Activin receptor type ii a / b (actriia / b) antibodies

Abstract

Provided herein are antibodies and / or antigen-binding fragments thereof that bind to ActRIIA and / or ActRIIB, and methods of using the same.

Description

[0001] Attorney Docket No. : 769460: DGT9-009PC

[0002] ACTIVIN RECEPTOR TYPE II A / B (ActRIIA / B) ANTIBODIES

[0003] RELATED APPLICATIONS

[0004] This application claims priority to U.S. Provisional Patent Application Serial No. 63 / 705,126, filed October 9, 2024, the entire disclosure of which is hereby incorporated herein by reference.

[0005] BACKGROUND

[0006] Pulmonary hypertension (PH) is a rare but serious condition that occurs when blood pressure in the lungs is higher than normal. This is the result of concomitant downregulation of ALK1 signaling as presented above and hyperactivation of the ALK4 / ActRII(s) pathway. Activin receptors Type II A and B (ActRIIA / B) are capable of binding to diverse TGF-P proteins. Activation of the ALK4-TGF-P type II receptor ActRIIA / B pathway by increased amount of ligands such as activins, GDFs and eventually BMP9 can lead to hyperproliferation and development of PAH. Similarly, this receptor-ligand axis has been implicated in the development of left heart disease (heart failure with preserved ejection fraction).

[0007] Defective signaling in ActRIIA / B mediated pathway is also a hallmark of familial and sporadic PAH patients, which leads to endothelial dysfunction, i.e., apoptosis, proliferation, interaction with smooth muscle cells (SMC) and transdifferentiation. Over the time, vasculature remodeling obstructs small pulmonary arteries, resulting in increased pulmonary vascular resistance and pulmonary pressures. This leads to reduced cardiac output, right heart failure, and ultimately death.

[0008] SUMMARY

[0009] In an aspect, provided herein is an antibody or an antigen-binding fragment thereof that specifically binds to activin receptor type II (ActRIIA and / or ActRIIB), wherein the antibody or antigen-binding fragment thereof is a single-domain antibody (sdAb) comprising HCDR1, HCDR2, and HCDR3 amino acid sequences, the sequences comprising RYDMG (SEQ ID NO: 1), FITISDGTTYYADSVKG (SEQ ID NO: 2), and AVRPGDYD (SEQ ID NO: 3), respectively.

[0010] In some embodiments, the single-domain antibody is a VHH.

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[0012] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0013] In some embodiments, the antibody or antigen-binding domain comprises an amino acid sequence at least about 90%, at least about 95%, or at least 98% identical to the amino acid sequence of SEQ ID NO: 4.

[0014] In some embodiments, the antibody or antigen-binding domain comprises an amino acid sequence of SEQ ID NO: 4.

[0015] In another aspect, provided herein is an antibody or antigen-binding fragment thereof that specifically binds to activin receptor Type II (ActRIIA and / or ActRIIB), wherein the antibody or antigen-binding thereof comprises HCDR1, HCDR2, HCDR3, LCDR1, LCDR2, and LCDR3 amino acid sequences, the sequences comprising: NYAMT (SEQ ID NO: 5), AIGASGGSTYYADSVKG (SEQ ID NO: 6), ENVAPRPLDY (SEQ ID NO: 7), RASQSVSRFLN (SEQ ID NO: 8), GASILQT (SEQ ID NO: 9), and QQSYTTPTWT (SEQ ID NO: 10), respectively; TSAMS (SEQ ID NO: 13), SISGSGGTAYYADSVKG (SEQ ID NO: 14), GGYWLDY (SEQ ID NO: 15), RTSQSISNYLN (SEQ ID NO: 16), AASSSQT (SEQ ID NO: 17), and QQTYNTPRT (SEQ ID NO: 18), respectively; TYAMT (SEQ ID NO: 21), GISGGGGSTNYADSVKG (SEQ ID NO: 22), GLRHPDY (SEQ ID NO: 23), RASQSISNFLS (SEQ ID NO: 24), AASGLQS (SEQ ID NO: 25), and QQSYRVPRT (SEQ ID NO: 26), respectively; HYAMT (SEQ ID NO: 29), GISGSGLNTYYADSVKG (SEQ ID NO: 30), RGHTMPQPLDP (SEQ ID NO: 31), RASQSITRFLN (SEQ ID NO: 32), AASNLQV (SEQ ID NO: 33), and QQSYSTPPT (SEQ ID NO: 34), respectively; NYAMA (SEQ ID NO: 37), AISVTGGSTYYADSVKG (SEQ ID NO: 38), HGSGTRAFDS (SEQ ID NO: 39), RASQSISRHLN (SEQ ID NO: 40), EASTLQT (SEQ ID NO: 41), and QQSYSTPWT (SEQ ID NO: 42), respectively; SYVMS (SEQ ID NO: 45), GISASGGTTYYADSVKG (SEQ ID NO: 46), GWYWFDP (SEQ ID NO: 47), RASQTISNYVN (SEQ ID NO: 48), AATSLHS (SEQ ID NO: 49), and QQGYNTPRT (SEQ ID NO: 50), respectively; SYAMG (SEQ ID NO: 53), SISTSGGSTYYADSVKG (SEQ ID NO: 54), SPAHSPHPFDI (SEQ ID NO: 55), RASQSVSRFLN (SEQ ID NO: 56), AASNLQS (SEQ ID NO: 57), and QQSYSSLFT (SEQ ID NO: 58), respectively; SQGMS (SEQ ID NO: 61), AISGSGGSRYYADSVKG (SEQ ID NO: 62), EQGPGPYAFDI (SEQ ID NO: 63), RASQSVSRFLN (SEQ ID NO: 64), GISTLQS (SEQ ID NO: 65), and QQSFSLPRT (SEQ ID NO: 66), respectively; AYAMS (SEQ ID NO: 69), AISGSGDDTYYADSVKG (SEQ ID NO: 70), QLIPPAPLDY (SEQ ID NO: 71), RASQGISRFLN (SEQ ID NO: 72), GVSVLQS (SEQ ID NO: 73), and QQSFSSLFT (SEQ ID NO: 74), respectively; or DYAMS (SEQ ID NO: 77), SVSGSGSSTYYADSVKG (SEQ ID NO: 78), GSIGAPWPLDY (SEQ ID NO: 79), RASQSISRFLN (SEQ ID NO: 80), GASILQG (SEQ ID NO: 81), and QQTYSTQWT (SEQ ID NO: 82), respectively.

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[0017] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0018] In some embodiments, the antibody or antigen binding fragment thereof comprises: a heavy chain variable domain (VH) comprising an amino acid sequence at least about 90%, at least about 95%, or at least 98% identical to the amino acid sequence of SEQ ID NO: 11, SEQ ID NO: 19, SEQ ID NO: 27, SEQ ID NO: 35, SEQ ID NO: 43, SEQ ID NO: 51, SEQ ID NO: 59, SEQ ID NO: 67, SEQ ID NO: 75, or SEQ ID NO: 83; and / or a light chain variable domain (VL) comprising an amino acid sequence at least about 90%, at least about 95%, or at least 98% identical to the amino acid sequence of SEQ ID NO: 12, SEQ ID NO: 20, SEQ ID NO: 28, SEQ ID NO: 36, SEQ ID NO: 44, SEQ ID NO: 52, SEQ ID NO: 60, SEQ ID NO: 68, SEQ ID NO: 76, or SEQ ID NO: 84.

[0019] In some embodiments, the antibody or antigen-binding fragment thereof comprises a VH domain comprising an amino acid sequence comprising the amino acid sequence of SEQ ID NO: 11, SEQ ID NO: 19, SEQ ID NO: 27, SEQ ID NO: 35, SEQ ID NO: 43, SEQ ID NO: 51, SEQ ID NO: 59, SEQ ID NO: 67, SEQ ID NO: 75, or SEQ ID NO: 83; and / or a VL domain comprising an amino acid sequence comprising the amino acid sequence of SEQ ID NO: 12, SEQ ID NO: 20, SEQ ID NO: 28, SEQ ID NO: 36, SEQ ID NO: 44, SEQ ID NO: 52, SEQ ID NO: 60, SEQ ID NO: 68, SEQ ID NO: 76, or SEQ ID NO: 84.

[0020] In some embodiments, the antibody or antigen-binding fragment thereof further comprises a first and / or second heavy constant region. In some embodiments, the first and / or second heavy constant region comprises a human IgGl, IgG2, IgG3, or IgG4. In some embodiments the first heavy chain constant region and / or the second heavy chain constant region comprise an amino acid sequence of SEQ ID NO: 85 or SEQ ID NO: 126.

[0021] In some embodiments, at least one heavy chain constant region comprises a substitution at amino acid position 234, according to EU numbering. In some embodiments, the substitution at amino acid position 234 is an alanine (A).

[0022] In some embodiments, at least one heavy chain constant region comprises a substitution at amino acid position 235, according to EU numbering. In some embodiments, the substitution at amino acid position 235 is an alanine (A).

[0023] In some embodiments, at least one heavy chain constant region comprises a substitution at amino acid position 237, according to EU numbering. In some embodiments, the substitution at amino acid position 237 is an alanine (A).

[0024] In some embodiments, at least one heavy chain constant region comprises one or more substitutions at amino acid positions 234, 235, or 237, according to EU numbering. In some embodiments, the substitution at amino acid position 234 is an alanine (A), the substitution at

[0025] 3

[0026] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC amino acid position 235 is an alanine (A), and the substitution at amino acid position 237 is an alanine (A).

[0027] In some embodiments, the heavy chain constant region comprises heterodimerization mutations to promote heterodimerization of the first binding moiety with the second binding moiety.

[0028] In some embodiments, the heterodimerization mutations are Knob-in-Hole (KIH) mutations. In some embodiments, the first heavy chain constant region comprises an amino acid substitution at amino acid position 366, 368, or 407 which produces a hole, and the second heavy chain constant region comprises an amino acid substitution at amino acid position 366 which produces a knob. In some embodiments, the first heavy chain constant region comprises the amino acid substitution T366S, L368A, or Y407V, and the second heavy chain constant region comprises the amino acid substitution T366W.

[0029] In some embodiments, the heterodimerization mutations are charge stabilization mutations. In some embodiments, the first heavy chain constant region comprises the amino acid substitution N297K, and the second heavy chain constant region comprises the amino acid substitution N297D. In some embodiments, the first heavy chain constant region comprises the amino acid substitution T299K, and the second heavy chain constant region comprises the amino acid substitution T299D.

[0030] In some embodiments, the heterodimerization mutations comprise an engineered disulfide bond. In some embodiments, the engineered disulfide bond is formed by a first heavy chain constant region comprising the amino acid substitution Y349C, and a second heavy chain constant region comprising the amino acid substitution S354C.

[0031] In some embodiments, the engineered disulfide bond is formed by a C-terminal extension peptide fused to the C-terminus of each of the first heavy chain constant region and the second heavy chain constant region. In some embodiments, the first heavy chain constant region C-terminal extension comprises the amino acid sequence GEC, and the second heavy chain constant region C-terminal extension comprises the amino acid sequence SCDKT.

[0032] In some embodiments, at least one heavy chain constant region comprises one or more mutations to promote increased half-life.

[0033] In some embodiments, at least one heavy chain constant region comprises one or more substitutions at amino acid positions 252, 254, or 256, according to EU numbering. In some embodiments, the substitution at amino acid position 252 is a tyrosine (Y), the substitution at amino acid position 254 is a threonine (T), and the substitution at amino acid position 256 is a glutamic acid (E).

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[0035] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0036] In some embodiments, at least one heavy chain constant region comprises one or more substitutions at amino acid positions 428 or 434, according to EU numbering. In some embodiments, the substitution at amino acid position 428 is a leucine (L), and the substitution at amino acid position 434 is a serine (S).

[0037] In some embodiments, the antibody or antigen binding domain comprises a modified hinge region. In some embodiments, the antibody or antigen binding domain further comprises a first and / or second modified hinge region.

[0038] In an aspect, provided herein is a multispecific antibody comprising the antibody or antigen-binding fragment as described herein.

[0039] In some embodiments, the antibody binds to ActRIIA and / or ActRIIB and a second target. In some embodiments, the second target is ALK1.

[0040] In an aspect, provided herein is a pharmaceutical composition comprising the antibody or antigen-binding fragment thereof or the multispecific antibody as described herein and a pharmaceutically acceptable carrier.

[0041] In another aspect, provided herein is an isolated nucleic acid molecule encoding the antibody or antigen-binding fragment thereof or the multispecific antibody as described herein. In some embodiments, an expression vector comprises the nucleic acid molecule as described herein.

[0042] In yet another aspect, provided herein is a method for treating a disease or disorder in a subject, comprising administering to a subject in need thereof the antibody or antigen-binding fragment thereof or the multispecific antibody as described herein.

[0043] In some embodiments, the disease or disorder is a vascular disease or disorder. In some embodiments, the vascular disease or disorder is a pulmonary hypertension disease or disorder. In some embodiments, the pulmonary hypertension disease or disorder is pulmonary arterial hypertension (PAH). In some embodiments, the vascular disease or disorder is hereditary hemorrhagic telangiectasia (HHT).

[0044] In some embodiments, the antibody or antigen-binding fragment thereof or the multispecific antibody as described herein is used as a medicament.

[0045] In an aspect, provided herein is a method for reducing ActRIIA and / or ActRIIB signaling in a subject, comprising administering the antibody or antigen-binding fragment thereof or the multispecific antibody as described herein.

[0046] In another aspect, provided herein a method for treating hereditary hemorrhagic telangiectasia (HHT) in a subject in need thereof, comprising administering a multi-specific binding protein comprising a first binding moiety and a second binding moiety, wherein the

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[0048] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC first binding moiety specifically binds to ActRIIA and / or ActRIIB and the second binding moiety specifically binds to activin receptor-like kinase 1 (ALK1).

[0049] DETAILED DESCRIPTION

[0050] Before the present disclosure is described, it is to be understood that this disclosure is not limited to particular methods and experimental conditions described, as such methods and conditions may vary. 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 be limiting, since the scope of the present disclosure will be limited only by the appended claims.

[0051] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

[0052] Although any methods and materials similar or equivalent to those described herein can be used in the practice of the present disclosure, exemplary methods and materials are now described. All publications mentioned herein are incorporated herein by reference to describe in their entirety.

[0053] As used herein, the terms “antibody” and “antibodies” include full-length antibodies, antigen-binding fragments of full-length antibodies, and molecules comprising antibody CDRs, VH regions, and / or VL regions. Examples of antibodies include, without limitation, monoclonal antibodies, recombinantly produced antibodies, monospecific antibodies, multispecific antibodies (including bispecific antibodies), human antibodies, humanized antibodies, chimeric antibodies, immunoglobulins, synthetic antibodies, tetrameric antibodies comprising two heavy chain and two light chain molecules, an antibody light chain monomer, an antibody heavy chain monomer, an antibody light chain dimer, an antibody heavy chain dimer, an antibody light chain- antibody heavy chain pair, intrabodies, heteroconjugate antibodies, antibody-drug conjugates, single domain antibodies, monovalent antibodies, single chain antibodies or single-chain Fvs (scFv), camelid antibodies, affibodies, common light chain antibodies, Fab fragments, F(ab’)2 fragments, disulfide-linked Fvs (sdFv), anti -idiotypic (anti- id) antibodies (including, e.g., anti-anti-Id antibodies), and antigen-binding fragments of any of the above. In certain embodiments, antibodies described herein refer to polyclonal antibody populations. Antibodies can be of any type (e.g., IgG, IgE, IgM, IgD, IgA or IgY), any class (e.g., IgGl, IgG2, IgG3, IgG4, IgAl or IgA2), or any subclass (e.g., IgG2a or IgG2b) of immunoglobulin molecule. In certain embodiments, antibodies described herein are IgG

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[0055] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC antibodies, or a class (e.g., human IgGl or IgG4) or subclass thereof. As used herein, the terms “VH” and “VL” refer to antibody heavy and light chain variable domain, respectively, as described in Kabat et al., (1991) Sequences of Proteins of Immunological Interest (NIH Publication No. 91-3242, Bethesda), which is herein incorporated by reference in its entirety.

[0056] As used herein, the term “VHH” refers to the heavy chain variable domain of a camelid heavy chain-only antibody (HCAb) and humanized variants thereof, as described in Hamers- Casterman C. et al., Nature (1993) 363:446-8.10.1038 / 363446a0, which is incorporated by reference herein in its entirety.

[0057] As used herein, the term “VH / VL Pair” refers to a combination of a VH and a VL that together form the binding site for an antigen.

[0058] As used herein, the term “heavy chain” when used in reference to an antibody can refer to any distinct type, e.g., alpha (a), delta (5), epsilon (a), gamma (y), and mu (p), based on the amino acid sequence of the constant domain, which give rise to IgA, IgD, IgE, IgG, and IgM classes of antibodies, respectively, including subclasses of IgG, e.g., IgGl, IgG2, IgG3, and IgG4.

[0059] As used herein, the term “full-length antibody heavy chain” refers to an antibody heavy chain comprising, from N to C terminal, a VH, a CHI region, a hinge region, a CH2 domain and a CH3 domain.

[0060] As used herein, the term “light chain” when used in reference to an antibody can refer to any distinct type, e.g., kappa (K) or lambda (X) based on the amino acid sequence of the constant domains. Light chain amino acid sequences are well known in the art. In specific embodiments, the light chain is a human light chain. As used herein, the term “complementarity determining region” or “CDR” refers to sequences of amino acids within antibody variable regions, which confer antigen specificity and binding affinity. In general, there are three CDRs in each heavy chain variable region (CDR-H1, CDR-H2, CDR-H3) and three CDRs in each light chain variable region (CDR-L1, CDR-L2, CDR-L3). “Framework regions” or “FR” are known in the art to refer to the non-CDR portions of the variable regions of the heavy and light chains. In general, there are four FRs in each heavy chain variable region (FR-H1, FR-H2, FR- H3, and FR-H4), and four FRs in each light chain variable region (FR-L1, FR-L2, FR-L3, and FR-L4).

[0061] The precise amino acid sequence boundaries of a given CDR or FR can be readily determined using any of a number of well-known schemes, including those described by Kabat et al. (1991), “Sequences of Proteins of Immunological Interest,” 5th Ed. Public Health Service, National Institutes of Health, Bethesda, MD. (“Kabat” numbering scheme), Al-Lazikani et al.,

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[0063] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0064] (1997) JMB 273, 927-948 (“Chothia” numbering scheme), MacCallum et al., J. Mol. Biol. 262:732-745 (1996), “Antibody-antigen interactions: Contact analysis and binding site topography,” J. Mol. Biol. 262, 732-745. (“Contact” numbering scheme), Lefranc M. P. et al., “IMGT unique numbering for immunoglobulin and T cell receptor variable domains and Ig superfamily V-like domains,” Dev. Comp. Immunol., 2003 January; 27(l):55-77 (“IMGT” numbering scheme), and Honegger A. and Pluckthun A., “Yet another numbering scheme for immunoglobulin variable domains: an automatic modeling and analysis tool,” J. Mol. Biol., 2001 Jun. 8; 309(3):657-70, (AHo numbering scheme).

[0065] The boundaries of a given CDR or FR may vary depending on the scheme used for identification. For example, the Kabat scheme is based on sequence alignments, while the Chothia scheme is based on structural information. Numbering for both the Kabat and Chothia schemes is based upon the most common antibody region sequence lengths, with insertions accommodated by insertion letters, for example, “30a,” and deletions appearing in some antibodies. The two schemes place certain insertions and deletions (“indels”) at different positions, resulting in differential numbering. The Contact scheme is based on analysis of complex crystal structures and is similar in many respects to the Chothia numbering scheme.

[0066] As used herein, the term “single chain variable fragment” (scFv) refers to a fusion protein comprising at least one antibody fragment comprising a variable region of a light chain and at least one antibody fragment comprising a variable region of a heavy chain, wherein the light and heavy chain variable regions are contiguously linked via a short flexible polypeptide linker, and capable of being expressed as a single chain polypeptide, and wherein the scFv retains the specificity of the intact antibody from which it is derived. Unless specified, as used herein an scFv may have the VL and VH variable regions in either order, e.g., with respect to the N-terminal and C-terminal ends of the polypeptide, the scFv may comprise VL-linker-VH or may comprise VH-linker-VL.

[0067] The term “human antibody,” as used herein, is intended to include antibodies having variable and constant regions derived from human germline immunoglobulin sequences. The human mAbs of the disclosure may include amino acid residues not encoded by human germline immunoglobulin sequences (e.g., mutations introduced by random or site-specific mutagenesis in vitro or by somatic mutation in vivo), for example in the CDRs and in particular CDR3. However, the term “human antibody,” as used herein, is not intended to include mAbs in which CDR sequences derived from the germline of another mammalian species (e.g., mouse), have been grafted onto human FR sequences. The term includes antibodies

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[0069] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC recombinantly produced in a non-human mammal, or in cells of a non-human mammal. The term is not intended to include antibodies isolated from or generated in a human subject.

[0070] The term “multi specific antigen-binding molecules,” as used herein refers to bispecific, tri-specific or multi-specific antigen-binding molecules, and antigen-binding fragments thereof. Multispecific antigen-binding molecules may be specific for different epitopes of one target polypeptide or may contain antigen-binding domains specific for epitopes of more than one target polypeptide. A multispecific antigen-binding molecule can be a single multifunctional polypeptide, or it can be a multimeric complex of two or more polypeptides that are covalently or non-covalently associated with one another. The term “multispecific antigen-binding molecules” includes antibodies of the present disclosure that may be linked to or co-expressed with another functional molecule, e.g., another peptide or protein. For example, an antibody or fragment thereof can be functionally linked (e.g., by chemical coupling, genetic fusion, non-covalent association or otherwise) to one or more other molecular entities, such as a protein or fragment thereof to produce a bi-specific or a multi-specific antigen-binding molecule with a second binding specificity. According to the present disclosure, the term “multispecific antigen-binding molecules” also includes bispecific, trispecific or multispecific antibodies or antigen-binding fragments thereof. In certain exemplary embodiments, an antibody of the present disclosure is functionally linked to another antibody or antigen-binding fragment thereof to produce a bispecific antibody with a second binding specificity.

[0071] In exemplary embodiments, the heteromeric antibodies of the present disclosure are bispecific antibodies. Bispecific antibodies can be monoclonal, e.g., human or humanized, antibodies that have binding specificities for at least two different antigens.

[0072] Methods for making bispecific antibodies are well-known. Traditionally, the recombinant production of bispecific antibodies was based on the co-expression of two immunoglobulin heavy chain / light chain pairs, where the two heavy chains have different specificities (Milstein et al., Nature 305:537 (1983)). Because of the random assortment of immunoglobulin heavy and light chains, the hybridomas (quadromas) produce a potential mixture of ten different antibody molecules, of which only one has the correct bispecific structure. The purification of the correct molecule is usually accomplished by affinity chromatography steps. More modem techniques for generating bispecific antibodies employ heterodimerization domains that favor desired pairing of heavy chain from the antibody with a first specificity to the heavy chain of an antibody with a second specificity.

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[0075] Antibody variable domains with the desired binding specificities can be fused to immunoglobulin constant domain sequences. The fusion typically is with an immunoglobulin heavy chain constant domain, comprising at least part of the hinge, CH2, and CH3 regions. It may have the first heavy chain constant region (CHI) containing the site necessary for light chain binding present in at least one of the fusions. DNAs encoding the immunoglobulin heavy chain fusions and, if desired, the immunoglobulin light chain, are inserted into separate expression vectors, and are co-transformed into a suitable host organism. For further details of generating bispecific antibodies see, for example Suresh et al., Meth. Enzymol. 121 :210 (1986).

[0076] As used herein, the term “Fc” refers to a polypeptide comprising a CH2 domain and a CH3 domain, wherein the C-terminus of the CH2 domain is linked (directly or indirectly) to the N-terminus of the CH3 domain. The term “Fc polypeptide” includes an antibody heavy chain linked to an antibody light chain by disulfide bonds (e.g., to form a half-antibody).

[0077] In certain embodiments, an Fc chain begins in the hinge region just upstream of the papain cleavage site and ends at the C-terminus of the antibody. Accordingly, a complete Fc chain comprises at least a hinge domain, a CH2 domain, and a CH3 domain. In certain embodiments, an Fc chain comprises at least one of a hinge (e.g., upper, middle, and / or lower hinge region) domain, a CH2 domain, a CH3 domain, a CH4 domain, or a variant, portion, or fragment thereof. In certain embodiments, an Fc domain comprises a complete Fc chain (i.e., a hinge domain, a CH2 domain, and a CH3 domain). In certain embodiments, an Fc chain comprises a hinge domain (or portion thereof) fused to a CH3 domain (or portion thereof). In certain embodiments, an Fc chain comprises a CH2 domain (or portion thereof) fused to a CH3 domain (or portion thereof). In certain embodiments, an Fc chain consists of a CH3 domain or portion thereof. In certain embodiments, an Fc chain consists of a hinge domain (or portion thereof) and a CH3 domain (or portion thereof). In certain embodiments, an Fc chain consists of a CH2 domain (or portion thereof) and a CH3 domain. In certain embodiments, an Fc chain consists of a hinge domain (or portion thereof) and a CH2 domain (or portion thereof). In certain embodiments, an Fc chain lacks at least a portion of a CH2 domain (e.g., all or part of a CH2 domain). An Fc chain herein generally refers to a polypeptide comprising all or part of the Fc chain of an immunoglobulin heavy-chain. This includes, but is not limited to, polypeptides comprising the entire CHI, hinge, CH2, and / or CH3 domains as well as fragments of such peptides comprising only, e.g., the hinge, CH2, and CH3 domain. The Fc chain may be derived from an immunoglobulin of any species and / or any subtype, including, but not limited to, a human IgGI, IgG2, IgG3, IgG4, IgD, IgA, IgE, or IgM antibody. The Fc domain

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[0079] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC encompasses native Fc and Fc variant molecules. As with Fc variants and native Fc's, the term Fc chain includes molecules in monomeric or multimeric form, whether digested from whole antibody or produced by other means. In some embodiment, the Fc chain comprises the carboxy -terminal portions of both heavy chains held together by disulfides. In certain embodiments, an Fc chain consists of a CH2 domain and a CH3 domain.

[0080] In some embodiments, an Fc polypeptide comprises part or all of a wild-type hinge sequence (generally at its N-terminal). In some embodiments, an Fc polypeptide does not comprise a functional or wild-type hinge sequence.

[0081] As used herein, the term “CHI domain” refers to the first constant domain of an antibody heavy chain (e.g., amino acid positions 118-215 of human IgGl, according to the EU index). The term includes naturally occurring CHI domains and engineered variants of naturally occurring CHI domains (e.g., CHI domains comprising one or more amino acid insertions, deletions, substitutions, or modifications relative to a naturally occurring CHI domain).

[0082] As used herein, the term “CH2 domain” refers to the second constant domain of an antibody heavy chain (e.g., amino acid positions 231-340 of human IgGl, according to the EU index). The term includes naturally occurring CH2 domains and engineered variants of naturally occurring CH2 domains (e.g., CH2 domains comprising one or more amino acid insertions, deletions, substitutions, or modifications relative to a naturally occurring CH2 domain).

[0083] As used herein, the term “CH3 domain” refers to the third constant domain of an antibody heavy chain (e.g., amino acid positions 341-447 of human IgGl, according to the EU index). The term includes naturally occurring CH3 domains and engineered variants of naturally occurring CH3 domains (e.g., CH3 domains comprising one or more amino acid insertions, deletions, substitutions, or modifications relative to a naturally occurring CH3 domain).

[0084] As used herein, the term “hinge region” refers to the portion of an antibody heavy chain comprising the cysteine residues (e.g., the cysteine residues at amino acid positions 226 and 229 of human IgGl, according to the EU index) that mediate disulfide bonding between two heavy chains in an intact antibody. The term includes naturally occurring hinge regions and engineered variants of naturally occurring hinge regions (e.g., hinge regions comprising one or more amino acid insertions, deletions, substitutions, or modifications relative to a naturally occurring hinge regions). An exemplary full-length IgGl hinge region comprises amino acid positions 216-230 of human IgGl, according to the EU index. A hinge region may consist of

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[0086] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC at least 2 (e.g., 5, 10, 15, 20, 40, 60 or more) amino acids which result in a flexible or semiflexible linkage between adjacent variable regions and / or constant domains in a single polypeptide molecule. In some embodiments, the hinge region is an immunoglobulin-like hinge region. In some embodiments, the immunoglobulin-like hinge region can be from or derived from any IgGl, IgG2, IgG3, or IgG4 subtype, or from IgA, IgE, IgD or IgM, including chimeric forms thereof, e.g., a chimeric IgGl / 2 hinge region.

[0087] In some embodiments, the hinge region can be from the human IgGl subtype extending from amino acid 216 to amino acid 230 according to the numbering system of the EU index, or from amino acid 226 to amino acid 243 according to the numbering system of Kabat. Those skilled in the art may differ in their understanding of the exact amino acids corresponding to the various domains of the IgG molecule. Thus, the N-terminal or C-terminal of the domains outlined above may extend or be shortened by 1, 2, 3, 4, 5, 6, 7, 8, 9, or even 10 amino acids.

[0088] The term “upper hinge” as used herein typically refers to the last residue of the CHI domain up to but not including the first inter-heavy chain cysteine. The upper hinge can sometimes be defined as the N-terminal sequence from position 216 to position 225 according to the Kabat EU numbering system of an IgGl antibody (Kabat et al., Sequences of Proteins of Immunological Interest, 5th Ed. Public Health Service, National Institute of Health, Bethesda, Md., 1991). The term “middle hinge” refers to the region extending from the first inter-heavy chain cysteine to a proline residue adjacent to the carboxyl-end of the last middle hinge cysteine. The middle hinge can be the N-terminal sequence from position 226 to position 230 according to the Kabat EU numbering system. The term “lower hinge” refers to a highly conserved 7-8 amino acids. The lower hinge can be defined as the sequence from position 231 to 238 according the Kabat EU numbering system of an IgGl antibody. In some embodiments, the antibody according to the present invention effectively comprises an upper, a middle, and a lower hinge.

[0089] As used herein, the term "a modified hinge region" refers to a hinge region in which alterations are made in one or more of the characteristics of the hinge, including, but not limited to, flexibility, length, conformation, charge and hydrophobicity relative to a wild-type hinge. The modified hinge regions disclosed herein may be generated by methods well known in the art, such as, for example introducing a modification into a wild-type hinge. In some embodiments, the hinge region may be modified by one or more amino acids. Modifications which may be utilized to generate a modified hinge region include, but are not limited to, amino acid insertions, deletions, substitutions, and rearrangements. Said modifications of the hinge and the modified hinge regions disclosed are referred to herein jointly as “hinge modifications

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[0091] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC of the invention”, “modified hinge(s) of the invention” or simply “hinge modifications” or “modified hinge(s).” The modified hinge regions disclosed herein may be incorporated into a molecule of choice including, but not limited to, antibodies and fragments thereof. In some embodiments, the hinge region may be truncated and contain only a portion of the full hinge region.

[0092] As demonstrated herein, molecules comprising a modified hinge may exhibit altered (e.g., enhanced) clustering activity when compared to a molecule having the same amino acid sequence except for the modified hinge, such as, for example, a molecule having the same amino acid sequence except comprising a wild type hinge. In some embodiments, the antibody comprises a modified hinge region wherein the upper hinge region is up to 7 amino acids in length. In some embodiments, the upper hinge region is absent. In some embodiments, the modified hinge is a modified IgGl linker. In some embodiments, the modified IgGl hinge is derived from the sequence PLAPDKTHT (SEQ ID NO: 86). In some embodiments, the modified IgGl hinge comprises the sequence PLAP (SEQ ID NO: 87). In some embodiments, the modified IgGl hinge comprises the sequence DKTHT (SEQ ID NO: 88). In some embodiments, the modified hinge is a modified IgG4 hinge. In some embodiments, the modified IgGl hinge comprises the sequence EKSYGPP (SEQ ID NO: 89). In some embodiments, the modified hinge is a Gly / Ser hinge. In some embodiments, the Gly / Ser hinge comprises the sequence GGGGSGGGGSGGGGSGGGGS (SEQ ID NO: 90). In some embodiments, the C-terminal residues of the variable domain adjacent to the upper hinge are truncated. In some embodiments, at least one residue of the variable domain adjacent to the upper hinge is truncated. In some embodiments, at least two residues of the variable domain adjacent to the upper hinge is truncated.

[0093] As used herein, the term “EU index” refers to the EU numbering convention for the constant regions of an antibody, as described in Edelman, GM. et al., Proc. Natl. Acad. USA, 63, 78-85 (1969) and Kabat et al., Sequences of Proteins of Immunological Interest, U.S. Dept. Health and Human Services, 5th edition, 1991, each of which is herein incorporated by reference in its entirety. All numbering of amino acid positions of the Fc polypeptides, or fragments thereof, used herein is according to the EU index. As used herein, the term “linker” refers to 0-100 contiguous amino acid residues. The linkers are, present or absent, and same or different. Linkers comprised in a protein or a polypeptide may all have the same amino acid sequence or may have different amino acid sequences.

[0094] In some embodiments, the term “linker” refers to 1-100 contiguous amino acid residues. Typically, a linker provides flexibility and spatial separation between two amino acids or

[0095] 13

[0096] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC between two polypeptide domains. A linker may be inserted between VH, VL, CH and / or CL domains to provide sufficient flexibility and mobility for the domains of the light and heavy chains depending on the format of the molecule. A linker is typically inserted at the transition between variable domains between variable and knockout domain, or between variable and constant domains, respectively, at the amino sequence level. The transition between domains can be identified because the approximate sizes of the immunoglobulin domains are well understood. The precise location of a domain transition can be determined by locating peptide stretches that do not form secondary structural elements such as beta-sheets or alpha-helices as demonstrated by experimental data or as can be determined by techniques of modeling or secondary structure prediction.

[0097] As used herein, the term “specifically binds,” “specifically binding,” “binding specificity” or “specifically recognized” refers that an antigen binding protein or antigenbinding fragment thereof that exhibits appreciable affinity for an antigen (e.g., ActRIIA and / or ActRIIB) and does not exhibit significant cross reactivity to a target that is not an ActRIIA and / or ActRIIB protein. As used herein, the term “affinity” refers to the strength of the interaction between an antigen binding protein or antigen-binding fragment thereof antigen binding site and the epitope to which it binds. In certain exemplary embodiments, affinity is measured by surface plasmon resonance (SPR), e.g., in a Biacore instrument. As readily understood by those skilled in the art, an antigen binding protein affinity may be reported as a dissociation constant (KD) in molarity (M). The antigen binding protein or antigen-binding fragment thereof of the disclosure have KD values in the range of about IO'5M to about 10'12M (i.e., low micromolar to picomolar range), about 10'7M to 10'11M, about 10'8M to about IO-10M, about 10'9M. In certain embodiments, the antigen binding protein or antigen-binding fragment thereof has a binding affinity of about 10'5M ,10'6M, 10-7M, 10'8M, 10'9M, IO'10M, 10'11M, or IO’12M. In certain embodiments, the antigen binding protein or antigen-binding fragment thereof has a binding affinity of about 10'7M to about 10'9M (nanomolar range).

[0098] Specific binding can be determined according to any art-recognized means for determining such binding. In some embodiments, specific binding is determined by competitive binding assays (e.g., ELISA) or Biacore assays. In certain embodiments, the assay is conducted at about 20°C, 25°C, 30°C, or 37°C.

[0099] As used herein, “administer” or “administration” refers to the act of injecting or otherwise physically delivering a substance as it exists outside the body (e.g., an isolated binding polypeptide provided herein) into a patient, such as by, but not limited to, pulmonary (e.g., inhalation), mucosal (e.g., intranasal), intradermal, intravenous, intramuscular delivery

[0100] 14

[0101] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC and / or any other method of physical delivery described herein or known in the art. When a disease, or a symptom thereof, is being managed or treated, administration of the substance typically occurs after the onset of the disease or symptoms thereof. When a disease, or symptom thereof, is being prevented, administration of the substance typically occurs before the onset of the disease or symptoms thereof and may be continued chronically to defer or reduce the appearance or magnitude of disease-associated symptoms.

[0102] As used herein, the term “composition” is intended to encompass a product containing the specified ingredients (e.g., an isolated binding polypeptide provided herein) in, optionally, the specified amounts, as well as any product which results, directly or indirectly, from combination of the specified ingredients in, optionally, the specified amounts.

[0103] “Effective amount” means the amount of active pharmaceutical agent (e.g., an isolated binding polypeptide of the present disclosure) sufficient to effectuate a desired physiological outcome in an individual in need of the agent. The effective amount may vary among individuals depending on the health and physical condition of the individual to be treated, the taxonomic group of the individuals to be treated, the formulation of the composition, assessment of the individual's medical condition, and other relevant factors.

[0104] As used herein, the terms “subject” and “patient” are used interchangeably. As used herein, a subject can be a mammal, such as a non-primate (e.g., cows, pigs, horses, cats, dogs, rats, mice, etc.) or a primate (e.g., monkey and human). In certain embodiments, the term “subject,” as used herein, refers to a vertebrate, such as a mammal. Mammals include, without limitation, humans, non-human primates, wild animals, feral animals, farm animals, sport animals, and pets.

[0105] As used herein, the term “therapy” refers to any protocol, method and / or agent that can be used in the prevention, management, treatment and / or amelioration of a disease or a symptom related thereto. In some embodiments, the term “therapy” refers to any protocol, method and / or agent that can be used in the modulation of an immune response to an infection in a subject or a symptom related thereto. In some embodiments, the terms “therapies” and “therapy” refer to a biological therapy, supportive therapy, and / or other therapies useful in the prevention, management, treatment and / or amelioration of a disease or a symptom related thereto, known to one of skill in the art such as medical personnel. In other embodiments, the terms “therapies” and “therapy” refer to a biological therapy, supportive therapy, and / or other therapies useful in the modulation of an immune response to an infection in a subject or a symptom related thereto known to one of skill in the art such as medical personnel.

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[0108] As used herein, the terms “treat,” “treatment” and “treating” refer to the reduction or amelioration of the progression, severity, and / or duration of a disease or a symptom related thereto, resulting from the administration of one or more therapies (including, but not limited to, the administration of one or more prophylactic or therapeutic agents, such as an isolated binding polypeptide provided herein). The term “treating,” as used herein, can also refer to altering the disease course of the subject being treated. Therapeutic effects of treatment include, without limitation, preventing occurrence or recurrence of disease, alleviation of symptom(s), diminishment of direct or indirect pathological consequences of the disease, decreasing the rate of disease progression, amelioration or palliation of the disease state, and remission or improved prognosis.

[0109] The term “about” or “approximately” means within about 20%, such as within about 10%, within about 5%, or within about 1% or less of a given value or range.

[0110] ActRIIA / B

[0111] As used herein, the term “ActRIIA” refers to a family of activin receptor type IIA (ActRIIA) proteins from any species and variants derived from such ActRIIA proteins by mutagenesis or other modification. Reference to ActRIIA herein is understood to be a reference to any one of the currently identified forms. Members of the ActRIIA family are generally transmembrane proteins, composed of a ligand-binding extracellular domain comprising a cysteine-rich region, a transmembrane domain, and a cytoplasmic domain with predicted serine / threonine kinase activity. The term “ActRIIA” includes polypeptides comprising any naturally occurring polypeptide of an ActRIIA family member as well as any variants thereof (including mutants, fragments, fusions, and peptidomimetic forms) that retain a useful activity.

[0112] As used herein, the term “ActRIIB” refers to a family of activin receptor type IIB (ActRIIB) proteins from any species and variants derived from such ActRIIB proteins by mutagenesis or other modification. Reference to ActRIIB herein is understood to be a reference to any one of the currently identified forms. Members of the ActRIIB family are generally transmembrane proteins, composed of a ligand-binding extracellular domain comprising a cysteine-rich region, a transmembrane domain, and a cytoplasmic domain with predicted serine / threonine kinase activity. The term “ActRIIA” and “ActRIIB” includes polypeptides comprising any naturally occurring polypeptide of an ActRIIA / ActRIIB family member as well as any variants thereof (including mutants, fragments, fusions, and peptidomimetic forms) that retain a useful activity. Examples of such variant ActRIIA and ActRIIB polypeptides are provided throughout the present disclosure as well as in International Patent Application

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[0114] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0115] Publication Nos. WO 2006 / 012627 and WO 2008 / 097541, which are incorporated herein by reference in its entirety.

[0116] ActRIIA and / or ActRIIB Antibodies

[0117] Antibodies and antigen-binding fragments thereof as provided herein promote the activation of ActRIIA and / or ActRIIB. Antibodies according to the current invention can be produced with high yields. The antibodies or their binding domains can be easily maturated, or screening approaches can be used to detect binders with optimized binding capabilities. Each binding site can be optimized. Finally, even in the absence of downstream signaling, e.g., due to a genetic defect, an antibody approach could still be able to rescue the ActRIIA / B signaling cascade.

[0118] The antibodies and antigen-binding fragments thereof as disclosed herein specifically bind to ActRIIA and / or ActRIIB, i.e., they bind to their targets with an affinity that is higher (e.g., at least 2-fold higher) than their binding affinity for an irrelevant antigen (e.g., bovine serum albumin (BSA), casein).

[0119] In certain embodiments according to the first aspect, the antibodies specifically bind an extracellular domain of ActRIIA and / or ActRIIB. In some embodiments, the ActRIIA and / or ActRIIB is human ActRIIA and / or human ActRIIB or a fragment thereof.

[0120] In some embodiments, the antibody binds to ActRIIA and / or ActRIIB with a Kd of at most about IO’4M to about IO’13M (e.g., IO’4M, IO'4 5M, 10’5M, 10'5 5M, IO’6M, IO'6 5M, IO’7M, IO’7 5M, IO’8M, 10'8 5M, IO’9M, IO'9 5M, IO’10M, IO'10 5M, 10’11M, 10'11 5M, IO’12M, IO’12 5M, 10’13M).

[0121] The Kd of antibody binding to an antigen can be assayed using any method known in the art including, for example, immunoassays such as enzyme-linked immunosorbent assay (ELISA), Bimolecular Interaction Analysis (BIA) (e.g., Sjolander & Urbaniczky; Anal. Chem. 63:2338-2345, 1991 ; Szabo, et al., Curr. Opin. Struct. Biol. 5:699-705, 1995), and fluorescence-activated cell sorting (FACS) for quantification of antibody binding to cells that express an antigen. BIA is a technology for analyzing bispecific interactions in real time, without labeling any of the interactants (e.g., BIACORE™). Changes in the optical phenomenon surface plasmon resonance (SPR) can be used as an indication of real-time reactions between biological molecules.

[0122] In some embodiments, the binding moiety which binds specifically to ActRIIA is cross- reactive with ActRIIB.

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[0125] In some embodiments, the binding moiety which binds specifically to ActRIIA and / or ActRIIB comprises HCDR1, HCDR2, and HCDR3 amino acid sequences. In some embodiments, the binding moiety which binds specifically to ActRIIA and / or ActRIIB comprises HCDR1, HCDR2, HCDR3, LCDR1, LCDR2, and LCDR3 amino acid sequences. In some embodiments, the HCDR3 comprises an amino acid sequence comprising AVRPGDYD (SEQ ID NO: 3), ENVAPRPLDY (SEQ ID NO: 7), GGYWLDY (SEQ ID NO: 15), GLRHPDY (SEQ ID NO: 23), RGHTMPQPLDP (SEQ ID NO: 31), HGSGTRAFDS (SEQ ID NO: 39), GWYWFDP (SEQ ID NO: 47), SPAHSPHPFDI (SEQ ID NO: 56), EQGPGPYAFDI (SEQ ID NO: 63), QLIPPAPLDY (SEQ ID NO: 71), OR GSIGAPWPLDY (SEQ ID NO: 79).

[0126] Except if there is an obvious incompatibility for a person skilled in the art, each of the embodiments describing the binding capabilities can be combined with each of the embodiment describing the format of the antibody.

[0127] Binding Domains

[0128] One component of the antibodies of the present disclosure is a binding domain or binding specificity which binds ActRIIA and / or ActRIIB.

[0129] Any type of binding moiety that specifically binds to a specific receptor subunit can be employed in the antibody or antigen binding domain or fragment thereof disclosed herein. In certain embodiments, the binding moiety comprises an antibody variable domain. Exemplary binding moieties comprising an antibody variable domain include, without limitation, a VH, a VL, a VHH, a VH / VL pair, an scFv, a diabody, or a Fab. Other suitable binding moiety formats include, without limitation, lipocalins (see e.g., Gebauer M. et al., 2012, Method Enzymol. 503: 157-188, which is incorporated by reference herein in its entirety), adnectins (see e.g., Lipovsek D., 2011, Protein Eng. Des. Sei. 24:3-9, which is incorporated by reference herein in its entirety), avimers (see e.g., Silverman J, et al., 2005, Nat. Biotechnol. 23:1556-1561, which is incorporated by reference herein in its entirety), fynomers (see e.g., Schlatter D, et al., 2012, mAbs 4:497-508, which is incorporated by reference herein in its entirety), kunitz domains (see e.g., Hosse R.J. et al., 2006, Protein Sci. 15: 14-27, which is incorporated by reference herein in its entirety), knottins (see e.g., Kintzing J.R. et al., 2016, Curr. Opin. Chem. Biol. 34: 143-150, which is incorporated by reference herein in its entirety), affibodies (see e.g., Feldwisch J. et al., 2010 J. Mol. Biol. 398:232-247, which is incorporated by reference herein in its entirety), and DARPins (see e.g., Pluckthun A., 2015, Annu. Rev. Pharmacol. Toxicol. 55:489-511, which is incorporated by reference herein in its entirety).

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[0131] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0132] In certain embodiments, the binding domain comprises the heavy and / or light chain variable regions of a conventional antibody or antigen binding fragment thereof (e.g., a Fab or scFv), wherein the term “conventional antibody” is used herein to describe heterotetrameric antibodies containing heavy and light immunoglobulin chains arranged according to the “Y” configuration. Such conventional antibodies may derive from any suitable species including but not limited to antibodies of llama, alpaca, camel, mouse, rat, rabbit, goat, hamster, chicken, monkey, or human origin. In certain exemplary embodiments, the conventional antibody comprises a heavy chain variable domain (VH) and a light chain variable domain (VL) wherein the VH and / or VL domains or one or more complementarity determining regions (CDRs) thereof are derived from the same antibodies. In certain embodiments, the conventional antibody antigen binding region may be referred to as a “Fab” (Fragment antigen-binding). The Fab comprises one constant and one variable domain from each of heavy chain and light chain. The variable heavy and light chains contain the CDRs responsible for antigen binding.

[0133] In other embodiments, the specific receptor subunit binding subunit comprises at least a CDR or VHH domain of a VHH antibody or Nanobody. VHH antibodies, which are camelid- derived heavy chain antibodies, are composed of two heavy chains and are devoid of light chains (Hamers-Casterman, et al. Nature. 1993; 363; 446-8). Each heavy chain of the VHH antibody has a variable domain at the N-terminus, and these variable domains are referred to in the art as “VHH” domains in order to distinguish them from the variable domains of the heavy chains of the conventional antibodies i.e., the VH domains. Similar to conventional antibodies, the VHH domains of the molecule comprise HCDR1, HCDR2 and HCDR3 regions which confer antigen binding specificity and therefore VHH antibodies or fragments such as isolated VHH domains, are suitable as components of the multispecific binding proteins of the present disclosure.

[0134] Multispecific Binding Proteins

[0135] In certain embodiments, the ActRIIA / B antibody or antigen binding domain as disclosed herein can be paired together or operatively linked to generate a multi-specific binding protein capable of binding two antigens. In some embodiments, the first specific binding domain (e.g., VHH) is operatively linked (directly or indirectly) to the N and / or C terminus of a first Fc domain or polypeptide, and the second specific binding domain is operatively linked to the N and / or C terminus of second Fc domain or polypeptide, such that the first Fc domain and the second Fc domain facilitate heterodimerization of the first and second specific binding domains.

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[0138] In certain exemplary embodiments, the multispecific binding proteins of the disclosure are agonistic to any given signaling pathway, i.e., they are not antagonistic to the ActRIIA / B pathway. In some embodiments, agonism may be measured using a specific receptor potency assay (e.g., Pathhunter U2OS dimerization assay (DiscoverX) Potency assays (e.g., Pathhunter) involve a cell line (e.g., U2OS) that expresses the target receptors of interest. The binding of the bispecific antibodies to the receptors triggers a signaling cascade leading to the expression of a reporter gene which can be quantified.

[0139] In certain embodiments, the multispecific binding protein comprises a dual variable domain format. “Dual variable domain” (“DVD”) binding proteins of the disclosure comprise two or more antigen binding sites and are tetravalent or multivalent binding proteins. The DVDs of the disclosure are multispecific, i.e., capable of binding ActRIIA / B and a second target. A DVD binding protein comprising two heavy chain DVD polypeptides and two light chain DVD polypeptides is referred to as a “DVD immunoglobulin” or “DVD-Ig”. Each half of a DVD-Ig comprises a heavy chain DVD polypeptide and a light chain DVD polypeptide, and two or more antigen binding sites. Each binding site comprises a heavy chain variable domain and a light chain variable domain with a total of six CDRs involved in antigen binding per antigen binding site.

[0140] A description of the design, expression, and characterization of DVD-Ig molecules is provided in PCT Publication No. WO 2007 / 024715; U.S. Pat. No. 7,612,181; and Wu et al., Nature Biotechnol., 25: 1290-1297 (2007). An example of such DVD-Ig molecules comprises a heavy chain that comprises the structural formula VDl-(Xl)n-VD2-C-(X2)n, wherein VD1 is a first heavy chain variable domain, VD2 is a second heavy chain variable domain, C is a heavy chain constant domain, XI is a linker with the proviso that it is not CHI, X2 is an Fc region, and n is 0 or 1; and a light chain that comprises the structural formula VDl-(Xl)n- VD2-C-(X2)n, wherein VD1 is a first light chain variable domain, VD2 is a second light chain variable domain, C is a light chain constant domain, XI is a linker with the proviso that it is not CHI, and X2 does not comprise an Fc region; and n is 0 or 1. Such a DVD-Ig may comprise two such heavy chains and two such light chains, wherein each chain comprises variable domains linked in tandem without an intervening constant region between variable regions, wherein a heavy chain and a light chain associate to form tandem functional antigen binding sites, and a pair of heavy and light chains may associate with another pair of heavy and light chains to form a tetrameric binding protein with four functional antigen binding sites. In another example, a DVD-Ig molecule may comprise heavy and light chains that each comprise three variable domains (VD1, VD2, VD3) linked in tandem without an intervening constant

[0141] 20

[0142] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC region between variable domains, wherein a pair of heavy and light chains may associate to form three antigen binding sites, and wherein a pair of heavy and light chains may associate with another pair of heavy and light chains to form a tetrameric binding protein with six antigen binding sites.

[0143] In an embodiment, the disclosure provides a binding protein comprising first and second polypeptide chains, wherein said first polypeptide chain comprises a first VDl-(Xl)n- VD2-C-(X2)n, wherein: VD1 is a first heavy chain variable domain; VD2 is a second heavy chain variable domain; C is a heavy chain constant domain; XI is a linker with the proviso that it is not CHI; X2 is an Fc region; and n is independently 0 or 1; and wherein said second polypeptide chain comprises a second VDl-(Xl)n-VD2-C-(X2)n, wherein: VD1 is a first light chain variable domain; VD2 is a second light chain variable domain; C is a light chain constant domain; XI is a linker with the proviso that it is not CHI; X2 does not comprise an Fc region; and n is independently 0 or 1.

[0144] With respect to constructing DVD-Ig or other binding protein molecules, a “linker” is used to denote a single amino acid or a polypeptide (“linker polypeptide”) comprising two or more amino acid residues joined by peptide bonds and used to link one or more antigen binding portions. Such linker polypeptides are well known in the art (see, e.g., Holliger et al., Proc. Natl. Acad. Sci. USA, 90: 6444-6448 (1993); Poljak, R. J., Structure, 2: 1121-1123 (1994)). Flexible linkers may be employed, which are generally composed of small, non-polar (e.g. Gly) or polar (e.g. Ser or Thr) amino acids. Exemplary flexible linkers include, but are not limited to, GGGGSG (SEQ ID NO: 91), GGSGG (SEQ ID NO: 92), GGGGSGGGGS (SEQ ID NO: 93), GGSGGGGSG (SEQ ID NO: 94), GGSGGGGSGS (SEQ ID NO: 95), GGSGGGGSGGGGS (SEQ ID NO: 96), GGGGSGGGGS GGGG (SEQ ID NO: 97), GGGGSGGGGSGGGGS (SEQ ID NO: 98), and

[0145] RADAAAAGGGGSGGGGSGGGGSGGGGS (SEQ ID NO: 99).

[0146] Alternatively, rigid linkers may be employed to join one or more antigen binding proteins. Said rigid linkers may allow for the maintenance of fixed distances between linked antigen binding proteins, thereby promoting the activity of each individual protein. Rigid linkers may employ one of more proline amino acids to confer the rigidity. Exemplary rigid linkers include, but are not limited to, ASTKGP (SEQ ID NO: 100), ASTKGPSVFPLAP (SEQ ID NO: 101), TVAAP (SEQ ID NO: 102), RTVAAP (SEQ ID NO: 103), TVAAPSVFIFPP (SEQ ID NO: 104), RTVAAPSVFIFPP (SEQ ID NO: 105), AKTTPKLEEGEFSEAR (SEQ ID NO: 106), AKTTPKLEEGEFSEARV (SEQ ID NO: 107), AKTTPKLGG (SEQ ID NO: 108), SAKTTPKLGG (SEQ ID NO: 109), SAKTTP (SEQ ID NO: 110), RADAAP (SEQ ID NO:

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[0149] Ill), RADAAPTVS (SEQ ID NO: 112), RADAAAAGGPGS (SEQ ID NO: 113), SAKTTPKLEEGEFSEARV (SEQ ID NO: 114), ADAAP (SEQ ID NO: 115), ADAAPTVSIFPP (SEQ ID NO: 116), QPKAAP (SEQ ID NO: 117), QPKAAPSVTLFPP (SEQ ID NO: 118), AKTTPP (SEQ ID NO: 119), AKTTPPSVTPLAP (SEQ ID NO: 120), AKTTAP (SEQ ID NO: 121), AKTTAPSVYPLAP (SEQ ID NO: 122), GENKVEYAPALMALS (SEQ ID NO: 123), GPAKELTPLKEAKVS (SEQ ID NO: 124), and GHEAAAVMQVQYPAS (SEQ ID NO: 125).

[0150] In certain embodiments, the linker comprises a modified hinge region as described herein.

[0151] In certain embodiments, the linker comprises or consists of PLAP, PAPNLLGGP, PLAPDKTHT, EKSYGPP, or DKTHT.

[0152] In certain embodiments, the multispecific binding protein comprises a first and a second polypeptide chain, wherein: said first polypeptide chain comprises VHl-(HXl)n-VH2-C-(HX2)n, wherein:

[0153] VH1 is a first heavy chain variable domain; VH2 is a second heavy chain variable domain; C is a heavy chain constant domain; HX1 is a linker; HX2 is an Fc region; and n is independently 0 or 1 ; and said second polypeptide chain comprises VLl-(LXl)n-VL2-C-(LX2)n, wherein:

[0154] VL1 is a first light chain variable domain; VL2 is a second light chain variable domain; C is a light chain constant domain; LX1 is a linker; LX2 does not comprise an Fc region; and n is independently 0 or 1.

[0155] In certain embodiments, VH1 binds specifically to human ActRIIA and / or ActRIIB and VH2 binds specifically to a second target.

[0156] In certain embodiments, VL1 binds specifically to human ActRIIA and / or ActRIIB and VL2 binds specifically to a second target.

[0157] In certain embodiments, VH1 binds specifically to a target and VH2 binds to human ActRIIA and / or ActRIIB.

[0158] In certain embodiments, VL1 binds specifically to a target and VL2 binds to human ActRIIA and / or ActRIIB.

[0159] In certain embodiments, linker HX1 comprises an amino acid sequence of PLAP or PAPNLLGGP.

[0160] In certain embodiments, linker LX1 comprises an amino acid sequence of PLAP or PAPNLLGGP.

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[0163] In certain embodiments, linker HX1 comprises an amino acid sequence of PLAP and linker LX1 comprises an amino acid sequence of PLAP or PAPNLLGGP.

[0164] In certain embodiments, the multispecific binding protein comprises two polypeptide chains of VHl-(HXl)n-VH2-C-(HX2)n and two polypeptide chains of VLl-(LXl)n-VL2-C- (LX2)n.

[0165] In certain embodiments, for (HXl)n, n is 1 and for (HX2)n, n is 1.

[0166] In certain embodiments, for (LXl)n, n is 1 and for (LX2)n, n is 0.

[0167] In certain embodiments, the multispecific binding protein comprises a first and a second polypeptide chain, wherein: said first polypeptide chain comprises VHl-(HXl)n-VH2-C-Fc, wherein:

[0168] VH1 is a first heavy chain variable domain; VH2 is a second heavy chain variable domain; C is a heavy chain constant domain; HX1 is a linker; Fc is an Fc region; and n is independently 0 or 1 ; and said second polypeptide chain comprises VLl-(LXl)n-VL2-C, wherein:

[0169] VL1 is a first light chain variable domain; VL2 is a second light chain variable domain; C is a light chain constant domain; LX1 is a linker; and n is independently 0 or 1.

[0170] Non-DVD-Ig Formats

[0171] In another aspect of the disclosure, the multispecific binding protein comprises from N-terminus to C-terminus: ai) a first polypeptide chain comprising a first antigen binding domain, a first linker (e.g., a modified hinge region), and a first constant region; and bi) a second polypeptide chain comprising a second antigen binding domain, a second linker (e.g., a modified hinge region), and a second constant region; aii) a first polypeptide chain comprising a second antigen binding domain, a first antigen binding domain, a first linker (e.g., a modified hinge region), and a first constant region; and bii) a second polypeptide chain comprising a second linker (e.g., a modified hinge region) or the absence of a linker, and a second constant region; aiii) a first polypeptide chain comprising a first linker (e.g., a modified hinge region) or the absence of a linker, and a first constant region; and biii) a second polypeptide chain comprising a second antigen binding domain, a first antigen binding domain, a second linker (e.g., a modified hinge region), and a second constant region; or

[0172] 23

[0173] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC aiv) a first polypeptide chain comprising a first antigen binding domain, an optional first linker (e.g., a modified hinge region), a second antigen binding domain, an optional second linker (e.g., a modified hinge region), and a first constant region; and biv) a second polypeptide chain comprising a third antigen binding domain, an optional third linker (e.g., a modified hinge region), a fourth antigen binding domain, an optional fourth linker (e.g., a modified hinge region), and a second constant region.

[0174] In certain embodiments, the first antigen binding domain comprises an scFv, VHH, Fab, F(ab’)2, or a single domain antibody.

[0175] In certain embodiments, the second antigen binding domain comprises an scFv, VHH, Fab, F(ab’)2, or a single domain antibody.

[0176] In certain embodiments, the third antigen binding domain comprises an scFv, VHH, Fab, F(ab’)2, or a single domain antibody.

[0177] In certain embodiments, the fourth antigen binding domain comprises an scFv, VHH, Fab, F(ab’)2, or a single domain antibody.

[0178] In certain embodiments, any one or more of the first antigen binding domain, second antigen binding domain, third antigen binding domain, and fourth antigen binding domain comprise an scFv, VHH, Fab, F(ab’)2, or a single domain antibody.

[0179] In certain embodiments, the first antigen binding domain, second antigen binding domain, third antigen binding domain, and fourth antigen binding domain each comprise an scFv.

[0180] Fc Domain

[0181] The Fc polypeptides employed in the antibodies of the disclosure generally comprise a CH2 domain and a CH3 domain, wherein the C-terminus of the CH2 domain is linked (directly or indirectly) to the N-terminus of the CH3 domain. Any naturally occurring or variant CH2 and / or CH3 domain can be used. For example, in certain embodiments, the CH2 and / or CH3 domain is a naturally occurring CH2 or CH3 domain from an IgGl, IgG2, IgG3, IgG4, IgAl, or IgA2 antibody heavy chain, e.g., a human IgGl, IgG2, IgG3, IgG4, IgAl, or IgA2 antibody heavy chain. The CH2 and CH3 domains can be from the same or different antibody heavy chains. In certain embodiments, the Fc polypeptide comprises a CH2 and CH3 domaincontaining portion from a single antibody heavy chain. In certain embodiments, the CH2 and / or CH3 domain is a variant of a naturally occurring CH2 or CH3 domain, respectively. In certain embodiments, the CH2 and / or CH3 domain is a variant comprising one or more amino acid insertions, deletion, substitutions, or modifications relative to a naturally occurring CH2

[0182] 24

[0183] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC or CH3 domain, respectively. In certain embodiments, the CH2 and / or CH3 domain is a chimera of one or more CH2 or CH3 domains, respectively. In certain embodiments, the CH2 domain comprises amino acid positions 231-340 of a naturally occurring hinge region (e.g., human IgGl), according to the EU index. In certain embodiments, the CH3 domain comprises amino acid positions 341-447 of a naturally occurring hinge region (e.g., human IgGl), according to the EU index. In certain embodiments, the Fc domain comprises the amino acid sequence of SEQ ID NO: 85.

[0184] GPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVS VLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGF YPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKS LSLSPGK (Wild-type Fc domain; SEQ ID NO : 85 )

[0185] In certain embodiments, the Fc domain comprises the amino acid sequence of SEQ ID NO: 126.

[0186] GPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRVVS VLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCLVKGF YPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKS LSLSPG ( Fc domain; SEQ ID NO : 126 )

[0187] In certain embodiments, the Fc polypeptides further comprise a hinge region, wherein the C-terminus of hinge region is linked (directly or indirectly) to the N-terminus of the CH2 domain. For example, in certain embodiments, the hinge region is a naturally occurring hinge region from an IgGl, IgG2, IgG3, IgG4, IgAl, or IgA2 antibody heavy chain, e.g., a human IgGl, IgG2, IgG3, IgG4, IgAl, or IgA2 antibody heavy chain. The hinge region can be from the same or different antibody heavy chain than the CH2 and / or CH3 domains. In certain embodiments, the hinge region is a variant comprising one or more amino acid insertions, deletion, substitutions, or modifications relative to a naturally occurring hinge region. In certain embodiments, the hinge region is a chimera of one or more hinge regions. In certain embodiments, the hinge region comprises amino acid positions 226-229 of a naturally occurring hinge region (e.g., human IgGl), according to the EU index. In certain embodiments, the hinge region comprises amino acid positions 216-230 of a naturally occurring hinge region (e.g., human IgGl), according to the EU index. In certain embodiments, the hinge region comprises amino acid positions 216-230 of a naturally occurring hinge region (e.g., human IgGl), according to the EU index. In certain embodiments, the hinge region is a variant IgG4 hinge region comprising a serine (S) at amino acid position 228, according to the EU index.

[0188] 25

[0189] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0190] In certain embodiments, the Fc polypeptides further comprise a CHI domain, wherein the C-terminus of CHI domain is linked (directly or indirectly) to the N-terminus of the hinge region. For example, in certain embodiments, the CHI domain is a naturally occurring CHI domain from an IgGl, IgG2, IgG3, IgG4, IgAl, or IgA2 antibody heavy chain, e.g., a human IgGl, IgG2, IgG3, IgG4, IgAl, or IgA2 antibody heavy chain. The CHI domain can be from the same or different antibody heavy chain than the hinge region, CH2 domain and / or CH3 domain. In certain embodiments, the CHI domain is a variant comprising one or more amino acid insertions, deletions, substitutions, or modifications relative to a naturally occurring CHI domain. In certain embodiments, the CHI domain is a chimera of one or more CHI domain. In certain embodiments, the CHI domain comprises amino acid positions 118-215 of a naturally occurring hinge region (e.g., human IgGl), according to the EU index.

[0191] In certain embodiment, the Fc polypeptide lacks a CHI domain or comprises mutations in a CHI domain or heavy chain variable domain that prevent association of the heavy chain with an antibody light chain. In certain embodiments, the antibody heavy chain lacks a portion of a hinge region.

[0192] Heterodimerization Motifs

[0193] In certain exemplary embodiments, the first and second Fc domains are further engineered to enhance heterodimerization of the first specific and second specific binding domains and minimize the effects of incorrect chain pairing (i.e., pairing of ActRIIA and / or B and a second specific target).

[0194] Any art-recognized approach that addresses the problem of incorrect chain pairing can be employed to improve desired multispecific antibody production. For instance, US2010 / 0254989 Al describes the construction of bispecific cMet - ErbBl antibodies, where the VH and VL of the individual antibodies are fused genetically via a GlySer linker. For bispecific antibodies including an Fc domain, mutations may be introduced into the Fc to promote the correct heterodimerization of the Fc portion. Several such approaches are reviewed in Klein et al. (mAbs (2012) 4:6, 1 -11), the contents of which are incorporated herein by reference in their entirety.

[0195] In certain embodiments, the first specific and second specific binding specificities of the multispecific antibody are heterodimerized through knobs-into-holes (KiH) pairing of Fc domains. This dimerization technique utilizes “protuberances” or “knobs” with “cavities” or “holes” engineered into the interface of CH3 domains. Where a suitably positioned and dimensioned knob or hole exists at the interface of either the first or second CH3 domain, it is

[0196] 26

[0197] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC only necessary to engineer a corresponding hole or knob, respectively, at the adjacent interface, thus promoting and strengthening Fc domain pairing in the CH3 / CH3 domain interface. The IgG Fc domain that is fused to the VHH is provided with a knob, and the IgG Fc domain of the conventional antibody is provided with a hole designed to accommodate the knob, or vice- versa. A “knob” refers to an at least one amino acid side chain, typically a larger side chain, that protrudes from the interface of the CH3 portion of a first Fc domain. The protrusion creates a “knob” which is complementary to and received by a “hole” in the CH3 portion of a second Fc domain. The “hole” is an at least one amino acid side chain, typically a smaller side chain, which recedes from the interface of the CH3 portion of the second Fc domain. This technology is described, for example, in U.S. Pat. Nos. 5,821,333; 5,731,168 and 8,216,805; Ridgway et al. Protein Engineering (1996) 9:617-621); and Carter P. J. Immunol. Methods (2001) 248: 7- 15, which are herein incorporated by reference.

[0198] Exemplary amino acid residues that may act as the knob include arginine (R), phenylalanine (F), tyrosine (Y) or tryptophan (W). An existing amino acid residue in the CH3 domain may be replaced or substituted with a knob amino acid residue. Preferred amino acids to substitute may include any amino acids with a small side chain, such as alanine (A), asparagine (N), aspartic acid (D), glycine (G), serine (S), threonine (T), or valine (V).

[0199] Exemplary amino acid residues that may act as the hole include alanine (A), serine (S), threonine (T), or valine (V). An existing amino acid residue in the CH3 domain may be replaced or substituted with a hole amino acid residue. Preferred amino acids to substitute may include any amino acids with a large side chain, such as arginine (R), phenylalanine (F), tyrosine (Y) or tryptophan (W).

[0200] The CH3 domain is preferably derived from a human IgGl antibody. Exemplary amino acid substitutions to the CH3 domain include Y349C, S354C, T366S, T366Y, T366W, F405A, F405W, Y407T, Y407A, Y407V, T394S, or combinations thereof. A preferred exemplary combination is S354C, T366Y or T366W for the knob mutation on a first CH3 domain and Y349C, T366S, L368A, Y407T or Y407V for the hole mutation on a second CH3 domain.

[0201] In certain embodiments, the two Fc domains of the antigen binding construct are heterodimerized through Fab arm exchange (FAE). A human IgGl possessing a P228S hinge mutation may contain an F405L or K409R CH3 domain mutation. Mixing of the two antibodies with a reducing agent leads to FAE. This technology is described in US Patent 9,212,230 and Labrijn A. F. PNAS (2013) 110(13):5145-5150, which are incorporated herein by reference.

[0202] In other embodiments, the two Fc domains of the antigen binding construct are heterodimerized through electrostatic steering effects. This dimerization technique utilizes

[0203] 27

[0204] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC electrostatic steering to promote and strengthen Fc domain pairing in the CH3 / CH3 domain interface. The charge complementarity between two CH3 domains is altered to favor heterodimerization (opposite charge pairing) over homodimerization (same charge pairing). In this method, the electrostatic repulsive forces prevent homodimerization. Certain exemplary amino acid residue substitutions which confer electrostatic steering effects include K409D, K392D, and / or K370D in a first CH3 domain and D399K, E356K, and / or E357K in a second CH3 domain. This technology is described in US Patent Publication No. 2014 / 0154254 Al and Gunasekaran K. JBC (2010) 285(25): 19637-19646, which are incorporated herein by reference.

[0205] In other embodiments, the charge complementarity is formed by a first Fc domain comprising a N297K and / or a T299K mutation, and a second Fc domain comprising a N297D and / or a T299D mutation.

[0206] In an aspect of the invention, the two Fc domains of the antigen binding construct are heterodimerized through hydrophobic interaction effects. This dimerization technique utilizes hydrophobic interactions instead of electrostatic ones to promote and strengthen Fc domain pairing in the CH3 / CH3 domain interface. Exemplary amino acid residue substitution may include K409W, K360E, Q347E, Y349S, and / or S354C in a first CH3 domain and D399V, F405T, Q347R, E357W, and / or Y349C in a second CH3 domain. Preferred pairs of amino acid residue substitutions between a first CH3 domain and a second CH3 domain include K409W:D399V, K409W:F405T, K360E:Q347R, Y349S:E357W, and S354C:Y349C. This technology is described in US Patent Publication No. 2015 / 0307628 Al.

[0207] In an aspect of the invention, heterodimerization can be mediated through the use of leucine zipper fusions. Leucine zipper domains fused to the C terminus of each CH3 domain of the antibody chains force heterodimerization. This technology is described in Wranik B. JBC (2012) 287(52):43331-43339.

[0208] In an aspect of the invention, heterodimerization can be mediated through the use of a Strand Exchange Engineered Domain (SEED) body. CH3 domains derived from an IgG and IgA format force heterodimerization. This technology is described in Muda M. PEDS (2011) 24(5): 447-454.

[0209] In other embodiments, the heterodimerization motif may comprise non-native, disulfide bonds formed by engineered cysteine residues. In certain embodiments, the first set of disulfide may comprise a Y349C mutation in the first Fc domain and a S354C mutation in the second Fc domain. In other embodiment, an engineered disulfide bond may be introduced by fusion a C- terminal extension peptide with an engineered cysteine residue to the C-terminus of each of the

[0210] 28

[0211] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC two Fc domains. In certain embodiments, the first Fc domain may comprise the substitution of the carboxyl-terminal as “PGK” with “GEC”, and the second Fc domain may comprise the substitution of the carboxyl terminal amino acids “PGK” with “KSCDKT”.

[0212] In yet another approach, a multispecific antibody may employ the CrossMab principle (as reviewed in Klein et al.), which involves domain swapping between heavy and light chains so as to promote the formation of the correct pairings. Yet another approach involves engineering the interfaces between the paired VH-VL domains or paired CHI -CL domains of the heavy and light chains so as to increase the affinity between the heavy chain and its cognate light chain (Lewis et al. Nature Biotechnology (2014) 32: 191 -198).

[0213] An alternative approach to the production of multi specific antibody preparations having the correct antigen specificity has been the development of methods that enrich for antibodies having the correct heavy chain-light chain pairings. For example, Spiess et al. (Nature Biotechnology (2013) 31 : 753-758) describe a method for the production of a MET-EGFR bispecific antibody from a co-culture of bacteria expressing two distinct half-antibodies.

[0214] Methods have also been described wherein the constant region of at least one of the heavy chains of a bispecific antibody is mutated so as to alter its binding affinity for an affinity agent, for example Protein A. This allows correctly paired heavy chain heterodimers to be isolated based on a purification technique that exploits the differential binding of the two heavy chains to an affinity agent (see US2010 / 0331527, WO2013 / 136186).

[0215] International patent application no. PCT / EP2012 / 071866 (W02013 / 064701) addresses the problem of incorrect chain pairing using a method for multispecific antibody isolation based on the use of anti -idiotypic binding agents, in particular anti -idiotypic antibodies. The antiidiotype binding agents are employed in a two-step selection method in which a first agent is used to capture antibodies having a VH-VL domain pairing specific for a first antigen and a second agent is subsequently used to capture antibodies also having a second VH-VL domain pairing specific for a second antigen.

[0216] In yet another embodiment, the multispecific antibody employs a first binding specificity having a conventional Fab binding region and a second binding specificity comprising a single domain antibody (VHH) binding region. The heterodimerization method employed forces the binding of the heavy chain region of the Fab and the full, heavy chain only, of the VHH. Because the VHH chain does not associate with light chains, the light chain region of the Fab portion will only associate with its corresponding heavy chain.

[0217] In certain other embodiments, the multispecific binding protein described herein further comprises a common light chain. The term “common light chain” as used herein refers to a

[0218] 29

[0219] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC light chain which is capable of pairing with a first heavy chain of an antibody which binds to a first antigen in order to form a binding site specifically binding to said first antigen and which is also capable of pairing with a second heavy chain of an antibody which binds to a second antigen in order to form a binding site specifically binding to said second antigen. A common light chain is a polypeptide comprising in N-terminal to C-terminal direction an antibody light chain variable domain (VL), and an antibody light chain constant domain (CL), which is herein also abbreviated as “VL-CL”. Multispecific binding proteins with a common light chain require heterodimerization of the distinct heavy chains. In certain embodiments, the heterodimerization methods listed above may be used with a common light chain. In certain exemplary embodiments, the heterodimerization motif may comprise non-native, disulfide bonds formed by engineered cysteine residues. Adding disulfide bonds, both between the heavy and light chain of an antibody has been shown to improve stability. Additionally, disulfide bonds have also been used as a solution to improve light-chain pairing within bispecific antibodies (Geddie M. L. et al, mABs (2022) 14(1)).

[0220] Unless otherwise stated, all antibody constant region numbering employed herein corresponds to the EU numbering scheme, as described in Edelman et al. (Proc. Natl. Acad. Sci. 63(1): 78-85. 1969).

[0221] Additional methods of heterodimerization of heavy and / or light chains and the generation and purification of asymmetric antibodies are known in the art. See, for example, Klein C. mAbs (2012) 4(6): 653-663, and U.S. Patent 9,499,634, each of which is incorporated herein by reference.

[0222] Effector Function Mutations

[0223] As discussed above, the antibodies or antigen binding fragments of the disclosure can be provided in various isotypes and with different constant regions. The Fc region of the antibody or antigen binding fragments primarily determines its effector function in terms of Fc binding, antibody-dependent cell-mediated cytotoxicity (ADCC) activity, complementdependent cytotoxicity (CDC) activity, and antibody-dependent cell phagocytosis (ADCP) activity. These "cellular effector functions", as distinct from effector T cell function, involve the recruitment of cells bearing Fc receptors to the site of the target cells, resulting in killing of the antibody -bound cell.

[0224] An antibody according to the present invention may be one that exhibits reduced effector function. In certain embodiments, the one or more mutations reduces one or more of antibody-dependent cellular cytotoxicity (ADCC), antibody-dependent cellular phagocytosis

[0225] 30

[0226] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0227] (ADCP), or complement-dependent cytotoxicity (CDC). In certain embodiments, an antibody according to the present invention may lack ADCC, ADCP, and / or CDC activity. In either case, an antibody according to the present invention may comprise, or may optionally lack, an Fc region that binds to one or more types of Fc receptor. Use of different antibody formats, and the presence or absence of FcR binding and cellular effector functions, allow the antibody to be tailored for use in particular therapeutic purposes as discussed elsewhere herein.

[0228] In certain embodiments, the first and the second Fc domain comprise one or more mutations that reduces Fc effector function. In certain embodiments, the first Fc domain and the second Fc domain each comprise a L234A and L235A mutation. These IgGl mutations are also known as the “LALA” mutations and are described in further detail in Xu et al. (Cell Immunol. 2000; 200: 16-26). In certain embodiments the first Fc domain and the second Fc domain each comprise a L234A, L235A, G237A, and / or P329G mutation. The Fc domain amino acid positions referred to herein are based on EU antibody numbering. Alternatively, an antibody may have a constant region which is effector null. An antibody may have a heavy chain constant region that does not bind Fey receptors, for example the constant region may comprise a L235E mutation. Another optional mutation for a heavy chain constant region is S228P, which increases stability. A heavy chain constant region may be an IgG4 comprising both the L235E mutation and the S228P mutation. This "IgG4-PE" heavy chain constant region is effector null. A disabled IgGl heavy chain constant region is also effector null. A disabled IgGl heavy chain constant region may contain alanine at position 234, 235 and / or 237 (EU index numbering), e.g., it may be an IgGl sequence comprising the L234A, L235A and / or G237A mutations ("LALAGA"). In certain embodiments, the first Fc domain and the second Fc domain each comprise a L234A, L235A, and P329A mutation (“LALAPA).

[0229] Human IgGl constant regions containing specific mutations or altered glycosylation on residue Asn297 (e.g., N297Q, N297D, and N297K, EU index numbering) have been shown to reduce binding to Fc receptors.

[0230] In some embodiments, the first Fc domain and / or the second Fc domain each comprise a L234F, L235E, and P331S mutation (FES).

[0231] In some embodiments, the first Fc domain and / or the second Fc domain each comprise a E233P, L234V, L235A, G236Del, and S267K mutation.

[0232] In other embodiments, it may be desirable to enhance the binding of the Fc region of a multispecific antibody to human Fc gamma receptor IIIA (FcgRIIIA) relative to that of the Fc region of a corresponding naturally occurring antibody. In certain embodiments, a constant region may be engineered for enhanced ADCC and / or CDC and / or ADCP. The potency of Fc-

[0233] 31

[0234] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC mediated effects may be enhanced by engineering the Fc domain by various established techniques. Such methods increase the affinity for certain Fc-receptors, thus creating potential diverse profiles of activation enhancement. This can be achieved by modification of one or several amino acid residues. Example mutations are one or more of the residues selected from 239, 332 and 330 for human IgGl constant regions (or the equivalent positions in other IgG isotypes). An antibody may thus comprise a human IgGl constant region having one or more mutations independently selected from S239D, I332E and A330L (EU index numbering).

[0235] Increased affinity for Fc receptors can also be achieved by altering the natural glycosylation profile of the Fc domain by, for example, generating under fucosylated or de- fucosylated variants. Non-fucosylated antibodies harbor a tri-mannosyl core structure of complex-type N-glycans of Fc without fucose residue. These glycoengineered antibodies that lack core fucose residue from the Fc N-glycans may exhibit stronger ADCC than fucosylated equivalents due to enhancement of FcyRIIIA binding capacity. For example, to increase ADCC, residues in the hinge region can be altered to increase binding to FcyRIIIA. Thus, an antibody may comprise a human IgG heavy chain constant region that is a variant of a wild-type human IgG heavy chain constant region. In certain embodiments, the variant human IgG heavy chain constant region binds to human Fey receptors selected from the group consisting of FcyRIIB and FcyRIIA with higher affinity than the wild type human IgG heavy chain constant region binds to the human FcyRIIIA. The antibody may comprise a human IgG heavy chain constant region that is a variant of a wild type human IgG heavy chain constant region, wherein the variant human IgG heavy chain constant region binds to human FcyRIIB with higher affinity than the wild type human IgG heavy chain constant region binds to human FcyRIIB. The variant human IgG heavy chain constant region can be a variant human IgGl, a variant human IgG2, or a variant human IgG4 heavy chain constant region. In one embodiment, the variant human IgG heavy chain constant region comprises one or more amino acid mutations selected from G236D, P238D, S239D, S267E, L328F, and L328E (EU index numbering system). In another embodiment, the variant human IgG heavy chain constant region comprises a set of amino acid mutations selected from the group consisting of: S267E and L328F; P238D and L328E; P238D and one or more substitutions selected from the group consisting of E233D, G237D, H268D, P271G, and A330R; P238D, E233D, G237D, H268D, P271G, and A330R; G236D and S267E; S239D and S267E; V262E, S267E, and L328F; and V264E, S267E, and L328F (EU index numbering system).

[0236] The enhancement of CDC may be achieved by amino acid changes that increase affinity for Clq, the first component of the classic complement activation cascade. Another approach

[0237] 32

[0238] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC is to create a chimeric Fc domain created from human IgGl and human IgG3 segments that exploit the higher affinity of IgG3 for Clq. Antibodies of the present invention may comprise mutated amino acids at residues 329, 331 and / or 322 to alter the Clq binding and / or reduced or abolished CDC activity. In another embodiment, the antibodies or antibody fragments disclosed herein may contain Fc regions with modifications at residues 231 and 239, whereby the amino acids are replaced to alter the ability of the antibody to fix complement. In one embodiment, the antibody or fragment has a constant region comprising one or more mutations selected from E345K, E430G, R344D and D356R, in particular a double mutation comprising R344D and D356R (EU index numbering system).

[0239] The functional properties of the multi specific binding proteins may be further tuned by combining amino acid substitutions that alter Fc binding affinity with amino acid substitutions that affect binding to FcRn. Binding proteins with amino acid substitutions that affect binding to FcRn (also referred to herein as “FcRn variants”) may in certain situations also increase serum half-life in vivo as compared to an unmodified binding protein. As will be appreciated, any combination of Fc and FcRn variants may be used to tune clearance of the antigen-antibody complex. Suitable FcRn variants that may be combined with any of the Fc variants described herein that include without limitation N434A, N434S, M428L, V308F, V259I, M428L / N434S, V259I / V308F, Y436I / M428L, Y436I / N434S, Y436V / N434S, Y436V / M428L, M252Y, M252Y / S254T / T256E, and V259I / V308F / M428L. In some embodiments, the Fc variant includes H433K / N434K. In some embodiments, the Fc variant includes M428L / N434S.

[0240] Expression of Antigen-Binding Proteins

[0241] In one aspect, polynucleotides encoding the binding proteins (e.g., antibodies and antigen-binding fragments thereof) disclosed herein are provided. Methods of making binding proteins comprising expressing these polynucleotides are also provided.

[0242] Polynucleotides encoding the binding proteins disclosed herein are typically inserted in an expression vector for introduction into host cells that may be used to produce the desired quantity of the binding proteins. Accordingly, in certain aspects, the disclosure provides expression vectors comprising polynucleotides disclosed herein and host cells comprising these vectors and polynucleotides.

[0243] The term “vector” or “expression vector” is used herein to mean vectors used in accordance with the present disclosure as a vehicle for introducing into and expressing a desired gene in a cell. As known to those skilled in the art, such vectors may readily be selected from the group consisting of plasmids, phages, viruses and retroviruses. In general, vectors

[0244] 33

[0245] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC compatible with the disclosure will comprise a selection marker, appropriate restriction sites to facilitate cloning of the desired gene and the ability to enter and / or replicate in eukaryotic or prokaryotic cells.

[0246] Numerous expression vector systems may be employed for the purposes of this disclosure. For example, one class of vector utilizes DNA elements which are derived from animal viruses such as bovine papilloma virus, polyoma virus, adenovirus, vaccinia virus, baculovirus, retroviruses (RSV, MMTV or MOMLV), or SV40 virus. Others involve the use of polycistronic systems with internal ribosome binding sites. Additionally, cells which have integrated the DNA into their chromosomes may be selected by introducing one or more markers which allow selection of transfected host cells. The marker may provide for prototrophy to an auxotrophic host, biocide resistance (e.g., antibiotics) or resistance to heavy metals such as copper. The selectable marker gene can either be directly linked to the DNA sequences to be expressed or introduced into the same cell by co-transformation. Additional elements may also be needed for optimal synthesis of mRNA. These elements may include signal sequences, splice signals, as well as transcriptional promoters, enhancers, and termination signals. In some embodiments, the cloned variable region genes are inserted into an expression vector along with the heavy and light chain constant region genes (e.g., human constant region genes) synthesized as discussed above.

[0247] In other embodiments, the binding proteins may be expressed using polycistronic constructs. In such expression systems, multiple gene products of interest such as heavy and light chains of antibodies may be produced from a single polycistronic construct. These systems advantageously use an internal ribosome entry site (IRES) to provide relatively high levels of polypeptides in eukaryotic host cells. Compatible IRES sequences are disclosed in U.S. Pat. No. 6,193,980, which is incorporated by reference herein in its entirety for all purposes. Those skilled in the art will appreciate that such expression systems may be used to effectively produce the full range of polypeptides disclosed in the instant application.

[0248] More generally, once a vector or DNA sequence encoding a binding protein, e.g. an antibody or fragment thereof, has been prepared, the expression vector may be introduced into an appropriate host cell. That is, the host cells may be transformed. Introduction of the plasmid into the host cell can be accomplished by various techniques well known to those of skill in the art. These include, but are not limited to, transfection (including electrophoresis and electroporation), protoplast fusion, calcium phosphate precipitation, cell fusion with enveloped DNA, microinjection, and infection with intact virus. See, Ridgway, A. A. G. “Mammalian Expression Vectors” Chapter 24.2, pp. 470-472 Vectors, Rodriguez and Denhardt, Eds.

[0249] 34

[0250] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0251] (Butterworths, Boston, Mass. 1988). Plasmid introduction into the host can be by electroporation. The transformed cells are grown under conditions appropriate to the production of the light chains and heavy chains, and assayed for heavy and / or light chain protein synthesis. Exemplary assay techniques include enzyme-linked immunosorbent assay (ELISA), radioimmunoassay (RIA), or fluorescence-activated cell sorter analysis (FACS), immunohistochemistry and the like.

[0252] As used herein, the term “transformation” shall be used in a broad sense to refer to the introduction of DNA into a recipient host cell that changes the genotype.

[0253] Along those same lines, “host cells” refers to cells that have been transformed with vectors constructed using recombinant DNA techniques and encoding at least one heterologous gene. In descriptions of processes for isolation of polypeptides from recombinant hosts, the terms “cell” and “cell culture” are used interchangeably to denote the source of antibody unless it is clearly specified otherwise. In other words, recovery of polypeptide from the “cells” may mean either from spun down whole cells, from supernatant of lysed cells culture, or from the cell culture containing both the medium and the suspended cells.

[0254] In one embodiment, a host cell line used for antibody expression is of mammalian origin. Those skilled in the art can determine particular host cell lines which are best suited for the desired gene product to be expressed therein. Exemplary host cell lines include, but are not limited to, GS-CHO and CH0-K1 (Chinese Hamster Ovary lines), DG44 and DUXB11 (Chinese Hamster Ovary lines, DHFR minus), HELA (human cervical carcinoma), CV-1 (monkey kidney line), COS (a derivative of CV-1 with SV40 T antigen), R1610 (Chinese hamster fibroblast) BALBC / 3T3 (mouse fibroblast), HEK (human kidney line), SP2 / O (mouse myeloma), BFA-lclBPT (bovine endothelial cells), RAJI (human lymphocyte), 293 (human kidney). In one embodiment, the cell line provides for altered glycosylation, e.g., afucosylation, of the antibody expressed therefrom (e.g., PER.C6® (Crucell) or FUT8-knock- out CHO cell lines (POTELLIGENT® cells) (Biowa, Princeton, N.J.)). In one embodiment, NSO cells may be used. CHO cells are particularly useful. Host cell lines are typically available from commercial services, e.g., the American Tissue Culture Collection, or from authors of published literature.

[0255] In vitro production allows scale-up to give large amounts of the desired polypeptides. Techniques for mammalian cell cultivation under tissue culture conditions are known in the art and include homogeneous suspension culture, e.g., in an airlift reactor or in a continuous stirrer reactor, or immobilized or entrapped cell culture, e.g., in hollow fibers, microcapsules, on agarose microbeads or ceramic cartridges. If necessary and / or desired, the solutions of

[0256] 35

[0257] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC polypeptides can be purified by the customary chromatography methods, for example gel filtration, ion-exchange chromatography, chromatography over DEAE-cellulose and / or (immuno-) affinity chromatography.

[0258] Genes encoding the binding proteins featured in the disclosure can also be expressed in non-mammalian cells such as bacteria or yeast or plant cells. In this regard, it will be appreciated that various unicellular non-mammalian microorganisms such as bacteria can also be transformed, i.e., those capable of being grown in cultures or fermentation. Bacteria, which are susceptible to transformation, include members of the enterobacteriaceae, such as strains of Escherichia coli or Salmonella; Bacillaceae, such as Bacillus subtilis; Pneumococcus; Streptococcus, and Haemophilus influenzae. It will further be appreciated that, when expressed in bacteria, the binding proteins can become part of inclusion bodies. In some embodiments, the binding proteins are then isolated, purified and assembled into functional molecules. In some embodiments, the binding proteins of the disclosure are expressed in a bacterial host cell. In some embodiments, the bacterial host cell is transformed with an expression vector comprising a nucleic acid molecule encoding a binding protein of the disclosure.

[0259] In addition to prokaryotes, eukaryotic microbes may also be used. Saccharomyces cerevisiae, or common baker’s yeast, is the most commonly used among eukaryotic microbes, although a number of other strains are commonly available. For expression in Saccharomyces, the plasmid YRp7, for example (Stinchcomb et al., Nature, 282:39 (1979); Kingsman et al., Gene, 7: 141 (1979); Tschemper et al., Gene, 10: 157 (1980)), is commonly used. This plasmid already contains the TRP1 gene which provides a selection marker for a mutant strain of yeast lacking the ability to grow in tryptophan, for example ATCC No. 44076 or PEP4-1 (Jones, Genetics, 85: 12 (1977)). The presence of the trpl lesion as a characteristic of the yeast host cell genome then provides an effective environment for detecting transformation by growth in the absence of tryptophan.

[0260] Pulmonary Hypertension (PH)

[0261] In certain embodiments, the antibodies or antigen-binding domains thereof are used to treat a vascular disease or disorder. In some embodiments, the vascular disease or disorder is a pulmonary hypertension. Pulmonary hypertension is a heterogenous clinical disease characterized foremost by an abnormal increase in pulmonary artery pressure. Pulmonary hypertension can be categorized into five different groups (Groups 1-5). Group 1 is also known as pulmonary arterial hypertension (PAH). Group 2 is caused by left-sided heart disease, such as mitral valve stenosis or left heart diastolic dysfunction. Group 3 is generally caused by

[0262] 36

[0263] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC chronic lung disease or hypoxemia, such as chronic obstructive pulmonary disease (COPD) or interstitial lung disease. Group 4 is caused by pulmonary artery obstructions, such as chronic thromboembolic pulmonary hypertension. Group 5 occurs with unknown or multiple causes, such as metabolic disorders, systemic disorders, or hematologic disorders. Proliferative, fibrotic, and plexogenic remodeling of distal pulmonary arterioles is the hallmark pathological feature of PAH. PAH is a rare, progressive disease that causes high blood pressure in the lungs’ arteries. It occurs when the small arteries in the lungs narrow and thicken, which makes it harder for blood to flow through the lungs. This can cause the right ventricle of the heart to work harder to pump blood into the lungs, which can in turn damage the heart over time. Symptoms of PAH include shortness of breath, chest pain, fainting swelling in the ankles or legs, dizziness, rapid heart rate, lightheadedness, flushing, gastrointestinal issues, and headache.

[0264] Hereditary Hemorrhagic Telangiectasia (HHT)

[0265] In certain embodiments, the antibodies or antigen-binding domains thereof are used to treat a vascular disease or disorder. In some embodiments, the vascular disease or disorder is a hereditary hemorrhagic telangiectasia (HHT). HHT is a genetic disorder in which blood vessels do not develop normally leading to bleeding that can be serious or life threatening. HHT is characterized by abnormal connections between arteries and veins known as arteriovenous malformations (AVMs). The most common locations affected are the nose, lungs, brain and liver.

[0266] Frequent nosebleeds are the most common sign. HHT is also known as Osler-Weber-Rendu disease. Other symptoms include lacy red vessels or tiny red spots, particularly on the lips, face, fingertips, tongue and inside surfaces of the mouth, iron deficiency anemia, shortness of breath, headaches, and / or seizures.

[0267] Heart Failure with preserved ejection fraction (HFpEF)

[0268] In certain embodiments, the antibodies or antigen-binding domains thereof are used to treat cardiovascular disease or disorder. In some embodiments, the cardiovascular disease or disorder is Heart Failure with Preserved Ejection Fraction. HFpEF is a left heart disease, disorder in which cardiac function is impaired notably via a reduction in cardiomyocytes function due to enhanced ActRII(s) activation that increases proteasome-dependent degradation of sarcoplasmic reticulum Ca2+ATPase (SERCA2a).

[0269] 37

[0270] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0271] F ormulations / Pharmaceutical Compositions

[0272] In certain embodiments, a pharmaceutical composition comprising a pharmaceutically acceptable carrier and a therapeutically effective amount of an antigen-binding protein described herein is provided. Some embodiments include pharmaceutical compositions comprising a therapeutically effective amount of any one of the binding proteins as described herein, or a binding protein-drug conjugate, in admixture with a pharmaceutically or physiologically acceptable formulation agent selected for suitability with the mode of administration.

[0273] Acceptable formulation materials are typically non-toxic to recipients at the dosages and concentrations employed.

[0274] In some embodiments, the pharmaceutical composition can contain formulation materials for modifying, maintaining, or preserving, for example, the pH, osmolarity, viscosity, clarity, color, isotonicity, odor, sterility, stability, rate of dissolution or release, adsorption, or penetration of the composition. Suitable formulation materials include, but are not limited to, amino acids (such as glycine, glutamine, asparagine, arginine, or lysine), antimicrobials, antioxidants (such as ascorbic acid, sodium sulfite, or sodium hydrogen-sulfite), buffers (such as borate, bicarbonate, Tris-HCl, citrates, phosphates, or other organic acids), bulking agents (such as mannitol or glycine), chelating agents (such as ethylenediamine tetraacetic acid (EDTA)), complexing agents (such as caffeine, polyvinylpyrrolidone, beta-cyclodextrin, or hydroxypropyl-beta-cyclodextrin), fillers, monosaccharides, di saccharides, and other carbohydrates (such as glucose, mannose, or dextrins), proteins (such as serum albumin, gelatin, or immunoglobulins), coloring, flavoring and diluting agents, emulsifying agents, hydrophilic polymers (such as polyvinylpyrrolidone), low molecular weight polypeptides, saltforming counterions (such as sodium), preservatives (such as benzalkonium chloride, benzoic acid, salicylic acid, thimerosal, phenethyl alcohol, methylparaben, propylparaben, chlorhexidine, sorbic acid, or hydrogen peroxide), solvents (such as glycerin, propylene glycol, or polyethylene glycol), sugar alcohols (such as mannitol or sorbitol), suspending agents, surfactants or wetting agents (such as pluronics; PEG; sorbitan esters; polysorbates such as polysorbate 20 or polysorbate 80; triton; tromethamine; lecithin; cholesterol or tyloxapal), stability enhancing agents (such as sucrose or sorbitol), tonicity enhancing agents (such as alkali metal halides, e.g., sodium or potassium chloride, or mannitol sorbitol), delivery vehicles, diluents, excipients and / or pharmaceutical adjuvants (see, e.g., REMINGTON’S PHARMACEUTICAL SCIENCES (18th Ed., A.R. Gennaro, ed., Mack Publishing Company 1990), and subsequent editions of the same, incorporated herein by reference for any purpose).

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[0276] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0277] In some embodiments the optimal pharmaceutical composition will be determined by a skilled artisan depending upon, for example, the intended route of administration, delivery format, and desired dosage. Such compositions can influence the physical state, stability, rate of in vivo release, and rate of in vivo clearance of the binding protein.

[0278] In some embodiments the primary vehicle or carrier in a pharmaceutical composition can be either aqueous or non-aqueous in nature. For example, a suitable vehicle or carrier for injection can be water, physiological saline solution, or artificial cerebrospinal fluid, possibly supplemented with other materials common in compositions for parenteral administration. Neutral buffered saline or saline mixed with serum albumin are further exemplary vehicles. Other exemplary pharmaceutical compositions comprise Tris buffer of about pH 7.0-8.5, or acetate buffer of about pH 4.0-5.5, which can further include sorbitol or a suitable substitute. In one embodiment of the disclosure, binding protein compositions can be prepared for storage by mixing the selected composition having the desired degree of purity with optional formulation agents in the form of a lyophilized cake or an aqueous solution. Further, the binding protein can be formulated as a lyophilizate using appropriate excipients such as sucrose.

[0279] In some embodiments, the pharmaceutical compositions of the disclosure can be selected for parenteral delivery or subcutaneous delivery. Alternatively, the compositions can be selected for inhalation or for delivery through the digestive tract, such as orally. The preparation of such pharmaceutically acceptable compositions is within the skill of the art. In some embodiments, the formulation components are present in concentrations that are acceptable to the site of administration. For example, buffers are used to maintain the composition at physiological pH or at a slightly lower pH, typically within a pH range of from about 5 to about 8.

[0280] When parenteral administration is contemplated, the therapeutic compositions for use can be in the form of a pyrogen-free, parenterally acceptable, aqueous solution comprising the desired binding protein in a pharmaceutically acceptable vehicle. A particularly suitable vehicle for parenteral injection is sterile distilled water in which a binding protein is formulated as a sterile, isotonic solution, properly preserved. Yet another preparation can involve the formulation of the desired molecule with an agent, such as injectable microspheres, bio- erodible particles, polymeric compounds (such as polylactic acid or polyglycolic acid), beads, or liposomes, that provides for the controlled or sustained release of the product which can then be delivered via a depot injection. Hyaluronic acid can also be used, and this can have the

[0281] 39

[0282] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC effect of promoting sustained duration in the circulation. Other suitable means for the introduction of the desired molecule include implantable drug delivery devices.

[0283] In one embodiment, a pharmaceutical composition can be formulated for inhalation. For example, a binding protein can be formulated as a dry powder for inhalation. Binding protein inhalation solutions can also be formulated with a propellant for aerosol delivery. In yet another embodiment, solutions can be nebulized.

[0284] It is also contemplated that certain formulations can be administered orally. In one embodiment of the disclosure, ActRIIA and / or B antibodies that are administered in this fashion can be formulated with or without those carriers customarily used in the compounding of solid dosage forms such as tablets and capsules. For example, a capsule can be designed to release the active portion of the formulation at the point in the gastrointestinal tract when bioavailability is maximized and pre-systemic degradation is minimized. Additional agents can be included to facilitate absorption of the binding protein. Diluents, flavorings, low melting point waxes, vegetable oils, lubricants, suspending agents, tablet disintegrating agents, and binders can also be employed.

[0285] Another pharmaceutical composition can involve an effective quantity of antibodies in a mixture with non-toxic excipients that are suitable for the manufacture of tablets. By dissolving the tablets in sterile water, or another appropriate vehicle, solutions can be prepared in unit-dose form. Suitable excipients include, but are not limited to, inert diluents, such as calcium carbonate, sodium carbonate or bicarbonate, lactose, or calcium phosphate; or binding agents, such as starch, gelatin, or acacia; or lubricating agents such as magnesium stearate, stearic acid, or talc.

[0286] Additional pharmaceutical compositions of the disclosure will be evident to those skilled in the art, including formulations involving binding proteins in sustained- or controlled- delivery formulations. Techniques for formulating a variety of other sustained- or controlled- delivery means, such as liposome carriers, bio-erodible microparticles or porous beads and depot injections, are also known to those skilled in the art. Additional examples of sustained- release preparations include semipermeable polymer matrices in the form of shaped articles, e.g., films, or microcapsules. Sustained release matrices can include polyesters, hydrogels, polylactides, copolymers of L-glutamic acid and gamma ethyl-L-glutamate, poly(2- hydroxyethyl-methacrylate), ethylene vinyl acetate, or poly-D(-)-3 -hydroxybutyric acid. Sustained-release compositions can also include liposomes, which can be prepared by any of several methods known in the art.

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[0288] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0289] In some embodiments, pharmaceutical compositions are to be used for in vivo administration typically must be sterile. This can be accomplished by filtration through sterile filtration membranes. Where the composition is lyophilized, sterilization using this method can be conducted either prior to, or following, lyophilization and reconstitution. The composition for parenteral administration can be stored in lyophilized form or in a solution. In addition, parenteral compositions generally are placed into a container having a sterile access port, for example, an intravenous solution bag or vial having a stopper that can be pierced by a hypodermic injection needle.

[0290] Once the pharmaceutical composition has been formulated, it can be stored in sterile vials as a solution, suspension, gel, emulsion, solid, or as a dehydrated or lyophilized powder. Such formulations can be stored either in a ready -to-use form or in a form (e.g., lyophilized) requiring reconstitution prior to administration.

[0291] The disclosure also encompasses kits for producing a single dose administration unit. The kits can each contain both a first container having dried antibodies and a second container having an aqueous formulation. Also included within the scope of this disclosure are kits containing single and multi-chambered pre-filled syringes (e.g., liquid syringes and lyosyringes).

[0292] The effective amount of a binding protein pharmaceutical composition to be employed therapeutically will depend, for example, upon the therapeutic context and objectives. One skilled in the art will appreciate that the appropriate dosage levels for treatment will thus vary depending, in part, upon the molecule delivered, the indication for which the binding protein is being used, the route of administration, and the size (body weight, body surface, or organ size) and condition (the age and general health) of the patient. Accordingly, the clinician can titer the dosage and modify the route of administration to obtain the optimal therapeutic effect.

[0293] Dosing frequency will depend upon the pharmacokinetic parameters of the binding protein in the formulation being used. Typically, a clinician will administer the composition until a dosage is reached that achieves the desired effect. The composition can therefore be administered as a single dose, as two or more doses (which may or may not contain the same amount of the desired molecule) over time, or as a continuous infusion via an implantation device or catheter. Further refinement of the appropriate dosage is routinely made by those of ordinary skill in the art and is within the ambit of tasks routinely performed by them. Appropriate dosages can be ascertained through use of appropriate dose-response data.

[0294] The route of administration of the pharmaceutical composition is in accord with known methods, e.g., orally; through injection by intravenous, intraperitoneal, intracerebral

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[0296] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC

[0297] (intraparenchymal), intracerebroventricular, intramuscular, intraocular, intraarterial, intraportal, or intralesional routes; by sustained release systems; or by implantation devices. Where desired, the compositions can be administered by bolus injection or continuously by infusion, or by implantation device.

[0298] In some embodiments, the composition can also be administered locally via implantation of a membrane, sponge, or other appropriate material onto which the desired molecule has been absorbed or encapsulated. Where an implantation device is used, the device can be implanted into any suitable tissue or organ, and delivery of the desired molecule can be via diffusion, timed-release bolus, or continuous administration.

[0299] ActRIIA / B antibodies or antigen-binding fragments thereof disclosed herein can be formulated as an aerosol for topical application, such as by inhalation (see, e.g., U.S. Patent Nos. 4,044,126, 4,414,209 and 4,364,923, which describe aerosols for delivery of a steroid useful for treatment of inflammatory diseases, particularly asthma and are herein incorporated by reference in their entireties). These formulations for administration to the respiratory tract can be in the form of an aerosol or solution for a nebulizer, or as a microfine powder for insufflations, alone or in combination with an inert carrier such as lactose. In such a case, the particles of the formulation will, in one embodiment, have diameters of less than 50 microns, in one embodiment less than 10 microns.

[0300] An antibody disclosed herein can be formulated for local or topical application, such as for topical application to the skin and mucous membranes, such as in the eye, in the form of gels, creams, and lotions and for application to the eye or for intracistemal or intraspinal application. Topical administration is contemplated for transdermal delivery and also for administration to the eyes or mucosa, or for inhalation therapies. Nasal solutions of the heterodimeric protein alone or in combination with other pharmaceutically acceptable excipients can also be administered.

[0301] Transdermal patches, including iontophoretic and electrophoretic devices, are well known to those of skill in the art, and can be used to administer a heterodimeric protein. For example, such patches are disclosed in U.S. Patent Nos. 6,267,983, 6,261,595, 6,256,533, 6,167,301, 6,024,975, 6,010715, 5,985,317, 5,983,134, 5,948,433, and 5,860,957, all of which are herein incorporated by reference in their entireties.

[0302] In certain embodiments, a pharmaceutical composition comprising an ActRIIA / B antibody as disclosed herein is a lyophilized powder, which can be reconstituted for administration as solutions, emulsions and other mixtures. It may also be reconstituted and formulated as solids or gels. The lyophilized powder is prepared by dissolving heterodimeric

[0303] 42

[0304] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC protein described herein, or a pharmaceutically acceptable derivative thereof, in a suitable solvent. In certain embodiments, the lyophilized powder is sterile. The solvent may contain an excipient which improves the stability or other pharmacological component of the powder or reconstituted solution, prepared from the powder. Excipients that may be used include, but are not limited to, dextrose, sorbitol, fructose, corn syrup, xylitol, glycerin, glucose, sucrose or other suitable agents. The solvent may also contain a buffer, such as citrate, sodium or potassium phosphate or other such buffer known to those of skill in the art at, in one embodiment, about neutral pH. Subsequent sterile filtration of the solution followed by lyophilization under standard conditions known to those of skill in the art provides the desired formulation. In one embodiment, the resulting solution will be apportioned into vials for lyophilization. Each vial will contain a single dosage or multiple dosages of the compound. The lyophilized powder can be stored under appropriate conditions, such as at about 4°C to room temperature. Reconstitution of this lyophilized powder with water for injection provides a formulation for use in parenteral administration. For reconstitution, the lyophilized powder is added to sterile water or other suitable carrier. The precise amount depends upon the selected compound. Such amount can be empirically determined. Antibodies or antigen-binding fragments thereof provided herein can also be formulated to be targeted to a particular tissue, receptor, or other area of the body of the subject to be treated. Many such targeting methods are well known to those of skill in the art. All such targeting methods are contemplated herein for use in the instant compositions. For non-limiting examples of targeting methods, see, e.g., U.S. PatentNos. 6,316,652, 6,274,552, 6,271,359, 6,253,872, 6,139,865, 6,131,570, 6,120,751, 6,071,495, 6,060,082, 6,048,736, 6,039,975, 6,004,534, 5,985,307, 5,972,366, 5,900,252, 5,840,674, 5,759,542 and 5,709,874, all of which are herein incorporated by reference in their entireties.

[0305] Method of Treatment / Use

[0306] Another aspect of the disclosure is an antibody and / or an antigen-binding fragment thereof as described herein for use as a medicament.

[0307] In a particular embodiment, a method of treating a disorder through the activation of ActRIIA / B is provided, the method comprising administering to a subject in need thereof an effective amount of an antigen-binding protein described herein.

[0308] The antibody and / or an antigen-binding fragment thereof can be employed in any known assay method, such as competitive binding assays, direct and indirect sandwich assays, and immunoprecipitation assays for the detection and quantitation of ActRIIA / B. The antibody

[0309] 43

[0310] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC and / or an antigen-binding fragment thereof will bind ActRIIA / B with an affinity that is appropriate for the assay method being employed.

[0311] For diagnostic applications, in some embodiments, the antibody and / or an antigenbinding fragment thereof can be labeled with a detectable moiety. The detectable moiety can be any one that is capable of producing, either directly or indirectly, a detectable signal. For example, the detectable moiety can be a radioisotope, such as3H,14C,32P,35S,125I, "Tc,inIn, or67Ga; a fluorescent or chemiluminescent compound, such as fluorescein isothiocyanate, rhodamine, or luciferin; or an enzyme, such as alkaline phosphatase, P-galactosidase, or horseradish peroxidase.

[0312] The antibody and / or an antigen-binding fragment thereof are also useful for in vivo imaging. A binding protein labeled with a detectable moiety can be administered to an animal, e.g., into the bloodstream, and the presence and location of the labeled antibody in the host assayed. The binding protein can be labeled with any moiety that is detectable in an animal, whether by nuclear magnetic resonance, radiology, or other detection means known in the art.

[0313] The disclosure also relates to a kit comprising a binding protein and other reagents useful for detecting target antigen levels in biological samples. Such reagents can include a detectable label, blocking serum, positive and negative control samples, and detection reagents. In some embodiments, the kit comprises a composition comprising any binding protein, polynucleotide, vector, vector system, and / or host cell described herein. In some embodiments, the kit comprises a container and a label or package insert on or associated with the container. Suitable containers include, for example bottles, vials, syringes, IV solution bags, etc. The containers may be formed from a variety of materials such as glass or plastic. The container holds a composition which is by itself or combined with another composition effective for treating, preventing and / or diagnosing a condition and may have a sterile access port (for example the container may be an intravenous solution bag or a vial having a stopper that can be pierced by a hypodermic injection needle). In some embodiments, the label or package insert indicates that the composition is used for preventing, diagnosing, and / or treating the condition of choice. Alternatively, or additionally, the article of manufacture or kit may further comprise a second (or third) container comprising a pharmaceutically acceptable buffer, such as bacteriostatic water for injection (BWFI), phosphate-buffered saline, Ringer’s solution and dextrose solution. It may further include other materials desirable from a commercial and user standpoint, including other buffers, diluents, filters, needles, and syringes.

[0314] In some embodiments, the present disclosure relates to a method of preventing and / or treating a disease or disorder. In some embodiments, the method comprises administering to a

[0315] 44

[0316] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC patient a therapeutically effective amount of at least one of the binding proteins, or pharmaceutical compositions related thereto, described herein. In some embodiments, the patient is a human.

[0317] The contents of the articles, patents, and patent applications, and all other documents and electronically available information mentioned or cited herein, are hereby incorporated by reference in their entirety to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference. Applicants reserve the right to physically incorporate into this application any and all materials and information from any such articles, patents, patent applications, or other physical and electronic documents.

[0318] While the present disclosure has been described with reference to the specific embodiments thereof, it should be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the true spirit and scope of the disclosure. It will be readily apparent to those skilled in the art that other suitable modifications and adaptations of the methods described herein may be made using suitable equivalents without departing from the scope of the embodiments disclosed herein. In addition, many modifications may be made to adapt a particular situation, material, composition of matter, process, process step or steps, to the objective, spirit and scope of the present disclosure. All such modifications are intended to be within the scope of the claims appended hereto. Having now described certain embodiments in detail, the same will be more clearly understood by reference to the following examples, which are included for purposes of illustration only and are not intended to be limiting.

[0319] EXAMPLES

[0320] Example 1. Identification and Characterization of ActRIIA and / or ActRIIB Antibodies.

[0321] Anti-ActRIIA / ActRIIB antibodies were identified using naive VHH and scFv libraries using phage display techniques and reduction in antigen concentration to identify binders with the highest enrichment. The screening was performed against human ActRIIA and ActRIIB Fc fusions and an unrelated Fc fusion protein was used as a control.

[0322] Example 2. Characterization of ActRIIA / B binders via ELISA.

[0323] Unique binders were expressed as Fc fusions and then characterized by ELISA. IOOUL of 2pg / ml of human ActRIIA or ActRIIB was diluted in pH7.4 phosphate buffered saline (PBS) buffer and used to coat 96 well polystyrene ELISA plate (Corning 9018) overnight at 4°C. After blocking with lx PBS (pH 7.4) containing 1.0% BSA for 1 h at room temperature, the

[0324] 45

[0325] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC plate was washed 3 times with wash buffer (R&D System WA126) and incubated with anti- ActRIIA / B antibodies at two concentrations (100 nM and 10 nM) at room temperature for 1 h. After washing 3 times with the wash buffer, either 1 : 10,000 diluted horseradish peroxidase (HRP)-conjugated anti-human IgG Fc fragment (Jackson Immuno 709-035-098) or 2 ug / ml HRP-conjugated anti-human IgGFc antibody (Invitrogen 05-4220) were added. After washing three times with PBST, 100 pL TMB ELISA substrate (R&D System DY999B) was added per well, 50 pL of stop solution (R&D System DY994) was added to neutralize, and the absorbance at 450 nm and 540 nm were recorded. The results are depicted below in Table 1.

[0326] Table 1. Abs 450 measurements from ELISA

[0327] Example 3. Characterization of ActRIIA / B binders via Carterra.

[0328] Surface plasmon resonance (SPR) experiments were performed using Carterra LSA equipped with an HC30M chip (Carterra-Bio). Binding assays were carried out at 25°C with HBSTE (lOmM HEPES ph7.4, 150mM NaCl, 3mM EDTA, 0.05% Tween-20) with 0.5g / L BSA. A density of anti-human IgG-H+L capture lawn was established on an HC30M chip using amine coupling. To prepare the lawn, the chip was activated with 40mM EDC and lOmM S-NHS in lOOmM MES pH5.5. Coupling of goat anti-human IgG (H+L) multi-species SP ads- UNLB (Southern Biotech, 2087-01) with standard immobilization was done for 15 minutes in

[0329] 46

[0330] 81197558. v1 Attorney Docket No. : 769460: DGT9-009PC lOmM sodium acetate pH 4.5 and quenched using lOmM glycine pH2.0. The anti-human IgG(H+L) capture surface was then used to capture a panel of selected antibodies at lOug / mL, 2ug / mL or 400ng / mL. Monomeric antigen for human ActRIIA or ActRIIB targeted by the antibodies was injected over the captured antibody array at 6 concentrations in 3 -fold dilution series starting at 500nM. Binding data was referenced and blanked from a buffer injected, then globally fit to a 1 : 1 Langmuir binding model for estimation of ka, kd, and KD using Carterra Kinetics Software.

[0331] Carterra's LSA was used to perform epitope binning assays in a classical sandwich assay format using selected group of antibodies as analyte and ligands. A HC-30M or HC- 200M (pre-activated) chip type was used and experiments were performed at 25° C. The SFC and 96PH were primed in running buffer of 25 mM MES pH5.5 and 0.01% Tween20. The ligand Abs were diluted to 20 pg / ml in 10 mM sodium acetate pH 4.5, pH4.75, pH5.0 or pH5.25 (coupling buffer) and coupled via the 96PH using 7 min contact time at each print block location. After 4 serial docks of the 96PH to build up a 384-ligand array, the SFC was docked over the entire surface to quench excess reactive esters by injecting ethanolamine pH8.5 for 7 min. The 96PH was returned to water for cleaning and the SFC was primed in an assay run buffer of HBSTE (lOmM HEPES ph7.4, 150mM NaCl, 3mM EDTA, 0.05% Tween-20) +0.5 g / 1 BSA. Each binning cycle involved a co-inject style of sample delivery whereby the antigen (200 nM human ActRIIA or ActRIIB) and antibody analyte (20 ug / ml antibody or buffer) samples were injected back-to-back, with minimal dissociation time between them over the 384- ligand array. Typical association times were 3 or 5 min and surfaces were regenerated with lOmM glycine pH2.0 after each binning cycle. The binding data were analyzed in Carterra's Epitope software. Three communities of ActRIIA binders and two communities of ActRIIB were identified. The affinity values are shown below in Table 2. Notably, certain binders possessed affinity to both ActRIIA and ActRIIB (TB905-029, TB906-009, TB906-028, TB906-030, TB906-049, TB906-053, and TB905-055), while others only bound ActRIIB (TB906-010, TB906-019, TB906-034), in this assay.

[0332] Table 2. Affinity measurements of ActRIIA / B binders.

[0333] 47

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[0335] Table 3. ActRIIA / B CDR sequences

[0336] 48

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[0338] Table 4. ACTRIIA / B VH and VL amino acid sequences.

[0339] 49

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[0341] Example 4. ActRIIA / B binders in a bispecific format.

[0342] The ActRIIA / B binders that were selected were then incorporated into a bispecific format, using an ALK1 binder as disclosed in PCT / EP2018 / 079333. The ALK1 binder amino acid sequence used in the following experiment is:

[0343] EVQLLESGGGLVQPGGSLRLSCAASGFTFSSYAMSWVRQAPGKGLEWVANINQDGSEKNYVDSMRGRF TISRDNSKNTLYLQMNSLRAEDTAVYYCAREFDYWGQGTLVTVTSSGGGGSGGGGSGGGGSQSVLAQP PSASGTPGQRVTISCSGSSSNIGSNYVYWYQQLPGTAPKLLIYGNNKRPSGVPDRFSGSKSGTSASLA ISGLRSEDEADYYCAAWDDSLNGRVFGGGTKLTVL ( SEQ ID NO : 58 ) .

[0344] The bispecific antibodies were screened for agonist activity. PathHunter® U2OS ACVRL1 / ACVR2 Dimerization Cell Line (493-0963C3) and PathHunter® U2OS ACVRL1 / ACVR2B Dimerization Cell Line (493-0964C3) were obtained from Discover X (Eurofins). These cells use Enzyme Fragment Complementation (EFC) technology using P- galactosidase fragments to evaluate protein-protein interactions. Reporter cells were revived and cultured according to supplier’s recommendations. Bispecific antibodies were compared to the natural ligands BMP9.

[0345] 50

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[0347] To perform the assay, cells were detached and removed from the flask with cell detachment reagent (DiscoverX, 92-0009). Cells were spun at 300g for four minutes and resuspended at a density of 250K / ml in assay plating media (DiscoverX 93-0563R22A). 20 ul of the suspension were plated / well of a 384 well plate and incubated at 37°C for 24 hours. Antibodies were diluted to approximately 100 nM. 5 ul of the bispecific was added to the 384 well plate and incubated for six hours. 25 ul of flash detection reagent (DiscoverX, 93-0247) was added / well and the plates were read on a Verilux Skan at 60 minutes. The results are shown in Table 5. Several bispecific antibodies displayed robust agonist activity in the assay relative to BMP9.

[0348] Table 5. Bispecific antibody agonism as a % of BMP9 activation.

[0349] 51

[0350] 81197558. v1

Claims

Attorney Docket No. : 769460: DGT9-009PCCLAIMS1. An antibody or an antigen-binding fragment thereof that specifically binds to activin receptor type II (ActRIIA and / or ActRIIB), wherein the antibody or antigen-binding fragment thereof is a single-domain antibody (sdAb) comprising HCDR1, HCDR2, and HCDR3 amino acid sequences, the sequences comprising RYDMG (SEQ ID NO: 1), FITISDGTTYYADSVKG (SEQ ID NO: 2), and AVRPGDYD (SEQ ID NO: 3), respectively.

2. The antibody or antigen-binding fragment of claim 1, wherein the single-domain antibody is a VHH.

3. The antibody or antigen-binding fragment of claim 1 or 2, wherein the antibody or antigen-binding domain comprises an amino acid sequence at least about 90%, at least about 95%, or at least 98% identical to the amino acid sequence of SEQ ID NO: 4.

4. The antibody or antigen-binding fragment according to any one of claims 1-3, wherein the antibody or antigen-binding domain comprises an amino acid sequence of SEQ ID NO: 4.

5. An antibody or antigen-binding fragment thereof that specifically binds to activin receptor Type II (ActRIIA and / or ActRIIB), wherein the antibody or antigen-binding fragment thereof comprises HCDR1, HCDR2, HCDR3, LCDR1, LCDR2, and LCDR3 amino acid sequences, the sequences comprising: a. NYAMT (SEQ ID NO: 5), AIGASGGSTYYADSVKG (SEQ ID NO: 6), ENVAPRPLDY (SEQ ID NO: 7), RASQSVSRFLN (SEQ ID NO: 8), GASILQT (SEQ ID NO: 9), and QQSYTTPTWT (SEQ ID NO: 10), respectively; b. TSAMS (SEQ ID NO: 13), SISGSGGTAYYADSVKG (SEQ ID NO: 14), GGYWLDY (SEQ ID NO: 15), RTSQSISNYLN (SEQ ID NO: 16), AASSSQT (SEQ ID NO: 17), and QQTYNTPRT (SEQ ID NO: 18), respectively; c. TYAMT (SEQ ID NO: 21), GISGGGGSTNYADSVKG (SEQ ID NO: 22), GLRHPDY (SEQ ID NO: 23), RASQSISNFLS (SEQ ID NO: 24), AASGLQS (SEQ ID NO: 25), and QQSYRVPRT (SEQ ID NO: 26), respectively;5281197558. v1Attorney Docket No. : 769460: DGT9-009PC d. HYAMT (SEQ ID NO: 29), GISGSGLNTYYADSVKG (SEQ ID NO: 30), RGHTMPQPLDP (SEQ ID NO: 31), RASQSITRFLN (SEQ ID NO: 32), AASNLQV (SEQ ID NO: 33), and QQSYSTPPT (SEQ ID NO: 34), respectively; e. NYAMA (SEQ ID NO: 37), AISVTGGSTYYADSVKG (SEQ ID NO: 38), HGSGTRAFDS (SEQ ID NO: 39), RASQSISRHLN (SEQ ID NO: 40), EASTLQT (SEQ ID NO: 41), and QQSYSTPWT (SEQ ID NO: 42), respectively; f. SYVMS (SEQ ID NO: 45), GISASGGTTYYADSVKG (SEQ ID NO: 46), GWYWFDP (SEQ ID NO: 47), RASQTISNYVN (SEQ ID NO: 48), AATSLHS (SEQ ID NO: 49), and QQGYNTPRT (SEQ ID NO: 50), respectively; g. SYAMG (SEQ ID NO: 53), SISTSGGSTYYADSVKG (SEQ ID NO: 54), SPAHSPHPFDI (SEQ ID NO: 55), RASQSVSRFLN (SEQ ID NO: 56), AASNLQS (SEQ ID NO: 57), and QQSYSSLFT (SEQ ID NO: 58), respectively; h. SQGMS (SEQ ID NO: 61), AISGSGGSRYYADSVKG (SEQ ID NO: 62), EQGPGPYAFDI (SEQ ID NO: 63), RASQSVSRFLN (SEQ ID NO: 64), GISTLQS (SEQ ID NO: 65), and QQSFSLPRT (SEQ ID NO: 66), respectively; i. AYAMS (SEQ ID NO: 69), AISGSGDDTYYADSVKG (SEQ ID NO: 70), QLIPPAPLDY (SEQ ID NO: 71), RASQGISRFLN (SEQ ID NO: 72), GVSVLQS (SEQ ID NO: 73), and QQSFSSLFT (SEQ ID NO: 74), respectively; or j . DYAMS (SEQ ID NO: 77), SVSGSGSSTYYADSVKG (SEQ ID NO: 78), GSIGAPWPLDY (SEQ ID NO: 79), RASQSISRFLN (SEQ ID NO: 80), GASILQG (SEQ ID NO: 81), and QQTYSTQWT (SEQ ID NO: 82), respectively.

6. The antibody or antigen binding fragment thereof of claim 5, wherein the antibody or antigen-binding fragment thereof comprises: a heavy chain variable domain (VH) comprising an amino acid sequence at least about 90%, at least about 95%, or at least 98% identical to the amino acid sequence of SEQ ID NO: 11, SEQ ID NO: 19, SEQ ID NO: 27, SEQ ID NO: 35, SEQ ID NO: 43, SEQ ID NO: 51, SEQ ID NO: 59, SEQ ID NO: 67, SEQ ID NO: 75, or SEQ ID NO: 83; and / or a light chain variable domain (VL) comprising an amino acid sequence at least about90%, at least about 95%, or at least 98% identical to the amino acid sequence of SEQ ID NO: 12, SEQ ID NO: 20, SEQ ID NO: 28, SEQ ID NO: 36, SEQ ID NO: 44, SEQ ID NO: 52, SEQ ID NO: 60, SEQ ID NO: 68, SEQ ID NO: 76, or SEQ ID NO: 84.5381197558. v1Attorney Docket No. : 769460: DGT9-009PC7. The antibody or antigen binding fragment thereof of claim 5 or 6, wherein the antibody or antigen-binding fragment thereof comprises a VH domain comprising an amino acid sequence comprising the amino acid sequence of SEQ ID NO: 11, SEQ ID NO: 19, SEQ ID NO: 27, SEQ ID NO: 35, SEQ ID NO: 43, SEQ ID NO: 51, SEQ ID NO: 59, SEQ ID NO: 67, SEQ ID NO: 75, or SEQ ID NO: 83; and / or a VL domain comprising an amino acid sequence comprising the amino acid sequence of SEQ ID NO: 12, SEQ ID NO: 20, SEQ ID NO: 28, SEQ ID NO: 36, SEQ ID NO: 44, SEQ ID NO: 52, SEQ ID NO: 60, SEQ ID NO: 68, SEQ ID NO: 76, or SEQ ID NO: 84.

8. The antibody or antigen-binding fragment thereof according to any one of claims 1-7, further comprising a first and / or second heavy constant region.

9. The antibody or antigen-binding fragment thereof of claim 8, wherein the first and / or second heavy constant region comprises a human IgGl, IgG2, IgG3, or IgG4.

10. The antibody or antigen-binding fragment thereof or claim 9, wherein the first heavy chain constant region and / or the second heavy chain constant region comprise an amino acid sequence of SEQ ID NO: 85 or SEQ ID NO: 126.

11. The antibody or antigen-binding fragment thereof of claim 10, wherein at least one heavy chain constant region comprises a substitution at amino acid position 234, according to EU numbering.

12. The antibody or antigen-binding fragment thereof of claim 11, wherein the substitution at amino acid position 234 is an alanine (A).

13. The antibody or antigen-binding fragment thereof of claim 10, wherein at least one heavy chain constant region comprises a substitution at amino acid position 235, according to EU numbering.

14. The antibody or antigen-binding fragment thereof of claim 13, wherein the substitution at amino acid position 235 is an alanine (A).5481197558. v1Attorney Docket No. : 769460: DGT9-009PC15. The antibody or antigen-binding fragment thereof of claim 10, wherein at least one heavy chain constant region comprises a substitution at amino acid position 237, according to EU numbering.

16. The antibody or antigen-binding fragment thereof of claim 15, wherein the substitution at amino acid position 237 is an alanine (A).

17. The antibody or antigen-binding fragment thereof of claim 10, wherein at least one heavy chain constant region comprises one or more substitutions at amino acid positions 234, 235, or 237, according to EU numbering.

18. The antibody or antigen-binding fragment thereof of claim 17, wherein the substitution at amino acid position 234 is an alanine (A), wherein the substitution at amino acid position 235 is an alanine (A), and wherein the substitution at amino acid position 237 is an alanine (A).

19. The antibody or antigen-binding fragment thereof of any one of claims 1-9, wherein at least one heavy chain constant region comprises a substitution at amino acid position 234, 235, and 329, according to EU numbering.

20. The antibody or antigen-binding fragment thereof of claim 19, wherein the substitution at amino acid position 234 is an alanine (A), wherein the substitution at amino acid position 235 is an alanine (A), and wherein the substitution at amino acid position 239 is an alanine (A).

21. The antibody or antigen-binding fragment thereof of any one of claims 1-9, wherein at least one heavy chain constant region comprises a substitution at amino acid position 234, 235, and 331, according to EU numbering.

23. The antibody or antigen-binding fragment thereof of claim 21, wherein the substitution at amino acid position 234 is a phenylalanine (F), wherein the substitution at amino acid position 235 is a glutamic acid (E), and wherein the substitution at amino acid position 331 is an serine (S).5581197558. v1Attorney Docket No. : 769460: DGT9-009PC24. The antibody or antigen-binding fragment thereof of any one of claims 1-9, wherein at least one heavy chain constant region comprises a substitution at amino acid position 233, 234, 235, 236, and 267, according to EU numbering.

25. The antibody or antigen-binding fragment thereof of 24, wherein the substitution at amino acid position 233 is a proline (P), 234 is a valine (V), wherein the substitution at amino acid position 235 is an alanine (A), wherein the substitution at amino acid position 236 is an amino acid deletion (G236del), and wherein the substitution at amino acid position 267 is a lysine (K).

26. The antibody or antigen-binding fragment thereof of any of the previous claims, wherein the heavy chain constant region comprises heterodimerization mutations to promote heterodimerization of the first binding moiety with the second binding moiety.

27. The antibody or antigen-binding fragment thereof of claim 26, wherein the heterodimerization mutations are Knob-in-Hole (KIH) mutations.

28. The antibody or antigen-binding fragment thereof of claim 27, wherein the first heavy chain constant region comprises an amino acid substitution at position 366, 368, or 407 which produces a hole, and the second heavy chain constant region comprises an amino acid substitution at amino acid position 366 which produces a knob.

29. The antibody or antigen-binding fragment thereof of claim 28, wherein the first heavy chain constant region comprises the amino acid substitution T366S, L368A, or Y407V, and the second heavy chain constant region comprises the amino acid substitution T366W.

30. The antibody or antigen-binding fragment thereof of claim 26, wherein the heterodimerization mutations comprise an engineered disulfide bond.

31. The antibody or antigen-binding fragment thereof of claim 30, wherein the engineered disulfide bond is formed by a first heavy chain constant region comprising the amino acid substitution Y349C, and a second heavy chain constant region comprising the amino acid substitution S354C.5681197558. v1Attorney Docket No. : 769460: DGT9-009PC32. The antibody or antigen-binding fragment thereof of any one of the previous claims, wherein at least one heavy chain constant region comprises one or more mutations to promote increased half-life.

33. The antibody or antigen-binding fragment thereof of claim 32, wherein at least one heavy chain constant region comprises one or more substitutions at amino acid positions 252, 254, and / or 256, according to EU numbering.

34. The antibody or antigen-binding fragment thereof of claim 33, wherein the substitution at amino acid position 252 is a tyrosine (Y), wherein the substitution at amino acid position 254 is a threonine (T), and / or wherein the substitution at amino acid position 256 is a glutamic acid (E).

35. The antibody or antigen-binding fragment of claim 32, wherein at least one heavy chain constant region comprises one or more substitutions at amino acid positions 428 and / or 434, according to EU numbering.

36. The antibody or antigen-binding fragment of claim 35, wherein the substitution at amino acid position 428 is a leucine (L), and / or wherein the substitution at amino acid position 434 is a serine (S).

37. The antibody or antigen binding fragment thereof according to any one of claims 1- 36, wherein the antibody or antigen binding domain thereof comprises a modified hinge region.

38. The antibody or antigen binding fragment thereof of claim 37, further comprising a first and / or second modified hinge region.

39. A multispecific antibody comprising the antibody or antigen-binding fragment according to any one of claims 1-38.

40. The multispecific antibody of claim 39, wherein the antibody binds to BMPRII and a second target.5781197558. v1Attorney Docket No. : 769460: DGT9-009PC41. The multispecific antibody of claim 39, wherein the second target is ALK1.

42. A pharmaceutical composition comprising the antibody or antigen-binding fragment thereof according to any one of claims 1-38 or the multispecific antibody according to any one of claims 39-41 and a pharmaceutically acceptable carrier.

43. An isolated nucleic acid molecule encoding the antibody or antigen-binding fragment thereof according to any one of claims 1-38 or the multispecific antibody according to any one of claims 39-41.

44. An expression vector comprising the isolated nucleic acid molecule of claim 43.

45. A method for treating a disease or disorder in a subject, comprising administering to a subject in need thereof the antibody or antigen binding fragment thereof of any one of claims 1-38 or the multispecific antibody according to any one of claims 39-41.

46. The method of claim 45, wherein the disease or disorder is a vascular disease or disorder.

47. The method of claim 46, wherein the vascular disease or disorder is hereditary hemorrhagic telangiectasia (HHT).

48. The method of claim 46, wherein the vascular disease or disorder is a pulmonary hypertension disease or disorder.

49. The method of claim 48, wherein the pulmonary hypertension disease or disorder is pulmonary arterial hypertension (PAH).

50. The method of claim 45, wherein the disease or disorder is Heart Failure with preserved ejection fraction (HFpEF).5881197558. v1Attorney Docket No. : 769460: DGT9-009PC51. The antibody or antigen binding fragment thereof according to any one of claims 1-38 or the multispecific antibody of any one of claims 39-41, for use as a medicament.

52. A method for inducing ActRIIA and / or ActRIIB signaling in a subject, comprising administering the antibody or antigen binding fragment thereof according to any one of claims 1-38 or the multispecific antibody according to any one of claims 39-41.5981197558. v1