KR20240112755A - A Novel Liquid Formulation for Preventing or Treating Thrombotic Disease - Google Patents

Abstract

The present invention relates to a pharmaceutical formulation composition for plasma proteins, specifically ADAMTS13 protein, variants and functional fragments thereof, and compositions for preventing or treating thrombotic diseases containing the same. The composition of the present invention not only efficiently avoids representative autoantibodies known to have high binding affinity to the main domain of ADAMTS-13, but also maintains colloidal stability, refrigeration stability, purity, and aggregation blocking rate at high levels for a long period of time due to the combination of efficient formulation components. can be maintained. The composition of the present invention also has a significantly lower therapeutically effective amount compared to commercially available enzyme replacement treatments, so it can be used as an efficient treatment with safety and patient compliance suitable for long-term administration.

Description

Novel liquid formulation for preventing or treating thrombotic disease {A Novel Liquid Formulation for Preventing or Treating Thrombotic Disease}

The present invention relates to liquid formulation compositions for plasma proteins, specifically ADAMTS-13 protein, and dosages for their use.

Thrombotic thrombocytopenic purpura is a rare blood disease belonging to thrombotic microangiopathy in which blood clots form in small blood vessels throughout the body and can lead to death if not treated immediately. The incidence rate is known to be about 1.5-6 cases per million people per year, and the incidence rate is high mainly in adults and women with an average age of 40. Pathological characteristics include a decrease in platelets, a decrease in red blood cells, and an increase in HCT (hematocrit), and it is known that dysfunction of various organs (kidneys, heart, brain, etc.) occurs due to blood clots. Symptoms include bruising, fever, fatigue, difficulty breathing, confusion of consciousness, and headache.

Thrombotic thrombocytopenic purpura is caused by abnormalities in the function of the gene encoding the ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) protein, resulting in congenital ADAMTS13 functional deficiency, cTTP (congenital TTP), and acquired causes. It is divided into two types: aTTP (aquired TTP) caused by decreased ADAMTS13 activity. In general, TTP is diagnosed when ADAMTS13 activity is less than 10% of normal. It has been reported that the causes of aTTP are bacterial infections, certain drugs, autoimmune diseases such as lupus, and pregnancy, and one of the main mechanisms of development is ADAMTS13 enzyme caused by autoantibodies that recognize ADAMTS13. Activity inhibition has been reported (GARD program, 2018). The ADAMTS13 enzyme is responsible for breaking down large multimers of von Willebrand factor (vWF) into smaller units. Antibodies found in aTTP patients bind to ADAMTS13 and inhibit its function, preventing vWF from being broken down, resulting in This causes excessive formation of blood clots along with platelets, causing disease.

As a standard treatment, for cTTP patients, supplementation therapy is used to add insufficient decomposition enzymes through injection of fresh frozen plasma, and for aTTP patients, plasma exchange (PEX) is performed to increase ADAMTS13 levels in plasma. The purpose is to relieve symptoms by removing neutralizing antibodies. For aTTP patients, immunosuppressants (prednisolone, corticosteroid, etc.) are administered together to increase the effect of treatment and prevent recurrence, and rituximab, which induces B cell death to reduce the production of neutralizing antibodies, is also used. do. The number of plasma exchange procedures varies depending on the severity of the disease and progression of symptoms, but usually multiple plasma exchanges are required to normalize the platelet count. Current treatment methods have limitations such as the inconvenience of repeated plasma exchange and increased vulnerability to infection due to the use of immunosuppressants.

Accordingly, to overcome the limitations of conventional treatments for TTP, the present inventors produced ADAMTS13 protein, specifically an autoantibody-evading variant identified by the present inventors, and confirmed its therapeutic efficacy and maintenance in an aTTP-mimic mouse model. In addition, commercialized competition is being conducted by comparatively evaluating the efficacy of a drug already approved as a TTP treatment (Cablivi ^® ) or a drug under development (recombinant human wild type-ADAMTS13, rh WT-ADAMTS13) in aTTP-mimic disease mouse or aTTP patient plasma. It was confirmed that it was superior to the material.

Numerous papers and patent documents are referenced and citations are indicated throughout this specification. The disclosures of the cited papers and patent documents are incorporated herein by reference in their entirety to more clearly explain the content of the present invention and the level of technical field to which the present invention pertains.

Patent Document 1. Japanese Patent Publication No. 2018-203781

The present inventors have made extensive research efforts to develop effective and fundamental treatment methods for various ADAMTS13 dysfunction diseases, most of which are incurable rare diseases. As a result, we identified the core regions recognized by autoantibodies of ADAMTS13 and found that when substitutions were made to some amino acids in these regions, binding to autoantibodies was blocked and VWF decomposition and thrombosis inhibitory activities were maintained. In addition, the The present invention was completed by identifying liquid formulation components to improve the stability of ADAMTS13 protein, which has a high risk of contamination and denaturation from the moment of purification, and the optimal administration dose to maximize its treatment efficiency.

Therefore, the purpose of the present invention is to provide a pharmaceutical formulation composition comprising a plasma protein selected from the group consisting of ADAMTS13 protein, its variant, and some functional fragments thereof.

Another object of the present invention is to provide a composition for preventing or treating thrombotic diseases.

Other objects and advantages of the present invention will become clearer from the following detailed description, claims, and drawings.

According to one aspect of the present invention, the present invention provides a pharmaceutical formulation comprising a plasma protein selected from the group consisting of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) protein, variants thereof, and functional partial fragments thereof. Provided is a composition, wherein the plasma protein is included in the composition to be administered in an amount of 0.02 mg to 0.25 mg per kg of body weight of the subject.

The present inventors have made extensive research efforts to develop effective and fundamental treatment methods for various ADAMTS13 dysfunction diseases, most of which are incurable rare diseases. As a result, we identified the core regions recognized by autoantibodies of ADAMTS13 and found that when substitutions were made to some amino acids in these regions, binding to autoantibodies was blocked and VWF decomposition and thrombosis inhibitory activities were maintained. In addition, the Liquid formulation ingredients to improve the stability of ADAMTS13 protein, which has a high risk of contamination and denaturation from the moment of purification, and the optimal administration dose to maximize its treatment efficiency were identified.

According to a specific embodiment of the present invention, the term “subject” may be a human, and the term “adult subject” may be an “adult.”

As used herein, the term “protein” refers to a linear molecule formed by linking amino acid residues together through peptide bonds.

As used herein, the term “functional portion” refers to a fragment in which some amino acid residues have been deleted from a full-length protein and an analogue of the full-length protein that maintains its original biological activity and function.

More specifically, the plasma protein is included in the composition to be administered at 0.03 mg to 0.2 mg per kg of body weight of the subject.

According to a specific embodiment of the present invention, the composition is administered intravenously.

According to a specific embodiment of the present invention, the composition of the present invention includes 0.2 mg/ml to 1.2 mg/ml of plasma protein and 40mM to 200mM of amino acid stabilizer.

The present inventors have developed an excellent liquid formulation composition that improves the stability of plasma proteins, which have a high risk of contamination and denaturation from the moment they are separated and purified from blood, and can maintain their physical properties, biological activity, and pharmacological effects for a long period of time, especially even when freeze-dried. To this end, diligent research efforts were made. As a result, the plasma protein, which is a pharmacological ingredient, in the formulation is 0.2 mg/ml to 1.2 mg/ml, specifically 0.25 mg/ml to 1.0 mg/ml, more specifically 0.3 mg/ml to 0.7 mg/ml, and more. Specifically, it is included at 0.3 mg/ml to 0.4 mg/ml, most specifically about 0.36 mg/ml, and the amino acid stabilizer, specifically arginine, is included at 40 mM to 200 mM, more specifically 60 mM to 60 mM. 180mM, more specifically 60mM to 160mM, even more specifically 60mM to 140mM, even more specifically 80mM to 135mM, even more specifically 100mM to 130mM, most specifically It was found that when contained at about 120mM, it showed significantly excellent stability in various indicators including colloidal stability, refrigeration stability, unfolding inhibition, aggregation blocking, and cake properties after freeze-drying.

As used herein, the term “plasma protein” refers to the general term for water-soluble proteins present in the plasma of humans or animals, and includes all protein components other than those contained in white blood cells and red blood cells among the proteins contained in the blood. . Plasma proteins account for approximately 8% of total plasma and are responsible for hemostatic function (prothrombin, fibrinogen), transport of hormones (serum albumin and lipoprotein, etc.), and immune function (immunoglobulin and complement protein). Plasma proteins can be obtained by various fractionation and purification methods known in the art, but problems of chemical instability and physical instability due to long-term storage and environmental changes must be overcome. Physical instability involves modifications that do not induce covalent changes in the protein, such as adsorption, aggregation, and precipitation, while chemical instability involves modifications such as deamidation, racemization, hydrolysis, oxidation, beta elimination, and disulfide exchange. do. This instability leads to distortion of the intrinsic biological activity and reduction of the pharmacological effect.

In this specification, the term “stabilizer” is used to increase the stability of the active ingredient and to prevent the active ingredient from being arbitrarily denatured, oxidized, aggregated, crystallized, or converted into related substances, ultimately resulting in loss or deterioration of pharmacological activity. It refers to any additive added to the formulation, and is not particularly limited as long as it is pharmaceutically acceptable. The term “amino acid stabilizer” refers to a stabilizer that induces the above-described stabilizing effect by adding amino acids to the formulation as a main or auxiliary ingredient.

According to a specific embodiment of the present invention, the amino acid is at least one selected from the group consisting of arginine (Arg), proline (Pro), and pharmaceutically acceptable salts thereof.

As used herein, the term “pharmaceutically acceptable salt” includes salts derived from pharmaceutically acceptable inorganic acids, organic acids, or bases. Examples of suitable acids include hydrochloric acid, hydrobromic acid, sulfuric acid, nitric acid, perchloric acid, fumaric acid, maleic acid, phosphoric acid, glycolic acid, lactic acid, salicylic acid, succinic acid, toluene-p-sulfonic acid, tartaric acid, acetic acid, trifluoroacetic acid, citric acid, methane. Examples include sulfonic acid, formic acid, benzoic acid, malonic acid, naphthalene-2-sulfonic acid, and benzenesulfonic acid. Salts derived from suitable bases may include alkali metals such as sodium, alkaline earth metals such as magnesium, ammonium, and the like.

According to a specific embodiment of the present invention, the composition additionally includes 0 to 1.5 w/v% of a sugar stabilizer based on the total composition.

More specifically 0.2 - 1.5 w/v%, even more specifically 0.3 - 1.5 w/v%, even more specifically 0.5 - 1.5 w/v%, even more specifically 0.7 - 1.3 w/v%. , more specifically 0.9 to 1.1 w/v%, and most specifically about 1 w/v% of a sugar stabilizer.

According to a specific embodiment of the present invention, the sugar is one or more selected from the group consisting of sucrose, trehalose, and pharmaceutically acceptable salts thereof.

According to a specific embodiment of the present invention, the composition additionally includes 100mM to 400mM of an inorganic salt.

As used herein, the term “inorganic salt” refers to a salt in which cations and anions are combined through ionic bonds in an aqueous solution and is derived from an inorganic substance and does not contain a CH bond. Inorganic salts that can be used in the present invention include, but are not limited to, for example NaCl, CaCl ₂ , KCl, MgCl ₂ and combinations thereof. Specifically, the inorganic salt of the present invention is a mixture of NaCl and CaCl ₂ .

According to a specific embodiment of the present invention, among the inorganic salts, NaCl may be included in an amount of 140 to 370mM, more specifically, 180 to 340mM, and even more specifically, 220 to 310mM. and, more specifically, 260 to 300mM may be included, and most specifically, about 280mM may be included.

According to a specific embodiment of the present invention, among the inorganic salts, CaCl ₂ may be included in an amount of 2mM to 6mM, more specifically, 3 to 5mM, and most specifically, about 4mM. .

According to a specific embodiment of the present invention, the composition of the present invention contains 10mM to 30mM histidine, more specifically 15mM to 25mM histidine, and most specifically about 20mM histidine. Includes.

According to a specific embodiment of the present invention, the composition additionally includes 0.01 to 0.1 v/v % of a nonionic surfactant based on the total composition.

The term “surfactant” used in the specification of the present invention refers to a soluble compound used to increase the water solubility of a hydrophobic substance or to increase the miscibility of a plurality of substances having different hydrophobicities. The term “nonionic surfactant” refers to a surfactant that does not contain ionized functional groups or atomic groups in the entire molecule and thus dissolves without dissociation even in aqueous solution.

According to a specific embodiment of the present invention, the nonionic surfactant that can be used in the present invention is at least one selected from the group consisting of polysorbate 80, polysorbate 60, and polysorbate 40, and more specifically, polysorbate It's 80.

According to a specific embodiment of the invention, the composition of the invention comprises 0.03 to 0.08 v/v % of a nonionic surfactant, most specifically about 0.05 v/v % of a nonionic surfactant.

According to a specific embodiment of the present invention, the variant of the ADAMTS13 protein is 85, 93, 126, 135, 278, 282, 308, 314, 317, 334, 364, 376, 413, 427, 452 of the first sequence of the sequence listing. , 465, 567, 578, 585, 589, 607, 608, 609, 612, 618, 624, 630, 635, 643, 650, 651, 654, 655, 656, 658, 664 and 672 from the group consisting of residues and substitution of one or more amino acid residues of choice.

According to the present invention, the first sequence in the sequence list is the amino acid sequence of the ADAMTS13 protein consisting of 1427 amino acids. Accordingly, the ADAMTS13 mutant protein of the present invention or a functional partial fragment thereof may be an ADAMTS13 variant in which the mutations listed above are introduced into the full-length (1427a.a) ADAMTS13 protein or a partial fragment thereof including the region 75-685. Some fragments containing region 75-685 may be, for example, 1-685 (685 a.a) or 75-685 (611 a.a).

The first sequence of the sequence listing, which is the amino acid sequence essentially included in the ADAMTS13 protein and some functional fragments thereof of the present invention, also includes an amino acid sequence showing substantial identity with the above sequence. Substantial identity means that the amino acid sequence and any other sequence are aligned to correspond as much as possible, and when the aligned sequence is analyzed using an algorithm commonly used in the art, homology is at least 70%, specifically, It refers to an amino acid sequence that exhibits at least 80% homology, more specifically at least 90% homology, and most specifically at least 95% homology.

The present inventors identified the core regions recognized by autoantibodies of ADAMTS13, and when substitutions were made to some amino acids in these regions, binding to autoantibodies was blocked and vWF decomposition activity and thrombosis inhibitory activity were maintained, thereby preventing thrombotic thrombocytopenia. It was discovered that it can be used as an effective treatment composition for various diseases caused by excessive blood clot formation, including purpura (TTP).

As used herein, the term “autoantibody” refers to an immunoglobulin protein that includes one or more variable domains that bind to an epitope of an antigen and specifically recognizes the corresponding antigen. It is produced by the individual's own immune system and is transmitted to the individual. It refers to an antibody that recognizes and targets its own protein. The presence of autoantibodies causes a decrease or loss of the intrinsic function or biological activity of the protein specifically recognized by the autoantibody, thereby causing various diseases.

According to a specific embodiment of the present invention, the variant of the ADAMTS13 protein is selected from the group consisting of mutant proteins each containing a substitution of one or more amino acid residues at the following positions:

- Residues 85 and 317; Residue 612; two or more of residues 282, 465, and 672; residue 635; residues 452 and 612; two or more of residues 278, 334, and 427; Residue 618; residue 135; two or more of residues 126, 567, and 651; residue 413; Residue 334; residue 314; two or more of residues 93, 364, and 376; Residue 308; Residue 656; Residue 607; Residues 612 and 624; residue 589; Residues 650 and 656; Residue 643; Residues 585 and 658; Two or more of residues 630, 654, and 664; Four or more of residues 589, 608, 609, 624, and 655; Residue 578; residue 585; Residues 314 and 635; and residues 314 and 612.

More specifically, the substitution of the amino acid residues includes substitution of the 85th residue with Phe, substitution of the 93rd residue with Val, substitution of the 126th residue with Met, substitution of the 135th residue with Ile, and substitution of the 278th residue with Substitution with Ile, substitution of residue 282 with Ala, substitution of residue 308 with Lys, substitution of residue 314 with Thr, substitution of residue 317 with His, substitution of residue 334 with Thr or Val. Substitution, substitution of residue 364 with Arg, substitution of residue 376 with Asp, substitution of residue 413 with Asp, substitution of residue 427 with Asn, substitution of residue 452 with Ile, substitution of residue 465 substitution of Asp, substitution of residue 567 with Ser, substitution of residue 578 with Leu, substitution of residue 585 with Asn or Met, substitution of residue 589 with Gln, substitution of residue 607 with Arg. Substitution of, substitution of residue 608 with Met, substitution of residue 609 with Leu, substitution of residue 612 with Phe or Tyr, substitution of residue 618 with Ser, substitution of residue 624 with Asp or Cys. Substitutions, substitution of residue 630 with Leu, substitution of residue 635 with Val, substitution of residue 643 with Phe, substitution of residue 650 with His, substitution of residue 651 with Asp, substitution of residue 654 substitution of Gly, substitution of residue 655 with Val, substitution of residue 656 with Arg or His, substitution of residue 658 with His, substitution of residue 664 with Asn and substitution of residue 672 with Val. It is one or more selected from the group consisting of the substitution of.

According to a specific embodiment of the present invention, the Fc region of IgG4 immunoglobulin is conjugated to the plasma protein selected from the group consisting of the above-described ADAMTS13 protein of the present invention, its variant, and some functional fragments thereof.

The present inventors found that when an Fc region derived from IgG4 immunoglobulin is conjugated to the ADAMTS13 mutant protein discovered in the present invention, in vivo stability is greatly increased while maintaining the inherent vWF cleavage activity and neutralizing antibody evasion activity, and in particular, the C of ADAMTS13 - It was found that the structural instability that appears in open form fragments with some of the ends removed was significantly improved.

According to a specific embodiment of the present invention, the Fc region includes the substitution of one or more amino acid residues selected from the group consisting of residues 22, 24, and 26 of the second sequence of the sequence listing. More specifically, the 22nd residue is substituted with Tyr, the 24th residue with Thr, and the 26th residue with Glu.

According to the present invention, the second sequence in the sequence list is the Fc region (217a.a) derived from IgG4 immunoglobulin. The present inventors found that when fusing the above-described ADAMTS13 mutant protein or a functional fragment thereof with an Fc region derived from an IgG4 immunoglobulin [IgG4 (YTE)] in which residues 22, 24, and 26 are substituted with Tyr, Thr, and Glu, respectively, the blood half-life It was found that the physiological activity could be maintained for a long period of time after administration.

According to a specific embodiment of the present invention, the above-described fusion protein of the present invention additionally includes a hinge region of IgG1 immunoglobulin between the plasma protein and the Fc region of the IgG4 immunoglobulin.

According to the present invention, the hinge region derived from IgG1 immunoglobulin may be represented by sequence number 3 (15a.a) in the sequence listing.

According to another aspect of the present invention, the present invention provides a composition for preventing or treating thrombotic diseases comprising the above-described pharmaceutical formulation composition of the present invention as an active ingredient.

According to another aspect of the present invention, the present invention provides a method for preventing or treating thrombotic disease comprising administering the above-described pharmaceutical formulation composition of the present invention to a subject.

According to another aspect of the present invention, the present invention provides the use of the above-described pharmaceutical formulation composition of the present invention for preventing or treating thrombotic diseases.

As used herein, the term “thrombotic disease” refers to a systemic disease in which blood flow is reduced or blocked due to blood clots formed when platelets agglomerate in the microcirculatory system of blood vessels, resulting in ischemic damage to each organ such as the kidneys, heart, and brain. means.

When the ADAMTS13 enzyme is inhibited by neutralizing antibodies and cannot properly decompose von Willerant factor (vWF), excessive platelet aggregation and thrombus formation occur. Therefore, the ADAMTS13 mutant protein of the present invention, which evades neutralizing antibodies with high efficiency and maintains or improves vWF decomposition activity, can be used as an efficient prevention or treatment composition for various thrombotic diseases.

As used herein, the term “prevention” refers to suppressing the occurrence of a disease or disease in a subject who has not been diagnosed as having the disease or disease but is likely to develop the disease or disease.

As used herein, the term “treatment” refers to (a) inhibiting the development of a disease, condition or symptom; (b) alleviation of a disease, condition or symptom; or (c) means eliminating a disease, condition or symptom. When the composition of the present invention is administered to a subject, it specifically recognizes and decomposes VWF, regardless of the presence of neutralizing antibodies, and blocks the formation of excessive blood clots, thereby suppressing the progression of thrombotic disease, eliminating or alleviating it. do. Accordingly, the composition of the present invention may itself be a composition for treating these diseases, or may be administered together with other pharmacological ingredients and applied as a treatment adjuvant for these diseases. Accordingly, in this specification, the term “treatment” or “therapeutic agent” includes the meaning of “therapeutic aid” or “therapeutic aid.”

As used herein, the term “administration” or “administer” refers to directly administering a therapeutically effective amount of the composition of the present invention to a subject so that the same amount is formed in the subject's body.

In the present invention, the term “therapeutically effective amount” refers to the content of the composition in which the pharmacological ingredients in the composition are contained in a sufficient amount to provide a therapeutic or preventive effect to the individual to whom the pharmaceutical composition of the present invention is to be administered. It is meant to include a “prophylactic effective amount.”

As used herein, the term “subject” includes, without limitation, humans, mice, rats, guinea pigs, dogs, cats, horses, cows, pigs, monkeys, chimpanzees, baboons, or rhesus monkeys. Specifically, the subject of the present invention is a human.

According to a specific embodiment of the present invention, the thrombotic disease is thrombotic microangiopathy (TMA). More specifically, the thrombotic microangiopathy includes thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count), It is selected from the group consisting of preeclampsia and sickle cell disease, more specifically thrombotic thrombocytopenic purpura or sickle cell disease, and most specifically thrombotic thrombocytopenic purpura.

The features and advantages of the present invention are summarized as follows:

(a) The present invention provides a pharmaceutical formulation composition for plasma proteins, specifically ADAMTS-13 protein, and a composition for preventing or treating thrombotic diseases containing the same.

(b) The composition of the present invention not only efficiently avoids representative autoantibodies known to have high binding affinity to the main domain of ADAMTS-13, but also maintains colloidal stability, refrigeration stability, purity, and aggregation blocking rate for a long period of time due to the combination of efficient formulation components. It can be maintained at a high level for a long time.

(c) The composition of the present invention also has a significantly lower therapeutically effective amount compared to commercially available enzyme replacement treatments, so it can be used as an efficient treatment with safety and patient compliance suitable for long-term administration.

Figure 1 is a diagram showing the results of measuring the B ₂₂ value to evaluate the colloidal stability of the formulation according to the addition of five amino acid stabilizers.
Figure 2 is a picture showing the results of size exclusion liquid chromatography (SE-HPLC) to evaluate the degree of monomer recovery at room temperature after adding 7 types of stabilizers (6 types of amino acids and sucrose).
Figure 3 is a diagram showing the results of evaluating refrigeration stability by SE-HPLC compared to the control group according to the addition of 20 mM arginine.
Figure 4 is a diagram showing the results of evaluating purity and stability according to the concentration of the pharmacological ingredient protein (ADAMTS-13) and arginine concentration by SE-HPLC.
Figure 5 is a diagram showing the cake properties according to the change in NaCl concentration (Figure 5a) and the difference in purity evaluated through SE-HPLC (Figure 5b).
Figure 6 is a diagram showing SE-HPLC results according to NaCl concentration in the liquid formulation in the presence of 20 mM arginine.
Figure 7 is a picture showing the cake properties (Figure 7a) and SE-HPLC results (Figure 7b) according to the concentration of sucrose and the addition of trehalose in the presence of 120 mM NaCl.
Figure 8 is a picture showing the cake properties (Figure 8a) and SE-HPLC results (Figure 8b) according to the mixing ratio of sucrose and mannitol or glycine, which are bulking agents.
Figure 9 is a diagram comparing cake properties according to glycine concentration in the presence of 120 mM NaCl.
Figure 10 is a diagram comparing cake properties according to arginine concentration in the presence of 120 mM NaCl.
Figure 11 is a picture showing the cake properties (Figure 11a) and SE-HPLC results (Figure 11b) according to the NaCl to sucrose mixing ratio when arginine was not added.
Figure 12 is a picture showing the cake properties (Figure 12a) and SE-HPLC results (Figure 12b) according to the NaCl to sucrose mixing ratio in the presence of 120mM arginine.
Figure 13 shows the results of measuring the change in purity after 1 month at 40°C according to the NaCl to sucrose mixing ratio.
Figure 14 is a diagram showing the effect of preventing stirring-induced aggregation depending on the concentration of polysorbate 80 through property observation (Figure 14a), turbidity measurement (Figure 14b), and SE-HPLC (Figure 14c).
Figure 15 shows the results of evaluating liquid stability according to polysorbate 80 concentration by SE-HPLC.
Figure 16 shows the results of evaluating the quality of the formulation after freeze-drying according to polysorbate 80 concentration through SE-HPLC (Figure 16a) and whether higher-order aggregates were formed (Figure 16b).
Figure 17 is a diagram showing the thermal unfolding (T _m ) measurement results (Figure 17a) and thermal aggregation (T _agg ) evaluation results (Figure 17b) according to pH, respectively.
Figure 18 is a diagram showing the freeze-dried cake properties (Figure 18a) and SE-HPLC analysis results (Figure 18b) according to CaCl ₂ concentration.
Figure 19 is a diagram illustrating the results of property evaluation according to NaCl and sucrose concentrations (Figure 19a) and a figure showing the cake properties at each concentration (Figure 19b), respectively.
Figure 20 is a picture showing cake properties according to NaCl and sucrose concentrations.
Figure 21 is a graph showing the results of colloidal stability evaluation according to arginine concentration.
Figure 22 is a picture showing cake properties (Figure 22a) and purity (Figure 22b) according to arginine concentration.
Figure 23 is a picture showing the physical properties of the liquid formulation composition finally selected in the present invention, showing the change in purity over time (Figure 23a), change in titer (Figure 23b), change in protein concentration (Figure 23c), and change in turbidity (Figure 23b). Figure 23d) is shown, respectively.
Figure 24 is a diagram showing long-term storage stability according to NaCl and sucrose concentrations, showing changes in purity (Figure 24a) and titer (Figure 24b) at the start of storage and after 6 months, respectively.
Figure 25 is a diagram showing the results of confirming the binding site of each domain of ADAMTS13 that binds to a neutralizing antibody. Figure 25a shows a schematic diagram of six types of ADAMTS13 fragments (or full-length wild-type ADAMTS13) combining various domains, prepared to confirm the expression rate of ADAMTS13 or the binding site of a neutralizing antibody. Figure 25b shows the results of immunoprecipitation using proteins expressed in each ADAMTS13 domain by mixing protein A-Sepharose and each neutralizing antibody, followed by Western blotting with anti-V5 antibody. Input shows the expression level of protein for each domain. Figure 25c is a schematic diagram of the ADAMTS13 neutralizing antibody binding site, showing that the Ab 4-16 antibody specifically binds to the S domain, the Ab 67 antibody to the D domain, and the Ab 66 antibody to the T2-T8 domain.
Figure 26 is a diagram showing the results of selection of variants that avoid anti-ADAMTS13 antibodies or have better activity than wild-type ADAMTS13. The evasion rate and ADAMTS13 activity against Ab 4-16 antibody (FIG. 26a) or Ab 67 antibody (FIG. 26b) were measured in wild-type clones and ADAMTS13 mutants. Relative activity was calculated by checking the specific titer of the wild-type clone and mutant and substituting it into the following formula: Relative activity (%) = specific titer of variant / specific titer of wild-type ADAMTS13
Figures 27a-27b show the results of confirming the single neutralizing antibody evasion rate of 12 full-length ADAMTS13 variants. The antibody evasion rate against 7 types of neutralizing antibodies (Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, Ab67) was measured in 12 full-length ADAMTS13 variants. The neutralizing antibody evasion rate was calculated by checking the relative binding level by comparing it with the WT ADAMTS13 value and then using this to substitute the relative evasion rate into the following formula: evasion rate (%) = (1- variant binding capacity/WT ADAMTS13 binding capacity) x 100
Figures 28a-28b show the results of confirming the evasion ability of a single neutralizing antibody under culture conditions expressing Fc-attached MDTCS fragment variants. MDTCS fragmentation of the 12 selected variants was performed, and the Fc-attached variants were combined with the selected variant amino acid residues to produce a culture medium in which a total of 14 variants, including DM1 and DM2 variants with two amino acid mutations, were expressed. The neutralizing antibody evasion rate and ADAMTS13 relative activity of eight single neutralizing antibodies (Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, and Ab67) were measured. Evasion rate (%) = (1- variant binding capacity/binding capacity) x 100; Relative activity (%)=variant specific titer/WT ADAMTS13 specific titer x 100
Figure 29 shows the results of confirming the evasion ability of mixed neutralizing antibodies under culture conditions expressing Fc-attached MDTCS fragment variants. 9 types of neutralizing antibodies (Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, Ab66, Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, Ab66, After reacting by mixing Ab67), the residual activity of each candidate variant was calculated by substituting the following formula: Residual activity (%) = A ÷ B x 100 (A: Activity under mixed neutralizing antibody conditions, B: Neutralizing antibody activity under untreated conditions)
Figure 30 shows the results of confirming the evasion ability of single neutralizing antibodies in Fc-attached MDTCS fragment mutant culture medium and purified liquid conditions. Eight types of single neutralizing antibodies ( Neutralizing antibody evasion rate and relative activity for (Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, Ab67) were measured (Figures 30a and 30b). The concentration of the purified solution was confirmed through Fc ELISA. Evasion rate (%) = (1- variant binding capacity/MDTCS-Fc binding capacity) x 100, relative activity (%) = variant specific titer/MDTCS-Fc specific titer x 100. Blue bars represent purified mutant proteins, gray bars represent purified mutant proteins The median value of expressed mutant proteins is shown, respectively.
Figure 31 shows the results of confirming the ability of the Fc-attached MDTCS fragment variant to evade mixed neutralizing antibodies in culture and purification conditions. Eight types of neutralizing antibodies (Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, After reacting by mixing Ab65, Ab67), the residual activity of each candidate variant was measured. Residual activity was calculated by substituting the formula below. Residual activity (%) = A ÷ B x 100 (A: Activity under mixed neutralizing antibody conditions, B: Activity under conditions without neutralizing antibody treatment)
Figure 32 is a graph showing the pharmacokinetic results of Fc-attached MDTCS fragment variants. MDTCS or Fc (IgG1-YTE)-attached MDTCS and four final candidate variants (1C03, 5C09, 7A02, DM2) fragment proteins were administered to mice through the tail vein, and plasma was obtained over time. Based on the specific titer of each substance, it was administered to reach 160 IU/kg, and the activity of the remaining substance in the plasma obtained at each time was measured through an activity assay.
Figure 33 shows the results of confirming the evasion ability against a single neutralizing antibody under culture conditions expressing MDTCS fragment variants attached to IgG1-YTE. The five selected variants were subjected to MDTCS fragmentation, and 8 types of single neutralizing antibodies (Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, The neutralizing antibody evasion rate and relative activity of Ab67) were measured (Figures 33a and 33b). Evasion rate (%) = (1-variant binding capacity/MDTCS-IgG1-YTE binding capacity) x 100, relative activity (%) = variant specific titer/MDTCS-IgG1-YTE specific titer x 100.
Figure 34 shows the results of confirming the evasion ability against mixed neutralizing antibodies under culture conditions expressing MDTCS fragment variants attached to IgG1-YTE. 9 types of neutralizing antibodies (Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, After reacting by mixing Ab66, Ab67), the residual activity of each candidate variant was calculated using the following formula: Residual activity (%) = A ÷ B x 100 (A: Activity under mixed neutralizing antibody conditions, B: Neutralizing antibody activity under untreated conditions).
Figure 35 shows the results of confirming the evasion ability of the MDTCS fragment variant attached to IgG1-YTE to mixed neutralizing antibodies under purified solution conditions. 9 types of neutralizing antibodies (Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, Ab66) mixed in equal proportions of control MDTCS-IgG1-YTE and 5 candidate variants in 4nM purified solution , Ab67), the residual activity of each candidate variant was calculated using the following formula: Residual activity (%) = A ÷ B x 100 (A: Activity under mixed neutralizing antibody conditions, B: Neutralizing antibody treatment activity under no conditions).
Figure 36 is a schematic diagram of the neutralizing antibody evasion rate test procedure using the aTTP-mimic mouse model (Figure 36a) and a diagram showing the ADAMTS13 residual activity by dose of variant candidate substances (Figure 36b).
Figure 37 is a schematic diagram of the test procedure for ADAMTS13 residual activity maintenance and clinical symptoms by concentration of DM2-IgG1-YTE, which showed the best neutralizing antibody evasion rate using the aTTP-mimic mouse model (Figure 37a), platelets (PLT) and This figure shows the improvement in LDH levels, ADAMTS13 activity (FIG. 37b), and clinical symptom observation results (FIG. 37c), respectively.
Figure 38 is a schematic diagram of the test procedure for improvement of hematological and clinical symptoms and degree of recovery of human ADAMTS13 activity by administering DM2-IgG1-YTE to a cTTP mouse model (Figure 38a), and improvement of platelet and LDH levels and ADAMTS13 activity. This figure shows the results of observing recovery (Figure 38b).
Figure 39 is a diagram showing a schematic diagram of the test process for measuring the treatment effect and degree of maintenance following GC1126A administration (Figure 39a) and the PLT (Figure 39b) and LDH (Figure 39c) values measured therefrom.
Figure 40 is a schematic diagram of the test process for measuring the therapeutically effective dose range of GC1126A (Figure 40a), PLT and LDH values measured 6 hours after administration of GC1126A (Figure 40b), and PLT measured 24 hours after administration, This figure shows the residual activity values of LDH and ADAMTS13 (Figure 40c), respectively.
Figure 41 is a diagram showing the results of analysis of ADAMTS13 antigen and ADAMTS13 residual activity at each time point after administration of various doses of GC1126A to ADAMTS13 knock-out mouse (KO mouse) (Figure 41a) and normal monkey (Figure 41b).
Figures 42A-42C show PK exposure (AUC, C _max ) at a therapeutically effective dose (0.15 mg/kg) in ADAMTS13 knock-out mice using human PK modeling and C _trough satisfying ADAMTS13 residual activity of 1 IU/mL. This picture shows the results of confirming the effective dose in a 70 kg human.
Figure 43 is a schematic diagram of the test process for comparing the therapeutic effect of GC1126A with a competitor (Cablivi ^® ) in the aTTP mimic mouse model (Figure 43a) and PLT values measured at 6 hours, 24 hours, and 48 hours (Figure 43b) This picture shows each level of recovery.
Figure 44 is a schematic diagram of the test process for comparing the therapeutic effects of human recombinant wild type ADAMTS-13 (rh WT ADAMTS13) and GC1126A in the aTTP mimic mouse model (Figure 44a) and recovery of PLT levels measured at 6 hours (Figure 44b) This picture shows each degree.
Figure 45 is a schematic diagram of the test process to compare the ability of GC1126A, rh WT ADAMTS13, and Cablivi ^® to prevent PLT decline over time in the aTTP mimic mouse model (Figure 45a), PLT level (Figure 45b), and residual activity (Figure 45c) ; This is a schematic diagram of the test process for comparing the recovery ability of PLT levels (Figure 45d), PLT levels (Figure 45e), and residual activity (Figure 45f), respectively.
Figure 46 is a picture showing the residual activity of ADAMTS13 after autoantibody evasion in the plasma of six aTTP patients, each of rh WT ADAMTS13, MDTCS-Fc, and GC1126A.

Hereinafter, the present invention will be described in more detail through examples. These examples are only for illustrating the present invention in more detail, and it will be apparent to those skilled in the art that the scope of the present invention is not limited by these examples according to the gist of the present invention. .

Example

Example 1: Selection of formulation components of ADAMTS13 protein

Each component and content of the liquid formulation composition for ADAMTS13 protein, described later in Example 3, were determined through the following process.

Freeze drying process

1.0 ml of each sample solution whose formulation was completed was dispensed into a glass vial (3 ml), half-closed with a rubber stopper, and then loaded onto the shelf of a freeze dryer (Lyostar 3, SP scientific). Thereafter, freeze-drying was performed under the conditions shown in Table 1 below, and the prepared freeze-dried preparation was capped with an aluminum cap after freeze-drying was completed.

step division Rate/hold shelf temperature Time (min) Vacuum degree (mTorr) One loading Hold 5℃ 20 N/A 2 freezing Rate -55℃ 200 N/A 3 freezing Hold -55℃ 300 N/A 4 1st warming Rate -25℃ 100 60 5 1st drying Hold -25℃ 2000 60 7 2nd warming Rate 25℃ 167 50 8 Secondary drying Hold 25℃ 600 50

The stability of the prepared freeze-dried preparation was analyzed after reconstitution with 1.0 ml distilled water.

Size exclusion liquid chromatography (SE-HPLC)

To perform size exclusion chromatography, the sample was diluted to 1.0 mg/ml with a mobile phase (1 It was prepared by inserting it into a screw top vial (vial insert). After connecting the mobile phase to the pump, the mobile phase was flowed through Waters e2695 and Waters 2489 instruments (Waters, Japan) at a flow rate of 0.5 mL/min, and an analytical column (TSKgel G3000SWXL, Tosoh) was installed. The mobile phase was flowed at a rate of 0.5 mL/min for more than 30 minutes to reach equilibrium until the detector signal was stabilized, and when the temperature of the autosampler fell to 4°C, the sample was inserted into the sampler. After injecting 30 μL of the sample, the mobile phase was run for 35 minutes to confirm the detection peak at 280 nm. Afterwards, analysis was performed using Empower Pro software on a PC.

Colloidal stability (B22)

Because the degree of protein-protein interaction affects aggregation and solubility, colloidal stability is an important item that must be considered in the development of protein formulations. B ₂₂ (second virial coefficient), a representative colloidal stability index, was used. In general, when the B ₂₂ value is large and positive, the repulsion force between proteins is strong, reducing the probability of aggregation occurring.

To evaluate the colloidal stability of five types of stabilizers, glycine and lysine were used as amino acids in a composition at pH 7.4 containing 1.2 mg/ml ADAMTS protein, 20 mM histidine, 4.0 mM CaCl ₂ , 120mM NaCl, and 1.0% sucrose as a common composition. , proline, alanine, or arginine were included at 100mM each.

Liquid samples of each composition after completion of formulation were analyzed for colloidal stability (B ₂₂ ) using the UNCLE instrument.

As the B ₂₂ value increases to a positive value, it means that the proteins do not clump together and are well dispersed. As shown in Figure 1, colloidal stability was confirmed in the order of arginine > glycine > proline > alanine > lysine > control group.

Turbidity analysis

Turbidity was analyzed with Lunatic (Unchained Labs). 2.0 μL of sample was injected into a Lunatic plate (Unchained Labs) and turbidity was measured at 350 nm. The turbidity of the placebo buffer was subtracted from the turbidity value of the sample to calculate the final value.

Thermal unfolding and thermal aggregation analysis

As the temperature increases, the degree to which a protein is unfolded can be measured by detecting the emission wavelength caused by tryptophan exposed on the surface when the protein unfolds. UNCLE (Unchained Labs) equipment was used to analyze differential scanning fluorimetry based on this intrinsic fluorescence intensity. To analyze the thermal stability of proteins using the above equipment, Tm (thermal unfolding) and Tagg (thermal aggregation) were measured as follows:

After repeatedly injecting 8.8 μL of the sample into the Uni sample loader (Unchained Labs) twice, the temperature was increased from 25°C to 95°C at a rate of 1°C/min. As the temperature was increased, the intensity of the wavelength (250-720nm) emitted by the excitation wavelength of 266nm was measured. Fluorescence data analysis used UNCLE Analysis software (Unchained Labs).

Through the above analysis, the temperature at the maximum of the fluorescence emission peak was defined as Tm, and the temperature at the start of protein aggregation was determined by measuring static light scattering at 266 nm (SLS266) of the protein. temperature) was defined as Tagg.

SE-HPLC evaluation of 7 types of stabilizers

Arginine, serine, valine, threonine, proline or glycine are each added as amino acid stabilizers in a composition at pH 7.4 containing 0.9 mg/ml ADAMTS protein, 20mM histidine, 2.0mM CaCl ₂ and 120mM NaCl as a common composition. Alternatively, 1.0 w/v% of sucrose was included as a sugar stabilizer.

Liquid samples of each composition whose formulation was completed were stored at room temperature for 7 hours and then subjected to SE-HPLC analysis. As a result, as shown in Figure 2, arginine had the best liquid stability among the seven stabilizers in the comparative experiment, and the stability and purity were arginine > sucrose > proline > glycine > valine, threonine > control > It was ranked highest in the order of Serine.

Liquid stability evaluation according to arginine addition

To evaluate the liquid stability according to the addition of 20mM arginine to a pH 7.4 composition containing 0.049 mg/mL ADAMTS protein, 15mM sodium phosphate, and 50mM NaCl, the formulated liquid sample was stored at room temperature for 3 hours and 19 hours. SE-HPLC analysis was performed at each analysis time point. As a result, as shown in Figure 3, it was confirmed that when 20mM of arginine was added, the refrigeration stability at 5°C was significantly improved compared to the control group.

Liquid stability evaluation according to objective protein concentration and arginine concentration

SE-HPLC analysis

ADAMTS protein was included at 0.2, 0.6 and 1.0 mg/ml, respectively, and arginine at concentrations of 20, 80 and 140 mM in a composition at pH 7.4 containing 20 mM histidine, 4.0 mM CaCl ₂ and 160 mM NaCl as a common composition. The stability of the prepared liquid samples was evaluated.

As a result of performing SE-HPLC analysis on the formulated sample after storing it at room temperature for 18 hours, it was confirmed that the purity improved as the concentration of the target protein decreased and the arginine concentration increased, as shown in Figure 4a.

DOE design

Meanwhile, DOE (Design Of Experiments) was performed to more closely explore the optimal concentration of arginine and the target protein. The two operating parameters, arginine concentration and ADAMTS protein concentration, were set as factors (X values) and purity (SE-HPLC) was set as response (Y value), and then a DOE design was performed using the JMP® 10.0 statistical program. Specifically, RSM (Response Surface Model) was used, and the axis point was set to CCD (Central Composite Design) type. Finally, a total of 9 Run conditions were designed, including “2-level full factorial design 4 Runs + central point 1 Run + axis point 4 Runs for 2 factors”.

The sample stock solution (1.1 mg/mL) was diluted with arginine according to DOE conditions and left at room temperature (approximately 15-25°C) for 18 hours before SE-HPLC analysis.

DOE statistical analysis was performed through multiple regression analysis using stepwise regression, and the establishment of the model followed response surface modeling. The analysis used JMP's Fit model method, and the effects used in the model included two main effects, a two-way interaction, and the square term of each main effect. The P-value threshold was used as a stopping rule to remove non-significant factors and select significant terms (P value ≤ 0.25, direction: Mixed).

As a result of the analysis, the R square of the model equation is 0.96 and the R square correction is 0.94. The P-value of the model's ANOVA (analysis of variance) was 0.0006, which is less than the significance level of 0.05, confirming the significance of this model.

The factors that are considered significant because they have a P-value lower than the significance level α=0.05 are the main effect, protein concentration, and the main effect, arginine concentration. The P-value for arginine*arginine curvature was 0.0765, which was close to the significance level of α=0.05 (Figure 4b).

As a result of prediction profiler analysis, the monomer % value was highest around 120 mM arginine, indicating that 100 to 140 mM was the optimal concentration of arginine (FIG. 4c).

Quality evaluation of freeze-dried composition according to NaCl concentration

NaCl was added to a composition at pH 7.4 containing 1.2 mg/ml ADAMTS protein, 20 mM histidine, 4.0 mM CaCl ₂ and 0.05% PS80 at concentrations of 50, 100, 120, 150, 200 and 300 mM. As a result of freeze-drying the formulated sample to observe the cake properties and performing SE-HPLC analysis, as the NaCl concentration increased, more solid and excellent cake properties were shown (Figure 5a), while SE-HPLC results showed that the main No appreciable difference in purity was observed (Figure 5b).

Liquid stability evaluation according to NaCl concentration

NaCl was added to a composition at pH 7.4 containing 1.2 mg/ml ADAMTS protein, 20mM histidine, 4.0mM CaCl ₂ and 20mM arginine at concentrations of 0, 40, 80, 120 and 160mM. The formulated liquid sample was stored at room temperature, and SE-HPLC analysis was performed at 4, 8, and 12 hours. As shown in Figure 6, it was confirmed that the higher the concentration of NaCl, the better the liquid stability.

Quality evaluation of freeze-dried composition according to sugar concentration (NaCl 120mM)

Sucrose at concentrations of 0.0, 0.5, 1.0 and 2.0% (w/v) in a composition at pH 7.4 containing 1.2 mg/ml ADAMTS protein, 120 mM NaCl, 20mM histidine, 4.0 mM CaCl ₂ and 0.05% PS80 in common composition. Alternatively, trehalose at a concentration of 1.0% (w/v) was added. As a result of freeze-drying the formulated sample, observing the cake properties, and performing SE-HPLC analysis, it was found that in NaCl 120mM, no collapse occurred when 1.0% sucrose was added, but collapse occurred when 2.0% was added, and collapse began. The resulting sucrose concentration was predicted to be between 1.0 and 2.0% (Figure 7a). The formulation with 1.0% trehalose showed similar properties to the formulation with 1.0% sucrose (Figure 7a). Meanwhile, SE-HPLC results No significant difference in purity was observed depending on the added sugar concentration, indicating that purity was maintained even when collapse occurred.

Quality evaluation of freeze-dried composition according to the content ratio of sucrose and bulking agent (NaCl 120mM)

Sucrose and extenders (mannitol, glycine) were added at 1.0 / _3.0 (w/ v) (content ratio 1:3) and 2.0 / 2.0 % (w/v) (content ratio 1:1) were added. The formulated sample was lyophilized to observe the cake properties and SE-HPLC analysis was performed. As a result, all samples collapsed when NaCl was fixed at 120mM and the sucrose to extender content ratio was added at 1:3 and 2:2. occurred (Figure 8a), and no significant difference was observed between samples as a result of SE-HPLC (Figure 8b).

Freeze-drying quality evaluation according to glycine concentration (NaCl 120mM)

Glycine was added at 0, 20, 40 , ₆₀ , 80 and It was added at a concentration of 100 mM. As a result of observing the cake properties by freeze-drying the formulated sample and performing SE-HPLC analysis, it was found that when NaCl 120mM and sucrose 1.0% were added fixedly and the concentration of glycine was increased, it had a negative effect on the cake properties; It was found that when 60mM or more of glycine was added, it completely collapsed (Figure 9).

Freeze-dried quality evaluation according to arginine concentration (NaCl 120mM)

Arginine was added at 0, 20, 60 and 100 mM in a composition at pH 7.4 containing 1.2 mg/ml ADAMTS protein, 120mM NaCl , 1.0% sucrose, 20mM histidine, 4.0mM CaCl ₂ and 0.05% PS80 in common composition. It was added in concentration. As a result of freeze-drying the formulated sample to observe the cake properties and performing SE-HPLC analysis, it was found that when NaCl 120mM and sucrose 1.0% were added fixedly and the arginine concentration was increased, it had a negative effect on the cake properties, and arginine When more than 60mM was added, it completely collapsed (Figure 10).

Freeze-dried quality evaluation according to the content ratio of NaCl and sucrose (w/o arginine)

NaCl at concentrations of 120, 160 and 200 mM and sucrose at 1.0, 1.5 and 2.0 in a composition at pH 7.4 containing in common composition 1.2 mg/ml ADAMTS protein, 20 mM histidine, 4.0 mM CaCl ₂ and 0.05% PS80. It was added at a concentration of % (w/v). As a result of freeze-drying the formulated sample to observe the cake properties and performing SE-HPLC analysis, the cake properties were shown to be better as the NaCl concentration increased and the sucrose concentration decreased. Specifically, i) when 120mM of NaCl was added. The point of collapse exists within the range of 1.0 - 1.5% of sucrose, ii) in the range of 1.5 - 2.0% of sucrose when 160mM of NaCl is added, and iii) in the range of over 2.0% of sucrose when 200mM of NaCl is added. It was confirmed (Figure 11a).

Meanwhile, as a result of SE-HPLC, when arginine was not added, no significant change was observed depending on the NaCl and sucrose content ratio (FIG. 11b).

Freeze-dried quality evaluation according to the content ratio of NaCl and sucrose (arginine 120mM)

NaCl was added at concentrations of 160, 200, 240 and 280 mM and sucrose in a composition at pH 7.4 containing 0.5 mg/ml ADAMTS protein, 20 mM histidine, 4.0 mM CaCl ₂ , 0.05% PS80 and 120 mM arginine as a common composition. It was added at concentrations of 0.0, 0.5, and 1.0 % (w/v). As a result of freeze-drying the formulated sample to observe the cake properties and performing SE-HPLC analysis, when arginine was fixedly added at 120mM, solid cake properties appeared as the NaCl concentration increased and the sucrose concentration decreased. Specifically, i) in the section where more than 0.0 - 0.5% of sucrose was added when 160mM of NaCl was added, ii) in the section where more than 1.0% of sucrose was added when 200mM of NaCl was added, iii) in the section where more than 1.0% of sucrose was added when 240mM of NaCl was added. In, iv) when 280mM of NaCl was added, it was found that there was a collapse initiation point in each section where more than 1.0% of sucrose was added (FIG. 12a).

Meanwhile, SE-HPLC results showed no notable change in purity depending on NaCl and sucrose concentration when arginine 120mM was included, but the purity was 97.4% in the formulation without NaCl 160mM and sucrose, which was relatively low compared to other samples. (Figure 12b).

Evaluation of freeze-drying stability according to NaCl to sucrose mixing ratio (arginine 120mM)

A composition at pH 7.4 containing 0.5 mg/ml ADAMTS protein, 20 mM histidine, 4.0 mM CaCl ₂ , 0.05% PS80 and 120 mM arginine as a common composition was added with NaCl at concentrations of 200, 240 and 280 mM, sucrose at 0.0, It was added at concentrations of 0.5 and 1.0% (w/v). As a result of evaluating the accelerated stability (40°C) by freeze-drying the formulated sample, there was no significant change in purity at 40°C for 1 month compared to the initial period depending on the NaCl to sucrose mixing ratio in the presence of 120mM arginine (Figure 13).

Prevention of agitation-induced aggregation depending on polysorbate 80 concentration

Polysorbate 80 was added at 0.0, 0.001, 0.005, 0.01, 0.05 and 0.1% in a composition at pH 7.4 containing 1.2 mg/ml ADAMTS protein, 20mM histidine, 4.0mM CaCl ₂ , 120mM NaCl and 1.0% sucrose in common composition. Each was added at a concentration of (v/v). Analysis (property, turbidity, SE-HPLC) was performed after vortexing the formulated liquid sample to generate artificial shear stress, and sampling was performed at 30 seconds and 2 minutes after the start of stirring. As a result of property analysis after 2 minutes of stirring, it was confirmed that the sample became clear and transparent when more than 0.005% of polysorbate 80 was added (FIG. 14a).

Meanwhile, when 0.005% or more of polysorbate 80 was added, it was confirmed that there was no change in turbidity compared to the initial stage, indicating that stirring-induced aggregation did not occur (FIG. 14b). In addition, SE-HPLC results It was confirmed that when more than 0.05% of polysorbate 80 was added, the purity decreased by less than 5% compared to the initial level (FIG. 14c).

Liquid stability evaluation according to polysorbate 80 concentration

Polysorbate 80 was added at _0.0 , 0.005, 0.01, 0.05 and 0.09% ( It was added at a concentration of v/v). As a result of performing SE-HPLC analysis on the formulated liquid sample after storing it at room temperature for 6 hours, it was confirmed that as the concentration of polysorbate 80 increased, the liquid stability (purity) decreased slightly (FIG. 15).

Freeze-drying quality evaluation according to polysorbate 80 concentration

Polysorbate 80 was added at _0.0 , 0.005, 0.01, 0.05 and 0.09% (v. It was added at a concentration of /v). As a result of performing SE-HPLC analysis after freeze-drying the formulated liquid sample, as the concentration of polysorbate 80 increases, the effect of preventing purity loss due to the freeze-drying process increases, and when more than 0.01% is added, monomer recovery of more than 94% is confirmed. (Figure 16a). In addition, as the polysorbate 80 concentration increased, the formation of higher-order aggregates was efficiently blocked (FIG. 16b).

Thermal unfolding and thermo-coagulation evaluation according to pH

After preparing different dilution filtration buffers in advance with a common composition of 20mM histidine, 4mM CaCl ₂ and 0.05% PS80 and pH of 6.0, 6.5, 7.0, 7.2 and 7.4, the buffer was exchanged with a solution containing ADAMTS protein. Samples were prepared through the process. Amicon® Ultra-15 Centrifugal Filter Units 30K were used, and centrifugation was performed at 3000 rpm under refrigerated conditions.

The common composition of the sample for which buffer exchange was completed was 10 mg/ml ADAMTS protein, 20mM histidine, 4mM CaCl ₂ and 0.05% PS80, and the pH was 6.0, 6.5, 7.0, 7.2 and 7.4, respectively.

As a result of performing T _m and T _agg analysis on the formulated liquid sample using UNCLE equipment, the Tm (thermal unfolding) value, which is proportional to the structural thermal stability of the protein, increases as the pH increases, and at pH 6.0, it is lower than other experimental groups. It was confirmed that the Tm value was visible (FIG. 17a). In the case of thermal aggregation (T _agg ), which reflects the degree of unstable aggregation, it was confirmed that the higher the pH, the higher the T _agg value, and at pH 6.0 and pH 6.5, the T _agg value was lower than that of other experimental groups (Figure 17b) ).

Freeze-drying quality evaluation according to CaCl ₂ concentration

CaCl ₂ at concentrations of 2.0, 4.0 and 8.0 mM was added to a composition at pH 7.4 containing 1.2 mg/ml ADAMTS protein, 20 mM histidine, 120mM NaCl, 1.0% sucrose and 0.05% PS80 as a common composition. As a result of freeze-drying the formulated sample and performing SE-HPLC analysis, it showed partially collapsed properties regardless of CaCl ₂ concentration (FIG. 18a), and SE-HPLC analysis showed that purity improved as CaCl ₂ concentration increased. Confirmed (FIG. 18b).

Example 2: Further optimization of formulation components of ADAMTS13 protein

Evaluation of freeze-dried quality according to NaCl to sucrose mixing ratio

NaCl was added at ₁₀₀ , 150, 200, 250, 300, 350, and To a concentration of 400mM, sucrose was added at concentrations of 0, 0.5, 1 and 1.5% (w/v). The formulation-completed sample was freeze-dried to observe the cake properties, and the purity before and after the process was analyzed by SE-HPLC. As a result, as shown in Table 2 below, no significant change in purity was observed depending on the NaCl and sucrose content ratio, indicating that excellent purity was maintained in all tested ranges.

Purity recovery after freeze-drying (%) division NaCl (mM) 100 150 200 250 300 350 400 sucrose
(%) 0 100.6 100.8 100.3 100.1 99.4 99.8 100.0 0.5 100.7 100.9 100.3 100.2 99.9 99.9 99.9 One 100.7 100.9 100.4 100.2 100.2 99.9 99.9 1.5 100.1 101.0 100.1 100.2 100.2 100.0 100.0

However, as shown in Figures 19a and 19b, it was confirmed that as the NaCl concentration increased and the sucrose concentration decreased, good cake properties were observed.

Freeze-dried quality evaluation according to high-concentration sucrose treatment

In a composition at pH 7.4 containing 0.36 mg/ml ADAMTS protein, 20 mM histidine, 4mM CaCl ₂ , 120mM L-Arg, and 0.05% PS80, NaCl was added at concentrations of 200, 250, and 300mM, and sucrose at 1.5%. and was added at a concentration of 2.5%. As a result of observing the cake properties by freeze-drying the formulated sample, it was confirmed that as the NaCl concentration increased and the sucrose concentration decreased, good cake properties were observed, as shown in FIG. 20.

Colloidal stability evaluation according to arginine concentration (B ₂₂ ,kD)

Arginine was added at 40, 80, 120, 160 and 200 in a composition at pH 7.4 containing 0.36 mg/ml ADAMTS protein, 20 mM histidine, 4 mM CaCl ₂ , 280 mM NaCl, 1% sucrose and 0.05% PS80. It was added at a concentration of mM. The colloidal stability (B ₂₂ , kD) of the formulated liquid sample was analyzed using the UNCLE instrument. As the B ₂₂ and kD values become more positive, it means that the proteins are well dispersed without aggregation. As shown in Figure 21, it was confirmed that the closer the arginine content is to 120 mM, the better the colloidal stability.

Freeze-dried quality evaluation according to arginine concentration

Arginine was added at 40, 80, 120, 160 and 200 in a composition at pH 7.4 containing 0.36 mg/ml ADAMTS protein, 20 mM histidine, 4 mM CaCl ₂ , 280 mM NaCl, 1% sucrose and 0.05% PS80. It was added at a concentration of mM. The formulated sample was freeze-dried, the cake properties were observed, and the purity was analyzed by SE-HPLC. As a result, for arginine concentrations of 80mM and 120mM, It was confirmed that the properties were excellent (Figure 22a), but no significant difference in purity was observed depending on arginine concentration (Figure 22b).

Storage time and temperature stability for GC1126A final liquid formulation

A fully formulated liquid sample at pH 7.4 containing 0.36 mg/ml ADAMTS protein, 20 mM histidine, 4mM CaCl ₂ , 120 mM L-Arg, 280 mM NaCl, 1% Sucrose, and 0.05% PS80 was stored at room temperature (25°C). Changes over time were confirmed by analyzing purity (SE-HPLC), titer (ADAMTS13 activity), protein concentration (UV), and turbidity after storage under ) and refrigerated (4°C) conditions, respectively. As a result, purity showed a decrease of about 4% compared to the initial level from the 3rd day of storage at room temperature, a decrease of about 15% compared to the initial level on the 7th day of storage, and no change over time was observed until the 7th day of refrigerated storage (FIG. 23a) .

As a result of observing the change in titer, the titer decreased by about 50% compared to the initial level at 7 days of room temperature storage, and considering the deviation of the titer analysis, no clear change over time was observed until the 7th day of refrigerated storage (FIG. 23b).

In the case of protein concentration, the protein concentration increased from the initial 3 days of storage at room temperature, which is believed to be the result of increased UV absorbance as the opacity of the sample increased due to particle aggregation. No changes were observed over time until 7 days of refrigerated storage (Figure 23c).

Meanwhile, the turbidity of the final liquid formulation showed an increase from 3 days of storage at room temperature, but no change over time was observed until 7 days of refrigerated storage (Figure 23d).

Optimization of NaCl and sucrose concentrations

A composition at pH 7.4 containing 0.5 mg/ml ADAMTS protein, 20 mM histidine, 4mM CaCl ₂ , 120mM L-Arg, and 0.05% PS80 was mixed with NaCl at concentrations of 200, 240, and 280 mM, and sucrose. was added at concentrations of 0, 0.5 and 1%.

Design Of Experiments (DOE) was performed to explore the optimal concentrations of NaCl and sucrose. After setting the two operating parameters NaCl and sucrose concentration as factors (X values) and purity (SE-HPLC) and titer (ADAMTS13 activity) as responses (Y values), the DOE was calculated using the JMP ^® 10.0 statistical program. The design was carried out. For the experimental design, a full factorial design was used and two central points were included. Ultimately, a total of 6 conditions were designed, including “2-level full factorial design 4 Runs + center point 2 Runs”.

Run X NaCl (mM) sucrose One 280 0 2 (center point) 240 0.5 3 280 One 4 200 0 5 200 One 6 (center point) 240 0.5

A formulation buffer was prepared according to pre-designed conditions and mixed with the stock solution to prepare the final stock solution. The prepared formulation was freeze-dried by dispensing 1 ml into 3 ml vials, and the freeze-dried sample was stored in the refrigerator (5°C) and quality analysis was performed 6 months later.

DOE statistical analysis was conducted using multiple regression analysis using stepwise regression. Analyze was done using JMP's 'Fit model' method, and the effects used in the model included two main effects, a two-way interaction, and the square term of each main effect. The p-value threshold was used as a stopping rule to remove non-significant factors and select significant terms (P value ≤ 0.25, direction: Mixed).

As a result of the analysis, good purity was shown for 6 months under all experimental conditions, and no difference in purity depending on NaCl and sucrose concentrations was confirmed (FIG. 24a). In addition, compared to the initial titer of each experimental group, the titer after 6 months was within the analysis deviation and did not show a significant difference (FIG. 24b).

Example 3: Construction of ADAMTS13 protein variants

The present inventors attempted to create a human ADAMTS13 variant that can efficiently evade ADAMTS13 neutralizing antibodies possessed by aTTP patients using a random mutation method. To determine whether variants with mutations in the MDTCS region or S domain can evade neutralizing antibodies of ADAMTS13, Fabs were produced using Bio-Rad's HuCAL system for antibodies that recognize different epitopes for human ADAMTS13. 16 species with excellent binding ability to human ADAMTS13 were selected. The binding region of each antibody is shown in the figure. As shown in Figure 25c, Ab 4-16 specifically binds to the S domain, Ab 67 to the MDTCS portion, and Ab 66 to the C-terminal portion (TSP-2 to TSP-8 domains).

The evaluation of variants was conducted through comparative results analysis of the wild-type ADAMTS13 construct and non-mutant or silent mutant variants (hereinafter referred to as wild-type clones) having the same amino acid sequence as wild-type ADAMTS13 among variants produced through random mutagenesis. A total of 59 wild-type clones were analyzed for the activity and binding capacity of Ab 4-16 and Ab 67, and the analysis results of each wild-type clone were relativized based on the results of the wild-type ADAMTS13 construct and are shown in Figure 26. As shown in Figure 26, the escape rates for Ab 4-16 and Ab 67 antibodies against wild-type ADAMTS13 (59 species), mutated ADAMTS13 (304 species) and selected ADAMTS13 (26 species) containing conservative amino acid substitutions, and Relative activity was shown. Although the wild-type clone had no mutation, it showed a difference in results relative to the wild-type ADAMTS13 construct result, and among the mutated ADAMTS13 (304 species), as shown in Table 4 below, it had a value above a certain level of evasion rate or relative activity. Twenty-six mutant ADAMTS13 strains were selected.

Specifically, the Ab 4-16 evasion rate of mutated ADAMTS13 ranged from -29.5% to 33.4%, the Ab 67 evasion rate ranged from -24.4% to 30.5%, and the relative activity ranged from 62.7% to 128.9%. The range is shown (Table 4). As a result of applying the normal distribution using the three-sigma rule, the Ab 4-16 evasion rate ranged from -34.1% to 38.5%, the Ab 67 evasion rate ranged from -38.5% to 42.3%, and the relative activity ranged from 47.0% to 145.2%. For WT clones, almost all results were expected to fall within this distribution. Therefore, in the selection of variants, based on the maximum value of three-sigma, Ab 4-16 evasion rate of more than 38.5%, Ab 67 evasion rate of more than 42.3%, or relative activity of more than 47.0% were applied as selection criteria.

Evasion rate and relative activity range of neutralizing antibody Ab4-16 or Ab67 category Ab 4-16 Evasion Rate Ab 67 Evasion Rate relative activity minimum value -29.5% -24.4% 62.7% maximum value 33.4% 30.5% 128.9% average 2.2% 1.9% 96.1% Standard Deviation 12.1% 13.5% 16.4% Mean - 3 standard deviations -34.1% -38.5% 47.0% Mean + 3 standard deviations 38.5% 42.3% 145.2%

Selection of variants that avoid ADAMTS13 neutralizing antibodies and have activity higher than that of wild-type ADAMTS13

After the WT clone and variants with amino acid mutations were transfected into cells, the amount of protein present in the culture medium was measured, and neutralizing antibody binding and activity assays were performed on 304 variants with an expression concentration of 50 ng/mL or more. It was found that variants with amino acid mutations had a diverse distribution in neutralizing antibody binding ability or relative activity compared to the WT clone, and among these, 26 variants that satisfied the selection criteria were finally selected. It was confirmed that 18 of the 26 variants had mutations in the S domain, and in particular, 13 of the variants had mutations in the S domain (1C03, 1G07, 2B01, 2B02, 3B05, 3G04, 5C09, 5G08, 6B12, 7A02). , 8C04, 8D01, 8F01) had a high evasion rate against Ab 4-16, and five species (7E01, 7G08, 8C02, 8D01, 8D05) showed characteristics of high relative activity (Table 5). Six variants have mutations in the D domain, and five of them (46, 3A06, 4C07, 4E11, 4H07) have a high evasion rate against Ab 67. In addition, six types of variants with mutations in the M domain, two types in the C domain, and two types in the T domain were identified. The reproducibility of the results was confirmed through three repeated experiments for the 26 selected variants, and 12 variants that continuously maintained superiority over the WT clone even in repeated tests were selected as the subject of in vitro efficacy testing. Among the 12 variants, 1C03, 2B01, 2B02, 3B05, 5C09, 5G08, 7A02, and 8D01 were selected because of their excellent Ab4-16 antibody evasion rate, and 4C07, 4E11, and 4H07 were selected because of their excellent Ab67 evasion rate. Finally, 8D05 was selected based on its excellent relative activity.

In order to confirm the evasion ability of the 12 selected variants against additional neutralizing antibodies, we wanted to check whether evasion was possible against Ab4-20, Ab60, Ab61, Ab64, and Ab65 neutralizing antibodies in addition to the Ab4-16 and Ab67 antibodies used in screening. Among the 12 variants, 8 variants 1C03, 2B01, 2B02, 3B05, 5C09, 5G08, 7A02, and 8D01, excluding 8D05, out of 9 with amino acid mutations in the S domain, were based on the ADAMTS13 autoantibody sequence from aTTP patient. It showed excellent evasion rate against Ab4-16 and Ab4-20 produced by , and also showed excellent evasion ability against Ab60 and Ab61. On the other hand, variants 4C07, 4E11, and 4H07 with amino acid mutations in the D domain had excellent evasion rates against Ab67 (Figure 27, Table 6).

Selection of 26 variants with excellent Ab4-16 and Ab67 neutralizing antibody evasion or relative activity Variant ID mutation
Applicable domain variant amino acid residues Evasion rate of Ab4-16 antibody Evasion rate of Ab67 antibody relative activity 46 M,D L85F
P317H 46.30% 53.90% 66.80% 1C03 S S612Y 48.00% 10.40% 104.60% 1G07 M,C,S V282A
A465D
D672V 41.40% 57.90% 63.80% 2B01 S D635V 87.40% 5.40% 62.20% 2B02 C, S R452I
S612Y 69.80% 15.30% 88.80% 3A06 M,D,T R278I
A334T
D427N 42.60% 58.50% 62.90% 3B05 S P618S 66.00% 48.40% 71.20% 3E01 M T135I 52.30% 36.00% 60.00% 3G04 M, S V126M
A567S
E651D 42.00% 29.40% 103.50% 3H12 T N413D -69.00% -104.60% 162.40% 4C07 D A334V -6.60% 72.30% 153.10% 4E11 D A314T 10.30% 96.40% 71.90% 4H03 M,D F93V
K364R
E376D 40.30% 37.60% 65.70% 4H07 D N308K 30.20% 64.60% 106.40% 5C09 S S612F 60.90% -10.50% 88.50% 5G08 S Q656H 41.40% 26.00% 91.90% 6B12 S G607R 43.90% -101.60% 93.80% 7A02 S S612F
G624D 57.00% -80.50% 128.50% 7E01 S R589Q -36.60% -89.70% 149.90% 7G08 S Q650H
Q656R -25.20% -47.60% 160.70% 8C02 S I643F -19.20% -50.90% 168.10% 8C04 S I585N
Y658H 51.30% 34.80% 69.00% 8C12 S V630L
D654G
E664N -12.00% 73.20% 48.10% 8D01 S R589Q
K608M
M609L
G624C
I655V 85.10% -78.30% 193.60% 8D05 S P578L -1.20% -5.70% 172.30% 8F01 S I585M 45.20% 34.40% 99.40%

Confirmation of evasion and relative activity of single neutralizing antibodies in 12 selected variants Variant ID mutation location Neutralizing antibody evasion rate (%) relative activity Ab4-16 Ab4-20 Ab60 Ab61 Ab64 Ab65 Ab67 1C03 S612Y 57.5% 59.4% 97.2% 94.7% 5.2% -11.0% 15.1% 103.7% 2B01 D635V 82.9% 88.6% 92.4% 97.4% 96.3% 8.1% 7.9% 66.8% 2B02 R452I
S612Y 65.4% 61.1% 97.3% 95.5% 0.9% -15.0% 15.1% 112.6% 3B05 P618S 51.3% -6.5% 24.9% 39.4% 19.4% -63.8% 37.4% 77.3% 4C07 A334V 4.2% -5.0% -3.3% -6.9% -2.2% -4.7% 78.5% 152.2% 4E11 A314T 16.6% -1.3% 2.7% 3.2% 5.4% -0.8% 98.9% 78.3% 4H07 N308K 27.9% 1.5% 11.0% 16.4% 17.0% 12.8% 61.3% 94.7% 5C09 S612F 64.6% 54.7% 97.3% 95.2% 7.8% -1.6% 11.8% 104.8% 5G08 Q656H 47.0% 7.2% 32.1% 46.2% 27.4% -51.4% 30.3% 95.9% 7A02 S612F
G624D 57.1% 55.4% 97.6% 95.5% 1.9% -26.2% -12.9% 125.3% 8D01 R589Q
K608M
M609L
G624C
I655V 90.1% 98.5% 95.2% 94.1% 20.0% -95.9% 7.3% 127.0% 8D05 P578L -9.3% -43.1% 3.2% 15.9% -0.9% -116.4% 11.5% 154.7%

Meanwhile, in a structural-functional study, it was reported that among the 14 domains of ADAMTS13, the MDTCS domain with the C-terminal TSP-2 to CUB2 domains removed has a metalloprotease function similar to ADAMTS13 and is capable of cleaving VWF (Shelat et al. ., 2005). This suggests that the MDTCS fragment alone, rather than the full-length ADAMTS13, may function as a treatment for TTP disease, and that it can avoid neutralizing antibodies present in patient plasma that bind to the C-terminal portion in a truncated form. .

Accordingly, the 12 selected variants were fragmented with MDTCS, and DM1 and DM2 variants with two amino acid mutations were additionally created by combining the selected mutant amino acid residues. We attempted to select final candidates by measuring the evasion rate and relative activity of single or mixed neutralizing antibodies using culture and purification solutions expressed in cells using the previously mentioned method.

As a result of measuring the binding evasion rate and relative activity of eight types of single neutralizing antibodies using culture medium, 2B01, 3B05, 4H07, 5G08, 8D05, and DM1 evaded all neutralizing antibodies at a similar level (Figure 28, Table 7). 1C03, 2B02, 5C09, 7A02, 8D01, and DM2 showed excellent binding avoidance rates for 3-01 and Ab60. All six candidates have amino acid mutations in the S domain, and except for 8D01, they have a mutation at the 612th amino acid in common. In the case of 4E11 and DM2, the binding evasion rate against Ab67 was excellent, and both had mutations at amino acid 314 of the D domain. In terms of relative activity, DM1 had the lowest at 57.9% and 1C03 had the highest at 133.1%. All candidates except the above two showed relative activities of 78.2 - 125.1%, similar to the MDTCS-Fc control group (Table 7). Under conditions where 9 types of neutralizing antibodies (Ab3-01, Ab4-16, Ab4-20, Ab60, Ab61, Ab64, Ab65, Ab66, Ab67) were mixed in equal proportions, 12 types excluding 4C07 and 5C09 compared to MDTCS-Fc, the control group. To confirm the evasion ability of the candidate variants, 7.5 nM of mixed neutralizing antibodies and 4 nM of each variant expression culture medium were mixed and reacted at room temperature for 1 hour to measure the residual activity. In the case of MDTCS-Fc, it was shown to maintain a residual activity of 3.5%, and 3B05, 4E11, 4H07, 5G08 and 8D05 were confirmed to have a residual activity of 1.24 - 2.42%, showing lower residual activity compared to MDTCS-Fc (Figure 29). On the other hand, in the case of 1C03, 2B01, 2B02, 7A02, 8D01, DM1 and DM2, the residual activity was maintained at 7.69 - 18.81%, confirming that the evasion by mixed neutralizing antibodies was superior to MDTCS-Fc (Figure 29).

In order to confirm the neutralizing antibody evasion ability of the candidate variant using purification solution, protein purification was performed from each culture medium using the Phytip system (protein A resin), and the evasion rate of a single neutralizing antibody was confirmed using the obtained purification solution. Most variants had similar trends to the results evaluated in culture (Figure 30).

It was confirmed that 2B01 5G08, 8D05 and DM1 variants evaded neutralizing antibodies by more than 24.6% for all eight types of neutralizing antibodies, and in the case of 1C03, 2B02, 7A02, 8D01 and DM2, similar to the culture results, 3-01 and Ab60 showed excellent binding avoidance rate. In the case of 4E11 and DM2, it was confirmed that the binding evasion rate for Ab67 was excellent, consistent with the results of the culture medium. The relative activity of each variant is shown in Figure 30 and Table 8. As a result of measuring the residual activity under mixed neutralizing antibody conditions, it was confirmed that 3.76% of MDTCS-Fc was maintained, and the activity of 3B05, 4E11, 4H07 and 8D05 variants was 2.05 - 3.50%, which was confirmed to be more inhibited compared to MDTCS-Fc. . On the other hand, in the case of 1C03, 2B01, 2B02, 5G08, 7A02, 8D01, DM1 and DM2, residual activity of 6.34-12.8% was maintained, which showed superior mixed neutralizing antibody evasion compared to MDTCS-Fc (Figure 31).

Based on the above results, considering the relative activity or mixed neutralizing antibody evasion rate comprehensively, 1C03, 2B02, 7A02, DM2, and 5C09, which is believed to have excellent ability to evade mixed neutralizing antibodies due to its amino acid mutation at 612, were selected as five types for further research. was selected as a candidate.

Confirmation of single neutralizing antibody evasion and relative activity of MDTCS fragments containing 14 variants (culture medium conditions) Mutant ID transition
location Neutralizing antibody evasion rate (%) relative
activation 3-01 4-16 4-20 Ab60 Ab61 Ab64 Ab65 Ab67 1C03 S612Y 100.0% 2.0% -11.0% 91.3% 3.9% -5.9% -16.9% 1.1% 133.1% 2B01 D635V 25.1% 28.2% 38.1% 38.4% 36.2% 26.8% 11.0% 24.9% 78.2% 2B02 R452I
S612Y 99.0% 1.2% 4.2% 93.5% 2.9% -2.1% -12.9% 3.1% 116.5% 3B05 P618S 35.3% 18.9% 25.5% 23.6% 19.1% 21.3% 17.9% 17.8% 92.7% 4C07 A334V -5.9% -11.2% -9.6% -11.3% -3.3% -12.4% -14.6% 14.5% 118.2% 4E11 A314T 15.3% 7.3% 11.9% 8.1% 9.0% 9.7% 8.8% 83.5% 89.7% 4H07 N308K 36.1% 20.4% 25.8% 19.5% 22.5% 25.1% 21.0% 53.8% 93.6% 5C09 S612F 100.0% 15.7% 18.7% 100.0% 12.4% 13.0% 0.5% 8.5% 108.2% 5G08 Q656H 48.7% 38.3% 41.2% 44.2% 41.9% 37.2% 27.8% 47.6% 85.4% 7A02 S612F
G624D 100.0% 7.5% 17.4% 97.5% 11.2% 7.2% -7.2% 12.3% 125.1% 8D01 R589Q
K608M
M609L
G624C
I655V 100.0% 38.9% 49.1% 71.2% 31.6% 36.3% 18.1% 41.8% 78.4% 8D05 P578L 39.6% 29.9% 38.3% 32.6% 32.4% 32.5% 21.5% 43.7% 82.1% DM1 A314T
D635V 52.3% 48.2% 56.9% 60.6% 54.7% 51.6% 38.1% 86.8% 57.9% DM2 A314TS612F 100.0% 12.0% 22.0% 95.1% 21.6% 13.0% 7.3% 84.8% 97.7%

Confirmation of single neutralizing antibody evasion and relative activity of MDTCS fragments containing 14 variants (purified solution conditions) Variant ID transition
location Neutralizing antibody evasion rate (%) relative
activation 3-01 4-16 4-20 Ab60 Ab61 Ab64 Ab65 Ab67 1C03 S612Y 100.0% 15.6% 21.1% 100.0% 16.3% 7.3% -7.1% 10.9% 81.4% 2B01 D635V 46.0% 37.8% 49.6% 65.5% 43.7% 49.7% 28.5% 28.2% 56.3% 2B02 R452I 100.0% 8.4% 15.0% 100.0% 10.3% 4.4% -9.0% 0.2% 91.1% S612Y 3B05 P618S 25.5% 11.9% 13.3% 14.9% 10.5% 13.8% 7.9% 10.2% 83.7% 4E11 A314T 19.6% 6.2% 11.5% 15.7% 1.8% 8.8% 12.6% 84.4% 77.5% 4H07 N308K 32.6% 12.80% 16.8% 29.0% 9.4% 16.9% 17.0% 47.1% 77.5% 5G08 Q656H 89.6% 64.5% 70.2% 81.9% 57.90% 68.9% 59.0% 37.7% 18.3% 7A02 S612F
G624D 100.0% 10.4% 12.8% 100.0% 8.5% 3.4% -7.3% 14.4% 97.8% 8D01 R589Q
K608M
M609L
G64C
I655V 100.0% 29.5% 48.2% 91.7% 20.5% 17.1% 14.2% 31.5% 65.1% 8D05 P578L 51.0% 27.4% 35.1% 49.5% 27.2% 33.8% 29.9% 46.0% 56.3% DM1 A314T
D635V 50.2% 34.0% 54.0% 66.50% 45.3% 52.9% 24.6% 85.1% 50.3% DM2 A314T
S612F 100.0% 16.2% 24.2% 100.0% 24.0% 11.5% 11.0% 86.5% 73.1%

DNA was prepared by conjugating IgG1-YTE to the five finally selected MDTCS variant fragments, and the binding evasion and relative activity of eight types of single neutralizing antibodies were measured in culture medium expressed in cells. As a result, 1C03, 2B02, 5C09, and 7A02 showed excellent binding evasion rates for Ab3-01 and Ab60, and in the case of DM2, it was confirmed that the binding evasion rates were excellent for Ab3-01, Ab60, and Ab67 (FIG. 33). In the case of relative activity, it showed similar activity to MDTCS-IgG1-YTE at 98.6-127.7% (Figure 33). In order to check the evasion ability of 5 types of mutant substances compared to the control group MDTCS-IgG1-YTE under the condition of mixing 9 types of neutralizing antibodies in equal proportions, mixed neutralizing antibodies (9 types) and each variant expression culture were mixed, and then 1 ml at room temperature. Residual activity was measured by reacting over time. In the case of MDTCS-IgG1-YTE, the residual activity was maintained at 5.5%, and in the case of the five substances, the residual activity was maintained at 8.18 - 13.42%, confirming that the evasion by neutralizing antibodies was superior to the control group (Figure 34).

Proteins were purified from the expression culture medium in which IgG1-YTE was conjugated to the above five MDTCS variant fragments using the Phytip system (protein A resin), and the residual activity and specific titer of mixed neutralizing antibodies were measured in the purification liquid. The concentration of the purified solution was confirmed through Fc ELISA, and it was confirmed that the target protein was eluted through silver staining. As a result of measuring the residual activity under mixed neutralizing antibody conditions, it was confirmed that MDTCS-IgG1-YTE was maintained at 0.4%, and 1C03, 2B02, 5C09, 7A02, and DM2 were 5.7%, 1.7%, 8.8%, 2.6%, and 7.9%, respectively. It was confirmed that the residual activity was maintained and that the mixed antibody evasion ability was superior to MDTCS-IgG1-YTE. As a result of specific titer measurement, it was confirmed that the four variants, excluding 7A02 (10,288 IU/mg), showed specific titers of 19,091-22,379 IU/mg, similar to the control group (18,030 IU/mg) (FIG. 35). As a result, it was confirmed that the IgG1-YTE conjugate material of the 5 variant fragments had excellent evasion ability against mixed neutralizing antibodies compared to the control group, and that the 4 variants excluding 7A02 had a specific titer similar to that of the control group.

Evaluating whether the half-life of MDTCS fragment variants is increased by Fc attachment

Pharmacokinetic analysis was performed in mice to confirm whether Fc (IgG1-YTE) attached to MDTCS would actually increase the half-life. For this purpose, MDTCS or MDTCS with IgG1-YTE attached and the four final candidate (1C03, 5C09, 7A02, DM2) mutant fragment proteins were administered to mice through the tail vein, and plasma was obtained over time. Based on the specific titer of each substance, it was administered to reach 160 IU/kg, and the activity of substances remaining in the plasma obtained at each time was measured through an activity assay. The obtained results were summarized using the naive pooled method, and pharmacokinetic analysis was performed using noncompartmental analysis. The half-life of MDTCS was measured at 2.898 hours, MDTCS-IgG1-YTE at 11.51 hours, and for each variant between 5.184 and 9.902 hours. The half-life was extended by 1.79 to 3.97 times by IgG1-YTE conjugation compared to the control MDTCS. In addition, the MRT (Mean Residence Time) value, which represents the average residence time of the material in the body, also showed an increased residence time of 7.189 - 11.67 hours compared to 3.743 hours due to IgG1-YTE conjugation (Table 9, Figure 32). As a result, it was confirmed that the IgG1-YTE fusion was effective in maintaining activity through blood half-life and average duration in vivo.

Pharmacokinetic results candidate substance PK analysis parameters t _1/2 ,terminal (hr) AUC _Inf (IU*hr/mL) MRT (hrs) MDTCS 2.898 5.467 3.743 MDTCS-IgG1-YTE 11.51 16.89 11.67 1C03-IgG1-YTE 6.087 12.33 8.695 5C09-IgG1-YTE 5.184 12.06 7.982 7A02-IgG1-YTE 9.902 14.49 10.35 DM2-IgG1-YTE 5.986 11.39 7.189

As discussed above, the present inventors discovered 26 new variants that evade ADAMTS13 neutralizing antibodies that bind to the MDTCS portion or S domain or exhibit activity higher than that of wild-type ADAMTS13. Among these, 12 types with the best evasion or significantly superior comparative activity against 9 types of neutralizing antibodies were selected to produce MDTCS fragments essential for vWF cleavage while efficiently evading neutralizing antibodies that bind to the C-terminus, thereby producing D, A variant with a significantly improved evasion rate of autoantibodies binding to the C or S domain was identified. The variant of the present invention can be usefully used as an effective pharmacological ingredient with improved stability and persistence of physiological activity by increasing the blood half-life through IgG1-YTE conjugation.

Results of variant PoC confirmation in aTTP mimic disease mouse model

To select the final candidate in the established aTTP-mimic mouse model, a control substance (MDTCS-IgG1-YTE) or five selected variant candidates (1C03-IgG1-YTE, 2B02-IgG1-YTE, 5C09-IgG1-YTE, After administration (7A02-IgG1-YTE, DM2-IgG1-YTE), the neutralizing antibody evasion rate was evaluated (Figure 36a). Among the five variants, DM2-IgG1-YTE showed the highest human ADAMTS13 residual activity at all doses of 5,000 or 7,000 IU/kg (Figure 36b). The DM2-IgG1-YTE material that showed the best neutralizing antibody evasion rate was finally selected and administered at different concentrations to confirm the ability to maintain human ADAMTS13 residual activity and the degree of relief of clinical symptoms (Figure 37a). As the DM2 dose increased, clinical symptoms decreased. It was confirmed that the degree of relief increased, and in the 7000 IU/kg administration group, a relatively high improvement in platelet and LDH levels was observed by administration of DM2-IgG1-YTE compared to MDTCS-IgG1-YTE (Figure 37b) ). Consistent with the improvement in platelet and LDH levels, the results of the human ADAMTS13 activity test showed an increase in residual activity proportional to the administered dose of the control or candidate substance (FIG. 37b). As a result of observing clinical symptoms, it was confirmed that death and hematuria in the aTTP-mimic mouse model tended to be alleviated by administration of the control or candidate substances. In particular, in the DM2-IgG1-YTE treatment group, there were no deaths at all doses, and no subjects showing hematuria were observed when administered at more than 7000 IU/kg (FIG. 37c). When 7000 IU/kg was administered, the average residual activity was 0.32 IU/mL for DM2-IgG1-YTE, which was 9.6 times higher than 0.03 IU/mL for MDTCS-IgG1-YTE, and the difference in the results observed in the preceding clinical symptoms was due to this difference in residual activity. It was judged that it was done. As a result of general blood tests, clinical chemistry tests, and observation of clinical symptoms, administration of MDTCS-IgG1-YTE and DM2-IgG1-YTE showed a tendency to improve aTTP clinical symptoms in the aTTP-mimic mouse model, which led to in vivo PoC was able to confirm. In particular, when administered at 7000 IU/kg, it was confirmed that DM2-IgG1-YTE had a superior improvement effect compared to MDTCS-IgG1-YTE.

Results of variant PoC confirmation in cTTP disease mouse model

Using DM2-IgG1-YTE, which showed the best efficacy among the five variant candidates in the aTTP mimic mouse model, the improvement of hematological and clinical symptoms seen in TTP disease and the degree of recovery of human ADAMTS13 activity were confirmed in the cTTP mouse model ( Figure 38a). It was confirmed that improvement in platelet and LDH levels occurred in a concentration-dependent manner as the administered dose of DM2-IgG1-YTE increased, and a significant increase in platelets was observed in the DM2-IgG1-YTE 180 and 360 IU/kg administration groups compared to the control group. In particular, in the 360 IU/kg administered group, recovery to normal levels was seen (Figure 38b). In the case of LDH levels, it was confirmed that LDH was recovered to a level similar to that of the control group in the 180 IU/kg administered group (FIG. 38b). In the case of ADAMTS13 activity, an average of 0.1 IU/mL or more was observed in the DM2-IgG1-YTE 60 IU/kg administered group, and an average of 1.08 IU/mL was measured at the 360 IU/kg administered dose (FIG. 38b). Therefore, it was found that the DM2-IgG1-YTE variant effectively improved clinical symptoms and restored the activity of ADAMTS13 in mice with cTTP disease.

Example 4: Search for optimal doses of ADAMTS13 protein variants

Experiment method

Confirmation of therapeutic efficacy and maintenance of GC1126A in aTTP mimic mouse model

The aTTP mimic mouse model is a mixture of 9 types of hADAMTS13 neutralizing antibodies (h3-01, h4-16, h4-20, mAb60, mAb61, mAb64, mAb65, mAb66, mAb67) in ADAMTS13 knock-out mice (ADAMTS13 KO mice) at 0.23 mg/min. kg was administered into the caudal vein, and 15 minutes later, 2,000 IU/kg of rh-vWF was administered to induce thrombosis. To confirm the therapeutic efficacy and degree of maintenance of the recombinant ADAMTS13 variant (GC1126A) of the present invention, 15 minutes after rh-vWF treatment, 0.08 mg/kg of GC1126A or formulation buffer (vehicle) was administered into the caudal vein. 700 μL of blood was collected from the heart at 6 or 24 hours. Of the collected blood, 300 mL was stored at 4°C after roller mixing in an EDTA-2K tube (BD Medical, REF365974) to be used as whole blood, and 400 μL was stored in an SST (serum separate tube) tube (BD Medical, REF365967). After standing at room temperature for 30 minutes, serum was separated by centrifugation (3,000 g, 15 min, 4°C). Whole blood was subjected to general blood tests such as platelets (PLT) using a blood cell analyzer (ADVIA 2120i, Siemens), and serum was tested for lactate dehydrogenase (LDH) using a blood biochemical analyzer (Hitachi, 7180). Measured. The graph represents the mean and standard deviation, and 6 mice were used in each group. In the vehicle group, 1 out of 6 animals died 6 or 24 hours after neutralizing antibody administration, and in the WT group, 1 animal out of 6 died. In the case of the GC1126A administration group and the vehicle group, one coagulation occurred in each sample obtained 24 hours after neutralizing antibody administration, and analysis was performed for each test group consisting of 4-6 pieces of data. The results at 6 hours and 24 hours for the WT group and vehicle group were reflected in the graph by summing the number of results performed independently 2 to 3 times.

Confirmation of the therapeutically effective dose range of GC1126A in aTTP mimic mouse model

To confirm the effective dose range according to therapeutic administration of GC1126A, the aTTP mimic mouse model constructed above was used. 15 minutes after administration of 2,000 IU/kg rh-vWF, various doses of GC1126A or formulation buffer (vehicle) were administered into the caudal vein. For analysis, more than 600 μL of blood was collected from the anesthetized mouse heart 6 or 24 hours after the end of administration of 0.23 mg/kg hADMATS13 neutralizing antibody, 200 μL was placed in an EDTA-2K tube, and 400 μL was placed in a lithium hairpin tube (BD Medial , REF365985) or aliquoted into SST tubes. Samples contained in lithium hairpin tubes or SST tubes were centrifuged (2,000 g, 20 min, 4°C) to separate plasma or serum, respectively, and only the supernatant was separated and transferred to a 1.5 mL tube, which was used for LDH analysis. Samples contained in EDTA-2K tubes were used to measure platelet counts through CBC testing. LDH analysis was performed by diluting plasma or serum by 1/10, and it was confirmed that there was no difference in analysis values between plasma and serum samples (data not shown). After GC1126A administration, ADAMTS13 residual activity was analyzed in collected plasma using a Technozym ADAMTS-13 activity ELISA kit (Technoclone, cat no. 5450701), and the relative residual activity (%) was calculated by converting the value measured in WT mice to 100%. Calculated.

* Relative residual activity (%) = (ADAMTS13 activity value of each sample / ADAMTS13 activity value of WT mouse sample)

In the ADAMTS13 residual activity graph, LLOQ (the lower limit of quantification, 0.31 IU/mL) is indicated by a dotted line (FIG. 40c). In the dose-response curve, the relationship between the GC1126A administered dose and the PLT level or ADAMTS13 residual activity was confirmed by a non-linear regression trend line (FIG. 40c). Graphs represent means and standard deviations, and analyzes were performed on 5-12 individuals per group. The test, in which blood was collected and analyzed 6 hours after drug administration, was a synthesis of the results of two independently performed tests.

Pharmacokinetic evaluation of GC1126A in ADAMTS13 knock-out mice

Pharmacokinetics were evaluated using ADAMTS13 knock-out mice in the 0.025-0.200 mg/kg dose range, which includes the therapeutically effective dose of GC1126A. After administering a single dose of GC1126A to the caudal vein, the orbital venous plexus was measured 0.0833, 0.5, 1, 4, 8, 24 hours, 2, 3, 5, and 7 days (total of 10 points) based on the end of administration for analysis of GC1126A in biological samples. More than 300 μL of blood was collected from the sample and sampled into an e-tube containing sodium citrate. The sample contained in the e-tube was centrifuged (3,000 rpm, 15 min, 4°C) to separate plasma, and only the supernatant plasma was separated into e-tubes and used for GC1126A PK analysis. The collected plasma was analyzed using Human ADAMTS13 Duoset ELISA and Technozyme ADAMTS13 activity ELISA kits, respectively, to analyze GC1126A ADAMTS13 antigen and ADAMTS13 residual activity. To calculate the PK profile and parameters of the ELISA analysis values, NCA (Non-compartmental analysis) was performed using Phoenix ^TM WinNonlin software.

normal monkey Pharmacokinetic evaluation of GC1126A in

Pharmacokinetics were evaluated using normal monkeys in the 0.038-0.30 mg/kg dose range, which includes the therapeutically effective dose of GC1126A. After a single intravenous administration of GC1126A, 0.0833, 0.5, 1, 4, 8, 24 hours, 2, 3, 5, 7, 10, 13 days (total 12 points) from the end of administration for analysis of GC1126A in biological samples. Later, more than 1.5 mL of blood was collected from the femoral vein and sampled into an e-tube containing sodium citrate. The sample contained in the e-tube was centrifuged (3,000 rpm, 15 min, 4°C) to separate plasma, and only the supernatant was separated and distributed to the e-tube, which was used for GC1126A PK analysis. The collected plasma was analyzed using Human ADAMTS13 Duoset ELISA and Technozyme ADAMTS13 activity ELISA kits, respectively, to analyze GC1126A ADAMTS13 antigen and ADAMTS13 residual activity. To calculate the PK profile and parameters of the ELISA analysis values, NCA (Non-compartmental analysis) was performed using Phoenix ^TM WinNonlin software.

Human PK modeling and simulation using ADAMTS13 knock-out mice and normal monkeys

Based on the PK results of the therapeutically effective dose in ADAMTS13 knock-out mice and the PK results of normal monkeys, human PK modeling and expected clinically effective dose were estimated. We constructed a 3-compartment IV model and first-order elimination that best represent the monkey PK test results, and modeled human PK through the single-species allometry scaling method from the established monkey PK model. The clinical dose was predicted. As a target for predicting clinically effective dose, PK parameters (Cmax, AUC, Ctrough) at the therapeutically effective dose (0.10 mg/kg) of ADAMTS13 knock-out mice are shown in Table 10. Table 11 below. Bold numbers indicate each expected clinically effective dose and interval that satisfies the therapeutically effective dose of ADAMTS13 knock-out mice. The optimal dose in humans for actual application was simulated (Table 12). The purpose of the simulation is to determine the dose and administration that satisfies the target value (Ctrough standard 30.92 ng/mL or more). The standard is Ctrough among PK parameters and the dosage (administration interval) is QW (once a week administration interval) or Q3D ( When repeating administration with the goal of dosing interval once every 3 days, the minimum administered dose was confirmed for each to satisfy the target.

Dosage (mg/kg) AUC _inf (ng*h/mL) C _max (ng/mL) C _trough (ng/mL) 0.10 9269.47 1275.60 30.92

Volume
(mg) At steady state (28 days) QD Q3D QW AUC _τ,ss
(ng*h/mL) C _{max, ss}
(ng/mL) C _trough
(ng/mL) AUC _τss (ng*h/mL) C _{max, ss}
(ng/mL) C _trough
(ng/mL) AUC _τ,ss
(ng*h/mL) C _{max, ss}
(ng/mL) C _trough
(ng/mL) 0.7 2496.09 227.95 64.36 2496.02 174.42 10.69 2496.08 165.67 1.93 1.4 4992.19 455.9 128.72 4992.02 348.85 21.38 4992.18 331.35 3.86 2.1 7488.27 683.85 193.09 7488.02 523.27 32.08 7488.24 497.02 5.78 2.8 9984.35 911.8 257.45 9984.08 697.69 42.77 9984.37 662.69 7.71 3.5 12480.41 1139.7 321.81 12480.05 872.11 53.46 12480.47 828.37 9.64 4.2 14976.55 1367.7 386.17 14976.06 1046.5 64.15 14976.58 994.04 11.57 4.9 17472.54 1595.6 450.53 17472.07 1221 74.84 17472.67 1159.7 13.49 5.6 19968.71 1823.6 514.9 19968.1 1395.4 85.53 19968.72 1325.4 15.42 6.3 22464.71 2051.5 579.26 22464.09 1569.8 96.22 22464.81 1491.1 17.35 7 24960.88 2279.5 643.62 24960.17 1744.2 106.92 24960.84 1656.7 19.28 14 49921.86 4559 1287.2 49920.15 3488.5 213.83 49921.76 3313.5 38.55 21 74882.7 6838.5 September 1930 74880.24 5232.7 320.75 74882.44 4970.2 57.83

Dosing interval Predicted human dose (mg) Target 1(AUC _inf ) Target 2(C _max ) Target 3(C _trough ) QD ≥ 2.8
(≥0.04 mg/kg) ≥4.2 (≥0.06 mg/kg) ≥0.7 (≥0.01 mg/kg) at all simulated doses Q3D ≥5.6 (≥0.08 mg/kg) ≥2.1 (≥0.03 mg/kg) QW ≥5.6 (≥0.08 mg/kg) ≥14 (≥0.2 mg/kg)

GC1126A and competitor in aTTP mimic mice (Cablivi ^® ) Comparison of treatment effects

To compare and evaluate the in vivo therapeutic effects of GC1126A and a competing substance (Cablivi ^® ), aTTP mimic mice were prepared as described in the GC1126A therapeutic efficacy test process. However, to induce blood clots, rh-vWF was administered at 500 IU/kg. It was administered through the caudal vein. 15 minutes after rh-vWF administration, GC1126A 0.1 mg/kg, Cablivi ^® 0.1, 2 mg/kg, and formulation buffer were administered through the caudal vein, respectively. Platelet (PLT) levels were measured using CBC analysis using orbital blood samples at 6, 24, and 48 hours. The graph represents the mean and standard deviation, and 4 mice were used in each group, and no deaths occurred in any test group. The WT group results were reflected in the graph by summing the number of subjects performed independently twice.

Comparison of therapeutic efficacy of GC1126A and rh WT ADAMTS13 in aTTP mimic mouse model

To compare and evaluate the in vivo therapeutic efficacy of GC1126A and rh WT-ADAMTS13, aTTP mimic mice were prepared as described in the GC1126A therapeutic efficacy test procedure. 15 minutes after rh-vWF administration through the caudal vein, GC1126A 0.08 mg/kg, rh WT-ADAMTS13 0.07 (same molar concentration as GC1126A), 2.15 mg/kg, and formulation buffer were each administered into the caudal vein, and platelets were collected through cardiac blood sampling at 6 hours. and LDH were measured. The graph represents the mean and standard deviation, and 6 mice were used in each group. In the vehicle and rh WT-ADAMTS13 0.07 mg/kg administration groups, 1 out of 6 animals died 6 hours after neutralizing antibody administration. On the other hand, no deaths occurred in the GC1126A 0.08 mg/kg administration group and the rh WT-ADAMTS13 2.15 mg/kg administration group, and the analysis was ultimately performed on 5 to 6 animals in each test group. The results at 6 hours for the WT and vehicle groups were reflected in the graph by summing the numbers of results performed independently 2 to 3 times.

Time-dependent expression of GC1126A and competitors (rh WT ADAMTS13 and Cablivi) in aTTP mimic mouse model ^® ) Comparison of PLT reduction prevention and recovery abilities

To compare and evaluate the ability of GC1126A, rh WT-ADAMTS13, and Cablivi ^® to prevent PLT decline over time after treatment, aTTP mimic mice were prepared in the same manner as the GC1126A therapeutic efficacy test procedure. 15 minutes after caudal vein administration of 2,000 IU/kg rh-vWF to ADAMTS13 knock-out mice, equivalent doses of substances based on mg/kg were administered: GC1126A 0.1 mg/kg, rh WT-ADAMTS13 0.1 mg/kg, and Cablivi ^® 0.1 mg/kg. rh WT-ADAMTS13 0.5 mg/kg, Cablivi ^® 2 mg/kg, and formulation buffer, which are the effective concentrations of the comparative substances, were administered through the caudal vein, respectively, and PLT was obtained through orbital blood collection at 1, 6, 24, 48, and 72 hours. The values were measured. In addition, plasma collected from the rh WT-ADAMTS13 and GC1126A administration groups was used to measure the residual activity of ADAMTS13 in plasma according to the instructions using the Technozyme ADAMTS13 activity ELISA kit. The graph represents the mean and standard deviation, and 4 mice were used in each group.

To compare and evaluate the PLT recovery ability over time after treatment of GC1126A, rh WT-ADAMTS13, and Cablivi ^® , platelet count was reduced 7.75 hours after the first administration of 2,000 IU/kg rh-vWF into the caudal vein to ADAMTS13 knockout mice (vehicle group). Neutralizing antibodies were administered at a standard level of approximately 150 G/L), and 15 minutes later, each of the three drugs was administered. Considering the results of previous experiments showing that the effect of maintaining the reduced PLT level by administering 2,000 IU/kg of rh-vWF in the blood was as short as 48 hours and that the magnitude of individual variation increased after 48 hours, 32 hours after the first rh-vWF administration, rh -vWF 500 IU/kg was administered secondarily. The concentration of the drug was the same as the above preventive ability evaluation experiment, and blood was obtained through orbital blood collection at 9, 24, 48, and 72 hours, and PLT levels were measured through CBC analysis. The residual activity of ADAMTS13 in plasma was measured in the plasma collected from the rh WT-ADAMTS13 and GC1126A administration groups using the same method as the above preventive ability evaluation experiment. The graph represents the mean and standard deviation, and 4 mice were used in each group.

Confirmation of autoantibody evasion ability of GC1126A and rh WT-ADAMTS13 in aTTP patient plasma

To compare and evaluate the ability of GC1126A, MDTCS-Fc, and rh WT-ADAMTS13 to evade autoantibodies present in the plasma of aTTP patients, 6 cases of plasma from Korean aTTP patients were obtained and the residual activity of ADAMTS13 was measured. Antibody activity in patient plasma was analyzed by measuring BU (Bethesda units) (B Plaimauer et al., 2011), and was diluted with HIP (Heat Inactivated Plasma) to final concentrations of 0, 0.5, 1, 2, and 3 BU/mL. Plasma was prepared. Each drug of GC1126A, MDTCS-Fc, and rh WT-ADAMTS13 was diluted with HIP and prepared at concentrations of 3, 15, and 75 nM, mixed 1:1 with patient plasma, and reacted at 37°C for 1 hour (each substance Final concentrations are 1.5, 7.2, and 37.5 nM). Afterwards, the residual activity of the sample was measured using the Technozyme ADAMTS13 activity ELISA kit according to the manual in the kit. ADAMTS13 relative residual activity is calculated as a ratio of the residual activity result (IU/mL) of each sample compared to HIP (control) and expressed as a percentage. The test was repeated twice and the average value was reflected in the graph.

* Relative residual activity (%) = (ADAMTS13 activity value of mixture with each patient's plasma / ADAMTS13 activity value of mixture with HIP)

Statistical analysis

Statistical analysis of the in vivo comparative evaluation test was performed with Prism 9 software (GraphPad Software, Inc., La Jolla, CA), and independent t- test (Figure 39) or one-way analysis of variance (bonferroni) was used to confirm statistical significance between test groups. It was analyzed by post hoc test, Figures 40 and 41). P values are expressed as * p < 0.05, ** p < 0.01, *** p < 0.001, and **** p < 0.0001, respectively.

Experiment result

Therapeutic effect and maintenance level of GC1126A in aTTP mimic mouse model

To confirm the therapeutic effect of GC1126A using the aTTP mimic mouse model, the levels of biomarkers PLT and LDH were measured at the final 6 or 24 hours after GC1126A administration (Figure 39a). The PLT values of the vehicle group at 6 or 24 hours were measured at 279.80 ± 179.80 G/L (10 ⁹ /L) and 95.00 ± 53.34 G/L, respectively, and the WT group was measured at 998.50 ± 133.60 G/L. A decrease of more than 80% in PLT values in the vehicle group was observed compared to the PLT values in the WT group, confirming that thrombosis was induced (FIG. 39b). The PLT level of the GC1126A administration group was measured at 610.70 ± 142.50 G/L after 6 hours and 442.20 ± 143.90 G/L after 24 hours, and the PLT levels at each blood collection time were 2.18 and 4.65 times higher than those of the vehicle group, respectively. It was confirmed that PLT values were recovered statistically significantly in the GC1126A administered group compared to the vehicle group at all blood collection points (FIG. 39b). As a result of measuring LDH levels, the vehicle group showed 12,064 ± 2,959 U/L and 11,858 ± 3,489 U/L at 6 or 24 hours, respectively, and the WT group showed 1,145 ± 207.5 U/L. It was found that LDH levels increased by more than 10 times in the vehicle group compared to the WT group, and the pathophysiology seen in aTTP patients was induced (FIG. 39c). In the GC1126A administration group, LDH levels were measured at 4,282 ± 601.3 U/L after 6 hours and 371.4 ± 101.4 U/L after 24 hours, and decreased by 64.5% and 96.9%, respectively, compared to the vehicle group levels at each blood collection time. As the time after administration increased, the LDH level of the GC1126A administration group completely recovered to the WT level (1,145 ± 207.5 U/L) and showed statistical significance compared to the vehicle group at all blood collection time points (FIG. 39c). The decrease in PLT levels and increase in LDH levels seen in the aTTP mimic mouse model were statistically significantly recovered by administration of GC1126A, and this effect was confirmed to be maintained until 24 hours.

Confirmation of the therapeutic effective dose range of GC1126A in aTTP mimic mouse model

To confirm the therapeutically effective dose range of GC1126A using the aTTP mimic mouse model, the number of PLTs, LDH levels, and ADAMTS13 residual activity were analyzed at 6 or 24 hours after administration of various doses of GC1126A (FIG. 40a). Analysis results 6 hours after drug administration showed a dose-related recovery in the number of PLTs as the GC1126A administered dose increased (FIG. 40b). This recovery in the number of PLTs was statistically significant from 0.110 mg/kg (680.90±149.61 cells/μL) compared to the vehicle-administered group (192.00±111.14 cells/μL), and from the same dose, the WT group (1006.5±132.08 cells/μL) It was confirmed that the saturation level was approximately 70%. In the case of LDH levels, a dose-related recovery was confirmed as the GC1126A administration dose increased, and statistically significant results were observed from 0.110 mg/kg (3146.50 ± 537.79 U/L) compared to the vehicle administration group (4263.89 ± 876.23 U/L). I could see it. The recovery of LDH levels was saturated to about twice that of the WT group (1217.00±213.08 U/L) in the 0.146 mg/kg (2683.90±852.15 U/L) administration group. Through these analysis results, it was confirmed that the maximum effective dose of GC1126A, which saturates the recovery of both PLT count and LDH level, is 0.146 mg/kg. In the analysis results 24 hours after drug administration, the recovery of PLT numbers showed a dose correlation as the dose increased (Figure 40c). The recovery of PLT count was statistically significant in the 0.100 mg/kg administration group (558.8±276.5 cells/μL) compared to the vehicle group (88.7±41.9 cells/μL), and the 0.200 mg/kg administration group (742.0±213.8 cells/μL). showed similar values to the WT group (839.8±295.6 cells/μL). The recovery of LDH levels following GC1126A administration showed a statistically significant decrease from the 0.050 mg/kg administration group (3943.0±2592.0 U/L) compared to the vehicle administration group (9205.0±3619.0 U/L), showing a dose-related recovery. As a result of ADAMTS13 residual activity analysis, a dose-related increase in ADAMTS13 residual activity was confirmed. The increase in ADAMTS13 residual activity following GC1126A administration was statistically significant starting from the 0.050 mg/kg administered group (30.5±12.4%) compared to the vehicle administered group (7.7±7.9%), but this value was lower than LLOQ (the lower limit of quantification, 0.31). Since the value was less than IU/mL, it was difficult to view it as a reliable result. When the increase in ADAMTS13 residual activity following GC1126A administration was greater than the intrinsic ADAMTS13 activity level (100%) of mice in the WT group (0.200 mg/kg administration group, 521.2±188.2%), recovery of PLT levels was confirmed to be similar to that of the WT group. did. Overall, it was confirmed that the recovery of PLT count, LDH level, and ADAMTS13 residual activity following therapeutic administration of GC1126A in the aTTP mimic mouse model showed a dose correlation. In addition, it was confirmed that the minimum effective dose of GC1126A, which showed statistically significant recovery of PLT count and LDH level compared to the vehicle-administered group, was 0.100 mg/kg. When comprehensively considering the analysis results 6 or 24 hours after GC1126A administration, it was confirmed that the therapeutic effective dose range of GC1126A in the aTTP mimic mouse model was 0.100-0.146 mg/kg.

Pharmacokinetic evaluation of GC1126A in ADAMTS13 knock-out mice and normal monkeys

To evaluate the pharmacokinetics in the 0.025-0.20 mg/kg dose range, which includes the therapeutically effective dose of GC1126A, using ADAMTS13 knock-out mice, 0.0833, 0.5, 1, 4, 8, 24 hours, 2, ADAMTS13 antigen and ADAMTS13 residual activity were analyzed on days 3, 5, and 7 (total of 10 points) (Figure 41a). After intravenous administration of GC1126A, the in vivo recovery rate (IVR) calculated from the maximum blood drug concentration (C _max ) was confirmed to be 53.4-66.5% and the half-life (T _1/2 ) was confirmed to be 7.1 - 23.5 hr. A linear pharmacokinetic profile was confirmed in which the maximum blood drug concentration (C _max ) and systemic exposure (AUC) increased in proportion to the administered dose, but the clearance rate (CL) remained constant (Figure 41a, Table 13).

Volume
(mg/kg) C _max
(ng/mL) AUC _last
(hr·ng/mL) Dose-corrected AUC _last
(hr·kg·ng/mL/mg) T _1/2
(hr) CL (mL/hr/kg) IVR
(%) 0.025 314.12
±36.69 2156.01
±61.62 56737.07 ±
1621.69 15.25
±3.63 18.07
±0.55 62.8 0.10 1275.60
±199.39 9219.07
±933.76 61460.49 ±
6225.09 19.86
±3.25 16.31
±1.54 63.8 0.20 2660.00
±348.90 18625.60
±1532.28 62085.34 ±
5107.61 23.49
±3.44 16.14
±1.33 66.5 Volume
(mg/kg) C _max
(IU/mL) AUC _last
(hr·IU/mL) Dose-corrected AUC _last
(hr·kg·IU/mL/mg) T _1/2 (hr) CL
(mg/(hr*IU/mL)/kg) IVR
(%) 0.025 12.20
±0.92 74.19
±6.27 1952.47 ±
165.10 7.06
±1.45 4.68e ^-4
±5.52e ^-5 61.0
0.10 42.68
±3.94 281.24
±7.98 1874.91
±53.21 7.88
±1.31 4.76e ^-4
±2.80e ^-5 53.4
0.20 104.87
±19.88 625.01
±43.39 2083.38
±144.63 10.33
±1.15 4.61e ^-4
±3.83e ^-5 65.5

To evaluate the pharmacokinetics in normal monkeys in the 0.038-0.30 mg/kg dose range, which includes the therapeutically effective dose of GC1126A, 0.0833, 0.5, 1, 4, 8, 24 hours, 2, 3, 5 after GC1126A administration. , ADAMTS13 antigen and ADAMTS13 residual activity were analyzed on days 7, 10, and 13 (total 12 points) (Figure 41b). After intravenous administration of GC1126A, the in vivo recovery rate (IVR) calculated from the maximum blood drug concentration (C _max ) was confirmed to be 73.8-82.6% and the half-life (T _1/2 ) was confirmed to be 20.1 to 37.8 hours. Monkeys, which are highly homologous to humans, showed increased recovery rate and half-life in the body compared to rodents. As proportional body exposure (C _max , AUC) and constant drug elimination rate (CL) were confirmed as the dose increased, a linear pharmacokinetic profile was confirmed (Figure 41b, Table 14).

Volume
(mg/kg) C _max
(ng/mL) AUC _last
(hr·ng/mL) Dose-corrected AUC _last
(hr·kg·ng/mL/mg) T _1/2
(hr) CL (mL/hr/kg) IVR
(%) 0.038 622.50
±141.97 6288.80
±2038.40 165494.65
±53642.21 37.35
±5.31 6.53
±2.45 73.8 0.15 2520.00
±710.21 23426.44
±1640.57 156176.23
±10937.12 35.45
±3.00 6.42
±0.47 75.6 0.30 4986.67
±1357.66 44200.65
±6351.94 147335.50
±21173.14 37.78
±6.24 6.88
±1.05 74.8 Dose
(mg/kg) C _max
(IU/mL) AUC _last
(hr·IU/mL) Dose-corrected AUClast
(hr*kg*IU/mL/mg) T _1/2
(hr) CL
(mg/(hr*IU/mL)/kg) IVR
(%) 0.038 28.17
±1.19 309.24
±73.50 8137.90
±1934.23 20.09 ±8.16 1.19e ^-4
±3.52e ^-5 82.6 0.15 99.81
±20.47 1192.91
±117.73 7952.71
±784.84 32.79 ±2.36 1.21e ^-4
±1.36e ^-5 74.1 0.30 207.77
±7.36 2209.78
±124.86 7365.94
±416.22 30.04
±5.33 1.33e ^-4
±7.00e ^-6 77.2

Human PK modeling and simulation using ADAMTS13 knock-out mice and normal monkeys

Various doses and administrations were simulated using human PK modeling. The expected clinically effective dose standard was set as an efficacious target at a therapeutically effective dose (0.10 mg/kg) in ADAMTS13 knock-out mice, with C _trough satisfying PK exposure (AUC, C _max ) and residual activity of 1 IU/mL. (Table 10). As a result of human PK modeling simulation test, the clinically effective dose regimen that meets the target of each PK parameter (AUC, C _max , C _trough ) is at least 0.03 mg/kg based on twice-weekly administration and at least 0.2 mg based on once-weekly administration. It was predicted to be more than /kg (Figure 42, Table 12).

Comparison of therapeutic effects of competitor substance (Cablivi ^® ) and GC1126A in aTTP mimic mouse model

To confirm the therapeutic efficacy of GC1126A compared to the competitor (Cablivi ^® ) using the aTTP mimic mouse model, PLT levels were measured at the final 6 hours after administration of each drug (Figure 43a). Since the effect of Cablivi ^® could not be seen in the aTTP mimic mouse model in which thrombosis was induced by administering 2,000 IU/kg of rh-VWF (data not shown), rh-VWF was administered as low as 500 IU/kg to compare the effect with GC1126A. An experiment was conducted.

In the PLT measurement results at 6 hours after administration, statistically significant recovery of PLT values was confirmed in the Cablivi ^® group only in the 2 mg/kg (990.30 ± 41.41 G/L) administered group compared to the vehicle group (FIG. 43b). In the case of the GC1126A 0.1 mg/kg administered group (1,284.00±153.50 G/L), a statistically significant recovery of PLT levels was observed compared to the vehicle group, and at this time, the PLT levels were similar to those of WT mice. At 24 hours after administration, a statistically significant difference in PLT levels was confirmed in the Cablivi ^® 2 mg/kg group (465.50 ± 140.50 G/L) and the GC1126A 0.1 mg/kg group (1,122.00 ± 83.60 G/L) compared to the vehicle group. . However, the PLT level of the Cablivi ^® 2 mg/kg group decreased rapidly by 53.0% compared to the value at 6 hours, while the GC1126A 0.1 mg/kg group decreased by only 12.6%, still maintaining a similar level to that of WT mice. This tendency was further intensified in the results at 48 hours after administration, and in the case of the Cablivi ^® 2 mg/kg group (378.00 ± 242.90 G/L), statistical significance in PLT recovery compared to the vehicle was not confirmed. On the other hand, the PLT level of the GC1126A 0.1 mg/kg administered group (1,119 ± 67.12 G/L) was measured to be similar to the PLT level (1,284.00 ± 153.50 G/L) at 6 hours, and it was confirmed that significant recovery of PLT level was maintained compared to the vehicle. . As a result, it was confirmed that the therapeutically effective dose showing statistically significant recovery of PLT levels was 2 mg/kg for Cablivi ^® and 0.1 mg/kg for GC1126A, and based on the mg/kg administered dose, GC1126A was approximately 20 times more effective than Cablivi ^® . It was found that similar levels of efficacy were observed at low doses. In addition, the therapeutic effect of Cablivi ^® decreases rapidly 24 hours after administration, while the therapeutic effect of GC1126A is maintained for up to 48 hours, confirming that GC1126A is superior in terms of maintaining effect.

Comparison of therapeutic effects of GC1126A and rh WT ADAMTS-13 in aTTP mimic mouse model

To confirm the therapeutic effect of GC1126A compared to rh WT-ADAMTS13 using the aTTP mimic mouse model, PLT levels were measured at the final 6 hours after administration of each drug (FIG. 44a). When the same amount of drug was administered for comparative evaluation and converted to molarity, the effective therapeutic concentration of GC1126A, 0.08 mg/kg, was 0.07 mg/kg for rh WT-ADAMTS13. As a result of checking the PLT level, the GC1126A 0.08 mg/kg administration group showed significant PLT level recovery (610.70±142.50 G/L) compared to the vehicle. On the other hand, the group administered rh WT-ADAMTS13 0.07 mg/kg showed PLT levels at the vehicle level and no recovery of PLT levels was observed, while the group administered 2.15 mg/kg WT ADAMTS13 recovered PLT levels to a level similar to that of GC1126A 0.08 mg/kg (479.3 ± 120.3 G/L) (Figure 44b).

Time-dependent expression of GC1126A and competitors (rh WT ADAMTS13 and Cablivi) in aTTP mimic mouse model ^® ) Comparison of PLT reduction prevention and recovery abilities

To compare and evaluate the ability to prevent PLT decline over time after administration of GC1126A, rh WT-ADAMTS13, and Cablivi ^®, three types of drugs were administered each 30 minutes after administration of neutralizing antibody and rh-vWF, and changes in PLT values over time were measured. Comparison was made (Figure 45a). From 6 hours to 48 hours after administration of the substance, both the rh WT ADAMTS13 0.1 mg/kg group and the two doses (0.1 and 2 mg/kg) of Cablivi ^® administered groups showed a PLT reduction similar to that of the vehicle group (FIG. 45b). However, in the GC1126A 0.1 mg/kg group and the rh WT-ADAMTS13 0.5 mg/kg group, it was confirmed that PLT levels were maintained without a decrease from 6 to 48 hours after administration. In addition, as a result of measuring the residual activity of ADAMTS13 in the blood, the GC1126A 0.1 mg/kg administration group showed a high residual activity of 15.95 IU/mL on average 1 hour after administration, and the activity gradually decreased over time, but remained at the measurement limit of 0.03 IU/mL even at 72 hours. It showed residual activity of more than mL (Figure 45c). The group administered rh WT-ADAMTS13 0.5 mg/kg showed a low residual activity of 3.71 IU/mL on average after 1 hour, and the activity gradually decreased over time, making it impossible to derive a value below the measurement limit after 48 hours. It is estimated that the PLT decrease was prevented in both groups due to relatively high activity, and the rh WT-ADAMTS13 0.1 mg/kg group was unable to prevent the PLT decrease due to its low activity of 0.07 IU/mL after 1 hour. Therefore, on a mg/kg basis, it was confirmed that PLT reduction prevention can be induced even at an administration dose that is at least 20 times lower than that of the competing substance, Cablivi ^® , and at least 5 times lower than that of rh WT-ADAMTS13.

To compare the recovery ability of PLT levels over time after administration of GC1126A, rh WT-ADAMTS13, and Cablivi ^® , neutralizing antibodies and three types of drugs were administered while PLT levels were reduced 8 hours after rh-vWF administration. . Unlike the vehicle, Calbivi ^® , and rh WT-ADAMTS13 administration groups, where the PLT level decreased more 16 hours after drug administration than 1 hour after drug administration (9 hours after the first rh-vWF administration), the GC1126A 0.1 mg/kg administration group showed a statistically significant decrease. PLT levels were quickly recovered, and it was confirmed that PLT recovery was at a level closest to that of WT mice after 72 hours (FIG. 45e). In the measurement results of residual activity, the GC1126A 0.1 mg/kg group showed a high residual activity of 7.15 IU/mL on average 1 hour after administration, and the activity gradually decreased over time, reaching an average of 0.04 IU/mL, which was above the measurement limit even after 48 hours. showed residual activity (Figure 45f). However, in the group administered rh WT-ADAMTS13 0.5 mg/kg, low residual activity was observed, close to the measurement limit, with an average of 0.04 IU/mL after 1 hour, and residual activity could not be measured after 16 hours, and when administered at 0.1 mg/kg, It was found to be below the measurement limit at all times. The high activity of GC1126A prevents further decrease in PLT after administration and maintains a certain level of PLT, allowing it to recover to normal level more quickly. Therefore, on a mg/kg basis, it was confirmed that GC1126A prevents further decrease in PLT and induces rapid recovery to normal values even at an administered dose that is at least 20 times lower than that of the competing substance Cablivi ^® and at least 5 times lower than that of rh WT-ADAMTS13.

Comparison of autoantibody evasion ability of rh WT-ADAMT13 and GC1126A using aTTP patient plasma.

To compare and evaluate the ability of GC1126A, MDTCS-Fc, and rh WT-ADAMTS13 to evade autoantibodies present in the plasma of aTTP patients, 6 cases of plasma from Korean aTTP patients were obtained and the residual activity of ADAMTS13 was measured. It was confirmed that the relative residual activity of GC1126A was maintained in the range of 70% to 130% regardless of the autoantibody activity concentration (BU/mL), and this was observed to be maintained regardless of the material treatment concentration (Figure 46, red dot). On the other hand, the MDTCS-Fc or rh WT-ADAMTS13 treatment group showed a lower relative residual activity level compared to GC1126A, and it was confirmed that the relative residual activity increased depending on the treatment concentration of each substance (Figure 40, black and blue dots). This is presumed to be a phenomenon that occurs when the concentration of substances exceeding that of autoantibodies is processed under each test condition. The excellent autoantibody evasion ability seen in GC1126A compared to MDTCS-Fc and rh WT-ADAMTS13 was confirmed to be more evident when treated with a low substance concentration (1.5 nM) under conditions of high autoantibody activity concentration (3.0 BU/mL). (Figure 46). In conclusion, GC1126A was found to have superior ability to evade autoantibodies present in aTTP patients compared to MDTCS-Fc and rh WT-ADAMTS13.

To confirm the therapeutic effect concentration of GC1126A, a novel variant that effectively avoids ADAMTS13 neutralizing antibodies, and to compare its efficacy with Cablivi ^® , a drug already approved as a TTP treatment, and rh WT-ADAMTS13, a drug under development, it was tested in the plasma of aTTP mimic disease mice or aTTP patients. Confirmed. In aTTP mimic mice, GC1126A effectively evades neutralizing antibodies and exhibits high ADAMTS13 residual activity, which can prevent further decrease in PLT and lead to faster recovery. Based on the administration concentration based on mg/kg, GC1126A was confirmed to have a similar level of efficacy at doses that were approximately 20 times and approximately 5 times lower than Cablivi ^® and rh WT-ADAMTS13, respectively. In addition, compared to rh WT-ADAMTS13 and Cablivi ^® , GC1126A showed superiority in terms of maintaining the therapeutic effect by maintaining the therapeutic effect for up to 48 hours. In the aTTP patient plasma test system, GC1126A showed superior autoantibody evasion compared to rh WT-ADAMTS13 or the MDTCS-Fc comparison material that does not contain the variant, and this effect was confirmed to be more pronounced the higher the autoantibody activity concentration. In conclusion, GC1126A was confirmed to be superior in terms of therapeutic efficacy and maintenance compared to existing TTP treatments through efficacy evaluation in aTTP mimic mouse and aTTP patient plasma, and showed that it can be used as an effective treatment for TTP disease. In addition, the therapeutically effective dose range of GC1126A in the aTTP mimic mouse model was confirmed to be 0.100-0.146 mg/kg, and linear pharmacokinetic characteristics were confirmed through pharmacokinetic evaluation of three doses including the therapeutically effective dose in normal monkeys. Based on these results, the dosage range considering the effective dose in healthy adults was predicted to be 0.03 - 0.2 mg/kg through human PK modeling and simulation.

As the specific parts of the present invention have been described in detail above, it is clear to those skilled in the art that these specific techniques are merely preferred embodiments and do not limit the scope of the present invention. Accordingly, the substantial scope of the present invention will be defined by the appended claims and their equivalents.

Sequence list electronic file attached

Claims (22)

A pharmaceutical formulation composition containing as an active ingredient a plasma protein selected from the group consisting of ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) protein, variants thereof, and functional fragments thereof, wherein the plasma protein is administered to the subject. A composition characterized in that it is included in the composition to be administered at 0.02 mg to 0.25 mg per 1 kg of body weight.
The composition according to claim 1, wherein the plasma protein is included in the composition to be administered in an amount of 0.03 mg to 0.2 mg per 1 kg of body weight of the subject.
The composition according to claim 1, wherein the composition is administered intravenously.
The composition of claim 1, wherein the composition comprises 0.2 mg/ml to 1.2 mg/ml of plasma protein and 40 to 200 mM of an amino acid stabilizer.
The composition according to claim 4, wherein the amino acid is at least one selected from the group consisting of arginine (Arg), proline (Pro), and pharmaceutically acceptable salts thereof.
The formulation composition according to claim 4, wherein the composition additionally contains 0 to 1.5 w/v% of a sugar stabilizer based on the total composition.
The composition according to claim 6, wherein the sugar is at least one selected from the group consisting of sucrose, trehalose, and pharmaceutically acceptable salts thereof.
The formulation composition according to claim 4, wherein the composition additionally contains 100mM to 400mM of an inorganic salt.
The composition according to claim 8, wherein the inorganic salt is at least one selected from the group consisting of NaCl, CaCl ₂ , KCl and MgCl ₂ .
The composition according to claim 9, wherein the inorganic salt is a mixture of NaCl and CaCl ₂ .
The composition according to claim 4, wherein the composition additionally comprises 0.01 to 0.1 v/v % of a nonionic surfactant based on the total composition.
The composition of claim 11, wherein the nonionic surfactant is at least one selected from the group consisting of polysorbate 80, polysorbate 60, and polysorbate 40.
The method of claim 1, wherein the variant of the ADAMTS13 protein is 85, 93, 126, 135, 278, 282, 308, 314, 317, 334, 364, 376, 413, 427, 452, 465 of the first sequence of the sequence listing. one selected from the group consisting of residues 567, 578, 585, 589, 607, 608, 609, 612, 618, 624, 630, 635, 643, 650, 651, 654, 655, 656, 658, 664 and 672 A composition comprising substitution of one or more amino acid residues.
The composition of claim 13, wherein the variant of the ADAMTS13 protein is selected from the group consisting of mutant proteins each containing a substitution of one or more amino acid residues at the following positions:
- Residues 85 and 317; Residue 612; two or more of residues 282, 465, and 672; residue 635; residues 452 and 612; two or more of residues 278, 334, and 427; Residue 618; residue 135; two or more of residues 126, 567, and 651; residue 413; Residue 334; residue 314; two or more of residues 93, 364, and 376; Residue 308; Residue 656; Residue 607; Residues 612 and 624; residue 589; Residues 650 and 656; Residue 643; Residues 585 and 658; Two or more of residues 630, 654, and 664; Four or more of residues 589, 608, 609, 624, and 655; Residue 578; residue 585; Residues 314 and 635; and residues 314 and 612.
The method of claim 13, wherein the substitution of the amino acid residue is substitution of the 85th residue with Phe, substitution of the 93rd residue with Val, substitution of the 126th residue with Met, substitution of the 135th residue with Ile, and substitution of the 278th residue. substitution of Ile, substitution of residue 282 with Ala, substitution of residue 308 with Lys, substitution of residue 314 with Thr, substitution of residue 317 with His, substitution of residue 334 with Thr or Val. Substitution of, substitution of the 364th residue with Arg, substitution of the 376th residue with Asp, substitution of the 413th residue with Asp, substitution of the 427th residue with Asn, substitution of the 452nd residue with Ile, 465th Substitution of residues with Asp, substitution of residue 567 with Ser, substitution of residue 578 with Leu, substitution of residue 585 with Asn or Met, substitution of residue 589 with Gln, Arg at residue 607. Substitution, substitution of residue 608 with Met, substitution of residue 609 with Leu, substitution of residue 612 with Phe or Tyr, substitution of residue 618 with Ser, substitution of residue 624 with Asp or Cys. Substitution of, substitution of the 630th residue with Leu, substitution of the 635th residue with Val, substitution of the 643rd residue with Phe, substitution of the 650th residue with His, substitution of the 651st residue with Asp, 654th Substitution of residues with Gly, substitution of residue 655 with Val, substitution of residue 656 with Arg or His, substitution of residue 658 with His, substitution of residue 664 with Asn and substitution of residue 672 with Val. A composition characterized in that it is one or more selected from the group consisting of substitution with .
The composition according to claim 1, wherein the plasma protein selected from the group consisting of the ADAMTS13 protein, its variant, and its functional fragment is conjugated with the Fc region of an IgG4 immunoglobulin.
The composition of claim 16, wherein the Fc region comprises a substitution of one or more amino acid residues selected from the group consisting of residues 22, 24, and 26 of SEQ ID NO:2.
The composition according to claim 17, wherein the 22nd residue is substituted with Tyr, the 24th residue with Thr, and the 26th residue with Glu.
The composition of claim 16, wherein a hinge region of an IgG1 immunoglobulin is additionally included between the plasma protein and the Fc region of the IgG4 immunoglobulin.
A composition for preventing or treating thrombotic diseases comprising the composition of any one of claims 1 to 19 as an active ingredient.
The composition of claim 20, wherein the thrombotic disease is thrombotic microangiopathy (TMA).
The method of claim 21, wherein the thrombotic microangiopathy is thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) , a composition selected from the group consisting of preeclampsia and sickle cell disease.