I 1111111111111111 11111 1111111111 11111 1111111111 1111111111 lll111111111111111
`US008759291B2
`
`02) United States Patent
`Young et al.
`
`(10) Patent No.:
`(45) Date of Patent:
`
`US 8,759,291 B2
`*Jun.24, 2014
`
`(54) METHODS OF TREATMENT USING
`EXENDIN PEPTIDES OR GLP-1 PEPTIDES
`
`(75)
`
`Inventors: Andrew A. Young, Research Triangle
`Park, NC (US); Will Vine, Poway, CA
`(US); Kathryn Prickett, Foster City, CA
`(US); Nigel R.A. Seeley, Solana Beach,
`CA(US)
`
`(73) Assignees: Amylin Pharmaceuticals, LLC, San
`Diego, CA (US); AstraZeneca
`Pharmaceuticals LP, Wilmington, DE
`(US)
`
`( *) Notice:
`
`Subject to any disclaimer, the term of this
`patent is e11.1ended or adjusted under 35
`U.S.C. 154(b) by 54 1 days.
`
`This patent is subject to a terminal dis(cid:173)
`claimer.
`
`(21) Appl. No.: 13/080,051
`
`(22)
`
`Filed:
`
`Apr. 5, 2011
`
`(65)
`
`Prior Publication Data
`
`US 20 ll/0 195904Al
`
`Aug. 11 , 20 11
`
`Related U.S. Application Data
`
`(60)
`
`Continuation of application No. 12/247,141, filed on
`Oct. 7, 2008, now Pat. No. 7,928,065, which is a
`continuation of application No. 10/656,093, filed on
`Sep. 5, 2003, now Pat. No. 7,442,680, which is a
`division of application No. 09/622,105, filed as
`application No. PCT/US99/02554 on Feb. 5, 1999,
`now Pat. No. 6,703,359.
`
`(60)
`
`Provisional application No. 60/075,122, filed on Feb.
`13, 1998.
`
`(30)
`
`Foreign Application Priority Data
`
`May 24, 2004
`
`(KR) ........................ 10-2004-0036855
`
`(51)
`
`(52)
`
`(58)
`
`(56)
`
`(2006.01)
`(2006.01)
`
`Int. C l.
`A61K 38/22
`C07K 141575
`U.S. CI.
`USPC ........ 514/11.7; 514/15.4; 514/15.7; 514/16.4
`Field of C lassification Search
`None
`See application file for complete search history.
`
`References Cited
`
`U.S. PATENT DOCUMENTS
`
`5,424,286 A
`5,512,549 A
`5,545,618 A
`5,574,008 A
`5,846,937 A
`5,955,480 A
`6,703,359 Bl
`7J05,490 B2
`
`6/ 1995 Eng
`4/ 1996 Chen et al.
`8/ I 996 Buckley et al.
`11/ l 996 Johnson et al.
`1211998 Drucker
`9/ 1999 Chang
`3/2004 Young et aJ.
`9/2006 Beeley et al.
`
`7,153,825 B2
`7,442,680 B2
`7,928,065 B2 *
`
`12/2006 Young et al.
`10/2008 Young et al.
`4/2011 Young et aJ .................... 514/6.7
`
`FOREIGN PATENT DOCUMENTS
`
`WO
`WO
`
`W098/053Sl
`WO99/07404
`
`2/ 1998
`2/ 1999
`
`OTHER PUBLICATIONS
`
`Barragan at al. , Interactions of Exendin-(9-39) with the effects of
`glucagon-like peptide-1-(7-36) amide and of li'<endin-4 on arterial
`blood pressure and heart rate in rats, Regulato,y Peptides 67:63-68
`(1996).
`Bhaysar et aJ., Inhibition of gastric emptying and of food intake
`apperu· to be independently controlled in rodents, Soc. Nemosci.
`Abstr. 21:460 (Abstract 188.8) (1995).
`D' Alessio et al., Elimination of the Action ofGlucagon-like Peptide
`I Causes an Impainnent of Glucose Tolerance after Nutrient Inges(cid:173)
`tion by Healthy Baboons, J. Clin. Invest. 97(1): 133-138 (1996).
`Edwards et al., Cardiovascular and Pancreatic Endocrine Responses
`to Glucagon-Like Peptide- I (7-36) Amide in the Conscious Calf,Exp.
`Pltysiol. 82:709-716 (1997).
`Eissele at al. , Rat Gastric Somatostatin and Gastrin Release: Interac(cid:173)
`tions ofExendin-4 and Tmncated Glucagon-Like Peptide-I (GLP-1)
`Amide, Life Sci. 55(8):629-634 (1994).
`Enget al., Purification and StructureofExendin-3, a New Pancreatic
`Secretagoguge Isolated from Heloderma horridum Venom, J. Biol.
`Chem. 265(33):20259-20262 (1990).
`Enget aJ., Isolation and Characterization ofExendin-4, an Exendin-3
`Analogue, from Heloderma suspectum Venom, J. Biol. Chem.,
`267(11):7402-7405 (1992).
`Fehmann et al., Stable Expression of the Rat GLP-1(7-36)-A.mide,
`Oxyntomodulin, Exendin-4, and Exemlin
`(9-39), Peptides,
`15(3):453-456 (1994).
`Ferguson et aJ., Cell-Sudace Anchoring of Proteins via
`Glycosylphosphatidylinositol Structures, Am111. Rev. Biochem.
`57:285-320 (1988).
`
`(Continued)
`
`Jeffrey E Russel
`Primary Examiner -
`(74) Attorney, Agent, or Firm - Womble, Carlyle,
`Sandridge & Rice LLP; Mark J. Pino; Alireza Behrooz
`
`(57)
`
`ABSTR.\.CT
`
`Methods for increasing urine flow are disclosed, comprising
`administration of an effective amount of GLP-1, an exendin,
`or an exendin or GLP-1 agonist. Methods for increasing uri(cid:173)
`nary sodium excretion and decreasing urinary potassium con(cid:173)
`centration are also disclosed. The methods are usefol for
`treating conditions or disorders associated with toxjc hyper(cid:173)
`volemia, such as renal failure, congestive heart failure, neph(cid:173)
`rotic syndrome, cirrhosis, pulmonary edema, and hyperten(cid:173)
`sion. 'Jbe present invention also relates to methods for
`inducing an inotropic response comprising administration of
`an effective amount of GLP-1, an exendin, or an exendin or
`GLP-l agonist. These methods are usefol for treating condi(cid:173)
`tions or disorders that can be alleviated by an increase in
`cardiac contractility such as congestive heart failure. Pharma(cid:173)
`ceutical compositions for use in the methods of the invention
`are also disclosed.
`
`15 C laims, 18 Drawing Sheets
`
`FRESENIUS EXHIBIT 1017
`Page 1 of 68
`
`

`

`US 8,759,291 B2
`Page 2
`
`(56)
`
`References Cited
`
`OTHER PUBLICATIONS
`Goke et al., Exedin-4 is a High Potency Agonist and Tr11J1cate-0
`Exenin-(9-39)-amide an Antagonist at the Glucagon-like Peptide
`1-(7-36)-arnide Receptor of Insulin-secreting f3 Cells, J. Biol. Chem.
`268(26): 19650-19655 (1993).
`Knudsen et al. , Potent Derivatives ofGlucagon-like Peptide- I with
`Phannacokinetic Properties Suitable for Once Daily Administration,
`J. Med. Chem.43:1664-1669 (2000).
`Kolligs et al., Reduction of the lncretin Effecty in Rats by the
`Glucagon-Like Peptide I Receptor Angatonist Exendin (9-39)
`Amide, Diaberes44:16-19 (1995).
`Malhotra et al., Exendin-4, a new peptide fromHe/oderma s11spectwn
`venom, potentiates cholecystokinin-induced amylase release from
`rat pancreatic acini, Regulatory Peptides 41: 149-156 ( 1992).
`Montrose-Rafizadeh et al., Strucnire-Function Analysis of E-<endin-4
`/ GLP- 1 analogs, Diabetes45(Suppl. 2) :152A(1996).
`O'Halloran et al., Glucagon-Like Peptide-I (7-36)-NH2 : a physi(cid:173)
`ological inhibitor of gastric acid secretaion in man, J. Endocrinology
`126:169-173 (1990).
`0rskov et al., Biological Effects and Metabolic Rates ofGlucagon(cid:173)
`like Peptide-I 7-36 Amide and Glucagonlike Peptide-I 7-37 in
`Healthy Subjects are Indistinguishable, Diabetes 42:658-661 ( 1993).
`Raufman et aJ., Exendin-3 , a Novel Peptide from Heloderma hor(cid:173)
`ridum Venom, Interacts with Vasoactive Intestinal Peptide Receptors
`and a Newly Described Receptor on Dispersed Acini from Guinea
`Pig Pancreas, J. Biol. Chem., 266(5):2897-2902 (1991).
`Raufman et aJ., Tnmcated Glucagon-Like Peptide-I Interacts with
`Exendin Receptors in Dispersed Acini from Guinea Pig Pancreas, J.
`Biol. Chem. 267(30):21432-21437 (1992).
`Schepp et al., Exendin-4 and Exendin-(9-39)NH2: Agonist and
`Antagonist, Respectively, at the Rat Pa.iietal Cell Receptor for
`Glucagon-Like Peptide- l -(7-36)NH2, Ew: J. Phann. 269:183- 191
`(1994).
`
`Schinzel et al., The Phosphate Recognition Site of Escherichia coli
`Maltodext:rin Phospho1ylase, FEBS Lellers 286: 125-128 (1991).
`Schjold.-iger et aJ., GLP-1 (Glucagon-like Peptide I) and Tnincated
`GLP-1, Fragments of Human Proglucagon, Inhibit Gastric Acid
`Secretion in Humans,Digestive Disease and Sciences 34(5):703-708
`(1989).
`Singh et al. , Use of 125I-[Y39 ]E-<endin-4 to characterize receptors on
`dispersed pancreatic acini and gastric chief cells from guinea pig,
`Reg11lato1y Peptides 53:47-59 (1994).
`Tang-Christensen et al. , Central administration of GLP-1-(7-36)
`a.inide inhibits food and water intake in rats, Am. J. Physiol.
`271 :R848-R856 (1996).
`Thorens et al., Expression cloning of the Pancreatic f3 Cell Receptor
`for the gluco-incretin hormone glucagon-like peptide 1, Proc. Natl.
`Acad. Sci. USA 88:8641-8645 ( 1992).
`Thorens et al. , Cloning and Functional Expression of the Human Islet
`GLP-1 Receptor,Diaberes 42:1678-1682 ( 1993).
`Turton et al., A Role for Glucagon-like peptide-I in the central
`regulation of feeding, Nawre 379:69-72 (1996).
`Wang et al., Glucagon-like Peptide-I is a Physiological incretin in
`Rat, J. Cli11. J11vesr. 95:417-421 (1995).
`Wettergren el al., Trnncated GLP-1 (Proglucagon 78-107-Amide)
`Inhibits Gastric and Pancreatic Functions in Man, Diges1ive Diseases
`and Sciences 38(4):665-673 (1993).
`Whims et al., Gastric emptying, Glucose Responses, and Insulin
`Secretion after a Liquid TestMeaJ: Effects of Exogenous Glucagon(cid:173)
`LikePeptide-1 (GLP-1-(7-36)Amide iNType2 (Noninsulin-Depen(cid:173)
`dent) Diabetic Patietns, J. Clin. Endocrinol Metab. 8 1(1):327-332
`( 1996).
`Young et aJ., Preclinical Pharmacology of Pramlintide in the Rat:
`Comparisons with Human and and Rat Arnylin, Drug Development
`Researdi 37:231-248 (1996).
`
`"' cited by examiner
`
`FRESENIUS EXHIBIT 1017
`Page 2 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 1 of 18
`
`US 8,759,291 B2
`
`--165 pg GlP1
`..... 16.5 pg Gl.P1
`~ 1.65 pg GLP1
`-Jf-0.165pgGLP1
`-o-0.0165 µg GLP1
`-O-saline
`
`-.- 120
`
`• 0 ,,
`f
`a.
`~
`~ 110
`~
`
`100
`
`904-----.---....---..----r---,----t-......... --,----,
`-4.5
`0.0
`2.5
`0.5
`1.0
`1.S
`.1.0
`2.0
`-1.5
`hours post lv dose
`
`FlGURe1A
`
`FRESENIUS EXHIBIT 1017
`Page 3 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 2 of 18
`
`US 8,759,291 B2
`
`Dose-response curve:
`IIAPtoGLP-1
`
`EOso=1.2±0.27 1.u.
`
`200
`
`100
`
`0
`
`-100-t---T---....---.----..---.---.
`-2
`-3
`-1
`0
`3
`2
`1
`log Iv dose (µg)
`
`FIGURE1B
`
`FRESENIUS EXHIBIT 1017
`Page 4 of 68
`
`

`

`U.S. Patent
`
`Jun. 24, 2014
`
`Sheet 3 of 18
`
`US 8,759,291 B2
`
`iii
`> 120
`
`130 • :s
`i C: 8 110
`... 0
`(1 -..
`~ "0
`
`C:
`u 100
`f:?
`GI
`
`lnotropic effect of GLP-1
`
`Dose~ .
`
`Time of day
`
`FIGURB2
`
`FRESENIUS EXHIBIT 1017
`Page 5 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 4 of 18
`
`US 8,759,291 B2
`
`Response of urine flow to GLP-1
`
`---165 µg Gl.P1
`_._.16.5 pg GLP1
`-.1r-1.65 µg GLP1
`-..-o.165 pg GlP1
`-0-0.0165 f19 GLP1
`-O-saline
`
`2500
`
`_ 2000
`CD
`ftJ
`0
`-0
`
`CD a_ 1s00
`
`~
`c;: 1000
`CD
`C
`"C
`::>
`
`500
`
`0-1------------.-----------------.
`o.s
`1.0
`hows J>O$t Iv dose
`
`-1.0
`
`PIGURE3A
`
`FRESENIUS EXHIBIT 1017
`Page 6 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 5 of 18
`
`US 8,759,291 B2
`
`Dose-response curve:
`Urine flow to GLP-1
`
`2000
`
`EDso=0.71±0.26 l.u.
`
`o-t-=· =:;::::::......,.----.,-----.---.----.
`1
`0
`3
`4
`-2
`•1
`2
`tog Iv dose (Jig)
`
`FlGUR.B3B
`
`FRESENIUS EXHIBIT 1017
`Page 7 of 68
`
`

`

`U.S. Patent
`
`Jun.24, 2014
`
`Sheet 6 of 18
`
`US 8,759,291 B2
`
`Response of sodium excretion to GLP-1
`
`3000
`
`C
`o _ 2000
`':;:J a,
`f! WI
`c., 0
`
`)( 'ti •e e o. a~
`
`"0-
`~ 1000
`
`-O-saline
`-o-0.0165 µg GLP1
`-.-Q.165 µg GLP1
`-.tr--1,65 µg Gl.P1
`-+-16.5 pg GlP1
`-.-155 µg GlP1
`
`014---?!-,;...._.;;;..--,r--..;;,_--,.---r--,----,----,
`~.s
`o.s
`-1.0
`1.0
`1.5
`2.0
`2.5
`G.O
`hours post Iv dose
`
`FIGORB4A
`
`FRESENIUS EXHIBIT 1017
`Page 8 of 68
`
`

`

`U.S. Patent
`
`Jun. 24, 2014
`
`Sheet 7 of 18
`
`US 8,759,291 B2
`
`C .e IO
`~ 0 • • a,
`C: .,
`00
`. : "C e QI
`u ...
`>< C.
`GI~ e
`::,
`16
`0 •
`
`3000
`
`2()00
`
`1000
`
`0
`-3
`
`Dose.response curve:
`Sodium excretion to GLP·1
`
`EOso=0.77±0.05 l.u..
`
`0
`1
`·1
`log Iv dose (ltg)
`
`2
`
`3
`
`FIGURB4B
`
`FRESENIUS EXHIBIT 1017
`Page 9 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 8 of 18
`
`US 8,759,291 B2
`
`Response of urine potassium concentration to GLP-1
`
`150
`
`125 -0 .,
`
`o 100
`,:, .
`:!
`a.
`~
`-
`
`75
`
`g
`---165 pg GLP1
`~ so ---16.5 pg GLP1
`'§
`-.a.-1.65 pg GLP1
`-¥-0.165 µg Gt.P1
`25 -o-0.0165 pg GlP1
`-<>-saline
`O+----r----ir----,,----r---r---.....-----,
`o.o
`1.0
`-1.0
`-0.5
`2.0
`0.$
`1.$
`hours post Iv dose
`
`FIGUR.BSA
`
`FRESENIUS EXHIBIT 1017
`Page 10 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 9 of 18
`
`US 8,759,291 B2
`
`Dose-response curve:
`Urine potassium concentration to GLP-1
`
`125
`
`IQ di
`.... llt
`
`C e 100
`c:, .g 75
`•• 0 ge, so
`.,~
`C 5
`
`25
`
`0-1--------...---~-"r---r----,
`3
`-1
`-2
`0
`1
`2
`..::S
`log Iv dose (v.g)
`
`E050=0.25i0.34 lu.
`
`•
`
`FRESENIUS EXHIBIT 1017
`Page 11 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 10 of 18
`
`US 8,759,291 B2
`
`Response of MAP to Exencfin-4
`
`1
`
`:
`
`130
`
`0 ,,
`f 120
`~
`~
`~110
`0.
`<(
`:i 100
`
`90
`
`---210 1.19 exendin-4
`-♦-21 µg exendin-4
`-"f-2.1 µg e.xendin-4
`-.\-0.21 ~ exendin-4
`~0.021 !JO exencfin-4
`-a-0.002.1 µg exendin-4
`-O-sallne
`
`804---,----,--,----,-----r---r----,
`2.5
`-1.0
`-0.5
`0.0
`0.5
`1.0
`1.5
`2.0
`hours post Iv cbs4S
`
`AGURE6A
`
`FRESENIUS EXHIBIT 1017
`Page 12 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 11 of 18
`
`US 8,759,291 B2
`
`Dose-Response Curve:
`MAP to Exendln-4
`
`EDS0=0.24:.t0.24 l.u.
`
`f
`
`I
`
`75
`
`5Q
`
`25
`
`0
`
`.25-4---,---r--~--.---,----,,-----,
`~ ~ ~ ~ 0
`1
`2
`3
`log iv dose (J1g)
`
`FIGURE68
`
`FRESENIUS EXHIBIT 1017
`Page 13 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 12 of 18
`
`US 8,759,291 B2
`
`lonotropic effect of exendin-4
`
`-Saline
`-o.1µg
`-o-1µg
`-<>-1<>1.J9
`
`3.2
`
`3.0
`
`io
`'o
`i 2.8
`GI e
`g 2.6
`ID
`,E
`01
`X 2.4
`E
`.[
`i 2.2
`CL -u
`
`2.0
`
`1.8
`
`1.5
`
`2.0
`
`2.5
`Da)'$ of treatment
`
`3.0
`
`3.5
`
`f'agure7
`
`FRESENIUS EXHIBIT 1017
`Page 14 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 13 of 18
`
`US 8,759,291 B2
`
`Response of Urine FJow to &encfin-4
`
`500
`
`.coo
`~ .g .5 ~00
`CD _e c --c :1. 200
`
`:::J
`
`100
`
`--- 210 JJQ exencin-4
`- - 21 µg exendin4
`_.,_ 2. 1 µg exendi~
`--6:- 0.21 µg exendin-4
`-311-- 0.021 µg exendin-4
`-a-0.0021 µg exendin4
`-O-&aline
`
`0
`~1.0
`
`..0.5
`
`0..5
`1.0
`0.0
`1.5
`hours post Iv dose
`
`2.0
`
`2.5
`
`FIGURE SA
`
`FRESENIUS EXHIBIT 1017
`Page 15 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 14 of 18
`
`US 8,759,291 B2
`
`Dose-Response curve:
`Urine Row to Exendin-4
`
`E050=0.21:t-0.18 l.u.
`
`____ I
`
`500
`
`100
`
`0-f----..--------.,---.-------------,
`1
`2
`-1
`-4
`0
`3
`log Iv dose (pg)
`
`FIGURE SB
`
`FRESENIUS EXHIBIT 1017
`Page 16 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 15 of 18
`
`US 8,759,291 B2
`
`Response of Sodium Excretion to Exendin-4
`
`2500
`
`2000
`
`C
`
`"E
`
`80
`";- CD
`
`C: "C
`
`9. 8 1500
`~f ea.
`i ';Je 1000
`·JJ( • CG z
`
`---210 µg exendin-4
`_... 21 J.19 exendin-4
`-1'- 2.1 l,IQ exencin,-4
`-4-0.21 pg exendin-4
`.Jl--0.021 pg exendin-4
`-a- 0.0021 µg exendin-4
`-O-saline
`
`0-1-.....::=--.:;:....--....---...... ---r----r----r-----,
`o.s
`-0.5
`0.0
`~1.0
`1.0
`U
`2.0
`2.5
`houn. post iv dose
`
`FIGURE9A
`
`FRESENIUS EXHIBIT 1017
`Page 17 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 16 of 18
`
`US 8,759,291 B2
`
`Does-Response Curve:
`Sodium Excretion to E.xendin~4
`
`EDS0=0.,05i0.2S Lu.
`
`l
`
`0-1--:=::;::=-_,,....----.--....--.....----.,.---,
`Q
`3
`
`log lv dose (µg)
`
`F\GURE9B
`
`FRESENIUS EXHIBIT 1017
`Page 18 of 68
`
`

`

`U.S. Patent
`
`Jun.24,2014
`
`Sheet 17 of 18
`
`US 8,759,291 B2
`
`Response of Urine Potassium Concentration to Exendin-4
`
`150
`
`2S
`
`0-t---r--,.---,----.---.----.----.
`•1 .0
`.0.5
`0.0
`0.5
`1.o
`1.S
`2.5
`2.0
`hours post Iv dose
`
`FIGURE10A
`
`--- 21 o µg exendin--4
`-.- 21 µ.g exendln--4
`_,,,_ 2. 1 µg exendin-4
`-1:r- 0.2 1 µg e)(eodin-4
`-V- 0.021 µg exendln--4
`-a-0. 0021 µg exendin-4
`-O-saline
`
`FRESENIUS EXHIBIT 1017
`Page 19 of 68
`
`

`

`U.S. Patent
`
`Jun. 24, 2014
`
`Sheet 18 of 18
`
`US 8,759,291 B2
`
`Dose-Response Curve:
`Urine Potassium Concentration to Exendin-4
`
`0
`
`l
`
`~ -100
`c _
`ol:
`<( 'a, -200
`
`-.. .s:
`:::, .
`se:iw -e ~-G)
`
`C:
`"C
`::1
`
`.:JOO
`
`EOS0=0.07±0.261.u.
`
`l
`
`....00-1----.----.---...-------.------.
`-2
`2
`-4
`0
`1
`3
`log Iv dose (µg)
`
`FIGURE10B
`
`FRESENIUS EXHIBIT 1017
`Page 20 of 68
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`

`

`us 8,759,29 1 82
`
`1
`METHODS OF TREATMENT USING
`EXENDIN PEPTIDES OR GLP-1 PEPTIDES
`
`RELATED APPLICATIONS
`
`This application is a continuation of U.S. application Ser.
`No. 12/247,141 filed Oct. 7, 2008, issued as U.S. Pat. No.
`7,928,065, which is a continuation of U.S. application Ser.
`No. 10/656,093 filed Sep. 5, 2003, issued as U.S. Pat. No.
`7,442,680, which is a divisional of U.S. application Ser. No. 10
`09/622,1 05 filed Sep. 22, 2000, issued as U.S. Pat. No. 6,703,
`359, which is a §371 of PCT/US99/02554 filed Feb. 5, 1999,
`which claims the benefit ofU.S. Provisional Application No.
`60/075, I 22 filed Feb. 13, 1998. All applications are incorpo(cid:173)
`rated herein by reference.
`
`2
`GLP-1 did not have this effect. (Tand-Christensen et al., Am.
`J. Physiol., 271:R848-56, 1996). GLP-1 [7-37], which has an
`additional glycine residue at its carboxy terminus, also stimu(cid:173)
`lates insulin secretion in humans (Orskov, et al., Diabetes,
`s 42:658-61, 1993). A transmembrane G-protein adenylate(cid:173)
`cyclase-coupled receptor believed to be responsible for the
`insulinotropic effect ofGLP-1 has been cloned from a ~-cell
`line (111orens, Proc. Natl. Acad. Sci., USA 89:8641-45,
`1992).
`Glucagon and glucagon-like peptides have been found to
`have different cardiovascular effects. Glucagon has been
`reported to have positive inotropic and chronotropic effects,
`produce a slight increase in arterial blood pressure in normal
`individuals, and affect regional blood circulation. GLP-1 has
`15 been found to produce a moderate increase in both systolic
`and diastolic blood pressure, while GLP-2 has no effect on
`those parameters. GLP-1, administered through the jugular
`vein, has been reported to induce an increase in systolic and
`diastolic blood pressure and heart rate. (Reviewed in Bar-
`20 ragan, J. M., et al., Regul. Peptides, 67:63-68, 1996).
`Exendins are peptides that are found in the venom of the
`Gila-monster, a lizard endogenous to Arizona, and the Mexi(cid:173)
`can Beaded Lizard. Exendin-3 is present in the venom of
`Heloderma horridum, and exendin-4 is present in the venom
`25 of Heloderma suspectum (Eng, J., et al., J Biol. Chem., 265:
`20259-62, 1990; Eng., J., et al., J. Biol. Chem., 267:7402-05,
`1992). The exendins have some sequence similarity to several
`members of the glucagon-like peptide family, with the higl1-
`est homology, 53%, being to GLP-1 (Goke, et al., J. Biol.
`30 Chem., 268:19650-55, 1993).
`Exendin-4 is a potent agonist at GLP-1 receptors on insu(cid:173)
`lin-secreting ~TC I cells, at dispersed acinar cells from guinea
`pig pancreas, and at parietal cells from stomach; the peptide
`also stimulates somatostatin release and inhibits gastrin
`35 release in isolated stomachs (Goke, et al., J. Biol. Chem.
`268:19650-55, 1993; Schepp, et al., Eur. J. Pharmacol.,
`69:183-91 , 1994; Eissele, etal.,LifeSci., 55:629-34, 1994).
`Exendin-3 and exendi.n-4 were found to be GLP-1 agocists in
`stimulating cAMP production in, and amylase release from,
`40 pancreatic acinar cells (Malhotra, R., et al., Regulatory Pep(cid:173)
`tides, 41 : 149-56, 1992; Raufman, et al., J. Biol. Chem. 267:
`2 1432-37, 1992; Singh, et al., Regul. Pept. 53:47-59, 1994).
`The use ofthe iusu)jnotropic activities ofexendin-3 and exen(cid:173)
`din-4 for the treatment of diabetes mellitus and the prevention
`45 of hyperglycemia has been proposed (Eng, U.S. Pat. No.
`5,424,286).
`Tnmcated exendin peptides such as exendin[9-39], a car(cid:173)
`boxyamidated molecule, and fragments 3-39 through 9-39
`have been reported to be potent and selective antagonists of
`so GLP-1 (Goke, et al., J. Biol. Chem., 268:19650-55, 1993;
`Raufman, J. P., et al., J. Biol. Ch.em. 266:2897-902, 1991;
`Schepp, W., et al., Eur. J. Phann. 269:183-91, 1994; Mon(cid:173)
`trose-Rafizadeh, et al., Diabetes, 45(Suppl. 2): I 52A, I 996).
`Exendin[9-39] blocks endogenous GLP-1 in vivo, resulting
`55 in reduced insulin secretion. Wang, et al., J. Clin. Invest.,
`95:417-21, I 995; D' Alessio, etal.,J. Clin. lnvesl., 97:133-38,
`1996). The receptor apparently responsible for the insulino(cid:173)
`tropic effect of GLP-1 has been cloned from rat pancreatic
`islet cells (Thorens, B., Proc. Natl. Acad. Sci. USA 89:8641-
`60 8645, 1992). Exendins and exendin[9-39] bind to the cloned
`GLP-1 receptor (rat pancreatic ~-cell GLP-1 receptor: Feh(cid:173)
`mann H C, et al., Peptides 15 (3): 453-6, 1994;human GLP-1
`receptor: Thorens B,et al., Diabetes42 (11): 1678-82, 1993).
`In ceUs transfected with the cloned OLP-I receptor, exen-
`65 din-4 is an agonist, i.e., it increases cAMP, while exendin[9-
`39] is an antagonist, i.e., it blocks the stimulatory actions of
`exendin-4 and GLP-1. Id.
`
`FIELD OF THE INVENTION
`
`1l1e present invention relates to methods for increasing
`urine flow comprising administration of an effective amount
`of glucagon-like peptide-I [7-36] amide ( abbreviated "GLP(cid:173)
`[7-36] NH2" or simply"GLP-1 "), an exendin, or an exendin or
`GLP-1 agonist. Methods for increasing urinary sodium excre(cid:173)
`tion and decreasing urinary potassimn concentration are also
`disclosed. The methods are useful for treating conditions or
`disorders associated with toxic hypervolemia, such as renal
`failure, congestive heart failure, nephrotic syndrome, cirrho(cid:173)
`sis, pulmonary edema, and hypertension. Phannaceutical
`compositions for use in the methods of the invention are also
`disclosed.
`The present invention also relates to methods for inducing
`an inotropic response comprising administration of an effec(cid:173)
`tive amount of an exendin, GLP-1, or an exendin or GLP- 1
`agonist. These methods are useful for treating conditions or
`disorders that can be alleviated by an increase in cardiac
`contractility, such as congestive heart failure.
`The fo)lowing description smnmarizes infonnation rel(cid:173)
`evant to the present invention. It is not an admission that any
`of the information provided herein is prior art to the presently
`claimed invention, nor that any of the publjcations specifi(cid:173)
`cally or implicitly referenced are prior art to that invention.
`Glucagon-like peptide-I [7-36] amide (also referred to as
`GLP-1 [7-36]NH2 or G LP-1) is a product ofthe proglucagon
`gene. It is secreted into plasma mainly from the gut and
`produces a variety of biological effects related to pancreatic
`and gastrointestinal function. The parent peptide, progluca(cid:173)
`gon (PG), has numerous cleavage sites that produce other
`peptide products dependent on the tissue of origin including
`glucagon (PG[32-62]) and GLP-1[7-36]NH2 (PG[72-107])
`in the pancreas, and GLP-1(7-37] (PG[78-1 08]) and GLP-1
`[7-36] NH2 (PG [78-107]) in the L cells of the intestine where
`GLP-1[7-36]NH2 (78-107 PG) is the major product.
`GLP-1 [7-36]NH2, also known as proglucagon (78-107], or
`commonly, just "GLP-1," as used herein, has an insulinotro(cid:173)
`pic effect, stimulating insulin secretion from pancreatic
`~-cells; GLP-1 also inhibits glucagon secretion from pancre(cid:173)
`atic a-cells (Orskov, et al., Diabetes, 42:658-61 , 1993;
`D' Alessio, et al., J. Clin. lnvest., 97:133-38, 1996). GLP-1 is
`reported to inhibit gastric emptying (\1/illiams B, et al.,J Clin
`Endocrinol Metab 81 (1): 327-32, 1996; WettergrenA, et al.,
`Dig Dis Sci38 (4): 665-73, 1993), and gastric acid secretion.
`(Schjoldager BT, et al., Dig Dis Sci 34 (5): 703-8, 1989;
`O'Halloran DJ, et al., J Endocrinol 126 (1): 169-73, 1990;
`Wettergren A, et al., Dig Dis Sci 38 (4): 665-73, 1993). A
`diuretic, antidypsogenic effect of intracerebroventricular
`administration of GLP-1 has been reported, however, trus
`report claims that a peripheral, intraperitoneal injection of
`
`FRESENIUS EXHIBIT 1017
`Page 21 of 68
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`

`

`us 8,759,291 82
`
`3
`Exendin[9-39) also acts as an antagonist of the foll length
`exendins, inhibiting stimulation of pancreatic acinar cells by
`exendin-3 and exendin-4 (Raufman, et al., J. Biol. Chem.
`266:2897-902, 1991; Raufman, et al., J. Biol. Chem., 266:
`21432-37, I 992). Exendin[9-39] inhibits the stimulation of s
`plasma insulin levels by exendin-4, and inhibits the soma(cid:173)
`tostatin release-stimulating and gastrin release-inhibiting
`activities of exendin-4 and GLP-1 (Kolligs, F., et al., Diabe(cid:173)
`tes, 44: 16-19, 1995; Eissele, et al., Life Sciences, 55:629-34,
`1994). Exendin-4, administered through the jugular vein, has 10
`been reported to induce an increase in systolic, diastolic and
`mean arterial blood pressure, and in heart rate (Barragan, et
`al.,Regul. Pep. 67:63-68, 1996).
`Exendins have recently been found to inhibit gastric emp(cid:173)
`tying (U.S. patent application Ser. No. 08/694,954, filedAug. 15
`8, 1996, which enjoys common ownership with the present
`invention and is hereby incorporated by reference). Exendin
`[9-39) has been used to investigate the physiological rel(cid:173)
`evance of central GLP-1 in control of food intake (Turton, M.
`D. et al., Nature, 379:69-72, 1996). GLP-1 administered by 20
`intracerebroventricular (ICV) injection inhibits food intake in
`rats. This satiety-inducing effect of GLP-1 delivered by
`intracerebroventricular injection is reported to be inhibited by
`ICV injection of exendin[9-39) (Turton, supra). However, it
`has been reported that GLP-1 does not inhibit food intake in 25
`mice when administered by peripheral injection (Turton, M.
`D., Nature 379:69-72, 1996; Bhavsar, S. P., Soc. Neurosci.
`Abstr. 21 :460 (I 88.8), I 995). Administration of exendins and
`exendin agonists has also recently been found to reduce food
`intake (U.S. Provisional Patent Application Ser. No. 60/034, 30
`905, filed Jan. 7, J 997, which enjoys common ownership with
`the present invention and is hereby incorporated by refer(cid:173)
`ence).
`Agents that increase urine flow, or diuretics, are usefol for
`treating conditions or disorders that are associated with toxic 35
`hypervolemic states. Such conditions or disorders include
`renal failure, congestive heart failure, nephrotic syndrome,
`cirrhosis, pulmonary edema, and hypertension. Diuretics are
`also employed to treat conditions in pregnancy, such as pre(cid:173)
`eclampsia and eclampsia. Further uses of diuretics include 40
`their use to reduce volume before some surgical procedures
`such as ocular surgery and neurosurgery.
`One difficulty encountered with many diuretics such as
`thiazides, loop diuretics, carbonic anhydrase inhibitors, and
`osmotic diuretics, is that although they may be employed to 45
`increase sodium excretion, they also result in an increase of
`urinary potassium loss. Examples of the effects of potassium
`loss include muscular weakness, paralysis (including the
`paralysis of respiratory muscles), electrocardiographic
`abnormalities, cardiac dysrhytlunia, and cardiac arrest.
`,.\nother difficulty encountered with some diuretics is their
`slow rate of action, which is not conducive to their use in an
`emergency setting.
`Thus, there is a need for a method of increasing urine flow
`that does not deplete potassium concentration in the patient 55
`and which has a rapid mode of action. Such methods, and
`compounds and compositions which are useful therefore,
`have been invented and are described and claimed herein.
`Compounds that induce inotropic effects ( e.g., increase of
`force of contraction of the heart) have been recognized as 60
`being useful for the treatment of, for example, congestive
`heart failure. Congestive heart failure, which is one of the
`most common causes of death and disability in industrialized
`nations, has a mortality rateofabout 50% at five years (Good(cid:173)
`man and Oilman's The Pharmacological Basis ofTherapeu- 65
`tics, 9th Ed. McGraw Hill, New York, pp. 809-838). Inotropic
`agents currently in clinical use include digitalis, sympatho-
`
`50
`
`4
`mimetic amines and amrinone (Harrison's Principles oflnter(cid:173)
`nal Medicine, 12th Edition, 1991 , McGraw Hill, New York,
`pp. 894-899).
`Digotoxin, a cardiac glycoside, an ancient but eftective
`therapy for cardiac failure, was initially derived from the
`foxglove leaf, Digitalis purpurea and Digitalis lanata. Cardiac
`glycosides are potent and highly selective inhibitors of the
`active transport of sodium and potassium ions across cell
`membranes (Goodman and Gilman, supra). Cardiac glyco(cid:173)
`sides have been reported to increase the velocity of shortening
`of cardiac muscle, resulting in an improvement in ventricular
`.function; this effect has been reported to be due to an increase
`in the availability during systole of cytosolic Ca2
`+ to interact
`with contractile proteins to increase the velocity and extent of
`sarcomere shortening (Goodman and Gilman, supra).
`Digotoxin and related cardiac glycosides (e.g. digitoxin)
`have useful durations of action because their excretion,
`mainly via the kidneys, results in plasma t½ of 1.5-5 days.
`But the therapeutic index of these dnigs is very low with
`mildly toxic:minimally-effective dose ratio being 2:l and
`lethal:minimally-effective dose ratio being between 5: I and
`I 0: I. Urinary potassimu loss due to use of thiazide and loop
`diuretics may seriously enhance the dangers of digitalis
`intoxication, including susceptibility to cardiac arrhythmia,
`and potassium-sparing diuretics are often necessary. Slow
`elimination of cardiac glycosides can prolong the period of
`jeopardy during digitalis intoxication, which has been
`reported to occur in 20% of hospital patients on these drugs.
`Absorption and onset of action for all cardiac glycosides
`except ouabain is somewhat prolonged, and this may be a
`disadvantage in emergency cardiac conditions.
`Sympathomimetic amines, which generally include epi(cid:173)
`nephrine, isoproterenol, dopamine and dobutamine, can be
`useful in an acute setting to stimulate myocardial contractil(cid:173)
`ity, but they usually require constant intravenous infusion and
`continuous intensive monitoring of the patient. They typically
`Jose their effectiveness after ~8 hours, apparently due to
`receptor downregulation.
`Amrinone, a noncatecholamine, non-glycoside agent also
`requires continuous intravenous administration.
`This description of available inotropic agents illustrates the
`need for, and desirability of, therapies that are (1) inotropic,
`with (2) rapid onset of action, with (3) prolonged duration of
`action (including a persistent effect, with absence of tachy(cid:173)
`phylaxis), with (4) low toxicity (a high ratio of toxic to thera(cid:173)
`peutic dose), with (5) rapid and profound diuretic effect, with
`(6) a sparing of urinary potassium loss, and with (7) a conve(cid:173)
`nient (non-intravenous) route of administration. We have dis(cid:173)
`covered that exendin and GLP-1 fulfill these criteria.
`
`SUMMARY OF THE INVENTION
`
`The present invention concerns the surprising discovery
`that exendins, GLP-1, and agonists of these compounds have
`rapid inotropic and diuretic effects. Although GLP-1 has been
`reported to not have a diuretic effect when administered
`peripherally, we have found, surprisingly, that GLP-1 does in
`fact have a diuretic effect after peripheral administration. This
`diuretic effect of exendins, GLP-1, and exendin and GLP-1
`agonists, is accompanied by an increase in urinary sodium
`concentration. This diuretic effect is also accompanied by a
`decrease in urinary potassium concentration which is unan(cid:173)
`ticipated as many diuretics have been found to cause a pro(cid:173)
`found increase in urinary potassium concentration.
`The present invention is directed to novel methods for
`increasing urine flow comprising the administration of an
`exendin, for example, exendin-3 [SEQ ID NO. I: His Ser Asp
`
`FRESENIUS EXHIBIT 1017
`Page 22 of 68
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`

`us 8,759,291 82
`
`15
`
`5
`Gly Tiir Phe Tiir Ser Asp Leu Ser Lys Gin Met Glu Glu Glu
`Ala Val Arg Leu Phe Ile Glu Trp Leu Lys Asn Gly Gly Pro Ser
`SerGly Ala Pro Pro ProSer-NI-12], or exendin-4 [SEQ ID NO.
`2: His Gly Glu Gly Thr Phe Tlir Ser Asp Leu Ser Lys Gin Met
`Glu Glu Glu Ala Val Arg Leu Phe Ile Glu Trp Leu Lys Asn Gly 5
`Gly Pro Ser Ser Gly Ala Pro Pro Pro Ser-NI-12] , or other
`compounds which effectively bind to the receptor at which
`exendin exerts its action on increasing urine flow (exendin
`agonists). The present invention is also directed to novel
`methods for increasing urine flow comprising the administra- 10
`tion ofGLP-1 [SEQ ID NO. 3: His Ala Glu Gly TI1rPheTI1r
`Ser Asp Val SerSerTyr Leu Glu Gly Gin Ala Ala LysGlu Phe
`Ile Ala Trp Leu Val Lys Gly Arg-NI-12 ], or other compounds
`which effectively bind to the receptor at which GLP-1 exerts
`its action on increasing urine flow (GLP-1 agonists ) .
`ln a first aspect, the invention features a method ofincreas(cid:173)
`ing urine flow in an individual comprising administering to
`the individual a therapeutically effective amount of an exen(cid:173)
`din or an exendin agonist. ln one preferred aspect, said exen(cid:173)
`din is exendin-3. More preferably, said exendin is exendin-4. 20
`By an "exendinagonist" is meant a compom1d that mimics the
`effects ofexendin on increasing urine flow, increasing sodium
`excretion, and/or decreasing urinary potassium concentra(cid:173)
`tion, (the potassium concentration in excreted urine)