U.S. patent application number 17/587941 was filed with the patent office on 2022-08-25 for factor viii-fc chimeric and hybrid polypeptides, and methods of use thereof.
The applicant listed for this patent is BIOVERATIV THERAPEUTICS INC.. Invention is credited to Alan J. BITONTI, Jennifer A. DUMONT, Haiyan JIANG, Lian LI, Susan LOW, Alvin LUK, Byron MCKINNEY, Karen NUGENT, Matt OTTMER, Robert PETERS, Glenn PIERCE, Jurg SOMMER.
Application Number | 20220265780 17/587941 |
Document ID | / |
Family ID | |
Filed Date | 2022-08-25 |
United States Patent
Application |
20220265780 |
Kind Code |
A1 |
DUMONT; Jennifer A. ; et
al. |
August 25, 2022 |
FACTOR VIII-FC CHIMERIC AND HYBRID POLYPEPTIDES, AND METHODS OF USE
THEREOF
Abstract
The present invention provides methods of administering Factor
VIII; methods of administering chimeric and hybrid polypeptides
comprising Factor VIII; chimeric and hybrid polypeptides comprising
Factor VIII; polynucleotides encoding such chimeric and hybrid
polypeptides; cells comprising such polynucleotides; and methods of
producing such chimeric and hybrid polypeptides using such
cells.
Inventors: |
DUMONT; Jennifer A.;
(Groton, MA) ; LOW; Susan; (Pepperill, MA)
; BITONTI; Alan J.; (Acton, MA) ; PIERCE;
Glenn; (Rancho Santa Fe, CA) ; LUK; Alvin;
(Boston, MA) ; JIANG; Haiyan; (Belmont, MA)
; MCKINNEY; Byron; (San Diego, CA) ; OTTMER;
Matt; (Newton, MA) ; SOMMER; Jurg; (Wayland,
MA) ; NUGENT; Karen; (Princes Risborough, GB)
; LI; Lian; (Lexington, MA) ; PETERS; Robert;
(Needham, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
BIOVERATIV THERAPEUTICS INC. |
Waltham |
MA |
US |
|
|
Appl. No.: |
17/587941 |
Filed: |
January 28, 2022 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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16270302 |
Feb 7, 2019 |
11266720 |
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17587941 |
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14964289 |
Dec 9, 2015 |
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16270302 |
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13793783 |
Mar 11, 2013 |
9241978 |
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14964289 |
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13513424 |
Dec 28, 2012 |
9050318 |
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PCT/US2010/059136 |
Dec 6, 2010 |
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13793783 |
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61419676 |
Dec 3, 2010 |
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61410929 |
Nov 7, 2010 |
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61373113 |
Aug 12, 2010 |
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61363065 |
Jul 9, 2010 |
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61301592 |
Feb 4, 2010 |
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61285054 |
Dec 9, 2009 |
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61267070 |
Dec 6, 2009 |
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International
Class: |
A61K 38/37 20060101
A61K038/37; A61K 47/64 20060101 A61K047/64; A61K 47/68 20060101
A61K047/68; C07K 14/755 20060101 C07K014/755; C07K 16/46 20060101
C07K016/46 |
Claims
1. A method of administering Factor VIII to a human subject in need
thereof, comprising administering to the subject a therapeutic dose
of a chimeric polypeptide comprising a Factor VIII portion and an
Fc portion at a dosing interval at least about one and one-half
times longer than the dosing interval required for an equivalent
amount of a polypeptide consisting of said Factor VIII portion.
2. (canceled)
3. The method of claim 1, where said dosing interval is at least
about one and one-half to six times longer, one and one-half to
five times longer, one and one-half to four times longer, one and
one-half to three times longer, or one and one-half to two times
longer, than the dosing interval required for an equivalent amount
of a polypeptide consisting of said Factor VIII portion.
4-5. (canceled)
6. The method of claim 1, wherein said subject is in need of
prophylactic treatment, on-demand treatment, treatment for a
bleeding episode, treatment for hemarthrosis, muscle bleed, oral
bleed, hemorrhage, hemorrhage into muscles, oral hemorrhage,
trauma, trauma capitis, gastrointestinal bleeding, intracranial
hemorrhage, intra-abdominal hemorrhage, intrathoracic hemorrhage,
bone fracture, central nervous system bleeding, bleeding in the
retropharyngeal space, bleeding in the retroperitoneal space,
bleeding in the illiopsoas sheath, surgical prophylaxis,
peri-operative management, or treatment for surgery.
7. (canceled)
8. The method of claim 1, wherein said subject is in need of
treatment for a bleeding episode.
9. (canceled)
10. The method of claim 1, wherein said subject is in need of
surgical prophylaxis, peri-operative management, or treatment for
surgery.
11. (canceled)
12. The method of claim 1, wherein said dosing interval of said
chimeric polypeptide is about once every 24-36, 24-48, 24-72, 24,
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, 63, 64, 65, 66, 67, 68, 69, 70, 71, or 72 hours or
longer.
13. The method of claim 1, wherein said therapeutic dose is 10-100
IU/kg.
14-17. (canceled)
18. The method of claim 1, wherein said Factor VIII has a full or
partial deletion of the B domain.
19-24. (canceled)
25. The method of claim 1, wherein said chimeric polypeptide is in
the form of a hybrid comprising a second polypeptide in association
with said chimeric polypeptide, wherein said second polypeptide
consists essentially of an Fc.
26-29. (canceled)
30. The method of claim 1, wherein said chimeric polypeptide is
administered as part of a pharmaceutical composition comprising at
least one excipient.
31. A method of administering Factor VIII to a human subject in
need thereof, comprising administering to the subject a therapeutic
dose of a chimeric polypeptide comprising a Factor VIII portion and
a second portion to obtain an area under the plasma concentration
versus time curve (AUC) at least about one and one-quarter times
greater than the AUC obtained by an equivalent amount of a
polypeptide consisting of said Factor VIII portion.
32. (canceled)
33. The method of claim 31, wherein said subject is in need of
prophylactic treatment.
34. The method of claim 31, wherein said subject is in need of
on-demand treatment.
35. The method of claim 31, wherein said subject is in need of
treatment for a bleeding episode.
36-57. (canceled)
58. A method of administering Factor VIII to a human subject in
need thereof, comprising administering to the subject a therapeutic
dose of a polypeptide comprising a Factor VIII and an Fc at a
dosing interval of about every five, six, seven, eight, nine, ten,
eleven, twelve, thirteen, or fourteen days or longer.
59. The method of any of claim 58, wherein said subject is in need
of prophylactic treatment.
60. The method of claim 58, wherein said therapeutic dose is 10-100
IU/kg.
61. The method of claim 60, wherein said therapeutic dose is 10-20,
20-30, 30-40, 40-50, 50-60, 60-70, 70-80, 80-90, or 90-100
IU/kg.
62-108. (canceled)
109. The method of claim 1, wherein the therapeutic dose is about
10 to about 150, 100-110, 110-120, 120-130, 130-140, 140-150, 110,
115, 120, 125, 130, 135, 140, 145, or 150 IU/kg.
110. The method of claim 1, wherein the dosing interval is one and
one-half to 5, one and one-half, 2, 3, 4, or 5 days or longer.
Description
REFERENCE TO EARLIER FILED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 16/270,302, filed Feb. 7, 2019, which is a
continuation of U.S. patent application Ser. No. 14/964,289, filed
Dec. 9, 2015, which is a division of U.S. patent application Ser.
No. 13/793,783, filed Mar. 11, 2013, now U.S. Pat. No. 9,241,978,
which is a division of U.S. patent application Ser. No. 13/513,424,
filed Dec. 28, 2012, now U.S. Pat. No. 9,050,318, which is a 35
U.S.C. .sctn. 371 filing of International Patent Application No.
PCT/US2010/059136, filed Dec. 6, 2010, which claims the benefit of
U.S. Provisional Application No. 61/267,070, filed Dec. 6, 2009,
U.S. Provisional Application No. 61/285,054, filed Dec. 9, 2009,
U.S. Provisional Application No. 61/301,592, filed Feb. 4, 2010,
U.S. Provisional Application No. 61/363,065, filed Jul. 9, 2010,
U.S. Provisional Application No. 61/373,113, filed Aug. 12, 2010,
U.S. Provisional Application No. 61/410,929, filed Nov. 7, 2010,
and U.S. Provisional Application No. 61/419,676, filed Dec. 3,
2010, all of which are incorporated herein by reference in their
entireties.
REFERENCE TO SEQUENCE LISTING SUBMITTED ELECTRONICALLY VIA
EFS-WEB
[0002] The content of the electronically submitted sequence listing
(Name: 726683_SA9-408USDV2CON2_ST25.txt, Size: 95.2 KB; and Date of
Creation: Jan. 28, 2022) submitted in this application is
incorporated herein by reference in its entirety.
BACKGROUND OF THE INVENTION
Field of the Invention
[0003] The present invention relates generally to the field of
therapeutics for hemostatic disorders.
Background Art
[0004] Hemophilia A is an X-linked bleeding 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 hemorrhage and
excessive bleeding after trauma. Over time, the repeated bleeding
into 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
mobility of joints, muscle atrophy and chronic pain
(Rodriguez-Merchan, E. C., Semin. Thromb. Hemost. 29:87-96 (2003),
which is herein incorporated by reference in its entirety).
[0005] The A2 domain is necessary for the procoagulant activity of
the factor VIII molecule. Studies show that porcine factor VIII has
six-fold greater procoagulant activity than human factor VIII
(Lollar, P., and E. T. Parker, J. Biol. Chem. 266:12481-12486
(1991)), and that the difference in coagulant activity 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)), incorporated herein by reference in its
entirety.
[0006] Treatment of hemophilia A is by replacement therapy
targeting restoration of FVIII activity to 1 to 5% of normal levels
to prevent spontaneous bleeding (Mannucci, P. M., et al., N. Engl.
J. Med. 344:1773-1779 (2001), which is herein incorporated by
reference in its entirety). There are plasma-derived and
recombinant FVIII products available to treat bleeding episodes
on-demand or to prevent bleeding episodes from occurring by
treating prophylactically. Based on the half-life of these products
treatment regimens require frequent intravenous administration.
Such frequent administration is painful and inconvenient.
[0007] Reduced mortality, prevention of joint damage and improved
quality of life have been important achievements due to the
development of plasma-derived and recombinant FVIII. Prolonged
protection from bleeding would represent another key advancement in
the treatment of hemophilia A patients. However, to date, no
products that allow for prolonged protection have been developed.
Therefore, there remains a need for improved methods of treating
hemophilia due to factor VIII deficiency that are more tolerable
and more effective than current therapies.
BRIEF SUMMARY OF THE INVENTION
[0008] The present invention provides methods of administering
Factor VIII; methods of administering chimeric polypeptides
comprising Factor VIII and hybrids of such chimeric polypeptides;
chimeric polypeptides comprising Factor VIII and hybrids of such
chimeric polypeptides; polynucleotides encoding such chimeric and
hybrid polypeptides; cells comprising such polynucleotides; and
methods of producing such chimeric and hybrid polypeptides using
such cells.
[0009] 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, e.g., a chimeric Factor VIII-Fc polypeptide, at a
dosing interval at least about one and one-half times longer than
the dosing interval required for an equivalent amount of said
Factor VIII without the non-Factor VIII portion (a polypeptide
consisting of said Factor VIII portion), e.g., without the Fc
portion.
[0010] The dosing interval may be at least about one and one-half
to six times longer, one and one-half to five times longer, one and
one-half to four times longer, one and one-half to three times
longer, or one and one-half to two times longer, than the dosing
interval required for an equivalent amount of said Factor VIII
without the non-Factor VIII portion (a polypeptide consisting of
said Factor VIII portion), e.g., the Fc portion. The dosing
interval may be at least about one and one-half, two, two and
one-half, three, three and one-half, four, four and one-half, five,
five and one-half or six times longer than the dosing interval
required for an equivalent amount of said Factor VIII without the
non-Factor VIII portion (a polypeptide consisting of said Factor
VIII portion), e.g., the Fc portion. The dosing interval may be
about every five, six, seven, eight, nine, ten, eleven, twelve,
thirteen, or fourteen days or longer.
[0011] The dosing interval may be at least about one and one-half
to 5, one and one-half, 2, 3, 4, or 5 days or longer.
[0012] 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, e.g., a chimeric Factor VIII-Fc
polypeptide, to obtain an area under the plasma concentration
versus time curve (AUC) at least about one and one-quarter times
greater than the AUC obtained by an equivalent amount of said
Factor VIII without the non-Factor VIII portion (a polypeptide
consisting of said Factor VIII portion), e.g., without the Fc
portion.
[0013] 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 polypeptide
comprising a Factor VIII and an Fc at a dosing interval of about
every five, six, seven, eight, nine, ten, eleven, twelve, thirteen,
or fourteen days or longer.
[0014] The methods of the invention may be practiced on a subject
in need of prophylactic treatment or on-demand treatment.
[0015] On-demand treatment includes treatment for a bleeding
episode, hemarthrosis, muscle bleed, oral bleed, hemorrhage,
hemorrhage into muscles, oral hemorrhage, trauma, trauma capitis
(head trauma), gastrointestinal bleeding, intracranial hemorrhage,
intra-abdominal hemorrhage, intrathoracic hemorrhage, bone
fracture, central nervous system bleeding, bleeding in the
retropharyngeal space, bleeding in the retroperitoneal space, or
bleeding in the illiopsoas sheath. The subject may be in need of
surgical prophylaxis, pen-operative management, or treatment for
surgery. Such surgeries include, e.g., 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.
[0016] For on-demand treatment, the dosing interval of said
chimeric polypeptide is about once every 24-36, 24-48, 24-72, 24,
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, 63, 64, 65, 66, 67, 68, 69, 70, 71, or 72 hours or
longer.
[0017] The therapeutic doses that may be used in the methods of the
invention are about 10 to about 100 IU/kg, more specifically, about
10-20, 20-30, 30-40, 40-50, 50-60, 60-70, 70-80, 80-90, or 90-100
IU/kg, and more specifically, about 10, 15, 20, 25, 30, 35, 40, 45,
50, 55, 60, 65, 70, 75, 80, 85, 90, 95, or 100 IU/kg.
[0018] The therapeutic doses that may be used in the methods of the
invention are about 10 to about 150 IU/kg, more specifically, about
100-110, 110-120, 120-130, 130-140, 140-150 IU/kg, and more
specifically, about 110, 115, 120, 125, 130, 135, 140, 145, or 150
IU/kg.
[0019] The subject in the methods of the invention may be a human
subject or may be a non-human mammal. Non-human mammals include,
e.g., mice, dogs, primates, monkeys, cats, horses, cows, pigs, and
other domestic animals and small animals. The determination of
dosing interval and AUC may be carried out in a single subject or
in a population of subjects.
[0020] The Factor VIII (or Factor VIII portion of a chimeric
polypeptide) may be a human Factor VIII, or a non-human Factor
VIII, such as porcine, mouse or canine factor VIII. The Factor VIII
(or Factor VIII portion of a chimeric polypeptide) may have a full
or partial deletion of the B domain.
[0021] The Factor VIII (or Factor VIII portion of a chimeric
polypeptide) may be at least 90% or 95% identical to a Factor VIII
amino acid sequence shown in Table 2 without a signal sequence
(amino acids 1 to 1438 of SEQ ID NO:2; amino acids 1 to 2332 of SEQ
ID NO:6; amino acids 1 to 740 of SEQ ID NO:8; amino acids 1 to 745
of SEQ ID NO:10; or amino acids 1 to 684 of SEQ ID NO:12). The
Factor VIII (or Factor VIII portion of a chimeric polypeptide) may
be identical to a Factor VIII amino acid sequence shown in Table 2
without a signal sequence (amino acids 1 to 1438 of SEQ ID NO:2;
amino acids 1 to 2332 of SEQ ID NO:6; amino acids 1 to 740 of SEQ
ID NO:8; amino acids 1 to 745 of SEQ ID NO:10; or amino acids 1 to
684 of SEQ ID NO:12).
[0022] The Factor VIII (or Factor VIII portion of a chimeric
polypeptide) may 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 ID NO:2; amino acids -19 to 2332 of SEQ ID
NO:6; amino acids -19 to 740 of SEQ ID NO:8; amino acids -19 to 745
of SEQ ID NO:10; or amino acids -20 to 684 of SEQ ID NO:12). The
Factor VIII (or Factor VIII portion of a chimeric polypeptide) may
be identical to a Factor VIII amino acid sequence shown in Table 2
with a signal sequence (amino acids -19 to 1438 of SEQ ID NO:2;
amino acids -19 to 2332 of SEQ ID NO:6; amino acids -19 to 740 of
SEQ ID NO:8; amino acids -19 to 745 of SEQ ID NO:10; or amino acids
-20 to 684 of SEQ ID NO:12).
[0023] The Fc portion (or Fc portion of a chimeric polypeptide) may
be at least 90% or 95% identical to the Fc amino acid sequence
shown in Table 2 (amino acids 1439 to 1665 of SEQ ID NO:2; amino
acids 2333 to 2559 of SEQ ID NO:6; amino acids 741 to 967 of SEQ ID
NO:8; amino acids 746 to 972 of SEQ ID NO:10; amino acids 685 to
924 of SEQ ID NO:12). The Fc portion (or Fc portion of a chimeric
polypeptide) may be identical to the Fc amino acid sequence shown
in Table 2 (amino acids 1439 to 1665 of SEQ ID NO:2; amino acids
2333 to 2559 of SEQ ID NO:6; amino acids 741 to 967 of SEQ ID NO:8;
amino acids 746 to 972 of SEQ ID NO:10; amino acids 685 to 924 of
SEQ ID NO:12).
[0024] The chimeric polypeptide may comprise a sequence at least
90% or 95% identical to the Factor VIII and Fc amino acid sequence
shown in Table 2A(i) without a signal sequence (amino acids 1 to
1665 of SEQ ID NO:2) or at least 90% or 95% identical to the Factor
VIII and Fc amino acid sequence shown in Table 2A(i) with a signal
sequence (amino acids -19 to 1665 of SEQ ID NO:2). The chimeric
polypeptide may comprise a sequence identical to the Factor VIII
and Fc amino acid sequence shown in Table 2A(i) without a signal
sequence (amino acids 1 to 1665 of SEQ ID NO:2) or identical to the
Factor VIII and Fc amino acid sequence shown in Table 2A(i) with a
signal sequence (amino acids -19 to 1665 of SEQ ID NO:2).
[0025] The chimeric polypeptide may be in the form of a hybrid
comprising a second polypeptide in association with said chimeric
polypeptide, wherein said second polypeptide comprises or consists
essentially of an Fc.
[0026] 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 ID 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 SEQ ID 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 SEQ ID NO:4) or
identical to the amino acid sequence shown in Table 2A(ii) with a
signal sequence (amino acids -20 to 227 of SEQ ID NO:4).
[0027] The chimeric polypeptide or hybrid may be administered as
part of a pharmaceutical composition comprising at least one
excipient.
[0028] The invention also provides the above-described chimeric and
hybrid polypeptides themselves, polynucleotides encoding them, a
cultured human embryonic cells comprising the polynucleotides, and
methods of producing such chimeric and hybrid polypeptides, and the
polypeptides produced by such methods.
BRIEF DESCRIPTION OF THE DRAWINGS/FIGURES
[0029] FIG. 1. Schematic Representation of rFVIIIFc monomer.
[0030] FIG. 2. WBCT of rFVIIIFc compared to REFACTO.RTM. in
hemophilia A mice after a 50 IU/kg intravenous dose (n=6 mice per
group).
[0031] FIG. 3. Chromogenic Activity in Plasma from hemophilia A
mice after a single IV dose of 50 IU/kg rFVIIIFc, REFACTO.RTM. and
ADVATE.RTM..
[0032] FIG. 4A. WBCT of rFVIIIFc in hemophilia A dogs.
[0033] FIG. 4B. WBCT of REFACTO.RTM. in hemophilia A dogs followed
by rFVIIIFc in a
[0034] Crossover Study.
[0035] FIG. 5. Pharmacokinetics of intravenous rFVIIIIFc and
REFACTO.RTM. in Hemophilia A Dogs (measured by ELISA).
[0036] FIG. 6. Activity of rFVIII and REFACTO.RTM. after a single
intravenous dose in hemophilia A dogs (measured by FVIII-specific
chromogenic activity assay).
[0037] FIG. 7. Group mean plasma concentration over time of
rFVIIIFc and XYNTHA.RTM. after a single intravenous dose (125
IU/kg) in cynomolgus monkeys (n=6, mean.+-.SD). Plasma
concentrations were measured by ELISA.
[0038] FIGS. 8A-8B. Individual plasma concentration versus time
curves of rFVIIIFc and XYNTHA.RTM. after a single intravenous dose
(125 IU/kg) in cynomolgus monkeys (n=6, mean.+-.SD). Plasma
concentrations were measured by ELISA. (FIG. 8A) rFVIIIFc by ELISA.
(FIG. 8B) XYNTHA.RTM. by ELISA.
[0039] FIG. 9. Group mean plasma chromogenic activity after a
single intravenous dose (125 IU/kg) of rFVIIIFc and XYNTHA.RTM. in
cynomolgus monkeys (n=6, mean.+-.SD). FVIII activity was measured
using a FVIII-specific chromogenic activity assay.
[0040] FIGS. 10A-10B. Individual plasma chromogenic activity versus
time curves after a single intravenous dose (125 IU/kg) of rFVIIIFc
and XYNTHA.RTM. in cynomolgus monkeys (n=6, mean.+-.SD). FVIII
activity was measured using a FVIII-specific chromogenic activity
assay. (FIG. 10A) rFVIIIFc Chromogenic Activity. (FIG. 10B)
XYNTHA.RTM. Chromogenic Activity.
[0041] FIG. 11. Biochemical characterization of rFVIII-Fc:
Activation of Factor X as a function of Factor X concentration.
[0042] FIG. 12. Biochemical characterization of rFVIII-Fc:
Activation of Factor X as a function of Factor IXa
concentration.
[0043] FIG. 13A. Observed group mean FVIII activity (.+-.SE) (one
stage assay, 25 IU/kg) versus time.
[0044] FIG. 13B. Observed group mean FVIII activity (.+-.SE) (one
stage assay, 65 IU/kg) versus time.
[0045] FIG. 13C. Observed group mean FVIII activity (.+-.SE)
(chromogenic assay, 25 IU/kg) versus time.
[0046] FIG. 13D. Observed group mean FVIII activity (.+-.SE)
(chromogenic assay, 65 IU/kg) versus time.
[0047] FIG. 14A. Observed group mean FVIII activity (.+-.SE) (one
stage assay) versus time.
[0048] FIG. 14B. Observed group mean FVIII activity (.+-.SE)
(chromogenic assay) versus time.
DETAILED DESCRIPTION OF THE INVENTION
[0049] The present invention provides a method of treating
Hemophilia A with Factor VIII using a longer dosing interval and/or
greater AUC than is possible with currently known Factor VIII
products. The present invention also provides improved Factor VIII
chimeric polypeptides, Factor VIII chimeric polynucleotides, and
methods of production.
[0050] Treatment of hemophilia A is by replacement therapy
targeting restoration of FVIII activity to 1 to 5% of normal levels
to prevent spontaneous bleeding (Mannucci, P. M., et al., N. Engl.
J. Med. 344:1773-9 (2001), herein incorporated by reference in its
entirety). There are plasma-derived and recombinant FVIII products
available to treat bleeding episodes on-demand or to prevent
bleeding episodes from occurring by treating prophylactically.
Based on the half-life of these products (10-12 hr) (White G. C.,
et al., Thromb. Haemost. 77:660-7 (1997); Morfini, M., Haemophilia
9 (suppl 1):94-99; discussion 100 (2003)), treatment regimens
require frequent intravenous administration, commonly two to three
times weekly for prophylaxis and one to three times daily for
on-demand treatment (Manco-Johnson, M. J., et al., 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 inconvenient.
[0051] 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, e.g., a chimeric Factor VIII-Fc polypeptide, or a
hybrid of such a polypeptide at a dosing interval at least about
one and one-half times longer than the dosing interval required for
an equivalent amount of said Factor VIII without the non-Factor
VIII portion (a polypeptide consisting of said Factor VIII
portion), e.g., without the Fc portion.
[0052] The dosing interval may be at least about one and one-half
to six times longer, one and one-half to five times longer, one and
one-half to four times longer, one and one-half to three times
longer, or one and one-half to two times longer, than the dosing
interval required for an equivalent amount of said Factor VIII
without the non-Factor VIII portion (a polypeptide consisting of
said Factor VIII portion), e.g., without the Fc portion. The dosing
interval may be at least about one and one-half, two, two and
one-half, three, three and one-half, four, four and one-half, five,
five and one-half or six times longer than the dosing interval
required for an equivalent amount of said Factor VIII without the
non-Factor VIII portion (a polypeptide consisting of said Factor
VIII portion), e.g., without the Fc portion. The dosing interval
may be about every five, six, seven, eight, nine, ten, eleven,
twelve, thirteen, or fourteen days or longer.
[0053] The dosing interval may be at least about one and one-half
to 5, one and one-half, 2, 3, 4, or 5 days or longer.
[0054] 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, e.g., a chimeric Factor VIII-Fc
polypeptide, or a hybrid of such a polypeptide to obtain an area
under the plasma concentration versus time curve (AUC) at least
about one and one-quarter times greater than the AUC obtained by an
equivalent amount of said Factor VIII without non-Factor VIII
portion (a polypeptide consisting of said Factor VIII portion),
e.g., without the Fc portion.
[0055] 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 polypeptide
comprising a Factor VIII and an Fc or a hybrid of such a
polypeptide at a dosing interval of about every five, six, seven,
eight, nine, ten, eleven, twelve, thirteen, or fourteen days or
longer.
[0056] The methods of the invention may be practiced on a subject
in need of prophylactic treatment or on-demand treatment.
[0057] "Administering," as used herein, means to give a
pharmaceutically acceptable Factor VIII polypeptide of the
invention to a subject via a pharmaceutically acceptable route.
Preferred routes of administration are intravenous, e.g.,
intravenous injection and intravenous infusion. Additional routes
of administration include, e.g., subcutaneous, intramuscular, oral,
nasal, and pulmonary administration. Chimeric polypeptides and
hybrid proteins may be administered as part of a pharmaceutical
composition comprising at least one excipient.
[0058] "Area under the plasma concentration versus time curve
(AUC)," as used herein, is the same as the term of art in
pharmacology, and is based upon the rate and extent of absorption
if factor VIII following administration. AUC is determined over a
specified time period, 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, AUC is determined for infinity.
The determination of AUC may be carried out in a single subject, or
in a population of subjects for which the average is
calculated.
[0059] "B domain" of Factor VIII, as used herein, is the same as
the B domain known in the art that is defined by internal amino
acid sequence identity and sites of proteolytic cleavage by
thrombin, e.g., residues Ser741-Arg1648 of full length human factor
VIII. The other human factor VIII domains are defined by the
following amino acid residues: A1, residues Ala1-Arg372; A2,
residues Ser373-Arg740; A3, residues Ser1690-Ile2032; Cl, residues
Arg2033-Asn2172; C2, residues Ser2173-Tyr2332. The A3-C1-C2
sequence includes residues Ser1690-Tyr2332. The remaining sequence,
residues Glu1649-Arg1689, is usually referred to as the factor VIII
light chain activation peptide. The locations of the boundaries for
all of the 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 ("B domain deleted factor VIII" or
"BDD FVIII"). An example of a BDD FVIII is REFACTO.RTM.
(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 SEQ ID NO:2).
[0060] A "B domain deleted factor VIII" may have the full or
partial deletions disclosed in U.S. Pat. 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, 5,112,950, 4,868,112,
and 6,458,563, each of which is incorporated herein by reference in
its entirety. In some embodiments, a B domain deleted factor VIII
sequence of the present invention comprises any one of the
deletions disclosed at col. 4, line 4 to col. 5, line 28 and
examples 1-5 of U.S. Pat. No. 6,316,226 (also in U.S. Pat. No.
6,346,513). In some embodiments, a B domain deleted factor VIII of
the present invention has a deletion disclosed at col. 2, lines
26-51 and examples 5-8 of U.S. Pat. No. 5,789,203 (also U.S. Pat.
Nos. 6,060,447, 5,595,886, and 6,228,620). In some embodiments, a B
domain deleted factor VIII has a deletion described in col. 1,
lines 25 to col. 2, line 40 of U.S. Pat. No. 5,972,885; col. 6,
lines 1-22 and example 1 of U.S. Pat. No. 6,048,720; col. 2, lines
17-46 of U.S. Pat. No. 5,543,502; col. 4, line 22 to col. 5, line
36 of U.S. Pat. No. 5,171,844; col. 2, lines 55-68, FIG. 2, and
example 1 of U.S. Pat. No. 5,112,950; col. 2, line 2 to col. 19,
line 21 and table 2 of U.S. Pat. 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, and col. 11, line 5 to col. 13, line 39 of
U.S. Pat. No. 7,041,635; or col. 4, lines 25-53, of U.S. Pat. No.
6,458,563. In some embodiments, a B domain deleted factor VIII has
a deletion of most of the B domain, but still contains
amino-terminal sequences of the B domain that are essential for in
vivo proteolytic processing of the primary translation product into
two polypeptide chain, as disclosed in WO 91/09122, which is
incorporated herein by reference in its entirety. In some
embodiments, a B domain deleted factor VIII is constructed with a
deletion of amino acids 747-1638, i.e., virtually a complete
deletion of the B domain. Hoeben R. C., et al. J. Biol. Chem. 265
(13): 7318-7323 (1990), incorporated herein by reference in its
entirety. A B domain deleted factor VIII may also contain a
deletion of amino acids 771-1666 or amino acids 868-1562 of factor
VIII. Meulien P., et al. Protein Eng. 2(4): 301-6 (1988),
incorporated herein by reference in its entirety. Additional B
domain deletions that are part of the invention include, e.g.:
deletion of amino acids 982 through 1562 or 760 through 1639 (Toole
et al., Proc. Natl. Acad. Sci. U.S.A. (1986) 83, 5939-5942)), 797
through 1562 (Eaton, et al. Biochemistry (1986) 25:8343-8347)), 741
through 1646 (Kaufman (PCT published application No. WO 87/04187)),
747-1560 (Sarver, et al., DNA (1987) 6:553-564)), 741 though 1648
(Pasek (PCT application No. 88/00831)), 816 through 1598 or 741
through 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 foregoing deletions may be made in any Factor
VIII sequence.
[0061] "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 may
include, e.g., two, three, four, five, six, seven, or more
polypeptides from different sources, such as different genes,
different cDNAs, or different animal or other species. Chimeric
polypeptides may include, e.g., one or more linkers joining the
different subsequences. Thus, the subsequences may be joined
directly or they may be joined indirectly, via linkers, or both,
within a single chimeric polypeptide. Chimeric polypeptides may
include, e.g., additional peptides such as signal sequences and
sequences such as 6His and FLAG that aid in protein purification or
detection. In addition, chimeric polypeptides may have amino acid
or peptide additions to the N- and/or C-termini.
[0062] In some embodiments, the chimeric polypeptide comprises a
Factor VIII portion and a non-Factor VIII portion. Exemplary
non-Factor VIII portions include, e.g., Fc, XTEN, and albumin.
Exemplary chimeric polypeptides of the invention include, e.g.,
chimeric Factor VIII-Fc polypeptides, chimeric Factor VIII-XTEN
polypeptides, and chimeric Factor VIII-albumin polypeptides.
[0063] Exemplary chimeric Factor VIII-Fc polypeptides include,
e.g., SEQ ID NOs:2, 6, 8, 10, and 12 (Table 2), with or without
their signal sequences and the chimeric Fc polypeptide of SEQ ID
NO:4 (Table 2).
[0064] The chimeric polypeptide may comprise a sequence at least
90% or 95% identical to the Factor VIII and Fc amino acid sequence
shown in Table 2A(i) without a signal sequence (amino acids 1 to
1665 of SEQ ID NO:2) or at least 90% or 95% identical to the Factor
VIII and Fc amino acid sequence shown in Table 2A(i) with a signal
sequence (amino acids -19 to 1665 of SEQ ID NO:2). The chimeric
polypeptide may comprise a sequence identical to the Factor VIII
and Fc amino acid sequence shown in Table 2A(i) without a signal
sequence (amino acids 1 to 1665 of SEQ ID NO:2) or identical to the
Factor VIII and Fc amino acid sequence shown in Table 2A(i) with a
signal sequence (amino acids -19 to 1665 of SEQ ID NO:2).
[0065] As discussed above, exemplary chimeric polypeptides include
Factor VIII 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-terminal end of the XTEN polypeptide or to the
C-terminal end of the XTEN polypeptide, provided the Factor VIII
component of the Factor VIII-XTEN fusion protein can be processed
by an protease to yield a processed Factor VIII containing
polypeptide. A protease site may be included between the XTEN
portion and the Factor VIII portion to allow such processing. XTEN
polypeptides include, e.g., those disclosed in WO 2009/023270, WO
2010/091122, WO 2007/103515, US 2010/0189682, and US 2009/0092582,
each of which is incorporated herein by reference in its
entirety.
[0066] As discussed above, exemplary chimeric polypeptides also
include Factor VIII 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 albumin or to the C-terminal
end of the albumin, provided the Factor VIII component of the
Factor VIII-albumin fusion protein can be processed by an
enzymatically-active proprotein convertase to yield a processed
Factor VIII-containing polypeptide. Examples of albumin, e.g.,
fragments thereof, that may be used in the present invention are
known. e.g., U.S. Pat. Nos. 7,592,010; 6,686,179; and Schulte,
Thrombosis Res. 124 Suppl. 2:S6-S8 (2009), each of which is
incorporated herein by reference in its entirety.
[0067] In some embodiments, a chimeric polypeptide comprising a
Factor VIII portion has an increased half-life (t1/2) over a
polypeptide consisting of the same Factor VIII portion without the
non Factor VIII portion. A chimeric Factor VIII polypeptide with an
increased t1/2 may be referred to herein as a long-acting Factor
VIII. Long-acting chimeric Factor VIII polypeptides include, e.g.,
Factor VIII fused to Fc (including, e.g., chimeric Factor VIII
polypeptides in the form of a hybrid such as a FVIIIFc monomer
dimer hybrid; see Example 1, FIG. 1, and Table 2A; and U.S. Pat.
Nos. 7,404,956 and 7,348,004), Factor VIII fused to XTEN, and
Factor VIII fused to albumin.
[0068] "Culture," "to culture" and "culturing," as used herein,
means to incubate cells under in vitro conditions that allow for
cell growth or division or to maintain cells in a living state.
"Cultured cells," as used herein, means cells that are propagated
in vitro.
[0069] "Factor VIII," as used herein, means functional factor VIII
polypeptide 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 the human,
porcine, canine, and murine factor VIII proteins. As described in
the Background Art section, the full length 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 SEQ ID NOs:2, 6, 8, 10,
and 12 (Table 2). Factor VIII polypeptides include, e.g.,
full-length factor VIII, full-length factor VIII minus Met at the
N-terminus, mature factor VIII (minus the signal sequence), mature
factor VIII with an additional Met at the N-terminus, and/or factor
VIII with a full or partial deletion of the B domain. Preferred
Factor VIII variants include B domain deletions, whether partial or
full deletions.
[0070] A great many functional factor VIII variants are known, as
is discussed above and below. In addition, hundreds of
nonfunctional mutations in factor VIII have been identified in
hemophilia patients, and it has been determined that the effect of
these mutations on factor VIII function is due more to where they
lie within the 3-dimensional structure of factor VIII than on 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 factor VIII from humans and other
species has identified conserved residues that are likely to be
required for function (Cameron et al., Thromb. Haemost. 79:317-22
(1998); U.S. Pat. No. 6,251,632), incorporated herein by reference
in its entirety.
[0071] The human factor VIII gene was isolated and expressed in
mammalian cells (Toole, J. J., et al., Nature 312:342-347 (1984);
Gitschier, J., et al., Nature 312:326-330 (1984); Wood, W. I., 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; U.S.
Pat. No. 4,757,006), each of which is incorporated herein by
reference in its entirety, and the amino acid sequence was deduced
from cDNA. Capon et al., U.S. Pat. No. 4,965,199, incorporated
herein by reference in its entirety, disclose a recombinant DNA
method for producing factor VIII in mammalian host cells and
purification of human factor VIII. Human factor VIII expression in
CHO (Chinese hamster ovary) cells and BHKC (baby hamster kidney
cells) has been reported. Human factor VIII has been modified to
delete part or all of the B domain (U.S. Pat. Nos. 4,994,371 and
4,868,112, each of which is incorporated herein by reference in its
entirety), and replacement of the human factor VIII B domain with
the human factor V B domain has been performed (U.S. Pat. No.
5,004,803, incorporated herein by reference in its entirety). The
cDNA sequence encoding human factor VIII and predicted amino acid
sequence are shown in SEQ ID NOs:1 and 2, respectively, of US
Application Publ. No. 2005/0100990, incorporated herein by
reference in its entirety.
[0072] U.S. Pat. No. 5,859,204, Lollar, J. S., incorporated herein
by reference in its entirety, reports functional mutants of factor
VIII having reduced antigenicity and reduced immunoreactivity. U.S.
Pat. No. 6,376,463, Lollar, J. S., incorporated herein by reference
in its entirety, also reports mutants of factor VIII having reduced
immunoreactivity. US Application Publ. No. 2005/0100990, Saenko et
al., incorporated herein by reference in its entirety, reports
functional mutations in the A2 domain of factor VIII.
[0073] A number of functional factor VIII molecules, including
B-domain deletions, are disclosed in the following patents U.S.
Pat. Nos. 6,316,226 and 6,346,513, both assigned to Baxter; U.S.
Pat. No. 7,041,635 assigned to In2Gen; U.S. Pat. Nos. 5,789,203,
6,060,447, 5,595,886, and 6,228,620 assigned to Chiron; U.S. Pat.
Nos. 5,972,885 and 6,048,720 assigned to Biovitrum, U.S. Pat. Nos.
5,543,502 and 5,610,278 assigned to Novo Nordisk; U.S. Pat. No.
5,171,844 assigned to Immuno Ag; U.S. Pat. No. 5,112,950 assigned
to Transgene S.A.; U.S. Pat. No. 4,868,112 assigned to Genetics
Institute, each of which is incorporated herein by reference in its
entirety.
[0074] The porcine factor VIII sequence is published, (Toole, J.
J., et al., Proc. Natl. Acad. Sci. USA 83:5939-5942 (1986)),
incorporated herein by reference in its entirety, and the complete
porcine cDNA sequence obtained from PCR amplification of factor
VIII sequences from a pig spleen cDNA library has been reported
(Healey, J. F., et al., Blood 88:4209-4214 (1996), incorporated
herein by reference in its entirety). Hybrid human/porcine factor
VIII having substitutions of all domains, all subunits, and
specific amino acid sequences were disclosed in U.S. Pat. No.
5,364,771 by Lollar and Runge, and in WO 93/20093, incorporated
herein by reference in its entirety. More recently, the nucleotide
and corresponding amino acid sequences of the A1 and A2 domains of
porcine factor VIII and a chimeric factor VIII with porcine A1
and/or A2 domains substituted for the corresponding human domains
were reported in WO 94/11503, incorporated herein by reference in
its entirety. U.S. Pat. No. 5,859,204, Lollar, J. S., also
discloses the porcine cDNA and deduced amino acid sequences.
6,458,563, incorporated herein by reference in its entirety
assigned to Emory discloses a B-domain deleted porcine Factor
VIII.
[0075] The Factor VIII (or Factor VIII portion of a chimeric
polypeptide) may be at least 90% or 95% identical to a Factor VIII
amino acid sequence shown in Table 2 without a signal sequence
(amino acids 1 to 1438 of SEQ ID NO:2; amino acids 1 to 2332 of SEQ
ID NO:6; amino acids 1 to 740 of SEQ ID NO:8; amino acids 1 to 745
of SEQ ID NO:10; or amino acids 1 to 684 of SEQ ID NO:12). The
Factor VIII (or Factor VIII portion of a chimeric polypeptide) may
be identical to a Factor VIII amino acid sequence shown in Table 2
without a signal sequence (amino acids 1 to 1438 of SEQ ID NO:2;
amino acids 1 to 2332 of SEQ ID NO:6; amino acids 1 to 740 of SEQ
ID NO:8; amino acids 1 to 745 of SEQ ID NO:10; or amino acids 1 to
684 of SEQ ID NO:12).
[0076] The Factor VIII (or Factor VIII portion of a chimeric
polypeptide) may 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 ID NO:2; amino acids -19 to 2332 of SEQ ID
NO:6; amino acids -19 to 740 of SEQ ID NO:8; amino acids -19 to 745
of SEQ ID NO:10; or amino acids -20 to 684 of SEQ ID NO:12). The
Factor VIII (or Factor VIII portion of a chimeric polypeptide) may
be identical to a Factor VIII amino acid sequence shown in Table 2
with a signal sequence (amino acids -19 to 1438 of SEQ ID NO:2;
amino acids -19 to 2332 of SEQ ID NO:6; amino acids -19 to 740 of
SEQ ID NO:8; amino acids -19 to 745 of SEQ ID NO:10; or amino acids
-20 to 684 of SEQ ID NO:12).
[0077] "Equivalent amount," as used herein, means the same amount
of Factor VIII activity as expressed in International Units, which
is independent of molecular weight of the polypeptide in question.
One International Unit (IU) of factor VIII activity corresponds
approximately to the quantity of factor VIII in one milliliter of
normal human plasma. Several assays are available for measuring
Factor VIII activity, including the European Pharmacopoeia
chromogenic substrate assay and a one stage clotting assay.
[0078] "Fc," as used herein, means functional neonatal Fc receptor
(FcRn) binding partners, unless otherwise specified. An FcRn
binding partner is any molecule that can be specifically bound by
the FcRn receptor with consequent active transport by the FcRn
receptor of the FcRn binding partner. Thus, the term Fc includes
any variants of IgG Fc that are functional. The region of the Fc
portion of IgG that binds to the FcRn receptor has been described
based on X-ray crystallography (Burmeister et al. 1994, Nature
372:379, incorporated herein by reference in its entirety). The
major contact area of the Fc with the FcRn is near the junction of
the CH2 and CH3 domains. Fc-FcRn contacts are all within a single
Ig heavy chain. The FcRn binding partners include, e.g., whole IgG,
the Fc fragment of IgG, and other fragments of IgG that include the
complete binding region of FcRn. The 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
433-436 of the CH3 domain. References made to amino acid numbering
of immunoglobulins or immunoglobulin fragments, or regions, are all
based on Kabat et al. 1991, Sequences of Proteins of Immunological
Interest, U. S. Department of Public Health, Bethesda; MD,
incorporated herein by reference in its entirety. (The FcRn
receptor has been isolated from several mammalian species including
humans. The sequences of the human FcRn, rat FcRn, and mouse FcRn
are known (Story et al. 1994, J. Exp. Med. 180: 2377), incorporated
herein by reference in its entirety.) An Fc may comprise the CH2
and CH3 domains of an immunoglobulin with or without the hinge
region of the immunoglobulin. Exemplary Fc variants are provided in
WO 2004/101740 and WO 2006/074199, incorporated herein by reference
in its entirety.
[0079] Fc (or Fc portion of a chimeric polypeptide) may contain one
or more mutations, and combinations of mutations.
[0080] Fc (or Fc portion of a chimeric polypeptide) may contain
mutations conferring increased half-life such as M252Y, S254T,
T256E, and combinations thereof, as disclosed in Oganesyan et al.,
Mol. Immunol. 46:1750 (2009), which is incorporated herein by
reference in its entirety; H433K, N434F, and combinations thereof,
as disclosed in Vaccaro et al., Nat. Biotechnol. 23:1283 (2005),
which is incorporated herein by reference in its entirety; the
mutants disclosed at pages 1-2, paragraph [0012], and Examples 9
and 10 of US 2009/0264627 A1, which is incorporated herein by
reference in its entirety; and the mutants disclosed at page 2,
paragraphs [0014] to [0021] of US 20090163699 A1, which is
incorporated herein by reference in its entirety.
[0081] Fc (or Fc portion of a chimeric polypeptide) may also
include, e.g., the following mutations: The Fc region of IgG can be
modified according to well recognized procedures such as site
directed mutagenesis and the like to yield modified IgG or Fc
fragments or portions thereof that will be bound by FcRn. Such
modifications include, e.g., modifications remote from the FcRn
contact sites as well as modifications within the contact sites
that preserve or even enhance binding to the FcRn. For example the
following single amino acid residues in human IgG1 Fc (Fcy1) can be
substituted without significant loss of Fc 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 wildtype proline substituted by alanine at position
number 238. In addition to alanine other amino acids may be
substituted for the wildtype amino acids at the positions specified
above. Mutations may be introduced singly into Fc giving rise to
more than one hundred FcRn binding partners distinct from native
Fc. Additionally, combinations of two, three, or more of these
individual mutations may be introduced together, giving rise to
hundreds more FcRn binding partners. Certain of these mutations may
confer new functionality upon the FcRn binding partner. For
example, one embodiment incorporates N297A, removing a highly
conserved N-glycosylation site. The effect of this mutation is to
reduce immunogenicity, thereby enhancing circulating half-life of
the FcRn binding partner, and to render the FcRn binding partner
incapable of binding to FcyRI, FcyRIIA, FcyRIIB, and FcyRIIIA,
without compromising affinity for 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 et al.
1995, J. Biol. Chem. 276:6591, which is incorporated herein by
reference in its entirety). Additionally, at least three human Fc
gamma receptors appear to recognize a binding site on IgG within
the lower hinge region, generally amino acids 234-237. Therefore,
another example of new functionality and potential decreased
immunogenicity may arise from mutations of this region, as for
example by replacing amino acids 233-236 of human IgG1 "ELLG" to
the corresponding sequence from IgG2 "PVA" (with one amino acid
deletion). It has been shown that FcyRI, FcyRII, and FcyRIII which
mediate various effector functions will not bind to IgG1 when such
mutations have been introduced (Ward and Ghetie 1995, Therapeutic
Immunology 2:77, which is incorporated herein by reference in its
entirety; and Armour et al. 1999, Eur. J. Immunol. 29:2613, which
is incorporated herein by reference in its entirety). As a further
example of new functionality arising from mutations described above
affinity for FcRn may be increased beyond that of wild type in some
instances. This increased affinity may reflect an increased "on"
rate, a decreased "off" rate or both an increased "on" rate and a
decreased "off" rate. Mutations believed to impart an increased
affinity for FcRn include, e.g., T256A, T307A, E380A, and N434A
(Shields et al. 2001, J. Biol. Chem. 276:6591, which is
incorporated herein by reference in its entirety).
[0082] The Fc (or Fc portion of a chimeric polypeptide) may be at
least 90% or 95% identical to the Fc amino acid sequence shown in
Table 2 (amino acids 1439 to 1665 of SEQ ID NO:2; amino acids 2333
to 2559 of SEQ ID NO:6; amino acids 741 to 967 of SEQ ID NO:8;
amino acids 746 to 972 of SEQ ID NO:10; amino acids 685 to 924 of
SEQ ID NO:12). The Fc (or Fc portion of a chimeric polypeptide) may
be identical to the Fc amino acid sequence shown in Table 2 (amino
acids 1439 to 1665 of SEQ ID NO:2; amino acids 2333 to 2559 of SEQ
ID NO:6; amino acids 741 to 967 of SEQ ID NO:8; amino acids 746 to
972 of SEQ ID NO:10; amino acids 685 to 924 of SEQ ID NO:12).
[0083] "Hybrid" polypeptides and proteins, as used herein, means a
combination of a chimeric polypeptide with a second polypeptide.
The chimeric polypeptide and the second polypeptide in a hybrid may
be associated with each other via protein-protein interactions,
such as charge-charge or hydrophobic interactions. The chimeric
polypeptide and the second polypeptide in a hybrid may be
associated with each other via disulfide or other covalent bond(s).
Hybrids are described in WO 2004/101740 and WO 2006/074199, each of
which is incorporated herein by reference in its entirety. See also
U.S. Pat. Nos. 7,404,956 and 7,348,004, each of which is
incorporated herein by reference in its entirety. The second
polypeptide may be a second copy of the same chimeric polypeptide
or it may be a non-identical chimeric polypeptide. See, e.g., FIG.
1, Example 1, and Table 2. In preferred embodiments, the second
polypeptide is a polypeptide comprising an Fc. In preferred
embodiments, the chimeric polypeptide is a chimeric Factor VIII-Fc
polypeptide and the second polypeptide consists essentially of Fc,
e.g, the hybrid polypeptide of Example 1, which is a rFVIIIFc
recombinant fusion protein consisting of a single molecule of
recombinant B-domain deleted human FVIII (BDD-rFVIII) fused to the
dimeric Fc domain of the human IgG1, with no intervening linker
sequence. This hybrid polypeptide is referred to herein as FVIIIFc
monomeric Fc fusion protein, FVIIIFc monomer hybrid, monomeric
FVIIIIFc hybrid, and FVIIIFc monomer-dimer. See Example 1, FIG. 1,
and Table 2A. The Examples provide preclinical and clinical data
for this hybrid polypeptide.
[0084] 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 Table 2A(ii) without a signal sequence
(amino acids 1 to 227 of SEQ ID 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 SEQ ID 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 SEQ ID NO:4) or
identical to the amino acid sequence shown in Table 2A(ii) with a
signal sequence (amino acids -20 to 227 of SEQ ID NO:4).
[0085] FIG. 1 is a schematic showing the structure of a B domain
deleted factor VIII-Fc chimeric polypeptide, and its association
with a second polypeptide that is an Fc polypeptide. To obtain this
hybrid, the coding sequence of human recombinant B-domain deleted
FVIII was obtained by reverse transcription-polymerase chain
reaction (RT-PCR) from human liver poly A RNA (Clontech) using
FVIII-specific primers. The FVIII sequence includes the native
signal sequence for FVIII. The B-domain deletion was from serine
743 (S743; 2287 bp) to glutamine 1638 (Q1638; 4969 bp) for a total
deletion of 2682 bp. Then, the coding sequence for human
recombinant Fc was obtained by RT-PCR from a human leukocyte cDNA
library (Clontech) using Fc specific primers. Primers were designed
such that the B-domain deleted FVIII sequence was fused directly to
the N-terminus of the Fc sequence with no intervening linker. The
FVIIIFc DNA sequence was cloned into the mammalian dual expression
vector pBUDCE4.1 (Invitrogen) under control of the CMV promoter. A
second identical Fc sequence including the mouse Igk signal
sequence was obtained by RT-PCR and cloned downstream of the second
promoter, EF1.alpha., in the expression vector pBUDCE4.1.
[0086] The rFVIIIFc expression vector was transfected into human
embryonic kidney 293 cells (HEK293H; Invitrogen) using
Lipofectamine 2000 transfection reagent (Invitrogen). Stable clonal
cell lines were generated by selection with Zeocin (Invitrogen).
One clonal cell line, 3C4-22 was used to generate FVIIIFc for
characterization in vivo. Recombinant FVIIIFc was produced and
purified (McCue et al. 2009) at Biogen Idec (Cambridge, Mass.). The
transfection strategy described above was expected to yield three
products, i.e., monomeric rFVIIIFc hybrids, dimeric rFVIIIFc
hybrids and dimeric Fc. However, there was essentially no dimeric
rFVIIIFc detected in the conditioned medium from these cells.
Rather, the conditioned medium contained Fc and monomeric rFVIIIFc.
It is possible that the size of dimeric rFVIIIFc was too great and
prevented efficient secretion from the cell. This result was
beneficial since it rendered the purification of the monomer less
complicated than if all three proteins had been present. The
material used in these studies had a specific activity of
approximately 9000 IU/mg.
[0087] "Dosing interval," as used herein, means the amount of time
that elapses between multiple doses being administered to a
subject. The comparison of dosing interval may be carried out in a
single subject or in a population of subjects and then the average
obtained in the population may be calculated.
[0088] The dosing interval when administering a chimeric Factor
VIII polypeptide, e.g., a chimeric Factor VIII-Fc polypeptide (a
polypeptide comprising a Factor VIII or a hybrid) of the invention
may be at least about one and one-half times longer than the dosing
interval required for an equivalent amount of said Factor VIII
without the non-Factor VIII portion, e.g., without the Fc portion
(a polypeptide consisting of said Factor VIII). The dosing interval
may be at least about one and one-half to six times longer, one and
one-half to five times longer, one and one-half to four times
longer, one and one-half to three times longer, or one and one-half
to two times longer, than the dosing interval required for an
equivalent amount of said Factor VIII without the non-Factor VIII
portion, e.g., without the Fc portion (a polypeptide consisting of
said Factor VIII). The dosing interval may be at least about one
and one-half, two, two and one-half, three, three and one-half,
four, four and one-half, five, five and one-half or six times
longer than the dosing interval required for an equivalent amount
of said Factor VIII without the non-Factor VIII portion, e.g.,
without the Fc portion (a polypeptide consisting of said Factor
VIII). The dosing interval may be about every five, six, seven,
eight, nine, ten, eleven, twelve, thirteen, or fourteen days or
longer. The dosing interval may be at least about one and one-half
to 5, one and one-half, 2, 3, 4, or 5 days or longer. For on-demand
treatment, the dosing interval of said chimeric polypeptide or
hybrid is about once every 24-36, 24-48, 24-72, 24, 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,
63, 64, 65, 66, 67, 68, 69, 70, 71, or 72 hours or longer.
[0089] 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 dosing interval is once every 3-5,
3-6, 3-7, 3, 4, 5, 6, 7, or 8 or more days, or three times per
week, or no more than three times per week. Preferably, the
effective dose is 65 IU/kg and the dosing interval is once weekly,
or once every 6-7 days.
[0090] "Long-acting Factor VIII" is a Factor VIII having an
increased half-life (also referred to herein as t1/2, t1/2 beta,
elimination half-life and HL) over a reference Factor VIII. The
increased half-life of a long-acting Factor VIII may be due to
fusion to one or more non-Factor VIII polypeptides such as, e.g.,
Fc, XTEN or albumin. The increased half-life may be due to one or
more modification, such as, e.g., pegylation. Exemplary long-acting
Factor VIII polypeptides include, e.g., chimeric Factor VIII
polypeptides comprising Fc, chimeric Factor VIII polypeptides
comprising XTEN and chimeric Factor VIII polypeptides comprising
albumin. Additional exemplary long-acting Factor VIII polypeptides
include, e.g., pegylated Factor VIII.
[0091] The "reference" polypeptide, in the case of a long-acting
chimeric Factor VIII polypeptide, is a polypeptide consisting
essentially of the Factor VIII portion of the chimeric polypeptide,
e.g., the same Factor VIII portion without the Fc portion, without
the XTEN portion, or without the albumin portion. Likewise, the
reference polypeptide in the case of a modified Factor VIII is the
same Factor VIII without the modification, e.g., a Factor VIII
without the pegylation.
[0092] In some embodiments, the long-acting Factor VIII has one or
more of the following properties when administered to a
subject:
a mean residence time (MRT) (activity) in said subject of about
14-41.3 hours; a clearance (CL) (activity) in said subject of about
1.22-5.19 mL/hour/kg or less; a t1/2beta (activity) in said subject
of about 11-26.4 hours; an incremental recovery (K value)
(activity; observed) in said subject of about 1.38-2.88 IU/dL per
IU/kg; a Vss (activity) in said subject of about 37.7-79.4 mL/kg;
and an AUC/dose in said subject of about 19.2-81.7 IU*h/dL per
IU/kg.
[0093] In some embodiments, the long-acting Factor VIII has one or
more of the following properties when administered to a patient
population:
a mean incremental recovery (K-Value) (activity; observed) greater
that 1.38 IU/dL per IU/kg; a mean incremental recovery (K-Value)
(activity; observed) of at least about 1.5, at least about 1.85, or
at least about 2.46 IU/dL per IU/kg. a mean clearance (CL)
(activity) in said patient population of about 2.33.+-.1.08
mL/hour/kg or less; a mean clearance (CL) (activity) in said
patient population of about 1.8-2.69 mL/hour/kg; a mean clearance
(CL) (activity) in said patient population that is about 65% of the
clearance of a polypeptide comprising said Factor VIII without
modification; a mean mean residence time (MRT) (activity) in said
patient population of at least about 26.3.+-.8.33 hours; a mean MRT
(activity) in said patient population of about 25.9-26.5 hours; a
mean MRT (activity) in said patent population that is about 1.5
fold longer than the mean MRT of a polypeptide comprising said
Factor VIII without modification; a mean t1/2beta (activity) in
said patient population of about 18.3.+-.5.79 hours; a mean
t1/2beta (activity) in said patient population that is about
18-18.4 hours; a mean t1/2beta (activity) in said patient
population that is about 1.5 fold longer than the mean t1/2beta of
a polypeptide comprising said Factor VIII without modification; a
mean incremental recovery (K value) (activity; observed) in said
patient population of about 2.01.+-.0.44 IU/dL per IU/kg; a mean
incremental recovery (K value) (activity; observed) in said patient
population of about 1.85-2.46 IU/dL per IU/kg; a mean incremental
recovery (K value) (activity; observed) in said patient population
that is about 90% of the mean incremental recovery of a polypeptide
comprising said Factor VIII without modification; a mean Vss
(activity) in said patient population of about 55.1.+-.12.3 mL/kg;
a mean Vss (activity) in said patient population of about 45.3-56.1
mL/kg; a mean AUC/dose (activity) in said patient population of
about 49.9.+-.18.2 IU*h/dL per IU/kg; a mean AUC/dose (activity) in
said patient population of about 44.8-57.6 IU*h/dL per IU/kg.
[0094] "On-demand treatment," as used herein, means treatment that
is intended to take place over a short course of time and is in
response to an existing condition, such as a bleeding episode, or a
perceived need such as planned surgery. Conditions that may require
on-demand treatment include, e.g., a bleeding episode,
hemarthrosis, muscle bleed, oral bleed, hemorrhage, hemorrhage into
muscles, oral hemorrhage, trauma, trauma capitis, gastrointestinal
bleeding, intracranial hemorrhage, intra-abdominal hemorrhage,
intrathoracic hemorrhage, bone fracture, central nervous system
bleeding, bleeding in the retropharyngeal space, bleeding in the
retroperitoneal space, or bleeding in the illiopsoas sheath. The
subject may be in need of surgical prophylaxis, pen-operative
management, or treatment for surgery. Such surgeries include, e.g.,
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.
[0095] Preferably, on-demand treatment resolves greater than 80%
(greater than 80%, greater than 81%, greater than 82%, greater than
83%, greater than 84%, greater than 85%, greater than 86%, greater
than 87%, greater than 88%, greater than 89%, greater than 90%,
greater than 91%, greater than 92%, greater than 93%, greater than
94%, greater than 95%, greater than 96%, greater than 97%, greater
than 98%, greater than 99%, or 100%) or 80-100%, 80-90%, 85-90%,
90-100%, 90-95%, or 95-100% of bleeds (e.g., spontaneous bleeds) in
a single dose. Preferably, greater than 80% (greater than 81%,
greater than 82%, greater than 83%, greater than 84%, greater than
85%, greater than 86%, greater than 87%, greater than 88%, greater
than 89%, greater than 90%, greater than 91%, greater than 92%,
greater than 93%, greater than 94%, greater than 95%, greater than
96%, greater than 97%, greater 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 physicians after on-demand
treatment. Preferably, greater than 5%, (greater than 6%, greater
than 7%, greater than 8%, greater than 9%, greater than 10%,
greater than 11%, greater than 12%, greater than 13%, greater than
14%, greater than 15%, greater than 16%, greater than 17%, greater
than 18%, greater than 19%, greater than 20%), or 5-20%, 5-15%,
5-10%, 10-20%, or 10-15% of bleeding episodes are rated as fair by
physicians after on-demand treatment.
[0096] "Polypeptide," "peptide" and "protein" are used
interchangeably and refer to a polymeric compound comprised of
covalently linked amino acid residues.
[0097] "Polynucleotide" and "nucleic acid" are used interchangeably
and refer to a polymeric compound comprised of covalently linked
nucleotide residues. Polynucleotides may be DNA, cDNA, RNA, single
stranded, or double stranded, vectors, plasmids, phage, or viruses.
Polynucleotides include, e.g., those in Table 1, which encode the
polypeptides of Table 2 (see Table 1). Polynucleotides also
include, e.g., fragments of the polynucleotides of Table 1, e.g.,
those that encode fragments of the polypeptides of Table 2, such as
the Factor VIII, Fc, signal sequence, 6His and other fragments of
the polypeptides of Table 2.
[0098] "Prophylactic treatment," as used herein, means
administering a Factor VIII polypeptide in multiple doses to a
subject over a course of time to increase the level of Factor VIII
activity in a subject's plasma. Preferably, the increased level is
sufficient to decrease the incidence of spontaneous bleeding or to
prevent bleeding, e.g., in the event of an unforeseen injury.
Preferably, during prophylactic treatment, the plasma protein level
in the subject does not fall below the baseline level for that
subject, or below the level of Factor VIII that characterizes
severe hemophilia (<1 IU/dl [1%]).
[0099] Preferably, the prophylaxis regimen is "tailored" to the
individual patient, preferably by determining PK data for each
patient and administering Factor VIII of the invention at a dosing
interval that maintains a trough level of 1-3% FVIII activity.
Adjustments may be made when a subject experiences unacceptable
bleeding episodes defined as .gtoreq.2 spontaneous bleeding
episodes over a rolling two-month period. In this case, adjustment
will target trough 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, e.g., sustained protection can be
demonstrated by an increased AUC to last measured time point
(AUC-LAST) and reduced clearance, resulting in increased terminal
t1/2 compared to short acting FVIII. Preferably, prophylaxis is
demonstrated by better Cmax, better Tmax, and/or greater mean
residence time versus short-acting FVIII. Preferably, prophylaxis
results in no spontaneous bleeding episodes within about 24, 36,
48, 72, or 96 hours (e.g., 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, 63, 64, 65, 66, 67, 68,
69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85,
96, 87, 88, 89, 90, 91, 92, 93, 94, 95, or 96 hours, preferably
within 72 hours), after injection (e.g., the last injection).
Preferably, prophylaxis results in greater than 30% (e.g., greater
than 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,
63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79,
80, 81, 82, 83, 84, 85, 96, 87, 88, 89, or 90%, preferably greater
than 50%), mean reduction in annualized bleeding episodes with once
weekly dosing (e.g., at 65 IU/kg).
[0100] "Subject," as used herein means a human or a non-human
mammal. Non-human mammals include, e.g., mice, dogs, primates,
monkeys, cats, horses, cows, pigs, and other domestic animals and
small animals.
[0101] "Therapeutic dose," as used herein, means a dose that
achieves a therapeutic goal, as described herein. The calculation
of the required dosage of factor VIII is based upon the empirical
finding that, on average, 1 IU of factor VIII per kg body weight
raises the plasma factor VIII activity by approximately 2 IU/dL.
The required dosage is determined using the following formula:
Required units=body weight (kg).times.desired factor VIII rise
(IU/dL or % of normal).times.0.5 (IU/kg per IU/dL)
[0102] The therapeutic doses that may be used in the methods of the
invention are about 10-100 IU/kg, more specifically, 10-20, 20-30,
30-40, 40-50, 50-60, 60-70, 70-80, 80-90, or 90-100 IU/kg, and more
specifically, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70,
75, 80, 85, 90, 95, or 100 IU/kg.
[0103] Additional therapeutic doses that may be used in the methods
of the invention are about 10 to about 150 IU/kg, more
specifically, about 100-110, 110-120, 120-130, 130-140, 140-150
IU/kg, and more specifically, about 110, 115, 120, 125, 130, 135,
140, 145, or 150 IU/kg.
[0104] "Variant," as used herein, refers to a polynucleotide or
polypeptide differing from the original polynucleotide or
polypeptide, but retaining essential properties thereof, e.g.,
factor VIII coagulant activity or Fc (FcRn binding) activity.
Generally, variants are overall closely similar, and, in many
regions, identical to the original polynucleotide or polypeptide.
Variants include, e.g., polypeptide and polynucleotide fragments,
deletions, insertions, and modified versions of original
polypeptides.
[0105] Variant polynucleotides may comprise, or alternatively
consist of, a nucleotide sequence which is at least 85%, 90%, 95%,
96%, 97%, 98% or 99% identical to, for example, the nucleotide
coding sequence in SEQ ID NO:1, 3, 5, 7, 9, or 11 (the factor VIII
portion, the Fc portion, individually or together) or the
complementary strand thereto, the nucleotide coding sequence of
known mutant and recombinant factor VIII or Fc such as those
disclosed in the publications and patents cited herein or the
complementary strand thereto, a nucleotide sequence encoding the
polypeptide of SEQ ID NO:2, 4, 6, 8, 10, or 12 (the factor VIII
portion, the Fc portion, individually or together), and/or
polynucleotide fragments of any of these nucleic acid molecules
(e.g., those fragments described herein). Polynucleotides which
hybridize to these nucleic acid molecules under stringent
hybridization conditions or lower stringency conditions are also
included as variants, as are polypeptides encoded by these
polynucleotides as long as they are functional.
[0106] Variant polypeptides may comprise, or alternatively consist
of, an amino acid sequence which is at least 85%, 90%, 95%, 96%,
97%, 98%, 99% identical to, for example, the polypeptide sequence
shown in SEQ ID NO:2, 4, 6, 8, 10, or 12 (the factor VIII portion,
the Fc portion, individually or together), and/or polypeptide
fragments of any of these polypeptides (e.g., those fragments
described herein).
[0107] By a nucleic acid having a nucleotide sequence at least, for
example, 95% "identical" to a reference nucleotide sequence, it is
intended that the nucleotide sequence of the nucleic acid is
identical to the reference sequence except that the nucleotide
sequence may include up to five point mutations per each 100
nucleotides of the reference nucleotide sequence. In other words,
to obtain a nucleic acid having a nucleotide sequence at least 95%
identical to a reference nucleotide sequence, up to 5% of the
nucleotides in the reference sequence may be deleted or substituted
with another nucleotide, or a number of nucleotides up to 5% of the
total nucleotides in the reference sequence may be inserted into
the reference sequence. The query sequence may be, for example, the
entire sequence shown in SEQ ID NO:1 or 3, the ORF (open reading
frame), or any fragment specified as described herein.
[0108] As a practical matter, whether any particular nucleic acid
molecule or polypeptide is at least 85%, 90%, 95%, 96%, 97%, 98% or
99% identical to a nucleotide sequence or polypeptide of the
present invention can be determined conventionally using known
computer programs. A preferred method for determining the best
overall match between a query sequence (reference or original
sequence) and a subject sequence, also referred to as a global
sequence alignment, can be determined using the FASTDB computer
program based on the algorithm of Brutlag et al. (Comp. App.
Biosci. (1990) 6:237-245), which is herein incorporated by
reference in its entirety In a sequence alignment the query and
subject sequences are both DNA sequences. An RNA sequence can be
compared by converting U's to T's. The result of said global
sequence alignment is in percent identity. Preferred parameters
used in a FASTDB alignment of DNA sequences to calculate percent
identity are: Matrix=Unitary, k-tuple=4, Mismatch Penalty=1,
Joining Penalty=30, Randomization Group Length=0, Cutoff Score=1,
Gap Penalty=5, Gap Size Penalty 0.05, Window Size=500 or the length
of the subject nucleotide sequence, whichever is shorter.
[0109] If the subject sequence is shorter than the query sequence
because of 5' or 3' deletions, not because of internal deletions, a
manual correction must be made to the results. This is because the
FASTDB program does not account for 5' and 3' truncations of the
subject sequence when calculating percent identity. For subject
sequences truncated at the 5' or 3' ends, relative to the query
sequence, the percent identity is corrected by calculating the
number of bases of the query sequence that are 5' and 3' of the
subject sequence, which are not matched/aligned, as a percent of
the total bases of the query sequence. Whether a nucleotide is
matched/aligned is determined by results of the FASTDB sequence
alignment. This percentage is then subtracted from the percent
identity, calculated by the above FASTDB program 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 displayed by the FASTDB alignment, which are
not matched/aligned with the query sequence, are calculated for the
purposes of manually adjusting the percent identity score.
[0110] For example, a 90 base subject sequence is aligned to 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 matched/alignment of the first 10
bases at 5' end. The 10 unpaired bases represent 10% of the
sequence (number of bases at the 5' and 3' ends not matched/total
number of bases in the query sequence) so 10% is subtracted from
the percent identity score calculated by the FASTDB program. If the
remaining 90 bases were perfectly matched the final percent
identity would be 90%. In another example, a 90 base subject
sequence is compared with a 100 base query sequence. This time the
deletions are internal deletions so that there are no bases on the
5' or 3' of the subject sequence which are not matched/aligned with
the query. In this case the percent identity calculated by FASTDB
is not manually corrected. Once again, only bases 5' and 3' of the
subject sequence which are not matched/aligned with the query
sequence are manually corrected for. No other manual corrections
are to made for the purposes of the present invention.
[0111] By a polypeptide having an amino acid sequence at least, for
example, 95% "identical" to a query amino acid sequence of the
present invention, it is intended that the amino acid sequence of
the subject polypeptide is identical to the query sequence except
that the subject polypeptide sequence may include up to five amino
acid alterations per each 100 amino acids of the query amino acid
sequence. In other words, to obtain a polypeptide having an amino
acid sequence at least 95% identical to a query amino acid
sequence, up to 5% of the amino acid residues in the subject
sequence may be inserted, deleted, (indels) or substituted with
another amino acid. These alterations of the reference sequence may
occur at the amino or carboxy terminal positions of the reference
amino acid sequence or anywhere between those terminal positions,
interspersed either individually among residues in the reference
sequence or in one or more contiguous groups within the reference
sequence.
[0112] As a practical matter, whether any particular polypeptide is
at least 85%, 90%, 95%, 96%, 97%, 98% or 99% identical to, for
instance, the amino acid sequences of SEQ ID NO:2 (the factor VIII
portion, the Fc portion, individually or together) or 4, or a known
factor VIII or Fc polypeptide sequence, can be determined
conventionally using known computer programs. A preferred method
for determining the best overall match between a query sequence
(reference or original sequence) and a subject sequence, also
referred to as a global sequence alignment, can be determined using
the FASTDB computer program based on the algorithm of Brutlag et
al., Comp. App. Biosci. 6:237-245(1990), incorporated herein by
reference in its entirety. In a sequence alignment the query and
subject sequences are either both nucleotide sequences or both
amino acid sequences. The result of said global 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,
Joining Penalty=20, Randomization Group Length=0, Cutoff Score=1,
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.
[0113] If the subject sequence is shorter than the query sequence
due to N- or C-terminal deletions, not because of internal
deletions, a manual correction must be made to the results. This is
because the FASTDB program does not account for N- and C-terminal
truncations of the subject sequence when calculating global percent
identity. For subject sequences truncated at the N- and C-termini,
relative to the query sequence, the percent identity is corrected
by calculating the number of residues of the query sequence that
are N- and C-terminal of the subject sequence, which are not
matched/aligned with a corresponding subject residue, as a percent
of the total bases of the query sequence. Whether a residue is
matched/aligned is determined by results of the FASTDB sequence
alignment. This percentage is then subtracted from the percent
identity, calculated by the above FASTDB program 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 residues to the N- and C-termini of
the subject sequence, which are not matched/aligned with the query
sequence, are considered for the purposes of manually adjusting the
percent identity score. That is, only query residue positions
outside the farthest N- and C-terminal residues of the subject
sequence.
[0114] For example, a 90 amino acid residue subject sequence is
aligned with a 100 residue query sequence to determine percent
identity. The deletion occurs at the N-terminus of the subject
sequence and therefore, the FASTDB alignment does not show a
matching/alignment of the first 10 residues at the N-terminus. The
10 unpaired residues represent 10% of the sequence (number of
residues at the N- and C-termini not matched/total number of
residues in the query sequence) so 10% is subtracted from the
percent identity score calculated by the FASTDB program. If the
remaining 90 residues were perfectly matched the final percent
identity would be 90%. In another example, a 90 residue subject
sequence is compared with a 100 residue query sequence. This time
the deletions are internal deletions so there are no residues at
the N- or C-termini of the subject sequence which are not
matched/aligned with the query. In this case the percent identity
calculated by FASTDB is not manually corrected. Once again, only
residue positions outside the N- and C-terminal ends of the subject
sequence, as displayed in the FASTDB alignment, which are not
matched/aligned with the query sequence are manually corrected for.
No other manual corrections are to made for the purposes of the
present invention.
[0115] The polynucleotide variants may contain alterations in the
coding regions, non-coding regions, or both. Especially preferred
are polynucleotide variants containing alterations which produce
silent substitutions, additions, or deletions, but do not alter the
properties or activities of the encoded polypeptide. Nucleotide
variants produced by silent substitutions due to the degeneracy of
the genetic code are preferred. Moreover, variants in which 5-10,
1-5, or 1-2 amino acids are substituted, deleted, or added in any
combination are also preferred. Polynucleotide variants can be
produced for a variety of reasons, e.g., to optimize codon
expression for a particular host (change codons in the human mRNA
to those preferred by a bacterial host such as E. coli).
[0116] Naturally occurring variants are called "allelic variants,"
and refer to one of several alternate forms of a gene occupying a
given locus 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 may be produced by mutagenesis
techniques or by direct synthesis.
[0117] Using known methods of protein engineering and recombinant
DNA technology, variants may be generated to improve or alter the
characteristics of the polypeptides. For instance, one or more
amino acids can be deleted from the N-terminus or C-terminus of the
secreted protein without substantial loss of biological function.
The authors of Ron et al., J. Biol. Chem. 268: 2984-2988 (1993),
incorporated herein by reference in its entirety, reported variant
KGF proteins having heparin binding activity even after deleting 3,
8, or 27 amino-terminal amino acid residues. Similarly, Interferon
gamma exhibited up to ten times higher activity after deleting 8-10
amino acid residues from the carboxy terminus of this protein.
(Dobeli et al., J. Biotechnology 7:199-216 (1988), incorporated
herein by reference in its entirety.)
[0118] Moreover, ample evidence demonstrates that variants often
retain a biological activity similar to that of the naturally
occurring protein. For example, Gayle and coworkers (J. Biol. Chem
268:22105-22111 (1993), incorporated herein by reference in its
entirety) conducted extensive mutational analysis of human cytokine
IL-1a. They used random mutagenesis to generate over 3,500
individual IL-1a 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
investigators found that "[m]ost of the molecule could be altered
with little effect on either [binding or biological activity]."
(See Abstract.) In fact, only 23 unique amino acid sequences, out
of more than 3,500 nucleotide sequences examined, produced a
protein that significantly differed in activity from wild-type.
[0119] As stated above, polypeptide variants include, e.g.,
modified polypeptides. Modifications include, e.g., acetylation,
acylation, ADP-ribosylation, amidation, covalent attachment of
flavin, covalent attachment of a heme moiety, covalent attachment
of a nucleotide or nucleotide derivative, covalent attachment of a
lipid or lipid derivative, covalent attachment of
phosphotidylinositol, cross-linking, cyclization, disulfide bond
formation, demethylation, formation of covalent cross-links,
formation of cysteine, formation of pyroglutamate, 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, transfer-RNA mediated addition of amino
acids to proteins such as arginylation, and ubiquitination. In some
embodiments, Factor VIII is modified, e.g., pegylated, at any
convenient location. In some embodiments, Factor VIII is pegylated
at a surface exposed amino acid of Factor VIII, preferably a
surface exposed cysteine, which may be an engineered cysteine. Mei
et al. (2010). In some embodiments, modified Factor VIII, e.g.,
pegylated Factor VIII, is a long-acting Factor VIII.
[0120] "Volume of distribution at steady state (Vss)," as used
herein, has the same meaning as the term used in pharmacology,
which is the apparent space (volume) into which a drug distributes.
Vss=the amount of drug in the body divided by the plasma
concentration at steady state.
[0121] "About," as used herein for a range, modifies both ends of
the range. Thus, "about 10-20" means "about 10 to about 20."
[0122] Having now described the present invention in detail, the
same will be more clearly understood by reference to the following
examples, which are included herewith for purposes of illustration
only and are not intended to be limiting of the invention. All
patents and publications referred to herein are expressly
incorporated by reference.
Example 1
Abstract
[0123] A recombinant B-domain-deleted factor VIII-Fc (rFVIIIFc)
fusion protein was created to extend the half-life of FVIII.
rFVIIIFc was studied in mouse and dog models of severe hemophilia A
and compared to rFVIII (REFACTO.RTM.). Whole blood clotting time
(WBCT) in hemophilia A mice was corrected for approximately two to
three times longer and the elimination half-life in plasma was
nearly twice as long for rFVIIIFc compared to REFACTO.RTM.. In
hemophilia A dogs, an intravenous dose of rFVIIIFc (125 IU/kg)
corrected the WBCT to normal. The WBCT remained below 20 min, the
time consistent with FVIII:C >1%, through approximately 96 hr,
compared to 48 hr for dogs treated with REFACTO.RTM.. The
elimination half-life of rFVIIIFc in dog plasma, when measured
using ELISA or chromogenic activity assays, was 15.7.+-.1.7 hr and
15.4.+-.0.3 hr, respectively. REFACTO.RTM. corrected WBCT for
approximately one half as long as rFVIIIFc and the plasma half-life
was 7.0 hr. Thus, fusion of FVIII to Fc produced a molecule with an
increased plasma half-life and the ability to provide prolonged
protection from bleeding.
Introduction
[0124] Reduced mortality, prevention of joint damage and improved
quality of life have been important achievements due to the
development of plasma-derived and recombinant FVIII. Prolonged
protection from bleeding would represent another key advancement in
the treatment of hemophilia A patients. The inventors have created
a recombinant factor VIII-Fc (rFVIIIFc) chimeric protein and hybrid
as an approach to extend the half-life of FVIII.
[0125] rFVIIIFc is a heterodimeric hybrid protein comprised of
B-domain-deleted FVIII fused recombinantly to the Fc domain of
human immunoglobulin G1 (IgG1) (FIG. 1, SEQ ID NO:2; Table 2A)
(This protein is also referred to herein as FVIIIFc monomeric Fc
fusion protein, FVIIIFc monomer hybrid, monomeric FVIIIIFc hybrid,
and FVIIIFc monomer-dimer.). The Fc enables binding to the neonatal
Fc receptor (FcRn), which is responsible for protection of IgG from
degradation and confers on IgG the three week half-life observed in
humans (Ghetie V, and Ward E S., Annu. Rev. Immunol. 2000;
18:739-766; Roopenian D C, and Akilesh S., Nature Rev. Immunol.
2007; 7:715-725, each of which is incorporated herein by reference
in its entirety).
[0126] The Fc domain of IgG1 has been fused to growth factors,
cytokines, enzymes and ligand-binding regions of receptors
(Ashkanazi A, et al., Int. Rev. Immunol. 1993:10:219-27; Chamow S
M, and Ashkanazi A, Trends Biotechnol. 1996:14:52-60; Fisher et
al., N. Engl. J. Med. 1996:334(26):1697-702, each of which is
incorporated herein by reference in its entirety). Several of these
have become important therapeutic molecules (e.g. etanercept,
alefacept, abatacept). In these fusion proteins, two effector
molecules are connected to two Fc molecules. In this example,
rFVIIIFc has been constructed as a monomeric Fc fusion protein (one
copy of a polypeptide consisting of the sequence in Table 2A(i)
(SEQ ID NO:2) with or without the signal sequence and one copy of a
polypeptide consisting of the sequence in Table 2A(ii) (SEQ ID
NO:4) with or without the signal sequence), i.e., with only one
copy of the effector molecule (see FIG. 1), and the studies
presented herein compare the pharmacodynamics and pharmacokinetics
of this novel protein to rFVIII in mouse and dog models of
hemophilia A. The signal sequence is cleavage during secretion.
This protein construct is referred to herein as FVIIIFc monomeric
Fc fusion protein, FVIIIFc monomer hybrid, monomeric FVIIIIFc
hybrid, and FVIIIFc monomer-dimer. See Example 1, FIG. 1, Table 2A;
and U.S. Pat. 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
[0127] Recombinant FVIIIFc
[0128] The coding sequence of human recombinant B-domain deleted
FVIII was obtained by reverse transcription-polymerase chain
reaction (RT-PCR) from human liver poly A RNA (Clontech) using
FVIII-specific primers. The FVIII sequence includes the native
signal sequence for FVIII. The B-domain deletion was from serine
743 (S743; 2287 bp) to glutamine 1638 (Q1638; 4969 bp) for a total
deletion of 2682 bp See Example 1, FIG. 1, Table 2A; and U.S. Pat.
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.
[0129] The coding sequence for human recombinant Fc was obtained by
RT-PCR from a human leukocyte cDNA library (Clontech) using Fc
specific primers. Primers were designed such that the B-domain
deleted FVIII sequence was fused directly to the N-terminus of the
Fc sequence with no intervening linker. The FVIIIFc DNA sequence
was cloned into the mammalian dual expression vector pBUDCE4.1
(Invitrogen) under control of the CMV promoter. A second identical
Fc sequence including the mouse Igk signal sequence was obtained by
RT-PCR and cloned downstream of the second promoter, EF1a, in the
expression vector pBUDCE4.1.
[0130] The rFVIIIFc expression vector was transfected into human
embryonic kidney 293 cells (HEK293H; Invitrogen) using
Lipofectamine 2000 transfection reagent (Invitrogen). Stable clonal
cell lines were generated by selection with Zeocin (Invitrogen).
One clonal cell line, 3C4-22 was used to generate FVIIIFc for
characterization in vivo. Recombinant FVIIIFc was produced and
purified (McCue J T, et al., J. Chromatogr. A 2009; 7824-7830,
incorporated by reference herein in its entirety) at Biogen Idec
(Cambridge, Mass.). The transfection strategy described above was
expected to yield three products, i.e., monomeric rFVIIIFc hybrid,
dimeric rFVIIIFc hybrid and dimeric Fc. However, there was
essentially no dimeric rFVIIIFc detected in the conditioned medium
from these cells. Rather, the conditioned medium contained Fc and
monomeric rFVIIIFc. It is possible that the size of dimeric
rFVIIIFc was too great and prevented efficient secretion from the
cell. This result was beneficial since it rendered the purification
of the monomer less complicated than if all three proteins had been
present. The material used in these studies had a specific activity
of approximately 9000 IU/mg. In addition, these human cells
produced higher protein level than other cells that were attempted
in this experiment.
Recombinant FVIII
[0131] Recombinant B-domain deleted FVIII (REFACTO.RTM.) was
purchased from Novis Pharmaceuticals and was prepared according to
manufacturer's instructions. REFACTO.RTM. (recombinant B-domain
deleted FVIII) has the same amino acid sequence as amino acids 1 to
1438 of SEQ ID NO:2.
Hemophilia A Animals
[0132] The hemophilia A mice are FVIII exon 16 knockouts on a
129.times.B6 background that were obtained from Dr. Kazazian at the
University of Pennsylvania (Bi L, et al., Nat. Genet. 1995;
10(1):119-121, incorporated by reference herein in its entirety)
and bred at Syntonix. These mice exhibit prolonged whole blood
clotting times (>60 min), and are thus a good model of severe
hemophilia A.
[0133] Hemophilia A dogs were from the in-bred colony maintained at
the Francis Owen Blood Research Laboratory at the University of
North Carolina, Chapel Hill (Graham, J B, et al., J. Exp. Med.
1949; 90:97-111, incorporated by reference herein in its entirety).
These dogs have a severe hemophilic phenotype comparable to the
severe form of the human disease (Graham, J B, et al., J. Exp. Med.
1949; 90:97-111; Lozier, J N, et al., Proc. Natl. Acad. Sci. 2002;
99:12991-12996, each of which is incorporated by reference herein
in its entirety).
Study Designs
[0134] Hemophilia A Mouse Studies
[0135] The effect of rFVIIIFc and REFACTO.RTM. on whole blood
clotting time (WBCT) was studied in FVIII-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 various
time points post-dosing. The blood samples were incubated in
microtubes at 37.degree. C. and visually inspected once per minute
for the presence of a clot. Time of clot formation was recorded. If
no clot formed by 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.
[0136] In a second set of studies, hemophilia A mice were
administered a single intravenous dose of 50 IU/kg rFVIIIFc,
REFACTO.RTM. or ADVATE.RTM. (4 mice per time point). Blood was
collected by cardiac puncture in one tenth volume 3.2% sodium
citrate at 0.25, 8, 24, 48 and 72 hr after dosing. Plasma was
prepared and stored at -80.degree. C. until analysis for FVIII
activity using a FVIII-specific chromogenic activity assay.
Hemophilia A Dog Studies
[0137] In a single dose PK/PD study of rFVIIIFc, two hemophilia A
dogs from the Chapel Hill colony were administered a single
intravenous dose of 125 IU/kg and blood samples were collected
pre-dose and after dosing at selected time points for WBCT,
activated partial thromboplastin time (aPTT), FVIIIFc plasma
concentration, hematology and serum chemistry. Time points for WBCT
included pre-dose, 5 and 30 min and 1, 2, 4, 8, 24, 32, 48, 72, 96,
144, and 168 hr after dosing. Blood collections for clotting
activity (aPTT) and FVIIIFc plasma concentration included the time
points listed above for WBCT as well as 15 min and 3, 6, 12 hours
after dosing.
[0138] A second study was conducted in which REFACTO.RTM. (114
IU/kg for dog M12 and 120 IU/kg for dog M38) was administered
intravenously. WBCT was measured until clotting times were
.gtoreq.20 min (consistent with FVIII:C >1%), and then 125 IU/kg
rFVIIIFc was administered intravenously to the same dogs and blood
samples were collected for WBCT, aPTT, FVIIIFc plasma
concentration, hematology and serum chemistry. Time points for WBCT
included pre-dose, 5 and 30 min and 1, 2, 4, 8, 24, 32, 48, 72 hr
after dosing. Blood was also collected at 96, 120, 144, and 168 hr
after dosing with FVIIIFc. Blood collections for clotting activity
and FVIIIFc plasma concentration included the time points listed
above for WBCT as well as 15 min and 3, 6, 12 hours after
dosing.
[0139] The WBCT procedure in hemophilia A dogs was slightly
different than that in the hemophilia A mice. After dosing with
rFVIIIFc or REFACTO.RTM., one mL of blood was collected at various
time points and 0.5 mL was distributed into two siliconized glass
tubes which were subsequently placed into a 28.degree. C. water
bath. Beginning at one minute, one tube was tilted every 30 sec,
the second left undisturbed. When a clot formed in the tilted tube,
the second tube was then tilted every 30 sec until a clot formed.
The time for a fully gelled clot in the second tube was recorded as
the WBCT.
FVIII Activity in Plasma
[0140] Measurement of FVIII Activity in Plasma by FVIII-Specific
Chromogenic Assay
[0141] Plasma samples were tested for FVIII activity by an
automated chromogenic method using a Sysmex CA1500 instrument and
reagents were from Siemans Healthcare Diagnostics (Dallas, Tex.,
kit #B4238-40). Activity of rFVIIIFc was determined using a
standard curve created using the 7th International Standard Factor
FVIII Concentrate (NIBSC code 99/678) spiked into human
FVIII-depleted plasma (Stago USA) at concentrations ranging from
1.5-0.016 IU/mL.
Measurement of rFVIIIFc or FVIII by ELISA
[0142] FVIIIFc in Dog Plasma by ELISA
[0143] A FVIII antibody specific to the A1 domain (Green Mountain
Antibodies: GMA-8002) was coated on 96 well plates and incubated
for 1 hr at 37.degree. C. The coated plates were blocked with
Tris-buffered saline containing Tween 20, CaCl.sub.2 and bovine
serum albumin for 1 hr at room temperature and then standards,
controls and samples that were prepared in normal dog plasma, were
diluted 1:10 and then added to the plates and incubated for 1 hour
at 37.degree. C. The plates were washed and then donkey
(F(ab)'.sub.2) anti-human Fc-HRP (Jackson: 709-036-098) was added
and incubated for 1 hr at 37.degree. C. After washing, TMB (BioFx
supersensitive substrate: TMBS-0100-01) was added to the plates,
the substrate reaction was quenched with acid and absorbance was
measured on a SpectraMax Plus plate reader (Molecular Devices) at
450 nm.
REFACTO.RTM. in Dog Plasma by ELISA
[0144] An anti-FVIII antibody specific to the A1 domain on the
heavy chain (Green Mountain Antibodies: GMA-8002) was coated on 96
well plates and incubated for 2 hr at room temperature. The coated
plates were blocked for 1 hr at 37.degree. C. and after washing,
the standards, controls and samples were prepared in normal dog
plasma then diluted 1:10 were added to the plates and incubated for
2 hr at room temperature. The plates were washed then treated with
the detection antibody, a pre-diluted anti-FVIII horse radish
peroxidase conjugate (Affinity Biologicals: F8C-EIA-D), and
incubated at room temperature for 1 hr. After washing TMB (BioFx
supersensitive substrate: TMBS-0100-01) was added to the plates for
10 min. The substrate reaction was quenched with acid and the
signal was measured on a SpectraMax Plus plate reader (Molecular
Devices) at a wavelength of 450 nm.
Measurement of Fibrinogen
[0145] The concentration of fibrinogen in plasma was measured at
Esoterix (Research Triangle Park, N.C.) using a kit that contains
HemosIL.TM. PT-Fibrinogen-HS reagent (Instrumentation Laboratory,
Lexington, Mass., Catalog #0008468210) and an ACL 7000 Coagulation
Analyzer (Beckman Coulter), according to the manufacturer's
instructions.
Measurement of Platelets
[0146] Platelets were counted in EDTA anti-coagulated whole blood
by automated methods using the Vet-ABC-Diff Hematology Analyzer
programmed with a species specific smart card (SCIL Animal Care
Co., Gurnee, Ill.).
Pharmacokinetic Analysis
[0147] The pharmacokinetic parameters were calculated by
noncompartmental analysis using WinNonlin software from Pharsight,
version 5.2 (Mountain View, Ca). PK parameters included the maximum
concentration in plasma (C.sub.max), area under the plasma
concentration versus time curve (AUC), elimination half-life
(t.sub.1/2), volume of distribution (Vss), and clearance (Cl).
Results
[0148] Recombinant FVIII-Fc
[0149] rFVIIIFc is a recombinant fusion of human B-domain deleted
FVIII with Fc from human IgG1, with no intervening linker sequence
(rFVIIIFc; FIG. 1).
[0150] Purified rFVIIIFc had a specific activity of approximately
9000 IU/mg as determined using a chromogenic activity assay.
Recombinant B-domain deleted FVIII (REFACTO.RTM.) has a reported
specific activity of 9110-13700 IU/mg. Conversion of specific
activity into IU/nmol to take into account the size difference
between FVIIIFc and REFACTO.RTM. (216 kDa and 170 kDa
respectively), indicates that the two proteins have approximately
equivalent specific activities (1970 IU/nmol for rFVIIIFc and
1521-2287 IU/nmol for REFACTO.RTM.). Thus the FVIII activity of
rFVIIIFc is not affected by fusion of the C-terminus of human FVIII
to the N-terminus of human Fc.
Administration to Hemophilia A Mice
[0151] A single 50 IU/kg dose of rFVIIIFc or REFACTO.RTM. was
administered intravenously to FVIII-deficient mice (n=6/group).
Blood samples were collected pre-dose and after dosing through 120
hr and WBCT determined as described in Materials and Methods.
Baseline WBCT were greater than 60 min. Data from a representative
experiment are shown in FIG. 2 and Table 3. Immediately after
dosing with either rFVIIIFc or REFACTO.RTM., WBCT was corrected to
2-17 minutes. Blood from mice treated with REFACTO.RTM. lost the
ability to clot by 42 hr, whereas blood from all mice treated with
rFVIIIFc still clotted at 96 hr, the blood from one of six was
clotted at 113 hr, but all had lost the ability to clot by 120 hr.
These data suggest that the duration of effect for rFVIIIFc is
approximately two to three times longer than for REFACTO.RTM..
[0152] The chromogenic activity of rFVIIIFc, REFACTO.RTM. or
ADVATE.RTM. (full-length recombinant FVIII) was studied in the
FVIII-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
hr. The activity was measured using a FVIII-specific chromogenic
activity assay and is shown in FIG. 3. The pharmacokinetic
parameters are reported in Table 4. The circulating half-life for
rFVIIIFc was approximately 1.6 to 2 fold longer (11.1 hr) compared
to ADVATE.RTM. (7 hr) and REFACTO.RTM. (5 hr). The Cmax was
1.6.+-.0.36 IU/mL for rFVIIIFc compared to 0.47.+-.0.30 IU/mL for
ADVATE.RTM. and 0.67.+-.0.44 IU/mL for REFACTO.RTM.. The systemic
exposure of rFVIIIFc was markedly greater for rFVIIIFc (22.6
hrIU/mL) compared to REFACTO.RTM. (6.94 hrIU/mL) and ADVATE.RTM.
(3.90 hrIU/mL) and clearance for rFIIIFc was notably lower (2.09
mL/hr/kg) compared to both REFACTO.RTM. (7.2 mL/hr/kg) and
ADVATE.RTM. (12.8 hr/mL/kg) in the hemophilia A mice.
Administration to Hemophilia A Dogs
[0153] The pharmacodynamics (PD) and pharmacokinetics (PK) of
rFVIIIFc were studied in the Chapel Hill colony of hemophilia A
dogs. A single intravenous dose of 125 IU/kg rFVIIIFc was
administered to each of four hemophilia A dogs and the WBCT was
immediately corrected to normal (FIG. 4). The range of WBCT in
normal dogs is 8-12 min. The WBCT remained below 20 min, the time
consistent with FVIII:C >1%, through approximately 96 hr with
the exception of one dog that had WBCT <20 min through 72 hr. In
addition, aPTT was also immediately corrected to normal (Table 6).
The concentration of rFVIIIFc in plasma was measured using a
specific ELISA which was designed to detect both the FVIII and Fc
portions of the molecule. The plasma concentration versus time
curves are shown in FIG. 5. PK analysis of the data showed that the
t.sub.1/2 was 15.7.+-.1.7 hr (Table 5). Similar results were
obtained when rFVIIIFc was measured using a FVIII-specific
chromogenic activity assay (t.sub.1/2=15.4.+-.0.3 hr, Table 5) and
the plasma concentration versus time curves were similar using both
methods (FIG. 5 and FIG. 6). When the activity data were converted
from IU/mL to ng/mL using the specific activity for rFVIIIFc, there
was a good correlation with the ELISA data, thereby demonstrating
that the protein that was measured by ELISA was fully active.
[0154] Two of the dogs treated with rFVIIIFc also received a single
dose of REFACTO.RTM., 114 IU/kg for dog M12 and 120 IU/kg for dog
M38, 72 hr prior to dosing with rFVIIIFc. WBCT and aPTT were
corrected to normal immediately after dosing with REFACTO.RTM..
However, the WBCT normalization after the single dose of rFVIIIFc
lasted approximately twice as long compared to REFACTO.RTM. (FIG.
4). Moreover, the plasma half-life of rFVIIIFc (15.7.+-.1.7 hr) was
approximately twice as long for rFVIIIFc compared to REFACTO.RTM.
(7.0 and 6.7 hr) when the concentration of the proteins in plasma
were measured by ELISA (Table 5). Similar results were obtained
when the two molecules were measured by FVIII-specific chromogenic
activity.
[0155] To assess the potential risk of thrombogenicity, platelets
and fibrinogen were measured. After dosing with either rFVIIIFc or
REFACTO.RTM., platelet numbers and plasma fibrinogen concentration
did not change from pre-dose values (data not shown).
Discussion
[0156] Recombinant FVIIIFc was produced in human embryonic kidney
293 (HEK 293) cells from a stably transfected cell line and was
purified from cell culture medium. Production in a human cell line
represents a significant change in manufacturing compared to
currently marketed rFVIII products which are produced in either
Chinese Hamster Ovary cells or Baby Hamster Kidney cells. The
rationale for this change was that it was expected that the human
cells were best equipped to perform the necessary
post-translational modifications for the FVIII portion of this
molecule.
[0157] Conversion of the specific activity to IU/nmol to take into
account the difference in molecular weights for rFVIIIFc and
recombinant B-domain deleted FVIII (REFACTO.RTM.) indicated that
the specific activities are similar for both proteins (1970 IU/nmol
for rFVIIIFc and 1521-2287 IU/nmol for REFACTO.RTM.). It is
somewhat surprising that the specific activity for rFVIIIFc is not
affected by fusion of the C terminus of FVIII with the N-terminus
of Fc since the C1 and C2 domain of FVIII are involved in
phospholipid binding which is essential for full FVIII activity
(Fay, P J, 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).
[0158] Treatment of hemophilia A is on-demand at the time of a
bleeding episode or by prophylaxis for the prevention of bleeding.
Although on-demand treatment is still frequently used, there is a
trend toward prophylaxis and the prevention of joint damage
(Blanchette P, et al., Haemophilia 2004: 10; 679-683,
Manco-Johnson, M J, et al., N. Engl. J. Med. 2007; 357:535-544,
each of which is incorporated by reference herein 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 hr in
order to maintain a FVIII:C above 1% in patients (Morfini, M,
Haemophilia 2003; 9 (suppl 1):94-99; discussion 100, White G C, et
al., Thromb. Haemost. 1997:77:660-7, Blanchette, P, et al., J.
Thromb. Haemost. 2008 August; 6(8):1319-26, each of which is
incorporated by reference herein in its entirety). Longer-acting
FVIII therapies that provide prolonged protection from bleeding
would represent a marked improvement in the quality of life for
patients with hemophilia A. Strategies to extend the half-life of
clotting factors include those that have been successful for other
molecules, including pegylation (Rostin J, et al., Bioconj. Chem.
2000; 11:387-96, incorporated by reference herein in its entirety),
glycopegylation (Stennicke H R, et al., Thromb. Haemost. 2008;
100:920-8, incorporated by reference herein 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 by reference herein in its entirety) and
conjugation with albumin (Schulte S., Thromb. Res. 2008; 122 Suppl
4:S14-9, incorporated by reference herein in its entirety).
Pegylation represents an approach to reduce clearance, however, the
effect of the modification in vivo is currently unknown. The
outcome of direct pegylation of FVIII on in vivo is currently
unknown, whereas FVIII formulated with pegylated liposomes has been
studied clinically and showed a modest to no effect on bleeding
periods (Spira J, et al., Blood 2006; 108:3668-3673, Spira J, et
al., Thromb. Haemost. 2008 September; 100(3):429-34, each of which
is incorporated by reference herein in its entirety).
[0159] The present approach to extend the half-life of FVIII was to
recombinantly fuse FVIII to the Fc domain of IgG1. Fc binds to the
naturally occurring receptor, FcRn, of which the normal function is
protection of IgG from degradation. The results described herein
represent the initial pharmacokinetic and efficacy characterization
of rFVIIIFc compared to a rFVIII product in hemophilia A mice and
hemophilia A dogs. In both species, the half-life of rFVIIIFc was
approximately twice that of rFVIII when measured by FVIII activity
or ELISA (dogs only). These data also correlated well with the WBCT
results from both animal models, i.e. the duration of the effect of
rFVIIIFc on WBCT was approximately twice as long compared to
REFACTO.RTM.. In dogs, the C.sub.max and clearance were similar for
rFVIIIFc and REFACTO.RTM., but the AUC and volume of distribution
at steady state were approximately 1.5 fold and 2 fold greater for
rFVIIIFc compared to REFACTO.RTM., respectively. The PK parameters
for REFACTO.RTM. in this animal model are consistent with the
values reported in the literature (Brinkhous K, et al., Sem.
Thromb. Haemost. 2002; 28:269-272, incorporated by reference herein
in its entirety).
[0160] If these findings translate to the same extension of
half-life in humans, this could represent a significant advancement
in the treatment of patients with hemophilia A.
Additional References (Each of which is Incorporated Herein by
Reference in its Entirety)
[0161] Berkner K., Methods Enzymol. 1993; 222:450-477. [0162]
Bitonti A J, and Dumont J A., Adv. Drug Del. Rev. 2006;
58:1106-1118. [0163] Dumont J A, et al., J. Aerosol Med. 2005;
18:294-303. [0164] Dumont J A, et al., BioDrugs 2006:20:151-160.
[0165] Ellis C N, and Krueger G G., N. Engl. J. Med. 2001;
345:248-55. [0166] Low S C, et al., Hum Reprod. 2005:7:1805-1813.
[0167] Manco-Johnson, M., Haemophilia 2007; 13 Suppl; 2: 4-9.
[0168] Mannucci, P M, and Tuddenham, E G D., N. Engl. J. Med. 2001;
344:1773-1779. [0169] Peyvandi F, et al., Haemophilia 2006;
12(Suppl 3):82-89. [0170] Rodriguez-Merchan, E C., Semin. Thromb.
Hemost. 2003; 29:87-96. [0171] Srour M A, et al., Ann. Hematol.
2008; 87:107-12.
Example 2
[0172] The objective of the study was to determine the
pharmacokinetics and pharmacodynamics of rFVIIIFc and BDD-rFVIII
(XYNTHA.RTM.) in cynomolgus monkeys after a single intravenous
dose.
Materials and Methods
[0173] rFVIIIFc (Biogen Idec), supplied as a frozen liquid at a
concentration of 1.2 mg/mL, and 9882 IU/mL. The specific activity
is 8235 IU/mg. Storage was at -70.degree. C. It was diluted prior
to injection.
[0174] Name: XYNTHA.RTM. (Novis Pharmaceuticals), Supplied as a
lyophilized powder which was reconstituted according to the
manufacturer's instructions to produce a solution with a nominal
concentration of 525 IU/mL. Storage was according to the
manufacturer's recommendations.
Animals
[0175] Cynomolgus monkeys from the New Iberia Research Center
(NIRC) colony were used, and the study (NIRC Study #8733-0903) was
conducted under an approved NIRC IACUC protocol (APS 2008-8733-058)
at NIRC in New Iberia, La.
[0176] Six naive cynomolgus monkeys (three males, three females)
that were determined to be in good health were used in the
study.
[0177] The study was performed in compliance with the protocol and
UL Lafayette-NIRC Standard Operating Procedures.
Study Design
[0178] rFVIIIFc was administered intravenously at 125 IU/kg to each
of six monkeys (three males, three females). XYNTHA.RTM.
(BDD-rFVIII) was administered intravenously to the same animals at
125 IU/kg in a crossover design. Group 1 animals (n=3) received
XYNTHA.RTM. on Day 0 and rFVIIIFc on Day 3, while Group 2 animals
(n=3) received rFVIIIFc on Day 0 followed by XYNTHA.RTM. on Day 4.
The additional day between doses for group 2 was to ensure that the
rFVIIIFc had sufficient time to decrease below projected baseline
levels. Blood was collected for plasma in one-tenth volume 3.2%
sodium citrate from each animal predose and after dosing at 0.25,
4, 12, 24, 36, 48 and 72 hr for measurement of rFVIIIFc or
XYNTHA.RTM. by ELISA and a FVIII-specific chromogenic activity
assay.
ELISA to Measure rFVIIIFc and FVIII in Plasma Method to Measure
rFVIIIFc in Monkey Plasma
[0179] This Enzyme Linked ImmunoSorbent Assay (ELISA) is designed
to quantify rFVIIIFc in monkey plasma. In this ELISA method, goat
anti-human IgG-(H+L) antibody (monkey absorbed) from Bethyl
Laboratories (Cat #A80-319A) is diluted in Coating Buffer and
immobilized onto a 96-well microtiter sample plate. The plate is
aspirated, and all un-adsorbed sites are blocked with the addition
of Blocking Buffer (3% BSA/1.times.Tris) for approximately 2 hours
at 37.degree. C. Plasma samples are diluted 1:20 with High Calcium
Sample Dilution Buffer (3% Non-Fat Dry Milk/TBST with 30 mM CaCl2)
and dispensed onto the sample plate. Plates are incubated for
approximately 2 hours at 37.degree. C. The plate is subsequently
washed and mouse anti-B domain-deleted (.alpha..BDDA1) Factor VIII
(A1 domain) antibody from Green Mountain Antibodies (Cat #GMA-8002)
is added to the plate and incubated for approximately 1 hour at
37.degree. C. After washing the plate, HRP-conjugated goat
anti-mouse IgG2a antibody from Southern Biotech (Cat #1080-05) is
added to the plate and incubated for approximately 30 minutes at
room temperature. The plate is washed again and a
tetramethylbenzidine (TMB) peroxidase substrate solution is added
and incubated for approximately 30 minutes at room temperature. The
reaction is stopped by addition of a non-acidic Stop Solution.
Color develops in proportion to the amount of rFVIIIFc in the
sample. Plates are read on an absorbance plate reader using a
single detection wavelength, 650 nm. rFVIIIFc concentrations are
determined on a standard curve obtained by plotting optical density
(OD) versus concentration using a four-parameter logistic
curve-fitting program. The calibration curve range of this method
is 0.400 ng/mL-51.2 ng/mL in 5% monkey plasma (8.00 ng/mL-1024
ng/mL in 100% monkey plasma). One calibrator outside the qualified
range of the assay at 0.200 ng/mL in 5% monkey plasma may be
included to serve as an anchor point to facilitate curve-fitting.
The anchor point is removed or retained based on the best fit of
the curve (i.e., the highest number of standards read within
defined accuracy, % RE).
Method to Measure FVIII in Monkey Plasma
[0180] This Enzyme Linked ImmunoSorbent Assay (ELISA) is designed
to quantify FVIII in monkey plasma. In this ELISA method, mouse
.alpha.BDDA1 FVIII antibody from Green Mountain Antibodies (Cat
#GMA-8002) is diluted in Coating Buffer and immobilized onto a
96-well microtiter sample plate. The plate is aspirated, and all
un-adsorbed sites are blocked with the addition of Blocking Buffer
(3% BST/1.times.Tris) for approximately 1 hour at 37.degree. C.
Plasma samples are diluted 1:20 with High Calcium Sample Dilution
Buffer (Blocking Buffer with 100 mM CaCl2) and dispensed onto the
sample plate. Plates are incubated for approximately 2 hours at
37.degree. C. After washing the plate, a Detecting Antibody from
the Affinity Biologicals Kit, an HRP labeled polyclonal antibody
(Cat #F8C-EIA-D), is further diluted in TBS/0.05% Tween 20, and
added to the plate and incubated for approximately 1 hour at room
temperature. The plate is washed again and a tetramethylbenzidine
(TMB) peroxidase substrate solution is added and incubated for
approximately 30 minutes at room temperature. The reaction is
stopped by addition acidic Stop Solution. Color develops in
proportion to the amount of FVIIIFc in the sample. Plates are read
on an absorbance plate reader using a single detection wavelength,
450 nm. FVIII concentrations are determined on a standard curve
obtained by plotting optical density (OD) versus concentration
using a four-parameter logistic curve-fitting program. The
calibration curve range of this method is 0.625 ng/mL-20 ng/mL in
5% monkey plasma (12.5 ng/mL-400 ng/mL in 100% monkey plasma). Two
calibrators outside the qualified range of the assay at 0.313 and
0.156 ng/mL in 5% monkey plasma may be included to serve as anchor
points to facilitate curve-fitting. The anchor points can be
removed or retained based on the best fit of the curve (i.e., the
highest number of standards read within defined accuracy, %
RE).
FVIII-Specific Chromogenic Assay
[0181] FVIII activity in cynomolgus monkey plasma samples was
estimated based on administered dose, and then diluted to
approximately 0.25-1 IU/ml in human FVIII-depleted plasma
(Diagnostica Stago). Samples were analyzed in a Sysmex CA1500
(Siemens Diagnostic Healthcare) using a FVIII chromogenic kit
(Siemens). In this chromogenic assay, rFVIIIFc in the plasma
samples is activated by thrombin. Activated Factor VIII (FVIIIa)
then accelerates the conversion of Factor X (FX) to Factor Xa (FXa)
in the presence of activated Factor IX (FIXa), phospholipids (PL)
and calcium ions. The FXa activity is assessed by hydrolysis of a
p-nitroanilide substrate specific to FXa. The initial rate of
release of p-nitroaniline (pNA) measured at 405 nm is proportional
to the FXa activity, and thus to the FVIII activity in the sample.
The limit of quantitation of FVIII activity due to rFVIIIFc in this
assay is .about.0.3 IU/ml. The assay can measure total FVIII
activity down to a lower limit of approximately 0.06 IU/ml with an
accuracy of .+-.20%. The calculated activity of the pre-dose sample
for individual animals was subtracted from the value at each time
point to generate the PD curves (FVIII activity vs. time).
[0182] A standard curve was generated from the NIBSC 7th
International Standard FVIII concentrate diluted to 1 IU/ml in
human FVIII-deficient plasma. Standard curves were diluted serially
in the Sysmex instrument to yield concentrations of 0.15, 0.1,
0.05, 0.025, 0.0053 and 0.0026 IU/ml. Since the instrument dilutes
all samples 1:10 internally, the FVIII standard concentrations
correspond to plasma concentrations of 1.5-0.026 IU/ml, which is
the range of FVIII activities that can be measured.
PK Analysis
[0183] The concentration time profiles were evaluated using the
non-compartmental analysis module in the WinNonlin software program
(Version 5.2, Pharsight Corporation, Mountain View, Calif.).
Results
[0184] The concentration of rFVIIIFc in monkey plasma was measured
using a sandwich ELISA format that measured both the FVIII and Fc
portions of the molecule and the data are reported in Table 7. All
predose samples were below the limit of quantitation. FIG. 7
illustrates the group mean rFVIIIFc and XYNTHA.RTM. plasma
concentrations over time and individual plasma concentration versus
time curves are shown in FIGS. 8A-8B. A summary of the PK
parameters for rFVIIIFc and XYNTHA.RTM. are shown in Tables 9 and
10, respectively. The mean t1/2 for rFVIIIFc was 11.9.+-.1.7 hr
(range 9.3 to 14.1 hr) and for XYNTHA.RTM., the mean elimination
t1/2 was 12.7.+-.4.4 hr (range 9.2 to 19.9 hr).
[0185] FVIII activity was measured using a FVIII-specific
chromogenic activity assay and the data are reported in Table 8.
Pre-dose activity due to endogenous FVIII was subtracted from all
samples. A graph of the mean group data is shown in FIG. 9 and the
individual plasma concentration vs. time curves are shown in FIGS.
10A-10B. A summary of the PK parameters are reported for rFVIIIFc
and XYNTHA.RTM. in Tables 9 and 10, respectively. The mean
elimination t1/2 was 16.1.+-.6.9 hr (range 11.6 to 29.4 hr) for
rFVIIIFc and 12.5.+-.1.7 hr (range 10.4 to 14.3 hr) for
XYNTHA.RTM..
Discussion and Conclusions
[0186] The elimination half-lives were similar for rFVIIIFc and
XYNTHA.RTM. after a single intravenous dose of 125 IU/kg. whether
the test article was measured by ELISA or a chromogenic activity
assay.
Example 3
[0187] This will be a Phase I/IIa, open-label, crossover,
dose-escalation, multi-center, and first-in-human study designed to
evaluate the safety, tolerability, and pharmacokinetics of a single
dose of rFVIIIFc in subjects with severe (defined as <1 IU/dL
[1%] endogenous factor VIII [FVIII]) hemophilia A. A total of
approximately 12 previously treated patients will be enrolled and
dosed with rFVIIIFc at 25 or 65 IU/kg. After the screening
(scheduled within 28 days prior to the first dose of the
ADVATE.RTM. [rFVIII], the reference comparator agent) and a minimum
of 4-days (96 hours) elapsing with no FVIII treatment prior to the
first injection, approximately 6 subjects will receive a single 25
IU/kg dose of ADVATE.RTM. followed by a 3-day (72 hours)
pharmacokinetic (PK) profile then crossover and receive a 25 IU/kg
single, open-label dose of rFVIIIFc for a 7-day (168 hours) PK
profiling. The first 3 subjects will be dosed sequentially. For the
first three (3) subjects dosed with 25 IU/kg of rFVIIIFc, each
subject will undergo an inhibitor assessment at 14-days (336 hours)
post-injection of rFVIIIFc. Dosing of the next subject (for the
first three subjects only) will occur once the inhibitor testing is
completed. After the 3rd subject completed the 14 day inhibitor
assessment, the remaining three subjects at 25 IU/kg and the six
subjects at 65 IU/kg will begin enrollment sequentially at least 1
day apart within each dose group.
[0188] One week after the last subject receives the 25 IU/kg dose
of the rFVIIIFc, approximately 6 unique subjects will be recruited
for the 65 IU/kg cohort. Each subject in the 65 IU/kg cohort will
receive a single 65 IU/kg dose of ADVATE.RTM. followed by a 4-day
(96 hours) PK profiling then crossover and receive a 65 IU/kg
single, open-label dose of rFVIIIFc for a 10-day (240 hours)
profiling. If a bleeding episode occurs before the first injection
of rFVIIIFc in any cohort, subject's pre-study FVIII product should
be used for treatment and an interval of at least 4 days must then
pass before receiving the first injection of rFVIIIFc for the PK
profile.
[0189] All subjects will be followed for a 14-day (336 hours) and
28 day safety evaluation period after administration of rFVIIIFc 25
IU/kg or 65 IU/kg for safety. All subjects will undergo
pharmacokinetic sampling pre- and post-dosing along with blood
samples for analysis of FVIII activity at designated time
points.
Example 4
[0190] Activity within the Xase Complex
[0191] To investigate the binding of the FVIII proteins (rBDD FVIII
and rFVIIIFc) with FIXa, and measure the ability of these proteins
to activate FX, kinetic studies were performed examining these
interactions in the context of the Xase complex. This assay
involved the formation of the Xase complex with activated FIX and
activated rBDD FVIII or rFVIIIFc protein on a phospholipid surface
in the presence of calcium, and monitoring the conversion of FX to
FXa as measured by cleavage of a chromogenic or fluorogenic
substrate.
[0192] Briefly, FVIII is first activated with a-thrombin for 5 min,
then mixed with FIXa in the presence of Ca2+, and synthetic
phospholipid vesicles (25% phosphatidylserine (PS)/75%
phosphatidylcholine (PC)) or platelets. Under conditions described
below, FVIIIa and FIXa interact in the presence of a phospholipid
surface and calcium ions to form an active Xase complex that
mediates the conversion of FX into FXa through proteolytic
processing. In turn, FXa cleaves a FXa-specific chromogenic or
fluorogenic substrate. 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 quantitated by
measuring the absorbance of the solution at 405 nm.
A. Activation of Factor X
[0193] The ability of rBDD FVIII and rFVIIIFc to activate FX were
studied in the context of the Xase complex as described above.
Thrombin-activated FVIII proteins were incubated with FIXa and
phospholipids in the presence of calcium, then added to different
concentrations of FX in the presence of a FX-specific substrate and
the rates of FXa generation determined (FIG. 11).
[0194] Based on these data, the Km and Vmax for the different FVIII
proteins in the context of the Xase complex were calculated (Chang
1997) (Table 11). Data are expressed as the mean of six analyses (3
experiments containing duplicate runs).+-.the corresponding
standard deviation. Based on these data, these proteins (rBDD FVIII
and rFVIIIFc) were found to have comparable Km and Vmax values,
within the variation of the assay. Therefore, the Xase complex
formed with rFVIIIFc behaves similarly to the Xase complex formed
with the licensed product rBDD FVIII (REFACTO.RTM.) with respect to
interactions with phospholipids and ability to activate FX. Note
that these comparable data also demonstrate that rFVIIIFc is
activated to a comparable degree as rBDD FVIII after a short
incubation with thrombin.
B. Interaction with FIXa
[0195] The interaction between rBDD FVIII and rFVIIIFc with FIXa
were also examined in the context of the Xase complex. The Xase
complex was assembled as above, using a fixed amount of FX and
varying FIXa levels, and FXa generation rates determined (FIG. 12).
From these data, the Kd value for the Xase complex formed with both
of the FVIII proteins to FIXa were determined (Chang 1997). Data
are expressed as the mean of six analyses (3 experiments containing
duplicate runs).+-.the corresponding standard deviation (Table 12).
Both proteins were found to have similar Kd and Vmax values,
indicating that rFVIIIFc has comparable interactions with FIXa as
the licensed rBDD FVIII product.
Example 5
[0196] Interim pharmacokinetic data for the Phase I/IIa clinical
trial discussed in Example 3 demonstrated the following results for
FVIIIFc. FVIIIFc had about a 50% increase in systemic exposure
(AUC.sub.INF), about 50% reduction in clearance (Cl), and about
50-70% increase in elimination half-life and MRT compared to
ADVATE.RTM. (full length rFVIII). In addition, FVIIIFc showed
increased C168, TBLP1, TBLP3, and TBLP5 values compared to
ADVATE.RTM..
AUC.sub.INF Area under the concentration-time curve from zero to
infinity Beta HL Elimination phase half-life; also referred to as
Lim C168 Estimated FVIIIFc activity above baseline at approximately
168 h after dose
Cl Clearance
[0197] MRT Mean residence time TBLP1 Model-predicted time after
dose when FVIIIFc activity has declined to approximately 1 IU/dL
above baseline TBLP3 Model-predicted time after dose when FVIIIFc
activity has declined to approximately 3 IU/dL above baseline TBLP5
Model-predicted time after dose when FVIIIFc activity has declined
to approximately 5 IU/dL above baseline
Example 6
[0198] A recombinant B-domain-deleted factor VIII-Fc (rFVIIIFc)
fusion protein has been created as an approach to extend the
half-life of FVIII. The pharmacokinetics (PK) of rFVIIIFc were
compared to rFVIII in hemophilia A mice. We found that the terminal
half-life was twice as long for rFVIIIFc compared to rFVIII. In
order to confirm that the underlying mechanism for the extension of
half-life was due to the protection of rFVIIIFc by FcRn, the PK
were evaluated in FcRn knockout and human FcRn transgenic mice. A
single intravenous dose (125 IU/kg) was administered and the plasma
concentration measured using a chromogenic activity assay. The Cmax
was similar between rFVIIIFc and rFVIII (XYNTHA.RTM.) in both mouse
strains. However, while the half-life for rFVIIIFc was comparable
to that of rFVIII in the FcRn knockout mice, the half-life for
rFVIIIFc was extended to approximately twice longer than that for
rFVIII in the hFcRn transgenic mice. These results confirm that
FcRn mediates or is responsible for the prolonged half-life of
rFVIIIFc compared to rFVIII. Since hemostasis in whole blood
measured by rotation thromboelastometry (ROTEM) has been shown to
correlate with the efficacy of coagulation factors in bleeding
models of hemophilia mice as well as in clinical applications, we
sought to evaluate the ex vivo efficacy of rFVIIIFc in the
hemophilia A mice using ROTEM. Hemophilia A mice were administered
a single intravenous dose of 50 IU/kg rFVIIIFc, XYNTHA.RTM. (FVIII)
or ADVATE.RTM. (FVIII). At 5 minutes post dose, clot formation was
similar with respect to clotting time (CT), clot formation time
(CFT) and a-angle. However, rFVIIIFc showed significantly improved
CT at 72 and 96 hr post dose, and CFT and a-angle were also
improved at 96 hrs compared to both XYNTHA.RTM. (FVIII) and
ADVATE.RTM. (FVIII), consistent with prolonged PK of rFVIIIFc.
Therefore construction of an Fc fusion of FVIII produces a molecule
with a defined mechanism of action that has an increased half-life
and the potential to provide prolonged protection from
bleeding.
Example 7
[0199] This Example presents final analysis results for FVIII
activity from 16 patients treated with 25 and 65 IU/kg FVIII
products. See Examples 3 and 5.
[0200] In this Example, rFVIIIFc is a recombinant fusion protein
comprised of a single molecule of recombinant B-domain deleted
human FVIII (BDD-rFVIII) fused to the dimeric Fc domain of the
human IgG1, with no intervening linker sequence. This protein
construct is also referred to herein as rFVIIIFc heterodimeric
hybrid protein, FVIIIFc monomeric Fc fusion protein, FVIIIFc
monomer hybrid, monomeric FVIIIIFc hybrid, and FVIIIFc
monomer-dimer. See Example 1, FIG. 1, and Table 2A.
[0201] Preclinical studies with rFVIIIFc have shown an
approximately 2-fold prolongation of 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 frozen liquid
formulation and provide data on the PK in severe hemophilia A
subjects. For this study, 16 evaluable subjects were available for
PK evaluation. Single administration of two doses of both rFVIIIFc
and ADVATE.RTM. at a nominal dose of 25 (n=6) and 65 IU/kg of body
weight (n=10) were infused intravenously over approximately 10
minutes. Blood samples for plasma PK assessments were obtained
before infusion, as well as up to 10 days after dosing. The PK of
FVIII activity for both ADVATE.RTM. and rFVIIIFc were characterized
in this study using a model-dependent method.
Objectives
[0202] The primary objective of this study was to assess the safety
and tolerability of single administration of two doses of rFVIIIFc
(25 and 65 IU/kg) in previously treated patients (PTPs) aged 12 and
above with severe hemophilia A.
[0203] The secondary objectives were to determine the
pharmacokinetics (PK) parameters determined by pharmacodynamic (PD)
activity of FVIII over time after a single administration of 25 or
65 IU/kg of rFVIIIFc compared to ADVATE.RTM. in one-stage clotting
and chromogenic assays.
Study Design (See Example 3)
[0204] Blood samples were collected for FVIII activity PK
evaluations at the screening visit (within 28 days prior to dosing
ADVATE.RTM.); on Day 0 (injection of ADVATE.RTM.) pre-injection and
at 10 and 30 minutes and 1, 3, 6, and 9 hours post-injection; on
Day 1 at 24 hours post-injection of ADVATE.RTM.; on Day 2 at 48
hours post-injection of ADVATE.RTM.; on Day 3 at 72 hours
post-injection of ADVATE.RTM.; and on Day 4 at 96 hours
post-injection of high dose of ADVATE.RTM. (Cohort B only).
[0205] Blood samples were collected for FVIII activity PK
evaluations on the day of rFVIIIFc injection just prior to the
administration of rFVIIIFc, at 10 and 30 minutes and 1, 3, 6, and 9
hours post-injection of rFVIIIFc; on Day 1 at 24 hours
post-injection of rFVIIIFc; on Days 2 through 5 at 48, 72, 96, and
120 hours post-injection of rFVIIIFc; on Day 7 at 168 hours
post-injection of rFVIIIFc; on Days 8, 9, and 10 at 192, 216, and
240 hours post-injection of high dose of rFVIIIFc (Cohort B only).
FVIII activity was also measured at the final study visit (28 days
post-injection of rFVIIIFc) at 672 hours post-injection of
rFVIIIFc.
Pharmacokinetic Modeling and Calculations
[0206] Abbreviations
[0207] TBLP1=Model-predicted time after dose when FVIII activity
has declined to approximately 1 IU/dL above baseline.
[0208] TBLP3=Model-predicted time after dose when FVIII activity
has declined to approximately 3 IU/dL above baseline
KV_M = Cmax_M / Actual .times. Dose .times. ( IU / kg )
##EQU00001## KV_OB = Cmax_OB / Actual .times. Dose .times. ( IU /
kg ) ##EQU00001.2## IVR_M = 100 .times. Cmax_M .times. Plasma
.times. Volume .times. ( dL ) / Total .times. Dose .times. in
.times. IU ; .times. where .times. plasma .times. volume .times. in
.times. mL = ( 23.7 .times. Ht .times. in .times. cm ) + ( 9.
.times. Wt .times. in .times. kg ) - 1709. ##EQU00001.3## IVR_OB =
100 .times. Cmax_OB .times. Plasma .times. Volume .times. ( dL ) /
Total .times. Dose .times. in .times. IU ; .times. where .times.
plasma .times. volume .times. in .times. mL = ( 23.7 .times. Ht
.times. .times. in .times. cm ) + ( 9. .times. Wt .times. in
.times. kg ) - 1709. ##EQU00001.4##
Results
[0209] FIG. 13. Observed group mean (+SE) FVIII activity versus
time profiles, sorted by dose level, grouped by compound (one-stage
assay, 25 IU/kg (A) and 65 IU/kg (B)) and (chromogenic assay, 25
IU/kg (C) and 65 IU/kg (D)).
[0210] FIG. 14. Observed group mean (+SE) FVIII activity versus
time profiles, grouped by dose level and compound (one-stage assay;
A) (chromogenic assay; B).
Single-Dose Pharmacokinetics (One-Stage Assay)
[0211] Observed FVIII activity increased sharply after the short IV
infusion of either ADVATE.RTM. or rFVIIIFc, with mean (.+-.SD)
model-predicted Cmax values of 56.6.+-.4.74 and 121.+-.28.2 IU/dL
for ADVATE.RTM. and 55.6.+-.8.18 and 108.+-.16.9 IU/dL for rFVIIIFc
for the 25 and 65 IU/kg dose groups, respectively. All ADVATE.RTM.-
and rFVIIIFc-treated patients had dose-related increases in FVIII
activity. The observed increase in both Cmax and AUCINF was
slightly less than proportional to dose over the dose range
evaluated.
[0212] After the end of the infusion, the decline of the observed
FVIII activity exhibited monoexponential decay characteristics
until the baseline level was reached. The rate of decline in FVIII
activity was slower for rFVIIIFc than for ADVATE.RTM. with mean
(.+-.SD) model-predicted elimination half-life values of
11.9.+-.2.98 and 10.4.+-.3.03 hr for ADVATE.RTM. and 18.0.+-.3.88
and 18.4.+-.6.99 hr for rFVIIIFc for the 25 and 65 IU/kg dose
groups, respectively. Elimination half-life values appeared to be
dose-independent over the dose range evaluated for both FVIII
products.
[0213] Total systemic FVIII exposure (assessed by AUCINF) was
.about.48% and 61% greater following rFVIIIFc administration than
ADVATE.RTM. at 25 and 65 IU/kg dose levels, respectively. Mean
(.+-.SD) model-predicted AUCINF values were 974.+-.259 and
1810.+-.606 hr*IU/dL for ADVATE.RTM. and 1440.+-.316 and
2910.+-.1320 hr*IU/dL for rFVIIIFc for the 25 and 65 IU/kg dose
groups, respectively.
[0214] Similar to elimination half-life, the MRT was prolonged for
rFVIIIFc relative to ADVATE.RTM.. Mean (.+-.SD) model-predicted MRT
values were 17.1.+-.4.29 and 14.9.+-.4.38 hr for ADVATE.RTM. and
25.9.+-.5.60 and 26.5.+-.10.1 hr for rFVIIIFc for the 25 and 65
IU/kg dose groups, respectively. MRT values appeared to be
dose-independent over the dose range evaluated for both FVIII
products.
[0215] In addition, primary PK parameter values for CL and V were
determined. CL values for rFVIIIFc only accounted for .about.66% of
those observed for ADVATE.RTM. at equivalent doses. Mean (.+-.SD)
model-predicted CL values were 2.70.+-.0.729 and 4.08.+-.1.69
mL/hr/kg for ADVATE.RTM. and 1.80.+-.0.409 and 2.69.+-.1.25
mL/hr/kg for rFVIIIFc for the 25 and 65 IU/kg dose groups,
respectively. V values were comparable between ADVATE.RTM. and
rFVIIIFc with mean (.+-.SD) model-predicted V values of
43.9.+-.4.27 and 56.1.+-.13.4 mL/kg for ADVATE.RTM. 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 noted with increasing dose of ADVATE.RTM. and rFVIIIFc;
however, the increase in standard deviations at the 65 IU/kg dose
coupled with limited dose levels confounded an assessment of the
dose-dependency of these parameters. For example, the CV %
geometric mean CL value for the rFVIIIFc treatment group increased
from 23.0% (25 IU/kg) to 48.6% (65 IU/kg).
[0216] In addition to the primary PK parameters, secondary PK
parameters (e.g. K-values, IVR, etc.) were determined to evaluate
FVIII duration of effect. Evidence of PK difference was also
observed with rFVIIIFc demonstrating increased TBLP1 and TBLP3
values compared to ADVATE.RTM. at equivalent doses. IVR and
K-values for ADVATE.RTM. and rFVIIIFc appeared to be comparable. A
slight increase in TBLP1 and TBLP3 values were observed with
increasing dose of ADVATE.RTM. and rFVIIIFc. In contrast, slight
decreases in mean IVR and K-values were noted with increasing dose
of ADVATE.RTM. and rFVIIIFc. As previously indicated, an assessment
of the dose dependency of these parameters is confounded by limited
dose levels.
[0217] Mean (.+-.SD) observed TBLP1 were 2.88.+-.0.733 and
2.93.+-.0.848 IU/dL per IU/kg for ADVATE.RTM. and 4.28.+-.0.873 and
5.16.+-.2.02 IU/dL per IU/kg for rFVIIIFc for the 25 and 65 IU/kg
dose groups, respectively. Mean (.+-.SD) observed TBLP3 were
2.06.+-.0.527 and 2.26.+-.0.666 IU/dL per IU/kg for ADVATE.RTM. and
3.09.+-.0.623 and 3.93.+-.1.59 IU/dL per IU/kg for rFVIIIFc for the
25 and 65 IU/kg dose groups, respectively.
[0218] Mean IVR and K-values calculated using observed Cmax values
(subtracted with baseline and residual drug within the model) were
generally greater than values determined using model-predicted Cmax
values; consistent with slight underestimation of the observed peak
activity using the one-compartment model. Mean (.+-.SD) observed
K-values were 2.57.+-.0.198 and 2.13.+-.0.598 IU/dL per IU/kg for
ADVATE.RTM. and 2.46.+-.0.330 and 1.85.+-.0.332 IU/dL per IU/kg for
rFVIIIFc for the 25 and 65 IU/kg dose groups, respectively. Mean
(.+-.SD) observed IVR values were 94.1.+-.15.6 and 85.8.+-.16.5%
for ADVATE.RTM. 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)
[0219] Observed FVIII activity increased sharply after the short IV
infusion of either ADVATE.RTM. or rFVIIIFc, with mean (.+-.SD)
model-predicted Cmax values of 70.2.+-.9.60 and 157.+-.38.6 IU/dL
for ADVATE.RTM. and 70.3.+-.10.0 and 158.+-.34.7 IU/dL for rFVIIIFc
for the 25 and 65 IU/kg dose groups, respectively.
[0220] All ADVATE.RTM.- and rFVIIIFc-treated patients had
dose-related increases in FVIII activity. The observed increase in
both Cmax and AUC.sub.INF was slightly less than proportional to
dose over the dose range evaluated.
[0221] After the end of the infusion, the decline of the observed
FVIII activity exhibited monoexponential decay characteristics
until the baseline level was reached. The rate of decline in FVIII
activity was slower for rFVIIIFc than for ADVATE.RTM. with mean
(.+-.SD) model-predicted elimination half-life values of
10.7.+-.1.98 and 10.3.+-.3.27 hr for ADVATE.RTM. and 16.2.+-.2.92
and 19.0.+-.7.94 hr for rFVIIIFc for the 25 and 65 IU/kg dose
groups, respectively. Elimination half-life values appeared to be
dose-independent over the dose range evaluated for both FVIII
products.
[0222] Total systemic FVIII exposure (assessed by AUCINF) was
.about.53% and 84% greater following rFVIIIFc administration than
ADVATE.RTM. at 25 and 65 IU/kg dose levels, respectively. Mean
(.+-.SD) model-predicted AUCINF values were 1080.+-.236 and
2320.+-.784 hr*IU/dL for ADVATE.RTM. and 1650.+-.408 and
4280.+-.1860 hr*IU/dL for rFVIIIFc for the 25 and 65 IU/kg dose
groups, respectively.
[0223] Similar to elimination half-life, the MRT was prolonged for
rFVIIIFc relative to ADVATE.RTM.. Mean (.+-.SD) model-predicted MRT
values were 15.3.+-.2.86 and 14.8.+-.4.72 hr for ADVATE.RTM. and
23.4.+-.4.22 and 27.3.+-.11.4 hr for rFVIIIFc for the 25 and 65
IU/kg dose groups, respectively. MRT values appeared to be
dose-independent over the dose range evaluated for both FVIII
products.
[0224] In addition, primary PK parameter values for CL and V were
determined. CL values for rFVIIIFc only accounted for .about.58-66%
of those observed for ADVATE.RTM. at equivalent doses. Mean
(.+-.SD) model-predicted CL values were 2.39.+-.0.527 and
3.21.+-.1.40 mL/hr/kg for ADVATE.RTM. and 1.57.+-.0.349 and
1.86.+-.0.970 mL/hr/kg for rFVIIIFc for the 25 and 65 IU/kg dose
groups, respectively. V values were comparable between ADVATE.RTM.
and rFVIIIFc with mean (.+-.SD) model-predicted V values of
35.8.+-.5.52 and 43.6.+-.11.2 mL/kg for ADVATE.RTM. and
35.9.+-.6.65 and 42.7.+-.8.91 mL/kg for rFVIIIFc for the 25 and 65
IU/kg dose groups, respectively. Increases in mean CL and V values
were noted with increasing dose of ADVATE.RTM. and rFVIIIFc;
however, the increase in standard deviations at 65 IU/kg coupled
with limited dose levels confounded an assessment of the
dose-dependency of these parameters.
[0225] In addition to the primary PK parameters, secondary PK
parameters (e.g. K-values, IVR, etc.) were determined to evaluate
FVIII duration of effect. Evidence of PK difference was also
observed with rFVIIIFc demonstrating increased TBLP1 and TBLP3
values compared to ADVATE.RTM. at equivalent doses. IVR and
K-values for ADVATE.RTM. and rFVIIIFc appeared to be
comparable.
[0226] A slight increase in TBLP1 and TBLP3 values were observed
with increasing dose of ADVATE.RTM. and rFVIIIFc. In contrast,
slight decreases in mean IVR and K-values were noted with
increasing dose of ADVATE.RTM. and rFVIIIFc. As previously
indicated, an assessment of the dose dependency of these parameters
is confounded by limited dose levels.
[0227] Mean (.+-.SD) observed TBLP1 were 2.70.+-.0.511 and
3.09.+-.0.978 IU/dL per
[0228] IU/kg for ADVATE.RTM. and 4.06.+-.0.798 and 5.66.+-.2.38
IU/dL per IU/kg for rFVIIIFc for the 25 and 65 IU/kg dose groups,
respectively. Mean (.+-.SD) observed TBLP3 were 1.98.+-.0.377 and
2.39.+-.0.718 IU/dL per IU/kg for ADVATE.RTM. and 3.04.+-.0.598 and
4.44.+-.1.84 IU/dL per IU/kg for rFVIIIFc for the 25 and 65 IU/kg
dose groups, respectively.
[0229] Mean IVR and K-values calculated using observed Cmax values
(subtracted with baseline and residual drug within the model) were
generally greater than values determined using model-predicted Cmax
values; consistent with slight underestimation of the observed peak
activity using the one-compartment model. Mean (.+-.SD) observed
K-values were 3.08.+-.0.429 and 2.85.+-.0.721 IU/dL per IU/kg for
ADVATE.RTM. and 3.12.+-.0.451 and 2.92.+-.0.985 IU/dL per IU/kg for
rFVIIIFc for the 25 and 65 IU/kg dose groups, respectively. Mean
(.+-.SD) observed IVR values were 112.+-.14.5 and 116.+-.26.9% for
ADVATE.RTM. and 113.+-.16.3 and 117.+-.33.6% for rFVIIIFc for the
25 and 65 IU/kg dose groups, respectively.
Conclusions
[0230] All ADVATE.RTM.- and rFVIIIFc-treated patients had
comparable dose-related increases in Cmax and AUCINF over the dose
range evaluated. Peak plasma levels of ADVATE.RTM. 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 infusion, the decline in baseline
corrected FVIII activity exhibited monoexponential decay until the
baseline was reached for both products. Parameter values for
elimination half-life and MRT appeared to be dose-independent over
the dose range evaluated for both FVIII products. Slight increases
in mean CL and V values were noted with increasing dose of
ADVATE.RTM. and rFVIIIFc; however, increased intersubject
variability at the 65 IU/kg coupled with limited dose levels
confounded an assessment of the dose-dependency of these
parameters.
[0231] Comparison of rFVIIIFc and ADVATE.RTM. activity PK revealed
an approximate 48-61% (One-Stage Assay) or 53-84% (Chromogenic
Assay) increase in systemic exposure, approximate 30-40% reduction
in clearance, and an approximate 50-80% increase in both
elimination half-life and MRT for rFVIIIFc relative to ADVATE.RTM.
at comparable doses. Evidence of PK difference was also observed
with rFVIIIFc demonstrating increased TBLP1 and TBLP3 values
compared to ADVATE.RTM. at equivalent doses. IVR and K-values for
ADVATE.RTM. and rFVIIIFc appeared to be comparable.
[0232] The PK parameters obtained from Chromogenic Assay results
generally agreed with those from the One-Stage Assay, except that
the Chomogenic Assay yielded a higher estimation of exposure
parameters (e.g. Cmax, AUC.sub.INF, etc.).
[0233] With the observed improvements in PK, rFVIIIFc may provide a
prolonged protection from bleeding, allowing less frequent
injections for individuals with Hemophilia A.
Example 8
[0234] On the basis of the interim PK analysis from the
first-inhuman study of rFVIII:Fc (Example 3), the A-LONG study was
designed. A-LONG is an open label, multi-center evaluation of the
safety, pharmacokinetics, and efficacy of recombinant Factor VIII
Fc fusion (FVIII:Fc) in the prevention and treatment of bleeding in
previously treated subjects with severe hemophilia A (defined as
<1 IU/dL [<1%] endogenous FVIII).
[0235] Approximately 106 subjects will be enrolled into one of
three regimens: a tailored prophylaxis regimen (arm 1), a weekly
dosing regimen (arm 2), and an on-demand regimen (arm 3).
Arm 1: Tailored Prophylaxis Regimen
[0236] Arm 1 will include an overall group and a PK subgroup.
Approximately 66 subjects will be enrolled. The initial regimen
will be twice weekly at 25 IU/kg on the first day, followed by 50
IU/kg on the fourth day of the week. Subjects will administer
rFVIIIFc on this weekly prophylaxis regimen until PK results for
rFVIIIFc are available. Base don these results, a tailored
prophylaxis regimen will be established for each individual, in
which the dose and interval will be determined to maintain a trough
level of 1-3% FVIII activity. Each subject will then administer his
individually tailored prophylaxis regimen throughout the study.
[0237] 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 .gtoreq.2 spontaneous bleeding episodes over a rolling
two-month period. In this case, adjustment will target trough
levels of 3-5%.
Arm 2: Weekly Dosing Regimen
[0238] Approximately 20 subjects will be enrolled/randomized and
undergo abbreviated rFVIIIFc PK profiling as follows: Washout of at
least 96 hours; a single dose of rFVIIIFc 65 IU/kg; Abbreviated
sampling beginning on rFVIIIFc Day 0, including pre-injection and
10 (.+-.2) minutes, 3 hours (.+-.15 minutes), 72 (.+-.2) hours [Day
3], and 96 (.+-.2) hours [Day 4] from the start of injection.
Following the abbreviated PK profiling, subjects will then
administer a fixed dose of 65 IU/kg rFVIIIFc every 7 days.
Arm 3: On-Demand Regimen
[0239] A minimum of 10 major surgeries in at least 5 subjects will
be evaluated in the study. Major surgery is defined as any surgical
procedure (elective or emergent) that involves general anesthesia
and/or respiratory assistance in which a major body cavity is
penetrated and exposed, or for which a substantial impairment of
physical or physiological functions is produced (e.g., laparotomy,
thoracotomy, craniotomy, joint replacement, and limb
amputation).
[0240] For prophylaxis during surgery, subjects will be treated
with 35 to 50 IU/kg rFVIIIFc every 12 to 24 hours. Prior to
surgery, the physician will review the subject's rFVIIIFc PK
profile and assess the dose regimen of Factor VIII replacement
generally required for the type of planned surgery and the clinical
status of the subject. Recommendation for the appropriate dosing of
rFVIIIFc in the surgical treatment period, including any
rehabilitation time, will take these factors into
consideration.
[0241] The primary objectives of this study are (a) to evaluate the
safety and tolerability of rFVIIIFc administered as prophylaxis,
on-demand, and surgical treatment regimens; and (b) to evaluate the
efficacy of rFVIIIFc administered as prophylaxis, on-demand, and
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 currently marketed product, ADVATE.RTM.; (b)
to evaluate individual responses with FVIIIFc; and (c) to evaluate
FVIIIFc consumption.
Primary Objectives
[0242] To evaluate safety and tolerability of rFVIIIFc administered
as prophylaxis, weekly, on-demand, and surgical treatment regimens
[0243] To evaluate the efficacy of rFVIIIFc administered as
tailored prophylaxis, on-demand, and surgical treatment
regimens
Secondary Objectives
[0243] [0244] To characterize the PK profile of rFVIIIFc and
compare the PK of rFVIIIFc with the currently marketed product,
ADVATE.RTM. [0245] To evaluate individual responses with rFVIIIFc
[0246] To characterize the range of dose and schedules required to
adequately prevent bleeding in a prophylaxis regimen; maintain
homeostasis in a surgical setting; or to treat bleeding episodes in
an on-demand, weekly treatment, or prophylaxis setting [0247] To
evaluate rFVIIIFc consumption (e.g., total annualized rFVIIIFc
consumption per subject)
Example 9
Clinical ROTEM Assessment
[0248] In the study in Example 8, in addition to the measurement of
plasma FVIII activity by one-stage activated partial thromboplastin
time (aPTT) assay, whole blood rotational thromboelastometry
(ROTEM) has also been explored to assess the improvement in global
hemostasis by rFVIIIFc and ADVATE.RTM. in 2 subjects, specifically,
1 in the low dose cohort and 1 in the high dose cohort.
[0249] rFVIIIFc and ADVATE.RTM. appear to be comparably active in
clot formation when spiked into subjects' blood prior to rFVIIIFc
treatment. The clotting time (CT) was linear with respect to the
dose of rFVIIIFc and ADVATE.RTM. in the range of approximately 1%
of 100% of normal, and the dose response was comparable between
rFVIIIFc and ADVATE.RTM. in the same subject.
[0250] Following dosing with ADVATE.RTM. and subsequently rFVIIIFc,
citrated whole blood was sampled at various time points and the
clot formation following recalcification was monitored by ROTEM.
Despite the variable baseline CT due to residue FVIII levels prior
to ADVATE.RTM. or rFVIIIFc dosing, both products effectively
corrected the CT to comparable levels 30 minutes post-injection. In
addition, the improvement in CT was better sustained at and after 3
hours post-injection of 25 IU/kg of rFVIIIFc relative to
ADVATE.RTM. in the subject dosed at this low dose. However, the
differential improvement of rFVIIIFc versus ADVATE.RTM. was much
less appreciable at the 65 IU/kg dose.
Tables
TABLE-US-00001 [0251] TABLE 1 Polynucleotide Sequences A. B-Domain
Deleted FVIIIFc (i) B-Domain Deleted FVIIIFc Chain DNA Sequence
(FVIII signal peptide underlined, Fc region in bold) (SEQ ID NO: 1,
which encodes SEQ ID NO: 2) 661 A TGCAAATAGA GCTCTCCACC TGCTTCTTTC
721 TGTGCCTTTT GCGATTCTGC TTTAGTGCCA CCAGAAGATA CTACCTGGGT
GCAGTGGAAC 781 TGTCATGGGA CTATATGCAA AGTGATCTCG GTGAGCTGCC
TGTGGACGCA AGATTTCCTC 841 CTAGAGTGCC AAAATCTTTT CCATTCAACA
CCTCAGTCGT GTACAAAAAG ACTCTGTTTG 901 TAGAATTCAC GGATCACCTT
TTCAACATCG CTAAGCCAAG GCCACCCTGG ATGGGTCTGC 961 TAGGTCCTAC
CATCCAGGCT GAGGTTTATG ATACAGTGGT CATTACACTT AAGAACATGG 1021
CTTCCCATCC TGTCAGTCTT CATGCTGTTG GTGTATCCTA CTGGAAAGCT TCTGAGGGAG
1081 CTGAATATGA TGATCAGACC AGTCAAAGGG AGAAAGAAGA TGATAAAGTC
TTCCCTGGTG 1141 GAAGCCATAC ATATGTCTGG CAGGTCCTGA AAGAGAATGG
TCCAATGGCC TCTGACCCAC 1201 TGTGCCTTAC CTACTCATAT CTTTCTCATG
TGGACCTGGT AAAAGACTTG AATTCAGGCC 1261 TCATTGGAGC CCTACTAGTA
TGTAGAGAAG GGAGTCTGGC CAAGGAAAAG ACACAGACCT 1321 TGCACAAATT
TATACTACTT TTTGCTGTAT TTGATGAAGG GAAAAGTTGG CACTCAGAAA 1381
CAAAGAACTC CTTGATGCAG GATAGGGATG CTGCATCTGC TCGGGCCTGG CCTAAAATGC
1441 ACACAGTCAA TGGTTATGTA AACAGGTCTC TGCCAGGTCT GATTGGATGC
CACAGGAAAT 1501 CAGTCTATTG GCATGTGATT GGAATGGGCA CCACTCCTGA
AGTGCACTCA ATATTCCTCG 1561 AAGGTCACAC ATTTCTTGTG AGGAACCATC
GCCAGGCGTC CTTGGAAATC TCGCCAATAA 1621 CTTTCCTTAC TGCTCAAACA
CTCTTGATGG ACCTTGGACA GTTTCTACTG TTTTGTCATA 1681 TCTCTTCCCA
CCAACATGAT GGCATGGAAG CTTATGTCAA AGTAGACAGC TGTCCAGAGG 1741
AACCCCAACT ACGAATGAAA AATAATGAAG AAGCGGAAGA CTATGATGAT GATCTTACTG
1801 ATTCTGAAAT GGATGTGGTC AGGTTTGATG ATGACAACTC TCCTTCCTTT
ATCCAAATTC 1861 GCTCAGTTGC CAAGAAGCAT CCTAAAACTT GGGTACATTA
CATTGCTGCT GAAGAGGAGG 1921 ACTGGGACTA TGCTCCCTTA GTCCTCGCCC
CCGATGACAG AAGTTATAAA AGTCAATATT 1981 TGAACAATGG CCCTCAGCGG
ATTGGTAGGA AGTACAAAAA AGTCCGATTT ATGGCATACA 2041 CAGATGAAAC
CTTTAAGACT CGTGAAGCTA TTCAGCATGA ATCAGGAATC TTGGGACCTT 2101
TACTTTATGG GGAAGTTGGA GACACACTGT TGATTATATT TAAGAATCAA GCAAGCAGAC
2161 CATATAACAT CTACCCTCAC GGAATCACTG ATGTCCGTCC TTTGTATTCA
AGGAGATTAC 2221 CAAAAGGTGT AAAACATTTG AAGGATTTTC CAATTCTGCC
AGGAGAAATA TTCAAATATA 2281 AATGGACAGT GACTGTAGAA GATGGGCCAA
CTAAATCAGA TCCTCGGTGC CTGACCCGCT 2341 ATTACTCTAG TTTCGTTAAT
ATGGAGAGAG ATCTAGCTTC AGGACTCATT GGCCCTCTCC 2401 TCATCTGCTA
CAAAGAATCT GTAGATCAAA GAGGAAACCA GATAATGTCA GACAAGAGGA 2461
ATGTCATCCT GTTTTCTGTA TTTGATGAGA ACCGAAGCTG GTACCTCACA GAGAATATAC
2521 AACGCTTTCT CCCCAATCCA GCTGGAGTGC AGCTTGAGGA TCCAGAGTTC
CAAGCCTCCA 2581 ACATCATGCA CAGCATCAAT GGCTATGTTT TTGATAGTTT
GCAGTTGTCA GTTTGTTTGC 2641 ATGAGGTGGC ATACTGGTAC ATTCTAAGCA
TTGGAGCACA GACTGACTTC CTTTCTGTCT 2701 TCTTCTCTGG ATATACCTTC
AAACACAAAA TGGTCTATGA AGACACACTC ACCCTATTCC 2761 CATTCTCAGG
AGAAACTGTC TTCATGTCGA TGGAAAACCC AGGTCTATGG ATTCTGGGGT 2821
GCCACAACTC AGACTTTCGG AACAGAGGCA TGACCGCCTT ACTGAAGGTT TCTAGTTGTG
2881 ACAAGAACAC TGGTGATTAT TACGAGGACA GTTATGAAGA TATTTCAGCA
TACTTGCTGA 2941 GTAAAAACAA TGCCATTGAA CCAAGAAGCT TCTCTCAAAA
CCCACCAGTC TTGAAACGCC 3001 ATCAACGGGA AATAACTCGT ACTACTCTTC
AGTCAGATCA AGAGGAAATT GACTATGATG 3061 ATACCATATC AGTTGAAATG
AAGAAGGAAG ATTTTGACAT TTATGATGAG GATGAAAATC 3121 AGAGCCCCCG
CAGCTTTCAA AAGAAAACAC GACACTATTT TATTGCTGCA GTGGAGAGGC 3181
TCTGGGATTA TGGGATGAGT AGCTCCCCAC ATGTTCTAAG AAACAGGGCT CAGAGTGGCA
3241 GTGTCCCTCA GTTCAAGAAA GTTGTTTTCC AGGAATTTAC TGATGGCTCC
TTTACTCAGC 3301 CCTTATACCG TGGAGAACTA AATGAACATT TGGGACTCCT
GGGGCCATAT ATAAGAGCAG 3361 AAGTTGAAGA TAATATCATG GTAACTTTCA
GAAATCAGGC CTCTCGTCCC TATTCCTTCT 3421 ATTCTAGCCT TATTTCTTAT
GAGGAAGATC AGAGGCAAGG AGCAGAACCT AGAAAAAACT 3481 TTGTCAAGCC
TAATGAAACC AAAACTTACT TTTGGAAAGT GCAACATCAT ATGGCACCCA 3541
CTAAAGATGA GTTTGACTGC AAAGCCTGGG CTTATTTCTC TGATGTTGAC CTGGAAAAAG
3601 ATGTGCACTC AGGCCTGATT GGACCCCTTC TGGTCTGCCA CACTAACACA
CTGAACCCTG 3661 CTCATGGGAG ACAAGTGACA GTACAGGAAT TTGCTCTGTT
TTTCACCATC TTTGATGAGA 3721 CCAAAAGCTG GTACTTCACT GAAAATATGG
AAAGAAACTG CAGGGCTCCC TGCAATATCC 3781 AGATGGAAGA TCCCACTTTT
AAAGAGAATT ATCGCTTCCA TGCAATCAAT GGCTACATAA 3841 TGGATACACT
ACCTGGCTTA GTAATGGCTC AGGATCAAAG GATTCGATGG TATCTGCTCA 3901
GCATGGGCAG CAATGAAAAC ATCCATTCTA TTCATTTCAG TGGACATGTG TTCACTGTAC
3961 GAAAAAAAGA GGAGTATAAA ATGGCACTGT ACAATCTCTA TCCAGGTGTT
TTTGAGACAG 4021 TGGAAATGTT ACCATCCAAA GCTGGAATTT GGCGGGTGGA
ATGCCTTATT GGCGAGCATC 4081 TACATGCTGG GATGAGCACA CTTTTTCTGG
TGTACAGCAA TAAGTGTCAG ACTCCCCTGG 4141 GAATGGCTTC TGGACACATT
AGAGATTTTC AGATTACAGC TTCAGGACAA TATGGACAGT 4201 GGGCCCCAAA
GCTGGCCAGA CTTCATTATT CCGGATCAAT CAATGCCTGG AGCACCAAGG 4261
AGCCCTTTTC TTGGATCAAG GTGGATCTGT TGGCACCAAT GATTATTCAC GGCATCAAGA
4321 CCCAGGGTGC CCGTCAGAAG TTCTCCAGCC TCTACATCTC TCAGTTTATC
ATCATGTATA 4381 GTCTTGATGG GAAGAAGTGG CAGACTTATC GAGGAAATTC
CACTGGAACC TTAATGGTCT 4441 TCTTTGGCAA TGTGGATTCA TCTGGGATAA
AACACAATAT TTTTAACCCT CCAATTATTG 4501 CTCGATACAT CCGTTTGCAC
CCAACTCATT ATAGCATTCG CAGCACTCTT CGCATGGAGT 4561 TGATGGGCTG
TGATTTAAAT AGTTGCAGCA TGCCATTGGG AATGGAGAGT AAAGCAATAT 4621
CAGATGCACA GATTACTGCT TCATCCTACT TTACCAATAT GTTTGCCACC TGGTCTCCTT
4681 CAAAAGCTCG ACTTCACCTC CAAGGGAGGA GTAATGCCTG GAGACCTCAG
GTGAATAATC 4741 CAAAAGAGTG GCTGCAAGTG GACTTCCAGA AGACAATGAA
AGTCACAGGA GTAACTACTC 4801 AGGGAGTAAA ATCTCTGCTT ACCAGCATGT
ATGTGAAGGA GTTCCTCATC TCCAGCAGTC 4861 AAGATGGCCA TCAGTGGACT
CTCTTTTTTC AGAATGGCAA AGTAAAGGTT TTTCAGGGAA 4921 ATCAAGACTC
CTTCACACCT GTGGTGAACT CTCTAGACCC ACCGTTACTG ACTCGCTACC 4981
TTCGAATTCA CCCCCAGAGT TGGGTGCACC AGATTGCCCT GAGGATGGAG GTTCTGGGCT
5041 GCGAGGCACA GGACCTCTAC GACAAAACTC ACACATGCCC ACCGTGCCCA
GCTCCAGAAC 5101 TCCTGGGCGG ACCGTCAGTC TTCCTCTTCC CCCCAAAACC
CAAGGACACC CTCATGATCT 5161 CCCGGACCCC TGAGGTCACA TGCGTGGTGG
TGGACGTGAG CCACGAAGAC CCTGAGGTCA 5221 AGTTCAACTG GTACGTGGAC
GGCGTGGAGG TGCATAATGC CAAGACAAAG CCGCGGGAGG 5281 AGCAGTACAA
CAGCACGTAC CGTGTGGTCA GCGTCCTCAC CGTCCTGCAC CAGGACTGGC 5341
TGAATGGCAA GGAGTACAAG TGCAAGGTCT CCAACAAAGC CCTCCCAGCC CCCATCGAGA
5401 AAACCATCTC CAAAGCCAAA GGGCAGCCCC GAGAACCACA GGTGTACACC
CTGCCCCCAT 5461 CCCGGGATGA GCTGACCAAG AACCAGGTCA GCCTGACCTG
CCTGGTCAAA GGCTTCTATC 5521 CCAGCGACAT CGCCGTGGAG TGGGAGAGCA
ATGGGCAGCC GGAGAACAAC TACAAGACCA 5581 CGCCTCCCGT GTTGGACTCC
GACGGCTCCT TCTTCCTCTA CAGCAAGCTC ACCGTGGACA 5641 AGAGCAGGTG
GCAGCAGGGG AACGTCTTCT CATGCTCCGT GATGCATGAG GCTCTGCACA 5701
ACCACTACAC GCAGAAGAGC CTCTCCCTGT CTCCGGGTAA A (ii) Fc DNA sequence
(mouse Ig.kappa. signal peptide underlined) (SEQ ID NO: 3, which
encodes SEQ ID NO: 4) 7981 ATGGA GACAGACACA 8041 CTCCTGCTAT
GGGTACTGCT GCTCTGGGTT CCAGGTTCCA CTGGTGACAA AACTCACACA 8101
TGCCCACCGT GCCCAGCACC TGAACTCCTG GGAGGACCGT CAGTCTTCCT CTTCCCCCCA
8161 AAACCCAAGG ACACCCTCAT GATCTCCCGG ACCCCTGAGG TCACATGCGT
GGTGGTGGAC 8221 GTGAGCCACG AAGACCCTGA GGTCAAGTTC AACTGGTACG
TGGACGGCGT GGAGGTGCAT 8281 AATGCCAAGA CAAAGCCGCG GGAGGAGCAG
TACAACAGCA CGTACCGTGT GGTCAGCGTC 8341 CTCACCGTCC TGCACCAGGA
CTGGCTGAAT GGCAAGGAGT ACAAGTGCAA GGTCTCCAAC 8401 AAAGCCCTCC
CAGCCCCCAT CGAGAAAACC ATCTCCAAAG CCAAAGGGCA GCCCCGAGAA 8461
CCACAGGTGT ACACCCTGCC CCCATCCCGC GATGAGCTGA CCAAGAACCA GGTCAGCCTG
8521 ACCTGCCTGG TCAAAGGCTT CTATCCCAGC GACATCGCCG TGGAGTGGGA
GAGCAATGGG 8581 CAGCCGGAGA ACAACTACAA GACCACGCCT CCCGTGTTGG
ACTCCGACGG CTCCTTCTTC 8641 CTCTACAGCA AGCTCACCGT GGACAAGAGC
AGGTGGCAGC AGGGGAACGT CTTCTCATGC 8701 TCCGTGATGC ATGAGGCTCT
GCACAACCAC TACACGCAGA AGAGCCTCTC CCTGTCTCCG 8761 GGTAAA B. Full
Length FVIIIFc (i) Full Length FVIIIFc DNA Sequence (FVIII signal
peptide underlined, Fc region in bold) (SEQ ID NO: 5, which encodes
SEQ ID NO: 6) 661 ATG CAAATAGAGC TCTCCACCTG 721 CTTCTTTCTG
TGCCTTTTGC GATTCTGCTT TAGTGCCACC AGAAGATACT ACCTGGGTGC 781
AGTGGAACTG TCATGGGACT ATATGCAAAG TGATCTCGGT GAGCTGCCTG TGGACGCAAG
841 ATTTCCTCCT AGAGTGCCAA AATCTTTTCC ATTCAACACC TCAGTCGTGT
ACAAAAAGAC 901 TCTGTTTGTA GAATTCACGG ATCACCTTTT CAACATCGCT
AAGCCAAGGC CACCCTGGAT 961 GGGTCTGCTA GGTCCTACCA TCCAGGCTGA
GGTTTATGAT ACAGTGGTCA TTACACTTAA 1021 GAACATGGCT TCCCATCCTG
TCAGTCTTCA TGCTGTTGGT GTATCCTACT GGAAAGCTTC 1081 TGAGGGAGCT
GAATATGATG ATCAGACCAG TCAAAGGGAG AAAGAAGATG ATAAAGTCTT 1141
CCCTGGTGGA AGCCATACAT ATGTCTGGCA GGTCCTGAAA GAGAATGGTC CAATGGCCTC
1201 TGACCCACTG TGCCTTACCT ACTCATATCT TTCTCATGTG GACCTGGTAA
AAGACTTGAA 1261 TTCAGGCCTC ATTGGAGCCC TACTAGTATG TAGAGAAGGG
AGTCTGGCCA AGGAAAAGAC 1321 ACAGACCTTG CACAAATTTA TACTACTTTT
TGCTGTATTT GATGAAGGGA AAAGTTGGCA 1381 CTCAGAAACA AAGAACTCCT
TGATGCAGGA TAGGGATGCT GCATCTGCTC GGGCCTGGCC 1441 TAAAATGCAC
ACAGTCAATG GTTATGTAAA CAGGTCTCTG CCAGGTCTGA TTGGATGCCA 1501
CAGGAAATCA GTCTATTGGC ATGTGATTGG AATGGGCACC ACTCCTGAAG TGCACTCAAT
1561 ATTCCTCGAA GGTCACACAT TTCTTGTGAG GAACCATCGC CAGGCGTCCT
TGGAAATCTC 1621 GCCAATAACT TTCCTTACTG CTCAAACACT CTTGATGGAC
CTTGGACAGT TTCTACTGTT 1681 TTGTCATATC TCTTCCCACC AACATGATGG
CATGGAAGCT TATGTCAAAG TAGACAGCTG 1741 TCCAGAGGAA CCCCAACTAC
GAATGAAAAA TAATGAAGAA GCGGAAGACT ATGATGATGA
1801 TCTTACTGAT TCTGAAATGG ATGTGGTCAG GTTTGATGAT GACAACTCTC
CTTCCTTTAT 1861 CCAAATTCGC TCAGTTGCCA AGAAGCATCC TAAAACTTGG
GTACATTACA TTGCTGCTGA 1921 AGAGGAGGAC TGGGACTATG CTCCCTTAGT
CCTCGCCCCC GATGACAGAA GTTATAAAAG 1981 TCAATATTTG AACAATGGCC
CTCAGCGGAT TGGTAGGAAG TACAAAAAAG TCCGATTTAT 2041 GGCATACACA
GATGAAACCT TTAAGACTCG TGAAGCTATT CAGCATGAAT CAGGAATCTT 2101
GGGACCTTTA CTTTATGGGG AAGTTGGAGA CACACTGTTG ATTATATTTA AGAATCAAGC
2161 AAGCAGACCA TATAACATCT ACCCTCACGG AATCACTGAT GTCCGTCCTT
TGTATTCAAG 2221 GAGATTACCA AAAGGTGTAA AACATTTGAA GGATTTTCCA
ATTCTGCCAG GAGAAATATT 2281 CAAATATAAA TGGACAGTGA CTGTAGAAGA
TGGGCCAACT AAATCAGATC CTCGGTGCCT 2341 GACCCGCTAT TACTCTAGTT
TCGTTAATAT GGAGAGAGAT CTAGCTTCAG GACTCATTGG 2401 CCCTCTCCTC
ATCTGCTACA AAGAATCTGT AGATCAAAGA GGAAACCAGA TAATGTCAGA 2461
CAAGAGGAAT GTCATCCTGT TTTCTGTATT TGATGAGAAC CGAAGCTGGT ACCTCACAGA
2521 GAATATACAA CGCTTTCTCC CCAATCCAGC TGGAGTGCAG CTTGAGGATC
CAGAGTTCCA 2581 AGCCTCCAAC ATCATGCACA GCATCAATGG CTATGTTTTT
GATAGTTTGC AGTTGTCAGT 2641 TTGTTTGCAT GAGGTGGCAT ACTGGTACAT
TCTAAGCATT GGAGCACAGA CTGACTTCCT 2701 TTCTGTCTTC TTCTCTGGAT
ATACCTTCAA ACACAAAATG GTCTATGAAG ACACACTCAC 2761 CCTATTCCCA
TTCTCAGGAG AAACTGTCTT CATGTCGATG GAAAACCCAG GTCTATGGAT 2821
TCTGGGGTGC CACAACTCAG ACTTTCGGAA CAGAGGCATG ACCGCCTTAC TGAAGGTTTC
2881 TAGTTGTGAC AAGAACACTG GTGATTATTA CGAGGACAGT TATGAAGATA
TTTCAGCATA 2941 CTTGCTGAGT AAAAACAATG CCATTGAACC AAGAAGCTTC
TCCCAGAATT CAAGACACCC 3001 TAGCACTAGG CAAAAGCAAT TTAATGCCAC
CACAATTCCA GAAAATGACA TAGAGAAGAC 3061 TGACCCTTGG TTTGCACACA
GAACACCTAT GCCTAAAATA CAAAATGTCT CCTCTAGTGA 3121 TTTGTTGATG
CTCTTGCGAC AGAGTCCTAC TCCACATGGG CTATCCTTAT CTGATCTCCA 3181
AGAAGCCAAA TATGAGACTT TTTCTGATGA TCCATCACCT GGAGCAATAG ACAGTAATAA
3241 CAGCCTGTCT GAAATGACAC ACTTCAGGCC ACAGCTCCAT CACAGTGGGG
ACATGGTATT 3301 TACCCCTGAG TCAGGCCTCC AATTAAGATT AAATGAGAAA
CTGGGGACAA CTGCAGCAAC 3361 AGAGTTGAAG AAACTTGATT TCAAAGTTTC
TAGTACATCA AATAATCTGA TTTCAACAAT 3421 TCCATCAGAC AATTTGGCAG
CAGGTACTGA TAATACAAGT TCCTTAGGAC CCCCAAGTAT 3481 GCCAGTTCAT
TATGATAGTC AATTAGATAC CACTCTATTT GGCAAAAAGT CATCTCCCCT 3541
TACTGAGTCT GGTGGACCTC TGAGCTTGAG TGAAGAAAAT AATGATTCAA AGTTGTTAGA
3601 ATCAGGTTTA ATGAATAGCC AAGAAAGTTC ATGGGGAAAA AATGTATCGT
CAACAGAGAG 3661 TGGTAGGTTA TTTAAAGGGA AAAGAGCTCA TGGACCTGCT
TTGTTGACTA AAGATAATGC 3721 CTTATTCAAA GTTAGCATCT CTTTGTTAAA
GACAAACAAA ACTTCCAATA ATTCAGCAAC 3781 TAATAGAAAG ACTCACATTG
ATGGCCCATC ATTATTAATT GAGAATAGTC CATCAGTCTG 3841 GCAAAATATA
TTAGAAAGTG ACACTGAGTT TAAAAAAGTG ACACCTTTGA TTCATGACAG 3901
AATGCTTATG GACAAAAATG CTACAGCTTT GAGGCTAAAT CATATGTCAA ATAAAACTAC
3961 TTCATCAAAA AACATGGAAA TGGTCCAACA GAAAAAAGAG GGCCCCATTC
CACCAGATGC 4021 ACAAAATCCA GATATGTCGT TCTTTAAGAT GCTATTCTTG
CCAGAATCAG CAAGGTGGAT 4081 ACAAAGGACT CATGGAAAGA ACTCTCTGAA
CTCTGGGCAA GGCCCCAGTC CAAAGCAATT 4141 AGTATCCTTA GGACCAGAAA
AATCTGTGGA AGGTCAGAAT TTCTTGTCTG AGAAAAACAA 4201 AGTGGTAGTA
GGAAAGGGTG AATTTACAAA GGACGTAGGA CTCAAAGAGA TGGTTTTTCC 4261
AAGCAGCAGA AACCTATTTC TTACTAACTT GGATAATTTA CATGAAAATA ATACACACAA
4321 TCAAGAAAAA AAAATTCAGG AAGAAATAGA AAAGAAGGAA ACATTAATCC
AAGAGAATGT 4381 AGTTTTGCCT CAGATACATA CAGTGACTGG CACTAAGAAT
TTCATGAAGA ACCTTTTCTT 4441 ACTGAGCACT AGGCAAAATG TAGAAGGTTC
ATATGACGGG GCATATGCTC CAGTACTTCA 4501 AGATTTTAGG TCATTAAATG
ATTCAACAAA TAGAACAAAG AAACACACAG CTCATTTCTC 4561 AAAAAAAGGG
GAGGAAGAAA ACTTGGAAGG CTTGGGAAAT CAAACCAAGC AAATTGTAGA 4621
GAAATATGCA TGCACCACAA GGATATCTCC TAATACAAGC CAGCAGAATT TTGTCACGCA
4681 ACGTAGTAAG AGAGCTTTGA AACAATTCAG ACTCCCACTA GAAGAAACAG
AACTTGAAAA 4741 AAGGATAATT GTGGATGACA CCTCAACCCA GTGGTCCAAA
AACATGAAAC ATTTGACCCC 4801 GAGCACCCTC ACACAGATAG ACTACAATGA
GAAGGAGAAA GGGGCCATTA CTCAGTCTCC 4861 CTTATCAGAT TGCCTTACGA
GGAGTCATAG CATCCCTCAA GCAAATAGAT CTCCATTACC 4921 CATTGCAAAG
GTATCATCAT TTCCATCTAT TAGACCTATA TATCTGACCA GGGTCCTATT 4981
CCAAGACAAC TCTTCTCATC TTCCAGCAGC ATCTTATAGA AAGAAAGATT CTGGGGTCCA
5041 AGAAAGCAGT CATTTCTTAC AAGGAGCCAA AAAAAATAAC CTTTCTTTAG
CCATTCTAAC 5101 CTTGGAGATG ACTGGTGATC AAAGAGAGGT TGGCTCCCTG
GGGACAAGTG CCACAAATTC 5161 AGTCACATAC AAGAAAGTTG AGAACACTGT
TCTCCCGAAA CCAGACTTGC CCAAAACATC 5221 TGGCAAAGTT GAATTGCTTC
CAAAAGTTCA CATTTATCAG AAGGACCTAT TCCCTACGGA 5281 AACTAGCAAT
GGGTCTCCTG GCCATCTGGA TCTCGTGGAA GGGAGCCTTC TTCAGGGAAC 5341
AGAGGGAGCG ATTAAGTGGA ATGAAGCAAA CAGACCTGGA AAAGTTCCCT TTCTGAGAGT
5401 AGCAACAGAA AGCTCTGCAA AGACTCCCTC CAAGCTATTG GATCCTCTTG
CTTGGGATAA 5461 CCACTATGGT ACTCAGATAC CAAAAGAAGA GTGGAAATCC
CAAGAGAAGT CACCAGAAAA 5521 AACAGCTTTT AAGAAAAAGG ATACCATTTT
GTCCCTGAAC GCTTGTGAAA GCAATCATGC 5581 AATAGCAGCA ATAAATGAGG
GACAAAATAA GCCCGAAATA GAAGTCACCT GGGCAAAGCA 5641 AGGTAGGACT
GAAAGGCTGT GCTCTCAAAA CCCACCAGTC TTGAAACGCC ATCAACGGGA 5701
AATAACTCGT ACTACTCTTC AGTCAGATCA AGAGGAAATT GACTATGATG ATACCATATC
5761 AGTTGAAATG AAGAAGGAAG ATTTTGACAT TTATGATGAG GATGAAAATC
AGAGCCCCCG 5821 CAGCTTTCAA AAGAAAACAC GACACTATTT TATTGCTGCA
GTGGAGAGGC TCTGGGATTA 5881 TGGGATGAGT AGCTCCCCAC ATGTTCTAAG
AAACAGGGCT CAGAGTGGCA GTGTCCCTCA 5941 GTTCAAGAAA GTTGTTTTCC
AGGAATTTAC TGATGGCTCC TTTACTCAGC CCTTATACCG 6001 TGGAGAACTA
AATGAACATT TGGGACTCCT GGGGCCATAT ATAAGAGCAG AAGTTGAAGA 6061
TAATATCATG GTAACTTTCA GAAATCAGGC CTCTCGTCCC TATTCCTTCT ATTCTAGCCT
6121 TATTTCTTAT GAGGAAGATC AGAGGCAAGG AGCAGAACCT AGAAAAAACT
TTGTCAAGCC 6181 TAATGAAACC AAAACTTACT TTTGGAAAGT GCAACATCAT
ATGGCACCCA CTAAAGATGA 6241 GTTTGACTGC AAAGCCTGGG CTTATTTCTC
TGATGTTGAC CTGGAAAAAG ATGTGCACTC 6301 AGGCCTGATT GGACCCCTTC
TGGTCTGCCA CACTAACACA CTGAACCCTG CTCATGGGAG 6361 ACAAGTGACA
GTACAGGAAT TTGCTCTGTT TTTCACCATC TTTGATGAGA CCAAAAGCTG 6421
GTACTTCACT GAAAATATGG AAAGAAACTG CAGGGCTCCC TGCAATATCC AGATGGAAGA
6481 TCCCACTTTT AAAGAGAATT ATCGCTTCCA TGCAATCAAT GGCTACATAA
TGGATACACT 6541 ACCTGGCTTA GTAATGGCTC AGGATCAAAG GATTCGATGG
TATCTGCTCA GCATGGGCAG 6601 CAATGAAAAC ATCCATTCTA TTCATTTCAG
TGGACATGTG TTCACTGTAC GAAAAAAAGA 6661 GGAGTATAAA ATGGCACTGT
ACAATCTCTA TCCAGGTGTT TTTGAGACAG TGGAAATGTT 6721 ACCATCCAAA
GCTGGAATTT GGCGGGTGGA ATGCCTTATT GGCGAGCATC TACATGCTGG 6781
GATGAGCACA CTTTTTCTGG TGTACAGCAA TAAGTGTCAG ACTCCCCTGG GAATGGCTTC
6841 TGGACACATT AGAGATTTTC AGATTACAGC TTCAGGACAA TATGGACAGT
GGGCCCCAAA 6901 GCTGGCCAGA CTTCATTATT CCGGATCAAT CAATGCCTGG
AGCACCAAGG AGCCCTTTTC 6961 TTGGATCAAG GTGGATCTGT TGGCACCAAT
GATTATTCAC GGCATCAAGA CCCAGGGTGC 7021 CCGTCAGAAG TTCTCCAGCC
TCTACATCTC TCAGTTTATC ATCATGTATA GTCTTGATGG 7081 GAAGAAGTGG
CAGACTTATC GAGGAAATTC CACTGGAACC TTAATGGTCT TCTTTGGCAA 7141
TGTGGATTCA TCTGGGATAA AACACAATAT TTTTAACCCT CCAATTATTG CTCGATACAT
7201 CCGTTTGCAC CCAACTCATT ATAGCATTCG CAGCACTCTT CGCATGGAGT
TGATGGGCTG 7261 TGATTTAAAT AGTTGCAGCA TGCCATTGGG AATGGAGAGT
AAAGCAATAT CAGATGCACA 7321 GATTACTGCT TCATCCTACT TTACCAATAT
GTTTGCCACC TGGTCTCCTT CAAAAGCTCG 7381 ACTTCACCTC CAAGGGAGGA
GTAATGCCTG GAGACCTCAG GTGAATAATC CAAAAGAGTG 7441 GCTGCAAGTG
GACTTCCAGA AGACAATGAA AGTCACAGGA GTAACTACTC AGGGAGTAAA 7501
ATCTCTGCTT ACCAGCATGT ATGTGAAGGA GTTCCTCATC TCCAGCAGTC AAGATGGCCA
7561 TCAGTGGACT CTCTTTTTTC AGAATGGCAA AGTAAAGGTT TTTCAGGGAA
ATCAAGACTC 7621 CTTCACACCT GTGGTGAACT CTCTAGACCC ACCGTTACTG
ACTCGCTACC TTCGAATTCA 7681 CCCCCAGAGT TGGGTGCACC AGATTGCCCT
GAGGATGGAG GTTCTGGGCT GCGAGGCACA 7741 GGACCTCTAC GACAAAACTC
ACACATGCCC ACCGTGCCCA GCTCCAGAAC TCCTGGGCGG 7801 ACCGTCAGTC
TTCCTCTTCC CCCCAAAACC CAAGGACACC CTCATGATCT CCCGGACCCC 7861
TGAGGTCACA TGCGTGGTGG TGGACGTGAG CCACGAAGAC CCTGAGGTCA AGTTCAACTG
7921 GTACGTGGAC GGCGTGGAGG TGCATAATGC CAAGACAAAG CCGCGGGAGG
AGCAGTACAA 7981 CAGCACGTAC CGTGTGGTCA GCGTCCTCAC CGTCCTGCAC
CAGGACTGGC TGAATGGCAA 8041 GGAGTACAAG TGCAAGGTCT CCAACAAAGC
CCTCCCAGCC CCCATCGAGA AAACCATCTC 8101 CAAAGCCAAA GGGCAGCCCC
GAGAACCACA GGTGTACACC CTGCCCCCAT CCCGGGATGA 8161 GCTGACCAAG
AACCAGGTCA GCCTGACCTG CCTGGTCAAA GGCTTCTATC CCAGCGACAT 8221
CGCCGTGGAG TGGGAGAGCA ATGGGCAGCC GGAGAACAAC TACAAGACCA CGCCTCCCGT
8281 GTTGGACTCC GACGGCTCCT TCTTCCTCTA CAGCAAGCTC ACCGTGGACA
AGAGCAGGTG 8341 GCAGCAGGGG AACGTCTTCT CATGCTCCGT GATGCATGAG
GCTCTGCACA ACCACTACAC 8401 GCAGAAGAGC CTCTCCCTGT CTCCGGGTAA A (ii)
Fc (same sequence as A (ii) (SEQ ID NO: 3))] C. (i) Heavy Chain
(HC)-Fc DNA sequence (no linker between HC and Fc) (signal peptide
underlined, Fc region in bold) (SEQ ID NO: 7, which encodes SEQ ID
NO: 8) 1 ATGCAAATAG AGCTCTCCAC CTGCTTCTTT CTGTGCCTTT TGCGATTCTG
CTTTAGTGCC 61 ACCAGAAGAT ACTACCTGGG TGCAGTGGAA CTGTCATGGG
ACTATATGCA AAGTGATCTC 121 GGTGAGCTGC CTGTGGACGC AAGATTTCCT
CCTAGAGTGC CAAAATCTTT TCCATTCAAC 181 ACCTCAGTCG TGTACAAAAA
GACTCTGTTT GTAGAATTCA CGGATCACCT TTTCAACATC 241 GCTAAGCCAA
GGCCACCCTG GATGGGTCTG CTAGGTCCTA CCATCCAGGC TGAGGTTTAT 301
GATACAGTGG TCATTACACT TAAGAACATG GCTTCCCATC CTGTCAGTCT TCATGCTGTT
361 GGTGTATCCT ACTGGAAAGC TTCTGAGGGA GCTGAATATG ATGATCAGAC
CAGTCAAAGG 421 GAGAAAGAAG ATGATAAAGT CTTCCCTGGT GGAAGCCATA
CATATGTCTG GCAGGTCCTG 481 AAAGAGAATG GTCCAATGGC CTCTGACCCA
CTGTGCCTTA CCTACTCATA TCTTTCTCAT 541 GTGGACCTGG TAAAAGACTT
GAATTCAGGC CTCATTGGAG CCCTACTAGT ATGTAGAGAA 601 GGGAGTCTGG
CCAAGGAAAA GACACAGACC TTGCACAAAT TTATACTACT TTTTGCTGTA
661 TTTGATGAAG GGAAAAGTTG GCACTCAGAA ACAAAGAACT CCTTGATGCA
GGATAGGGAT 721 GCTGCATCTG CTCGGGCCTG GCCTAAAATG CACACAGTCA
ATGGTTATGT AAACAGGTCT 781 CTGCCAGGTC TGATTGGATG CCACAGGAAA
TCAGTCTATT GGCATGTGAT TGGAATGGGC 841 ACCACTCCTG AAGTGCACTC
AATATTCCTC GAAGGTCACA CATTTCTTGT GAGGAACCAT 901 CGCCAGGCGT
CCTTGGAAAT CTCGCCAATA ACTTTCCTTA CTGCTCAAAC ACTCTTGATG 961
GACCTTGGAC AGTTTCTACT GTTTTGTCAT ATCTCTTCCC ACCAACATGA TGGCATGGAA
1021 GCTTATGTCA AAGTAGACAG CTGTCCAGAG GAACCCCAAC TACGAATGAA
AAATAATGAA 1081 GAAGCGGAAG ACTATGATGA TGATCTTACT GATTCTGAAA
TGGATGTGGT CAGGTTTGAT 1141 GATGACAACT CTCCTTCCTT TATCCAAATT
CGCTCAGTTG CCAAGAAGCA TCCTAAAACT 1201 TGGGTACATT ACATTGCTGC
TGAAGAGGAG GACTGGGACT ATGCTCCCTT AGTCCTCGCC 1261 CCCGATGACA
GAAGTTATAA AAGTCAATAT TTGAACAATG GCCCTCAGCG GATTGGTAGG 1321
AAGTACAAAA AAGTCCGATT TATGGCATAC ACAGATGAAA CCTTTAAGAC TCGTGAAGCT
1381 ATTCAGCATG AATCAGGAAT CTTGGGACCT TTACTTTATG GGGAAGTTGG
AGACACACTG 1441 TTGATTATAT TTAAGAATCA AGCAAGCAGA CCATATAACA
TCTACCCTCA CGGAATCACT 1501 GATGTCCGTC CTTTGTATTC AAGGAGATTA
CCAAAAGGTG TAAAACATTT GAAGGATTTT 1561 CCAATTCTGC CAGGAGAAAT
ATTCAAATAT AAATGGACAG TGACTGTAGA AGATGGGCCA 1621 ACTAAATCAG
ATCCTCGGTG CCTGACCCGC TATTACTCTA GTTTCGTTAA TATGGAGAGA 1681
GATCTAGCTT CAGGACTCAT TGGCCCTCTC CTCATCTGCT ACAAAGAATC TGTAGATCAA
1741 AGAGGAAACC AGATAATGTC AGACAAGAGG AATGTCATCC TGTTTTCTGT
ATTTGATGAG 1801 AACCGAAGCT GGTACCTCAC AGAGAATATA CAACGCTTTC
TCCCCAATCC AGCTGGAGTG 1861 CAGCTTGAGG ATCCAGAGTT CCAAGCCTCC
AACATCATGC ACAGCATCAA TGGCTATGTT 1921 TTTGATAGTT TGCAGTTGTC
AGTTTGTTTG CATGAGGTGG CATACTGGTA CATTCTAAGC 1981 ATTGGAGCAC
AGACTGACTT CCTTTCTGTC TTCTTCTCTG GATATACCTT CAAACACAAA 2041
ATGGTCTATG AAGACACACT CACCCTATTC CCATTCTCAG GAGAAACTGT CTTCATGTCG
2101 ATGGAAAACC CAGGTCTATG GATTCTGGGG TGCCACAACT CAGACTTTCG
GAACAGAGGC 2161 ATGACCGCCT TACTGAAGGT TTCTAGTTGT GACAAGAACA
CTGGTGATTA TTACGAGGAC 2221 AGTTATGAAG ATATTTCAGC ATACTTGCTG
AGTAAAAACA ATGCCATTGA ACCAAGAGAC 2281 AAAACTCACA CATGCCCACC
GTGCCCAGCT CCAGAACTCC TGGGCGGACC GTCAGTCTTC 2341 CTCTTCCCCC
CAAAACCCAA GGACACCCTC ATGATCTCCC GGACCCCTGA GGTCACATGC 2401
GTGGTGGTGG ACGTGAGCCA CGAAGACCCT GAGGTCAAGT TCAACTGGTA CGTGGACGGC
2461 GTGGAGGTGC ATAATGCCAA GACAAAGCCG CGGGAGGAGC AGTACAACAG
CACGTACCGT 2521 GTGGTCAGCG TCCTCACCGT CCTGCACCAG GACTGGCTGA
ATGGCAAGGA GTACAAGTGC 2581 AAGGTCTCCA ACAAAGCCCT CCCAGCCCCC
ATCGAGAAAA CCATCTCCAA AGCCAAAGGG 2641 CAGCCCCGAG AACCACAGGT
GTACACCCTG CCCCCATCCC GGGATGAGCT GACCAAGAAC 2701 CAGGTCAGCC
TGACCTGCCT GGTCAAAGGC TTCTATCCCA GCGACATCGC CGTGGAGTGG 2761
GAGAGCAATG GGCAGCCGGA GAACAACTAC AAGACCACGC CTCCCGTGTT GGACTCCGAC
2821 GGCTCCTTCT TCCTCTACAG CAAGCTCACC GTGGACAAGA GCAGGTGGCA
GCAGGGGAAC 2881 GTCTTCTCAT GCTCCGTGAT GCATGAGGCT CTGCACAACC
ACTACACGCA GAAGAGCCTC 2941 TCCCTGTCTC CGGGTAAA C. (ii) Heavy Chain
(HC)-Fc DNA sequence (5 amino acid linker between HC and Fc)
(signal peptide underlined, Fc region in bold, 5 amino acid linker
is double- underlined) (SEQ ID NO: 9, which encodes SEQ ID NO: 10)
1 ATGCAAATAG AGCTCTCCAC CTGCTTCTTT CTGTGCCTTT TGCGATTCTG CTTTAGTGCC
61 ACCAGAAGAT ACTACCTGGG TGCAGTGGAA CTGTCATGGG ACTATATGCA
AAGTGATCTC 121 GGTGAGCTGC CTGTGGACGC AAGATTTCCT CCTAGAGTGC
CAAAATCTTT TCCATTCAAC 181 ACCTCAGTCG TGTACAAAAA GACTCTGTTT
GTAGAATTCA CGGATCACCT TTTCAACATC 241 GCTAAGCCAA GGCCACCCTG
GATGGGTCTG CTAGGTCCTA CCATCCAGGC TGAGGTTTAT 301 GATACAGTGG
TCATTACACT TAAGAACATG GCTTCCCATC CTGTCAGTCT TCATGCTGTT 361
GGTGTATCCT ACTGGAAAGC TTCTGAGGGA GCTGAATATG ATGATCAGAC CAGTCAAAGG
421 GAGAAAGAAG ATGATAAAGT CTTCCCTGGT GGAAGCCATA CATATGTCTG
GCAGGTCCTG 481 AAAGAGAATG GTCCAATGGC CTCTGACCCA CTGTGCCTTA
CCTACTCATA TCTTTCTCAT 541 GTGGACCTGG TAAAAGACTT GAATTCAGGC
CTCATTGGAG CCCTACTAGT ATGTAGAGAA 601 GGGAGTCTGG CCAAGGAAAA
GACACAGACC TTGCACAAAT TTATACTACT TTTTGCTGTA 661 TTTGATGAAG
GGAAAAGTTG GCACTCAGAA ACAAAGAACT CCTTGATGCA GGATAGGGAT 721
GCTGCATCTG CTCGGGCCTG GCCTAAAATG CACACAGTCA ATGGTTATGT AAACAGGTCT
781 CTGCCAGGTC TGATTGGATG CCACAGGAAA TCAGTCTATT GGCATGTGAT
TGGAATGGGC 841 ACCACTCCTG AAGTGCACTC AATATTCCTC GAAGGTCACA
CATTTCTTGT GAGGAACCAT 901 CGCCAGGCGT CCTTGGAAAT CTCGCCAATA
ACTTTCCTTA CTGCTCAAAC ACTCTTGATG 961 GACCTTGGAC AGTTTCTACT
GTTTTGTCAT ATCTCTTCCC ACCAACATGA TGGCATGGAA 1021 GCTTATGTCA
AAGTAGACAG CTGTCCAGAG GAACCCCAAC TACGAATGAA AAATAATGAA 1081
GAAGCGGAAG ACTATGATGA TGATCTTACT GATTCTGAAA TGGATGTGGT CAGGTTTGAT
1141 GATGACAACT CTCCTTCCTT TATCCAAATT CGCTCAGTTG CCAAGAAGCA
TCCTAAAACT 1201 TGGGTACATT ACATTGCTGC TGAAGAGGAG GACTGGGACT
ATGCTCCCTT AGTCCTCGCC 1261 CCCGATGACA GAAGTTATAA AAGTCAATAT
TTGAACAATG GCCCTCAGCG GATTGGTAGG 1321 AAGTACAAAA AAGTCCGATT
TATGGCATAC ACAGATGAAA CCTTTAAGAC TCGTGAAGCT 1381 ATTCAGCATG
AATCAGGAAT CTTGGGACCT TTACTTTATG GGGAAGTTGG AGACACACTG 1441
TTGATTATAT TTAAGAATCA AGCAAGCAGA CCATATAACA TCTACCCTCA CGGAATCACT
1501 GATGTCCGTC CTTTGTATTC AAGGAGATTA CCAAAAGGTG TAAAACATTT
GAAGGATTTT 1561 CCAATTCTGC CAGGAGAAAT ATTCAAATAT AAATGGACAG
TGACTGTAGA AGATGGGCCA 1621 ACTAAATCAG ATCCTCGGTG CCTGACCCGC
TATTACTCTA GTTTCGTTAA TATGGAGAGA 1681 GATCTAGCTT CAGGACTCAT
TGGCCCTCTC CTCATCTGCT ACAAAGAATC TGTAGATCAA 1741 AGAGGAAACC
AGATAATGTC AGACAAGAGG AATGTCATCC TGTTTTCTGT ATTTGATGAG 1801
AACCGAAGCT GGTACCTCAC AGAGAATATA CAACGCTTTC TCCCCAATCC AGCTGGAGTG
1861 CAGCTTGAGG ATCCAGAGTT CCAAGCCTCC AACATCATGC ACAGCATCAA
TGGCTATGTT 1921 TTTGATAGTT TGCAGTTGTC AGTTTGTTTG CATGAGGTGG
CATACTGGTA CATTCTAAGC 1981 ATTGGAGCAC AGACTGACTT CCTTTCTGTC
TTCTTCTCTG GATATACCTT CAAACACAAA 2041 ATGGTCTATG AAGACACACT
CACCCTATTC CCATTCTCAG GAGAAACTGT CTTCATGTCG 2101 ATGGAAAACC
CAGGTCTATG GATTCTGGGG TGCCACAACT CAGACTTTCG GAACAGAGGC 2161
ATGACCGCCT TACTGAAGGT TTCTAGTTGT GACAAGAACA CTGGTGATTA TTACGAGGAC
2221 AGTTATGAAG ATATTTCAGC ATACTTGCTG AGTAAAAACA ATGCCATTGA ACCAAGA
2281 GACAAAAC TCACACATGC CCACCGTGCC CAGCTCCAGA ACTCCTGGGC 2341
GGACCGTCAG TCTTCCTCTT CCCCCCAAAA CCCAAGGACA CCCTCATGAT CTCCCGGACC
2401 CCTGAGGTCA CATGCGTGGT GGTGGACGTG AGCCACGAAG ACCCTGAGGT
CAAGTTCAAC 2461 TGGTACGTGG ACGGCGTGGA GGTGCATAAT GCCAAGACAA
AGCCGCGGGA GGAGCAGTAC 2521 AACAGCACGT ACCGTGTGGT CAGCGTCCTC
ACCGTCCTGC ACCAGGACTG GCTGAATGGC 2581 AAGGAGTACA AGTGCAAGGT
CTCCAACAAA GCCCTCCCAG CCCCCATCGA GAAAACCATC 2641 TCCAAAGCCA
AAGGGCAGCC CCGAGAACCA CAGGTGTACA CCCTGCCCCC ATCCCGGGAT 2701
GAGCTGACCA AGAACCAGGT CAGCCTGACC TGCCTGGTCA AAGGCTTCTA TCCCAGCGAC
2761 ATCGCCGTGG AGTGGGAGAG CAATGGGCAG CCGGAGAACA ACTACAAGAC
CACGCCTCCC 2821 GTGTTGGACT CCGACGGCTC CTTCTTCCTC TACAGCAAGC
TCACCGTGGA CAAGAGCAGG 2881 TGGCAGCAGG GGAACGTCTT CTCATGCTCC
GTGATGCATG AGGCTCTGCA CAACCACTAC 2941 ACGCAGAAGA GCCTCTCCCT
GTCTCCGGGT AAA C. (iii) Light Chain (LC)-Fc DNA sequence (signal
peptide underlined, Fc region in bold) (SEQ ID NO: 11, which
encodes SEQ ID NO: 12) 1 ATGGAGACAG ACACACTCCT GCTATGGGTA
CTGCTGCTCT GGGTTCCAGG TTCCACTGGT 61 GAAATAACTC GTACTACTCT
TCAGTCAGAT CAAGAGGAAA TTGACTATGA TGATACCATA 121 TCAGTTGAAA
TGAAGAAGGA AGATTTTGAC ATTTATGATG AGGATGAAAA TCAGAGCCCC 181
CGCAGCTTTC AAAAGAAAAC ACGACACTAT TTTATTGCTG CAGTGGAGAG GCTCTGGGAT
241 TATGGGATGA GTAGCTCCCC ACATGTTCTA AGAAACAGGG CTCAGAGTGG
CAGTGTCCCT 301 CAGTTCAAGA AAGTTGTTTT CCAGGAATTT ACTGATGGCT
CCTTTACTCA GCCCTTATAC 361 CGTGGAGAAC TAAATGAACA TTTGGGACTC
CTGGGGCCAT ATATAAGAGC AGAAGTTGAA 421 GATAATATCA TGGTAACTTT
CAGAAATCAG GCCTCTCGTC CCTATTCCTT CTATTCTAGC 481 CTTATTTCTT
ATGAGGAAGA TCAGAGGCAA GGAGCAGAAC CTAGAAAAAA CTTTGTCAAG 541
CCTAATGAAA CCAAAACTTA CTTTTGGAAA GTGCAACATC ATATGGCACC CACTAAAGAT
601 GAGTTTGACT GCAAAGCCTG GGCTTATTTC TCTGATGTTG ACCTGGAAAA
AGATGTGCAC 661 TCAGGCCTGA TTGGACCCCT TCTGGTCTGC CACACTAACA
CACTGAACCC TGCTCATGGG 721 AGACAAGTGA CAGTACAGGA ATTTGCTCTG
TTTTTCACCA TCTTTGATGA GACCAAAAGC 781 TGGTACTTCA CTGAAAATAT
GGAAAGAAAC TGCAGGGCTC CCTGCAATAT CCAGATGGAA 841 GATCCCACTT
TTAAAGAGAA TTATCGCTTC CATGCAATCA ATGGCTACAT AATGGATACA 901
CTACCTGGCT TAGTAATGGC TCAGGATCAA AGGATTCGAT GGTATCTGCT CAGCATGGGC
961 AGCAATGAAA ACATCCATTC TATTCATTTC AGTGGACATG TGTTCACTGT
ACGAAAAAAA 1021 GAGGAGTATA AAATGGCACT GTACAATCTC TATCCAGGTG
TTTTTGAGAC AGTGGAAATG 1081 TTACCATCCA AAGCTGGAAT TTGGCGGGTG
GAATGCCTTA TTGGCGAGCA TCTACATGCT 1141 GGGATGAGCA CACTTTTTCT
GGTGTACAGC AATAAGTGTC AGACTCCCCT GGGAATGGCT 1201 TCTGGACACA
TTAGAGATTT TCAGATTACA GCTTCAGGAC AATATGGACA GTGGGCCCCA 1261
AAGCTGGCCA GACTTCATTA TTCCGGATCA ATCAATGCCT GGAGCACCAA GGAGCCCTTT
1321 TCTTGGATCA AGGTGGATCT GTTGGCACCA ATGATTATTC ACGGCATCAA
GACCCAGGGT 1381 GCCCGTCAGA AGTTCTCCAG CCTCTACATC TCTCAGTTTA
TCATCATGTA TAGTCTTGAT 1441 GGGAAGAAGT GGCAGACTTA TCGAGGAAAT
TCCACTGGAA CCTTAATGGT CTTCTTTGGC 1501 AATGTGGATT CATCTGGGAT
AAAACACAAT ATTTTTAACC CTCCAATTAT TGCTCGATAC 1561 ATCCGTTTGC
ACCCAACTCA TTATAGCATT CGCAGCACTC TTCGCATGGA GTTGATGGGC 1621
TGTGATTTAA ATAGTTGCAG CATGCCATTG GGAATGGAGA GTAAAGCAAT ATCAGATGCA
1681 CAGATTACTG CTTCATCCTA CTTTACCAAT ATGTTTGCCA CCTGGTCTCC
TTCAAAAGCT 1741 CGACTTCACC TCCAAGGGAG GAGTAATGCC TGGAGACCTC
AGGTGAATAA TCCAAAAGAG 1801 TGGCTGCAAG TGGACTTCCA GAAGACAATG
AAAGTCACAG GAGTAACTAC TCAGGGAGTA 1861 AAATCTCTGC TTACCAGCAT
GTATGTGAAG GAGTTCCTCA TCTCCAGCAG TCAAGATGGC
1921 CATCAGTGGA CTCTCTTTTT TCAGAATGGC AAAGTAAAGG TTTTTCAGGG
AAATCAAGAC 1981 TCCTTCACAC CTGTGGTGAA CTCTCTAGAC CCACCGTTAC
TGACTCGCTA CCTTCGAATT 2041 CACCCCCAGA GTTGGGTGCA CCAGATTGCC
CTGAGGATGG AGGTTCTGGG CTGCGAGGCA 2101 CAGGACCTCT ACGACAAAAC
TCACACATGC CCACCGTGCC CAGCTCCAGA ACTCCTGGGC 2161 GGACCGTCAG
TCTTCCTCTT CCCCCCAAAA CCCAAGGACA CCCTCATGAT CTCCCGGACC 2221
CCTGAGGTCA CATGCGTGGT GGTGGACGTG AGCCACGAAG ACCCTGAGGT CAAGTTCAAC
2281 TGGTACGTGG ACGGCGTGGA GGTGCATAAT GCCAAGACAA AGCCGCGGGA
GGAGCAGTAC 2341 AACAGCACGT ACCGTGTGGT CAGCGTCCTC ACCGTCCTGC
ACCAGGACTG GCTGAATGGC 2401 AAGGAGTACA AGTGCAAGGT CTCCAACAAA
GCCCTCCCAG CCCCCATCGA GAAAACCATC 2461 TCCAAAGCCA AAGGGCAGCC
CCGAGAACCA CAGGTGTACA CCCTGCCCCC ATCCCGGGAT 2521 GAGCTGACCA
AGAACCAGGT CAGCCTGACC TGCCTGGTCA AAGGCTTCTA TCCCAGCGAC 2581
ATCGCCGTGG AGTGGGAGAG CAATGGGCAG CCGGAGAACA ACTACAAGAC CACGCCTCCC
2641 GTGTTGGACT CCGACGGCTC CTTCTTCCTC TACAGCAAGC TCACCGTGGA
CAAGAGCAGG 2701 TGGCAGCAGG GGAACGTCTT CTCATGCTCC GTGATGCATG
AGGCTCTGCA CAACCACTAC 2761 ACGCAGAAGA GCCTCTCCCT GTCTCCGGGT AAA
TABLE-US-00002 TABLE 2 Polypeptide Sequences A. B-Domain Deleted
FVIII-Fc Monomer Hybrid (BDD FVIIIFc monomer dimer): created by
coexpressing BDD FVIIIFc and Fc chains. Construct = HC-LC-Fc
fusion. An Fc expression cassette is cotransfected with BDDFVIII-Fc
to generate the BDD FVIIIFc monomer-. For the BDD FVIIIFc chain,
the Fc sequence is shown in bold; HC sequence is shown in double
underline; remaining B domain sequence is shown in italics. Signal
peptides are underlined. i) B domain deleted FVIII-Fc chain (19
amino acid signal sequence underlined) (SEQ ID NO: 2)
MQIELSTCFFLCLLRFCFS
ATRRYYLGAVELSWDYMQSDLGELPVDARFPPRVPKSFPFNTSVVYKKTLFVEFTDHLFNIAKPR
PPWMGLLGPTIQAEVYDTVVITLKNMASHPVSLHAVGVSYWKASEGAEYDDQTSQREKEDDKVFP
GGSHTYVWQVLKENGPMASDPLCLTYSYLSHVDLVKDLNSGLIGALLVCREGSLAKEKTQTLHKF
ILLFAVFDEGKSWHSETKNSLMQDRDAASARAWPKMHTVNGYVNRSLPGLIGCHRKSVYWHVIGM
GTTPEVHSIFLEGHTFLVRNHRQASLEISPITFLTAQTLLMDLGQFLLFCHISSHQHDGMEAYVK
VDSCPEEPQLRMKNNEEAEDYDDDLTDSEMDVVRFDDDNSPSFIQIRSVAKKHPKTWVHYIAAEE
EDWDYAPLVLAPDDRSYKSQYLNNGPQRIGRKYKKVRFMAYTDETFKTREAIQHESGILGPLLYG
EVGDTLLIIFKNQASRPYNIYPHGITDVRPLYSRRLPKGVKHLKDFPILPGEIFKYKWTVTVEDG
PIKSDPRCLTRYYSSFVNMERDLASGLIGPLLICYKESVDQRGNQIMSDKRNVILFSVFDENRSW
YLTENIQRFLPNPAGVQLEDPEFQASNIMHSINGYVFDSLQLSVCLHEVAYWYILSIGAQTDFLS
VFFSGYTFKHKMVYEDTLTLFPFSGETVFMSMENPGLWILGCHNSDFRNRGMTALLKVSSCDKNT
GDYYEDSYEDISAYLLSKNNAIEPRSFSQNPPVLKRHQREITRTTLQSDQEEIDYDDTISVEMKK
EDFDIYDEDENQSPRSFQKKTRHYFIAAVERLWDYGMSSSPHVLRNRAQSGSVPQFKKVVFQEFT
DGSFTQPLYRGELNEHLGLLGPYIRAEVEDNIMVTFRNQASRPYSFYSSLISYEEDQRQGAEPRK
NFVKPNETKTYFWKVQHHMAPTKDEFDCKAWAYFSDVDLEKDVHSGLIGPLLVCHTNTLNPAHGR
QVTVQEFALFFTIFDETKSWYFTENMERNCRAPCNIQMEDPTFKENYRFHAINGYIMDTLPGLVM
AQDQRIRWYLLSMGSNENIHSIHFSGHVFTVRKKEEYKMALYNLYPGVFETVEMLPSKAGIWRVE
CLIGEHLHAGMSTLFLVYSNKCQTPLGMASGHIRDFQITASGQYGQWAPKLARLHYSGSINAWST
KEPFSWIKVDLLAPMIIHGIKTQGARQKFSSLYISQFIIMYSLDGKKWQTYRGNSTGTLMVFFGN
VDSSGIKHNIFNPPIIARYIRLHPTHYSIRSTLRMELMGCDLNSCSMPLGMESKAISDAQITASS
YFTNMFATWSPSKARLHLQGRSNAWRPQVNNPKEWLQVDFQKTMKVTGVTTQGVKSLLTSMYVKE
FLISSSQDGHQWTLFFQNGKVKVFQGNQDSFTPVVNSLDPPLLTRYLRIHPQSWVHQIALRMEVL
GCEAQDLYDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNW
YVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQ
PREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLY
SKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK ii) Fc chain (20 amino
acid heterologous signal peptide from mouse Ig.kappa. chain
underlined) (SEQ ID NO: 4) METDTLLLVLLLWVPGSTG
DKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVH
NAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYT
LPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKS
RWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK B. Full length FVIIIFc monomer
hybrid (Full length FVIIIFc monomer dimer): created by coexpressing
FVIIIFc and Fc chains. Construct = HC-B-LC-Fc fusion. An Fc
expression cassette is cotransfected with full length FVIII-Fc to
generate the full length FVIIIFc monomer. For the FVIIIFc chain,
the Fc sequence is shown in bold; HC sequence is shown in double
underline; B domain sequence is shown in italics. Signal peptides
are underlined. i) Full length FVIIIFc chain (FVIII signal peptide
underlined (SEQ ID NO: 6) MQIELSTCFFLCLLRFCFS
ATRRYYLGAVELSWDYMQSDLGELPVDARFPPRVPKSFPFNTSVVYKKTLFVEFTDHLFNIAKPR
PPWMGLLGPTIQAEVYDTVVITLKNMASHPVSLHAVGVSYWKASEGAEYDDQTSQREKEDDKVFP
GGSHTYVWQVLKENGPMASDPLCLTYSYLSHVDLVKDLNSGLIGALLVCREGSLAKEKTQTLHKF
ILLFAVFDEGKSWHSETKNSLMQDRDAASARAWPKMHTVNGYVNRSLPGLIGCHRKSVYWHVIGM
GTTPEVHSIFLEGHTFLVRNHRQASLEISPITFLTAQTLLMDLGQFLLFCHISSHQHDGMEAYVK
VDSCPEEPQLRMKNNEEAEDYDDDLTDSEMDVVRFDDDNSPSFIQIRSVAKKHPKTWVHYIAAEE
EDWDYAPLVLAPDDRSYKSQYLNNGPQRIGRKYKKVRFMAYTDETFKTREAIQHESGILGPLLYG
EVGDTLLIIFKNQASRPYNIYPHGITDVRPLYSRRLPKGVKHLKDFPILPGEIFKYKWTVTVEDG
PIKSDPRCLTRYYSSFVNMERDLASGLIGPLLICYKESVDQRGNQIMSDKRNVILFSVFDENRSW
YLTENIQRFLPNPAGVQLEDPEFQASNIMHSINGYVFDSLQLSVCLHEVAYWYILSIGAQTDFLS
VFFSGYTFKHKMVYEDTLTLFPFSGETVFMSMENPGLWILGCHNSDFRNRGMTALLKVSSCDKNT
GDYYEDSYEDISAYLLSKNNAIEPRSFSQNSRHPSTRQKQFNATTIPENDIEKTDPWFAHRTPMP
KIQNVSSSDLLMLLRQSPTPHGLSLSDLQEAKYETFSDDPSPGAIDSNNSLSEMTHERPQLHHSG
DMVETPESGLQLRINEKLGTTAATELKKLDEKVSSTSNNLISTIPSDNLAAGTDNTSSLGPPSMP
VHYDSQLDTTLFGKKSSPLTESGGPLSLSEENNDSKLLESGLMNSQESSWGKNVSSTESGRLFKG
KRAHGPALLTKDNALFKVSISLLKTNKTSNNSATNRKTHIDGPSLLTENSPSVWQNILESDTEFK
KVTPLIHDRMLMDKNATALRINHMSNKTTSSKNMEMVQQKKEGPIPPDAQNPDMSFEKMLFLPES
ARWIQRTHGKNSLNSGQGPSPKQLVSLGPEKSVEGQNFLSEKNKVVVGKGEFTKDVGLKEMVFPS
SRNLFLTNIQNLHENNTHNQEKKIQEEIEKKETLIQENVVLPQIHTVTGTKNFMKNIFLLSTRQN
VEGSYDGAYAPVLQDFRSLNDSTNRTKKHTAHFSKKGEEENLEGLGNQTKQIVEKYACTTRISPN
TSQQNFVTQRSKRALKQFRLPLEETELEKRIIVDDTSTQWSKNMKHLTPSTLTQIDYNEKEKGAI
TQSPLSDCLTRSHSIPQANRSPLPIAKVSSFPSIRPIKETRVLFQDNSSHEPAASYRKKDSGVQE
SSHFLQGAKKNNLSLATLTLEMTGDQREVGSLGTSATNSVTYKKVENTVLPKPDLPKTSGKVELL
PKVHIYQKDLFPTETSNGSPGHLDLVEGSLLQGTEGAIKWNEANRPGKVPFLRVATESSAKTPSK
LLDPLAWDNHYGTQIPKEEWKSQEKSPEKTAFKKKDTILSLNACESNHAIAAINEGQNKPEIEVT
WAKQGRTERLCSQNPPVLKRHQREITRTTLQSDQEEIDYDDTISVEMKKEDFDIYDEDENQSPRS
FQKKTRHYFIAAVERLWDYGMSSSPHVLRNRAQSGSVPQFKKVVFQEFTDGSFTQPLYRGELNEH
LGLLGPYIRAEVEDNIMVTFRNQASRPYSFYSSLISYEEDQRQGAEPRKNFVKPNETKTYFWKVQ
HHMAPTKDEFDCKAWAYFSDVDLEKDVHSGLIGPLLVCHTNTLNPAHGRQVTVQEFALFFTIFDE
TKSWYFTENMERNCRAPCNIQMEDPTFKENYRFHAINGYIMDTLPGLVMAQDQRIRWYLLSMGSN
ENIHSIHFSGHVFTVRKKEEYKMALYNLYPGVFETVEMLPSKAGIWRVECLIGEHLHAGMSTLFL
VYSNKCQTPLGMASGHIRDFQITASGQYGQWAPKLARLHYSGSINAWSTKEPFSWIKVDLLAPMI
IHGIKTQGARQKFSSLYISQFIIMYSLDGKKWQTYRGNSTGTLMVFFGNVDSSGIKHNIFNPPII
ARYIRLHPTHYSIRSTLRMELMGCDLNSCSMPLGMESKAISDAQITASSYFTNMFATWSPSKARL
HLQGRSNAWRPQVNNPKEWLQVDFQKTMKVTGVITQGVKSLLTSMYVKEFLISSSQDGHQWTLFF
QNGKVKVFQGNQDSFTPVVNSLDPPLLTRYLRIHPQSWVHQIALRMEVLGCEAQDLYDKTHTCPP
CPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPRE
EQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDEL
TKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVF
SCSVMHEALHNHYTQKSLSLSPGK ii) Fc chain (20 amino acid heterologous
signal peptide from mouse Ig.kappa. chain underlined) (SEQ ID NO:
4) METDTLLLVLLLWVPGSTG
DKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVH
NAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYT
LPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKS
RWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK C. FVIII-Fc Heterodimer Hybrid
This is made by cotransfecting HC-Fc and LC-Fc constructs. Two
HC-Fc constructs have been made. One has no linker between HC and
Fc (HC-Fc) while the other has a 5 amino acid linker between HC and
Fc (HC + 5-Fc). The FVIII signal peptide was used for the HC-Fc
constructs, while the mouse ID( signal sequence was used for the
LC-Fc construct. (i) HC-Fc (Fc sequence is shown in bold, signal
peptide underlined) (SEQ ID NO: 8) MQIELSTCFFLCLLRFCFS
ATRRYYLGAVELSWDYMQSDLGELPVDARFPPRVPKSFPFNTSVVYKKTLFVEFTDHLFNIAKPR
PPWMGLLGPTIQAEVYDTVVITLKNMASHPVSLHAVGVSYWKASEGAEYDDQTSQREKEDDKVFP
GGSHTYVWQVLKENGPMASDPLCLTYSYLSHVDLVKDLNSGLIGALLVCREGSLAKEKTQTLHKF
ILLFAVFDEGKSWHSETKNSLMQDRDAASARAWPKMHTVNGYVNRSLPGLIGCHRKSVYWHVIGM
GTTPEVHSIFLEGHTFLVRNHRQASLEISPITFLTAQTLLMDLGQFLLFCHISSHQHDGMEAYVK
VDSCPEEPQLRMKNNEEAEDYDDDLTDSEMDVVRFDDDNSPSFIQIRSVAKKHPKTWVHYIAAEE
EDWDYAPLVLAPDDRSYKSQYLNNGPQRIGRKYKKVRFMAYTDETFKTREAIQHESGILGPLLYG
EVGDTLLIIFKNQASRPYNIYPHGITDVRPLYSRRLPKGVKHLKDFPILPGEIFKYKWTVTVEDG
PIKSDPRCLTRYYSSFVNMERDLASGLIGPLLICYKESVDQRGNQIMSDKRNVILFSVFDENRSW
YLTENIQRFLPNPAGVQLEDPEFQASNIMHSINGYVFDSLQLSVCLHEVAYWYILSIGAQTDFLS
VFFSGYTFKHKMVYEDTLTLFPFSGETVFMSMENPGLWILGCHNSDFRNRGMTALLKVSSCDKNT
GDYYEDSYEDISAYLLSKNNAIEPRDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVT
CVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSN
KALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENN
YKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK (ii) HC +
5-Fc (Fc sequence is shown in bold, 5 amino acid linker sequence
(from the B domain of FVIII) is shown in italics, signal peptide
underlined.)(SEQ ID NO: 10) MQIELSTCFFLCLLRFCFS
ATRRYYLGAVELSWDYMQSDLGELPVDARFPPRVPKSFPFNTSVVYKKTLFVEFTDHLFNIAKPR
PPWMGLLGPTIQAEVYDTVVITLKNMASHPVSLHAVGVSYWKASEGAEYDDQTSQREKEDDKVFP
GGSHTYVWQVLKENGPMASDPLCLTYSYLSHVDLVKDLNSGLIGALLVCREGSLAKEKTQTLHKF
ILLFAVFDEGKSWHSETKNSLMQDRDAASARAWPKMHTVNGYVNRSLPGLIGCHRKSVYWHVIGM
GTTPEVHSIFLEGHTFLVRNHRQASLEISPITFLTAQTLLMDLGQFLLFCHISSHQHDGMEAYVK
VDSCPEEPQLRMKNNEEAEDYDDDLTDSEMDVVRFDDDNSPSFIQIRSVAKKHPKTWVHYIAAEE
EDWDYAPLVLAPDDRSYKSQYLNNGPQRIGRKYKKVRFMAYTDETFKTREAIQHESGILGPLLYG
EVGDTLLIIFKNQASRPYNIYPHGITDVRPLYSRRLPKGVKHLKDFPILPGEIFKYKWTVTVEDG
PIKSDPRCLTRYYSSFVNMERDLASGLIGPLLICYKESVDQRGNQIMSDKRNVILFSVFDENRSW
YLTENIQRFLPNPAGVQLEDPEFQASNIMHSINGYVFDSLQLSVCLHEVAYWYILSIGAQTDFLS
VFFSGYTFKHKMVYEDTLTLFPFSGETVFMSMENPGLWILGCHNSDFRNRGMTALLKVSSCDKNT
GDYYEDSYEDISAYLLSKNNAIEPRSFSQNDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISR
TPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYK
CKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNG
QPENNYKTTPPVLDSDGSFELYSKLTVDKSRWQQGNVESCSVMHEALHNHYTQKSLSLSPGK
(iii) LC-Fc6His (Fc sequence is shown in bold, signal peptide
underlined.) (SEQ ID NO: 12) METDTLLLVLLLWVPGSTG
EITRTTLQSDQEEIDYDDTISVEMKKEDFDIYDEDENQSPRSFQKKTRHYFIAAVERLWDYGMSS
SPHVLRNRAQSGSVPQFKKVVFQEFTDGSFTQPLYRGELNEHLGLLGPYIRAEVEDNIMVTFRNQ
ASRPYSFYSSLISYEEDQRQGAEPRKNFVKPNETKTYFWKVQHHMAPTKDEFDCKAWAYFSDVDL
EKDVHSGLIGPLLVCHTNTLNPAHGRQVTVQEFALFFTIFDETKSWYFTENMERNCRAPCNIQME
DPTFKENYRFHAINGYIMDTLPGLVMAQDQRIRWYLLSMGSNENIHSIHFSGHVFTVRKKEEYKM
ALYNLYPGVFETVEMLPSKAGIWRVECLIGEHLHAGMSTLFLVYSNKCQTPLGMASGHIRDFQIT
ASGQYGQWAPKLARLHYSGSINAWSTKEPFSWIKVDLLAPMIIHGIKTQGARQKFSSLYISQFII
MYSLDGKKWQTYRGNSTGTLMVFFGNVDSSGIKHNIFNPPIIARYIRLHPTHYSIRSTLRMELMG
CDLNSCSMPLGMESKAISDAQITASSYFTNMFATWSPSKARLHLQGRSNAWRPQVNNPKEWLQVD
FQKTMKVTGVTTQGVKSLLTSMYVKEFLISSSQDGHQWTLFFQNGKVKVFQGNQDSFTPVVNSLD
PPLLTRYLRIHPQSWVHQTALRMEVLGCEAQDLYDKTHTCPPCPAPELLGGPSVFLFPPKPKDTL
MISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNG
KEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEW
ESNGQPENNYKTTPPVLDSDGSFELYSKLTVDKSRWQQGNVESCSVMHEALHNHYTQKSLSLSPG
K
TABLE-US-00003 TABLE 3 Whole blood clotting time (WBCT)
determination in hemophilia A mice after a single intravenous dose
of 50 IU/kg rFVIIIFc or REFACTO .RTM. Animal Time of Blood
Collection, hr Treatment Number Pre-dose 0.25 24 36 42 96 113 120
A. WBCT, min 50 IU/kg 1 >60 18 >60 ND ND REFACTO .RTM. 2
>60 5 16 >60 ND 3 >60 4 7 >60 ND 4 >60 7 8 10 >60
5 >60 6 9 16 >60 6 >60 5 15 >60 ND 50 IU/kg 7 >60 7
8 >60 ND rFVIIIFc 8 >60 5 8 >60 ND 9 >60 4 16 >60 ND
10 >60 3 11 4 >60 11 >60 3 9 >60 ND 12 >60 4 6
>60 ND Animal Time of Blood Collection, hr Treatment Number
Pre-dose 0.25 24 48 96 120 B. WBCT, min 50 IU/kg 1 >60 11 15
>60 >60 ND REFACTO .RTM. 2 >60 3 3 >60 >60 >60 3
>60 4 6 >60 >60 >60 50 IU/kg 4 >60 3 5 5 >60
>60 rFVIIIFc 5 >60 3 6 7 13 >60 6 >60 5 8 9 9 >60 ND
= Not determined since previous time point was > 60 min
TABLE-US-00004 TABLE 4 PK Parameters after a single intravenous
dose in hemophilia A mice (50 IU/kg) C.sub.max AUC T.sub.1/2 CL Vss
Treatment (IU/mL) (hr IU/mL) (hr) (mL/hr/kg) (mL/kg) rFVIIIFc 1.56
22.6 11.1 2.09 28.4 REFACTO .RTM. 0.67 6.94 5.0 7.2 43.8 ADVATE
.RTM. 0.47 3.90 7.1 12.8 103
TABLE-US-00005 TABLE 5 PK Parameters after a single intravenous
dose in hemophilia A dogs (125 IU/kg rFVIIIFc, 114 and 120 IU/kg
REFACTO .RTM.) A. PK determined from chromogenic activity data
C.sub.max AUC T.sub.1/2 CL (mL/ Vz Treatment (IU/mL) (hr IU/mL (hr)
hr/kg) (mL/kg) rFVIIIFc 2.0 .+-. 0.54 25.9 .+-. 6.47 15.4 .+-. 0.3
5.1 .+-. 1.4 113 .+-. 29 REFACTO .RTM.* 2.0 18.2 7.4 6.5 68.7 B. PK
determined from ELISA data C.sub.max AUC T.sub.1/2 CL (mL/ Vz
Treatment (ng/mL) (hr ng/mL (hr) hr/kg) (mL/kg) rFVIIIFc 210 .+-.
33 2481 .+-. 970 15.7 .+-. 1.7 6.2 .+-. 3.0 144 .+-. 83 REFACTO
.RTM.* 211 1545 6.9 8.7 85 Mean .+-. sd, n = 4 for rFVIIIFc, n = 2
for REFACTO .RTM. *sd not reported for REFACTO .RTM. since there
were just two dogs
TABLE-US-00006 TABLE 6 Clotting activity measured by aPTT in
hemophilia A dogs after a single intravenous dose with rFVIIIFc or
REFACTO .RTM.. aPTT, sec 5 min Dog ID Treatment PreDose post dose
M10 rFVIIIFc 86.5 53.6 M11 rFVIIIFc 99.8 56.4 M12 rFVIIIFc 119 68.7
REFACTO .RTM. 108 60.7 M38 rFVIIIFc 115 76.6 REFACTO .RTM. 118
68.0
TABLE-US-00007 TABLE 7 Plasma Concentration of rFVIIIFc or XYNTHA
in monkeys administered as a single intravenous dose of 125 IU/kg
measured by ELISA. Group 1 Group 2 Time, hr 604376 606595 C36195
C36066 C36174 604362 Mean SD A. rFVIIIFc concentration in plasma
(.mu.g/mL) Pre BLQ BLQ BLQ BLQ BLQ BLQ 0.25 0.400 0.334 0.374 0.348
0.383 0.323 0.360 0.030 4 0.266 0.259 0.236 0.233 0.259 0.217 0.245
0.019 12 0.165 0.152 0.12 0.15 0.161 0.149 0.150 0.016 24 0.079
0.074 0.047 0.08 0.088 0.076 0.074 0.014 36 0.035 0.04 0.022 0.04
0.041 0.046 0.037 0.008 48 0.019 0.021 BLQ 0.021 0.024 0.025 0.022
0.002 B. XYNTHA .RTM. concentration in plasma (.mu.g/mL) Pre BLQ
BLQ BLQ BLQ BLQ BLQ 0.25 0.252 0.074 0.155 0.317 0.217 0.167 0.197
0.084 4 0.197 0.159 0.152 0.229 0.19 0.082 0.168 0.051 12 0.137
0.099 0.104 0.166 0.158 0.081 0.124 0.035 24 0.09 0.068 0.051 0.082
0.08 0.084 0.076 0.014 36 0.037 0.043 0.015 0.041 0.035 BLQ 0.034
0.011 48 0.022 BLQ BLQ 0.017 0.013 BLQ 0.017 0.005
TABLE-US-00008 TABLE 8 Plasma Concentration of rFVIIIFc or XYNTHA
in monkeys administered a single intravenous dose of 125 IU/kg
measured by the FVIII-specific chromogenic activity assay (reported
in IU/mL). Time (hr) Group 1 Group 2 Predose 604376 606595 C36195
C36066 C36174 604362 A. XYNTHA .RTM. 0.25 5.62 4.55 5.01 4.5 5.15
3.77 4 3.9 4.05 3.2 3.19 3.46 2.36 12 2.51 2.82 1.69 2.17 2.5 2.01
24 1.67 1.66 1.18 0.95 1.57 1.5 36 0.7 0.85 0.48 0.44 0.85 0.82 48
BLQ BLQ BLQ BLQ 0.38 0.48 B. rFVIIIFc 0.25 4.31 3.82 3.54 4.13 4.12
3.68 4 3 3.36 2.53 2.7 2.74 2.81 12 2 2.15 1.42 2.28 2.75 2.22 24
1.01 1.17 0.5 1.5 1.61 1.01 36 BLQ 0.52 0.48 0.88 0.72 0.64 48 0.31
BLQ BLQ BLQ BLQ BLQ 72 BLQ BLQ BLQ BLQ 0.31 BLQ BLQ = below the
limit of quantitation
TABLE-US-00009 TABLE 9 PK Parameters of rFVIIIFc after a single 125
IU/kg dose PK Group 1 Group 2 Parameter units 604376 606595 C36195
C36066 C36174 604362 Average SD rFVIIIFc ELISA Data Tmax hr 0.25
0.25 0.25 0.25 0.25 0.25 0.25 0.00 Cmax .mu.g/mL 0.4 0.334 0.374
0.348 0.383 0.323 0.368 0.030 T.sub.1/2 hr 11.4 13.3 9.3 12.7 12.7
14.1 11.9 1.7 AUC .mu.g*hr/mL 5.86 5.65 4.37 5.56 4.37 5.58 5.16
0.68 CL mL/hr/kg 2.15 2.23 2.88 2.27 2.07 2.26 2.32 0.29 Vz mL/kg
35.3 42.5 38.8 37.9 37.9 46.1 38.5 3.9 MRT hr 15.3 17 12.1 17.1
17.3 19.2 15.8 2.4 rFVIIIFc Chromogenic Activity Data Tmax hr 0.25
0.25 0.25 0.25 0.25 0.25 0.25 0.00 Cmax IU/mL 4.31 3.82 3.54 4.13
4.12 3.68 3.93 0.30 T.sub.1/2 hr 13.4 12.0 11.6 17.5 12.4 29.4 16.1
6.9 AUC IU*hr/mL 74.7 75.5 53.5 92.9 88.9 92.7 79.7 15.2 CL
mL/hr/kg 1.67 1.65 2.34 1.35 1.41 1.35 1.63 0.38 Vz mL/kg 32.3 28.7
39.2 33.9 25.2 57.2 36.1 11.4 MRT hr 17.8 16.8 16.9 25 19.2 33.3
21.5 6.5
TABLE-US-00010 TABLE 10 PK Parameters of XYNTHA after a single IV
dose (125 IU/kg) PK Group 1 Group 2 Parameter units 604376 606595
C36195 C36066 C36174 604362 Average SD XYNTHA .RTM. ELISA Data Tmax
hr 0.25 4 0.25 0.25 0.25 0.25 0.88 1.53 Cmax IU/mL 0.252 0.159
0.155 0.317 0.217 0.167 0.21 0.06 T.sub.1/2 hr 13.6 19.9 9.7 11 9.2
nd 12.7 4.4 AUC IU*hr/mL 5.15 4.39 3.17 5.53 4.79 6.32 5.24 0.74 CL
mL/hr/kg 2.21 2.6 3.59 2.06 2.38 nd 2.57 0.61 Vz mL/kg 43.4 74.7
50.1 32.9 31.5 nd 46.5 17.5 MRT hr 19 28.4 14 16.1 15.9 nd 18.7 5.7
XYNTHA .RTM. Chromogenic Activity Data Tmax hr 0.25 0.25 0.25 0.25
0.25 0.25 0.25 0 Cmax IU/mL 5.62 4.55 5.01 4.5 5.15 3.77 4.77 0.64
T.sub.1/2 hr 12.8 14.3 11.4 10.4 11.7 14.6 12.5 1.7 AUC IU*hr/mL
97.1 104.2 71.3 70.7 94.0 82.8 86.7 14.0 CL mL/hr/kg 1.29 1.20 1.75
1.77 1.33 1.51 1.48 0.24 Vz mL/kg 23.7 24.8 28.9 26.6 22.5 31.8
26.4 3.5 MRT hr 17.8 20.1 16.0 14.8 18.4 23.2 18.4 3.0
TABLE-US-00011 TABLE 11 Activation of Factor X Km (nM) Vmax
(nM/min) rFVIIIFc 55.0 .+-. 5.9 65.6 .+-. 8.6 BDD FVIII 51.0 .+-.
8.7 73.5 .+-. 10.1
TABLE-US-00012 TABLE 12 Interaction with Factor IXa Kd (nM) Vmax
(nM/min) rFVIIIFc 2.8 .+-. 0.4 4.5 .+-. 0.3 BDD FVIII 2.5 .+-. 0.3
4.0 .+-. 1.0
Sequence CWU 1
1
1215052DNAArtificial SequenceB-Domain Deleted FVIIIFc
Chainmisc_signal(1)..(57)FVIII signalmisc_feature(4372)..(5052)Fc
region 1atgcaaatag agctctccac ctgcttcttt ctgtgccttt tgcgattctg
ctttagtgcc 60accagaagat actacctggg tgcagtggaa ctgtcatggg actatatgca
aagtgatctc 120ggtgagctgc ctgtggacgc aagatttcct cctagagtgc
caaaatcttt tccattcaac 180acctcagtcg tgtacaaaaa gactctgttt
gtagaattca cggatcacct tttcaacatc 240gctaagccaa ggccaccctg
gatgggtctg ctaggtccta ccatccaggc tgaggtttat 300gatacagtgg
tcattacact taagaacatg gcttcccatc ctgtcagtct tcatgctgtt
360ggtgtatcct actggaaagc ttctgaggga gctgaatatg atgatcagac
cagtcaaagg 420gagaaagaag atgataaagt cttccctggt ggaagccata
catatgtctg gcaggtcctg 480aaagagaatg gtccaatggc ctctgaccca
ctgtgcctta cctactcata tctttctcat 540gtggacctgg taaaagactt
gaattcaggc ctcattggag ccctactagt atgtagagaa 600gggagtctgg
ccaaggaaaa gacacagacc ttgcacaaat ttatactact ttttgctgta
660tttgatgaag ggaaaagttg gcactcagaa acaaagaact ccttgatgca
ggatagggat 720gctgcatctg ctcgggcctg gcctaaaatg cacacagtca
atggttatgt aaacaggtct 780ctgccaggtc tgattggatg ccacaggaaa
tcagtctatt ggcatgtgat tggaatgggc 840accactcctg aagtgcactc
aatattcctc gaaggtcaca catttcttgt gaggaaccat 900cgccaggcgt
ccttggaaat ctcgccaata actttcctta ctgctcaaac actcttgatg
960gaccttggac agtttctact gttttgtcat atctcttccc accaacatga
tggcatggaa 1020gcttatgtca aagtagacag ctgtccagag gaaccccaac
tacgaatgaa aaataatgaa 1080gaagcggaag actatgatga tgatcttact
gattctgaaa tggatgtggt caggtttgat 1140gatgacaact ctccttcctt
tatccaaatt cgctcagttg ccaagaagca tcctaaaact 1200tgggtacatt
acattgctgc tgaagaggag gactgggact atgctccctt agtcctcgcc
1260cccgatgaca gaagttataa aagtcaatat ttgaacaatg gccctcagcg
gattggtagg 1320aagtacaaaa aagtccgatt tatggcatac acagatgaaa
cctttaagac tcgtgaagct 1380attcagcatg aatcaggaat cttgggacct
ttactttatg gggaagttgg agacacactg 1440ttgattatat ttaagaatca
agcaagcaga ccatataaca tctaccctca cggaatcact 1500gatgtccgtc
ctttgtattc aaggagatta ccaaaaggtg taaaacattt gaaggatttt
1560ccaattctgc caggagaaat attcaaatat aaatggacag tgactgtaga
agatgggcca 1620actaaatcag atcctcggtg cctgacccgc tattactcta
gtttcgttaa tatggagaga 1680gatctagctt caggactcat tggccctctc
ctcatctgct acaaagaatc tgtagatcaa 1740agaggaaacc agataatgtc
agacaagagg aatgtcatcc tgttttctgt atttgatgag 1800aaccgaagct
ggtacctcac agagaatata caacgctttc tccccaatcc agctggagtg
1860cagcttgagg atccagagtt ccaagcctcc aacatcatgc acagcatcaa
tggctatgtt 1920tttgatagtt tgcagttgtc agtttgtttg catgaggtgg
catactggta cattctaagc 1980attggagcac agactgactt cctttctgtc
ttcttctctg gatatacctt caaacacaaa 2040atggtctatg aagacacact
caccctattc ccattctcag gagaaactgt cttcatgtcg 2100atggaaaacc
caggtctatg gattctgggg tgccacaact cagactttcg gaacagaggc
2160atgaccgcct tactgaaggt ttctagttgt gacaagaaca ctggtgatta
ttacgaggac 2220agttatgaag atatttcagc atacttgctg agtaaaaaca
atgccattga accaagaagc 2280ttctctcaaa acccaccagt cttgaaacgc
catcaacggg aaataactcg tactactctt 2340cagtcagatc aagaggaaat
tgactatgat gataccatat cagttgaaat gaagaaggaa 2400gattttgaca
tttatgatga ggatgaaaat cagagccccc gcagctttca aaagaaaaca
2460cgacactatt ttattgctgc agtggagagg ctctgggatt atgggatgag
tagctcccca 2520catgttctaa gaaacagggc tcagagtggc agtgtccctc
agttcaagaa agttgttttc 2580caggaattta ctgatggctc ctttactcag
cccttatacc gtggagaact aaatgaacat 2640ttgggactcc tggggccata
tataagagca gaagttgaag ataatatcat ggtaactttc 2700agaaatcagg
cctctcgtcc ctattccttc tattctagcc ttatttctta tgaggaagat
2760cagaggcaag gagcagaacc tagaaaaaac tttgtcaagc ctaatgaaac
caaaacttac 2820ttttggaaag tgcaacatca tatggcaccc actaaagatg
agtttgactg caaagcctgg 2880gcttatttct ctgatgttga cctggaaaaa
gatgtgcact caggcctgat tggacccctt 2940ctggtctgcc acactaacac
actgaaccct gctcatggga gacaagtgac agtacaggaa 3000tttgctctgt
ttttcaccat ctttgatgag accaaaagct ggtacttcac tgaaaatatg
3060gaaagaaact gcagggctcc ctgcaatatc cagatggaag atcccacttt
taaagagaat 3120tatcgcttcc atgcaatcaa tggctacata atggatacac
tacctggctt agtaatggct 3180caggatcaaa ggattcgatg gtatctgctc
agcatgggca gcaatgaaaa catccattct 3240attcatttca gtggacatgt
gttcactgta cgaaaaaaag aggagtataa aatggcactg 3300tacaatctct
atccaggtgt ttttgagaca gtggaaatgt taccatccaa agctggaatt
3360tggcgggtgg aatgccttat tggcgagcat ctacatgctg ggatgagcac
actttttctg 3420gtgtacagca ataagtgtca gactcccctg ggaatggctt
ctggacacat tagagatttt 3480cagattacag cttcaggaca atatggacag
tgggccccaa agctggccag acttcattat 3540tccggatcaa tcaatgcctg
gagcaccaag gagccctttt cttggatcaa ggtggatctg 3600ttggcaccaa
tgattattca cggcatcaag acccagggtg cccgtcagaa gttctccagc
3660ctctacatct ctcagtttat catcatgtat agtcttgatg ggaagaagtg
gcagacttat 3720cgaggaaatt ccactggaac cttaatggtc ttctttggca
atgtggattc atctgggata 3780aaacacaata tttttaaccc tccaattatt
gctcgataca tccgtttgca cccaactcat 3840tatagcattc gcagcactct
tcgcatggag ttgatgggct gtgatttaaa tagttgcagc 3900atgccattgg
gaatggagag taaagcaata tcagatgcac agattactgc ttcatcctac
3960tttaccaata tgtttgccac ctggtctcct tcaaaagctc gacttcacct
ccaagggagg 4020agtaatgcct ggagacctca ggtgaataat ccaaaagagt
ggctgcaagt ggacttccag 4080aagacaatga aagtcacagg agtaactact
cagggagtaa aatctctgct taccagcatg 4140tatgtgaagg agttcctcat
ctccagcagt caagatggcc atcagtggac tctctttttt 4200cagaatggca
aagtaaaggt ttttcaggga aatcaagact ccttcacacc tgtggtgaac
4260tctctagacc caccgttact gactcgctac cttcgaattc acccccagag
ttgggtgcac 4320cagattgccc tgaggatgga ggttctgggc tgcgaggcac
aggacctcta cgacaaaact 4380cacacatgcc caccgtgccc agctccagaa
ctcctgggcg gaccgtcagt cttcctcttc 4440cccccaaaac ccaaggacac
cctcatgatc tcccggaccc ctgaggtcac atgcgtggtg 4500gtggacgtga
gccacgaaga ccctgaggtc aagttcaact ggtacgtgga cggcgtggag
4560gtgcataatg ccaagacaaa gccgcgggag gagcagtaca acagcacgta
ccgtgtggtc 4620agcgtcctca ccgtcctgca ccaggactgg ctgaatggca
aggagtacaa gtgcaaggtc 4680tccaacaaag ccctcccagc ccccatcgag
aaaaccatct ccaaagccaa agggcagccc 4740cgagaaccac aggtgtacac
cctgccccca tcccgggatg agctgaccaa gaaccaggtc 4800agcctgacct
gcctggtcaa aggcttctat cccagcgaca tcgccgtgga gtgggagagc
4860aatgggcagc cggagaacaa ctacaagacc acgcctcccg tgttggactc
cgacggctcc 4920ttcttcctct acagcaagct caccgtggac aagagcaggt
ggcagcaggg gaacgtcttc 4980tcatgctccg tgatgcatga ggctctgcac
aaccactaca cgcagaagag cctctccctg 5040tctccgggta aa
505221684PRTArtificial SequenceB domain deleted FVIII-Fc
chainSIGNAL(1)..(19)mat_peptide(20)..(1684)MISC_FEATURE(20)..(753)Heavy
chain (HC)MISC_FEATURE(760)..(773)B
domainMISC_FEATURE(1457)..(1684)Fc region 2Met Gln Ile Glu Leu Ser
Thr Cys Phe Phe Leu Cys Leu Leu Arg Phe1 5 10 15Cys Phe Ser Ala Thr
Arg Arg Tyr Tyr Leu Gly Ala Val Glu Leu Ser 20 25 30Trp Asp Tyr Met
Gln Ser Asp Leu Gly Glu Leu Pro Val Asp Ala Arg 35 40 45Phe Pro Pro
Arg Val Pro Lys Ser Phe Pro Phe Asn Thr Ser Val Val 50 55 60Tyr Lys
Lys Thr Leu Phe Val Glu Phe Thr Asp His Leu Phe Asn Ile65 70 75
80Ala Lys Pro Arg Pro Pro Trp Met Gly Leu Leu Gly Pro Thr Ile Gln
85 90 95Ala Glu Val Tyr Asp Thr Val Val Ile Thr Leu Lys Asn Met Ala
Ser 100 105 110His Pro Val Ser Leu His Ala Val Gly Val Ser Tyr Trp
Lys Ala Ser 115 120 125Glu Gly Ala Glu Tyr Asp Asp Gln Thr Ser Gln
Arg Glu Lys Glu Asp 130 135 140Asp Lys Val Phe Pro Gly Gly Ser His
Thr Tyr Val Trp Gln Val Leu145 150 155 160Lys Glu Asn Gly Pro Met
Ala Ser Asp Pro Leu Cys Leu Thr Tyr Ser 165 170 175Tyr Leu Ser His
Val Asp Leu Val Lys Asp Leu Asn Ser Gly Leu Ile 180 185 190Gly Ala
Leu Leu Val Cys Arg Glu Gly Ser Leu Ala Lys Glu Lys Thr 195 200
205Gln Thr Leu His Lys Phe Ile Leu Leu Phe Ala Val Phe Asp Glu Gly
210 215 220Lys Ser Trp His Ser Glu Thr Lys Asn Ser Leu Met Gln Asp
Arg Asp225 230 235 240Ala Ala Ser Ala Arg Ala Trp Pro Lys Met His
Thr Val Asn Gly Tyr 245 250 255Val Asn Arg Ser Leu Pro Gly Leu Ile
Gly Cys His Arg Ser Ser Val 260 265 270Tyr Trp His Val Ile Gly Met
Gly Thr Thr Pro Glu Val His Ser Ile 275 280 285Phe Leu Glu Gly His
Thr Phe Leu Val Arg Asn His Arg Gln Ala Ser 290 295 300Leu Glu Ile
Ser Pro Ile Thr Phe Leu Thr Ala Gln Thr Leu Leu Met305 310 315
320Asp Leu Gly Gln Phe Leu Leu Phe Cys His Ile Ser Ser His Gln His
325 330 335Asp Gly Met Glu Ala Tyr Val Lys Val Asp Ser Cys Pro Glu
Glu Pro 340 345 350Gln Leu Arg Met Lys Asn Asn Glu Glu Ala Glu Asp
Tyr Asp Asp Asp 355 360 365Leu Thr Asp Ser Glu Met Asp Val Val Arg
Phe Asp Asp Asp Asn Ser 370 375 380Pro Ser Phe Ile Gln Ile Arg Ser
Val Ala Lys Lys His Pro Lys Thr385 390 395 400Trp Val His Tyr Ile
Ala Ala Glu Glu Glu Asp Trp Asp Tyr Ala Pro 405 410 415Leu Val Leu
Ala Pro Asp Asp Arg Ser Tyr Lys Ser Gln Tyr Leu Asn 420 425 430Asn
Gly Pro Gln Arg Ile Gly Arg Ser Tyr Lys Lys Val Arg Phe Met 435 440
445Ala Tyr Thr Asp Glu Thr Phe Lys Thr Arg Glu Ala Ile Gln His Glu
450 455 460Ser Gly Ile Leu Gly Pro Leu Leu Tyr Gly Glu Val Gly Asp
Thr Leu465 470 475 480Leu Ile Ile Phe Lys Asn Gln Ala Ser Arg Pro
Tyr Asn Ile Tyr Pro 485 490 495His Gly Ile Thr Asp Val Arg Pro Leu
Tyr Ser Arg Arg Leu Pro Lys 500 505 510Gly Val Lys His Leu Lys Asp
Phe Pro Ile Leu Pro Gly Glu Ile Phe 515 520 525Lys Tyr Lys Trp Thr
Val Thr Val Glu Asp Gly Pro Thr Lys Ser Asp 530 535 540Pro Arg Cys
Leu Thr Arg Tyr Tyr Ser Ser Phe Val Asn Met Glu Arg545 550 555
560Asp Leu Ala Ser Gly Leu Ile Gly Pro Leu Leu Ile Cys Tyr Lys Glu
565 570 575Ser Val Asp Gln Arg Gly Asn Gln Ile Met Ser Asp Lys Arg
Asn Val 580 585 590Ile Leu Phe Ser Val Phe Asp Glu Asn Arg Ser Trp
Tyr Leu Thr Glu 595 600 605Asn Ile Gln Arg Phe Leu Pro Asn Pro Ala
Gly Val Gln Leu Glu Asp 610 615 620Pro Glu Phe Gln Ala Ser Asn Ile
Met His Ser Ile Asn Gly Tyr Val625 630 635 640Phe Asp Ser Leu Gln
Leu Ser Val Cys Leu His Glu Val Ala Tyr Trp 645 650 655Tyr Ile Leu
Ser Ile Gly Ala Gln Thr Asp Phe Leu Ser Val Phe Phe 660 665 670Ser
Gly Tyr Thr Phe Lys His Lys Met Val Tyr Glu Asp Thr Leu Thr 675 680
685Leu Phe Pro Phe Ser Gly Glu Thr Val Phe Met Ser Met Glu Asn Pro
690 695 700Gly Leu Trp Ile Leu Gly Cys His Asn Ser Asp Phe Arg Asn
Arg Gly705 710 715 720Met Thr Ala Leu Leu Lys Val Ser Ser Cys Asp
Lys Asn Thr Gly Asp 725 730 735Tyr Tyr Glu Asp Ser Tyr Glu Asp Ile
Ser Ala Tyr Leu Leu Ser Lys 740 745 750Asn Asn Ala Ile Glu Pro Arg
Ser Phe Ser Gln Asn Pro Pro Val Leu 755 760 765Lys Arg His Gln Arg
Glu Ile Thr Arg Thr Thr Leu Gln Ser Asp Gln 770 775 780Glu Glu Ile
Asp Tyr Asp Asp Thr Ile Ser Val Glu Met Lys Lys Glu785 790 795
800Asp Phe Asp Ile Tyr Asp Glu Asp Glu Asn Gln Ser Pro Arg Ser Phe
805 810 815Gln Lys Lys Thr Arg His Tyr Phe Ile Ala Ala Val Glu Arg
Leu Trp 820 825 830Asp Tyr Gly Met Ser Ser Ser Pro His Val Leu Arg
Asn Arg Ala Gln 835 840 845Ser Gly Ser Val Pro Gln Phe Lys Lys Val
Val Phe Gln Glu Phe Thr 850 855 860Asp Gly Ser Phe Thr Gln Pro Leu
Tyr Arg Gly Glu Leu Asn Glu His865 870 875 880Leu Gly Leu Leu Gly
Pro Tyr Ile Arg Ala Glu Val Glu Asp Asn Ile 885 890 895Met Val Thr
Phe Arg Asn Gln Ala Ser Arg Pro Tyr Ser Phe Tyr Ser 900 905 910Ser
Leu Ile Ser Tyr Glu Glu Asp Gln Arg Gln Gly Ala Glu Pro Arg 915 920
925Ser Asn Phe Val Lys Pro Asn Glu Thr Lys Thr Tyr Phe Trp Lys Val
930 935 940Gln His His Met Ala Pro Thr Lys Asp Glu Phe Asp Cys Lys
Ala Trp945 950 955 960Ala Tyr Phe Ser Asp Val Asp Leu Glu Lys Asp
Val His Ser Gly Leu 965 970 975Ile Gly Pro Leu Leu Val Cys His Thr
Asn Thr Leu Asn Pro Ala His 980 985 990Gly Arg Gln Val Thr Val Gln
Glu Phe Ala Leu Phe Phe Thr Ile Phe 995 1000 1005Asp Glu Thr Lys
Ser Trp Tyr Phe Thr Glu Asn Met Glu Arg Asn 1010 1015 1020Cys Arg
Ala Pro Cys Asn Ile Gln Met Glu Asp Pro Thr Phe Lys 1025 1030
1035Glu Asn Tyr Arg Phe His Ala Ile Asn Gly Tyr Ile Met Asp Thr
1040 1045 1050Leu Pro Gly Leu Val Met Ala Gln Asp Gln Arg Ile Arg
Trp Tyr 1055 1060 1065Leu Leu Ser Met Gly Ser Asn Glu Asn Ile His
Ser Ile His Phe 1070 1075 1080Ser Gly His Val Phe Thr Val Arg Ser
Lys Glu Glu Tyr Lys Met 1085 1090 1095Ala Leu Tyr Asn Leu Tyr Pro
Gly Val Phe Glu Thr Val Glu Met 1100 1105 1110Leu Pro Ser Lys Ala
Gly Ile Trp Arg Val Glu Cys Leu Ile Gly 1115 1120 1125Glu His Leu
His Ala Gly Met Ser Thr Leu Phe Leu Val Tyr Ser 1130 1135 1140Asn
Lys Cys Gln Thr Pro Leu Gly Met Ala Ser Gly His Ile Arg 1145 1150
1155Asp Phe Gln Ile Thr Ala Ser Gly Gln Tyr Gly Gln Trp Ala Pro
1160 1165 1170Lys Leu Ala Arg Leu His Tyr Ser Gly Ser Ile Asn Ala
Trp Ser 1175 1180 1185Thr Lys Glu Pro Phe Ser Trp Ile Lys Val Asp
Leu Leu Ala Pro 1190 1195 1200Met Ile Ile His Gly Ile Lys Thr Gln
Gly Ala Arg Gln Lys Phe 1205 1210 1215Ser Ser Leu Tyr Ile Ser Gln
Phe Ile Ile Met Tyr Ser Leu Asp 1220 1225 1230Gly Lys Lys Trp Gln
Thr Tyr Arg Gly Asn Ser Thr Gly Thr Leu 1235 1240 1245Met Val Phe
Phe Gly Asn Val Asp Ser Ser Gly Ile Lys His Asn 1250 1255 1260Ile
Phe Asn Pro Pro Ile Ile Ala Arg Tyr Ile Arg Leu His Pro 1265 1270
1275Thr His Tyr Ser Ile Arg Ser Thr Leu Arg Met Glu Leu Met Gly
1280 1285 1290Cys Asp Leu Asn Ser Cys Ser Met Pro Leu Gly Met Glu
Ser Lys 1295 1300 1305Ala Ile Ser Asp Ala Gln Ile Thr Ala Ser Ser
Tyr Phe Thr Asn 1310 1315 1320Met Phe Ala Thr Trp Ser Pro Ser Lys
Ala Arg Leu His Leu Gln 1325 1330 1335Gly Arg Ser Asn Ala Trp Arg
Pro Gln Val Asn Asn Pro Lys Glu 1340 1345 1350Trp Leu Gln Val Asp
Phe Gln Lys Thr Met Lys Val Thr Gly Val 1355 1360 1365Thr Thr Gln
Gly Val Lys Ser Leu Leu Thr Ser Met Tyr Val Lys 1370 1375 1380Glu
Phe Leu Ile Ser Ser Ser Gln Asp Gly His Gln Trp Thr Leu 1385 1390
1395Phe Phe Gln Asn Gly Lys Val Lys Val Phe Gln Gly Asn Gln Asp
1400 1405 1410Ser Phe Thr Pro Val Val Asn Ser Leu Asp Pro Pro Leu
Leu Thr 1415 1420 1425Arg Tyr Leu Arg Ile His Pro Gln Ser Trp Val
His Gln Ile Ala 1430 1435 1440Leu Arg Met Glu Val Leu Gly Cys Glu
Ala Gln Asp Leu Tyr Asp 1445 1450 1455Lys Thr His Thr Cys Pro Pro
Cys Pro Ala Pro Glu Leu Leu Gly 1460 1465 1470Gly Pro Ser Val Phe
Leu Phe Pro Pro Lys Pro Lys Asp Thr Leu 1475 1480 1485Met Ile Ser
Arg Thr Pro Glu Val Thr Cys Val Val Val Asp Val 1490 1495 1500Ser
His Glu Asp Pro Glu Val Lys Phe Asn Trp Tyr Val Asp Gly 1505 1510
1515Val Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln Tyr
1520 1525 1530Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val Leu
His Gln 1535 1540 1545Asp Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys
Val Ser Asn Lys 1550 1555 1560Ala Leu Pro Ala Pro Ile Glu Lys Thr
Ile Ser Lys Ala Lys Gly 1565 1570
1575Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Arg Asp
1580 1585 1590Glu Leu Thr Lys Asn Gln Val Ser Leu Thr Cys Leu Val
Lys Gly 1595 1600 1605Phe Tyr Pro Ser Asp Ile Ala Val Glu Trp Glu
Ser Asn Gly Gln 1610 1615 1620Pro Glu Asn Asn Tyr Lys Thr Thr Pro
Pro Val Leu Asp Ser Asp 1625 1630 1635Gly Ser Phe Phe Leu Tyr Ser
Lys Leu Thr Val Asp Lys Ser Arg 1640 1645 1650Trp Gln Gln Gly Asn
Val Phe Ser Cys Ser Val Met His Glu Ala 1655 1660 1665Leu His Asn
His Tyr Thr Gln Lys Ser Leu Ser Leu Ser Pro Gly 1670 1675
1680Lys3741DNAArtificial SequenceFc regionmisc_signal(1)..(60)Mouse
Ig kappa signal 3atggagacag acacactcct gctatgggta ctgctgctct
gggttccagg ttccactggt 60gacaaaactc acacatgccc accgtgccca gcacctgaac
tcctgggagg accgtcagtc 120ttcctcttcc ccccaaaacc caaggacacc
ctcatgatct cccggacccc tgaggtcaca 180tgcgtggtgg tggacgtgag
ccacgaagac cctgaggtca agttcaactg gtacgtggac 240ggcgtggagg
tgcataatgc caagacaaag ccgcgggagg agcagtacaa cagcacgtac
300cgtgtggtca gcgtcctcac cgtcctgcac caggactggc tgaatggcaa
ggagtacaag 360tgcaaggtct ccaacaaagc cctcccagcc cccatcgaga
aaaccatctc caaagccaaa 420gggcagcccc gagaaccaca ggtgtacacc
ctgcccccat cccgcgatga gctgaccaag 480aaccaggtca gcctgacctg
cctggtcaaa ggcttctatc ccagcgacat cgccgtggag 540tgggagagca
atgggcagcc ggagaacaac tacaagacca cgcctcccgt gttggactcc
600gacggctcct tcttcctcta cagcaagctc accgtggaca agagcaggtg
gcagcagggg 660aacgtcttct catgctccgt gatgcatgag gctctgcaca
accactacac gcagaagagc 720ctctccctgt ctccgggtaa a
7414247PRTArtificial SequenceFc chainSIGNAL(1)..(20)Heterologous
signal from Mouse Ig kappa chainmat_peptide(21)..(247) 4Met Glu Thr
Asp Thr Leu Leu Leu Trp Val Leu Leu Leu Trp Val Pro1 5 10 15Gly Ser
Thr Gly Asp Lys Thr His Thr Cys Pro Pro Cys Pro Ala Pro 20 25 30Glu
Leu Leu Gly Gly Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys 35 40
45Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr Cys Val Val Val
50 55 60Asp Val Ser His Glu Asp Pro Glu Val Lys Phe Asn Trp Tyr Val
Asp65 70 75 80Gly Val Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu
Glu Gln Tyr 85 90 95Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val
Leu His Gln Asp 100 105 110Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys
Val Ser Asn Lys Ala Leu 115 120 125Pro Ala Pro Ile Glu Lys Thr Ile
Ser Lys Ala Lys Gly Gln Pro Arg 130 135 140Glu Pro Gln Val Tyr Thr
Leu Pro Pro Ser Arg Asp Glu Leu Thr Lys145 150 155 160Asn Gln Val
Ser Leu Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser Asp 165 170 175Ile
Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu Asn Asn Tyr Lys 180 185
190Thr Thr Pro Pro Val Leu Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser
195 200 205Lys Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly Asn Val
Phe Ser 210 215 220Cys Ser Val Met His Glu Ala Leu His Asn His Tyr
Thr Gln Lys Ser225 230 235 240Leu Ser Leu Ser Pro Gly Lys
24557734DNAArtificial SequenceFull length
FVIIIFcmisc_signal(1)..(57)FVIII signalmisc_feature(7054)..(7734)Fc
region 5atgcaaatag agctctccac ctgcttcttt ctgtgccttt tgcgattctg
ctttagtgcc 60accagaagat actacctggg tgcagtggaa ctgtcatggg actatatgca
aagtgatctc 120ggtgagctgc ctgtggacgc aagatttcct cctagagtgc
caaaatcttt tccattcaac 180acctcagtcg tgtacaaaaa gactctgttt
gtagaattca cggatcacct tttcaacatc 240gctaagccaa ggccaccctg
gatgggtctg ctaggtccta ccatccaggc tgaggtttat 300gatacagtgg
tcattacact taagaacatg gcttcccatc ctgtcagtct tcatgctgtt
360ggtgtatcct actggaaagc ttctgaggga gctgaatatg atgatcagac
cagtcaaagg 420gagaaagaag atgataaagt cttccctggt ggaagccata
catatgtctg gcaggtcctg 480aaagagaatg gtccaatggc ctctgaccca
ctgtgcctta cctactcata tctttctcat 540gtggacctgg taaaagactt
gaattcaggc ctcattggag ccctactagt atgtagagaa 600gggagtctgg
ccaaggaaaa gacacagacc ttgcacaaat ttatactact ttttgctgta
660tttgatgaag ggaaaagttg gcactcagaa acaaagaact ccttgatgca
ggatagggat 720gctgcatctg ctcgggcctg gcctaaaatg cacacagtca
atggttatgt aaacaggtct 780ctgccaggtc tgattggatg ccacaggaaa
tcagtctatt ggcatgtgat tggaatgggc 840accactcctg aagtgcactc
aatattcctc gaaggtcaca catttcttgt gaggaaccat 900cgccaggcgt
ccttggaaat ctcgccaata actttcctta ctgctcaaac actcttgatg
960gaccttggac agtttctact gttttgtcat atctcttccc accaacatga
tggcatggaa 1020gcttatgtca aagtagacag ctgtccagag gaaccccaac
tacgaatgaa aaataatgaa 1080gaagcggaag actatgatga tgatcttact
gattctgaaa tggatgtggt caggtttgat 1140gatgacaact ctccttcctt
tatccaaatt cgctcagttg ccaagaagca tcctaaaact 1200tgggtacatt
acattgctgc tgaagaggag gactgggact atgctccctt agtcctcgcc
1260cccgatgaca gaagttataa aagtcaatat ttgaacaatg gccctcagcg
gattggtagg 1320aagtacaaaa aagtccgatt tatggcatac acagatgaaa
cctttaagac tcgtgaagct 1380attcagcatg aatcaggaat cttgggacct
ttactttatg gggaagttgg agacacactg 1440ttgattatat ttaagaatca
agcaagcaga ccatataaca tctaccctca cggaatcact 1500gatgtccgtc
ctttgtattc aaggagatta ccaaaaggtg taaaacattt gaaggatttt
1560ccaattctgc caggagaaat attcaaatat aaatggacag tgactgtaga
agatgggcca 1620actaaatcag atcctcggtg cctgacccgc tattactcta
gtttcgttaa tatggagaga 1680gatctagctt caggactcat tggccctctc
ctcatctgct acaaagaatc tgtagatcaa 1740agaggaaacc agataatgtc
agacaagagg aatgtcatcc tgttttctgt atttgatgag 1800aaccgaagct
ggtacctcac agagaatata caacgctttc tccccaatcc agctggagtg
1860cagcttgagg atccagagtt ccaagcctcc aacatcatgc acagcatcaa
tggctatgtt 1920tttgatagtt tgcagttgtc agtttgtttg catgaggtgg
catactggta cattctaagc 1980attggagcac agactgactt cctttctgtc
ttcttctctg gatatacctt caaacacaaa 2040atggtctatg aagacacact
caccctattc ccattctcag gagaaactgt cttcatgtcg 2100atggaaaacc
caggtctatg gattctgggg tgccacaact cagactttcg gaacagaggc
2160atgaccgcct tactgaaggt ttctagttgt gacaagaaca ctggtgatta
ttacgaggac 2220agttatgaag atatttcagc atacttgctg agtaaaaaca
atgccattga accaagaagc 2280ttctcccaga attcaagaca ccctagcact
aggcaaaagc aatttaatgc caccacaatt 2340ccagaaaatg acatagagaa
gactgaccct tggtttgcac acagaacacc tatgcctaaa 2400atacaaaatg
tctcctctag tgatttgttg atgctcttgc gacagagtcc tactccacat
2460gggctatcct tatctgatct ccaagaagcc aaatatgaga ctttttctga
tgatccatca 2520cctggagcaa tagacagtaa taacagcctg tctgaaatga
cacacttcag gccacagctc 2580catcacagtg gggacatggt atttacccct
gagtcaggcc tccaattaag attaaatgag 2640aaactgggga caactgcagc
aacagagttg aagaaacttg atttcaaagt ttctagtaca 2700tcaaataatc
tgatttcaac aattccatca gacaatttgg cagcaggtac tgataataca
2760agttccttag gacccccaag tatgccagtt cattatgata gtcaattaga
taccactcta 2820tttggcaaaa agtcatctcc ccttactgag tctggtggac
ctctgagctt gagtgaagaa 2880aataatgatt caaagttgtt agaatcaggt
ttaatgaata gccaagaaag ttcatgggga 2940aaaaatgtat cgtcaacaga
gagtggtagg ttatttaaag ggaaaagagc tcatggacct 3000gctttgttga
ctaaagataa tgccttattc aaagttagca tctctttgtt aaagacaaac
3060aaaacttcca ataattcagc aactaataga aagactcaca ttgatggccc
atcattatta 3120attgagaata gtccatcagt ctggcaaaat atattagaaa
gtgacactga gtttaaaaaa 3180gtgacacctt tgattcatga cagaatgctt
atggacaaaa atgctacagc tttgaggcta 3240aatcatatgt caaataaaac
tacttcatca aaaaacatgg aaatggtcca acagaaaaaa 3300gagggcccca
ttccaccaga tgcacaaaat ccagatatgt cgttctttaa gatgctattc
3360ttgccagaat cagcaaggtg gatacaaagg actcatggaa agaactctct
gaactctggg 3420caaggcccca gtccaaagca attagtatcc ttaggaccag
aaaaatctgt ggaaggtcag 3480aatttcttgt ctgagaaaaa caaagtggta
gtaggaaagg gtgaatttac aaaggacgta 3540ggactcaaag agatggtttt
tccaagcagc agaaacctat ttcttactaa cttggataat 3600ttacatgaaa
ataatacaca caatcaagaa aaaaaaattc aggaagaaat agaaaagaag
3660gaaacattaa tccaagagaa tgtagttttg cctcagatac atacagtgac
tggcactaag 3720aatttcatga agaacctttt cttactgagc actaggcaaa
atgtagaagg ttcatatgac 3780ggggcatatg ctccagtact tcaagatttt
aggtcattaa atgattcaac aaatagaaca 3840aagaaacaca cagctcattt
ctcaaaaaaa ggggaggaag aaaacttgga aggcttggga 3900aatcaaacca
agcaaattgt agagaaatat gcatgcacca caaggatatc tcctaataca
3960agccagcaga attttgtcac gcaacgtagt aagagagctt tgaaacaatt
cagactccca 4020ctagaagaaa cagaacttga aaaaaggata attgtggatg
acacctcaac ccagtggtcc 4080aaaaacatga aacatttgac cccgagcacc
ctcacacaga tagactacaa tgagaaggag 4140aaaggggcca ttactcagtc
tcccttatca gattgcctta cgaggagtca tagcatccct 4200caagcaaata
gatctccatt acccattgca aaggtatcat catttccatc tattagacct
4260atatatctga ccagggtcct attccaagac aactcttctc atcttccagc
agcatcttat 4320agaaagaaag attctggggt ccaagaaagc agtcatttct
tacaaggagc caaaaaaaat 4380aacctttctt tagccattct aaccttggag
atgactggtg atcaaagaga ggttggctcc 4440ctggggacaa gtgccacaaa
ttcagtcaca tacaagaaag ttgagaacac tgttctcccg 4500aaaccagact
tgcccaaaac atctggcaaa gttgaattgc ttccaaaagt tcacatttat
4560cagaaggacc tattccctac ggaaactagc aatgggtctc ctggccatct
ggatctcgtg 4620gaagggagcc ttcttcaggg aacagaggga gcgattaagt
ggaatgaagc aaacagacct 4680ggaaaagttc cctttctgag agtagcaaca
gaaagctctg caaagactcc ctccaagcta 4740ttggatcctc ttgcttggga
taaccactat ggtactcaga taccaaaaga agagtggaaa 4800tcccaagaga
agtcaccaga aaaaacagct tttaagaaaa aggataccat tttgtccctg
4860aacgcttgtg aaagcaatca tgcaatagca gcaataaatg agggacaaaa
taagcccgaa 4920atagaagtca cctgggcaaa gcaaggtagg actgaaaggc
tgtgctctca aaacccacca 4980gtcttgaaac gccatcaacg ggaaataact
cgtactactc ttcagtcaga tcaagaggaa 5040attgactatg atgataccat
atcagttgaa atgaagaagg aagattttga catttatgat 5100gaggatgaaa
atcagagccc ccgcagcttt caaaagaaaa cacgacacta ttttattgct
5160gcagtggaga ggctctggga ttatgggatg agtagctccc cacatgttct
aagaaacagg 5220gctcagagtg gcagtgtccc tcagttcaag aaagttgttt
tccaggaatt tactgatggc 5280tcctttactc agcccttata ccgtggagaa
ctaaatgaac atttgggact cctggggcca 5340tatataagag cagaagttga
agataatatc atggtaactt tcagaaatca ggcctctcgt 5400ccctattcct
tctattctag ccttatttct tatgaggaag atcagaggca aggagcagaa
5460cctagaaaaa actttgtcaa gcctaatgaa accaaaactt acttttggaa
agtgcaacat 5520catatggcac ccactaaaga tgagtttgac tgcaaagcct
gggcttattt ctctgatgtt 5580gacctggaaa aagatgtgca ctcaggcctg
attggacccc ttctggtctg ccacactaac 5640acactgaacc ctgctcatgg
gagacaagtg acagtacagg aatttgctct gtttttcacc 5700atctttgatg
agaccaaaag ctggtacttc actgaaaata tggaaagaaa ctgcagggct
5760ccctgcaata tccagatgga agatcccact tttaaagaga attatcgctt
ccatgcaatc 5820aatggctaca taatggatac actacctggc ttagtaatgg
ctcaggatca aaggattcga 5880tggtatctgc tcagcatggg cagcaatgaa
aacatccatt ctattcattt cagtggacat 5940gtgttcactg tacgaaaaaa
agaggagtat aaaatggcac tgtacaatct ctatccaggt 6000gtttttgaga
cagtggaaat gttaccatcc aaagctggaa tttggcgggt ggaatgcctt
6060attggcgagc atctacatgc tgggatgagc acactttttc tggtgtacag
caataagtgt 6120cagactcccc tgggaatggc ttctggacac attagagatt
ttcagattac agcttcagga 6180caatatggac agtgggcccc aaagctggcc
agacttcatt attccggatc aatcaatgcc 6240tggagcacca aggagccctt
ttcttggatc aaggtggatc tgttggcacc aatgattatt 6300cacggcatca
agacccaggg tgcccgtcag aagttctcca gcctctacat ctctcagttt
6360atcatcatgt atagtcttga tgggaagaag tggcagactt atcgaggaaa
ttccactgga 6420accttaatgg tcttctttgg caatgtggat tcatctggga
taaaacacaa tatttttaac 6480cctccaatta ttgctcgata catccgtttg
cacccaactc attatagcat tcgcagcact 6540cttcgcatgg agttgatggg
ctgtgattta aatagttgca gcatgccatt gggaatggag 6600agtaaagcaa
tatcagatgc acagattact gcttcatcct actttaccaa tatgtttgcc
6660acctggtctc cttcaaaagc tcgacttcac ctccaaggga ggagtaatgc
ctggagacct 6720caggtgaata atccaaaaga gtggctgcaa gtggacttcc
agaagacaat gaaagtcaca 6780ggagtaacta ctcagggagt aaaatctctg
cttaccagca tgtatgtgaa ggagttcctc 6840atctccagca gtcaagatgg
ccatcagtgg actctctttt ttcagaatgg caaagtaaag 6900gtttttcagg
gaaatcaaga ctccttcaca cctgtggtga actctctaga cccaccgtta
6960ctgactcgct accttcgaat tcacccccag agttgggtgc accagattgc
cctgaggatg 7020gaggttctgg gctgcgaggc acaggacctc tacgacaaaa
ctcacacatg cccaccgtgc 7080ccagctccag aactcctggg cggaccgtca
gtcttcctct tccccccaaa acccaaggac 7140accctcatga tctcccggac
ccctgaggtc acatgcgtgg tggtggacgt gagccacgaa 7200gaccctgagg
tcaagttcaa ctggtacgtg gacggcgtgg aggtgcataa tgccaagaca
7260aagccgcggg aggagcagta caacagcacg taccgtgtgg tcagcgtcct
caccgtcctg 7320caccaggact ggctgaatgg caaggagtac aagtgcaagg
tctccaacaa agccctccca 7380gcccccatcg agaaaaccat ctccaaagcc
aaagggcagc cccgagaacc acaggtgtac 7440accctgcccc catcccggga
tgagctgacc aagaaccagg tcagcctgac ctgcctggtc 7500aaaggcttct
atcccagcga catcgccgtg gagtgggaga gcaatgggca gccggagaac
7560aactacaaga ccacgcctcc cgtgttggac tccgacggct ccttcttcct
ctacagcaag 7620ctcaccgtgg acaagagcag gtggcagcag gggaacgtct
tctcatgctc cgtgatgcat 7680gaggctctgc acaaccacta cacgcagaag
agcctctccc tgtctccggg taaa 773462578PRTArtificial SequenceFull
length FVIIIFc chainSIGNAL(1)..(19)FVIII
signalmat_peptide(20)..(2578)MISC_FEATURE(20)..(759)HCMISC_FEATURE(760)..-
(1667)B domainMISC_FEATURE(2352)..(2578)Fc region 6Met Gln Ile Glu
Leu Ser Thr Cys Phe Phe Leu Cys Leu Leu Arg Phe1 5 10 15Cys Phe Ser
Ala Thr Arg Arg Tyr Tyr Leu Gly Ala Val Glu Leu Ser 20 25 30Trp Asp
Tyr Met Gln Ser Asp Leu Gly Glu Leu Pro Val Asp Ala Arg 35 40 45Phe
Pro Pro Arg Val Pro Lys Ser Phe Pro Phe Asn Thr Ser Val Val 50 55
60Tyr Lys Lys Thr Leu Phe Val Glu Phe Thr Asp His Leu Phe Asn Ile65
70 75 80Ala Lys Pro Arg Pro Pro Trp Met Gly Leu Leu Gly Pro Thr Ile
Gln 85 90 95Ala Glu Val Tyr Asp Thr Val Val Ile Thr Leu Lys Asn Met
Ala Ser 100 105 110His Pro Val Ser Leu His Ala Val Gly Val Ser Tyr
Trp Lys Ala Ser 115 120 125Glu Gly Ala Glu Tyr Asp Asp Gln Thr Ser
Gln Arg Glu Lys Glu Asp 130 135 140Asp Lys Val Phe Pro Gly Gly Ser
His Thr Tyr Val Trp Gln Val Leu145 150 155 160Lys Glu Asn Gly Pro
Met Ala Ser Asp Pro Leu Cys Leu Thr Tyr Ser 165 170 175Tyr Leu Ser
His Val Asp Leu Val Lys Asp Leu Asn Ser Gly Leu Ile 180 185 190Gly
Ala Leu Leu Val Cys Arg Glu Gly Ser Leu Ala Lys Glu Lys Thr 195 200
205Gln Thr Leu His Lys Phe Ile Leu Leu Phe Ala Val Phe Asp Glu Gly
210 215 220Lys Ser Trp His Ser Glu Thr Lys Asn Ser Leu Met Gln Asp
Arg Asp225 230 235 240Ala Ala Ser Ala Arg Ala Trp Pro Lys Met His
Thr Val Asn Gly Tyr 245 250 255Val Asn Arg Ser Leu Pro Gly Leu Ile
Gly Cys His Arg Ser Ser Val 260 265 270Tyr Trp His Val Ile Gly Met
Gly Thr Thr Pro Glu Val His Ser Ile 275 280 285Phe Leu Glu Gly His
Thr Phe Leu Val Arg Asn His Arg Gln Ala Ser 290 295 300Leu Glu Ile
Ser Pro Ile Thr Phe Leu Thr Ala Gln Thr Leu Leu Met305 310 315
320Asp Leu Gly Gln Phe Leu Leu Phe Cys His Ile Ser Ser His Gln His
325 330 335Asp Gly Met Glu Ala Tyr Val Lys Val Asp Ser Cys Pro Glu
Glu Pro 340 345 350Gln Leu Arg Met Lys Asn Asn Glu Glu Ala Glu Asp
Tyr Asp Asp Asp 355 360 365Leu Thr Asp Ser Glu Met Asp Val Val Arg
Phe Asp Asp Asp Asn Ser 370 375 380Pro Ser Phe Ile Gln Ile Arg Ser
Val Ala Lys Lys His Pro Lys Thr385 390 395 400Trp Val His Tyr Ile
Ala Ala Glu Glu Glu Asp Trp Asp Tyr Ala Pro 405 410 415Leu Val Leu
Ala Pro Asp Asp Arg Ser Tyr Lys Ser Gln Tyr Leu Asn 420 425 430Asn
Gly Pro Gln Arg Ile Gly Arg Ser Tyr Lys Lys Val Arg Phe Met 435 440
445Ala Tyr Thr Asp Glu Thr Phe Lys Thr Arg Glu Ala Ile Gln His Glu
450 455 460Ser Gly Ile Leu Gly Pro Leu Leu Tyr Gly Glu Val Gly Asp
Thr Leu465 470 475 480Leu Ile Ile Phe Lys Asn Gln Ala Ser Arg Pro
Tyr Asn Ile Tyr Pro 485 490 495His Gly Ile Thr Asp Val Arg Pro Leu
Tyr Ser Arg Arg Leu Pro Lys 500 505 510Gly Val Lys His Leu Lys Asp
Phe Pro Ile Leu Pro Gly Glu Ile Phe 515 520 525Lys Tyr Lys Trp Thr
Val Thr Val Glu Asp Gly Pro Thr Lys Ser Asp 530 535 540Pro Arg Cys
Leu Thr Arg Tyr Tyr Ser Ser Phe Val Asn Met Glu Arg545 550 555
560Asp Leu Ala Ser Gly Leu Ile Gly Pro Leu Leu Ile Cys Tyr Lys Glu
565 570 575Ser Val Asp Gln Arg Gly Asn Gln Ile Met Ser Asp Lys Arg
Asn Val 580 585 590Ile Leu Phe Ser Val Phe Asp Glu Asn Arg Ser Trp
Tyr Leu Thr Glu 595 600 605Asn Ile Gln Arg Phe Leu Pro Asn Pro Ala
Gly Val Gln Leu Glu Asp 610 615 620Pro Glu Phe Gln Ala Ser Asn Ile
Met His Ser Ile Asn Gly Tyr Val625
630 635 640Phe Asp Ser Leu Gln Leu Ser Val Cys Leu His Glu Val Ala
Tyr Trp 645 650 655Tyr Ile Leu Ser Ile Gly Ala Gln Thr Asp Phe Leu
Ser Val Phe Phe 660 665 670Ser Gly Tyr Thr Phe Lys His Lys Met Val
Tyr Glu Asp Thr Leu Thr 675 680 685Leu Phe Pro Phe Ser Gly Glu Thr
Val Phe Met Ser Met Glu Asn Pro 690 695 700Gly Leu Trp Ile Leu Gly
Cys His Asn Ser Asp Phe Arg Asn Arg Gly705 710 715 720Met Thr Ala
Leu Leu Lys Val Ser Ser Cys Asp Lys Asn Thr Gly Asp 725 730 735Tyr
Tyr Glu Asp Ser Tyr Glu Asp Ile Ser Ala Tyr Leu Leu Ser Lys 740 745
750Asn Asn Ala Ile Glu Pro Arg Ser Phe Ser Gln Asn Ser Arg His Pro
755 760 765Ser Thr Arg Gln Lys Gln Phe Asn Ala Thr Thr Ile Pro Glu
Asn Asp 770 775 780Ile Glu Lys Thr Asp Pro Trp Phe Ala His Arg Thr
Pro Met Pro Lys785 790 795 800Ile Gln Asn Val Ser Ser Ser Asp Leu
Leu Met Leu Leu Arg Gln Ser 805 810 815Pro Thr Pro His Gly Leu Ser
Leu Ser Asp Leu Gln Glu Ala Lys Tyr 820 825 830Glu Thr Phe Ser Asp
Asp Pro Ser Pro Gly Ala Ile Asp Ser Asn Asn 835 840 845Ser Leu Ser
Glu Met Thr His Phe Arg Pro Gln Leu His His Ser Gly 850 855 860Asp
Met Val Phe Thr Pro Glu Ser Gly Leu Gln Leu Ala Arg Gln Glu865 870
875 880Lys Leu Gly Thr Thr Ala Ala Thr Glu Leu Lys Lys Leu Asp Phe
Lys 885 890 895Val Ser Ser Thr Ser Asn Asn Leu Ile Ser Thr Ile Pro
Ser Asp Asn 900 905 910Leu Ala Ala Gly Thr Asp Asn Thr Ser Ser Leu
Gly Pro Pro Ser Met 915 920 925Pro Val His Tyr Asp Ser Gln Leu Asp
Thr Thr Leu Phe Gly Lys Lys 930 935 940Ser Ser Pro Leu Thr Glu Ser
Gly Gly Pro Leu Ser Leu Ser Glu Glu945 950 955 960Asn Asn Asp Ser
Lys Leu Leu Glu Ser Gly Leu Met Asn Ser Gln Glu 965 970 975Ser Ser
Trp Gly Lys Asn Val Ser Ser Thr Glu Ser Gly Arg Leu Phe 980 985
990Lys Gly Lys Arg Ala His Gly Pro Ala Leu Leu Thr Lys Asp Asn Ala
995 1000 1005Leu Phe Lys Val Ser Ile Ser Leu Leu Lys Thr Asn Lys
Thr Ser 1010 1015 1020Asn Asn Ser Ala Thr Asn Arg Ser Thr His Ile
Asp Gly Pro Ser 1025 1030 1035Leu Leu Ile Glu Asn Ser Pro Ser Val
Trp Gln Asn Ile Leu Glu 1040 1045 1050Ser Asp Thr Glu Phe Lys Lys
Val Thr Pro Leu Ile His Asp Arg 1055 1060 1065Met Leu Met Asp Lys
Asn Ala Thr Ala Leu Ala Arg Gln His Met 1070 1075 1080Ser Asn Lys
Thr Thr Ser Ser Lys Asn Met Glu Met Val Gln Gln 1085 1090 1095Lys
Lys Glu Gly Pro Ile Pro Pro Asp Ala Gln Asn Pro Asp Met 1100 1105
1110Ser Phe Phe Lys Met Leu Phe Leu Pro Glu Ser Ala Arg Trp Ile
1115 1120 1125Gln Arg Thr His Gly Lys Asn Ser Leu Asn Ser Gly Gln
Gly Pro 1130 1135 1140Ser Pro Lys Gln Leu Val Ser Leu Gly Pro Glu
Lys Ser Val Glu 1145 1150 1155Gly Gln Asn Phe Leu Ser Glu Lys Asn
Lys Val Val Val Gly Lys 1160 1165 1170Gly Glu Phe Thr Lys Asp Val
Gly Leu Lys Glu Met Val Phe Pro 1175 1180 1185Ser Ser Arg Asn Leu
Phe Leu Thr Asn Leu Asp Asn Leu His Glu 1190 1195 1200Asn Asn Thr
His Asn Gln Glu Lys Lys Ile Gln Glu Glu Ile Glu 1205 1210 1215Lys
Lys Glu Thr Leu Ile Gln Glu Asn Val Val Leu Pro Gln Ile 1220 1225
1230His Thr Val Thr Gly Thr Lys Asn Phe Met Lys Asn Leu Phe Leu
1235 1240 1245Leu Ser Thr Arg Gln Asn Val Glu Gly Ser Tyr Asp Gly
Ala Tyr 1250 1255 1260Ala Pro Val Leu Gln Asp Phe Arg Ser Leu Asn
Asp Ser Thr Asn 1265 1270 1275Arg Thr Lys Lys His Thr Ala His Phe
Ser Lys Lys Gly Glu Glu 1280 1285 1290Glu Asn Leu Glu Gly Leu Gly
Asn Gln Thr Lys Gln Ile Val Glu 1295 1300 1305Lys Tyr Ala Cys Thr
Thr Arg Ile Ser Pro Asn Thr Ser Gln Gln 1310 1315 1320Asn Phe Val
Thr Gln Arg Ser Lys Arg Ala Leu Lys Gln Phe Arg 1325 1330 1335Leu
Pro Leu Glu Glu Thr Glu Leu Glu Lys Arg Ile Ile Val Asp 1340 1345
1350Asp Thr Ser Thr Gln Trp Ser Lys Asn Met Lys His Leu Thr Pro
1355 1360 1365Ser Thr Leu Thr Gln Ile Asp Tyr Asn Glu Lys Glu Lys
Gly Ala 1370 1375 1380Ile Thr Gln Ser Pro Leu Ser Asp Cys Leu Thr
Arg Ser His Ser 1385 1390 1395Ile Pro Gln Ala Asn Arg Ser Pro Leu
Pro Ile Ala Lys Val Ser 1400 1405 1410Ser Phe Pro Ser Ile Arg Pro
Ile Tyr Leu Thr Arg Val Leu Phe 1415 1420 1425Gln Asp Asn Ser Ser
His Leu Pro Ala Ala Ser Tyr Arg Ser Lys 1430 1435 1440Asp Ser Gly
Val Gln Glu Ser Ser His Phe Leu Gln Gly Ala Lys 1445 1450 1455Lys
Asn Asn Leu Ser Leu Ala Ile Leu Thr Leu Glu Met Thr Gly 1460 1465
1470Asp Gln Arg Glu Val Gly Ser Leu Gly Thr Ser Ala Thr Asn Ser
1475 1480 1485Val Thr Tyr Lys Lys Val Glu Asn Thr Val Leu Pro Lys
Pro Asp 1490 1495 1500Leu Pro Lys Thr Ser Gly Lys Val Glu Leu Leu
Pro Lys Val His 1505 1510 1515Ile Tyr Gln Lys Asp Leu Phe Pro Thr
Glu Thr Ser Asn Gly Ser 1520 1525 1530Pro Gly His Leu Asp Leu Val
Glu Gly Ser Leu Leu Gln Gly Thr 1535 1540 1545Glu Gly Ala Ile Lys
Trp Asn Glu Ala Asn Arg Pro Gly Lys Val 1550 1555 1560Pro Phe Leu
Arg Val Ala Thr Glu Ser Ser Ala Lys Thr Pro Ser 1565 1570 1575Lys
Leu Leu Asp Pro Leu Ala Trp Asp Asn His Tyr Gly Thr Gln 1580 1585
1590Ile Pro Lys Glu Glu Trp Lys Ser Gln Glu Lys Ser Pro Glu Lys
1595 1600 1605Thr Ala Phe Lys Lys Lys Asp Thr Ile Leu Ser Leu Asn
Ala Cys 1610 1615 1620Glu Ser Asn His Ala Ile Ala Ala Ile Asn Glu
Gly Gln Asn Lys 1625 1630 1635Pro Glu Ile Glu Val Thr Trp Ala Lys
Gln Gly Arg Thr Glu Arg 1640 1645 1650Leu Cys Ser Gln Asn Pro Pro
Val Leu Lys Arg His Gln Arg Glu 1655 1660 1665Ile Thr Arg Thr Thr
Leu Gln Ser Asp Gln Glu Glu Ile Asp Tyr 1670 1675 1680Asp Asp Thr
Ile Ser Val Glu Met Lys Lys Glu Asp Phe Asp Ile 1685 1690 1695Tyr
Asp Glu Asp Glu Asn Gln Ser Pro Arg Ser Phe Gln Lys Lys 1700 1705
1710Thr Arg His Tyr Phe Ile Ala Ala Val Glu Arg Leu Trp Asp Tyr
1715 1720 1725Gly Met Ser Ser Ser Pro His Val Leu Arg Asn Arg Ala
Gln Ser 1730 1735 1740Gly Ser Val Pro Gln Phe Lys Lys Val Val Phe
Gln Glu Phe Thr 1745 1750 1755Asp Gly Ser Phe Thr Gln Pro Leu Tyr
Arg Gly Glu Leu Asn Glu 1760 1765 1770His Leu Gly Leu Leu Gly Pro
Tyr Ile Arg Ala Glu Val Glu Asp 1775 1780 1785Asn Ile Met Val Thr
Phe Arg Asn Gln Ala Ser Arg Pro Tyr Ser 1790 1795 1800Phe Tyr Ser
Ser Leu Ile Ser Tyr Glu Glu Asp Gln Arg Gln Gly 1805 1810 1815Ala
Glu Pro Arg Ser Asn Phe Val Lys Pro Asn Glu Thr Lys Thr 1820 1825
1830Tyr Phe Trp Lys Val Gln His His Met Ala Pro Thr Lys Asp Glu
1835 1840 1845Phe Asp Cys Lys Ala Trp Ala Tyr Phe Ser Asp Val Asp
Leu Glu 1850 1855 1860Lys Asp Val His Ser Gly Leu Ile Gly Pro Leu
Leu Val Cys His 1865 1870 1875Thr Asn Thr Leu Asn Pro Ala His Gly
Arg Gln Val Thr Val Gln 1880 1885 1890Glu Phe Ala Leu Phe Phe Thr
Ile Phe Asp Glu Thr Lys Ser Trp 1895 1900 1905Tyr Phe Thr Glu Asn
Met Glu Arg Asn Cys Arg Ala Pro Cys Asn 1910 1915 1920Ile Gln Met
Glu Asp Pro Thr Phe Lys Glu Asn Tyr Arg Phe His 1925 1930 1935Ala
Ile Asn Gly Tyr Ile Met Asp Thr Leu Pro Gly Leu Val Met 1940 1945
1950Ala Gln Asp Gln Arg Ile Arg Trp Tyr Leu Leu Ser Met Gly Ser
1955 1960 1965Asn Glu Asn Ile His Ser Ile His Phe Ser Gly His Val
Phe Thr 1970 1975 1980Val Arg Ser Lys Glu Glu Tyr Lys Met Ala Leu
Tyr Asn Leu Tyr 1985 1990 1995Pro Gly Val Phe Glu Thr Val Glu Met
Leu Pro Ser Lys Ala Gly 2000 2005 2010Ile Trp Arg Val Glu Cys Leu
Ile Gly Glu His Leu His Ala Gly 2015 2020 2025Met Ser Thr Leu Phe
Leu Val Tyr Ser Asn Lys Cys Gln Thr Pro 2030 2035 2040Leu Gly Met
Ala Ser Gly His Ile Arg Asp Phe Gln Ile Thr Ala 2045 2050 2055Ser
Gly Gln Tyr Gly Gln Trp Ala Pro Lys Leu Ala Arg Leu His 2060 2065
2070Tyr Ser Gly Ser Ile Asn Ala Trp Ser Thr Lys Glu Pro Phe Ser
2075 2080 2085Trp Ile Lys Val Asp Leu Leu Ala Pro Met Ile Ile His
Gly Ile 2090 2095 2100Lys Thr Gln Gly Ala Arg Gln Lys Phe Ser Ser
Leu Tyr Ile Ser 2105 2110 2115Gln Phe Ile Ile Met Tyr Ser Leu Asp
Gly Lys Lys Trp Gln Thr 2120 2125 2130Tyr Arg Gly Asn Ser Thr Gly
Thr Leu Met Val Phe Phe Gly Asn 2135 2140 2145Val Asp Ser Ser Gly
Ile Lys His Asn Ile Phe Asn Pro Pro Ile 2150 2155 2160Ile Ala Arg
Tyr Ile Arg Leu His Pro Thr His Tyr Ser Ile Arg 2165 2170 2175Ser
Thr Leu Arg Met Glu Leu Met Gly Cys Asp Leu Asn Ser Cys 2180 2185
2190Ser Met Pro Leu Gly Met Glu Ser Lys Ala Ile Ser Asp Ala Gln
2195 2200 2205Ile Thr Ala Ser Ser Tyr Phe Thr Asn Met Phe Ala Thr
Trp Ser 2210 2215 2220Pro Ser Lys Ala Arg Leu His Leu Gln Gly Arg
Ser Asn Ala Trp 2225 2230 2235Arg Pro Gln Val Asn Asn Pro Lys Glu
Trp Leu Gln Val Asp Phe 2240 2245 2250Gln Lys Thr Met Lys Val Thr
Gly Val Thr Thr Gln Gly Val Lys 2255 2260 2265Ser Leu Leu Thr Ser
Met Tyr Val Lys Glu Phe Leu Ile Ser Ser 2270 2275 2280Ser Gln Asp
Gly His Gln Trp Thr Leu Phe Phe Gln Asn Gly Lys 2285 2290 2295Val
Lys Val Phe Gln Gly Asn Gln Asp Ser Phe Thr Pro Val Val 2300 2305
2310Asn Ser Leu Asp Pro Pro Leu Leu Thr Arg Tyr Leu Arg Ile His
2315 2320 2325Pro Gln Ser Trp Val His Gln Ile Ala Leu Arg Met Glu
Val Leu 2330 2335 2340Gly Cys Glu Ala Gln Asp Leu Tyr Asp Lys Thr
His Thr Cys Pro 2345 2350 2355Pro Cys Pro Ala Pro Glu Leu Leu Gly
Gly Pro Ser Val Phe Leu 2360 2365 2370Phe Pro Pro Lys Pro Lys Asp
Thr Leu Met Ile Ser Arg Thr Pro 2375 2380 2385Glu Val Thr Cys Val
Val Val Asp Val Ser His Glu Asp Pro Glu 2390 2395 2400Val Lys Phe
Asn Trp Tyr Val Asp Gly Val Glu Val His Asn Ala 2405 2410 2415Lys
Thr Lys Pro Arg Glu Glu Gln Tyr Asn Ser Thr Tyr Arg Val 2420 2425
2430Val Ser Val Leu Thr Val Leu His Gln Asp Trp Leu Asn Gly Lys
2435 2440 2445Glu Tyr Lys Cys Lys Val Ser Asn Lys Ala Leu Pro Ala
Pro Ile 2450 2455 2460Glu Lys Thr Ile Ser Lys Ala Lys Gly Gln Pro
Arg Glu Pro Gln 2465 2470 2475Val Tyr Thr Leu Pro Pro Ser Arg Asp
Glu Leu Thr Lys Asn Gln 2480 2485 2490Val Ser Leu Thr Cys Leu Val
Lys Gly Phe Tyr Pro Ser Asp Ile 2495 2500 2505Ala Val Glu Trp Glu
Ser Asn Gly Gln Pro Glu Asn Asn Tyr Lys 2510 2515 2520Thr Thr Pro
Pro Val Leu Asp Ser Asp Gly Ser Phe Phe Leu Tyr 2525 2530 2535Ser
Lys Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly Asn Val 2540 2545
2550Phe Ser Cys Ser Val Met His Glu Ala Leu His Asn His Tyr Thr
2555 2560 2565Gln Lys Ser Leu Ser Leu Ser Pro Gly Lys 2570
257572958DNAArtificial SequenceHeavy Chain
(HC)-Fcmisc_signal(1)..(57)misc_feature(2278)..(2958)Fc region
7atgcaaatag agctctccac ctgcttcttt ctgtgccttt tgcgattctg ctttagtgcc
60accagaagat actacctggg tgcagtggaa ctgtcatggg actatatgca aagtgatctc
120ggtgagctgc ctgtggacgc aagatttcct cctagagtgc caaaatcttt
tccattcaac 180acctcagtcg tgtacaaaaa gactctgttt gtagaattca
cggatcacct tttcaacatc 240gctaagccaa ggccaccctg gatgggtctg
ctaggtccta ccatccaggc tgaggtttat 300gatacagtgg tcattacact
taagaacatg gcttcccatc ctgtcagtct tcatgctgtt 360ggtgtatcct
actggaaagc ttctgaggga gctgaatatg atgatcagac cagtcaaagg
420gagaaagaag atgataaagt cttccctggt ggaagccata catatgtctg
gcaggtcctg 480aaagagaatg gtccaatggc ctctgaccca ctgtgcctta
cctactcata tctttctcat 540gtggacctgg taaaagactt gaattcaggc
ctcattggag ccctactagt atgtagagaa 600gggagtctgg ccaaggaaaa
gacacagacc ttgcacaaat ttatactact ttttgctgta 660tttgatgaag
ggaaaagttg gcactcagaa acaaagaact ccttgatgca ggatagggat
720gctgcatctg ctcgggcctg gcctaaaatg cacacagtca atggttatgt
aaacaggtct 780ctgccaggtc tgattggatg ccacaggaaa tcagtctatt
ggcatgtgat tggaatgggc 840accactcctg aagtgcactc aatattcctc
gaaggtcaca catttcttgt gaggaaccat 900cgccaggcgt ccttggaaat
ctcgccaata actttcctta ctgctcaaac actcttgatg 960gaccttggac
agtttctact gttttgtcat atctcttccc accaacatga tggcatggaa
1020gcttatgtca aagtagacag ctgtccagag gaaccccaac tacgaatgaa
aaataatgaa 1080gaagcggaag actatgatga tgatcttact gattctgaaa
tggatgtggt caggtttgat 1140gatgacaact ctccttcctt tatccaaatt
cgctcagttg ccaagaagca tcctaaaact 1200tgggtacatt acattgctgc
tgaagaggag gactgggact atgctccctt agtcctcgcc 1260cccgatgaca
gaagttataa aagtcaatat ttgaacaatg gccctcagcg gattggtagg
1320aagtacaaaa aagtccgatt tatggcatac acagatgaaa cctttaagac
tcgtgaagct 1380attcagcatg aatcaggaat cttgggacct ttactttatg
gggaagttgg agacacactg 1440ttgattatat ttaagaatca agcaagcaga
ccatataaca tctaccctca cggaatcact 1500gatgtccgtc ctttgtattc
aaggagatta ccaaaaggtg taaaacattt gaaggatttt 1560ccaattctgc
caggagaaat attcaaatat aaatggacag tgactgtaga agatgggcca
1620actaaatcag atcctcggtg cctgacccgc tattactcta gtttcgttaa
tatggagaga 1680gatctagctt caggactcat tggccctctc ctcatctgct
acaaagaatc tgtagatcaa 1740agaggaaacc agataatgtc agacaagagg
aatgtcatcc tgttttctgt atttgatgag 1800aaccgaagct ggtacctcac
agagaatata caacgctttc tccccaatcc agctggagtg 1860cagcttgagg
atccagagtt ccaagcctcc aacatcatgc acagcatcaa tggctatgtt
1920tttgatagtt tgcagttgtc agtttgtttg catgaggtgg catactggta
cattctaagc 1980attggagcac agactgactt cctttctgtc ttcttctctg
gatatacctt caaacacaaa 2040atggtctatg aagacacact caccctattc
ccattctcag gagaaactgt cttcatgtcg 2100atggaaaacc caggtctatg
gattctgggg tgccacaact cagactttcg gaacagaggc 2160atgaccgcct
tactgaaggt ttctagttgt gacaagaaca ctggtgatta ttacgaggac
2220agttatgaag atatttcagc atacttgctg agtaaaaaca atgccattga
accaagagac 2280aaaactcaca catgcccacc gtgcccagct ccagaactcc
tgggcggacc gtcagtcttc 2340ctcttccccc caaaacccaa ggacaccctc
atgatctccc ggacccctga ggtcacatgc 2400gtggtggtgg acgtgagcca
cgaagaccct gaggtcaagt tcaactggta cgtggacggc 2460gtggaggtgc
ataatgccaa gacaaagccg cgggaggagc agtacaacag cacgtaccgt
2520gtggtcagcg tcctcaccgt cctgcaccag gactggctga atggcaagga
gtacaagtgc 2580aaggtctcca acaaagccct cccagccccc atcgagaaaa
ccatctccaa agccaaaggg 2640cagccccgag aaccacaggt gtacaccctg
cccccatccc gggatgagct gaccaagaac 2700caggtcagcc tgacctgcct
ggtcaaaggc ttctatccca gcgacatcgc cgtggagtgg 2760gagagcaatg
ggcagccgga gaacaactac aagaccacgc ctcccgtgtt ggactccgac
2820ggctccttct tcctctacag caagctcacc gtggacaaga gcaggtggca
gcaggggaac 2880gtcttctcat gctccgtgat gcatgaggct ctgcacaacc
actacacgca gaagagcctc
2940tccctgtctc cgggtaaa 29588986PRTArtificial
SequenceHC-FcSIGNAL(1)..(19)mat_peptide(20)..(986)MISC_FEATURE(760)..(986-
)Fc region 8Met Gln Ile Glu Leu Ser Thr Cys Phe Phe Leu Cys Leu Leu
Arg Phe1 5 10 15Cys Phe Ser Ala Thr Arg Arg Tyr Tyr Leu Gly Ala Val
Glu Leu Ser 20 25 30Trp Asp Tyr Met Gln Ser Asp Leu Gly Glu Leu Pro
Val Asp Ala Arg 35 40 45Phe Pro Pro Arg Val Pro Lys Ser Phe Pro Phe
Asn Thr Ser Val Val 50 55 60Tyr Lys Lys Thr Leu Phe Val Glu Phe Thr
Asp His Leu Phe Asn Ile65 70 75 80Ala Lys Pro Arg Pro Pro Trp Met
Gly Leu Leu Gly Pro Thr Ile Gln 85 90 95Ala Glu Val Tyr Asp Thr Val
Val Ile Thr Leu Lys Asn Met Ala Ser 100 105 110His Pro Val Ser Leu
His Ala Val Gly Val Ser Tyr Trp Lys Ala Ser 115 120 125Glu Gly Ala
Glu Tyr Asp Asp Gln Thr Ser Gln Arg Glu Lys Glu Asp 130 135 140Asp
Lys Val Phe Pro Gly Gly Ser His Thr Tyr Val Trp Gln Val Leu145 150
155 160Lys Glu Asn Gly Pro Met Ala Ser Asp Pro Leu Cys Leu Thr Tyr
Ser 165 170 175Tyr Leu Ser His Val Asp Leu Val Lys Asp Leu Asn Ser
Gly Leu Ile 180 185 190Gly Ala Leu Leu Val Cys Arg Glu Gly Ser Leu
Ala Lys Glu Lys Thr 195 200 205Gln Thr Leu His Lys Phe Ile Leu Leu
Phe Ala Val Phe Asp Glu Gly 210 215 220Lys Ser Trp His Ser Glu Thr
Lys Asn Ser Leu Met Gln Asp Arg Asp225 230 235 240Ala Ala Ser Ala
Arg Ala Trp Pro Lys Met His Thr Val Asn Gly Tyr 245 250 255Val Asn
Arg Ser Leu Pro Gly Leu Ile Gly Cys His Arg Ser Ser Val 260 265
270Tyr Trp His Val Ile Gly Met Gly Thr Thr Pro Glu Val His Ser Ile
275 280 285Phe Leu Glu Gly His Thr Phe Leu Val Arg Asn His Arg Gln
Ala Ser 290 295 300Leu Glu Ile Ser Pro Ile Thr Phe Leu Thr Ala Gln
Thr Leu Leu Met305 310 315 320Asp Leu Gly Gln Phe Leu Leu Phe Cys
His Ile Ser Ser His Gln His 325 330 335Asp Gly Met Glu Ala Tyr Val
Lys Val Asp Ser Cys Pro Glu Glu Pro 340 345 350Gln Leu Arg Met Lys
Asn Asn Glu Glu Ala Glu Asp Tyr Asp Asp Asp 355 360 365Leu Thr Asp
Ser Glu Met Asp Val Val Arg Phe Asp Asp Asp Asn Ser 370 375 380Pro
Ser Phe Ile Gln Ile Arg Ser Val Ala Lys Lys His Pro Lys Thr385 390
395 400Trp Val His Tyr Ile Ala Ala Glu Glu Glu Asp Trp Asp Tyr Ala
Pro 405 410 415Leu Val Leu Ala Pro Asp Asp Arg Ser Tyr Lys Ser Gln
Tyr Leu Asn 420 425 430Asn Gly Pro Gln Arg Ile Gly Arg Ser Tyr Lys
Lys Val Arg Phe Met 435 440 445Ala Tyr Thr Asp Glu Thr Phe Lys Thr
Arg Glu Ala Ile Gln His Glu 450 455 460Ser Gly Ile Leu Gly Pro Leu
Leu Tyr Gly Glu Val Gly Asp Thr Leu465 470 475 480Leu Ile Ile Phe
Lys Asn Gln Ala Ser Arg Pro Tyr Asn Ile Tyr Pro 485 490 495His Gly
Ile Thr Asp Val Arg Pro Leu Tyr Ser Arg Arg Leu Pro Lys 500 505
510Gly Val Lys His Leu Lys Asp Phe Pro Ile Leu Pro Gly Glu Ile Phe
515 520 525Lys Tyr Lys Trp Thr Val Thr Val Glu Asp Gly Pro Thr Lys
Ser Asp 530 535 540Pro Arg Cys Leu Thr Arg Tyr Tyr Ser Ser Phe Val
Asn Met Glu Arg545 550 555 560Asp Leu Ala Ser Gly Leu Ile Gly Pro
Leu Leu Ile Cys Tyr Lys Glu 565 570 575Ser Val Asp Gln Arg Gly Asn
Gln Ile Met Ser Asp Lys Arg Asn Val 580 585 590Ile Leu Phe Ser Val
Phe Asp Glu Asn Arg Ser Trp Tyr Leu Thr Glu 595 600 605Asn Ile Gln
Arg Phe Leu Pro Asn Pro Ala Gly Val Gln Leu Glu Asp 610 615 620Pro
Glu Phe Gln Ala Ser Asn Ile Met His Ser Ile Asn Gly Tyr Val625 630
635 640Phe Asp Ser Leu Gln Leu Ser Val Cys Leu His Glu Val Ala Tyr
Trp 645 650 655Tyr Ile Leu Ser Ile Gly Ala Gln Thr Asp Phe Leu Ser
Val Phe Phe 660 665 670Ser Gly Tyr Thr Phe Lys His Lys Met Val Tyr
Glu Asp Thr Leu Thr 675 680 685Leu Phe Pro Phe Ser Gly Glu Thr Val
Phe Met Ser Met Glu Asn Pro 690 695 700Gly Leu Trp Ile Leu Gly Cys
His Asn Ser Asp Phe Arg Asn Arg Gly705 710 715 720Met Thr Ala Leu
Leu Lys Val Ser Ser Cys Asp Lys Asn Thr Gly Asp 725 730 735Tyr Tyr
Glu Asp Ser Tyr Glu Asp Ile Ser Ala Tyr Leu Leu Ser Lys 740 745
750Asn Asn Ala Ile Glu Pro Arg Asp Lys Thr His Thr Cys Pro Pro Cys
755 760 765Pro Ala Pro Glu Leu Leu Gly Gly Pro Ser Val Phe Leu Phe
Pro Pro 770 775 780Lys Pro Lys Asp Thr Leu Met Ile Ser Arg Thr Pro
Glu Val Thr Cys785 790 795 800Val Val Val Asp Val Ser His Glu Asp
Pro Glu Val Lys Phe Asn Trp 805 810 815Tyr Val Asp Gly Val Glu Val
His Asn Ala Lys Thr Lys Pro Arg Glu 820 825 830Glu Gln Tyr Asn Ser
Thr Tyr Arg Val Val Ser Val Leu Thr Val Leu 835 840 845His Gln Asp
Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val Ser Asn 850 855 860Lys
Ala Leu Pro Ala Pro Ile Glu Lys Thr Ile Ser Lys Ala Lys Gly865 870
875 880Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Arg Asp
Glu 885 890 895Leu Thr Lys Asn Gln Val Ser Leu Thr Cys Leu Val Lys
Gly Phe Tyr 900 905 910Pro Ser Asp Ile Ala Val Glu Trp Glu Ser Asn
Gly Gln Pro Glu Asn 915 920 925Asn Tyr Lys Thr Thr Pro Pro Val Leu
Asp Ser Asp Gly Ser Phe Phe 930 935 940Leu Tyr Ser Lys Leu Thr Val
Asp Lys Ser Arg Trp Gln Gln Gly Asn945 950 955 960Val Phe Ser Cys
Ser Val Met His Glu Ala Leu His Asn His Tyr Thr 965 970 975Gln Lys
Ser Leu Ser Leu Ser Pro Gly Lys 980 98592973DNAArtificial
SequenceHeavy Chain (HC)-Fc (5 amino acid linker between HC and
Fc)misc_signal(1)..(57)misc_feature(2278)..(2292)5 amino acid
linkermisc_feature(2293)..(2973)Fc region 9atgcaaatag agctctccac
ctgcttcttt ctgtgccttt tgcgattctg ctttagtgcc 60accagaagat actacctggg
tgcagtggaa ctgtcatggg actatatgca aagtgatctc 120ggtgagctgc
ctgtggacgc aagatttcct cctagagtgc caaaatcttt tccattcaac
180acctcagtcg tgtacaaaaa gactctgttt gtagaattca cggatcacct
tttcaacatc 240gctaagccaa ggccaccctg gatgggtctg ctaggtccta
ccatccaggc tgaggtttat 300gatacagtgg tcattacact taagaacatg
gcttcccatc ctgtcagtct tcatgctgtt 360ggtgtatcct actggaaagc
ttctgaggga gctgaatatg atgatcagac cagtcaaagg 420gagaaagaag
atgataaagt cttccctggt ggaagccata catatgtctg gcaggtcctg
480aaagagaatg gtccaatggc ctctgaccca ctgtgcctta cctactcata
tctttctcat 540gtggacctgg taaaagactt gaattcaggc ctcattggag
ccctactagt atgtagagaa 600gggagtctgg ccaaggaaaa gacacagacc
ttgcacaaat ttatactact ttttgctgta 660tttgatgaag ggaaaagttg
gcactcagaa acaaagaact ccttgatgca ggatagggat 720gctgcatctg
ctcgggcctg gcctaaaatg cacacagtca atggttatgt aaacaggtct
780ctgccaggtc tgattggatg ccacaggaaa tcagtctatt ggcatgtgat
tggaatgggc 840accactcctg aagtgcactc aatattcctc gaaggtcaca
catttcttgt gaggaaccat 900cgccaggcgt ccttggaaat ctcgccaata
actttcctta ctgctcaaac actcttgatg 960gaccttggac agtttctact
gttttgtcat atctcttccc accaacatga tggcatggaa 1020gcttatgtca
aagtagacag ctgtccagag gaaccccaac tacgaatgaa aaataatgaa
1080gaagcggaag actatgatga tgatcttact gattctgaaa tggatgtggt
caggtttgat 1140gatgacaact ctccttcctt tatccaaatt cgctcagttg
ccaagaagca tcctaaaact 1200tgggtacatt acattgctgc tgaagaggag
gactgggact atgctccctt agtcctcgcc 1260cccgatgaca gaagttataa
aagtcaatat ttgaacaatg gccctcagcg gattggtagg 1320aagtacaaaa
aagtccgatt tatggcatac acagatgaaa cctttaagac tcgtgaagct
1380attcagcatg aatcaggaat cttgggacct ttactttatg gggaagttgg
agacacactg 1440ttgattatat ttaagaatca agcaagcaga ccatataaca
tctaccctca cggaatcact 1500gatgtccgtc ctttgtattc aaggagatta
ccaaaaggtg taaaacattt gaaggatttt 1560ccaattctgc caggagaaat
attcaaatat aaatggacag tgactgtaga agatgggcca 1620actaaatcag
atcctcggtg cctgacccgc tattactcta gtttcgttaa tatggagaga
1680gatctagctt caggactcat tggccctctc ctcatctgct acaaagaatc
tgtagatcaa 1740agaggaaacc agataatgtc agacaagagg aatgtcatcc
tgttttctgt atttgatgag 1800aaccgaagct ggtacctcac agagaatata
caacgctttc tccccaatcc agctggagtg 1860cagcttgagg atccagagtt
ccaagcctcc aacatcatgc acagcatcaa tggctatgtt 1920tttgatagtt
tgcagttgtc agtttgtttg catgaggtgg catactggta cattctaagc
1980attggagcac agactgactt cctttctgtc ttcttctctg gatatacctt
caaacacaaa 2040atggtctatg aagacacact caccctattc ccattctcag
gagaaactgt cttcatgtcg 2100atggaaaacc caggtctatg gattctgggg
tgccacaact cagactttcg gaacagaggc 2160atgaccgcct tactgaaggt
ttctagttgt gacaagaaca ctggtgatta ttacgaggac 2220agttatgaag
atatttcagc atacttgctg agtaaaaaca atgccattga accaagaagc
2280ttctcccaga atgacaaaac tcacacatgc ccaccgtgcc cagctccaga
actcctgggc 2340ggaccgtcag tcttcctctt ccccccaaaa cccaaggaca
ccctcatgat ctcccggacc 2400cctgaggtca catgcgtggt ggtggacgtg
agccacgaag accctgaggt caagttcaac 2460tggtacgtgg acggcgtgga
ggtgcataat gccaagacaa agccgcggga ggagcagtac 2520aacagcacgt
accgtgtggt cagcgtcctc accgtcctgc accaggactg gctgaatggc
2580aaggagtaca agtgcaaggt ctccaacaaa gccctcccag cccccatcga
gaaaaccatc 2640tccaaagcca aagggcagcc ccgagaacca caggtgtaca
ccctgccccc atcccgggat 2700gagctgacca agaaccaggt cagcctgacc
tgcctggtca aaggcttcta tcccagcgac 2760atcgccgtgg agtgggagag
caatgggcag ccggagaaca actacaagac cacgcctccc 2820gtgttggact
ccgacggctc cttcttcctc tacagcaagc tcaccgtgga caagagcagg
2880tggcagcagg ggaacgtctt ctcatgctcc gtgatgcatg aggctctgca
caaccactac 2940acgcagaaga gcctctccct gtctccgggt aaa
297310991PRTArtificial
SequenceHC+5-FcSIGNAL(1)..(19)mat_peptide(20)..(991)MISC_FEATURE(760)..(7-
64)B domainMISC_FEATURE(765)..(991)Fc region 10Met Gln Ile Glu Leu
Ser Thr Cys Phe Phe Leu Cys Leu Leu Arg Phe1 5 10 15Cys Phe Ser Ala
Thr Arg Arg Tyr Tyr Leu Gly Ala Val Glu Leu Ser 20 25 30Trp Asp Tyr
Met Gln Ser Asp Leu Gly Glu Leu Pro Val Asp Ala Arg 35 40 45Phe Pro
Pro Arg Val Pro Lys Ser Phe Pro Phe Asn Thr Ser Val Val 50 55 60Tyr
Lys Lys Thr Leu Phe Val Glu Phe Thr Asp His Leu Phe Asn Ile65 70 75
80Ala Lys Pro Arg Pro Pro Trp Met Gly Leu Leu Gly Pro Thr Ile Gln
85 90 95Ala Glu Val Tyr Asp Thr Val Val Ile Thr Leu Lys Asn Met Ala
Ser 100 105 110His Pro Val Ser Leu His Ala Val Gly Val Ser Tyr Trp
Lys Ala Ser 115 120 125Glu Gly Ala Glu Tyr Asp Asp Gln Thr Ser Gln
Arg Glu Lys Glu Asp 130 135 140Asp Lys Val Phe Pro Gly Gly Ser His
Thr Tyr Val Trp Gln Val Leu145 150 155 160Lys Glu Asn Gly Pro Met
Ala Ser Asp Pro Leu Cys Leu Thr Tyr Ser 165 170 175Tyr Leu Ser His
Val Asp Leu Val Lys Asp Leu Asn Ser Gly Leu Ile 180 185 190Gly Ala
Leu Leu Val Cys Arg Glu Gly Ser Leu Ala Lys Glu Lys Thr 195 200
205Gln Thr Leu His Lys Phe Ile Leu Leu Phe Ala Val Phe Asp Glu Gly
210 215 220Lys Ser Trp His Ser Glu Thr Lys Asn Ser Leu Met Gln Asp
Arg Asp225 230 235 240Ala Ala Ser Ala Arg Ala Trp Pro Lys Met His
Thr Val Asn Gly Tyr 245 250 255Val Asn Arg Ser Leu Pro Gly Leu Ile
Gly Cys His Arg Ser Ser Val 260 265 270Tyr Trp His Val Ile Gly Met
Gly Thr Thr Pro Glu Val His Ser Ile 275 280 285Phe Leu Glu Gly His
Thr Phe Leu Val Arg Asn His Arg Gln Ala Ser 290 295 300Leu Glu Ile
Ser Pro Ile Thr Phe Leu Thr Ala Gln Thr Leu Leu Met305 310 315
320Asp Leu Gly Gln Phe Leu Leu Phe Cys His Ile Ser Ser His Gln His
325 330 335Asp Gly Met Glu Ala Tyr Val Lys Val Asp Ser Cys Pro Glu
Glu Pro 340 345 350Gln Leu Arg Met Lys Asn Asn Glu Glu Ala Glu Asp
Tyr Asp Asp Asp 355 360 365Leu Thr Asp Ser Glu Met Asp Val Val Arg
Phe Asp Asp Asp Asn Ser 370 375 380Pro Ser Phe Ile Gln Ile Arg Ser
Val Ala Lys Lys His Pro Lys Thr385 390 395 400Trp Val His Tyr Ile
Ala Ala Glu Glu Glu Asp Trp Asp Tyr Ala Pro 405 410 415Leu Val Leu
Ala Pro Asp Asp Arg Ser Tyr Lys Ser Gln Tyr Leu Asn 420 425 430Asn
Gly Pro Gln Arg Ile Gly Arg Ser Tyr Lys Lys Val Arg Phe Met 435 440
445Ala Tyr Thr Asp Glu Thr Phe Lys Thr Arg Glu Ala Ile Gln His Glu
450 455 460Ser Gly Ile Leu Gly Pro Leu Leu Tyr Gly Glu Val Gly Asp
Thr Leu465 470 475 480Leu Ile Ile Phe Lys Asn Gln Ala Ser Arg Pro
Tyr Asn Ile Tyr Pro 485 490 495His Gly Ile Thr Asp Val Arg Pro Leu
Tyr Ser Arg Arg Leu Pro Lys 500 505 510Gly Val Lys His Leu Lys Asp
Phe Pro Ile Leu Pro Gly Glu Ile Phe 515 520 525Lys Tyr Lys Trp Thr
Val Thr Val Glu Asp Gly Pro Thr Lys Ser Asp 530 535 540Pro Arg Cys
Leu Thr Arg Tyr Tyr Ser Ser Phe Val Asn Met Glu Arg545 550 555
560Asp Leu Ala Ser Gly Leu Ile Gly Pro Leu Leu Ile Cys Tyr Lys Glu
565 570 575Ser Val Asp Gln Arg Gly Asn Gln Ile Met Ser Asp Lys Arg
Asn Val 580 585 590Ile Leu Phe Ser Val Phe Asp Glu Asn Arg Ser Trp
Tyr Leu Thr Glu 595 600 605Asn Ile Gln Arg Phe Leu Pro Asn Pro Ala
Gly Val Gln Leu Glu Asp 610 615 620Pro Glu Phe Gln Ala Ser Asn Ile
Met His Ser Ile Asn Gly Tyr Val625 630 635 640Phe Asp Ser Leu Gln
Leu Ser Val Cys Leu His Glu Val Ala Tyr Trp 645 650 655Tyr Ile Leu
Ser Ile Gly Ala Gln Thr Asp Phe Leu Ser Val Phe Phe 660 665 670Ser
Gly Tyr Thr Phe Lys His Lys Met Val Tyr Glu Asp Thr Leu Thr 675 680
685Leu Phe Pro Phe Ser Gly Glu Thr Val Phe Met Ser Met Glu Asn Pro
690 695 700Gly Leu Trp Ile Leu Gly Cys His Asn Ser Asp Phe Arg Asn
Arg Gly705 710 715 720Met Thr Ala Leu Leu Lys Val Ser Ser Cys Asp
Lys Asn Thr Gly Asp 725 730 735Tyr Tyr Glu Asp Ser Tyr Glu Asp Ile
Ser Ala Tyr Leu Leu Ser Lys 740 745 750Asn Asn Ala Ile Glu Pro Arg
Ser Phe Ser Gln Asn Asp Lys Thr His 755 760 765Thr Cys Pro Pro Cys
Pro Ala Pro Glu Leu Leu Gly Gly Pro Ser Val 770 775 780Phe Leu Phe
Pro Pro Lys Pro Lys Asp Thr Leu Met Ile Ser Arg Thr785 790 795
800Pro Glu Val Thr Cys Val Val Val Asp Val Ser His Glu Asp Pro Glu
805 810 815Val Lys Phe Asn Trp Tyr Val Asp Gly Val Glu Val His Asn
Ala Lys 820 825 830Thr Lys Pro Arg Glu Glu Gln Tyr Asn Ser Thr Tyr
Arg Val Val Ser 835 840 845Val Leu Thr Val Leu His Gln Asp Trp Leu
Asn Gly Lys Glu Tyr Lys 850 855 860Cys Lys Val Ser Asn Lys Ala Leu
Pro Ala Pro Ile Glu Lys Thr Ile865 870 875 880Ser Lys Ala Lys Gly
Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu Pro 885 890 895Pro Ser Arg
Asp Glu Leu Thr Lys Asn Gln Val Ser Leu Thr Cys Leu 900 905
910Val Lys Gly Phe Tyr Pro Ser Asp Ile Ala Val Glu Trp Glu Ser Asn
915 920 925Gly Gln Pro Glu Asn Asn Tyr Lys Thr Thr Pro Pro Val Leu
Asp Ser 930 935 940Asp Gly Ser Phe Phe Leu Tyr Ser Lys Leu Thr Val
Asp Lys Ser Arg945 950 955 960Trp Gln Gln Gly Asn Val Phe Ser Cys
Ser Val Met His Glu Ala Leu 965 970 975His Asn His Tyr Thr Gln Lys
Ser Leu Ser Leu Ser Pro Gly Lys 980 985 990112793DNAArtificial
SequenceLight Chain
(LC)-Fcmisc_signal(1)..(60)misc_feature(2113)..(2793)Fc region
11atggagacag acacactcct gctatgggta ctgctgctct gggttccagg ttccactggt
60gaaataactc gtactactct tcagtcagat caagaggaaa ttgactatga tgataccata
120tcagttgaaa tgaagaagga agattttgac atttatgatg aggatgaaaa
tcagagcccc 180cgcagctttc aaaagaaaac acgacactat tttattgctg
cagtggagag gctctgggat 240tatgggatga gtagctcccc acatgttcta
agaaacaggg ctcagagtgg cagtgtccct 300cagttcaaga aagttgtttt
ccaggaattt actgatggct cctttactca gcccttatac 360cgtggagaac
taaatgaaca tttgggactc ctggggccat atataagagc agaagttgaa
420gataatatca tggtaacttt cagaaatcag gcctctcgtc cctattcctt
ctattctagc 480cttatttctt atgaggaaga tcagaggcaa ggagcagaac
ctagaaaaaa ctttgtcaag 540cctaatgaaa ccaaaactta cttttggaaa
gtgcaacatc atatggcacc cactaaagat 600gagtttgact gcaaagcctg
ggcttatttc tctgatgttg acctggaaaa agatgtgcac 660tcaggcctga
ttggacccct tctggtctgc cacactaaca cactgaaccc tgctcatggg
720agacaagtga cagtacagga atttgctctg tttttcacca tctttgatga
gaccaaaagc 780tggtacttca ctgaaaatat ggaaagaaac tgcagggctc
cctgcaatat ccagatggaa 840gatcccactt ttaaagagaa ttatcgcttc
catgcaatca atggctacat aatggataca 900ctacctggct tagtaatggc
tcaggatcaa aggattcgat ggtatctgct cagcatgggc 960agcaatgaaa
acatccattc tattcatttc agtggacatg tgttcactgt acgaaaaaaa
1020gaggagtata aaatggcact gtacaatctc tatccaggtg tttttgagac
agtggaaatg 1080ttaccatcca aagctggaat ttggcgggtg gaatgcctta
ttggcgagca tctacatgct 1140gggatgagca cactttttct ggtgtacagc
aataagtgtc agactcccct gggaatggct 1200tctggacaca ttagagattt
tcagattaca gcttcaggac aatatggaca gtgggcccca 1260aagctggcca
gacttcatta ttccggatca atcaatgcct ggagcaccaa ggagcccttt
1320tcttggatca aggtggatct gttggcacca atgattattc acggcatcaa
gacccagggt 1380gcccgtcaga agttctccag cctctacatc tctcagttta
tcatcatgta tagtcttgat 1440gggaagaagt ggcagactta tcgaggaaat
tccactggaa ccttaatggt cttctttggc 1500aatgtggatt catctgggat
aaaacacaat atttttaacc ctccaattat tgctcgatac 1560atccgtttgc
acccaactca ttatagcatt cgcagcactc ttcgcatgga gttgatgggc
1620tgtgatttaa atagttgcag catgccattg ggaatggaga gtaaagcaat
atcagatgca 1680cagattactg cttcatccta ctttaccaat atgtttgcca
cctggtctcc ttcaaaagct 1740cgacttcacc tccaagggag gagtaatgcc
tggagacctc aggtgaataa tccaaaagag 1800tggctgcaag tggacttcca
gaagacaatg aaagtcacag gagtaactac tcagggagta 1860aaatctctgc
ttaccagcat gtatgtgaag gagttcctca tctccagcag tcaagatggc
1920catcagtgga ctctcttttt tcagaatggc aaagtaaagg tttttcaggg
aaatcaagac 1980tccttcacac ctgtggtgaa ctctctagac ccaccgttac
tgactcgcta ccttcgaatt 2040cacccccaga gttgggtgca ccagattgcc
ctgaggatgg aggttctggg ctgcgaggca 2100caggacctct acgacaaaac
tcacacatgc ccaccgtgcc cagctccaga actcctgggc 2160ggaccgtcag
tcttcctctt ccccccaaaa cccaaggaca ccctcatgat ctcccggacc
2220cctgaggtca catgcgtggt ggtggacgtg agccacgaag accctgaggt
caagttcaac 2280tggtacgtgg acggcgtgga ggtgcataat gccaagacaa
agccgcggga ggagcagtac 2340aacagcacgt accgtgtggt cagcgtcctc
accgtcctgc accaggactg gctgaatggc 2400aaggagtaca agtgcaaggt
ctccaacaaa gccctcccag cccccatcga gaaaaccatc 2460tccaaagcca
aagggcagcc ccgagaacca caggtgtaca ccctgccccc atcccgggat
2520gagctgacca agaaccaggt cagcctgacc tgcctggtca aaggcttcta
tcccagcgac 2580atcgccgtgg agtgggagag caatgggcag ccggagaaca
actacaagac cacgcctccc 2640gtgttggact ccgacggctc cttcttcctc
tacagcaagc tcaccgtgga caagagcagg 2700tggcagcagg ggaacgtctt
ctcatgctcc gtgatgcatg aggctctgca caaccactac 2760acgcagaaga
gcctctccct gtctccgggt aaa 279312931PRTArtificial
SequenceLC-Fc6HisSIGNAL(1)..(20)mat_peptide(21)..(931)MISC_FEATURE(705)..-
(931)Fc region 12Met Glu Thr Asp Thr Leu Leu Leu Trp Val Leu Leu
Leu Trp Val Pro1 5 10 15Gly Ser Thr Gly Glu Ile Thr Arg Thr Thr Leu
Gln Ser Asp Gln Glu 20 25 30Glu Ile Asp Tyr Asp Asp Thr Ile Ser Val
Glu Met Lys Lys Glu Asp 35 40 45Phe Asp Ile Tyr Asp Glu Asp Glu Asn
Gln Ser Pro Arg Ser Phe Gln 50 55 60Lys Lys Thr Arg His Tyr Phe Ile
Ala Ala Val Glu Arg Leu Trp Asp65 70 75 80Tyr Gly Met Ser Ser Ser
Pro His Val Leu Arg Asn Arg Ala Gln Ser 85 90 95Gly Ser Val Pro Gln
Phe Lys Lys Val Val Phe Gln Glu Phe Thr Asp 100 105 110Gly Ser Phe
Thr Gln Pro Leu Tyr Arg Gly Glu Leu Asn Glu His Leu 115 120 125Gly
Leu Leu Gly Pro Tyr Ile Arg Ala Glu Val Glu Asp Asn Ile Met 130 135
140Val Thr Phe Arg Asn Gln Ala Ser Arg Pro Tyr Ser Phe Tyr Ser
Ser145 150 155 160Leu Ile Ser Tyr Glu Glu Asp Gln Arg Gln Gly Ala
Glu Pro Arg Ser 165 170 175Asn Phe Val Lys Pro Asn Glu Thr Lys Thr
Tyr Phe Trp Lys Val Gln 180 185 190His His Met Ala Pro Thr Lys Asp
Glu Phe Asp Cys Lys Ala Trp Ala 195 200 205Tyr Phe Ser Asp Val Asp
Leu Glu Lys Asp Val His Ser Gly Leu Ile 210 215 220Gly Pro Leu Leu
Val Cys His Thr Asn Thr Leu Asn Pro Ala His Gly225 230 235 240Arg
Gln Val Thr Val Gln Glu Phe Ala Leu Phe Phe Thr Ile Phe Asp 245 250
255Glu Thr Lys Ser Trp Tyr Phe Thr Glu Asn Met Glu Arg Asn Cys Arg
260 265 270Ala Pro Cys Asn Ile Gln Met Glu Asp Pro Thr Phe Lys Glu
Asn Tyr 275 280 285Arg Phe His Ala Ile Asn Gly Tyr Ile Met Asp Thr
Leu Pro Gly Leu 290 295 300Val Met Ala Gln Asp Gln Arg Ile Arg Trp
Tyr Leu Leu Ser Met Gly305 310 315 320Ser Asn Glu Asn Ile His Ser
Ile His Phe Ser Gly His Val Phe Thr 325 330 335Val Arg Ser Lys Glu
Glu Tyr Lys Met Ala Leu Tyr Asn Leu Tyr Pro 340 345 350Gly Val Phe
Glu Thr Val Glu Met Leu Pro Ser Lys Ala Gly Ile Trp 355 360 365Arg
Val Glu Cys Leu Ile Gly Glu His Leu His Ala Gly Met Ser Thr 370 375
380Leu Phe Leu Val Tyr Ser Asn Lys Cys Gln Thr Pro Leu Gly Met
Ala385 390 395 400Ser Gly His Ile Arg Asp Phe Gln Ile Thr Ala Ser
Gly Gln Tyr Gly 405 410 415Gln Trp Ala Pro Lys Leu Ala Arg Leu His
Tyr Ser Gly Ser Ile Asn 420 425 430Ala Trp Ser Thr Lys Glu Pro Phe
Ser Trp Ile Lys Val Asp Leu Leu 435 440 445Ala Pro Met Ile Ile His
Gly Ile Lys Thr Gln Gly Ala Arg Gln Lys 450 455 460Phe Ser Ser Leu
Tyr Ile Ser Gln Phe Ile Ile Met Tyr Ser Leu Asp465 470 475 480Gly
Lys Lys Trp Gln Thr Tyr Arg Gly Asn Ser Thr Gly Thr Leu Met 485 490
495Val Phe Phe Gly Asn Val Asp Ser Ser Gly Ile Lys His Asn Ile Phe
500 505 510Asn Pro Pro Ile Ile Ala Arg Tyr Ile Arg Leu His Pro Thr
His Tyr 515 520 525Ser Ile Arg Ser Thr Leu Arg Met Glu Leu Met Gly
Cys Asp Leu Asn 530 535 540Ser Cys Ser Met Pro Leu Gly Met Glu Ser
Lys Ala Ile Ser Asp Ala545 550 555 560Gln Ile Thr Ala Ser Ser Tyr
Phe Thr Asn Met Phe Ala Thr Trp Ser 565 570 575Pro Ser Lys Ala Arg
Leu His Leu Gln Gly Arg Ser Asn Ala Trp Arg 580 585 590Pro Gln Val
Asn Asn Pro Lys Glu Trp Leu Gln Val Asp Phe Gln Lys 595 600 605Thr
Met Lys Val Thr Gly Val Thr Thr Gln Gly Val Lys Ser Leu Leu 610 615
620Thr Ser Met Tyr Val Lys Glu Phe Leu Ile Ser Ser Ser Gln Asp
Gly625 630 635 640His Gln Trp Thr Leu Phe Phe Gln Asn Gly Lys Val
Lys Val Phe Gln 645 650 655Gly Asn Gln Asp Ser Phe Thr Pro Val Val
Asn Ser Leu Asp Pro Pro 660 665 670Leu Leu Thr Arg Tyr Leu Arg Ile
His Pro Gln Ser Trp Val His Gln 675 680 685Ile Ala Leu Arg Met Glu
Val Leu Gly Cys Glu Ala Gln Asp Leu Tyr 690 695 700Asp Lys Thr His
Thr Cys Pro Pro Cys Pro Ala Pro Glu Leu Leu Gly705 710 715 720Gly
Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys Asp Thr Leu Met 725 730
735Ile Ser Arg Thr Pro Glu Val Thr Cys Val Val Val Asp Val Ser His
740 745 750Glu Asp Pro Glu Val Lys Phe Asn Trp Tyr Val Asp Gly Val
Glu Val 755 760 765His Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln Tyr
Asn Ser Thr Tyr 770 775 780Arg Val Val Ser Val Leu Thr Val Leu His
Gln Asp Trp Leu Asn Gly785 790 795 800Lys Glu Tyr Lys Cys Lys Val
Ser Asn Lys Ala Leu Pro Ala Pro Ile 805 810 815Glu Lys Thr Ile Ser
Lys Ala Lys Gly Gln Pro Arg Glu Pro Gln Val 820 825 830Tyr Thr Leu
Pro Pro Ser Arg Asp Glu Leu Thr Lys Asn Gln Val Ser 835 840 845Leu
Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser Asp Ile Ala Val Glu 850 855
860Trp Glu Ser Asn Gly Gln Pro Glu Asn Asn Tyr Lys Thr Thr Pro
Pro865 870 875 880Val Leu Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser
Lys Leu Thr Val 885 890 895Asp Lys Ser Arg Trp Gln Gln Gly Asn Val
Phe Ser Cys Ser Val Met 900 905 910His Glu Ala Leu His Asn His Tyr
Thr Gln Lys Ser Leu Ser Leu Ser 915 920 925Pro Gly Lys 930
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