TRI-agonists of the GLP-1, GIP, and amylin receptors and uses thereof

Abstract

The present invention provides a GLP-1- / GIP- / amylin-receptor tri-agonist having a balanced potency ratio across all three receptors and / or having improved pharmacokinetic properties. The invention also provides pharmaceutical compositions comprising such a GLP-1- / GIP- / amylin-receptor tri-agonist as well as their use as a medicament for the treatment of subjects with overweight, obesity and associated co-morbidity.

Description

[0001] 240066W001

[0002] 1

[0003] TRI-AGONISTS OF THE GLP-1, GIP, AND AMYLIN RECEPTORS AND USES THEREOF

[0004] TECHNICAL FIELD GLP-1- / GIP- / amylin-receptor tri-agonists and compositions comprising such compounds for use in medicine.

[0005] BACKGROUND

[0006] Overweight and obesity are the abnormal or excessive accumulation of body fat that present a risk to an individual’s overall health. The WHO considers body mass index (BMI) to be the most convenient population-level measure of overweight and obesity. In adults, a BMI greater than or equal to 25 is considered overweight, and a BMI of greater than or equal to 30 is considered obese. Obesity is further subclassified into class I (BMI 30-34.9), class II (BMI 35-39.9) and class III (BMI>40).

[0007] Obesity is a leading risk factor in a large number of serious conditions, including type 2 diabetes and its associated co-morbidities, and cardiovascular diseases such as heart disease and stroke, which are the leading causes of death worldwide. Obesity is now recognised by the World Health Organization (WHO) as an issue that has grown to epidemic proportion, even in children: in 2016, 1.9 billion adults worldwide were reported to have obesity; in 2019, 38.3 million children under the age of 5 worldwide were reported to have obesity. According to the WHO, 422 million people worldwide have diabetes, and 1.6 million deaths are directly attributed to diabetes each year. There is, therefore, a huge incentive for the individual, as well as society, to try to prevent and / or treat obesity.

[0008] When life-style modification such as diet and exercise alone do not suffice in reducing the BMI of an individual living with obesity to an acceptable level, treatment with pharmaceutical drugs such as liraglutide, orlistat and naltrexone-bupropion have been shown to cause some weight loss. Nonetheless, these weight losses are often not sustained and are too small for individuals with class II and class III obesity. In these cases, bariatric surgery has proven necessary. While bariatric surgery is currently the most effective treatment in terms of obtaining long-term weight loss, it is an invasive procedure associated with high risk to the patient and high cost. Therefore, an efficacious and minimally invasive treatment would be a significant improvement in the treatment of obesity.

[0009] GLP-1 is a 30 or 31-amino acid polypeptide that is synthesised and secreted from enteroendocrine L-cells. GLP-1 is an incretin hormone, decreasing blood sugar levels in a glucose-dependent manner by enhancing the secretion of insulin. Endogenous GLP-1 is 240066W001

[0010] 2

[0011] rapidly degraded, primarily by dipeptidyl peptidase-4 (DPP-4), resulting in a half-life of <2 minutes.

[0012] Several marketed products containing a long-acting GLP-1 receptor agonist as the active pharmaceutical ingredient are approved for treatment of type 2 diabetes. These include dulaglutide (Trulicity®), exenatide (Byetta®, Bydureon®), liraglutide (Victoza®), lixisenatide (Lyxumia®), and semaglutide (Ozempic®).

[0013] Two marketed products containing a GLP-1 receptor agonist as the active pharmaceutical ingredient are approved for use in individuals living with overweight and have at least one weight-related co-morbidity or in individuals living with obesity: liraglutide (Saxenda®) and semaglutide (Wegovy®). The maximum efficacy that can be achieved with a GLP-1 receptor agonist is limited by tolerability. At increasing doses, side-effects such as nausea and vomiting become increasingly pronounced.

[0014] Native human GIP is a 42-amino acid polypeptide synthesized in and secreted by specialized enteroendocrine K-cells. These cells are concentrated primarily in the duodenum and proximal jejunum, although they also can be found throughout the intestine. The main stimulant for GIP secretion is ingestion of carbohydrate- and lipid-rich meals. Following ingestion, circulating plasma GIP levels increase 10- to 20-fold. Like GLP-1, GIP is an incretin hormone and in healthy humans it appears to be a more powerful incretin than GLP-1. However, in individuals living with type-2-diabetes GIP has lost its incretin effect. The halflife of intact GIP is estimated to be approximately 7 minutes in healthy subjects and approximately 5 minutes in people living with type-2 diabetes.

[0015] Long acting (or protracted) GIP analogues have been shown to lower body weight and improve glycaemic control. With regards to body weight reduction, this effect is comparatively less than long-acting GLP-1 analogues in rodent models (Mroz et al, Mol Metab, 2019, 20: 51-62). Moreover, GIP analogues induce body weight loss by an additive / synergistic action with long-acting GLP-1 analogues in dual administration (Finan et al, Sci Transl Med, 2013, 5 (209): 209ra151; N0rregaard et al, Diabetes Obes Metab, 2018, 20 (1): 60-68), and as such represent suitable candidates for amplification of GLP-1-based pharmacology. GIPR agonism can also be included as a partner to GLP-1 receptor agonism as a single molecule co-agonist to amplify GLP-1 driven body weight loss and improvement in glycaemic control, as has been shown in preclinical animal models (Finan et al, Sci Transl Med, 2013, 5 (209): 209ra151; Coskun et al, Mol Metab, 2018, 18: 3-14). Two different peptides (MAR709 and LY3298176, the latter known as tirzepatide) with high potency on both GLP-1 R and GIPR have been tested in multi-dose clinical trial studies. The clinical results have demonstrated improvements in glycaemic control and body weight that exceed 240066W001

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[0017] that achieved with comparable dosing of benchmark GLP-1 specific agonists (Frias et al, Cell Metab, 2017, 26 (2): 343-352; Frias et al, Lancet, 2018, 392 (10160): 2180-2193), demonstrating the translational aspects and therapeutic benefits of co-targeting GLP-1 and GIP receptors.

[0018] Lately this concept of co-targeting GLP-1 and GIP receptors with a GLP-1 / GIP coagonist has been proven, as the compound tirzepatide has been approved in 2022 for the treatment of diabetes. Furthermore, tirzepatide is also useful for the treatment of obesity, as it has shown in a phase 3 clinical trial that a high dose of tirzepatide (15 mg) helped patients to lose (mean) 20.9 % of their body weight after 72 weeks of treatment, including a 20-week dose-escalation period (AM Jastreboff, LJ Aronne, NN Ahmad, et al., N Engl J Med 2022; 387:205-216). Tirzepatide was recently approved for weight management in people with a BMI >30 or a BMI >27 and at least one weight related co-mobility (tradename: Zepbound®).

[0019] Beside tirzepatide, which is described in WO 2016 / 111971 A1, GLP-1 / GIP coagonists and their potential medical uses are described in several patent applications such as WO 2006 / 086769, WO 2010 / 011439, WO 2013 / 164483, WO 2014 / 192284, WO 2015 / 067715, WO 2015 / 022420, WO 2015 / 086728, WO 2015 / 086729, WO 2016 / 111971, WO 2020 / 023386, US 2014 / 162945, US 2014 / 357552, and WO 2022 / 018186.

[0020] Amylin is a 37-amino acid long polypeptide hormone produced in pancreatic beta (P)-cell from where it is co-secreted with insulin. Amylin has a half-life of 15-20 minutes. It produces its effects in several different organ systems, primarily acting via amylin receptors 1-3 (AMYR1-3). Amylin is an important regulator of energy metabolism in health and disease, inhibiting glucagon secretion, delaying gastric emptying, signalling satiety, and suppressing appetite. Other amylin actions have also been reported, such as on the cardiovascular system and on bone.

[0021] Clinical studies have shown that amylin receptor agonists may be useful for the treatment of overweight, obesity, type 1 diabetes and / or type 2 diabetes. Currently, there is one product on the market (Symlin®) which contains an amylin receptor agonist (pramlintide acetate) as the active pharmaceutical ingredient. Symlin®, a liquid pharmaceutical composition for subcutaneous administration, is approved for use in patients with type 1 or type 2 diabetes who use basal and mealtime insulin and have failed to achieve desired glycaemic control, despite optimal insulin therapy. Pramlintide for use in people living with overweight and obesity was also investigated. Pramlintide has a short half-life (less than 1 hour), necessitating administration thrice daily. Consequently, there is a large diurnal difference in the pramlintide plasma concentrations. 240066W001

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[0023] There has been a similar desire to be able to prolong the action of amylin and the co-targeting of the amylin receptor and the GLP-1 receptor has been described. Amylin receptor agonists and their potential medical uses are described in several patent applications such as WO 2012 / 168432, WO 2016 / 034604, WO 2022 / 129254, WO 2022 / 063925, or US 2022 / 0288168

[0024] A fixed-dose combination of an amylin receptor agonist, cagrilintide, and a GLP-1 receptor agonist, semaglutide, is currently under investigation for the treatment of overweight and obesity (Lancet 2021; 397: 1736-48). The drug products being investigated are separate liquid pharmaceutical compositions for subcutaneous use. A clinical trial has demonstrated that a combination of cagrilintide and semaglutide induced greater weight loss in people living with obesity than the maximal approved dose of semaglutide monotherapy. Worsening of the side-effect profile was not observed. Co-agonists of GLP-1 and amylin receptors, and their potential medical uses are described in several patent applications such as WO 2022 / 129526 A1. Therein peptide co-agonists of the human GLP-1 R and amylin receptor are disclosed, which are potent and are balanced, i.e., having a similar level of activation of both receptor systems, and which are showing oral bioavailability. Another example is WO 2007 / 022123, which describes hybrid polypeptides including exendin covalently linked to amylin. However, there is no co-agonist of GLP-1 and amylin receptors which has so far obtained market approval.

[0025] Finally, WO 2023 / 288313 and WO 2024 / 015922 disclose multi-agonist peptides useful as agents for the treatment and prevention of metabolic diseases and disorders, in particular diabetes and obesity. WO 2023 / 288313 discloses peptides including two or more component peptides including amylin, GIP, GLP-1, and / or calcitonin. The specifically disclosed peptides are tri-agonists of the GLP-1, GIP, and amylin receptors, showing activity on all three receptors and reduction of food intake and body weight in animals.

[0026] Whilst current therapy options and investigatory drugs provide promise, individuals living with overweight, obesity and / or associated co-morbidities can, at best, at current time hope to be treated with injectable pharmaceutical formulations or medications with some efficacy. There still remains a need in the art for a more efficacious medicament, which is potent in vitro and potent on weight loss, and which does not simultaneously result in a proportionally increased level of side-effects, and which has improved pharmacokinetic properties, has improved chemical stability, is suitable for once weekly dosing in humans, and / or is suitable for oral administration. 240066W001

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[0028] SUMMARY

[0029] The present invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[0030] Z1 - L1 - Z2 (I), wherein Z1 is a peptide GLP-1- / GIP-receptor co-agonist, L1 is a peptide linker and Z2 is a peptide amylin-receptor agonist and wherein the peptide according to formula (I) comprises one lysine (Lys, K).

[0031] In one aspect the present invention relates to a GLP-1- / GIP- / amylin-receptor triagonist comprising a peptide according to Formula I:

[0032] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[0033] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[0034] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[0035] X2represents Aib,

[0036] X12represents Ile (I) or Lys (K),

[0037] X₂₀ represents Arg (R) or Gln (Q),

[0038] X24represents Ala (A), Glu (E) or Gln (Q),

[0039] X27 represents Leu (L) or He (I),

[0040] X₂₈ represents Ala (A) or Gln (Q),

[0041] X30 represents Gly (G) or Ala (A),

[0042] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[0043] X33represents Glu (E) or Ser (S),

[0044] X34 represents Gly (G) or Glu (E);

[0045] • L1 is a peptide linker; and

[0046] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): AX₅₂X₅₃LSTAX₅₈X₅₉X₆₀RLSAELHX₆₈LATX₇₂PRTETGSGSP (VI), wherein

[0047] X52 represents Gly (G) or Ser (S),

[0048] X₅₃ represents Gln (Q), Glu (E), or His (H),

[0049] X₅₈ represents Ala (A) or Gln (Q),

[0050] X59 represents Leu (L) or Thr (T),

[0051] X₆₀ represents Ala (A), Gly (G) or Gln (Q), 240066W001

[0052] 6

[0053] X₆₈ represents Gln (Q), Glu (E), or Lys (K),

[0054] X72 represents Leu (L) or Glu (E).

[0055] In some embodiments of the peptide Z1 X₂ is Aib, X₁₂ is Ile (I) or Lys (K), X₂₀ is Arg (R), X₂₄ is Glu (E), X₂₇ is Leu (L) or Ile (I), X₂₈ is Ala (A), X₃₀ is Gly (G) or Ala (A), X₃₁ is Gly (G), Ala (A) or Pro (P), X₃₃ is Ser (S) and X₃₄ is Gly (G).

[0056] In some embodiments of the peptide Z2 X₅₂ is Ser (S), X₅₃ is Glu (E) or His (H), X₅₈ is Ala (A) or Gln (Q), X₅₉ is Leu (L) or Thr (T), X₆₀ is Gly (G) or Gln (Q), X₆₈ is Gln (Q), Glu (E), or Lys (K), and X₇₂ is Leu (L).

[0057] In some embodiments, the GLP-1- / GIP- / amylin-receptor tri-agonist has an amino acid sequence which comprises or consists of YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAQLGRLSAELHQLATLPRTE TGSGSP (SEQ ID NO: 230), or YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSGAGEAPGEAPGASHLSTAQTQRLSAELHK LATLPRTETGSGSP (SEQ ID NO: 243), or YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAALGRLSAELHQLATLPRTE TGSGSP(SEQ ID NO: 244), or YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASELSTAALGRLSAELHQLATLPRTET GSGSP (SEQ ID NO: 246), or YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASELSTAALGRLSAELHELATLPRTET GSGSP (SEQ ID NO: 250), or YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSGAGASELSTAALGRLSAELHELATLPRTE TGSGSP (SEQ ID NO: 251), or YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAALGRLSAELHELATLPRTE TGSGSP (SEQ ID NO: 252), wherein in each X2is Aib.

[0058] In some embodiments, the GLP-1- / GIP- / amylin-receptor tri-agonist comprises a protraction moiety that increases half-life of the peptide Z1 - L1 -Z2, e.g. attached to via a lysine residue at position 12 of Z1 (X₁₂) or at position 18 of Z2 (X₆₈).

[0059] In a second aspect, the invention further relates to pharmaceutical compositions comprising such GLP-1- / GIP- / amylin-receptor tri-agonist and one or more pharmaceutically acceptable excipients, as well as the medical use of said tri-agonists, in particularly for use in the treatment of subjects with an initial BMI of 27 or more, such as 30 or more, optionally in the presence of at least one weight-related co-morbidity. 240066W001

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[0061] In a third aspect the invention relates to a balanced GLP-1- / GIP- / amylin-receptor triagonist that is capable of selectively activating or "agonising" all three of the GLP-1 receptor, the GIP receptor, and the amylin receptor to a similar level.

[0062] Also or alternatively, in a fourth aspect, the invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist with improved pharmacokinetic properties.

[0063] Also or alternatively, in a fifth aspect, the invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist which is suitable for once weekly administration.

[0064] Also or alternatively, in a sixth aspect, the invention relates to a GLP-1 - / GIP- / amylin-receptor tri-agonist which is suitable for oral administration.

[0065] Also or alternatively, in a seventh aspect, the invention relates to a GLP-1 - / GIP- / amylin-receptor tri-agonist that reduces food intake.

[0066] Also or alternatively, in an eighth aspect, the invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist with improved chemical stability.

[0067] The invention may also solve further problems that will be apparent from the disclosure of the exemplary embodiments and aspects.

[0068] DESCRIPTION

[0069] The present invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[0070] Z1 - L1 - Z2 (I),

[0071] wherein Z1 is a peptide GLP-1- / GIP-receptor co-agonist, L1 is a peptide linker and Z2 is a peptide amylin-receptor agonist and wherein the peptide according to formula (I) comprises one lysine (Lys, K).

[0072] The compounds disclosed herein are referred to as “GLP-1- / GIP- / amylin-receptor tri-agonist“ or “GLP-1 receptor-GIP receptor-amylin receptor tri-agonists” or “GLP-1 - / G I P- / amylin-receptor triple agonist" or “GLP-1 receptor-GIP receptor-amylin receptor triple agonists”.

[0073] The GLP-1 - / GIP- / amylin-receptor tri-agonist comprises a peptide Z1, which is a GLP-1- / GIP receptor co-agonist, a peptide linker L1, and a peptide Z2, which is an amylin receptor agonist. The GLP-1 - / GIP- / amylin-receptor tri-agonist is a compound that binds to each of the three GLP-1, GIP, and amylin receptors and is capable of activating each receptor GLP-1 R, GIPR, and amylin receptor, thus eliciting a response at each receptor. 240066W001

[0074] 8

[0075] The compounds disclosed herein are agonists at each of the receptors GLP-1, GIP, and amylin. Hence the compound of the present invention is a GLP-1 receptor agonist and a GIP receptor agonist and an amylin receptor agonist. It is capable of activating or "agonising" all three of the GLP-1 receptor, the GIP receptor, and the amylin receptor: it is a " GLP-1- / GIP- / amylin-receptor tri-agonist". The GLP-1 - / GIP- / amylin-receptortri-agonist may provide a similar level of activation of all three GLP-1, GIP, and amylin receptors; then it is referred to as a “balanced GLP-1- / GIP- / amylin-receptor tri-agonist” or in short a “balanced tri-agonist”.

[0076] A “receptor agonist” or “agonist” may be defined as a ligand, such as a compound, that binds to and activates a biological receptor to produce a biological response. A full agonist may be defined as one that elicits a response of the same magnitude as the natural ligand (see e.g., “Principles of Biochemistry", AL Lehninger, DL Nelson, MM Cox, Second Edition, Worth Publishers, 1993, page 763). Receptors can be activated by either endogenous agonists, such as endogenous hormones, or exogenous agonists, such as pharmaceutical drugs.

[0077] In the context of the current invention, a "co-agonist" is a compound capable of binding to and activating two different biological receptors, e.g. a compound comprising two different ligands, each of which binds to a given biological receptor, to produce a biological response that is characteristic of the natural ligands. In an analogous way, a “triple agonist” or “tri-agonist” is a compound capable of binding to and activating three different biological receptors, e.g. a compound comprising three different ligands, each of which binds to a given biological receptor, to produce a biological response that is characteristic of the natural ligands.

[0078] A “GLP-1 receptor agonist” may be defined as a compound which is capable of binding to the GLP-1 receptor and capable of activating it. A "full" GLP-1 receptor agonist may be defined as a GLP-1 receptor agonist which is capable of eliciting a magnitude of GLP-1 receptor response that is similar to native glucagon like peptide 1 (GLP-1). Semaglutide, disclosed in WO 2006 / 097537, Example 4, is an example of an exogenous GLP-1 receptor agonist.

[0079] A “GIP receptor agonist” may be defined as a compound which is capable of binding to the GIP receptor and capable of activating it. A "full" GIP receptor agonist may be defined as a GIP receptor agonist which is capable of eliciting a magnitude of GIP receptor response that is similar to native glucose-dependent insulinotropic polypeptide (GIP).

[0080] A “GLP-1 / GIP receptor co-agonist” may be defined as a compound which is capable of binding to both, the GLP-1 receptor, and the GIP receptor and capable of activating both 240066W001

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[0082] receptors. An example of a GLP-1 / GIP co-agonist is tirzepatide, which is described in WO 2016 / 111971.

[0083] An "amylin receptor agonist" may be defined as a compound which is capable of binding to the amylin receptors (AMYRs) and the calcitonin receptor (CTR) and capable of activating it. Amylin receptors consist of heterodimers of two components: the calcitonin receptor (CTR) and one of three receptor activity-modifying proteins (RAMP1-3), resulting in three possible complexes, AMYR1-3. Unless otherwise specified herein, “amylin receptor” at least refers to amylin receptor 3 (AMYR3). Nonetheless, some concomitant activity on the other receptors can be expected. A "full" amylin receptor agonist may be defined as an amylin receptor agonist which is capable of eliciting a magnitude of amylin receptor response that is similar to native amylin. An amylin receptor agonist will often also be a calcitonin receptor agonist. Examples of amylin receptor agonists are human amylin, pramlintide and cagrilintide (disclosed in WO 2012 / 168432). It is noted that all headings and sub-headings are used herein for convenience only and should not be construed as limiting the invention in any way.

[0084] The use of any and all examples, or exemplary language (e.g., “such as”) provided herein, is intended merely to better illuminate the invention, and does not pose a limitation on the scope of the invention unless otherwise claimed.

[0085] In order that the present invention may be more readily understood, certain terms are first defined.

[0086] In what follows, Greek letters may be represented by their symbol or the corresponding written name, for example: a = alpha; p = beta; y = gamma; E = epsilon; co = omega; etc. Also, the Greek letter of may be represented by “u”, e.g. in pl=ul, or in pM=uM.

[0087] Unless otherwise indicated in the specification, terms presented in singular form generally also include the plural situation. The term “a” or “an” is intended to mean “one or more.”

[0088] The term “comprise” and variations thereof such as “comprises” and “comprising,” when preceding the recitation of a step or an element, are intended to mean that the addition of further steps or elements is optional and not excluded. As disclosed herein the open-ended terms like “comprises” and “comprising” might be replaced with closed terms such as “consists of’, “consisting of’, and the like.

[0089] The term "about” is used herein to mean approximately, roughly, or around. When the term “about” is used in conjunction with a numerical range, it modifies that range by extending the boundaries above and below the numerical values set forth. In general, the 240066W001

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[0091] term “about” can modify a numerical value above and below the stated value by 10 percent, up or down (higher or lower).

[0092] Amino acids are molecules containing an amine group and a carboxylic acid group, and, optionally, one or more additional groups, often referred to as a side chain.

[0093] The term “amino acid” includes canonical amino acids (which are genetically encoded), and non-proteinogenic amino acids. Non-limiting examples of non-proteinogenic amino acids are Aib (a-aminoisobutyric acid or 2-aminoisobutyric acid), and the D-isomers of the canonical amino acids. All amino acid residues within the peptide for which the optical isomer is not stated is herein to be understood to mean the L-isomer, unless otherwise specified.

[0094] Herein, “amino acid substitution” or “substitution” refers to one or more amino acid(s) being replaced with the same number of amino acid(s) in the backbone of the peptide. Substitutions may be, but are not limited to, conservative substitutions. For example, an amino acid may be substituted to an amino acid with similar biochemical properties, for example, a basic amino acid may be substituted to another basic amino acid (e.g. lysine to arginine), an acidic amino acid may be substituted to another acidic amino acid (e.g. glutamate to aspartate), a neutral amino acid may be substituted to another neutral amino acid (e.g. threonine to serine), a charged amino acid may be substituted to another charged amino acid (e.g. glutamate to lysine), a hydrophilic amino acid may be substituted to another hydrophilic amino acid (e.g. asparagine to glutamine), a hydrophobic amino acid may be substituted to another hydrophobic amino acid (e.g. alanine to valine), a polar amino acid may be substituted to another polar amino acid (e.g. serine to threonine), an aromatic amino acid may be substituted to another aromatic amino acid (e.g. phenylalanine to tryptophan) and an aliphatic amino acid may be substituted to another aliphatic amino acid (e.g. leucine to isoleucine).

[0095] The term "excipient" as used herein broadly refers to any component other than the Active Pharmaceutical Ingredient (API).

[0096] The term “identity” or “sequence identity” as known in the art, refers to a relationship between the sequences of two or more polypeptides, as determined by comparing the sequences. In the art, “identity” also means the degree of sequence relatedness between polypeptides, as determined by the number of matches between strings of two or more amino acid residues. “Identity” measures the percentage of identical matches between the smaller of two or more sequences with gap alignments (if any) addressed by a particular mathematical model or computer program (i.e., “algorithms”). Identity of related polypeptides can be readily calculated by known methods, e.g. using Needleman (Needleman et al. J. 240066W001

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[0098] Mol. Biol. 1970; 48:443-453) from EMBOSS-6.6.0 using the parameters 10 and 0.5 for gaps opening and extensions, respectively (gapopen=10, gapextend=0.5) ore.g. calculated by: (I) comparing two optimally aligned sequences over a window of comparison (e.g., the length of the longer sequence, the length of the shorter sequence, a specified window, etc.), (2) determining the number of positions containing identical monomers (e.g., same amino acids occurs in both sequences) to yield the number of matched positions, (3) dividing the number of matched positions by the total number of positions in the comparison window (e g., the length of the longer sequence, the length of the shorter sequence, a specified window), and (4) multiplying the result by 100 to yield the percent “sequence identity”. For example, if peptides A and B are both 20 amino acids in length and have identical amino acids at all but 1 position, then peptide A and peptide B have 95 % sequence identity.

[0099] The term “polypeptide” or “peptide” as used herein includes oligopeptides and refers to a single chain of amino acids connected by one or more amide (or peptide) bonds. The terms “polypeptide” and “peptide” shall be used interchangeably herein.

[0100] The term “half-life” or “plasma half-life” as used herein refers to the time required for half the quantity of a substance administered to a person to be metabolized or eliminated from the serum or plasma of the person by normal biological processes.

[0101] The term “treatment” and variations thereof, as used herein, refers to the medical therapy of any human subject in need thereof. The term includes administering a therapeutically effective amount of a peptide as disclosed herein sufficient to reduce or eliminate at least one symptom of the disorder in question. “Treatment”, however, need not be a cure. The timing and purpose of said treatment may vary from one individual to another, according to the status quo of the subject’s health. Thus, said treatment may be prophylactic, palliative, symptomatic and / or curative. In terms of the present invention, prophylactic, palliative, symptomatic and / or curative treatments may represent separate aspects of the invention.

[0102] As used herein the terms “preventing”, “prevent” or “prevention” or variations thereof refers to protecting a subject from developing at least one symptom of a disease or reducing the severity of a symptom of a disorder.

[0103] The term “compound” is used herein to refer to a molecular entity, and “compounds” may thus have different structural elements besides the minimum element defined for each compound or group of compounds. It follows that a compound may be a peptide or a derivative thereof, as long as the compound comprises the defined structural and / or functional elements. The term “compound” is also meant to cover pharmaceutically relevant 240066W001

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[0105] forms thereof, i.e. a compound as defined herein or a pharmaceutically acceptable salt, amide, or ester thereof.

[0106] The compound disclosed herein may be a potent GLP-1 receptor agonist.

[0107] The compound disclosed herein may be a potent GIP receptor agonist.

[0108] The compound disclosed herein may be a potent amylin receptor agonist.

[0109] The in vitro potency of the agonists may be measured as described in the assays of Example 4. The term "potency" is used to describe the effect of a given compound in assays where a sigmoidal relationship between log concentration and the effect of a compound has been established. Furthermore, the response should be variable from 0 to 100%. The potency of the compound may be described by means of its EC(effective concentration)50values. EC50represents the concentration of compound upon which 50% of its maximal effect is observed in the assay, e.g., as described in Example 4. The lower the EC5o value, the more potent the compound.

[0110] The compound disclosed herein may provide a similar level of activation of all three GLP-1, GIP, and amylin receptors; that is, it may be “balanced” and is referred to as a “balanced GLP-1- / GIP- / amylin-receptor tri-agonist” or in short a “balanced tri-agonist”.

[0111] Relatively “balanced” receptor activation is advantageous because the relative ratio of the compound’s GLP-1, GIP, and amylin receptor agonist activities is locked to the molecule; it is not possible to titrate the three receptor agonists, relative to one another. Ultimately, where a molecule is "balanced", it may be dosed such that all three hormone systems are activated without side-effects outweighing benefits.

[0112] A tri-agonist whose potency ratio (A / B) of the potency (A) of the receptor with lowest potency (i.e. the highest numerical EC50value) divided by the potency (B) of the receptor with highest potency (i.e. the lowest numerical EC50value) is less than 50, preferably less than 30, is defined as a “balanced tri-agonist” or “balanced GLP-1- / GIP- / amylin-receptor tri-agonist” (based on the assays in the absence of human serum albumin (HSA), as shown in Example 4 Table 11 and Table 12). For example, compound 183 has an EC50of 14.7 pM on the GLP-1 receptor, an EC50of 2.17 pM on the GIP receptor, and an EC50of 7.08 pM on the amylin receptor. Hence it has lowest potency on the hGLP-1 and (A) corresponds to 14.7 pM, and it has its highest potency on the GIP receptor with 2.17 pM, which corresponds to (B). Hence the potency ratio (A / B) is 14.7 pM (A) divided by 2.17 pM (B) is equal to 7 (rounded accordingly), this means that compound 183 is a “balanced tri-agonist”.

[0113] A compound that is potent on one receptor and much less potent on the other(s) would be "unbalanced". Such an “unbalanced tri-agonist” is defined as compound having a potency ratio (A / B) of 50 or more, or alternatively, having a potency ratio (A / B) of 30 or more. 240066W001

[0114] 13

[0115] For example, reference compound 1 has a potency ratio (A / B) of 256 (i.e., 1680 pM (= A) divided by 6.55 pM (= B), rounded accordingly). For example, this reference compound being potent (i.e. EC50value of <30 pM) on the amylin receptor, less potent (i.e. EC50value of 221 pM) on the GIP receptor, and even less potent (i.e. EC50value of 1680 pM) on the GLP-1 receptor, would be unable to achieve optimal efficacy from all three hormone systems.

[0116] GLP-1 - / GIP-receptor co-agonist - Z1 peptide

[0117] The present invention relates to a peptide according to Formula I comprising a peptide Z1, which is a GLP-1 - / GIP-receptor co-agonist.

[0118] In one embodiment, the GLP-1- / GIP-receptor co-agonist, Z1, is a peptide having a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[0119] YX2EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2is Aib.

[0120] In one embodiment, the GLP-1- / GIP-receptor co-agonist is a peptide comprising or consisting of an amino acid sequence according to Formula (III) (SEQ ID NO: 168):

[0121] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[0122] X2represents Aib,

[0123] X12represents Ile (I) or Lys (K),

[0124] X₂₀ represents Arg (R) or Gln (Q), preferably Arg (R),

[0125] X24represents Ala (A), Glu (E) or Gln (Q), preferably Glu (E),

[0126] X27 represents Leu (L) or He (I),

[0127] X₂₈ represents Ala (A) or Gln (Q), preferably Ala (A),

[0128] X30 represents Gly (G) or Ala (A),

[0129] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P), preferably Pro (P) or Ala (A),

[0130] X33represents Glu (E) or Ser (S), preferably Ser (S),

[0131] X34 represents Gly (G) or Glu (E), preferably Gly (G).

[0132] In some embodiments, the peptide Z1 disclosed herein may have a maximum of 5 amino acid substitutions, relative to Formula II (SEQ ID NO: 1), wherein said substitution(s) can take place in any of the positions 1 to 34, preferably said substitution(s) take place in position 12, 17, 20, 24, 27, 28, 30, 31, 33 and / or 34, more preferably in positions 12, 17, 27, 30, 31, and / or 33. The present invention encompasses variants of the GLP-1- / GIP- / amylin- 240066W001

[0133] 14

[0134] receptor tri-agonist, as disclosed herein, wherein peptide Z1 may comprise 1, 2, 3, 4 or 5 amino acid substitution(s) relative to Formula II (SEQ ID NO: 1).

[0135] Preferred substitutions include a conservative substitution, those which, instead of the amino acid residue, which appears in the sequence, comprises an amino acid with similar biochemical properties or a structural analogue of the amino acid residue.

[0136] In one embodiment, the Z1 peptide according to Formula III has a maximum of 5 substitutions relative to Formula II (SEQ ID NO: 1), relative to Formula II.

[0137] In one embodiment, the GLP-1- / GIP-receptor co-agonist, Z1, is a peptide having a maximum of 5 substitutions relative to Formula (II), (SEQ ID NO: 1):

[0138] YX2EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein X2is Aib

[0139] and wherein Z1 comprises or consists of an amino acid sequence according to Formula (III) (SEQ ID NO: 168):

[0140] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[0141] X2represents Aib,

[0142] X12represents Ile (I) or Lys (K),

[0143] X₂₀ represents Arg (R) or Gln (Q), preferably Arg (R),

[0144] X24represents Ala (A), Glu (E) or Gln (Q), preferably Glu (E),

[0145] X27 represents Leu (L) or He (I),

[0146] X₂₈ represents Ala (A) or Gln (Q), preferably Ala (A),

[0147] X30 represents Gly (G) or Ala (A),

[0148] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P), preferably Ala (A), Gly (G) or Pro (P), X33represents Glu (E) or Ser (S), preferably Ser (S),

[0149] X34 represents Gly (G) or Glu (E), preferably Gly (G).

[0150] In one embodiment, the GLP-1- / GIP-receptor co-agonist, Z1, is a peptide having a maximum of 4 substitutions relative to Formula (II), (SEQ ID NO: 1):

[0151] YX2EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein X2is Aib

[0152] and wherein Z1 comprises or consists of an amino acid sequence according to Formula (VII) (SEQ ID NO: 162): 240066W001

[0153] 15 YX2EGTFTSDYSX12LLEEIAAX20EFIX24WLX27X28GGPSSX34(VII), wherein

[0154] X2represents Aib,

[0155] X12represents Ile (I) or Lys (K),

[0156] X₂₀ represents Arg (R) or Gln (Q),

[0157] X24represents Ala (A), Glu (E) or Gin (Q),

[0158] X27 represents Leu (L) or He (I),

[0159] X28represents Ala (A) or Gin (Q),

[0160] X34 represents Gly (G) or Glu (E).

[0161] In one embodiment, the Z1 peptide comprises or consists of an amino acid sequence according to Formula IV (SEQ ID NO: 169):

[0162] YX2EGTFTSDYSX12LLEEIAAREFIEWLX27AGX30X31SSG (IV), wherein

[0163] X2represents Aib,

[0164] X12represents Ile (I) or Lys (K),

[0165] X27represents Leu (L) or Ile (I),

[0166] X30 represents Gly (G) or Ala (A),

[0167] X31represents Ala (A), Gly (G) or Pro (P).

[0168] In one embodiment, the Z1 peptide comprises or consists of a peptide having an amino acid sequence selected from the group consisting of sequences shown in Table 1:

[0169] Table 1: Specific Z1 peptides

[0170] SEQ ID NO: Z1 peptide

[0171] 20 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGG

[0172] 21 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSG

[0173] 22 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSG

[0174] 23 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGPSSG

[0175] 24 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGE

[0176] 25 YX2EGTFTSDYSILLEEIAAREFIAWLIAGGPSSG

[0177] 26 YX2EGTFTSDYSILLEEIAAREFIQWLIAGGPSSG

[0178] 27 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSE

[0179]

[0180] 240066W001

[0181] 16

[0182] 28 YX2EGTFTSDYSILLEEIAAQEFIEWLLQGGPSSG

[0183] 29 YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSG

[0184] 30 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGQSSG

[0185] 31 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSG

[0186] 32 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGPSEG

[0187] 33 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGGSSG

[0188] 34 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSG

[0189]

[0190] wherein X2is Aib.

[0191] In one embodiment, the Z1 peptide comprises or consists of SEQ ID NO: 22. In one embodiment, the Z1 peptide comprises or consists of SEQ ID NO: 29. In one embodiment, the Z1 peptide comprises or consists of SEQ ID NO: 31. In one embodiment, the Z1 peptide comprises or consists of SEQ ID NO: 34.

[0192] L1 peptide linker

[0193] The GLP-1- / GIP- / amylin-receptor tri-agonist peptide backbone according to Formula I as disclosed herein comprise a peptide linker L1, which may comprise 1 to 14 amino acid residues, in particularly canonical amino acid residues. The peptide linker may comprise 1 to 10 amino acid residues, in particularly canonical amino acid residues, such as 2 to 10, 3 to 10, 4 to 10, 5 to 10, 6 to 10, 7 to 10, 8 to 10, 9 to 10, 1 to 9, 1 to 8, 1 to 7, 1 to 6, 1 to 5, 1 to 4, or 1 to 3 amino acid residues. Specifically, the peptide linker may comprise 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 amino acid residues, in particularly canonical amino acid residues.

[0194] The peptide linker L1 may be represented by Formula Villa:

[0195] X141X142X143X144X145X146X147X148X149X150X151X152X153X154(VIIIa), wherein any of X141-154is independently selected from any naturally occurring, or canonical, amino acid residue(s), and wherein any of X142-154may be absent.

[0196] The GLP-1- / GIP- / amylin-receptor tri-agonist peptide backbone disclosed herein comprise a peptide linker L1, wherein the peptide linker L1 comprises or consists of the amino acid sequence according to Formula Villa. Thus, the GLP-1- / GIP- / amylin-receptor triagonist may comprise a peptide or consist of a peptide according to the amino acid sequence of SEQ ID NO: 5.

[0197] Any of X141-154 may be selected from any nonaromatic amino acid residue. Any of X141-154 may be a charged amino acid. Any of X141-154 may be a polar amino acid. Any of X141-154 may be a hydrophobic amino acid. 240066W001

[0198] 17

[0199] Any of X141-154 may be independently selected from the group consisting of alanine (Ala, A), glutamic acid (Glu, E), glutamine (Gin, Q), glycine (Gly, G), leucine (Leu, L), phenylalanine (Phe, F), proline (Pro, P), serine (Ser, S), threonine (Thr, T), valine (Val, V) and asparagine (Asn, N). Preferably any of X141-154may be selected from the group consisting of alanine (Ala, A), glutamic acid (Glu, E), glutamine (Gln, Q), glycine (Gly, G), leucine (Leu, L) and proline (Pro, P).

[0200] In one embodiment, the peptide linker L1 may be represented by Formula Villa, or comprises or consists of the amino acid sequence according to Formula IV:

[0201] X141X142X143X144X145X146X147X148X149X150X151X152X153X154(VIIIa), wherein

[0202] X141represents Ala (A), Glu (E), Gly (G),

[0203] X142represents Gln (Q), Glu (E), Gly (G), Leu (L), Pro (P) or is absent,

[0204] X143represents Ala (A), Gln (Q), Glu (E), Gly (G), Pro (P) or is absent,

[0205] X144represents Ala (A), Gln (Q), Glu (E), Gly (G), Pro (P) or is absent,

[0206] X145represents Glu (E), Gly (G), Pro (P), Ser (S), Thr (T) or is absent,

[0207] X146represents Glu (E), Gly (G), Leu (L), Gln (Q) or is absent,

[0208] X147represents Ala (A), Gln (Q), Glu (E), Gly (G), Phe (F) or is absent,

[0209] X148represents Ala (A), Gln (Q), Glu (E), Gly (G), Thr (T), Pro (P), Val (V) or is absent,

[0210] X149represents Glu (E), Asn (N), Pro (P), Thr (T) or is absent,

[0211] X150 represents Ala (A), Gin (Q), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Vai (V) or is absent,

[0212] X151 represents Ala (A) or is absent,

[0213] X152 represents Gin (Q) or is absent,

[0214] X153 represents Thr (T) or is absent,

[0215] X154represents Leu (L) or is absent.

[0216] In one embodiment, the peptide linker L1 comprises or consists of 1 to 10 amino acid residues and may be represented by Formula VIII:

[0217] X41X42X43X44X45X46X47X48X49X50(VIII),

[0218] wherein any of X41-50is independently selected from any naturally occurring, or canonical, amino acid residue(s), and wherein any of X42-50may be absent.

[0219] The GLP-1- / GIP- / amylin-receptor tri-agonist peptide backbone disclosed herein comprises a peptide linker L1, wherein the peptide linker L1 comprises or consists of the amino acid sequence according to Formula VIII. Thus, the GLP-1- / GIP- / amylin-receptortri- 240066W001

[0220] 18

[0221] agonist may comprise a peptide or consist of a peptide according to the amino acid sequence of SEQ ID NO: 10.

[0222] Any of X41-50 may be selected from any nonaromatic amino acid residue. Any of X41-50 may be a charged amino acid. Any of X41-50 may be a polar amino acid. Any of X41-50 may be a hydrophobic amino acid.

[0223] Any of X41-50 may be independently selected from the group consisting of alanine (Ala, A), glutamic acid (Glu, E), glutamine (Gin, Q), glycine (Gly, G), leucine (Leu, L), proline (Pro, P), serine (Ser, S), and valine (Val, V). Preferably any of X41-50may be selected from the group consisting of alanine (Ala, A), glutamic acid (Glu, E), glycine (Gly, G), and proline (Pro, P).

[0224] In one embodiment the peptide linker L1 may be represented by Formula VIII, or comprises or consists of the amino acid sequence according to Formula VIII:

[0225] X41X42X43X44X45X46X47X48X49X50 (VIII), wherein

[0226] X41 represents Ala (A), Glu (E) or Gly (G),

[0227] X42 represents Glu (E), Gly (G) or is absent,

[0228] X43 represents Glu (E), Gly (G), Gin (Q) or is absent,

[0229] X44 represents Ala (A), Glu (E), Gly (G) or is absent,

[0230] X45 represents Glu (E), Gly (G), Pro (P) or is absent,

[0231] X46 represents Glu (E), Gly (G) or is absent,

[0232] X47 represents Gin (Q), Glu (E) or is absent,

[0233] X48 represents Ala (A), Glu (E) or is absent,

[0234] X49 represents Glu (E), Pro (P) or is absent,

[0235] X50 represents Ala (A), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Vai (V) or is absent.

[0236] In one embodiment, the peptide linker L1 may be represented by Formula VIII, or comprises or consists of the amino acid sequence according to Formula VIII:

[0237] X41X42X43X44X45X46X47X48X49X50 (VIII),

[0238] wherein

[0239] X41 represents Ala (A) or Glu (E),

[0240] X42 represents Glu (E), Gly (G) or is absent,

[0241] X43 represents Glu (E), Gly (G), Gin (Q) or is absent,

[0242] X44 represents Ala (A), Glu (E), Gly (G) or is absent,

[0243] X45 represents Glu (E), Gly (G), Pro (P) or is absent,

[0244] X46represents Glu (E), Gly (G) or is absent,

[0245] X47represents Gln (Q), Glu (E) or is absent, 240066W001

[0246] 19

[0247] X48represents Ala (A), Glu (E) or is absent,

[0248] X49represents Glu (E), Pro (P) or is absent,

[0249] X50represents Ala (A), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Val (V) or is absent.

[0250] In one embodiment, the peptide linker L1 may be any one of the peptide linkers represented by SEQ ID NOs 125-159. The peptide linker L1 may be any one of the peptide linkers listed in Table 2.

[0251] Table 2: Specific peptide linkers L1

[0252] SEQ ID NO Peptide linker SEQ ID NO Peptide linker

[0253] - A 132 ALAQTLFVNQ

[0254] - E 133 ALAQTLGTNE

[0255] - G 134 ALQAPGQAPG

[0256] - AE 135 ALQAPGQAPL

[0257] - GE 136 AGQAPGQAPG

[0258] 125 APPE 137 AGQAPGQAPL

[0259] 126 GGGE 138 GGGEGGGEGE

[0260] 127 AGQAPG 139 GQAPGQAPGE

[0261] 128 APPPSGGG 140 GQEPGQEPGE

[0262] 129 APPPSGGGE 141 APPPSLAQTLAQTL

[0263] 130 APPPSGGGG 150 EGQAPGQAPG

[0264] 131 ALAQTLAQTL 151 AGQEPGQAPG

[0265] - AG 152 AGQAEGQAPG

[0266] 142 AGGGG 153 AGQAPEQAPG

[0267] 143 AGEAPGQAPG 154 AGQAPGEAPG

[0268] 144 AGEAPGEAPG 155 AGQAPGQEPG

[0269] 145 AGQAPGQAPA 156 AGQAPGQAEG

[0270] 146 AGQAPGQAPE 157 AGQEPGQEPG

[0271] 147 AGQAPGQAPP 158 AGQAPGQAP

[0272] 148 AGQAPGQAPS 159 AGQAPGEAPL

[0273] 149 AGQAPGQAPV

[0274]

[0275] In one embodiment, the peptide linker L1 may be selected from the group consisting of A, E, G, AE, GE, AG, AGGGG (SEQ ID NO: 142), AGQAPGQAPG (SEQ ID NO: 136), 240066W001

[0276] 20

[0277] AGQAPGQAPL (SEQ ID NO: 137), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159).

[0278] In one embodiment, the peptide linker L1 may be selected from the group consisting of E, AE, AG, AGGGG (SEQ ID NO: 142), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159).

[0279] In a preferred embodiment, the peptide linker L1 may be AG or AGEAPGEAPG (SEQ ID NO: 144).

[0280] In one embodiment, the linker L1 comprises or consists of 1 to 10 amino acids residues. In a preferred embodiment, the linker comprises or consists of 1, 2, 5, 9 or 10 amino acid residues, more preferably 2 or 10 amino acid residues.

[0281] Amylin-receptor agonist - Z2 peptide

[0282] The present invention relates to a peptide according to Formula I comprising a peptide Z2, which is an amylin-receptor agonist.

[0283] In one embodiment, the amylin-receptor agonist, Z2, is a C-terminal amide and having a maximum of 10 amino acid substitutions relative to Formula V (SEQ ID NO: 2):

[0284] ASELSTAALGRLSAELHELATLPRTETGSGSP (V).

[0285] In one embodiment, the amylin-receptor agonist is a peptide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): 240066W001

[0286] 21

[0287] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[0288] X52 represents Gly (G) or Ser (S),

[0289] X53 represents Gin (Q), Glu (E), or His (H),

[0290] X₅₈ represents Ala (A) or Gln (Q),

[0291] X59 represents Leu (L) or Thr (T),

[0292] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[0293] 38 represents Gin (Q), Glu (E), or Lys (K),

[0294] X72 represents Leu (L) or Glu (E).

[0295] In one embodiment, the amylin-receptor agonist, Z2, is a C-terminal amide and having a maximum of 10 amino acid substitutions relative to Formula V (SEQ ID NO: 2):

[0296] ASELSTAALGRLSAELHELATLPRTETGSGSP (V)

[0297] and wherein Z2 comprises or consists of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[0298] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[0299] X52 represents Gly (G) or Ser (S),

[0300] X53 represents Gin (Q), Glu (E), or His (H),

[0301] X₅₈ represents Ala (A) or Gln (Q),

[0302] X59 represents Leu (L) or Thr (T),

[0303] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[0304] 38 represents Gin (Q), Glu (E), or Lys (K),

[0305] X72 represents Leu (L) or Glu (E).

[0306] The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z2 is a C-terminal amide and comprises or consists of an amino acid sequence according to Formula IX (SEQ ID NO: 61):

[0307] ASX53LSTAX58X59X60RLSAELHX68LATLPRTETGSGSP (IX), wherein

[0308] X53 represents Glu (E) or His (H),

[0309] X₅₈ represents Ala (A) or Gln (Q),

[0310] X59 represents Leu (L) or Thr (T), 240066W001

[0311] 22

[0312] X60represents Gly (G) or Gln (Q),

[0313] X68represents Gln (Q), Glu (E), or Lys (K).

[0314] The peptide Z2 disclosed herein may have a maximum of 10 amino acid substitution, relative to Formula (SEQ ID NO: 2), wherein said substitution(s) can take place in any of the positions 1 to 32, preferably said substitution(s) take place in position 2, 3, 7, 8, 9, 10, 15, 18, 20, 21, 22, 24 and / or 31, more preferably in positions 3, 8, 9, 10, and / or 18. The present invention encompasses variants of the GLP-1- / GIP- / amylin-receptor triagonist, as disclosed herein, wherein peptide Z2 may comprise 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 amino acid substitution(s) relative to Formula (SEQ ID NO: 2). Preferred substitutions include a conservative substitution, as above explained.

[0315] In one embodiment, the Z2 peptide is a C-terminal amide and comprises or consists of a peptide having an amino acid sequence selected from the group consisting of:

[0316] Table 3: Specific Z2 peptides

[0317] SEQ ID NO: Z2 peptide

[0318] 40 ASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0319] 41 ASHLSTAQLGRLSAELHELATLPRTETGSGSP

[0320] 42 ASHLSTAQLGRLSAELHQLATLPRTETGSGSP

[0321] 43 ASHLSTAQTQRLSAELHELATLPRTETGSGSP

[0322] 44 ASHLSTAALGRLSAELHELATLPRTETGSGSP

[0323] 45 ASHLSTAQTARLSAELHKLATLPRTETGSGSP

[0324] 46 ASQLSTAQTQRLSAELHKLATLPRTETGSGSP

[0325] 47 ASELSTAQTQRLSAELHKLATLPRTETGSGSP

[0326] 48 AGELSTAQTQRLSAELHKLATLPRTETGSGSP

[0327] 49 ASELSTAQTARLSAELHKLATLPRTETGSGSP

[0328] 50 ASHLSTAQTQRLSAELHKLATEPRTETGSGSP

[0329] 51 ASELSTAQTQRLSAELHKLATEPRTETGSGSP

[0330] 2 ASELSTAALGRLSAELHELATLPRTETGSGSP

[0331] 53 ASELSTAALGRLSAELHQLATLPRTETGSGSP

[0332] 54 ASELSTAALGRLSAELHQLATEPRTETGSGSP

[0333] 55 ASELSTAQLGRLSAELHQLATEPRTETGSGSP

[0334] 56 ASELSTAQTGRLSAELHQLATEPRTETGSGSP

[0335] 57 ASELSTAQTQRLSAELHQLATEPRTETGSGSP

[0336]

[0337] 240066W001

[0338] 23

[0339] 58 ASQLSTAQTQRLSAELHKLATEPRTETGSGSP

[0340] 59 ASELSTAQLGRLSAELHQLATLPRTETGSGSP

[0341] 60 ASHLSTAQLGRLSAELHQLATEPRTETGSGSP

[0342]

[0343] In one embodiment, the Z2 peptide comprises or consists of SEQ ID NO: 2. In one embodiment, the Z2 peptide comprises or consists of SEQ ID NO: 40. In one embodiment, the Z2 peptide comprises or consists of SEQ ID NO: 53. In one embodiment, the Z2 peptide comprises or consists of SEQ ID NO: 59.

[0344] GLP-GLP-1 - / GIP- / amylin-receptor tri-agonist peptide

[0345] In one aspect the invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist which is a peptide, also referred to a s “GLP-1- / GIP- / amylin-receptor tri-agonist peptide. The GLP-1- / GIP- / amylin-receptor tri-agonist comprise or consist of a peptide, Z1 — L1 — Z2 comprising a peptide Z1, a peptide linker L1, and a peptide Z2.

[0346] The peptide Z1 is a GLP-1- / GIP receptor co-agonist which is capable of binding to both, the GLP-1 receptor, and the GIP receptor and capable of activating both receptors. The C-terminus of peptide Z1 is attached to the peptide linker L1 via a peptide bond.

[0347] L1 is a peptide linker. Its N-terminus is attached to the C- terminus of Z1 and its C-terminus is attached to the N-terminus of Z2 via a peptide bond.

[0348] The peptide Z2 is an amylin receptor agonist which is capable of binding to at least amylin receptor and capable of activating it. The N-terminus of Z2 is attached to the C-terminus of L1 via a peptide bond. The C-terminus of Z2 is modified with an amide group, which is considered essential for bioactivity. In a preferred embodiment, the amine group of the C-terminal amide is NH2.

[0349] The molecular format may be a single chain peptide backbone comprising one lysine (Lys, K) residue. The one lysine (Lys, K) residue may be present in the peptide Z1 portion of the peptide backbone, or the one lysine (Lys, K) residue may be present in the peptide Z2 portion of the peptide backbone.

[0350] In one aspect, the present invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[0351] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[0352] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[0353] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), 240066W001

[0354] 24

[0355] wherein

[0356] X2represents Aib,

[0357] X12represents Ile (I) or Lys (K),

[0358] X₂₀ represents Arg (R) or Gln (Q),

[0359] X24represents Ala (A), Glu (E) or Gln (Q),

[0360] X27 represents Leu (L) or He (I),

[0361] X2a represents Ala (A) or Gin (Q),

[0362] X30 represents Gly (G) or Ala (A),

[0363] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[0364] X33 represents Glu (E) or Ser (S),

[0365] X34 represents Gly (G) or Glu (E);

[0366] • L1 is a peptide linker; and

[0367] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[0368] X52 represents Gly (G) or Ser (S),

[0369] X53 represents Gin (Q), Glu (E), or His (H),

[0370] X₅₈ represents Ala (A) or Gln (Q),

[0371] X59 represents Leu (L) or Thr (T),

[0372] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[0373] 38 represents Gin (Q), Glu (E), or Lys (K),

[0374] X72 represents Leu (L) or Glu (E).

[0375] In another aspect, the present invention relates to a GLP-1- / GIP- / amylin-receptor triagonist comprising a peptide according to Formula I:

[0376] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[0377] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula XVII (SEQ ID NO: 62):

[0378] YX2EGTFTSDYSX12LLEEIAAREFIX24WLX27X28GX30X31SX33X34 (XVII), wherein

[0379] X2represents Aib,

[0380] X12 represents lie (I) or Lys (K),

[0381] X24represents Ala (A), Glu (E) or Gln (Q), 240066W001

[0382] 25

[0383] X27represents Leu (L) or Ile (I),

[0384] X28 represents Ala (A) or Gin (Q),

[0385] X30 represents Gly (G) or Ala (A),

[0386] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[0387] X33 represents Glu (E) or Ser (S),

[0388] X34 represents Gly (G) or Glu (E);

[0389] • L1 is a peptide linker; and

[0390] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[0391] X52represents Gly (G) or Ser (S),

[0392] X53 represents Gin (Q), Glu (E), or His (H),

[0393] X₅₈ represents Ala (A) or Gln (Q),

[0394] X59 represents Leu (L) or Thr (T),

[0395] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[0396] 38 represents Gin (Q), Glu (E), or Lys (K),

[0397] X72represents Leu (L) or Glu (E).

[0398] In another aspect, the present invention relates to a GLP-1- / GIP- / amylin receptor triagonist comprising a peptide according to Formula I:

[0399] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[0400] • Z1 is a peptide comprising a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[0401] YX2

[0402]

[0403] EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib;

[0404] • L1 is a peptide linker; and

[0405] • Z2 is a peptide comprising a C-terminal amide and a maximum of 10 amino acid substitutions relative to Formula V (SEQ ID NO: 2):

[0406] ASELSTAALGRLSAELHELATLPRTETGSGSP (V).

[0407] In another aspect, the invention relates to a GLP-1- / GIP- / amylin receptor tri-agonist comprising a peptide according to Formula I:

[0408] Z1—L1—Z2 (I), 240066W001

[0409] 26

[0410] comprising one lysine (Lys, K) residue; wherein:

[0411] • Z1 is a peptide comprising a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[0412] YX2

[0413]

[0414] EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib,

[0415] and wherein Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[0416] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[0417] X2represents Aib,

[0418] X12represents Ile (I) or Lys (K),

[0419] X₂₀ represents Arg (R) or Gln (Q), preferably Arg (R),

[0420] X24represents Ala (A), Glu (E) or Gln (Q), preferably Glu (E)

[0421] X27 represents Leu (L) or He (I),

[0422] X₂₈ represents Ala (A) or Gln (Q),

[0423] X30 represents Gly (G) or Ala (A),

[0424] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[0425] X33represents Glu (E) or Ser (S),

[0426] X34represents Gly (G) or Glu (E);

[0427] • L1 is a peptide linker; and

[0428] • Z2 is a peptide comprising a C-terminal amide and a maximum of 10 amino acid substitutions relative to Formula (SEQ ID NO: 2):

[0429] ASELSTAALGRLSAELHELATLPRTETGSGSP (V), and wherein Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[0430] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[0431] X52 represents Gly (G) or Ser (S),

[0432] X₅₃ represents Gln (Q), Glu (E), or His (H),

[0433] X₅₈ represents Ala (A) or Gln (Q),

[0434] X59 represents Leu (L) or Thr (T),

[0435] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[0436] X68represents Gln (Q), Glu (E), or Lys (K),

[0437] X72 represents Leu (L) or Glu (E). 240066W001

[0438] 27

[0439] In another aspect the invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[0440] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[0441] • Z1 is a peptide having a maximum of 4 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[0442] YX2EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib,

[0443] and wherein Z1 comprises or consists of an amino acid sequence according to Formula VII (SEQ ID NO: 162):

[0444] YX2EGTFTSDYSX12LLEEIAAX20EFIX24WLX27X28GGPSSX34(VII), wherein

[0445] X2represents Aib,

[0446] X12represents Ile (I) or Lys (K),

[0447] X₂₀ represents Arg (R) or Gln (Q),

[0448] X24represents Ala (A), Glu (E) or Gin (Q),

[0449] X27 represents Leu (L) or He (I),

[0450] X28 represents Ala (A) or Gin (Q),

[0451] X34 represents Gly (G) or Glu (E);

[0452] • L1 is a peptide linker; and

[0453] • Z2 is a peptide comprising a C-terminal amide, and having a maximum of 10 amino acid substitutions relative to Formula V (SEQ ID NO: 2):

[0454] ASELSTAALGRLSAELHELATLPRTETGSGSP (V), and wherein Z2 comprises or consists of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[0455] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[0456] X52represents Gly (G) or Ser (S),

[0457] X53 represents Gin (Q), Glu (E), or His (H),

[0458] X58 represents Ala (A) or Gin (Q),

[0459] X59 represents Leu (L) or Thr (T),

[0460] X6o represents Ala (A), Gly (G) or Gin (Q),

[0461] X68 represents Gin (Q), Glu (E), or Lys (K),

[0462] X72 represents Leu (L) or Glu (E). 240066W001

[0463] 28

[0464] In one embodiment the GLP-1- / GIP- / amylin-receptor tri-agonist of the present invention may comprise a peptide Z1 comprising or consisting of the amino acid sequence according to Formula VX (SEQ ID NO: 167):

[0465] YX2EGTFTSDYSX12LLEEIAAREFIEWLX27AGGPSSX34(VX),

[0466] wherein

[0467] X2represents Aib,

[0468] X12represents Ile (I) or Lys (K),

[0469] X27represents Leu (L) or Ile (I),

[0470] X34represents Gly (G) or Glu (E); and

[0471] a peptide Z2 comprising or consisting of the amino acid sequence according to SEQ ID NO: 40):

[0472] ASHLSTAQTQRLSAELHKLATLPRTETGSGSP.

[0473] In one embodiment, the GLP-1- / GIP- / amylin-receptor tri-agonist of the present invention may comprise a peptide Z1 comprising or consisting of an amino acid sequence according to Formula IV (SEQ ID NO: 169):

[0474] YX2EGTFTSDYSX12LLEEIAAREFIEWLX27AGX30X31SSG (IV), wherein

[0475] X2represents Aib,

[0476] X12represents Ile (I) or Lys (K),

[0477] X27represents Leu (L) or lie (I),

[0478] X30 represents Gly (G) or Ala (A),

[0479] X31 represents Ala (A), Gly (G) or Pro (P); and

[0480] a peptide Z2 comprising or consisting of an amino acid sequence according to Formula IX (SEQ ID NO: 61):

[0481] ASX53LSTAX58X59X60RLSAELHX68LATLPRTETGSGSP (IX), wherein

[0482] X53represents Glu (E) or His (H),

[0483] X₅₈ represents Ala (A) or Gln (Q),

[0484] X59 represents Leu (L) or Thr (T),

[0485] X60represents Gly (G) or Gln (Q),

[0486] X68represents Gln (Q), Glu (E), or Lys (K).

[0487] In one embodiment the backbone of the peptide Z1 — L1 — Z2 comprises or consists of 66 to 80 amino acid residues, such as 66 to 76 amino acid residues. 240066W001

[0488] 29

[0489] In one embodiment the backbone of the peptide Z1 — L1 — Z2 comprises or consists of 67, 68, 71, 75 or 76 amino acid residues.

[0490] In a preferred embodiment the backbone of the peptide Z1 — L1 — Z2 comprises or consists of 68 or 76 amino acid residues.

[0491] In one embodiment the backbone of the peptide Z1 — L1 — Z2 comprises or consists of an amino acid sequence according to SEQ ID NO: 10. In one embodiment, the backbone of the peptide Z1 — L1 — Z2 comprises or consists of an amino acid sequence according to SEQ ID NO: 5.

[0492] In one embodiment the GLP-1- / GIP- / amylin-receptor tri-agonist comprises a peptide according to Formula I: Z1 — L1 — Z2, wherein the peptide comprises or consists of an amino acid sequence selected from the group consisting of SEQ ID NOs 170 to 252 shown in Table 4

[0493] Table 4: Amino acid sequences of the peptide backbone within compounds of the invention Backbone of

[0494] SEQ ID

[0495] compound Amino acid sequence

[0496] NO:

[0497] no.

[0498] 120, 160, 161, 170 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG 192, 220 QAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0499] 121 171 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSGAGQAPG QAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0500] 122 172 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GQAPGASHLSTAQLGRLSAELHELATLPRTETGSGSP

[0501] 123 173 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GQAPGASHLSTAQLGRLSAELHQLATLPRTETGSGSP

[0502] 124 174 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GQAPGASHLSTAQTQRLSAELHELATLPRTETGSGSP

[0503] 125, 142, 221 175 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPLASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0504] 126 176 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GQAPGASHLSTAALGRLSAELHELATLPRTETGSGSP

[0505] 127 177 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGPSSGAGQAPG

[0506] QAPGASHLSTAALGRLSAELHELATLPRTETGSGSP

[0507]

[0508] 240066W001

[0509] 30

[0510] 128 178 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPLASHLSTAQTARLSAELHKLATLPRTETGSGSP

[0511] 129 179 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GQAPLASHLSTAQLGRLSAELHQLATLPRTETGSGSP

[0512] 130 180 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASHL STAQLGRLSAELHQLATLPRTETGSGSP

[0513] 131, 193 181 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGASHL STAQTQRLSAELHKLATLPRTETGSGSP

[0514] 132 182 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPLASQLST AQTQRLSAELHKLATLPRTETGSGSP

[0515] 133 183 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPLASELSTAQTQRLSAELHKLATLPRTETGSGSP

[0516] 134 184 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGEASHLST AQTQRLSAELHKLATLPRTETGSGSP

[0517] 135 185 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPAASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0518] 136 186 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPEASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0519] 137 187 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPPASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0520] 138 188 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPSASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0521] 139 189 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPVASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0522] 140 190 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGGGGA SHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0523] 141 191 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGGGGA GELST AQTQRLSAELHKLATLPRTETGSGSP

[0524] 143 192 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSGAGQAPG QAPLASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0525] 144 193 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPGASELSTAQTQRLSAELHKLATLPRTETGSGSP

[0526] 145 194 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG

[0527] QAPGASELSTAQTARLSAELHKLATLPRTETGSGSP

[0528]

[0529] 240066W001

[0530] 31

[0531] 146, 211 195 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGQAPG QAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0532] 147, 212 196 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGEGQAPG QAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0533] 148, 213 197 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGEAPG QAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0534] 149, 214 198 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQEPG QAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0535] 150, 215 199 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAEG QAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0536] 151, 216 200 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPE QAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0537] 152, 217 201 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG EAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0538] 153, 218 202 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QEPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0539] 154, 219 203 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAEGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0540] 155 204 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSGAGQEPG QEPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0541] 156 205 YX2EGTFTSDYSILLEEIAAREFIAWLIAGGPSSGAGQEPG QEPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0542] 157 206 YX2EGTFTSDYSILLEEIAAREFIQWLIAGGPSSGAGQEPG QEPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0543] 158 207 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSGAGASHLS TAQTQRLSAELHKLATLPRTETGSGSP

[0544] 159 208 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0545] 162 209 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPGASHLSTAQTQRLSAELHKLATEPRTETGSGSP

[0546] 163 210 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPGASELSTAQTQRLSAELHKLATEPRTETGSGSP

[0547] 164 211 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG

[0548] EAPGASHLSTAQTQRLSAELHKLATEPRTETGSGSP

[0549]

[0550] 240066W001

[0551] 32

[0552] 165 212 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGQAPG QAPGASHLSTAQTQRLSAELHKLATEPRTETGSGSP

[0553] 166 213 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG EAPGASELSTAQTQRLSAELHKLATLPRTETGSGSP

[0554] 167 214 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGQAPG QAPGASELSTAQTQRLSAELHKLATLPRTETGSGSP

[0555] 168 215 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGQAPG EAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0556] 169 216 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GQAPGASELSTAALGRLSAELHELATLPRTETGSGSP

[0557] 170 217 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GQAPGASELSTAALGRLSAELHQLATLPRTETGSGSP

[0558] 171 218 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GEAPGASELSTAALGRLSAELHQLATLPRTETGSGSP

[0559] 172 219 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GEAPGASELSTAALGRLSAELHQLATEPRTETGSGSP

[0560] 173 220 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GEAPGASELSTAQLGRLSAELHQLATEPRTETGSGSP

[0561] 174 221 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GEAPGASELSTAQTGRLSAELHQLATEPRTETGSGSP

[0562] 175 222 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGQAP GEAPGASELSTAQTQRLSAELHQLATEPRTETGSGSP

[0563] 176 223 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGASEL STAQTQRLSAELHKLATLPRTETGSGSP

[0564] 177 224 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGASHLS TAQTQRLSAELHKLATLPRTETGSGSP

[0565] 178 225 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGASELS TAQTQRLSAELHKLATLPRTETGSGSP

[0566] 179 226 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGASHL STAQTQRLSAELHKLATEPRTETGSGSP

[0567] 180 227 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGASQL STAQTQRLSAELHKLATEPRTETGSGSP

[0568] 181 228 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGASQL

[0569] STAQTQRLSAELHKLATLPRTETGSGSP

[0570]

[0571] 240066W001

[0572] 33

[0573] 182 229 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGASQL STAQTQRLSAELHKLATEPRTETGSGSP

[0574] 183 230 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASEL STAQLGRLSAELHQLATLPRTETGSGSP

[0575] 184 231 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASHL STAQLGRLSAELHQLATEPRTETGSGSP

[0576] 185 232 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSEAGASHL STAQLGRLSAELHQLATEPRTETGSGSP

[0577] 186 233 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASEL STAQLGRLSAELHQLATEPRTETGSGSP

[0578] 187 234 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSEAGASEL STAQLGRLSAELHQLATLPRTETGSGSP

[0579] 188 235 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSEAGASEL STAQLGRLSAELHQLATEPRTETGSGSP

[0580] 189 236 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGEAPG EAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0581] 190 237 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSGAGEAPG QAPGASQLSTAQTQRLSAELHKLATLPRTETGSGSP

[0582] 191 238 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSGAGEAPG QAPGASELSTAQTQRLSAELHKLATLPRTETGSGSP

[0583] 194 239 YX2EGTFTSDYSILLEEIAAQEFIEWLLQGGPSSGAGASEL STAQTQRLSAELHKLATLPRTETGSGSP

[0584] 195 240 YX2EGTFTSDYSILLEEIAAQEFIEWLLQGGPSSGAGEAPG QAPGASELSTAQTQRLSAELHKLATLPRTETGSGSP

[0585] 196 241 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG EAPLASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0586] 197 242 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPG QAPLASHLSTAQTQRLSAELHKLATEPRTETGSGSP

[0587] 104, 114 243 YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSGAGEAPG EAPGASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[0588] 105, 115 244 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASEL STAALGRLSAELHQLATLPRTETGSGSP

[0589] 106 245 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGQSSGAGASEL

[0590] STAQLGRLSAELHQLATLPRTETGSGSP

[0591]

[0592] 240066W001

[0593] 34

[0594] 107, 116 246 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASEL STAALGRLSAELHQLATLPRTETGSGSP

[0595] 108 247 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAEASEL STAQLGRLSAELHQLATLPRTETGSGSP

[0596] 109 248 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGPSEGAGASEL STAQLGRLSAELHQLATLPRTETGSGSP

[0597] 110 249 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGGSSGAGASEL STAALGRLSAELHELATLPRTETGSGSP

[0598] 111, 118 250 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASEL STAALGRLSAELHELATLPRTETGSGSP

[0599] 112, 119 251 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSGAGASEL STAALGRLSAELHELATLPRTETGSGSP

[0600] 113, 117 252 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASEL

[0601] STAALGRLSAELHELATLPRTETGSGSP

[0602]

[0603] wherein X2represents Aib.

[0604] In a particular embodiment, the invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist peptide, wherein the peptide comprises or consists of an amino acid sequence selected from the list consisting of: SEQ ID NO: 230, SEQ ID NO: 243, SEQ ID NO: 244, SEQ ID NO: 246, SEQ ID NO: 250, SEQ ID NO: 251 and SEQ ID NO: 252.

[0605] In some embodiments of the present invention, the peptide Z1 comprises an amino acid sequence which has at least 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98 or 99 % identity (i.e., a sequence identity) to Formula II (SEQ ID NO: 1), and the peptide Z2 comprises an amino acid sequence which has at least 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 8990, 91, 92, 93, 94, 95, 96, 97, 98 or 99 % identity (i.e., a sequence identity) relative to Formula (SEQ ID NO: 2).

[0606] In some embodiments of the invention the GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein does not comprise a cysteine (Cys, C) residue and / or does not comprise a disulfide bridge. The term “disulfide bridge” in reference to human amylin and analogues thereof, refers to a functional group with the structure R-S-S-R' and may also be referred to as an “SS-bond”.

[0607] The GLP-1- / GIP- / amylin-receptor tri-agonist may exhibit a variety of properties rendering it useful as a medicament, as described herein. 240066W001

[0608] 35

[0609] Protraction moiety

[0610] In one aspect the invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist which may further comprise a protraction moiety. In such cases the tri-agonist is referred to as a “peptide derivative” ora “GLP-1- / GIP- / amylin-receptor tri-agonist derivative”. The addition of the term "derivative" thus means that a protraction moiety is present and a compound or compounds comprising a protraction moiety are referred to as “derivative” or “derivatives”.

[0611] The molecular format may be a single chain peptide backbone comprising one lysine (Lys, K) residue. The one lysine (Lys, K) residue may be present in the peptide Z1 portion of the peptide backbone, or the one lysine (Lys, K) residue may be present in the peptide Z2 portion of the peptide backbone. The one lysine residue may be covalently bound to a protraction moiety, which may be referred to herein as “LP-P”, wherein “LP” is an optional linker and “P” is a protractor. The peptide backbone of the GLP-1- / GIP- / amylin-receptor tri-agonist of the present invention typically comprises about 66 to about 76 amino acid residues linked together by peptide bonds.

[0612] The term “protraction moiety” as used herein refers to a moiety having half-life extending properties and comprising a “protractor P” and an optional “linker LP”, and may be represented by the general formula “LP-P”, in which LPis said optional linker and P is said protractor.

[0613] The term “protractor” as used herein refers to a molecule which is capable of increasing the plasma half-life of the peptide to which it is attached. The term ’’protraction” thus refers to half-life extension and the terms “protractor”, “protraction moiety” or “half-life extending moiety” thus serve the purpose of extending the plasma half-life of the peptides as disclosed herein.

[0614] Furthermore, the GLP-1- / GIP- / amylin-receptor tri-agonist of the present invention have a long plasma half-life relative to dosing interval, thus reducing the variability in steady state exposure, and thus making a once weekly administration possible. The compound disclosed herein may be orally bioavailable, hence suitable for oral administration of subjects in need thereof. Both the peptide backbone and the protraction moiety have been engineered and refined in order to achieve a compound having all of the above properties.

[0615] Each protraction moiety LP-P covalently attaches to the epsilon amino group of a lysine residue in the peptide backbone of the inventive GLP-1- / GIP- / amylin-receptor tri-agonist. The attachment point is generally referred to as R1.

[0616] In one embodiment, the protraction moiety LP-P may attach to the epsilon position (i.e., amino group) of the one lysine (Lys, K) residue. In one embodiment, the protraction 240066W001

[0617] 36

[0618] moiety LP-P may attach to the epsilon position (i.e., amino group) of a lysine (Lys, K) residue in the peptide Z1 portion of the peptide backbone (the “Z1” in Z1-L1-Z2), such as a lysine (Lys, K) residue at position 12 of the Z1 peptide (X12) of e.g. Formula III (SEQ ID NO: 168), Formula IV (SEQ ID NO: 169), Formula VII (SEQ ID NO: 162), Formula XV (SEQ ID NO: 167), or Formula XVII (SEQ ID NO: 62). In one embodiment, the protraction moiety LP-P may attach to the epsilon position (i.e., amino group) of a lysine (Lys, K) residue in SEQ ID NO: 22, SEQ ID NO: 23, SEQ ID NO: 27, SEQ ID NOs: 30-34, preferably in SEQ ID NO: 22 or SEQ ID NO: 31.

[0619] In one embodiment, the protraction moiety LP-P may attach to the epsilon position (i.e. amino group) of a lysine (Lys, K) residue in the peptide Z2 portion of the peptide backbone (the “Z2” in Z1-L1-Z2), such as a lysine (Lys, K) residue at position 18 (X68) of Formula VI (SEQ ID NO: 165), Formula IX (SEQ ID NO: 61), Formula X (SEQ ID NO: 166), or Formula XIV (SEQ ID NO: 4). In one embodiment, the protraction moiety LP-P may attach to the epsilon position (i.e., amino group) of a lysine (Lys, K) residue in SEQ ID NO: 40, SEQ ID NOs: 45-51, or SEQ ID NO: 58, preferably SEQ ID NO: 40.

[0620] In one embodiment, the protraction moiety LP-P may attach to the epsilon position (i.e., amino group) of a lysine (Lys, K) residue in the GLP-1- / GIP- / amylin-receptor tri-agonist peptide of SEQ ID NO: 230, SEQ ID NO: 243, SEQ ID NO: 244, SEQ ID NO: 246, SEQ ID NO: 250, SEQ ID NO: 251 or SEQ ID NO: 252.

[0621] When the optional linker LPis present, the protraction moiety LP-P covalently attaches to the peptide backbone via the linker LP. When the linker LPis absent, P covalently attaches to the peptide backbone.

[0622] The GLP-1- / GIP- / amylin-receptor tri-agonist of the present invention, as disclosed herein, comprises or consists of a peptide comprising one lysine (Lys, K) residue, to which a single protraction moiety is covalently attached / conjugated (at the epsilon amino group). A protraction moiety may consist of one protractor P. A protraction moiety may comprise one linker LPand one protractor P. A protraction moiety may comprise one linker LPand two or more protractors (in this case referred to as P1, P2 or P3 and so forth). The two protractors (P1 and P2) may be identical, or the two protractors (P1 and P2) may be non-identical. Where the peptide derivative comprises two or three protractors (P1, P2, P3), the protractors are preferably similar, more preferably substantially identical, or, most preferably, identical.

[0623] In the context of chemical moieties such as the protraction moieties disclosed herein, similarity and / or identity may be determined using any suitable computer program and / or algorithm known in the art. 240066W001

[0624] 37

[0625] The protraction moiety may be capable of non-covalently binding to albumin, thereby promoting the circulation of the peptide derivative of the present invention in the blood stream and prolonging its plasma half-life. Thus, the skilled person may also refer to the protraction moiety as being an "albumin binding moiety".

[0626] Protractor P

[0627] The protractor P may comprise an acyl group. The acyl group may be branched or unbranched. The acyl group may be saturated or unsaturated. The protractor P may comprise a fatty acid acyl group. The fatty acid acyl group may be branched or unbranched. The fatty acid acyl group may be saturated or unsaturated.

[0628] The protractor P may comprise a distal carboxylic acid group.

[0629] The protractor P may comprise a fatty acid group.

[0630] The protractor P may comprise a fatty acid group and an amide group.

[0631] The protractor P may comprise a distal carboxylic acid group and an amide group. The protractor P may comprise an alkyl group.

[0632] The protractor P may comprise an aryl group.

[0633] The protractor P may comprise a tetrazole group.

[0634] The protractor P may comprise a sulfonic acid group.

[0635] The protractor P may comprise a phenoxy group.

[0636] The protractor P may comprise a benzoic acid group.

[0637] The protractor P may comprise a phosphonic acid group.

[0638] The protractor may comprise a group defined by:

[0639] Chem. 1a: HOOC-(CH2)n-CO-* wherein n is an integer in the range of 6-30, which may also be referred to as a C(n+2)diacid (e.g. C18diacid) or as

[0640] O O

[0641] Chem. 1b:

[0642]

[0643] J n, wherein n is an integer in the range of 6-30. The asterisk (*) shows the point of attachment of the radical.

[0644] The protractor P may comprise 8-32 carbon atoms. The protractor may comprise 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 or 32 carbon atoms.

[0645] The protractor P may comprise 6-30 consecutive -CH2- groups. The protractor P may comprise a carbon chain comprising at least 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29 or 30 consecutive -CH2- groups. 240066W001

[0646] 38

[0647] The protractor P may comprise 12-26 carbon atoms. The protractor P may comprise 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 or 26 carbon atoms.

[0648] The protractor P may comprise 10-26 consecutive -CH2- groups. The protractor P may comprise a carbon chain comprising 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 or 26 consecutive -CH2- groups.

[0649] The protractor P may comprise 16-22 carbon atoms. The peptide derivative of the present invention may comprise a single protraction moiety with a protractor P comprising a carbon chain a side chain comprising 16, 17, 18, 19, 20, 21 or 22 carbon atoms.

[0650] The protractor P may comprise 14-20 consecutive -CH2- groups. The protractor P may comprise a carbon chain comprising 14, 15, 16, 17, 18, 19 or 20 consecutive -CH2-groups.

[0651] The protractor P may comprise 16-22 consecutive carbon atoms and 14-20 consecutive -CH2- groups.

[0652] The protractor P may comprise 16 consecutive carbon atoms and 14 consecutive -CH2- groups. The protractor P may be a C16diacid, which may be defined by the formula HOOC-(CH2)14-CO-*.

[0653] The protractor P may comprise 18 consecutive carbon atoms and 16 consecutive -CH2- groups. The protractor P may be a C18diacid, which may be defined by the formula HOOC-(CH2)16-CO-*.

[0654] The protractor P may comprise 20 consecutive carbon atoms and 18 consecutive -CH2- groups. The protractor P may be a C20diacid, which may be defined by the formula HOOC-(CH2)18-CO-*.

[0655] The protractor P may comprise 22 consecutive carbon atoms and 20 consecutive -CH2- groups. The protractor P may be a C22diacid, which may be defined by the formula HOOC-(CH2)20-CO-*.

[0656] The term "fatty acid" refers to aliphatic mono- or dicarboxylic acids having from 4 to 28 carbon atoms, it may be branched or un-branched, it is preferably un-branched, and it may be saturated or unsaturated, it is preferably saturated.

[0657] As described above, the peptide derivative disclosed herein comprise one lysine (Lys, K) residue and hence one protraction moiety (LP-P), wherein the protraction moiety is attached to the peptide backbone described herein via the epsilon position (i.e., amino group) of the lysine (Lys, K) residue (via an amide bond formed between a carboxylic acid group in the protraction moiety and the epsilon amino group of the lysine residue). The protraction moiety may be attached to the epsilon position of the one lysine (Lys, K) residue in the peptide backbone. 240066W001

[0658] 39

[0659] In one embodiment the protraction moiety may attach to the epsilon position of the lysine (Lys, K) residue in the peptide Z1 of the peptide backbone (the “Z1” in Z1-L1-Z2). In particular, the protraction moiety may attach to the epsilon position of the lysine (Lys, K) at position X12 of Formula III (SEQ ID NO: 168) or Formula VII (SEQ ID NO: 162) of peptide Z1. In particular, the protraction moiety may attach to the epsilon position of the lysine (Lys, K) at position 12 of peptide Z1.

[0660] In one embodiment the protraction moiety may attach to the epsilon position of the lysine (Lys, K) residue in the linker L1 portion of the peptide backbone (the “L1” in Z1-L1-Z2).

[0661] In one embodiment the protraction moiety may attach to the epsilon position of the lysine (Lys, K) residue in the peptide Z2 of the peptide backbone (the “Z2” in Z1-L1-Z2). In particular, the protraction moiety may attach to the epsilon position of the lysine (Lys, K) at position X68 of Formula VI (SEQ ID NO: 165) of peptide Z2. In particular, the protraction moiety may attach to the epsilon position of the lysine (Lys, K) residue at position 18 of peptide Z2. In a preferred embodiment the protraction moiety may attach to the epsilon position of the lysine (Lys, K) residue at position 18 of peptide Z2.

[0662] In some embodiments the GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide derivative as disclosed herein may comprise a protractor P, which is selected from any one of those depicted in

[0663] Table 5. R1 represents the site of attachment to (a) the backbone of the peptide derivative - more specifically the epsilon amino group of the lysine or (b) the present optional linker LP. Based on the disclosure herein, the skilled person will be able to determine also other chemical moieties for use as a protractor in a specific peptide derivative as disclosed herein, optionally after some limited routine experiments.

[0664] Table 5: Examples of protractors (P)

[0665] Protractor ID Structure

[0666] 0

[0667] R-L. JI

[0668] OH

[0669] Chem. 2

[0670] 0

[0671] C12 diacid

[0672] o

[0673] R-L 11

[0674] Chem. 3 ''OH

[0675] O

[0676]

[0677] 240066W001

[0678] 40

[0679] C14 diacid

[0680] O

[0681] R-L 11

[0682] ^OH Chem. 4

[0683] 0

[0684] C16 diacid

[0685] 0

[0686] Rk JL XZ \z \Z ''OH Chem. 5

[0687] 0

[0688] C18 diacid

[0689] 0

[0690] R1. 11

[0691] \Z ^0HChem. 6

[0692] 0

[0693] C20 diacid

[0694] [] 'v Chem. 7 0 HN_NZ / C17 tetrazole

[0695] 0

[0696] N

[0697] Chem. 8

[0698] HN_NZ / C18 tetrazole

[0699] OH

[0700] p-0 HChem. 32 jf <0

[0701] 0

[0702] C19 phosphonic acid

[0703]

[0704] In one embodiment the GLP-1- / GIP- / amylin-receptor tri-agonist comprises a peptide derivative comprising a protractor P, being a C12-C20 diacid.

[0705] In one embodiment the GLP-1- / GIP- / amylin-receptor tri-agonist comprises a peptide derivative comprising a protractor P selected from the group consisting of C16diacid, C18diacid, and C20diacid. 240066W001

[0706] 41

[0707] In a preferred embodiment, the GLP-1- / GIP- / amylin-receptor tri-agonist comprises a peptide derivative comprising a protractor P being a C18diacid (Chem. 5), a C20diacid (Chem. 6), or a C19phosphonic acid (Chem. 32).

[0708] Linker LP

[0709] In one embodiment the protractor is attached / conjugated directly onto the backbone of the peptide derivative, i.e., without use of a linker LP(i.e., by way of a covalent bond, e.g. an amide bond).

[0710] In other embodiments the protractor is covalently conjugated to the peptide derivative using a linker LP, hence, as described above, the protraction moiety (LP-P) comprises an optional linker LP. The linker LPmay comprise several “linker elements”. The linker elements may be selected so that they improve the overall properties of the molecule, e.g., so that they improve the oral bioavailability, the conversion of half-life or the protracting effect, thus improving the overall exposure profile upon oral administration of the compound.

[0711] The linker LPmay comprise Ado, Aeep or Aeeep, Ahx, Ala, s-Lys, Glu, yGlu, Gly, Ser, sulfonamide, Thr and / or Trx.

[0712] The linker LPmay comprise at least a moiety which may be represented by the following chemical formula (wherein the asterisks (*) show the points of attachment of the radicals):

[0713] Chem 9a: *-NH-(CH2)2-(O-(CH2)2)k-O-(CH2)n-CO-*

[0714]

[0715] Chem. 9b:

[0716] wherein k is an integer in the range of 1-5, and n is an integer in the range of 1-5. When k=1 and n=1, the linker element may be designated Ado, or 8-amino-3,6-dioxaoctanoyl, which may be represented by the following chemical formula:

[0717] Chem. 10a: *-NH-(CH2)2-O-(CH2)2-O-CH2-CO-*

[0718] or

[0719]

[0720] Chem. 11b:

[0721] When k=1 and n=2, the linker element may be designated Aeep, which may be represented by the following chemical formula: 240066W001

[0722] 42

[0723] Chem. 12a: *-NH-(CH2)2-O-(CH2)2-O-(CH2)2-CO-*

[0724] or

[0725]

[0726] o

[0727] Chem. 12b:

[0728] When k=2 and n=2, the linker element may be designated Aeeep, which may be represented by the following chemical formula:

[0729] Chem. 13a: *-NH-(CH2)2-O-(CH2)2O-(CH2)2-O-(CH2)2-CO-*

[0730] or

[0731] O

[0732]

[0733] Chem. 13b:

[0734] The linker LPmay comprise a sulfonamide-C4 moiety. A sulfonamide-C4 group is a sulfonamide group attached to a 4-butanoyl group, having the following chemical formula:

[0735] Chem 14a: *-NH-S(O)2-CH2-CH2-CH2-CO-*

[0736] or

[0737]

[0738] Chem 14b:

[0739] The linker LPmay comprise Trx. Trx is also referred to as Tranexamic acid, trans-4-(aminomethyl)cyclohexanecarboxylic acid, having the following chemical formula:

[0740] Chem. 15a: *-NH-CH2-(C6H10)-CO-*

[0741] or

[0742] Chem. 15b:

[0743]

[0744] M

[0745] The linker LPmay comprise Ahx. Ahx is also referred to as Aminocaproic acid, 6-aminohexanoic acid having the following chemical formula:

[0746] Chem 16a: *-NH-(CH2)5-CO-*

[0747] or 240066W001

[0748] 43

[0749] Chem 16b:

[0750]

[0751] The linker LPmay comprise epsilon-lysine (s-Lys).

[0752] The linker LPmay comprise lysine (Lys).

[0753] The linker LPmay comprise alanine (Ala).

[0754] The linker LPmay comprise glycine (Gly).

[0755] The linker LPmay comprise serine (Ser).

[0756] The linker LPmay comprise glutamic acid (Glu).

[0757] The linker LPmay comprise a Glu di-radical, such as

[0758]

[0759] Chem. 17:

[0760] wherein the Glu di-radical may be included p times, where p is an integer in the range of 1-3. Anyone of above disclosed amino acids, which are used as linker LPor as part of linker LP, may be used as L-isomer or as D-isomer.

[0761] Chem. 17 may also be referred to as gamma-Glu, or briefly yGlu, due to the fact that it is the gamma carboxy group of the amino acid glutamic acid which is here used for connection to the epsilon amino group of lysine. As described above, the other linker element may, for example, be another Glu residue, or an Ado molecule. The amino group of Glu in turn forms an amide bond with the carboxy group of the protracting moiety, or with the carboxy group of, e.g., an Ado molecule, if present, or with the gamma-carboxy group of, e.g., another Glu, if present.

[0762] The peptide derivative disclosed herein may comprise a linker LPwhich is selected from any one of those depicted in Table 6 below. R1 represents the residue in the peptide backbone to which the protraction moiety is attached to, and P represents the protractor.

[0763] In some embodiments the peptide derivative comprises a protraction moiety, wherein the protractor Chem. 4 or Chem. 5 or Chem. 6 or Chem. 32 is attached to the peptide backbone using the linker designated LP1, LP2, LP3, LP4, LP5 or LP6 in Table 6 below.

[0764] In some embodiments the peptide derivative comprises a protraction moiety, wherein the protractor Chem. 5 is attached to the peptide backbone using the linker designated LP1, LP2, LP3 LP4, LP5 or LP6 in Table 6 below, thus wherein said protraction moiety comprises Chem. 18, Chem. 19, Chem. 20, Chem. 21, Chem. 33 or Chem. 34 as linker LPand Chem. 5 as protractor P. 240066W001

[0765] 44

[0766] In some embodiments the peptide derivative comprises a protraction moiety, wherein the protractor Chem. 6 is attached to the peptide backbone using the linker designated LP1, LP2, LP3 LP4, LP5 or LP6 in Table 6 below, thus wherein said protraction moiety comprises Chem. 18, Chem. 19, Chem. 20, Chem. 21, Chem. 33 or Chem. 34 as linker LPand Chem. 6 as protractor P.

[0767] In some embodiments the peptide derivative comprises a protraction moiety, wherein the protractor Chem. 32 is attached to the peptide backbone using the linker designated LP1, LP2, LP3 LP4, LP5 or LP6 in Table 6 below, thus wherein said protraction moiety comprises Chem. 18, Chem. 19, Chem. 20, Chem. 21, Chem. 33 or Chem. 34 as linker LPand Chem. 32 as protractor P.

[0768] In a preferred embodiment the peptide derivative comprises a protraction moiety, wherein said protraction moiety comprises Chem. 20 or Chem. 21 as linker LPand Chem. 5 or Chem. 6 as protractor P.

[0769] In a preferred embodiment the peptide derivative comprises a protraction moiety, wherein the protractor Chem. 5 is attached to the peptide backbone using the linker designated LP3 in Table 6 below, thus wherein said protraction moiety comprises Chem. 20 as linker LPand Chem. 5 as protractor P.

[0770] In a preferred embodiment the peptide derivative comprises a protraction moiety, wherein the protractor Chem. 6 is attached to the peptide backbone using the linker designated LP3 in Table 6 below, thus wherein said protraction moiety comprises Chem. 20 as linker LPand Chem. 6 as protractor P.

[0771] Based on the disclosure herein, the skilled person will be able to determine the optimal LPlinker for use in a specific peptide derivative as disclosed herein, optionally after some limited routine experiments.

[0772] Table 6: Examples of optional linkers (LP) of the protraction moiety

[0773] Linker LP

[0774] Structure

[0775] ID

[0776] 0

[0777] LP1 II H

[0778] HO' Y

[0779] (Chem. 18)

[0780] 0<:::> XR1

[0781]

[0782] 240066W001

[0783] 45

[0784] o

[0785] II H

[0786] Lp2 JL _N.

[0787] HO 'y' P

[0788] (Chem. 19)

[0789] .xL O ^R1

[0790] x / x^ cr

[0791] H II

[0792] 0

[0793] o

[0794] II H LP3 JI _N

[0795] HO X^ P

[0796] (Chem. 20)

[0797] I °

[0798] H II

[0799] _ _ JI

[0800] t\K — cr >r x^ o x / RI

[0801] H ||

[0802] O

[0803] 0

[0804] II H

[0805] J-l

[0806] LP4 Her

[0807] (Chem. 21) r

[0808] H0

[0809] II

[0810] ^z\ -zx. N. JL A. ^x. ^. R1 o^^isr cr >< cr

[0811] H || H II 0 0

[0812] H H

[0813] o^o o^o

[0814] LP5 r I

[0815] > > >< 0

[0816] 1 1 = H II

[0817] (Chem. 33) JL JL c< JL c> RI HN^ ^T— N'^n — hr v / Ho X / x / ^-N"^ x / x / x / x^ I TH TH J H J

[0818] I T LP6 V? H fl H O II ¥ I ^K / X ZK / 'X / X.- / - _ _ JCx~ _0_ A J-. R1 (Chem. 34) I II H II: u n p o 0 =:Ho O^O

[0819] I

[0820] H

[0821]

[0822] 240066W001

[0823] 46

[0824] In some embodiments the peptide derivative comprises a protraction moiety which is selected from the group presented in Table 7. R1 represents the residue in the peptide backbone to which the protraction moiety is attached to.

[0825] Table 7 Examples of protraction moieties

[0826] Protraction Structure

[0827] moiety

[0828] C2o diacid 0 0

[0829] II H II JL.|\L _ _ _ X JL gamma-Glu Her ri OH (Chem. 22) J0

[0830] C20 diacid

[0831] gamma-Glu

[0832] J 0

[0833] gamma-Glu

[0834] J O. OH

[0835] (Chem. 23) f O 0

[0836] II = H ||

[0837] L JL x N JI

[0838] ^R1

[0839] H II |

[0840] 0

[0841] O^^OH

[0842] C20 diacid

[0843] gamma-Glu

[0844] gamma-Glu

[0845] J 0

[0846] gamma-Glu

[0847] J Os. OH O^. OH (Chem. 24) f 0 0

[0848] || = H || E

[0849] I JL x N JL x R1

[0850] >< NT

[0851] H II IHII

[0852] 0

[0853] O^ ^OH0

[0854] C20 diacid 0

[0855] H II

[0856] Ado ^ISL / S ^s. / S / S / S ^zs. / S J4.

[0857] / ^OH (Chem. 25) > 0

[0858] 0' 0

[0859] L 0^ JL

[0860] ^R1

[0861]

[0862] 240066W001

[0863] 47

[0864] C2o diacid 0 0

[0865] II H || JL JI

[0866] gamma-Glu HCT — OH Ado J0

[0867] (Chem. 26) / L O. / x R1

[0868] o-'^isr — ^cr

[0869] H II

[0870] 0

[0871] C2o diacid 0 0

[0872] II H || gamma-Glu JL / x / x / -x / ~x J-L HO Y^ —XOH 2xAdo J 0

[0873] r

[0874] H0

[0875] II

[0876] (Chem. 27) A X / ~x zx / x _C> JL

[0877] XNZ-XOZ>< R1

[0878] H ||

[0879] 0

[0880] Cis diacid 0 0

[0881] II H II gamma-Glu JL N / X / X / X / X / X / X / X / X JL HO OH

[0882] 2xAdo J 0

[0883] r

[0884] (Chem. 28) H0

[0885] ||

[0886] ,0^ ^x / x N / x / x O JL

[0887] 0^ t\r — — ^0^ >r ^RI

[0888] H ||

[0889] 0

[0890] C16 diacid O O

[0891] II H || gamma-Glu J-l ^x ^x ^x ^x ^x ^x ^x JI HCTO H

[0892] 2xAdo J 0

[0893] (Chem. 29) r0

[0894] H || A _ C> ^X _N ^X ^X C< Jt 0^ rr — ^RI H II

[0895] 0

[0896] Cis diacid 0 0 gamma-Glu

[0897] (Chem. 30)

[0898] O x^^RI0

[0899] Cis diacid

[0900] gamma-Glu

[0901] I

[0902] 3xAdo

[0903] JL JJx (Chem. 31) Y

[0904] A

[0905]

[0906] 240066W001

[0907] 48

[0908] C-I9 HO^ ^00

[0909] phosphonic II H I R1. _ O. JL O. N. JI

[0910] 0 xr 0 x / x^ NH acid IIHII | 0 0 Jx gamma-Glu I 2xAdo 0. XX XX XX XX XX XX XX XX J XX XX XX XX XX - - - Her I

[0911] (Chem. 35) OH

[0912] 0

[0913] i

[0914] (Chem. 36)z— / f 0 I <—

[0915] C2o diacid _ _ / ^ \ Z 0 —

[0916] \0

[0917] 2xGlu / 0 TA— /

[0918] Z \ ' —

[0919] gamma-Glu I o /

[0920] / O IZ

[0921] 2xAdo

[0922] 4c.

[0923] \ZI(Chem. 37)

[0924] i T

[0925] C20 diacid V ° 0 Y A xx Jk zX 0 / ^ 0x X X ^X N J HlT ^ / XXxXX X_X^\^XI

[0926] gamma-Glu.NX J — XX R1

[0927] | IIHII i H n 0 A ° o =o2xAdo

[0928] \ 0 I _ _ _ _ _ _ J^ XX XX XX XX XX O^ X) Glu

[0929] 0 H CA “ \ ^0=

[0930] gamma-Glu / Oiz

[0931]

[0932] In one embodiment, the protraction moiety is selected from the list consisting of ^0

[0933] Chem. 27, Chem. 35, Chem. 36, and Chem. 36. In a preferred embodiment, the protraction 0 moiety is Chem 27.

[0934] In one embodiment the free lysine may serve as a conjugation site for attaching one A 3 Ci6 diacid gamma-Glu 2xAdo fatty acid moiety (IUPAC name [2-[2-[2-[[2-[2-[2-[[(4S)-4-carboxy-4-(15-carboxypentadecanoylamino)butanoyl]amino]ethoxy]ethoxy]acetyl]amino] ethoxy]ethoxy]acetyl]), and thus the peptide derivative of the present invention comprises a protraction moiety, wherein said protraction moiety is a Ci6diacid (S) gamma-Glu 2xAdo fatty acid moiety.

[0935] In one embodiment a free lysine may serve as a conjugation site for attaching one Cis diacid gamma-Glu 2xAdo fatty acid moiety (IUPAC name [2-[2-[2-[[2-[2-[2-[[(4S)-4-carboxy-4-(17-carboxyheptadecanoylamino)butanoyl]amino]ethoxy]ethoxy]acetyl]amino] ethoxy]ethoxy]acetyl]), and thus the peptide derivative of the present invention comprises a protraction moiety, wherein said protraction moiety is a Ci8diacid (S) gamma-Glu 2xAdo fatty acid moiety. 240066W001

[0936] 49

[0937] In one embodiment a free lysine may serve as a conjugation site for attaching one C2o diacid gamma-Glu 2xAdo fatty acid moiety (IUPAC name [2-[2-[2-[[2-[2-[2-[[(4S)-4-carboxy-4-(19-carboxynonadecanoylamino)butanoyl]amino]ethoxy]ethoxy]acetyl]amino] ethoxy]ethoxy]acetyl]), and thus the peptide derivative of the present invention comprises a protraction moiety, wherein said protraction moiety is a C20 diacid (S) gamma-Glu 2xAdo fatty acid moiety.

[0938] In one embodiment a free lysine may serve as a conjugation site for attaching one Cis diacid gamma-Glu fatty acid moiety (IUPAC name [(4S)-4-carboxy-4-(17-carboxy-heptadecanoylaminojbutanoyl]), and thus the peptide derivative of the present invention comprises a protraction moiety, wherein said protraction moiety is a Ci8diacid (S) gamma-Glu fatty acid moiety.

[0939] In one embodiment a free lysine may serve as a conjugation site for attaching one C20 diacid gamma-Glu fatty acid moiety (IUPAC name [(4S)-4-carboxy-4-(19-carboxy-nonadecanoylaminojbutanoyl]), and thus the peptide derivative of the present invention comprises a protraction moiety, wherein said protraction moiety is a C20 diacid (S) gamma-Glu fatty acid moiety.

[0940] In a preferred embodiment a free lysine may serve as a conjugation site for attaching one Ci8diacid gamma-Glu 2xAdo fatty acid moiety (IUPAC name [2-[2-[2-[[2-[2-[2-[[(4S)-4-carboxy-4-(17-carboxypentadecanoylamino)butanoyl]amino]ethoxy]ethoxy]acetyl] amino]ethoxy]ethoxy]acetyl]), and thus the peptide derivative of the present invention comprises a protraction moiety, wherein said protraction moiety is a Ci8diacid (S) gamma-Glu 2xAdo fatty acid moiety.

[0941] In a preferred embodiment a free lysine may serve as a conjugation site for attaching one C20 diacid gamma-Glu 2xAdo fatty acid moiety (IUPAC name [2-[2-[2-[[2-[2-[2-[[(4S)-4-carboxy-4-(19-carboxynonadecanoylamino)butanoyl]amino]ethoxy]ethoxy]acetyl] amino]ethoxy]ethoxy]acetyl]), and thus the peptide derivative of the present invention comprises a protraction moiety, wherein said protraction moiety is a C20 diacid (S) gamma-Glu 2xAdo fatty acid moiety.

[0942] In a most preferred embodiment a free lysine may serve as a conjugation site for attaching one Ci8diacid gamma-Glu 2xAdo fatty acid moiety (IUPAC name [2-[2-[2-[[2-[2-[2-[[(4S)-4-carboxy-4-(17-carboxyheptadecanoylamino)butanoyl]amino]ethoxy]ethoxy]acetyl] amino]ethoxy]ethoxy]acetyl]), and thus the peptide derivative of the present invention comprises a protraction moiety, wherein said protraction moiety is a Ci8diacid (S) gamma-Glu 2xAdo fatty acid moiety. 240066W001

[0943] 50

[0944] GLP-1- / GIP- / amylin-receptor tri-agonist derivative

[0945] As described above, the GLP-1- / GIP- / amylin-receptor tri-agonist of the present invention may comprise a peptide linker and further comprise a protraction moiety.

[0946] Therefore, the present invention relates in another aspect to a GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[0947] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[0948] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[0949] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[0950] X2represents Aib,

[0951] X12represents Ile (I) or Lys (K),

[0952] X₂₀ represents Arg (R) or Gln (Q),

[0953] X24represents Ala (A), Glu (E) or Gln (Q),

[0954] X27 represents Leu (L) or He (I),

[0955] X₂₈ represents Ala (A) or Gln (Q),

[0956] X30 represents Gly (G) or Ala (A),

[0957] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[0958] X33represents Glu (E) or Ser (S),

[0959] X34 represents Gly (G) or Glu (E);

[0960] • L1 is a peptide linker; and

[0961] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): AX₅₂X₅₃LSTAX₅₈X₅₉X₆₀RLSAELHX₆₈LATX₇₂PRTETGSGSP (VI), wherein

[0962] X52 represents Gly (G) or Ser (S),

[0963] X₅₃ represents Gln (Q), Glu (E), or His (H),

[0964] X₅₈ represents Ala (A) or Gln (Q),

[0965] X59 represents Leu (L) or Thr (T),

[0966] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[0967] X68represents Gln (Q), Glu (E), or Lys (K),

[0968] X72 represents Leu (L) or Glu (E),

[0969] wherein the peptide is a peptide derivative comprising a protraction moiety selected from Table 7. 240066W001

[0970] 51

[0971] In another aspect, the present invention relates to a GLP-1- / GIP- / amylin-receptor triagonist comprising a peptide according to Formula I:

[0972] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[0973] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula XVII (SEQ ID NO: 62):

[0974] YX2EGTFTSDYSX12LLEEIAAREFIX24WLX27X28GX30X31SX33X34(XVII), wherein

[0975] X2represents Aib,

[0976] X12represents Ile (I) or Lys (K),

[0977] X24represents Ala (A), Glu (E) or Gln (Q),

[0978] X27represents Leu (L) or Ile (I),

[0979] X₂₈ represents Ala (A) or Gln (Q),

[0980] X30represents Gly (G) or Ala (A),

[0981] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[0982] X33represents Glu (E) or Ser (S),

[0983] X34 represents Gly (G) or Glu (E);

[0984] • L1 is a peptide linker; and

[0985] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[0986] X52 represents Gly (G) or Ser (S),

[0987] X₅₃ represents Gln (Q), Glu (E), or His (H),

[0988] X₅₈ represents Ala (A) or Gln (Q),

[0989] X59 represents Leu (L) or Thr (T),

[0990] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[0991] X68represents Gln (Q), Glu (E), or Lys (K),

[0992] X72 represents Leu (L) or Glu (E),

[0993] wherein the peptide is a peptide derivative comprising a protraction moiety selected from Table 7.

[0994] In another aspect, the invention relates to a GLP-1- / GIP- / amylin receptor tri-agonist comprising a peptide according to Formula I: 240066W001

[0995] 52

[0996] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[0997] • Z1 is a peptide comprising a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[0998] YX2

[0999]

[1000] EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib,

[1001] and wherein Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[1002] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[1003] X2represents Aib,

[1004] X12represents Ile (I) or Lys (K),

[1005] X₂₀ represents Arg (R) or Gln (Q), preferably Arg (R),

[1006] X24represents Ala (A), Glu (E) or Gln (Q), preferably Glu (E) X27 represents Leu (L) or He (I),

[1007] X₂₈ represents Ala (A) or Gln (Q),

[1008] X30 represents Gly (G) or Ala (A),

[1009] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[1010] X33represents Glu (E) or Ser (S),

[1011] X34 represents Gly (G) or Glu (E);

[1012] • L1 is a peptide linker; and

[1013] • Z2 is a peptide comprising a C-terminal amide and comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[1014] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1015] X52 represents Gly (G) or Ser (S),

[1016] X₅₃ represents Gln (Q), Glu (E), or His (H),

[1017] X₅₈ represents Ala (A) or Gln (Q),

[1018] X59 represents Leu (L) or Thr (T),

[1019] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[1020] X68represents Gln (Q), Glu (E), or Lys (K),

[1021] X72 represents Leu (L) or Glu (E),

[1022] wherein the peptide is a peptide derivative comprising a protraction moiety selected from Table 7. 240066W001

[1023] 53

[1024] In another aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[1025] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[1026] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[1027] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[1028] X2represents Aib,

[1029] X12represents Ile (I) or Lys (K),

[1030] X₂₀ represents Arg (R) or Gln (Q), preferably Arg (R),

[1031] X24represents Ala (A), Glu (E) or Gln (Q), preferably Glu (E), X27 represents Leu (L) or He (I),

[1032] X₂₈ represents Ala (A) or Gln (Q), preferably Ala (A),

[1033] X30 represents Gly (G) or Ala (A),

[1034] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P), preferably Pro (P) or Ala (A),

[1035] X33represents Glu (E) or Ser (S), preferably Ser (S),

[1036] X34 represents Gly (G) or Glu (E); preferably Gly (G), and

[1037] • L1 is a peptide linker selected from the group consisting of: E, AE, AG, AGGGG (SEQ ID NO: 142), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159), preferably AG or AGEAPGEAPG (SEQ ID NO: 144); and

[1038] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): 240066W001

[1039] 54

[1040] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1041] X52 represents Gly (G) or Ser (S),

[1042] X53 represents Gin (Q), Glu (E), or His (H),

[1043] X₅₈ represents Ala (A) or Gln (Q),

[1044] X59 represents Leu (L) or Thr (T),

[1045] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[1046] 38 represents Gin (Q), Glu (E), or Lys (K),

[1047] X72 represents Leu (L) or Glu (E),

[1048] wherein the peptide is a peptide derivative comprising a protraction moiety selected from Table 7, preferably Chem. 27.

[1049] In another aspect, the present invention relates to a GLP-1- / GIP- / amylin-receptor triagonist comprising a peptide according to Formula I:

[1050] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[1051] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula XVII (SEQ ID NO: 62):

[1052] YX2EGTFTSDYSX12LLEEIAAREFIX24WLX27X28GX30X31SX33X34 (XVII), wherein

[1053] X2represents Aib,

[1054] X12represents Ile (I) or Lys (K),

[1055] X24represents Ala (A), Glu (E) or Gln (Q), preferably Glu (E),

[1056] X27 represents Leu (L) or He (I),

[1057] X28represents Ala (A) or Gin (Q), preferably Ala (A),

[1058] X30 represents Gly (G) or Ala (A),

[1059] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[1060] X33 represents Glu (E) or Ser (S), preferably Ser (S),

[1061] X34 represents Gly (G) or Glu (E); preferably Gly (G); and

[1062] • L1 is a peptide linker selected from the group consisting of: E, AE, AG, AGGGG (SEQ ID NO: 142), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), 240066W001

[1063] 55

[1064] AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159), preferably AG or AGEAPGEAPG (SEQ ID NO: 144); and

[1065] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1066] X52 represents Gly (G) or Ser (S), preferably Ser (S),

[1067] X53 represents Gin (Q), Glu (E), or His (H),

[1068] X₅₈ represents Ala (A) or Gln (Q),

[1069] X59 represents Leu (L) or Thr (T),

[1070] X₆₀ represents Ala (A), Gly (G) or Gln (Q), preferably Gly (G) or Gin (Q), 38 represents Gin (Q), Glu (E), or Lys (K),

[1071] X72 represents Leu (L) or Glu (E), preferably Leu (L),

[1072] wherein the peptide is a peptide derivative comprising a protraction moiety selected from Table 7, preferably Chem. 27.

[1073] In another aspect, the invention relates to a GLP-1- / GIP- / amylin receptor tri-agonist comprising a peptide according to Formula I:

[1074] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[1075] • Z1 is a peptide comprising a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[1076] YX2

[1077]

[1078] EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib,

[1079] and wherein Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[1080] YX2EGTFTSDYSX12LLEEIAAX20EFIX24WLX27X28GX30X31SX33X34 (III), wherein

[1081] X2represents Aib,

[1082] X12represents Ile (I) or Lys (K),

[1083] X20 represents Arg (R) or Gin (Q), preferably Arg (R),

[1084] X24represents Ala (A), Glu (E) or Gln (Q), preferably Glu (E), X27 represents Leu (L) or He (I), 240066W001

[1085] 56

[1086] X28 represents Ala (A) or Gin (Q), preferably Ala (A),

[1087] X30 represents Gly (G) or Ala (A),

[1088] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P), preferably Pro (P) or Ala (A),

[1089] X33 represents Glu (E) or Ser (S), preferably Ser (S),

[1090] X34 represents Gly (G) or Glu (E), preferably Gly (G); and

[1091] • L1 is a peptide linker selected from the group consisting of: E, AE, AG, AGGGG (SEQ ID NO: 142), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159), preferably AG or AGEAPGEAPG (SEQ ID NO: 144); and

[1092] • Z2 is a peptide comprising a C-terminal amide and comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1093] X52 represents Gly (G) or Ser (S), preferably Ser (S),

[1094] X53 represents Gin (Q), Glu (E), or His (H), preferably Glu (E) or His (H), X₅₈ represents Ala (A) or Gln (Q),

[1095] X59 represents Leu (L) or Thr (T),

[1096] X₆₀ represents Ala (A), Gly (G) or Gln (Q), preferably Gly (G) or Gin (Q), 38 represents Gin (Q), Glu (E), or Lys (K),

[1097] X72 represents Leu (L) or Glu (E), preferably Leu (L); and

[1098] wherein the peptide is a peptide derivative comprising a protraction moiety selected from Table 7, preferably Chem. 27.

[1099] In yet another aspect, the invention relates to a GLP-1- / GIP- / amylin-receptor triagonist comprising a peptide according to Formula I:

[1100] Z1—L1—Z2 (I), 240066W001

[1101] 57

[1102] comprising one lysine (Lys, K) residue; wherein:

[1103] • Z1 is a peptide having a maximum of 4 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[1104]

[1105] YX2EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib,

[1106] and

[1107] Z1 comprises or consists of an amino acid sequence according to Formula VII (SEQ ID NO: 162):

[1108] YX2EGTFTSDYSX12LLEEIAAX20EFIX24WLX27X28GGPSSX34 (VII), wherein

[1109] X2represents Aib,

[1110] X12represents Ile (I) or Lys (K),

[1111] X₂₀ represents Arg (R) or Gln (Q),

[1112] X24represents Ala (A), Glu (E) or Gin (Q),

[1113] X27 represents Leu (L) or He (I),

[1114] X28 represents Ala (A) or Gin (Q),

[1115] X34 represents Gly (G) or Glu (E);

[1116] • L1 is a peptide linker selected from the group consisting of E, GE, APPPSGGGE (SEQ ID NO: 129), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137) and AGQAPGEAPG (SEQ ID NO: 154);

[1117] • Z2 is a peptide comprising a C-terminal amide, and having a maximum of 10 amino acid substitutions relative to Formula V (SEQ ID NO: 2):

[1118] ASELSTAALGRLSAELHELATLPRTETGSGSP (V), and

[1119] Z2 comprises or consists of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[1120] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1121] X52represents Gly (G) or Ser (S),

[1122] X53 represents Gin (Q), Glu (E), or His (H),

[1123] X58 represents Ala (A) or Gin (Q),

[1124] X59 represents Leu (L) or Thr (T),

[1125] X6o represents Ala (A), Gly (G) or Gin (Q),

[1126] X68 represents Gin (Q), Glu (E), or Lys (K),

[1127] X72 represents Leu (L) or Glu (E); and 240066W001

[1128] 58

[1129] wherein the peptide is a peptide derivative comprising a protraction moiety.

[1130] The GLP-1- / GIP- / amylin-receptor tri-agonists of the present invention may be a peptide derivative which comprise any one of the above disclosed peptides Z1, any one of the above disclosed peptides Z2, any one of the above disclosed peptide linkers L1 and any one of the above disclosed protraction moieties, and based on the disclosure herein, the skilled person will be able to determine the optimal combination to come to a specific peptide derivative which is a potent GLP-1- / GIP- / amylin-receptor tri-agonist having specific properties as described below.

[1131] The GLP-1- / GIP- / amylin-receptor tri-agonists of the invention may be selected from compound no. 104-197 as described in Example 2 herein. Preferred GLP-1- / GIP- / amylin- receptor tri-agonists of the present invention are

[1132]

[1133] 240066W001

[1134] 59

[1135] Compound 105:

[1136] Compound 107:

[1137]

[1138] 240066W001

[1139] 60

[1140] Compound 111:

[1141] Compound 112:

[1142]

[1143] 240066W001

[1144] 61

[1145] Compound 113:

[1146] Compound 183:

[1147]

[1148] 240066W001

[1149] 62

[1150] Pharmaceutically acceptable salt

[1151] The compounds of the invention may be in the form of a pharmaceutically acceptable salt, or amide.

[1152] Salts are formed by a chemical reaction between a base and an acid, e.g.: 2 NH3+ H2SO4(NH4)2SO4.

[1153] The salt may be a basic salt, an acid salt, or it may be neither nor (i.e., a neutral salt). Basic salts produce hydroxide ions and acid salts produce hydronium ions in water.

[1154] The salts of the compounds of the invention may be formed with added cations or anions between anionic or cationic groups, respectively. These groups may be situated in the peptide moiety, and / or in the protraction moiety of the compounds of the invention.

[1155] Non-limiting examples of anionic groups of the compounds of the invention include free carboxylic groups in the protraction moiety, if any, as well as in the peptide backbone. The peptide backbone may include free carboxylic groups at internal amino acid residues such as Asp (D) and Glu (E).

[1156] Non-limiting examples of cationic groups in the peptide backbone include the free amino group at the N-terminus, if present, as well as any free amino group of internal basic amino acid residues such as His (H), Arg (R), and Lys (K).

[1157] The amide of the compound of the invention may, e.g., be formed during peptide synthesis (based on the used resin) or by the reaction of a free carboxylic acid group with an amine or a substituted amine, or by reaction of a free or substituted amino group with a carboxylic acid. The amide formation may be at any free carboxylic group in the protraction moiety, the free amino group at the N-terminus of the peptide, and / or any free or substituted amino group in the peptide backbone.

[1158] In one aspect, the derivative of the invention is in the form of a pharmaceutically acceptable salt, preferably in the form of a trifluoroacetate salt.

[1159] Functional properties

[1160] In the first functional aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention of the invention have good potency at each of the GLP-1- / GIP- / amylin-receptors. Preferably, they are potent GLP-1- / GIP- / amylin-receptor agonists as is reflected by their ability to activate each of the GLP-1 / GIP- / amylin-receptors, Also, or alternatively, in a second functional aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention are balanced tri-agonists. Also, or alternatively, in a third functional aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention reduces food intake in vivo. Also, or alternatively, in a fourth functional aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention have 240066W001

[1161] 63

[1162] improved pharmacokinetic properties. Also, or alternatively, in a fifth functional aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention are chemically stable.

[1163] Biological activity – in vitro potency

[1164] According to a first functional aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention are biologically active, or potent at each of the GLP-1- / GIP- / amylin-receptors, i.e. a GLP-1- / GIP- / amylin-receptor tri-agonist peptide which is capable of activating the human GIP, GLP-1, and amylin receptors in vitro.

[1165] When tested as described in “GLP-1 receptor assay” (in the absence of HSA), the GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein may have an EC5o value of less than 125 pM, preferably less than 100 pM, such as less than 75 pM, even more preferably less than 50 pM, such as less than 40 pM, and most preferably less than 30 pM, such as less than 20 pM, such as less than 10 pM, such as less than 5 pM.

[1166] When tested as described in “GIP receptor assay” (in the absence of HSA), the GLP-1- / GIP- / amylin-receptor tri-agonist peptide disclosed herein may have an EC5o value of less than 125 pM, preferably less than 100 pM, such as less than 75 pM, even more preferably less than 50 pM, such as less than 40 pM, and most preferably less than 30 pM, such as less than 20 pM, such as less than 10 pM, such as less than 5 pM.

[1167] When tested as described in “Amylin receptor assay” (in the absence of HSA), the GLP-1- / GIP- / amylin-receptor tri-agonist peptide disclosed herein may have an EC5o value of less than 125 pM, preferably less than 100 pM, such as less than 75 pM, even more preferably less than 50 pM, such as less than 40 pM, and most preferably less than 30 pM, such as less than 20 pM, such as less than 10 pM, such as less than 5 pM. The GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein agonise, or activate, the amylin receptor.

[1168] The GLP-1 - / GIP- / amylin-receptor tri-agonist disclosed herein may be tested for GLP-1, GIP and / or amylin activity as described in Example 4.

[1169] The more potent the compound, the lower its EC5o value. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay (see Example 4) of about 100 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC50in a human GLP-1 receptor functional assay of about 90 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC50in a human GLP-1 receptor functional assay of about 80 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 75 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC50in a human GLP-1 receptor functional assay of about 70 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a 240066W001

[1170] 64

[1171] human GLP-1 receptor functional assay of about 60 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 50 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 40 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 30 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 25 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 20 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 15 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 10 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GLP-1 receptor functional assay of about 5 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein may have a similar potency as that of semaglutide or tirzepatide.

[1172] The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay (see Example 4) of about 125 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 100 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 90 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 80 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 75 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 70 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 60 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 50 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 40 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 30 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 25 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 20 pM or less. The GLP-1 - / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 15 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 10 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a 240066W001

[1173] 65

[1174] human GIP receptor functional assay of about 9 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 8 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 7 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 6 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human GIP receptor functional assay of about 5 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein may have a similar potency as that of tirzepatide.

[1175] The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay (see Example 4) of about 125 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 100 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 90 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 80 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 75 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 70 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 60 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 50 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 40 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 30 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 25 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 20 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 15 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 10 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 9 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 8 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 7 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 6 pM or less. The GLP-1- 240066W001

[1176] 66

[1177] / GIP- / amylin-receptor tri-agonist may have an EC5o in a human amylin receptor functional assay of about 5 pM or less. The GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein may have a similar potency as that of cagrilintide.

[1178] Biological activity – balanced GLP-1- / GIP- / amylin-receptor tri-agonists

[1179] In a second functional aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention activates the human GIP, GLP-1 and amylin receptors in vitro, when measured without HSA in assays as described in Example 4, and which has a potency ratio (A / B) of less than 50, preferably less than 30.

[1180] In one embodiment, the GLP-1- / GIP- / amylin-receptor tri-agonist activates the human GIP, GLP-1, and amylin receptors in vitro, when measured without HSA in assays as described in Example 4, and has a potency ratio A / B of less than 50. In one embodiment, the GLP-1- / GIP- / amylin-receptor tri-agonist activates the human GIP, GLP-1, and amylin receptors in vitro, when measured without HSA in assays as described in Example 4, and has a potency ratio A / B of less than 30.

[1181] The balanced GLP-1- / GIP- / amylin-receptor tri-agonist of the present invention activates the human GIP, GLP-1, and amylin receptors in vitro, when measured without HSA in assays as described in Example 4, and has a potency ratio (A / B), i.e., potency (A) of the receptor with lowest potency divided by potency (B) of the receptor with highest potency, of less than 50, preferably less than 30. The tri-agonists disclosed herein may have a potency ratio (A / B) of less than 50, preferably less than 30 or 20, such as less than 19, less than 18, less than 17, less than 16, even more preferred less than 15, such as less than 14, less than 13, less than 12, and most preferred less than 11, such as less than 10, less than 9, less than 8 and less than 7.

[1182] Biological activity – in vivo pharmacology

[1183] In as third functional aspect, the GLP-1 - / GIP- / amylin-receptor tri-agonist disclosed herein may reduce food intake in a subject, e.g., normal weight rats or SD rats.

[1184] Administration of the GLP-1 - / GIP- / amylin-receptor tri-agonist disclosed herein may result in an acute reduction in the intake of food. The in vivo effect of the GLP-1 - / GIP- / amylin-receptor tri-agonist on food intake in rats may be assessed as described in Example 5. A reduction of food intake of 100 % (hypothetical value), relative or compared to vehicle, means that the rat does not eat.

[1185] In one embodiment, the GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein, after a single subcutaneous administration of 10 nmol / kg, may reduce food intake at day 1 240066W001

[1186] 67

[1187] (0-24 hours) by at least 10 % compared to vehicle, preferably by at least 30 or 50 % compared to vehicle, such as at least 70 % compared to vehicle. The GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein, after a single subcutaneous administration of

[1188] 10 nmol / kg, may reduce food intake at day 1 (0-24 hours) by 1 % to 100 %, when compared to vehicle, such as 15 % to 95 %, preferably by 40 % to 85 % when compared to vehicle, even more preferably by 50 % to 80 %, when compared to vehicle.

[1189] In one embodiment, the GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein, after a single subcutaneous administration of 10 nmol / kg, may reduce food intake at day 2 (24-48 hours) by at least 15 % compared to vehicle, preferably by at least 30 or 50 % compared to vehicle, such as at least 70 % compared to vehicle. The GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein, after a single subcutaneous administration of

[1190] 10 nmol / kg, may reduce food intake at day 2 (24-48 hours) by 1 % to 100 %, when compared to vehicle, such as 15 % to 95 %, preferably by 40 % to 95 % when compared to vehicle, even more preferably by 70 % to 95 %, when compared to vehicle.

[1191] In one embodiment, the GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein, after a single subcutaneous administration of 30 nmol / kg, may reduce food intake at day 1 (0-24 hours) by at least 15 % compared to vehicle, preferably by at least 35 % compared to vehicle. The GLP-1- / GIP- / amylin-receptor tri-agonist disclosed herein, after a single subcutaneous administration of 30 nmol / kg, may reduce food intake at day 2 (24-48 hours) by at least 15 % compared to vehicle, preferably by at least 35 % compared to vehicle.

[1192] Pharmacokinetic profile

[1193] In a fourth functional aspect, the GLP-1- / GIP- / amylin-receptor tri-agonist of the invention have improved pharmacokinetic properties such as increased terminal half-life.

[1194] Half-life is an important parameter as a long half-life indicates that less frequent administration of a compound may be possible. Based on the disclosure herein, the skilled person will be able to determine the protraction moiety for use in a specific peptide derivative as disclosed herein, optionally after some limited routine experiments. The GLP-1- / GIP- / amylin-receptor tri-agonists or the peptide derivatives of the present invention have a long half-life relative to dosing interval, thus reducing the variability in steady state exposure.

[1195] The in vivo pharmacology, including half-life, of the GLP-1- / GIP- / amylin-receptor tri-agonist described herein may be assessed as described in Example 6. In some embodiments, the half-life is half-life (t%) in vivo in minipigs or in rats after i.v. administration, e.g., as described in Example 6. The half-life of the GLP-1- / GIP- / amylin-receptor tri-agonist in minipigs may be as long as about 90 hours, or longer. The half-life of the GLP-1- / GIP- 240066W001

[1196] 68

[1197] / amylin-receptor tri-agonist in minipigs may be at least 80 hours, preferably at least 90 hours. The half-life of the GLP-1- / GIP- / amylin-receptor tri-agonist in minipigs may be more than 80, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140, 150, 160, or 170 hours. The half-life of the GLP-1- / GIP- / amylin-receptor tri-agonist in minipigs may be 80-200 hours, such as 90-190 hours, such as 95-185 hours. The half-life of the GLP-1- / GIP- / amylin-receptor tri-agonist in rats may be as long as about 5 hours, or longer. The half-life of the GLP-1- / GIP- / amylin-receptor tri-agonist in rats may be at least 8 hours, preferably at least 10 hours. The half-life of the GLP-1- / GIP- / amylin-receptor tri-agonist in rats may be more than 5, 6, 7, 8, 9, 10, 12, 14, 16, 20, or 25 hours. The half-life of the GLP-1- / GIP- / amylin-receptor tri-agonist in rats may be 5-50 hours, such as 10-35 hours, such as 12-30 hours.

[1198] In one embodiment, the present invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist which is suitable for once weekly administration. The GLP-1- / GIP- / amylin-receptor tri-agonists or the peptide derivatives of the present invention have a long half-life relative to dosing interval, thus reducing the variability in steady state exposure, and thus making a once weekly administration possible.

[1199] In a one embodiment, the present invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist which is suitable for oral administration. The GLP-1- / GIP- / amylin-receptor tri-agonist described herein may be orally bioavailable; that is, present in the bloodstream following per oral administration. Therefore, the compound is suitable for oral administration of subjects in need thereof.

[1200] Chemical

[1201]

[1202] In the fifth aspect, the present invention relates to a GLP-1- / GIP- / amylin-receptor tri-agonist having improved chemical stability. The term "chemical stability" refers to chemical (in particular covalent) changes in the polypeptide structure leading to formation of chemical degradation products, such as high molecular weight proteins (HMWPs), deamidation, isomerization and hydrolysis products potentially having a reduced biological potency, and / or increased immunogenic effect as compared to the intact polypeptide. The chemical stability may be determined by measuring the purity loss, e.g., by measuring the amount of chemical degradation products at various time-points after exposure to different environmental conditions, e.g., by SEC-HPLC, and / or LCMS, e.g., as described in Example 7 herein. The GLP-1- / GIP- / amylin-receptor tri-agonist of the invention has a purity loss per week of less than 10.0 percent, preferably less than 5.0 percent, such as 4.0 or 3.0 percent, more preferably less than 2.0 percent, and most preferred less than 1.5 percent, upon incubation at 37 °C and as determined in Example 7 described herein. 240066W001

[1203] 69

[1204] Both the peptide backbone and the protraction moiety have been engineered and refined to achieve a peptide derivative having all of the above properties.

[1205] Method of production

[1206] The tri-agonists disclosed herein may be produced by classical peptide synthesis, e.g. solid phase peptide synthesis using t-Boc or Fmoc chemistry, or other well established techniques, see e.g. Greene and Wuts, " Protective Groups in Organic Synthesis", John Wiley & Sons, 1999; Florencio Zaragoza Dorwald, " Organic Synthesis on Solid Phase", Wiley-VCH Verlag GmbH, 2000; and " Fmoc Solid Phase Peptide Synthesis", Edited by W. C. Chan and P. D. White, Oxford University Press, 2000. In some embodiments, methods for preparing the tri-agonists are described herein. In some embodiments, the methods for preparing the tri-agonists as described herein comprises a step of solid phase peptide synthesis.

[1207] Also, or alternatively, the compounds, the peptide sequence or parts of the peptide sequences may be produced by recombinant methods, e.g., by culturing a host cell containing a DNA sequence encoding the tri-agonist peptide sequence and capable of expressing the peptide, in a suitable nutrient medium under conditions permitting the expression of the peptide. Non-limiting examples of host cells suitable for expression of these peptides are: Escherichia coli, Saccharomyces cerevisiae as well as mammalian BHK or CHO cell lines.

[1208] The tri-agonists that include non-natural amino acids and / or covalently attached substituents (protraction moieties) may be produced as described under ‘General method for peptide synthesis' in the experimental part. Or see e.g., Hodgson et al: " The synthesis of peptides and proteins containing non-natural amino acids", Chemical Society Reviews, vol.

[1209] 33, no. 7 (2004), p. 422-430.

[1210] The tri-agonists as described herein which include a protraction moiety may, e.g., be produced as described under ‘General method for peptide synthesis' in the experimental part. In some embodiments, the protraction moiety is built as part of the solid phase peptide synthesis or produced separately and attached via the one lysine residue after the solid phase peptide synthesis.

[1211] Specific examples of methods of preparing a number of the tri-agonists as described herein are provided below.

[1212] A further aspect of the invention relates to a method for preparing the receptor tri-agonists described herein. 240066W001

[1213] 70

[1214] In one embodiment, the method for preparing a compound as described herein comprises a step of solid phase peptide synthesis. The protraction moiety may be built sequentially as part of the solid phase peptide synthesis or produced separately and attached via the lysine residue after peptide synthesis.

[1215] Pharmaceutical compositions

[1216] In a further aspect the present invention relates to a pharmaceutical composition comprising said GLP-1- / GIP- / amylin-receptor tri-agonist. Disclosed herein is a pharmaceutical composition comprising the GLP-1- / GIP- / amylin-receptor tri-agonist as disclosed herein, and one or more pharmaceutically acceptable excipients. Pharmaceutical composition comprising the GLP-1- / GIP- / amylin-receptor tri-agonist as disclosed herein, and one or more pharmaceutically acceptable excipients, may be prepared using methods known to the person skilled in the art.

[1217] The term "pharmaceutically acceptable excipient" refers to any ingredient in the pharmaceutical composition which is not the active pharmaceutical ingredient, or the GLP-1- / GIP- / amylin-receptor tri-agonist as disclosed herein. The term "pharmaceutically acceptable excipient" means an excipient that is useful in preparing a pharmaceutical composition that is generally safe, non-toxic and includes excipients that are acceptable for human pharmaceutical use. Such excipients can for example be solid, liquid or semisolid.

[1218] The excipient may be functional or inert and may serve various purposes, e.g. as a buffer, an isotonicity agent, a carrier, a vehicle, a filler, a binder, a lubricant, a glidant, a disintegrant, a flow control agent, a crystallization inhibitor, a solubilizer, a stabilizer, a colouring agent, a flavouring agent, a surfactant, emulsifier, or combinations thereof and / or to improve administration, and / or absorption of the active pharmaceutical ingredient(s). The amount of each excipient used may vary within ranges conventional in the art.

[1219] Techniques and excipients which may be used are described in e.g., Handbook of Pharmaceutical Excipients (e.g., 8thedition, Sheskey et al., Eds., American Pharmaceuticals Association and Pharmaceutical Press, publications department of the Royal Pharmaceutical Society of Great Britain (2017) and later editions) and Remington: The Science and Practice of Pharmacy (e.g., 23rdedition, Remington and Allen, Eds., Pharmaceutical Press (2021) and later editions).

[1220] The pharmaceutical composition comprising the GLP-1- / GIP- / amylin-receptor triagonist as disclosed herein may be for oral administration.

[1221] The pharmaceutical composition comprising the GLP-1- / GIP- / amylin-receptor triagonist as disclosed herein may be a solid pharmaceutical composition (e.g., a tablet or 240066W001

[1222] 71

[1223] capsule) containing the active pharmaceutical ingredient, for example as a freeze-dried or spray-dried composition, and may be used as is, dissolved prior to use, or combined with excipients in the formulation.

[1224] The pharmaceutical composition may be a solid pharmaceutical composition comprising the compound disclosed herein, a salt of / V-[8-(2-hydroxybenzoyl)amino] caprylate, preferably sodium / V-(8-(2-hydroxybenzoyl)amino)caprylate, and one or more further excipients, as is described in the art. For example, the solid pharmaceutical composition may be as described in WO 2012 / 080471, WO 2013 / 139694, WO 2013 / 189988, WO 2019 / 149880, WO 2019 / 215063, WO 2021 / 219710 or WO 2023 / 012263 A1.

[1225] Alternatively, the pharmaceutical composition comprising the GLP-1- / GIP- / amylin-receptor tri-agonist as disclosed herein may be a liquid composition, such as an aqueous composition. Such liquid compositions may be suitable for oral administration or for parenteral administration, for example intravenous, intramuscular, or subcutaneous administration.

[1226] Liquid compositions that are suitable for injection can be prepared using conventional techniques of the pharmaceutical industry which involve dissolving and mixing the ingredients as appropriate to give the desired end product. Thus, according to one procedure, the compound described herein is dissolved in a suitable buffer at a suitable pH. The composition may be sterilized, for example, by sterile filtration. Techniques and excipients which may be used to prepare liquid formulations are described in in e.g., Handbook of Pharmaceutical Excipients (e.g., 8thedition, Sheskey et al., Eds., American Pharmaceuticals Association and Pharmaceutical Press, publications department of the Royal Pharmaceutical Society of Great Britain (2017) and later editions) and Remington: The Science and Practice of Pharmacy (e.g., 23rdedition, Remington and Allen, Eds., Pharmaceutical Press (2021) and later editions). Preferably, in an embodiment wherein pharmaceutical composition is in a liquid formulation, the liquid formulation provides an improved stability.

[1227] The pharmaceutical compositions are typically administered to a subject already suffering from a disease, such as the indications described below, in an amount sufficient to cure, alleviate or partially arrest the disease and its complications. An amount adequate to accomplish this is defined as "therapeutically effective amount". As will be understood by the person skilled in the art amounts effective for this purpose will depend on the severity of the disease as well as the weight and general state of the subject.

[1228] In some embodiments the dose of the compounds to be delivered by subcutaneous administration may be from about 0.1 mg to 500 mg of the compound per day, preferably 240066W001

[1229] 72

[1230] from about 0.5 mg to 150 mg per day, per every second day, per every third day, per every fourth day, per every fifth day, per every sixth day or once weekly depending on the severity of the condition.

[1231] A suitable dose may also be adjusted for a particular compound based on the properties of that compound, including its in vivo half-life or mean residence time and its biological activity. For example, compounds to be delivered could in one embodiment be administered once daily, or in another embodiment once weekly. Accordingly, the pharmaceutical compositions may be used for dosing approximately once daily, such as once every 12-36 hours, such as once every 18-30 hours, such as approximately once every 24 hours, or may be used for dosing approximately once weekly, such as once every 6-8 days.

[1232] In one embodiment the present invention relates to an injection device comprising said pharmaceutical composition.

[1233] Pharmaceutical indications

[1234] In a further aspect the present invention relates to the GLP-1- / GIP- / amylin-receptor triple agonist as disclosed herein for use as a medicament.

[1235] The GLP-1- / GIP- / amylin-receptor triple agonist as disclosed herein may be used for the following medical treatments or indications:

[1236] (i) prevention and / or treatment of all forms of diabetes, such as hyperglycaemia, type 2 diabetes, impaired glucose tolerance, type 1 diabetes, non-insulin dependent diabetes, MODY (maturity onset diabetes of the young), gestational diabetes, and / or for reduction of HbA1c;

[1237] (ii) delaying or preventing diabetic disease progression, such as progression in type 2 diabetes, delaying the progression of impaired glucose tolerance (IGT) to insulin requiring type 2 diabetes, and / or delaying the progression of non-insulin requiring type 2 diabetes to insulin requiring type 2 diabetes;

[1238] (iii) prevention and / or treatment of eating disorders, such as obesity, e.g., by decreasing food intake, reducing body weight, suppressing appetite, inducing satiety; treating or preventing binge eating disorder, food cravings, bulimia nervosa and / or obesity induced by administration of an antipsychotic ora steroid; reduction of gastric motility; and / or delaying gastric emptying;

[1239] (iv) weight maintenance after successful weight loss (either drug induced or by diet and exercise) - i.e., prevention of weight gain after successful weight loss; 240066W001

[1240] 73

[1241] (v) prevention and / or treatment of cardiovascular diseases, such as delaying or reducing development of a major adverse cardiovascular event (MACE) selected from the group consisting of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, revascularisation, hospitalisation for unstable angina pectoris, and hospitalisation for heart failure.

[1242] (vi) prevention and / or treatment of non-alcoholic fatty liver disease (NAFLD, otherwise known as metabolic-dysfunction associated fatty liver disease, MAFLD) and / or non-alcoholic steatohepatitis (NASH, otherwise known as metabolic dysfunction-associated steatohepatitis, MASH);

[1243] (vii) prevention and / or treatment of cognitive impairment, such as that caused by Alzheimer's disease;

[1244] (viii) the prevention and / or treatment of chronic kidney disease;

[1245] (ix) the prevention and / or treatment of obstructive sleep apnoea.

[1246] In some embodiments the indication is (i). In some embodiments the indication is (ii). In a still further particular aspect the indication is (iii). In some embodiments the indication is (iv). In some embodiments the indication is (v). In some embodiments the indication is (vi). In some embodiments the indication is (vii). In some embodiments the indication is (viii). In some embodiments the indication is (ix). In some embodiments the indication is type 2 diabetes. In some embodiments the indication is overweight or obesity.

[1247] The term "treatment", as used herein, refers to the medical therapy of any human or other vertebrate subject in need thereof. Said subject is expected to have undergone physical examination by a medical practitioner, or a veterinary medical practitioner, who has given a tentative or definitive diagnosis which would indicate that the use of said specific treatment is beneficial to the health of said human or other vertebrate. The timing and purpose of said treatment may vary from one individual to another, according to the status quo of the subject's health. Thus, said treatment may be prophylactic (preventive), palliative, symptomatic and / or curative.

[1248] In some embodiments the indication is (i) and (iii). In some embodiments the indication is (ii) and (iii).

[1249] The World Health Organisation (WHO) defines overweight and obesity as being the abnormal or excessive accumulation of body fat that present a risk to an individual’s overall health. Generally, all subjects suffering from obesity are also considered to be suffering from overweight. The subject suffering from obesity may be a human being, such as an adult human or a paediatric human, wherein “paediatric human” includes the infant, the child and 240066W001

[1250] 74

[1251] the adolescents. Alternative to overweight, also the term pre-obesity is used in this field. The Korean WHO considers body mass index (BMI) to be the most convenient population-level meas classificationure of overweight and obesity. Body mass index (BMI) is a measure of body fat based on height and weight. The formula for calculation is BMI = weight in kilograms (kg) / height in meters Taiwanese

[1252] squared (m2).

[1253] classification

[1254] For adults, the WHO defines overweight, and obesity as follows: overweight means having a BMI greater than or equal to 25; obesity means having a BMI greater than or equal to 30.

[1255] p Jaanese

[1256] For children, the WHO considers age when defining overweight and obesity. For classification

[1257] children under the age of five, overweight means having a weight-for-height greater than two standard deviations above the WHO Child Growth Standards median; and obesity means having a weight-for-height greater than three standard deviations above the WHO Child Growth Standards median. Overweight and ob Chineseesity are defined as follows for children aged five to nineteen: overweight means having ppoulation a BMI-for-age that is greater than one standard deviation above the WHO Growth Reference median; and obesity means having a BMI-for-age that is greater than two standard deviations above the WHO Growth Reference median.

[1258] International /

[1259] Nonetheless, the diagnostic criteria for underweight, the normal range, pre- p Euroean / US

[1260] obesity / overweight and obesity can differ between countries / populations, as illustrated in classification

[1261] Table 8 below for adults.

[1262] Table 8: Definitions of underweight, the normal range, pre-obesity / overweight and obesity in adults

[1263] BMI (kg / m2) [table content rendered via embedded image imgf000074_0001_table]

[1264]

[1265] 240066W001

[1266] 75

[1267] Obesity class II > / =35.0 and > / =30 and > / =30 and > / =30 and <40 <35 <35 <35 Obesity class III > / =40 > / =35 and > / =35 > / =35 <40

[1268] Obesity class IV > / =40

[1269]

[1270] Guidelines for the Asian population were published by Misra A et al. J Assoc Physicians India. 2009; 57:163-70. Guidelines for the Chinese population were issued in the 2006 edition of the Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults, compiled by the Chinese Working Group on Obesity. Guidelines for the Japanese population were issued, in 2016, by the Japanese Society for the Study of Obesity (JASSO) in Guidelines for the management of obesity disease. Guidelines for the Taiwanese population were issued by the Taiwanese government's Health Promotion Administration (HPA), Ministry of Health and Welfare in 2023, in the 2ndedition of its “Evidence-Based Guideline on Adult Obesity Prevention and Management.

[1271] In some embodiments the subject suffering from obesity is human, such as an adult human or a paediatric human (including infants, children, and adolescents). A human subject suffering from obesity thus may have a BMI of 25 or more, or 27 or more, or 28 or more, or 30 or more; this subject may also be referred to as being obese. The obesity may be class I, class II, class III or class IV obesity (as defined in Table 8). In some embodiments the human subject suffering from obesity may have a BMI of >35 or a BMI in the range of >30 to <40. In some embodiments the obesity is severe obesity or morbid obesity, wherein the human subject may have a BMI of >40.

[1272] In some embodiments the invention relates to a method for treatment or prevention of overweight, optionally in the presence of at least one weight-related co-morbidity. In one embodiment the GLP-1- / GIP- / amylin-receptor triple agonist as disclosed herein is for use in the treatment of a subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, or 30 or more; optionally in the presence of at least one weight-related comorbidity.

[1273] In some embodiments the invention relates to use of the formulation for treatment or prevention of overweight, optionally in the presence of at least one weight-related comorbidity. In some embodiments the subject suffering from overweight is human, such as an adult human ora paediatric human (including infants, children, and adolescents). In some embodiments an adult human subject suffering from overweight may have a BMI of 23 or more, or 24 or more, or 25 or more, or 27 or more. In some embodiments a human subject 240066W001

[1274] 76

[1275] suffering from overweight has a BMI in the range of 24 to <27, in the range of 24 to < 28, in the range of 25 to <30 or in the range of 27 to <30. In some embodiments the weight-related co-morbidity is selected from the group consisting of hypertension, dysglycaemia (prediabetes or type 2 diabetes), dyslipidaemia, high cholesterol, cardiovascular disease and obstructive sleep apnoea.

[1276] In some embodiments, the tri-agonist as disclosed herein relates to a method for weight management. In some embodiments, the tri-agonist as disclosed herein relates to a method for reduction of appetite. In some embodiments, the tri-agonist as disclosed herein relates to a method for reduction of food intake. In some embodiments, the tri-agonist as disclosed herein relates to a method of preventing or treating overweight in a subject.

[1277] The term "reduction of body weight" may include treatment or prevention of obesity and / or overweight.

[1278] Administration of the compound disclosed herein may be as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, or 30 or more; or in an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more; optionally in the presence of at least one weight-related co-morbidity (e.g., hypertension, dysglycaemia (prediabetes or type 2 diabetes), dyslipidaemia, high cholesterol, cardiovascular disease or obstructive sleep apnoea).

[1279] Particular embodiments

[1280] 1. A GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[1281] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[1282] • Z1 is a peptide comprising a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[1283] YX2

[1284]

[1285] EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib;

[1286] • L1 is a peptide linker; and

[1287] • Z2 is a peptide comprising a C-terminal amide and a maximum of 10 amino acid substitutions relative to Formula (SEQ ID NO: 2):

[1288] ASELSTAALGRLSAELHELATLPRTETGSGSP (V). 240066W001

[1289] 77

[1290] 2. A GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[1291] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[1292] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[1293] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[1294] X2represents Aib,

[1295] X12represents Ile (I) or Lys (K),

[1296] X₂₀ represents Arg (R) or Gln (Q), preferably Arg (R),

[1297] X24represents Ala (A), Glu (E) or Gln (Q), preferably Glu (E),

[1298] X27 represents Leu (L) or He (I),

[1299] X₂₈ represents Ala (A) or Gln (Q),

[1300] X30 represents Gly (G) or Ala (A),

[1301] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[1302] X33represents Glu (E) or Ser (S),

[1303] X34 represents Gly (G) or Glu (E);

[1304] • L1 is a peptide linker; and

[1305] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[1306] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1307] X52 represents Gly (G) or Ser (S),

[1308] X₅₃ represents Gln (Q), Glu (E), or His (H),

[1309] X₅₈ represents Ala (A) or Gln (Q),

[1310] X59 represents Leu (L) or Thr (T),

[1311] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[1312] X68represents Gln (Q), Glu (E), or Lys (K),

[1313] X72 represents Leu (L) or Glu (E).

[1314] 3. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments comprising a peptide according to Formula I:

[1315] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein: 240066W001

[1316] 78

[1317] • Z1 is a peptide having a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[1318] YX2

[1319]

[1320] EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib,

[1321] and

[1322] Z1 comprises or consists of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[1323] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[1324] X2represents Aib,

[1325] X12represents Ile (I) or Lys (K),

[1326] X₂₀ represents Arg (R) or Gln (Q),

[1327] X24represents Ala (A), Glu (E) or Gln (Q),

[1328] X27 represents Leu (L) or He (I),

[1329] X₂₈ represents Ala (A) or Gln (Q),

[1330] X30 represents Gly (G) or Ala (A),

[1331] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[1332] X33represents Glu (E) or Ser (S),

[1333] X34 represents Gly (G) or Glu (E);

[1334] • L1 is a peptide linker; and

[1335] • Z2 is a peptide comprising a C-terminal amide, and Z2 comprises or consists of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[1336] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1337] X52 represents Gly (G) or Ser (S),

[1338] X₅₃ represents Gln (Q), Glu (E), or His (H),

[1339] X₅₈ represents Ala (A) or Gln (Q),

[1340] X59 represents Leu (L) or Thr (T),

[1341] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[1342] X68represents Gln (Q), Glu (E), or Lys (K),

[1343] X72 represents Leu (L) or Glu (E).

[1344] 4. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments wherein Z1 is a peptide having a maximum of 4 amino acid substitutions relative to Formula II (SEQ ID NO: 1). 240066W001

[1345] 79

[1346] 5. A GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[1347] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[1348] • Z1 is a peptide having a maximum of 4 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[1349] YX2EG

[1350]

[1351] TFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib,

[1352] and

[1353] Z1 comprises or consists of an amino acid sequence according to Formula VII (SEQ ID NO: 162):

[1354] YX2EGTFTSDYSX12LLEEIAAX20EFIX24WLX27X28GGPSSX34(VII), wherein

[1355] X2represents Aib,

[1356] X12represents Ile (I) or Lys (K),

[1357] X₂₀ represents Arg (R) or Gln (Q),

[1358] X24represents Ala (A), Glu (E) or Gin (Q),

[1359] X27 represents Leu (L) or He (I),

[1360] X28 represents Ala (A) or Gin (Q),

[1361] X34 represents Gly (G) or Glu (E);

[1362] • L1 is a peptide linker; and

[1363] • Z2 is a peptide comprising a C-terminal amide, and having a maximum of 10 amino acid substitutions relative to Formula V (SEQ ID NO: 2):

[1364] ASELSTAALGRLSAELHELATLPRTETGSGSP (V), and

[1365] Z2 comprises or consists of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[1366] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1367] X52 represents Gly (G) or Ser (S),

[1368] X53 represents Gin (Q), Glu (E), or His (H),

[1369] X₅₈ represents Ala (A) or Gln (Q),

[1370] X59 represents Leu (L) or Thr (T),

[1371] X₆₀ represents Ala (A), Gly (G) or Gln (Q), 240066W001

[1372] 80

[1373] X₆₈ represents Gln (Q), Glu (E), or Lys (K),

[1374] X72 represents Leu (L) or Glu (E).

[1375] 6. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the one lysine (Lys, K) residue is present in the peptide Z1 or in the peptide Z2.

[1376] 7. The GLP-1 / GIP- / amylin-receptortri-agonist according to any one of the preceding embodiments, wherein the one lysine (Lys, K) residue is present in the peptide Z1.

[1377] 8. The GLP-1 / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 6, wherein the one lysine (Lys, K) residue is present in the peptide Z2.

[1378] 9. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Formula I comprises no more than one lysine (Lys, K) residue.

[1379] 10. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the GLP-1- / GIP- / amylin-receptor triple agonist does not comprise a cysteine (Cys, C) residue.

[1380] 11. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the GLP-1- / GIP- / amylin-receptor triple agonist does not comprise a disulfide bridge.

[1381] 12. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X12 is Lys (K).

[1382] 13. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 11, wherein X12 is He (I).

[1383] 14. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X2o is Arg (R).

[1384] 15. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 13, wherein X20 is Gin (Q). 240066W001

[1385] 81

[1386] 16. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X24is Glu (E).

[1387] 17. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 15, wherein X24is Ala (A).

[1388] 18. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 15, wherein X24is Gin (Q).

[1389] 19. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X27is Leu (L).

[1390] 20. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 18, wherein X27is He (I).

[1391] 21. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X28is Ala (A).

[1392] 22. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 20, wherein X28is Gin (Q).

[1393] 23. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X30is Gly (G).

[1394] 24. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 22, wherein X30is Ala (A).

[1395] 25. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X3iis Pro (P).

[1396] 26. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 24, wherein X3iis Ala (A). 240066W001

[1397] 82

[1398] 27. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 24, wherein X31is Gly (G).

[1399] 28. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 24, wherein X31is Gin (Q).

[1400] 29. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X33is Ser (S).

[1401] 30. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 28, wherein X33is Glu (E).

[1402] 31. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X34is Gly (G).

[1403] 32. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 30, wherein X34is Glu (E).

[1404] 33. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X30X3iis Gly-Pro (GP).

[1405] 34. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 32, wherein X30X3iis Gly-Ala (GA).

[1406] 35. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 32, wherein X30X3iis Ala-Pro (AP).

[1407] 36. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 32, wherein X30X3iis Gly-Gly (GG).

[1408] 37. The GLP-1 / GIP- / amylin-receptortri-agonist according to any one of embodiments 1- 32, wherein X3irepresents Gly (G), Gin (Q), or Ala (A). 240066W001

[1409] 83

[1410] 38. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z1 comprises or consists of an amino acid sequence according to Formula IV (SEQ ID NO: 169):

[1411] YX2EGTFTSDYSXi2LLEEIAAREFIEWLX27AGX30X31SSG (IV), wherein

[1412] X2represents Aib,

[1413] X12represents Ile (I) or Lys (K),

[1414] X27represents Leu (L) or Ile (I),

[1415] X30represents Gly (G) or Ala (A),

[1416] X31represents Ala (A), Gly (G) or Pro (P).

[1417] 39. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z1 comprises or consists of an amino acid sequence according to Formula XI (SEQ ID NO: 163):

[1418] YX2EGTFTSDYSX12LLEEIAAREFIEWLLAGGPSSG (XI), wherein

[1419] X2represents Aib,

[1420] X12 represents lie (I) or Lys (K).

[1421] 40. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z1 comprises or consists of an amino acid sequence selected from the list consisting of:

[1422] SEQ ID NO: Z1 peptide

[1423] 20 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGG

[1424] 21 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSG

[1425] 22 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSG

[1426] 23 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGPSSG

[1427] 24 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGE

[1428] 25 YX2EGTFTSDYSILLEEIAAREFIAWLIAGGPSSG

[1429] 26 YX2EGTFTSDYSILLEEIAAREFIQWLIAGGPSSG

[1430] 27 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSE

[1431] 28 YX2EGTFTSDYSILLEEIAAQEFIEWLLQGGPSSG

[1432] 29 YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSG

[1433]

[1434] 240066W001

[1435] 84

[1436] 30 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGQSSG

[1437] 31 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSG

[1438] 32 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGPSEG

[1439] 33 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGGSSG

[1440] 34 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSG

[1441]

[1442] wherein X2is Aib.

[1443] 41. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z1 comprises or consists of an amino acid sequence selected from the list consisting of:

[1444] SEQ ID NO: Z1 peptide

[1445] 22 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSG

[1446] 29 YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSG

[1447] 31 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSG

[1448] 34 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSG

[1449]

[1450] wherein X2is Aib.

[1451] 42. The GLP-1- / GIP-amylin-receptortri-agonist according to any one of the preceding embodiments, wherein Z1 comprises or consists of an amino acid sequence is SEQ ID NO: 22.

[1452] 43. The GLP-1- / GIP-amylin-receptortri-agonist according to any one of the embodiments 1-41, wherein Z1 comprises or consists of an amino acid sequence is SEQ ID NO: 29.

[1453] 44. The GLP-1- / GIP-amylin-receptortri-agonist according to any one of the embodiments 1-41, wherein Z1 comprises or consists of an amino acid sequence is SEQ ID NO: 31.

[1454] 45. The GLP-1- / GIP-amylin-receptortri-agonist according to any one of the embodiments 1-41, wherein Z1 comprises or consists of an amino acid sequence is SEQ ID NO: 34. 240066W001

[1455] 85

[1456] 46. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide linker L1 comprises 1 to 14, 1 to 10, or 2 to 9, or 5 amino acid residues.

[1457] 47. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide linker L1 comprises 1 to 14 amino acid residues selected from the group consisting of Ala (A), Glu (E), Gin (Q), Gly (G), Leu (L), Phe (F), Pro (P), Ser (S), Thr (T), Vai (V), Asn (N).

[1458] 48. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide linker L1 comprises or consists of the amino acid sequence according to Formula Villa:

[1459] X141X142X143X144X145X146X147X148X149X150X151X152X153X154(VIIIa), wherein

[1460] X141 represents Ala (A), Glu (E), Gly (G),

[1461] X142 represents Gin (Q), Glu (E), Gly (G), Leu (L), Pro (P) or is absent,

[1462] X143 represents Ala (A), Gin (Q), Glu (E), Gly (G), Pro (P) or is absent,

[1463] X144 represents Ala (A), Gin (Q), Glu (E), Gly (G), Pro (P) or is absent,

[1464] X145 represents Glu (E), Gly (G), Pro (P), Ser (S), Thr (T) or is absent,

[1465] X146 represents Glu (E), Gly (G), Leu (L), Gin (Q) or is absent,

[1466] X147 represents Ala (A), Gin (Q), Glu (E), Gly (G), Phe (F) or is absent,

[1467] X148represents Ala (A), Gln (Q), Glu (E), Gly (G), Thr (T), Pro (P), Val (V) or is absent,

[1468] X149 represents Glu (E), Asn (N), Pro (P), Thr (T) or is absent,

[1469] X150 represents Ala (A), Gin (Q), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Vai (V) or is absent,

[1470] X151 represents Ala (A) or is absent,

[1471] X152 represents Gin (Q) or is absent,

[1472] X153 represents Thr (T) or is absent,

[1473] X154 represents Leu (L) or is absent.

[1474] 49. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide linker L1 comprises 1 to 10 amino acid residues selected from the group consisting of Ala (A), Glu (E), Gin (Q), Gly (G), Leu (L), Pro (P), Ser (S), Vai (V). 240066W001

[1475] 86

[1476] 50. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide linker L1 comprises or consists of the amino acid sequence according to Formula VIII:

[1477] X41 X42X43X44X45X46X47X48X49X50 (VI 11), wherein

[1478] X41 represents Ala (A), Gly (G) or Glu (E),

[1479] X42 represents Glu (E), Gly (G) or is absent,

[1480] X43 represents Glu (E), Gly (G), Gin (Q) or is absent,

[1481] X44 represents Ala (A), Glu (E), Gly (G) or is absent,

[1482] X45 represents Glu (E), Gly (G), Pro (P) or is absent,

[1483] X46represents Glu (E), Gly (G) or is absent,

[1484] X47represents Gln (Q), Glu (E) or is absent,

[1485] X48represents Ala (A), Glu (E) or is absent,

[1486] X49 represents Glu (E), Pro (P) or is absent,

[1487] X50represents Ala (A), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Val (V) or is absent.

[1488] 51. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide linker L1 comprises or consists of the amino acid sequence according to Formula VIII:

[1489] X41 X42X43X44X45X46X47X48X49X50 (VI 11), wherein

[1490] X41 represents Ala (A) or Glu (E),

[1491] X42 represents Glu (E), Gly (G) or is absent,

[1492] X43 represents Glu (E), Gly (G), Gin (Q) or is absent,

[1493] X44 represents Ala (A), Glu (E), Gly (G) or is absent,

[1494] X45 represents Glu (E), Gly (G), Pro (P) or is absent,

[1495] X46represents Glu (E), Gly (G) or is absent,

[1496] X47represents Gln (Q), Glu (E) or is absent,

[1497] X48represents Ala (A), Glu (E) or is absent,

[1498] X49 represents Glu (E), Pro (P) or is absent,

[1499] X50represents Ala (A), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Val (V) or is absent. 240066W001

[1500] 87

[1501] 52. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide linker L1 is selected from the group consisting of A, E, G, AE, AG, GE, APPE (SEQ ID NO: 125), GGGE (SEQ ID NO: 126), AGQAPG (SEQ ID NO: 127), APPPSGGG (SEQ ID NO: 128), APPPSGGGE (SEQ ID NO: 129), APPPSGGGG (SEQ ID NO: 130), ALAQTLAQTL (SEQ ID NO: 131), ALAQTLFVNQ (SEQ ID NO: 132), ALAQTLGTNE (SEQ ID NO: 133), ALQAPGQAPG (SEQ ID NO: 134), ALQAPGQAPL (SEQ ID NO: 135), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), GGGEGGGEGE (SEQ ID NO: 138), GQAPGQAPGE (SEQ ID NO: 139), GQEPGQEPGE (SEQ ID NO: 140), APPPSLAQTLAQTL (SEQ ID NO: 141), AGGGG (SEQ ID NO: 142), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159).

[1502] 53. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments,

[1503] wherein the peptide linker L1 is selected from the group consisting of A, E, G, AE, AG, GE, AGGGG (SEQ ID NO: 142), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159). 240066W001

[1504] 88

[1505] 54. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments,

[1506] wherein the peptide linker L1 is selected from the group consisting of E, AE, AG, AGGGG (SEQ ID NO: 142), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159).

[1507] 55. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide linker L1 is selected from the group consisting of AG and AGEAPGEAPG (SEQ ID NO: 144).

[1508] 56. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X52 is Ser (S).

[1509] 57. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 55, wherein X52 is Gly (G).

[1510] 58. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X53 is Glu (E).

[1511] 59. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 57, wherein X53 is His (H).

[1512] 60. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 57, wherein X53 is Gin (Q).

[1513] 61. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X58is Ala (A). 240066W001

[1514] 89

[1515] 62. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 60, wherein X58is Gin (Q).

[1516] 63. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X59 is Leu (L).

[1517] 64. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 62, wherein X59 is Thr (T).

[1518] 65. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X60is Gly (G).

[1519] 66. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 64, wherein X60is Gin (Q).

[1520] 67. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 64, wherein X60is Ala (A).

[1521] 68. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X68is Gin (Q).

[1522] 69. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 67, wherein X68is Glu (E).

[1523] 70. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 67, wherein X68is Lys (K).

[1524] 71. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein X72 is Leu (L).

[1525] 72. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1- 70, wherein X72 is Glu (E). 240066W001

[1526] 90

[1527] 73. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z2 comprises or consists of an amino acid sequence according to Formula IX (SEQ ID NO: 61):

[1528] ASX53LSTAX58X59X60RLSAELHX68LATLPRTETGSGSP (IX), wherein

[1529] X53 represents Glu (E) or His (H),

[1530] X₅₈ represents Ala (A) or Gln (Q),

[1531] X59 represents Leu (L) or Thr (T),

[1532] X60represents Gly (G) or Gln (Q),

[1533] X68represents Gln (Q), Glu (E), or Lys (K).

[1534] 74. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z2 comprises or consists of an amino acid sequence according to Formula X (SEQ ID NO: 166):

[1535] ASX53LSTAQTQRLSAELHKLATLPRTETGSGSP (X),

[1536] wherein

[1537] X53 represents Glu (E) or His (H).

[1538] 75. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z2 comprises or consists of an amino acid sequence selected from the group consisting of:

[1539] SEQ ID NO: Z2 peptide

[1540] 40 ASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[1541] 41 ASHLSTAQLGRLSAELHELATLPRTETGSGSP

[1542] 42 ASHLSTAQLGRLSAELHQLATLPRTETGSGSP

[1543] 43 ASHLSTAQTQRLSAELHELATLPRTETGSGSP

[1544] 44 ASHLSTAALGRLSAELHELATLPRTETGSGSP

[1545] 45 ASHLSTAQTARLSAELHKLATLPRTETGSGSP

[1546] 46 ASQLSTAQTQRLSAELHKLATLPRTETGSGSP

[1547] 47 ASELSTAQTQRLSAELHKLATLPRTETGSGSP

[1548] 48 AGELSTAQTQRLSAELHKLATLPRTETGSGSP

[1549] 49 ASELSTAQTARLSAELHKLATLPRTETGSGSP

[1550] 50 ASHLSTAQTQRLSAELHKLATEPRTETGSGSP

[1551]

[1552] 240066W001

[1553] 91

[1554] 51 ASELSTAQTQRLSAELHKLATEPRTETGSGSP

[1555] 2 ASELSTAALGRLSAELHELATLPRTETGSGSP

[1556] 53 ASELSTAALGRLSAELHQLATLPRTETGSGSP

[1557] 54 ASELSTAALGRLSAELHQLATEPRTETGSGSP

[1558] 55 ASELSTAQLGRLSAELHQLATEPRTETGSGSP

[1559] 56 ASELSTAQTGRLSAELHQLATEPRTETGSGSP

[1560] 57 ASELSTAQTQRLSAELHQLATEPRTETGSGSP

[1561] 58 ASQLSTAQTQRLSAELHKLATEPRTETGSGSP

[1562] 59 ASELSTAQLGRLSAELHQLATLPRTETGSGSP

[1563] 60 ASHLSTAQLGRLSAELHQLATEPRTETGSGSP

[1564]

[1565] 76. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z2 comprises or consists of an amino acid sequence selected from the group consisting of:

[1566] SEQ ID NO: Z2 peptide

[1567] 59 ASELSTAQLGRLSAELHQLATLPRTETGSGSP

[1568] 40 ASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[1569] 53 ASELSTAALGRLSAELHQLATLPRTETGSGSP

[1570] 2 ASELSTAALGRLSAELHELATLPRTETGSGSP

[1571]

[1572] 77. The GLP-1- / GIP-amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein Z2 comprises or consists of an amino acid sequence is SEQ ID NO: 59.

[1573] 78. The GLP-1- / GIP-amylin-receptor tri-agonist according to any one of embodiments 1- 76, wherein Z2 comprises or consists of an amino acid sequence is SEQ ID NO: 40.

[1574] 79. The GLP-1- / GIP-amylin-receptor tri-agonist according to any one of embodiments 1- 76, wherein Z2 comprises or consists of an amino acid sequence is SEQ ID NO: 53.

[1575] 80. The GLP-1- / GIP-amylin-receptor tri-agonist according to any one of embodiments 1- 76, wherein Z2 comprises or consists of an amino acid sequence is SEQ ID NO: 2. 240066W001

[1576] 92

[1577] 81. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 comprises or consists of an amino acid sequence wherein:

[1578] • Z1 is selected from the group consisting of:

[1579] SEQ ID NO: Z1 peptide

[1580] 20 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGG 21 YX2EGTFTSDYSILLEEIAAREFIEWLIAGGPSSG 22 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSG 23 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGPSSG 24 YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGE 25 YX2EGTFTSDYSILLEEIAAREFIAWLIAGGPSSG 26 YX2EGTFTSDYSILLEEIAAREFIQWLIAGGPSSG 27 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSE 28 YX2EGTFTSDYSILLEEIAAQEFIEWLLQGGPSSG 29 YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSG 30 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGQSSG 31 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSG 32 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGPSEG 33 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGGGSSG 34 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSG

[1581]

[1582] • L1 is selected from the group consisting of:

[1583] E, AE, AG, AGGGG (SEQ ID NO: 142), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159), and • Z2 is selected from the group consisting of: 240066W001

[1584] 93

[1585] SEQ ID NO: Z2 peptide

[1586] 40 ASHLSTAQTQRLSAELHKLATLPRTETGSGSP 41 ASHLSTAQLGRLSAELHELATLPRTETGSGSP 42 ASHLSTAQLGRLSAELHQLATLPRTETGSGSP 43 ASHLSTAQTQRLSAELHELATLPRTETGSGSP 44 ASHLSTAALGRLSAELHELATLPRTETGSGSP 45 ASHLSTAQTARLSAELHKLATLPRTETGSGSP 46 ASQLSTAQTQRLSAELHKLATLPRTETGSGSP 47 ASELSTAQTQRLSAELHKLATLPRTETGSGSP 48 AGELSTAQTQRLSAELHKLATLPRTETGSGSP 49 ASELSTAQTARLSAELHKLATLPRTETGSGSP 50 ASHLSTAQTQRLSAELHKLATEPRTETGSGSP 51 ASELSTAQTQRLSAELHKLATEPRTETGSGSP 2 ASELSTAALGRLSAELHELATLPRTETGSGSP 53 ASELSTAALGRLSAELHQLATLPRTETGSGSP 54 ASELSTAALGRLSAELHQLATEPRTETGSGSP 55 ASELSTAQLGRLSAELHQLATEPRTETGSGSP 56 ASELSTAQTGRLSAELHQLATEPRTETGSGSP 57 ASELSTAQTQRLSAELHQLATEPRTETGSGSP 58 ASQLSTAQTQRLSAELHKLATEPRTETGSGSP 59 ASELSTAQLGRLSAELHQLATLPRTETGSGSP 60 ASHLSTAQLGRLSAELHQLATEPRTETGSGSP

[1587]

[1588] 82. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 comprises or consists of an amino acid sequence wherein:

[1589] • Z1 is selected from the group consisting of:

[1590] SEQ ID NO: Z1 peptide

[1591] 22 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSG

[1592] 29 YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSG

[1593] 31 YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSG

[1594] 34 YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSG

[1595]

[1596] 240066W001

[1597] 94

[1598] • L1 is selected from the group consisting of AG and AGEAPGEAPG (SEQ ID NO: 144),

[1599] • Z2 is selected from the group consisting of

[1600] SEQ ID NO: Z2 peptide

[1601] 59 ASELSTAQLGRLSAELHQLATLPRTETGSGSP

[1602] 40 ASHLSTAQTQRLSAELHKLATLPRTETGSGSP

[1603] 53 ASELSTAALGRLSAELHQLATLPRTETGSGSP

[1604] 2 ASELSTAALGRLSAELHELATLPRTETGSGSP

[1605]

[1606] 83. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 comprises or consists of an amino acid sequence selected from the group consisting of SEQ ID NO: 170 to 252.

[1607] 84. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein peptide Z1 - L1 - Z2 comprises or consists of an amino acid sequence selected from the group consisting of:

[1608] YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAQLGRLSAELHQLAT LPRTETGSGSP (SEQ ID NO: 230), or YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSGAGEAPGEAPGASHLSTAQTQRLS AELHKLATLPRTETGSGSP (SEQ ID NO: 243), or YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAALGRLSAELHQLAT LPRTETGSGSP(SEQ ID NO: 244), or YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASELSTAALGRLSAELHQLATL PRTETGSGSP (SEQ ID NO: 246), or YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASELSTAALGRLSAELHELATL PRTETGSGSP (SEQ ID NO: 250), or YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSGAGASELSTAALGRLSAELHELAT LPRTETGSGSP (SEQ ID NO: 251), or YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAALGRLSAELHELAT LPRTETGSGSP (SEQ ID NO: 252), wherein in each X2is Aib.

[1609] 85. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the backbone of the peptide Z1 - L1 - Z2 comprises or 240066W001

[1610] 95

[1611] consists of 66 to 80 amino acid residues, such as 66 to 76 amino acid residues or 67 to 75 amino acid residues.

[1612] 86. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the backbone of the peptide Z1 - L1 - Z2 comprises or consists of 67, 68, 71, 75, or 76 amino acid residues.

[1613] 87. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the backbone of the peptide Z1 - L1 - Z2 comprises or consists of 68 amino acid residues.

[1614] 88. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the backbone of the peptide Z1 - L1 - Z2 comprises or consists of 76 amino acid residues.

[1615] 89. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety.

[1616] 90. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety comprises a protractor P being a C12-C20diacid.

[1617] 91. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety comprises a protractor P selected from the group consisting of:

[1618] o

[1619]

[1620] o

[1621] (Chem. 2); 240066W001

[1622] 96

[1623] (Chem. 5);

[1624] R1

[1625] OH

[1626] O

[1627] (Chem. 6);

[1628] R1.

[1629] (Chem. 8); and

[1630] OH I O H

[1631] •P<

[1632] ■" O

[1633]

[1634] o (Chem. 32).

[1635] 92. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein the protraction moiety comprises a protractor P selected 240066W001

[1636] 97

[1637] from the group consisting of C18diacid, C20diacid, and C19phosphonic acid; preferably the protractor P is a C20diacid (Chem. 6).

[1638] 93. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon position of the one lysine (Lys, K) residue.

[1639] 94. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon amino group of the one lysine (Lys, K) residue in the peptide Z1 or to the epsilon amino group of the lysine (Lys, K) residue in the peptide Z2.

[1640] 95. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon amino group of the one lysine (Lys, K) at position 12 of peptide Z1 (X12).

[1641] 96. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon amino group of the one lysine (Lys, K) at position 18 of peptide Z2 (X68).

[1642] 97. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety further comprises a linker LPselected from the group consisting of:

[1643] o

[1644]

[1645] (Chem. 18); 240066W001

[1646] 98

[1647] (Chem. 19);

[1648]

[1649] (Chem. 20);

[1650] o

[1651] (Chem. 21);

[1652] (Chem. 33); and

[1653] i

[1654]

[1655] H (Chem. 34). 240066W001

[1656] 99

[1657] 98. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety further comprises a linker LPselected from the group consisting of: Chem. 20, Chem. 33, and Chem. 34, preferably the linker LPis Chem. 20.

[1658] 99. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety is selected from the group consisting of:

[1659]

[1660] 240066W001

[1661]

[1662] 240066W001

[1663] 101

[1664]

[1665] wherein R1 is the point of attachment an epsilon amino group of a lysine (Lys, K). 240066W001

[1666] 102

[1667] 100. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety is selected from the group consisting of: Chem. 27, Chem. 35, Chem. 36, and Chem. 37.

[1668] 101. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety is Chem. 27.

[1669] 102. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative selected from the group consisting of compound no.’s 104-197 of Example 2 herein.

[1670] 103. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative selected from the group consisting of compound no.’s 104-193 and 196-197 of Example 2 herein.

[1671] 104. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is Compound 104 of Example 2 herein

[1672]

[1673] 240066W001

[1674] 103

[1675] 105. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1-103 which is Compound 105 of Example 2 herein:

[1676] ■ASELSTAALGRLSAELHQLATLPRTETGSG H2

[1677]

[1678] 106. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1-103 which is Compound 107 of Example 2 herein:

[1679]

[1680] 240066W001

[1681] 104

[1682] 107. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1-103 which is Compound 111 of Example 2 herein:

[1683]

[1684] 108. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1-103 which is Compound 112 of Example 2 herein:

[1685]

[1686] 240066W001

[1687] 105

[1688] 109. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1-103 which is Compound 113 of Example 2 herein:

[1689]

[1690] 110. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1-103 which is Compound 183 of Example 2 herein:

[1691]

[1692] 240066W001

[1693] 106

[1694] 111. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments wherein the peptide has the amide modification of the C-terminus.

[1695] 112. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is capable of activating the human GIP receptor.

[1696] 113. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is capable of activating the human GIP receptor in an assay with whole cells expressing the human GIP receptor.

[1697] 114. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which activates the human GIP receptor in vitro, preferably with an EC50of less than 125 pM, even more preferably with an EC50of less than 100 pM, and most preferably with an EC50of less than 50 pM, when measured without HSA in the assay as described in Example 4.

[1698] 115. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is capable of activating the human GLP-1 receptor.

[1699] 116. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is capable of activating the human GLP-1 receptor in an assay with whole cells expressing the human GLP-1 receptor.

[1700] 117. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which activates the human GLP-1 receptor in vitro, preferably with an EC50of less than 125 pM, even more preferably with an EC50of less than 100 pM, and most preferably with an EC50of less than 50 pM, when measured without HSA in the assay as described in Example 4.

[1701] 118. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is capable of activating the human amylin receptor.

[1702] 119. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is capable of activating the human amylin receptor in an assay with whole cells expressing the human amylin receptor. 240066W001

[1703] 107

[1704] 120. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which activates the human amylin receptor in vitro, preferably with an EC50of less than 125 pM, even more preferably with an EC50of less than 100 pM, and most preferably with an EC50of less than 50 pM, when measured without HSA in the assay as described in Example 4.

[1705] 121. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is capable of activating the human GIP, GLP-1, and amylin receptors.

[1706] 122. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is capable of activating the human GIP, GLP-1, and amylin receptors in assays with whole cells expressing the human GIP receptor, GLP-1, and amylin receptors.

[1707] 123. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which activates the human GIP, GLP-1 and amylin receptors in vitro, preferably with an EC50of less than 125 pM, even more preferably with an EC50of less than 100 pM, and most preferably with an EC50of less than 50 pM, when measured without HSA as described in Example 4.

[1708] 124. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, which activates the human GIP, GLP-1 and amylin receptors in vitro, when measured without HSA as described in Example 4, and which has a potency ratio of less than 50, such as less than 30.

[1709] 125. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the potency ratio is less than 20.

[1710] 126. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, wherein the potency ratio is less than 15, and most preferred less than 10. 240066W001

[1711] 108

[1712] 127. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which has improved pharmacokinetic properties.

[1713] 128. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which has an increased half-life.

[1714] 129. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, which has an increased half-life of 80-200 hours, when determined in minipigs as described in Example 6, preferably of 90-190 hours, even more preferably 95-185 hours.

[1715] 130. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, which has an increased half-life of 40 hours to 145 hours, when determined in minipigs as described in Example 6, preferably of 90 hours to 140 hours, even more preferably 85 hours to 125 hours.

[1716] 131. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, which has an increased half-life of 5 hours to 50 hours, when determined in rats as described in Example 6, preferably 10 hours to 35 hours, even more preferably 12 hours to 30 hours.

[1717] 132. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, which has improved chemical stability.

[1718] 133. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments, which has improved chemical stability and which has a purity loss of no more than 5.0 percent per week, such as determined in Example 7 described herein, preferably a purity loss of less than 3.0 percent per week, even more preferably a purity loss of less than 2.0 percent per week.

[1719] 134. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which has the effect in vivo of reducing food intake in normal weight rats, as determined in the experimental protocol for efficacy testing on appetite, such as Example 5 described herein. 240066W001

[1720] 109

[1721] 135. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding embodiments which is a pharmaceutically acceptable salt of the GLP-1- / GIP- / amylin- receptor triple agonist.

[1722] 136. A pharmaceutical composition comprising a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of the preceding embodiments, and one or more pharmaceutically acceptable excipients.

[1723] 137. The pharmaceutical composition according to embodiment 136, which is for oral or for subcutaneous administration.

[1724] 138. The pharmaceutical composition according to any one of the embodiments 136 or 137, which is a solid pharmaceutical composition.

[1725] 139. The solid pharmaceutical composition according to embodiment 138, which is a tablet.

[1726] 140. The solid pharmaceutical composition according to any one of embodiments 138 or 139, comprising a salt of / V-[8-(2-hydroxybenzoyl)amino] caprylate, preferably sodium / V-(8-(2-hydroxybenzoyl)amino)caprylate, and magnesium stearate.

[1727] 141. The solid pharmaceutical composition according to any one of the embodiments 138 to 140, comprising 75-600 mg sodium / V-(8-(2-hydroxybenzoyl)amino)caprylate and 7-8.5 mg magnesium stearate.

[1728] 142. The pharmaceutical composition according to any one of embodiments 136 to 141, which is for dosing approximately once daily, such as once every 12-36 hours, such as once every 18-30 hours, such as approximately once every 24 hours; or which is for dosing approximately once weekly, such as once every 6-8 days.

[1729] 143. An injection device comprising the GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of embodiments 1 to 135, or the pharmaceutical composition according to any one of embodiments 136 to 142. 240066W001

[1730] 110

[1731] 144. The GLP-1- / GIP- / amylin-receptor tri-agonist peptide according to any of embodiments 1 to 88 for use as an intermediate in the manufacture of a GLP-1- / GIP- / amylin-receptor tri-agonist peptide derivative according to any of embodiments 89 to 135.

[1732] 145. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142 for use as a medicament.

[1733] 146. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142 for use in the treatment of type 2 diabetes, obesity, metabolic dysfunction-associated steatohepatitis (MASH), and / or cardiovascular disease.

[1734] 147. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142, for use in the treatment of a subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, or 30 or more.

[1735] 148. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142, for use in the treatment of a subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, 30 or more; and in the presence of at least one weight-related co-morbidity.

[1736] 149. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142, for use as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more; or in an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more. 240066W001

[1737] 111

[1738] 150. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 124, for use as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more; or in an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more; and in the presence of at least one weight-related co-morbidity.

[1739] 151. The use according to embodiment 148 or embodiment 150, wherein the at least one weight-related co-morbidity is selected from the group consisting of hypertension, dysglycaemia (prediabetes or type 2 diabetes), dyslipidaemia, high cholesterol, cardiovascular disease and obstructive sleep apnoea.

[1740] 152. Use of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142, in the manufacture of a medicament for the treatment of type 2 diabetes, obesity, metabolic dysfunction-associated steatohepatitis (MASH), and / or cardiovascular disease.

[1741] 153. Use of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142, in the manufacture of a medicament for the treatment of a subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, 30 or more; and optionally in the presence of at least one weight-related comorbidity.

[1742] 154. Use of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142, in the manufacture of a medicament for the treatment of an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more; or an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more; and optionally in the presence of at least one weight- related co-morbidity. 240066W001

[1743] 112

[1744] 155. Use of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 or the pharmaceutical composition according to any one of embodiments 136 to 142, in the manufacture of a medicament for chronic weight management in an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more; or in an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more; and optionally in the presence of at least one weight-related co-morbidity.

[1745] 156. The use according to embodiment 154 or embodiment 155, wherein the medicament is an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in an adult subject suffering from obesity or overweight.

[1746] 157. A method for treating type 2 diabetes, obesity, metabolic dysfunction-associated steatohepatitis (MASH), and / or cardiovascular disease comprising administering a pharmaceutically relevant amount of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135 to a subject in need thereof.

[1747] 158. A method of treating a human subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, or 30 or more, comprising administering to said human subject a pharmaceutically relevant amount of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135.

[1748] 159. A method for reducing excess body weight in a human subject, in combination with a reduced-calorie diet and increased physical activity, comprising administering to said human subject a pharmaceutically relevant amount of a GLP-1- / GIP- / amylin- receptor triple agonist according to any one of embodiments 1 to 135.

[1749] 160. The method according to embodiment 158 or embodiment 159, wherein said human subject is an adult subject, suffering from overweight and has an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more. 240066W001

[1750] 113

[1751] 161. The method according to embodiment 158 or embodiment 159, wherein said human subject is an adult subject, suffering from obesity and has an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more.

[1752] 162. The method according to any one of embodiments 158 to 161, wherein said human subject has at least one weight-related comorbidity selected from the group consisting of hypertension, dysglycaemia (prediabetes or type 2 diabetes), dyslipidaemia, high cholesterol, cardiovascular disease and obstructive sleep apnoea.

[1753] 163. A method for preparing the GLP-1- / GIP- / amylin-receptor triple agonist according to any one of embodiments 1 to 135.

[1754] 164. The method according to embodiment 163, comprises a step of solid phase peptide synthesis.

[1755] Particular alternative embodiments

[1756] 1. A GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[1757] Z1—L1—Z2 (I),

[1758] comprising one lysine (Lys, K) residue; wherein:

[1759] • Z1 is a peptide comprising a maximum of 4 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[1760] YX2EGTFTS

[1761]

[1762] DYSILLEEQAAREFIEWLLAGGPSKG (II),

[1763] wherein the amino acid at position X2represents Aib;

[1764] • L1 is a peptide linker; and

[1765] • Z2 is a peptide comprising a C-terminal amide and a maximum of 10 amino acid substitutions relative to Formula (SEQ ID NO: 2):

[1766] ASELSTAALGRLSAELHELATLPRTETGSGSP (V).

[1767] 2. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiment 1, wherein peptide Z1 comprises an amino acid sequence which has at least 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98 or 99 % identity to Formula II (SEQ ID NO: 1), and peptide Z2 comprises an amino acid sequence which has at least 70, 71, 72, 73, 74, 240066W001

[1768] 114

[1769] 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89 90, 91, 92, 93, 94, 95, 96, 97, 98 or 99 % identity relative to Formula V (SEQ ID NO: 2).

[1770] 3. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiments 1 to 2, wherein the one lysine (Lys, K) residue is present in the peptide Z1 or in the peptide Z2.

[1771] 4. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiments 1 to 3, wherein the GLP-1- / GIP- / amylin-receptor triple agonist does not comprise a cysteine (Cys, C) residue.

[1772] 5. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiments 1 to 4, wherein the GLP-1- / GIP- / amylin-receptor triple agonist does not comprise a disulfide bridge.

[1773] 6. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiments 1 to 5, wherein:

[1774] • Z1 is a peptide having a maximum of 4 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[1775] YX2EGTFTSD

[1776]

[1777] YSILLEEQAAREFIEWLLAGGPSKG (II),

[1778] wherein the amino acid at position X2represents Aib,

[1779] and

[1780] Z1 comprises or consists of an amino acid sequence according to Formula VII (SEQ ID NO: 162):

[1781] YX2EGTFTSDYSX12LLEEIAAX20EFIX24WLX27X28GGPSSX34(VII),

[1782] wherein

[1783] X2represents Aib,

[1784] X12represents Ile (I) or Lys (K),

[1785] X₂₀ represents Arg (R) or Gln (Q),

[1786] X24represents Ala (A), Glu (E) or Gin (Q),

[1787] X27 represents Leu (L) or He (I),

[1788] X28 represents Ala (A) or Gin (Q),

[1789] X34 represents Gly (G) or Glu (E);

[1790] • L1 is a peptide linker; and 240066W001

[1791] 115

[1792] • Z2 is a peptide comprising a C-terminal amide, and having a maximum of 10 amino acid substitutions relative to Formula (SEQ ID NO: 2):

[1793] ASELSTAALGRLSAELHELATLPRTETGSGSP (V),

[1794] and

[1795] Z2 comprises or consists of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[1796] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI),

[1797] wherein

[1798] X52 represents Gly (G) or Ser (S),

[1799] X53 represents Gin (Q), Glu (E), or His (H),

[1800] X58 represents Ala (A) or Gin (Q),

[1801] X59 represents Leu (L) or Thr (T),

[1802] X6o represents Ala (A), Gly (G) or Gin (Q),

[1803] X68 represents Gin (Q), Glu (E), or Lys (K),

[1804] X72 represents Leu (L) or Glu (E).

[1805] 7. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 1 to 6, wherein the peptide linker L1 comprises 1 to 14, 1 to 10, 4 to 10 or 9 to 10 amino acid residues.

[1806] 8. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 1 to 7, wherein the peptide linker L1 comprises 1 to 14 amino acid residues selected from the group consisting of Ala (A), Glu (E), Gin (Q), Gly (G), Leu (L), Phe (F), Pro (P), Ser (S), Thr (T), Vai (V), Asn (N).

[1807] 9. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 1 to 8, wherein the peptide linker L1 comprises or consists of the amino acid sequence according to Formula Villa:

[1808] X141X142X143X144X145X146X147X148X149X150X151X152X153X154(VIIIa), wherein

[1809] X141 represents Ala (A), Glu (E), Gly (G),

[1810] X142 represents Gin (Q), Glu (E), Gly (G), Leu (L), Pro (P) or is absent,

[1811] X143 represents Ala (A), Gin (Q), Glu (E), Gly (G), Pro (P) or absent,

[1812] X144 represents Ala (A), Gin (Q), Glu (E), Gly (G), Pro (P) or absent,

[1813] X145 represents Glu (E), Gly (G), Pro (P), Ser (S), Thr (T) or is absent, 240066W001

[1814] 116

[1815] X146 represents Glu (E), Gly (G), Leu (L), Gin (Q) or is absent,

[1816] X147 represents Ala (A), Gin (Q), Glu (E), Gly (G), Phe (F) or is absent,

[1817] X148represents Ala (A), Gln (Q), Glu (E), Gly (G), Thr (T), Pro (P), Val (V) or is absent,

[1818] X149 represents Glu (E), Asn (N), Pro (P), Thr (T) or is absent,

[1819] X150represents Ala (A), Gln (Q), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Val (V) or is absent,

[1820] X151 represents Ala (A) or is absent,

[1821] X152 represents Gin (Q) or is absent,

[1822] X153 represents Thr (T) or is absent,

[1823] X154 represents Leu (L) or is absent.

[1824] 10. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 1 to 9,

[1825] wherein the peptide linker L1 comprises or consists of the amino acid sequence according selected from the group consisting of A, E, G, AE, AG, GE, APPE (SEQ ID NO: 125), GGGE (SEQ ID NO: 126), AGQAPG (SEQ ID NO: 127), APPPSGGG (SEQ ID NO: 128), APPPSGGGE (SEQ ID NO: 129), APPPSGGGG (SEQ ID NO: 130), ALAQTLAQTL (SEQ ID NO: 131), ALAQTLFVNQ (SEQ ID NO: 132), ALAQTLGTNE (SEQ ID NO: 133), ALQAPGQAPG (SEQ ID NO: 134), ALQAPGQAPL (SEQ ID NO: 135), AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), GGGEGGGEGE (SEQ ID NO: 138), GQAPGQAPGE (SEQ ID NO: 139), GQEPGQEPGE (SEQ ID NO: 140), APPPSLAQTLAQTL (SEQ ID NO: 141), AGGGG (SEQ ID NO: 142), AGEAPGQAPG (SEQ ID NO: 143), AGEAPGEAPG (SEQ ID NO: 144), AGQAPGQAPA (SEQ ID NO: 145), AGQAPGQAPE (SEQ ID NO: 146), AGQAPGQAPP (SEQ ID NO: 147), AGQAPGQAPS (SEQ ID NO: 148), AGQAPGQAPV (SEQ ID NO: 149), EGQAPGQAPG (SEQ ID NO: 150), AGQEPGQAPG (SEQ ID NO: 151), AGQAEGQAPG (SEQ ID NO: 152), AGQAPEQAPG (SEQ ID NO: 153), AGQAPGEAPG (SEQ ID NO: 154), AGQAPGQEPG (SEQ ID NO: 155), AGQAPGQAEG (SEQ ID NO: 156), AGQEPGQEPG (SEQ ID NO: 157), AGQAPGQAP (SEQ ID NO: 158) and AGQAPGEAPL (SEQ ID NO: 159).

[1826] 11. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiment 10, 240066W001

[1827] 117

[1828] wherein the peptide linker L1 is selected from the group consisting of E, GE, APPPSGGGE (SEQ ID NO: 129), AGQAPGQAPG (SEQ ID NO: 136) AGQAPGQAPL (SEQ ID NO: 137), and AGQAPGEAPG (SEQ ID NO: 154).

[1829] 12. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 1 to 5 and 7 to 11,

[1830] wherein the peptide Z2 comprises or consists of the amino acid sequence according to Formula XIV (SEQ ID NO: 4):

[1831] ASX53LSTAX58X59X60RLSAX65LHX68LX70X71LPX74TETGSGX81P (XIV), wherein

[1832] X53represents Lys (K),

[1833] X58 represents Ala (A) or Gin (Q),

[1834] X59 represents Gin (Q), Leu (L) or Thr (T),

[1835] X6o represents Ala (A), Gly (G) or Gin (Q),

[1836] X65 represents Glu (E),

[1837] X68represents Arg (R), Gin (Q), Glu (E), Gly (G), His (H), Thr (T) or Tyr (Y), X70represents Ala (A),

[1838] X7irepresents Asp (D) or Thr (T),

[1839] X74represents Arg (R),

[1840] X8irepresents Ala (A) or Ser (S);

[1841] or

[1842] X53 represents Gin (Q), Glu (E), or His (H),

[1843] X58 represents Ala (A) or Gin (Q),

[1844] X59 represents Gin (Q), Leu (L) or Thr (T),

[1845] X6o represents Ala (A), Gly (G) or Gin (Q),

[1846] X65 represents Lys (K),

[1847] X68represents Arg (R), Gin (Q), Glu (E), Gly (G), His (H), Thr (T) or Tyr (Y), X70represents Ala (A),

[1848] X7irepresents Asp (D) or Thr (T),

[1849] X74represents Arg (R),

[1850] X8irepresents Ala (A) or Ser (S);

[1851] or

[1852] X53 represents Gin (Q), Glu (E) or His (H),

[1853] X58 represents Ala (A) or Gin (Q),

[1854] X59 represents Gin (Q), Leu (L) or Thr (T), 240066W001

[1855] 118

[1856] X6o represents Ala (A), Gly (G) or Gin (Q),

[1857] X65 represents Glu (E),

[1858] X68 represents Lys (K),

[1859] X7o represents Ala (A),

[1860] X71 represents Asp (D) or Thr (T),

[1861] X74 represents Arg (R),

[1862] X8irepresents Ala (A) or Ser (S);

[1863] or

[1864] X53 represents Gin (Q), Glu (E) or His (H),

[1865] X58 represents Ala (A) or Gin (Q),

[1866] X59 represents Gin (Q), Leu (L) or Thr (T),

[1867] X6o represents Ala (A), Gly (G) or Gin (Q),

[1868] X65 represents Glu (E),

[1869] X68represents Arg (R), Gin (Q), Glu (E), Gly (G), His (H), Thr (T) or Tyr (Y), X70 represents Lys (K),

[1870] X71 represents Asp (D) or Thr (T),

[1871] X74 represents Arg (R),

[1872] X8irepresents Ala (A) or Ser (S);

[1873] or

[1874] X53 represents Gin (Q), Glu (E) or His (H),

[1875] X58 represents Ala (A) or Gin (Q),

[1876] X59 represents Gin (Q), Leu (L) or Thr (T),

[1877] X6o represents Ala (A), Gly (G) or Gin (Q),

[1878] X65 represents Glu (E),

[1879] X68represents Arg (R), Gin (Q), Glu (E), Gly (G), His (H), Thr (T) or Tyr (Y), X70 represents Ala (A),

[1880] X71 represents Asp (D) or Thr (T),

[1881] X74 represents Lys (K),

[1882] X8irepresents Ala (A) or Ser (S).

[1883] 13. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiment 6, wherein the peptide Z1 comprises or consists of the amino acid sequence according to Formula VX (SEQ ID NO: 167):

[1884] YX2EGTFTSDYSX12LLEEIAAREFIEWLX27AGGPSSX34(VX), wherein 240066W001

[1885] 119

[1886] X2represents Aib,

[1887] X12represents Ile (I) or Lys (K),

[1888] X27represents Leu (L) or Ile (I),

[1889] X34 represents Gly (G) or Glu (E).

[1890] 14. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiment 6 or alternative embodiment 13, wherein the peptide Z2 comprises or consists of the amino acid sequence

[1891] ASHLSTAQTQRLSAELHKLATLPRTETGSGSP (SEQ ID NO: 40).,

[1892] 15. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 6, 13 or 14,

[1893] wherein the peptide Z1 comprises or consists of the amino acid sequence according to Formula XV (SEQ ID NO: 167):

[1894] YX2EGTFTSDYSXI2LLEEIAAREFIEWLX27AGGPSSX34(XV), wherein

[1895] X2represents Aib,

[1896] X12represents Ile (I) or Lys (K),

[1897] X27represents Leu (L) or lie (I),

[1898] X34 represents Gly (G) or Glu (E); and

[1899] wherein the peptide Z2 comprises or consists of the amino acid sequence ASHLSTAQTQRLSAELHKLATLPRTETGSGSP (SEQ ID NO: 40).

[1900] 16. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 6 or 13-15,

[1901] wherein the peptide Z1 comprises or consists of the amino acid sequence according to Formula XI (SEQ ID NO: 163):

[1902] YX2EGTFTSDYSXI2LLEEIAAREFIEWLLAGGPSSG (XI), wherein

[1903] X2represents Aib,

[1904] Xi2represents lie (I) or Lys (K)

[1905] 17. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 6 or 13-16, 240066W001

[1906] 120

[1907] wherein the peptide Z2 comprises or consists of the amino acid sequence according to Formula X (SEQ ID NO: 166):

[1908] ASX59LSTAQTQRLSAELHKLATLPRTETGSGSP (X), wherein

[1909] X59 represents Glu (E) or His (H).

[1910] 18. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 1 to 5 and 7 to 11,

[1911] wherein the peptide Z1 — L1 — Z2 comprises or consists of an amino acid sequence selected from the group consisting of SEQ ID NOs 170 to 242, wherein X2represents Aib.

[1912] 19. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments wherein the backbone of the peptide Z1 — L1 — Z2 comprises 66 to 80 amino acid residues.

[1913] 20. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments wherein the backbone of the peptide Z1 — L1 — Z2 comprises 67, 68, 75 or 76 amino acid residues, preferably 76 amino acid residues.

[1914] 21. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments wherein the peptide is a peptide derivative comprising a protraction moiety.

[1915] 22. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety comprises a protractor P being a C12-C20diacid.

[1916] 23. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety comprise a protractor P selected from the group consisting of: 240066W001

[1917] 121

[1918] O

[1919] O

[1920] (Chem. 6);

[1921]

[1922] (Chem. 8); and 240066W001

[1923] 122

[1924]

[1925] (Chem. 32).

[1926] 24. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety comprises a protractor P selected from the group consisting of C16diacid, C18diacid, C20diacid, and C19phosphonic acid; preferably the protractor P is a C18diacid or a C20diacid.

[1927] 25. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon position of the one lysine (Lys, K) residue.

[1928] 26. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon position of the lysine (Lys, K) residue in the peptide Z1 or to the epsilon position of the lysine (Lys, K) residue in the peptide Z2.

[1929] 27. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon position of the lysine (Lys, K) residue at position 12 or position 33 or position 34 of peptide Z1, preferably at position 12 or position 33 of peptide Z1.

[1930] 28. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon position of the lysine (Lys, K) residue at positions 3, 15, 18, 20, or 24 of peptide Z2. 240066W001

[1931] 123

[1932] 29. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein the protraction moiety is attached to the epsilon position of the lysine (Lys, K) residue at position 15 of peptide Z2 or at position 18 of peptide Z2.

[1933] 30. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety further comprises a linker LPselected from the group consisting of:

[1934] o

[1935] (Chem. 18); o

[1936] o (Chem. 19); o

[1937] o (Chem. 20); o

[1938]

[1939] o o 240066W001

[1940] 124

[1941] (Chem. 21);

[1942] (Chem. 33); and

[1943] i

[1944]

[1945] H (Chem. 34).

[1946] 31. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety comprises Chem. 20 or Chem. 21 as linker LPand Chem. 5 or Chem. 6 as protractor P.

[1947] 32. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety,

[1948] wherein said protraction moiety consists of (i) a linker LPselected from the group presented in Table 6 and (ii) a protractor P selected from the group presented in Table 5, preferably said protraction moiety is selected from the group presented in Table 7.

[1949] 33. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety is a C18diacid (S) gamma-Glu 2xAdo fatty acid moiety (Chem. 28) or a C20diacid (S) gamma-Glu 2xAdo fatty acid moiety (Chem. 27). 240066W001

[1950] 125

[1951] 34. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the alternative embodiments 1 to 33,

[1952] wherein the peptide Z1 comprises or consists of the amino acid sequence according to Formula VII (SEQ ID NO: 162):

[1953] YX2EGTFTSDYSX12LLEEIAAX20EFIX24WLX27X28GGPSSX34(VII),

[1954] wherein

[1955] X2represents Aib,

[1956] X12represents Ile (I) or Lys (K),

[1957] X₂₀ represents Arg (R) or Gln (Q),

[1958] X24represents Ala (A), Glu (E) or Gin (Q),

[1959] X27 represents Leu (L) or He (I),

[1960] X28represents Ala (A) or Gin (Q),

[1961] X34 represents Gly (G) or Glu (E);

[1962] wherein the peptide linker L1 comprises or consists of the amino acid sequence selected from the group consisting of E, AG, AGQAPGQAPG (SEQ ID NO: 136), AGQAPGQAPL (SEQ ID NO: 137), AGGGG (SEQ ID NO: 142), AGEAPGQAPG (SEQ ID NO: 143), and AGQAPGEAPG (SEQ ID NO: 154);

[1963] wherein the peptide Z2 comprises or consists of the amino acid sequence according to Formula VI (SEQ ID NO: 165):

[1964] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[1965] X52 represents Gly (G) or Ser (S),

[1966] X53 represents Gin (Q), Glu (E), or His (H),

[1967] X58 represents Ala (A) or Gin (Q),

[1968] X59 represents Leu (L) or Thr (T),

[1969] X6o represents Ala (A), Gly (G) or Gin (Q),

[1970] X68 represents Gin (Q), Glu (E), or Lys (K),

[1971] X72 represents Leu (L) or Glu (E); and

[1972] wherein the peptide is a peptide derivative comprising a protraction moiety.

[1973] 35. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiment 34, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety comprises a protractor P being a C12-C20diacid. 240066W001

[1974] 126

[1975] 36. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiment 35, wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety further comprises a linker LPselected from the group presented in Table 6.

[1976] 37. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the alternative embodiments 34 to 36, wherein the peptide Z1 comprises or consists of the amino acid sequence according to Formula XI (SEQ ID NO: 163):

[1977] YX2EGTFTSDYSX12LLEEIAAREFIEWLLAGGPSSG (XI), wherein

[1978] X2represents Aib,

[1979] X12represents Ile (I) or Lys (K).

[1980] 38. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the alternative embodiments 34 to 37, wherein the peptide Z2 comprises or consists of the amino acid sequence according to Formula X (SEQ ID NO: 166):

[1981] ASX59LSTAQTQRLSAELHKLATLPRTETGSGSP (X), wherein

[1982] X59 represents Glu (E) or His (H).

[1983] 39. A GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[1984] Z1—L1—Z2 (I),

[1985] comprising one lysine (Lys, K) residue; wherein:

[1986] • Z1 is a peptide having a maximum of 4 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[1987] YX2EGTFTSD

[1988]

[1989] YSILLEEQAAREFIEWLLAGGPSKG (II),

[1990] wherein the amino acid at position X2represents Aib,

[1991] and wherein

[1992] Z1 comprises or consists of an amino acid sequence according to Formula VII (SEQ ID NO: 162):

[1993] YX2EGTFTSDYSX12LLEEIAAX20EFIX24WLX27X28GGPSSX34(VII),

[1994] wherein

[1995] X2represents Aib,

[1996] X22 represents He (I) or Lys (K), 240066W001

[1997] 127

[1998] X₂₀ represents Arg (R) or Gln (Q),

[1999] X24represents Ala (A), Glu (E) or Gln (Q),

[2000] X27represents Leu (L) or Ile (I),

[2001] X28represents Ala (A) or Gin (Q),

[2002] X34represents Gly (G) or Glu (E);

[2003] • L1 is a peptide linker comprising or consisting of 1 to 14, 1 to 10, 4 to 10 or 9 to 10 amino acid residues; and

[2004] • Z2 is a peptide comprising a C-terminal amide, and having a maximum of 10 amino acid substitutions relative to Formula (SEQ ID NO: 2):

[2005] ASELSTAALGRLSAELHELATLPRTETGSGSP (V),

[2006] and

[2007] Z2 comprises or consists of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[2008] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI),

[2009] wherein

[2010] X52represents Gly (G) or Ser (S),

[2011] X53 represents Gin (Q), Glu (E), or His (H),

[2012] X58 represents Ala (A) or Gin (Q),

[2013] X59 represents Leu (L) or Thr (T),

[2014] X6o represents Ala (A), Gly (G) or Gin (Q),

[2015] X68 represents Gin (Q), Glu (E), or Lys (K),

[2016] X72represents Leu (L) or Glu (E);

[2017] wherein the peptide is a peptide derivative comprising a protraction moiety, wherein said protraction moiety comprises a protractor P being a C16-C20diacid and further comprises a linker LPselected from the group presented in Table 6.

[2018] 40. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments wherein the compound is selected from compound no. 120- 197 and 211-221 of Example 2 herein.

[2019] 41. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments wherein the peptide has the amide modification of the C- terminus. 240066W001

[2020] 128

[2021] 42. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which is capable of activating the human GIP receptor.

[2022] 43. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which is capable of activating the human GIP receptor in an assay with whole cells expressing the human GIP receptor.

[2023] 44. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which activates the human GIP receptor in vitro, preferably with an EC5o of less than 125 pM, even more preferably with an EC5o of less than 100 pM, and most preferably with an EC5o of less than 50 pM, when measured without HSA in an assay as described in Example 4.

[2024] 45. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which is capable of activating the human GLP-1 receptor.

[2025] 46. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which is capable of activating the human GLP-1 receptor in an assay with whole cells expressing the human GLP-1 receptor.

[2026] 47. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which activates the human GLP-1 receptor in vitro, preferably with an EC5o of less than 125 pM, even more preferably with an EC5o of less than 100 pM, and most preferably with an EC5o of less than 50 pM, when measured without HSA in an assay as described in Example 4.

[2027] 48. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which is capable of activating the human amylin receptor.

[2028] 49. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which is capable of activating the human amylin receptor in an assay with whole cells expressing the human amylin receptor.

[2029] 50. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which activates the human amylin receptor in vitro, 240066W001

[2030] 129

[2031] preferably with an EC5o of less than 125 pM, even more preferably with an EC5o of less than 100 pM, and most preferably with an EC5o of less than 50 pM, when measured without HSA in an assay as described in Example 4.

[2032] 51. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which is capable of activating the human GIP, GLP-1, and amylin receptors.

[2033] 52. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which is capable of activating the human GIP, GLP-1, and amylin receptors in assays with whole cells expressing the human GIP receptor, GLP- 1, and amylin receptors.

[2034] 53. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments which activates the human GIP, GLP-1 and amylin receptors in vitro, preferably with an EC5o of less than 125 pM, even more preferably with an EC5O of less than 100 pM, and most preferably with an EC5o of less than 50 pM, when measured without HSA in assays as described in Example 4.

[2035] 54. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the preceding alternative embodiments, which activates the human GIP, GLP-1 and amylin receptors in vitro, when measured without HSA in assays as described in Example 4, and which has a potency ratio of less than 50.

[2036] 55. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to alternative embodiment 54, wherein the potency ratio is less than 20.

[2037] 56. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to alternative embodiment 54 or 55, wherein the potency ratio is less than 15, and most preferred less than 11.

[2038] 57. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the alternative embodiments 21 to 41 which has improved pharmacokinetic properties.

[2039] 58. The GLP-1 - / GIP- / amylin-receptor tri-agonist according to any one of the alternative embodiments 21 to 41 which has an increased half-life. 240066W001

[2040] 130

[2041] 59. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiment 58, which has an increased half-life of 40 hours to 145 hours, when determined in minipigs, preferably of 90 hours to 140 hours, even more preferably 85 hours to 125 hours.

[2042] 60. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the alternative embodiments 21 to 59, which has improved chemical stability.

[2043] 61. The GLP-1- / GIP- / amylin-receptor tri-agonist according to alternative embodiment 60, which has improved chemical stability and which has a purity loss of no more than 6.0 percent per week, such as determined in Example 7 described herein, preferably a purity loss of less than 3.0 percent per week, such as determined in Example 7 described herein.

[2044] 62. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the alternative embodiments 21 to 61 which has the effect in vivo of reducing food intake in normal weight rats, as determined in the experimental protocol for efficacy testing on appetite, such as Example 5 described herein.

[2045] 63. A pharmaceutically acceptable salt of the GLP-1- / GIP- / amylin-receptor triple agonist according to any one of the preceding alternative embodiments.

[2046] 64. A pharmaceutical composition comprising a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of the preceding alternative embodiments, and one or more pharmaceutically acceptable excipients.

[2047] 65. The pharmaceutical composition according to alternative embodiment 64, which is for oral or for subcutaneous administration.

[2048] 66. The pharmaceutical composition according to the alternative embodiments 64 or 65, which is a solid pharmaceutical composition.

[2049] 67. The solid pharmaceutical composition according to alternative embodiment 66, which is a tablet. 240066W001

[2050] 131

[2051] 68. The solid pharmaceutical composition according to alternative embodiment 66 or 67, comprising a salt of / V-[8-(2-hydroxybenzoyl)amino] caprylate, preferably sodium / V- (8-(2-hydroxybenzoyl)amino)caprylate and magnesium stearate.

[2052] 69. The solid pharmaceutical composition according to any one of the alternative embodiments 66 to 68, comprising 75-600 mg sodium / V-(8-(2- hydroxybenzoyl)amino)caprylate and 7-8.5 mg magnesium stearate.

[2053] 70. The pharmaceutical composition according to any one of alternative embodiments 64 to 69, which is for dosing approximately once daily, such as once every 12-36 hours, such as once every 18-30 hours, such as approximately once every 24 hours; or which is for dosing approximately once weekly, such as once every 6-8 days.

[2054] 71. An injection device comprising the GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of alternative embodiments 1 to 63, or the pharmaceutical composition according to any one of embodiments 64 to 70.

[2055] 72. The GLP-1- / GIP- / amylin-receptor tri-agonist peptide according to any of alternative embodiments 1 to 19 for use as an intermediate in the manufacture of a GLP-1- / GIP- / amylin-receptor tri-agonist peptide derivative according to any of embodiments 22 to 64.

[2056] 73. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 or the pharmaceutical composition according to any one of embodiments 64 to 70 for use as a medicament.

[2057] 74. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 or the pharmaceutical composition according to any one of embodiments 64 to 70 for use in the treatment of type 2 diabetes, obesity, metabolic dysfunction-associated steatohepatitis (MASH), and / or cardiovascular disease.

[2058] 75. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 or the pharmaceutical composition according to any one of 240066W001

[2059] 132

[2060] embodiments 64 to 70, for use in the treatment of a subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, or 30 or more.

[2061] 76. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 or the pharmaceutical composition according to any one of embodiments 64 to 70, for use in the treatment of a subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, 30 or more; and in the presence of at least one weight-related co-morbidity.

[2062] 77. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 or the pharmaceutical composition according to any one of embodiments 64 to 70, for use as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more; or in an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more.

[2063] 78. The GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 or the pharmaceutical composition according to any one of embodiments 64 to 70, for use as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more; or in an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more; and in the presence of at least one weight-related co-morbidity.

[2064] 79. The use according to alternative embodiment 76 or alternative embodiment 78, wherein the at least one weight-related co-morbidity is selected from the group consisting of hypertension, dysglycaemia (prediabetes or type 2 diabetes), dyslipidaemia, high cholesterol, cardiovascular disease and obstructive sleep apnoea.

[2065] 80. Use of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 in the manufacture of a medicament for the 240066W001

[2066] 133

[2067] treatment of type 2 diabetes, obesity, metabolic dysfunction-associated steatohepatitis (MASH), and / or cardiovascular disease.

[2068] 81. Use of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 in the manufacture of a medicament for the treatment of a subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, 30 or more; and optionally in the presence of at least one weight-related co-morbidity.

[2069] 82. Use of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 in the manufacture of a medicament for the treatment of an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more; or an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more; and optionally in the presence of at least one weight-related co-morbidity.

[2070] 83. Use of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 in the manufacture of a medicament for chronic weight management in an adult subject suffering from obesity, i.e. with an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more; or in an adult subject suffering from overweight, i.e. with an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more; and optionally in the presence of at least one weight-related co-morbidity.

[2071] 84. The use according to alternative embodiment 82, wherein the medicament is an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in an adult subject suffering from obesity or overweight.

[2072] 85. A method for treating type 2 diabetes, obesity, metabolic dysfunction-associated steatohepatitis (MASH), and / or cardiovascular disease comprising administering a pharmaceutically relevant amount of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63 to a subject in need thereof. 240066W001

[2073] 134

[2074] 86. A method of treating a human subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, or 30 or more, comprising administering to said human subject a pharmaceutically relevant amount of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63.

[2075] 87. A method for reducing excess body weight in a human subject, in combination with a reduced-calorie diet and increased physical activity, comprising administering to said human subject a pharmaceutically relevant amount of a GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63.

[2076] 88. The method according to alternative embodiment 86 or alternative embodiment 87, wherein said human subject is an adult subject, suffering from overweight and has an initial body mass index (BMI) of 23 or more, or 24 or more, or 25 or more, or 27 or more.

[2077] 89. The method according to alternative embodiment 86 or alternative embodiment 87, wherein said human subject is an adult subject, suffering from obesity and has an initial body mass index (BMI) of 25 or more, or 27 or more, or 28 or more, 30 or more.

[2078] 90. The method according to any one of alternative embodiments 86 to 89, wherein said human subject has at least one weight-related comorbidity selected from the group consisting of hypertension, dysglycaemia (prediabetes or type 2 diabetes), dyslipidaemia, high cholesterol, cardiovascular disease and obstructive sleep apnoea.

[2079] 91. A method for preparing the GLP-1- / GIP- / amylin-receptor triple agonist according to any one of alternative embodiments 1 to 63.

[2080] 92. The method according to alternative embodiment 91, comprises a step of solid phase peptide synthesis. 240066W001

[2081] 135

[2082] Particular second alternative embodiments

[2083] 1. A GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:

[2084] Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:

[2085] • Z1 is a peptide comprising or consisting of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[2086] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[2087] X2represents Aib,

[2088] X12represents Ile (I) or Lys (K),

[2089] X₂₀ represents Arg (R) or Gln (Q),

[2090] X24represents Ala (A), Glu (E) or Gln (Q),

[2091] X27 represents Leu (L) or He (I),

[2092] X₂₈ represents Ala (A) or Gln (Q),

[2093] X30 represents Gly (G) or Ala (A),

[2094] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[2095] X33represents Glu (E) or Ser (S),

[2096] X34 represents Gly (G) or Glu (E);

[2097] • L1 is a peptide linker; and

[2098] • Z2 is a peptide comprising a C-terminal amide comprising or consisting of an amino acid sequence according to Formula VI (SEQ ID NO: 165): AX₅₂X₅₃LSTAX₅₈X₅₉X₆₀RLSAELHX₆₈LATX₇₂PRTETGSGSP (VI), wherein

[2099] X52 represents Gly (G) or Ser (S),

[2100] X₅₃ represents Gln (Q), Glu (E), or His (H),

[2101] X₅₈ represents Ala (A) or Gln (Q),

[2102] X59 represents Leu (L) or Thr (T),

[2103] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[2104] X68represents Gln (Q), Glu (E), or Lys (K),

[2105] X72 represents Leu (L) or Glu (E),

[2106] or a pharmaceutically acceptable salt thereof.

[2107] 2. The GLP-1- / GIP- / amylin-receptor tri-agonist according to particular second alternative embodiment 1, 240066W001

[2108] 136

[2109] • Z1 is a peptide having a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):

[2110] YX2

[2111]

[2112] EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2represents Aib,

[2113] and

[2114] Z1 comprises or consists of an amino acid sequence according to Formula III (SEQ ID NO: 168):

[2115] YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), wherein

[2116] X2represents Aib,

[2117] X12represents Ile (I) or Lys (K),

[2118] X₂₀ represents Arg (R) or Gln (Q),

[2119] X24represents Ala (A), Glu (E) or Gln (Q),

[2120] X27 represents Leu (L) or I (He),

[2121] X₂₈ represents Ala (A) or Gln (Q),

[2122] X30 represents Gly (G) or Ala (A),

[2123] X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)

[2124] X33represents Glu (E) or Ser (S),

[2125] X34 represents Gly (G) or Glu (E);

[2126] • L1 is a peptide linker; and

[2127] • Z2 is a peptide comprising a C-terminal amide, and Z2 comprises or consists of an amino acid sequence according to Formula VI (SEQ ID NO: 165):

[2128] AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), wherein

[2129] X52 represents Gly (G) or Ser (S),

[2130] X₅₃ represents Gln (Q), Glu (E), or His (H),

[2131] X₅₈ represents Ala (A) or Gln (Q),

[2132] X59 represents Leu (L) or Thr (T),

[2133] X₆₀ represents Ala (A), Gly (G) or Gln (Q),

[2134] X68represents Gln (Q), Glu (E), or Lys (K),

[2135] X72 represents Leu (L) or Glu (E). 240066W001

[2136] 137

[2137] 3. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein Z1 comprises or consists of an amino acid sequence according to Formula IV (SEQ ID NO: 169):

[2138] YX2EGTFTSDYSXi2LLEEIAAREFIEWLX27AGX30X31SSG (IV), wherein

[2139] X2represents Aib,

[2140] X12represents Ile (I) or Lys (K),

[2141] X27 represents Leu (L) or I (He),

[2142] X30represents Gly (G) or Ala (A),

[2143] X31 represents Gly (G), Ala (A) or Pro (P).

[2144] 4. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein Z2 comprises or consists of an amino acid sequence according to Formula IX (SEQ ID NO: 61):

[2145] ASX53LSTAX58X59X60RLSAELHX68LATLPRTETGSGSP (IX), wherein

[2146] X53represents Glu (E) or His (H),

[2147] X₅₈ represents Ala (A) or Gln (Q),

[2148] X59 represents Leu (L) or Thr (T),

[2149] X60represents Gly (G) or Gln (Q),

[2150] X68represents Gln (Q), Glu (E), or Lys (K).

[2151] 5. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein the peptide linker L1 comprises or consists of the amino acid sequence according to Formula VIII:

[2152] X41 X42X43X44X45X46X47X48X49X50 (VI 11), wherein

[2153] X41 represents Ala (A), Gly (G) or Glu (E),

[2154] X42 represents Glu (E), Gly (G) or is absent,

[2155] X43represents Glu (E), Gly (G), Gin (Q) or absent,

[2156] X44 represents Ala (A), Glu (E), Gly (G) or absent,

[2157] X45 represents Glu (E), Gly (G), Pro (P) or is absent,

[2158] X46represents Glu (E), Gly (G) or is absent,

[2159] X47represents Gln (Q), Glu (E) or is absent,

[2160] X48represents Ala (A), Glu (E) or is absent,

[2161] X49 represents Glu (E), Pro (P) or is absent, 240066W001

[2162] 138

[2163] X50represents Ala (A), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Val (V) or is absent.

[2164] 6. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein the peptide Z1 - L1 - Z2 comprises or consists of an amino acid sequence selected from the group consisting of SEQ ID NO: 170 to 252.

[2165] 7. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein peptide Z1 - L1 - Z2 comprises or consists of an amino acid sequence selected from the group consisting of:

[2166] YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAQLGRLSAELHQLAT LPRTETGSGSP (SEQ ID NO: 230), YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSGAGEAPGEAPGASHLSTAQTQRLS AELHKLATLPRTETGSGSP (SEQ ID NO: 243), YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAALGRLSAELHQLAT LPRTETGSGSP(SEQ ID NO: 244), YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASELSTAALGRLSAELHQLATL PRTETGSGSP (SEQ ID NO: 246), YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASELSTAALGRLSAELHELATL PRTETGSGSP (SEQ ID NO: 250), YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSGAGASELSTAALGRLSAELHELAT LPRTETGSGSP (SEQ ID NO: 251), and YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAALGRLSAELHELAT LPRTETGSGSP (SEQ ID NO: 252), wherein X2is Aib.

[2167] 8. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety.

[2168] 9. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, and wherein said protraction moiety comprises a protractor P being a C12-C20 diacid. 240066W001

[2169] 139

[2170] 10. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety further comprises a linker LP.

[2171] 11. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding particular second alternative embodiments, wherein the peptide Z1 - L1 - Z2 is a peptide derivative comprising a protraction moiety, wherein said protraction moiety is

[2172]

[2173] wherein R1 is the point of attachment an epsilon amino group of a lysine (Lys, K).

[2174] 12. A GLP-1- / GIP- / amylin-receptor tri-agonist which is

[2175] Compound 104; Compound 105; Compound 107; Compound 111; Compound 112; Compound 113; or Compound 183.

[2176] 13. A pharmaceutical composition comprising a GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of particular second alternative embodiments 1-12, and one or more pharmaceutically acceptable excipients.

[2177] 14. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of particular second alternative embodiments 1-12 or the pharmaceutical composition according to particular second alternative embodiments 13 for use a s a medicament. 240066W001

[2178] 140

[2179] 15. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of particular second alternative embodiments 1-12 or the pharmaceutical composition according to particular second alternative embodiments 13, for use in the treatment of a subject with an initial body mass index (BMI) of 25 or more, 27 or more, or 28 or more, or 30 or more; optionally in the presence of at least one weight-related co-morbidity. 240066W001

[2180] 141

[2181] Examples

[2182] Materials and Methods

[2183] List of Abbreviations

[2184] The following abbreviations are used in the following, in alphabetical order: Ado: 8-amino-3,6-dioxaoctanoic acid

[2185] Aib: 2-aminoisobutyric acid

[2186] amu: atomic mass unit

[2187] BHK Baby Hamster Kidney

[2188] Boc: t-butyloxycarbonyl

[2189] CAD: Charged Aerosol Detector

[2190] cAMP: cyclic adenosine monophosphate

[2191] CRE: cAMP response element

[2192] DCM: dichloromethane

[2193] DIC: / V, / V’-diisopropylcarbodiimide

[2194] DIO: Diet Induced Obese

[2195] DMB: 2,4-dimethoxybenzyl

[2196] DMEM: Dulbecco’s Modified Eagle’s Medium

[2197] DMF: / V, / V-dimethyl formamide

[2198] DTT: 1,4-dithiothreitol

[2199] EC50: half maximal effective concentration

[2200] EDTA: ethylenediaminetetraacetic acid

[2201] ES: Electrospray

[2202] FBS: Fetal Bovine Serum

[2203] Fmoc: 9-fluorenylmethyloxycarbonyl

[2204] FWHM: Full Width at Half Maximum

[2205] GIP: Glucose-dependent Insulinotropic Polypeptide

[2206] GLP-1: Glucagon-Like Peptide- 1

[2207] hAMYR3: human Amylin receptor 3

[2208] hGIPR: human Glucose-dependent Insulinotropic Polypeptide Receptor hGLP-1R: human Glucagon-Like Peptide- 1 Receptor

[2209] HEPES: / V-(2-Hydroxyethyl)piperazine- / V’-(2-ethanesulfonic acid) HFIP: 1,1,1,3,3,3-hexafluoro-2-propanol or hexafluoroisopropanol HPLC: High Performance Liquid Chromatography 240066W001

[2210] 142

[2211] HSA: Human Serum Albumin

[2212] i.v.: intravenously

[2213] LCMS or LC-MS: Liquid Chromatography Mass Spectrometry

[2214] LLoQ: Lower limit of Quantitation

[2215] Luc: luciferase

[2216] MeCN: acetonitrile

[2217] MRI: Magnetic resonance imaging

[2218] MS: Mass Spectrometry

[2219] Mtt: 4-methyltrityl

[2220] NCA: non-compartmental pharmacokinetic method

[2221] nd: not determined

[2222] OtBu: tert-butoxy

[2223] Oxyma Pure®: cyano-hydroxyimino-acetic acid ethyl ester

[2224] Pbf: 2,2,4,6,7-pentamethyldihydrobenzofuran-5-sulfonyl

[2225] PBS: phosphate-buffered saline

[2226] PK: pharmacokinetic

[2227] QD: quaque die (once a day)

[2228] QTof: Quadrupole Time of Flight

[2229] RAMP3: receptor modifying protein 3

[2230] RT: Room Temperature

[2231] s.c.: subcutaneously

[2232] SD: Sprague Dawley

[2233] SEM: Standard Error of Mean

[2234] SPPS: Solid Phase Peptide Synthesis

[2235] tBu: tert-butyl

[2236] TFA: trifluoroacetic acid

[2237] TIPS: triisopropylsilane

[2238] TQ: Triple Quadrupole

[2239] Trt: triphenylmethyl or trityl

[2240] UPLC: Ultra Performance Liquid Chromatography

[2241] UV: Ultraviolet

[2242] Fatty diacid and special amino acid building blocks

[2243] For synthesis of octadecanedioic acid mono-tert-butyl ester (C diacid mono-tert-butyl ester): see patent application WO 2010 / 102886 (pages 27-28). The corresponding 240066W001

[2244] 143

[2245] mono-tert-butyl esters of C12-C20 diacid, in particular Ci6diacid and C20 diacid, can be prepared accordingly.

[2246] Fmoc-Leu-Ser(njMe,Mepro)-OH, Fmoc-Tyr(tBu)-Ser(njMe,Mepro)-OH, and Fmoc-Gly-(DMB)Gly-OH were commercially available from TechnoComm Ltd.

[2247] General method for

[2248]

[2249] The preparation of the peptides (for reference compounds and compounds of the invention) was carried out by SPPS using Fmoc based chemistry on a Symphony X from Protein Technologies, a PurePep Chorus from Protein Technologies, a MultiPep 2 from CEM, a Vapourtec RS-500 from Vapourtec or a CS136XT from CSBio. The Fmoc-protected amino acids used in the methods were the standard recommended: Fmoc-Ala-OH, Fmoc-Arg(Pbf)-OH, Fmoc-Asp(OfBu)-OH, Fmoc-Asn(Trt)-OH, Fmoc-Cys(Trt)-OH, Fmoc-Gln(Trt)-OH, Fmoc-Glu(OfBu)-OH, Fmoc-Gly-OH, Fmoc-His(Trt)-OH, Fmoc-lle-OH, Fmoc-Leu-OH, Fmoc-Lys(Boc)-OH, Fmoc-Phe-OH, Fmoc-Pro-OH, Fmoc-Ser(tBu)-OH, Fmoc-Thr(tBu)-OH, Fmoc-Trp(Boc)-OH, Fmoc-Tyr(tBu)-OH, Fmoc-Val-OH, Fmoc-Lys(Mtt)-OH, Boc-His(Trt)-OH, Fmoc-Aib-OH, Fmoc-Glu-OfBu, and Fmoc-Ado-OH supplied from e.g. Gyros Protein Technologies, Bachem, Iris Biotech, or NovabioChem. The building blocks Fmoc-Leu-Ser(iMe Mepro)-OH, Fmoc-Tyr(fBu)-Ser(iMe Mepro)-OH, and Fmoc-Gly-(DMB)Gly-OH, e.g. commercially available from TechnoComm Ltd, were introduced where applicable.

[2250] Fmoc-PAL AM resin or Rink-Amide AM resin were used, which were commercially available from NovabioChem. The subsequent amino acids were introduced in a stepwise procedure by the Symphony X peptide synthesizer following the SPPS principles.

[2251] Fmoc-deprotection was achieved with 20% piperidine in DMF with 0.1 M Oxyma Pure for 2 x 10 min. Introduction of the substituent (i.e. protraction moiety comprising a “protractor” P and an optional “linker LP”) at the alpha-position of the N-terminal amino acid was accomplished using a standard Fmoc-protected amino acid. The peptide couplings were performed with DIC and collidine. Amino acid / Oxyma Pure solutions (0.3 M / 0.3 M in DMF at a molar excess of 5-10-fold) was added to the resin first. Then, the same molar equivalent of DIC was added (1.5 M in DMF), followed by collidine (1.5 M in DMF). Most commonly, it was mixed for 1 hour. In some cases, the coupling time was increased, additional DIC was added, or the coupling step was repeated. Afterwards, a capping step was performed with 1 M acetic anhydride in DMF and collidine. Introduction of the protraction moiety at the epsilon-nitrogen of a lysine (Lys, K) within the sequence was achieved using Fmoc-Lys(Mtt)-OH. Following the synthesis of the peptide backbone sequence the Mtt group was removed by treatment with HFIP / DCM / TIPS (75:23:2) (5 min), followed by a wash with DCM. The resin 240066W001

[2252] 144

[2253] was then resuspended in HFIP / DCM / TIPS (75:23:2) (2x25 min), and subsequently washed with DCM and DMF. The protraction moieties were introduced in a stepwise procedure as described above, using suitably protected building blocks for the linker LP, such as the standard Fmoc-protected amino acids such as Fmoc-8-amino-3,6-dioxaoctanoic acid or Fmoc-Glu-OtBu. Introduction of the protractor, fatty acid group, was achieved using the suitable building block, such as but not limited to, octadecanedioic acid mono-tert-butyl-ester or eicosanedioic acid mono-tert-butyl-ester.

[2254] General cleavage method

[2255] The peptides were cleaved from the resin with TFA / TIPS / H2O / DTT (90:4:3:3) for 2-3 hours. Hereafter, the peptide was drained into cold diethyl ether, and centrifuged. The ether was decanted off, and the peptide precipitate was washed with ether two additional times.

[2256] General method for purification and quantification of the derivative

[2257] The crude peptide was dissolved in acetic acid / MeCN / Milli-Q water (45:10:45 or 40:20:40) and orthogonally purified by reversed-phase preparative HPLC (Waters Delta Prep 4000) on a column comprising C18-silica gel. The first elution was performed with an increasing gradient from 20-50% of MeCN in Milli-Q water comprising 1% ammonium bicarbonate. Relevant fractions were analysed with UPLC. Fractions containing the target peptide were pooled and diluted with Milli-Q water (1:1) prior to a second reversed-phase preparative HPLC. The second elution was performed with an increasing gradient from 20-50% of MeCN in Milli-Q water comprising 0.1% TFA. Relevant fractions were analysed with UPLC. Fractions containing the pure target peptide were pooled. The resulting solution was analysed (UPLC, LCMS) and the peptide derivative was quantified using a CAD specific HPLC detector (Thermo-Fischer Vanquish HPLC-CAD). The product was dispensed into glass vials. The vials were capped with Millipore glass fibre prefilters. Freeze-drying afforded the trifluoroacetate salt of the derivative as a white solid.

[2258] Compounds synthesized below have been prepared using the methods described above. 240066W001

[2259] 145

[2260] Example 1: Reference Compounds

[2261] Reference compound 1

[2262] (GLP-1- / GIP- / amylin-receptor tri-agonist disclosed in WO 2023 / 288313, example 1, peptide I compound no. 16; SEQ ID NO: 11)

[2263]

[2264] Reference compound 2

[2265] (Tri-agonist based on conjugation of tirzepatide and cagrilintide, SEQ ID NO: 12)

[2266]

[2267] 240066W001

[2268] 146

[2269] Reference compound 3

[2270] (Tri-agonist based on conjugation of tirzepatide and amylin receptor agonist disclosed in example 21 in WO 2016 / 034604, SEQ ID NO: 13)

[2271]

[2272] Reference compound 4

[2273] (GIP receptor agonist disclosed in WO 2019 / 211451, ex. 1, compound 31, SEQ ID NO: 14)

[2274]

[2275] Reference compound 5

[2276] (GLP-1 / GIP co-agonist tirzepatide, SEQ ID NO: 15)

[2277]

[2278] 240066W001

[2279] 147

[2280] Reference compound 6

[2281] (Amylin receptor agonist cagrilintide, WO 2012 / 168432, example 53, SEQ ID NO: 16)

[2282]

[2283] Reference compound 7

[2284] (GLP-1 receptor agonist semaglutide, WO 2006 / 097537, example 4, SEQ ID NO: 17)

[2285]

[2286] 240066W001

[2287] 148

[2288] Example 2: GLP-1- / GIP- / amylin-receptor tri-aqonists according to the invention Compound 104:

[2289] Compound 105:

[2290]

[2291] 240066W001

[2292] 149

[2293] Compound 106:

[2294] Compound 107:

[2295]

[2296] 240066W001

[2297] 150

[2298] Compound 108:

[2299] Compound 109:

[2300]

[2301] 240066W001

[2302] 151

[2303] Compound 110:

[2304] Compound 111:

[2305]

[2306] 240066W001

[2307] 152

[2308] Compound 112:

[2309] Compound 113:

[2310]

[2311] 240066W001

[2312] 153

[2313] Compound 114:

[2314] Compound 115:

[2315]

[2316] 240066W001

[2317] 154

[2318] Compound 116:

[2319] Compound 117:

[2320]

[2321] 240066W001

[2322] 155

[2323] Compound 118:

[2324] Compound 119:

[2325] └ASELSTAALGRLSAELHELATLPRTETGSGS—N[pyrrolidine]—NH2

[2326]

[2327] 240066W001

[2328] 156

[2329] Compound 120:

[2330] Compound 121:

[2331]

[2332] 240066W001

[2333] 157

[2334] Compound 122:

[2335] └ASHLSTAQLGRLSAELHELATLPRTETGSGS—N[pyrrolidine]—NH2Compound 123:

[2336]

[2337] 240066W001

[2338] 158

[2339] Compound 124:

[2340] Compound 125:

[2341]

[2342] 240066W001

[2343] 159

[2344] Compound 126:

[2345] Compound 127:

[2346] └ASHLSTAALGRLSAELHELATLPRTETGSGS—N[pyrrolidine]—NH2

[2347]

[2348] 240066W001

[2349] 160

[2350] Compound 128:

[2351] └EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPL—

[2352] Compound 129:

[2353]

[2354] 240066W001

[2355] 161

[2356] Compound 130:

[2357] Compound 131:

[2358] GT F T S DYS I L L E E I AARE F I EWL LAGG PS

[2359]

[2360] 240066W001

[2361] 162

[2362] Compound 132:

[2363] Compound 133:

[2364]

[2365] 240066W001

[2366] 163

[2367] Compound 134:

[2368] Compound 135:

[2369]

[2370] 240066W001

[2371] 164

[2372] Compound 136:

[2373] Compound 137:

[2374]

[2375] O O 240066W001

[2376] 165

[2377] Compound 138:

[2378] Compound 139:

[2379]

[2380] 240066W001

[2381] 166

[2382] Compound 140:

[2383] GT F T S DYS I L L E E I AAR E F I EWL L AGG P S

[2384] Compound 141:

[2385] H2N-EGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGGGG-

[2386] AGELSTAQTQRLSAEL

[2387] HO.

[2388]

[2389] 240066W001

[2390] 167

[2391] Compound 142:

[2392] Compound 143:

[2393]

[2394] 240066W001

[2395] 168

[2396] Compound 144:

[2397] Compound 145:

[2398] EEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGS

[2399]

[2400] 240066W001

[2401] 169

[2402] Compound 146

[2403] Compound 147:

[2404]

[2405] 240066W001

[2406] 170

[2407] Compound 148:

[2408] H GT F T SDYS I L L E E I AARE F I EWL LAGGP SSGAGEA PGQAPG-,

[2409] LSAELATLPRTETGSGS-NH₂

[2410] Compound 149:

[2411] EGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGS SGAGQE PGQAPG-i

[2412] -ASHLSLSAELATLPRTETGSGS-NH₂

[2413]

[2414] 240066W001

[2415] 171

[2416] Compound 150:

[2417] EGTFTSDYSILLEEIAAREFIEWL

[2418] Compound 151:

[2419] EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPEQAPG-i

[2420]

[2421] 240066W001

[2422] 172

[2423] Compound 152:

[2424] Compound 153:

[2425] EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQE

[2426] ASHLSTAQTQRLSAELH

[2427] HO,

[2428]

[2429] 240066W001

[2430] 173

[2431] Compound 154:

[2432]

[2433] 240066W001

[2434] 174

[2435] Compound 156:

[2436] Compound 157:

[2437]

[2438] 240066W001

[2439] 175

[2440] Compound 158:

[2441] Compound 159:

[2442]

[2443] 240066W001

[2444] 176

[2445] Compound 160:

[2446] Compound 161:

[2447] EEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPG

[2448]

[2449] 240066W001

[2450] 177

[2451] Compound 162:

[2452] Compound 163:

[2453] EWLLAGGPSSGAGQAPGQAPG-i

[2454]

[2455] O O 240066W001

[2456] 178

[2457] Compound 164:

[2458] Compound 165:

[2459]

[2460] 240066W001

[2461] 179

[2462] Compound 166:

[2463] EEEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGEAPG

[2464] Compound 167:

[2465] EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPG

[2466] ASELSTAQTQRLSAELH

[2467] HO,

[2468]

[2469] 240066W001

[2470] 180

[2471] Compound 168:

[2472] EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPG

[2473] Compound 169:

[2474]

[2475] O 240066W001

[2476] 181

[2477] Compound 170:

[2478] Compound 171:

[2479] H2

[2480]

[2481] 240066W001

[2482] 182

[2483] Compound 172:

[2484] Compound 173:

[2485] L-AS E L S TAQ LGR L SAE L HQ LAT E P RT E TGSG H2

[2486]

[2487] 240066W001

[2488] 183

[2489] Compound 174:

[2490] Compound 175:

[2491]

[2492] 240066W001

[2493] 184

[2494] Compound 176:

[2495] EEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGS

[2496]

[2497] 240066W001

[2498] 185

[2499] Compound 178:

[2500] Compound 179:

[2501] GT F T S DYS I L L E E I AARE F I EWL LAGG P

[2502] ASHLSTAQTQRLSAELH

[2503] HO.

[2504]

[2505] 240066W001

[2506] 186

[2507] Compound 180:

[2508]

[2509] 240066W001

[2510] 187

[2511] Compound 182:

[2512] Compound 183:

[2513]

[2514] 240066W001

[2515] 188

[2516] Compound 184:

[2517] Compound 185:

[2518]

[2519] 240066W001

[2520] 189

[2521] Compound 186:

[2522] Compound 187:

[2523]

[2524] 240066W001

[2525] 190

[2526] Compound 188:

[2527] 0

[2528] Compound 189:

[2529] H EGTFTSDYSILLEEIAAREFIEWL L AGGPS SGAGEAPGEAPG-,

[2530] L-ASH L S TAQTQR L SAE L H2

[2531] HO.

[2532]

[2533] 240066W001

[2534] 191

[2535] Compound 190:

[2536] Compound 191:

[2537] GT F T S DYS I L L E E I AA R E F I EWL I AGG P S SGAG EA PGQA

[2538] L-AS E L S TAQTQR L SA E L

[2539]

[2540] 240066W001

[2541] 192

[2542] Compound 192:

[2543] EGTFTSDYSILLEEIAAREFIEWL

[2544] Compound 193:

[2545] H GT F T S DYS L L E E I AARE F I EWL L AGGPSSGAG-,

[2546]

[2547] 240066W001

[2548] 193

[2549] Compound 194:

[2550] GT F T S DY S I L L E E I AAQE F I EWL LQGG P S

[2551] Compound 195:

[2552]

[2553] 240066W001

[2554] 194

[2555] Compound 196:

[2556] Compound 197:

[2557]

[2558] 240066W001

[2559] 195

[2560] Compound 211:

[2561] Compound 212:

[2562] Compound 213:

[2563] GT F T S DYS I L L E E I AARE F I EWL L AGGP SSGAG EA PGQA

[2564] LAS H L STAQTQR L SA E L H K LAT L PRT E TGSG H2

[2565]

[2566] 240066W001

[2567] 196

[2568] Compound 214:

[2569] Compound 215:

[2570]

[2571] Compound 216:

[2572]

[2573] 240066W001

[2574] 197

[2575] Compound 217:

[2576] H2GT F T S DYS I L L E E I AARE F I EWL L AGG P SSGAGQAPGEAPG-i

[2577] L-AS H L S TAQTQR L S A E L H K L AT L P RT E TGSG 2 Compound 218:

[2578]

[2579] Compound 219:

[2580]

[2581] 240066W001

[2582] 198

[2583] Compound 220:

[2584] Compound 221:

[2585]

[2586] Table 9: Structure and amino acid sequences of the synthesized GLP-1- / GIP- / amylin- receptor tri-agonists according to the invention.

[2587] ComSEQ

[2588] pound ID Amino acid sequences Protraction moiety

[2589] no. NO:

[2590] (Table 4 (Table 6) (Table 5) (Table 7)

[2591] YX2EGTFTSDYSILLEEIAAREFIEWL LAGGASSGAGEAPGEAPGASHLST

[2592] 104 243 Chem. 20 Chem. 6 Chem. 27

[2593] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGASELSTAALGRLSA

[2594] 105 244 Chem. 20 Chem. 6 Chem. 27

[2595] ELHQLATLPRTETGSGSP

[2596]

[2597] 240066W001

[2598] 199

[2599] YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGQSSGAGASELSTAQLGRLS

[2600] 106 245 Chem. 20 Chem. 6 Chem. 27

[2601] AELHQLATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2602] LI AGAPSSGAGASELSTAALG RLSA

[2603] 107 246 Chem. 20 Chem. 6 Chem. 27

[2604] ELHQLATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAEASELSTAQLGRLS

[2605] 108 247 Chem. 20 Chem. 6 Chem. 27

[2606] AELHQLATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW LIAGGPSEGAGASELSTAQLGRLSA

[2607] 109 248 Chem. 20 Chem. 6 Chem. 27

[2608] ELHQLATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW LIAGGGSSGAGASELSTAALGRLSA

[2609] 110 249 Chem. 20 Chem. 6 Chem. 27

[2610] ELHELATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2611] LI AGAPSSGAGASELSTAALG RLSA

[2612] 111 250 Chem. 20 Chem. 6 Chem. 27

[2613] ELHELATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGGSSGAGASELSTAALGRLS

[2614] 112 251 Chem. 20 Chem. 6 Chem. 27

[2615] AELHELATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGASELSTAALGRLS

[2616] 113 252 Chem. 20 Chem. 6 Chem. 27

[2617] AELHELATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL LAGGASSGAGEAPGEAPGASHLST

[2618] 114 243 Chem. 20 Chem. 5 Chem. 28

[2619] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGASELSTAALGRLS

[2620] 115 244 Chem. 20 Chem. 5 Chem. 28

[2621] AELHQLATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2622] LI AGAPSSGAGASELSTAALG RLSA

[2623] 116 246 Chem. 20 Chem. 5 Chem. 28

[2624] ELHQLATLPRTETGSGSP

[2625]

[2626] 240066W001

[2627] 200

[2628] YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGASELSTAALGRLS

[2629] 117 252 Chem. 20 Chem. 5 Chem. 28

[2630] AELHELATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2631] LI AGAPSSGAGASELSTAALG RLSA

[2632] 118 250 Chem. 20 Chem. 5 Chem. 28

[2633] ELHELATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGGSSGAGASELSTAALGRLS

[2634] 119 251 Chem. 20 Chem. 5 Chem. 28

[2635] AELHELATLPRTETGSGSP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPGASHLS

[2636] 120 170 Chem. 20 Chem. 6 Chem. 27

[2637] TAQTQRLSAELHKLATLPRTETGSG SP YX2EGTFTSDYSILLEEIAAREFIEWL IAGGPSSGAGQAPGQAPGASHLST

[2638] 121 171 Chem. 20 Chem. 6 Chem. 27

[2639] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGQAPGASHLS

[2640] 122 172 Chem. 20 Chem. 6 Chem. 27

[2641] TAQLGRLSAELHELATLPRTETGSG SP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGQAPGASHLS

[2642] 123 173 Chem. 20 Chem. 6 Chem. 27

[2643] TAQLGRLSAELHQLATLPRTETGSG SP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGQAPGASHLS

[2644] 124 174 Chem. 20 Chem. 6 Chem. 27

[2645] TAQTQRLSAELHELATLPRTETGSG SP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPLASHLST

[2646] 125 175 Chem. 20 Chem. 6 Chem. 27

[2647] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGQAPGASHLS

[2648] 126 176 Chem. 20 Chem. 6 Chem. 27

[2649] TAALGRLSAELHELATLPRTETGSG SP YX2EGTFTSDYSKLLEEIAAREFIEW LIAGGPSSGAGQAPGQAPGASHLS

[2650] 127 177 Chem. 20 Chem. 6 Chem. 27

[2651] TAALGRLSAELHELATLPRTETGSG

[2652]

[2653] SP 240066W001

[2654] 201

[2655] YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPLASHLST

[2656] 128 178 Chem. 20 Chem. 6 Chem. 27

[2657] AQTARLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGQAPLASHLS

[2658] 129 179 Chem. 20 Chem. 6 Chem. 27

[2659] TAQLGRLSAELHQLATLPRTETGSG SP YX2EGTFTSDYSKLLEEIAAREFIEW

[2660] 130 180 LLAGG PSSG AG ASH LSTAQLG RLS Chem. 20 Chem. 6 Chem. 27

[2661] AELHQLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2662] 131 181 LAG G PSSG AG ASH LSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2663] ELHKLATLPRTETGSGSP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPLASQLST

[2664] 132 182 Chem. 20 Chem. 6 Chem. 27

[2665] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPLASELST

[2666] 133 183 Chem. 20 Chem. 6 Chem. 27

[2667] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIEWL

[2668] 134 184 LAGG PSSG EASH LSTAQTQ RLSAE Chem. 20 Chem. 6 Chem. 27

[2669] LHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2670] LAG G PSSG AGQ APG QAPAASH LST

[2671] 135 185 Chem. 20 Chem. 6 Chem. 27

[2672] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPEASHLST

[2673] 136 186 Chem. 20 Chem. 6 Chem. 27

[2674] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPPASHLST

[2675] 137 187 Chem. 20 Chem. 6 Chem. 27

[2676] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIEWL

[2677] LAG G PSSG AGQ APG QAPSASH LST

[2678] 138 188 Chem. 20 Chem. 6 Chem. 27

[2679] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIEWL

[2680] LAG G PSSG AGQ APG QAPVASH LST

[2681] 139 189 Chem. 20 Chem. 6 Chem. 27

[2682] AQTQRLSAELHKLATLPRTETGSGS

[2683]

[2684] P 240066W001

[2685] 202

[2686] YX2EGTFTSDYSILLEEIAAREFIEWL

[2687] 140 190 LAGGPSSGAGGGGASHLSTAQTQ Chem. 20 Chem. 6 Chem. 27

[2688] RLSAELHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2689] 141 191 LAGGPSSGAGGGGAGELSTAQTQ Chem. 20 Chem. 6 Chem. 27

[2690] RLSAELHKLATLPRTETGSGSP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPLASHLST

[2691] 142 175 Chem. 19 Chem. 6 Chem. 27

[2692] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIEWL IAGGPSSGAGQAPGQAPLASHLST

[2693] 143 192 Chem. 20 Chem. 6 Chem. 27

[2694] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPGASELST

[2695] 144 193 Chem. 20 Chem. 6 Chem. 27

[2696] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPGASELST

[2697] 145 194 Chem. 20 Chem. 6 Chem. 27

[2698] AQTARLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGQAPGQAPGASHLST

[2699] 146 195 Chem. 20 Chem. 6 Chem. 27

[2700] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGEGQAPGQAPGASHLS

[2701] 147 196 Chem. 20 Chem. 6 Chem. 27

[2702] TAQTQRLSAELHKLATLPRTETGSG SP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGEAPGQAPGASHLST

[2703] 148 197 Chem. 20 Chem. 6 Chem. 27

[2704] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQEPGQAPGASHLS

[2705] 149 198 Chem. 20 Chem. 6 Chem. 27

[2706] TAQTQRLSAELHKLATLPRTETGSG SP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAEGQAPGASHLS

[2707] 150 199 Chem. 20 Chem. 6 Chem. 27

[2708] TAQTQRLSAELHKLATLPRTETGSG

[2709]

[2710] SP 240066W001

[2711] 203

[2712] YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPEQAPGASHLST

[2713] 151 200 Chem. 20 Chem. 6 Chem. 27

[2714] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGEAPGPGASHLST

[2715] 152 201 Chem. 20 Chem. 6 Chem. 27

[2716] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQEPGASHLS

[2717] 153 202 Chem. 20 Chem. 6 Chem. 27

[2718] TAQTQRLSAELHKLATLPRTETGSG SP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAEGASHLS

[2719] 154 203 Chem. 20 Chem. 6 Chem. 27

[2720] TAQTQRLSAELHKLATLPRTETGSG SP YX2EGTFTSDYSILLEEIAAREFIEWL IAGGPSSGAGQEPGQEPGASHLST

[2721] 155 204 Chem. 20 Chem. 6 Chem. 27

[2722] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIAWL IAGGPSSGAGQEPGQEPGASHLST

[2723] 156 205 Chem. 20 Chem. 6 Chem. 27

[2724] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIQWL IAGGPSSGAGQEPGQEPGASHLST

[2725] 157 206 Chem. 20 Chem. 6 Chem. 27

[2726] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIEWL

[2727] 158 207 IAGGPSSGAGASHLSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2728] ELHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2729] 159 208 LAGGPSSGAGQAPGQAPASHLSTA Chem. 20 Chem. 6 Chem. 27

[2730] QTQRLSAELHKLATLPRTETGSGSP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPGASHLS

[2731] 160 170 Chem. 33 Chem. 6 Chem. 36

[2732] TAQTQRLSAELHKLATLPRTETGSG SP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPGASHLS

[2733] 161 170 Chem. 34 Chem. 6 Chem. 37

[2734] TAQTQRLSAELHKLATLPRTETGSG

[2735]

[2736] SP 240066W001

[2737] 204

[2738] YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPGASHLS

[2739] 162 209 Chem. 20 Chem. 6 Chem. 27

[2740] TAQTQRLSAELHKLATEPRTETGS GSP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPGASELST

[2741] 163 210 Chem. 20 Chem. 6 Chem. 27

[2742] AQTQRLSAELHKLATEPRTETGSG SP YX2EEEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGEAPGPGASHLST

[2743] 164 211 Chem. 20 Chem. 6 Chem. 27

[2744] AQTQRLSAELHKLATEPRTETGSG SP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGQAPGQAPGASHLST

[2745] 165 212 Chem. 20 Chem. 6 Chem. 27

[2746] AQTQRLSAELHKLATEPRTETGSG SP YX2EGTFTSDYSILLEEIAAREFIEWL

[2747] LAGG PSSG AGQAPG EAPG ASELST

[2748] 166 213 Chem. 20 Chem. 6 Chem. 27

[2749] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIEWL

[2750] LAGG PSSEAGQAPGQAPG ASELST

[2751] 167 214 Chem. 20 Chem. 6 Chem. 27

[2752] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGEAGQAPGEAPGASHLST

[2753] 168 215 Chem. 20 Chem. 6 Chem. 27

[2754] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGQAPGASELS

[2755] 169 216 Chem. 20 Chem. 6 Chem. 27

[2756] TAALGRLSAELHELATLPRTETGSG SP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGQAPGASELS

[2757] 170 217 Chem. 20 Chem. 6 Chem. 27

[2758] TAALGRLSAELHQLATLPRTETGSG SP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGEAPGASELS

[2759] 171 218 Chem. 20 Chem. 6 Chem. 27

[2760] TAALGRLSAELHQLATLPRTETGSG SP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGEAPGASELS

[2761] 172 219 Chem. 20 Chem. 6 Chem. 27

[2762] TAALGRLSAELHQLATEPRTETGSG

[2763]

[2764] SP 240066W001

[2765] 205

[2766] YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGEAPGASELS

[2767] 173 220 Chem. 20 Chem. 6 Chem. 27

[2768] TAQLGRLSAELHQLATEPRTETGS GSP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGEAPGASELS

[2769] 174 221 Chem. 20 Chem. 6 Chem. 27

[2770] TAQTGRLSAELHQLATEPRTETGS GSP YX2EGTFTSDYSKLLEEIAAREFIEW LLAGGPSSGAGQAPGEAPGASELS

[2771] 175 222 Chem. 20 Chem. 6 Chem. 27

[2772] TAQTGRLSAELHQLATEPRTETGS GSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2773] 176 223 LAGGPSSGAGASELSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2774] ELHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2775] 177 224 LAGGPSSEAGASHLSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2776] ELHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2777] 178 225 LAG G PSSEAG ASELSTAQTQ RLSA Chem. 20 Chem. 6 Chem. 27

[2778] ELHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2779] 179 226 LAG G PSSG AG ASH LSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2780] ELHKLATEPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2781] 180 227 LAGGPSSGAGASQLSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2782] ELHKLATEPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2783] 181 228 LAGGPSSEAGASQLSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2784] ELHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAREFIEWL

[2785] 182 229 LAGGPSSEAGASQLSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2786] ELHKLATEPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2787] 183 230 LLAGGPSSGAGASELSTAQLGRLS Chem. 20 Chem. 6 Chem. 27

[2788] AELHQLATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2789] 184 231 LLAGG PSSG AG ASH LSTAQLG RLS Chem. 20 Chem. 6 Chem. 27

[2790] AELHQLATEPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2791] 185 232 LLAGGPSSEAGASHLSTAQLGRLS Chem. 20 Chem. 6 Chem. 27

[2792] AELHQLATEPRTETGSGSP

[2793]

[2794] 240066W001

[2795] 206

[2796] YX2EGTFTSDYSKLLEEIAAREFIEW

[2797] 186 233 LLAGGPSSGAGASELSTAQLGRLS Chem. 20 Chem. 6 Chem. 27

[2798] AELHQLATEPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2799] 187 234 LLAGGPSSEAGASELSTAQLGRLS Chem. 20 Chem. 6 Chem. 27

[2800] AELHQLATLPRTETGSGSP YX2EGTFTSDYSKLLEEIAAREFIEW

[2801] 188 235 LLAGGPSSEAGASELSTAQLGRLS Chem. 20 Chem. 6 Chem. 27

[2802] AELHQLATEPRTETGSGSP YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGEAPGEAPGASHLST

[2803] 189 236 Chem. 20 Chem. 6 Chem. 27

[2804] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIEWL IAGGPSSGAGEAPGQAPGASQLST

[2805] 190 237 Chem. 20 Chem. 6 Chem. 27

[2806] AQTQRLSAELHKLATLPRTETGSGS P YX2EGTFTSDYSILLEEIAAREFIEWL IAGGPSSGAGEAPGQAPGASELST

[2807] 191 238 Chem. 20 Chem. 6 Chem. 27

[2808] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPGASHLS

[2809] 192 170 Chem. 20 Chem. 32 Chem. 35

[2810] TAQTQRLSAELHKLATLPRTETGSG SP YX2EGTFTSDYSILLEEIAAREFIEWL

[2811] 193 181 LAG G PSSG AG ASH LSTAQTQRLSA Chem. 20 Chem. 32 Chem. 35

[2812] ELHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAQEFIEWL

[2813] 194 239 LQGGPSSGAGASELSTAQTQRLSA Chem. 20 Chem. 6 Chem. 27

[2814] ELHKLATLPRTETGSGSP YX2EGTFTSDYSILLEEIAAQEFIEWL LQGGPSSGAGEAPGQAPGASELST

[2815] 195 240 Chem. 20 Chem. 6 Chem. 27

[2816] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGEAPGPLASHLST

[2817] 196 241 Chem. 20 Chem. 6 Chem. 27

[2818] AQTQRLSAELHKLATLPRTETGSGS P YX2EEEGTFTSDYSILLEEIAAREFIEWLLAGGPSSGAGQAPGQAPGSSEAGQAPGQAPGGAGQAPGQAPLASHLST

[2819] 197 242 Chem. 20 Chem. 6 Chem. 27

[2820] AQTQRLSAELHKLATEPRTETGSG

[2821]

[2822] SP

[2823] wherein each X2is Aib. 240066W001

[2824] 207

[2825] Example 3: LCMS characterization of the synthesized compounds

[2826] LCMS characterization method

[2827] LCMS analysis was performed on a set up consisting of Waters Acquity UPLC H Class system and Waters Xevo G2-XS QTof. Eluents: A: Milli-Q water; B: MeCN; C: 2% formic acid + 0.1% TFA in Milli-Q water.

[2828] The analysis was performed at RT (column temperature 60 °C) by injecting an appropriate volume of the sample onto the column. The sample was eluted with a linear gradient of 5-95% B in A, and constant 5% C.

[2829] The UPLC conditions, detector settings, and mass spectrometer settings were: Column: Waters Acquity BEH Shield, C-18, 1.7 pm, 2.1 mm x 50 mm. Gradient: Linear 5% -95% B, and constant 5% C during 4.0 min at 0.4 ml / min. Total run-time: 7.0 min. Detection: MS sensitivity mode, ionisation method: ES. Scan: 50-5000 amu.

[2830] The monoisotopic mass was recorded for the synthesized compounds and their found and calculated values are depicted in Table 10.

[2831] Table 10: Measured and calculated MS species for all synthesized compounds Species m / z found m / z calc

[2832] Reference [M+5H]5+ 1385.469 1385.485

[2833] compound 1 [M+6H]6+ 1154.892 1154.739

[2834] Reference [M+5H]5+ 1796.108 1795.913

[2835] compound 2 [M+6H]6+ 1496.760 1496.762

[2836] Reference [M+5H]5+ 1675.279 1675.266

[2837] compound 3 [M+6H]6+ 1396.379 1396.223

[2838] Reference [M+3H]3+ 1517.136 1517.156

[2839] compound 4 [M+4H]4+ 1138.116 1138.119

[2840] Reference [M+3H]3+ 1604.490 1604.516

[2841] compound 5 [M+4H]4+ 1203.626 1203.639

[2842] Reference [M+3H]3+ 1469.738 1469.758

[2843] compound 6 [M+4H]4+ 1102.568 1102.570

[2844] Reference [M+3H]3+ 1371.374 1371.379

[2845] compound 7 [M+4H]4+ 1028.789 1028.786

[2846] [M+5H]5+ 1718.092 1718.081

[2847] Compound 104

[2848] [M+6H]6+ 1431.917 1431.902

[2849]

[2850] 240066W001

[2851] 208

[2852] [M+5H]5+ 1559.819 1559.809 Compound 105

[2853] [M+6H]6+ 1300.038 1300.009 [M+5H]5+ 1577.425 1577.415 Compound 106

[2854] [M+6H]6+ 1314.854 1314.680 [M+5H]5+ 1562.617 1562.612 Compound 107

[2855] [M+6H]6+ 1302.357 1302.345 [M+5H]5+ 1585.825 1585.618 Compound 108

[2856] [M+6H]6+ 1321.869 1321.516 [M+5H]5+ 1579.637 1579.616 Compound 109

[2857] [M+6H]6+ 1316.695 1316.514 [M+5H]5+ 1552.005 1552.000 Compound 110

[2858] [M+6H]6+ 1293.523 1293.501 [M+5H]5+ 1563.022 1562.809 Compound 111

[2859] [M+6H]6+ 1302.682 1302.509 [M+5H]5+ 1552.214 1552.000 Compound 112

[2860] [M+6H]6+ 1293.509 1293.501 [M+5H]5+ 1560.013 1560.006 Compound 113

[2861] [M+6H]6+ 1300.186 1300.173 [M+5H]5+ 1712.498 1712.474 Compound 114

[2862] [M+6H]6+ 1427.414 1427.230 [M+5H]5+ 1554.215 1554.203 Compound 115

[2863] [M+6H]6+ 1295.349 1295.337 [M+5H]5+ 1557.218 1557.006 Compound 116

[2864] [M+6H]6+ 1297.855 1297.673 [M+5H]5+ 1554.408 1554.400 Compound 117

[2865] [M+6H]6+ 1295.674 1295.501 [M+5H]5+ 1557.218 1557.203 Compound 118

[2866] [M+6H]6+ 1297.855 1297.837 [M+5H]5+ 1546.607 1546.394 Compound 119

[2867] [M+6H]6+ 1289.008 1288.829 [M+5H]5+ 1723.077 1722.890 Compound 120

[2868] [M+6H]6+ 1435.903 1435.910 [M+5H]5+ 1723.077 1722.890 Compound 121

[2869] [M+6H]6+ 1435.903 1435.910

[2870]

[2871] 240066W001

[2872] 209

[2873] [M+5H]5+ 1714.270 1714.282 Compound 122

[2874] [M+6H]6+ 1428.731 1428.736 [M+5H]5+ 1714.287 1714.085 Compound 123

[2875] [M+6H]6+ 1428.731 1428.572 [M+5H]5+ 1726.068 1726.082 Compound 124

[2876] [M+6H]6+ 1438.557 1438.569 [M+5H]5+ 1734.292 1734.103 Compound 125

[2877] [M+6H]6+ 1445.255 1445.253 [M+5H]5+ 1702.867 1702.877 Compound 126

[2878] [M+6H]6+ 1419.232 1419.232 [M+5H]5+ 1702.867 1702.877 Compound 127

[2879] [M+6H]6+ 1419.232 1419.232 [M+5H]5+ 1722.686 1722.698 Compound 128

[2880] [M+6H]6+ 1435.748 1435.750 [M+5H]5+ 1725.286 1725.297 Compound 129

[2881] [M+6H]6+ 1437.905 1437.916 [M+5H]5+ 1572.809 1572.817 Compound 130

[2882] [M+6H]6+ 1310.841 1310.849 [M+5H]5+ 1581.620 1581.622 Compound 131

[2883] [M+6H]6+ 1318.171 1318.186 [M+5H]5+ 1732.298 1732.302 Compound 132

[2884] [M+6H]6+ 1443.747 1443.753 [M+5H]5+ 1732.485 1732.499 Compound 133

[2885] [M+6H]6+ 1443.918 1443.917 [M+5H]5+ 1581.815 1581.819 Compound 134

[2886] [M+6H]6+ 1318.513 1318.350 [M+5H]5+ 1725.677 1725.693 Compound 135

[2887] [M+6H]6+ 1438.401 1438.246 [M+5H]5+ 1737.481 1737.294 Compound 136

[2888] [M+6H]6+ 1447.902 1447.913 [M+5H]5+ 1730.884 1730.896 Compound 137

[2889] [M+6H]6+ 1442.580 1442.581 [M+5H]5+ 1729.080 1728.892 Compound 138

[2890] [M+6H]6+ 1440.902 1440.911

[2891]

[2892] 240066W001

[2893] 210

[2894] [M+5H]5+ 1731.293 1731.299 Compound 139

[2895] [M+6H]6+ 1442.907 1442.917 [M+5H]5+ 1615.824 1615.835 Compound 140

[2896] [M+6H]6+ 1346.693 1346.697 [M+5H]5+ 1608.428 1608.230 Compound 141

[2897] [M+6H]6+ 1340.347 1340.359 [M+5H]5+ 1705.080 1705.088 Compound 142

[2898] [M+6H]6+ 1421.068 1421.074 [M+5H]5+ 1734.087 1734.103 Compound 143

[2899] [M+6H]6+ 1445.240 1445.253 [M+5H]5+ 1721.276 1721.287 Compound 144

[2900] [M+6H]6+ 1434.570 1434.574 [M+5H]5+ 1709.867 1709.882 Compound 145

[2901] [M+6H]6+ 1425.067 1425.070 [M+5H]5+ 1737.293 1737.294 Compound 146

[2902] [M+6H]6+ 1448.073 1447.913 [M+5H]5+ 1734.479 1734.491 Compound 147

[2903] [M+6H]6+ 1445.567 1445.577 [M+5H]5+ 1723.077 1723.087 Compound 148

[2904] [M+6H]6+ 1436.229 1436.074 [M+5H]5+ 1734.479 1734.491 Compound 149

[2905] [M+6H]6+ 1445.567 1445.577 [M+5H]5+ 1729.284 1729.288 Compound 150

[2906] [M+6H]6+ 1441.399 1441.241 [M+5H]5+ 1737.481 1737.294 Compound 151

[2907] [M+6H]6+ 1447.902 1447.913 [M+5H]5+ 1723.077 1723.087 Compound 152

[2908] [M+6H]6+ 1436.074 1436.074 [M+5H]5+ 1734.479 1734.491 Compound 153

[2909] [M+6H]6+ 1445.567 1445.577 [M+5H]5+ 1729.284 1729.288 Compound 154

[2910] [M+6H]6+ 1441.244 1441.241 [M+5H]5+ 1746.278 1746.092 Compound 155

[2911] [M+6H]6+ 1455.231 1455.245

[2912]

[2913] 240066W001

[2914] 211

[2915] [M+5H]5+ 1734.479 1734.491 Compound 156

[2916] [M+6H]6+ 1445.567 1445.577 [M+5H]5+ 1745.885 1745.895 Compound 157

[2917] [M+6H]6+ 1455.075 1455.081 [M+5H]5+ 1581.620 1581.622 Compound 158

[2918] [M+6H]6+ 1318.350 1318.186 [M+5H]5+ 1711.475 1711.486 Compound 159

[2919] [M+6H]6+ 1426.396 1426.406 [M+5H]5+ 1774.701 1774.507 Compound 160

[2920] [M+6H]6+ 1478.920 1478.924 [M+5H]5+ 1774.494 1774.507 Compound 161

[2921] [M+6H]6+ 1478.920 1478.924 [M+5H]5+ 1726.068 1726.082 Compound 162

[2922] [M+6H]6+ 1438.557 1438.569 [M+5H]5+ 1724.470 1724.478 Compound 163

[2923] [M+6H]6+ 1437.222 1437.233 [M+5H]5+ 1726.272 1726.279 Compound 164

[2924] [M+6H]6+ 1438.728 1438.733 [M+5H]5+ 1740.673 1740.486 Compound 165

[2925] [M+6H]6+ 1450.567 1450.573 [M+5H]5+ 1721.480 1721.484 Compound 166

[2926] [M+6H]6+ 1434.895 1434.738 [M+5H]5+ 1735.673 1735.691 Compound 167

[2927] [M+6H]6+ 1446.563 1446.577 [M+5H]5+ 1737.481 1737.491 Compound 168

[2928] [M+6H]6+ 1448.073 1448.077 [M+5H]5+ 1701.263 1701.274 Compound 169

[2929] [M+6H]6+ 1417.891 1417.896 [M+5H]5+ 1701.263 1701.077 Compound 170

[2930] [M+6H]6+ 1417.721 1417.732 [M+5H]5+ 1701.263 1701.274 Compound 171

[2931] [M+6H]6+ 1417.891 1417.896 [M+5H]5+ 1704.455 1704.466 Compound 172

[2932] [M+6H]6+ 1420.543 1420.556

[2933]

[2934] 240066W001

[2935] 212

[2936] [M+5H]5+ 1715.864 1715.870 Compound 173

[2937] [M+6H]6+ 1430.046 1430.060 [M+5H]5+ 1713.457 1713.463 Compound 174

[2938] [M+6H]6+ 1428.051 1428.054 [M+5H]5+ 1727.854 1727.670 Compound 175

[2939] [M+6H]6+ 1439.892 1439.893 [M+5H]5+ 1580.009 1580.019 Compound 176

[2940] [M+6H]6+ 1317.013 1316.850 [M+5H]5+ 1596.026 1596.026 Compound 177

[2941] [M+6H]6+ 1330.176 1330.190 [M+5H]5+ 1594.424 1594.423 Compound 178

[2942] [M+6H]6+ 1328.848 1328.854 [M+5H]5+ 1584.812 1584.814 Compound 179

[2943] [M+6H]6+ 1320.833 1320.846 [M+5H]5+ 1583.004 1583.014 Compound 180

[2944] [M+6H]6+ 1319.509 1319.346 [M+5H]5+ 1594.228 1594.226 Compound 181

[2945] [M+6H]6+ 1328.684 1328.690 [M+5H]5+ 1597.416 1597.418 Compound 182

[2946] [M+6H]6+ 1331.341 1331.350 [M+5H]5+ 1571.203 1571.214 Compound 183

[2947] [M+6H]6+ 1309.507 1309.513 [M+5H]5+ 1576.009 1576.009 Compound 184

[2948] [M+6H]6+ 1313.495 1313.508 [M+5H]5+ 1590.406 1590.413 Compound 185

[2949] [M+6H]6+ 1325.508 1325.512 [M+5H]5+ 1574.401 1574.405 Compound 186

[2950] [M+6H]6+ 1312.160 1312.172 [M+5H]5+ 1585.610 1585.618 Compound 187

[2951] [M+6H]6+ 1321.502 1321.516 [M+5H]5+ 1588.806 1588.810 Compound 188

[2952] [M+6H]6+ 1324.167 1324.176 [M+5H]5+ 1723.485 1723.284 Compound 189

[2953] [M+6H]6+ 1436.229 1436.238

[2954]

[2955] 240066W001

[2956] 213

[2957] [M+5H]5+ 1721.276 1721.287 Compound 190

[2958] [M+6H]6+ 1434.570 1434.574 [M+5H]5+ 1721.480 1721.484 Compound 191

[2959] [M+6H]6+ 1434.895 1434.738 [M+5H]5+ 1730.271 1730.085 Compound 192

[2960] [M+6H]6+ 1441.896 1441.906 [M+5H]5+ 1588.806 1588.817 Compound 193

[2961] [M+6H]6+ 1324.182 1324.182 [M+5H]5+ 1585.806 1585.815 Compound 194

[2962] [M+6H]6+ 1321.845 1321.680 [M+5H]5+ 1727.276 1727.279 Compound 195

[2963] [M+6H]6+ 1439.566 1439.567 [M+5H]5+ 1734.292 1734.299 Compound 196

[2964] [M+6H]6+ 1445.411 1445.417 [M+5H]5+ 1737.481 1737.294 Compound 197

[2965] [M+6H]6+ 1447.902 1447.913 [M+5H]5+ 1588.594 1588.603 Compound 211

[2966] [M+6H]6+ 1324.167 1324.004 [M+5H]5+ 1585.790 1585.800 Compound 212

[2967] [M+6H]6+ 1321.666 1321.668 [M+5H]5+ 1574.384 1574.395 Compound 213

[2968] [M+6H]6+ 1312.160 1312.164 [M+5H]5+ 1585.790 1585.800 Compound 214

[2969] [M+6H]6+ 1321.830 1321.668 [M+5H]5+ 1580.594 1580.597 Compound 215

[2970] [M+6H]6+ 1317.325 1317.332 [M+5H]5+ 1588.594 1588.603 Compound 216

[2971] [M+6H]6+ 1324.167 1324.004 [M+5H]5+ 1574.384 1574.395 Compound 217

[2972] [M+6H]6+ 1312.160 1312.164 [M+5H]5+ 1585.790 1585.800 Compound 218

[2973] [M+6H]6+ 1321.666 1321.668 [M+5H]5+ 1580.594 1580.597 Compound 219

[2974] [M+6H]6+ 1317.325 1317.332

[2975]

[2976] 240066W001

[2977] 214

[2978] [M+5H]5+ 1574.189 1574.199

[2979] Compound 220

[2980] [M+6H]6+ 1311.997 1312.000

[2981] [M+5H]5+ 1585.610 1585.411

[2982] Compound 221

[2983] [M+6H]6+ 1321.339 1321.344

[2984]

[2985] Example 4: Human GLP-1-, GIP-, and Amylin-receptors in vitro potency assay (High throughput assay)

[2986] GLP-1 receptor assay

[2987] To determine the ability of compounds to activate or agonize the GLP-1 receptor, in vitro potency assay on Baby Hamster Kidney (BHK) cells expressing the human GLP-1 receptor (hGLP-1R) was performed as described below. To assess how the activation of the receptors is potentially influenced by the presence of human serum albumin (HSA), the in vitro assay was performed in the absence of HSA and presence of 1% (w / v) HSA. Unless stated otherwise the reference to the “GLP-1 receptor assay as described in Example 4” throughout the specification shall refer to the described herein assay procedure (hGLP-1 R assay) in the absence of HSA.

[2988] Assay principle

[2989] Activation of the human GLP-1 receptor leads to increased intra-cellular concentrations of cyclic AMP (cAMP) and the consequent transcription activation from promoters containing multiple copies of the cAMP response element (CRE). It is thus possible to measure GLP-1 receptor activity using a CRE-luciferase reporter gene introduced into Baby Hamster Kidney (BHK) cells co-expressing the human GLP-1 receptor.

[2990] Cells and assay reagents

[2991] Cell stocks were prepared by culturing of a cell line stably expressing the human GLP-1 receptor and containing the CRE responsive luciferase (CRE-Luc) reporter gene (BHK 467-12A KZ-10 prepared according to methods known to the person skilled in the art) in growth medium consisting of DMEM (Gibco, 61965-026) supplemented with 10% FBS (Gibco, 10100-147), 1% Penicillin-Streptomycin (Gibco, 15140-122), 1 mM Na-Pyruvate (Gibco, 11360-039), 0.5 mg / mL G418 (Gibco, 10131-027) and 240 nM Methotrexate (Pfizer, 15936). Cells at approximately 80-90% confluence were washed once in PBS (Gibco 14190-094) and loosened from the cell flasks with Versene (Gibco, 15040-033). After centrifugation, the cell pellet was resuspended and diluted to approximately 1.5x106cells / mL in Recovery™ 240066W001

[2992] 215

[2993] Cell Culture Freezing Medium (Gibco, 12648-010). Cells were aliquoted and stored at-180°C until use.

[2994] The assay buffer consisted of DMEM without phenol red (Gibco, 11880-028) supplemented with 1X GlutaMAX (Gibco, 35050-038), 10 mM HEPES (Gibco, 15630-056), 1% (w / v) ovalbumin (Sigma, A5503) and 0.1% (v / v) Pluronic F-68 (Gibco, 24040-032) either with HSA or without HSA (Sigma, A9511).

[2995] Procedure (hGLP-1R assay)

[2996] To perform the assay, serial dilutions (7-fold dilutions, 7 concentrations per compound and one well containing only assay buffer) of reference compounds and GLP-1- / GIP- / amylin-receptortri-agonists were performed in assay buffer in a 96-well plate. Serial dilutions were transferred to a 384-well assay plate (Revvity, 6007688) and mixed with an equal volume (10 pL) of assay buffer without or with 3% (w / v) HSA (Sigma, A9511). Frozen stocks of hGLP-1R BHK Cre-Luc cells were thawed in a 37 °C water bath, washed once in PBS (Gibco 14190-094), diluted to 1.5 x105(1.5E+5) cells / mL in assay buffer (without HSA) and added (10 pL) to each well of the 384-well assay plate. After a short centrifugation, the assay plates were incubated for 3 hours at 37 °C in 5% CO2and let to equilibrate at room temperature for 10 minutes before the addition of 30 µL steadylite plusTM (Revvity, 6066759) per well. Plates were sealed and incubated at room temperature with gentle shaking for 30 minutes while protected from light. Luminescence was detected on a luminescence plate reader e.g. a Synergy 2 (BioTek). The EC50-values [pM] were calculated by non-linear curve fitting applying a four-parameter logistic model (Hill slope = 1) using GraphPad Prism (GraphPad Software, Boston, MA, USA) or by means of TIBCO Enterprise Runtime for R (TIBCO Software, Palo Alto, CA, USA).

[2997]

[2998] GIP

[2999] To determine the ability of compounds to activate or agonize the GIP receptor, in vitro potency assay on Baby Hamster Kidney (BHK) cells expressing the human GIP receptor (hGIPR) was performed as described below. To assess how the activation of the receptors is potentially influenced by the presence of human serum albumin (HSA), the in vitro assay was performed in the absence of HSA and presence of 1% (w / v) HSA. Unless stated otherwise the reference to the “GIP receptor assay as described in Example 4” throughout the specification shall refer to the described herein assay procedure (hGIPR assay) in the absence of HSA. 240066W001

[3000] 216

[3001]

[3002] Activation of the human GIP receptor leads to increased intra-cellular concentrations of cyclic AMP (cAMP) and the consequent transcription activation from promoters containing multiple copies of the cAMP response element (CRE). It is thus possible to measure GIP receptor activity using a CRE-luciferase reporter gene introduced into Baby Hamster Kidney (BHK) cells co-expressing the human GIP receptor.

[3003] Cells and

[3004]

[3005] Cell stocks were prepared by culturing of a cell line stably expressing the human GIP receptor and containing the CRE responsive luciferase (CRE-Luc) reporter gene (hGIPR BHK Cre-Luc2p clone#5 prepared according to methods known to the person skilled in the art) at 5% CO2and 37 °C in growth medium consisting of DMEM (Gibco, 61965-026) supplemented with 10% fetal calf serum (Gibco, 10100-147), 0.5 mg / ml G418 (Gibco, 10131-027), 1% Penicillin-Streptomycin (Gibco, 15140-122) and 0.3 mg / ml Hygromycin B (ThermoFisher, 10687010). Cells at about 80-90% confluency were washed once with PBS (Gibco 14190-094) and detached from the cell flasks with Versene (Gibco, 15040-066). After centrifugation, the cells were counted, resuspended and diluted to approximately 1.5-3.0 x106(1.5E+6 to 3.0E+6) cells / mL in Recovery Cell Culture Freezing Medium (Gibco, 12648-010) and stored at -180 °C in suitable aliquots until use.

[3006] The assay buffer consisted of DMEM without phenol red (Gibco, 11880-028) supplemented with 1X GlutaMAX (Gibco, 35050-038), 10 mM HEPES (Gibco, 15630-056), 1% (w / v) ovalbumin (Sigma, A5503) and 0.1% (v / v) Pluronic F-68 (Gibco, 24040-032) either with HSA or without HSA (Sigma, A9511).

[3007] Procedure

[3008]

[3009] To perform the assay, serial dilutions (7-fold dilutions, 7 concentrations per compound and one well containing only assay buffer) of reference compounds and GLP-1- / GIP- / amylin-receptor tri-agonists were prepared in assay buffer in a 96-well plate. Serial dilutions were transferred to a 384-well assay plate (Revvity, 6007688) and mixed with an equal volume (10 pL) of assay buffer without or with 3% HSA (Sigma, A9511). Frozen stocks of hGIPR BHK Cre-Luc cells were thawed in a 37 °C water bath, washed once in PBS (Gibco 14190-094), diluted to 1.5 x105(1.5E+5) cells / mL in assay buffer (without HSA) and added (10 pL) to each well of the 384-well assay plate. After a short centrifugation, the assay plates were incubated for 3 hours at 37 °C in 5% CO2and let to equilibrate at room temperature for 10 minutes before the addition of 30 pL steadylite plusTM (Revvity, 6066759) per well. Plates 240066W001

[3010] 217

[3011] were sealed and incubated at room temperature with gentle shaking for 30 minutes while protected from light. Luminescence was detected on a luminescence plate reader e.g. a Synergy 2 (BioTek). The EC50-values [pM] were calculated by non-linear curve fitting applying a four-parameter logistic model (Hill slope = 1) using GraphPad Prism (GraphPad Software, Boston, MA, USA) or by means of TIBCO Enterprise Runtime for R (TIBCO Software, Palo Alto, CA, USA).

[3012]

[3013] To determine the ability of compounds to activate or agonize the amylin receptor, in vitro potency assay on Baby Hamster Kidney (BHK) cells expressing the human amylin receptor (hAMYR3) was performed as described below. To assess how the activation of the receptors is potentially influenced by the presence of human serum albumin (HSA), the in vitro assay was performed in the absence of HSA and presence of 1% (w / v) HSA. Unless stated otherwise the reference to the “amylin receptor assay as described in Example 4” throughout the specification shall refer to the described herein assay procedure (hAMYR3 assay) in the absence of HSA.

[3014]

[3015] Activation of the human amylin 3 receptor leads to increased intra-cellular concentrations of cAMP and the consequent transcription activation from promoters containing multiple copies of the cAMP response element (CRE). It is thus possible to measure hAMYR3 activity using a CRE-luciferase reporter gene introduced into Baby Hamster Kidney (BHK) cells co-expressing the hAMYR3.

[3016] Cells and assay reagents

[3017] A BHK cell line was engineered to stably express the human calcitonin receptor(a) and to contain a CRE-responsive luciferase (CRE-Luc) reporter gene according to methods known to the person skilled in the art (Hollex-1 cell line, obtained from Zymogenetics described in US patent 5,622,839). The cell line was further transfected with human receptor modifying protein 3 (hRAMP3) using standard methods. Association of hRAMP3 with the human calcitonin receptor give rice to the human amylin-3-(a) receptor (hAMYR3) Cells stocks were prepared by culturing of the hAMYR3 BHK Cre-Luc cell line in growth medium consisting of DMEM (Gibco, 31966-021) supplemented with 10% FBS (Gibco, 10100-147), 1% Penicillin-Streptomycin (Gibco, 15140-122), 0.5 mg / mL Geneticin (Gibco, 10131-027), 0.4 mg / mL Hygromycin (ThermoFisher, 10687010) and 250 nM 240066W001

[3018] 218

[3019] Methotrexate (Sigma, A6770). Cells at approximately 80-90% confluence were washed once with PBS (Gibco 14190-094) and loosened from the cell flasks with Versene (Gibco, 15040-033) orTrypLE™ (Gibco, 12605-010). After centrifugation, the cell pellet was resuspended and diluted to approximately 2.5-4.0x106(2.5E+6 to 4.0E+6) cells / mL in Recovery™ Cell Culture Freezing Medium (Gibco, 12648-010). Cells were aliquoted and stored at -180 °C until use.

[3020] The assay buffer consisted of DMEM without phenol red (Gibco, 11880-028) supplemented with 1X GlutaMAX (Gibco, 35050-038), 10 mM HEPES (Gibco, 15630-056) and 1% (w / v) ovalbumin (Sigma, A5503) either with or without 0.1% (v / v) Pluronic F-68 (Gibco, 24040-032) and either with or without HSA (Sigma, A9511).

[3021] Procedure (hAMYR3)

[3022] To perform the assay, hAMYR3 BHK Cre-Luc cells were thawed, washed once in PBS (Gibco 14190-094) and seeded in 40 pL growth medium in a white 384-well culture plate (Revvity, 6007688) at a cell density of 4.0 x103(4.0E+3) cells / well the day before the experiment. The plate was incubated over night at 37 °C in 5% CO2. On the day of the assay, serial dilutions (7-fold dilutions, 7 concentrations per compound and one well containing only assay buffer) of reference compounds and GLP-1- / GIP- / amylin-receptor tri-agonists were prepared in assay buffer in 96-well plates. Serial dilutions were then mixed in a new 96-well plate with equal volume (1:1:1 ratio) of assay buffer and either assay buffer without or with 3% HSA (Sigma, A9511). Twenty microliters of the solution mix were transferred to the cells which previously were washed once with PBS (Gibco 14190-094). After a short centrifugation, the assay plates were incubated for 3 hours at 37 °C in 5% CO2and let to equilibrate at room temperature for 10 minutes before the addition of 30 pL steadylite plusTM (Revvity, 6066759) per well. Plates were sealed and incubated at room temperature with gentle shaking for 30 minutes while protected from light. Luminescence was detected on a luminescence plate reader e.g., a Synergy 2 (BioTek). The EC50-values [pM] were calculated by non-linear curve fitting applying a four-parameter logistic model (Hill slope = 1.5, shared bottom response within each plate) using GraphPad Prism (GraphPad Software, Boston, MA, USA) or by means of TIBCO Enterprise Runtime for R (TIBCO Software, Palo Alto, CA, USA). 240066W001

[3023] 219

[3024] Results:

[3025] Table 11: In vitro activity data for reference compounds on hGLP-1R, hGIPR, and hAMYR3 measured in the absence of HSA

[3026] hGLP-1R hGIPR hAMYR3

[3027] Reference

[3028] Potency, Potency Potency,

[3029] compound

[3030] no HSA, no HSA, no HSA,

[3031] no.

[3032] EC50[pM] EC50[pM] EC50[pM]

[3033] 1 1680 221 6.55

[3034] 2 627 21.2 52.0

[3035] 3 238 6.79 13.8

[3036] 4 nd 2.27 nd

[3037] 5 72.0 4.32 nd

[3038] 6 nd nd 2.37

[3039] 7 4.62 nd nd

[3040]

[3041] The results in Table 11 shows that the reference compounds 4 to 7 are agonists or co-agonists on one or two of the GLP-1 receptor, GIP receptor, and amylin receptor (hAMYR3).

[3042] According to Table 11, the activity data for reference compound 2 shows that linking the C-terminus of a potent GLP-1 / GIP co-agonist (tirzepatide), via a peptide linker, to the N-terminus of a potent amylin receptor agonist (cagrilintide) does not result in a compound that is equally potent on these three receptors and that can necessarily function as a GLP-1 - / GIP- / amylin-receptor tri-agonist (i.e., a compound according to the invention). A comparison of the reference compound 2 with the reference compound 5 (tirzepatide) and reference compound 6 (cagrilintide) illustrates this point. The reference compound 2 significantly loses potency on the GLP-1 receptor and show further some loss of potency on the amylin receptor, when compared to the original compounds, reference compounds 5 (tirzepatide) and 6 (cagrilintide).

[3043] The reference compounds 1 to 3 show a functional activation of all three receptors but have all an impaired potency on one or more of the GLP-1 -, GIP-, and amylin-receptors compared to the GLP-1 / GIP- / amylin receptor tri-agonists of the present invention. Reference compounds 1-3 are therefore not potent and balanced at all three receptors. 240066W001

[3044] 220

[3045] Table 12: In vitro activity data for the synthesized compound of the invention on hGLP-1R, hGIPR, and hAMYR3 measured in the absence of HSA

[3046] Compound hGLP-1R Potency, hGIPR Potency, hAMYR3 Potency, no. no HSA, EC50[pM] no HSA, EC50[pM] no HSA, EC50[pM] 104 24.6 4.14 8.05

[3047] 105 15.4 2.21 8.25

[3048] 106 20.7 2.98 6.77

[3049] 107 9.14 2.52 10.4

[3050] 108 19.8 2.48 13.1

[3051] 109 10.2 3.14 12.2

[3052] 110 6.36 3.57 11.1

[3053] 111 9.5 3.0 15.4

[3054] 112 19.5 2.8 16.2

[3055] 113 15.2 2.19 12.5

[3056] 114 23.5 5.8 7.8

[3057] 115 26.1 4.3 7.4

[3058] 116 13.0 3.5 8.22

[3059] 117 23.3 2.3 10.7

[3060] 118 11.1 3.8 15.5

[3061] 119 35.3 6.1 10.5

[3062] 120 25.2 2.96 7.54

[3063] 121 9.5 2.95 7.63

[3064] 122 21.0 3.73 7.68

[3065] 123 19.9 3.69 7.89

[3066] 124 21.3 3.4 15.2

[3067] 125 23.8 3.06 6.26

[3068] 126 21.7 3.38 11.0

[3069] 127 5.28 3.15 12.4

[3070] 128 43.9 6.31 7.5

[3071] 129 25.0 3.66 5.46

[3072] 130 21.2 4.05 7.24

[3073] 131 29.6 4.24 5.44

[3074] 132 29.8 3.69 5.29

[3075] 133 21.4 3.67 8.78

[3076]

[3077] 240066W001

[3078] 221

[3079] 134 27.9 3.88 7.33 135 33.6 4.86 8.3 136 34.3 4.64 10.2 137 28.3 3.71 5.1 138 19.7 2.3 5.5 139 19.0 2.1 7.1 140 28.0 3.3 10.2 141 24.2 2.53 7.64 142 26.9 3.9 6.43 143 28.8 3.89 6.16 144 20.8 2.72 8.07 145 25.0 4.15 10.2 146 34.0 2.93 6.83 147 33.6 3.06 7.12 148 25.7 2.35 6.56 149 30.8 3.14 8.86 150 23.3 2.15 7.77 151 24.1 2.37 9.48 152 20.8 2.3 8.7 153 21...

Claims

240066W001238CLAIMS1. A GLP-1- / GIP- / amylin-receptor tri-agonist comprising a peptide according to Formula I:Z1—L1—Z2 (I), comprising one lysine (Lys, K) residue; wherein:• Z1 is a peptide comprising the amino acid sequence according to Formula III (SEQ ID NO: 168):YX₂EGTFTSDYSX₁₂LLEEIAAX₂₀EFIX₂₄WLX₂₇X₂₈GX₃₀X₃₁SX₃₃X₃₄ (III), whereinX2represents Aib,X12represents Ile (I) or Lys (K),X₂₀ represents Arg (R) or Gln (Q),X24represents Ala (A), Glu (E) or Gln (Q),X27 represents Leu (L) or He (I),X₂₈ represents Ala (A) or Gln (Q),X30 represents Gly (G) or Ala (A),X31 represents Gly (G), Gin (Q), Ala (A) or Pro (P)X33represents Glu (E) or Ser (S),X34 represents Gly (G) or Glu (E);• L1 is a peptide linker; and• Z2 is a peptide comprising a C-terminal amide and Z2 comprises the amino acid sequence according to Formula VI (SEQ ID NO: 165):AX52X53LSTAX58X59X60RLSAELHX68LATX72PRTETGSGSP (VI), whereinX52 represents Gly (G) or Ser (S),X₅₃ represents Gln (Q), Glu (E), or His (H),X₅₈ represents Ala (A) or Gln (Q),X59 represents Leu (L) or Thr (T),X₆₀ represents Ala (A), Gly (G) or Gln (Q),X68represents Gln (Q), Glu (E), or Lys (K),X72 represents Leu (L) or Glu (E),or a pharmaceutically acceptable salt thereof.240066W0012392. The GLP-1- / GIP- / amylin-receptor tri-agonist according to claim 1, wherein the peptide Z1 has a maximum of 5 amino acid substitutions relative to Formula II (SEQ ID NO: 1):YX2EGTFTSDYSILLEEQAAREFIEWLLAGGPSKG (II), wherein the amino acid at position X2is Aib.

3. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding claims, wherein Z1 comprises the amino acid sequence according to Formula IV (SEQ ID NO: 169):YX2EGTFTSDYSXi2LLEEIAAREFIEWLX27AGX30X31SSG (IV), whereinX2represents Aib,X12represents Ile (I) or Lys (K),X27 represents Leu (L) or He (I),X30 represents Gly (G) or Ala (A),X31 represents Gly (G), Ala (A) or Pro (P).

4. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding claims, wherein Z2 comprises the amino acid sequence according to Formula IX (SEQ ID NO: 61):ASX53LSTAX58X59X60RLSAELHX68LATLPRTETGSGSP (IX), whereinX53represents Glu (E) or His (H),X₅₈ represents Ala (A) or Gln (Q),X59 represents Leu (L) or Thr (T),X60represents Gly (G) or Gln (Q),X68represents Gln (Q), Glu (E), or Lys (K).

5. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding claims, wherein the peptide linker L1 comprises the amino acid sequence according to Formula VIII:X41X42X43X44X45X46X47X48X49X50(VIII), whereinX41 represents Ala (A), Gly (G) or Glu (E),X42represents Glu (E), Gly (G) or is absent,X43represents Glu (E), Gly (G), Gin (Q) or absent,240066W001240X44represents Ala (A), Glu (E), Gly (G) or absent,X45 represents Glu (E), Gly (G), Pro (P) or is absent,X46represents Glu (E), Gly (G) or is absent,X47represents Gln (Q), Glu (E) or is absent,X48represents Ala (A), Glu (E) or is absent,X49 represents Glu (E), Pro (P) or is absent,X50represents Ala (A), Glu (E), Gly (G), Leu (L), Pro (P), Ser (S), Val (V) or is absent.

6. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding claims, wherein the peptide Z1 - L1 - Z2 comprises the amino acid sequence selected from the group consisting of SEQ ID NO: 170 to 252.

7. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding claims, wherein peptide Z1 - L1 - Z2 comprises the amino acid sequence selected from the group consisting of:YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAQLGRLSAELHQLAT LPRTETGSGSP (SEQ ID NO: 230), YX2EGTFTSDYSILLEEIAAREFIEWLLAGGASSGAGEAPGEAPGASHLSTAQTQRLS AELHKLATLPRTETGSGSP (SEQ ID NO: 243), YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAALGRLSAELHQLAT LPRTETGSGSP(SEQ ID NO: 244), YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASELSTAALGRLSAELHQLATL PRTETGSGSP (SEQ ID NO: 246), YX2EGTFTSDYSKLLEEIAAREFIEWLIAGAPSSGAGASELSTAALGRLSAELHELATL PRTETGSGSP (SEQ ID NO: 250), YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGGSSGAGASELSTAALGRLSAELHELAT LPRTETGSGSP (SEQ ID NO: 251), and YX2EGTFTSDYSKLLEEIAAREFIEWLLAGGPSSGAGASELSTAALGRLSAELHELAT LPRTETGSGSP (SEQ ID NO: 252), wherein in each X2is Aib.

8. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of the preceding claims, further comprising a protraction moiety.

9. The GLP-1- / GIP- / amylin-receptor tri-agonist according to claim 8, wherein the protraction moiety comprises a protractor P being a C12-C20 diacid.240066W00124110. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of claims 8-9, wherein the protraction moiety further comprises a linker LP.

11. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of claims 8-10, wherein the protraction moiety is selected from the group consisting of:wherein R1 is the point of attachment of the protraction moiety to the epsilon amino group of the lysine (Lys, K) in the peptide Z1 - L1 - Z2.

12. A GLP-1- / GIP- / amylin-receptor tri-agonist selected from the group consisting of Compound 104:240066W001242Compound 105:Compound 107:240066W001243Compound 111:Compound 112:240066W001244Compound 113:240066W00124513. A pharmaceutical composition comprising a GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of claims 1-12, and one or more pharmaceutically acceptable excipients.

14. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of claims 1-12 or the pharmaceutical composition according to claim 13 for use as a medicament.

15. The GLP-1- / GIP- / amylin-receptor tri-agonist according to any one of claims 1-12 or the pharmaceutical composition according to claim 13, for use in the treatment of type 2 diabetes, obesity, metabolic dysfunction-associated steatohepatitis (MASH), and / or cardiovascular disease.

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