Modified factor VII polypeptides for subcutaneous administration and on-demand treatment
Provided herein are modified FVII polypetides, and modified FVIIa polypeptides, and methods of treatment of acute and episodic bleeding with modified FactorVIIa polypeptides. To effect treatment and use, in some embodiments, the modified polypeptides are subcutaneously administered to provide on-demand treatment. In some embodiments, the on-demand treatment is provided in a multiple dosing regimen over a twenty-four hour period. The subcutaneous administration of the modified polypeptides of the disclosure exhibit increased coagulant activity, potency, bioavailablilty and prolonged duration.
1. A method of providing an on-demand treatment to a human subject experiencing a spontaneous bleed, comprising administering to the subject a subcutaneous dose of a modified FVIIa, wherein the modified FVIIa comprises the amino acid sequence set forth in SEQ ID NO: 280, wherein the subcutaneous dose is administered up to three times in a 24-hour period, and wherein each subcutaneous dose is about 20 μg/kg, 30 μg/kg, about 45 μg/kg, about 60 μg/kg, about 90 μg/kg or about 120 μg/kg of body weight of the subject.
2. The method of claim 1 , wherein the spontaneous bleed is any one or more of a joint bleed, muscle bleed, and bleeding gums.
3. The method of claim 1 , wherein the modified FVIIa is administered subcutaneously up to three times in a 24-hour period until the bleeding stops or the bleeding is corrected.
4. The method of claim 1 , wherein the dose of the modified FVIIa is in a volume of less than about 5 mL.
5. The method of claim 1 , further comprising administering any one or more of an additional coagulant treatment or factor, an anti-tissue factor pathway inhibitor (TFPI) antibody, an RNA interference (RNAi) therapeutic targeting antithrombin (AT), and emicizimab.
6. The method of claim 1 , wherein the subject has any one or more of: blood coagulation disorders, hematologic disorders, hemorrhagic disorders, hemophilia A, hemophilia B, hemophilia A with inhibitors, hemophilia B with inhibitors, Factor VII deficiency, Glanzmann thrombasthenia, and acquired hemophilia, and/or wherein the subject is taking anti-coagulant therapy, and/or wherein the subject has autoantibodies to factor VIII or factor IX, and other bleeding disorders.
7. The method of claim 6 , wherein the subject has hemophilia, and the hemophilia is congenital.
8. The method of claim 6 , wherein the subject has hemophilia, and the hemophilia is acquired.
9. The method of claim 1 , wherein the modified FVIIa polypeptide is a two-chain activated Factor VII (FVIIa) polypeptide comprising the amino acid sequence of SEQ ID NO: 280, and is cleaved between the arginine at position 152 and the isoleucine at position 153.
10. The method of claim 9 , wherein the first and second chains of the two-chain polypeptide consist respectively of amino acids 1-152 and 153-406 of SEQ ID NO: 280.
11. The method of claim 1 , wherein the modified FVIIa polypeptide is post-translationally modified, wherein a post-translational modification is any one or more of O-linked glycosylation, N-linked glycosylation, carboxylation of glutamic acid to γ-carboxyglutamic acid, and hydroxylation of aspartic acid to P-hydroxyaspartic acid.
12. The method of claim 1 , wherein the modified FVIIa has any one or more of: increased coagulant activity in absence of tissue factor, increased coagulant activity in presence of tissue factor, increased kcat/km in a tissue-factor dependent assay, increased serum half-life, an increased terminal elimination half-life, greater coagulation activity, greater potency, and increased bioavailability as compared to an unmodified FVIIa comprising the amino acid sequence as set forth in SEQ ID NO: 3.
13. The method of claim 1 , wherein the subcutaneous administration of the modified FVIIa exhibits an increased bioavailability compared to a subcutaneous administration of an unmodified FVIIa comprising the amino acid sequence as set forth in SEQ ID NO: 3.
14. The method of claim 1 , wherein the subcutaneous administration of the modified FVIIa exhibits an increased terminal elimination half-life compared to an intravenous administration of the modified FVIIa.
15. The method of claim 1 , wherein the subcutaneous administration of the modified FVIIa has an activity or potency greater than an intravenous administration of the modified FVIIa polypeptide has an activity or potency greater than an intravenous administration of an FVIIa polypeptide that is unmodified and/or has an activity or potency greater than a subcutaneous administration of an FVIIa polypeptide that is unmodified.
16. The method of claim 1 , wherein the subcutaneous dose of a modified FVIIa is administered more than once and up to three times in a 24-hour period, and wherein each dose occurs about 2 to about 6 hours apart.
17. The method of claim 1 , wherein the subject is experiencing a spontaneous bleed and the subcutaneous dose is administered about 1 minute to about 4 hours after onset of the bleed.