TFPI inhibitors and methods of use

1. A peptide that binds TFPI, comprising the structure of formula (XI):

X4001-Q-X4003-X4004-X4005-X4006-X4007-X4008-X4009-X4010-X4011-X4012-X4013-X4014-R-X4016-X4017-X4018-X4019-X4020 (XI),

wherein X4001 is an amino acid selected from the group consisting of F, L, M, Y, 1Ni, Thi, Bta, and Dopa;

wherein X4003 is an amino acid selected from the group consisting of C, D, E, M, Q, R, S, T, Ede(O), and Cmc;

wherein X4004 is an amino acid selected from the group consisting of Aib, E, G, I, K, L, M, P, R, W, and Y;

wherein X4005 is an amino acid selected from the group consisting of a, A, Aib, C, D, d, E, G, H, K, k, M, N, Nmg, p, Q, R, NpropylG, aze, pip, tic, oic, hyp, nma, Ncg, Abg, Apg, thz, and dtc;

wherein X4006 is an amino acid selected from the group consisting of A, C, C(NEM), D, E, G, H, K, M, N, Q, R, S, V, Cit, C(Acm), Nle, I, Ede(O), Cmc, Ed, Eea, Eec, Eef, Nif, and Eew;

wherein X4007 is an amino acid selected from the group consisting of I, V, T, Chg, Phg, and Tle;

wherein X4008 is an amino acid selected from the group consisting of F, H, 1Ni, 2Ni, Pmy, and Y;

wherein X4009 is an amino acid selected from the group consisting of Aib, V, Chg, Phg, Abu, Cpg, Tle, and L-2-amino-4,4,4-trifluorobutyric acid;

wherein X4010 is an amino acid selected from the group consisting of A, C, D, d, E, F, H, K, M, N, P, Q, R, S, T, V, W, Y, Nmd, and C(NEM);

wherein X4011 is an amino acid selected from the group consisting of A, a, G, p, Sar, c, and hcy;

wherein X4012 is an amino acid selected from the group consisting of Y, Tym, Pty, Dopa, and Pmy;

wherein X4013 is an amino acid selected from the group consisting of C, F, 1Ni, Thi, and Bta;

wherein X4014 is an amino acid selected from the group consisting of A, Aib, C, C(NEM), D, E, K, L, M, N, Q, R, T, V, and Hcy;

wherein X4016 is an amino acid selected from the group consisting of L, Hcy, Hle, and Aml;

wherein X4017 is an amino acid selected from the group consisting of A, a, Aib, C, c, Cha, Dab, Eag, Eew, H, Har, Hci, Hle, I, K, L, M, Nle, Nva, Opa, Orn, R, S, Deg, Ebc, Eca, Egz, Aic, Apc, and Egt;

wherein X4018 is an amino acid selected from the group consisting of A, Aib, Hcy, hcy, C, c, L, Nle, M, N, and R;

wherein X4019 is an amino acid selected from the group consisting of K, R, and Har; and

wherein X4020 is an amino acid selected from the group consisting of K, L, Hcy, and Aml; and

wherein the peptide does not comprise the following structure of formula (XII): X5001-Q-X5003-X5004-X5005-X5006-I/V-X5008-Aib/V-X5010-G-Y-X5013-X5014-R-L-X5017-X5018-K-K/L (XII),

wherein X5001 is an amino acid selected from the group consisting of F, L, M, and Y;

wherein X5003 is an amino acid selected from the group consisting of C, D, E, M, Q, R, S, and T;

wherein X5004 is an amino acid selected from the group consisting of E, G, I, K, L, M, P, R, W, and Y;

wherein X5005 is an amino acid selected from the group consisting of a, A, Aib, C, D, d, E, G, H, K, k, M, N, Nmg, Q, R, and p;

wherein X5006 is an amino acid selected from the group consisting of A, C, D, E, G, H, K, M, N, Q, R, S, and V;

wherein X5008 is an amino acid selected from the group consisting of F, H, and Y;

wherein X5010 is an amino acid selected from the group consisting of A, C, D, E, F, H, D, M, N, P, Q, R, S, T, V, W, and Y;

wherein X5013 is an amino acid selected from the group consisting of Aib, C, and F;

wherein X5014 is an amino acid selected from the group consisting of A, Aib, C, D, E, K, L, M, N, Q, R, T, and V;

wherein X5017 is an amino acid selected from the group consisting of A, Aib, C, Cha, Dab, Eag, Eew, H, Har, Hci, Hle, I, K, L, M, Nle, Nve, Opa, Orn, R, and S; and

wherein X5018 is an amino acid selected from the group consisting of A, C, L, M, N, and R.

2. The peptide of claim 1 , wherein the peptide consists of the amino acid sequence selected from the group consisting of SEQ ID NOs: 4024, 4032, 4036-4047, 4049-4078, 4086-4097, 4100-4127, 4129-4170, 4173-4195, 4200-4214, 4217-4225, 4228, 4230, 4231, 4238, and 4239.

3. A peptide consisting of the amino acid sequence selected from the group consisting of SEQ ID NOs: 1294-1336, 4002, 4013, 4021, 4023, 4025-4031, 4033-4035, 4048, 4079-4085, 4098, 4099, 4128, 4171, 4172, 4196-4199, 4215, 4216, 4226, 4227, 4229, 4232, and 4233.

4. A method for treating a subject suffering from a blood coagulation disorder or at risk of suffering from a blood coagulation disorder, the method comprising administering to the subject the peptide according to claim 1 .

5. A method for treating a subject suffering from a blood coagulation disorder or at risk of suffering from a blood coagulation disorder, the method comprising administering to the subject the peptide according to claim 3 .

6. A method for treating a subject suffering from a blood coagulation disorder or at risk of suffering from a blood coagulation disorder, the method comprising administering to the subject the peptide according to claim 2 .

7. The peptide according to claim 1 ,

wherein X4001 is an amino acid selected from the group consisting of F, Y, 1Ni, Bta, and Dopa;

wherein X4003 is an amino acid selected from the group consisting of D, E, and S;

wherein X4004 is K;

wherein X4005 is an amino acid selected from the group consisting of p, Nmg, NpropylG, aze, pip, tic, oic, and hyp;

wherein X4006 is an amino acid selected from the group consisting of C, E, K, R, S, V, C(Acm), Nle, C(NEM), I, and Cit;

wherein X4007 is V or Tle;

wherein X4008 is an amino acid selected from the group consisting of H, 1Ni, 2Ni, and Pmy;

wherein X4009 is an amino acid selected from the group consisting of V, Abu, and Tle;

wherein X4010 is an amino acid selected from the group consisting of D, P, C, and T;

wherein X4011 is an amino acid selected from the group consisting of G, a, c, hcy, and Sar;

wherein X4012 is Y;

wherein X4013 is an amino acid selected from the group consisting of F, 1Ni, and Bta;

wherein X4014 is an amino acid selected from the group consisting of Aib, C, E, and Hcy;

wherein X4016 is an amino acid selected from the group consisting of L, Aml, Hle, and Hcy;

wherein X4017 is an amino acid selected from the group consisting of A, Aib, C, c, Aic, Eca, and Deg;

wherein X4018 is an amino acid selected from the group consisting of A, Aib, C, c, L, and Hcy;

wherein X4019 is K; and

wherein X4020 is an amino acid selected from the group consisting of L, Aml, and Hcy.

8. The peptide according to claim 1 further comprising N-terminal amino acid(s) and/or moieties linked to X4001 and selected from the group consisting of FAM-Ttds, PE, Palm, 2-phenyl acetyl, 3-phenyl propionyl, 2-(naphtha-2-yl)acetyl, hexanoyl, 2-methyl propionyl, 3-methyl butanoyl, 2-naphthylsulfonyl, and 1-naphthylsulfonyl.

9. The peptide according to claim 1 further comprising X4021 linked to X4020, wherein X4021 comprises C-terminal amino acid(s) and/or moieties selected from the group consisting of C, c, C(NEM), K(Ttds-maleimidopropionyl(EtSH)), FA19205, FA19204, FA19203, FA03202, K(Tdts-maleimide), K(AOA), and Cea.

10. The peptide according to claim 8 further comprising X4021 linked to X4020, wherein X4021 comprises C-terminal amino acid(s) and/or moieties selected from the group consisting of C, c, C(NEM), K(Ttds-maleimidopropionyl(EtSH)), FA19205, FA19204, FA19203, FA03202, K(Tdts-maleimide), K(AOA), and Cea.

11. The peptide according to claim 1 , wherein the peptide comprises a cyclic structure.

12. The peptide according to claim 11 , wherein the cyclic structure is formed between X4018 and X4021.

13. The peptide according to claim 12 , wherein (a) X4018 is C or c and (b) X4021 is Cea.

14. The peptide according to claim 11 , wherein the cyclic structure is formed between X4011 and X4014.

15. The peptide according to claim 14 , wherein (a) X4011 is c or hcy and (b) X4014 is C or Hcy.

16. The peptide according to claim 1 , comprising an intramolecular disulfide bond.

17. The peptide according to claim 1 , wherein the IC 50 of the peptide is less than 250 nM.

18. The peptide according to claim 1 , wherein the IC 50 of the peptide is less than 50 nM.

19. The peptide according to claim 1 , wherein the IC 50 of the peptide is less than 10 nM.

20. The peptide according to claim 1 , wherein the peptide inhibits TFPI activity and binds to TFPI 1-alpha with a dissociation constant of less than 10 μM.

21. The peptide according to claim 1 , wherein the peptide is conjugated to a polyethylene glycol (PEG) moiety.

22. The peptide according to claim 2 , wherein the peptide is conjugated to a polyethylene glycol (PEG) moiety, human serum albumin (HSA), an antibody or fragment thereof, hydroxyethyl starch, a proline-alanine-serine multimer (PASylation), a C12-C18 fatty acid, or polysialic acid.

23. The peptide according to claim 3 , wherein the peptide is conjugated to a polyethylene glycol (PEG) moiety, human serum albumin (HSA), an antibody or fragment thereof, hydroxyethyl starch, a proline-alanine-serine multimer (PASylation), a C12-C18 fatty acid, or polysialic acid.

24. A TFPI-binding peptide comprising a homo-dimer or homo-multimer of two or more peptides according to claim 1 .

25. A TFPI-binding peptide comprising a homo-dimer or homo-multimer of two or more peptides according to claim 2 .

26. A TFPI-binding peptide comprising a homo-dimer or homo-multimer of two or more peptides according to claim 3 .

27. A TFPI-binding peptide comprising a hetero-dimer or hetero-multimer of two or more peptides according to claim 1 .

28. A TFPI-binding peptide comprising a hetero-dimer or hetero-multimer of two or more peptides according to claim 2 .

29. A TFPI-binding peptide comprising a hetero-dimer or hetero-multimer of two or more peptides according to claim 3 .

30. A method for treating a subject suffering from a blood coagulation disorder or at risk of suffering from a blood coagulation disorder, the method comprising administering to the subject the peptide according to claim 24 .

31. A method for treating a subject suffering from a blood coagulation disorder or at risk of suffering from a blood coagulation disorder, the method comprising administering to the subject the peptide according to claim 27 .