W O 2016/028826 A1 25 February 2016 (25.02.2016) W IPO I PCT
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(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date W O 2016/028826 A1 25 February 2016 (25.02.2016) W IPO I PCT (51) International Patent Classification: (74) Agents: SWISS, Gerald F. et al.; Foley & Lardner, LLP, A61K38/22 (2006.01) 3579 Valley Centre Drive, Suite 300, San Diego, Califor (21) International Application Number: nia 92130 (US). PCT/US2015/045777 (81) Designated States (unless otherwise indicated,for every ) .a kind of national protection available): AE, AG, AL, AM, (22) International Filng Date: AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, 18 August 2015 (18.08.2015) BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, (25) Filing Language: English DO, DZ, EC, EE, EG, ES, Fl, GB, GD, GE, GH, GM, GT, HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, (26) Publication Language: English KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, (30) Priority Data: MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, 62/039,358 19 August 2014 (19.08.2014) US PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, 62/046,748 5 September 2014 (05.09.2014) US SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, 62/050,690 15 September 2014 (15.09.2014) US TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. 62/057,181 29 September 2014 (29.09.2014) US (84) Designated States (unless otherwise indicated,for every 62/057,184 29 September 2014 (29.09.2014) US kind of regional protection available): ARIPO (BW, GH, 62/063,897 14 October 2014 (14.10.2014) US GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, 62/108,948 28 January 2015 (28.01.2015) US TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, 62/118,423 19 February 2015 (19.02.2015) US TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, 62/192,448 14 July 2015 (14.07.2015) US DK, EE, ES, Fl, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, 62/201,530 5 August 2015 (05.08.2015) US LV, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, (71) Applicant: OXEIA BIOPHARMACEUTICALS, INC. SM, TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, [US/US]; 12463 Carmel Park Drive, San Diego, California GW, KM, ML, MR, NE, SN, TD, TG). 92130 (US). Published: (72) Inventors: SHAH, Kartik Kiran; c/o Oxeia Biopharma- with internationalsearch report (Art. 21(3)) ceuticals, Inc., 12463 Carmel Park Drive, San Diego, Cali fornia 92130 (US). MUNSHI, Amit Dilip; c/o Oxeia Bio- before the expiration of the time limit for amending the pharmaceuticals, Inc., 12463 Carmel Park Drive, San claims and to be republished in the event of receipt of Diego, California 92130 (US). amendments (Rule 48.2(h)) (54) Title: METHODS OF TREATING MILD BRAIN INJURY (57) Abstract: The present disclosure provides methods for treating mild brain injury and other neurological disorders in a subject in f4 need thereof, comprising administering to the subject an effective amount of a compound comprising a ghrelin or ghrelin variant. This invention provides for methods for treating a mild brain injury or concussion in a patient wherein said method comprises ad ministering to the subject in need thereof suffering from said mild brain injury or concussion an effective amount of a ghrelin variant or a composition comprising a ghrelin variant so as to treat said mild brain injury or concussion. WO 2016/028826 PCT/US2015/045777 METHODS OF TREATING MILD BRAIN INJURY CROSS-REFERENCE TO RELATED APPLICATION [0001] This application claims benefit of priority to U.S. Provisional Application No. 62/039,358, filed August 19, 2014, U.S. Provisional Application No. 62/046,748, filed September 05, 2014, U.S. Provisional Application No. 62/050,690, filed September 15, 2014, U.S. Provisional Application No. 62/057,181, filed September 29, 2014, U.S. Provisional Application No. 62/057,184, filed September 29, 2014, U.S. Provisional Application No. 62/063,897, filed October 14, 2014, U.S. Provisional Application No. 62/108,948, filed January 28, 2015, U.S. Provisional Application No. 62/118,423, filed February 19, 2015, U.S. Provisional Application No. 62/192,448, filed July 14, 2015, U.S. Provisional Application No. 62/201,530, filed August 5, 2015, the disclosures of each of which are incorporated herein by reference in their entireties. FIELD OF THE INVENTION [0002] The present disclosure provides methods for treating mild brain injuries, concussion, and other neurological disorders arising from such an injury in a subject in need thereof by administering to the subject an effective amount of a composition comprising a ghrelin variant. BACKGROUND [0003] Mild brain injuries (mBI), typically including concussions, having "your bell rung", and the like, describe an insult to the brain that, in turn, can cause long term injury to the brain. It most often occurs from direct contact to the head, but can also result from indirect injury (e.g., whiplash injury or violent shaking of the head). Individuals who have suffered one brain injury are more at risk for a second brain injury and more susceptible for subsequent injuries. The damage from successive mBIs is cumulative (Cantu, R. C, Second-impact syndrome, Clinics in Sports Medicine, 17(l):37-44, 1998). [0004] The long term damage arising from mBI include cognitive and motor skill deterioration such as psychomotor slowing, poor concentration and attention retrieval resulting in increased 1 WO 2016/028826 PCT/US2015/045777 variability of performance, and overall executive dysfunction (Stuss et al., Adult Clinical Neuropsychology: Lessons from Studies of the Frontal Lobes, Annual Review of Psychology, 53, 401-433 (2003)). Common examples of the long term effect of mBI are found in soldiers, boxers, football players, soccer players, and the like. Well documented examples are individuals who, long after the occurrence of the mBl(s), begin to manifest the cumulative damage to the brain by loss of one or more cognitive skills and/or motor skills. [0005] The difference between mBI and other brain diseases is that mBI is caused by one or more injuries as opposed to a disease. In the former case, the injuries to the brain cannot be attributed to an underlying pathology but, rather, are the results of the injuries. [0006] Ghrelin is a neuroendocrine hormone that acts as an endogenous ligand for growth hormone secretagogue receptor. It is a 28-amino acid and an endogenously produced peptide predominantly secreted by gastric mucosa. It has been referred to as the "hunger hormone," due to its well-studied effects on appetite, but it also is believed to play a significant role in regulating the distribution and rate of use of energy. [0007] Regardless, the majority of brain injuries is considered mild in nature and arise from non-disease related phenomena. To date, there has been little to no credible treatment of such mild brain injuries (mBI). Thus, there is a significant unmet need for a therapy for treating mBI that does not impose undesirable costs and delays and are effective. As provided below, this invention is predicated upon the discovery of a profound and surprising effect of ghrelin variants and analogs in the treatment of mBl. Such treatments can be easily administered without delays for individuals suffering from mBI to ensure that they are capable of performing certain tasks safely without risk to themselves or others. SUMMARY OF THE INVENTION [0008] This invention provides for methods for treating a mild brain injury or concussion in a patient wherein said method comprises administering to the subject in need thereof suffering from said mild brain injury or concussion an effective amount of a ghrelin variant or a 2 WO 2016/028826 PCT/US2015/045777 composition comprising a ghrelin variant so as to treat said mild brain injury or concussion. In one embodiment, the ghrelin variant is administered in a non-endogenous carrier. [0009] In some embodiments, the ghrelin variants can be a sequence that includes any of a number of modifications to the wild type ghrelin sequence, which comprises a polypeptide having an amino acid sequence of Gly-Ser-Ser-Phe-Leu-Ser-Pro-Glu-His-Gln-Arg-Val-Gln-Gln Arg-Lys-Glu-Ser-Lys-Lys-Pro-Pro-Ala-Lys-Leu-Gln-Pro-Arg (SEQ ID NO. 1). Non-limiting examples of potential modifications include modifying the length (shorter or longer) of the sequences, modifying the chemistry of the amino acids, substituting one or more of the amino acids with another amino acid, a synthetic amino acid or otherwise rare or non-naturally occurring amino acid, introducing protecting groups at the N and/or C termini, etc. In some embodiments, the polypeptide is modified with one or more fatty acids. In some embodiments, the fatty acid is an octanoic acid. In some embodiments, the polypeptide is modified at serine at amino acid position 2 and/or serine at amino acid position 3 of SEQ ID No. 1. [0010] For example, in some embodiments, the ghrelin variants include C-C 20 acylation of the carboxyl group of one or both of the glutamic acid residues or of the C-terminus arginine group. In other embodiments, ghrelin variants include C-C2 0 acylation of one or more of the hydroxyl groups of the serine residues. Yet, in other embodiments, ghrelin variants include replacing one or more of the L-amino acids with a D-amino acid.