Uses and methods for modulating bile acid homeostasis and treatment of bile acid disorders and diseases

1. A method of reducing bile acid synthesis in a subject having primary biliary cirrhosis, comprising administering to the subject an effective amount of a peptide, wherein the peptide comprises:

a) an N-terminal region comprising at least seven amino acid residues, the N-terminal region having a first amino acid position and a last amino acid position, wherein the N-terminal region comprises DSSPL (SEQ ID NO:121) or DASPH (SEQ ID NO:122); and

b) a C-terminal region comprising a portion of SEQ ID NO:99 [FGF19], the C-terminal region having a first amino acid position and a last amino acid position, wherein the C-terminal region comprises

(i) a first C-terminal region sequence comprising WGDPIRLRHLYTSG (amino acids 16 to 29 of SEQ ID NO:99 [FGF 19 ]), wherein the W residue corresponds to the first amino acid position of the C-terminal region; and

(ii) a second C-terminal region sequence comprising PHGLSSCFLRIRADGVVDCARGQSAHSLLEIKAVALRTVAIKGVHS VRYLCMGADGKMQGLLQYSEEDCAFEEEIRPDGYNVYRSEKHRL PVSLSSAKQRQLYKNRGFLPLSHFLPMLPMVPEEPEDLRGHLESD MFSSPLETDSMDPFGLVTGLEAVRSPSFEK (amino acid residues 30 to 194 of SEQ ID NO:99 [FGF19]);

wherein the peptide

(i) binds to fibroblast growth factor receptor 4 (FGFR4) with an affinity equal to or greater than FGF19 binding affinity for FGFR4;

(ii) activates FGFR4 to an extent or amount equal to or greater than FGF19 activates FGFR4;

(iii) has at least one of reduced hepatocellular carcinoma (HCC) formation; greater glucose lowering activity, less lipid increasing activity, less triglyceride activity, less cholesterol activity, less non-HDL activity or less HDL increasing activity, as compared to FGF19, or as compared to an FGF19 variant sequence having any of GQV, GDI, WGPI, WGDPV, WGDI, GDPI, GPI, WGQPI, WGAPI, AGDPI, WADPI, WGDAI, WGDPA, WDPI, WGDI, WGDP or FGDPI substituted for the WGDPI sequence at amino acids 16-20 of FGF19 (SEQ ID NO:99); and/or

(iv) has less lean mass reducing activity as compared to FGF21;

thereby reducing bile acid synthesis in said subject.

2. The method of claim 1 , wherein the second C-terminal region sequence comprises from 1 to 5 amino acid substitutions, deletions or insertions.

3. The method of claim 1 , wherein the peptide is less than about 250 amino acids in length.

4. The method of claim 1 , wherein the N-terminal region comprises amino acid residues VHYG (SEQ ID NO:101), DASPHVHYG (SEQ ID NO:102), or DSSPLVHYG (SEQ ID NO:103).

5. The method of claim 4 , wherein the G corresponds to the last position of the N-terminal region.

6. The method of claim 5 , wherein the N-terminal region further comprises:

RHPIP (SEQ ID NO:106), wherein R is the first amino acid position of the N-terminal region;

HPIP (SEQ ID NO:107), wherein H is the first amino acid position of the N-terminal region;

RPLAF (SEQ ID NO:108), wherein R is the first amino acid position of the N-terminal region;

PLAF (SEQ ID NO:109), wherein P is the first amino acid position of the N-terminal region; or

R, wherein R is the first amino acid position of the N-terminal region.

7. The method of claim 1 , wherein the N-terminal region comprises amino acid residues DSSPLLQ (SEQ ID NO:104), and wherein the Q residue is the last amino acid position of the N-terminal region.

8. The method of claim 7 , wherein the N-terminal region further comprises:

RHPIP (SEQ ID NO:106), wherein R is the first amino acid position of the N-terminal region;

HPIP (SEQ ID NO:107), wherein H is the first amino acid position of the N-terminal region;

RPLAF (SEQ ID NO:108), wherein R is the first amino acid position of the N-terminal region;

PLAF (SEQ ID NO:109), wherein P is the first amino acid position of the N-terminal region; or

R, wherein R is the first amino acid position of the N-terminal region.

9. The method of claim 1 , wherein the N-terminal region comprises amino acid residues DSSPLLQFGGQV (SEQ ID NO:105), and wherein the V residue corresponds to the last position of the N-terminal region.

10. The method of claim 1 , wherein amino acid residues HPIP (SEQ ID NO:107) are the first 4 amino acid residues of the N-terminal region.

11. The method of claim 1 , wherein

the first position of the N-terminal region is a R or M residue;

the first and second positions of the N-terminal region is a MR, RM, RD, DS, MD or MS sequence;

the first through third positions of the N-terminal region is a MDS, RDS, MSD, MSS, or DSS sequence;

the first through fourth positions of the N-terminal region is a RDSS (SEQ ID NO:115) or MDSS (SEQ ID NO:116) sequence;

the first through fifth positions of the N-terminal region is an MRDSS (SEQ ID NO:117) sequence;

the first through sixth positions of the N-terminal region is an MDSSPL (SEQ ID NO:119) sequence; or

the first through seventh positions of the N-terminal region is an MSDSSPL (SEQ ID NO:120) sequence.

12. The method of claim 1 , wherein the N-terminal region and the first C-terminal region of the peptide has an amino acid sequence comprising or consisting of any of:

RPLAFSDASPHVHYGWGDPIRLRHLYTSG (M1) (amino acids

1-29 of SEQ ID NO: 1);

PLAFSDASPHVHYGWGDPIRLRHLYTSG (M1-R) (amino acids

2-29 of SEQ ID NO: 1);

RPLAFSDSSPLVHYGWGDPIRLRHLYTSG (M2) (amino acids

1-29 of SEQ ID NO: 2);

PLAFSDSSPLVHYGWGDPIRLRHLYTSG (M2-R) (amino acids

2-29 of SEQ ID NO: 2);

RHPIPDSSPLLQWGDPIRLRHLYTSG (M8) (amino acids

1-26 of SEQ ID NO: 8);

RHPIPDSSPLLQFGWGDPIRLRHLYTSG (M9) (amino acids

1-28 of SEQ ID NO: 9);

RPLAFSDSSPLVHWGDPIRLRHLYTSG (M26) (amino acids

1-27 of SEQ ID NO: 26);

PLAFSDSSPLVHWGDPIRLRHLYTSG (M26-R) (amino acids

2-27 of SEQ ID NO: 26);

HPIPDSSPLLQWGDPIRLRHLYTSG (M47) (amino acids

1-25 of SEQ ID NO: 47);

RDSSPLLQWGDPIRLRHLYTSG (M52) (amino acids

1-22 of SEQ ID NO: 52);

DSSPLLQWGDPIRLRHLYTSG (M52-R) (amino acids

2-22 of SEQ ID NO: 52);

MDSSPLVHYGWGDPIRLRHLYTSG (M53) (amino acids

1-24 of SEQ ID NO: 53);

RDSSPLVHYGWGDPIRLRHLYTSG (M69) (amino acids

1-24 of SEQ ID NO: 69);

DSSPLVHYGWGDPIRLRHLYTSG (M69-R) (amino acids

2-24 of SEQ ID NO: 69);

MRDSSPLVHYGWGDPIRLRHLYTSG (M70) (amino acids

1-25 of SEQ ID NO: 70);

DSSPLVHYGWGDPIRLRHLYTSG (M141) (amino acids

1-23 of SEQ ID NO: 141);

or

HPIPDSSPLLQFGWGDPIRLRHLYTSG (M163) (amino acids

1-27 of SEQ ID NO. 163).

13. The method of claim 1 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:1 (M1), SEQ ID NO:2 (M2), SEQ ID NO:8 (M8), SEQ ID NO:9 (M9), SEQ ID NO:26 (M26), SEQ ID NO:47 (M47), SEQ ID NO:52 (M52), SEQ ID NO:53 (M53), SEQ ID NO:69, (M69), SEQ ID NO:70 (M70); SEQ ID NO:141 or SEQ ID NO:163.

14. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:1.

15. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:2.

16. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:52.

17. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:53.

18. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:69.

19. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:8.

20. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:9.

21. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:26.

22. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:47.

23. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:141.

24. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NO:163.

25. The method of claim 13 , wherein the peptide has an amino acid sequence comprising or consisting of SEQ ID NOs:1, 2, 8, 9, 26, 52 or 69, wherein the arginine (R) residue at the first amino acid position of the N-terminal region of the sequence is deleted.

26. The method of claim 1 , wherein the N-terminal region first amino acid position is a methionine (M), arginine (R), serine (S), histidine (H), proline (P), leucine (L) or aspartic acid (D) residue.

27. The method of claim 1 , wherein the N-terminal region does not have a methionine (M) or arginine (R) residue at the first amino acid position of the N-terminal region.

28. The method of claim 1 , wherein the N-terminal region comprises any one of the following amino acid sequences: MDSSPL (SEQ ID NO:119), MSDSSPL (SEQ ID NO:120), or SDSSPL (SEQ ID NO:112).

29. The method of claim 1 , wherein the peptide has at least one of reduced HCC formation; greater glucose lowering activity, or less lipid increasing activity as compared to FGF19, or as compared to an FGF19 variant having any of GQV, GDI, WGPI, WGDPV, WGDI, GDPI, GPI, WGQPI, WGAPI, AGDPI, WADPI, WGDAI, WGDPA, WDPI, WGDI, WGDP or FGDPI substituted for the WGDPI sequence at amino acids 16-20 of FGF19 (SEQ ID NO:99).

30. The method of claim 29 , wherein the HCC formation, glucose lowering activity, or lipid increasing activity is ascertained in a db/db mouse.

31. The method of claim 1 , wherein the peptide has less lean mass reducing activity as compared to the lean mass reducing activity of FGF21.

32. The method of claim 31 , wherein the lean mass reducing activity is ascertained in a db/db mouse.

33. The method of claim 1 , wherein the second C-terminal region sequence comprises at least one amino acid substitution to the EIRPD sequence of SEQ ID NO:99.

34. The method of claim 33 , wherein the at least one amino acid substitution is to the IRP sequence of the EIRPD sequence of SEQ ID NO:99.

35. The method of claim 34 , wherein the at least one amino acid substitution is to the RP sequence of the EIRPD sequence of SEQ ID NO:99.

36. The method of claim 35 , wherein the RP sequence is substituted with a LE sequence.

37. The method of claim 1 , wherein the peptide is formulated as a pharmaceutical composition, wherein the pharmaceutical composition further comprises a pharmaceutically acceptable carrier.

38. The method of claim 1 , wherein the method further comprises administration of a supplemental therapy.

39. The method of claim 1 , wherein the peptide is fused with an immunoglobulin Fc region.

40. A method of reducing bile acid synthesis in a subject having primary biliary cirrhosis, comprising administering to the subject an effective amount of a peptide having an amino acid sequence comprising or consisting of

(SEQ ID NO: 70)

MRDSSPLVHYGWGDPIRLRHLYTSGPHGLSSCFLRIRADGVVDCARGQSAH

SLLEIKAVALRTVAIKGVHSVRYLCMGADGKMQGLLQYSEEDCAFEEEIRP

DGYNVYRSEKHRLPVSLSSAKQRQLYKNRGFLPLSHFLPMLPMVPEEPEDL

RGHLESDMFSSPLETDSMDPFGLVTGLEAVRSPSFEK,

thereby reducing bile acid synthesis in said subject.

41. The method of claim 40 , wherein the peptide has an amino acid sequence comprising SEQ ID NO:70.

42. The method of claim 41 , wherein the peptide is fused with an immunoglobulin Fc region.

43. The method of claim 40 , wherein the peptide has an amino acid sequence consisting of SEQ ID NO:70.

44. The method of claim 43 , wherein the peptide is fused with an immunoglobulin Fc region.

45. The method of claim 40 , wherein the amino acid sequence comprises at least one amino acid substitution to the EIRPD sequence of SEQ ID NO:70.

46. The method of claim 45 , wherein the at least one amino acid substitution is to the IRP sequence of the EIRPD sequence of SEQ ID NO:70.

47. The method of claim 46 , wherein the at least one amino acid substitution is to the RP sequence of the EIRPD sequence of SEQ ID NO:70.

48. The method of claim 47 , wherein the RP sequence is substituted with a LE sequence.

49. The method of claim 40 , wherein the peptide is formulated as a pharmaceutical composition, wherein the pharmaceutical composition further comprises a pharmaceutically acceptable carrier.

50. The method of claim 40 , wherein the method further comprises administration of a supplemental therapy.

51. The method of claim 40 , wherein the peptide is fused with an immunoglobulin Fc region.

52. A method of reducing bile acid synthesis in a subject having primary biliary cirrhosis, comprising administering to the subject an effective amount of a peptide having an amino acid sequence comprising or consisting of

(SEQ ID NO: 69)

RDSSPLVHYGWGDPIRLRHLYTSGPHGLSSCFLRIRADGVVDCARGQSAHS

LLEIKAVALRTVAIKGVHSVRYLCMGADGKMQGLLQYSEEDCAFEEEIRPD

GYNVYRSEKHRLPVSLSSAKQRQLYKNRGFLPLSHFLPMLPMVPEEPEDLR

GHLESDMFSSPLETDSMDPFGLVTGLEAVRSPSFEK,

thereby reducing bile acid synthesis in said subject.

53. The method of claim 52 , wherein the peptide has an amino acid sequence comprising SEQ ID NO:69.

54. The method of claim 53 , wherein the peptide is fused with an immunoglobulin Fc region.

55. The method of claim 52 , wherein the peptide has an amino acid sequence consisting of SEQ ID NO:69.

56. The method of claim 55 , wherein the peptide is fused with an immunoglobulin Fc region.

57. The method of claim 52 , wherein the amino acid sequence comprises at least one amino acid substitution to the EIRPD sequence of SEQ ID NO:69.

58. The method of claim 57 , wherein the at least one amino acid substitution is to the IRP sequence of the EIRPD sequence of SEQ ID NO:69.

59. The method of claim 58 , wherein the at least one amino acid substitution is to the RP sequence of the EIRPD sequence of SEQ ID NO:69.

60. The method of claim 59 , wherein the RP sequence is substituted with a LE sequence.

61. The method of claim 52 , wherein the peptide is formulated as a pharmaceutical composition, wherein the pharmaceutical composition further comprises a pharmaceutically acceptable carrier.

62. The method of claim 52 , wherein the method further comprises administration of a supplemental therapy.

63. The method of claim 52 , wherein the peptide is fused with an immunoglobulin Fc region.