Anti-adrenomedullin (adm) binding agents for treatment or prophylaxis of disease symptoms

Abstract

The present invention relates to anti-adrenomedullin (ADM) binding agents for use in the treatment or prophylaxis of disease symptoms. In particular, the present invention relates to an anti-adrenomedullin antibody or an anti-adrenomedullin antibody fragment or an anti-ADM non-Ig scaffold for use in the treatment or prevention of a symptom of a disease and / or for use in the treatment or prevention of a disease characterized by said symptom. The disease condition may be selected from the group consisting of nausea, headache, muscular pain, back pain, trembling, vomiting in a subject, wherein the antibody or fragment or scaffold may bind to amino acid 1-52 (SEQ ID NO: 1) of ADM or a fragment thereof.

Description

[0001] This application is a divisional application of the application with international application date of September 25, 2018, international application number PCT / EP2018 / 075987, which entered the Chinese national phase on March 24, 2020, application number 201880062062.1, and invention name “Anti-adrenomedullin (ADM) binders for treating or preventing disease symptoms”. Technical Field

[0002] The subject of the present invention is an anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms and / or for treating or preventing diseases characterized by said symptoms. The disease symptoms may be selected from nausea, headache, muscle pain, back pain, tremor, vomiting in a subject, wherein the antibody or fragment or scaffold may bind to amino acids 1-52 of ADM (SEQ ID NO: 1) or a fragment thereof. Background Art

[0003] A variety of disorders or diseases may have common, partially non-specific symptoms that may range from unpleasant to unbearable for the individual suffering from the disorder. Individuals experiencing more than one symptom often need to take several medications to relieve the symptoms. There is a continuing need for new modalities to treat or prevent symptoms associated with many different underlying disorders or diseases. In particular, it would be helpful to provide an agent or drug that can be used to treat or prevent more than one symptom associated with an underlying disorder or disease. The present invention addresses this need.

[0004] The peptide adrenomedullin (ADM) was first discovered in 1993 ( Kitamura K. et al., 1993. Biochemistry and Biophysics Journal of Chinese Academy of Sciences Vol. 192(2):553-560) was first described as a novel hypotensive peptide comprising 52 amino acids, which had been isolated from human chromaffin cells. In the same year, a cDNA encoding a precursor peptide comprising 185 amino acids and the complete amino acid sequence of this precursor peptide were also described. The precursor peptide, which contains a signal sequence of 21 amino acids at the N-terminus, is called "pre-pro-adrenomedullin" (pre-proADM). In the present specification, all amino acid positions specified generally refer to pre-proADM comprising 185 amino acids. The peptide adrenomedullin (ADM) is a peptide comprising 52 amino acids (SEQ ID NO: 1) and containing amino acids 95 to 146 of pre-proADM, which is formed by proteolytic cleavage of pre-proADM. To date, only a few of the peptide fragments formed in the cleavage of pre-proADM have been more accurately characterized, in particular the physiologically active peptide adrenomedullin (ADM) and "PAMP", a peptide containing 20 amino acids (22-41) after the 21 amino acids of the signal peptide in pre-proADM. The discovery and characterization of ADM in 1993 triggered an intensive research campaign, the results of which have been summarized in various review articles, and in the context of this specification, particular reference is made to the articles in the issue "Peptides" that specifically focus on ADM ( Editorial, Takahashi K. 2001. "Peptides" 22:1691 )and( Eto T. 2001. Peptide 22: 1693-1711 ). Another review is ( Hinson et al. 2000. Endocrine Reviews 21(2):138-167 In scientific studies to date, it has been found that ADM can be considered a multifunctional regulatory peptide. It is released into the circulation in an inactive form extended by glycine ( Kitamura K. et al., 1998. Biochemical and Biophysical Research Communications 244(2):551-555 There is also a binding protein ( Pio R. et al., 2001. Journal of Biological Chemistry 276(15):12292-12300 ), which are specific for ADM and may also modulate the effects of ADM. The physiological effects of ADM and PAMPs that are most important in studies to date are those that affect blood pressure.

[0005] ADM is a potent vasodilator, and its hypotensive effect can be linked to a specific peptide in the C-terminal portion of ADM. In addition, it has been found that other physiologically active peptides PAMPs formed from pre-proADM also exhibit hypotensive effects, even though they have a different mechanism of action from ADM.

[0006] It has also been found that in many pathological conditions, the ADM concentrations that can be measured in the circulation and other biological fluids are significantly higher than those of healthy controls. Thus, ADM levels are increased to varying degrees in patients with congestive heart failure, myocardial infarction, kidney disease, hypertensive diseases, diabetes, acute phase of shock, as well as sepsis and septic shock. In some of the aforementioned pathological conditions, PAMP concentrations also increase, but plasma levels are lower relative to ADM (Eto, T., supra). In addition, it is known that abnormally high ADM concentrations are observed in sepsis, with the highest concentrations being observed in septic shock (see (Eto, T., supra) and (Hirata et al., Clinical Journal of Clinical Endocrinology and Metabolism, 1996.81(4):1449-1453; Ehlenz K. et al., 1997. Experimental and Clinical Endocrinology and Diabetes 105:156-162); Tomoda Y. et al., 2001. Peptides 22:1783-1794; Ueda S. et al., 1999. American Journal of Respiratory and Critical Care Medicine 160:132-136; and Wang P. Peptides 2001.22: 1835-1840 ).

[0007] Knowledge of the role of adrenomedullin in migraine is very limited. Since adrenomedullin has vasodilatory effects in the cerebral circulation, it is hypothesized to be involved in migraine. On the one hand, intravenous infusion of human ADM in patients with migraine did not cause significantly more headaches or migraines than placebo ( Petersen et al., 2008. Headache 29: 23-30 In addition, Akcali et al. reported that plasma adrenomedullin levels were low in patients with migraine during the natural course of the disease ( Akcali A. 2016. Medical Science and Discovery 3(4):153-158 On the other hand, it has been suggested by Kis et al. that there is a need to develop novel, potent, specific and possibly non-peptide receptor antagonists as effective therapeutic tools to inhibit ADM-mediated hyperplasia as anti-migraine drugs ( Kis et al., 2003. Hypertension Research 26(Suppl):S61-S70. ).

[0008] definition

[0009] Before describing the present invention in detail, it is advisable to provide definitions for certain technical terms used throughout the specification. Although the present invention will be described with respect to specific embodiments, the description should not be construed as limiting. Before describing the exemplary embodiments of the present invention in detail, definitions important for understanding the present invention are given.

[0010] As used in this specification and the appended claims, singular references without a specific number also include the respective plural unless the context clearly indicates otherwise.

[0011] In the context of the present invention, the terms "about" and "approximately" denote a range of accuracy that a person skilled in the art will understand as still ensuring the technical effect of the feature in question. The terms generally denote a deviation of ±20%, preferably ±15%, more preferably ±10%, even more preferably ±5% from the indicated numerical value.

[0012] It should be understood that the term "comprising" is not restrictive. For the purposes of the present invention, the term "consisting of" is considered to be a preferred embodiment of the term "comprising". If a group is defined below as comprising at least a certain number of embodiments, this means also including a group that preferably consists only of these embodiments.

[0013] It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to limit the scope of the present invention which will be limited only by the appended claims.

[0014] As used herein, the term "nausea" refers to a feeling of discomfort and discomfort in the upper stomach accompanied by involuntary vomiting ( Metz A.2017. Australian Family Physician, Vol. 36(9):688-692 ). It may occur before vomiting, but someone can be nauseous without vomiting. Over time, symptoms can be debilitating. Nausea is a nonspecific symptom, which means there can be many causes. Some common causes of nausea are motion sickness, dizziness, migraines, fainting, low blood sugar, gastroenteritis (stomach infection), or food poisoning. Nausea is a side effect of many medications, including chemotherapy or morning sickness in early pregnancy. Nausea can also be caused by anxiety, disgust, and depression.

[0015] As used herein, the term "headache" is a painful symptom anywhere in the head or neck area. It occurs in migraines (sharp or throbbing pain), tension-type headaches, and cluster headaches ( Waldman et al., 2014. Yoga and Journal of Physical Therapy 2014,4:1 ). People who have severe headaches are also at increased risk for depression. Many conditions can cause headaches, whether severe or not. There are many different headache classification systems. It is well known that causes of headaches can include fatigue, lack of sleep, stress, medication effects, recreational drug effects, viral infections, loud noises, the common cold, head injuries, rapid ingestion of very cold food or drink, and dental or sinus problems.

[0016] Headaches are broadly classified as either "primary" or "secondary" ( Oleson 2005. Functional Neurology 20(2):61- 68 ). Primary headaches are benign, recurring headaches that are not caused by an underlying disease or structural problem. For example, migraine is a primary headache. Although primary headaches can cause severe daily pain and disability, they are not dangerous. The four categories of primary headaches are: migraine, tension-type headaches (TTH), cluster headaches, and other trigeminal autonomic cerebral pains, and other primary headaches.

[0017] Secondary headaches of organic, metabolic or drug-induced origin are caused by an underlying disorder, such as infection, head injury, vascular conditions, brain hemorrhage or tumors. Secondary headaches may be harmless or dangerous. Migraine is a primary headache disorder characterized by recurrent headaches of moderate to severe intensity (for review, see: Diener et al., 2012. Nature Reviews Neurology 8(3):162-71). Typically, the headaches affect one half of the head, are pulsating in nature, and last from 2 to 72 hours. Accompanying symptoms may include nausea, vomiting, and sensitivity to light, sound or smells. The pain is often aggravated by physical activity. Up to one-third of people have an aura: a usually brief visual disturbance that indicates that the headache will soon occur. Occasionally, an aura occurs with little or no headache afterwards.

[0018] As used herein, the term "muscle pain", "muscle pain", also known as "myalgia", refers to a symptom of many diseases and conditions (for review, see: Kyriakides et al., 2013. Eur J Neurosci 20:997-1005 ). The most common cause is overuse or overstretching of a muscle or group of muscles. Myalgia without a history of trauma is often due to a viral infection. Long-term myalgia may indicate a metabolic myopathy, certain nutritional deficiencies, or chronic fatigue syndrome.

[0019] As used herein, the term "back pain" refers to a painful sensation in any part of the back. Back pain episodes may be acute, subacute or chronic, depending on duration. The pain may be characterized by a dull, shooting or stabbing pain, or a burning sensation. The pain may radiate to the arms and hands as well as the legs or feet, and may include paresthesias (tingling for no apparent reason), weakness or numbness in the legs and arms. The anatomical classification of back pain is based on the segment of the spine: cervical pain (neck), mid-back pain (chest), lower back pain (lumbar) or coccygeal pain (coccyx or sacrum pain), with pain in the lumbar region being the most common. The pain may originate from the muscles, nerves, bones, joints or other structures of the spine (spinal column), but internal structures (such as the gallbladder and pancreas) may also cause the referred back pain ( Cohen et al., 2008. BMJ 337:a2718 ).

[0020] As used herein, the term "shivering" (also known as "shivering") is a body function of warm-blooded animals in response to incipient hypothermia or simply feeling cold. When the core body temperature drops, the shiver reflex is triggered to maintain homeostasis. Skeletal muscles begin to shake in small movements, creating warmth by expending energy. Shivering can also be a response to a fever, as the person may feel cold. During a fever, the temperature set point of the hypothalamus increases. The increase in the set point causes the body temperature to increase (fever), but it also makes the patient feel cold until the new set point is reached. Severe cold shivers accompanied by violent shivering are called shivers. Shivers occur because the patient's body is shivering physiologically in an attempt to raise the body temperature to the new set point. Shivering can also occur after surgery, known as post-anesthetic shivering.

[0021] As used herein, the term "vomiting" refers to the involuntary forceful expulsion of gastric contents through the mouth and sometimes through the nose. Metz A. 2017. Australian Family Physician, Vol. 36(9): 688-692 ). Vomiting can be caused by a variety of conditions; it may be a specific response to an ailment such as gastritis or poisoning, or it may be a nonspecific sequelae of conditions ranging from brain tumors to increased intracranial pressure to overexposure to ionizing radiation.

[0022] As used herein, symptoms of a disease or condition in a patient in need of treatment and / or prevention of such symptoms are selected from disease indications including inflammation, autoimmune disease, metabolic disease, brain disease, cardiovascular disease, and drug-induced disease.

[0023] Below, the types of symptoms and diseases associated therewith are provided in the form of a non-limiting list. Note that the treatment or prevention described herein can be directed to more than one type of symptom. In addition, it should be noted that a given medical indication, disease or illness may be associated with more than one symptom.

[0024] The symptom "nausea" may be related to diseases within the abdomen, such as obstructive diseases (e.g. pyloric obstruction, small intestinal obstruction, colonic obstruction, superior mesenteric artery syndrome), intestinal infection (e.g. viral or bacterial infection), inflammatory diseases (e.g. cholecystitis, pancreatitis, appendicitis, hepatitis), sensorimotor dysfunction (e.g. gastroparesis, intestinal pseudo-obstruction, gastroesophageal reflux disease, chronic idiopathic nausea, functional vomiting, cyclic vomiting syndrome, rumination syndrome) or biliary colic; diseases outside the abdomen, such as cardiopulmonary disorders (e.g. cardiomyopathy, myocardial infarction), Inner ear diseases (e.g. motion sickness, labyrinthitis, malignant tumors), brain diseases (e.g. hemorrhage, abscess, hydrocephalus, malignant tumors), psychiatric disorders (e.g. anorexia and bulimia, depression), postoperative vomiting, nausea related to medications and drugs (e.g. chemotherapy and biological therapy, antibiotics, antiarrhythmic drugs, digoxin, oral hypoglycemic drugs, oral contraceptives), nausea related to endocrine / metabolic diseases (e.g. pregnancy, uremia, ketoacidosis, thyroid and parathyroid diseases, adrenal insufficiency), nausea due to poisoning due to liver failure, alcoholism, etc.

[0025] The symptom "back pain" may be associated with diseases caused by inflammation, especially in the acute phase, which usually lasts two weeks to three months, and can be associated with low back pain, trauma, injury, infection, cancer (especially cancers known to spread to the spine, such as breast cancer, lung cancer, and prostate cancer), etc.

[0026] Symptoms of "myalgia" or "muscle pain" may be related to injury or trauma, including sprains, hematomas, or overuse, where a muscle is used too much, too often, including protection from isolated injuries, chronic strain, caused by rhabdomyolysis, muscle pain associated with, for example, viral infections, compression injuries, medication-related (e.g., fibrates and statins, ACE inhibitors, certain antiretroviral drugs), severe potassium deficiency, fibromyalgia, Ehrlich-Danlos syndrome, autoimmune disorders (including, for example, mixed connective tissue disease, systemic lupus erythematosus, polymyalgia rheumatica, polymyositis (e.g., polymyositis, dermatomyositis, and inclusion body myositis), multiple sclerosis, myalgic encephalomyelitis (chronic fatigue syndrome), syndrome), familial Mediterranean fever, polyarteritis nodosa, DeWey's disease, morphea, sarcoidosis), metabolic diseases (e.g., carnitine palmitoyltransferase II deficiency, Conn's syndrome, adrenal insufficiency, hyperthyroidism, hypothyroidism, diabetes, hypogonadism, and ion channelopathies, Stickler syndrome, hypokalemia, hypotonia (low muscle tone), exercise intolerance, mastocytosis, peripheral neuropathy, eosinophilic myalgia syndrome, Baculo fever, herpes, hemochromatosis (also known as iron overload disease), delayed onset muscle soreness, AIDS, HIV infection, tumor-induced rickets, vitamin D deficiency, myocardial infarction.

[0027] The symptom "headache" can be associated with a primary headache. 90% of all headaches are primary headaches. Primary headaches usually first start between the ages of 20 and 40. The most common types of primary headaches are migraines and tension-type headaches. They have different characteristics. Migraines usually present with throbbing headaches, nausea, photophobia (sensitivity to light), and phonophobia (sensitivity to sound). Tension-type headaches usually present as non-pulsating "band-like" pressure on both sides of the head, without other symptoms. Other very rare types of primary headaches include: Cluster headaches: short-term attacks (15-180 minutes) of severe pain, usually around one eye, accompanied by autonomic symptoms (tearing, red eyes, nasal congestion), occurring at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine, or lithium. Trigeminal or occipital neuralgia, characterized by flashes of facial pain, continuous migraines, i.e., persistent unilateral pain with sharp attacks of pain. Primary stabbing headaches, i.e., recurrent attacks of stabbing "ice pick" or "jab-like rebound pains" lasting from 1 second to several minutes without autonomic symptoms (tearing, red eyes, stuffy nose). Primary cough headaches, which start suddenly after coughing, sneezing, or pulling (anything that increases pressure in the head) and last for several minutes. Serious causes must be ruled out before a "benign" primary cough headache can be diagnosed (see the Secondary Headache Red Flags section). Primary exertional headaches, characterized by throbbing, pulsating pain that begins during or after exercise and lasts from 5 minutes to 24 hours. The mechanism of these headaches is unclear, but they may be caused by traction that dilates the veins in the head, causing pain; primary sexual headaches, characterized by a dull, bilateral headache that begins during sexual activity and becomes worse during orgasm; headaches before bed; and secondary headaches that may be caused by problems elsewhere in the head or neck. Some of these are harmless, such as cervicogenic headache (pain arising from the muscles of the neck), medication overuse headaches from overuse of analgesics for headaches, meningitis characterized by inflammation of the meninges with fever and pseudomeningitis or neck stiffness; intracerebral hemorrhage (bleeding in the brain); subarachnoid hemorrhage (acute, severe headache, stiff neck without fever); ruptured aneurysm, arteriovenous malformation, intraparenchymal bleeding; temporal arteritis, an inflammatory artery disease common in older people (average age 70 years), polymyalgia rheumatica; acute angle-closure glaucoma (increased pressure in the eye); postictal headaches that occur after a seizure or other type of epileptic seizure as part of the postictal period (postictal state); gastrointestinal disorders that can cause headaches, including Helicobacter pylori infection, celiac disease, non-celiac gluten sensitivity, irritable bowel syndrome, inflammatory bowel disease, gastroparesis, and hepatobiliary disease. Treatment of gastrointestinal disorders can cause headache relief or improvement.

[0028] The term headache was defined as either a primary or secondary headache. Primary headaches were defined as migraine, tension-type headache (TTH), cluster headache and other trigeminal autonomic headaches, and other primary headaches.

[0029] The diagnosis or assessment of headache is well known in the art. The assessment can be performed based on subjective measures such as the patient's symptom presentation. For example, migraine can be diagnosed based on the following criteria: 1) a headache attack lasting 4 to 72 hours. 2) two of the following symptoms: unilateral pain, throbbing, aggravated by movement, and moderate or severe pain; 3) one of the following symptoms: nausea or vomiting, and photophobia or phonophobia ( Goadsby et al. New England Journal of Medicine 346:257-270, 2002 ).

[0030] The symptom "shivering" can be associated with fever, cold sensitivity, menopause, panic attacks, anxiety, bacterial infections, rickettsial infections, viral infections, medication withdrawal, etc.

[0031] The symptom "vomiting" can be associated with gastritis (inflammation of the stomach lining), gastroenteritis, gastroesophageal reflux disease, celiac disease, non-celiac gluten sensitivity, pyloric stenosis, intestinal obstruction, overeating, acute abdominal and / or peritonitis, intestinal obstruction, food allergies (often associated with hives or swelling); cholecystitis, pancreatitis, appendicitis, hepatitis; food poisoning, allergic reaction to milk proteins (such as milk allergy or lactose intolerance); motion sickness, Meniere's disease, concussion, cerebral hemorrhage, migraine, brain tumor, benign intracranial hypertension and hydrocephalus, metabolic disorders (such as hypercalcemia), uremia, adrenal insufficiency, hypoglycemia, hyperglycemia, drug reactions, alcoholism, opioid ingestion, selective serotonin reuptake inhibitors; use of chemotherapy drugs; stomach inflammation caused by a range of viruses and bacteria, such as norovirus, influenza; or psychiatric / behavioral disorders, such as bulimia nervosa and diarrhoea. BRIEF DESCRIPTION OF THE DRAWINGS

[0032] Figure 1 It was shown that disease scores were significantly lower for both 2 mg / kg and 8 mg / kg adezumab than for placebo between the 210 min (T210) and 450 min (T450) time points (p=0.011 and 0.005, respectively; GLM repeated measures).

[0033] Figure 2 The distribution of disease scores for each treatment group at T270 (time point 270 minutes) and T300 (time point 300 minutes) are shown. Figure 2 A and 2B), supporting the surprising beneficial effects of the antibodies of the present invention.

[0034] Figure 3 shows the contribution of the single disease score components to the effect: A) nausea, B) headache, C) muscle pain, D) back pain and E) tremor, where all symptoms shown contributed significantly to the effect and vomiting occurred only in two patients, once in each patient, and could not be analyzed.

[0035] Figure 4 An alternative assessment is shown, in which another score, the disease extent score, is assessed using a single question regarding overall disease extent, ranging from 0 to 10, and the results show that the disease extent score decreases more rapidly in patients treated with the anti-ADM antibody (adezumab).

[0036] Figure 5 It was shown that in healthy subjects, within the first 1.5 hours after administration of NT-H antibody, the ADM value increased rapidly, then reached a plateau and slowly decreased. DETAILED DESCRIPTION

[0037] Embodiments of the present invention are provided below. Note that, in general, an embodiment can be combined with any other embodiment of the same category (product, process, use, method).

[0038] One embodiment of the present invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for treating or preventing disease symptoms or for treating or preventing diseases characterized by such symptoms. The symptoms can be selected from nausea, headache, muscle pain, back pain, tremor, vomiting in a subject in need thereof. The antibody or fragment or scaffold binds to mature ADM, such as amino acids 1-52 of ADM (SEQ ID NO: 1), or a fragment of mature ADM, such as the middle region of ADM (MR-ADM) (SEQ ID NO: 3) or the N-terminus of ADM (SEQ ID NO: 4), as described below.

[0039] Therefore, another embodiment of the present invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms, wherein the antibody or fragment or scaffold binds to mature ADM, e.g., amino acids 1-52 of ADM (SEQ ID NO: 1), or a fragment thereof as defined above.

[0040] Another embodiment of the present invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for treating or preventing a disease characterized by symptoms such as nausea, headache, muscle pain, back pain, tremor, vomiting, etc., wherein the antibody or fragment or scaffold binds to mature ADM, such as amino acids 1-52 of ADM (SEQ ID NO: 1), or a fragment thereof as defined above.

[0041] In a further embodiment, the invention relates to an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold for use in treating or preventing a disease in a subject in need thereof, wherein the antibody or fragment or scaffold binds mature ADM, e.g., ADM of amino acids 1 to 52 (SEQ ID NO: 1) as defined above, or a fragment thereof, and wherein the disease is selected from the following indications, wherein the amount of C-reactive protein (CRP) in the sample is ≥ 10 mg / L, and / or wherein the amount of TNF in the sample is ≥ 50 pg / ml, and / or the amount of bio-ADM in the sample is ≥ 43 pg / ml, and / or wherein mean arterial pressure is reduced.

[0042] In another embodiment, the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing a disease in a subject in need thereof, wherein the antibody or fragment or scaffold binds mature ADM, e.g., amino acids 1-52 of ADM as defined above (SEQ ID NO: 1), or a fragment thereof, and wherein the disease is migraine.

[0043] In another embodiment, the present invention relates to an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold for use in treating or preventing a disease in a subject in need thereof, wherein the antibody or fragment or scaffold binds mature ADM, e.g., amino acids 1-52 of ADM as defined above (SEQ ID NO: 1), or a fragment thereof, and wherein the disease is migraine, wherein the amount of C-reactive protein (CRP) in the sample of the subject in need thereof is ≥ 10 mg / L, and / or wherein the amount of TNF is ≥ 50 pg / ml, and / or wherein the amount of bio-ADM is ≥ 43 pg / ml, and / or wherein mean arterial pressure is reduced.

[0044] In another embodiment, the present invention relates to an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold for use in treating or preventing a disease in a subject in need thereof, wherein the antibody or fragment or scaffold binds to mature ADM, e.g., amino acids 1-52 of ADM as defined above (SEQ ID NO: 1), or a fragment thereof, and wherein the disease is migraine, wherein the amount of C-reactive protein (CRP) in the sample of the subject in need thereof is ≥ 10 mg / L, and / or wherein the amount of TNF is ≥ 50 pg / ml, and / or wherein the amount of bio-ADM is ≥ 43 pg / ml, and / or wherein the mean arterial pressure is reduced, and wherein the subject in need thereof shows at least one of the following disease symptoms selected from: nausea, headache, muscle pain, back pain, tremor, vomiting.

[0045] In one embodiment of the invention, the sample is selected from the group consisting of whole blood, plasma and serum.

[0046] Mean arterial pressure (MAP) is defined as the average pressure in a patient's arteries during one cardiac cycle. It is considered an indicator of perfusion to vital organs. A MAP greater than 70 mmHg is believed to be sufficient to maintain the organs of an average person. In the context of the present invention, the term "reduced mean arterial pressure" refers to a MAP below 75 mmHg.

[0047] The mature adrenomedullin peptide is an amidated peptide (ADM-NH2) comprising 52 amino acids (SEQ ID NO: 1) and comprising amino acids 95 to 146 of pre-proADM 1-146, which is formed by proteolytic cleavage of pre-proADM 1-146. Throughout the application, mature ADM, bio-ADM and ADM-NH2 are used synonymously and are the molecule of SEQ ID No.: 1.

[0048] Another embodiment of the invention relates to an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold according to the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, backache, pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, wherein the antibody or fragment or scaffold binds to the N-terminal portion (aa 1-21) of ADM:

[0049] YRQSMNNFQGLRSFGCRFGTC (SEQ ID No. 4).

[0050] Another embodiment of the present invention relates to an anti-ADM antibody or an anti-ADM antibody fragment that binds to ADM or an anti-ADM non-Ig scaffold that binds to ADM for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, according to any of the preceding embodiments, wherein the antibody, antibody fragment or non-Ig scaffold binds to the middle region of adrenomedullin aa 21-42:

[0051] CTVQKLAHQIYQFTDKDKDNVA (SEQ ID No. 3).

[0052] Another embodiment of the invention relates to an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, wherein the antibody or antibody fragment or non-Ig scaffold is monospecific, in particular monoclonal.

[0053] Another embodiment of the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof according to any of the preceding embodiments, wherein the antibody or fragment or scaffold exhibits a binding affinity for ADM of at least 10 based on label-free surface plasmon resonance using a Biacore 2000 system. -7 M.

[0054] Another embodiment of the invention relates to an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof according to any of the preceding embodiments, wherein the antibody or fragment or scaffold is not ADM-binding-protein 1 (complement factor H).

[0055] Another embodiment of the invention relates to an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, wherein the antibody or fragment or scaffold recognizes and binds to the N-terminus (aa 1) of ADM.

[0056] Another embodiment of the present invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof according to any of the preceding embodiments, wherein the antibody or fragment or scaffold is such that the half-life (t 1 / 2 The half retention time (half retention time) is prolonged by at least 10%, preferably by at least 50%, more preferably by >50%, and most preferably by >100% of the ADM-stabilized antibody or fragment or scaffold.

[0057] Another embodiment of the invention relates to an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof according to any of the preceding embodiments, wherein in CHO-K1 cells expressing human recombinant ADM receptor, using hADM 22-52 as a reference antagonist, the antibody or fragment or scaffold blocks no more than 80%, preferably no more than 50% of the ADM biological activity.

[0058] Another embodiment of the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any of the preceding embodiments, wherein the subject in need thereof is selected from a subject suffering from the following conditions: migraine, viral infection, drug-induced disease symptoms (e.g., chemotherapy-induced, or induced by treatment with biologics, antibiotics, antiviral compounds, etc.). In a specific embodiment, the condition or disease (these terms are used interchangeably) is migraine.

[0059] Another embodiment of the present invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremors, vomiting in a subject, wherein the subject is undergoing cancer treatment (chemotherapy).

[0060] Chemotherapy is a type of cancer treatment that uses one or more anticancer drugs (chemotherapeutic agents) as part of a standard chemotherapy regimen. Chemotherapy drugs may include the following drug classes: alkylating agents, kinase inhibitors, vinca alkaloids, anthracyclines, antimetabolites, aromatase inhibitors, topoisomerase inhibitors, engineered anticancer agents (e.g., monoclonal antibodies), cytokines, gene therapy vectors, antisense, and peptide molecules.

[0061] Another embodiment of the present invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject according to any of the preceding embodiments, wherein the antibody or fragment is a human monoclonal antibody or fragment that binds to the N-terminal region (aa 1-21) of ADM (SEQ ID No. 4) or an antibody fragment thereof, wherein the heavy chain comprises the following sequence:

[0062] CDR1: SEQ ID NO: 5

[0063] GYTFSRYW

[0064] CDR2: SEQ ID NO: 6

[0065] ILPGSGST

[0066] CDR3: SEQ ID NO: 7

[0067] TEGYEYDGFDY

[0068] The light chain contains the following sequence:

[0069] CDR1: SEQ ID NO: 8

[0070] QSIVYSNGNTY

[0071] CDR2:

[0072] RVS

[0073] CDR3: SEQ ID NO: 9

[0074] FQGSHIPYT.

[0075] Another embodiment of the present invention relates to a human monoclonal antibody or fragment that binds to ADM or an antibody fragment thereof for use in a subject for treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, according to any of the preceding embodiments, wherein the antibody or fragment comprises as a VH region a sequence selected from the following sequences:

[0076] SEQ ID NO:10 (AM-VH-C)

[0077] QVQLQQSGAELMKPGASVKISCKATGYTFSRYWIEWVKQRPGHGLEWIGEILPGSGSTNYNEKFKGKATITADTSSNTAYMQLSSSLTSEDSAVYYCTEGYEYDGFDYWGQGT TLTVSSASTKGPSVFPLAPSSKSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0078] SEQ ID NO:11 (AM-VH1)

[0079] QVQLVQSGAEVKKPGSSVKVSCKASGYTFSRYWISWVRQAPGQGLEWMGRILPGSGSTNYAQKFQGRVTITADESTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGTTVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0080] SEQ ID NO:12(AM-VH2-E40)

[0081] QVQLVQSGAEVKKPGSSVKVSCKASGYTFSRYWIEWVRQAPGQGLEWMGRILPGSGSTNYAQKFQGRVTITADESTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGTTVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0082] SEQ ID NO:13(AM-VH3-T26-E55)

[0083] QVQLVQSGAEVKKPGSSVKVSCKATGYTFSRYWISWVRQAPGQGLEWMGEILPGSGSTNYAQKFQGRVTITADESTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGTTVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0084] SEQ ID NO:14(AM-VH4-T26-E40-E55)

[0085] QVQLVQSGAEVKKPGSSVKVSCKATGYTFSRYWIEWVRQAPGQGLEWMGEILPGSGSTNYAQKFQGRVTITADESTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGTTVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0086] and includes the following sequence as the VL region:

[0087] SEQ ID NO:15(AM-VL-C)

[0088] DVLLSQTPLSLPVSLGDQATISCRSSQSIVYSNGNTYLEWYLQKPGQSPKLLIYRVSNRFSGVPDRFSGSGSGTDFTLKISRVEAEDLGVYYCFQGSHIPYTFGGGTKLEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC

[0089] SEQ ID NO:16(AM-VL1)

[0090] DVVMTQSPLSLPVTLGQPASISCRSSQSIVYSNGNTYLNWFQQRPGQSPRRLIYRVSNRDSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYYCFQGSHIPYTFGQGTKLEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC

[0091] SEQ ID NO:17(AM-VL2-E40)

[0092] DVVMTQSPLSLPVTLGQPASISCRSSQSIVYSNGNTYLEWFQQRPGQSPRRLIYRVSNRDSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYYCFQGSHIPYTFGQGTKLE IKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC.

[0093] Another embodiment of the invention relates to a human monoclonal antibody or fragment that binds to ADM or an antibody fragment thereof for use in a subject for treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, according to any of the preceding embodiments, wherein the antibody or fragment comprises the following sequence as a heavy chain:

[0094] SEQ ID NO:22

[0095] QVQLVQSGAEVKKPGSSVKVSCKASGYTFSRYWIEWVRQAPGQGLEWIGEILPGSGSTNYNQKFQGRVTITADTSTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGT TVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEPKSCDKT HTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKT ISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFScSVMHEALHNHYTQKSLSLSPGK

[0096] and contains the following sequence as a light chain:

[0097] SEQ ID NO:23

[0098] DVVLTQSPLSLPVTLGQPASISCRSSQSIVYSNGNTYLEWYLQRPGQSPRLLIYRVSNRFSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYYCFQGSHIPYTFGGGTKLE IKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC.

[0099] In a specific embodiment of the invention, the antibody comprises the following sequence or a sequence with >95%, preferably >98%, preferably >99% identity thereto as a heavy chain:

[0100] SEQ ID NO:22

[0101] QVQLVQSGAEVKKPGSSVKVSCKASGYTFSRYWIEWVRQAPGQGLEWIGEILPGSGSTNYNQKFQGRVTITADTSTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGT TVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEPKSCDKT HTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKT ISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK,

[0102] And comprises the following sequence or a sequence with identity >95%, preferably >98%, preferably >99% thereof as a light chain:

[0103] SEQ ID NO:23

[0104] DVVLTQSPLSLPVTLGQPASISCRSSQSIVYSNGNTYLEWYLQRPGQSPRLLIYRVSNRFSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYYCFQGSHIPYTFGGGTKLE IKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC.

[0105] To assess the identity between two amino acid sequences, a pairwise alignment is performed. Identity is defined as the percentage of directly matching amino acids in the alignment.

[0106] A pharmaceutical composition comprising the antibody as described above.

[0107] Another embodiment of the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, used in combination with a known anti-nausea agent.

[0108] Another embodiment of the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, used in combination with a known anti-headache agent.

[0109] Another embodiment of the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, used in combination with a known antimyalgia agent.

[0110] Another embodiment of the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, used in combination with a known anti-tremor agent.

[0111] Another embodiment of the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, used in combination with a known anti-emetic agent.

[0112] Another embodiment of the invention relates to an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to any of the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, used in combination with a known back pain agent.

[0113] Another embodiment of the invention relates to a pharmaceutical formulation for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, comprising an antibody or fragment or scaffold according to any one of the preceding embodiments.

[0114] Another embodiment of the present invention relates to a pharmaceutical formulation for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof according to the preceding embodiments, wherein the pharmaceutical formulation is a solution, preferably a ready-to-use solution.

[0115] Another embodiment of the present invention relates to a pharmaceutical formulation according to the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject, wherein the pharmaceutical formulation is in a lyophilized state.

[0116] Another embodiment of the invention relates to a pharmaceutical formulation for use in treating or preventing a symptom of a disease selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, according to any of the preceding embodiments relating to such formulations, wherein the pharmaceutical formulation is administered intramuscularly.

[0117] Another embodiment of the invention relates to a pharmaceutical formulation for use in treating or preventing a symptom of a disease selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject in need thereof, according to any of the preceding embodiments relating to such formulations, wherein the pharmaceutical formulation is administered intravascularly.

[0118] Another embodiment of the invention relates to a pharmaceutical formulation according to the preceding embodiments for use in treating or preventing a disease symptom selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject, wherein the pharmaceutical formulation is administered by infusion.

[0119] Another embodiment of the invention relates to a pharmaceutical formulation according to any of the preceding embodiments relating to such formulations for use in treating or preventing a symptom of a disease selected from nausea, headache, muscle pain, back pain, tremor, vomiting, or for treating or preventing a disease characterized by such symptoms, such as migraine, in a subject, wherein the pharmaceutical formulation is to be administered systemically.

[0120] As used herein, the definition of "illness score" relates to the clinical symptoms caused by LPS, including nausea, headache, muscle aches, back pain, tremors and vomiting. These symptoms are combined into one score (=illness score): for example, each symptom is scored on a scale of 0 to 5, except for vomiting (0 or 3, depending on whether vomiting occurred in the past 30 minutes). The sickness score is the sum of all symptoms (theoretical range is 0 to 28).

[0121] It should be emphasized that the embodiments described herein involving anti-ADM antibodies or anti-ADM antibody fragments or anti-ADM non-Ig scaffolds are intended for the treatment or prevention of symptoms associated with a disease and are therefore not necessarily intended to be any primary treatment or first-line treatment for an acute disease or acute condition itself, which must be considered an underlying disease. This means that the present invention does not provide a curative therapy for, for example, cancer, sepsis, septic shock, COPD, congestive heart disease (acute heart failure).

[0122] In addition, in an embodiment of the present invention, the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold is monospecific. A monospecific anti-ADM antibody or a monospecific anti-ADM antibody fragment or a monospecific anti-ADM non-Ig scaffold refers to a specific region of the antibody or antibody fragment or non-Ig scaffold that binds to the target ADM containing at least 5 amino acids. A monospecific anti-ADM antibody or a monospecific anti-ADM antibody fragment or a monospecific anti-ADM non-Ig scaffold is an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold that all have affinity for the same antigen.

[0123] In a specific and preferred embodiment, the present invention provides a monospecific anti-ADM antibody or a monospecific anti-ADM antibody fragment or a monospecific anti-ADM non-Ig scaffold, characterized in that the antibody or antibody fragment or non-Ig scaffold binds to a specific region of the target ADM containing at least 4 amino acids. In another specific embodiment, the anti-ADM antibody or antibody fragment that binds to ADM is a monospecific antibody. Monospecific means that the antibody or antibody fragment binds to a specific region of the target ADM that preferably contains at least 4 or at least 5 amino acids. Monospecific antibodies or fragments are antibodies or fragments that all have affinity for the same antigen. Monoclonal antibodies are monospecific, but monospecific antibodies can also be produced by other means besides being produced from common germ cells.

[0124] The antibody according to the present invention is a protein comprising one or more polypeptides substantially encoded by immunoglobulin genes of specific binding antigens. Recognized immunoglobulin genes include κ, λ, α (IgA), γ (IgG1, IgG2, IgG3, IgG4), δ (IgD), ε (IgE) and μ (IgM) constant region genes, as well as countless immunoglobulin variable region genes. The length of a full-length immunoglobulin light chain is generally about 25kDa or 214 amino acids. The length of a full-length immunoglobulin heavy chain is generally about 50kDa or 446 amino acids. The light chain is encoded by a variable region gene (length of about 110 amino acids) at the NH2-end and a κ or λ constant region gene at the COOH-end. The heavy chain is similarly encoded by a variable region gene (length of about 116 amino acids) and one of the other constant region genes.

[0125] The basic structural unit of an antibody is usually a tetramer, which consists of two pairs of identical immunoglobulin chains, each pair having one light chain and one heavy chain. In each pair, the light and heavy chain variable regions bind to the antigen, and the constant regions mediate effector functions. Immunoglobulins also exist in a variety of other forms, including, for example, Fv, Fab and (Fab')2, as well as bifunctional hybrid antibodies and single chains (e.g. Lanzavecchia et al., 1987. European Journal of Immunology 17:105; Huston et al., 1988. PNAS 85: 5879-5883; Bird et al., 1988. Science 242:423-426; Hood et al., 1984. Immunology, Benjamin, NY, 2nd edition; Hunkapiller and Hood, 1986. Nature 323:15-16 ). The variable region of an immunoglobulin light chain or heavy chain comprises a framework region interspersed with three hypervariable regions, also called complementarity determining regions (CDRs) (see E. Kabat et al., U.S. Department of Health and Human Services, "Protein Sequences of Immunological Interest", 1983). As described above, the CDRs are primarily responsible for binding to the epitope of the antigen. An immune complex is an antibody, such as a monoclonal antibody, a chimeric antibody, a humanized antibody or a human antibody or a functional antibody fragment, that specifically binds to an antigen.

[0126] Chimeric antibodies are antibodies that have been constructed of light chain and heavy chain genes from immunoglobulin variable and constant region genes belonging to different species, usually by genetic engineering. For example, the variable segment of the gene from a mouse monoclonal antibody can be connected to a human constant segment, such as κ and γ1 or γ3. In one example, therapeutic chimeric antibodies are therefore hybrid proteins composed of variable or antigen-binding domains from mouse antibodies and constant or effector domains from human antibodies, although other mammalian species can be used, or variable regions can be produced by molecular techniques. Methods for preparing chimeric antibodies are well known in the art, for example, referring to U.S. Patent No. 5,807,715. "Humanized" immunoglobulins are immunoglobulins comprising human framework regions and one or more CDRs from non-human (e.g., mouse, rat or synthetic) immunoglobulins. The non-human immunoglobulins providing CDRs are referred to as "donors", and the human immunoglobulins providing frameworks are referred to as "acceptors". In one embodiment, all CDRs in humanized immunoglobulins are from donor immunoglobulins. Constant regions do not have to be present, but if present, they must be substantially identical to human immunoglobulin constant regions, i.e., at least about 85-90%, such as about 95% or more identity. Therefore, except for possible CDRs, all parts of humanized immunoglobulins are substantially identical to corresponding parts of natural human immunoglobulin sequences. "Humanized antibodies" are antibodies comprising humanized light chain and humanized heavy chain immunoglobulins. Humanized antibodies bind to the same antigen as the donor antibody providing the CDRs. The acceptor framework of a humanized immunoglobulin or antibody can be substituted with a limited number of amino acids from the donor framework. Humanized or other monoclonal antibodies may have other conservative amino acid substitutions that have substantially no effect on antigen binding or other immunoglobulin functions. Exemplary conservative substitutions are, for example, gly, ala; val, ile, leu; asp, glu; asn, gin; ser, thr; lys, arg; and phe, tyr. Humanized immunoglobulins can be constructed by genetic engineering (e.g., see U.S. Patent No. 5,585,089). Human antibodies are antibodies in which the light chain and heavy chain genes are derived from humans. Human antibodies can be produced using methods known in the art. Human antibodies can be produced by immortalizing human B cells that secrete the antibody of interest. Immortality can be achieved, for example, by EBV infection or by fusing human B cells with myeloma or hybridoma cells to produce tri-tumor cells. Human antibodies can also be produced by phage display methods (see, e.g., Dower et al., PCT Publication No. WO 91 / 17271; McCafferty et al.; PCT Publication No. WO 92 / 001047; and Winter, PCT Publication No. WO 92 / 20791), or selected from human combinatorial monoclonal antibody libraries (see Morphosys website).Human antibodies can also be prepared by using transgenic animals carrying human immunoglobulin genes (eg, see PCT Publication No. WO 93 / 12227; and PCT Publication No. WO 91 / 10741).

[0127] Therefore, the anti-ADM antibody can have a form known in the art. Examples are human antibodies, monoclonal antibodies, humanized antibodies, chimeric antibodies, CDR-grafted antibodies. In a preferred embodiment, the antibody according to the present invention is a recombinantly produced antibody, such as IgG, a typical full-length immunoglobulin, or an antibody fragment comprising at least the F variable domain of the heavy chain and / or light chain, for example, a chemically coupled antibody (antigen binding fragment), including but not limited to Fab fragments, including Fab miniantibodies, single-chain Fab antibodies, monovalent Fab antibodies with epitope tags, such as Fab-V5Sx2; divalent Fab (miniantibodies) dimerized with a CH3 domain; divalent Fab or multivalent Fab, for example, multimerized with the aid of a heterologous domain, such as formed by dimerization of a dHLX domain, such as Fab-dHLX-FSx2; F(ab')2-fragment, scFv fragment, multi-multivalent or / and multi-specific scFv fragment, bivalent and / or bispecific diabody (bispecific T cell engagers), trifunctional antibodies, multivalent antibodies, for example, from a different class than G; single domain antibodies, such as nanobodies derived from camelid or fish immunoglobulins, etc.

[0128] In addition to anti-ADM antibodies, other biopolymer scaffolds are well known in the art, complex target molecules, and have been used to generate highly target-specific biopolymers. Examples are aptamers, spiegelmers, anticalins, and conotoxins. For a description of antibody formats, see WO 2013 / 072513. Figure 1 a, 1b and 1c.

[0129] Antibody fragments according to the invention are antigen-binding fragments of the antibodies according to the invention.

[0130] In a preferred embodiment, the ADM antibody form is selected from Fv fragments, scFv fragments, Fab fragments, scFab fragments, (Fab) 2 fragments and scFv-Fc fusion proteins. In another preferred embodiment, the antibody form is selected from scFab fragments, Fab fragments, scFv fragments and bioavailability optimized conjugates thereof, such as PEGylated fragments. One of the most preferred forms is the scFab form.

[0131] The non-Ig scaffold can be a protein scaffold and can be used as an antibody mimetic because they are able to bind to a ligand or antigen. The non-Ig scaffold can be selected from a tetranectin-based non-Ig scaffold (e.g., described in US2010 / 0028995), a fibronectin scaffold (e.g., described in EP 1266025); a scaffold based on lipocalin (e.g., described in WO 2011 / 154420); a ubiquitin scaffold (e.g., described in WO 2011 / 073214), a transfer scaffold (e.g., described in US2004 / 0023334), a protein A scaffold (e.g., described in EP 2231860), a scaffold based on ankyrin repeats (e.g., described in WO 2010 / 060748), a microprotein (preferably a microprotein that forms a cystine knot) scaffold (e.g., described in EP 2314308), a scaffold based on Fyn SH3 domains (e.g., described in WO 2011 / 023685), EGFR-A domain-based scaffolds (e.g., described in WO 2005 / 040229) and Kunitz domain-based scaffolds (e.g., described in EP 1941867).

[0132] In one embodiment of the invention, the antibodies according to the invention can be produced as follows: Balb / c mice are immunized with 100 μg ADM-peptide-BSA-conjugate (emulsified in 100 μl complete Freund's adjuvant) on days 0 and 14, and 50 μg (in 100 μl incomplete Freund's adjuvant) on days 21 and 28. Three days before the fusion experiment, the animals receive 50 μg of the conjugate dissolved in 100 μl saline, given with one intraperitoneal injection and one intravenous injection. The spleen cells from the immunized mice and the cells of the myeloma cell line SP2 / 0 are fused with 1 ml 50% polyethylene glycol at 37° C. for 30 s. After washing, the cells are seeded in 96-well cell culture plates. Hybrid clones are selected by growing in HAT culture medium (RPMI1640 culture medium supplemented with 20% fetal bovine serum and HAT-supplements). After two weeks, the HAT culture medium is replaced with HT culture medium three times, and then returned to normal cell culture medium. Three weeks after confluency, cell culture supernatants were screened for initial antigen-specific IgG antibodies. Microcultures that tested positive were transferred to 24-well plates for propagation. After retesting, selected cultures were cloned and recloned using limiting dilution techniques and isotyped (see also Lane, R.D. 1985. Journal of Immunological Methods 81:223-228; Ziegler B et al. 1996. Hormone and Metabolic Research 28:11-15 ).

[0133] Antibodies can also be produced by phage display according to the following procedure: human natural antibody gene library HAL7 / 8 is used to separate the recombinant single-chain F variable domain (scFv) for ADM peptide. The antibody gene library is screened with a panning strategy, which includes using a peptide containing a biotin tag connected to the ADM peptide sequence by two different spacers. The panning round of the antigen bound by non-specific binding and streptavidin is mixed to minimize the background of non-specific binding agents. The phage from the elution of the third round of panning has been used to produce an Escherichia coli strain expressing monoclonal scFv. The supernatant from the culture of these clonal strains has been directly used for antigen ELISA test (see references cited in WO 2013 / 072513, which are incorporated herein in their entirety).

[0134] The humanization of murine antibodies can be performed according to the following procedure: For the humanization of murine antibodies, the structural interactions of the framework region (FR) of the antibody sequence with the complementary determining region (CDR) and the antigen are analyzed. Based on structural modeling, appropriate human FRs are selected, and the mouse CDR sequences are transplanted into human FRs. Changes in the amino acid sequence of CDR or FR can be introduced to restore structural interactions, which are eliminated by species conversion of FR sequences. In a preferred embodiment, this restoration of structural interactions can be achieved by a random method using a phage display library or by a direct method guided by molecular modeling ( Almagro and Fransson 2008. Journal of Frontiers in Biological Sciences 13:1619-33 ). The ADM antibody form is selected from Fv fragments, scFv fragments, Fab fragments, scFab fragments, F(ab)2 fragments and scFv-Fc fusion proteins. In another preferred embodiment, the antibody form is selected from scFab fragments, Fab fragments, scFv fragments and bioavailability optimized conjugates thereof, such as PEGylated fragments. One of the most preferred forms is the scFab form. In another preferred embodiment, the anti-ADM antibody, anti-ADM antibody fragment or anti-ADM non-Ig scaffold is a full-length antibody, antibody fragment or non-Ig scaffold.

[0135] In a preferred embodiment, the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold is directed to and can bind to an epitope of at least 5 amino acids in length contained in ADM.

[0136] In another preferred embodiment, the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold is directed to and can bind to an epitope of at least 4 amino acids in length contained in ADM.

[0137] In a specific embodiment of the present invention, an anti-ADM antibody or anti-ADM antibody fragment or an anti-ADM non-Ig scaffold that binds to ADM is provided for treating an acute disease or acute condition in a patient, wherein the antibody or fragment or scaffold is not ADM binding protein 1 (complement factor H). The acute disease or acute condition may be migraine.

[0138] In a specific embodiment of the present invention, an anti-ADM antibody or an anti-ADM antibody fragment that binds to ADM or an anti-ADM non-Ig scaffold that binds to ADM is provided for treating an acute disease or acute condition in a patient, wherein the antibody or antibody fragment or non-Ig scaffold binds to a region of preferably at least 4 or at least 5 amino acids within the sequence of amino acids 1-42 of mature human ADM.

[0139] The above-mentioned acute disease or acute condition may be headache, preferably primary headache, most preferably migraine.

[0140] In a specific embodiment of the present invention, an anti-ADM antibody or anti-ADM antibody fragment or an anti-ADM non-Ig scaffold that binds to ADM is provided for use in treating an acute disease or acute condition in a patient, wherein the antibody or fragment or scaffold binds to a region of preferably at least 4 or at least 5 amino acids within the sequence of amino acids 1-21 of mature human ADM:

[0141] YRQSMNNFQGLRSFGCRFGTC (SEQ ID NO.: 4).

[0142] The above-mentioned acute disease or acute condition may be migraine.

[0143] In a preferred embodiment of the present invention, the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold binds to the region of ADM located in the N-terminal portion of ADM (amino acids 1-21).

[0144] In another preferred embodiment, the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold recognizes and binds to the N-terminus (aa1) of ADM. The N-terminus refers to amino acid 1, i.e., "Y" of SEQ ID No. 1 or 4 is essential for antibody binding. The antibody or fragment or non-Ig scaffold will not bind to N-terminally extended or N-terminally modified ADM and N-terminally degraded ADM.

[0145] In a preferred embodiment, the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold is directed to and can bind to an epitope of at least 5 amino acids in length contained in ADM, preferably in human ADM.

[0146] In a preferred embodiment, the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold is directed to and can bind to an epitope of at least 4 amino acids in length contained in ADM, preferably in human ADM.

[0147] In a specific embodiment, it is preferred to use an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold according to the present invention, wherein the anti-ADM antibody or the anti-ADM antibody fragment or the anti-ADM non-Ig scaffold is an ADM stable antibody or an ADM stable antibody fragment or an ADM stable non-Ig scaffold, which can extend the half-life (t 1 / 2 The half-retention time (half retention time) of ADM can be extended by at least 10%, preferably at least 50%, more preferably>50%, and most preferably>100%. The half-life (half retention time) of ADM can be measured in human plasma by quantitative ADM using an immunoassay in the absence and presence of ADM stabilizing antibodies or ADM stabilizing antibody fragments or ADM stabilizing non-Ig scaffolds, respectively.

[0148] You can perform the following steps:

[0149] - ADM can be diluted in human citrated plasma in the absence and presence of ADM stabilizing antibodies or ADM stabilizing antibody fragments or ADM stabilizing non-IG scaffolds, respectively, and can be incubated at 24°C;

[0150] - Aliquots were taken at selected time points (eg within 24 hours) and degradation of ADM was stopped by freezing at -20°C.

[0151] - If the chosen assay is not affected by stabilizing antibodies, the amount of ADM can be determined directly by hADM immunoassay. Alternatively, an aliquot can be treated with a denaturant such as HCl and after clarifying the sample (e.g. by centrifugation), the pH can be neutralized and ADM quantified by ADM immunoassay. Alternatively, ADM quantification can be performed using non-immunoassay techniques (e.g., RP-HPLC).

[0152] - Calculation of the ADM half-life of ADM incubated in the absence and presence of ADM stabilizing antibodies or ADM stabilizing antibody fragments or ADM stabilizing non-IG scaffolds, respectively.

[0153] - The half-life extension of stabilized ADM was calculated compared to ADM incubated in the absence of ADM stabilizing antibody or ADM stabilizing antibody fragment or ADM stabilizing non-Ig scaffold.

[0154] A two-fold increase in the half-life of ADM is a 100% increase in the half-life. The half-life (half retention time) is defined as the time required for the concentration of a chemical or drug in a specific fluid or blood to drop to half of the baseline concentration.

[0155] In a specific embodiment, the anti-ADM antibody, anti-ADM antibody fragment or anti-ADM non-Ig scaffold is a non-neutralizing antibody, fragment or non-Ig scaffold. Neutralizing anti-ADM antibody, anti-ADM antibody fragment or anti-ADM non-Ig scaffold will block close to 100%, at least greater than 90%, preferably at least greater than 95% of the ADM biological activity.

[0156] In contrast, a non-neutralizing anti-ADM antibody, anti-ADM antibody fragment or anti-ADM non-Ig scaffold blocks less than 100%, preferably less than 95%, preferably less than 90%, more preferably less than 80%, and even more preferably less than 50% of the biological activity of ADM. This means that the residual biological activity of ADM bound to the non-neutralizing anti-ADM antibody, anti-ADM antibody fragment or anti-ADM non-Ig scaffold will be greater than 0%, preferably greater than 5%, preferably greater than 10%, more preferably greater than 20%, and more preferably greater than 50%. In this context, molecules that are antibodies or antibody fragments or non-Ig scaffolds having "non-neutralizing anti-ADM activity", collectively referred to herein for simplicity as "non-neutralizing" anti-ADM antibodies, antibody fragments or non-Ig scaffolds that block less than 80% of the biological activity of ADM, are defined as molecules that bind to ADM and that, upon addition to a culture of a eukaryotic cell line expressing a functional human recombinant ADM receptor consisting of CRLR (calcitonin receptor-like receptor) and RAMP3 (receptor activity modifying protein 3), reduce the amount of cAMP produced by the cell line by the action of a human synthetic ADM peptide added in parallel, wherein the added human synthetic ADM is added in an amount that causes half-maximal stimulation of cAMP synthesis in the absence of the non-neutralizing antibody to be analyzed, wherein the degree of cAMP reduction caused by the molecule to be analyzed that binds to ADM does not exceed 80% even when the non-neutralizing molecule to be analyzed that binds to ADM is added in an amount that is 10 times the amount required for the maximum reduction in cAMP synthesis obtainable with the non-neutralizing antibody. The same definition applies to other ranges, 95%, 90%, 50%, etc.

[0157] In a specific embodiment according to the present invention, an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold is used, wherein the antibody or antibody fragment or non-Ig scaffold blocks less than 80% of (baseline value), preferably less than 50% of (baseline value) of the ADM bioactivity. This means blocking no more than 80% or no more than 50% of the circulating ADM, respectively. It is understood that even when the concentration of the antibody, antibody fragment or non-Ig scaffold is too high, that is, when the antibody, antibody fragment or non-Ig scaffold is in excess relative to ADM, the limited blocking of the bioactivity of ADM will occur. The limited blocking is an inherent property of the ADM binder itself. That is, the antibody, antibody fragment or non-Ig scaffold has a maximum inhibition of 80% or 50%, respectively. This implies that despite the administration of an appropriate or excessive amount of the antibody, antibody fragment or non-Ig scaffold, respectively, there is still 20% or 50% of residual ADM bioactivity, respectively.

[0158] In a preferred embodiment, the anti-ADM antibody, anti-ADM antibody fragment or anti-ADM non-Ig scaffold will block at least 5% of the biological activity of ADM. This implies that there is still a residual 95% circulating ADM biological activity. This is a lower threshold of biological activity remaining after the anti-ADM antibody, anti-ADM antibody fragment or anti-ADM non-Ig scaffold is used. Biological activity is defined as the effect of a substance on a living organism or tissue or organ or functional unit after its interaction in vivo or in vitro (e.g., in an assay). In the case of ADM biological activity, this may be the effect of ADM in the human recombinant ADM receptor cAMP functional assay. Therefore, according to the present invention, biological activity is defined by the ADM receptor cAMP functional assay. In order to determine the biological activity of ADM in this assay, the following steps can be performed:

[0159] - Perform dose response curves with ADM in the human recombinant ADM receptor cAMP functional assay.

[0160] - The ADM concentration for half-maximal cAMP stimulation can be calculated.

[0161] - Dose response curves (up to 100 μl final concentration) were performed with ADM stabilized antibody or ADM stabilized antibody fragment or ADM stabilized non-Ig scaffold, respectively, at a constant ADM concentration that stimulated half-maximal cAMP.

[0162] The maximum (at the maximum dose) inhibition of the ADM stabilizing antibody is 50%, which means that the ADM antibody or the ADM antibody fragment or the ADM non-Ig scaffold respectively blocks 50% of the biological activity of the baseline value. The maximum inhibition of 80% in the ADM bioassay means that the anti-ADM antibody or the anti-ADM antibody fragment or the anti-ADM non-Ig scaffold respectively blocks 80% of the biological activity of ADM. This means that no more than 80% of the biological activity of ADM is blocked.

[0163] In a preferred embodiment, a regulatory anti-ADM antibody or regulatory anti-ADM antibody fragment or regulatory anti-ADM non-Ig scaffold is used. A "regulatory" anti-ADM antibody or regulatory anti-ADM antibody fragment or regulatory anti-ADM non-Ig scaffold is an antibody or ADM antibody fragment or non-Ig scaffold that prolongs the half-life (t half retention time) of ADM in serum, blood, plasma by at least 10%, preferably at least 50%, more preferably>50%, most preferably>100%, and blocks less than 80%, preferably less than 50% of the biological activity of ADM, and wherein the anti-ADM antibody, anti-ADM antibody fragment or anti-ADM non-Ig scaffold will block at least 5% of the biological activity of ADM. In order to determine these values, it is necessary to understand these values ​​related to half-life and biological activity blocking relative to the aforementioned determination. It means blocking no more than 80% or no more than 50% of circulating ADM, respectively. This means that 20% of the biological activity of ADM or 50% of the biological activity of ADM remain, respectively. Such regulatory anti-ADM antibodies or regulatory anti-ADM antibody fragments or regulatory anti-ADM non-Ig scaffolds provide advantages that facilitate dosing. Partial blocking or partial reduction of ADM bioactivity and increased in vivo half-life (increased ADM bioactivity) together produce a beneficial anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold for ease of administration. In the case of excess endogenous ADM, the activity reduction effect is the main effect of the antibody or fragment or scaffold, thereby limiting the (negative) effects of ADM. If the endogenous ADM concentration is low or normal, the biological effect of the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold is a combination of reduction (by partial blocking) and increase by increasing the ADM half-life. Therefore, non-neutralizing and regulatory ADM antibodies or ADM antibody fragments or ADM non-Ig scaffolds are similar to ADM bioactivity buffers to keep the bioactivity of ADM within a certain physiological range.

[0164] The anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to the present invention exhibits affinity for human ADM with an affinity constant greater than 10 -7 M, preferably 10 -8 M, preferably with an affinity greater than 10 -9 M, most preferably greater than 10 -10M. A person skilled in the art will appreciate that it is possible to consider compensating for the lower affinity by administering a higher dose of the compound, and that this measure does not lead to a departure from the scope of the present invention. The affinity constant can be determined according to the method described in Example 1 of WO 2013 / 072513.

[0165] It should be emphasized that the term "ADM binding protein" includes ADM binding protein-1 (complement factor H). However, according to the definition of the present invention, the ADM binding protein is neither a non-neutralizing anti-ADM antibody / antibody fragment / non-Ig scaffold nor a regulatory anti-ADM antibody / antibody fragment / non-Ig scaffold. The subject matter of the present invention is further an anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold according to the present invention for treating an acute disease or acute condition in a patient, wherein the antibody or antibody fragment or non-Ig scaffold can be used in combination with other active ingredients.

[0166] The subject of the present invention is further a pharmaceutical preparation comprising an anti-ADM antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold according to the present invention. The subject of the present invention is further a pharmaceutical preparation according to the present invention, wherein the pharmaceutical preparation is a solution, preferably a ready-to-use solution. In another embodiment, the subject of the present invention is further a pharmaceutical preparation according to the present invention, wherein the pharmaceutical preparation is in a dry state and requires reconstitution before use. The pharmaceutical preparation can be administered intramuscularly. The pharmaceutical preparation can be administered intravascularly. The pharmaceutical preparation can be administered by infusion. In another embodiment, another subject of the present invention is further a pharmaceutical preparation according to the present invention, wherein the pharmaceutical preparation is in a lyophilized state.

[0167] In another more preferred embodiment, the present invention provides a pharmaceutical preparation comprising an anti-ADM antibody or an anti-ADM antibody fragment that binds to ADM or an anti-ADM non-Ig scaffold that binds to ADM, for treating or preventing disease symptoms in a patient, wherein the pharmaceutical preparation is to be administered to a patient in need.

[0168] In another embodiment of the invention, the pharmaceutical formulation according to the invention is administered to a patient for the treatment and / or prevention of symptoms associated with a disease as defined above, provided that said patient is in need of such treatment.

[0169] In one embodiment, the ADM antibody or ADM antibody fragment or ADM non-IG scaffold according to the present invention is a non-neutralizing ADM antibody or a non-neutralizing ADM antibody fragment or a non-neutralizing ADM non-Ig scaffold.

[0170] As used herein, the antibody format is selected from the group consisting of an Fv fragment, a scFv fragment, a Fab fragment, a scFab fragment, a (Fab)2 fragment and a scFv-Fc fusion protein.

[0171] In an embodiment of the present invention, an ADM antibody or ADM antibody fragment or non-Ig scaffold for treating a patient in need thereof according to any of the preceding embodiments, wherein the antibody or fragment can be administered at a dose of at least 0.5 mg / kg body weight, particularly at least 1.0 mg / kg body weight, more particularly 1.0 to 20.0 mg / kg body weight, for example 2.0 to 10 mg / kg body weight, 2.0 to 8.0 mg / kg body weight, or 2.0 to 5.0 mg / kg body weight.

[0172] In an embodiment of the present invention, the disease symptoms referred to herein are not associated with any disease selected from the group consisting of sepsis, diabetes, cancer, heart failure (acute heart failure) and septic shock.

[0173] In a preferred embodiment of the invention, the disease condition being treated or prevented using the ADM antibody or ADM antibody fragment or non-Ig scaffold according to any of the preceding embodiments is associated with migraine.

[0174] In a preferred embodiment of the present invention, the disease symptoms treated or prevented using the ADM antibody or ADM antibody fragment or non-Ig scaffold according to any of the preceding embodiments are related to viral infection, wherein the virus is selected from the family Hepadnaviridae, the family Adenoviridae, the family Herpesviridae, the family Influenza virus, the family Arenaviridae, the family Filoviridae, the family Togaviridae, the family Norovirus, the family Flaviviridae, the family Retroviridae, the family Measles virus, the family Reoviridae, the family Enteroviridae, the family Picornaviridae, the family Caliciviridae, etc.

[0175] In a preferred embodiment of the present invention, the disease symptoms treated or prevented using the ADM antibody or ADM antibody fragment or non-Ig scaffold according to any of the preceding embodiments are related to the drug treatment of the primary disease, such as chemotherapy, biologic therapy (such as antibodies or fragments thereof), antibiotics, or any drug that causes any of the above disease symptoms.

[0176] Other preferred embodiments of the present invention relate to a method for treating (e.g., treating, curing, alleviating, improving, alleviating, etc.) or preventing a symptom as defined in any one of the aforementioned embodiments, comprising administering an ADM antibody or ADM antibody fragment or a non-Ig scaffold according to any one of the aforementioned embodiments to a subject in need thereof. The subject is preferably a human.

[0177] Administration of the ADM antibody or ADM antibody fragment or non-Ig scaffold can be by any means known in the art, including: oral, intravenous, subcutaneous, intraarterial, intramuscular, intracardiac, intraspinal, intrathoracic, intraperitoneal, intraventricular, sublingual, transdermal and / or by inhalation. Administration can be systemic, such as intravenous, or local.

[0178] In one aspect, the invention provides a method for treating or preventing headache, preferably primary headache, more preferably migraine, in a subject by administering to the subject an effective amount of an ADM antibody or ADM antibody fragment or a non-Ig scaffold.

[0179] In another embodiment, the present invention provides a method for alleviating, controlling, reducing the incidence, or delaying the development or progression of headache, preferably primary headache, more preferably migraine, in an individual, comprising administering to the individual an effective amount of an ADM antibody or anti-ADM antibody fragment or non-Ig scaffold.

[0180] The ADM antibody or ADM antibody fragment or non-Ig scaffold can be administered before, during and / or after a headache. In some embodiments, the ADM antibody or ADM antibody fragment or non-Ig scaffold is administered before the onset of a headache.

[0181] In some embodiments, an ADM antibody or ADM antibody fragment or non-Ig scaffold can be administered in combination with another agent, such as another agent for treating headaches.

[0182] The "development" or "progression" of a headache refers to the initial manifestation and / or subsequent progression of the condition. The development of a headache can be detected and assessed using standard clinical techniques well known in the art. However, development also refers to a progression that may not be detected. For purposes of the present invention, development or progression refers to the biological course of a symptom. "Development" includes occurrence, recurrence, and onset. As used herein, an "onset" or "onset" of a headache includes an initial onset and / or a recurrence.

[0183] As used herein, an "effective dose" or "effective amount" of a drug, compound, or pharmaceutical composition is an amount sufficient to achieve a beneficial or desired result. For preventive use, beneficial or desired results include results such as eliminating or reducing risk, reducing severity, or delaying the onset of a disease, including biochemical, histological, and / or behavioral symptoms of the disease, its complications, and intermediate pathological phenotypes that occur during the course of the disease. For therapeutic use, beneficial or desired results include clinical results such as: reducing pain intensity, duration, or frequency of headache attacks, and alleviating one or more symptoms (biochemical, histological, and / or behavioral) caused by headache, including its complications and intermediate pathological phenotypes that occur during the course of the disease, increasing the quality of life of patients with the disease, reducing the dose of other agents required to treat the disease, enhancing the effect of another agent, and / or delaying the progression of the patient's disease. The effective dose may be administered in one or more doses. For the purposes of the present invention, an effective dose of a drug, compound, or pharmaceutical composition is an amount sufficient to achieve prevention or treatment directly or indirectly. As understood in a clinical context, an effective dose of a drug, compound, or pharmaceutical composition may or may not be achieved in combination with another drug, compound, or pharmaceutical composition. Thus, an "effective dose" may be considered in the context of administration of one or more therapeutic agents, and a single agent may be considered to be administered in an effective amount if, in combination with one or more other agents, the desired result is possible or achieved.

[0184] The following embodiments are subject of the present invention:

[0185] 1. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof, wherein the antibody or fragment or scaffold binds ADM (1-52; SEQ ID NO: 1) or a fragment thereof.

[0186] 2. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to item 1, wherein the antibody or fragment or scaffold binds to the N-terminal portion (aa 1-21) of ADM:

[0187] YRQSMNNFQGLRSFGCRFGTC (SEQ ID No. 4).

[0188] 3. An anti-adrenomedullin (ADM) antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold binding to ADM for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any one of items 1 to 2, characterized in that the antibody, antibody fragment or non-Ig scaffold binds to the middle region (MR-) portion of ADM, which consists of aa 21-42 of ADM:

[0189] CTVQKLAHQIYQFTDKDKDNVA (SEQ ID No. 3).

[0190] 4. An anti-adrenomedullin (ADM) antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold bound to ADM for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any one of items 1 to 3, wherein the disease symptoms are selected from nausea, headache, muscle pain, back pain, tremors and / or vomiting.

[0191] 5. An anti-adrenomedullin (ADM) antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold bound to ADM for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms according to any one of items 1 to 4, wherein the disease is characterized by an amount of C-reactive protein (CRP) in the sample ≥ 10 mg / L, and / or wherein the amount of TNF in the sample is ≥ 50 pg / ml, and / or wherein the amount of bio-ADM in the sample is ≥ 43 pg / ml, and / or wherein the mean arterial pressure of the subject in need is reduced.

[0192] 6. An anti-adrenomedullin (ADM) antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold bound to ADM for use in treating or preventing disease symptoms or for treating or preventing diseases characterized by such symptoms in a subject in need thereof according to any one of items 1 to 5, wherein the disease in the patient in need of treatment and / or prevention of such symptoms or diseases is selected from the following indications: inflammation, autoimmune diseases, metabolic diseases, brain diseases, cardiovascular diseases and drug-induced diseases.

[0193] 7. An anti-adrenomedullin (ADM) antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold bound to ADM for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any one of items 1 to 5, wherein the disease is migraine.

[0194] 8. An anti-adrenomedullin (ADM) antibody or an anti-adrenomedullin antibody fragment or an anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any one of items 1 to 7, wherein the antibody or antibody fragment or non-Ig scaffold is monospecific.

[0195] 9. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any one of items 1 to 8, wherein the antibody or fragment or scaffold exhibits a binding affinity for ADM of at least 10 based on label-free surface plasmon resonance using a Biacore 2000 system. -7 M.

[0196] 10. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any one of items 1 to 9, wherein the antibody or fragment or scaffold is not ADM-binding protein-1 (complement factor H).

[0197] 11. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any of the preceding items, wherein the antibody or fragment or scaffold recognizes and binds to the N-terminus (aa 1) of ADM.

[0198] 12. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any one of the preceding items, wherein the antibody or fragment or scaffold is an antibody or fragment or scaffold that reduces the half-life (t 1 / 2 The half retention time (half retention time) is prolonged by at least 10%, preferably by at least 50%, more preferably by >50%, and most preferably by >100% of the ADM-stabilized antibody or fragment or scaffold.

[0199] 13. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any of the preceding items, wherein in CHO-K1 cells expressing human recombinant ADM receptor, using hADM22-52 as a reference antagonist, the antibody or fragment or scaffold blocks no more than 80%, preferably no more than 50% of the ADM biological activity.

[0200] 14. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any of the preceding items, wherein the subject is undergoing chemotherapy, treatment with a biologic, an antibiotic, or treatment with an antiviral compound.

[0201] 15. An anti-adrenomedullin (ADM) antibody or anti-adrenomedullin antibody fragment or anti-ADM non-Ig scaffold for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof according to any one of the preceding items, wherein the antibody or fragment is a human monoclonal antibody or fragment that binds to ADM or an antibody fragment thereof, wherein the heavy chain comprises the following sequence:

[0202] CDR1: SEQ ID NO: 5

[0203] GYTFSRYW

[0204] CDR2: SEQ ID NO: 6

[0205] ILPGSGST

[0206] CDR3: SEQ ID NO: 7

[0207] TEGYEYDGFDY

[0208] The light chain contains the following sequence:

[0209] CDR1: SEQ ID NO: 8

[0210] QSIVYSNGNTY

[0211] CDR2:

[0212] RVS

[0213] CDR3: SEQ ID NO: 9

[0214] FQGSHIPYT.

[0215] 16. A human monoclonal antibody or fragment thereof that binds to ADM or an antibody fragment thereof for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject according to item 15, wherein the antibody or fragment comprises a sequence selected from the following sequences as a VH region:

[0216] SEQ ID NO:10 (AM-VH-C)

[0217] QVQLQQSGAELMKPGASVKISCKATGYTFSRYWIEWVKQRPGHGLEWIGEILPGSGSTNYNEKFKGKATITADTSSNTAYMQLSSSLTSEDSAVYYCTEGYEYDGFDYWGQGT TLTVSSASTKGPSVFPLAPSSKSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0218] SEQ ID NO:11 (AM-VH1)

[0219] QVQLVQSGAEVKKPGSSVKVSCKASGYTFSRYWISWVRQAPGQGLEWMGRILPGSGSTNYAQKFQGRVTITADESTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGT TVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0220] SEQ ID NO:12 (AM-VH2-E40)

[0221] QVQLVQSGAEVKKPGSSVKVSCKASGYTFSRYWIEWVRQAPGQGLEWMGRILPGSGSTNYAQKFQGRVTITADESTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGT TVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0222] SEQ ID NO:13(AM-VH3-T26-E55)

[0223] QVQLVQSGAEVKKPGSSVKVSCKATGYTFSRYWISWVRQAPGQGLEWMGEILPGSGSTNYAQKFQGRVTITADESTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGTTVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0224] SEQ ID NO:14(AM-VH4-T26-E40-E55)

[0225] QVQLVQSGAEVKKPGSSVKVSCKATGYTFSRYWIEWVRQAPGQGLEWMGEILPGSGSTNYAQKFQGRVTITADESTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGTTVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKHHHHHH

[0226] and comprises a sequence selected from the following sequences as the VL region:

[0227] SEQ ID NO:15(AM-VL-C)

[0228] DVLLSQTPLSLPVSLGDQATISCRSSQSIVYSNGNTYLEWYLQKPGQSPKLLIYRVSNRFSGVPDRFSGSGSGTDFTLKISRVEAEDLGVYYCFQGSHIPYTFGGGTKLEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC

[0229] SEQ ID NO:16(AM-VL1)

[0230] DVVMTQSPLSLPVTLGQPASISCRSSQSIVYSNGNTYLNWFQQRPGQSPRRLIYRVSNRDSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYYCFQGSHIPYTFGQGTKL EIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC

[0231] SEQ ID NO:17 (AM-VL2-E40)

[0232] DVVMTQSPLSLPVTLGQPASISCRSSQSIVYSNGNTYLEWFQQRPGQSPRRLIYRVSNRDSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYYCFQGSHIPYTFGQGTKLE IKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC.

[0233] 17. A human monoclonal antibody or fragment thereof that binds to ADM or an antibody fragment thereof for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject according to item 15, wherein the antibody or fragment comprises the following sequence or a sequence with >95% identity thereto as a heavy chain:

[0234] SEQ ID NO:22

[0235] QVQLVQSGAEVKKPGSSVKVSCKASGYTFSRYWIEWVRQAPGQGLEWIGEILPGSGSTNYNQKFQGRVTITADTSTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGT TVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEPKSCDKT HTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKT ISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK,

[0236] and comprising as a light chain the following sequence or a sequence with >95% identity thereto:

[0237] SEQ ID NO:23

[0238] DVVLTQSPLSLPVTLGQPASISCRSSQSIVYSNGNTYLEWYLQRPGQSPRLLIYRVSNRFSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYYCFQGSHIPYTFGGGTKLE IKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC.

[0239] 18. A pharmaceutical formulation for use in treating or preventing disease symptoms or for treating or preventing a disease characterized by such symptoms in a subject in need thereof, comprising the antibody or fragment or scaffold according to any one of items 1 to 17.

[0240] 19. An antibody comprising the following sequence or a sequence with >95%, preferably >98% identity thereto as a heavy chain:

[0241] SEQ ID NO:22

[0242] QVQLVQSGAEVKKPGSSVKVSCKASGYTFSRYWIEWVRQAPGQGLEWIGEILPGSGSTNYNQKFQGRVTITADTSTSTAYMELSSLRSEDTAVYYCTEGYEYDGFDYWGQGT TVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVVTVPSSSLGTQTYICNVNHKPSNTKVDKKVEPKSCDKT HTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKT ISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPGK,

[0243] and comprises the following sequence or a sequence with identity >95%, preferably >98% thereof as a light chain:

[0244] SEQ ID NO:23

[0245] DVVLTQSPLSLPVTLGQPASISCRSSQSIVYSNGNTYLEWYLQRPGQSPRLLIYRVSNRFSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYYCFQGSHIPYTFGGGTKLE IKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC.

[0246] 20. A pharmaceutical composition comprising the antibody according to item 19.

[0247] Example

[0248] Antibody Generation and Determination of Their Affinity Constants

[0249] Several human and murine antibodies were generated and their affinity constants determined (see Table 1).

[0250] Peptides / conjugates for immunization:

[0251] The peptides used for immunization were synthesized, see Table 1 (JPT Technologies, Berlin, Germany), with an additional N-terminal cysteine ​​(if cysteine ​​is not present in the selected ADM sequence) residue for binding the peptide to bovine serum albumin (BSA). The peptide was covalently linked to BSA by using Sulfolink coupling gel (Perbio Technologies, Bonn, Germany). The coupling procedure was performed according to the manual of Perbio.

[0252] Rat antibodies were generated according to the following method:

[0253] Balb / c mice were immunized with peptide-BSA conjugates (emulsified in 100 μl complete Freund's adjuvant) on days 0 and 14, and in 100 μl incomplete Freund's adjuvant on days 21 and 28. Three days before fusion experiments, animals received 50 μg of conjugate in 100 μl saline, given as one intraperitoneal and one intravenous injection.

[0254] The splenocytes from the immunized mice and the cells of the myeloma cell line SP2 / 0 were fused with 1 ml of 50% polyethylene glycol at 37°C for 30 s. After washing, the cells were seeded in 96-well cell culture plates. Hybrid clones were selected by growing in HAT medium (RPMI 1640 medium supplemented with 20% fetal bovine serum and HAT-supplements). After two weeks, the HAT medium was replaced with HT medium three times, and then returned to normal cell culture medium.

[0255] Three weeks after confluency, cell culture supernatants were screened for initial antigen-specific IgG antibodies. Microcultures that tested positive were transferred to 24-well plates for propagation. After retesting, selected cultures were cloned and recloned using limiting dilution techniques and isotypes were determined (see also Lane, RD 1985. Journal of Immunological Methods 81: 223-228; Ziegler et al. .1996. Hormone and Metabolism Research 28:11-15 ).

[0256] Mouse monoclonal antibody production :

[0257] Antibodies were prepared by standard antibody production methods ( Marx et al., 1997. Monoclonal Antibody Manufacturing, ATLA 25，121 ) and purified by protein A. Based on SDS gel electrophoresis analysis, the antibody purity was >95%.

[0258] Human Antibodies :

[0259] Human antibodies were generated by phage display according to the following procedure:

[0260] Use people's original antibody gene library HAL7 / 8 to separate the recombinant single chain F variable domain (scFv) for ADM peptide.Screen the antibody gene library with panning strategy, which includes using the peptide containing the biotin tag connected to the ADM peptide sequence by two different spacers.The panning round of the antigen of non-specific binding and streptavidin combination is mixed to minimize the background of non-specific binding agent.The phage from the elution of the third round of panning has been used to produce the Escherichia coli strain expressing monoclonal scFv.The culture supernatant of these cloned strains has been directly used for antigen ELISA test ( See also Hust et al. et al., 2011. Journal of Biotechnology 152, 159-170; Schütte et al., 2009. PLoS One 4, e6625 ).

[0261] Positive clones were negatively selected by streptavidin-coated microtiter plates based on positive ELISA signals for antigen. For further characterization, the scFv open reading frame was cloned into the expression plasmid pOPE107 ( Hust et al., 2011. Journal of Biotechnology, 152, 159-170 ), captured from culture supernatant by immobilized metal ion affinity chromatography, and purified by size exclusion chromatography.

[0262] Affinity constant:

[0263] To determine the affinity of the antibodies for ADM, the binding kinetics of ADM to the immobilized antibodies were measured by label-free surface plasmon resonance using a Biacore 2000 system (GE Healthcare Europe GmbH, Freiburg, Germany). Reversible immobilization of the antibodies was performed using an anti-mouse Fc antibody covalently coupled at high density to the surface of a CM5 sensor according to the manufacturer's instructions (Mouse Antibody Capture Kit; GE Healthcare). Lorenz et al., 2011. Antimicrobial Agents and Chemotherapy 55(1):165- 173 ).

[0264] Monoclonal antibodies were generated against the following ADM regions of human and mouse ADM, respectively. The following table represents a series of antibodies obtained for further experiments. Selection based on target region:

[0265] Table 1:

[0266]

[0267] Generation of antibody fragments by enzymatic digestion :

[0268] Fab and F(ab)2 fragments were produced by enzymatic digestion of the full-length mouse antibody NT-M. Antibody NT-M was digested using a) a pepsin-based F(ab)2 preparation kit (Pierce 44988) and b) a papain-based Fab preparation kit (Pierce 44985). The fragmentation procedure was performed according to the instructions provided by the supplier. In the case of F(ab)2 fragmentation, digestion was performed at 37°C for 8 hours. Fab fragmentation digestion was performed for 16 hours respectively.

[0269] Procedure for generating and purifying Fab:

[0270] The immobilized papain was balanced by washing the resin with 0.5ml digestion buffer and centrifuging the column at 5000 × g for 1 minute. The buffer was discarded thereafter. The desalting column was prepared by removing the storage solution and washing with digestion buffer, and then centrifuged at 1000 × g for 2 minutes each time. 0.5ml of the prepared IgG sample was added to the centrifuge column tube containing the balanced immobilized papain. The incubation time of the digestion reaction was 16 hours on a table shaker at 37°C. The column was centrifuged at 5000 × g for 1 minute to separate the digest from the immobilized papain. Then, the resin was washed with 0.5ml PBS and centrifuged at 5000 × g for 1 minute. The wash fraction was added to the digested antibody, and the total sample volume was 1.0ml. The NAb protein A column was balanced with PBS and IgG elution buffer at room temperature. The column was centrifuged for 1 minute to remove the storage solution (containing 0.02% sodium azide), and balanced by adding 2ml PBS, centrifuged again for 1 minute and discarded the flow-through. The sample was loaded onto the chromatographic column and resuspended by inversion. Incubate at room temperature for 10 minutes with inversion mixing. Centrifuge the column for 1 minute to retain the flow-through containing the Fab fragment. (Reference: Coulter and Harris 1983. Journal of Immunological Methods 59, 199-203.; Lindner et al. 2010. Cancer Research. 70, 277-87; Kaufmann et al. 2010. PNAS. 107, 18950-5.; Chen et al. 2010. PNAS. 107, 14727-32; Uysal et al. 2009 Journal of Experimental Medicine 206, 449-62; Thomas et al. 2009. Journal of Experimental Medicine Kong et al. 2009 Journal of Cell Biology. 185, 1275-840. ).

[0271] Procedure for the generation and purification of F(ab')2 fragments:

[0272] The immobilized pepsin was balanced by washing the resin with 0.5 ml of digestion buffer and centrifuging the column at 5000 x g for 1 minute. The buffer was discarded thereafter. The desalting column was prepared by removing the storage solution and washing with digestion buffer, and then centrifuged at 1000 x g for 2 minutes each time. 0.5 ml of the prepared IgG sample was added to the centrifuge column tube containing the balanced immobilized pepsin. The incubation time of the digestion reaction was 16 hours on a table shaker at 37 ° C. The column was centrifuged at 5000 × g for 1 minute to separate the digest from the immobilized papain. Then, the resin was washed with 0.5 mL of PBS and centrifuged at 5000 × g for 1 minute. The wash fraction was added to the digested antibody, and the total sample volume was 1.0 ml. The NAb protein A column was balanced with PBS and IgG elution buffer at room temperature. The column was centrifuged for 1 minute to remove the storage solution (containing 0.02% sodium azide), and balanced by adding 2 mL of PBS, centrifuged again for 1 minute and discarded the flow-through. The sample was loaded onto the chromatographic column and resuspended by inversion. Incubate at room temperature for 10 minutes with inversion mixing. Centrifuge the column for 1 minute to retain the flow-through containing the Fab fragment. (Reference: Mariani et al., 1991. Molecular Immunology 28:69-77; Beale 1987. Clinical and Experimental Immunology 11:287- 96; Ellerson et al. 1972. FEBS Letters 24(3):318-22; Kerbel and Elliot 1983. Methods in Enzymology 93: 113-147; Kulkarni et al. 1985. Cancer Immunol Immunotherapy 19:211-4; Lamoyi 1986. Enzymological Methods 121:652-663; Parham et al., 1982. Journal of Immunological Methods 53:133-73; Raychaudhuri et al., 1985. Mol Immunol 22(9):1009-19; Rousseaux et al. 1980. Mol Immunol 17:469-82; Rousseaux et al. Wilson et al., 1991. Journal of Immunological Methods 138: 111-9. ).

[0273] NT-H-Antibody Fragment Humanization:

[0274] Humanization of antibody fragments by CDR grafting Jones et al., 1986, Nature 321, 522-525. ).

[0275] Perform the following steps to obtain the humanized sequence:

[0276] -Total RNA extraction: Total RNA was extracted from NT-H hybridoma using Qiagen kit.

[0277] -First round RT-PCR: Use OneStep RT-PCR Kit (Cat. No. 210210). RT-PCR was performed with primer sets specific for the heavy and light chains. For each RNA sample, 12 independent heavy chain and 11 light chain RT-PCR reactions were set up using a degenerate forward primer mix covering the variable region leader sequence. The reverse primers were located in the constant region of the heavy and light chains. No restriction sites were engineered into the primers.

[0278] - Reaction settings: 5x OneStep RT-PCR buffer 5.0μl, dNTP mixture (containing 10mM of each dNTP) 0.8μl, primer set 0.5μl, OneStep RT-PCR enzyme mix 0.8μl, template RNA 2.0μl, RNase-free water added to 20.0μl, total volume 20.0μl PCR conditions: Reverse transcription: 50℃, 30 minutes; initial PCR activation: 95℃, 15 minutes Cycle: 20 cycles: 94℃, 25 seconds; 54℃, 30 seconds; 72℃, 30 seconds; final extension: 72℃, 10 minutes. Second round of semi-nested PCR: The RT-PCR products of the first round reaction were further amplified in the second round of PCR. Using semi-nested primer sets specific for the variable regions of antibodies, 12 separate heavy chain and 11 light chain RT-PCR reactions were set up.

[0279] - Reaction setup: 2x PCR mix 10 μl; primer set 2 μl; first round PCR product 8 μl; total volume 20 μl; hybridoma antibody clone reporter PCR conditions: initial denaturation at 95°C for 5 min; 25 cycles: 95°C, 25 sec, 57°C, 30 sec, 68°C, 30 sec; final extension at 68°C for 10 min.

[0280] -After PCR is completed, the PCR reaction samples are moved to an agarose gel to observe the amplified DNA fragments. After sequencing the DNA fragments of more than 15 clones amplified by nested RT-PCR, several mouse antibody heavy chains and light chains have been cloned and appear to be correct. Protein sequence alignment and CDR analysis identify one heavy chain and one light chain. Since the amino acids at positions 26, 40, and 55 of the variable heavy chain and the amino acid at position 40 of the variable light chain are crucial for binding properties, they can be restored to the original mouse. The resulting candidates are shown below. ( Padlan 1991. Molecular Immunology 28, 489-498; Harris and Bajorath. 1995. Protein Science 4, 306-310 ).

[0281] Annotation of antibody fragment sequences (SEQ ID No.: 10 to 17): Bold and underlined are CDR 1, 2, 3 in numerical order from N-terminus to C-terminus; italics are constant regions; the hinge region is highlighted in bold, underlined letters, and the histidine tag at the C-terminus is highlighted in bold and italic letters.

[0282] SEQ ID No.:10(AM-VH-C)

[0283]

[0284] SEQ ID No.:11(AM-VH1)

[0285]

[0286] SEQ ID No.:12(AM-VH2-E40)

[0287]

[0288] SEQ ID No.: 13(AM-VH3-T26-E55)

[0289]

[0290] SEQ ID No.: 14(AM-VH4-T26-E40-E55)

[0291]

[0292] SEQ ID No.:15(AM-VL-C)

[0293]

[0294] SEQ ID No.:16(AM-VL1)

[0295]

[0296] SEQ ID No.:17(AM-VL2-E40)

[0297]

[0298] SEQ ID NO:22 (Adezumab heavy chain)

[0299]

[0300] SEQ ID NO:23 (Adezumab light chain)

[0301]

[0302] Example 2 - Escalating single intravenous doses of A randomized, double-blind study of the safety, tolerability, and pharmacokinetics / dynamics of the anti-ADM antibody (adezumab) (HAM8101) Placebo-controlled phase I study.

[0303] Overall experimental design

[0304] A randomized, double-blind, placebo-controlled, Phase I study of healthy male volunteers during experimental endotoxemia with escalating doses of adezumab administered as an intravenous infusion over 1 hour. Experimental endotoxemia was induced by administration of a continuous LPS (lipopolysaccharide) model; an initial bolus of LPS at a dose of 1 ng / kg was followed by a continuous infusion of 1 ng / kg / h for 3 hours. Subjects received one course of study agent (adezumab or placebo) 1 hour after the start of LPS administration. Models of systemic inflammation have been described recently (Kiers et al. 2017. Sci Rep 7:40149).

[0305] Adezumab was administered as a single infusion of 0.5 mg / kg over 1 hour, which was increased to 2.0 and 8.0 mg / kg in subsequent treatment groups (see Table 2).

[0306] Table 2: Study Group of 8 Subjects Treated by 1 Hour Infusion

[0307]

[0308] Selection of trial population

[0309] The study population consisted of healthy young male volunteers. To be included in the trial, subjects had to meet all inclusion criteria and none of the exclusion criteria.

[0310] Inclusion criteria

[0311] 1. Before any study-mandated procedure, you must sign an informed consent form to participate in this trial.

[0312] 2. Male subjects aged between 18 and 35 years old.

[0313] 3. Subjects must agree to use reliable contraceptive methods with their partners from the start of the study until 3 months after study drug administration.

[0314] 4. BMI between 18 and 30 kg / m 2 The lower weight limit is 50kg and the upper weight limit is 100kg.

[0315] 5. Health status as determined by medical history, physical examination, vital signs, 12-lead electrocardiogram, and clinical laboratory parameters.

[0316] Exclusion criteria

[0317] 1. Unwilling to give up any medication, recreational drug or antioxidant vitamin supplement during the study and within 7 days before treatment day.

[0318] 2. Unwilling to quit smoking or drinking within 1 day before treatment.

[0319] 3. Have previously participated in a trial in which LPS was administered.

[0320] 4. Surgery or trauma with significant blood loss or voluntary blood donation within 3 months before treatment.

[0321] 5. History, signs, or symptoms of cardiovascular disease, especially:

[0322] History of frequent vasovagal collapse or postural hypotension

[0323] Resting pulse rate ≤45 or ≥100 beats / min

[0324] Hypertension (RR systolic blood pressure >160 or RR diastolic blood pressure >90 mmHg)

[0325] Hypotension (RR systolic blood pressure <100 or RR diastolic blood pressure <50 mmHg)

[0326] Conduction abnormalities on the electrocardiogram, including first-degree atrioventricular block or complex bundle branch block

[0327] Any chronic arrhythmia (except PAC, PVC)

[0328] 6. Kidney damage: plasma creatinine>120μmol / L

[0329] 7. Liver function tests (alkaline phosphatase, AST, ALT and / or γ-GT) are higher than 2 times the upper limit of normal.

[0330] 8. History of asthma

[0331] 9. Atopic constitution

[0332] 10. CRP is higher than 2 times the upper limit of normal or clinically significant acute illness (including infection) within 2 weeks before the treatment day.

[0333] 11. Patients who have been treated with study drugs or participated in any other clinical trials within 30 days before the treatment date.

[0334] 12. Known or suspected inability to comply with the trial protocol.

[0335] 13. Known hypersensitivity to any excipient of the pharmaceutical formulation used.

[0336] 14. Unable to provide written informed consent in person (e.g., for language or psychological reasons) and / or participate in the research.

[0337] Lipopolysaccharide (LPS) from Escherichia coli O113

[0338] To achieve a controlled inflammatory state, subjects received lipopolysaccharide (LPS, US Reference Endotoxin [Escherichia coli O:113, List Biolabs, Inc., Campbell, CA, USA]) intravenously.

[0339] Check levels and time windows

[0340] Pre-dose blood samples were drawn at T = 0 (baseline). Vital signs were measured after 5 minutes of rest in the supine or semi-supine position. Schedule of blood samples and control examinations (see Table 2 for more details):

[0341] On the treatment day (Day 0), blood samples must be collected within ± 5 minutes of the scheduled time.

[0342] - After 24 hours (Day 1), a follow-up visit and blood draw must be planned within ± 1 hour after IMP administration.

[0343] On day 7, a follow-up visit can be scheduled at any time ± 1 day.

[0344] On days 14 and 28, follow-up visits can be planned at any time within ± 2 days.

[0345] On days 60 and 90, follow-up visits can be planned at any time within ± 3 days.

[0346] Laboratory monitoring

[0347] The following hematological parameters were analyzed: hemoglobin, hematocrit, RBC, MCV, MCH, MCHC, WBC, platelets, differential blood cell count.

[0348] Blood samples were collected in serum separator tubes and analyzed for the following biochemical parameters: CRP, AF, ALT, AST, Y-GT, creatine kinase, LDH, urea-N, creatinine, sodium, potassium, PT, and APTT.

[0349] The primary endpoint variables were: adverse events; vital signs such as heart rate, blood pressure, blood oxygen saturation, body temperature within the first 10 hours after administration of adezumab and during the follow-up period (T=24 hours, T=7 days, T=14 days, T=28 days, T=60 days, T=90 days); local tolerance at the intravenous infusion site; safety laboratory parameters (Hb, Ht, leukocytes, platelets, leukocyte differential blood count, sodium, potassium, creatinine, urea, alkaline phosphatase, ALT, AST, GGT, CK, CRP, PT, APTT); 12-lead electrocardiogram (ECG) 2 and 8 hours after administration of adezumab.

[0350] Secondary endpoints are: pharmacokinetics of adezumab during experimental endotoxemia (including AUC, Cmax, terminal T1 / 2, C1, V); plasma levels of inflammatory mediators on the day of endotoxemia (including but not limited to TNFα, IL-6, IL-8, IL-10); symptom disease score; optional: renal injury markers (including but not limited to creatinine clearance, proenkephalin and KIM-1).

[0351] Table 2: Baseline characteristics of each group (mean ± SD)

[0352] Placebo 0.5mg / kg 2.0mg / kg 8.0mg / kg P-value* age 22.0±1.1 22.0±2.8 23.3±2.5 22.5±2.7 0.745 BMI 23.7±1.3 23.3±1.5 24.7±1.9 25.6±3.0 0.263

[0353] *After one-way ANOVA analysis

[0354] No serious adverse events (SAEs) or suspected serious unexpected adverse reactions (SUSARs) were observed during the entire study period (including the 90-day follow-up period).

[0355] result

[0356] Disease scores declined more rapidly with adezumab compared with placebo.

[0357] Between the 210 min (T210) and 450 min (T450) time points, sickness scores were significantly lower for both 2 mg / kg and 8 mg / kg than for placebo (p=0.011 and 0.005, respectively; GLM repeated measures) ( Figure 1 ).

[0358] Figure 2 The distribution of disease scores for each treatment group at T270 (time point 270 minutes) and 300 minutes (time point 300 minutes) are shown. Figure 2 A) and B), support the surprising beneficial effects of the antibodies of the present invention.

[0359] The contribution of the single disease score components to the effect is shown in Figure 3: A) nausea, B) headache, C) muscle pain, D) back pain and E) tremor. All symptoms shown contributed significantly to the effect. Vomiting occurred only in two patients, once in each patient, and could not be analyzed.

[0360] Figure 4 An alternative assessment is shown. Here, another score, the disease extent score, is assessed using a single question about overall disease extent, with a score range of 0 to 10. Again, the disease extent score decreased more rapidly in patients treated with the anti-ADM antibody (adezumab).

[0361] NT-H administration to healthy people

[0362] This study was conducted in healthy male subjects and was a randomized, double-blind, placebo-controlled study in which single ascending doses of NT-H antibody (0.5 mg / kg in the first group, 2 mg / kg in the second group, and 8 mg / kg in the third group) were administered by intravenous (iv) infusion to 3 consecutive groups of 8 healthy male subjects in each group (n=6 active drugs and n=2 placebo in each group).

[0363] The main inclusion criteria were written informed consent, age between 18 and 35 years, agreement to use a reliable method of contraception, and a BMI between 18 and 30 kg / m 2 between.

[0364] Subjects received a single intravenous dose of NT-H antibody (0.5 mg / kg; 2 mg / kg; 8 mg / kg) or placebo by slow infusion over 1 hour at the study unit.

[0365] There was no difference in baseline ADM values ​​among the four groups. The median ADM value was 7.1 pg / mL in the placebo group, 6.8 pg / mL in the first treatment group (0.5 mg / kg), 5.5 pg / mL in the second treatment group (2 mg / kg), and 7.1 pg / mL in the third treatment group (8 mg / mL).

[0366] The results showed that in healthy subjects, ADM values ​​increased rapidly within the first 1.5 hours after administration of NT-H antibody, then reached a plateau and slowly decreased ( Figure 5 ).

[0367] Two subjects in the placebo group and a total of three subjects in the treatment group reported migraine symptoms before receiving a single dose of placebo and NT-H antibody, respectively. After each time point, symptoms were asked again. The subject treated with NT-H antibody did not report any migraine symptoms 4 hours after treatment, while the two subjects who received placebo still suffered from migraine symptoms as before the infusion.

Claims

1. Use of an anti-adrenomedullin (ADM) antibody or an anti-ADM antibody fragment or an anti-ADM non-Ig scaffold in the preparation of a medicament for treating or preventing a disease in a subject in need thereof, wherein the subject is a human, wherein the symptoms of the disease are selected from nausea, headache, muscle pain, back pain, tremor and / or vomiting, wherein the disease is characterized by an amount of C-reactive protein (CRP) in the sample ≥10 mg / L, and / or wherein the amount of TNF in the sample ≥50 pg / ml, and / or wherein the amount of bio-ADM in the sample ≥43 pg / ml, wherein the sample is selected from whole blood, plasma and serum, and wherein the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold binds to the N-terminal portion (aa 1-21) of ADM: YRQSMNNFQGLRSFGCRFGTC (SEQ ID No. 4).

2. The use according to claim 1, wherein the antibody is a human antibody, a monoclonal antibody, a humanized antibody, a chimeric antibody or a CDR-grafted antibody.

3. The use according to claim 1 or 2, wherein the disease is selected from the following indications: inflammation, autoimmune diseases, metabolic diseases, brain diseases, cardiovascular diseases and drug-induced diseases.

4. The use according to claim 3, wherein the inflammation is systemic inflammation.

5. The use according to claim 3, wherein the inflammation is trauma, sepsis or burns.

6. The use according to claim 1 or 2, wherein the subject suffers from congestive heart failure, myocardial infarction, kidney disease, hypertensive disease, diabetes, sepsis or septic shock, or is in the acute stage of shock.

7. The use according to claim 1 or 2, wherein the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold is administered at a dose of 2.0 to 8.0 mg / kg body weight, and wherein the subject's ADM level is significantly higher than that of healthy controls, and wherein the amount of bio-ADM in the subject's sample is ≥43 pg / ml.

8. The use according to claim 1 or 2, wherein the anti-ADM antibody or anti-ADM antibody fragment or anti-ADM non-Ig scaffold is administered at a dose of 2 mg / kg to 8 mg / kg body weight, and wherein the disease is associated with an amount of C-reactive protein (CRP) ≥10 mg / L in a sample of the subject, and / or an amount of TNF ≥50 pg / ml in a sample of the subject.

9. A pharmaceutical preparation comprising an anti-ADM antibody or anti-ADM antibody fragment or an anti-ADM non-Ig scaffold as defined in any one of claims 1 to 8.

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