor VIII minus Met at the N-terminus, mature Factor VIII (minus signal sequence), Factor VIII
Mature VIII with an additional Met at the N-terminal end,
<img file="MX336830B_D0038.tif" />
and / or Factor VIII with a total or partial deletion of the Industrial Philosophy domain B. Preferred variants of Factor VIII include the deletion of domain B, either partial or total deletions.
A large number of functional variants of Factor VIII are known, as discussed above and below. In addition, hundreds of non-functional mutations in Factor VIII have been identified in hemophilia patients, and it was determined that the effect of these mutations on Factor VIII function is due more to where they are found within the three-dimensional structure of Factor VIII than to the nature of the substitution (Cutler et al., Hum. Mutat. 19: 274-8 (2002)), incorporated herein by reference in its entirety.
In addition, comparisons between human Factor VIII and other species identified conserved residues likely to be required for function (Cameron et al., Thromb Haemost. 79: 317-22 (1998); US 6,251,632), which is incorporated into the present for reference in its entirety.
The human Factor VIII gene was isolated and expressed in mammalian cells (Toole, JJ, et al., Nature 312: 342347 (1984); Gitschier, J., et al. Nature 312: 326-330 (1984);
Wood, WI, et al., Nature 312: 330-337 (1984); Vehar, G.
A., et al., Nature 312: 337-342 (1984); WO 87/04187, WO
88/08035, WO 88/03558; United States Patent No. 4,757,006), each of which is incorporated into the
<img file="MX336830B_D0039.tif" />
Institute
Mexican present for reference in its entirety, and the sequence®4fifeP * 'Oplecta ^
Amino acid industries was deduced from the cDNA. Capon et al., United States Patent No. 4,965,199, which is incorporated herein by reference in its entirety, describe a recombinant DNA method for the production of Factor VIII in mammalian host cells and the purification of human Factor VIII. Human Factor VIII expression was reported in CHO cells (Chinese hamster ovary) and BHKC cells (baby hamster kidney cells).
Human Factor VIII was modified to remove part or all of domain B (US Patent Nos. 4,994,371 and 4,868,112, each of which is incorporated herein by reference in its entirety), and the substitution was made from domain B of human Factor VIII to domain B of human Factor V (US Patent No. 5,004,803, incorporated herein by reference in its entirety). The cDNA sequence encoding human Factor VIII and the previous amino acid sequence are shown in secs. with nos. of ident .: 1 and 2, respectively, of the publication of the application of the United States no. 2005/0100990, which is incorporated herein by reference in its entirety.
United States Patent No. 5,859,204,
Lollar, JS, which is incorporated herein by reference in its entirety, reports functional mutants of
<img file="MX336830B_D0040.tif" />
Factor VIII that have reduced antigenicity and Mexican de Ja Property reduced immunoreactivity. United States Patent Industrial No. 6,376,463, Lollar, JS, which is incorporated herein by reference in its entirety, also reports Factor VIII mutants having reduced immunoreactivity. Publication of United States Patent Application No. 2005/0100990, Saenko et al., Which is incorporated herein by reference in its entirety, report functional mutations in the A2 domain of Factor
VIII.
A number of functional Factor VIII molecules, including deletions of domain B, are described in the following United States Patent Nos. 6,316,226 and 6,346,513, both assigned to Baxter, 7,041,635 assigned to
In2Gen, 5,789,203, 6,060,447, 5,595,886, and 6,228,620 assigned to Chiron; 5,972,885 and 6,048,720 assigned to Biovitrum, 5,543,502 and 5,610,278 assigned to Novo Nordisk; 5,171,844 assigned to Immuno Ag; 5,112,950 assigned to Transgene SA; 4,868,112 assigned to Genetics Institute, each of which is incorporated herein by reference in its entirety.
The porcine Factor VIII sequence was published, (Toole, JJ, et al., Proc. Nati. Acad Sci. USA 83: 5939-5942 (1986)), is incorporated herein by reference in its entirety, and reported the cDNA sequence
<img file="MX336830B_D0041.tif" />
complete swine that was obtained from the PCR amplifi of the Factor VIII sequences from a ^<sup>Ui</sup>^ ® ^ porcine spleen cDNA library (Healey, JF, et al.,
Blood 88: 4209-4214 (1996), which is incorporated herein by reference in its entirety). A human / porcine hybrid Factor VIII was described having substitutions for all domains, subunits, and all specific amino acid sequences described in US Pat. 5,364,771 by Lollar and Runge, - and in WO 93/20093, which are incorporated herein by reference in their entirety. More recently, the nucleotide and corresponding acidic amino acid sequences of the Al and A2 domains of porcine Factor VIII and a chimeric Factor VIII with the Al domains and / or porcine A2 domains substituted for the corresponding human domains were reported in WO 94 / 11503, which is incorporated herein by reference in its entirety. United States Patent No. 5,859,204, Lollar, J. S., also discloses the amino acid sequences of the cDNA and the amino acid sequence that is deduced. Patent 6,458,563, which is incorporated herein by reference in its entirety, assigned to Emory discloses a porcine Factor VIII with the B domain deleted.
Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can be at least 90% or 95% identical
<img file="MX336830B_D0042.tif" />
LUU
Instituto Mexicano to an amino acid sequence of Factor VIII shown ^ j ^ g | p ^ pledOCl industriar
Table 2 without a signal sequence (amino acids 1 to 1438 of seq. With ID #: 2; amino acids 1 to 2332 of seq.
with no. from ident.:6; amino acids 1 to 740 of sec. with no.
from ident.:8; amino acids 1 to 745 of sec. with no. from ident.:10; or amino acids 1 to 684 of sec. with no. from ident.:12). Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can be identical to an amino acid sequence of ^ Factor VIII shown in Table 2 without a
<td>sequence</td><td>signal (amino acids</td><td>1st</td><td> 1438</td><td>of sec. with</td><td>no.</td><td>of</td>
<td>ident.:2;</td><td>amino acids 1 a</td><td> 2332</td><td>of</td><td>the sec. with</td><td>no.</td><td>of</td>
<td>ident.:6;</td><td>amino acids 1 a</td><td> 740</td><td>of ,</td><td>the sec. with</td><td>no.</td><td>of</td>
<td>ident.:8;</td><td>amino acids 1 a</td><td> 745</td><td>of</td><td>the sec. with</td><td>no.</td><td>of</td>
<td>ident.:10;</td><td>or amino acids 1</td><td colspan="2">to 684 from</td><td>the sec. with</td><td>no.</td><td>of</td>
ident.:12).
Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can be at least 90% or 95% identical to a Factor VIII amino acid sequence shown in
Table 2 with a signal sequence (amino acids -19 to 1438 of the seq with ID no .: 2; amino acids -19 to 2332 of the seq.
with no. of ident. : 6; amino acids -19 to 740 of sec. with no. of ident. : 8; amino acids -19 to 745 of sec. with no.
of ident. : 10; or amino acids -20 to 684 of sec. with no. of ident. : 12). Factor VIII (or the Factor VIII portion of a chimeric polypeptide) can be identical to a sequence
<img file="MX336830B_D0043.tif" />
amino acids of Factor VIII shown in Table 2 CBMp signal sequence (amino acids -19 to 1438 of sec. with
<td>from ident.:2; amino acids -19</td><td>2332 from the</td><td>sec. with num</td><td>. of</td>
<td>ident.:6; amino acids -19 to</td><td colspan="2">740 of sec. with no.</td><td>of</td>
<td>ident.:8; amino acids -19 to</td><td colspan="2">745 of sec. with no.</td><td>of</td>
<td>ident.:10; or amino acids -20</td><td>684 from</td><td>sec. with num</td><td>. of</td>
<td>ident.:12).</td><td></td><td></td><td></td>
<td>Equivalent quantity,</td><td>how to use</td><td colspan="2">at the moment,</td>
<td>means the same amount</td><td>of activity</td><td>Factor</td><td>VIII</td>
expressed in International Units, which is independent of the molecular weight of the polypeptide in question. One International Unit (IU) of Factor VIII activity roughly corresponds to the amount of Factor VIII in one milliliter of normal human plasma. Several assays are available to measure Factor VIII activity, including the European Pharmacopoeia chromogenic substrate assay and a one-step coagulation assay.
Fe, as used herein, means functional neonatal Fe receptor (FcRn) binding partners, unless otherwise specified. An FcRn binding partner is any molecule that can specifically bind to the FcRn receptor with consequent active transport by the FcRn receptor of the FcRn binding partner. Thus, the term Fe includes the Fe variants of IgG that are functional. The region of the Fe portion of IgG that binds to the FcRn receptor was described on the basis of
<img file="MX336830B_D0044.tif" />
Ututo X-ray crystallography (Burmeister et al. 1994, Naturifloxlcano does the Property
372: 379, which is incorporated by reference herein in its entirety). The major contact area of Fe with FcRn is near the junction of the CH2 and CH3 domains. The Fe-FcRn contacts are all within a single Ig heavy chain.
FcRn binding partners include, for example, all IgG, the Fe fragment of IgG, and other IgG fragments that include the entire FcRn binding region. Major contact sites include amino acid residues 248, 250-257, 272, 285, 288, 290-291, 308-311, and 314 of the CH2 domain and amino acid residues 385-387, 428, and 433436 of the CH3 domain. References to amino acid numbering of immunoglobulins or immunoglobulin fragments, or regions, are based on Kabat et al.
1991, Sequence of Proteins of Immunological Interest, US Department of Public Health, Bethesda; MD, which is incorporated herein by reference in its entirety. The FcRn receptor was isolated from several species of mammals, including humans. (The sequences of human FcRn, rat FcRn, and mouse FcRn are known (Story et al., 1994, J. Exp. Med. 180: 2377), are incorporated herein by reference in their entirety.) An Fe can comprise the CH2 and CH3 domains of an immunoglobulin with or without the hinge region of the immunoglobulin. Examples of Fe variants are
<img file="MX336830B_D0045.tif" />
provided in WO 2004/101740 and WO 2006/074199, incorporated herein by reference in their entirety.
Fe (or the Fe portion of a chimeric polypeptide) can contain one or more mutations, and combinations of mutations.
Fe (or the Fe portion of a chimeric polypeptide) may contain mutations that confer longer half-life such as M252Y, S254T, T256E, and combinations thereof, as described in Oganesyan et al., Mol. Immunol. 46: 1750 (2009), which is incorporated herein by reference in its entirety; H433K, N434F, and combinations thereof, as described in Vaccaro et al. Nat. Biotechnol. 23: 1283 (2005), which is incorporated herein by reference in its entirety; the mutants described on pages 1-2, paragraph [0012], and Examples 9 and 10 of US 2009/0264627 Al, which is incorporated herein by reference in their entirety, and the mutants described on page 2, paragraphs [0014] to [0021] of US 20090163699 Al, which is incorporated herein by reference in its entirety.
Fe (or the Fe portion of a chimeric polypeptide) can also include, for example, the following mutations: The Fe region of IgG can be modified according to well-recognized procedures, such as site-directed mutagenesis and the like to yield IgG or Modified Fe fragments or parts thereof that will bind to the FcRn.
<img file="MX336830B_D0046.tif" />
ÜJL3
Institute
Such modifications include, for example, modif icacy ^^ g ^^ ®® ^ ® away from the FcRn contact sites as well as modifications within the contact sites that preserve or even enhance binding to FcRn. For example the following single amino acid residues in human IgGl Fe (Fcyl) can be substituted without significant loss of Fe-binding affinity for FcRn: P238A, S239A,
K246A, K248A, D249A, M252A, T256A, E258A, T260A, D265A,
S267A, H268A, E269A, D270A, E272A, L274A, N276A, Y278A,
D280A, V282A, E283A, H285A, N286A, T289A, K290A, R292A,
E293A, E294A, Q295A, Y296F, N297A, S298A, Y300F, R301A,
V303A, V305A, T307A, L309A, Q311A, D312A, N315A, K317A,
E318A, K320A, K322A, S324A, K326A, A327Q; P329A, A330Q,
A330S, P331A, P331S, E333A, K334A, T335A, S337A, K338A,
K340A, Q342A, R344A, E345A, Q347A, R355A, E356A, M358A,
T359A, K360A, N361A, Q362A, Y373A, S375A D376A, A378Q, E380A,
E382A, S383A, N384A, Q386A, E388A, N389A, N390A, Y391F,
K392A, L398A, S400A, D401A, D413A, K414A, R416A, Q418A,
Q419A, N421A, V422A, S424A, E430A, N434A, T437A, Q438A,
K439A, S440A, S444A, and K447A, where for example P238A represents wild-type proline substituted for alanine at position number 238. In addition to alanine other amino acids can be substituted for wild-type amino acids at positions specified above. Mutations can be introduced separately into Fe resulting in more
<img file="MX336830B_D0047.tif" />
Institute of one hundred FcRn-binding pairs other than the native one. In addition, combinations of two, three, or more of these individual IndUSfrlaf mutations can be introduced together, resulting in hundreds of more FcRn-binding partners. Some of these mutations can confer new functionality to the FcRn binding partner. For example, one embodiment incorporates N297A, by removing a highly conserved N-glycosylation site. The effect of this mutation is to reduce immunogenicity, which increases the circulating half-life of the FcRn-binding partner, and yields an FcRn-binding partner unable to bind to FcyRI, FcyRIIA, FcyRIIB, and FcyRIIIA, without compromising affinity. by FcRn (Routledge et al., 1995, Transplantation 60: 847, which is incorporated herein by reference in its entirety; Friend et al., 1999, Transplantation 68: 1632, which is incorporated herein by reference in its entirety ; Shields and others,
1995, J. Biol. Chem. 276: 6591, which is incorporated herein by reference in its entirety). Furthermore, at least three human Fe gamma receptors appear to recognize an IgG-binding site within the lower hinge region, generally amino acids 234-237. Therefore, another example of a new functionality and potential decrease in immunogenicity can arise from mutations in this region, such as by substituting amino acids 233-236 of human IgGl.
<img file="MX336830B_D0048.tif" />
title
ELLG by the corresponding sequence of IgG2 PVA (with laMex / Cano <sup>of</sup> the Suppression Property of an Amino Acid). FcyRI, Indusf / fofFcyRII, and FcyRIII that mediate various effector functions were shown not to bind to IgGl when such mutations are introduced (Ward and Ghetie 1995, Therapeutic Immunology 2:77, which is incorporated herein by reference in its in its entirety, and Armor et al. 1999, Eur. J. Immunol. 29: 2613, which is incorporated herein by reference in its entirety). As a further example of the new functionality arising from the mutations described above, the affinity for FcRn can be increased beyond that of the wild type in some cases. This higher affinity may reflect an increase in the rate of association, a decrease in the rate of dissociation, or both an increase in the rate of association and a decrease in the rate of dissociation. Mutations believed to increase affinity for FcRn include, for example, T256A, T307A,
E380A, and N434A (Shields et al., 2001, J. Biol. Chem. 276: 6591, which is incorporated herein by reference in its entirety).
Fe (or the Fe portion of a chimeric polypeptide) can be at least 90% or 95% identical to the amino acid sequence of Fe shown in Table 2 (amino acids 1439 to
1665 of sec. with no. from ident.:2; amino acids 2333 to 2559 of sec. with no. from ident.:6; amino acids 741 to 967 of the
<img file="MX336830B_D0049.tif" />
sec. with no. of ident with no. of ident. : Io;
: 8; amino acids 746 to amino acids 685 to 924
972 of the sec <sup>, @ x</sup>'cano of the sec ^ co & ^^ ectotf ffldusfrtor No. of ident. : 12). Fe (or the Fe portion of a chimeric polypeptide) may be identical to the amino acid sequence of Fe shown in Table 2 (amino acids 1439 to 1665 of seq. ID #: 2; amino acids 2333 to 2559 of the sec.
with no. of ident. : 6; amino acids 741 to 967 of sec. with no. of ident. : 8; amino acids 746 to 972 of sec. with no.
of ident. : 10; amino acids 685 to 924 of sec. with no. from ident.:12).
Hybrid polypeptides and proteins, as used herein, mean a combination of a chimeric polypeptide with a second polypeptide. The chimeric polypeptide and the second polypeptide in a hybrid can associate with each other through protein-protein interactions, such as charge-charge or hydrophobic interactions. The chimeric polypeptide and the second polypeptide in a hybrid can associate with each other through disulfide or covalent bonding (s). The hybrids are described in WO 2004/101740 and WO 2006/074199, each of which is incorporated herein by reference in its entirety. See also US Patent Nos. 7,404,956 and 7,348,004, each of which is incorporated herein by reference in its entirety. The second polypeptide can be a second copy of it
<img file="MX336830B_D0050.tif" />
ΓόΙΙ>
Chimeric polypeptide institute or may be a chimeric polypeptide noM © Xícano d Ja Identical property. See, for example, Figure 1, Example 1, and lantíusMcst Table 2. In preferred embodiments, the second polypeptide is a polypeptide comprising an Fe. In preferred embodiments, the chimeric polypeptide is a Factor VIII-Fc chimeric polypeptide and the second polypeptide consists essentially of an Fe, eg, the hybrid polypeptide of Example 1, which is a recombinant fusion protein rFVIIIFc consisting of a single molecule. of
Recombinant human FVIII with the deleted B domain (BDDrFVIII) fused to the dimeric Fe domain of human IgGl, without the intervention of a binding sequence. This hybrid polypeptide is referred to herein as the FVIIIFc Fe monomeric fusion protein, monomeric FVIIIFc hybrid, monomeric FVIIIIFc hybrid, and FVIIIFc monomer-dimer. See Example 1, Figure 1, and Table 2A. The examples provide preclinical and clinical data for this hybrid polypeptide.
The second polypeptide in a hybrid may comprise or consist essentially of a sequence at least 90% or 95% identical to the amino acid sequence shown in the Table.
2A (ii) without a signal sequence (amino acids 1 to 227 of the seq. ID #: 4) or at least 90% or 95% identical to the amino acid sequence shown in Table 2A (ii) with a signal sequence (amino acids -20 to 227 of the seq.
<img file="MX336830B_D0051.tif" />
ident.:4) consist sequence sequence ident.:4)
Real
Mexican
The second polypeptide can comprise essentially an identical sequence of amino acids shown in Table 2A (ii) without a signal (amino acids 1 to 227 of the sect. With no. Of or identical to the amino acid sequence displayed
<td>on the</td><td>Table 2A</td><td>(ii)</td><td>with</td><td>a signal sequence</td><td>(amino acids -20</td>
<td>to 227</td><td>of sec.</td><td>. with</td><td>num</td><td>. of ident.:4).</td><td></td>
<td></td><td>The figure</td><td>1 is</td><td>a</td><td>schematic showing</td><td>the structure of the</td>
Chimeric Factor VIII polypeptide with the deleted B domainFc, and its association with a second polypeptide that is an Fe polypeptide. To obtain this hybrid, the coding sequence of Factor VIII with the recombinant human deleted B domain was obtained by chain reaction of the polymerase (RT-PCR) from human liver poly A RNA (Clontech) using primers specific for FVIII. The FVIII sequence includes the native signal sequence for FVIII. The deletion of domain B was from serine 743 (S743, 2287 bp) to glutamine 1638 (Q1638,
4969 bp) for a total deletion of 2682 base pairs. The recombinant human Fe coding sequence was then obtained by RT-PCR from a human leukocyte cDNA library (Clontech) using Fe-specific primers. The primers were designed in such a way that the sequence of the FVIII with the deleted B domain will fuse directly to the N-terminal sequence i * J
<img file="MX336830B_D0052.tif" />
of Faith without intervening linker. The sequence of
FVIIIFc was cloned into the mammalian dual expression vector JnclUStrtat pBUDCE4.1 (Invitrogen), under the control of the CMV promoter. A second identical Fe sequence including the mouse Igk signal sequence was obtained by RT-PCR and cloned downstream of the second promoter, EFla, into the expression vector pBUDCE4.1.
The rFVIIIFc expression vector was transfected into human embryonic kidney 293 cells (HEK293H; Invitrogen), using the Lipofectamine 2000 transfection reagent (Invitrogen). Clonal stable cell lines were generated by selection with Zeocin (Invitrogen). A clonal cell line, 3C4-22 was used to generate FVIIIFc for in vivo characterization. Recombinant FVIIIFc was produced and purified (McCue et al., 2009) at Biogen Idee (Cambridge, MA). The transfection strategy described above was expected to yield three products, ie, the monomeric rFVIIIFc hybrids, the dimeric rFVIIIFc hybrids, and the dimeric Fe. However, essentially no dimeric rFVIIIFc was detected in the conditioned medium of these cells. Rather, the conditioned medium contained monomeric Fe and rFVIIIFc. It is possible that the size of the dimeric rFVIIIFc was too large and prevented efficient secretion by the cell. This result was beneficial as it resulted in less complicated monomer purification than if they were present. The material that was studied had a specific activity of
<img file="MX336830B_D0053.tif" />
of Ια Property used in estolndustrtap approximately
9000 Ul / mg.
Dosage interval, as used herein, means the amount of time that elapses between multiple doses that are administered to a subject. Comparison of the dosage range can be carried out on a single subject or on a population of subjects and then the average obtained in the population can be calculated.
The dosage range when administering a chimeric Factor VIII polypeptide, for example, a Factor VIII-Fc chimeric polypeptide (a polypeptide comprising a Factor VIII or a hybrid) of the invention may be at least about one and a half times as long than the dosage range required for an equivalent amount of Factor VIII without the non-Factor VIII portion, eg, without the Fe portion (a polypeptide consisting of Factor VIII). The dosing interval can be at least about one and a half to six times as long, one and a half to five times as long, one and a half to four times as long, one and a half to three times as long, or one and a half to two times longer than the required dosage range for an equivalent amount of Factor VIII without the non-Factor VIII portion,
<img file="MX336830B_D0054.tif" />
that consistM®W * ®no of Id Property can be a single medium, three, for example, without the Fe portion (a Factor VIII polypeptide). The dosing interval less approximately one and a half, two, two and a half, four, four and a half, five, five and a half, or six times longer than the dosage interval required for an equivalent amount of Factor VIII without the non-Factor VIII portion, for example, without the Fe portion (a polypeptide consisting of Factor VIII) .The dosage interval can be approximately every five, six, seven, eight, nine, ten, eleven, twelve, thirteen or fourteen days or more. The dosage range can be at least about one and a half to 5, one and a half, 2, 3, 4, or 5 days or more. For on-demand treatment, the dosage range of the chimeric or hybrid polypeptide is
<td>about once every 24-36, 24-48, 24-72, 24,</td><td> 25,</td><td> 26,</td>
<td> 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39,</td><td> 40,</td><td> 41,</td>
<td> 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54,</td><td> 55,</td><td> 56,</td>
57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, or hours or more.
Preferably, the effective dose is 25-65 IU / kg (25,
26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40,
41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55,
56, 57, 58, 59, 60, 61, 62, 62, 64, or 65 IU / kg) and the dosage interval is once every 3-5, 3-6, 3-7, 3,
4, 5, 6, 7, or 8 or more days, or three times a week, or no more
<img file="MX336830B_D0055.tif" />
Mexican stffuto three times a week. Preferably, the dose ef e £ fcyfto | iiecfacf is 65 IU / kg and the dosing interval is once a week, or once every 6-7 days.
Long-acting Factor VIII is a Factor VIII that has a longer half-life (also referred to herein as tl / 2, tl / 2 beta, elimination half-life, and HL) relative to a reference Factor VIII. The increased half-life of a long-acting Factor VIII may be due to fusion with one or more non-Factor VIII polypeptides such as, for example, Fe, XTEN, or albumin. The increase in half-life can be due to one or more modifications, such as, for example, pegylation. Examples of long-acting Factor VIII polypeptides include, for example, chimeric Factor VIII polypeptides comprising Fe, chimeric Factor VIII polypeptides comprising XTEN, and chimeric Factor VIII polypeptides comprising albumin. Additional exemplary long-acting Factor VIII polypeptides include, for example, pegylated Factor VIII.
A reference polypeptide, in the case of a long-acting Factor VIII chimeric polypeptide, is a polypeptide consisting essentially of the portion
Chimeric polypeptide Factor VIII, for example, the same Factor VIII portion without the Fe portion, without the XTEN portion, or without the albumin portion. Also, the
<img file="MX336830B_D0056.tif" />
Reference polypeptide in the case of a Factor PfQfftedad
Modified industrial is the same Factor VIII without the modification, for example a Factor VIII without the pegylation.
In some embodiments, long-acting Factor VIII has one or more of the following properties when administered to a subject:
a mean residence time (MTR) (activity) in the subject of about 14-41.3 hours;
a clearance (CL) (activity) in the subject of about 1.22-5.19 ml / hour / kg or less;
a tl / 2 beta (activity) in the subject of about 11-26.4 hours;
an incremental recovery (K-value) (activity, observed) in the subject of approximately 1.38 to 2.88 IU / di per IU / kg;
a Vss (activity) in the subject of approximately 37.7-79.4 ml / kg, and an AUC / dose of the subject of approximately 19.2-81.7 IU * h / dl per IU / kg.
In some modalities, long-acting Factor VIII has one or more of the following properties when administered to a patient population: an incremental mean recovery (K-value) (activity, observed) greater than 1.38 IU / dl per IU / kg ;
an incremental mean recovery (K value)
<img file="MX336830B_D0057.tif" />
Institute
Mexican (activity; observed) of at least approximately i <4 © lOéftopledad
Industry less about 1.85, or at least about 2.46 IU / dl per IU / kg.
mean clearance (CL) (activity) in the patient population of approximately 2.33 + 1.08 ml / hour / kg or less;
an average clearance (CL) (activity) in the patient population of approximately 1.8-2.69 ml / hour / kg;
an average clearance (CL) (activity) in the patient population that is approximately 65% of the clearance of a polypeptide comprising unmodified Factor VIII;
a mean residence time (MRT) (activity) in the patient population of at least approximately 26.3 + 8.33 hours;
a mean MRT (activity) in the patient population of approximately 25.9-26.5 hours;
a mean MRT (activity) in the patient population that is approximately 1.5 times longer than the mean MRT of a polypeptide comprising unmodified Factor VIII;
a mean tl / 2beta (activity) in the patient population of approximately 18.3 ± 5.79 hours;
a mean tl / 2beta (activity) in the patient population that is about 18-18.4 hours;
a mean tl / 2beta (activity) in the population of
<img file="MX336830B_D0058.tif" />
patients that is approximately 1.5 times longer than the average fyJgxjQgpg tl / 2beta of a polypeptide comprising unmodified Factor ^;
a (Value
K) 5 incremental mean recovery (activity; observed) in the patient population of approximately 2.01 + 0.44 IU / dl per IU / kg;
an incremental mean recovery (K-value) (activity, observed) in the patient population of approximately 1.85 to 2.46 IU / dl per IU / kg;
an incremental mean recovery (K-value) (activity; observed) in the patient population that is approximately 90% of the incremental mean recovery of a polypeptide comprising unmodified Factor VIII;
a mean Vss (activity) in the patient population of approximately 55.1 + 12.3 ml / kg;
a mean Vss (activity) in the patient population of approximately 45.3 to 56.1 ml / kg;
a mean AUC / dose (activity) in the patient population of approximately 49.9 + 18.2 IU * h / dl per IU / kg;
an average AUC / dose (activity) in the patient population of approximately 44.8 to 57.6 IU * h / dl per IU / kg.
On-demand treatment, as used herein, means a treatment that is intended to take place in a short course of time and in response to a condition.
<img file="MX336830B_D0059.tif" />
existing, such as a bleeding episode, or perceived need such as planned surgery. I conditioned them<sup>to F</sup> Industry may require on-demand treatment include, for example, bleeding episode, hemarthrosis, muscle bleeding, oral bleeding, hemorrhage, muscle bleeding, oral bleeding, trauma, capitis trauma, gastrointestinal bleeding, intracranial hemorrhage, intracranial hemorrhage abdominal, intrathoracic hemorrhage, bone fracture, central nervous system bleeding, bleeding in the retropharyngeal space, bleeding in the retroperitoneal space, or bleeding into the illiopsoas sheath. The subject may need surgical prophylaxis, peri-surgical procedures, or surgical treatment. Surgeries of this type include, for example, minor surgery, major surgery, tooth extraction, tonsillectomy, inguinal herniotomy, synovectomy, total knee replacement, craniotomy, osteosynthesis, trauma surgery, intracranial surgery, intra-abdominal surgery, intrathoracic surgery, or joint replacement surgery.
Preferably, on-demand treatment solves more
<td>what</td><td> 80%</td><td>(plus</td><td>what</td><td> 80%,</td><td>plus</td><td>what</td><td> 81%,</td><td>plus</td><td>what</td><td> 82%,</td><td>plus</td><td>than 83%,</td>
<td>plus</td><td>what</td><td> 84%,</td><td>plus</td><td>what</td><td> 85%,</td><td>plus</td><td>what</td><td> 86%,</td><td>plus</td><td>what</td><td> 87%,</td><td>more than</td>
<td> 88%,</td><td>plus</td><td>what</td><td> 89%,</td><td>plus</td><td>what</td><td> 90%,</td><td>plus</td><td>what</td><td> 91%,</td><td>plus</td><td>what</td><td>92%, more</td>
<td>what</td><td> 93%,</td><td>plus</td><td>what</td><td> 94%,</td><td>plus</td><td>what</td><td> 95%,</td><td>plus</td><td>what</td><td> 96%,</td><td>plus</td><td>than 97%,</td>
<td>plus</td><td>what</td><td> 98%,</td><td>plus</td><td>what</td><td> 99%,</td><td colspan="2">Or 100%)</td><td>or 80</td><td> -100%</td><td> , 80</td><td> -90%,</td><td> 85-90%,</td>
<img file="MX336830B_D0060.tif" />
90-100%, 90-95%, or 95-100% of bleeds (eg, spontaneous bleeds) in a single dose.
Pref erentemeStelR ^ Industrial piety more than 80% (more than 81%, more than 82%, more than 83%, more than, e
84%, more than 85%, more. than 86%, more than 87%, more than 88%, more than 89%, more than 90%, more than 91%, more than 92%, more than 93%, more than 94%, more than 95%, more than 96%, more than 97%, more than
98%, or 100%) OR 80-100%, 80-90%, 85-90%, 90-100%, 90-95%, or 95-100% of bleeding episodes are rated excellent or good by the doctors after on-demand treatment. Preferably, more than 5%, (more than 6%, more than 7%, more than
<td> 8%,</td><td>plus</td><td>than 9%,</td><td>plus</td><td>what</td><td> 10%,</td><td>plus</td><td>what</td><td> 11%,</td><td>plus</td><td>than 12%,</td><td>plus</td>
<td>what</td><td> 13%,</td><td>more than</td><td> 14%,</td><td>plus</td><td>what</td><td> 15%,</td><td>plus</td><td>what</td><td> 16%,</td><td>more than</td><td> 17%,</td>
<td>plus</td><td>what</td><td>18%, more</td><td>what</td><td> 19%</td><td>, plus</td><td>what</td><td> 20%</td><td>), or</td><td colspan="2"> 5-20%, 5-15%</td><td> , 5-</td>
10%, 10-20%, or 10-15% of bleeding episodes are rated acceptable by clinicians after on-demand treatment.
Polypeptide, peptide, and protein are used interchangeably and refer to a polymeric compound composed of covalently linked amino acid residues.
Polynucleotide and nucleic acid are used interchangeably and> refer to a polymeric compound composed of covalently linked nucleotide residues. The polynucleotides can be DNA, cDNA, single-stranded, or double-stranded RNA, vectors, plasmids, phages, or viruses. Polynucleotides include, for example, those in Table 1, which
<img file="MX336830B_D0061.tif" />
encode the polypeptides of Table 2 (see Table 1). <sup>The £</sup>^ ex | cgnQ polynucleotides also include, for example, fragments of the polynucleotides in Table 1, for example, those encoding fragments of the polypeptides of Table 2, such as Factor VIII, Fe, the signal sequence , the 6His fragments and others of the polypeptides in Table 2.
Prophylactic treatment, as used herein, means the administration of a Factor VIII polypeptide in multiple doses to a subject over a time course to increase the level of Factor VIII activity in the subject's plasma. Preferably, the increase in level is sufficient to decrease the incidence of spontaneous bleeding or to prevent bleeding, for example, in the case of an unforeseen injury. Preferably, during prophylactic treatment, the subject's plasma protein level does not fall below the baseline level for that subject, or below the Factor VIII level that characterizes severe hemophilia (<1 IU / dl [1%] ).
Preferably, the prophylaxis regimen is tailored for the individual patient, preferably by determining the PK data for each patient and by administering the Factor VIII of the invention at a dosage range that maintains a level of 1-3% la FVIII activity. Adjustments can be made when a subject experiences unacceptable bleeding episodes defined as
<img file="MX336830B_D0062.tif" />
tftufo> 2 spontaneous bleeding episodes in a continuous Mexican period of two months. In this case, the adjustment will go to levels of 3-5%. Preferably, prophylactic treatment results in prevention and control of bleeding, sustained control of bleeding, sustained protection from bleeding, and / or sustained benefit. Prophylaxis, for example. Sustained protection can be demonstrated by an increase in AUC at the last measured time point (AUC-LAST) and a decrease in clearance, resulting in a higher terminal tl / 2 compared to short-acting Factor VIII. Preferably, prophylaxis is demonstrated by better Cmax, better Tmax, and / or longer mean residence time compared to short-acting FVIII. Preferably, prophylaxis does not result in spontaneous bleeding episodes within approximately 24, 36, 48, 72, or 96 hours (for
<td>example,</td><td> 25,</td><td> 26,</td><td> 27,</td><td> 28,</td><td> 29,</td><td> 30,</td><td> 31,</td><td> 32,</td><td> 33,</td><td> 34, 35, 36,</td><td> 37,</td>
<td> 38, 39,</td><td> 40,</td><td> 41,</td><td> 42,</td><td> 43,</td><td> 44,</td><td> 45,</td><td> 46,</td><td> 47,</td><td> 48,</td><td> 49, 50, 51,</td><td> 52,</td>
<td> 53, 54,</td><td> 55,</td><td> 56,</td><td> 57,</td><td> 58,</td><td> 59,</td><td> 60,</td><td> 61,</td><td> 62,</td><td> 63,</td><td> 64, 65, 66,</td><td> 67,</td>
<td> 68, 69,</td><td> 70,</td><td> 71,</td><td> 72,</td><td> 73,</td><td> 74,</td><td> 75,</td><td> 76,</td><td> 77,</td><td> 78,</td><td> 79, 80, 81,</td><td> 82,</td>
<td> 83, 84,</td><td> 85,</td><td> 96,</td><td> 87,</td><td> 88,</td><td> 89</td><td> , 90</td><td> , 91</td><td> , 92</td><td> , 93</td><td>, 94, 95, or</td><td> 96</td>
hours, preferably within 72 hours), after the injection (for example, the last injection). Preferably, prophylaxis results in an average reduction of more than 30% (for example, more than 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49,
<img file="MX336830B_D0063.tif" />
50,
51, 52, 53, 54
55, 56, 57, 58,
59, 60
61, 62, 63 „fiWyWKHIO of Ια Property
66, 67, 68, 69
70, 71, 72, 73
74, 75
76, 77, 78, 7 ^, ClUStrtClt
81, 82, 83
84, 85, 96
87, 88, 89, or 90% preferably greater than 50%), in annual bleeding episodes with a dosage of once a week (for example, at 65 IU / kg).
Subject as used herein, means a human or a non-human mammal. Non-human mammals include, for example, mice, dogs, primates, monkeys, cats, horses, cows, pigs, and other domestic animals and small animals.
Therapeutic dose, as used herein, means a dose that achieves a therapeutic goal, as described herein. The calculation of the required dose of Factor VIII is based on the empirical finding that, on average, 1 IU of Factor VIII per kg of body weight increases plasma Factor VIII activity by approximately 2 IU / dl. The required dose is determined by the following formula:
Units required = body weight (kg) x desired Factor VIII increase (IU / dl or% of normal) x 0.5 (IU / kg per IU / dl)
The therapeutic doses that can be used in the methods of the invention are approximately 10-100 IU / kg, more specifically, 10-20, 20-30, 30-40, 40-50, 50-60, 60-70,
<img file="MX336830B_D0064.tif" />
100 Ul / kg, and more specifically, 10,
90 of the Property
40, 45, 50, 55, 60, 65, 70, 75, 80, 85, <sup>90</sup> Additional therapeutic / IndUStrlClt that can be used in the invention are from about 10 to 150 IU / kg, more specifically,
100-110, 110-120, 120-130, 130-140, 140-150
70-80, 80-90, or
20, 25, 30, 35,
95, or 100 Ul / kg.
Doses methods of approximately approximately
Ul / kg, and more specifically, about 110, 115, 120,
125, 130, 135, 140, 145, or 150 IU / kg.
"Variant," as used herein, refers to a polynucleotide or polypeptide different from the original polynucleotide or polypeptide, but which retains the essential properties thereof, for example, the clotting activity of Factor VIII or the activity of Fe (binding to the
FcRn). Generally, the variants are generally very similar, and, in many regions, identical to the original polynucleotide or polypeptide. Variants include, for example, polypeptide and polynucleotide fragments, deletions, insertions, and modified versions of the original polypeptides.
Polynucleotide variants may comprise, or alternatively consist of, a nucleotide sequence that is at least 85%, 90%, 95%, 96%, 97%, 98%, or 99% identical to, for example, the nucleotide sequence that encode the sec. with nos. of ident: 1, 3, 5, 7, 9, or 11 (the portion of the
ΓηΊΐ ^^ ί Mexican stttuto
Factor VIII, the Fe portion, individually or together) ^ pfOfiledGd the chain complementary to it, a nucleotide coding sequence of mutants and recombinants of the
Known Factor VIII or Fe, such as those described in the publications and patents cited herein or the complementary strand thereof, a nucleotide sequence encoding the polypeptide of sec. with no. ident: 2, 4, 6, 8, 10, or 12 (the Factor VIII portion, the Fe portion, individually or together), and / or polynucleotide fragments of any of these nucleic acid molecules (e.g., those fragments described herein). Polynucleotides that hybridize to these nucleic acid molecules under stringent hybridization conditions or less stringent conditions are also included as variants, as are polypeptides encoded by these polynucleotides, as long as they are functional.
The polypeptide variants can comprise, or
<td>a11e natively</td><td>consist</td><td>in,</td><td>a</td><td>sequence</td><td>of</td><td>amino acids</td>
<td>what is at least</td><td colspan="2"> 85%, 90%, 95%,</td><td> 96%,</td><td> 97%, 98%,</td><td> 99%</td><td>identical to,</td>
<td>for example, the</td><td>sequence</td><td>of</td><td colspan="2">polypeptide that</td><td>I know</td><td>shows in</td>
<td>the sec. with no.</td><td>from ident:</td><td> 2,</td><td> 4, 6,</td><td>8, 10, or</td><td> 12</td><td>(Serving</td>
of Factor VIII, the Fe portion, individually or together), and / or polypeptide fragments of any of these polypeptides (eg, those fragments described herein).
<img file="MX336830B_D0065.tif" />
Mexican
For a nucleic acid that has at least one nucleotide industrial frequency sequence. For example, 95% identical to a reference nucleotide sequence, the nucleotide sequence of the nucleic acid is intended to be identical to the reference sequence, except that the nucleotide sequence may include up to five point mutations per 100 nucleotides of the reference nucleotide sequence. In other words, to obtain a nucleic acid that has a nucleotide sequence at least 95% identical to a reference nucleotide sequence, up to 5% of the nucleotides in the reference sequence can be deleted or replaced with another nucleotide, or a number of nucleotides up to 5% of the total nucleotides in the reference sequence can be inserted into the reference sequence. The query sequence can be, for example, the entire sequence shown in sec. with no. ident: 1 or 3, the open reading frame (ORF), or any fragment specified as described herein.
As a practical matter, it can be conventionally determined whether any particular polypeptide or nucleic acid molecule is at least 85%, 90%, 95%, 96%, 97%,
98% or 99% identical to a nucleotide or polypeptide sequence of the present invention through the use of known computer programs. A preferred method for
<img file="MX336830B_D0066.tif" />
determine the best overall match between a sequence | 5 |<sub>former</sub>j<sub>honey</sub> Query Property (reference or original sequence) and ηη ^ 0<sub>υ5</sub>|<sub>Γ</sub>|<sub>σ</sub>| subject sequence, also referred to as a global alignment sequence, can be determined by using the FASTDB computer program which is based on the algorithm of
Brutlag et al. (Comp. App. Biosci. (1990) 6: 237-245), which is incorporated herein by reference in its entirety.
In a sequence alignment the query and subject sequences are both DNA sequences. You can compare a
<td>10 sequence</td><td>of</td><td>RNA by</td><td>converting from U to T.</td><td>The</td>
<td>result</td><td>of</td><td>the alignment</td><td>global of sequences is</td><td>in</td>
<td>percentage</td><td>of</td><td>identity. The</td><td>preferred parameters that</td><td>I know</td>
used in a FASTDB alignment of DNA sequences to calculate percent identity are: matrix = unitary, k15 tuple = 4, mismatch penalty = 1, union penalty = 30, randomization group length = 0, cutoff score = l, gap penalty = 5, gap size penalty 0.05, window size = 500, or the length of the subject nucleotide sequence, whichever is shorter.
If the subject sequence is shorter than the query sequence due to 5 'or 3 deletions<sup>1</sup> , not due to internal blanks, a manual correction must be made to
<td>the results. This</td><td>because</td><td>the</td><td>Program</td><td>FASTDB</td><td>do not</td>
<td colspan="2">consider truncation 5<sup>1</sup> Y</td><td> 3'</td><td colspan="2">of the sequence</td><td>of</td>
<td>25 subject when calculating the</td><td>percentage</td><td>of</td><td>identity.</td><td>For</td><td>the</td>
<img file="MX336830B_D0067.tif" />
Institute
Mexican subject sequences truncated at the 5 'or 3 ends • Property
Industrial relation to the query sequence, the percent identity is corrected by calculating the number of bases in the query sequence that are 5 'and 3' from the subject sequence, which do not match / align, as a percentage of the total bases of the query sequence. Whether a nucleotide matches / aligns is determined by the results of the FASTDB sequence alignment. This percentage is subtracted from the percent identity, which was calculated by the FASTDB program above, using the specified parameters, to arrive at a final percent identity score. This corrected score is what is used for the purposes of the present invention. Only bases outside the 5 'and 3' bases of the subject sequence, as shown by the FASTDB alignment, that do not match / align with the query sequence, are calculated in order to manually adjust the percent identity score. .
For example, a 90 base subject sequence is aligned with a 100 base query sequence to determine percent identity. The deletions occur at the 5 'end of the subject sequence, and therefore the FASTDB alignment does not show a match / alignment of the first 10 bases at the 5' end. The 10 unpaired bases represent 10% of the sequence (number of bases in the
<img file="MX336830B_D0068.tif" />
5 'and 3' ends that do not match / with the number tot ^ l bases in the query sequence) so 10% is subtracted J ^ dUStriat from the percent identity score that was calculated by the FASTDB program. If the rest of the 90 bases coincide perfectly, the final identity percentage would be 90%.
In another example, a 90 base subject sequence is compared to a 100 base query sequence. This time the deletions are internal deletions such that there are no bases at the 5 'or 3' end of the subject sequence that do not match / align with the query. In this case, the percent identity that was calculated by FASTDB is not manually corrected. Again, only the 5 'and 3' bases of the subject sequence that do not match / align with the query sequence are manually corrected. No other manual corrections are made for the purposes of the present invention.
For a polypeptide having an amino acid sequence at least, for example, 95% identical to a query amino acid sequence of the present invention, the amino acid sequence of the subject polypeptide is intended to be identical to the query sequence, except that the sequence of the subject polypeptide can include up to five amino acid alterations for every 100 amino acids of the query amino acid sequence. In other words, to obtain a polypeptide that has a
<img file="MX336830B_D0069.tif" />
amino acid sequence at least 95% identical query amino acid sequence, up to 5% industrial amino acid residues in the subject sequence can be inserted, deleted (indels) or substituted with another amino acid. These reference sequence alterations can occur at the terminal amino or carboxyl positions of the reference amino acid sequence or anywhere between those terminal positions, either individually interspersed between residues in the reference sequence or in one or more groups. contiguous within the reference sequence.
As a practical matter, whether any particular polypeptide is at least 85%, 90%, 95%, 96%, 97%, 98% or 99% identical to, for example, the amino acid sequences of sec. with no. Identification code: 2 (the Factor VIII portion, the Fe portion, individually or together) or 4, or a known polypeptide sequence of Factor VIII or Fe, can be conventionally determined using known computer programs. A preferred method of determining the best overall match between a query sequence (reference or original sequence) and a subject sequence, which is also referred to as a global alignment sequence, can be determined by using the FASTDB computer program that is based on the algorithm of Brutlag et al., Comp. App. Biosci. 6: 237-245 (1990), which is incorporated
<img file="MX336830B_D0070.tif" />
stltuto, „,. ,, Mexican herein by reference in its entirety, sequence alignment the query and subject sequences are either both nucleotide sequences or both amino acid sequences. The result of the overall sequence alignment is in percent identity. Preferred parameters used in a FASTDB amino acid alignment are: matrix = PAM 0, k-tuple = 2, mismatch penalty = 1, binding penalty = 20, randomization group length = 0, cutoff score = l, window size = sequence length, gap penalty = 5, gap size penalty = 0.05, window size = 500, or the length of the subject amino acid sequence, whichever is shorter.
If the subject sequence is shorter than the query sequence due to N-terminal or C-terminal deletions, not internal deletions, a manual correction must be made to the results. This is because the FASTDB program does not take into account the N-terminal and C-terminal truncations of the subject sequence in calculating the overall percent identity. For subject sequences truncated at the N and C-terminus, relative to the query sequence, the percent identity is corrected by calculating the number of residues in the query sequence that are N- and C-termini of the sequence. subject, which do not match / align with the corresponding subject residue, as a percentage of
<img file="MX336830B_D0071.tif" />
Institute the total bases of the query sequence. If a residue M © XiCCJno
-Property matches / aligns is determined by the results of l<sup>to</sup>lndUStriat ~ FASTDB alignment sequence. This percentage is subtracted from the percent identity, which was calculated by the FASTDB program above, using the specified parameters, to arrive at a final percent identity score. This final percent identity score is what is used for the purposes of the present invention. Only the N- and C-terminal residues of the subject sequence, which do not match / align with the query sequence, are considered for the purpose of manually adjusting the percent identity score. That is, only the positions of the query residues outside the farthest N- and C-terminal residues of the subject sequence.
For example, a subject sequence of 90 amino acid residues is aligned with a query sequence of 100 residues to determine percent identity. The deletion occurs at the N-terminal end of the subject sequence and therefore the FASTDB alignment does not show a match / alignment of the first 10 residues at the N-terminal end. The 10 unpaired residues represent 10% of the sequence (number of residues in the N- and C terminals that do not match / total number of residues in the query sequence) so that 10% is subtracted from it.
<img file="MX336830B_D0072.tif" />
the percentage score of the FASTDB program. If the remaining 90 residues were conditioned 8-l € kFfOpí®Cfad
Industry perfectly the final identity percentage would be 90%.
In another example, a 90 residue sequence is compared to a 100 residue query sequence. This time, the deletions are internal deletions so that there are no residues at the N-terminus or C-terminus of the subject sequence that do not match / align with the query. In this case, the percent identity that was calculated by FASTDB is not manually corrected. Again, only residue positions outside the N- and C-termini of the subject sequence ends, as shown in the FASTDB alignment, that do not match / align with the query sequence are manually corrected. No other manual corrections are made for the purposes of the present invention.
Polynucleotide variants can contain alterations in coding regions, non-coding regions, or both. Polynucleotide variants that contain alterations that produce silent substitutions, additions, or deletions, but do not alter the properties or activities of the encoded polypeptide, are especially preferred. Nucleotide variants that are produced by silent substitutions due to degeneracy of the genetic code are preferred. Furthermore, variants are also preferred in which 5-10, 1-5, 1-2
<img file="MX336830B_D0073.tif" />
In ututo del Pmr /<sup>Dog</sup>° amino acids are substituted, deleted or added to Property
Industry any combination. Polynucleotide variants can be produced for a variety of reasons, for example, to optimize the expression of a codon for a particular host (change codons in human mRNA for those preferred by a bacterial host such as E. coli).
The naturally occurring variants are called allelic variants, and refer to one of several alternative forms of a gene that occupy a certain place on a chromosome of an organism (Genes II, Lewin, B., ed.,
John Wiley & Sons, New York (1985)). These allelic variants can vary at either the polynucleotide and / or polypeptide level and are included in the present invention. Alternatively, non-naturally occurring variants can be produced by mutagenesis techniques or by direct synthesis.
Through the use of known methods of protein engineering and recombinant DNA technology, variants can be generated to improve or alter the characteristics of polypeptides. For example, one or more amino acids can be removed from the N-terminal or C-terminal of the secreted protein without substantial loss of biological function. The authors of Ron et al., J. Biol. Chem. 268:
2984-2988 (1993), which is incorporated herein by reference in its entirety, reported on proteins
<img file="MX336830B_D0074.tif" />
Institute
Mexican KGF variants that have hepag ^ ifg binding activity. Property even after removing 3, 8, ~ ----<sup>J</sup> ^^ UStilal · or 27 residues similarly, the
Of amino-terminal amino acids.
Interferon gamma exhibited up to ten times greater activity after removing amino acid residues 8-10 from the carboxyl terminal of this protein. (Dobeli et al., J. Biotechnology 7: 199-216 (1988), which is incorporated herein by reference in its entirety.)
Furthermore, extensive evidence shows that variants often retain biological activity similar to that of natural protein. For example, Gayle et al. (J. Biol. Chem. 268: 22105-22111 (1993), incorporated herein by reference in its entirety) carried out extensive mutational analysis of the human cytokine IL-la.
They used random mutagenesis to generate more than 3,500 individual IL-la mutants that averaged 2.5 amino acid changes per variant over the entire length of the molecule. Multiple mutations were examined at every possible amino acid position. The researchers found that most of the molecule can be altered with little effect on both binding and biological activity. (See summary). In fact, only 23 unique amino acid sequences, out of the more than 3,500 nucleotide sequences analyzed, produced a protein that was significantly different in activity from the wild-type one.
<img file="MX336830B_D0075.tif" />
Institute
As noted above, "Mexican Property Polypeptide variants include, for example, polypeptides modified slfldUStrtat Modifications include, for example, acetylation, acylation, ADP ribosylation, amidation, covalent attachment of flavin, covalent attachment of a heme group , covalent bonding of a nucleotide or nucleotide derivative, covalent bonding of a lipid or a lipid derivative, covalent bonding of phosphatidylinositol, crosslinking, cyclization, disulfide bonding, demethylation, covalent crosslinking, cysteine formation, pyroglutamate formation, formylation, gamma carboxylation, glycosylation, GPI anchor formation, hydroxylation, iodination, methylation, myristoylation, oxidation, pegylation (Mei et al., Blood 116: 270-79 (2010), which is incorporated herein by reference in its entirety), proteolytic processing, phosphorylation, prenylation, racemization, selenoylation, sulfation, the addition of amino acids to proteins mediated by transfer RNA such as arginylcytion, and ubiquitination. In some embodiments, the γΐΙΙ Factor is modified, eg, pegylated, at any convenient location. In some embodiments, Factor VIII pegylates to a surface exposed Factor VIII amino acid, preferably a surface exposed cysteine, which may be an engineered cysteine. Mei and others (2010). In some modalities, the
Modified Factor VIII, for example Factor VIII
<img file="MX336830B_D0076.tif" />
Indusfrtat is a long-acting Factor VIII.
Steady-state volume of distribution (Vss), as used herein, has the same meaning as the term used in pharmacology, which is the apparent space (volume) in which a drug is distributed. Vss = the amount of drug in the body divided by the steady-state plasma concentration.
Roughly, as used herein for a range, it modifies both ends of the range. So about 10-20 means about 10 to about 20.
After describing the present invention in detail, the same. It will be more clearly understood by reference to the following examples, which are included below for purposes of illustration only and are not intended to be limiting of the invention. All patents and publications referenced herein are expressly incorporated by reference.
Example 1
Summary
A recombinant Factor VIII fusion protein with the deleted B-Fc domain (rFVIIIFc) was created to extend the half-life of FVIII. RFVIIIFc was studied in models of
<img file="MX336830B_D0077.tif" />
mouse and dog with severe hemophilia A.
. of the property
Recombinant Factor VIII (ReFacto). Whole blood clotting time | nd (j $ | f | gf (WBCT) in mice with hemophilia A was corrected to approximately two to three times longer and the elimination half-life in plasma was almost double the time for rFVIIIFc compared to ReFacto® In dogs with hemophilia A, an intravenous dose of rFVIIIFc (125 IU / kg) corrected the WBCT to normal. The WBCT was kept below 20 minutes, the time consistent with FVIII: C> 1%, up to approximately 96 hours, compared to 48 hours for
<td colspan="2">treated dogs</td><td>with the</td><td>ReFacto®. The</td><td>lifetime</td><td>half of</td>
<td colspan="3">removal of rFVIIIFc in the</td><td>plasma of</td><td>dog,</td><td>when</td>
<td>measured by</td><td>of</td><td colspan="3">use of ELISA or assays</td><td>activity</td>
<td>chromogenic was</td><td>of</td><td> 15.7 +</td><td>1.7 h, and</td><td> 15.4</td><td>± 0.3 h,</td>
<td>respectively.</td><td>The</td><td>€ ReFacto</td><td>'he corrected</td><td>the</td><td>WBCT by</td>
approximately half the length of rFVIIIFc and the plasma half-life was 7.0 h. Therefore, the fusion of FVIII to Fe produces a molecule with a longer plasma half-life and the ability to provide prolonged bleeding protection.
Introduction
The reduction in mortality, the prevention of joint damage and the improvement in the quality of life are important achievements due to the development of FVIII that derives from the
<img file="MX336830B_D0078.tif" />
plasma and recombinants. Prolonged protection from bleeding Instituto Mexicano would represent another key advance in the treatment of pacflftilQbProperty
Industrié with hemophilia A. The inventors created a recombinant and hybrid chimeric protein Factor VIII-Fe (rFVIIIFc) as an approach to extend the half-life of FVIII.
RFVIIIFc is a hybrid heterodimeric protein composed of B-domain deleted FVIII that fuses λ:
recombinantly to the Fe domain of human immunoglobulin G1 (IgGl) (Figure 1, sec. with Ident # 2, Table 2A) (This protein is also referred to herein as the FVIIIFc monomeric Fe fusion protein, the FVIIIFc monomer hybrid, the monomeric FVIIIIFc hybrid, and the monomer-dimer FVIIIFc.). Fe allows binding to the neonatal Fe receptor (FcRn), which is responsible for protecting IgG from degradation and gives IgG the three-week half-life observed in humans (Ghetie V., and Ward ES.
Annu. Rev. Immunol. 2000; 18: 739-766; Roopenian DC, and Akilesh
S., Nature Rev. Immunol 2007; 7: 715-725, each is incorporated herein by reference in its entirety).
The Fe domain of IgGl fuses with growth factors, cytokines, enzymes, and the ligand-binding receptor regions (Ashkanazi A, et al. Int. Rev. Immunol. 1993: 10: 219-27; Chamow SM, and Ashkanazi A, Trends Biotechnol 1996: 14: 52-60; Fisher et al. N. Engl. J. Med. 1996: 334 (26): 1697702, each of which is incorporated herein as
<img file="MX336830B_D0079.tif" />
reference in its entirety). Several of them have become important therapeutic molecules (eg, etanercept, ®ntiueftfaf alefacept, abatacept). In these fusion proteins, two effector molecules are linked to two Fe molecules. In this example, rFVIIFc was constructed as a monomeric Fe fusion protein (a copy of a polypeptide consisting of the sequence in Table 2A (i) (sec. with ID #: 2) with or without the signal sequence and a copy of a polypeptide consisting of the sequence in Table 2A (ii) (seq. with ID #: 4) with or without the signal sequence ), that is, with only one copy of the effector molecule (see
Figure 1), and the studies presented here compare the pharmacodynamics and pharmacokinetics of this new protein of
Recombinant factor VIII in mouse and dog models of hemophilia A. The signal sequence is cleaved during secretion. This protein construct is referred to herein as the Fe FVIIIFc monomeric fusion protein, the hybrid monomeric FVIIIFc, the monomeric FVIIIIFc hybrid, and the monomerdimeric FVIIIFc. See Example 1, Figure 1, Table 2A, and US Patent Nos. 7,404,956 and 7,348,004, each of which is incorporated herein by reference in its entirety, for the structure and production of this protein. Methods and Materials
FVIII preparations
Recombinant FVIIIFc
The coding sequence of FVIII with domain B
<img file="MX336830B_D0080.tif" />
Deleted recombinant human was obtained by reaction e:
<img file="MX336830B_D0081.tif" />
Mexican inausTnar polymerase chain (RT-PCR) derived from RNA poly js in human liver (Clontech) through the use of specific primers for FVIII. The FVIII sequence includes the native signal sequence for FVIII. The deletion of domain B ranged from serine 743 (S743; 2287 bp) to glutamine 1638 (Q1638; 4969 bp) for a total deletion of 2682 bp See Example 1, Figure 1, Table 2A, and patents from US Nos. 7,404,956 and 7,348,004, each of which is incorporated herein by reference in its entirety, for the structure and production of this protein.
The coding sequence for recombinant human Fe was obtained by RT-PCR from a human leukocyte cDNA library (Clontech) using primers specific for Fe. The primers were designed in such a way that the sequence of FVIII with the deleted B domain it will fuse directly to the N-terminal sequence of Fe without intervening a linker. The FVIIIFc DNA sequence was cloned into the mammalian dual expression vector pBUDCE4.1 (Invitrogen), under the control of the CMV promoter. A second sequence identical to Fe that includes the mouse Igk signal sequence was obtained by RT-PCR and cloned downstream of the second promoter, EFla, into the expression vector pBUDCE4.1.
The rFVIIIFc expression vector was transfected into
<img file="MX336830B_D0082.tif" />
human embryonic kidney 293 cells (HEK293H; Invit] by using the transfection reagent Lipofectamine 2000 (Invitrogen). Clonal stable cell lines were generated by selection with Zeocin (Invitrogen). A clonal cell line, 3C4-22 was used to generating FVIIIFc for in vivo characterization Recombinant FVIIIFc was produced and purified (McCue JT, et al. J. Chromatogr. As of 2009; 7824-7830, which is incorporated herein by reference in its entirety) in Biogen Idee (Cambridge, MA). The transfection strategy described above was expected to yield three products, ie the monomeric rFVIIIFc hybrid, the dimeric rFVIIIFc hybrid, and the dimeric Fe. However, essentially no dimeric rFVIIIFc was detected in the conditioned medium of these cells. Rather, the conditioned medium contained monomeric Fe and rFVIIIFc. It is possible that the size of the dimeric rFVIIIFc was too large and prevented efficient secretion by the cell. This result was beneficial as it yields less complicated monomer purification than if all three proteins were present. The material used in these studies had a specific activity of approximately 9000 IU / mg. Furthermore, these human cells produced higher levels of protein than other cells that were attempted in this experiment.
Recombinant FVIII
Recombinant FVIII with the B domain deleted
<img file="MX336830B_D0083.tif" />
(ReFacto®) was purchased from Novis Pharmaceuticals and is in accordance with the manufacturer's instructions. The (recombinant FVIII with deleted domain B) has the same amino acid sequence as amino acids 1 to 1438 of sec. with no. Identification number: 2.
Animals with hemophilia A
Hemophilia A mice are knocked out for exon 16 FVIII on a 129 x B6 background obtained from Dr.
Kazazian at the University of Pennsylvania (Bi L, et al. Nat. Genet. 1995; 10 (1): 119-121, incorporated herein by reference in its entirety) and were raised on Syntonix. These mice have long whole blood clotting times (> 60 min), and are therefore a good model of severe hemophilia A.
The dogs with hemophilia A were from a congenital colony maintained at the Francis Owen Blood Research Laboratory of the University of North Carolina,
Chapel Hill (Graham, JB, et al. J. Exp. Med. 1949; 90: 97111, incorporated herein by reference in its entirety). These dogs have a severe hemophilic phenotype comparable to the severe form of the human disease (Graham,
JB, et al. J. Exp. Med. 1949; 90: 97-111; Lozier, JN, et al. Proc. Nati. Acad Sci. 2002; 99: 12991-12996, each of which is incorporated herein by reference in its entirety).
<img file="MX336830B_D0084.tif" />
Study design
Studies in mice with hemophilia A The effect of rFVIIIFc and ReFacto<sup>8</sup> The whole blood clotting time (WBCT) was studied in Factor VIII-deficient mice. Each protein was administered intravenously at 50 IU / kg and blood was collected from the tail vein of each mouse pre-dose and at various points after dosing. Blood samples were incubated in microtubes at 37 ° C and visually inspected once per minute for the presence of a clot. The time of clot formation was recorded. If a clot did not form within 60 min, the clotting time was recorded as> 60 min. Blood from normal mice clots in approximately 4 min (range 2-7 min, n = 10 mice) in the WBCT assay.
In a second group of studies, mice with hemophilia A were administered a single intravenous dose of 50 IU / kg of rFVIIIFc, ReFacto * or Advate® (4 mice for each time point). Blood was collected by cardiac puncture in one-tenth volume of 3.2% sodium citrate at
0.25, 8, 24, 48 and 72 hours after dosing. Plasma was, prepared, and stored at -80 ° C until analysis for FVIII activity using a chromogenic FVIII-specific activity assay.
Studies in dogs with hemophilia Ά
In a single dose PK / PD study of rFVIIIFc, two
<img file="MX336830B_D0085.tif" />
I or 18 ^
Institute
Mexican dogs with hemophilia A from the Chapel Hill colony were administered a single intravenous dose of 125 IU / kg and the ^ UlMal blood samples were collected pre-dose and post-dose at selected time points for the WBCT, time activated partial thromboplastin (APTT), plasma FVIIIFc concentration, hematology, and blood biochemistry. Time points for the WBCT included pre-doses, 5 and 30 min and 1, 2,
4, 8, 24, 32, 48, 72, 96, 144, and 168 hours after dosing. Blood collections for clotting activity (APTT) and plasma concentration of FVIIIFc included the time points indicated above for WBCT as well as 15 min and 3, 6, 12 hours after dosing.
A second study was conducted in which the ReFacto<sup>19</sup> (114 IU / kg for dog M12 and 120 IU / kg for dog M38) was administered intravenously. WBCT was measured until clotting times were ^ 20 min (consistent with FVIII: C> 1%), and then 125 IU / kg of rFVIIIFc was administered intravenously to the same dogs and blood samples were collected. for WBCT, aPTT, plasma FVIIIFc concentration, hematology and blood biochemistry. Time points for the WBCT included pre-dose, 5 and 30 min and 1, 2, 4, 8, 24, 32, 48, 72 h after dosing. Blood was also collected at
<img file="MX336830B_D0086.tif" />
ÜJLS fatuto 96, 120, 144, and 168 hours after dosing. ^: ^^ ®® ^ ® the FVIIIFc. The blood collection for clotting activity and plasma concentration of FVIIIFc included the time points mentioned above for the WBCT as well as 15 min and 3, 6, 12 hours after dosing.
The WBCT procedure in dogs with hemophilia A was slightly different than that in mice with hemophilia A. After dosing with either rFVIIIFc or ReFacto®, 1 ml of blood was collected at various time points and 0.5 ml was distributed in two siliconized glass tubes that were subsequently placed in a water bath at 28 ° C. Starting at one minute, a tube was tilted every 30 seconds, without disturbing the second. When a clot formed in the inclined tube, the second tube was then tilted every 30 seconds until a clot formed. The time to a fully gelled clot in the second tube was recorded as the WBCT.
FVIII activity in plasma
Measurement of FVIII activity in plasma by a specific chromogenic assay for FVIII
Plasma samples were evaluated for Factor VIII activity by an automated chromogenic method using a Sysmex CA1500 instrument and reagents were from Siemans Healthcare Diagnostics (Dallas, TX, kit
<img file="MX336830B_D0087.tif" />
# Β4238-40). RFVIIIFc activity was determined by using a standard curve created with the 7th Norm.
International for FVIII concentrate (NIBSC code 99/678) that was added to Factor VIII depleted human plasma (Stago, USA) in concentrations ranging from 1.5 to 0.016 IU / ml.
Measurement of rFVIIIFc or FVIII by ELISA
FVIIIFc in dog plasma by ELISA
An antibody specific for the Al domain of FVIII (Green Mountain Antibodies: GMA-8002) was coated on 96-well plates and incubated for 1 hour at 37 ° C.
Coated plates were blocked with Tris buffered saline containing Tween 20, CaCl<sub>2</sub> and bovine serum albumin for 1 hour at room temperature and then standards, controls and samples were prepared in normal dog plasma, diluted 1:10 and then added to plates and incubated for 1 hour at 37 ° C. The plates were washed and then donkey anti-human Fe-HRP (Jackson: 709-036098) was added and incubated for 1 hour at 37 ° C. After washing, TMB (supersensitive substrate
BioFx: TMBS-0100-01), the substrate reaction was quenched with acid and absorbance was measured on a SpectraMax Plus plate reader (Molecular Devices) at 450nm.
<img file="MX336830B_D0088.tif" />
ReFacto® in dog plasma by ELISA Mexican Title of Property
An anti-FVIII antibody specific for the AlInustitot domain of the heavy chain (Green Mountain Antibodies: GMA-8002) was coated on 96-well plates and incubated for 2 hours at room temperature. The coated plates were blocked for 1 hour at 37 ° C and after washing, standards, controls and samples were prepared in normal dog plasma and diluted 1:10 added to the plates and incubated for 2 hours at room temperature. The plates were washed and then treated with the detection antibody, a pre-diluted anti-FVIII conjugated with horseradish peroxidase (Affinity Biologicals: F8C-EIAD), and incubated at room temperature for 1 h. After washing TMB (Supersensitive BioFx Substrate: TMBS-0100-01) was added to the plates for 10 minutes. The substrate reaction was inactivated with acid and the signal was measured on a SpectraMax Plus plate reader (Molecular Devices) at a wavelength of 450 nm.
Fibrinogen measurement
Fibrinogen concentration in plasma was measured at Esoterix (Research Triangle Park, North Carolina) using a kit containing the HemosILÜ PTFibrinogen-HS reagent (Instrumentation Laboratory, Lexington, MA, Catalog # 0008468210) and the analyzer ACL 7000 Coagulation System (Beckman Coulter), according to the instructions of the
<img file="MX336830B_D0089.tif" />
maker.
Platelet measurement
Mexican Industrial Property
Platelets were counted in EDTA anticoagulated whole blood by automated methods using the Vet-ABC-Diff hematology analyzer that was programmed with a species-specific smart card (SCIL Animal Care Co., Gurnee, IL).
Pharmacokinetic analysis
Pharmacokinetic parameters were calculated by non-compartmental analysis using WinNonlin Pharsight software, version 5.2 (Mountain View, CA). Pharmacokinetic parameters included maximum plasma concentration (C<sub>m</sub>ax), the area under the curve of plasma concentration versus time (AUC), the elimination half-life (ti /<sub>2</sub>), volume of distribution (Vss), and clearance (Cl).
Results
Recombinant FVIII-Fe
RFVIIIFc is a recombinant fusion of FVIII with the Fe-deleted human B domain of human IgGl, with no intermediate linker sequence (rFVIIIFc; Figure 1).
The purified rFVIIIFc had a specific activity of approximately 9000 IU / mg which was determined using a 'chromogenic activity assay. Recombinant FVIII with the deleted B domain (ReFacto<sup>and</sup>) had a
L '-. FrtfftsSS
<img file="MX336830B_D0090.tif" />
Reported specific activity of 9110 to 13700 IU / mg.
conversion of specific activity to Ul / nmol for tefieJa ^ pp<sup>1</sup>®^!
Industrie ^ ®
Considering the difference in size between FVIIIFc and ReFacto (216 kDa and 170 kDa, respectively), it indicated that the two proteins had approximately equivalent specific activities (1970 IU / nmol of rFVIIIFc and 1521 to 2287 IU / nmol of ReFacto®). Thus, the FVIII activity of rFVIIIFc is not affected by fusion of the C-terminal human FVIII to
N-terminal of human Faith.
Administration to mice with hemophilia A
A single 50 IU / kg dose of rFVIIIFc or ReFacto® was administered intravenously to Factor VIII-deficient mice (n = 6 / group). Blood samples were taken pre-dose and after dosing for 120 hours and the WBCT was determined as described in Materials and Methods. The baseline WBCT was greater than 60 min. Data from a representative experiment are shown in Figure 2 and Table 3. Immediately after administration with either rFVIIIFc or ReFacto®, the WBCT was corrected to 2-17 minutes. The blood of the mice treated with ReFacto® lost the ability to clot in 42 hours, while the blood of all the mice treated with rFVIIIFc still clotted at 96 hours, the blood of one of six clotted at 113 hours, but all had lost the ability to clot at 120 hours. These data suggest that
<img file="MX336830B_D0091.tif" />
duration of effect of rFVIIIFc <sub>t</sub> _____ of the Property three times as long as for ReFacto. Industrialize
The chromogenic activity of rFVIIIFc, ReFacto®, or Advate® (full-length recombinant Factor VIII) was studied in Factor VIII-deficient mice after a single intravenous dose of 50 IU / kg. Blood was collected pre-dose and after dosing at 8, 24, 48 and 72 hours. Activity was measured using a FVIII specific activity chromogenic assay and is shown in Figure 3.
The pharmacokinetic parameters are shown in Table 4. The circulating half-life for rFVIIIFc was approximately 1.6 to 2 times longer (11.1 hours) compared to Advate® (7 hrs) and ReFacto® (5 hrs). The Cmax was 1.6 ± 0.36 IU / ml for rFVIIIFc compared to 0.47 + 0.30 IU / ml for Advate® and 0.67 ± 0.44 IU / ml for ReFacto®. The systemic exposure of rFVIIIFc was markedly higher for rFVIIIFc (22.6 h »IU / ml) compared to ReFacto® (6.94 h * IU / ml) and Advate® (3.90 h * IU / ml) and the clearance of rFIIIFc was markedly lower (2.09 ml / h / kg) compared to both ReFacto® (7.2 ml / h / kg) and Advate® (12.8 h / ml / kg) in mice with hemophilia A.
Administration to dogs with hemophilia A
The pharmacodynamics (PD) and pharmacokinetics (PK) of rFVIIIFc were studied in the Chapel Hill colony of dogs with hemophilia A. A single intravenous dose of 125 IU / kg
<img file="MX336830B_D0092.tif" />
of rFVIIIFc was administered to each of four dogs <sup>with </sup>hemophilia A and WBCT were immediately corrected to * ® normal (Figure 4). The WBCT interval in normal dogs was 8-12 min. WBCT was kept below 20 min, the time consistent with FVIII: C> 1%, for approximately 96 hours with the exception of one dog that had WBCT <20 min for 72 h. Furthermore, aPTT immediately corrected to normal (Table 6). The concentration of rFVIIIFc. in plasma it was measured using a specific ELISA that was designed to detect both the FVIII and Fe portion of the molecule. The plasma concentration versus time curves are shown in Figure 5. PK analysis of the data showed that the ti /<sub>2</sub> was 15.7 + 1.7 h (Table 5). Similar results were obtained when rFVIIIFc was measured using a chromogenic FVIII-specific activity assay (ti /<sub>2</sub>= 15.4 ± 0.3 h, Table 5) and the plasma concentration versus time curves were similar when using both methods (Figures 5 and 6). When the activity data were converted from IU / ml to ng / ml by using the specific activity for rFVIIIFc, there was a good correlation with the ELISA data, which showed that the protein that was measured by ELISA was fully active. .
Two of the rFVIIIFc-treated dogs also received a single dose of ReFacto®, 114 IU / kg for the
<img file="MX336830B_D0093.tif" />
Institute dog M12 and 120 IU / kg for dog M38, 72 hours before djs g dosing with the rFVIIIFc. The WBCT and aPPT were corrected to normal immediately after dosing with ReFacto ”. However, the normalization of the WBCT after the single dose of rFVIIIFc lasted approximately two times longer compared to ReFacto® (Figure 4). Furthermore, the plasma half-life of rFVIIIFc (15.7. + 1.7 hours) was approximately twice the time for rFVIIIFc compared to ReFacto® (7.0 and 6.7 h) when the concentration of proteins in plasma were measured by
ELISA (Table 5). Similar results were obtained when the two molecules were measured for specific chromogenic activity of FVIII.
To assess the potential risk of thrombogenicity, platelets and fibrinogen were measured. After dosing with either rFVIIIFc or ReFacto®, platelet numbers and plasma fibrinogen concentration did not change from pre-dose values (data not shown).
Discussion
Recombinant FVIIIFc was produced in human embryonic kidney 293 cells (HEK 293) from a stably transfected cell line and purified from cell culture medium. Production in a human cell line represents a significant change in manufacturing
<img file="MX336830B_D0094.tif" />
Chinese hamster ovary or baby hamster kidney cells.
The reason for this change was that human cells were expected to be better equipped to make the necessary post-translational modifications to the portion
FVIII of this molecule.
Conversion of specific activity to Ul / nmol to account for difference in molecular weights for rFVIIIFc and recombinant FVIIIB with deleted B domain
Φ (ReFacto) indicated that the specific activities are similar for both proteins (1970 Ul / nmol for rFVIIIFc and 1521-2287 Ul / nmol for ReFacto®). It is surprising that the specific activity of rFVIIIFc is not affected by fusion of the C-terminus of pvill with the N-terminus of Fe since the Cl and C2 domains of FVIII are involved in binding to the phospholipid which is essential for full FVIII activity (Fay, PJ, J. Hematology 83: 103-8 (2006) and Raut, S, et al., Br. J. Haematol. 107: 323 (1999), each of which is incorporated by reference herein in its entirety).
Hemophilia A treatment is on-demand at the time of a bleeding episode or prophylaxis to prevent bleeding. Although on-demand treatment is still frequently used, there is a trend toward
<img file="MX336830B_D0095.tif" />
prophylaxis and prevention of joint damage (Blanchette PMexIcano Property et al. Haemophilia 2004: 10; 679-683, Manco-Johnson, MJ, Yndusfrlat others N. Engl. J. Med. 2007 ;. 357: 535-544, each one of which is incorporated herein by reference in its entirety). Current FVIII products are administered every two to three days for prophylaxis due to the relatively short half-life of 10-12 hours in order to maintain an FVIII: C above 1% in patients (Morfini, H, Haemophilia 2003; 9 (suppl 1): 94-99, - discussion
100, White GC, and others Thromb Haemost. 1997: 77: 660-7,
Blanchette, P, and others J. Thromb. Haemost. August 2008; 6 (8): 1319-26, each of which is incorporated herein by reference in its entirety). Longer-acting FVIII therapies that provide prolonged protection from bleeding would represent a marked improvement in the quality of life of patients with hemophilia A. Strategies to extend the half-life of clotting factors include those that were successful for other molecules, including pegylation (Rostin J, et al. Bioconj Chem. 2000; 11: 387-96, which is incorporated herein by reference in in its entirety), glycopegylation (Stennicke HR, et al. Thromb Haemost. 2008; 100: 920-8, incorporated herein by reference in its entirety), formulation with pegylated liposomes (Spira J, et al.
Blood 2006; 108: 3668-3673, Pan J, et al., Blood 2009 ;.
114: 2802-2811, each of which is incorporated
<img file="MX336830B_D0096.tif" />
cano present for reference in its entirety) and conj dáiata.eK> p! 0clacf fndusfrlat with albumin (Schulte S., Thromb Res. 2008; 122 Suppl 4:
S14-9, which is incorporated herein by reference in its entirety). Pegylation represents one approach to reducing clearance, however the effect of the modification in vivo is currently unknown. The result of direct PEGylation of FVIII in vivo is currently unknown, whereas FVIII that was formulated with pegylated liposomes was clinically studied and showed a modest or no effect on periods of bleeding (Spira J, et al. Blood 2006 ;. 108: 3668-3673, Spira J, et al. Thromb Haemost. September 2008; 100 (3): 429-34, each of which is incorporated herein by reference in its entirety).
The present approach to extend the half-life of
FVIII was recombinantly fusing FVIII to the Fe domain of IgGl. Fe binds to the naturally occurring receptor,
FcRn, of which the normal function is the protection of IgG from degradation. The results described herein represent the initial pharmacokinetic characterization and efficacy of rFVIIIFc compared to a product of rFVIII in mice with hemophilia A and in dogs with hemophilia A. In both species, the half-life of rFVIIIFc was approximately twice that of rFVIII. when measured by FVIII activity or by ELISA (dogs only). These
<img file="MX336830B_D0097.tif" />
Institute data also correlate well with the dMOXiCGno cte Property results.
WBCT of both animal models, that is, the duration of the modustrlot effect of rFVIIIFc on the WBCT was approximately twice the time compared to the ReFacto. In dogs, Cmax and clearance were similar for rFVIIIFc and
Φ
ReFacto, but the steady-state AUC and volume of distribution were approximately 1.5-fold and 2-fold higher for rFVIIIFc compared to ReFacto®, respectively. The pharmacochemical parameters of ReFacto in this animal model are consistent with the values described in the literature (Brinkhous K, et al. Sem Thromb. Haemost. 2002; 28: 269-272, which is incorporated herein by reference in its entirety).
If these results translate into the same half-life extension in humans, this could represent a significant advance in the treatment of patients with hemophilia A.
Additional references (each nail of which is incorporated by reference in its entirety herein)
Berkner K., Methods Enzymol. 1993; 222: 450-477.
Bitonti AJ, and Dumont JA., Adv. Drug Del. Rev.
-2006,-58 :1106-1118.
Dumont JA, et al., J. Aerosol Med. 2005; 18: 294-303. Dumont JA, et al. BioDrugs 2006: 20: 151-160.
Ellis CN, and Krueger GG., N. Engl. J. Med. 2001; 345: 248-55.
<img file="MX336830B_D0098.tif" />
Low SC, et al., Hum Reprod.
Manco-Johnson, M., Haemophili
Mannucci, PM, and Tuddenham,
2001;344:1773-1779.
Peyvandi F, et al., Haemophilia 2006; 12 (Suppl 3): 8289.
Rodriguez-Merchan, EC., Semin. Thromb. Hemost.
2003;29:87-96.
Srour MA, et al., Ann. Hematol. 2008; 87: 107-12.
Example 2
The objective of the study was to determine the pharmacokinetics and pharmacodynamics of rFVIIIFc and BDDrFVI II- (Xyntha *) in macaques after a single intravenous dose.
Materials and methods
RFVIIIFc (Biogen Idee), was supplied as a frozen liquid at a concentration of 1.2 mg / ml, and 9882 IU / ml. The specific activity was 8235 IU / mg. Storage was at -70 ° C. It was diluted before injection.
Name: Xyntha (Novis Pharmaceuticals), supplied as a lyophilized powder that is reconstituted according to the manufacturer's instructions to produce a solution with a nominal concentration of 525 IU / ml. Storage was in accordance with the manufacturer's recommendations.
<img file="MX336830B_D0099.tif" />
Mexican Property Animals
Cynomolgus monkeys from the New IberialndUSÍTtOt Research Center (NIRC) colony were used, and the study (Study NIRC # 87330903) was carried out according to a protocol that was approved by the NIRC IACUC (APS 2008-8733-058) in NIRC at New Iberia,
THE.
Six previously untreated cynomolgus monkeys (three males, three females) were used in the study and determined to be in good health.
The study was conducted in compliance with UL Lafayette NIRC protocol and standard operating procedures.
Study design
RFVIIIFc was administered intravenously at 125 IU / kg to each of six monkeys (three males, three females). Xyntha (BDD-rFVIII) was administered intravenously to the same animals at 125 IU / kg in a crossover design. Group 1 (n = 3) animals received Xyntha on day 0 and rFVIIIFc on day 3, while group 2 (n = 3) animals received rFVIIIFc on day 0 followed by Xyntha on day 4. The additional day between doses for group 2 was to ensure that rFVIIIFc had enough time to fall below predicted baseline levels. Blood was collected for plasma in one-tenth volume of 3.2% sodium citrate from each animal
<img file="MX336830B_D0100.tif" />
pre-dose and after dosing at 0.25, 4, 12, 24, d? 9faPTOjÍiecfcic | Industrial and 72 hours for the measurement of rFVIIIFc or Xyntha by ELISA and a chromogenic assay of the specific activity of the
FVIII.
ELISA to measure rFVIIIFc and FVIII in plasma
Method for measuring rFVIIIFc in monkey plasma.
This enzyme-linked immunosorbent assay (ELISA) was designed to quantify rFVIIIFc in monkey plasma. In this ELISA method, a goat anti-human IgG (H + L) antibody (absorbed in monkey) from Bethyl Laboratories (Cat.
# A80-319A) was diluted in coating buffer and immobilized on a 96-well sample microtiter plate. The plate was aspirated, and all noadsorbed sites were blocked with the addition of blocking buffer (3% BSA / lxTris) for approximately 2 hours at 37 ° C. Plasma samples were diluted 1:20 with high calcium sample dilution buffer (3% dry skim milk / TBST with 30 mM CaCl2) and dispensed onto the sample plate. The plates were incubated for approximately 2 hours at 37 ° C. The plate was subsequently washed and the mouse anti-Factor VIII antibody with the deleted B domain (a.BDDAl) (Al domain) from Green Mountain Antibodies (Cat. # GMA-8002) was added to the plate and incubated for approximately 1 hour at 37 ° C. After washing the plate, the antibody from
<img file="MX336830B_D0101.tif" />
goat anti-mouse IgG2a conjugated to Southern BioteclM ^ Qgpg déla HRP (Cat # 1080-05) and incubated for approximately 3 minutes at room temperature. The plate was washed again and a tetramethylbenzidine (TMB) solution was added to the peroxidase substrate and incubated for approximately 30 minutes at room temperature. The reaction was stopped by adding a non-acid stop solution. Color developed in proportion to the amount of rFVIIIFc in the sample. The plates were read on an absorption plate reader using a single detection wavelength, 650 nm. RFVIIIFc concentrations were determined on a standard curve obtained by plotting optical density (OD) versus concentration using a four-parameter logistic curve fitting program. The range of the calibration curve for this method was 0.400 ng / ml-51.2 ng / ml in 5% monkey plasma (8.00 ng / ml -1024 ng / ml in 100% monkey plasma). A calibrator outside the rated range of the assay at 0.200 ng / ml in 5% monkey plasma can be included to serve as an anchor point to facilitate curve fitting. The anchor point is removed or retained based on the best curve shape (that is, the highest number of reading standards within a defined precision,% RE).
<img file="MX336830B_D0102.tif" />
<img file="MX336830B_D0103.tif" />
Method to measure Factor VIII in plasma of Mexican monkeys
This enzymatic immunosorbent assay (Elcfé ^ prógfteciacl Industriar designed to quantify FVIII in monkey plasma. In this ELISA method, Green Mountain Antibodies mouse antibody aBDDAl FVIII (Cat. # GMA-8002) was diluted in coating buffer and immobilized on a 96-well sample microtiter plate. The plate was aspirated and all non-adsorbed sites were blocked with the addition of blocking buffer (BST / lxTris 3%) for approximately 1 hour at 37 ° C. Plasma samples were diluted 1:20 with high calcium sample dilution buffer (blocking buffer with 100 mM CaCl2) and dispensed onto the sample plate. The plates were incubated for approximately 2 hours at 37 ° C. After washing the plate, a detection antibody from the Affinity Biologizals Biologicals kit, a HRP-labeled polyclonal antibody (Cat. # F8C-EIA-D), was re-diluted in TBS / 0.05% Tween 20, and added to the plate and incubated for about 1 hour at room temperature. The plate was washed again and a tetramethylbenzidine (TMB) peroxidase substrate solution was added and incubated for approximately 30 minutes at room temperature. The reaction was stopped by adding an acid stop solution. Color developed in proportion to the amount of FVIIIFc in the sample. The plates were read in
<img file="MX336830B_D0104.tif" />
an absobance reader for plates with a single length (fftexican of the Detection wave property, 450 nm. FVIII concentrations <sup>s</sup>^ idUStrtOt determined on a standard curve that was obtained by plotting the optical density (OD) as a function of the concentration by using a program of four logistic curve fitting parameters. The range of the calibration curve for this method was 0.625 ng / ml -20 ng / ml in 5% monkey plasma (12.5 ng / m - 400 ng / ml in 100% monkey plasma). Two calibrators outside of the full assay range at 0.313 and 0.156 ng / ml in 5% monkey plasma can be included to serve as anchor points to facilitate curve fitting. Anchor points are removed or can be removed or retained based on the best curve shape (that is, the highest number of reading standards with a defined precision,% RE).
FVIII-specific chromogenic assay FVIII activity in plasma samples from cynomolgus monkeys was estimated based on the administered dose, then diluted to approximately 0.25 - 1 IU / ml in Factor VIII suppressed human plasma (Diagnostica Stago ). The samples were analyzed on a Sysmex CA1500 (Siemens Diagnostic Healthcare) using a chromogenic kit for rl FVIII (Siemens). In this chromogenic assay, rFVIIIFc in plasma samples was activated by thrombin. Activated Factor VIII (FVIIIa) a
<img file="MX336830B_D0105.tif" />
then accelerated the conversion of Factor X (FX)
<img file="MX336830B_D0106.tif" />
Industrialize
Factor Xa (FXa) in the presence of activated factor IX (Fli ^ ,, phospholipids (PL) and calcium ions. The activity of FXa was evaluated by hydrolysis of a p-nitroanilide substrate specific to FXa. The initial rate of release of pnitroaniline (pNA) measured at 405 nm was proportional to the activity of FXa, and therefore to the activity of FVIII in the sample. The limit of quantification of the activity of the
FVIII due to rFVIIIFc in this assay was ~ 0.3 IU / ml. The assay was able to measure total FVIII activity down to a lower limit of approximately 0.06 IU / ml with a precision of + 20%. The activity that was calculated in the pre-dose sample for the individual animals was subtracted from the value at each time point to generate the PD curves (FVIII activity vs. time).
A standard curve was generated from 7<sup>ma</sup> International Standard for FVIII Concentrate NIBSC diluted to 1 IU / ml in FVIII-deficient human plasma. The calibration curves were serially diluted on the Sysmex instrument to give concentrations of 0.15, 0.1, 0.05, 0.025, 0.0053 and
0.0026 Ul / ml. Since the instrument diluted all samples 1:10 internally, the standard FVIII concentrations corresponded to plasma concentrations of 1.5 to 0.026 IU / ml, which was the range of FVIII activities that could be measured.
<img file="MX336830B_D0107.tif" />
Analysis of PK 'Mexicano de Ies Property
The concentration profiles over time were evaluated using the non-compartmental analysis module in the WinNonlin software program (Version 5.2, Pharsight Corporation, Mountain View, CA).
Results
The concentration of rFVIIIFc in monkey plasma was measured using a sandwich ELISA format that measured both FVIII and Fe portions of the molecule and the data is shown in Table 7. All pre-dose samples were below of the limit of quantification. Figure 7 illustrates the mean plasma concentration of rFVIIIFc and Xyntha of the group over time and the curves of individual plasma concentration versus time are shown in Figure 8. A summary of the pharmacokinetic parameters of rFVIIIFc and Xyntha are shown in Tables 9 and 10, respectively. The mean tl / 2 for rFVIIIFc was 11.9 ± 1.7 hours (range 9.3 to 14.1 hours) and for Xyntha, the mean tl / 2 of elimination was 12.7 ± 4.4 hours (range 9.2 to 19.9 hours).
FVIII activity was measured using a FVIII-specific activity chromogenic assay and the data is shown in Table 8. Pre-dose activity due to endogenous FVIII was subtracted from all samples. A graph of the group mean data is shown in Figure yUj
InSltuto and individual plasma concentration ν ^ θχιΟΟΠΟ time curves are shown in Figure 10. A summary pharmacokinetic parameters is presented for the rFVIIIFc and Xyntha in Tables 9 and 10, respectively. The mean tl / 2 elimination was 16.1 + 6.9 hours (range 11.6 to
29.4 hours) for the rFVIIIFc and 12.5 + 1.7 hours (interval of
10.4 to 14.3 hours) for Xyntha.
Discussion and Conclusions
Elimination half-lives were similar for rFVIIIFc and Xyntha after a single intravenous dose of 125 IU / kg if the test article was measured by ELISA or by a chromogenic activity assay.
Example 3
This will be a phase I / IIa, open-label, crossover, dose-escalation, multi-center trial, and the first human study designed to evaluate the safety, tolerability, and pharmacokinetics of a single dose of rFVIIIFc in subjects with severe hemophilia A ( defined as <1 Ul / dl [1%] of endogenous factor VIII [FVIII]). A total of approximately 12 pretreated patients will be enrolled and dosed with rFVIIIFc at 25 or 65 IU / kg. After screening (expected within 28 days prior to the first dose of Advate® [rFVIII], the reference comparator agent) and a minimum of 4 days (96 hours) without FVIII treatment prior to the first injection,
<img file="MX336830B_D0108.tif" />
approximately 6 subjects will receive a single dose
Instituto dft,, 2¿ '<sup>J</sup>®r<sup>AC</sup>no Property
Advate® IU / kg followed by a pharmacokinetic (PK) profile of todUSfrtat days (72 hours) and then they will cross over and receive a single open-label 25 IU / kg dose of rFVIIIFc for a 7-day PK profile (168 hours) . The first 3 subjects will be dosed sequentially. For the first three (3) subjects treated with 25 IU / kg rFVIIIFc, each subject will undergo an inhibitor evaluation 14 days (336 hours) after injection of rFVIIIFc. Dosing of the next subject (for the first three subjects only) will occur once the inhibitor assay is complete. After the third subject completes the 14-day inhibitor trial, the other three 25 IU / kg subjects and the six 65 IU / kg subjects will begin to enroll sequentially at least 1 day apart within each dose group. .
One week after the last subject receives the rFVIIIFc dose of 25 IU / kg, approximately 6 unique subjects will be recruited to the 65 IU / kg cohort. Each subject in the 65 IU / kg cohort will receive a single 65 IU / kg dose of Advate® followed by a 4-day (96-hour) PK profile then cross over and receive a single 65 IU / kg dose of rFVIIIFc, of open tag for a 10 day (240 hour) PK profile. If a bleeding episode occurs before the first injection of rFVIIIFc in any cohort, the
<img file="MX336830B_D0109.tif" />
Subject institute must be used for treatment with the product FVIII M © XICOno <3 © the Pre-study period and an interval of at least 4 days IndllStUCSt must pass before receiving the first injection of rFVIIIFc for the PK profile.
All subjects will be followed for a safety evaluation period of 14 days (336 hours) and 28 days after administration of 25 IU / kg or 65 IU / kg rFVIIIFc for safety. All subjects will undergo pre- and post-dosing pharmacokinetic sampling along with blood samples for analysis of FVIII activity at designated time points.
Example 4
Activity at the Xasa Complex
To investigate the binding of Factor VIII proteins (rBDD FVIII and rFVIIIFc) with FlXa, and to measure the ability of these proteins to activate FX, kinetic studies were performed to examine these interactions in the context of the Xase complex. This assay involved the formation of the Xase complex with the activated FIX and the activated rBDD FVIII or rFVIIIFc protein on a phospholipid surface in the presence of calcium, and the monitoring of the conversion of FX to FXa by measuring the cleavage of a chromogenic substrate. or fluorogenic.
Briefly, FVIII is first activated with otthrombin for 5 minutes, then mixed with FlXa in
Jnituto presence of Ca2 +, and synthetic phospholipid vesiclesgW®XlCQno
Property (25% phosphatidylserine (PS) / 75% phosphatidylcholine (PC)) dfKIUSfftQj platelets. Under the conditions described below,
FVIIIa and FlXa interact in the presence of a phospholipid surface and calcium ions to form an active Xase complex that mediates the conversion of FX to FXa through proteolytic processing. In turn, FXa cleaves a specific chromogenic or fluorogenic substrate by FXa. The cleaved substrate is chromogenic and therefore the amount of cleaved substrate in a solution is indicative of the amount of FXa generated. This is quantified by measuring the absorbance of the solution at 405 nm.
A. Activation of factor X
The ability of rBDD FVIII and rFVIIIFc to activate FX was studied in the context of the Xase complex as described above. Thrombin-activated FVIII proteins were incubated with FlXa and phospholipids in the presence of calcium, then added at different concentrations of
FX in the presence of a specific substrate by FX and the rate of generation of FXa was determined (Figure 11).
Based on these data, the Km and Vmax of the different FVIII proteins were calculated in the context of the Xase complex (Chang 1997) (Table 11). Data were expressed as the average of the six analyzes (3 experiments containing duplicate runs) ± the
<img file="MX336830B_D0110.tif" />
corresponding standard deviation. Based on these Ια Proftedad data, it was found that these Industrtot proteins (rBDD FVIII and rFVIIIFc) had comparable Km and Vmax values, within the variation of the assay. Thus, the Xase complex formed with rFVIIIFc behaved similarly to the Xase complex formed with the licensed product rBDD FVIII (ReFacto) with respect to interactions with phospholipids and the ability to activate FX. Note that these comparable data also demonstrate that rFVIIIFc is activated to a comparable degree to rBDD FVIII after a brief incubation with thrombin.
B. Interaction with FlXa
The interaction between rBDD FVIII and rFVIIIFc with FlXa was also examined in the context of the Xase complex. The Xase complex was assembled as before, using a fixed amount of FX and varying levels of FlXa, and the rate of generation was determined (Figure 12). From these data, the Kd value for the Xase complex formed with both FVIII to FlXa proteins was determined (Chang, 1997).
Data were expressed as the average of the six analyzes (3 experiments containing duplicate runs) ± the corresponding standard deviation (Table 12). Both proteins were found to have similar values, Kd and Vmax, indicating that rFVIIIFc had interactions with FlXa comparable to those of licensed product rBDD FVIII.
<img file="MX336830B_D0111.tif" />
κ. τ c Institute<sup>E; | empl</sup>° <sup>5</sup> Mexican
Interim pharmacokinetic data for the
Phase II clinical trials discussed in Example 3 demonstrated the following results for FVIIIFc. FVIIIFc had approximately a 50% increase in systemic exposure (AUCi<sub>NF</sub>), approximately 50% reduction in clearance (Cl), and approximately 5070% increase in elimination half-life and MRT compared to Advate (full-length FVIIIr).
In addition, the FVIIIFc showed an increase in C168 values,
TBLP1, TBLP3 and TBLP5 compared to Advate.
AUCxnf Area under the concentration-time curve from zero to infinity
Beta HL Half-life of the elimination phase; also referred to as ti /<sub>2</sub>p
C168 Estimated FVIIIFc activity above baseline value approximately 168 hours post-dose.
Cl Clearance
MRT Average residence time
TBLP1 Time after dose predicted by the model when FVIIIFc activity decreases to approximately 1 IU / dl above baseline
TBLP3 Time after dose predicted by the model when FVIIIFc activity decreases to
<img file="MX336830B_D0112.tif" />
100
Mexican approximately 3 Ul / dl above the baseline, of Ια Industrial Property
TBLP5 Time after dose predicted by the model when FVIIIFc activity decreases to approximately 5 IU / dl above baseline
Example 6
A recombinant Factor VIII fusion protein with the deleted B-Fc domain (rFVIIIFc) was created as a method of prolonging the half-life of FVIII. The pharmacokinetics (PK) of rFVIIIFc was compared to that of recombinant rFVIII in hemophilia A mice. The terminal half-life was found to be twice as long for rFVIIIFc compared to rFVIII. In order to confirm that the underlying mechanism of half-life extension was due to protection of rFVIIIFc by FcRn, PK was evaluated in FcRn knockout mice and transgenic mice for
Human FcR. A single intravenous dose (125 IU / kg) was administered and the plasma concentration was measured using a chromogenic activity assay. Cmax was similar between rFVIIIFc and rFVIII (Xyntha®) in both strains of mice. However, while the half-life for rFVIIIFc was comparable to that of rFVIII in FcRn knocked out mice, the half-life for rFVIIIFc was approximately twice that of rFVIII in hFcRn transgenic mice. These results confirm that FcRn mediates or is responsible for the long life
<img file="MX336830B_D0113.tif" />
101
ΓόΙΙ ^
Mean institute of rFVIIIFc compared to rFVIII. From ^ gijgPFQGietiCICÍ it was shown that hemostasis in whole blood measured by Industrial Rotational Thromboelastometry (ROTEM) correlates with the efficacy of clotting factors in bleeding models of mice with hemophilia, as well as in clinical applications, it was treated to evaluate the ex vivo efficacy of rFVIIIFc in mice with hemophilia A through the use of
ROTEM. Mice with hemophilia A mice were administered a single intravenous dose of 50 IU / kg of rFVIIIFc, Xynth® (FVIII) or ADVATE® (FVIII). At 5 minutes post-dose, clot formation was similar with respect to clotting time (TC), 'clotting time (CFT), and angle α. However, rFVIIIFc demonstrated significantly better CT at 72 and 96 hours post-dose, and CFT and a-angle were also better at hours compared to both Xyntha® (FVIII) and
ADVATE® (FVIII), in accordance with the prolonged PK of rFVIIIFc. Hence building a Fe fusion of
FVIII produces a molecule with a defined mechanism of action that has a longer half-life and the potential to provide prolonged protection from bleeding.
Example 7
This example presents the final results of the analysis of FVIII activity for 16 patients treated with 25 and 65 IU / kg of the FVIII products. See them
<img file="MX336830B_D0114.tif" />
102
Institute
Examples 3 and 5. RÁ © XICano of the Property
In this Example, rFVIIIFc is a recombinant IndUSÍftat fusion protein composed of a single recombinant human FVIII molecule with the deleted B domain (BDD-rFVIII) that fuses to the Fe dimeric domain of human IgGl, without the intervention of a single molecule. linker. This protein construct is also referred to herein as rFVIIIFc heterodimeric hybrid protein, FVIIIFc monomeric Fe fusion protein, FVIIIFc monomer hybrid,
Monomeric FVIIIIFc, and monomer-dimer FVIIIFc. Watch the
Example 1, Figure 1, and Table 2A.
Preclinical studies with rFVIIIFc demonstrated an approximately 2-fold prolongation in the half-life of rFVIII activity compared to commercially available rFVIII products. The rationale for this study was to evaluate the safety and tolerability of a single dose of rFVIIIFc in a frozen liquid formulation and to provide data on PK in subjects with severe hemophilia A. For this study, 16 evaluable patients were available for PK evaluation. A single administration of two doses of both rFVIIIFc and Advate at a nominal dose of 25 (n = 6) and 65 IU / kg body weight (n = 10) were infused intravenously over approximately 10 minutes. Blood samples for plasma PK evaluations were obtained prior to infusion as well
<img file="MX336830B_D0115.tif" />
103
Mexlc ίο as up to 10 days after dosing. The PK<sup>V</sup> FVIII activity, both for Advate and for <sub>and</sub> JltáUSlrtOt rFVIIIFc were characterized in this study by using a model-dependent method.
goals
The primary objective of this study was to evaluate the safety and tolerability of a single administration of two doses of rFVIIIFc (25 and 65 IU / kg) in previously treated (PTP) patients 12 years of age or older with hemophilia.
A severe.
The secondary objectives were to determine the pharmacokinetic parameters (PK) determined by the pharmacodynamic activity (PD) of Factor VIII over time after a single administration of 25 or 65 IU / kg of rFVIIIFc compared to Advate in coagulation and single-stage chromogenic.
Study design (see Example 3)
Blood samples were taken for PK evaluations of FVIII activity at the screening visit (within 28 days prior to dosing with
<td>Advate); in</td><td>on day 0 (injection of</td><td colspan="2">Advate)</td><td>before</td><td>of the</td>
<td>injection and</td><td>at 10 and 30 minutes and</td><td> 1,</td><td> 3,</td><td>6, and 9</td><td>hours</td>
<td>after</td><td>the injection; on day</td><td> 1</td><td>to</td><td>24 o'clock</td><td>hours</td>
<td>later</td><td>to the Advate injection;</td><td>in</td><td colspan="2">on the 2nd</td><td>48 o'clock</td>
hours after the Advate injection, on day 3 at
104
<img file="MX336830B_D0116.tif" />
hours after injection of Ad at 96 hours after injection
Advate (cohort B only).
Blood samples were taken for PK evaluations of FVIII activity on the day of rFVIIIFc injection just before rFVIIIFc administration, at 10 and 30 minutes, and at 1, 3, 6, and 9 hours after injection. of the rFVIIIFc; on day 1 at 24 hours after rFVIIIFc injection, on days 2-5 at 48, 72, 96 and 120 hours after rFVIIIFc injection, on day 7 at 168 hours after rFVIIIFc injection ; on days 8, 9, and 10 at 192, 216, and 240 hours after high-dose injection of rFVIIIFc (cohort B only).
FVIII activity was also measured at the final study visit (28 days after rFVIIIFc injection) at 672 hours after rFVIIIFc injection.
Pharmacokinetic models and calculations
Abbreviations
TBLPl = Time after dose predicted by the model when Factor VIII activity declines to approximately 1 IU / dl above baseline.
TBLP3 = Time post-dose predicted by the model when Factor VIII activity declines to about 3 IU / dl above baseline.
KV_M = Cmax_M / Real Dose (IU / kg)
<img file="MX336830B_D0117.tif" />
105 dose. 7 x Ht
KV_OB = Cmax_OB / Real Dose (Ul / kg)
IVR_M = 100 x Cmax_M plasma volume (di) / total in IU, where plasma volume in mi = (23 in cm) + (9.0 x Pt in kg) - 1709.
IVR_OB = 100 x Cmax_OB plasma volume (di) / total in IU, where plasma volume in mi = (23 in cm) + (9.0 x Pt in kg) - 1709.
Results
Figure 13. Mean (± SE) of observed group FVIII activity against time profiles, ordered by dose level, grouped by compound (one-step test, 25 IU / kg (A) and 65 IU / kg ( B)) and (chromogenic assay, 25 IU / kg (C) and 65 IU / kg (D)).
Figure 14. Mean (± SE) of observed group FVIII activity against time profiles, grouped by dose level and compound (one-step assay; A) (chromogenic assay; B).
Single Dose Pharmacokinetics (Single Stage Trial)
The FVIII activity observed increased strongly after short intravenous infusion of both Advate and rFVIIIFc, with model-predicted mean Cmax values (± SD) of 56.6 + 4.74 and 121 ± 28.2 Ul / dl for Advate and 55.6 ± 8.18 and 108 ± 16.9 IU / dl for rFVIIIFc for the 25 and 65 IU / .kg dose groups,
Mexican <sub>two</sub>$ lack
Induslslot. 7 x Ht
<img file="MX336830B_D0118.tif" />
106
Institute respectively. All patients who were treated with the ΜβχΙοαη of Ια Property
Advate and rFVIIIFc had dose-related increases in IndUStÍlOt FVIII activity. The observed increase in both Cmax and AUCINF was slightly less than dose-proportional over the range of doses evaluated.
After the end of the infusion, the observed decrease in FVIII activity exhibited monoexponential decay characteristics until the baseline level was reached. The rate of decrease in the activity of the
FVIII was slower for rFVIIIFc than for Advate with mean values for elimination half-life (± SD) predicted by the model of 11.9 ± 2.98 and 10.4 ± 3.03 h for Advate and
18.0 ± 3.88 and 18.4 ± 6.99 h for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively. The elimination half-life values appear to be independent of the dose in the dose range evaluated, for both FVIII products.
Total systemic exposure of FVIII (as tested by AUCINF) was ~ 48% and 61% higher after rFVIIIFc administration than Advate at doses of 25 and 65 IU / kg, respectively. The mean (+ SD) AUCINF values predicted by the model were 974 ± 259 and 1810 ± 606 h * Ul / dl for Advate and 1440 + 316 and 2910 + 1320 hr * Ul / dl for rFVIIIFc in the dose groups of 25 and 65 IU / kg, respectively.
<img file="MX336830B_D0119.tif" />
107
Institute
Mexican
Similar to the elimination half-life, the MRTy ^ g Industrial Property extended for rFVIIIFc relative to Advate. The mean of the MRT values (± SD) predicted by the model were 17.1 ± 4.29 and 14.9 ± 4.38 h for the Advate and 25.9 ± 5.60 and 26.5 + 10.1 h for the rFVIIIFc for the 25 and 65 dose groups of IU / kg, respectively. MRT values appeared to be independent of dose in the dose range evaluated, for both FVIII products.
Additionally, the primary values of the CL and V pharmacokinetic parameters were determined. The CL values for rFVIIIFc only represented approximately 66% of those observed for Advate at equivalent doses. The mean values of C1 (± SD) predicted by the model were 2.70 ± 0.729 and 4.08 + 1.69 mi / h / kg for the Advate and 1.80 ± 0.409 and 2.69 + 1.25 ml / h '/ kg for the rFVIIIFc for the dose groups of 25 and 65 IU / kg, respectively. The V values were comparable between the Advate and the rFVIIIFc with a mean of the V values (+ SD) predicted by the model of 43.9 ± 4.27 and 56.1 ± 13.4 ml / kg for the Advate and 45.3 + 7.23 and 61.6 + 10.6 ml / kg for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively. Slight increases in mean CL and V values were observed with increasing doses of Advate and rFVIIIFc; however, the increased standard deviation at the 65 IU / kg dose coupled with limited dose levels confused a
<img file="MX336830B_D0120.tif" />
108 institute evaluation of the dose dependence of these parameters Mexican For example, the CV% of the geometric mean of the values
CL for the rFVIIIFc treatment group increased from 23.0% (25 IU / kg) to 48.6% (65 IU / kg).
In addition to the primary PK parameters, secondary PK parameters (for example, K values, IVR, etc.) were determined to evaluate the duration of the effect of the
FVIII. Evidence of PK differences was also observed as rFVIIIFc demonstrated an increase in TBLPland TBLP3 values compared to Advate at equivalent doses. The IVR and K values for Advate and rFVIIIFc appeared comparable. A slight increase in TBLP3 and TBLP1 values was observed with increasing doses of Advate and rFVIIIFc. In contrast, slight decreases in mean IVR and K values were observed with increasing doses of Advate and rFVIIIFc. As indicated above, an assessment of the dose dependence of these parameters was confounded by the limited dose levels.
The mean TBLP1 (± SD) observed was 2.88 + 0.733 and 2.93 + 0.848 IU / dl per IU / kg for Advate and 4.28 ± 0.873 and 5.16 + 2.02 IU / dl per IU / kg for rFVIIIFc in the dose groups. 25 and 65 IU / kg, respectively. The mean TBLP3 (± SD) observed was 2.06 + 0.527 and 2.26 + 0.666 Ul / dl per Ul / kg for Advate and 3.09 ± 0.623 and 3.93 + 1.59 Ul / dl for
<img file="MX336830B_D0121.tif" />
109 , ... Jtltutc
IU / kg for rFVIIIFc for the 25 and IU / kg dose groups, respectively.
The mean IVR and K values calculated using the observed Cmax values (from which the baseline and residual drug in the model are subtracted) were generally higher than the values determined by means of the Cmax values predicted by the model; consistent with a slight underestimation of peak activity that was observed using the one-compartment model. The mean K values (± SD) observed were 2.57 ± 0.198 and 2.13 ± 0.598 Ul / dl per IU / kg for the Advate and 2.46 + 0.330 and 1.85 + 0.332 Ul / dl per IU / kg for the rFVIIIFc for the groups of doses of 25 and 65 IU / kg, respectively. The mean IVR values (+ SD) observed were 94.1 + 15.6 and 85.8 + 16.5% for the Advate and 89.5 ±
11.9 and 74.8 ± 6.72% for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively.
Single Dose Pharmacokinetics (Chromogenic Assay)
The observed FVIII activity increased considerably after short intravenous infusion of Advate or rFVIIIFc, with a mean (± SD) model predicted Cmax values of 70.2 + 9.60 and 157 ± 38.6 Ul / dl for Advate and 70.3 + 10.0 and 158 + 34.7 IU / dl for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively.
110
<img file="MX336830B_D0122.tif" />
rFVIIIFc had dose-related increases in FVI Jntfusfffaf activity. The observed increase in both Cmax and AUCINF was slightly less than dose-proportional over the range of doses evaluated.
After the end of the infusion, the observed decrease in FVIII activity exhibited monoexponential decay characteristics until the baseline level was reached. The rate of decrease in the activity of the
FVIII was slower for rFVIIIFc than for Advate with a mean (+ SD) of elimination half-life values predicted by the model of 10.7 + 1.98 and 10.3 + 3.27 h for Advate and 16.2 ± 2.92 and 19.0 + 7.94 h for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively. The elimination half-life values appeared to be independent of the dose in the dose range evaluated, for both products of the
FVIII.
The total systemic exposure of FVIII (as assessed by AUCINF) was ~ 53% and 84% higher after administration of rFVIIIFc than Advate at doses of 25 and 65 IU / kg, respectively. The mean (+ SD) of the AUCINF values predicted by the model were 1080 + 236 and 2320 + 784 h * IU / dl for the Advate and 1650 + 408 and 4280 + 1860 hr * Ul / dl for the rFVIIIFc for the groups of doses of 25 and 65 IU / kg, respectively.
lll
<img file="MX336830B_D0123.tif" />
Ituto
Similar to the elimination half-life, the MRT Ji ^ xicCinO prolonged for the rFVIIIFc in relation to the Advate (+ SD) of the MRT values predicted by the model were 15.3 ± 2.86 and 14.8 + 4.72 h for the Advate and 23.4 ± 4.22 and 27.3 ±
11.4 h for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively. MRT values appeared to be independent of dose in the dose range evaluated, for both FVIII products.
Additionally, the primary values of the CL and V pharmacokinetic parameters were determined. The CL values for rFVIIIFc only represented 58-66% of those observed for Advate in equivalent doses. The means (+ SD) of the CL values predicted by the model were 2.39 ± 0.527 and 3.21 ± 1.40 ml / h / g for Advate and 1.57 ±
0.349 and 1.86 + 0.970 ml / h / kg for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively. The V values were comparable between the Advate and the rFVIIIFc with a mean (+ SD) for the V values predicted by the model of 35.8 ± 5.52 and 43.6 ± 11.2 ml / kg for the Advate and 35.9 ± 6.65 and 42.7 ± 8.91 ml. / kg for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively. Increased mean CL and V values were observed with increasing doses of Advate and rFVIIIFc, however, increasing standard deviations to 65 IU / kg together with limited dose levels confounded an assessment of drug dependence. the
<img file="MX336830B_D0124.tif" />
112 dose of these parameters.
In addition to the primary PK parameters, the secondary PK parameters (for example, K values, IVR, etc.) were determined to evaluate the duration of the effect of the
FVIII. Evidence of PK differences was also observed as rFVIIIFc demonstrated an increase in TBLPly and TBLP3 values compared to Advate at equivalent doses. The IVR and K values for Advate and rFVIIIFc appeared comparable.
A slight increase in TBLP3 and TBLP1 values was observed with increasing doses of Advate and rFVIIIFc. In contrast, slight decreases in mean IVR and K values were observed with increasing doses of Advate and rFVIIIFc. As indicated above, an assessment of the dose dependence of these parameters was confounded by the limited dose levels.
The means (+ SD) of TBLP1 that were observed were 2.70 ± 0.511 and 3.09 ± 0.978 Ul / dl per Ul / kg for the Advate and 4.06 ± 0.798 and 5.66 ± 2.38 Ul / dl per Ul / kg for the rFVIIIFc for the groups doses of 25 and 65 IU / kg, respectively. The means (+ SD) of TBLP3 that were observed were 1.98 ± 0.377 and 2.39 ± 0.718 Ul / dl per Ul / kg for the Advate and 3.04 + 0.598 and 4.44 ± 1.84 Ul / dl per Ul / kg for the rFVIIIFc for the groups doses of 25 and 65 IU / kg, respectively.
The mean values of IVR and K calculated by means of the
<img file="MX336830B_D0125.tif" />
113 The use of observed Cmax values (from which 1 baseline and residual drug in the model is subtracted) was ^ '^^ Overall Od greater than the values that were determined by the Cmax values predicted by the model; consistent with a slight underestimation of peak activity that was observed using the one-compartment model. The averages (+ SD) of the observed K values were 3.08 ± 0.429 and 2.85 ± 0.721 Ul / dl per Ul / kg for the Advate and 3.12 + 0.451 and 2.92 ± 0.985 Ul / dl per Ul / kg for the rFVIIIFc for the groups doses of 25 and 65 IU / kg, respectively. The means (± SD) of the observed IVR values were 112 + 14.5 and 116 + 26.9% for Advate and 113 ± 16.3 and 117 ± 33.6% for rFVIIIFc for the 25 and 65 IU / kg dose groups, respectively. .
Conclusions
All patients treated with Advate and rFVIIIFc had comparable increases in Cmax and AUCINF relative to dose over the dose range evaluated. Peak plasma levels of Advate and rFVIIIFc activity were generally observed within the first hour after the end of the infusion and remained detectable for several days after dosing. After the end of the infusion, the baseline-corrected decrease in FVIII activity exhibited a monoexponential decline until the baseline was reached for
<img file="MX336830B_D0126.tif" />
114
Institute both products. The values of the mediMoxiCano life parameters of the Elimination Property and MRT appeared to be independent of lfodusfriat doses in the dose range evaluated, for both FVIII products. Slight increases in mean CL and V values were observed with increasing doses of Advate and rFVIIIFc; however, the increased intersubject variability at the 65 IU / kg dose coupled with limited dose levels confounded an assessment of the dose dependence of these parameters.
Comparison of the PK of rFVIIIFc and Advate activity showed an approximate 48-61% increase (single-stage assay) or 53-84% (chromogenic assay) in systemic exposure, an approximate 30- 40% clearance, and an approximate 50-80% increase in both elimination half-life and MRT for rFVIIIFc relative to Advate at comparable doses. Evidence of the difference in PK was also observed when rFVIIIFc demonstrated an increase in TBLP1 and TBLP3 values compared to Advate at equivalent doses. The IVR and K values for Advate and rFVIIIFc appeared comparable.
The PK parameters that were obtained from the chromogenic assay results were generally consistent with those of the one-stage assay, except that the chromogenic assay produced a higher estimate of the chromogenic parameters.
<img file="MX336830B_D0127.tif" />
115 exposure (for example, Cmax, AUCINF, etc.)
Mexican Institute of Prcpis
With the improvements seen in PK, rFVIIIFc can provide prolonged protection from bleeding, allowing less frequent injections for people with hemophilia A.
Example 8
Based on the tentative PK analysis of the first human study of rFVII: Fc (Example 3), the A-LONG study was designed. A-LONG is an open-label, multicenter study evaluating the safety, pharmacokinetics, and efficacy of recombinant Factor VIII Fe (FVIII: Fc) fusion in the prevention and treatment of bleeding in previously treated patients with severe hemophilia A ( defined as <1 Ul / dl [<1%] endogenous FVIII).
Approximately 106 subjects will be enrolled in one of three regimens: a tailored prophylaxis regimen (arm 1), a weekly dosing regimen (arm 2), and a demand regimen (arm 3).
Arm 1: Adapted prophylaxis regimen
Arm 1 will include a global group and a subgroup of PKs. Approximately 66 subjects will be enrolled. The initial regimen will be 25 IU / kg twice a week on the first day, followed by 50 IU / kg on the fourth day of the week. Subjects will be administered rFVIIIFc in this weekly prophylaxis regimen until PK results for the
<img file="MX336830B_D0128.tif" />
116 rFVIII Fc are available. Based on these results, PiOjiledCd industriar will establish a prophylaxis regimen adapted for each individual, in which the dose and the interval will be determined to maintain a baseline level of 1-3% of FVIII activity. Each subject will then be administered their tailored prophylaxis regimen throughout the study.
Subjects will be monitored throughout the study and ongoing dose and interval adjustments will be made. Adjustments will only be made when a subject experiences unacceptable bleeding episodes defined as 2 spontaneous bleeding episodes in two continuous months. In this case, the adjustment will go to levels of 3-5%.
Arm 2: Weekly Dosing Regimen Approximately 20 subjects will be enrolled / randomized and subjected to abbreviated PK profiles of rFVIIIFc as follows: washout of at least 96 hours, a single dose of rFVIIIFc of 65 IU / kg; abbreviated sampling start on Day 0 of rFVIIIFc, including preinjection and 10 (± 2) minutes, 3 hours (± 15 minutes), 72 (±
2) hours [day 3], and 96 (± 2) hours [day 4] from the start of the injection. Following the abbreviated PK profile, subjects will be administered a fixed dose of 65 IU / kg of rFVIIIFc every 7 days.
Arm 3: On-demand regime
A minimum of 10 surgeries will be evaluated in the study
<img file="MX336830B_D0129.tif" />
117 older in at least 5 subjects. Major surgery is defined as any surgical procedure (elective or Industrial emergency) that involves general anesthesia and / or respiratory assistance in which a main body cavity is penetrated and exposed, or by which a deterioration occurs. substantial physical or physiological functions (eg, laparotomy, thoracotomy, craniotomy, joint replacement, and limb amputation).
For prophylaxis during surgery, subjects will be treated with 35 to 50 IU / kg of rFVIIIFc every 12 to 24 hours.
Prior to surgery, the physician will review the subject's rFVIIIFc PK profile and test the Factor VIII replacement dose regimen that is generally required for the type of surgery scheduled and the subject's clinical status. The recommendation for the appropriate dosage of rFVIIIFc in the surgical treatment period, which includes the rehabilitation time, will take these factors into consideration.
The main objectives of this study are: (a) to evaluate the safety and tolerability of rFVIIIFc administered as prophylaxis, on-demand, and in surgical treatment regimens, and (b) to evaluate the efficacy of rFVIIIFc administered as prophylaxis, on-demand, and in surgical treatment regimens. The secondary objectives of this study are: (a) to characterize the PK profile of rFVIIIFc and compare the PK of FVIIIFc with the product
<img file="MX336830B_D0130.tif" />
118 that is currently marketed, the Advate, (b) evaluates ^ ® ^ J®9 ^ 9 <sup>4</sup> of Ια Property the individual responses with the FVIIIFc, and (c) evaluate thendUStflOt consumption of the FVIIIFc.
Primary Objectives • Evaluate the safety and tolerability of rFVIIIFc administered as prophylaxis, weekly, on demand, and surgical treatment regimens • Evaluate the efficacy of rFVIIIFc administered as tailored prophylaxis, on-demand, and treatment regimens surgical
Secondary objectives • Characterize the PK profile of rFVIIIFc and compare the PK of rFVIIIFc with the product currently marketed, Advate® • Evaluate individual responses with rFVIIIFc • Characterize the dose and time interval necessary to adequately prevent bleeding on a prophylaxis regimen; maintain homeostasis in a surgical setting, or to treat bleeding episodes on demand, weekly treatment, or tailored prophylaxis • Assess consumption of rFVIIIFc (eg, total annual consumption of rFVIIIFc per subject)
Example 9
Clinical evaluation of the ROTEMt
In the study in Example 8, in addition to measuring
<img file="MX336830B_D0131.tif" />
119 plasma FVIII activity by the ti | y ^ "assay (üp | gdod one-stage activated partial thromboplastin (aPTT), the
Industrial rotational whole blood thromboelastometry (ROTEM) was also explored to assess the improvement in global hemostasis by rFVIIIFc and Advate in 2 subjects, specifically, one in the low-dose cohort and one in the high-dose cohort.
RFVIIIFc and Advate appear comparably active in clot formation when added to the blood of subjects prior to rFVIIIFc treatment. Clotting time (CT) was linear with the dose of rFVIIIFc and Advate in a range of approximately 1% to 100% of normal, and the dose response was comparable between rFVIIIFc. and the Advate on the same subject.
After dosing with Advate and subsequently rFVIIIFc, citrated whole blood was sampled at various time points and clot formation was monitored after recalcification by ROTEM. Despite variable CT at baseline due to residual FVIII levels prior to dosing with Advate or rFVIIIFc, both products effectively corrected CT to comparable levels 30 minutes after injection. In addition, the improvement in TC was better maintained in and after 3 hours post-injection of 25 IU / kg of rFVIIIFc in relation to Advate in the subject dosed at this dose.
<img file="MX336830B_D0132.tif" />
120 come down. However, the differential improvement of rFVIIIFc on Advate was much less noticeable at the 65 dose.
BOARDS
Table 1: Sequences of polynucleotides A. The FVIIIFc with the deleted B domain (i) DNA sequence of the FVIIIFc chain
Institute <sup>contr £</sup>Mexican Property <sup>UI</sup>/ kg. Industriat with the B domain deleted (FVIII signal peptide underlined, region
Faith in bold) (section with ident number: 1, coding of section with ident number: 2)
<td> 661</td><td>TO</td><td>TGCAAATAGÁ</td>
<td>GCTCTCCACC TGCTTCTTTC</td><td></td><td></td>
<td>721 TGTGCCTTTT</td><td>GCGATTCTGC</td><td>TTTAGTGCCA</td><td>CCAGAAGATA</td>
<td>CTACCTGGGT GCAGTGGAAC 781 TGTCATGGGA</td><td>CTATATGCAA</td><td>AGTGATCTCG</td><td>GTGAGCTGCC</td>
<td>TGTGGACGCA AGATTTCCTC 841 CTAGAGTGCC</td><td>AAAATCTTTT</td><td>CCATTCAACA</td><td>CCTCAGTCGT</td>
<td>GTACAAAAAG ACTCTGTTTG 901 TAGAATTCAC</td><td>GGATCACCTT</td><td>TTCAACATCG</td><td>CTAAGCCAAG</td>
<td>GCCACCCTGG ATGGGTCTGC 961 TAGGTCCTAC</td><td>CATCCAGGCT</td><td>GAGGTTTATG</td><td>ATACAGTGGT</td>
<td>CATTACACTT AAGAACATGG 1021 CTTCCCATCC</td><td>TGTCAGTCTT</td><td>CATGCTGTTG</td><td>GTGTATCCTA</td>
<td>CTGGAAAGCT TCTGAGGGAG 1081 CTGAATATGA</td><td>TGATCAGACC</td><td>AGTCAAAGGG</td><td>AGAAAGAAGA</td>
TGATAAAGTC TTCCCTGGTG
<img file="MX336830B_D0133.tif" />
TGGACCTGGT
121
1141 GAAGCCATAC
TCCAATGGCC TCTGACCCAC
1201 TGTGCCTTAC
AAAAGACTTG AATTCAGGCC
1261 TCATTGGAGC
CAAGGAAAAG ACACAGACCT
1321 TGCACAAATT
GAAAAGTTGG CACTCAGAAA
1381 CAAAGAACTC
TCGGGCCTGG CCTAAAATGC
1441 ACACAGTCAA
GATTGGATGC CACAGGAAAT
1501 CAGTCTATTG
AGTGCACTCA ATATTCCTCG
1561 AAGGTCACAC
CTTGGAAATC TCGCCAATAA
1621 CTTTCCTTAC
GTTTCTACTG TTTTGTCATA
1681 TCTCTTCCCA
AGTAGACAGC TGTCCAGAGG
1741 AACCCCAACT
CTATGATGAT GATCTTACTG
1801 ATTCTGAAAT
TCCTTCCTTT ATCCAAATTC
1861 GCTCAGTTGC
ATATGTCTGG
CAGGTCCTGA
CTACTCATAT
CTTTCTCATG
CCTACTAGTA
TATACTACTT
CTTGATGCAG
TGGTTATGTA
GCATGTGATT
ATTTCTTGTG
TGCTCAAACA
CCAACATGAT
ACGAATGAAA
GGATGTGGTC
CAAGAAGCAT
TGTAGAGAAG
TTTGCTGTAT
GATAGGGATG
AACAGGTCTC
GGAATGGGCA
AGGAACCATC
CTCTTGATGG
GGCATGGAAG
AATAATGAAG
AGGTTTGATG
CCTAAAACTT
GGAGTCTGGC
TTGATGAAGG
CTGCATCTGC
TGCCAGGTCT
CCACTCCTGA
GCCAGGCGTC
ACCTTGGACA
CTTATGTCAA
AAGCGGAAGA
ATGACAACTC
GGGTACATTA
<img file="MX336830B_D0134.tif" />
122
<td colspan="3">CATTGCTGCT GAAGAGGAGG</td>
<td>1921 ACTGGGACTA</td><td>TGCTCCCTTA</td><td>GTCCTCGCCC</td>
<td>AAGTTATAAA AGTCAATATT 1981 TGAACAATGG</td><td>CCCTCAGCGG</td><td>ATTGGTAGGA</td>
<td>AGTCCGATTT ATGGCATACA 2041 CAGATGAAAC</td><td>CTTTAAGACT</td><td>CGTGAAGCTA</td>
<td>ATCAGGAATC TTGGGACCTT 2101 TACTTTATGG</td><td>GGAAGTTGGA</td><td>GACACACTGT</td>
<td>TAAGAATCAA GCAAGCAGAC</td><td></td><td> -</td>
<td>2161 CATATAACAT</td><td>CTACCCTCAC</td><td>GGAATCACTG</td>
<td>TTTGTATTCA AGGAGATTAC 2221 CAAAAGGTGT</td><td>AAAACATTTG</td><td>AAGGATTTTC</td>
<td>AGGAGAAATA TTCAAATATA 2281 AATGGACAGT</td><td>GACTGTAGAA</td><td>GATGGGCCAA</td>
<td>TCCTCGGTGC CTGACCCGCT 2341 ATTACTCTAG</td><td>TTTCGTTAAT</td><td>ATGGAGAGAG</td>
<td>AGGACTCATT GGCCCTCTCC 2401 TCATCTGCTA</td><td>CAAAGAATCT</td><td>GTAGATCAAA</td>
<td>GATAATGTCA GACAAGAGGA 2461 ATGTCATCCT</td><td>GTTTTCTGTA</td><td>TTTGATGAGA</td>
<td>GTACCTCACA GAGAATATAC 2521 AACGCTTTCT</td><td>CCCCAATCCA</td><td>GCTGGAGTGC</td>
<td>TCCAGAGTTC CAAGCCTCCA</td><td></td><td></td>
<td>2581 ACATCATGCA</td><td>CAGCATCAAT</td><td>GGCTATGTTT</td>
TTCAGCATGA
TGATTATATT
ATGTCCGTCC
CAATTCTGCC
CTAAATCAGA
ATCTAGCTTC
GAGGAAACCA
ACCGAAGCTG
AGCTTGAGGA
TTGATAGTTT
GCAGTTGTCA GTTTGTTTGC industriar
AGTACAAAAA
<img file="MX336830B_D0135.tif" />
123
2641 ATGAGGTGGC
GACTGACTTC CTTTCTGTCT
2701 TCTTCTCTGG
AGACACACTC ACCCTATTCC
2761 CATTCTCAGG
AGGTCTATGG ATTCTGGGGT
2821 GCCACAACTC
ACTGAAGGTT TCTAGTTGTG
2881 ACAAGAACAC
TATTTCAGCA TACTTGCTGA
2941 GTAAAAACAA
CCCACCAGTC TTGAAACGCC
3001 ATCAACGGGA
AGAGGAAATT GACTATGATG
3061 ATACCATATC
TTATGATGAG GATGAAAATC
3121 AGAGCCCCCG
TATTGCTGCA GTGGAGAGGC
3181 TCTGGGATTA
AAACAGGGCT CAGAGTGGCA
3241 GTGTCCCTCA
TGATGGCTCC TTTACTCAGC
3301 CCTTATACCG
GGGGCCATAT ATAAGAGCAG
3361
AAGTTGAAGA
ATACTGGTAC
ATATACCTTC
AGAAACTGTC
AGACTTTCGG
TGGTGATTAT
TGCCATTGAA
AATAACTCGT
AGTTGAAATG
CAGCTTTCAA
TGGGATGAGT
GTTCAAGAAA
TGGAGAACTA
TAATATCATG
ATTCTAAGCA
AAACACAAAA
TTCATGTCGA
AACAGAGGCA
TACGAGGACA
CCAAGAAGCT
ACTACTCTTC
AAGAAGGAAG
AAGAAAACAC
AGCTCCCCAC
GTTGTTTTCC
AATGAACATT
GTAACTTTCA
TTGGAGCARftxlcanO Institute of Industrial Property
TGGTCTATGA
TGGAAAACCC
TGACCGCCTT
GTTATGAAGA
TCTCTCAAAA
AGTCAGATCA
ATTTTGACAT
GACACTATTT
ATGTTCTAAG
AGGAATTTAC
TGGGACTCCT
GAAATCAGGC
<img file="MX336830B_D0136.tif" />
124
CTCTCGTCCC TATTCCTTCT
3421 ATTCTAGCCT
AGCAGAACCT AGAAAAAACT
3481 TTGTCAAGCC
GCAACATCAT ATGGCACCCA
3541 CTAAAGATGA
TGATGTTGAC CTGGAAAAAG
3601 ATGTGCACTC
CACTAACACA CTGAACCCTG
3661 CTCATGGGAG
TTTCACCATC TTTGATGAGA
3721 CCAAAAGCTG
CAGGGCTCCC TGCAATATCC
3781 AGATGGAAGA
TGCAATCAAT GGCTACATAA
3841 TGGATACACT
GATTCGATGG TATCTGCTCA
3901 GCATGGGCAG
TGGACATGTG TTCACTGTAC
3961 GAAAAAAAGA
TCCAGGTGTT TTTGAGACAG
4021 TGGAAATGTT
ATGCCTTATT GGCGAGCATC
4081 TACATGCTGG
TAAGTGTCAG ACTCCCCTGG
TATTTCTTAT
TAATGAAACC
GTTTGACTGC
AGGCCTGATT
ACAAGTGACA
GTACTTCACT
TCCCACTTTT
ACCTGGCTTA
CAATGAAAAC
GGAGTATAAA
ACCATCCAAA
GATGAGCACA
GAGGAAGATC
AAAACTTACT
AAAGCCTGGG
GGACCCCTTC
GTACAGGAAT
GAAAATATGG
AAAGAGAATT
GTAATGGCTC
ATCCATTCTA
ATGGCACTGT
GCTGGAATTT
CTTTTTCTGG
Instituto Mexicano w ra Property
AGAGGCAAGG fn0USf ffttf
TTTGGAAAGT
CTTATTTCTC
TGGTCTGCCA
TTGCTCTGTT
AAAGAAACTG
ATCGCTTCCA
AGGATCAAAG
TTCATTTCAG
ACAATCTCTA
GGCGGGTGGA
TGTACAGCAA
125
<img file="MX336830B_D0137.tif" />
<td>4141 GAATGGCTTC</td><td>TGGACACATT</td><td>AGAGATTTTC</td>
<td>TTCAGGACAA TATGGACAGT 4201 GGGCCCCAAA</td><td>GCTGGCCAGA</td><td>CTTCATTATT</td>
<td>CAATGCCTGG AGCACCAAGG 4261 AGCCCTTTTC</td><td>TTGGATCAAG</td><td>GTGGATCTGT</td>
<td>GATTATTCAC GGCATCAAGA 4321 CCCAGGGTGC</td><td>CCGTCAGAAG</td><td>TTCTCCAGCC</td>
<td>TCAGTTTATG ATCATGTATA 4381 GTCTTGATGG</td><td>GAAGAAGTGG</td><td>CAGACTTATC</td>
<td>CACTGGAACC TTAATGGTCT 4441 TCTTTGGCAA</td><td>TGTGGATTCA</td><td>TCTGGGATAA</td>
<td>TTTTAACCCT CCAATTATTG 4501 CTCGATACAT</td><td>CCGTTTGCAC</td><td>CCAACTCATT</td>
<td>CAGCACTCTT CGCATGGAGT 4561 TGATGGGCTG</td><td>TGATTTAAAT</td><td>AGTTGCAGCA</td>
<td>AATGGAGAGT AAAGCAATAT</td><td></td><td></td>
<td>4621 CAGATGCACA</td><td>GATTACTGCT</td><td>TCATCCTACT</td>
<td>GTTTGCCACC TGGTCTCCTT 4681 CAAAAGCTCG</td><td>ACTTCACCTC</td><td>CAAGGGAGGA</td>
<td>GAGACCTCAG GTGAÁTAATC</td><td></td><td></td>
<td>4741 CAAAAGAGTG</td><td>GCTGCAAGTG</td><td>GACTTCCAGA</td>
<td>AGTCACAGGA GTAACTACTC 4801 AGGGAGTAAA</td><td>ATCTCTGCTT</td><td>ACCAGCATGT</td>
<td>GTTCCTCATC TCCAGCAGTC 4861 AAGATGGCCA</td><td>TCAGTGGACT</td><td>CTCTTTTTTC</td>
CCGGATCAAT
TGGCACCAAT
TCTACATCTC
GAGGAAATTC
AACACAATAT
ATAGCATTCG
TGCCATTGGG
TTACCAATAT
GTAATGCCTG
AGACAATGAA
ATGTGAAGGA
AGAATGGCAA
126
AGTAAAGGTT TTTCAGGGAA
4921 ATCAAGACTC
ACCGTTACTG ACTCGCTACC
4981 TTCGAATTCA
GAGGATGGAG GTTCTGGGCT
5041 GCGAGGCACA
ACCGTGCCCA GCTCCAGAAC
5101 TCCTGGGCGG
CAAGGACACC CTCATGATCT
5161 CCCGGACCCC
CCACGAAGAC CCTGAGGTCA
5221 AGTTCAACTG
CAAGACAAAG CCGCGGGAGG
5281 AGCAGTACAA
CGTCCTGCAC CAGGACTGGC
5341 TGAATGGCAA
CCTCCCAGCC CCCATCGAGA
5401 AAACGATCTC
GGTGTACACC CTGCCCCCAT
5461 CCCGGGATGA
CCTGGTCAAA GGCTTCTATC
5521 CCAGCGACAT
GGAGAACAAC TACAAGACCA
5581 CGCCTCCCGT
CAGCAAGCTC ACCGTGGACA
CTTCACACCT
CCCCCAGAGT
TGGGTGCACC
GGACCTCTAC
ACCGTCAGTC
TGAGGTCACA
GTACGTGGAC
CAGCACGTAC
GGAGTACAAG
CAAAGCCAAA
GCTGACCAAG
CGCCGTGGAG
GTTGGACTCC
GACAAAACTC
TTCCTCTTCC
TGCGTGGTGG
GGCGTGGAGG
CGTGTGGTCA
TGCAAGGTCT
GGGCAGCCCC
AACCAGGTCA
TGGGAGAGCA
GACGGCTCCT
GTGGTGAACT
<img file="MX336830B_D0138.tif" />
Jndustrtot
AGATTGCCCT
ACACATGCCC
CCCCAAAACC
TGGACGTGAG
TGCATAATGC
GCGTCCTCAC
CCAACAAAGC
GAGAACCACA
GCCTGACCTG
ATGGGCAGCC
TCTTCCTCTA
<img file="MX336830B_D0139.tif" />
127
5641 AGAGCAGGTG
GATGCATGAG GCTCTGCACA
5701 ACCACTACAC
Mexican
GCAGCAGGGG AACGTCTTCT CATGqfcflgfflfop {<sub>e <</sub>j<sub>ac</sub>|
Indusírtat
GCAGAAGAGC CTCTCCCTGT CTCCGGGTAA A (ii) DNA sequence of Fe (signal peptide dg mouse IgK underlined) (seq with ident no .: 3, encoding seo, with ident no .: 4)
7981
ATGGA GACAGACACA
<td>8041 CTCCTGCTAT</td><td>GGGTACTGCT</td><td>GCTCTGGGTT</td><td>CCAGGTTCCA</td>
<td>CTGGTGACAA AACTCACACA 8101 TGCCCACCGT</td><td>GCCCAGCAGC</td><td>TGAACTCCTG</td><td>GGAGGACCGT</td>
<td>CAGTCTTCCT CTTCCCCCCA 8161 AAACCCAAGG</td><td>ACACCCTCAT</td><td>GATCTCCCGG</td><td>ACCCCTGAGG</td>
<td>TCACATGCGT GGTGGTGGAC 8221 GTGAGCCACG</td><td>AAGACCCTGA</td><td>GGTCAAGTTC</td><td>AACTGGTACG</td>
<td>TGGACGGCGT GGAGGTGCAT 8281 AATGCCAAGA</td><td>CAAAGCCGCG</td><td>GGAGGAGCAG</td><td>TACAACAGCA</td>
<td>CGTACCGTGT GGTCAGCGTC 8341 CTCACCGTCC</td><td>TGCACCAGGA</td><td>CTGGCTGAAT</td><td>GGCAAGGAGT</td>
<td>ACAAGTGCAA GGTCTCCAAC * 8401 AAAGCCCTCC</td><td>CAGCCCCCAT</td><td>CGAGAAAACC</td><td>ATCTCCAAAG</td>
<td>CCAAAGGGCA GCCCCGAGAA 8461 CCACAGGTGT</td><td>ACACCCTGCC</td><td>CCCATCCCGC</td><td>GATGAGCTGA</td>
<td>CCAAGAACCA GGTCAGCCTG 8521 ACCTGCCTGG</td><td>TCAAAGGCTT</td><td>CTATCCCAGC</td><td>GACATCGCCG</td>
<img file="MX336830B_D0140.tif" />
128
TGGAGTGGGA GAGCAATGGG ItltUtO cano
8581 CAGCCGGAGA ACAACTACAA GACCACGCCT CCC <3ed <lfO ^ I®Cl<sup>ad </sup>Industrial
ACTCCGACGG CTCCTTCTTC
8641 CTCTACAGCA AGCTCACCGT GGACAAGAGC AGGTGGCAGC
AGGGGAACGT CTTCTCATGC
8701 TCCGTGATGC ATGAGGCTCT GCACAACCAC TACACGCAGA
AGAGCCTCTC CCTGTCTCCG
8761 GGTAAA
B. Full-length FVIIIFe (i) Full-length FVIIIFc DNA sequence.
(FVIII signal peptide underlined, Fe region in bold) (Seq. ID #: 5, Seq. ID # coding: 6)
<td> 15</td><td>661 CAAATAGAGC TCTCCACCTG</td><td colspan="3">ATG</td>
<td></td><td>721 CTTCTTTCTG</td><td>TGCCTTTTGC</td><td>GATTCTGCTT</td><td>TAGTGCCACC</td>
<td></td><td>AGAAGATACT ACCTGGGTGC</td><td></td><td></td><td></td>
<td></td><td>781 AGTGGAACTG</td><td>TCATGGGACT</td><td>ATATGCAAAG</td><td>TGATCTCGGT</td>
<td></td><td>GAGCTGCCTG TGGACGCAAG</td><td></td><td></td><td></td>
<td> 20</td><td>841 ATTTCCTCCT</td><td>AGAGTGCCAA</td><td>AATCTTTTCC</td><td>ATTCAACACC</td>
<td></td><td>TCAGTCGTGT ACAAAAAGAC</td><td></td><td></td><td></td>
<td></td><td>901 TCTGTTTGTA</td><td>GAATTCACGG</td><td>ATCACCTTTT</td><td>CAACATCGCT</td>
<td></td><td>AAGCCAAGGC CACCCTGGAT</td><td></td><td></td><td></td>
<td></td><td>961 GGGTCTGCTA</td><td>GGTCCTACCA</td><td>TCCAGGCTGA</td><td>GGTTTATGAT</td>
<td> 25</td><td>ACAGTGGTCA TTACACTTAA</td><td></td><td></td><td></td>
<img file="MX336830B_D0141.tif" />
129
Institute
<td>1021 GAACATGGCT GTATCCTACT GGAAAGCTTC</td><td>TCCCATCCTG</td><td>TCAGTCTTCA</td><td>TGCTGTTGqmexicano of Pravedad Industriar</td>
<td>1081 TGAGGGAGCT AAAGAAGATG ATAAAGTCTT</td><td>GAATATGATG</td><td>ATCAGACCAG</td><td>TCAAAGGGAG</td>
<td>1141 CCCTGGTGGA GAGAATGGTC CAATGGCCTC</td><td>AGCCATACAT</td><td>ATGTCTGGCA</td><td>GGTCCTGAAA</td>
<td>1201 TGACCCACTG GACCTGGTAA AAGACTTGAA</td><td>TGCCTTACCT</td><td>ACTCATATCT</td><td>TTCTCATGTG</td>
<td>1261 TTCAGGCCTC AGTCTGGCCA AGGAAAAGAC</td><td>ATTGGAGCCC</td><td>TACTAGTATG</td><td>TAGAGAAGGG</td>
<td>1321 ACAGACCTTG GATGAAGGGA AAAGTTGGCA</td><td>CACAAATTTA</td><td>TACTACTTTT</td><td>TGCTGTATTT</td>
<td>1381 CTCAGAAACA GCATCTGCTC GGGCCTGGCC</td><td>AAGAACTCCT</td><td>TGATGCAGGA</td><td>TAGGGATGCT</td>
<td>1441 TAAAATGCAC CCAGGTCTGA TTGGATGCCA</td><td>ACAGTCAATG</td><td>GTTATGTAAA</td><td>CAGGTCTCTG</td>
<td>1501 CAGGAAATCA ACTCCTGAAG TGCACTCAAT</td><td>GTCTATTGGC</td><td>ATGTGATTGG</td><td>AATGGGCACC</td>
<td>1561 ATTCCTCGAA CAGGCGTCCT TGGAAATCTC</td><td>GGTCACACAT</td><td>TTCTTGTGAG</td><td>GAACCATCGC</td>
<td>1621 GCCAATAACT CTTGGACAGT TTCTACTGTT</td><td>TTCCTTACTG</td><td>CTCAAACACT</td><td>CTTGATGGAC</td>
<td>1681 TTGTCATATC TATGTCAAAG TAGACAGCTG</td><td>TCTTCCCACC</td><td>AACATGATGG</td><td>CATGGAAGCT</td>
<td>1741 TCCAGAGGAA</td><td>CCCCAACTAC</td><td>GAATGAAAAA</td><td>TAATGAAGAA</td>
<img file="MX336830B_D0142.tif" />
130
GCGGAAGACT ATGATGATGA
1801 TCTTACTGAT
GACAACTCTC CTTCCTTTAT
1861 CCAAATTCGC
GTACATTACA TTGCTGCTGA
1921 AGAGGAGGAC
GATGACAGAA GTTATAAAAG
1981 TCAATATTTG
TACAAAAAAG TCCGATTTAT
2041 GGCATACACA
CAGCATGAAT CAGGAATCTT
2101 - GGGACCTTTA
ATTATATTTA AGAATCAAGC
2161 AAGCAGACCA
GTCCGTCCTT TGTATTCAAG
2221 GAGATTACCA
ATTCTGCCAG GAGAAATATT
2281 CAAATATAAA
AAATCAGATC CTCGGTGCCT
2341 GACCCGCTAT
CTAGCTTCAG GACTCATTGG
2401 CCCTCTCCTC
GGAAACCAGA TAATGTCAGA
2461 CAAGAGGAAT
CGAAGCTGGT ACCTCACAGA
TCTGAAATGG
TCAGTTGCCA
TGGGACTATG
AACAATGGCC
GATGAAACCT
CTTTATGGGG
TATAACATCT
AAAGGTGTAA
TGGACAGTGA
TACTCTAGTT
ATCTGCTACA
GTCATCCTGT
ATGTGGTCAG
AGAAGCATCC
CTCCCTTAGT
CTCAGCGGAT
TTAAGACTCG
AAGTTGGAGA
ACCCTCACGG
AACATTTGAA
CTGTAGAAGA
TCGTTAATAT
AAGAATCTGT
TTTCTGTATT
TAAAACTTGG
CCTCGCCCCC
TGGTAGGAAG
TGAAGCTATT
CACACTGTTG
AATCACTGAT
GGATTTTCCA
TGGGCCAACT
GGAGAGAGAT
AGATCAAAGA
TGATGAGAAC
<img file="MX336830B_D0143.tif" />
131
<td>2521 GAATATACAA</td><td>CGCTTTCTCC</td><td>CCAATCCAGC</td><td>TGGAGTGCAG <sub>Μθχ1οαη0</sub></td>
<td>CTTGAGGATC CAGAGTTCCA</td><td></td><td></td><td>of the IndusWat Project</td>
<td>2581 AGCCTCCAAC</td><td>ATCATGCACA</td><td>GCATCAATGG</td><td>CTATGTTTTT</td>
<td>GATAGTTTGC AGTTGTCAGT</td><td></td><td></td><td></td>
<td>2641 TTGTTTGCAT</td><td>GAGGTGGCAT</td><td>ACTGGTACAT</td><td>TCTAAGCATT</td>
<td>GGAGCACAGA CTGACTTCCT</td><td></td><td></td><td></td>
<td>2701 TTCTGTCTTC</td><td>TTCTCTGGAT</td><td>ATACCTTCAA</td><td>ACACAAAATG</td>
<td>GTCTATGAAG ACACACTCAC</td><td></td><td></td><td></td>
<td>2761 CCTATTCCCA</td><td>TTCTCAGGAG</td><td>AAACTGTCTT</td><td>CATGTCGATG</td>
<td>GAAAACCCAG GTCTATGGAT</td><td></td><td></td><td></td>
<td>2821 TCTGGGGTGC</td><td>CACAACTCAG</td><td>ACTTTCGGAA</td><td>CAGAGGCATG</td>
<td>ACCGCCTTAC TGAAGGTTTC</td><td></td><td></td><td></td>
<td>2881 TAGTTGTGAC</td><td>AAGAACACTG</td><td>GTGATTATTA</td><td>CGAGGACAGT</td>
<td>TATGAAGATA TTTCAGCATA</td><td></td><td></td><td></td>
<td>2941 CTTGCTGAGT</td><td>AAAAACAATG</td><td>CCATTGAACC</td><td>AAGAAGCTTC</td>
<td>TCCCAGAATT CAAGACACCC</td><td></td><td></td><td></td>
<td>3001 TAGCACTAGG</td><td>CAAAAGCAAT</td><td>TTAATGCCAC</td><td>CACAATTCCA</td>
<td>GAAAATGACA TAGAGAAGAC</td><td></td><td></td><td></td>
<td>3061 TGACCCTTGG</td><td>TTTGCACACA '</td><td>GAACACCTAT</td><td>GCCTAAAATA</td>
<td>CAAAATGTCT CCTCTAGTGA</td><td></td><td></td><td></td>
<td>3121 TTTGTTGATG</td><td>CTCTTGCGAC</td><td>AGAGTCCTAC</td><td>TCCACATGGG</td>
<td>CTATCCTTAT CTGATCTCCA</td><td></td><td></td><td></td>
<td>3181 AGAAGCCAAA</td><td>TATGAGACTT</td><td>TTTCTGATGA</td><td>TCCATCACCT</td>
<td>GGAGCAATAG ACAGTAATAA</td><td></td><td></td><td></td>
<td>3241 CAGCCTGTCT</td><td>GAAATGACAC</td><td>ACTTCAGGCC</td><td>ACAGCTCCAT</td>
<img file="MX336830B_D0144.tif" />
132
CACAGTGGGG ACATGGTATT
3301 TACCCCTGAG
CTGGGGACAA CTGCAGCAAC
3361 AGAGTTGAAG
AATAATCTGA TTTCAACAAT
3421 TCCATCAGAC
TCCTTAGGAC CCCCAAGTAT
3481 GCCAGTTCAT
GGCAAAAAGT CATCTCCCCT
3541 TACTGAGTCT
AATGATTCAA AGTTGTTAGA
3601 ATCAGGTTTA
AATGTATCGT CAACAGAGAG
3661 TGGTAGGTTA
TTGTTGACTA AAGATAATGC
3721 CTTATTCAAA
ACTTCCAATA ATTCAGCAAC
3781 TAATAGAAAG
GAGAATAGTC CATCAGTCTG
3841 GCAAAATATA
ACACCTTTGA TTCATGACAG
3901 AATGCTTATG
CATATGTCAA ATAAAACTAC
3961 TTCATCAAAA
GGCCCCATTC CACCAGATGC
TCAGGCCTCC
AAACTTGATT
AATTTGGCAG
TATGATAGTC
GGTGGACCTC
ATGAATAGCC
TTTAAAGGGA
GTTAGCATCT
ACTCACATTG
TTAGAAAGTG
GACAAAAATG
AACATGGAAA
AATTAAGATT
TCAAAGTTTC
CAGGTACTGA
AATTAGATAC
TGAGCTTGAG
AAGAAAGTTC
AAAGAGCTCA
CTTTGTTAAA
ATGGCCCATC
ACACTGAGTT
CTACAGCTTT
TGGTCCAACA
TAGTACATCA
TAATACAAGT
CACTCTATTT
TGAAGAAAAT
ATGGGGAAAA
TGGACCTGCT
GACAAACAAA
ATTATTAATT
TAAAAAAGTG
GAGGCTAAAT
GAAAAAAGAG
<img file="MX336830B_D0145.tif" />
133
<td>4021 ACAAAATCCA CCAGAATCAG CAAGGTGGAT</td><td>GATATGTCGT</td><td>TCTTTAAGAT</td><td>GCTATTCT ^ cano d © the Property industrtaV</td>
<td>4081 ACAAAGGACT GGCCCCAGTC CAAAGCAATT</td><td>CATGGAAAGA</td><td>ACTCTCTGAA</td><td>CTCTGGGCAA</td>
<td>4141 AGTATCCTTA TTCTTGTCTG AGAAAAACAA</td><td>GGAGCAGAAA</td><td>AATCTGTGGA</td><td>AGGTCAGAAT</td>
<td>4201 AGTGGTAGTA CTCAAAGAGA, TGGTTTTTCC</td><td>GGAAAGGGTG</td><td>AATTTACAAA</td><td>GGACGTAGGA</td>
<td>4261 AAGCAGCAGA CATGAAAATA ATACACACAA</td><td>AACCTATTTC</td><td>TTACTAACTT</td><td>GGATAATTTA</td>
<td>4321 TCAAGAAAAA ACATTAATCC AAGAGAATGT</td><td>AAAATTCAGG</td><td>AAGAAATAGA</td><td>AAAGAAGGAA</td>
<td>4381 AGTTTTGCCT TTCATGAAGA ACCTTTTCTT</td><td>CAGATACATA</td><td>CAGTGACTGG</td><td>CACTAAGAAT</td>
<td>4441 ACTGAGCACT GCATATGCTC CAGTACTTCA</td><td>AGGCAAAATG</td><td>TAGAAGGTTC</td><td>ATATGACGGG</td>
<td>4501 AGATTTTÁGG AAACACACAG CTCATTTCTC</td><td>TCATTAAATG</td><td>ATTCAACAAA</td><td>TAGAACAAAG</td>
<td>4561 AAAAAAAGGG CAAACCAAGC AAATTGTAGA</td><td>GAGGAAGAAA</td><td>ACTTGGAAGG</td><td>CTTGGGAAAT</td>
<td>4621 GAAATATGCA CAGCAGAATT TTGTCACGCA</td><td>TGCACCACAA</td><td>GGATATCTCC</td><td>TAATACAAGC</td>
<td>4681 ACGTAGTAAG GAAGAAACAG AACTTGAAAA</td><td>AGAGCTTTGA</td><td>AACAATTCAG</td><td>ACTCCCACTA</td>
<td>4741 AAGGATAATT</td><td>GTGGATGACA</td><td>CCTCAACCCA</td><td>GTGGTCCAAA</td>
<img file="MX336830B_D0146.tif" />
134
AACATGAAAC ATTTGACCCC
4801 GAGCACCCTC
GGGGCCATTA CTCAGTCTCC
4861 CTTATCAGAT
GCAAATAGAT CTCCATTACC
4921 CATTGCAAAG
TATCTGACCA GGGTCCTATT
4981 CCAAGACAAC
AAGAAAGATT CTGGGGTCCA
5041 AGAAAGCAGT
CTTTCTTTAG CCATTCTAAC
5101 CTTGGAGATG
GGGACAAGTG CCACAAATTC
5161 AGTCACATAC
CCAGACTTGC CCAAAACATC
5221 TGGCAAAGTT
AAGGACCTAT TCCCTACGGA
5281 AACTAGCAAT
GGGAGCCTTC TTCAGGGAAC
5341 AGAGGGAGCG
AAAGTTCCCT TTCTGAGAGT
5401 AGCAACAGAA
GATCCTCTTG CTTGGGATAA
5461 CCACTATGGT
CAAGAGAAGT CACCAGAAAA
ACACAGATAG
ACTACAATGA
TGCCTTACGA
GGAGTCATAG
GTATCATCAT
TTCCATCTAT
TCTTCTCATC
TTCCAGCAGC
CATTTCTTAC
AAGGAGCCAA
ACTGGTGATC
AAAGAGAGGT
AAGAAAGTTG
AGAACACTGT
GAATTGCTTC
CAAAAGTTCA
GGGTCTCCTG
GCCATCTGGA
ATTAAGTGGA
ATGAAGCAAA
AGCTCTGCAA
AGACTCCCTC
ACTCAGATAC
CAAAAGAAGA
CATCCCTCAA
TAGACCTATA
ATCTTATAGA
AAAAAATAAC
TGGCTCCCTG
TCTCCCGAAA
CATTTATCAG
TCTCGTGGAA
CAGACCTGGA
I
CAAGCTATTG
GTGGAAATCC
135
5521 AACAGCTTTT
GCTTGTGAAA GCAATCATGC
5581 AATAGCAGCA
GAAGTCACCT GGGCAAAGCA
5641 AGGTAGGACT
TTGAAACGCC ATCAACGGGA
5701 AATAACTCGT
GACTATGATG ATACCATATC
5761 AGTTGAAATG
GATGAAAATC AGAGCCCCCG
5821 CAGCTTTCAA
GTGGAGAGGC TCTGGGATTA
5881 TGGGATGAGT
CAGAGTGGCA GTGTCCCTCA
5941 GTTCAAGAAA
TTTACTCAGC CCTTATACCG
6001 TGGAGAACTA
ATAAGAGCAG AAGTTGAAGA
6061 TAATATCATG
TATTCCTTCT ATTCTAGCCT
6121 TATTTCTTAT
AGAAAAAACT TTGTCAAGCC
6181 TAATGAAACC
ATGGCACCCA CTAAAGATGA
6241 GTTTGACTGC
AAGAAAAAGG
ATAAATGAGG
GAAAGGCTGT
ACTACTCTTC
AAGAAGGAAG
AAGAAAACAC
AGCTCCCCAC
GTTGTTTTCC
AATGAACATT
GTAACTTTCA
GAGGAAGATC
AAAACTTACT
AAAGCCTGGG
GACAAAATAA
GCTCTCAAAA
AGTCAGATCA
ATTTTGACAT
GACACTATTT
ATGTTCTAAG
AGGAATTTAC
TGGGACTCCT
GAAATCAGGC
AGAGGCAAGG
TTTGGAAAGT
CTTATTTCTC
ATACCATTTT
<img file="MX336830B_D0147.tif" />
Industrialize
GCCCGAAATA
CCCACCAGTC
AGAGGAAATT
TTATGATGAG
TATTGCTGCA
AAACAGGGCT
TGATGGCTCC
GGGGCCATAT
CTCTCGTCCC
AGCAGAACCT
GCAACATCAT
TGATGTTGAC
<img file="MX336830B_D0148.tif" />
136
CTGGAAAAAG ATGTGCACTC Mexican
<td>6301 AGGCCTGATT CTGAACCCTG CTCATGGGAG</td><td>GGACCCCTTC</td><td>TGGTCTGCCA</td><td>of the property CACT ^ & C ^<sub>ustw</sub></td>
<td>6361 ACAAGTGACA TTTGATGAGA CCAAAAGCTG</td><td>GTACAGGAAT</td><td>TTGCTCTGTT</td><td>TTTCACCATC</td>
<td>6421 GTACTTCACT TGCAATATCC AGATGGAAGA</td><td>GAAAATATGG</td><td>AAAGAAACTG</td><td>CAGGGCTCCC</td>
<td>6481 TCCCACTTTT GGCTACATAA TGGATACACT</td><td>AAAGAGAATT</td><td>ATCGCTTCCA</td><td>TGCAATCAAT</td>
<td>6541 ACCTGGCTTA TATCTGCTCA GCATGGGCAG</td><td>GTAATGGCTC</td><td>AGGATCAAAG</td><td>GATTCGATGG</td>
<td>6601 CAATGAAAAC TTCACTGTAO gaaaaaaaga</td><td>ATCCATTCTA</td><td>TTCATTTCAG</td><td>TGGACATGTG</td>
<td>6661 GGAGTATAAA TTTGAGACAG TGGAAATGTT</td><td>ATGGCACTGT</td><td>ACAATCTCTA</td><td>TCCAGGTGTT</td>
<td>6721 ACCATCCAAA GGCGAGCATC TACATGCTGG</td><td>GCTGGAATTT</td><td>GGCGGGTGGA</td><td>ATGCCTTATT</td>
<td>6781 GATGAGCACA ACTCCCCTGG GAATGGCTTC</td><td>CTTTTTCTCG</td><td>TGTACAGCAA</td><td>TAAGTGTCAG</td>
<td>6841 TGGACACATT TATGGACAGT GGGCCCCAAA</td><td>AGAGATTTTC</td><td>AGATTACAGC</td><td>TTCAGGACAA</td>
<td>6901 GCTGGCCAGA AGCACCAAGG AGCCCTTTTC</td><td>CTTCATTATT</td><td>CCGGATCAAT</td><td>CAATGCCTGG</td>
<td>6961 TTGGATCAAG</td><td>GTGGATCTGT</td><td>TGGCACCAAT</td><td>GATTATTCAC</td>
GGCATCAAGA CCCAGGGTGC
<img file="MX336830B_D0149.tif" />
137
7021 CCGTCAGAAG
ATCATGTATA GTCTTGATGG
7081 GAAGAAGTGG
TTAATGGTCT TCTTTGGCAA
7141 TGTGGATTCA
CCAATTATTG CTCGATACAT
7201 CCGTTTGCAC
CGCATGGAGT TGATGGGCTG
7261 TGATTTAAAT
AAAGCAATAT CAGATGCACA
7321 GATTACTGCT
TGGTCTCCTT CAAAAGCTCG
7381 ACTTCACCTC
GTGAATAATC CAAAAGAGTG
7441 GCTGCAAGTG
GTAACTACTC AGGGAGTAAA
7501 ATCTCTGCTT
TCCAGCAGTC AAGATGGCCA
7561 TCAGTGGACT
TTTCAGGGAA ATCAAGACTC
7621 CTTCACACCT
ACTCGCTACC TTCGAATTCA
7681 CCCCCAGAGT
GTTCTGGGCT GCGAGGCACA
7741 GGACCTCTAC
TTCTCCAGCC
CAGACTTATC
TCTGGGATAA
CCAACTCATT
AGTTGCAGCA
TCATCCTACT
CAAGGGAGGA
GACTTCCAGA
ACCAGCATGT
CTCTTTTTTC
GTGGTGAACT
TGGGTGCACC
GACAAAACTC
TCTACATCTC
GAGGAAATTC
AACACAATAT
ATAGCATTCG
TGCCATTGGG
TTACCAATAT
GTAATGCCTG
AGACAATGAA
ATGTGAAGGA
AGAATGGCAA
CTCTAGACCC
AGATTGCCCT
ACACATGCCC
TCAGTTTATC WITH THE PROI AGE
CACTGGAACC
TTTTAACCCT
CAGCACTCTT
AATGGAGAGT
GTTTGCCACC
GAGACCTCAG
AGTCACAGGA
GTTCCTCATC
AGTAAAGGTT
ACCGTTACTG
GAGGATGGAG
ACCGTGCCCA
<img file="MX336830B_D0150.tif" />
138
GCTCCAGAAC TCCTGGGCGG
7801 ACCGTCAGTC
CTCATGATCT CCCGGACCCC
7861 TGAGGTCACA
CCTGAGGTCA AGTTCAACTG
7921 GTACGTGGAC
CCGCGGGAGG AGCAGTACAA
7981 CAGCACGTAC
CAGGACTGGC TGAATGGCAA
8041 GGAGTACAAG
CCCATCGAGA AAACCATCTC
8101 CAAAGCCAAA
CTGCCCCCAT CCCGGGATGA
8161 GCTGACCAAG
GGCTTCTATC CCAGCGACAT
8221 CGCCGTGGAG
TACAAGACCA CGCCTCCCGT
8281 GTTGGACTCC
ACCGTGGACA AGAGCAGGTG
8341 GCAGCAGGGG
GCTCTGCACA ACCACTACAC
TTCCTCTTCC
TGCGTGGTGG
GGCGTGGAGG
CGTGTGGTCA
TGCAAGGTCT
GGGCAGCCCC
AACCAGGTCA
TGGGAGAGCA
GACGGCTCCT
AACGTCTTCT
CCCCAAAACC
TGGACGTGAG
TGCATAATGC
GCGTCCTCAC
CCAACAAAGC
GAGAACCACA
GCCTGACCTG
ATGGGCAGCC
TCTTCCTCTA
CATGCTCCGT
8401 GCAGAAGAGC CTCTCCCTGT CTCCGGGTAA A Property
CAAGGACAC ^^<sub>us</sub>|^<sub>s</sub>Y
CCACGAAGAC
CAAGACAAAG
CGTCCTGCAC
CCTCCCAGCC
GGTGTACACC
CCTGGTCAAA
GGAGAACAAC
CAGCAAGCTC
GATGCATGAG
<img file="MX336830B_D0151.tif" />
139 Mexican stltuto (ii) Fe (same sequence as A (ii) (section with no. Property <Industrial ident: 3))]
c.
(i) DNA sequence of heavy chain (HC) -Fe (no linker between HC and Fe) (underlined signal peptide, Fe region in bold) (seq. with ident no .: 7, coding seq. with ID number: 8)
ATGCAAATAG AGCTCTCCAC CTGCTTCTTT 61 ACCAGAAGAT ACTACCTGGG TGCAGTGGAA 121 GGTGAGCTGC CTGTGGACGC AAGATTTCCT 181 ACCTCAGTCG TGTACAAAAA GACTCTGTTT 241 GCTAAGCCAA GGCCACCCTG GATGGGTCTG 301 GATACAGTGG TCATTACACT TAAGAACATG 361 GGTGTATCCT ACTGGAAAGC TTCTGAGGGA 421 GAGAAAGAAG ATGATAAAGT CTTCCCTGGT 481 AAAGAGAATG GTCCAATGGC CTCTGACCCA 541 GTGGACCTGG TAAAAGACTT GAATTCAGGC 601 GGGAGTCTGG CCAAGGAAAA GACACAGACC 661 TTTGATGAAG GGAAAAGTTG GCACTCAGAA 721 GCTGCATCTG CTCGGGCCTG GCCTAAAATG 781 CTGCCAGGTC TGATTGGATG CCACAGGAAA 841 901 ACCACTCCTG AAGTGCACTC AATATTCCTC CGCCAGGCGT CCTTGGAAAT CTCGCCAATA 961 GACCTTGGAC AGTTTCTACT GTTTTGTCAT 1021 GCTTATGTCA AAGTAGACAG CTGTCCAGAG 1081 GAAGCGGAAG ACTATGATGA TGATCTTACT 1141 GATGACAACT CTCCTTGCTT TATCCAAATT 1201 TGGGTACATT ACATTGCTGC TGAAGAGGAG 1261 CCCGATGACA GAAGTTATAA AAGTCAATAT 1321 AAGTACAAAA AAGTCCGATT TATGGCATAC 1381 ATTCAGCATG AATCAGGAAT CTTGGGACCT
CTGTGCCTTT TGCGATTCTG CTTTAGTGCC
CTGTCATGGG ACTATATGCA AAGTGATCTC CCTAGAGTGC CAAAATCTTT TCCATTCAAC GTAGAATTCA CGGATCACCT TTTCAACATC CTAGGTCCTA CCATCCAGGC TGAGGTTTAT GCTTCCCATC CTGTCAGTCT TCATGCTGTT GCTGAATATG ATGATCAGAC CAGTCAAAGG GGAAGCCATA CATATGTCTG GCAGGTCCTG CTGTGCCTTA CCTACTCATA TCTTTCTCAT CTCATTGGAG CCCTACTAGT ATGTAGAGAA TTGCACAAAT TTATACTACT TTTTGCTGTA ACAAAGAACT CCTTGATGCA GGATAGGGAT CACACAGTCA ATGGTTATGT AAACAGGTCT TCAGTCTATT GGCATGTGAT TGGAATGGGC GAAGGTCACA CATTTCTTGT GAGGAACCAT ACTTTCCTTA CTGCTCAAAC ACTCTTGATG ATCTCTTCCC ACCAACATGA TGGCATGGAA GAACCCCAAC TACGAATGAA AAATAATGAA GATTCTGAAA TGGATGTGGT CAGGTTTGAT CGCTCAGTTG CCAAGAAGCA TCCTAAAACT GACTGGGACT ATGCTCCCTT AGTCCTCGCC TTGAACAATG GCCCTCAGCG GATTGGTAGG ACAGATGAAA CCTTTAAGAC TCGTGAAGCT TTACTTTATG GGGAAGTIGG AGACACACTG
2461GTGGAGGTGC
AGTACAACAG CACGTACCGT
2521GTGGTCAGCG
ATGGCAAGGA GTACAAGTGC
2581AAGGTCTCCA
ATAATGCCAA
TCCTCACCGT
ACAAAGCCCT
GACAAAGCCG
CCTGCACCAG
CCCAGCCCCC
CGGGAGGAGC
GACTGGCTGA
ATCGAGAAAA
CCATCTCCAA AGCCAAAGGG
<img file="MX336830B_D0152.tif" />
140
2641CAGCCCCGAG AACCACAGGT
GGGATGAGCT GACCAAGAAC
2701CAGGTCAGCC
GCGACATCGC CGTGGAGTGG
2761GAGAGCAATG
CTCCCGTGTT GGACTCCGAC
2821GGCTCCTTCT TCCTCTACAG
GCAGGTGGCA GCAGGGGAAC
2881GTCTTCTCAT
ACTACACGCA GAAGAGCCTC
2941TCCCTGTCTC CGGGTAAA
TGACCTGCCT
GGCAGCCGGA
GCTCCGTGAT
GTACACCCTG
GGTCAAAGGC
CccccATccWexIcano Institute of Industrial Property
TTCTATCCCA
GAACAACTAC AAGACCACGC
CAAGCTCACC GTGGACAAGA
GCATGAGGCT CTGCACAACC (ii) DNA sequence of heavy chain (HC) -Fe (5 amino acid linker between HC and Fe) (underlined signal peptide, Fe region in bold, double underlined 5 amino acid linker) (seq. Ident. of ident: 9, coding of the sec. with ident number: 10)
ATGCAAATAG AGCTCTCCAC
CTGCTTCTTT
CTGTGCCTTT
TGCGATTCTG CTTTAGTGCC
ACCAGAAGAT
ACTATATGCA AAGTGATCTC
121 GGTGAGCTGC
CAAAATCTTT TCCATTCAAC
181 ACCTCAGTCG
ACTACCTGGG
CTGTGGACGC
TGTACAAAAA
TGCAGTGGAA
AAGATTTCCT
GACTCTGTTT
CTGTCATGGG
CCTAGAGTGC
GTAGAATTCA
CGGATCACCT TTTCAACATC
<img file="MX336830B_D0153.tif" />
141
241 GCTAAGCCAA
CCATCCAGGC TGAGGTTTAT
301 GATACAGTGG
CTGTCAGTCT TCATGCTGTT
361 GGTGTATCCT
ATGATCAGAC CAGTCAAAGG
421 GAGAAAGAAG
CATATGTCTG GCAGGTCCTG
481 AAAGAGAATG
CCTACTCATA TCTTTCTCAT
541 GTGGACCTGG
CCCTACTAGT ATGTAGAGAA
601 GGGAGTCTGG
TTATACTACT TTTTGCTGTA
661 TTTGATGAAG
CCTTGATGCA GGATAGGGAT
721 GCTGCATCTG
ATGGTTATGT AAACAGGTCT
781 CTGCCAGGTC
GGCATGTGAT TGGAATGGGC
841 ACCACTCCTG
CATTTCTTGT GAGGAACCAT
901 CGCCAGGCGT
CTGCTCAAAC ACTCTTGATG
961 GACCTTGGAC
GGCCACCCTG
TCATTACACT
ACTGGAAAGC
ATGATAAAGT
GTCCAATGGC
TAAAAGACTT
CCAAGGAAAA
GGAAAAGTTG
CTCGGGCCTG
TGATTGGATG
AAGTGCACTC
CCTTGGAAAT
AGTTTCTACT
GATGGGTCTG
TAAGAACATG
TTCTGAGGGA
CTTCCCTGGT
CTCTGACCCA
GAATTCAGGC
GACACAGACC
GCACTCAGAA
GCCTAAAATG
CCACAGGAAA
AATATTCCTC
CTCGCCAATA
GTTTTGTCAT phone. Mexican CTAGGfelfttoQftoaaú taduetrlai
GCTTCCCATC
GCTGAATATG
GGAAGCCATA
CTGTGCCTTA
CTCATTGGAG
TTGCACAAAT
ACAAAGAACT
CACACAGTCA
TCAGTCTATT
GAAGGTCACA
ACTTTCCTTA
ATCTCTTCCC
<img file="MX336830B_D0154.tif" />
142
ACCAACATGA TGGCATGGAA
1021GCTTATGTCA
TACGAATGAA AAATAATGAA
108ÍGAAGCGGAAG
TGGATGTGGT CAGGTTTGAT
1141GATGACAACT
CCAAGAAGCA TCCTAAAACT
1201TGGGTACATT
ATGCTCCCTT AGTCCTCGCC
1261CCCGATGACA
GCCCTCAGCÓ GATTGGTAGG
1321AAGTACAAAA
CCTTTAAGAC TCGTGAAGGT
1381ATTCAGCATG
GGGAAGTTGG AGACACACTG
1441TTGATTATAT
TCTACCCTCA CGGAATCACT
1501GATGTCCGTC
TAAAACATTT GAAGGATTTT
1561CCAATTCTGC
TGACTGTAGA AGATGGGCCA
1621ACTAAATCAG
GTTTCGTTAA TATGGAGAGA
1681GATCTAGCTT
ACAAAGAATC TGTAGATCAA
AAGTAGACAG
ACTATGATGA
CTCCTTCCTT
ACATTGCTGC
GAAGTTATAA
AAGTCCGATT
AATCAGGAAT
TTAAGAATCA
CTTTGTATTC
CAGGAGAAAT
ATCCTCGGTG
CAGGACTCAT
CTGTCCAGAG
TGATCTTACT
TATCCAAATT
TGAAGAGGAG
AAGTCAATAT
TATGGCATAC
CTTGGGACCT
AGCAAGCAGA
AAGGAGATTA
ATTCAAATAT
CCTGACCCGC
TGGCCCTCTC
GATTCTGAAA
CGCTCAGTTG
GACTGGGACT
TTGAACAATG
ACAGATGAAA
TTACTTTATG
CCATATAACA
CCAAAAGGTG
AAATGGACAG
TATTACTCTA
CTCATCTGCT
143
1741AGAGGAAACC
TGTTTTCTGT ATTTGATGAG
1801AACCGAAGCT
TCCCCAATCC AGCTGGAGTG
1861CAGCTTGAGG
ACAGCATCAA TGGCTATGTT
1921TTTGATAGTT
CATACTGGTA CATTCTAAGC
1981ATTGGAGCAC
GATATACCTT CAAACACAAA
2041ATGGTCTATG
GAGAAACTGT CTTCATGTCG
2101ATGGAAAACC
CAGACTTTCG GAACAGAGGC
2161ATGACCGCCT
CTGGTGATTA TTACGAGGAC
2221AGTTATGAAG
ATGCCATTGA ACCAAGAAGC
2281TTCTCCCAGA
CAGCTCCAGA ACTCCTGGGC
2341GGACCGTCAG
CCCTCATGAT CTCCCGGACC
2401CCTGAGGTCA
ACCCTGAGGT CAAGTTCAAC
2461TGGTACGTGG
AGATAATGTC
GGTACCTCAC
ATCCAGAGTT
TGCAGTTGTC
AGACTGACTT
AAGACACACT
CAGGTCTATG
TACTGAAGGT
ATATTTCAGC
ATGACAAAAC
TCTTCCTCTT
CATGCGTGGT
ACGGCGTGGA
AGACAAGAGG
AGAGAATATA
CCAAGCCTCC
AGTTTGTTTG
CCTTTCTGTC
CACCCTATTC
GATTCTGGGG
TTCTAGTTGT
ATACTTGCTG
TCACACATGC
HasAAAA
GGTGGACGTG
GGTGCATAAT
<img file="MX336830B_D0155.tif" />
Industrialize
CAACGCTTTC
AACATCATGC
CATGAGGTGG
TTCTTCTCTG
CCATTCTCAG
TGCCACAACT
GACAAGAACA
AGTAAAAACA
CCACCGTGCC
CCCAAGGACA
AGCCACGAAG
GCCAAGACAA
144
<img file="MX336830B_D0156.tif" />
AGCCGCGGGA GGAGCAGTAC
2521AACAGCACGT
ACCAGGACTG GCTGAATGGC
2581AAGGAGTACA
CCCCCATCGA GAAAACCATC
2641TCCAAAGCCA
CCCTGCCCCC ATCCCGGGAT
2701GAGCTGACCA
AAGGCTTCTA TCCCAGCGAC
2761ATCGCCGTGG
ACTACAAGAC CACGCCTCCC
2821GTGTTGGACT
ACCGTGTGGT
AGTGCAAGGT
AAGGGCAGCC
AGAACCAGGT
AGTGGGAGAG
CCGACGGCTC
CAGCGTCCTC
CTCCAACAAA
CCGAGAACCA
CAGCCTGACC
CAATGGGCAG
CTTCTTCCTC
TCACCGTGGA CAAGAGCAGG
2881TGGCAGCAGG
AGGCTCTGCA CAACCACTAC
2941ACGCAGAAGA GCCTCTCCCT GTCTCCGGGT AAA
GGAACGTCTT
CTCATGCTCC
Institute
Mexican
AccGgg <ra <pfe $<sub>@C</sub>|<sub>to</sub>cj
Industrial
GCCCTCCCAG
CAGGTGTACA
TGCCTGGTCA
CCGGAGAACA
TACAGCAAGC
GTGATGCATG
c.
(iii) Light chain (LC) -Fe DNA sequence (underlined signal peptide, Fe region in bold) (seq with ident #: 11, coding of seq with ident #: 12)
ATGGAGACAG ACACACTCCT GCTATGGGTA CTGCTGCTCT
GGGTTCCAGG TTCCACTGGT
GAAATAACTC GTACTACTCT TCAGTCAGAT CAAGAGGAAA
TTGACTATGA TGATACCATA
145
121 TCAGTTGAAA
AGGATGAAAA TCAGAGCCCC
181 CGCAGCTTTC
CAGTGGAGAG GCTCTGGGAT
241 TATGGGATGA
CTCAGAGTGG CAGTGTCCCT
301 CAGTTCAAGA
CCTTTACTCA GCCCTTATAC
361 CGTGGAGAAC
ATATAAGAGC AGAAGTTGAA
421 GATAATATCA
CCTATTCCTT CTATTCTAGC
481 CTTATTTCTT
CTAGAAAAAA CTTTGTCAAG
541 CCTAATGAAA
ATATGGCACC CACTAAAGAT
601 GAGTTTGACT
ACCTGGAAAA AGATGTGCAC
661 TCAGGCCTGA, CACTGAACCC TGCTCATGGG
721 AGACAAGTGA
TCTTTGATGA GACCAAAAGC
781 TGGTACTTCA
CCTGCAATAT CCAGATGGAA
841 GATCCCACTT
TGAAGAAGGA
AAAAGAAAAC
GTAGCTCCCC
AAGTTGTTTT
TAAATGAACA
TGGTAACTTT
ATGAGGAAGA
CCAAAACTTA
GCAAAGCCTG
TTGGACCCCT
CAGTACAGGA
CTGAAAATAT
TTAAAGAGAA
AGATTTTGAC
ACGACACTAT
ACATGTTCTA
CCAGGAATTT
TTTGGGACTC
CAGAAATCAG
TCAGAGGCAA
CTTTTGGAAA
GGCTTATTTC
TCTGGTCTGC
ATTTGCTCTG
GGAAAGAAAC
TTATCGCTTC
<img file="MX336830B_D0157.tif" />
Industry!
TTTATTGCTG
AGAAACAGGG
ACTGATGGCT
CTGGGGCCAT
GCCTCTCGTC
GGAGCAGAAC
GTGCAACATC
TCTGATGTTG
CACACTAACA
TTTTTCACCA
TGCAGGGCTC
CATGCAATCA
<img file="MX336830B_D0158.tif" />
146
ATGGCTACAT AATGGATACA
901 CTACCTGGCT
GGTATCTGCT CAGCATGGGC
961 AGCAATGAAA
TGTTCACTGT ACGAAAAAAA
1021GAGGAGTATA
TTTTTGAGAC AGTGGAAATG
1081TTACCATCCA
TTGGCGAGCA TCTACATGCT
1141GGGATGAGCA
AGACTCCCCT GGGAATGGCT
1201TCTGGACACA
AATATGGACA GTGGGCCCCA
1261AAGCTGGCCA
GGAGCACCAA GGAGCCCTTT
1321TCTTGGATCA
ACGGCATCAA GACCCAGGGT
1381GCCCGTCAGA
TCATCATGTA TAGTCTTGAT
1441GGGAAGAAGT
CCTTAATGGT CTTCTTTGGC
1501AATGTGGATT
CTCCAATTAT TGCTCGATAC
1561ATCCGTTTGC
TTCGCATGGA GTTGATGGGC
TAGTAATGGC
ACATCCATTC
AAATGGCACT
AAGCTGGAAT
CACTTTTTCT
TTAGAGATTT
GACTTCATTA
AGGTGGATCT
AGTTCTCCAG
GGCAGACTTA
CATCTGGGAT
ACCCAACTCA
TCAGGATCAA
TATTCATTTC
GTACAATCTC
TTGGCGGGTG
GGTGTACAGC
TCAGATTACA
TTCCGGATCA
GTTGGCACCA
CCTCTACATC
TCGAGGAAAT
AAAACACAAT
TTATAGCATT
AGGATTCGAT
Mexican Property
Indusídal
AGTGGACATG
TATCCAGGTG
GAATGCCTTA
AATAAGTGTC
GCTTCAGGAC
ATCAATGCCT
ATGATTATTC
TCTCAGTTTA
TCCACTGGAA
ATTTTTAACC
CGCAGCACTC
<img file="MX336830B_D0159.tif" />
147
<td>1621TGTGATTTAA GTAAAGCAAT ATCAGATGCA</td><td>ATAGTTGCAG</td><td>CATGCCATTG</td><td>GGAATGGAGTMexlcanO from! aPrc> P<sup>to <, ad</sup>industry</td>
<td>1681CAGATTACTG CCTGGTCTCC TTCAAAAGCT</td><td>CTTCATCCTA</td><td>CTTTACCAAT</td><td>ATGTTTGCCA</td>
<td>1741CGACTTCACC AGGTGAATAA TCCAAAAGAG</td><td>TCCAAGGGAG</td><td>GAGTAATGCC</td><td>TGGAGACCTC</td>
<td>1801TGGCTGCAAG GAGTAACTAC TCAGGGAGTA</td><td>TGGACTTCCA</td><td>GAAGACAATG</td><td>AAAGTCACAG</td>
<td>1861AAATCTCTGC TCTCCAGCAG TCAAGATGGC</td><td>TTACCAGCAT</td><td>GTATGTGAAG</td><td>GAGTTCCTCA</td>
<td>1921CATCAGTGGA TTTTTCAGGG AAATCAAGAC</td><td>CTCTCTTTTT</td><td>TCAGAATGGC</td><td>AAAGTAAAGG</td>
<td>1981TCCTTCACAC TGACTCGCTA CCTTCGAATT</td><td>CTGTGGTGAA</td><td>CTCTCTAGAC</td><td>CCACCGTTAC</td>
<td>2041CACCCCCAGA AGGTTCTGGG CTGCGAGGCA</td><td>GTTGGGTGCA</td><td>CCAGATTGCC</td><td>CTGAGGATGG</td>
<td>2101CAGGACCTCT CAGCTCCAGA ACTCCTGGGC</td><td>ACGACAAAAC</td><td>TCACACATGC</td><td>CCACCGTGCC</td>
<td>2161GGACCGTCAG CCCTCATGAl CTCCCGGACC</td><td>TCTTCCTCTT</td><td>HasAAAA</td><td>CCCAAGGACA</td>
<td>2221CCTGAGGTCA ACCCTGAGGT CAAGTTCAAC</td><td>CATGCGTGGT</td><td>GGTGGACGTG</td><td>AGCCACGAAG</td>
<td>2281TGGTACGTGG AGCCGCGGGA GGAGCAGTAC</td><td>ACGGCGTGGA</td><td>GGTGCATAAT</td><td>GCCAAGACAA</td>
<td>2341AACAGCACGT</td><td>ACCGTGTGGT</td><td>CAGCGTCCTC</td><td>ACCGTCCTGC</td>
<img file="MX336830B_D0160.tif" />
148
I
Institute
Mexican
Gccggqgmgftedaci
Industrialize
AGTGCAAGGT
CTCCAACAAA
AAGGGCAGCC
CCGAGAACCA
AGAACCAGGT
CAGCCTGACC
CAATGGGCAG
AGTGGGAGAG
CTTCTTCCTC
CCGACGGCTC
ACCAGGACTG GCTGAATGGC
2401AAGGAGTACA
CCCCCATCGA GAAAACCATC
2461TCCAAAGCCA
CCCTGCCCCC ATCCCGGGAT
2521GAGCTGACCA
AAGGCTTCTA TCCCAGCGAC
2581ATCGCCGTGG
ACTACAAGAC CACGCCTCCC
2641GTGTTGGACT
TCACCGTGGA CAAGAGCAGG
2701TGGCAGCAGG
AGGCTCTGCA CAACCACTAC
2761ACGCAGAAGA GCCTCTCCCT GTCTCCGGGT AAA
Table 2: Polypeptide sequences
A. Hybrid of FVIII monomer with deleted B domain - Fe (BDD FVIIIFe dimer monomer): which was created by co-expression of the BDD FVIIIFc and Fe chains.
Construction = HC-LC-Fc fusion. An expression cassette
CAGGTGTACA
TGCCTGGTCA
CCGGAGAACA
TACAGCAAGC
GTGATGCATG
CTCATGCTCC
GGAACGTCTT of Fe is cotransfected with BDD FVIII-Fc to generate the BDD FVIIIFc monomer. For the FVIIIFc BDD chain, the Fe sequence is shown in bold; the HC sequence is shown in double underlined; the remaining sequence of domain B is shown in italics. Signal peptides are underlined.
<img file="MX336830B_D0161.tif" />
149
Institute
FVIII chain with deleted B domain-FcMQXlCOnO (19 amino acid signal sequence underlined) (seq. With ident # tndUStflOt: 2)
MQIELSTCFFLCLLRFCFS
ATRRYYLGAVELSWDYMQSDLGELPVDARFPPRVPKSFPFNTSWYKKTLFVEFT
DHLFNIAKPRPPWMGLLGPTIQAEVYDTWITLKNMASHPVSLHAVGV5YWKASEGAEYDD
QTSQREKEDDKVFPGGSHTYVWQVLKENGPMASDPLCLTYSYLSHVDLVKDLNSGLIGALL
VCREGSLAKEKTQTLHKFILLFAVFDEGKSWHSETKNSLMQDRDAASARAWPKMHTVNGYV
NRSLPGLIGCHRKSVYWHVIGMGTTPEVHSIFLEGHTFLVRNHRQASLEISPITFLTAQTL
LMDLGQFLLFCHISSHQHDGMEAYVKVDSCPEEPQLRMKNNEEAEDYDDDLTDSEMDWRF
DDDNS PS FIQIRSVAKKHPKTWVHYIAAEEEDWDYAPLVLAPDDRSYKSOYLNNGPQRIGR
KYKKVRFMAYTDETFKTREAIQHESGILGPLLYGEVGDTLLIIFKNQASRPYNIYPHGITD
VRPLYSRRLPKGVKHLKDFPILPGEIFKYKWTVTVEDGPTKSDPRCLTRYYSSFVNMERDL
ASGLIGPLLICYKESVDQRGNQIMSDKRNVILFSVFDENRSWYLTENIQRFLPNPAGVQLE
DPEFQASNIMHSINGYVFDSLQLSVCLHEVAYWYILSIGAQTDFLSVFFSGYTFKHKMVYE
DTLTLFPFSGETVFMSMENPGLWILGCHNSDFRNRGMTALLKVSSCDKNTGDYYEDSYEDI
SAYLLSKNNAIEPRSFSONPPVLKRHOREITRTTLQSDQEEIDYDDTISVEMKKEDFDIYD
EDENQSPRSFQKKTRHYFIAAVERLWDYGMSSSPHVLRNRAQSGSVPQFKKWFQEFTDGS
FTQPLYRGELNEHLGLLGPYIRAEVEDNIMVTFRNQASRPYSFYSSLISYEEDQRQGAEPR
KNFVKPNETKTYFWKVQHHMAPTKDEFDCKAWAYFSDVDLEKDVHSGLIGPLLVCHTNTLN
PAHGRQVTVQEFALFFTIFDETKSWYFTENMERNCRAPCNIQMEDPTFKENYRFHAINGYI
MDTLPGLVMAQDQRIRWYLLSMGSNENIHSIHFSGHVFTVRKKEEYKMALYNLYPGVFETV
EMLPSKAGIWRVECLIGEHLHAGMSTLFLVYSNKCQTPLGMASGHIRDFQITASGQYGQWA
PKLARLHYSGSINAWSTKEPFSWIKVDLLAPMIIHGIKTQGARQKFSSLYISQFIIMYSLD
GKKWQTYRGNSTGTLMVFFGNVDSSGIKHNIFNPPIIARYIRLHPTHYSIRSTLRMELMGC
<img file="MX336830B_D0162.tif" />
150
DLNSCSMPLGMES ΚΑΙ SDAQITAS SYFTNMFATWS PS KARLHLQGRSNAWRPQVNNPKEWL I nStitUÍO
Mexican
QVDFQKTMKVTGVTTQGVKSLLTSMYVKEFLISSSQDGHQWTLFFQNGKVKVFQGNQDQg'Jap<sub>ro</sub>^ j<sub>ec</sub>|<sub>to(</sub>j
Industrialize
PWNSLDPPLLTRYLRIHPQSWVHQIALRMEVLGCEAQDLYDKTHTCPPCPAPELLGGPSV '
FLFPPKPKDTLMISRTPEVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYR
WSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQ
VSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVF
SCSVMHEALHNHYTQKSLSLSPGK ii) Fe Chain (20 amino acid heterologous signal peptide from mouse Igic chain underlined) (Seq ID #: 4)
METDTLLLWVLLLWVPGSTG
DKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVWDVSHEDPEVKF
NWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTI
SKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPV
LDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK
B. Hybrid of full-length FVIIIFc monomers (full-length FVIIIFc monomer dimer): which was created by the co-expression of the FVIIIFc and
Faith.
Construction = HC-B-LC-Fc fusion. An Fe expression cassette is cotransfected with the full length FVIII-Fe to generate the full length monomer
FVIIIFc. For the FVIIIFc chain, the Fe sequence is shown in bold; HC sequence is shown in double underlined; the sequence of domain B is shown in italics.
<img file="MX336830B_D0163.tif" />
151 > Instifue
Signal peptides are underlined.
i) .FVIIIFc full length chain
- underlined FVIII signal (sec. ID #: 6)
MQIELSTCFFLCLLRFCFS
ATRRYYLGAVELSWDYMQSDLGELPVDARFPPRVPKSFPFNTSWYKKTLFVEFT
DHLFNIAKPRPPWMGLLGPTIQAEVYDTWITLKNMASHPVSLHAVGVSYWKASEGAEYDD
QTSQREKEDDKVFPGGSHTYVWQVLKENGPMASDPLCLTYSYLSHVDLVKDLNSGLIGALL
VCREGSLAKBKTQTLHKFILLFAVFDEGKSWHSETKNSLMQDRDAASARAWPKMHTVNGYV
NRSLPGLIGCHRKSVYWHVIGMGTTPEVHSIFLEGHTFLVRNHRQASLEISPITFLTAQTL
LMDLGQFLLFCHISSHQHDGMEAYVKVDSCPEEPQLRMKNNEEAEDYDDDLTDSEMDWRF
DDDNSPSFIQIRSVAKKHPKTWVHYIAAEEEDWDYAPLVLAPDDRSYKSOYLNNGPQRIGR
KYKKVRFMAYTDETFKTREAIQHESGILGPLLYGEVGDTLLIIFKNQASRPYNIYPHGITD
VRPLYSRRLPKGVKHLKDFPILPGEIFKYKWTVTVEDGPTKSDPRCLTRYYSSFVNMERDL
ASGLIGPLLICYKESVDQRGNQIMSDKRNVILFSVFDENRSWYLTENIQRFLPNPAGVQLE
DPEFQASNIMHSINGYVFDSLQLSVCLHEVAYWYILSIGAQTDFLSVFFSGYTFKHKMVYE
DTLTLFPFSGETVFMSMENPGLWILGCHNSDFRNRGMTALLKVSSCDKNTGDYYEDSYEDI
SAYLLSFNNAIFPRSFSONSRHPSTROKQFNATTIPENDIEKTDPWFÁHRTPMPKIQNVSS
SDLLMLLRQSPTPHGLSLSDLQEAKYETFSDDPSPGAIDSNNSLSEMTHFRPQLHHSGDMV
FTPESGLQLRLNEKLGTTAATELKKLDFKVSSTSNNLISTIPSDNLAAGTDNTSSLGPPSM
PVHYDSQLDTTLFGKKSSPLTESGGPLSLSEENNDSKLLESGLMNSQESSWGKNVSSTESG
RLFKGKRAHGPALLTKDNALFKVSISLLKTNKTSNNSATNRKTHIDGPSLLIENSPSVWQN.
ILESDTEFKKVTPLIHDRMLMDKNATALRLNHMSÑKTTSSKNMEMVQQKKEGPIPPDAQNP
DMSFFKMLFLPESARWIQRTHGKNSLNSGQGPSPKQLVSLGPEKSVEGQNFLSEKNKWVG
KGEFTKDVGLKEMVFPSSRNLFLTNLDNLHENNTHNQEKKIQEEIEKKETLIQENWLPQI
HTVTGTKNFMKNLFLLSTRQNVEGSYDGAYAPVLQDFRSLNDSTNRTKKHTAHFSKKGEEE
<img file="MX336830B_D0164.tif" />
152
NLEGLGNQTKQIVEKYACTTRISPNTSQQNFVTQRSKRALKQFRLPLEETELEKR
STQWSKNMKULTPSTLTQIDYNEKEKGAITQSPLSDCLTRSHSIPQANRSPLPIA
SIRPIYLTRVLFQDNSSHLPAASYRKKDSGVQESSHFLQGAKKNNLSLAILTLEMTGDQRE
VGSLGTSATNSVTYKKVENTVLPKPDLPKTSGKVELLPKVHIYQKDLFPTETSNGSPGHLD
LVEGSLLQGTEGAIKWNEANRPGKVPFLRVATESSAKTPSKLLDPLAWDNHYGTQIPKEEW
K3QEKSPEKTAFKKKDTIL5LNACESNHAIAAINEGQNKPEIEVTWAKQGRTERLCSQNPP
VLXRHQREITRTTLQSDQEEIDYDDTISVEMKKEDFDIYDEDENQSPRSFQKKTRHYFIAA
VERLWDYGMSSSPHVLRNRAQSGSVPQFKKWFQEFTDGSFTQPLYRGELNEHLGLLGPYI
RAEVEDNIMVTFRNQASRPYSFYSSLISYEEDQRQGAEPRKNFVKPNETKTYFWKVQHHMA
PTKDEFDCKAWAYFSDVDLEKDVHSGLIGPLLVCHTNTLNPAHGRQVTVQEFALFFTIFDE
TKSWYFTENMERNCRAPCNIQMEDPTFKENYRFHAINGYIMDTLPGLVMAQDQRIRWYLLS
MGSNENIHSIHFSGHVFTVRKKEEYKMALYNLYPGVFETVEMLPSKAGIWRVECLIGEHLH
AGMSTLFLVYSNKCQTPLGMASGHIRDFQITASGQYGQWAPKLARLHYSGSINAWSTKEPF
SWIKVDLLAPMIIHGIKTQGARQKFSSLYISQFIIMYSLDGKKWQTYRGNSTGTLMVFFGN
VDSSGIKHNlFNPPIIARYIRLHPTHYSIRSTLRMELMGCDLNSCSMPLGMESKAISDAQI
TASSYFTNMFATWSPSKARLHLQGRSNAWRPQVNNPKEWLQVDFQKTMKVTGVTTQGVKSL
LTSMYVKEFLISSSQDGHQWTLFFQNGKVKVFQGNQDSFTPWNSLDPPLLTRYLRIHPQS
WVHQIALRMEVLGCEAQDLYDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTC
WVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQDWLNGKEYKCK
VSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWES
NGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSIiS
PGK
153
<img file="MX336830B_D0165.tif" />
underlined mouse IgK chain amino acids) (seq. con | ndnyfflQ | ID #: 4)
METDTLLLWVLLLWVPGSTG
DKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVWDVSHEDPEVKF
NWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTI
SKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPV
LDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK
C. FVIII-Fc heterodimer hybrid
This is done by the co-transfer of HC-Fc and the LC-Fc constructs. Two HC-Fc constructs were made.
One has no linker between HC and Fe (HC-Fc), while the other has a 5 amino acid linker between HC and Fe (HC + 5-Fe). The FVIII signal peptide was used for the HC-Fc constructs, while the mouse Igx signal sequence was used for the LC-Fc construct.
(i) HC-Fc (Fe sequence shown in bold, signal peptide underlined) (seq. ID #: 8)
MQIELSTCFFLCLLRFCFS
ATRRYYLGAVELSWDYMQSDLGELPVDARFPPRVPKSFPFNTSWYKKTLFVEFT
DHLFNIAKPRPPWMGLLGPTIQAEVYDTWITLKNMASHPVSLHAVGVSYWKASEGAEYDD
QTSQREKEDDKVFPGGSHTYVWQVLKENGPMASDPLCLTYSYLSHVDLVKDLNSGLIGALL
VCREGSLAKEKTQTLHKFILLFAVFDEGKSWHSETKNSLMQDRDAA.SARAWPKMHTVNGYV
NRSLPGLIGCHRKSVYWHVIGMGTTPEVHSIFLEGHTFLVRNHRQASLEISPITFLTAQTL
LMDLGQFLLFCHISSHQHDGMEAYVKVDSCPEEPQLRMKNNEEAEDYDDDLTDSEMDWRF
<img file="MX336830B_D0166.tif" />
154
DDDNSPS FIQIRS VAKKHPKTWVHYIAAEEEDWDYAPLVLAPDDRS YKSQYLNNGPQRI GfyJfjjuto
Mexican
KYKKVRFMAYTDETFKTREAIQHESGILGPLLYGEVGDTLLIIFKNQASRPYNI ^ I ^ KjJ ^^ gj VRPLYSRRLPKGVKHLKDFPILPGEIFKYKWTVTVEDGPTKSDPRCLTRYYSSFVNMERllfi<sup>C</sup>^<sup>US</sup>^<sup>to</sup>^ ASGLIGPLLICYKESVDQRGNQIMSDKRNVILFSVFDENRSWYLTENIQRFLPNPAGVQLE
DPEFQASNIMHSINGYVFDSLQLSVCLHÉVAYWYILSIGAQTDFLSVFFSGYTFKHKMVYE
DTLTLFPFSGETVFMSMENPGLWILGCHNSDFRNRGMTALLKVSSCDKNTGDYYEDSYEDI
SAYLLSKNNAIEPRDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVWDVS
HEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQDWLNGKEYKCKVSNKAL
PAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPEN
NYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK (ii) HC + 5-Fe (Fe sequence is shown in bold, 5 amino acid linker sequence (from FVIII domain B) is shown in italics, with sec. Signal peptide underlined. from ident.:10)
MQIELSTCFFLCLLRFCFS
ATRRYYLGAVELSWDYMQSDLGELPVDARFPPRVPKSFPFNTSWYKKTLFVEFT
DHLFNIAKPRPPWMGLLGPTIQAEVYDTWITLKNMASHPVSLHAVGVSYWKASEGAEYDD
QTSQREKEDDKVFPGGSHTYVWQVLKENGPMASDPLCLTYSYLSHVDLVKDLNSGLIGALL
VCREGSLAKEKTQTLHKFILLFAVFDEGKSWHSETKNSLMQDRDAASARAWPKMHTVNGYV
NRSLPGLIGCHRKSVYWHVIGMGTTPEVHSIFLEGHTFLVRNHRQASLEISPITFLTAQTL
LMDLQQFLLFCHISSHQHDGMEAYVKVDSCPEEPQLRMKNNEEAEDYDDDLTDSEMDWRF
DDDNSPSFIQIRSVAKKHPKTWVHYIAAEEEDWDYAPLVLAPDDRSYKSQYLNNGPQRIGR
KYKKVRFMAYTDETFKTREAIQHESGILGPLLYGEVGDTLLIIFKNQASRPYNIYPHGITD
VRPLYSRRLPKGVKHLKDFPILPGEIFKYKWTVTVEDGPTKSDPRCLTRYYSSFVNMERDL
ASG LIGPLLICYKESVDQRGNQIMSDKRNVILFSVFDENRSWYLTENIQRFLPNPAGVQLE
<img file="MX336830B_D0167.tif" />
155
DPEFQASNÍMHSINGYVFDSLQLSVCLHEVAYWYILSIGAQTDFLSVFFSGYTFKHKMVY ^
DTLTLFPFSGETVFMSMENPGLWILGCHNSDFRNRGMTALLKVSSCDKNTGDYYEDÉ & áefTOptedOd industriar
SAYLLSKNNAIEPRSFSQNDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCV
WDVSHEDPBVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQDWLNGKEYKCKV
SNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESN
GQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSP
GK (iii) LC-Fc6His (Fe sequence is shown in bold, signal peptide underlined.) (Seq. ID: 12)
METDTLLLWVLLLWVPGSTG
EITRTTLQSDQEEIDYDDTISVEMKKEDFDIYDEDENQSPRSFQKKTRHYFIAAV
ERLWDYGMSSSPHVLRNRAQSGSVPQFKKWFQEFTDGSFTQPLYRGELNEHLGLLGPYIR
AEVEDNIMVTFRNQASRPYSFYSSLISYEEDQRQGAEPRKNFVKPNETKTYFWKVQHHMAP
TKDEFDCKAWAYFSDVDLEKDVHSGLIGPLLVCHTNTLNPAHGRQVTVQEFALFFTIFDET
KSWYFTENMERNCRAPCNIQMEDPTFKENYRFHAINGYIMDTLPGLVMAQDQRIRWYLLSM
GSNENIHSIHFSGHVFTVRKKEEYKMALYNLYPGVFETVEMLPSKAGIWRVECLIGEHLHA
GMSTLFLVYSNKCQTPLGMASGHIRDFQITASGQYGQWAPKLARLHYSGSINAWSTKEPFS
WIKVDLLAPMIIHGIKTQGARQKFSSLYISQFIIMYSLDGKKWQTYRGNSTGTLMVFFGNV
DSSGIKHNIFNPPIIARYIRLHPTHYSIRSTLRMELMGCDLNSCSMPLGMESKAISDAQIT
ASSYFTNMFATWSPSKARLHLQGRSNAWRPQVNNPKEWLQVDFQKTMKVTGVTTQGVKSLL
TSMYVKEFLISSSQDGHQWTLFFQNGKVKVFQGNQDSFTPWNSLDPPLLTRYLRIHPQSW
VHQIALRMEVLGCEAQDLYDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCV wdvshedpEvkfnwyvdgvevhnaktkpreeqynstyrwsvltvlhqdwlngkeykckv
SNKÁLPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESN
<img file="MX336830B_D0168.tif" />
156
GQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK institute
Mexican
Table 3 Determination of the coagulation time of the
Industrial total (WBCT) in hemophilia A mice after a single intravenous dose of 50 IU / kg of rFVIIIFc or the
ReFacto®.
TO.
<td></td><td></td><td colspan="8">Time of blood collection, h</td>
<td>Treatment</td><td>Number of animal</td><td>Pre- dose</td><td> 0.25</td><td> 24</td><td> 36</td><td> 42</td><td> 96</td><td> 113</td><td> 120</td>
<td></td><td></td><td colspan="8">WBCT, min</td>
<td>50 Ul / kg ReFacto®</td><td> 1</td><td> >60</td><td> 18</td><td> >60</td><td>ND</td><td>ND</td><td></td><td></td><td></td>
<td></td><td> 2</td><td> >60</td><td> 5</td><td> 16</td><td> >60</td><td>ND</td><td></td><td></td><td></td>
<td></td><td> 3</td><td> >60</td><td> 4</td><td> 7</td><td> >60</td><td>ND</td><td></td><td></td><td></td>
<td></td><td> 4</td><td> >60</td><td> 7</td><td> 8</td><td> 10</td><td> >60</td><td></td><td></td><td></td>
<td></td><td> 5</td><td> >60</td><td> 6</td><td> 9</td><td> 16</td><td> >60</td><td></td><td></td><td></td>
<td></td><td> 6</td><td> >60</td><td> 5</td><td> 15</td><td> >60</td><td>ND</td><td></td><td></td><td></td>
<td>50 Ul / kg rFVIIIFc</td><td> 7</td><td> >60</td><td> 7</td><td></td><td></td><td></td><td> 8</td><td> >60</td><td>ND</td>
<td></td><td>S</td><td> >60</td><td> 5</td><td></td><td></td><td></td><td> 8</td><td> >60</td><td>ND</td>
<td></td><td> 9</td><td> >60</td><td> 4</td><td></td><td></td><td></td><td> 16</td><td> >60</td><td>ND</td>
<td></td><td> 10</td><td> >60</td><td> 3</td><td></td><td></td><td></td><td> 11</td><td> 4</td><td> >60</td>
<td></td><td> 11</td><td> >60</td><td> 3</td><td></td><td></td><td></td><td> 9</td><td> >60</td><td>ND</td>
<td></td><td> 12</td><td> >60</td><td> 4</td><td></td><td></td><td></td><td> 6</td><td> >60</td><td>ND</td>
ND «Not determined as the previous time point was> 60 min
B.
<td></td><td></td><td colspan="6">Time of blood collection, h</td>
<td>Treatment</td><td>Number of animal</td><td>Pre- dose</td><td> 0.25</td><td> 24</td><td> 48</td><td> 96</td><td> 120</td>
<td></td><td></td><td colspan="6">WBCT, min</td>
<td>50 Ul / kg ReFacto®</td><td> 1</td><td> >60</td><td> 11</td><td> 15</td><td> >60</td><td> >60</td><td>ND</td>
<td> «</td><td> 2</td><td> >60</td><td> 3</td><td> 3</td><td> >60</td><td> >60</td><td> >60</td>
<td></td><td> 3</td><td> >60</td><td> 4</td><td> 6</td><td> >60</td><td> >60</td><td> >60</td>
<td>50 Ul / kg rFVIIIFc</td><td> 4</td><td> >60</td><td> 3</td><td> 5</td><td> 5</td><td> >60</td><td> >60</td>
<td></td><td> 5</td><td> >60</td><td> 3</td><td> 6</td><td> 7</td><td> 13</td><td> ' >60</td>
<td></td><td> 6</td><td> >60</td><td> 5</td><td> 8</td><td> 9</td><td> 9</td><td> >60</td>
ND = Not determined since the previous time point was> 60 min
<img file="MX336830B_D0169.tif" />
157
Table 4 PK Parameters After a Single Intravenous Dose in Hemophilia A Mice (50 IU / kg)
<td>Treatment</td><td>Cmax (IU / ml)</td><td>AUC (h IU / ml)</td><td><sup>T</sup>l / 2 (h)</td><td>Cl (ml / h / kg)</td><td>Vss (ml / kg)</td>
<td>rFVIIIFc</td><td> 1.56</td><td> 22.6</td><td> 11.1</td><td> 2.09</td><td> 28.4</td>
<td>ReFacto® '</td><td> 0.67</td><td> 6.94</td><td> 5.0</td><td> 7.2</td><td> 43.8</td>
<td>Advate '</td><td> 0.47</td><td> 3.90</td><td> 7.1</td><td> 12.8</td><td> 103</td>
Table 5 Pharmacokinetic parameters after a single intravenous dose in dogs with hemophilia A (125 IU / kg of rFVIIIFc, 114 and 120 IU / kg of ReFacto®)
A. PK determined from chromogenic activity data
<td>Treatment</td><td>CmSx (ui / ml)</td><td>AUC (h ui / ml</td><td>Tl / 2 (h)</td><td>Cl (ml / h / kg)</td><td>Vz (ml / kg)</td>
<td>rFVIIIFc</td><td> 2.0 ± 0.54</td><td> 25.9 ± 6.47</td><td> 15.4 ± 0.3</td><td> 5.1 ± 1.4</td><td> 113 ± 29</td>
<td>ReFacto® '<sup>4</sup></td><td> 2.0</td><td> 13.2</td><td> 7.4</td><td> 6.5</td><td> 68.7</td>
B. PK determined from ELISA data
<td>Treatment</td><td>^ max (ng / ml)</td><td>AUC (h ng / ml</td><td>Tl / 2 (h)</td><td>Cl (ml / h / kg)</td><td>Vz (ml / kg)</td>
<td>rFVIIIFc</td><td> 210 + 33</td><td> 2481 ± 970</td><td> 15.7 ± 1.7</td><td> 6.2 + 3.0</td><td> 144 ± 83</td>
<td>ReFacto® ”*</td><td> 211</td><td> 1545</td><td> 6.9</td><td> 8.7</td><td> 85</td>
Mean ± sd, n = 4 for rFVIIIFc, n = 2 for
ReFacto® * sd not reported for ReFacto® because there were only two dogs
158
Table 6 Clotting activity measured with hemophilia A after an intravenous dose with the rFVIIIFc or the
<img file="MX336830B_D0170.tif" />
unique by way of Industriar
ReFacto®.
<td></td><td></td><td colspan="2">aPTT, sec</td>
<td>Dog ID</td><td>Treatment</td><td>Predose</td><td>5 min post dose</td>
<td>OWN</td><td>rFVIIIFc</td><td> 86.5</td><td> 53.6</td>
<td>One thousand</td><td>rFVIIIFc</td><td> 99.8</td><td> 56.4</td>
<td>Ml2</td><td>rFVIIIFc</td><td> 119</td><td> 68.7</td>
<td></td><td>ReFacto®</td><td> 108</td><td> 60.7</td>
<td>M38</td><td>rFVIIIFc</td><td> 115</td><td> 76.6</td>
<td></td><td>ReFacto®</td><td> 118</td><td> 68.0</td>
Table 7 Plasma concentration of rFVIIIFc or Xyntha in monkeys administered with a single intravenous dose of 125
Ul / kg measured by ELISA.
A. Plasma concentration of rFVIIIFc (pg / ml)
<td></td><td colspan="3">Group 1</td><td colspan="3">Group 2</td><td rowspan="2">Average</td><td rowspan="2">SD</td>
<td>Time, h</td><td>S04376</td><td> 606595</td><td>C36195</td><td>C36066</td><td>C36174</td><td> 604362</td>
<td>Pre</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td></td><td></td>
<td> 0.25</td><td> ¡0.400</td><td> 0.334</td><td> 0.374</td><td> 0.348</td><td> 0.383</td><td> 0.323</td><td> 0.360</td><td> 0.030</td>
<td> 4</td><td> 0.266</td><td> 0.259</td><td> 0.236</td><td> 0.233</td><td> 0.259</td><td> 0.217</td><td> 0.245</td><td> 0.019</td>
<td> 12</td><td> 0.165</td><td> 0.152</td><td> 0.12</td><td> 0.15</td><td> 0.161</td><td> 0.149</td><td> 0.150</td><td> 0.016</td>
<td> 24</td><td> 0.079</td><td> 0.074</td><td> 0.047</td><td> 0.08</td><td> 0.088</td><td> 0.076</td><td> 0.074</td><td> 0.014</td>
<td> 36</td><td> 0.035</td><td> 0.04</td><td> 0.022</td><td> 0.04</td><td> 0.041</td><td> 0.046</td><td> 0.037</td><td> 0.008</td>
<td> 48</td><td> 0.019</td><td> 0.021</td><td>BLQ</td><td> 0.021</td><td> 0.024</td><td> 0.025</td><td> 0.022</td><td> 0.002</td>
B. Plasma concentration of Xyntha (pg / ml)
<td></td><td colspan="3">Group 1</td><td colspan="3">Group 2</td><td colspan="2"></td>
<td>Time, h</td><td> 604376</td><td> 606595</td><td>C36195</td><td>C36066</td><td>C36174</td><td> 604362</td><td>Promise gave</td><td>SD</td>
<td>Pre</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td></td><td></td>
<td> 0.25</td><td> 0.252</td><td> 0.074</td><td> 0.155</td><td> 0.317</td><td> 0.217</td><td> 0.167</td><td> 0.197</td><td> 0.084</td>
<td> 4</td><td> 0.197</td><td> 0.159</td><td> 0.152</td><td> 0.229</td><td> 0.19</td><td> 0.082</td><td> 0.168</td><td> 0.051</td>
<td> 12</td><td> 0.137</td><td> 0.099</td><td> 0.104</td><td> 0.166</td><td> 0.158</td><td> 0.081</td><td> 0.124</td><td> 0.035</td>
<td> 24</td><td> 0.09</td><td> 0.068</td><td> 0.051</td><td> 0.082</td><td> 0.08</td><td> 0.084</td><td> 0.076</td><td> 0.014</td>
<td> 36</td><td> 0.037</td><td> 0.043</td><td> 0.015</td><td> 0.041</td><td> 0.035</td><td>BLQ</td><td> 0.034</td><td> 0.011</td>
<td> 48</td><td> 0.022</td><td>BLQ</td><td>BLQ</td><td> 0.017</td><td> 0.013</td><td>BLQ</td><td> 0.017</td><td> 0.005</td>
<img file="MX336830B_D0171.tif" />
159
Table 8 Plasma concentration of rFVIIIFc or Xyntha in do (a Property monkeys that received a single intravenous dose of 125 measured by the FVIII specific activity chromogenic assay (reported in IU / ml).
A. Xyntha
<td>Time (h)</td><td colspan="3">Group 1</td><td colspan="3">Group 2</td>
<td>Predose</td><td> 604376</td><td> 606595</td><td>C36195</td><td>C36066</td><td>C36174</td><td> 604362</td>
<td> 0.25</td><td> 5.62</td><td> 4.55</td><td> 5.01</td><td> 4.5</td><td> 5.15</td><td> 3.77</td>
<td> 4</td><td> 3.9</td><td> 4.05</td><td> 3.2</td><td> 3.19</td><td> 3.46</td><td> 2.36</td>
<td> 12</td><td> 2.51</td><td> 2.82</td><td> 1.69</td><td> 2.17</td><td> 2.5</td><td> 2.01</td>
<td> 24</td><td> 1.67</td><td> 1.66</td><td> 1.18</td><td> 0.95</td><td> 1.57</td><td> 1.5</td>
<td> 36</td><td> 0.7</td><td> 0.85</td><td> 0.48</td><td> 0.44</td><td> 0.85</td><td> 0.82</td>
<td> 48</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td> 0.38</td><td> 0.48</td>
B. rFVIIIFc
<td>Time (h)</td><td colspan="3">Group 1</td><td colspan="3">Group 2</td>
<td>Predose</td><td> 604376</td><td> 606595</td><td>C36195</td><td>C36066</td><td>C36174</td><td> 604362</td>
<td> 0.25</td><td> 4.31</td><td> 3.82</td><td> 3.54</td><td> 4.13</td><td> 4.12</td><td> 3.68</td>
<td> 4</td><td> 3</td><td> 3.36</td><td> 2.53</td><td> 2.7</td><td> 2.74</td><td> 2.81</td>
<td> 12</td><td> 2</td><td> 2.15</td><td> 1.42</td><td> 2.28</td><td> 2.75</td><td> 2.22</td>
<td> 24</td><td> ' 1.01</td><td> 1.17</td><td> 0.5</td><td> 1.5</td><td> 1.61</td><td> 1.01</td>
<td> 36</td><td>BLQ</td><td> 0.52</td><td> 0.48</td><td> 0.88</td><td> 0.72</td><td> 0.64</td>
<td> 48</td><td> 0.31</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td>
<td> 72</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td>BLQ</td><td> 0.31</td><td>BLQ</td>
BLQ = below the limit of quantification
Table 9 PK parameters of rFVIIIFc after a single dose of 125 IU / kg
<td rowspan="3">Parameter PK</td><td colspan="9">RFVIIIFc ELISA data</td>
<td rowspan="2">units</td><td colspan="3">Group 1</td><td colspan="3">Group 2</td><td rowspan="2">Average</td><td rowspan="2">SD</td>
<td> 604376</td><td> 606595</td><td>C36195</td><td>C36066</td><td>C36174</td><td> 604362</td>
<td>Tmax</td><td>'h</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0,25</td><td> 0.00</td>
<td>Cmax</td><td>, pg / ml</td><td> 0.4</td><td> 0.334</td><td> 0.374</td><td> 0.348</td><td> 0.383</td><td> 0.323</td><td> 0.368</td><td> 0.030</td>
<td>Tl / 2</td><td>h</td><td> 11.4</td><td> 13.3</td><td> 9.3</td><td> 12.7</td><td> 12.7</td><td> 14.1</td><td> 11.9</td><td> 1.7</td>
<td>AUC</td><td>pg * h / tnl</td><td> 5.86</td><td> 5.65</td><td> 4.37</td><td> 5.56</td><td> 4.37</td><td> 5.58</td><td> 5.16</td><td> 0.68</td>
<td>Cl</td><td>ml / h / kg</td><td> 2.15</td><td> 2.23</td><td> 2.88</td><td> 2.27</td><td> 2.07</td><td> 2.26</td><td> 2.32</td><td> 0.29</td>
<td>Vz</td><td>ml / kg</td><td> 35.3</td><td> 42.5</td><td> 38.8</td><td> 37,9</td><td> 37.9</td><td> 46.1</td><td> 38.5</td><td> 3.9</td>
<td>MRT</td><td>h</td><td> 15.3</td><td> 17</td><td> 12.1</td><td> 17.1</td><td> 17.3</td><td> 19.2</td><td> 15.8</td><td> 2.4</td>
160
<img file="MX336830B_D0172.tif" />
Chromogenic Activity Data for rFVIIIFc
<td rowspan="2">Parameter PK</td><td rowspan="2">units</td><td colspan="3">Group 1</td><td colspan="3">Group 2</td><td colspan="2" rowspan="2">detaPr Average SD |</td>
<td> 604376</td><td> 606595</td><td>C36195</td><td>C36066</td><td>C36174</td><td> 604362</td>
<td>Tmax</td><td>h</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.00'</td>
<td>Cmax</td><td>Ul / ml</td><td> 4.31</td><td> 3.82</td><td> 3.54</td><td> 4.13</td><td> 4.12</td><td> 3.68</td><td> 3.93</td><td> 0.30</td>
<td>Tx / 2</td><td>h</td><td> 13.4</td><td> 12.0</td><td> 11.6</td><td> 17.5</td><td> 12.4</td><td> 29.4</td><td> 16.1</td><td> 6.9</td>
<td>AUC</td><td>U¿ * h / ml</td><td> 74.7</td><td> 75.5</td><td> 53.5</td><td> 92.9</td><td> 88.9</td><td> 92.7</td><td> 79.7</td><td> 15.2</td>
<td>Cl</td><td>ml / h / kg</td><td> 1.67</td><td> 1.65</td><td> 2.34</td><td> 1.35</td><td> 1.41</td><td> 1.35</td><td> 1.63</td><td> 0.38</td>
<td>Vz</td><td>ml / kg</td><td> 32.3</td><td> 28.7</td><td> 39.2</td><td> 33.9</td><td> 25.2</td><td> 57.2</td><td> 36.1</td><td> 11.4</td>
<td>MRT</td><td>h</td><td> 17.8</td><td> 16.8</td><td> 16.9</td><td> 25</td><td> 19.2</td><td> 33.3</td><td> 21.5</td><td> 6.5</td>
© xicano piety
Table 10 Xyntha PK parameters after a single IV dose (125 IU / kg)
<td rowspan="3">Parameter PK</td><td colspan="9">Xyntha ELISA data</td>
<td rowspan="2">units</td><td colspan="3">Group 1</td><td colspan="3">Group 2</td><td rowspan="2">Average</td><td rowspan="2">SD</td>
<td> 604376</td><td> 606595</td><td>C36195</td><td>C36066</td><td>C36174</td><td> 604362</td>
<td>Tmax</td><td>h</td><td> 0.25</td><td> 4</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.88</td><td> 1.53</td>
<td>Cmax</td><td>Ul / ínl</td><td> 0.252</td><td> 0.159</td><td> 0.155</td><td> 0.317</td><td> 0.217</td><td> 0.167</td><td> 0.21</td><td> 0.06</td>
<td>Tl / 2</td><td>h <sup>!</sup></td><td> 13.6</td><td> 19.9</td><td> 9.7</td><td> 11</td><td> 9.2</td><td>ND</td><td> 12.7</td><td> 4.4</td>
<td>AUC</td><td>IU * h / ml</td><td> 5.15</td><td> 4.39</td><td> 3,17</td><td> 5.53</td><td> 4.79</td><td> 6.32</td><td> 5.24</td><td> 0.74</td>
<td>Cl</td><td>ml / h / kg</td><td> 2.21</td><td> 2.6</td><td> 3.59</td><td> 2.06</td><td> 2.38</td><td>ND</td><td> 2.57</td><td> 0.61</td>
<td>vz</td><td>ml / kg</td><td> 43.4</td><td> 74.7</td><td> 50.1</td><td> 32.9</td><td> 31.5</td><td>ND</td><td> 46.5</td><td> 17.5</td>
<td>MRT</td><td>h</td><td> 19</td><td> 28.4</td><td> 14</td><td> 16.1</td><td> 15.9</td><td>ND</td><td> 18.7</td><td> 5.7</td>
<td rowspan="3">Parameter PK</td><td colspan="9">Xyntha Chromogenic Activity Data</td>
<td rowspan="2">units</td><td colspan="3">Group 1</td><td colspan="3">Group 2</td><td rowspan="2">Average</td><td rowspan="2">SD</td>
<td> 604376</td><td> 606595</td><td>C36195</td><td>C36066</td><td>C36174</td><td> 604362</td>
<td>Tmax</td><td>h</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0.25</td><td> 0</td>
<td>Cmax</td><td>Ul / ml</td><td> 5.62</td><td> 4.55</td><td> 5.01</td><td> 4.5</td><td> 5.15</td><td> 3.77</td><td> 4.77</td><td> 0.64</td>
<td>Ti / 2</td><td>h</td><td> 12.8'</td><td> 14.3</td><td> 11.4</td><td> 10.4</td><td> 11.7</td><td> 14.6</td><td> 12.5</td><td> 1.7</td>
<td>AUC</td><td>IU * h / ml</td><td> 97.1</td><td> 104.2</td><td> 71.3</td><td> 70.7</td><td> 94.0</td><td> 82.8</td><td> 86.7</td><td> 14.0</td>
<td>Cl</td><td>ml / h / kg</td><td> • 1.29</td><td> 1.20</td><td> 1.75</td><td> 1.77</td><td> 1.33</td><td> 1.51</td><td> 1.48</td><td> 0.24</td>
<td>Vz</td><td>ml / kg</td><td> 23.7</td><td> 24.8</td><td> 28.9</td><td> 26.6</td><td> 22.5</td><td> 31.8</td><td> 26.4</td><td> 3.5</td>
<td>MRT</td><td>h</td><td> 17.8</td><td> 20.1</td><td> 16.0</td><td> 14.8</td><td> 18.4</td><td> 23.2</td><td> 18.4</td><td> 3.0</td>
Table 11 Activation of factor X
<td></td><td>Km (nM)</td><td>Vmax (nM / min)</td>
<td>rFVIIIFc</td><td> 55.0 ± 5.9</td><td> 65.6 ± 8.6</td>
<td>BDD FVIII</td><td> 51.0 ± 8.7</td><td> 73.5 ± 10.1</td>
TABLE 12 Interaction with factor IXa
<td></td><td>Kd (nM)</td><td>Vmax (nM / min)</td>
<td>rFVIIIFc</td><td> 2.8 ± 0.4</td><td> 4.5 ± 0.3</td>
<td>BDD FVIII</td><td> 2.5 ± 0.3</td><td> 4.0 ± 1.0</td>
<img file="MX336830B_D0173.tif" />
161
It is noted that in relation to this date, the method known by the applicant to carry out the aforementioned invention is the one that is clear from the description of the invention.
Present
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Events
| Event | Code | |
|---|---|---|
| Grant or registrationFG | FG |
Numbers
- Publication
- 336830
- Application
- 6347
Titles2
- Spanish
- POLIPEPTIDOS HIBRIDOS Y QUIMERICOS DEL FACTOR VIII-FC, Y METODOS DE USO DE LOS MISMOS.
- English
- CHEMERIC AND HYBRID POLYPEPTIDES OF FACTOR VIII-FC, AND METHODS OF USE OF THE SAME.
Classification
- CPC, 11
- A61K38/37
- A61P7/04
- C07K14/755
- C07K16/46
- C07K2319/30
- A61K47/643
- A61K47/6811
- A61P41/00
- A61P7/00
- A61P7/02
- Y02A90/10
- IPC, 5
- A61K38 37
- A61K47 48
- A61P7 04
- C07K14 755
- C07K16 46