Patent Publication Number: US-2022218790-A1

Title: Parathyroid hormone fusion polypeptide

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This is a continuation of U.S. Ser. No. 16/608,611, filed on Oct. 25, 2019, which is the U.S. National Stage of International Application No. PCT/GB2018/051120, filed Apr. 27, 2018, which was published in English under PCT Article 21(2), which in turn claims the benefit of Great Britain Application No. 1706781.0, filed Apr. 28, 2017. 
    
    
     FIELD OF THE INVENTION 
     The disclosure relates to long acting parathyroid hormone fusion polypeptides comprising a receptor polypeptide wherein the receptor polypeptide is a parathyroid hormone receptor and/or growth hormone receptor; nucleic acid molecules encoding said fusion polypeptides; vectors adapted to express said fusion polypeptides; cells transformed or transfected with said nucleic acids or vectors; and use of said polypeptides in the treatment of hypoparathyroidism. 
     BACKGROUND OF THE INVENTION 
     Hypoparathyroidism, characterised by low parathyroid hormone (PTH) levels, is a rare condition and is either congenital or more often acquired following surgery to the neck. PTH is secreted by the four parathyroid glands which are located next to the thyroid gland in the neck and controls calcium homeostasis, vitamin D-dependent calcium absorption, renal calcium reabsorption and renal phosphate clearance. PTH stimulates the release of calcium from the bone and enhances absorption of calcium in the intestine. Reduced PTH levels lead to hypocalcaemia and include symptoms such as neuromuscular irritability, including paraesthesia, muscle twitching, laryngeal spasms, tetany and seizures and can lead, if untreated to death. 
     Current standard therapy is high dose calcium and active vitamin D; however, many patients show despite treatment fluctuating calcium levels, an increased incidence of depression as well as an increased risk of infections and renal complications such as calcifications and renal insufficiency. PTH is an 84-amino acid long polypeptide comprising a 34 long amino acid N-terminal biologically active domain which was found to be an effective PTH receptor agonist. 
     Currently recombinant PTH is administered as a daily subcutaneous injection. PTH is known to be unstable in vitro and has a short half-life in vivo resulting in fluctuating PTH levels which are associated with nausea and vomiting. Compositions stabilising PTH in vitro are disclosed in U.S. Pat. Nos. 7,550,434, 7,144,861, 6,770,623, WO2006/129995 or WO2013/108235, and recombinant PTH analogues with enhanced pharmacokinetics and pharmacodynamics comprising a modified PTH fragment of up to 36 amino acids are disclosed in WO2011143406. However, longer acting PTH biologics with an increased control over serum calcium levels and reduced side effects are urgently needed to minimise the need for daily subcutaneous injection. 
     Recombinant proteins and peptides used in pharmaceuticals often suffer from increased serum clearance. Factors that result in the removal of administered proteins from the circulation have two components; renal filtration and proteolysis. Typically, proteins with a molecular weight above 70 kDa are not cleared by glomerular filtration because they are simply too large to be filtered, however, proteins of small molecular weight are filtered by the glomerulus and are found in the urine. A method to increase the effective molecular weight of proteins and to produce a product which has reduced immunogenicity is to coat the protein in polyethylene glycol (PEG). PEG is believed to slow renal clearance by providing increased hydrodynamic volume in pegylated proteins (Maxfield et al.,  Polymer,  16:505-509 (1975)). However, pegylation of proteins can result in decreased affinity for its receptor reducing the biological activity. An alternative means to improved PK and PD of protein biologics is disclosed in WO2009/013461. Human growth hormone fused to an extracellular domain of human growth hormone receptor (GHR) have enhanced PK and PD improving PK by approximately 200-fold when compared to growth hormone. In PCT/GB2016/053218, currently unpublished, the effect of GHR on non-growth hormone polypeptides is disclosed wherein leptin and granulocyte colony stimulating factor (GSCF) when fused to GHR have improved PK and PD. 
     This disclosure relates to PTH fusion polypeptides wherein PTH fused to a receptor, for example, its cognate receptor and/or GHR have improved PK and PD. The PTH fusion polypeptides have utility in the treatment of conditions that result from abnormal PTH activity including hypoparathyroidism and treatment of conditions that benefit from PTH therapy including osteoporosis. 
     STATEMENTS OF THE INVENTION 
     According to an aspect of the invention there is provided a fusion polypeptide comprising
         a polypeptide comprising an amino acid sequence of a parathyroid hormone or biologically active fragment or analogue thereof,   a polypeptide comprising an amino acid sequence of a receptor polypeptide or fragment or analogue thereof wherein said parathyroid hormone or biologically active fragment or analogue thereof is linked either directly or indirectly as a translational fusion to said receptor polypeptide.       

     “Analogue” refers to a parathyroid hormone that binds parathyroid hormone receptor or a receptor polypeptide amino acid sequence variant. The parathyroid hormone analogue includes but is not limited to amino acid sequences encoding the parathyroid hormone related protein and variants thereof. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone comprising or consisting of the amino acid sequence set forth in SEQ ID NO: 10. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a fragment of SEQ ID NO: 10 including amino acids 1-28, 1-29, 1-30, 1-31, 1-32, 1-33, 1-34, or 1-35. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone comprising the sequence set forth in SEQ ID NO: 9. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a fragment of SEQ ID NO: 9 including amino acids 1-28, 1-29, 1-30, 1-31, 1-32, 1-33, 1-34, or 1-35. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone comprising or consisting of the amino acid sequence set forth in SEQ ID NO: 54. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone analogue comprising or consisting of the amino acid sequence of formula (I): 
     
       
         
           
               
            
               
                 (SEQ ID NO: 8) 
               
               
                 Xaa01-Val-Xaa03-Glu-Ile-Gln-Leu-Xaa08-His-Xaa10- 
               
               
                   
               
               
                 Xaa11-Xaa12-Xaa13-Xaa14-Leu-Xaa16-Xaa17-Xaa18-Arg- 
               
               
                   
               
               
                 Arg-Arg-Xaa22-Phe-Leu-Xaa25-Xaa26-Leu-Ile-Ala-Glu- 
               
               
                   
               
               
                 Ile-His-Thr-Ala-Glu-Ile 
               
            
           
         
       
         
         
           
             (I) where Xaa01 is Ser or Ala; Xaa03 is Ser or Ala; Xaa08 is Met or Leu; Xaa10 is Asn, Ala, Val, Asp, Glu, or Gln; Xaa11 is Leu, Ala, Val, Met, Lys, Arg, or Trp; Xaa12 is Gly, Ala, His, or Arg; Xaa13 is Lys, Ala, Leu, Gln, Arg, His, or Trp; Xaa14 is His, Leu, Arg, Phe, Trp, or Ser; Xaa16 is Gln or Asn; Xaa17 is Asp or Ser; Xaa18 is Ala, Leu, Met, Glu, Ser, or Phe; Xaa22 is Ala, Phe, Glu, Ser, Leu, Asn, Trp, or Lys; Xaa25 is His, Arg, Leu, Trp, or Lys; and Xaa26 is Lys, His, Ala, Ser, Asn, or Arg or a fragment thereof including amino acids 1-28, 1-29, 1-30, 1-31, 1-32, 1-33, 1-34, or 1-35 of formula (I), with the proviso that at least one of Xaa18 is not Leu or Met, Xaa22 is not Phe, and Xaa26 is not His. 
           
         
       
    
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone and parathyroid hormone analogue amino acid sequence comprising or consisting of the amino acid sequence set forth in SEQ ID NO: 37. 
     In an alternative embodiment of the invention said fusion polypeptide comprises a parathyroid hormone related protein or biologically active fragment or analogue thereof, comprising the amino acid sequence set forth in SEQ ID NO: 40. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a fragment of SEQ ID NO: 40 including amino acids 1-28, 1-29, 1-30, 1-31, 1-32, 1-33, 1-34, or 1-35. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a receptor polypeptide comprising a parathyroid hormone receptor extracellular domain. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone receptor extracellular domain comprising or consisting of the amino acid sequence set forth in SEQ ID NO: 3. 
     In a further preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone receptor extracellular domain, or fragment thereof, comprising an amino acid sequence, between 10-99% identical to the full length amino acid sequence set forth in SEQ ID NO: 3 and wherein said domain or fragment binds a parathyroid hormone, fragment or analogue thereof. 
     In a further preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone receptor extracellular domain or fragment thereof comprising an amino acid sequence that is 10, 15, 20, 30, 40, 50, 60, 70, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98 or 99% identical to the amino acid sequence set forth in SEQ ID NO: 3 and wherein said domain binds a parathyroid hormone, fragment or analogue thereof. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a modified amino acid sequence encoding the parathyroid hormone receptor extracellular domain wherein said modification is one or more amino acid substitutions selected from the group consisting of: I107 K, D109A, P104L or L159A as set forth in SEQ ID NO: 3. 
     In a further preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone receptor extracellular domain comprising an 107K substitution as set forth in SEQ ID NO: 3. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone comprising or consisting of the amino acid residues 1-14 of the sequence set forth in SEQ ID NO: 10. 
     In an alternative embodiment of the invention said fusion polypeptide comprises a modified parathyroid hormone receptor extracellular domain wherein said modification is by addition, deletion or substitution of at least one amino acid residue wherein said modified polypeptide substantially lacks parathyroid hormone binding activity or has reduced parathyroid hormone binding activity. 
     In an embodiment of the invention said fusion polypeptide comprising a receptor polypeptide and alternatively or additionally comprises a growth hormone binding domain polypeptide of growth hormone receptor. 
     In a preferred embodiment of the invention said fusion polypeptide comprises the extracellular growth hormone binding domain polypeptide of human growth hormone receptor. 
     In a further embodiment of the invention said fusion polypeptide comprises an extracellular growth hormone binding domain polypeptide comprising of the amino acid sequence set forth in SEQ ID NO: 5. 
     In an alternative embodiment of the invention said fusion polypeptide comprises a modified extracellular growth hormone binding domain polypeptide wherein said modification is by addition, deletion or substitution of at least one amino acid residue wherein said modified polypeptide substantially lacks growth hormone binding activity or has reduced growth hormone binding activity. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a modification of one or more of the amino acid residues selected from the group consisting of: W169, R43, E44, I103, W104, I105, P106, I164 and D165 as set forth in SEQ ID NO: 5. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a deletion of amino acid residue tryptophan 104 of the amino acid sequence set forth in SEQ ID NO: 5. 
     In an alternative embodiment of the invention said fusion polypeptide comprises a substitution of tryptophan 104 of the amino acid sequence as set forth in SEQ ID NO: 5. 
     In a preferred embodiment of the invention said fusion polypeptide comprises the substitution of tryptophan 104 for alanine as set forth in SEQ ID NO: 7. 
     In a further preferred embodiment of the invention said fusion polypeptide comprises or consists of a parathyroid hormone fragment comprising or consisting of the amino acid residues 1-28, 1-29, 1-30, 1-31, 1-32, 1-33, 1-34, or 1-35 of SEQ ID NO: 8. 
     In a further preferred embodiment said fusion polypeptide comprises a parathyroid hormone or analogue thereof comprising or consisting of the amino acid sequence set forth in SEQ ID Nos: 8, 9 or 10 wherein said parathyroid hormone amino acid sequence is modified by addition, deletion or substitution of at least one amino acid residue and wherein said modified fusion polypeptide retains parathyroid hormone activity. 
     In a further preferred embodiment said fusion polypeptide comprises a parathyroid hormone or analogue thereof comprising or consisting of the amino acid sequence set forth in SEQ ID NO: 54 wherein said parathyroid hormone amino acid sequence is modified by addition, deletion or substitution of at least one amino acid residue and wherein said modified fusion polypeptide retains parathyroid hormone activity. 
     In a further preferred embodiment said fusion polypeptide comprises a parathyroid hormone analogue comprising or consisting of the amino acid sequence set forth in SEQ ID NO: 37 or 40 wherein said parathyroid hormone amino acid sequence is modified by addition, deletion or substitution of at least one amino acid residue and wherein said modified fusion polypeptide retains parathyroid hormone activity. 
     In a further preferred embodiment said fusion polypeptide comprises a modified amino acid sequence that is 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99% identical over the full length of the amino acid sequence set forth in SEQ ID NOs: 8, 9 or 10. 
     In a further preferred embodiment said fusion polypeptide comprises a modified amino acid sequence that is 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99% identical over the full length of the amino acid sequence set forth in SEQ ID: NO: 40 or 37. 
     In a further preferred embodiment said fusion polypeptide comprises a modified amino acid sequence that is 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99% identical over the full length of the amino acid sequence set forth in SEQ ID: NO: 54. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid receptor domain polypeptide wherein said parathyroid receptor domain polypeptide is located at the carboxyl-terminal end of said fusion polypeptide. 
     In an alternative embodiment of the invention said fusion polypeptide comprises a parathyroid receptor domain polypeptide wherein said parathyroid receptor domain polypeptide is located at the amino-terminal end of said fusion polypeptide. 
     In an alternative embodiment of the invention said fusion polypeptide comprises a growth hormone binding domain polypeptide wherein said growth hormone binding domain polypeptide is located at the carboxyl terminal end of said fusion polypeptide. 
     In an embodiment of the invention said fusion polypeptide comprises a growth hormone binding domain polypeptide wherein said growth hormone binding domain polypeptide is located at the amino terminal end of said fusion polypeptide. 
     In a preferred embodiment of the invention said fusion polypeptide comprises or consists of an amino acid sequence set forth in SEQ ID NO: 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 or 36. 
     In a preferred embodiment of the invention said fusion polypeptide comprises or consists of an amino acid sequence set forth in SEQ ID NO: 15 or 20. 
     In a preferred embodiment of the invention said fusion polypeptide comprises or consists of an amino acid sequence set forth in SEQ ID NO: 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 or 53. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a pro-peptide. 
     In a further preferred embodiment of the invention said pro-peptide comprises or consists of SEQ ID NO: 11. 
     In an alternative preferred embodiment of the invention said pro-peptide comprises or consists of SEQ ID NO: 4. 
     In a preferred embodiment of the invention said fusion polypeptide further comprises a peptide secretion signal. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone peptide secretion signal. 
     In a preferred embodiment of the invention said parathyroid hormone peptide secretion signal comprises the amino acid sequence set forth in SEQ ID NO: 1. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone related protein peptide secretion signal. 
     In a preferred embodiment of the invention said parathyroid hormone related protein peptide secretion signal comprises the amino acid sequence set forth in SEQ ID NO: 41. 
     In an alternative preferred embodiment of the invention said fusion polypeptide comprises a growth hormone peptide secretion signal. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a growth hormone secretion signal comprising the amino acid sequence set forth in SEQ ID NO: 2. 
     In a preferred embodiment of the invention said fusion polypeptide comprises a parathyroid hormone, fragment or analogue thereof and is linked directly or indirectly to said receptor polypeptide by a peptide linker. 
     In an alternative embodiment of the invention said parathyroid hormone, fragment or analogue is directly linked to said receptor polypeptide as an in-frame translational fusion. 
     Preferably said peptide linker comprises the amino acid sequence Gly Gly Gly Gly Ser (residues 60-64 of SEQ ID NO: 12). 
     In a further preferred embodiment said peptide linker comprises 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 repeat units of a peptide comprising the amino acid sequence Gly Gly Gly Gly Ser (residues 60-64 of SEQ ID NO: 12). 
     In a further preferred embodiment said peptide linker comprises 4 repeat units of the amino acid sequence Gly Gly Gly Gly Ser (residues 60-64 of SEQ ID NO: 12). 
     According to a further aspect of the invention there is provided a nucleic acid molecule that encodes a fusion polypeptide according to the invention. 
     According to a further aspect of the invention there is provided a vector comprising a nucleic acid molecule according to the invention. 
     In a preferred embodiment of the invention said vector is an expression vector adapted to express the nucleic acid molecule according to the invention. 
     A vector including nucleic acid (s) according to the invention need not include a promoter or other regulatory sequence, particularly if the vector is to be used to introduce the nucleic acid into cells for recombination into the genome for stable transfection. Preferably the nucleic acid in the vector is operably linked to an appropriate promoter or other regulatory elements for transcription in a host cell. The vector may be a bi-functional expression vector which functions in multiple hosts. By “promoter” is meant a nucleotide sequence upstream from the transcriptional initiation site and which contains all the regulatory regions required for transcription. Suitable promoters include constitutive, tissue-specific, inducible, developmental or other promoters for expression in eukaryotic or prokaryotic cells. “Operably linked” means joined as part of the same nucleic acid molecule, suitably positioned and oriented for transcription to be initiated from the promoter. DNA operably linked to a promoter is “under transcriptional initiation regulation” of the promoter. 
     In a preferred embodiment the promoter is a constitutive, an inducible or regulatable promoter. 
     According to a further aspect of the invention there is provided a cell transfected or transformed with a nucleic acid molecule or vector according to the invention. 
     Preferably said cell is a eukaryotic cell. 
     In a preferred embodiment of the invention said cell is selected from the group consisting of; a fungal cell (e.g.  Pichia  spp,  Saccharomyces  spp,  Neurospora  spp); insect cell (e.g.  Spodoptera  spp); a mammalian cell (e.g. COS cell, CHO cell); a plant cell. 
     In an alternative embodiment of the invention said cell is a prokaryotic cell. 
     According to an aspect of the invention there is provided a method for the production of the fusion polypeptide according to the invention comprising the steps consisting of:
         i) providing a cell according to the invention and cell culture medium;   ii) culturing said cell; and   iii) isolating from said cell or medium a fusion polypeptide according to the invention.       

     According to a further aspect of the invention there is provided a pharmaceutical composition comprising a fusion polypeptide according to the invention including an excipient or carrier. 
     In a preferred embodiment of the invention said pharmaceutical composition is combined with a further therapeutic agent. 
     When administered the pharmaceutical composition of the present invention is administered in pharmaceutically acceptable preparations. Such preparations may routinely contain pharmaceutically acceptable concentrations of salt, buffering agents, preservatives, compatible carriers, and optionally other therapeutic agents for example chemotherapeutic agents. 
     The pharmaceutical compositions of the invention can be administered by any conventional route, including injection. The administration and application may, for example, be subcutaneous. 
     Pharmaceutical compositions of the invention are administered in effective amounts. An “effective amount” is that amount of pharmaceuticals/compositions that alone, or together with further doses or synergistic drugs, produces the desired response. This may involve only slowing the progression of the disease temporarily, although more preferably, it involves halting the progression of the disease permanently. This can be monitored by routine methods or can be monitored according to diagnostic methods. 
     The doses of the pharmaceutical compositions administered to a subject can be chosen in accordance with different parameters, in particular in accordance with the mode of administration used and the state of the subject (i.e. age, sex). When administered, the pharmaceutical compositions of the invention are applied in pharmaceutically-acceptable amounts and in pharmaceutically-acceptable compositions. When used in medicine salts should be pharmaceutically acceptable, but non-pharmaceutically acceptable salts may conveniently be used to prepare pharmaceutically-acceptable salts thereof and are not excluded from the scope of the invention. Such pharmacologically and pharmaceutically-acceptable salts include, but are not limited to, those prepared from the following acids: hydrochloric, hydrobromic, sulfuric, nitric, phosphoric, maleic, acetic, salicylic, citric, formic, malonic, succinic, and the like. Also, pharmaceutically-acceptable salts can be prepared as alkaline metal or alkaline earth salts, such as sodium, potassium or calcium salts. 
     The pharmaceutical compositions may be combined, if desired, with a pharmaceutically-acceptable carrier. The term “pharmaceutically-acceptable carrier” as used herein means one or more compatible solid or liquid fillers, diluents or encapsulating substances that are suitable for administration into a human. The term “carrier” denotes an organic or inorganic ingredient, natural or synthetic, with which the active ingredient is combined to facilitate the application. The components of the pharmaceutical compositions also are capable of being co-mingled with the molecules of the present invention, and with each other, in a manner such that there is no interaction that would substantially impair the desired pharmaceutical efficacy. 
     The pharmaceutical compositions may contain suitable buffering agents, including: acetic acid in a salt; citric acid in a salt; boric acid in a salt; and phosphoric acid in a salt. The pharmaceutical compositions also may contain, optionally, suitable preservatives, such as: benzalkonium chloride; chlorobutanol; parabens and thimerosal. 
     The pharmaceutical compositions may conveniently be presented in unit dosage form and may be prepared by any of the methods well-known in the art of pharmacy. All methods include the step of bringing the active agent into association with a carrier that constitutes one or more accessory ingredients. In general, the compositions are prepared by uniformly and intimately bringing the active compound into association with a liquid carrier, a finely divided solid carrier, or both, and then, if necessary, shaping the product. 
     Compositions suitable for subcutaneous administration conveniently comprise a sterile aqueous or non-aqueous preparation that is preferably isotonic with the blood of the recipient. This preparation may be formulated according to known methods using suitable dispersing or wetting agents and suspending agents. The sterile injectable preparation also may be a sterile injectable solution or suspension in a non-toxic parenterally-acceptable diluent or solvent, for example, as a solution in 1, 3-butane diol. Among the acceptable solvents that may be employed are water, Ringer&#39;s solution, and isotonic sodium chloride solution. In addition, sterile, fixed oils are conventionally employed as a solvent or suspending medium. For this purpose any bland fixed oil may be employed including synthetic mono- or di-glycerides. In addition, fatty acids such as oleic acid may be used in the preparation of injectables. Carrier formulation suitable for subcutaneous administrations can be found in Remington&#39;s Pharmaceutical Sciences, Mack Publishing Co., Easton, Pa. 
     According to an aspect of the invention there is provided a fusion polypeptide according to the invention for use in the treatment of hypoparathyroidism in a subject. 
     According to a further aspect of the invention there is provided a method to treat a human subject suffering from hypoparathyroidism comprising administering an effective amount of a fusion polypeptide according to the invention thereby treating hypoparathyroidism. 
     According to an aspect of the invention there is provided a fusion polypeptide according to the invention for use in the treatment of osteoporosis in a human subject. 
     According to a further aspect of the invention there is provided a method to treat a human subject suffering from osteoporosis comprising administering an effective amount of a fusion polypeptide according to the invention thereby treating osteoporosis. 
     In a preferred embodiment or method of the invention said fusion polypeptide comprises the amino acid sequence set forth in SEQ ID NO: 40. 
     In a preferred embodiment or method of the invention said fusion polypeptide is administered in combination with calcium carbonate and/or vitamin D supplements such as calcitrol or alfacalcitrol. 
     In a preferred embodiment or method of the invention said hypoparathyroidism is caused by thyroid or neck surgery, autoimmune disease, radiotherapy, cancer, Addison&#39;s disease or Di-George syndrome. 
     In a preferred embodiment or method of the invention said fusion polypeptide is administered at least once a day. 
     In an embodiment or method of the invention said fusion polypeptide is administered at least once or twice weekly. 
     Throughout the description and claims of this specification, the words “comprise” and “contain” and variations of the words, for example “comprising” and “comprises”, means “including but not limited to”, and is not intended to (and does not) exclude other moieties, additives, components, integers or steps. 
     Throughout the description and claims of this specification, the singular encompasses the plural unless the context otherwise requires. In particular, where the indefinite article is used, the specification is to be understood as contemplating plurality as well as singularity, unless the context requires otherwise. 
     Features, integers, characteristics, compounds, chemical moieties or groups described in conjunction with a particular aspect, embodiment or example of the invention are to be understood to be applicable to any other aspect, embodiment or example described herein unless incompatible therewith. 
     An embodiment of the invention will now be described by example only and with reference to the following figures: 
    
    
     
       BRIEF SUMMARY OF THE DRAWINGS 
         FIG. 1 : We have linked PTH (residues 1-34) to the N-terminal PTH receptor domain (PTHrExt) and the growth hormone binding protein (GHBP). GHBP is an inert moiety designed to increase molecular weight and delay clearance. The binding of PTH to PTHrExt protects PTH from degradation and produces a pool of “inactive” PTH that is in equilibrium with active PTH generating a more physiological PTH exposure. Molecules will be expressed under the control of either the PTH secretion signal (with or without the inclusion of the propeptide) or the growth hormone secretion signal to allow for efficient processing in a CHO cell line; 
         FIGS. 2A and 2B : SDS-PAGE Analysis of Purified Protein.  FIG. 2A ) Purified 14A1,  FIG. 2B ) Purified 14A2b. Proteins were expressed in a CHO cell line and purified as a secreted product from Hyclone SFM4CHO Utility media using a combination of Q-Sepharose and anti-growth hormone receptor affinity chromatography. Protein separates at ˜75-100 kDa and is intact with no sign of degradation; 
         FIG. 3 : In Vitro Bioactivity of 14A1 and 14A2 proteins. Purified proteins were tested for their ability to stimulate cAMP production from the PTH responsive cell line, UMR-106 (rat osteoblastic like cell line). Cells were stimulated for 15 minutes in the presence of test molecules and cAMP levels measured from cell lysates using a cAMP specific Elisa. Both positive controls, PTH 1-34 (100 μM), Forskolin (100 μM) and negative controls (Cells only, Buffer only and Control protein, Erythropoetin) were included in the analysis. Data is presented as pmol cAMP/ml+/−Standard deviation; 
         FIGS. 4A and 4B : Parathyroid Hormone, LOCUS NM_000315 834 bp mRNA linear PRI 13 Jun. 2016, DEFINITION  Homo sapiens  parathyroid hormone (PTH), transcript variant 1, mRNA., ACCESSION NM_000315, VERSION NM_000315.3, KEYWORDS RefSeq., SOURCE  Homo sapiens  (human).  FIG. 4A ) Signal peptide underlined, propeptide italics/lowercase, mature protein (1-34) shown in uppercase/bold,  FIG. 4B ) origin, Signal peptide is underlined (116-190 bp), Propeptide in lowercase/italics, Mature protein in uppercase/bold (209-460 bp); 
         FIGS. 5A-5D : PTH 1-34 used in fusion proteins;  FIG. 5A ) Amino acid sequence of PTH 1-34,  FIG. 5B ) nucleotide sequence (102 bp),  FIG. 5C ) Amino acid sequence of PTH signal peptide and propeptide sequence used in fusion proteins (propeptide in lowercase/italics),  FIG. 5D ) Nucleotide sequence of PTH signal peptide and propeptide sequence used in fusion proteins (propeptide in lowercase/italics); 
         FIGS. 6A and 6B : Human parathyroid hormone receptor 1,  FIG. 6A ) LOCUS NM_001184744 2007 bp mRNA linear PRI 6 Oct. 2016, DEFINITION  Homo sapiens  parathyroid hormone 1 receptor (PTH1R), transcript variant 2, mRNA. ACCESSION NM_001184744 VERSION NM_001184744.1, KEYWORDS RefSeq., SOURCE  Homo sapiens  (human), Signal peptide underlined, Mature extracellular domain in bold (D29-I187);  FIG. 6B ) Signal peptide underlined, Mature extracellular domain in bold; 
         FIGS. 7A and 7B : PTH receptor extracellular domain used in fusion proteins.  FIG. 7A ) Amino acid sequence (aa D29-L187),  FIG. 7B ) Nucleotide sequence (477 bp); 
         FIGS. 8A and 8B : Human growth hormone binding protein (GHBP),  FIG. 8A ) GHBP portion of the fusion is composed of amino acid residues 1-238 (extracellular domain) and includes a W104A mutation, Nucleotide sequence of GHBP (714 bp);  FIG. 8B ) Amino acid sequence (aa 1-238); 
         FIGS. 9A and 9B : GH Secretion signal,  FIG. 9A ) amino acid sequence,  FIG. 9B ) nucleotide sequence; 
         FIGS. 10A and 10B : PTH-(g4s)4-PTHrEx-(g4s)4-GHBP (Code #14A1); PTH Signal peptide: Lowercase, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (aa 1-159): bold/Lowercase, GHBP (aa 1-238): Uppercase; Linker regions (g4s)4: Uppercase/Bold;  FIG. 10A ) nucleotide sequence,  FIG. 10B ) protein sequence; 
         FIGS. 11A and 11B : PTH-(g4s)4-PTHrExt-(g4s)4-GHBP (Code #14A2), PTH Signal peptide and propeptide: Lowercase, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (aa 1-159): Lowercase/Bold, GHBP (aa 1-238): Uppercase, Linker regions (g4s)4: Uppercase/Bold;  FIG. 11A ) nucleotide sequence,  FIG. 11B ) protein sequence; 
         FIGS. 12A and 12  B: PTH-(g4s)4-PTHrExt-(g4s)4-GHBP (Code #14A3), GH Signal peptide: Lowercase, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (aa 1-159): Lowercase/Bold, GHBP (aa 1-238): Uppercase, Linker regions (g4s)4: Uppercase/Bold;  FIG. 12A ) nucleotide sequence,  FIG. 12B ) protein sequence; 
         FIGS. 13A and 13B : PTH-(g4s)4-GHBP (Code #14A4), GH Signal peptide: Lower case, PTH (aa 1-34): Uppercase/Underlined, GHBP (aa 1-238): Uppercase, Linker region (g4s)4: Uppercase/Bold;  FIG. 13A ) nucleotide sequence,  FIG. 13B ) protein sequence; 
         FIGS. 14A and 14B : PTH-(g4s)4-PTHrExt_Hist (Code #14A5_Hist), GH Signal peptide: Lower case, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (aa 1-159): Lowercase/Bold, Linker region (g4s)4: Uppercase/Bold, C-terminal 6× Hist tag: Uppercase/Underlined,  FIG. 14A ) nucleotide sequence,  FIG. 14B ) protein sequence; 
         FIGS. 15A and 15B : PTH-(g4s)4-PTHrExt (Code #14A5), GH Signal peptide: Lowercase, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (aa 1-159): Lowercase/Bold, Linker region (g4s)4: Uppercase/Bold;  FIG. 15A ) nucleotide sequence,  FIG. 15B ) protein sequence; 
         FIGS. 16A and 16B : PTH-(g4s)4-PTHrExt_Hist (Code #14A6_Hist), PTH Signal peptide &amp; propeptide: Lowercase), PTH (aa 1-34): Uppercase/Underlined, PTHrExt (aa 1-159): Lowercase/Bold, Linker regions (g4s)4: Uppercase/Bold, C-terminal 6× Hist tag: Uppercase/Underlined;  FIG. 16A ) nucleotide sequence,  FIG. 16B ) protein sequence; 
         FIGS. 17A and 17B : PTH-(g4s)4-PTHrExt_Hist (Code #14A6), PTH Signal peptide &amp; propeptide: Lower case, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (aa 1-159): Lowercase/Bold, Linker regions (g4s)4: Uppercase/Bold;  FIG. 17A ) nucleotide sequence,  FIG. 17B ) protein sequence; 
         FIGS. 18A and 18B : PTH-(g4s)4-GHBP (Code #14A7), PTH Signal peptide &amp; propeptide: Lowercase, PTH (aa 1-34): Uppercase/Underlined, GHBP (aa 1-238): Uppercase, Linker region (g4s)4: Uppercase/Bold;  FIG. 18A ) nucleotide sequence,  FIG. 18B ) protein sequence; 
         FIGS. 19A and 19B : PTH-(g4s)4-PTHrExt (I135K)-(g4s)4-GHBP (Code #14A8), PTH Signal peptide &amp; propeptide: Lowercase, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (I135K) (aa 1-159): Lowercase/Bold (I135K change underlined). GHBP (aa 1-238): Uppercase, Linker regions (g4s)4: Uppercase/Bold;  FIG. 19A ) nucleotide sequence,  FIG. 19B ) protein sequence; 
         FIGS. 20A and 20B : PTH-(g4s)4-GHBP (Code #14A9), GH Signal peptide: Lower case, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (I135K) (aa 1-159): Lowercase/Bold (I135K change underlined), GHBP (aa 1-238): Uppercase, Linker regions (g4s)4: Uppercase/Bold;  FIG. 20A ) nucleotide sequence,  FIG. 20B ) protein sequence; 
         FIGS. 21A and 21B : PTH-(g4s)4-PTHrExt (I135K)-Hist (Code #14A10), PTH Signal peptide: Lowercase, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (I135K) (aa 1-159): Lowercase/Bold (I135K change underlined), Linker region (g4s)4: Uppercase/Bold, C-terminal 6× Hist tag: Uppercase/Underlined;  FIG. 21A ) nucleotide sequence,  FIG. 21B ) protein sequence; 
         FIGS. 22A and 22B : PTH-(g4s)4-PTHrExt (I135K)-Hist (Code #14A11-Hist), GH Signal peptide: Lowercase, PTH (aa 1-34): Uppercase/Underlined, PTHrExt (I135K) (aa 1-159): Lowercase/Bold (I135K change underlined), Linker region (g4s)4: Uppercase/Bold, C-terminal 6× Hist tag: Uppercase/Underlined;  FIG. 22A ) nucleotide sequence,  FIG. 22B ) protein sequence; 
         FIG. 23  PTH Sequence (AA 1-84); 
         FIG. 24  (SEQ ID NO: 40): PTHrP (1-36); 
         FIG. 25  (SEQ ID NO: 41): PTHrP signal sequence; 
         FIG. 26  (SEQ ID NO: 4): PTHrP propeptide; 
         FIGS. 27A and 27B : Schematic models showing the structure of the PTH fusion molecules.  FIG. 27A : PTH (Purple) linked to PTHrExt (Green) which in turn is linked to GHBP (Orange). Linkers shown as grey lines. W104A change shown in blue on GHBP. It is hypothesised that a state of equilibrium exists between PTH bound to PTHrExt (Inactive State: A) and PTH being released and able to bind PTHR1 (Active State, B).  FIG. 27B : PTH (Purple) linked to GHBP (Orange). Linker shown as grey line. W104A change shown in blue on GHBP; 
         FIGS. 28A, 28B, and 29C : Analysis of purified PTH fusion molecules by 10% SDS-PAGE under non-reducing conditions (Coomassie Stained).  FIG. 28A : Lane 1: 5 μg 14A2c Lane 2: 5 μg 14A3b. 14A2c (contains PTH prepropeptide) separates as two diffuse bands from 60-100 kDa. 14A3b (GHss) resolves as a single diffuse band ˜75-100 kDa.  FIG. 28B : Lane 3: 6 μg 14A7 Lane 4: 3 μg 14A4. Proteins judged to be &gt;90% pure. Obtained ˜10 mg 14A2c, ˜4 mg 14A3b, 1.42 mg 14A7 and 0.29 mg 14A4 purified protein from a 1 litre roller bottle culture. 
         FIG. 28C : Western blot anti PTH 14A2c &amp; 14A3b. Analysis of purified PTH fusion molecules by 10% SDS-PAGE under non-reducing conditions. Samples were transferred to a PVDF membrane and probed with anti-human PTH (1-34) specific antibody. Lanes 1-3: 14A2c at a loading of 125 ng, 250 ng and 500 ng. Lanes 4-6: 14A3b at a loading of 125 ng, 250 ng and 500 ng. 14A2c is more sensitive to detection by anti-PTH antibody. Representative of 3 independent western blot experiments; 
         FIG. 29A : In vitro induction of cAMP. UMR-106 cells were challenged with either 500 nM PTH fusion or 100 nM human PTH 1-34 for 15 minutes at 3TC/5% CO 2 . Cells were lysed and cAMP levels measured using an R &amp; D systems Parameter cAMP Elisa. Data are presented as log pmol cAMP/ml ±SD. An 11-fold increase in cAMP levels was found for 14A2c over 14A3b: mean±SD 264±12 vs 25±0.95 pmol cAMP/ml. Both Fusions showed reduced biological activity when compared to PTH 1-34: mean±SD 2551±186 pmol cAMP/ml. Average of n=1 experiment carried out in duplicate. 
         FIG. 29B : Dual Luciferase Reporter Assay for cAMP Activity. UMR-106 cells were transfected with the reporter plasmid pGL4.29/CRE/Luc2/Hygro and transfection control plasmid phRL (Renilla) and challenged with either PTH fusion or human PTH 1-34 for 5 hours at 3TC/5% CO 2 . Cells were lysed and Luciferase activity measured using the Promega Dual Luciferase Assay kit. Data are presented as fold induction of control ±SD. 14A2c is more bioactive than 14A3b equating to a ˜1.3 to 1.6 fold increase at 100 &amp; 500 nM respectively: mean fold induction±SD, 16.5±1.7, 63±5.9 vs 12.4±1.0, 40.3±3.1. Average of triplicate values. Both Fusions showed reduced biological activity when compared to PTH 1-34 at an equivalent concentration of 100 nM: mean±SD, 67.3±1.6. Representative of 3 separate experiments. 
         FIG. 29C : Dual Luciferase Reporter Assay for cAMP Activity Comparison of all 4 PTH fusion molecules. UMR-106 cells were transfected with the reporter plasmid pGL4.29/CRE/Luc2/Hygro and transfection control plasmid phRL (Renilla) and challenged with either PTH fusion or human PTH 1-34 for 5 hours at 37° C./5% CO 2 . Cells were lysed and Luciferase activity measured using the Promega Dual Luciferase Assay kit. Data are presented as fold induction of control ±SD. Pattern of activity is similar to previous assays for 14A2c &amp; 14A3b vs PTH. Both PTH-GHBP fusion molecules (14A4, 49±4.17 &amp; 14A7, 44±0.42) are more active than the PTH-PTHrExt-GHBP fusion molecules (14A2c, 15±0.09 &amp; 14A3b, 7.7±3.13) at 100 nM. At 100 nM both 14A4 and 14A7 have comparable activity to PTH (54±2.7). 
         FIG. 29D : Determination of EC 50  values for PTH &amp; PTH fusions using the Dual Luciferase Reporter Assay. PTH has an EC 50  of 32±10.67 nM (n=4 experiments) and is ˜18-fold more potent than 14A2c (EC 50 =579±138 nM, n=3 experiments), 28-fold more potent than 14A3b (EC 50 =896 nM, n=1), and 4.7-fold more potent than 14A7 (EC 50 =153 nM, n=1 experiment). 
     
    
    
     SEQUENCE LISTING 
     The Sequence Listing is submitted as an ASCII text file in the form of the file name “Sequence.txt,” 163,840 bytes, created on Mar. 18, 2022, which is incorporated by reference herein. 
     
       
         
           
               
               
             
               
                 TABLE 1 
               
               
                   
               
               
                 Code (SEQ ID) 
                 Molecule Description 
               
               
                   
               
             
            
               
                 14A1 (12) 
                 PTHss-PTH-(g4s)4-PTHrExt-(g4s)4-GHBP 
               
               
                 14A2 (13) 
                 PTHss-pp-PTH-(g4s)4-PTHrExt-(g4s)4-GHBP 
               
               
                 14A3 (14) 
                 GHss-PTH-(g4s)4-PTHrExt-(g4s)4-GHBP 
               
               
                 14A4 (15) 
                 GHss-PTH-(g4s)4-GHBP 
               
               
                 14A5 (16) 
                 GHss-PTH-(g4s)4-PTHrExt 
               
               
                 14A5_Hist (17) 
                 GHss-PTH-(g4s)4-PTHrExt-Hist 
               
               
                 14A6_Hist (18) 
                 PTHss-pp-PTH-(g4s)4-PTHrExt-Hist 
               
               
                 14A6 (19) 
                 PTHss-pp-PTH-(g4s)4-PTHrExt 
               
               
                 14A7 (20) 
                 PTHss-pp-PTH-(g4s)4-GHBP 
               
               
                 14A8 (21) 
                 PTHss-pp-PTH-(g4s)4-PTHrExt (I135K)-(g4s)4- 
               
               
                   
                 GHBP 
               
               
                 14A9 (22) 
                 GHss-PTH-(g4s)4-PTHrExt (I135K)-(g4s)4-GHBP 
               
               
                 14A10_Hist (23) 
                 PTHss-pp-PTH-(g4s)4-PTHrExt (I135K)- Hist 
               
               
                 14A11_Hist (24) 
                 GHss-pp-PTH-(g4s)4-PTHrExt (I135K)-Hist 
               
               
                 14A12 (25) 
                 PTHss-pp-LA:PTH-(g4s)4-PTHrExt-(g4s)4-GHBP 
               
               
                 14A13 (26) 
                 GHss-LA:PTH-(g4s)4-PTHrExt-(g4s)4-GHBP 
               
               
                 14A15 (27) 
                 PTHss-pp-LA:PTH-(g4s)4-GHBP 
               
               
                 14A16 (28) 
                 GHss-LA:PTH-(g4s)4-GHBP 
               
               
                 14A17 (29) 
                 PTHss-pp-LA:PTH-(g4s)4-PTHrExt-Hist 
               
               
                 14A18 (30) 
                 GHss-LA:PTH-(g4s)4-PTHrExt-Hist 
               
               
                 14A19 (31) 
                 PTHss-pp-PTH (1-84)-(g4s)4-PTHrExt-(g4s)4- 
               
               
                   
                 GHBP 
               
               
                 14A20 (32) 
                 GHss-PTH (1-84)-(g4s)4-PTHrExt-(g4s)4-GHBP 
               
               
                 14A21 (33) 
                 PTHss-pp-PTH (1-84)-(g4s)4-GHBP 
               
               
                 14A22 (34) 
                 GHss-PTH (1-84)-(g4s)4-GHBP 
               
               
                 14A23 (35) 
                 PTHss-pp-PTH (1-84)-(g4s)4-PTHrExt-Hist 
               
               
                 14A24 (36) 
                 GHss-PTH (1-84)-(g4s)4-PTHrExt-Hist 
               
               
                   
               
               
                 PTHss = Parathyroid Hormone secretion signal; 
               
               
                 pp = proppeptide; 
               
               
                 GHss = Growth hormone secretion signal; 
               
               
                 PTH = (aa 1-34 or 1-84 as stated or fragments thereof); 
               
               
                 PTHrExt = PTH receptor extracellular domain; 
               
               
                 GHBP = Growth hormone binding protein (aa 1-238); 
               
               
                 (g4s)4 = 4 repeats of amino acids GGGGS (residues 66-85 of SEQ ID NO: 20); 
               
               
                 Hist tagged = HHHHHH (residues 242-247 of SEQ ID NO: 17); 
               
               
                 I135K = mutation of Isoleucine-135 to lysine in PTHrExt:LA:PTH = long acting PTH [fusion of PTH 1-14 with PTHrP as described in text]. 
               
            
           
         
       
     
     Linker regions in the above fusions are composed of multiples of GGGGS. In the examples given in Table 1 the linker regions are composed of 4×GGGGS (residues 66-85 of SEQ ID NO: 20), but variable multiples can be used. 
     The I135K change present in PTHrExt in selected constructs has been shown to reduce the binding of PTH for the receptor. Other amino acid changes can also be used in combination or as single point mutations such as D137A, P132L &amp; L187A. (SEQ ID NO: 56). 
     The numbering for the PTHrExt in the sequences below refer to the mature protein processed at Alanine 28 and therefore D29-I187 is thus referred to as amino acids 1-159 (SEQ ID NO: 3) in the following sequences. 
     All of above PTH sequences can be replaced with PTH 1-84 if desired and variables thereof. 
     
       
         
           
               
             
               
                 TABLE 2 
               
             
            
               
                   
               
               
                 List of all Proposed PTHrP Fusion Constructs (SEQ ID 42-53) 
               
            
           
           
               
               
            
               
                   
                 Molecule Description 
               
               
                   
               
               
                 14A25 (42) 
                 PTHrPss-pp-PTHrP-(g4s)4-PTHrExt-(g4s)4-GHBP 
               
               
                 14A26 (43) 
                 GHss-PTHrP-(g4s)4-PTHrExt-(g4s)4-GHBP 
               
               
                 14A27 (44) 
                 GHss-PTHrP-(g45)4-GHBP 
               
               
                 14A28 (45) 
                 GHss-PTHrP-(g45)4-PTHrExt 
               
               
                 14A29_Hist (46) 
                 GHss-PTHrP-(g4s)4-PTHrExt-Hist 
               
               
                 14A30_Hist (47) 
                 PTHrPss-pp-PTHrP-(g4s)4-PTHrExt-Hist 
               
               
                 14A31 (48) 
                 PTHrPss-pp-PTHrP-(g4s)4-PTHrExt 
               
               
                 14A32 (49) 
                 PTHrPss-pp-PTHrP-(g4s)4-GHBP 
               
               
                 14A33 (50) 
                 PTHrPss-pp-PTHrP-(g4s)4-PTHrExt (I135K)-(g4s)4- 
               
               
                   
                 GHBP 
               
               
                 14A34 (51) 
                 GHss-PTHrP-(g45)4-PTHrExt (I135K)-(g4s)4-GHBP 
               
               
                 14A35_Hist (52) 
                 PTHrPss-pp-PTHrP-(g4s)4-PTHrExt (I135K)-Hist 
               
               
                 14A36_Hist (53) 
                 GHss-pp-PTHrP-(g4s)4-PTHrExt (I135K)-Hist 
               
               
                   
               
            
           
         
       
     
     PTHrPss=Parathyroid Hormone related protein secretion signal; pp=proppeptide; GHss=Growth hormone secretion signal; PTHrP=(aa 1-36 or fragments thereof); PTHrExt=PTH receptor extracellular domain; GHBP=Growth hormone binding protein (aa 1-238); (g4s)4=4 repeats of amino acids GGGGS (residues 66-85 of SEQ ID NO: 20); Hist tagged=HHHHHH (residues 242-247 of SEQ ID NO: 17); I135K=mutation of Isoleucine-135 to lysine in PTHrExt 
     
       
         
           
               
             
               
                 TABLE 3 
               
             
            
               
                   
               
               
                 SEQ ID NUMBER SUMMARY 
               
            
           
           
               
               
            
               
                 SEQ ID 
                   
               
               
                 NO 
                 Name 
               
               
                   
               
            
           
           
               
               
            
               
                 1 
                 PTH Signal Peptide: MIPAKDMAKVMIVMLAICFLTKSDG 
               
               
                   
               
               
                 2 
                 GH Secretion signal: MATGSRTSLLLAFGLLCLPWLQEGSA 
               
               
                   
               
               
                 3 
                 PTH receptor ECD (1-159): 
               
               
                   
                 DDVMTKEEQIFLLHRAQAQCEKRLKEVLQRPASIMESDKGWTSASTSGKPRK 
               
               
                   
                 DKASGKLYPESEEDKEAPTGSRYRGRPCLPEWDHILCWPLGAPGEVVAVPCP 
               
               
                   
                 DYIYDFNHKGHAYRRCDRNGSWELVPGHNRTWANYSECVKFLTNETREREV 
               
               
                   
                 FDRL 
               
               
                   
               
               
                 4 
                 PTHrP propeptide: rsveglsrrl 
               
               
                   
               
               
                 5 
                 GH receptor ECD (1-238): 
               
               
                   
                   F SGSEATAAILSRAPWSLQSVNPGLKTNSSKEPKFTKCRSPERETFSCHWTD 
               
               
                   
                 EVHHGTKNLGPIQLFYTRRNTQEWTQEWKECPDYVSAGENSCYFNSSFTSIW 
               
               
                   
                 IPYCIKLTSNGGTVDEKCFSVDEIVQPDPPIALNWTLLNVSLTGIHADIQVRWEA 
               
               
                   
                 PRNADIQKGWMVLEYELQYKEVNETKWKMMDPILTTSVPVYSLKVDKEYEVR 
               
               
                   
                 VRSKQRNSGNYGEFSEVLYVTLPQMSQ 
               
               
                   
               
               
                 7 
                 GH ECD substitution: w104a substitution 
               
               
                   
                 FSGSEATAAILSRAPWSLQSVNPGLKTNSSKEPKFTKCRSPERETFSCHWTD 
               
               
                   
                 EVHHGTKNLGPIQLFYIRRNTQEWTQEWKECPDYVSAGENSCYFNSSFTSIAI 
               
               
                   
                 PYCIKLTSNGGTVDEKCFSVDEIVQPDPPIALNWTLLNVSLTGIHADIQVRWEA 
               
               
                   
                 PRNADIQKGWMVLEYELQYKEVNETKWKMMDPILTTSVPVYSLKVDKEYEVR 
               
               
                   
                 VRSKQRNSGNYGEFSEVLYVTLPQMSQ 
               
               
                   
               
               
                 8 
                 PTH formula (I): general AA formula (1-36) 
               
               
                   
               
               
                 9 
                 PTH 1-84: 
               
               
                   
                 SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNFVALGAPLAPRDAGSQRPR 
               
               
                   
                 KKEDNVLVESHEKSLGEADKADVNVLTKAKSQ 
               
               
                   
               
               
                 10 
                 PTH defined formula (I): Ala-Val-Ala-Glu-Ile-Gln-Leu-Met-His-Gln-Arg-Ala-Lys- 
               
               
                   
                 Trp-Ile-Gln-Asp-Ala-Arg-Arg-Arg-Ala-Phe-Leu-His-Lys-Leu-Ile-Ala-Glu-Ile-His- 
               
               
                   
                 Thr-Ala-Glu-Ile, or a fragment thereof including amino acids 1-28, 1-29, 1-30, 
               
               
                   
                 1-31, 1-32, 1-33, 1-34, or 1-35 of said sequence. (1-36) 
               
               
                   
               
               
                 11 
                 PTH Propeptide: ksvkkr 
               
               
                   
               
               
                 12-36 
                 Constructs of table 1 
               
               
                   
               
               
                 37 
                 PTH short (LA PTH): LA-PTH ([Ala1,3,12,Gln10,Arg11,Trp14]PTH(1- 
               
               
                   
                 14)/[Ala18,22,Lys26]PTHrP(15-36)COOH) 
               
               
                   
               
               
                 40 
                 PTHrP (1-36): AVSEHQLLHDKGKSIQDLRRRFFLHHLIAEIHTAEI 
               
               
                   
               
               
                 41 
                 PTHrP signal sequence: MQRRLVQQWSVAVFLLSYAVPSCG 
               
               
                   
               
               
                 42-53 
                 Constructs of table 2 
               
               
                   
               
               
                 54 
                 PTH 1-34: SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNF 
               
               
                   
               
               
                 55 
                 PTH ECD Signal peptide: MGTARIAPGLALLLCCPVLSSAYALVDA 
               
               
                   
               
               
                 56 
                 PTH receptor full length: 
               
               
                   
                 MGTARIAPGLALLLCCPVLSSAYALVDADDVMTKEEQIFLLHRAQAQCEKRLKE 
               
               
                   
                 VLQRPASIMESDKGWTSASTSGKPRKDKASGKLYPESEEDKEAPTGSRYRGR 
               
               
                   
                 PCLPEWDHILCWPLGAPGEVVAVPCPDYIYDFNHKGHAYRRCDRNGSWELV 
               
               
                   
                 PGHNRTWANYSECVKFLTNETREREVFDRLGMIYTVGYSVSLASLTVAVLILAY 
               
               
                   
                 FRRLHCTRNYIHMHLFLSFMLRAVSIFVKDAVLYSGATLDEAERLTEEELRAIAQ 
               
               
                   
                 APPPPATAAAGYAGCRVAVTFFLYFLATNYYWILVEGLYLHSLIFMAFFSEKKY 
               
               
                   
                 LWGFTVFGWGLPAVFVAVWVSVRATLANTGCWDLSSGNKKWIIQVPILASIVL 
               
               
                   
                 NFILFINIVRVLATKLRETNAGRCDTRQQYRKLLKSTLVLMPLFGVHYIVFMATP 
               
               
                   
                 YTEVSGTLWQVQMHYEMLFNSFQGFFVAIIYCFCNGEVQAEIKKSWSRWTLA 
               
               
                   
                 LDFKRKARSGSSSYSYGPMVSHTSVTNVGPRVGLGLPLSPRLLPTATTNGHP 
               
               
                   
                 QLPGHAKPGTPALETLETTPPAMAAPKDDGFLNGSCSGLDEEASGPERPPAL 
               
               
                   
                 LQEEWETVM 
               
               
                   
               
               
                 57 
                 Fusion of SEQ ID NO: 1, 11 and 9 
               
               
                   
               
               
                 58 
                 DNA sequence encoding SEQ ID NO: 57 
               
               
                   
               
               
                 59 
                 DNA sequence encoding SEQ ID NO: 59 
               
               
                   
               
               
                 60 
                 Fusion of SEQ ID NO: 1 and 11 
               
               
                   
               
               
                 61 
                 DNA sequence encoding SEQ ID NO: 60 
               
               
                   
               
               
                 62 
                 DNA sequence encoding SEQ ID NO: 56 
               
               
                   
               
               
                 63 
                 DNA sequence encoding SEQ ID NO: 3 
               
               
                   
               
               
                 64 
                 DNA sequence encoding SEQ ID NO: 7 
               
               
                   
               
               
                 65 
                 DNA sequence encoding SEQ ID NO: 2 
               
               
                   
               
               
                 66 
                 DNA sequence encoding SEQ ID NO: 12 
               
               
                   
               
               
                 67 
                 DNA sequence encoding SEQ ID NO: 13 
               
               
                   
               
               
                 68 
                 DNA sequence encoding SEQ ID NO: 14 
               
               
                   
               
               
                 69 
                 DNA sequence encoding SEQ ID NO: 15 
               
               
                   
               
               
                 70 
                 DNA sequence encoding SEQ ID NO: 17 
               
               
                   
               
               
                 71 
                 DNA sequence encoding SEQ ID NO: 16 
               
               
                   
               
               
                 72 
                 DNA sequence encoding SEQ ID NO: 18 
               
               
                   
               
               
                 73 
                 DNA sequence encoding SEQ ID NO: 19 
               
               
                   
               
               
                 74 
                 DNA sequence encoding SEQ ID NO: 20 
               
               
                   
               
               
                 75 
                 DNA sequence encoding SEQ ID NO: 21 
               
               
                   
               
               
                 39 
                 DNA sequence encoding SEQ ID NO: 22 
               
               
                   
               
               
                 38 
                 DNA sequence encoding SEQ ID NO: 23 
               
               
                   
               
               
                 6 
                 DNA sequence encoding SEQ ID NO: 24 
               
               
                   
               
            
           
         
       
     
     Materials and Methods 
     Construction of PTH fusions: Molecules were constructed by a combination of gene synthesis (Eurofin MWG) and standard DNA manipulation techniques. Recombinant genes encoding full length PTH fusions were cloned into a modified mammalian expression plasmid, pSecTag/FRT/V5/Hist-TOPO (Invitrogen). Stable cell lines were produced in the CHO Flp-In cell line (Invitrogen) according to manufacturer&#39;s instructions and adapted to serum free media in Hyclone SFM4CHO Utility (Thermo Scientific). PTH fusions were under the secreted expression of either the PTH or GH signal peptides. 
     Expression and Purification: Cells were maintained in roller bottle cultures in Hyclone SFM4CHO Utility medium with passaging every 2-3 days, keeping cell densities between 0.25×10 6  viable cells/ml (VCPM) and 1.5×10 6  VCPM. For expression studies, roller bottles were seeded at 0.5×10 6  VCPM and grown at 37° C., 5% CO 2  and allowed to reach 1×10 6  VPCM. Valproic acid was added to a final concentration of 2 mM and the temperature reduced to 31° C. Cells were grown for up to 8-10 days with viability still at ˜70% when harvest was clarified by centrifugation at 22,000×g using a Beckman JLA 16-25 rotor for 20 minutes at 4° C. EDTA and Benzamidine-HCl were added to final concentrations of 5 and 10 mM respectively and the medium concentrated using a Vivaflow 200 tangential flow concentrator and stored frozen at −20° C. Target protein was purified from this concentrate by anion exchange (Q-Sepharose FF, GE Healthcare) and affinity chromatography (anti GHBP antibody column). Protein concentrations were measured by Bradford protein assay and samples analysed by SDS-PAGE under non-reducing conditions and either stained with coomassie blue or western blotted using a commercial anti-PTH 1-34 antibody (Abcam 14493) or an in house developed anti GHBP antibody. Purified samples were aliquoted and stored at −80° C. 
     In Vitro Bioactivity: Purified proteins were tested for their ability to stimulate cAMP production from the PTH responsive cell line, UMR-106 (rat osteoblastic like cell line). Cells were stimulated for 15 minutes in the presence of test molecules and cAMP levels measured from cell lysates using a cAMP specific Elisa (R&amp;D systems). 
     Animal Model for Hypoparathyroidism Shimizu et al have used an animal model for hypoparathyroidism in their studies on LA-PT. In this model rats were thyroparathyroidectomized (TPTX) prior to treatment. Briefly: Surgical TPTX was performed on 6-week-old rats obtained from Charles River Laboratories Japan, Inc. After surgery, pellet food (CE-2; CLEA Japan, Inc., Tokyo, Japan) containing 1.10% calcium and 1.09% phosphate moisturized with tap water was supplied inside each cage for easy access and digestion in sham-operated and TPTX rats. Postsurgical rats exhibiting sCa levels less than 8.0 mg/dL at 5 days after TPTX surgery were selected for subsequent peptide injection studies from the next day. 
     Example 1 
     From the crystal structure analysis of PTH with the N-domain PTH receptor [1], the PTH is shown to sit in a groove formed by the N-terminal receptor portion. It is this mode of interaction that is hypothesised to protect PTH from degradation and to create an “inactive pool” of PTH, thus prolonging its biological activity to create a long acting PTH. It is proposed that the new molecules (See  FIG. 1 ) will be fusions between PTH (residues 1-34), the N-terminal PTH receptor domain (PTHrExt, most commonly residues D29-L187 but not restricted to other combinations) and the growth hormone binding protein (GHBP, residues 1-238). GHBP is an inert moiety designed to increase Mw &amp; therefore delay clearance. It will contain a W104A mutation to prevent interaction with GH in the circulation. 
     Example 2 
     Initial expression studies showed that we are able to express and purify a PTH fusion molecule from a CHO cell line at sufficient levels (˜10 mg/L) to justify further progress. All molecules appear to be intact and &gt;95% pure as judged by SDS-PAGE. 
     Both PTH fusion molecules so far tested are biologically activity and produce a dose response in an in vitro cAMP assay. 
     Example 3 
     PTH1-34 has been fused to growth hormone binding protein (GHbp) with or without the extracellular domain of the PTH receptor (PTHextR). Molecules have then been expressed with either the GH (GHss) or PTH (PTHss) signal sequence and propeptide (pp). Thus, the following 4 molecules have been generated:
         14A2c=PTHss-pp-PTH (1-34)-(g4s)4-PTHrExt-(g4s)4-GHbp (SEQ ID NO: 13)   14A3b=GHss-PTH (1-34)-(g4s)4-PTHrExt-(g4s)4-GHbp (SEQ ID NO: 14)   14A4=GHss-PTH (1-34)-(g4s)4-GHbp (SEQ ID NO: 15)   14A7=PTHss-pp-PTH(1-34)-(g4s)4-GHbp (SEQ ID NO: 20)       

     Stable clones for all 4 molecules have been generated, all stable clones expressed protein and all 4 proteins have been purified on an affinity column for GHbp. Those using the GHss are expressed at a lower level and SDS-PAGE analysis and bioassays suggest that there may be incomplete processing of the translated product with additional aa at the N-terminus and possibly differential glycosylation of those with the GHss compared to those with the PTHss. ( FIG. 28 ) This would fit with PTH requiring its own signal sequence for complete processing of the preproPTH sequence, which is in the design of the molecules with the PTHss. All molecules show bioactivity in the two bioassays used and evidence suggests that the molecule that includes the PTHextR is less bioactive ( FIGS. 29 and 30 ). 
     PTH Fusion Molecules: Design &amp; Hypothesis 
     Parathyroid hormone (PTH) is an 84-aa peptide with biological activity residing in residues 1-34. PTH is produced by the parathyroid glands in response to low serum calcium levels. PTH acts on the parathyroid receptor (PTHR1) on bone and kidney promoting the release of calcium from bone, slowing excretion of calcium from kidneys, increasing absorption from intestines and promoting renal excretion of phosphate. In Hypoparathyroidism (HypoPT) the parathyroid glands are either absent or damaged and therefore cannot produce any or sufficient amounts of parathyroid hormone. Initial treatment is with oral calcium and active VD3 supplements. Recently, replacement of PTH in HypoPT with Natpara (PTH 1-84) has been licensed but requires daily sc injections and is complicated by fluctuating calcium levels. Continuous pump therapy is effective but impractical for most patients. There is therefore an unmet need for a long acting PTH molecule that provides constant physiological levels of PTH activity. Previously we have shown that the fusion of growth hormone to its binding protein (GHBP) can generate a long-acting growth hormone (1). Using this technology we have generated a number of PTH fusion molecules (See  FIGS. 1A  &amp; B). The PTH fusions are predicted to have a prolonged circulating half-life through increased protein size, whilst retaining biological activity. As a further modification of the PTH fusion shown in  FIG. 1A , it is hypothesised that PTH will form intramolecular interactions with PTHrExt, be protected from degradation, and provide an intravascular pool of active PTH. To prevent GH binding, a single amino acid change of tryptophan-104 to alanine in the GHBP moiety (W104A) will be introduced in to all PTH fusion molecules. All PTH fusion will be expressed using either the naturally occurring PTH prepropeptide sequence or the GH secretion signal. 
     REFERENCES 
     
         
         Shimizu, M., et al., Pharmacodynamic Actions of a Long-Acting PTH Analog (LA-PTH) in Thyroparathyroidectomized (TPTX) Rats and Normal Monkeys. J Bone Miner Res, 2016. 31(7): p. 1405-12