Methods for treating vascular eye disorders with ActRII antagonists

1. A method for treating a vascular disorder of the eye in a patient, comprising administering to a patient in need thereof an effective amount of an activin type II receptor (ActRII) antagonist, wherein the patient has chronic anemia and myelodysplastic syndrome, wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 90% identical to the sequence of amino acids 29-109 of SEQ ID NO: 1, wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1, and wherein the polypeptide is capable of binding to GDF8 and/or GDF11.

2. The method of claim 1 , wherein the vascular disorder of the eye is associated with ischemia.

3. The method of claim 1 , wherein the vascular disorder of the eye is associated with microvascular insufficiency.

4. The method of claim 1 , wherein the ActRII antagonist is an ActRII polypeptide comprising an amino acid sequence that is at least 95% identical to the sequence of amino acids 29-109 of SEQ ID NO: 1.

5. The method of claim 1 , wherein the polypeptide comprises a D at position 79 with respect to SEQ ID NO: 1.

6. The method of claim 1 , wherein the polypeptide is a fusion protein comprising, in addition to an ActRII polypeptide domain an immunoglobulin Fc domain.

7. The method of claim 6 , wherein the fusion protein further comprises a linker domain positioned between the ActRII domain and the immunoglobulin Fc domain.

8. The method of claim 6 , wherein the polypeptide is an ActRII-Fc fusion protein comprising a polypeptide selected from the group consisting of:

a) a polypeptide comprising the amino acid sequence of SEQ ID NO: 40 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 40;

b) a polypeptide comprising the amino acid sequence of SEQ ID NO: 41 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 41;

c) a polypeptide comprising the amino acid sequence of SEQ ID NO: 44 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 44;

d) a polypeptide comprising the amino acid sequence of SEQ ID NO: 46 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 46;

e) a polypeptide comprising the amino acid sequence of SEQ ID NO: 50 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 50;

f) a polypeptide comprising the amino acid sequence of SEQ ID NO: 61 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 61;

g) a polypeptide comprising the amino acid sequence of SEQ ID NO: 64 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 64;

h) a polypeptide comprising the amino acid sequence of SEQ ID NO: 78 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 78; and

i) a polypeptide comprising the amino acid sequence of SEQ ID NO: 79 or comprising an amino acid sequence that is at least 90% identical to the amino acid sequence of SEQ ID NO: 79.

9. The method of claim 6 , wherein the polypeptide is an ActRII-Fc fusion protein comprising a polypeptide selected from the group consisting of:

a) a polypeptide comprising the amino acid sequence of SEQ ID NO: 40 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 40;

b) a polypeptide comprising the amino acid sequence of SEQ ID NO: 41 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 41;

c) a polypeptide comprising the amino acid sequence of SEQ ID NO: 44 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 44;

d) a polypeptide comprising the amino acid sequence of SEQ ID NO: 46 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 46;

e) a polypeptide comprising the amino acid sequence of SEQ ID NO: 50 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 50;

f) a polypeptide comprising the amino acid sequence of SEQ ID NO: 61 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 61;

g) a polypeptide comprising the amino acid sequence of SEQ ID NO: 64 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 64;

h) a polypeptide comprising the amino acid sequence of SEQ ID NO: 78 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 78; and

i) a polypeptide comprising the amino acid sequence of SEQ ID NO: 79 or comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 79.

10. The method of claim 6 , wherein the polypeptide is an ActRII-Fc fusion protein comprising a polypeptide selected from the group consisting of:

a) a polypeptide comprising the amino acid sequence of SEQ ID NO: 40 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 40;

b) a polypeptide comprising the amino acid sequence of SEQ ID NO: 41 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 41;

c) a polypeptide comprising the amino acid sequence of SEQ ID NO: 44 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 44;

d) a polypeptide comprising the amino acid sequence of SEQ ID NO: 46 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 46;

e) a polypeptide comprising the amino acid sequence of SEQ ID NO: 50 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 50;

f) a polypeptide comprising the amino acid sequence of SEQ ID NO: 61 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 61;

g) a polypeptide comprising the amino acid sequence of SEQ ID NO: 64 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 64;

h) a polypeptide comprising the amino acid sequence of SEQ ID NO: 78 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 78; and

i) a polypeptide comprising the amino acid sequence of SEQ ID NO: 79 or comprising an amino acid sequence that is at least 98% identical to the amino acid sequence of SEQ ID NO: 79.

11. The method of claim 8 , wherein the polypeptide comprises a D at position 79 with respect to SEQ ID NO: 1.

12. The method of claim 8 , wherein the polypeptide comprises a E at position 79 with respect to SEQ ID NO: 1.

13. The method of claim 4 , wherein the polypeptide comprises one or more amino acid modifications selected from: a glycosylated amino acid, a PEGylated amino acid, a farnesylated amino acid, an acetylated amino acid, a biotinylated amino acid, and an amino acid conjugated to a lipid moiety.

14. The method of claim 13 , wherein the polypeptide is glycosylated and has a mammalian glycosylation pattern.

15. The method of claim 14 , wherein the polypeptide is glycosylated and has a glycosylation pattern obtainable from a Chinese hamster ovary cell line.

16. The method of claim 4 , wherein the polypeptide binds to GDF11.

17. The method of claim 4 , wherein the polypeptide binds to GDF8.

18. The method of claim 4 , wherein the polypeptide binds to activin B.

19. The method of claim 1 , wherein the method further comprises administering to the patient one or more additional active agents or supportive therapies for treating or reducing the severity of an eye disorder.

20. The method of claim 19 , wherein the one or more additional active agents or supportive therapies is selected from the group consisting of: surgery, laser therapy, photocoagulation, anti-angiogenic therapy, VEGF inhibitors, bevacizumab, ranibizumab, aflibercept, Ca 2+ inhibitors, flunarizine, nifedipine, cryotherapy, hyperbaric oxygenation, Na + channel blockers, topiramate, iGluR antagonists, MK-801, dextromethorphan, eliprodil, flupirtine, antioxidants, dimethylthiourea, alpha-lipoic acid, superoxide dismutase, catalase, desferrioxamine, mannitol, allopurinol, calcium dobesilate, flupirtine, trimetazidine, EGB-761, anti-inflammatory agents, cyclodiathermy, cyclocryotherapy, ocular filtering procedures, implantation of drainage valves, antiplatelet therapy, aspirin, ticlopidine, clopidogrel, anticoagulant therapy, warfarin, heparin, steroids, systemic or local corticosteroids, prednisone triamcinolone, fluocinolone acetonide, dexamethasone, steroid-sparing immunosuppressants, cyclosporine, azathioprine, cyclophosphamide, mycophenolate, mofetil, infliximab, etanercept, dietary supplements, vitamin C, vitamin E, lutein, zinc, folic acid, vitamin B6, vitamin B12, zeaxanthin, vitrectomy, scleral buckle surgery, and pneumatic retinopexy.

21. The method of claim 19 , wherein the one or more additional active agents is selected from the group consisting of: a vascular endothelial growth factor (VEGF) inhibitor, a VEGF-A inhibitor, a placental growth factor (PLGF) inhibitor, a VEGF and PLGF inhibitor, aflibercept, ranibizumab, and bevacizumab.

22. The method of claim 1 , wherein the ActRII antagonist is administered by ocular or intravitreal administration.

23. The method of claim 4 , wherein the polypeptide is an ActRII-Fc fusion protein comprising a polypeptide comprising an amino acid sequence that is at least 95% identical to the amino acid sequence of SEQ ID NO: 64.

24. The method of claim 4 , wherein the polypeptide is an ActRII-Fc fusion protein comprising a polypeptide comprising the amino acid sequence of SEQ ID NO: 64.

25. The method of claim 1 , wherein the ActRII antagonist is an ActRII polypeptide comprising the sequence of amino acids 29-109 of SEQ ID NO: 1; but wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1.

26. The method of claim 1 , wherein the ActRII antagonist is an ActRII polypeptide comprising an amino acid sequence that is at least 90% identical to the sequence of amino acids 25-131 of SEQ ID NO: 1.

27. The method of claim 1 , wherein the ActRII antagonist is an ActRII polypeptide comprising an amino acid sequence that is at least 95% identical to the sequence of amino acids 25-131 of SEQ ID NO: 1.

28. The method of claim 1 , wherein the ActRII antagonist is an ActRII polypeptide comprising the sequence of amino acids 25-131 of SEQ ID NO: 1; but wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1.

29. The method of claim 4 , wherein the polypeptide comprises a D at position 79 with respect to SEQ ID NO: 1.

30. The method of claim 4 , wherein the polypeptide comprises an E at position 79 with respect to SEQ ID NO: 1.

31. A method for improving vision in a patient that has a vascular disorder of the eye, comprising administering to a patient in need thereof an effective amount of an activin type II receptor (ActRII) antagonist, wherein the patient has chronic anemia and myelodysplastic syndrome, wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 90% identical to the sequence of amino acids 29-109 of SEQ ID NO: 1, wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1, and wherein the polypeptide is capable of binding to GDF8 and/or GDF11.

32. The method of claim 31 , wherein the method increases visual acuity.

33. The method of claim 31 , wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 95% identical to the sequence of amino acids 29-109 of SEQ ID NO: 1.

34. The method of claim 31 , wherein the ActRII antagonist comprises a polypeptide comprising the amino acid sequence of amino acids 29-109 of SEQ ID NO: 1, but wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1.

35. The method of claim 31 , wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 90% identical to the sequence of amino acids 25-132 of SEQ ID NO: 1.

36. The method of claim 31 , wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 95% identical to the sequence of amino acids 25-132 of SEQ ID NO: 1.

37. The method of claim 31 , wherein the ActRII antagonist comprises a polypeptide comprising the amino acid sequence of amino acids 25-132 of SEQ ID NO: 1, but wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1.

38. A method of treating or reducing the severity of an eye disorder in a patient, comprising administering to a patient in need thereof an effective amount of an activin type II receptor (ActRII) antagonist, wherein the patient has chronic anemia and myelodysplastic syndrome, wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 90% identical to the sequence of amino acids 29-109 of SEQ ID NO: 1, wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1, and wherein the polypeptide is capable of binding to GDF8 and/or GDF11.

39. The method of claim 38 , wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 95% identical to the sequence of amino acids 29-109 of SEQ ID NO: 1.

40. The method of claim 38 , wherein the ActRII antagonist comprises a polypeptide comprising the amino acid sequence of amino acids 29-109 of SEQ ID NO: 1, but wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1.

41. The method of claim 38 , wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 90% identical to the sequence of amino acids 25-131 of SEQ ID NO: 1.

42. The method of claim 38 , wherein the ActRII antagonist comprises a polypeptide comprising an amino acid sequence that is at least 95% identical to the sequence of amino acids 25-131 of SEQ ID NO: 1.

43. The method of claim 38 , wherein the ActRII antagonist comprises a polypeptide comprising the amino acid sequence of amino acids 25-131 of SEQ ID NO: 1, but wherein the polypeptide comprises an acidic amino acid at the amino acid position corresponding to position 79 of SEQ ID NO: 1.