Use of C-type natriuretic peptide variants to treat skeletal dysplasia
The present disclosure provides for use of variants of C-type natriuretic peptide (CNP), and novel pharmaceutical compositions and formulations comprising CNP variant peptides for the treatment of skeletal dysplasias, one or more symptoms of skeletal dysplasias, such as long bone growth or growth velocity, and other disorders having a skeletal dysplasia and/or CNP-associated symptom or component.
1. A method of treating hypochondroplasia in a subject in need thereof comprising the step of administering to said subject a composition comprising a C-type natriuretic peptide (CNP) variant in an amount of at least 7.5 μg/kg of said CNP variant peptide, wherein the CNP variant is selected from the group consisting of:
QEHPNARKYKGANKKGLSKGCFGLKLDRIGSNSGLGC (SEQ ID NO: 1);
MQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 2);
PQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 3);
GQEHPNARKYKGANKKGLSKGCFGLKLDRIGSNSGLGC (SEQ ID NO: 4);
PGQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 5);
MGQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 6); and
GQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 7), wherein the CNP variant is in a formulation comprising citric acid monohydrate, sodium citrate dihydrate, trehalose dihydrate, D-mannitol, L-methionine and polysorbate 80 and wherein the step of administering treats said hypochondroplasia.
2. The method of claim 1 , wherein the administration results in an improvement in one or more symptoms of hypochondroplasia selected from the group consisting of increased absolute growth, increased growth velocity, increased quantitative computed tomography (QCT) bone mineral density (BMD), improvement in growth plate morphology, increased long-bone growth, improvement in morphology of the spine, improved elbow joint range of motion and decreased sleep apnea.
3. The method of claim 1 , comprising administering said composition once daily.
4. The method of claim 1 , comprising administering said composition subcutaneously.
5. The method of claim 1 comprising administering said composition comprising said CNP variant peptide to said subject in an amount of at least 15 μg/kg per day.
6. The method of claim 5 , wherein the formulation has a pH of between 5.0 and 6.0.
7. The method of claim 1 , wherein the formulation is lyophilized, is in liquid form, or is reconstituted from a lyophilized formulation.
8. The method of claim 1 , wherein the formulation comprises at least 2.0 mg/ml of the CNP variant.
9. The method of claim 1 , wherein, in the formulation, citric acid monohydrate is present at a concentration of from 0.15 mg/ml to 0.40 mg/ml, sodium citrate dihydrate is present at a concentration of from 0.5 mg/ml to 1.5 mg/ml, trehalose dihydrate is present at a concentration of from 30 mg/ml to 70 mg/ml, D-mannitol is present at a concentration of from 10 mg/ml to 20 mg/ml, L-methionine is present at a concentration of from 0.5 mg/ml to 1.5 mg/ml and polysorbate 80 is present at a concentration of from 0.01 mg/ml to 0.1 mg/ml.
10. The method of claim 1 , wherein, in the formulation, citric acid monohydrate is present at a concentration of 0.28 mg/ml, sodium citrate dihydrate is present at a concentration of 1.08 mg/ml, trehalose dihydrate is present at a concentration of 58.01 mg/ml, D-mannitol is present at a concentration of 15 mg/ml, L-methionine is present at a concentration of 0.73 mg/ml and polysorbate 80 is present at a concentration of 0.05 mg/ml.
11. The method of claim 1 , wherein the formulation comprises between 0.5 mg/ml to 2.0 mg/ml of the CNP variant.
12. A method of increasing long bone growth in a subject in need thereof comprising the step of administering to said subject a composition comprising a C-type natriuretic peptide (CNP) variant peptide in an amount of at least 7.5 μg/kg of said CNP variant peptide, wherein the CNP variant peptide is selected from the group consisting of:
QEHPNARKYKGANKKGLSKGCFGLKLDRIGSNSGLGC (SEQ ID NO: 1);
MQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 2);
PQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 3);
GQEHPNARKYKGANKKGLSKGCFGLKLDRIGSNSGLGC (SEQ ID NO: 4)
PGQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 5);
MGQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 6); and
GQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 7), wherein the CNP variant is in a formulation comprising citric acid monohydrate, sodium citrate dihydrate, trehalose dihydrate, D-mannitol, L-methionine and polysorbate 80 and wherein said step of administering increases long bone growth in said subject.
13. A method of increasing growth velocity in a subject in need thereof, said method comprising the step of administering a composition comprising a C-type natriuretic peptide (CNP) variant peptide to said subject in an amount of at least 7.5 μg/kg, wherein said CNP variant peptide is selected from the group consisting of:
QEHPNARKYKGANKKGLSKGCFGLKLDRIGSNSGLGC (SEQ ID NO: 1);
MQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 2);
PQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 3);
GQEHPNARKYKGANKKGLSKGCFGLKLDRIGSNSGLGC (SEQ ID NO: 4)
PGQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 5);
MGQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 6); and
GQEHPNARKYKGANKKGLSKGCFGLKLDRIGSMSGLGC (SEQ ID NO: 7), wherein the CNP variant is in a formulation comprising citric acid monohydrate, sodium citrate dihydrate, trehalose dihydrate, D-mannitol, L-methionine and polysorbate 80 and wherein the step of administering increases growth velocity in said subject.
14. The method of claim 13 that results in:
(i) a change in the upper body length to lower body length ratio of between −0.05 and 0.05;
(ii) a change in the upper arm length to forearm length ratio of between −0.05 to 0.05; and/or
(iii) a change in the upper leg length to lower leg length ratio of between −0.05 and 0.05.
15. The method of claim 13 , comprising administering said composition parenterally.
16. The method of claim 13 , comprising administering said composition daily, 3 times weekly, twice weekly, once weekly, or once every two weeks.