Truncated von Willebrand factor polypeptides for extravascular administration in the treatment or prophylaxis of a blood coagulation disorder

1. A method for the treatment of a blood coagulation disorder, comprising administering an effective amount of (i) a recombinant polypeptide consisting of (a) a truncated von Willebrand Factor (VWF) and (b) at least one non-VWF sequence, and (ii) a Factor VIII protein (FVIII) to a subject having a blood coagulation disorder,

wherein at least one of the non-VWF sequences is a half-life extending moiety (HLEM),

wherein the truncated VWF has a sequence identity of at least 90% to amino acids 764 to 1242 of SEQ ID NO:4,

wherein at least one of the recombinant polypeptide and the FVIII is administered extravascularly,

wherein the recombinant polypeptide is present as a dimer and wherein the ratio of dimer:monomer of the recombinant polypeptide is at least 1.5,

wherein said dimeric recombinant polypeptide is capable of binding to said FVIII and has a FVIII binding affinity characterized by a dissociation constant K D of less than 1 nM, and

wherein the molar ratio of the recombinant polypeptide to the FVIII is higher than 50.

2. The method of claim 1 , wherein the subject is a human subject.

3. The method of claim 1 , wherein the dimer binds to FVIII with a dissociation constant K D of less than 80 pM.

4. The method of claim 1 , wherein the recombinant polypeptide is administered subcutaneously, intradermally, or intramuscularly.

5. The method of claim 1 , wherein the truncated VWF consists of (a) amino acids 764 to 1242 of SEQ ID NO:4.

6. The method of claim 1 , wherein the HLEM is a heterologous amino acid sequence that is fused to the truncated VWF.

7. The method of claim 6 , wherein said heterologous amino acid sequence comprises a polypeptide selected from the group consisting of albumin or fragments thereof, transferrin or fragments thereof, the C-terminal peptide of human chorionic gonadotropin, an XTEN sequence, homo-amino acid repeats (HAP), proline-alanine-serine repeats (PAS), afamin, alpha-fetoprotein, Vitamin D binding protein, polypeptides capable of binding under physiological conditions to albumin or to immunoglobulin constant regions, polypeptides capable of binding to the neonatal Fc receptor (FcRn), and combinations thereof.

8. The method of claim 1 , wherein the HLEM is conjugated to the recombinant polypeptide.

9. The method of claim 8 , wherein said HLEM is selected from the group consisting of hydroxyethyl starch (HES), polyethylene glycol (PEG), polysialic acids (PSAs), elastin-like polypeptides, heparosan polymers, hyaluronic acid, and albumin binding ligands, and combinations thereof.

10. The method of claim 1 , wherein the time period for reaching a 1% trough level of the administered FVIII is prolonged compared to a reference treatment in which the FVIII is administered with a recombinant polypeptide that does not comprise said HLEM.

11. The method of claim 1 , wherein the plasma half-life of the recombinant polypeptide is increased compared to that of endogenous VWF and/or VWF of normal human plasma (NHP), wherein the plasma half-life of the recombinant polypeptide is at least 100% higher than that of endogenous VWF and/or VWF of normal human plasma (NHP).

12. The method of claim 1 , wherein the blood coagulation disorder is hemophilia A or von-Willebrand disease.

13. The method of claim 1 , wherein co-administration of the recombinant polypeptide and the FVIII is achieved either (i) by administration of a single composition comprising the recombinant polypeptide and the FVIII, or (ii) by administration of the recombinant polypeptide (first compound) and the FVIII (second compound) each provided in separate compositions, wherein the first compound is administered before, after, or concurrently with the second compound.

14. The method of claim 1 , wherein the FVIII is a plasma-derived protein or a recombinant protein.

15. The method of claim 1 , wherein the FVIII is administered extravascularly, and wherein, following co-administration of the recombinant polypeptide and the FVIII, the bioavailability of the administered FVIII is at least 2%.

16. The method of claim 1 , wherein the bioavailability of the recombinant polypeptide is at least 30%.

17. The method of claim 1 , wherein the dosage of the FVIII does not exceed 2500 IU/kg.

18. The method of claim 1 , wherein, following co-administration of the recombinant polypeptide and the FVIII, the maximal concentration (C max ) of the FVIII is at least 10 mIU/mL.

19. The method of claim 1 , wherein the molar ratio of the recombinant polypeptide to the FVIII is at least 75.

20. The method of claim 7 , wherein polypeptides capable of binding to the neonatal Fc receptor (FcRn) comprise immunoglobulin constant regions and portions thereof.

21. The method of claim 20 , wherein the immunoglobulin constant regions and portions thereof comprise the Fc portion of immunoglobulin, and combinations thereof.

22. The method of claim 1 , wherein the molar ratio of the recombinant peptide to the FVIII is higher than 100.

23. The method of claim 1 , wherein the recombinant polypeptide is administered subcutaneously.