BIFUNCTIONAL COMPOUNDS

TECHNICAL FIELD OF THE INVENTION

The present invention relates to bi-functional compounds which inhibits PCSK9 and stimulates the GLP-1 receptor and their pharmaceutical use.

BACKGROUND

High LDL-C (Low Density Lipoprotein cholesterol) levels and dyslipidaemia are well- recognised drivers of cardiovascular disease.

Statins have been approved for the treatment of dyslipidemia for 25 years. This class has demonstrated substantial and consistent reduction of cardiovascular events with an acceptable safety profile. The best-selling statin, atorvastatin (Lipitor™) was the world's best-selling drug of all time, with more than $125 billion in sales from 1996 to 2012.

Despite the availability and widespread use of statins and other lipid lowering agents, many patients do not reach their target LDL-C levels and remain at high risk for developing cardiovascular disease. PCSK9 (Proprotein Convertase Subtilisin/Kexin type 9) promotes hepatic LDL-R (LDL receptor) degradation, thereby reducing hepatic LDL-R surface expression and consequently clearance of LDL particles. Conversely, blocking PCSK9 increase the clearance of LDL-C as well as other atherogenic lipoproteins. Indeed, LDL receptors contribute to the clearance of atherogenic lipoproteins other than LDL, such as intermediate-density lipoproteins and remnant particles. Increased intermediate-density lipoproteins and remnant particle clearance may have therapeutic benefits beyond that provided by LDL reduction.

Statins increase the expression of both LDL-R and PCSK9 via the SREBP2 transcription factor. The increased expression of PCSK9 may diminish the effect of statins on LDL-C clearance from the circulation. By inhibiting the binding of PCSK9 to the LDL-R and thereby preventing LDL-R degradation the efficacy of statins is enhanced. Taken together, PCSK9 inhibition offers a novel approach to lipid management.

The EGF(A) (Epidermal Growth Factor-like domain A) sequence (40 amino acids) of the LDL-R (LDL-R-(293-332)) is well recognized as the site for PCSK9 binding. The isolated wild-type EGF(A) peptide has been shown to inhibit the binding of PCSK9 to the LDL-R with an IC ₅₀ in the low μΜ range (Biochemical and Biophysical Research Communications 375 (2008) 69-73). This poor potency will prevent a practical pharmaceutical use of the EGF(A) peptide. Furthermore, the half-life of such peptides would be expected to be too short to be of therapeutic use. WO2012177741 and J. Mol. Biol. (2012) 422, 685-696 disclose analogues of the EGF(A) and Fc-Fusion thereof.

Two anti-PCSK9 antibodies, alirocumab/Praluent ^® and evolocumab/Repatha ^® , have recently been approved for the treatment of high LDL-C levels. These are administered by 1 ml subcutaneous injections every two weeks.

In WO 2015/127273 the fusion of an anti-PCSK9 antibody and a GLP-1 agonist is explored seeking to combine the functionalities of GLP-1 and the anti-PCSK9 antibody.

Multiple treatments are available for treatment of diabetes and cardiovascular diseases, but combination of multiple individual drugs are not always attractive and a single molecule addressing both disease states would be desirable to improve treatment, such as efficacy, compliance and convenience.

SUMMARY

The present invention relates to EGF(A) analogues with the ability to inhibit PCSK9 binding to LDL-R and thereby reducing LDL cholesterol. Such molecules may be combined with GLP-1 receptor agonists forming bi-functional molecules providing further treatment options, addressing both diabetes and cardiovascular diseases by one drug. The invention in an aspect relates to a compound comprising a GLP-1 agonist and a PCSK9 inhibitor.

An aspect of the invention relates to a compound comprising a GLP-1 analogue and an EGF(A) analogue, wherein

i. said GLP-1 analogue is an analogue of GLP-1 (7-37) identified by SEQ ID No: 137 and

ii. said EGF(A) analogue is an analogue of the EGF(A) domain of LDL-R (293-332) identified by SEQ ID No:1 .

Such compounds may in an embodiment comprise a fusion polypeptide comprising the two analogues optionally linked by a spacer peptide inserted between the two analogues.

The compounds may further comprise a half-life extending moiety, which may be referred to as a substituent attached to an amino acid residue of one of the GLP-1 analogue, the EGF(A) analogue or the spacer. In one embodiment the compound comprise one or two substituents attached to different amino acid residues of the fusion polypeptide.

In further aspects the invention relates to a pharmaceutical composition comprising a compound of the invention as well as medical use of compounds of the invention. DESCRIPTION

The present invention relates to bi-functional compounds stimulating the GLP-1 receptor and inhibiting PCSK9. In order to prepare compounds of pharmaceutical relevance modification to the wild-type peptides is required both in order to improve functionality and to enable convenient administration.

An aspect of the invention relates to compound comprising a GLP-1 receptor agonist and a PCSK9 inhibitor. Several GLP-1 receptor agonists are known in the art and may be combined with various PCSK9 inhibitors. As described herein the GLP-1 receptor agonist may be analogues of human GLP-1 (7-37) (SEQ ID No: 137) or such as Extendin 4 and analogues hereof also known to function as a GLP-1 receptor agonist.

PCSK9 inhibitors are known in the form of antibodies, while the present application is primarily concerned with PCSK9 inhibitors in the form of analogues of the EGF(A) domain of LDL-R (293-332) (SEQ ID NO: 1 ).

An aspect of the invention relates to a compound comprising a GLP-1 analogue and an EGF(A) analogue, wherein said GLP-1 analogue is an analogue of GLP-1 (7-37) (SEQ ID No: 137) and said EGF(A) analogue is an analogue of the EGF(A) domain of LDL-R (293- 332) (SEQ ID NO: 1 ).

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 polypeptide 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 forms hereof, i.e. the invention relates to a compound as defined herein or a pharmaceutically acceptable salt, amide, or ester thereof.

The term "peptide" or "polypeptide", as e.g. used in the context of the invention, refers to a compound which comprises a series of amino acids interconnected by amide (or peptide) bonds. In a particular embodiment the peptide consists of amino acids

interconnected by peptide bonds.

The terms "fusion" and "fused" are used in relation to polypeptides comprising two individually defined peptide sequences which are connected by a peptide bond or by a peptide spacer (also connected by peptide bonds). A fusion polypeptide is thus a continuous stretch of amino acid residues connected by peptide bonds.

The term "analogue" generally refers to a peptide, the sequence of which has one or more amino acid changes when compared to a reference amino acid sequence. Analogues "comprising" certain specified changes may comprise further changes, when compared to their reference sequence. In particular embodiments, an analogue "has" or "comprises" specified changes. In other particular embodiments, an analogue "consists of" the changes. When the term "consists" or "consisting" is used in relation to an analogue e.g. an analogue consists or consisting of a group of specified amino acid substitutions, it should be understood that the specified amino acid substitutions are the only amino acid substitutions in the analogue. In contrast an analogue "comprising" a group of specified amino acid substitutions may have additional substitutions. An "analogue" may also include amino acid elongations in the N-terminal and/or C-terminal positions and/or truncations in the N-terminal and/or C-terminal positions.

In general amino acid residues may be identified by their full name, their one-letter code, and/or their three-letter code. These three ways are fully equivalent.

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

The term "amino acid" includes proteinogenic (or natural) amino acids (amongst those the 20 standard amino acids), as well as non-proteinogenic (or non-natural) amino acids. Proteinogenic amino acids are those which are naturally incorporated into proteins. The standard amino acids are those encoded by the genetic code. Non-proteinogenic amino acids are either not found in proteins, or not produced by standard cellular machinery (e.g., they may have been subject to post-translational modification). Non-limiting examples of non- proteinogenic amino acids are Aib (a-aminoisobutyric acid, or 2-aminoisobutyric acid), norleucine, norvaline as well as the D-isomers of the proteinogenic amino acids.

In what follows, each amino acid of the peptides of the invention for which the optical isomer is not stated is to be understood to mean the L-isomer (unless otherwise specified).

GLP-1 analogue

The present invention relates to compounds comprising a glucagon-like peptide 1 (GLP-1 ) analogue. The term "GLP-1 analogue" as used herein refers to an analogue (or variant) of the human glucagon-like peptide-1 (GLP-1 (7-37)), the sequence of which is included in the sequence listing as SEQ ID NO: 137. The peptide having the sequence of SEQ ID NO: 137 may also be designated "native" or wild-type GLP-1 .

The numbering of amino acid residues (such as "position 8") in the GLP-1 analogues of the invention follows the established practice in the art for native GLP-1 , namely that the first (N-terminal) amino acid residue is numbered or accorded position no. 7, and the subsequent amino acid residues downstream towards the C-terminus are numbered 8, 9, 10, and so on, until the last (C-terminal) amino acid residue. In native GLP-1 the C- terminal amino acid residue is Gly, with number 37.

The numbering is done differently in the sequence listing, where the first amino acid residue of SEQ ID NO: 137 (His) is assigned no. 1 , and the last (Gly) no. 31. However, herein we follow the established numbering practice in the art, as explained above.

GLP-1 analogues are known in the art and several GLP-1 analogues are supplied to the market for treatment of type 2 diabetes and obesity. GLP-1 analogues are, as described above, variants of the wt human GLP-1 sequence and thus comprise one or more amino acid substitution, deletion and/or addition compared to SEQ ID NO. 137.

Each of the GLP-1 analogues may be described by reference to i) the number of the amino acid residue in native GLP-1 (7-37) which corresponds to the amino acid residue which is changed (i.e., the corresponding position in native GLP-1 ), and to ii) the actual change.

In other words, the GLP-1 analogue of the invention may be described by reference to the native GLP-1 (7-37) peptide, namely as a variant thereof in which a number of amino acid residues have been changed when compared to native GLP-1 (7-37) (SEQ ID NO: 137).

These changes may represent, independently, one or more amino acid

substitutions, additions, and/or deletions.

The following is a non-limiting example of suitable analogue nomenclature. The GLP-1 analogue incorporated as GLP-1 analogue # 2 (SEQ ID NO: 139) and included in compound # 1 , may be referred to as (8Aib, 34R)GLP-1 (7-37).

When this analogue is aligned with native GLP-1 , the amino acid at the position in the analogue which corresponds, according to the alignment, to position 8 in native GLP-1 is Aib and the amino acid at the position in the analogue which corresponds to position 34 in native GLP-1 is R, while all other amino acids in this analogue are identical to the

corresponding amino acid in native GLP-1 .

Analogues "comprising" certain specified changes may comprise further changes, when compared to wt GLP-1 (SEQ ID NO: 137). In contrast the term "consisting" is used to refer to particular embodiment, where the analogue only has the specified changes i.e. there are no further changes in the GLP-1 analogue when compared to wt GLP-1 (SEQ ID NO: 137). By refereeing back to the example above the GLP-1 analogue # 2 (SEQ ID NO: 139) may be said to be a GLP-1 analogue wherein the substitutions consists of 8Aib and 34R, or for short at GLP-1 analogue consisting of 8Aib and 34R. The expressions "a position equivalent to" or "corresponding position" is used herein to characterise the site of change in a variant GLP-1 (7-37) sequence by reference to a reference sequence such as native GLP-1 (7-37) (SEQ ID NO: 137). Equivalent or corresponding positions, as well as the number of changes, are easily deduced, e.g. by simple handwriting and visual inspection; and/or a standard protein or peptide alignment program may be used, such as "align" which is based on a Needleman-Wunsch algorithm. This algorithm is described in Needleman, S.B. and Wunsch, CD., (1970), Journal of Molecular Biology, 48: 443-453, and the align program by Myers and W. Miller in "Optimal Alignments in Linear Space" CABIOS (computer applications in the biosciences) (1988) 4:1 1 - 17. For the alignment, the default scoring matrix BLOSUM62 and the default identity matrix may be used, and the penalty for the first residue in a gap may be set at -12, or preferably at -10, and the penalties for additional residues in a gap at -2, or preferably at -0.5.

An example of such alignment is inserted below of native GLP-1 of SEQ ID NO: 137 and the analogue thereof identified by SEQ ID NO: 139:

#=======================================

# Aligned sequences: 2

# 1: SEQ ID NO 137

# 2: SEQ ID NO _139

# Matrix: EBLOSUM62

# Gap penalty: 10.0

# Extend penalty: 0.5

#

# Length: 31

# Identity : 29/31 (93. .5%)

# Similarity : 30/31 (96. .8%)

# Gaps : 0/31 ( o . .0%)

# Score: 154.0 #

SEQ_ID_NO_137 1 HAEGTFTSDVSSYLEGQAAKEFIAWLVKGRG 31

I · I I I I I I I I I I I I I I I I I I I I I I I I I . I I I

SEQ ID NO 139 1 HXEGTFTSDVSSYLEGQAAKEFIAWLVRGRG 31 When 6 is added to the position numbers shown in this alignment (e.g. to "1 " and "31 " in SEQ ID NO 137) one gets the position numbering as used herein. For example, in wt GLP-1 (which is identical to SEQ ID NO: 137), the N-terminal amino acid (H) has position number 7, and the C-terminal amino acid (G) has number 37. Regarding GLP-1 analogue #2 (SEQ ID NO 139), the N-terminal amino acid (H) has number 7 and the C-terminal amino acid (G) has number 37 as for wt GLP-1 while residues 2 and 28 are substituted and numbered 8 and 34 respectively.

In case specific amino acid residues or the like with no one-letter codon (such as 2- Amino-2-methylpropanoic acid (Aib) are included in the sequence these may, for alignment purposes, be replaced with, e.g., X. If desired, X can later be manually corrected.

The following are non-limiting examples of what can be inferred from the above alignment:

As an example it can be inferred that sequence 2 has 2 amino acid changes as compared to sequence 1 (namely at all those positions where a full stop ("."), a colon (":"), or a horizontal hyphen ("-") is shown in the alignment).

In what follows, all amino acids of the GLP-1 analogue of the invention for which the optical isomer is not stated is to be understood to mean the L-isomer (unless otherwise specified).

In one embodiment the GLP-1 analogue of the invention is an analogue of GLP-1 (7- 37) consisting of 26 to 36 amino acid residues.

In one embodiment GLP-1 analogue has at most 10 amino acid substitutions compared to human GLP-1 (7-37). In further embodiments GLP-1 analogue has at most 8, such as at most 7, 6, 5, 4, 3 or 2 amino acid substitutions compared to human GLP-1 (7-37.) A wealth of GLP-1 analogues has previously been described as well as their function as GLP-1 receptor agonists.

The wt GLP-1 peptide of SEQ ID NO: 137 comprise two Lys residues in positions 26 and 34. As seen herein below the Lys residues are particular relevant when compounds comprising a substituent attached via Lys residues are to be prepared.

In one embodiment the GLP-1 analogue according to the invention comprises zero, one or two Lys residues. In one embodiment the GLP-1 analogue comprises one or two Lys residues which are selected from the wt Lys residues and Lys residues introduced to the GLP-1 analogue by amino acid substitution. A Lys residue introduced by amino acid substitution may be referred to as an additional Lys residue. In one embodiment the GLP-1 analogue comprises an additional Lys residue. An additional Lys may be introduced in various positions in the GLP-1 analogue, such as in one or more positions selected from position 12, 21 , 23, 24, 25, 27, 30, 31 , 32, 33 and 36K. In one embodiment the GLP-1 analogue comprises an additional Lys selected from the group of: 12K, 21 K, 23K, 24K, 25K, 27K, 30K, 31 K, 32K, 33K and 36K.

In one embodiment the GLP-1 analogue comprises one or two Lys residue selected from the group consisting of: 12K, 21 K, 23K, 24K, 25K, 26K, 27K, 30K, 31 K, 32K, 33K, 34K and 36K.

In one embodiment the GLP-1 analogue comprises one or two Lys residue selected from the group consisting of: 21 K, 23K, 24K, 25K, 26K, 27K, 30K, 31 K, 32K, 33K and 34K.

In one embodiment the GLP-1 analogue comprises exactly two Lys residue selected from the group consisting of: 12K, 21 K, 23K, 24K, 25K, 26K, 27K, 30K, 31 K, 32K, 33K, 34K and 36K.

In one embodiment the GLP-1 analogue comprises exactly two Lys residue selected from the group consisting of: 21 K, 23K, 24K, 25K, 26K, 27K, 30K, 31 K, 32K, 33K and 34K.

In one embodiment the GLP-1 analogue comprises exactly two Lys residues selected from the pairs of:

a) 21 K and 26K

b) 23K and 26K

c) 24K and 26K

d) 25K and 26K

e) 27K and 26K

f) 30K and 26K

g) 31 K and 26K

h) 32K and 26K

i) 33K and 26K

j) 34K and 26K

In one embodiment the GLP-1 analogue comprises the Lys residues 26K and 34K.

In one embodiment the GLP-1 analogue comprises exactly one Lys residue selected from: 12K, 21 K, 23K, 24K, 25K, 26K, 27K, 30K, 31 K, 32K, 33K, 34K and 36K.

In one embodiment the GLP-1 analogue comprises exactly one Lys residue selected from: 21 K, 23K, 24K, 25K, 26K, 27K, 30K, 31 K, 32K, 33K and 34K.

In one embodiment the GLP-1 analogue comprises exactly one Lys residue selected from: 21 K, 23K, 24K, 25K, 26K 27K 30K.

In one embodiment the GLP-1 analogue comprises exactly one Lys residue which is

26K. In one embodiment the GLP-1 analogue comprises a substitution or deletion of one or both of 26K and 34K. In one embodiment the GLP-1 analogue does not comprise 26K. In one embodiment the GLP-1 analogue comprises a deletion of 26K. In one embodiment the GLP-1 analogue comprises an amino acid substitution of 26K. In one embodiment the GLP-1 analogue comprises 26R.

In one embodiment the GLP-1 analogue does not comprise 34K. In one

embodiment the GLP-1 analogue comprises a deletion of 34K. In one embodiment the GLP- 1 analogue comprises an amino acid substitution of 34K. In one embodiment the GLP-1 analogue comprises 34R or 34Q.

As mentioned above the GLP-1 analogue according to the invention is similar in length to wt GLP-1. In one embodiment the GLP-1 analogue comprises at least 26, such as at least 28 or at least 30 amino acid residues. In one embodiment the GLP-1 analogue comprises at least 31 , such as at least 32 or at least 33 amino acid residues

In one embodiment the GLP-1 analogue has a deletion of 1-5 amino acids at the C- terminal. In one embodiment the GLP-1 analogue comprises a deletion of AA 35-37, AA 34- 37 or AA 33-37.

In one embodiment the GLP-1 analogue comprises 33L.

As mentioned above the GLP-1 analogue may comprise one or more amino acid substitutions compared to wt GLP-1 , such as at most 5 amino acid substitutions, such as at most 4 amino acid substitutions, such as at most 3 amino acid substitutions.

In one embodiment the GLP-1 analogue has at least 75 % identity, such as 80 %, such as 85, such as 90 or even 95 % identity to SEQ ID NO.: 127 corresponding to up to 7, 6, , 4 , 3 and 1 amino acid substitutions relative to SEQ ID NO 1 , respectively in case of no truncation.

In addition or in alternative to an additional Lys residues introduced by amino acid substitution the GLP-1 analogue may comprise one or more amino acid substitution, substituting a wt residue with a different amino acid residue.

In one embodiment the GLP-1 analogue comprises an amino acid substitution of 8A, such as a substitution of 8A to 8G or 8W, which may also be referred to as A8G and A8W.

In one embodiment the GLP-1 analogue comprises an amino acid substitution of 8A, such as a substitution of 8A to a non-proteogenic amino acid residue, such as Aib.

In one embodiment the GLP-1 analogue comprises an amino acid substitution of 8A to G, W or the non-proteogenic amino acid residue Aib. In one embodiment the GLP-1 analogue comprises one or more amino acid substitutions selected from amino acid substitutions in position 8, 12, 21 , 23, 24, 25, 26, 27,

29, 30, 31 , 32, 33, 34 and 36.

In one embodiment the GLP-1 analogue comprises one or more amino acid substitutions selected from amino acid substitutions in position 8, 21 , 23, 24, 25, 26, 27, 29,

30, 31 , 32, 33 and 34.

In one embodiment the GLP-1 analogue comprises one or more amino acid substitutions selected from amino acid substitutions in position 8, 21 , 23, 24, 25, 27, 29, 30,

31 , 32 or 33. In one embodiment the wt amino acid residue in position 8, 21 , 23, 24, 25, 27, 29, 30, 31 , 32 or 33 is substituted by a G, V, A, T, L or I residues.

In one embodiment the GLP-1 analogue comprises substitutions of 8A and 34K.

In one embodiment the GLP-1 analogue comprises 8Aib and 34R. In one embodiment the GLP-1 analogue comprises 8Aib and 34R and a substitution in a position selected from the positions 21 , 23, 24, 25, 27, 29, 30, 31 , 32 and 33.

In one embodiment the GLP-1 analogue comprises 8Aib and 34R. In one embodiment the GLP-1 analogue comprises 8Aib and 34R and a substitution in a position selected from the positions 21 , 23, 24, 25, 27, 29, 30, 31 , 32 and 33, wherein the substitution in position 21 , 23, 24, 25, 27, 29, 30, 31 , 32 or 33 is a G, V, A, T, L or I residue.

In one embodiment the GLP-1 analogue comprises one or two Lys residues and a group of substitutions selected from:

a) 8Aib, 21 G k) 8Aib, 31 G

b) 8Aib, 23G I) 8Aib, 32 A

c) 8Aib, 24G m) 8Aib, 32G

d) 8Aib, 24V n) 8Aib, 32I

e) 8Aib, 25G o) 8Aib, 32T

f) 8Aib, 25V p) 8Aib, 32V

g) 8Aib, 27G q) 8Aib, 33G

h) 8Aib, 29A, r) 8Aib, 33I and

i) 8Aib, 29V s) 8Aib, 33L

j) 8Aib, 30G t) 8Aib

In one embodiment the GLP-1 analogue comprises one or two Lys residues and a group of substitutions selected from;

a) 8Aib, 21 G j) 8Aib, 31 G

b) 8Aib, 23G k) 8Aib, 32 A c) 8Aib, 24G I) 8Aib, 32I

d) 8Aib, 24V m) 8Aib, 32T

e) 8Aib, 25G n) 8Aib, 32V

f) 8Aib, 25V o) 8Aib, 33G

g) 8Aib, 27G p) 8Aib, 33I and

h) 8Aib, 29V q) 8Aib, 33L

i) 8Aib, 30G r) 8Aib

In one embodiment, such GLP-1 analogue comprises one or two Lys residues as described herein above, such as 26K and/or 34K, or such as 26K and/or a Lys introduced by substitution together with K34R.

In one embodiment, the GLP-1 analogue has the sequence defined by SEQ ID NO 87: H-X8-E-G-T-X12-T-S-D-V-S-S-Y-L-X21-G-X23-X24-X25-X26-X27-F-X 29-X30-X31-X32-X33-X34- X35-X36-X37 wherein

X ₈ is A, G, W or Aib,

X ₁₂ F or K

X ₂₃ is Q, G or K

X ₂₄ is A, G, V or K

X ₂₅ is A, G, V or K

X ₂₆ is K or R

X ₂₇ is E, G or K

X ₂₉ is I, A or V

X ₃₀ is A, G or K

X ₃₂ is L, G, T, V, I or K

X33 is V, G, I, L, K or absent

X34 is K, R, Q or absent

X35 is G or absent

X36 is R, K or absent

X37 is G or is absent.

In one embodiment, the GLP-1 analogue has the sequence defined by SEQ ID NO

187i H-X8-E-G-T-Xi2-T-S-D-V-S-S-Y-L-X21-G-X23-X24-X ₂ 5-X26-X27-F-X29-X30-X31-X32-X33-X34"

X35-X36-X37 wherein X ₈ is A, G, W or Aib,

X ₂₃ is Q, G or K

X ₂₄ is A, G, V or K

X ₂₅ is A, G, V or K

X ₂₆ is K or R

X ₂₇ is E, G or K

X ₃₀ is A, G or K

X ₃₂ is L, G, T, V, I or K

X ₃₃ is V, G, I, L, K or absent

X ₃₄ is K, R, Q or absent

X35 is G or absent

X ₃ 6 is R, K or absent

X37 is G or is absent.

In one embodiment, the GLP-1 analogue has the sequence defined by SEQ ID NO 187: H-X8-E-G-T-X12-T-S-D-V-S-S-Y-L-X21-G-X23-X24-X25-X26-X27-F-X 29-X30-X31-X32-X33-X34- X35-X36-X37 wherein

X ₈ is A, G, W or Aib,

X ₂₃ is Q, G or K

X ₂₄ is A, G, V or K

X ₂₅ is A, G, V or K

X ₂₆ is K or R

X ₂₇ is E, G or K

X ₂₉ is I, A or V

X ₃₀ is A, G or K

X ₃₂ is L, T, V, I or K

X33 is V, G, I, L, K or absent

X34 is K, R, Q or absent X35 is G or absent

X ₃ 6 is R, K or absent

X37 is G or is absent. In one embodiment, the GLP-1 analogue has the sequence defined by SEQ ID NO

187 ! H-X8-E-G-T-X12-T-S-D-V-S-S-Y-L-X21-G-X23-X24-X25-X26-X27-F-X 29-X30-X31-X32-X33-X34- X35-X36-X37 wherein

X ₈ is A, G, W or Aib,

X33 is V, G, I, L, K or absent

X34 is K, R, Q or absent

X35 is G or absent

X36 is R, K or absent

X37 is G or is absent.

As seen, the Examples herein comprise more than 40 GLP-1 analogues which are also envisioned in the context of a compound comprising both a GLP-1 analogue and a EGF(A) analogue. These analogues are identified in the table below, wherein the amino acid changes compared to wt residues (as described herein above) are shown together with the Lys residue(s) present in the analogue.

GLP-1 analogue * GLP-1 analogues Lys residues SEQ ID

Wt 26 K, 34 K 137

1 8Aib 26 K, 34 K 138

2 8Aib, 34R 26K 139

3 8G, 34R 26K 140 GLP-1 analogue * GLP-1 analogues Lys residues SEQ ID

4 8W, 34R 26K 141

5 8Aib, 34Q 26K 142

6 8Aib, des(32-37) 26K 143

7 8Aib, des(33-37) 26K 144

8 8Aib, des(34-37) 26K 145

9 8Aib, 34R, des(35-37) 26K 146

10 8Aib, 12K, 26R, 34R 12K 147

1 1 8Aib, 21 K, 26R, 34R 21 K 148

12 8Aib, 24K, 26R, 34R 24K 149

13 8Aib, 25K, 26R, 34R 25K 150

14 8Aib, 26R, 27K, 34R 27K 151

15 8Aib, 26R, 31 K, 34R 31 K 152

16 8Aib, 26R, 32K, 34R 32 K 153

17 8Aib, 26R, 34R, 36K 36K 154

18 8Aib, 21 G, 34R 26K 155

19 8Aib, 23G, 34R 26K 156

20 8Aib, 24G, 34R 26K 157

21 8Aib, 24V, 34R 26K 158

22 8Aib, 25G, 34R 26K 159

23 8Aib, 25V, 34R 26K 160

24 8Aib, 27G, 34R 26K 161

25 8Aib, 29A, 34R 26K 162

26 8Aib, 29V, 34R 26K 163

27 8Aib, 30G, 34R 26K 164

28 8Aib, 31 G, 34R 26K 165

29 8Aib, 32A, 34R 26K 166

30 8Aib, 32G, 34R 26K 167

31 8Aib, 32I, 34R 26K 168

32 8Aib, 32T, 34R 26K 169

33 8Aib, 32V, 34R 26K 170

34 8Aib, 33G, 34R 26K 171

35 8Aib, 33I, 34R 26K 172

36 8Aib, 33L, 34R 26K 173 GLP-1 analogue * GLP-1 analogues Lys residues SEQ ID

37 8Aib, 21 K, 34R 21 K, 26K 174

38 8Aib, 23K, 34R 23K, 26K 175

39 8Aib, 24K, 34R 24 K, 26 K 176

40 8Aib, 25K, 34R 25K, 26K 177

41 8Aib, 27K, 34R 27K, 26K 178

42 8Aib, 30K, 34R 30K, 26K 179

43 8Aib, 31 K, 34R 31 K, 26K 180

44 8Aib, 32K, 34R 32 K, 26 K 181

45 8Aib, 33K, 34R 33K, 26K 182

46 8Aib, 26R, 34R - 183

47 8Aib, 23K, 26R, 34R 23K 184

48 8Aib, 26R, 30K, 34R 30K 185

49 8Aib, 26R, 33K, 34R 33K 186

50 H-X8-E-G-T-X12-T-S-D-V-S-S-Y-L- 187

X21 -G-X23-X24-X25-X26-X27-F-X29- X30-X31 -X32-X33-X34-X35-X36-X37

In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 138-186.

In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 138-142 and 144-186.

In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 138-142 and 144-166, 168, 169-186.

In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 138-142 and 144-161 , 163- 166, 168, 169-186.

In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 138-142 and 145-161 , 163- 166, 168, 169-186.

In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 139 and 147-154. In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 138 and 174-182 and 184- 186.

In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 166-170.

In one embodiment the GLP-1 analogue comprises or consists of an analogue selected from the group of analogues defined by SEQ ID NO.: 163-166.

In one embodiment the GLP-1 analogue comprises or consists of an analogue defined by SEQ ID NO.: 164. EGF(A) analogue

The term "EGF(A) analogue" herein refers to a variant of the EGF(A) domain of LDL-R (293-332) (SEQ ID NO: 1 ). A similar nomenclature is applied to the EGF(A) analogues as was described for GLP-1 analogues herein above.

The terms "EGF(A) domain of the LDL-R", "LDL-R (293-332)", "native LDL-R (293- 332), "EGF(A) (293-332)", "wild-type EGF(A)", "wt-EGF(A)" or "native EGF(A)" as used herein refer to a peptide consisting of the sequence SEQ ID NO: 1.

SEQ ID NO: 1 is :

Gly-Thr-Asn-Glu-Cys-Leu-Asp-Asn-Asn-Gly-Gly-Cys-Ser-His-Val- Cys-Asn-Asp-Leu- Lys-lle-Gly-Tyr-Glu-Cys-Leu-Cys-Pro-Asp-Gly-Phe-Gln-Leu-Val- Ala-Gln-Arg-Arg-Cys-Glu.

In this application the numbering of the amino acid residues follows the numbering for the EGF(A) domain of the LDL-R (LDL-R-(293-332)), wherein the first (N-terminal) amino acid residue is numbered or accorded position no. 293, and the subsequent amino acid residues towards the C-terminus are numbered 294, 295, 296 and so on, until the last (C- terminal) amino acid residue, which in the EGF(A) domain of the LDL-R is Glu with number 332.

The numbering is done differently in the sequence listing, where the first amino acid residue of SEQ ID NO: 1 (Gly) is assigned no. 1 , and the last (Glu) no. 40. The same applies for the other sequences of the sequence listing, i.e. the N-terminal amino acid assigned is no. 1 irrespective of its positioning relative to 293Gly or 293 substituting amino acid residue by reference to LDL-R(293-332). However, herein the numbering of amino acid positions is with reference to LDL-R(293-332), as explained above.

The level of identity to SEQ ID NO.:1 can be calculated by determining the number of amino acids that are not changed relative to SEQ ID NO 1. SEQ ID NO: 1 consists of 40 amino acid residues and if three amino acid substitutions are introduced the level of identity is 37/40%=92.5 %. If 5 amino acid residues are changed the level of identity is 87.5 %. If the peptide is N-terminal or C-terminal elongated that part is usually not included in the comparison, whereas a deletion of one or more amino acids shortens the comparator. For instance, in the examples above, if the N-terminal amino acid is deleted the level of identity is slightly reduced to 36/39X100% and 34/39X100%, respectively. When discussing identity of the back-bone sequences of a derivative the amino acid residue of the substituent e.g. the residue to which the substituent is attached, also termed the amino acid residue of the substituent may be either a wild type (wt) or a substituted amino acid. If the amino acid residue of the substituent is a wild type residue, such as 312K this residue is included in the calculation of identity level, whereas a Lys in any other position from 293 to 332 would be an amino acid substitution and not included when calculated amino acid identity to SEQ ID NO.:1.

Each of the EGF(A) analogues of the invention may be described by reference to i) the number of the amino acid residue in the native EGF(A) (LDL-R(293-332)) which corresponds to the amino acid residue which is changed (i.e., the corresponding position in native LDL-R(293-332) EGF(A)), and to ii) the actual change.

In other words, the EGF(A) analogues may be described by reference to the native LDL-R(293-332) EGF(A) peptide, namely as a variant thereof in which a number of amino acid residues have been changed when compared to native LDL-R(293-332) EGF(A) (SEQ ID NO: 1 ). These changes may represent, independently, one or more amino acid substitutions.

The followings are non-limiting examples of suitable analogue nomenclature:

The EGF(A) analogue incorporated in example compound #1 of the derivatives comprising a GLP-1 analogue and an EGF(A) analogue herein, may be referred to as the following LDL-R(293-332) EGF(A) analogue: (301 Leu, 309Arg, 312Glu, 321 Glu) LDL-R(293- 332) EGF(A), or (Leu301 , Arg309, Glu312, Glu321 )-LDL-R(293-332) EGF(A) or

(301 L,309R,312E,321 E) LDL-R(293-332) or (L301 ,R309,E312,E321 ) LDL-R(293-332). This means that when this analogue is aligned with native LDL-R(293-332), it has i) a Leu at the position in the analogue which corresponds, according to the alignment, to position 301 in native LDL-R(293-332) EGF(A), ii) an Arg at the position in the analogue which corresponds to position 309 in native LDL-R(293-332) EGF(A), iii) a Glu at the position in the analogue which corresponds to position 312 in native LDL-R(293-332) EGF(A), iv) a Glu at the position in the analogue which corresponds to position 321 in native LDL-R(293-332) EGF(A). The expressions "a position equivalent to" or "corresponding position" may be used to characterise the site of change in a variant LDL-R(293-332) EGF(A) sequence by reference to the reference sequence native LDL-R(293-332) EGF(A) (SEQ ID NO: 1 ).

Equivalent or corresponding positions, as well as the number of changes, are easily deduced, e.g. by simple calculation and/or a standard protein or peptide alignment program may be used, such as "align" which is based on a Needleman-Wunsch algorithm.

In one embodiment the EGF(A) analogue has 1-15 amino acid substitutions compared to SEQ ID NO.: 1 . In one embodiments the EGF(A) analogue has 1-10 amino acid substitutions compared to SEQ ID NO.: 1. In one embodiments the EGF(A) analogue has 1 -8 amino acid substitutions compared to SEQ ID NO.: 1 , such as 1-7, 1 -6, 1-5 amino acid substitutions compared to SEQ ID NO.: 1. In a particular embodiment, up to 7 amino acid substitutions may be present, for example up to 6, 5, 4, 3, 2 or 1 amino acid substitutions may be present in the EGF(A) analogue.

In one embodiment the EGF(A) analogue has at least 75 % identity, such as 80 %, such as 85, such as 90 or even 95 % identity to SEQ ID NO.:1 . In one embodiment wherein there is no deletion/truncation, this corresponds to up to 10, 8, 6, 4 and 2 amino acid substitutions relative to SEQ ID NO 1 , respectively.

In one embodiment the EGF(A) analogue has at least 90 % identity, such as 92 %, such as 94, such as 96 or even 98 % identity to SEQ ID NO.:1

In one embodiment the EGF(A) analogue comprises at least 35, such as 36, 37, 38,

39 or at least 40 amino acids. In a particular embodiment the EGF(A) analogue is composed of 36, such as 38 or 40 amino acids. In an additional particular embodiment the EGF(A) analogue consists of 35, 36, 37, 38, 39 or 40 amino acids.

In the presence of amino acid additions, referred to herein as N-terminal and C- terminal elongations, the EGF(A) analogue may comprise up to 60 amino acids. In a particular embodiment the EGF(A) analogue comprises 35-60, 38-55, 40-50, 40-45, 40-42 or 40-41 amino acids. In an embodiment, the EGF(A) analogue consists of 40 or 41 amino acid residues.

In one embodiment the EGF(A) analogue comprises the amino acid substitution of amino acid residue 301 from Asn to Leu, also described by Asn301 Leu or simply 301 Leu. In a specific embodiment, the EGF(A) analogue comprises the substitution 301 Leu.

In addition or alternatively the EGF(A) analogue comprises the amino acid residues 297Cys, 304Cys, 308Cys, 317Cys, 319Cys and 331 Cys. Those Cys residues are wild type residues which may be engaged in disulphide bridges, such as the disulphide bridges between 297Cys and 308Cys, between 304Cys and 317Cys and between 319Cys and 331 Cys.

In one embodiment, the EGF(A) analogue comprises 301 Leu and a number of further amino acid substitutions, as described below.

In one embodiment the EGF(A) analogue comprises 301 Leu, 31 OAsp and an amino acid substitution of 312Lys.

In one embodiment, the EGF(A) analogue comprises 301 Leu and 31 OAsp and wherein the analogue does not have a substitution of 299Asp to Glu, Val or His.

In one embodiment the EGF(A) analogue comprises 301 Leu, 309Arg and 312Glu. In one embodiment the EGF(A) analogue comprises 301 Leu, 309Arg, 312Glu and

321 Glu.

In one embodiment the EGF(A) analogue comprises 301 Leu and 309Arg with a proviso that the analogue does not have a substitution of 31 OAsp to 310Lys or

In one embodiment the EGF(A) analogue comprises 301 Leu and 309Arg with a proviso that the analogue does not have a substitution of 299Asp to Glu, Val or His.

In a further embodiment the EGF(A) analogue does not have any of the

substitutions D310K, D310N, D310Q, D310Q, D310R and D310A or even any substitution of 31 OAsp.

In one embodiment the EGF(A) analogue comprises one, two, three or all four wild type residues: 295Asn, 296Glu, 298Leu and 302Gly.

In one embodiment the EGF(A) analogue comprises one, two, three, four or all five wild type residues: 295Asn, 296Glu, 298Leu, 302Gly and 31 OAsp.

In one embodiment the peptide has 295Asn.

In one embodiment the EGF(A) analogue has 296Glu. In one embodiment the EGF(A) analogue has 298Leu. In one embodiment the EGF(A) analogue has 302Gly. In one embodiment the EGF(A) analogue has 31 OAsp.

In one embodiment the EGF(A) analogue has two or more of 31 OAsp, 295Asn and 296Glu. In one embodiment the EGF(A) analogue has all three of 31 OAsp, 295Asn and 296Glu.

The EGF(A) analogue may comprise further amino acid substitutions as described herein. In one embodiment the analogue may further comprise one or more amino acid substitution in a position(s) selected from the group of positions: 293, 294, 296, 299, 300, 303, 305, 306, 309, 31 1 , 312, 313, 314, 315, 316, 318, 320, 321 , 322, 323, 324, 325, 326, 328, 329, 330 and 332. In one embodiment the analogue may further comprise one or more amino acid substitution(s) in a position(s) selected from the group of positions: 293, 294, 299, 300, 303, 305, 306, 309, 31 1 , 312, 313, 314, 316, 318, 321 , 322, 323, 324, 325, 326, 328, 329, 330, 331 and 332.

In one embodiment the analogue may further comprise one or more amino acid substitution(s) in a position(s) selected from the 294, 299, 300, 303, 309, 312, 313, 314, 316, 318, 321 , 322, 323, 324, 325, 326, 328, 329, 330 and 332.

In one embodiment the analogue may further comprise one or more amino acid substitution(s) in a position(s) selected from the 299, 300, 309, 313, 316, 318, 321 , 322, 323, 324, 326, 328, 329, 330 and 332.

In one embodiment the analogue may further comprise one or further amino acid substitution(s) in a position(s) selected from the group of positions: 309, 312, 313, 321 , 324, 328 and 332.

In a further embodiment the EGF(A) analogue comprise either the wt amino acid residue or a different residue i.e. an amino acid substitution, in certain specific positions in addition to the amino acid residues specified herein above.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Gly(G) or Asn(N) in position 293.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Trp (W), Thr(T) or Gly(G) in position 294.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Asp(D), Gly(G), Pro(P), Arg(R), Lys(K), Ser(S), Thr(T), Asn(N), Gln(Q), Ala(A), lle(l), Leu(L), Met(M), Phe(F), Tyr(Y) or Trp(W) in position 299.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Asp(D), Gly(G), Pro (P), Arg(R), Lys(K), Ser(S), Thr(T), Asn(N), Gln(Q), Ala(A), Met(M), Phe(F), Tyr(Y) or Trp(W) in position 299.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Asp(D), Ser (S), Arg(R), Leu (L), Ala (A), Lys(K) or Tyr(Y) in position 299.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Asp(D) or Ala(A) in position 299.

In one such embodiment the EGF(A) analogue comprises the amino acid residue His(H) or Asn(N) in position 300.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Val(V), Ser(S), Thr (T) or lie (I) in position 307. In one such embodiment the EGF(A) analogue comprises the amino acid residue Val(V) or lie (I) in position 307.

In one such embodiment the EGF(A) analogue comprises Ser (S), Thr (T) or lie (I) in position 307.

In one such embodiment the EGF(A) analogue comprises lie (I) in position 307.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Asn(N) , Glu (E), His (H,) Arg (R), Ser (S) or Lys (K) in position 309.

In one such embodiment the EGF(A) analogue of the invention comprises the amino acid residue Asn(N) , Arg (R), Ser (S) or Lys (K) in position 309.

In one such embodiment the EGF(A) analogue comprises the amino acid residue

Asn(N) , Arg (R) or Ser (S) in position 309.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Asn(N) or Arg (R) in position 309.

In one such embodiment the EGF(A) analogue comprises the amino acid residue Lys(K) or Arg (R) in position 309.

The EGF(A) analogue may comprise several amino acid substitutions as described herein, such as one or more amino acid substitutions selected from the group of: 299Ala, 307lle and 321 Glu.

In further embodiments, the EGF(A) analogue comprises the amino acid residue Asp(D), Lys (K) or Glu(E) in position 321 .

In further embodiments, the EGF(A) analogue comprises the amino acid residue Asp(D) or Glu(E) in position 321.

In further embodiments, the EGF(A) analogue comprises the amino acid residue Glu(E) in position 321 .

In further embodiments, the EGF(A) analogue comprises the amino acid residue Gin

(Q) or Gly (G) in position 324.

In further embodiments, the EGF(A) analogue comprises the amino acid residue Arg (R) or His (H) in position 329.

In further embodiments, the EGF(A) analogue does not have a substitution of 300Asn(N) to Pro(P).

The EGF(A) domain of LDL-R includes a Lysine in position 312 which may be useful for substitution as described herein. In embodiments where attachment of the substituent to 312 is not wanted 312Lys may be substituted by another amino acid as described herein.

In one embodiment the EGF(A) analogue comprises no Lys residue. In one embodiment, Lys in position 312 is substituted by an amino acid residue selected from: Gly, Pro, Asp, Glu, Arg, His, Ser, Thr, Asn, Gin, Ala, Val, lie, Leu, Met, Phe and Tyr. In one embodiment, Lys in position 312 is substituted by an amino acid residue selected from: Gly, Asp, Glu, Ser, Thr, Asn, Ala, Val, lie, Leu, Phe and Tyr. In one

embodiment, Lys in position 312 is substituted by an amino acid residue selected from: Asp, Glu, Thr, Asn, lie, Leu, Phe and Tyr. In one embodiment, 312Lys is substituted by 312Asp, 312Glu, 312Thr, 312Asn, 312lle or 312Phe. In one embodiment, 312Lys is substituted by 312Glu, 312Asp, 312Gln or 312Arg.

In one embodiment, 312Lys is substituted by 312Glu, 312Thr, 312Asn, 312lle, 312Phe or 312Tyr. In one embodiment, 312Lys is substituted by 312Glu, 312Asn or 312lle,

In one embodiment, 312Lys is substituted by 312Glu or 312Arg. In one embodiment 312Lys is substituted by 312Arg. In one embodiment, 312Lys is substituted by 312Glu.

To include an option for attaching the substituent in various positions (see further below), a Lys may be introduced by amino acid substitution of a wild type residue of SEQ ID NO.: 1 or by a peptide elongation of SEQ ID NO.: 1 , such as a 292Lys or a 333Lys.

In cases where more than one substituent is desired one may be via 312Lys while the second is via a Lys introduced by peptide elongation or substitution in SEQ ID NO.: 1 .

In one embodiment the EGF(A) analogue of SEQ ID NO: 1 comprises at least one Lys residue in a position selected from the group of: 292Lys, 293Lys, 294Lys, 296Lys, 299Lys, 300Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 312Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In one embodiment the EGF(A) analogue of SEQ ID NO: 1 comprises at least one Lys residue in a position selected from the group of: 292Lys, 293Lys, 294Lys, 299Lys, 300Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 312Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In one embodiment the EGF(A) analogue of SEQ ID NO: 1 comprises at least one Lys residue in a position selected from the group of: 292Lys, 293Lys, 294Lys, 300Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 312Lys, 313Lys, 314Lys, 316Lys, 318Lys,

321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In one embodiment the EGF(A) analogue of SEQ ID NO: 1 comprises at least one Lys residue in a position selected from the group of: 292Lys, 293Lys, 294Lys, 300Lys, 303Lys, 305Lys, 306Lys, 31 1 Lys, 312Lys, 313Lys, 314Lys, 316Lys, 318Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In one embodiment the EGF(A) analogue of SEQ ID NO: 1 comprises at least one Lys residue in a position selected from the group of: 292Lys, 293Lys, 294Lys, 300Lys, 303Lys, 305Lys, 306Lys, 31 1 Lys, 313Lys, 314Lys, 316Lys, 318Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In addition or alternatively, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 295Lys, 296Lys, 298Lys, 299Lys, 301 Lys, 302Lys, 303Lys, 305Lys, 306Lys, 307Lys, 309Lys, 310Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from:292Lys, 293Lys, 294Lys, 295Lys, 296Lys, 298Lys, 299Lys, 302Lys, 303Lys, 305Lys, 306Lys, 307Lys, 309Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 295Lys, 296Lys, 298Lys, 299Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 295Lys, 296Lys, 299Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue peptide of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 296Lys, 299Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 299Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 299Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 299Lys, 303Lys, 305Lys, 306Lys, 310Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys,

322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 299Lys, 303Lys, 305Lys, 306Lys, 309Lys, 310Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 321 Lys,

322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys.

In a further embodiment, the EGF(A) analogue of the invention comprises at least one amino acid substitution selected from 292Lys, 293Lys, 294Lys, 303Lys, 305Lys, 306Lys, 310Lys, 31 1 Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys and 333Lys. In one embodiment, the EGF(A) analogues of the invention do not comprise any of the following substitutions: 296K, 298K, 301 K, 302K and 307K.

In one embodiment, the EGF(A) analogue comprises any of the following

substitution: 296K, 298K, 301 K, 302K, 307K and 31 OK.

In one embodiment, the EGF(A) analogue comprises any of the following

substitution: 296K, 298K, 301 K, 302K, 307K, and 295K.

In one embodiment, the EGF(A) analogue comprises any of the following

substitution: 296K, 298K, 301 K, 302K, 307K and 295D.

In a particular embodiment, the EGF(A) analogue comprises 1 or 2, of such Lys substitutions.

In addition or alternatively, the EGF(A) analogue may comprise 312Lys.

In one embodiment the EGF(A) analogue of the invention comprises two Lys residues. In one embodiment the EGF(A) analogue of the invention comprises two Lys residues selected from the pairs consisting of: i- 293K and 294K xiv. 313K and 321 K ii. 293K and 312K XV. 313K and 324K

iii. 293K and 333K xvi. 313K and 328K

iv. 309K and 313K xvii. 313K and 332K

v. 309K and 324K xviii. 313K and 333K

vi. 309K and 328K xix. 314K and 333K

vii. 309K and 332K XX. 321 K and 332K

viii. 309K and 333K xxi. 321 K and 333K

ix. 31 1 K and 313K xxii. 324K and 333K

X. 312K and 333K xxiii. 324K and 328K

xi. 312K and 313K xxiv. 328K and 333K

xii. 312K and 314K XXV. 330K and 333K and

xiii. 313K and 314K xxvi. 332K and 333K.

In a further embodiment the EGF(A) analogue comprises at least two amino acid substitutions identified by any of the groups l-XXIV shown below compared to SEQ ID NO.:1 .

In a still further embodiment, the EGF(A) analogue consists of the amino acid substitutions identified by any of the groups l-XXIV as shown below.

In a further embodiment the EGF(A) analogue comprises at least two amino acid substitutions identified by any of the groups l-XVI shown below compared to SEQ ID NO.:1 .

In a still further embodiment, the EGF(A) analogue consists of the amino acid substitutions identified by any of the groups l-XVI as shown below.

I. 301 Leu and 309Arg

II. 301 Leu, 309Arg, 312Glu

III. 301 Leu, 307lle and 309Arg

IV. 301 Leu, 307lle, 309Arg and 312Glu

V. 301 Leu, 309Arg and 321 Glu

VI. 301 Leu, 309Arg, 321 Glu and 312Glu

VII. 301 Leu, 307lle, 309Arg and 299Ala

VIII. 301 Leu, 307lle, 309Arg, 299Ala and 312Glu

IX. 301 Leu and 309Arg and at least one Lys substitution

X. 301 Leu, 309Arg, 312Glu and at least one Lys substitution

XI. 301 Leu, 307lle and 309Arg and at least one Lys substitution

XII. 301 Leu, 307lle, 309Arg and 312Glu and at least one Lys substitution XIII. 301 Leu, 309Arg and 321 Glu and at least one Lys substitution

XIV. 301 Leu, 309Arg, 321 Glu and 312Glu and at least one Lys substitution

XV. 301 Leu, 307lle, 309Arg and 299Ala and at least one Lys substitution or

XVI. 301 Leu, 307lle, 309Arg, 299Ala and 312Glu and at least one Lys substitution.

In one embodiment, the EGF(A) peptide analogue comprises or consists of the amino acid substitutions identified by any of

V. 301 Leu, 309Arg and 321 Glu

VI. 301 Leu, 309Arg, 321 Glu and 312Glu

XIII. 301 Leu, 309Arg, 312Glu and at least one Lys substitution or

XIV. 301 Leu, 309Arg, 321 Glu and 312Glu and at least one Lys substitution.

In a further embodiment the EGF(A) analogue comprises at least two amino acid substitutions identified by any of the groups XVII-XX shown below compared to SEQ ID NO. 1.

In a still further embodiment, the EGF(A) analogue consists of at the amino acid substitutions identified by any of the groups XVII-XX as shown below compared to SEQ ID NO.: 1.

XVII. 301 Leu and 309Lys

XVIII. 301 Leu, 309Lys and 312Glu

XIX. 301 Leu and 309Lys and at least one further Lys substitution

XX. 301 Leu, 309Lys and 312Glu and at least one further Lys substitution.

In a further embodiment the EGF(A) analogue according to the invention comprises at least two amino acid substitutions identified by any of the groups XXI-XXIV shown below compared to SEQ ID NO.: 1 .

In a still further embodiment, the EGF(A) analogue of the invention consists of the amino acid substitution identified by any of the groups XXI-XXIV as shown below compared to SEQ ID NO.: 1.

XXI. 301 Leu and 307lle,

XXII. 301 Leu, 307lle and 312Glu

XXIII. 301 Leu and 307lle and at least one further Lys substitution and

XXIV. 301 Leu, 3307lle and 312Glu and at least one further Lys substitution. In further specific embodiments the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by SEQ ID 1 to 1 14.

In one embodiment the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by SEQ ID NO.: 2-1 14.

In one embodiment the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by SEQ ID NO.: 2-47 and 49-1 14.

In one embodiment the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by anyone of the amino acid sequences SEQ ID NO.: 2-44, 46, 47 and 49-1 14.

In one embodiment the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by of SEQ ID NO.: 2-44, 46, 47, 49-53, 55, 58-1 14.

In one embodiment the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by SEQ ID NO.: 2-4, 6-44, 46, 47, 49-53, 55, 58-1 14.

In one embodiment the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by SEQ ID NO.: 2-4, 6-19, 21-44, 46, 47, 49-53, 55, 58-1 14.

In one embodiment the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by SEQ ID NO.: 19, 21 , 73, 107, 108, 109, 1 10, 1 1 1 , 1 12, 1 13, 1 14.

In one embodiment the EGF(A) analogue as described above comprises no Lys residues and the EGF(A) analogue thus comprises or consists of anyone of the amino acid sequences identified by SEQ ID NO.: 5, 6, 23, 26, 49, 50, 107-1 1 1 .

In one embodiment the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by SEQ ID NO.: 5, 6, 23, 26, 49, 50 or 107.

In one preferred embodiment the EGF(A) analogue comprises both a mutation of the 312K residue, the 321 D residue and no Lys residue, such as where the EGF(A) analogue comprises or consists of anyone of the amino acid sequences identified by SEQ ID NO.: 108, 109, 1 10 or 1 1 1 .

In one embodiment the EGF(A) analogue comprises or consists of the amino acid sequences identified by SEQ ID NO.:108.

The examples herein provide various EGF(A) analogues which are include in the table below including information on amino acid substitutions, Lys residues and the SEQ ID NO.

EGF(A) Sequence modifications Lys SEQ analogue # residues ID: NO

- WT - EGF(A) 1 EGF(A) Sequence modifications Lys SEQ analogue # residues ID: NO

1. 299A, 301 L, 307I, 309R, 31 OK 310K, 312K 2

2. 301 L, 309R 312K 3

3. 301 L, 309R, 312E, 333K 333K 4

4. 300P, 301 L, 307I, 309R, 312E None 5

5. 301 L, 309R, 312E None 6

6. 299K, 301 L, 309R, 312E 299K 7

7. 301 L, 309R, 312E, 330K 330K 8

8. 293N, 301 L, 307I, 309R, 312D, 333K 312K, 333K 9

9. 293N, 301 L, 309R, 312D, 333K 333K 10

10. 301 L, 309R, 312E, 332K 332K 1 1

1 1 . 293K, 301 L, 309R, 312E 293K 12

12. 293K, 301 L, 309R, 312E, 333K 293K, 333K 13

13. 301 L, 309R, 312E, 328K, 329H 328K, 14

14. 301 L, 309R, 312E, 332K, 333K 332K, 333K 15

15. 301 L, 309R, 312E, 330K, 333K 330K, 333K 16

16. 301 L, 309R, 312E, 321 K, 333K 321 K, 333K 17

17. 301 L, 309R, 333K 333K 18

18. 301 L, 309R, 312E, 321 E, 333K 333K 19

19. 295D, 301 L, 309R, 312E, 332K 332K 20

20. 301 L, 309R, 312E, 321 K 321 K 21

21 . 301 L, 309R, 312E, 324K 324K 22

22. 301 L, 309R, 312Q None 23

23. 301 L, 309R, 312E, 321 E, 332K 332K 24

24. 293K, 301 L, 309R, 312E, 321 E 293K 25

25. 300H, 301 L, 307I, 309R, 312E None 26

26. 300K, 301 L, 309R, 312E 300K 27

27. 293K, 294K, 301 L, 309R, 312E 293K 28

28. 293K, 301 L, 309R 293K, 312K 29

29. 301 L, 309K, 312E 309K 30

30. 301 L, 309R, 312E, 318K 318K 31

31 . 301 L, 309R, 312E, 313K, 333K 313K, 333K 32

32. 301 L, 309R, 312E, 326K 326K 33 EGF(A) Sequence modifications Lys SEQ analogue # residues ID: NO

33. 301 L, 309R, 312E, 325K 325K 34

34. 301 L, 309R, 312E, 323K 323K 35

35. 301 L, 309R, 312E, 322K 322K 36

36. 301 L, 309R, 312E, 320K 320K 37

37. 301 L, 309R, 312E, 329K 329K 38

38. 301 L, 309R, 312E, 313K 313K 39

39. 301 L, 309R, 312E, 328K 328K 40

40. 301 L, 309R, 312E, 316K 316K 41

41 . 301 L, 309R, 312E, 315K 315K 42

42. 300H, 301 L, 309R, 312R, 333K 333K 43

43. 301 L, 309R, 312E, 314K 314K 44

44. 301 L, 309R, 31 1 K, 312E 31 1 K 45

45. 301 L, 307K, 309R, 312E 307K 46

46. 301 L, 309S, 312R, 333K 333K 47

47. 301 L, 309S, 312E, 333K 333K 48

48. 301 L, 306Y, 309S, 312E None 49

49. 293N, 301 L, 309S, 312E None 50

50. 301 L, 306K, 309R, 312E 306K 51

51 . 301 L, 305K, 309R, 312E 305K 52

52. 301 L, 303K, 309R, 312E 303K 53

53. 301 L, 302K, 309R, 312E 302K 54

54. 293N, 300H, 301 L, 309R, 312R, 333K 333K 55

55. 301 K, 309R, 312E 301 K 56

56. 298K, 301 L, 309R, 312E 298K 57

57. 293N, 301 L, 309R, 312R, 333K 333K 58

58. 301 L, 307I, 332K 312K, 332K 59

59. 301 L, 306Y, 312E, 332K 332K 60

60. 301 L, 307I, 312E, 332K 332K 61

61 . 300H, 301 L, 309R 312K 62

62. 296K, 301 L, 309R, 312E 296K 63

63. 294K, 301 L, 309R, 312E 294K 64

64. 292K, 301 L, 309R, 312E 292K 65 EGF(A) Sequence modifications Lys SEQ analogue # residues ID: NO

65. des293, 294G, 301 L, 309R, 312E, 328K 328K 66

66. 301 L, 306D, 309R, 312E, 324G, 333K 333K 67

67. 301 L, 306D, 309R, 312E, 333K 333K 68

68. 300H, 301 L, 309R, 312E, 313K, 333K 313K, 333K 69

69. 301 L, 309R, 312E, 313K, 328K 313K, 328K 70

70. 301 L, 309R, 312E, 313K, 324K 313K, 324K 71

71 . 301 L, 309R, 312E, 324K, 333K 324K, 333K 72

72. 301 L, 309R, 312E, 313K, 321 K 313K, 321 K 73

73. des293, 300H, 301 L, 309R, 312E, 313K, 333K 313K, 333K 74

74. 292A, 301 L, 309R, 312E, 313K 313K 75

75. des293, 301 L, 309R, 312E, 313K 313K 76

76. 301 L, 309R, 312E, 313K, 332K 313K, 332K 77

77. 301 L, 309R, 312E, 328K, 333K 328K, 333K 78

78. 299A, 301 L, 307I, 309R 312K 79

79. 301 L, 309R, 31 OK 310K, 312K 80

80. 301 L 312K 81

81 . 300H, 301 L, 309R, 312E, 333K 333K 82

82. des293-294, 300H, 301 L, 309R, 312E, 313K, 333K 313K, 333K 83

83. 301 L, 309K, 312E, 333K 309K, 333K 84

84. 301 L, 306Y, 312E, 324K, 333K 324K, 333K 85

85. 300H, 301 L, 309R, 312E, 314K, 333K 314K, 333K 86

86. 294W, 301 L, 309R, 312E, 333K 333K 87

87. 301 L, 309K, 312E, 328K 309K, 328K 88

88. 301 L, 309K, 312E, 313K 309K, 313K 89

89. des293, 301 L, 309R, 312E, 333K 333K 90

90. 301 L, 309R, 312E, 324K, 328K 324K, 328K 91

91 . 292A, 301 L, 309R, 312E, 333K 333K 92

92. 301 L, 306Y, 309R, 312E, 313K, 333K 313K, 333K 93

93. 301 L, 309K, 312E, 332K 309K, 332K 94

94. 301 L, 309R, 312E, 321 K, 332K 321 K, 332 K 95

95. 300H, 301 L, 309R, 312E, 313K, 332K 313K, 332K 96

96. 301 L, 309R, 312E, 313K, 321 E, 332K 313K, 332K 97 EGF(A) Sequence modifications Lys SEQ analogue # residues ID: NO

97. 301 L, 309R, 312E, 313K, 321 E, 333K 313K, 333K 98

98. 301 L, 309R, 312E, 313K, 314K 313K, 314K 99

99. 301 L, 309R, 313K 312K, 313K 100

100. 301 L, 309R, 314K 312K,314K 101

101. 301 L, 309R, 31 1 K, 312E, 313K 31 1 K, 313K 102

102. 300H, 301 L, 309R, 312E, 313K, 321 E, 333K 313K, 333K 103

103. 301 L, 309R, 312E, 321 E, 328K, 333K 333K 104

104. 301 L, 309R, 312E, 321 E, 324K, 333K 324K, 333K 105

105. 301 L, 309K, 312E, 324K 309K, 324K 106

106. 301 L, 309R, 312E None 107

107. 301 L, 309R, 312E, 321 E None 108

108. 301 L, 307I, 309R, 312E, 321 E None 109

109. 301 L, 306Y, 312E, 321 E None 1 10

1 10. 300H, 301 L, 309R, 312E, 321 E None 1 1 1

1 1 1. 301 L, 309R, 312E, 313K, 321 E 313K 1 12

1 12. 301 L, 309R, 312E, 321 E, 324K 324K 1 13

1 13. 301 L, 309R, 312E, 321 E, 328K 328K 1 14

Fusion polypeptide

In one aspect the invention relates to a fusion polypeptide comprising the amino acid sequence of a GLP-1 analogue and the amino acid sequence of a EGF(A) analogue. As previously described herein an analogue of GLP-1 refers to a variant of (7-37) (SEQ ID No: 137) and an analogue of EGF(A) refers to a variant of the EGF(A) domain of LDL-R (293- 332) (SEQ ID NO: 1 ).

The fusion polypeptide may further be considered and intermediate in the preparation of derivatives as described herein below. When referring to derivatives of the invention the fusion polypeptide may be referred to as the back-bone or peptide back-bone.

Preparation of fusion proteins or fusion polypeptides is well known in the art. A recombinant vector for expressing the fusion polypeptide in a suitable host may be prepared and used to produce the fusion protein by heterologous expression according to common general knowledge (Sambrook et al., Molecular Cloning: a laboratory manual, 1989, Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y.). Alternatively shorter

polypeptides are frequently produced by solid-phase peptide synthesis and even peptides of extended length may be produced synthetically. Peptide elements may also be produced separately and subsequently subjected to native chemical ligation to produce the complete fusion polypeptide.

When two peptide segments are to be fused the order may influence the

functionality of the resulting fusion polypeptide, and compounds comprising it.

In one embodiment according to the invention the order of the GLP-1 analogue and the EGF(A) analogue starting from the N-terminal is the GLP-1 analogue followed by the EGF(A) analogue, optionally separated by a spacer peptide (see below). One may say that the GLP-1 analogue is fused with the EGF(A) analogue via the C-terminal of the GLP-1 analogue.

In an alternative embodiment the GLP-1 analogue is fused with the EGF(A) analogue via the C-terminal of the EGF(A) analogue placing the EGF(A) analogue at the N- terminal. The resulting fusion polypeptide, may be referred to by the term "back-bone" or "peptide back-bone" defining the polypeptide chain comprising both the GLP-1 analogue and the EGF(A) analogue and optionally a spacer peptide as described here blow.

In one embodiment the compounds of the invention, the fusion polypeptide and the derivatives thereof comprise a GLP-1 analogue as herein above defined, including any of the analogues defined by SEQ ID NO.: 138-187.

In one embodiment the compounds of the invention, the fusion polypeptide and the derivatives thereof comprise an EGF(A) analogue as herein above defined, including any of the analogues defined by SEQ ID NO.: 2-1 14.

Spacer

Frequently, fusion polypeptides include a spacer to ensure that any functionality residing in the ends of the two peptides are not disturbed by the proximity of the other peptides. In one embodiment the spacer is a peptide, which is herein referred to as a spacer peptide or a peptide spacer. Various spacer peptides are known in the art and may be placed between the GLP-1 analogue and the EGF(A) analogue to obtain fusion polypeptides. As described above the resulting fusion polypeptide (comprising a spacer) may be produced either synthetically or by heterologous expression.

The spacer peptides are usual peptide segments of 4-80 amino acids. Examples of such peptides as used herein are included below.

In one embodiment the compounds of the invention, the fusion polypeptide and the derivatives thereof comprise a peptide spacer, wherein the peptide spacer comprises a sequence selected from the peptides identified by SEQ ID NO 1 15-136.

In one embodiment the compounds of the invention, the fusion polypeptide and the derivatives thereof comprise a peptide spacer selected from the group of peptide spacers identified by SEQ ID NO 1 15-136. In one embodiment the compounds of the invention, the fusion polypeptide and the derivatives thereof comprise a peptide spacer comprising one or more segments of GQAP, such as 1 -20, such as 1-10, such as 1-6, such as 1 , 2, 3, 4 or 5 GQAP segments.

In one embodiment the peptide spacer comprise a peptide spacer selected from the group of peptides identified by SEQ ID NO.: 1 15-128.

In one embodiment the peptide spacer is selected from the sequences identified by SEQ ID NO.: 1 15-128.

In one embodiment the peptide spacer does not comprise a Lys residue.

In one embodiment the peptide spacer comprise a Lys residue.

In one embodiment the compounds of the invention, the fusion polypeptide and the derivatives thereof comprise a peptide spacer comprising one or more segments of GQAP wherein a Lys residue is introduce by amino acid substitution. In further such embodiments, the spacer may be selected from the group of sequences identified, by SEQ ID NO.: 121- 128.

In one embodiment the compounds of the invention, the fusion polypeptide and the derivatives thereof comprise a peptide spacer that is Glycine rich, such as a peptide spacer wherein at least half of the amino acid residues are Gly, such as at least ¾ of the amino acid residues are Gly. In such embodiments the peptide spacer may be selected from the peptides identified by SEQ ID NO.: 130-136.

In a further embodiment the peptide spacer is selected from the group of peptides identified by SEQ ID NO: 1 15-1 17 and 121 -136.

In a further embodiment the peptide spacer is selected from the group of peptides identified by SEQ ID NO: 1 15-1 17 and 121 -128.

In one embodiment the peptide spacer is selected from the sequences identified by SEQ ID NO.: 1 15-128.

In a further embodiment the peptide spacer is selected from the group of peptides identified by SEQ ID NO: 1 15-1 17. In a further embodiment the peptide spacer is identified by SEQ ID NO: 1 16.

Multiple examples of fusion polypeptides (peptide back-bones) according to the invention are provided in the examples showing variability in all elements, i.e. the GLP-1 analogue, the EGF(A) analogue and the peptide spacer.

In one embodiment the fusion polypeptide or the back-bone sequence of the derivatives of the invention consists of a GLP-1 analogue, an EGF(A) analogue and a peptide spacer as herein defined. The examples of the application include a plurality of such fusion polypeptides and derivatives including such fusion polypeptide as peptide back-bone. The identity of the fusion polypeptide may be deduced from the sequence of the individual elements, i.e. the GLP-1 analogue, the EGF(A) analogue and the peptide spacer which together forms the fusion polypeptide which are individually assigned a SEQ ID according to the following table.

Examples with GLP-1 analogue C-terminal to the EGF(A) analogue

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 188-384, 386-387.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 188-384.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 193, 226-233 and 381-384.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 379-380.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 193, 219 and 220.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 189, 193, 200-203 and 212-218.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 222-225.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 224-225.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 192-196. In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 221 , 236, 250, 264, 276, 279, 291 , 294, 306, 307, 310, 324, 336, 339, 351 , 352, 353, 356, 368 and 369.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 221 , 250, 276, 279, 291 , 294, 306, 307, 310, 324, 336, 351 , 353, 356, 368 and 369.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 217, 218, 219, 220, 221 , 310 and 386. In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 217, 218, 221 , 310 and 386. In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 217, 218, 310 and 386. In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 221 , 310 and 386. In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 310 and 386. In one embodiment the invention relates to a fusion polypeptide defined by SEQ ID NO.: 310.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 188 and 370-378.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 190, 191 , 197, 198 and 199.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 204-21 1.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 240-247, 254-261 , 268-275, 283-290, 298-305, 314-321 , 328-335, 343-350 and 360-367.

In one embodiment the invention relates to a fusion polypeptide selected from the group of fusion polypeptides defined by SEQ ID NO.: 234-235, 237-239, 248-249, 251-253, 262-263, 265-267, 277-278, 280-282, 292-293, 295-297, 308-309, 31 1-313, 322-323, 325- 327, 337-338, 340-342, 354-355 and 357-359.

In one embodiment the invention relates to a fusion polypeptide that comprises exactly one Lys residue.

In one embodiment the invention relates to a fusion polypeptide that comprises up to two Lys residues.

In one embodiment the invention relates to a fusion polypeptide that comprises two Lys residues. In one embodiment the invention relates to a derivative comprising a fusion polypeptide or peptide back-bone defined by SEQ ID NO.: 188-384, or any of the above defined fusion polypeptide, as further described herein below.

GLP-1 function

A receptor agonist may be defined as an analogue that binds to a receptor and elicits a response typical of the natural ligand. 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).

Thus, for example, 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.

And 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 GLP-1.

In one embodiment the GLP-1 analogues of the invention are a GLP-1 receptor agonist. In some embodiments the GLP-1 analogues of the invention are a full GLP-1 receptor agonist. In some embodiments the bi-functional compounds of the invention are a GLP-1 receptor agonist. In some embodiments the bi-functional compounds of the invention are a full GLP-1 receptor agonist. In some embodiments the derivatives of the invention are a GLP-1 receptor agonist. In some embodiments the derivatives of the invention are a full GLP-1 receptor agonist.

It follows that the GLP-1 receptor agonist should display "GLP-1 activity" which refers to the ability of the compound, i.e. a GLP-1 analogue or a compound comprising a GLP-1 analogue, to bind to the GLP-1 receptor and initiate a signal transduction pathway resulting in insulinotropic action or other physiological effects as is known in the art. For example, the GLP-1 analogues, bi-functional compounds and derivatives thereof can be tested for GLP-1 activity using the GLP-1 potency assay described in Method section C. herein. In one embodiment the GLP-1 analogues or the compounds comprising the GLP-1 analogues, i.e. the GLP-1/EGF(A) fusion polypeptides and derivatives thereof have GLP-1 activity.

The term half maximal effective concentration (EC ₅₀ ) generally refers to the concentration which induces a response halfway between the baseline and maximum, by reference to the dose response curve. EC ₅ o is used as a measure of the potency of a compound and represents the concentration where 50% of its maximal effect is observed. The in vitro potency of the GLP-1 analogues and compounds comprising the GLP-1 analogues may be determined as described above, and the EC ₅₀ determined. The lower the EC ₅ o value, the better the potency.

In one embodiment the GLP-1 analogue or the compound comprising the GLP-1 analogues have an EC50 in the GLP-1 in vitro potency assay described in C1 (without HSA) of upto 50 pM, 50-100 pM, 100-250 pM or 250-1000 pM. In one embodiment the EC50 is at most 500 pM, such as at most 300 pM, such as at most 200 pM. In one embodiment the EC50 is comparable to human GLP-1 (7-37), such as at most 50 pM. In a further embodiment the EC50 is at most 40 pM, such as at most 30 pM such as at most 20 pM, such as at most 10 pM. The high potency of compounds with a EC50 of around 10 pM is equivalent to the potency of the semaglutide molecule.

As described elsewhere herein the GLP-1 potency must be balanced with the potency of the EGF(A) analogue and therefore it may in some embodiments be preferred to include a GLP-1 analogue providing a GLP-1 potency that is less than the potency of semaglutide, such that the potency of the GLP-1 analogue or the compound comprising the GLP-1 analogue is reduced at least 2 fold, such as at least 5 fold compared to semaglutide, such as at least 10 fold, such as at least 25 fold, such as at least 50 fold, such as at least 100 fold compared to semaglutide. It may even be preferred that the potency is reduced compared to wt GLP-1.

In one embodiments, the EC50 (measured as described in C1 without HSA) of the

GLP-1 analogues or the compound comprising the GLP-1 analogue is at least 25 pM, such as at least 50 pM, such as at least 75 pM, such as at least 100 pM, such as at least 250 pM, or such as at least 500 pM.

In such embodiments, the EC50 measured as described in (C1 without HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is at most 500 pM, such as at most 400 pM, such as at most 300 pM, such as at most 200 pM, such as at most 100 pM, such as at most 50 pM

In further embodiments, the EC50 (measured as described in C1 without HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is 20-1000 pM, such as 50-500 pM, such as 100-250 pM, such as 75-100 pM.

In further embodiments, the EC50 (measured as described in C1 without HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is 20-800 pM, such as 20-600 pM, such as 20-400 pM, such as 20-200 pM or such as 20-100 pM Alternatively the EC50 (measured as described in C1 without HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is 200-1000 pM, such as 300- 800 pM or such as 400-600 pM or 250-750 pM or 300-500 pM.

The above potency considerations are also relevant when evaluating potency in the presence of HSA.

In one embodiments, the EC50 (measured as described in C1 with 1 % HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is at least 500 pM, such as at least 750 pM, such as at least 1000 pM, such as at least 1500 pM, or such as at least 2000 pM.

In such embodiments, the EC50 measured as described in (C1 with 1 % HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is at most 2500 pM, such as at most 2000 pM, such as at most 1500 pM, such as at most 1250 pM, or such as at most 1000 pM

In further embodiments, the EC50 (measured as described in C1 with 1 % HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is 500-2500 pM, such as 500-2000 pM, such as 500-1500 pM, such as 500-1000 pM.

In further embodiments, the EC50 (measured as described in C1 with 1 % HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is 750-2500 pM, such as 1000-2500 pM, such as 1500-2500 pM, such as 2000-2500 pM or such as 1800- 2500 pM

Alternatively the EC50 (measured as described in C1 with 1 % HSA) of the GLP-1 analogues or the compound comprising the GLP-1 analogue is 500-2500 pM, such as 750- 2000 pM or such as 1000-2000 pM or 1500-2000 pM. The GLP-1 potency may be reduced to allow for full binding to PCSK9 while reducing GLP-1 related side effects, such as, but not limited to nausea.

The in vitro binding affinity of GLP-1 analogues and compounds comprising a GLP-1 analogue may alternatively be tested in the in vitro binding assay described in C2, and the affinity for a compound with functionality equivalent to wt GLP-1 or semaglutide is in the neighbourhood of 1 nM when tested in the presence of low HSA.

In one embodiment the GLP-1 analogue or the compound comprising the GLP-1 analogues have an IC50 in the in vitro binding assay of at most 200nM, in a further embodiment the IC50 is at most 100 nM, such as at most 75 nM, such as at most 50 nM, such as at most 25 nM, such as at most 10 nM, such as at most 5 nM. In some embodiments it may be preferred to have binding that is less than the binding of semaglutide, such that the binding of the GLP-1 analogue or a compound comprising a GLP-1 analogue is reduced at least 5 fold compared to semaglutide, such as at least 10 fold, such as at least 25 fold, such as at least 50 fold, such as at least 100 fold compared to semaglutide. It may even be preferred that the binding affinity is reduced compared to wt GLP-1.

In one embodiment, the IC50 (measured as described in C2 without HSA) of the GLP-1 analogues or a compound comprising a GLP-1 analogue is at least 1 nM, such as at least 5 nM, such as at least 10 nM, such as at least 25 nM, such as at least 50 nM, such as at least 100 nM.

In such embodiments, the IC50 measured as described in (C2 without HSA) of the

GLP-1 analogues or a compound comprising a GLP-1 analogue is at most 200 nM, such as at most 100 nM, such as at most 75 nM, such as at most 50 nM, such as at most 25 nM, such as at most 15 nM, such as at most 10 nM, such as at most 5 nM.

In further embodiments, the IC50 (measured as described in C2 without HSA) of the

GLP-1 analogues or a compound comprising a GLP-1 analogue is 0.1 -200 nM, such as 1-

100 nM, such as 5-75 nM, such as 5-50 nM.

The above considerations are relevant when evaluating binding in the absence of

HSA. The GLP-1 binding may be reduced to allow for full binding to PCSK9 while reducing

GLP-1 related side effects, such as, but not limited to nausea.

The GLP-1 effect may alternatively or additionally be measured in vivo by measuring the effect of GLP-1 analogues and compounds comprising a GLP-1 analogue on blood glucose and/or body weight. A reduction of blood glucose and/or body weight can be measured in suitable models, such as in db/db mice as described in C7 and in DIO rats as described in C8.

In on embodiment a GLP-1 analogue or compound comprising a GLP-1 analogue has the ability to reduce blood glucose in db/db mice as described in C7 herein. The effect can be estimated based on the area under the curve for delta blood glucose from 0 until 24 hours (AUC ABG _24h ) and the Effective Doses 50% (ED50, dose of GLP-1 derivative that gives a response halfway between baseline and maximal effect) calculated for AUC ABG _24h ■ In an embodiment it is preferred that the GLP-1 analogue or compound comprising a GLP-1 analogue has a EC50 AUC ABG _24h of less than 15 nmol/kg. In one embodiment theEC50 AUC ABG _24h is between 1-15, such as 2-12 or such as 5-10 nmol/kg.

The ability to reduce body weight may likewise be evaluated using the DIO rats as described in C8. In one embodiment the GLP-1 analogue or compound comprising a GLP-1 analogue is capable of reducing body weight to at least 95 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days.

In one embodiment the GLP-1 analogue or compound comprising a GLP-1 analogue is capable of reducing body weight to at least 90 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days.

EGF(A) function - (PCSK9i)

As described herein the EGF(A) analogue is a variant of the LDL-R(293-332)

EGF(A) peptide defined by SEQ ID NO: 1 . The EGF(A) analogues are herein defined as peptides comprising an amino acid sequence which is an analogue of SEQ ID NO: 1.

Such EGF(A) analogues preferably have the ability to bind to PCSK9. In a specific embodiment, the EGF(A) analogues have an improved ability to bind to PCSK9, for example compared to native LDL-R(293-332) (native EGF(A)) or to other PCSK9-binding compounds.

EGF(A) analogues may further have the ability to inhibit PCSK9 binding to LDL-R. In one embodiment the EGF(A) analogue is a PCSK9 inhibitor. In one embodiment the EGF(A) analogue inhibits PCSK9 binding to human Low Density Lipoprotein Receptor (LDL-R).

Such binding may be assessed using the assay described in Section C3 herein, which measures the ability of a test compound to competitively inhibit the binding of PCSK9 to human LDLR. Due to their ability to inhibit the interaction of PCSK9 with LDL-R, such compounds are referred to as PCSK9 inhibitors.

In one embodiment the EGF(A) analogues and compounds comprising an EGF(A) analogue (fusion polypeptide or derivatives ) of the invention are PCSK9 inhibitor compounds or simply PCSK9 inhibitors. In one embodiment the invention relates to a compound comprising a EGF(A) analogue of SEQ ID NO.:1 , wherein the analogue is capable of inhibiting PCSK9 binding to human Low Density Lipoprotein Receptor (LDL-R).

In one embodiment the EGF(A) analogue and compounds comprising said analogue) have an improved ability to bind PCSK9 compared to EGF(A) LDL-R(293-332) (SEQ ID 1 ). As the wt sequence has a relatively poor inhibitory function comparison may also be made to an EGF(A) analogue. In one embodiment the EGF(A) analogue (and compounds comprising said analogue) have an improved ability to bind PCSK9 compared to[299A, 301 L, 307I, 309R, 310K]EGF(A) defined by SEQ ID NO.:2 . The potency as measured in the ELISA assay provides an apparent affinity for the EGF(A) analogue or a compound comprising an EGF(A) analogue reported as a K, and as described in C3, a low Ki is characteristic for compounds with a strong inhibitory function.

In one embodiment the K, of the EGF(A) analogues and compounds comprising said analogue as measured in the PCSK9-LDL-R binding competitive ELISA assay (Section C3) is below 50 nM, such as below 25 nM or such as below 10 nM. In a further embodiment the Ki of the EGF(A) analogues and compounds comprising said analogue as measured in the PCSK9-LDL-R binding competitive ELISA assay (Section C3) is below 8.0 nM, such as below 5.0 nM, such as below 2.5 nM or even below 2.0 nM. In one embodiment the K, of the EGF(A) analogues and compounds comprising said analogue as measured in the PCSK9- LDL-R binding competitive ELISA assay (Section C3) is 0.1 -10.0 nM, such as 0.1 -8.0 nM or 0.1 -5.0 nM.

Functionality of EGF(A) analogues and compounds comprising such may be further characterized by their ability to improve LDL uptake, such as described in Section C4 herein.

In one embodiment the EGF(A) analogue and compounds comprising said analogue increases LDL uptake in the presence of PCSK9. In one embodiment the EGF(A) analogue and compounds comprising said are capable of reversing or reducing PCSK9 mediated reduction of LDL uptake.

In one embodiment the EGF(A) analogue and compounds comprising said analogue have a EC50 as measured in the LDL uptake assay below 1500 nM, such as below 1000 nM or such as below 500 nM.

The effect of an EGF(A) analogue and compounds comprising an analogue on blood cholesterol can be evaluated in a suitable model, such as by a study in DIO rats as described in section C8 herein. The study involves several administrations of the test compound and the effect is thus dependent on the dosage and frequency of administration. In the present studies the effect of both low, high and very high dosages was evaluated after 21 days.

In one embodiment the EGF(A) analogue or compound comprising the EGF(A) analogue is capable of reducing cholesterol by at least 0.5 mmol/L when dosed with 30 nmol/kg/day and measured after 21 days. In further embodiments the cholesterol level is reduces at least 0.6 or such as 0.8 mmol/L when dosed with 30 nmol/kg/day and measured after 21 days.

In one embodiment the EGF(A) analogue or compound comprising the EGF(A) analogue is capable of reducing cholesterol by at least 0.8 mmol/L when dosed with 300 nmol/kg/day and measured after 21 days. In further embodiments the cholesterol level is reduces at least 1 .0 or such as 1.2 mmol/L when dosed with 300 nmol/kg/day and measured after 21 days.

Bifunctionality

As described herein above, different functionalities are associated with the two analogues, the GLP-1 analogue and the EGF(A) analogue. When combining the two, in compounds of the invention it is preferred that the functionalities of each analogue is maintained i.e. that the GLP-1 analogue has the ability to stimulate the GLP-1 receptor and that the EGF(A) analogue competitively binds PCSK9 and further that the compound comprising both analogues has both functionalities. The functionality of such compound may be tested in the assays described herein for testing GLP-1 and EGF(A) functionality.

In one embodiment the compounds are referred to as bi-functional molecules.

In order to obtain a compound suitable for therapeutic use the functionalities must be balanced to obtain the desired level of activity of both the PCSK9 inhibitor and the GLP-1 receptor agonist. In one embodiment the compound is a GLP-1 receptor agonist as described herein above. In one embodiment the compound is a PCSK9 inhibitor as described herein above. Measurement of GLP-1 receptor potency is described in section C1 and binding affinities for GLP-1 analogues are described in section C2 , and these functional requirements are equally relevant for compounds comprising a GLP-1 analogue and an EGF(A) analogue.

Likewise the functionality of EGF(A) analogues have been described in the section on EGF(A) function and assays described in section C3, C4 and C6 herein.

The compounds according to the present invention, comprising a GLP-1 analogue and an EGF(A) analogue, are monovalent with regards to each of the analogues i.e. the compounds comprise one EGF(A) analogue and one GLP-1 analogue. To balance the GLP- 1 receptor agonist function and the PCSK9 inhibitor function the analogues may individually be selected to obtain a suitable level of both activities. It is well known that high dosages of GLP-1 receptor agonists may provide side-effects such as nausea and it is therefore preferred to decrease GLP-1 potency while securing good PCSK9 inhibitory function to obtain a proper balance of both activities at the same plasma concentration.

In one embodiment the GLP-1 potency is reduced compared to GLP-1 (3-37) or semaglutide as described herein above. In such embodiments, the EC50 measured by the in vitro ere luc assay (section C1 without HSA) is at least 10 pM

In one embodiment the apparent K, measured by competitive ELISA (Section C3) is below 50 nM, ) In one embodiment the ratio of the apparent EGF(A) Ki (C3) and the GLP-1 potency (C1 without HSA) is at most 5000, such as at most 4000, such as at most 3000, such as at most 2000 or such as at most 1000.

In one embodiment the ratio of the apparent EGF(A) Ki (C3) and the GLP-1 potency (C1 without HSA) is at most 1000, such as at most 800, such as at most 600, such as at most 400 or such as at most 200.

In one embodiment the ratio of the apparent EGF(A) Ki (C3) and the GLP-1 potency (C1 without HSA) is at most 200, such as at most 150, such as at most 100, such as at most 50.

In order to confirm that the compound is truly bifunctional it is preferable to evaluate the functionalities which as described herein can be done in the DIO rats as described in section C8 herein, wherein the effect on both body weight and cholesterol can be measured.

In one embodiment the compound is capable of reducing cholesterol and body weight at least equal to GLP-1/EGF(A) Compound #41 in an in vivo rat study as described in section C8 herein.

In one embodiment the compound is capable of reducing cholesterol by at least 0.5 mmol/L when dosed with 30 nmol/kg/day and measured after 21 days.

In further embodiments the cholesterol level is reduces at least 0.6 or such as 0.8 mmol/L when dosed with 30 nmol/kg/day and measured after 21 days.

In one embodiment the compound is capable of reducing cholesterol by at least 0.8 mmol/L when dosed with 300 nmol/kg/day and measured after 21 days.

In further embodiments the cholesterol level is reduces at least 1 .0 or such as 1.2 mmol/L when dosed with 300 nmol/kg/day and measured after 21 days.

In one embodiment the compound is capable of reducing body weight to at least 95 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days.

In one embodiment the compound is capable of reducing body weight to at least 90 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days.

Derivative

The term "derivative" as used herein in the context of a bi-functional compound means a chemically modified bi-functional compound, in which one or more substituents has been covalently attached to the compound.

As described herein above, the substituent is covalently attached to the compounds. Multiple ways of attaching substituents to a polypeptides is known, such as by attaching the substituent via the N-terminal, the C-terminal or an internal amino acid residue. In one embodiment, the compound may comprise one or more substituents. In one embodiment, the compound comprises one or two substituents. In one embodiment, the compound has one or two substituents. In one embodiment, the compound has one substituent. In one embodiment, the compound has two substituents.

In embodiments where the compound has two substituents it is preferred that the two substituents are identical.

In one embodiment the one or two substituents are attached to nitrogen atoms of the peptide back-bone. In one embodiment the one or two substituents are attached to amino groups of the peptide back-bone. In one embodiment the one or two substituents are attached to the epsilon nitrogen's of one or two Lys residues.

In one embodiment the two substituents are attached to different Lys residues of the peptide back-bone. In one embodiment the two substituents are attached to the epsilon- nitrogens of different Lys residues in the peptide back-bone. As described herein above the fusion polypeptide or the peptide back-bone of the derivative comprising or consisting of an GLP-1 analogue, a peptide spacer and an EGF(A) analogue may have one or more Lys residues. Various examples of GLP-1 analogues, peptide spacers and EGF(A) analogues with different numbers of Lys residues have been described herein above, and such sequences may be combined to obtain the fusion polypeptide or peptide back-bone having exactly one or two Lys residues.

In one embodiment the peptide back-bone has one or two Lys residues. In one embodiment the peptide back-bone comprise only one Lys residue. In one embodiment the peptide back-bone comprise exactly two Lys residues.

In one embodiment the peptide back-bone comprise a GLP-1 analogue comprising one or two Lys residues. In one embodiment the peptide back-bone comprise a GLP-1 analogue comprising only one Lys residue. In one embodiment the peptide back-bone comprise a GLP-1 analogue comprising exactly two residues.

In one embodiment the peptide back-bone comprise an EGF(A) analogue comprising one or two Lys residues. In one embodiment the peptide back-bone comprise a an EGF(A) analogue comprising only one Lys residue. In one embodiment the peptide backbone comprises an EGF(A) analogue comprising exactly two Lys residues.

In one embodiment the peptide back-bone comprise a peptide spacer comprising one or two Lys residues. In one embodiment the peptide back-bone comprise a peptide spacer comprising only one Lys residue. In one embodiment the peptide back-bone comprise a peptide spacer comprising exactly two residues. In an embodiment the substituent is aimed at improving the functionality of the peptides.

In one embodiment the substituent increases half-life of the compound, so that the plasma half-live of a derivative comprising a peptide backbone and a substituent have an increased half-life compared to the half-life of the peptide backbone as illustrated herein (Section C5, table 5).

Methods for determining half-life in different species are well known in the art and exemplified herein for minipigs (Section C5).

In one embodiment the derivative according to the invention has a half-life above 12 hours.

In one embodiment the derivative according to the invention has a half-life above 24 hours, such as above 36 hours or such as above 48 hours in minipigs measured after either subcutaneously or intravenously dosing.

Substituent

The term "substituent" refers to a moiety that is attached to a polypeptide via an amino acid residue, by substituting the atom normally present in the same position.

Frequently the substituent replaces a hydrogen atom, such as a hydrogen of an amino group (-NH ₂ ). The substituent is thus a moiety covalently attached to a peptide or polypeptide. According to the invention it is preferred that the moiety e.g. the substituent has no or minimal effect on the functionality of the peptide while adding other beneficial properties, such as increase stability or increase half-life.

In one embodiment, a half-life extending substituent is a protein moiety. In a further such embodiment the protein moiety may include human albumin, an Fc-domain or an unstructured protein extension. In a further embodiment the protein moiety may by fused to one of the analogues. In a further embodiment, the protein moiety is an Fc domain and the Fc domain is fused to the GLP-1 analogue or the EGF(A) analogue. When an Fc fusion is prepared the resulting compound will usually be divalent as two Fc-polypeptides will form one Fc-domain.

In one embodiment the substituent is not a protein moiety.

In one embodiment the substituent is not a protein moiety fused to the peptide backbone.

In another embodiment the substituent is a non-protein moiety.

In a particular embodiment, the substituent is capable of forming non-covalent complexes with albumin, thereby promoting the circulation of the derivative within the blood stream, and also having the effect of protracting the time of action of the derivative. In a particular embodiment, the substituent is capable of protracting the time of action of the derivative without substantially decreasing its binding capacity to PCSK9 and/or the GLP-1 receptor.

In one embodiment the derivative comprises a half-life extending substituent.

Various half-life extending substituents are well-known in the art and include in particular albumin binders comprising a fatty acid group as described further below, and such albumin binders are non-protein substituents.

The substituent comprises at least one fatty acid group.

In a particular embodiment, the fatty acid group comprises a carbon chain which contains at least 8 consecutive -CH ₂ - groups. In one embodiment the fatty acid group comprise at least 10 consecutive -CH ₂ - groups, such as least 12 consecutive -CH ₂ - groups, at least 14 consecutive -CH ₂ - groups, at least 16 consecutive -CH ₂ - groups, at least 18 consecutive -CH ₂ - groups.

In one embodiment the fatty acid group comprises 8-20 consecutive -CH ₂ - groups.

In one embodiment the fatty acid group comprises 10-18 consecutive -CH ₂ - groups. In one embodiment the fatty acid group comprises 12-18 consecutive -CH ₂ - groups. In one embodiment the fatty acid group comprises 14-18 consecutive -CH ₂ - groups.

In situations where the derivative comprise two substituents, an increased half-life may be obtained with shorter fatty acid groups, thus in an embodiment where the derivate comprise two substituents the fatty acid groups may comprise at least 8 consecutive -CH ₂ - groups, such as least 10 consecutive -CH ₂ - groups, such as least 12 consecutive -CH ₂ - groups, at least 14 consecutive -CH ₂ - groups, at least 16 consecutive -CH ₂ - groups, at least 18 consecutive -CH ₂ - groups.

In a further embodiment where the derivative comprises two substituents, the substituents each comprise a fatty acid group comprising 8-18 consecutive -CH ₂ - groups. In further such embodiments the fatty acid groups comprise 10-18 consecutive -CH ₂ - groups, such as 12-18 consecutive -CH ₂ - groups, such as 14-18 consecutive -CH ₂ - groups.

The term "fatty acid group" as used herein may be referred to as chemical group comprising at least one functional group being a Br0nsted-Lowry acid with a pKa < 7.

In one embodiment the substituent comprises at least eight consecutive -CH ₂ - groups and at least one functional group (FG) with a pKa < 7. Non-limiting examples of such functional groups that are Bransted-Lowry acids include carboxylic acids (including also carboxyphenoxy). The fatty acid group in one embodiment comprise a carbonyl at the opposite end of the function group (the acid), such fatty acid groups may also be referred to as di-acids.

In one embodiment the term "protractor" may be used to describe the fatty acid group which is the terminal part of the substituent responsible for extending half-life of the compound.

In one embodiment the protractor may be defined by:

Chem. 1 : HOOC-(CH ₂ ) _n -CO- ^* wherein n is an integer in the range of 8-20, which may also be referred to as a C(n+2) diacid or as

Chem. 1 b: , wherein n is an integer in the range of 8-20.

In one embodiment the protractor may be defined by:

Chem. 2: HOOC-(C ₆ H ₄ )-0-(CH2) _m -CO- ^* wherein m is an integer in the range of 8-1 1 or as

Chem. 2b: wherein the carboxy group is in position 2, 3 or 4 of the (C ₆ H ₄ ) group of Chem. 3 and wherein m is an integer in the range of 8-1 1 .

In one embodiment the protractor may be defined by Cheml , Chem 1 b, Chem 2 or Chem 2b as defined above. Substituents according to the invention in an embodiment comprise one or more linker elements. The linker elements may be linked to each other and the protractor by amide bonds and referred to as "Z" (see further below).

As further defined herein below the number of linker elements may be at most 6, referred to as -Z1 -Z2-Z3-Z4-Z5-Z6-, where Z1 is connected with the protractor (Pro-) and the last Z element is connected with the peptide, in which case the substituent may be referred to as Pro-Z1 -Z2-Z3-Z4-Z5-Z6-. The symbol ^* above thus indicates the attachment point to Z1 , which when bound via an amide bond is a nitrogen. In an embodiment, where Z1 is a bond (see below), the symbol ^* indicates the attachment point to the nitrogen of the neighbouring Z element. In one embodiment the substituent is defined by: Pro-Z1 -Z2-Z3-Z4-Z5-Z6- wherin Pro- is selected from Cheml , Chem 1 b, Chem 2 and Chem 2b and wherein n is an integer in the range of 8-20 and m is an integer in the range of 8-1 1.

In a particular embodiment, n is 8, 9, 10, 1 1 , 12, 13, 14, 15, 16, 17, 18, 19 or 20 in Chem. 1 or 1 b and m is 8, 9, 10 or 1 1.

The term "bond" as used here means a covalent bond. When a linker element of Z1 - Z6 is defined as a bond, it is equivalent to a situation wherein said component is absent. The indication herein below that any of Z1 -Z6 is a bond may also be read as any of Z1 -Z ₆ being absent. Logically "a bond" cannot follow "a bond". The indication "a bond" here thus means that the previous Z element is covalently linked to the next Z element that is not "a bond" (or absent).

The linker elements Z1-Z6 are individually selected from chemical moieties capable of forming amide bonds, including amino acid like moieties, such as Glu, yGlu (also termed gamma Glu or gGlu and defined by ^* -NH-CH-(COOH)-CH ₂ -CH ₂ -CO- ^* ) Gly, Ser, Ala, Thr, Ado, Aeep and Aeeep and further moieties as described below.

In one embodiment the Z1 element is optional, in one such embodiment Z1 is selected from

Chem. 3: ^* -N -CH ₂ -(C ₆ H ₁₀ )-CO- ^* or

Chem. 3b: , and

a bond.

Chem.3 may also be referred to as Trx for Tranexamic acid trans-4- (aminomethyl)cyclohexanecarboxylic acid, where Chem 3. covers the o- (1 ,2), m- (1 ,3) and p- (1 ,4) forms, while Chem 3b .specifies the p- (1 ,4) form.

In one embodiment Z2 is selected from yGlu, Glu, or a bond. In one embodiment Z2 is yGlu.

In one embodiment Z3, Z4, Z5 and Z6 are selected, independently of each other, from Glu, yGlu, Gly, Ser, Ala, Thr, Ado, Aeep and Aeeep and a bond.

Glu, Gly, Ser, Ala, Thr are amino acid residues well known in the art.

yGlu is defined by Chem. 4: ^* -NH-CH(COOH)-(CH ₂ ) ₂ -CO- ^* which is the same as Chem. 4b: and may also be referred to as yGlu

Ado is defined by Chem. 5: ^* -NH-(CH ₂ ) ₂ -0-(CH ₂ ) ₂ -0-CH ₂ -CO- ^* may also be referred to as 8-amino-3,6-dioxaoctanoic acid and which is the same as

Chem. 5b:

Aeep is defined by Chem. 6: ^* NH-CH ₂ CH ₂ 0CH ₂ CH ₂ 0CH ₂ CH ₂ CO ^* , which may also be referred to as

Chem. 6b: Aeeep is defined of Chem. 7: ^* NH-CH ₂ CH ₂ 0CH ₂ CH ₂ 0CH ₂ CH ₂ 0CH ₂ CH ₂ CO ^* , which may also be referred to as

Chem. 7b:

In one embodiment Z ₃ , Z ₄ , Z ₅ and Z ₆ are selected, independently of each other, from Glu, yGlu, Gly, Ala, Ado, Aeep and Aeeep and a bond.

In one embodiment Z ₃ , Z ₄ , Z ₅ and Z ₆ are selected, independently of each other, from Glu, yGlu, Gly, Ala, Ado and a bond.

In one embodiment Z ₃ , Z ₄ , Z ₅ and Z ₆ are selected, independently of each other, from Glu, yGlu, Gly, Ado and a bond.

In one embodiment Z ₃ , Z ₄ , Z ₅ and Z ₆ are selected, independently of each other, from yGlu, Gly, Ado and a bond.

In one embodiment Z ₃ , Z ₄ , Z ₅ and Z ₆ are selected, independently of each other, from yGlu, Ado and a bond.

In an embodiment the substituent(s) is/are selected from the group of substituents defined by #1 to #14 below.

Substituent Pro Zl Z2 Z3 Z4 Z5 Z6

# Chem 1 or 2 Chem3 Chem 4 Chem 5 Chem 4/5 Chem 4/5 Chem 4/ 5

Substituent #1 is defined by Chem. 6: HOOC-(CH ₂ )i ₆ -CO-YGIu-Ado-Ado-* which is the same a

Chem. 6b:

Substituent #2 is defined by Chem. 7: HOOC-(CH ₂ )i ₆ -CO-YGIu-Ado-Ado-Ado-Ado-* which is the same as

Chem. 7b:

Substituent #3 is defined by Chem. 8: HOOC-(CH ₂ )i ₆ -CO-YGIu-Ado* which is the same as Chem. 8b:

Substituent #4 is defined by Chem. 9: HOOC-(CH ₂ )I ₆ -CO-YGIU-* which is the same as

Chem. 9b:

Substituent #5 is defined by Chem. 10: HOOC-(CH ₂ )i ₈ -CO-YGIu-Ado-Ado-* which is the same as

Chem. 10b:

Substituent #6 is defined by Chem. 1 1 : HOOC-(CH ₂ )i ₈ -CO-Trx-YGIu-Ado-Ado-* which is specified as

Chem. 1 1 b: Substituent #7 is defined by Chem. 1 2: HOOC-(CH ₂ ) ₁₈ -CO-TI-X-YGIU-YGIU-YGIU-

YGIU-* whic

Chem. 12b:

Substituent #8 is defined by Chem. 13: HOOC-(CH ₂ ) ₁₈ -CO-Trx-YGIu-Ado-Ado-Ado- which is specified as

Substituent #9 is defined by Chem. 14: HOOC-(CH ₂ )i ₈ -CO-Trx-YGIu-YGIu- ^* which

Substituent #1 1 is defined by Chem. 16: HOOC-(CH ₂ )i ₈ -CO-Trx-YGIu-Ado-Ado-Ado- Ado- ^* which

Chem. 16b:

Substituent #12 is defined by Chem. 17: HOOC-(CH ₂ )i ₈ -CO-Trx-YGIu- ^* which specified as Chem. 17b:

Substituent #13 is defined by Chem. 18: 4-COOH-PhO-C1 1-yGlu-Ado-Ado- ^* which is specified

Chem. 18b:

Substituent #14 is defined by Chem. 19: HOOC-(CH ₂ )i ₄ -CO-YGIu-Ado-Ado- ^* which is specified a

Chem. 19b: Bifunctional compounds

Multiple fusion compounds are described herein and as described elsewhere the challenge is to ensure that both functionalities are maintained and balanced. The

compounds disclosed include variation in the EGF(A) analogue, the spacer and the GLP-1 analogue and the order of the elements.

In one embodiment the fusion polypeptide comprises the GLP-1 analogue in the N- terminal and the EGF(A) analogue in the C-terminal, which was found to be important to maintain GLP-1 functionality.

In further embodiments the sequence of the EGF(A) analogues should the very least include the 301 L mutation, and preferable one or more of 309R and 309I as described in details herein and exemplified by the sequences of the EGF(A) analogue identified by SEQ ID NO.: 107 and 108 which may also include a 312E mutation to remove the wildtype lysine.

In one embodiment the GLP-1 analogue comprises mutations as described herein above, such as a mutation of residue 8, to such as 8Aib, 8G or 8W, and residue 34, to such as 34R, this allows for the substituent to be attached to K26. A further mutation such as 30G may be favourable to reduce the potency of the GLP-1 analogue. In such embodiments the compound comprises a GLP-1 analogue and an EGF(A) analogue, wherein

i) said GLP-1 analogue is identified by SEQ ID No.: 139,140, 141 , 142 or 164 and ii) said EGF(A) analogue is identified by SEQ ID No.: 107, 108 109.

In one embodiment the compound comprises a GLP-1 analogue and an EGF(A) analogue, wherein

i) said GLP-1 analogue is identified by SEQ ID No.: 139 or 164 and

ii) said EGF(A) analogue is identified by SEQ ID No.: 107 or 108.

In one embodiment the compound comprises a GLP-1 analogue and an EGF(A) analogue, wherein

i) said GLP-1 analogue is identified by SEQ ID No.: 164 and

ii) said EGF(A) analogue is identified by SEQ ID No.: 108.

In one embodiment the compound is any of the GLP-1/EGF(A) compounds #1 -74 and 76-314.

In one embodiment the compound is selected from the group of compounds defined as GLP-1/EGF(A) compounds #1 -74, 76-314.

In one embodiment the compound is the GLP-1/EGF(A) compounds #69 and/or #306. In one embodiment the compound is the GLP-1/EGF(A) compound #69. In one embodiment the compound is the GLP-1/EGF(A) compound #306.

In one embodiment the compound is the GLP-1/EGF(A) compounds #41 and/or #48. In one embodiment the compound is the GLP-1/EGF(A) compound #41. In one embodiment the compound is the GLP-1/EGF(A) compound #48.

Methods of preparation

The compounds described herein may be prepared using common general knowledge. The backbone or fusion polypeptide may be provided either by chemical synthesis (as described in Method section A1 ) or by heterologous expression. Expression vectors encoding the fusion polypeptide can be prepared by ordinary molecular biology and a suitable host can be selected. Methods may also be combined whereby one part of the backbone is prepared synthetically while another part of the back-bone is prepared by

recombinant technology. The substituent may be attached to the peptide back-bone during chemical synthesis or in a subsequent reaction with the back-bone or part hereof. Independently of the method of preparation the compounds are defined by their elements e.g. a fusion polypeptide (the peptide back-bone) and one or more substituent(s).

An aspect of the invention relates to a method of preparing a fusion polypeptide comprising a GLP-1 analogue and a EGF(A) analogue as described herein.

An aspect of the invention relates to a method of preparing a derivative of a fusion polypeptide comprising a GLP-1 analogue and an EGF(A) analogue further comprising one or more substituents covalently attached to the fusion polypeptide.

Pharmaceutical composition

The invention also relates to pharmaceutical compositions comprising a compound of the invention (or a pharmaceutically acceptable salt, amide, or ester thereof), and a pharmaceutically acceptable excipient. Such compositions may be prepared as is known in the art.

The term "excipient" broadly refers to any component other than the active therapeutic ingredient(s). The excipient may be an inert substance, an inactive substance, and/or a not medicinally active substance. The excipient may serve various purposes, e.g. as a carrier, vehicle, diluent, tablet aid, and/or to improve administration, and/or absorption of the active substance. Non-limiting examples of excipients are: solvents, diluents, buffers, preservatives, tonicity regulating agents, chelating agents, and stabilisers. The formulation of pharmaceutically active ingredients with various excipients is known in the art, see e.g.

Remington: The Science and Practice of Pharmacy (e.g. 19 ^th edition (1995), and any later editions).

A composition of the invention may be in the form of a liquid formulation, i.e.

aqueous formulation comprising water. A liquid formulation may be a solution, or a suspension. Alternatively, it may be a solid formulation, e.g. a freeze-dried or spray-dried composition.

A composition of the invention may be for parenteral administration, e.g.

administration is to be performed by subcutaneous, intramuscular, intraperitoneal or intravenous injection by means of a syringe, optionally a pen-like syringe, or by means of an infusion pump.

A pharmaceutical composition of the invention may further comprise a second active ingredient, such as a therapeutic agent, which may simplify administration in case of combination treatments. Examples of formulations include liquid formulations, i.e. aqueous formulations comprising water. A liquid formulation may be a solution, or a suspension. An aqueous formulation typically comprises at least 50% w/w water, or at least 60%, 70%, 80%, or even at least 90% w/w of water.

Alternatively, a pharmaceutical composition may be a solid formulation, e.g. a freeze-dried or spray-dried composition, which may be used as is, or whereto the physician or the patient adds solvents, and/or diluents prior to use.

The pH in an aqueous formulation may be anything between pH 3 and pH 10, for example from about 7.0 to about 9.5; or from about 3.0 to about 7.0, such as from 7.0 to 9.5, or from 3.0 to 7.0.

A pharmaceutical composition may comprise a buffer. The buffer may e.g. be selected from sodium acetate, sodium carbonate, citrate, glycylglycine, histidine, glycine, lysine, arginine, sodium dihydrogen phosphate, disodium hydrogen phosphate, sodium phosphate, and tris(hydroxymethyl)-aminomethan, bicine, tricine, malic acid, succinate, maleic acid, fumaric acid, tartaric acid, aspartic acid, and mixtures thereof.

A pharmaceutical composition may comprise a preservative. The preservative may e.g. be selected from phenol, o-cresol, m-cresol, p-cresol, methyl p-hydroxybenzoate, propyl p-hydroxybenzoate, 2-phenoxyethanol, butyl p-hydroxybenzoate, 2-phenylethanol, benzyl alcohol, chlorobutanol, and thiomerosal, bronopol, benzoic acid, imidurea, chlorohexidine, sodium dehydroacetate, chlorocresol, ethyl p-hydroxybenzoate, benzethonium chloride, chlorphenesine (3p-chlorphenoxypropane-1 ,2-diol), and mixtures thereof. The preservative may be present in a concentration from 0.1 mg/ml to 20 mg/ml.

A pharmaceutical composition may comprise an isotonic agent. The isotonic agent may e.g. be selected from a salt (e.g. sodium chloride), a sugar or sugar alcohol, an amino acid (e.g. glycine, histidine, arginine, lysine, isoleucine, aspartic acid, tryptophan, threonine), an alditol (e.g. glycerol (glycerine), 1 ,2-propanediol (propyleneglycol), 1 ,3-propanediol, 1 ,3- butanediol) polyethyleneglycol (e.g. PEG400), and mixtures thereof. Any sugar such as mono-, di-, or polysaccharides, or water-soluble glucans, including for example fructose, glucose, mannose, sorbose, xylose, maltose, lactose, sucrose, trehalose, dextran, pullulan, dextrin, cyclodextrin, alfa and beta HPCD, soluble starch, hydroxyethyl starch and carboxymethylcellulose-Na may be used. Sugar alcohol is defined as a C4-C8 hydrocarbon having at least one -OH group and includes, for example, mannitol, sorbitol, inositol, galactitol, dulcitol, xylitol, and arabitol. In one embodiment, the sugar alcohol additive is mannitol. A pharmaceutical composition may comprise a chelating agent. The chelating agent may e.g. be selected from salts of ethylenediaminetetraacetic acid (EDTA), citric acid, and aspartic acid, and mixtures thereof.

A pharmaceutical composition may comprise a stabiliser. The stabiliser may e.g. be one or more oxidation inhibitors, aggregation inhibitors, surfactants, and/or one or more protease inhibitors. A pharmaceutical composition may comprise a stabiliser selected from high molecular weight polymers or low molecular compounds. The stabiliser may e.g. be selected from polyethylene glycol (e.g. PEG 3350), polyvinyl alcohol (PVA),

polyvinylpyrrolidone, carboxy-/hydroxycellulose or derivates thereof (e.g. HPC, HPC-SL, HPC-L and HPMC), cyclodextrins, sulphur-containing substances as monothioglycerol, thioglycolic acid and 2-methylthioethanol, and different salts (e.g. sodium chloride).

A pharmaceutical composition may comprise additional stabilising agents such as, but not limited to, methionine and EDTA, which protect the polypeptide against methionine oxidation, and a nonionic surfactant, which protects the polypeptide against aggregation associated with freeze-thawing or mechanical shearing.

A pharmaceutical composition may comprise one or more surfactants. The term "surfactant" refers to any molecules or ions that are comprised of a water-soluble

(hydrophilic) part, and a fat-soluble (lipophilic) part. The surfactant may e.g. be selected from anionic surfactants, cationic surfactants, nonionic surfactants, and/or zwitterionic surfactants.

A pharmaceutical composition may comprise one or more protease inhibitors, such as, e.g., EDTA (ethylenediamine tetraacetic acid), and/or benzamidineHCI.

Additional, optional, ingredients of a pharmaceutical composition include, e.g., wetting agents, emulsifiers, antioxidants, bulking agents, metal ions, oily vehicles, proteins (e.g., human serum albumin, gelatine), and/or a zwitterion (e.g., an amino acid such as betaine, taurine, arginine, glycine, lysine and histidine).

The derivative or analogue may be administered in the form of a pharmaceutical composition. It may be administered to a patient in need thereof by various routes known in the art. The route of administration may be, for example, parenteral, epidermal; dermal; transdermal; conjunctival; uretal; vaginal; rectal; and/or ocular, lingual; sublingual; buccal; in the mouth; oral; in the stomach; in the intestine; nasal; pulmonary, such as through the bronchioles, the alveoli, or a combination thereof.

A composition may be administered in several dosage forms, for example as a solution; a suspension; an emulsion; a microemulsion; multiple emulsions; a foam; a salve; a paste; a plaster; an ointment; a tablet; a coated tablet; a chewing gum; a rinse; a capsule such as hard or soft gelatine capsules; a suppositorium; a rectal capsule; drops; a gel; a spray; a powder; an aerosol; an inhalant; eye drops; an ophthalmic ointment; an ophthalmic rinse; a vaginal pessary; a vaginal ring; a vaginal ointment; an injection solution; an in situ transforming solution such as in situ gelling, setting, precipitating, and in situ crystallisation; an infusion solution; or as an implant.

A composition may further be compounded in a drug carrier or drug delivery system, e.g. in order to improve stability, bioavailability, and/or solubility. A composition may also be used in the formulation of controlled, sustained, protracting, retarded, and/or slow release drug delivery systems. Medical use

In one aspect the invention relates to the use of a compound according to the invention for use in the manufacture of a medicament.

The invention also relates to a compound of the invention or a pharmaceutical composition thereof for use as a medicament or in the manufacture of a medicament.

In an embodiment, a compound of the invention or a composition thereof may be used for treatment or prevention of cardiovascular diseases and/or cardiovascular risks.

In an embodiment, a compound of the invention or a composition thereof may be used for

i. improving lipid parameters, such as prevention and/or treatment of dyslipidemia, lowering total serum lipids; lowering LDL-C, increasing HDL; lowering small, dense LDL; lowering VLDL; lowering triglycerides; lowering cholesterol; lowering plasma levels of lipoprotein a (Lp(a)); inhibiting generation of apolipoprotein A (apo(A)) ;

ii. the prevention and/or the treatment of cardiovascular diseases, such as cardiac syndrome X, atherosclerosis, myocardial infarction, coronary heart disease, reperfusion injury, stroke, cerebral ischemia, an early cardiac or early cardiovascular disease, left ventricular hypertrophy, coronary artery disease, hypertension, essential hypertension, acute hypertensive emergency, cardiomyopathy, heart insufficiency, exercise intolerance, acute and/or chronic heart failure, arrhythmia, cardiac dysrhythmia, syncopy, angina pectoris, cardiac bypass and/or stent reocclusion, intermittent claudication (atheroschlerosis oblitterens), diastolic dysfunction, and/or systolic dysfunction; and/or the reduction of blood pressure, such as reduction of systolic blood pressure; the treatment of cardiovascular disease. The invention also relates to a method for treatment or prevention of cardiovascular diseases and/or cardiovascular risks

The invention further relates to a method for (i) improving lipid parameters, such as prevention and/or treatment of dyslipidemia, lowering total serum lipids; increasing HDL-C; lowering LDL-C, lowering small, dense LDL-C; lowering VLDL-C; lowering triglycerides; lowering cholesterol; lowering plasma levels of lipoprotein a (Lp(a)); inhibiting generation of apolipoprotein A (apo(A)); (ii) prevention and/or treatment of cardiovascular diseases, such as cardiac syndrome X, atherosclerosis, myocardial infarction, coronary heart disease, reperfusion injury, stroke, cerebral ischemia, an early cardiac or early cardiovascular disease, left ventricular hypertrophy, coronary artery disease, hypertension, essential hypertension, acute hypertensive emergency, cardiomyopathy, heart insufficiency, exercise intolerance, acute and/or chronic heart failure, arrhythmia, cardiac dysrhythmia, syncopy, angina pectoris, cardiac bypass and/or stent reocclusion, intermittent claudication

(atheroschlerosis oblitterens), diastolic dysfunction, and/or systolic dysfunction; and/or reduction of blood pressure, such as reduction of systolic blood pressure; the treatment of cardiovascular disease; wherein a pharmaceutically active amount of a compound according to the invention is administered.

In some embodiments, the compound of the invention may be used for the following medical treatments:

i. prevention and/or treatment of all forms of diabetes, such as hyperglycemia, 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 HbA1 C;

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, delaying or preventing insulin resistance, and/or delaying the progression of non-insulin requiring type 2 diabetes to insulin requiring type 2 diabetes;

iii. improving β-cell function, such as decreasing β-cell apoptosis, increasing β-cell function and/or β-cell mass, and/or for restoring glucose sensitivity to β-cells;

iv. prevention and/or treatment of cognitive disorders and/or neurodegenerative

disorders, such as Alzheimer's disease, Parkinson's disease, and/or multiple sclerosis; 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, bulimia nervosa, and/or obesity induced by administration of an antipsychotic or a steroid; reduction of gastric motility; delaying gastric emptying; increasing physical mobility; and/or prevention and/or treatment of comorbidities to obesity, such as osteoarthritis and/or urine incontinence;

prevention and/or treatment of diabetic complications, such as angiopathy;

neuropathy, including peripheral neuropathy; nephropathy; and/or retinopathy;

improving lipid parameters, such as prevention and/or treatment of dyslipidemia, lowering total serum lipids; increasing HDL; lowering small, dense LDL; lowering VLDL; lowering triglycerides; lowering cholesterol; lowering plasma levels of lipoprotein a (Lp(a)) in a human; inhibiting generation of apolipoprotein a (apo(a)) in vitro and/or in vivo;

prevention and/or treatment of cardiovascular diseases, such as syndrome X, atherosclerosis, myocardial infarction, coronary heart disease, reperfusion injury, stroke, cerebral ischemia, an early cardiac or early cardiovascular disease, left ventricular hypertrophy, coronary artery disease, hypertension, essential

hypertension, acute hypertensive emergency, cardiomyopathy, heart insufficiency, exercise intolerance, acute and/or chronic heart failure, arrhythmia, cardiac dysrhythmia, syncopy, angina pectoris, cardiac bypass and/or stent reocclusion, intermittent claudication (atheroschlerosis oblitterens), diastolic dysfunction, and/or systolic dysfunction; and/or reduction of blood pressure, such as reduction of systolic blood pressure;

prevention and/or treatment of gastrointestinal diseases, such as inflammatory bowel disease, short bowel syndrome, or Crohn's disease or colitis; dyspepsia, and/or gastric ulcers; and/or inflammation, such as psoriasis, psoriactic arthritis, rheumatoid arthritis, and/or systemic lupus erythematosus;

prevention and/or treatment of critical illness, such as treatment of a critically ill patient, a critical illness poly-nephropathy (CIPNP) patient, and/or a potential CIPNP patient; prevention of development of critical illness or CIPNP; prevention, treatment and/or cure of systemic inflammatory response syndrome (SIRS) in a patient;

prevention or reduction of the likelihood of a patient suffering from bacteraemia, septicaemia, and/or septic shock during hospitalisation; and/or stabilising blood glucose, insulin balance and optionally metabolism in intensive care unit patients with acute illness; xi. prevention and/or treatment of polycystic ovary syndrome (PCOS);

xii. prevention and/or treatment of cerebral disease, such as cerebral ischemia, cerebral haemorrhage, and/or traumatic brain injury;

xiii. prevention and/or treatment of sleep apnoea; and/or

xiv. prevention and/or treatment of abuse, such as alcohol abuse and/or drug abuse.

In some embodiments the indication is selected from the group consisting of (i)-(xiv), such as indications (i)-(viii), (x)-(xiii), and/or (xiv), and relates in one way or the other to diabetes.

In some embodiments, the indication is selected from the group consisting of (i)-(iii) and (v)-(viii), such as indications (i), (ii), and/or (iii); or indication (v), indication (vi), indication (vii), and/or indication (viii).

In some embodiments, the indication is (i). In a further particular embodiment the indication is (v). In a still further particular embodiment the indication is (viii). In some embodiments the compound of the invention may be used in the treatment and/or prevention of all forms of diabetes including eating disorders, cardiovascular diseases, gastrointestinal diseases, diabetic complications, and/or polycystic ovary syndrome; and/or for improving lipid parameters, improving β-cell function, and/or for delaying or preventing diabetic disease progression.

The following indications are particularly preferred: Type 2 diabetes and/or obesity.

In some embodiments the invention relates to a method for weight management. In some embodiments the invention relates to a method for reduction of appetite. In some

embodiments the invention relates to a method for reduction of food intake.

Generally, all subjects suffering from obesity are also considered to be suffering from overweight. In some embodiments the invention relates to a method for treatment or prevention of obesity. In some embodiments the invention relates to use of the derivative or analogue of the invention for treatment or prevention of obesity. In some embodiments the subject suffering from obesity is human, such as an adult human or a paediatric human (including infants, children, and adolescents). Body mass index (BMI) is a measure of body fat based on height and weight. The formula for calculation is BMI = weight in

kilograms/(height in meters) ² . A human subject suffering from obesity may have a BMI of ≥30; this subject may also be referred to as obese. 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. 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 comorbidity.

In some embodiments the invention relates to use of the compound of the invention 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 or a paediatric human (including infants, children, and adolescents). In some embodiments a human subject suffering from overweight may have a BMI of≥25, such as a BMI of≥27. In some embodiments a human subject suffering from overweight has a BMI in the range of 25 to <30 or in the range of 27 to <30. In some embodiments the weight-related comorbidity is selected from the group consisting of hypertension, diabetes (such as type 2 diabetes), dyslipidaemia, high cholesterol, and obstructive sleep apnoea.

In some embodiments the invention relates to a method for reduction of body weight. In some embodiments the invention relates to use of the compound of the invention for reduction of body weight. A human to be subjected to reduction of body weight according to the present invention may have a BMI of≥25, such as a BMI of≥27 or a BMI of≥30. In some embodiments the human to be subjected to reduction of body weight according to the present invention may have a BMI of≥35 or a BMI of≥40. The term "reduction of body weight" may include treatment or prevention of obesity and/or overweight. In further embodiments the invention relates to use of compounds according to the invention in treatment or prevention of diabetes and cardiovascular diseases or

cardiovascular risks as mentioned above addressing two diseases or disorders by one drug.

In one embodiment the invention relates to a method of treatment as described above, comprising a step of administering a therapeutically effective dosage of a compound according to the invention to a patient in need thereof.

The dosage to be administered can be determined individually and could be less than 50 mg per week, such as 10-15 mg per week, or 70-100 mg/ month depending on the specific drug compound and dosing regimen selected.

While certain features of the invention have been illustrated and described herein, many modifications, substitutions, changes, and equivalents will now occur to those of ordinary skill in the art. It is, therefore, to be understood that the appended embodiments are intended to cover all such modifications and changes as fall within the true spirit of the invention. PAGE LEFT BLANK INTENTIONALLY

EMBODIMENTS

1. A compound comprising a GLP-1 analogue and an EGF(A) analogue, wherein

i. said GLP-1 analogue is an analogue of GLP-1 (7-37) identified by SEQ ID No: 137 and

ii. said EGF(A) analogue is an analogue of the EGF(A) domain of LDL-R (293-332) identified by SEQ ID No:1 .

2. The compound according to embodiment 1 , wherein said compound has at least one Lys residue.

3. The compound according to embodiment 1 , wherein said compound has at least two Lys residues. 4. The compound according to embodiment 1 , wherein said compound has exactly one or two Lys residue.

5. The compound according to embodiment 1 , wherein said compound has exactly one Lys residue.

6. The compound according to embodiment 1 , wherein said compound has exactly two Lys residue.

7. The compound according to embodiment 1 , wherein said compound comprises a fusion polypeptide.

8. The compound according to embodiment 7, wherein said fusion polypeptide comprise a GLP-1 analogue and a EGF(A) analogue. 9. The compound according to embodiment 8, wherein the GLP-1 analogue is fused to the EGF(A) analogue via the C-terminal amino acid residue of the GLP-1 analogue.

10. The compound according to embodiment 8, wherein the fusion polypeptide comprises the GLP-1 analogue in the N-terminal and the EGF(A) analogue in the C-terminal. The compound according to embodiment 8, wherein EGF(A) analogue is fused to a GLP- 1 analogue via the C-terminal amino acid residue of the EGF(A) analogue. The compound according to embodiment 8, wherein the fusion polypeptide comprises the EGF(A) analogue in the N-terminal and the GLP-1 analogue in the C-terminal. The compound according to any of the embodiments 7-12, wherein said fusion polypeptide comprises a peptide spacer. The compound according to embodiment 13, wherein the peptide spacer consists of 4-80 amino acid residues. The compound according to embodiment 14, wherein the peptide spacer consists of 4-20 amino acid residues. The compound according to embodiment 14, wherein the peptide spacer comprises a Lys residue. The compound according to embodiment 14, wherein the peptide spacer does not comprise a Lys residue. The compound according to embodiment 14, wherein the peptide spacer is selected from the group of peptides identified by SEQ ID NO 1 15-126. The compound according to embodiment 14, wherein the peptide spacer is selected from the group of peptides identified by SEQ ID NO 1 15-136. The compound according to any of the previous embodiments, wherein the GLP-1 analogue is a GLP-1 receptor agonist. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has an EC50 in the GLP-1 in vitro potency assay described in C1 (without HSA), which is 1-50 pM, 10-100 pM, 50-100 pM, 100-250 pM or 250-1000 pM 22. The compound according to any of the previous embodiments, wherein the GLP-1 analogue is a full GLP-1 receptor agonist.

23. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has an EC50 in the GLP-1 in vitro potency assay described in C1 (without HSA), which is comparable to wt GLP-1 .

24. The compound according to embodiment 23, wherein the GLP-1 analogue has an EC50 of at most 50 pM.

25. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has an EC50 in the GLP-1 in vitro potency assay described in C1 (without HSA), which is comparable to semaglutide. 26. The compound according to embodiment 25, wherein the GLP-1 analogue has an EC50 of 5-15 pM.

27. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has an EC50 in the GLP-1 in vitro potency assay described in C1 (with 1 % HSA), which is most 2500 pM.

28. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has an EC50 in the GLP-1 in vitro potency assay described in C1 (with 1 % HSA), which is a least 500 pM.

29. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has the ability to reduce blood glucose in db/db mice as described in C7.

30. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has the ability to reduce blood glucose in db/db mice as described in C7 and wherein the EC50 AUC ABG _24h is less than 15 nmol/kg.

31 . The compound according to any of the previous embodiments, wherein the GLP-1 analogue has the ability to reduce body weight in DIO rats as described in C8. 32. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has the ability to reduce body weight in DIO rats as described in C8 and wherein the GLP-1 analogue is capable of reducing body weight to at least 95 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days.

33. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has the ability to reduce body weight in DIO rats as described in C8 and wherein the GLP-1 analogue is capable of reducing body weight to at least 90 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days.

34. The compound according to any of the previous embodiments, wherein the GLP-1 analogue is at least 80, such as 85, such as 90, such as 95 % identical to SEQ ID NO.:137. 35. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises at most 6 amino acid substitutions compared to SEQ ID NO.: 137.

36. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises an amino acid substitution of 8A.

37. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises an amino acid substitution of 8A to G or W

38. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises a non-proteogenic amino acid residue in positions 8.

39. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises the non-proteogenic amino acid residue Aib in positions 8.

40. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises an amino acid substitution of 8A to G, W or the non-proteogenic amino acid residue Aib.

41 . The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises 8Aib. 42. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises zero, one or two Lys residues.

43. The compound according to any of the previous embodiments, wherein the GLP-1

analogue comprises one or two Lys residues selected from the group consisting of: 12K, 21 K, 23K, 24K, 25K, 26K, 27K, 30K, 31 K, 32K, 33K, 34K and 36K.

44. The compound according to any of the previous embodiments, wherein the GLP-1

analogue comprises the Lys residues 26K and 34K.

45. The compound according to any of the previous embodiments, wherein the GLP-1

analogue comprises a substitution or deletion of one or both of 26K and 34K.

46. The compound according to any of the previous embodiments, wherein the GLP-1

analogue does not comprise 26K.

47. The compound according to any of the previous embodiments, wherein the GLP-1

analogue comprises a deletion of 26K.

48. The compound according to any of the previous embodiments, wherein the GLP-1

analogue comprises an amino acid substitution of 26K.

49. The compound according to any of the previous embodiments, wherein the GLP-1

analogue comprises 26R.

50. The compound according to any of the previous embodiments, wherein the GLP-1

analogue comprises an additional Lys residue.

51 . The compound according to any of the previous embodiments, wherein the GLP-1

analogue comprises an additional Lys selected from the group of: 12K, 21 K, 23K, 24K, 25K, 27K, 30K, 31 K, 32K, 33K and 36K. 52. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises exactly one Lys residue selected from: 12K, 21 K, 23K, 24K, 25K, 26K, 27K, 30K, 31 K, 32K, 33K, 34K and 36K. 53. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises exactly two lys residues selected from the pairs of:

k) 21 K and 26K

I) 23K and 26K

m) 24K and 26K

n) 25K and 26K

o) 27K and 26K

P) 30K and 26K

q) 31 K and 26K

r) 32 K and 26K

s) 33K and 26K

t) 34 K and 26K

54. The compound according to any of the previous embodiments, wherein the GLP-1 analogue does not comprise 34K.

55. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises a deletion of 34K.

56. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises an amino acid substitution of 34K.

57. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises 34R or 34Q. 58. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises a deletion of amino acid residues 35-37, 34-37 or 33-37

59. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises 33L. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises at least 26, such as at least 27 or at least 28 amino acid residues. The compound according to any of the previous embodiments, wherein the GLP-1 analogue comprises an amino acid substitution of one of the amino acid residues 21 , 23, 24, 25, 27, 29, 30, 31 , 32 and 33. The compound according to any of the previous embodiments, wherein the GLP-1 analogue has the sequence defined as follows: H-X ₈ -E-G-T-X ₁₂ -T-S-D-V-S-S-Y-L-X2i-G- X ₂₃ -X ₂ 4-X25-X26-X27-F-X ₂ 9-X30-X3i-X32-X33-X34-X35-X36-X37 (SEQ I D NO 187) wherein

X ₈ is A, G, W or Aib,

X ₁₂ is F or K,

X ₂₃ is Q, G or K,

X ₂₄ is A, G, V or K,

X ₂₅ is A, G, V or K,

X ₂₇ is E, G or K,

X ₂₉ is I, A or V,

X ₃₀ is A, G or K,

X ₃₂ is L, G, T, V, I or K,

X33 is V, G, I, L, K or absent,

X34 is K, R, Q or absent,

X35 is G or absent,

X ₃ 6 is R, K or absent and

X37 is G or is absent. The compound according to any of the previous embodiments, wherein the GLP-1 analogue is selected from the group of GLP-1 analogues identified by SEQ ID NO.: 138 to 186, such as SEQ ID NO.: 139-146, 155-162, 164-173, such as SEQ ID NO.: 139-142, 155-162, 164-173, such as SEQ ID NO.: 139, 142, 155-162, 164-173, such as SEQ ID NO.: 139, 155-162, 164-173, such as SEQ ID NO.: 155-162, 164-173 or such as SEQ ID NO.: 139 and 164. 64. The compound according to any of the previous embodiments, wherein the EGF(A) analogue is a PCSK9 inhibitor.

65. The compound according to any of the previous embodiments, wherein the EGF(A) analogue has increased binding affinity to human PCSK9 compared to the EGF(A) domain of LDL-R (293-332) identified by SEQ ID NO.: 1 .

66. The compound according to any of the previous embodiments, wherein the EGF(A) analogue binds PCSK9 with a Ki below 50 nM, such as below 25 nM or such as below 10 nM, when measured in a PCSK9-LDL-R binding competitive ELISA assay as described in

Section C3.

67. The compound according to any of the previous embodiments, wherein the EGF(A) analogue binds PCSK9 with a Ki below 5 nM, when measured in the PCSK9-LDL-R binding competitive ELISA assay as described in Section C3.

68. The compound according to any of the previous embodiments, wherein the EGF(A) analogue increases LDL uptake. 69. The compound according to any of the previous embodiments, wherein the EGF(A) analogue increases LDL uptake in the presence of human PCSK9.

70. The compound according to any of the previous embodiments, wherein the EGF(A) analogue has a EC50 below 1000 nM when measured in the LDL uptake assay described in section C4.

71 . The compound according to any of the previous embodiments, wherein the EGF(A) analogue has a EC50 below 500 nM when measured in the LDL uptake assay described in section C4.

72. The compound according to any of the previous embodiments, wherein the EGF(A) analogue decreases blood cholesterol. 73. The compound according to any of the previous embodiments, wherein the EGF(A) analogue decreases blood cholesterol in DIO rats when evaluated as described in section C8 74. The compound according to any of the previous embodiments, wherein the EGF(A) analogue reduces blood cholesterol at least 0.5 mmol/L when dosed with 30 nmol/kg/day and measured after 21 days.

75. The compound according to any of the previous embodiments, wherein the EGF(A) analogue reduces blood cholesterol by at least 0.8 mmol/L when dosed with 300 nmol/kg/day and measured after 21 days.

76. The compound according to any of the previous embodiments, wherein the EGF(A) analogue is at least 80, 85, 90 or such as 95 % identical to SEQ ID NO.: 1.

77. The compound according to any of the previous embodiments, wherein the EGF(A) analogue comprises 1 -15 amino acid substitution(s) compared to SEQ ID NO.: 1.

78. The compound according to any of the previous embodiments, wherein the EGF(A) analogue comprises 301 L.

79. The compound according to any of the previous embodiments, wherein the EGF(A) analogue comprises 301 L and 309R. 80. The compound according to any of the previous embodiments, wherein the EGF(A) analogue comprises one or more of the (wild-type) amino acid residues 295N (Asn), 296E (Glu), 298L (Leu), 302G (Gly) and 310D (Asp).

81 . The compound according to any of the previous embodiments, wherein the EGF(A) analogue does not comprise any K residue.

82. The compound according to any of the previous embodiments, wherein the EGF(A) analogue does not comprise 312K. 83 The compound according to any of the previous embodiments, wherein the EGF(A) analogue comprises 312E, 312D, 312Q or 312R.

84 The compound according to any of the previous embodiments, wherein the EGF(A)

analogue comprises 301 L, 309R and an amino acid substitution of 312K, such as 312E.

85. The compound according to any of the previous embodiments, wherein the EGF(A)

analogue comprises 301 L, 310D and an amino acid substitution of 312K, such as 312E. 86. The compound according to any of the previous embodiments, wherein the EGF(A)

analogue comprises 301 L and 310D and the peptide does not have a substitution of 299D to G, V or H.

87. The compound according to any of the previous embodiments, wherein the EGF(A)

analogue comprises 321 D or 321 E.

88. The compound according to any of the previous embodiments, wherein the EGF(A)

analogue comprises 301 L, 309R, 312E and 321 E. 89. The compound according to any of the previous embodiments, wherein the EGF(A)

analogue sequence is defined by any one of SEQ ID NO.: 19, 21 , 73, 107, 108, 109, 1 10, 1 1 1 , 1 12, 1 13 and 1 14, such as 107, 108, 109, 1 10 and 1 1 1 , such as 107 and 108.

90. The compound according to any of the previous embodiments 7-89, wherein the fusion polypeptide comprises a GLP-1 analogue, a spacer peptide and an EGF(A) analogue.

91 . The compound according to embodiment 90, wherein the GLP-1 analogue is as defined in any of the embodiments 20-63. 92. The compound according to embodiment 90 or embodiment 91 , wherein the EGF(A) analogue is as defined in any of the embodiments 64-89.

93. The compound according to embodiment 90, 91 or 92, wherein spacer peptide is as

defined in any of the embodiments 14-19. 94. The compound according to embodiment 90, wherein the fusion polypeptide is selected from the group of sequences identified by SEQ ID NO.:188-384.

95. The compound according to any of the embodiment 90-94, wherein the fusion

polypeptide comprises up to two lysine residues.

96. The compound according to any of the previous embodiments, wherein the compound comprise up to two substituents. 97. The compound according to any of the previous embodiments, wherein the compound comprise up to two half-life extending substituents.

98. The compound according to any of the previous embodiments, wherein the compound is a derivative comprising a peptide back-bone and up to two substituents attached hereto.

99. The compound according to embodiment 98, wherein the peptide back-bone is a fusion peptide as defined in any of the embodiments 7-94.

100. The compound according to any of the previous embodiments 96-99, wherein at least one substituent is attached to the GLP-1 analogue, the EGF(A) analogue and/or the spacer.

101. The compound according to embodiment 100, wherein at least one substituent is attached to the GLP-1 analogue.

102. The compound according to embodiment 100, wherein at least one substituent is attached to the EGF(A) analogue.

103. The compound according to embodiment 100, wherein at least one substituent is attached to the spacer.

104. The compound according to embodiment 100, wherein at least one substituent is attached via a Lys/K amino acid residue. 105. The compound according to embodiment 100, wherein at least one substituent is attached to the GLP-1 analogue via a Lys/K amino acid residue.

106. The compound according to embodiment 100, wherein at least one substituent is attached to the GLP-1 analogue via a Lys/K amino acid residue selected from the group consisting of: 12K, 21 K, 24K, 25K, 26K, 27K, 31 K, 32K and 36K.

107. The compound according to embodiment 100, wherein at least one substituent is attached to the GLP-1 analogue via 26K.

108. The compound according to embodiment 100, wherein at least one substituent is attached to the EGF(A) analogue.

109. The compound according to embodiment 100, wherein at least one substituent is attached to the EGF(A) analogue via 292Lys, 293Lys, 294Lys, 299Lys, 300Lys, 303Lys,

305Lys, 306Lys, 309Lys, 31 1 Lys, 312Lys, 313Lys, 314Lys, 315Lys, 316Lys, 318Lys, 320Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys or 333Lys . 1 10. The compound according to embodiment 100, wherein at least one substituent is attached to the EGF(A) analogue via 292Lys, 293Lys, 294Lys, 300Lys, 303Lys, 305Lys, 306Lys, 309Lys, 31 1 Lys, 312Lys, 313Lys, 314Lys, 316Lys, 318Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys or 333Lys. 1 1 1. The compound according to embodiment 100, wherein at least one substituent is attached to the EGF(A) analogue via 292Lys, 293Lys, 294Lys, 300Lys, 303Lys, 305Lys, 306Lys, 31 1 Lys, 312Lys, 313Lys, 314Lys, 316Lys, 318Lys, 321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys or 333Lys. 1 12. The compound according to embodiment 100, wherein at least one substituent is attached to the EGF(A) analogue via 292Lys, 293Lys, 294Lys, 300Lys, 303Lys, 305Lys, 306Lys, 31 1 Lys, 313Lys, 314Lys, 316Lys, 318Lys,321 Lys, 322Lys, 323Lys, 324Lys, 325Lys, 326Lys, 327Lys, 328Lys, 329Lys, 330Lys, 332Lys or 333Lys. . The compound according to embodiment 100, wherein at least one substituent is attached to the EGF(A) analogue via 313Lys, 321 Lys, 324Lys, 328Lys or 333Lys. . The compound according to embodiment 100, wherein at least one substituent is attached to the peptide spacer. . The compound according to embodiment 100, wherein at least one substituent is attached to the peptide spacer via a Lys residue. . The compound according to embodiment 100, wherein at least one substituent is attached to the peptide spacer via a Lys residue, wherein the spacer is a variant of SEQ ID 1 16 having a Lys in position 1 , 2, 3, 4, 5, 6, 7 or 8. . The compound according to any one of the embodiments 96-1 16, wherein the compound comprises exactly two substituents attached to the fusion peptide. . The compound according to embodiment 1 17, wherein one substituent is attached via the GLP-1 analogue as defined in embodiments 105-107 and one substituent is attached to the spacer as defined in any one of embodiments 1 15-1 16. . The compound according to embodiment 1 17, wherein one substituent is attached via the EGF(A) analogue as defined in any one of embodiments 109-1 13 and one substituent is attached to the peptide spacer as defined in any one of embodiments 1 15- 1 16. . The compound according to embodiment 1 17, wherein one substituent is attached via the GLP-1 analogue as defined in any one of the embodiments 105-107 and one substituent is attached to the EGF (A) analogue as defined in any one of embodiments 109-1 13. . The compound according to embodiment 1 17, wherein the two substituents are attached via the GLP-1 analogue as defined in any one of embodiments 105-108. . The compound according to embodiment 1 17, wherein the two substituents are attached via the EGF(A) analogue as defined in any one of embodiments 109-1 13. 123. The compound according to any of the previous embodiments 96-122, wherein the substituent(s) comprises a fatty acid group (AB). 124. The compound according to embodiment 123, wherein the substituent(s) comprises a fatty acid group selected from the group consisting of Chem 1 -C(=0)-(CH ₂ )n-COOH wherein n is an integer in the range of 8-20 and Chem 2 -HOOC-(C ₆ H4)-0-(CH2)m-CO- ^* wherein m is an integer in the range of 8-1 1. 125. The compound according to embodiment 123, wherein the substituent(s) comprises a fatty acid group selected from di-acids -C(=0)-(CH ₂ )n-COOH wherein n is 14-20.

126. The compound according to embodiment 123, wherein the substituent(s) comprises a fatty acid group selected from di-acids (-HOOC-(C ₆ H4)-0-(CH2)m-CO- ^* ) wherein m is an integer in the range of 8-1 1.

127. The compound according to any of the embodiments 123-126, wherein the at least one substituent further comprises at least one linker element. 128. The compound according to any of the embodiments 123-126, wherein the at least one substituent further comprises at most 6 linker elements referred to as -Z1-Z2-Z3-Z4-Z5- ¾-.

129. The compound according to any of the embodiments 123-126, wherein the at least one substituent further comprises at most 6 linker elements referred to as -Z1-Z2-Z3-Z4-Z5-

Z ₆ -, wherein Z1 is connected with the fatty acid group and the last Z element is connected with the peptide back-bone.

130. The compound according to any of the embodiments 128 and 129, wherein -Z-i is ^* - NH-CH ₂ -(C ₆ H ₁₀ )-CO- ^* or a bond.

131. The compound according to any of the embodiments 128 and 130, wherein -Z ₂ - is yGlu, Glu or a bond. 132. The compound according to any of the embodiments 128 and 130, wherein -Z ₂ - is yGlu.

133. The compound according to any of the embodiments 128 and 132, wherein Z ₃ , Z ₄ , Z ₅ and Z ₆ are selected, independently of each other, from Glu, yGlu, and Ado and a bond.

134. The compound according to any of the embodiments 128 and 132, wherein Z ₃ , Z ₄ , Z ₅ and Z ₆ are selected, independently of each other, from yGlu, Ado and a bond.

135. The compound according to any of the embodiments 123 - 134, wherein the at least one substituent comprises a linker comprising -yGlu-Ado-Ado-.

136. The compound according to any of the embodiments 123, wherein the at least one substituent is selected from the substituents #1 -13, such as from substituents #1-4, #5-

12, #6-12 or the group of substituents consisting of: substituent # 1 , #5 and #6.

137. The compound according to any of the previous embodiments, wherein the

compound is bi-functional.

138. The compound according to any of the previous embodiments, wherein the

compound is a GLP-1 receptor agonist.

139. The compound according to embodiment 137 or embodiment 138, wherein the compound has an EC50 in the GLP-1 in vitro potency assay described in C1 (without

HSA), which is 1-50 pM, 10-100 pM, 50-100 pM, 100-250 pM or 250-1000 pM.

140. The compound according to any of the previous embodiments 137-139, wherein the compound is a full GLP-1 receptor agonist.

141. The compound according to any of the previous embodiments 137-139, wherein the compound has an EC50 in the GLP-1 in vitro potency assay described in C1 (without HSA), which is comparable to wt GLP-1 . 142. The compound according to any of the previous embodiments 137-139, wherein the compound has an EC50 in the GLP-1 in vitro potency assay described in C1 (without HSA) of at most 50 pM. 143. The compound according to any of the previous embodiments 137-139, wherein the compound has an EC50 in the GLP-1 in vitro potency assay described in C1 (without HSA), which is comparable to semaglutide.

144. The compound according to any of the previous embodiments 137-139, wherein the compound has an EC50 in the GLP-1 in vitro potency assay described in C1 (without

HSA) of 5-15 pM.

145. The compound according to any of the previous embodiments 137-139, wherein the compound has an EC50 in the GLP-1 in vitro potency assay described in C1 (with 1 % HSA), which is at most 2500 pM.

146. The compound according to any of the previous embodiments 137-139 , wherein the compound has an EC50 in the GLP-1 in vitro potency assay described in C1 (with 1 % HSA), which is a least 500 pM.

147. The compound according to any of the previous embodiments 137-146, wherein the compound has the ability to reduce blood glucose in db/db mice as described in C7.

148. The compound according to any of the previous embodiments 137-146, wherein the compound has the ability to reduce blood glucose in db/db mice as described in C7 and wherein the EC50 AUC ABG ₂ 4h is less than 15 nmol/kg.

149. The compound according to any of the previous embodiments 137-146, wherein the GLP-1 analogue has the ability to reduce body weight in DIO rats as described in C8.

150. The compound according to any of the previous embodiments 137-146, wherein the compound has the ability to reduce body weight in DIO rats as described in C8 and wherein the GLP-1 analogue is capable of reducing body weight to at least 95 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days. 151. The compound according to any of the previous embodiments 137-146, wherein the compound has the ability to reduce body weight in DIO rats as described in C8 and wherein the GLP-1 analogue is capable of reducing body weight to at least 90 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days.

152. The compound according to any of the previous embodiments, wherein the

compound is a PCSK9 inhibitor.

153. The compound according to any of the previous embodiments 137-145, wherein the compound has increased binding affinity to human PCSK9 compared to the EGF(A) domain of LDL-R (293-332) identified by SEQ ID NO.: 1 .

154. The compound according to any of the previous embodiments 137-145, wherein the compound binds PCSK9 with a Ki below 50 nM, such as below 25 nM or such as below 10 nM, when measured in a PCSK9-LDL-R binding competitive ELISA assay as described in Section C3.

155. The compound according to any of the previous embodiments 137-145, wherein the compound binds PCSK9 with a Ki below 5 nM, when measured in the PCSK9-LDL-R binding competitive ELISA assay as described in Section C3.

156. The compound according to any of the previous embodiments 137-145, wherein the compound increases LDL uptake. 157. The compound according to any of the previous embodiments 137-145, wherein the compound increases LDL uptake in the presence of human PCSK9.

158. The compound according to any of the previous embodiments 137-152, wherein the compound has an EC50 below 1000 nM when measured in the LDL uptake assay described in section C4.

159. The compound according to any of the previous embodiment 137-145, wherein the compound has an EC50 below 500 nM when measured in the LDL uptake assay described in section C4. 160. The compound according to any of the previous embodiments, wherein the compound decreases blood cholesterol when evaluated in DIO rats as described in section C8 161. The compound according to embodiment 160, wherein the compound reduces blood cholesterol at least 0.5 mmol/L when dosed with 30 nmol/kg/day and measured after 21 days.

162. The compound according to embodiment 160, wherein the compound reduces blood cholesterol by at least 0.8 mmol/L when dosed with 300 nmol/kg/day and measured after

21 days.

163. The compound according to any of the embodiments, wherein the compound is a GLP-1 receptor agonist as defined in any one of previous embodiments 139-144 and a PCSK9 inhibitor as defined in any one of the previous embodiments 153-159

164. The compound according to embodiment 160, wherein the compound has a ratio of the apparent EGF(A) Ki (C3) and the GLP-1 potency (C1 , without HSA) which is at most 5000, such as at most 4000, such as at most 3000, such as at most 2000 or such as at most 1000.

165. The compound according to embodiment 160, wherein the compound has a ratio of the apparent EGF(A) Ki (C3) and the GLP-1 potency (C1 , without HSA) which is at most 1000, such as at most 800, such as at most 600, such as at most 400 or such as at most 200.

166. The compound according to embodiment 160, wherein the compound has a ratio of the apparent EGF(A) Ki (C3) and the GLP-1 potency (C1 , without HSA) is at most 200, such as at most 150, such as at most 100, such as at most 50, 25 and 10.

167. The compound according to any of the previous embodiments 137-166, wherein the compound is capable of reducing cholesterol and body weight at least equal to GLP- 1/EGF(A) Compound #41 in an in vivo rat study as described in section C8 herein. 168. The compound according to embodiment 167, wherein the compound is capable of reducing cholesterol at least 0.5 mmol/L when dosed with 30 nmol/kg/day and measured after 21 days. 169. The compound according to embodiment 167, wherein the compound is capable of reducing cholesterol at least 0.6 such as 0.7 or such as 0.8 mmol/L, when dosed with 30 nmol/kg/day and measured after 21 days.

170. The compound according to embodiment 167, wherein the compound is capable of reducing cholesterol at least 0.8 mmol/L when dosed with 300 nmol/kg/day and measured after 21 days.

171. The compound according to embodiment 167,, wherein the compound is capable of reducing cholesterol at least 1.0 or such as 1.2 mmol/L when dosed with 300 nmol/kg/day and measured after 21 days.

172. The compound according to embodiment 167-171 , wherein the compound is

capable of reducing body weight to at least 95 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days.

173. The compound according to embodiment 167-171 , wherein the compound is

capable of reducing body weight to at least 90 % of baseline BW, when dosed with 300 nmol/kg/day and measured after 21 days. 174. The compound according to any of the previous embodiments, wherein the

compound is selected from the group of compounds defined as GLP-1/EGF(A) compounds #1 to #314.

175. A compound comprising a GLP-1 receptor agonist and an EGF(A) analogue,

wherein said EGF(A) analogue is an analogue of the EGF(A) domain of LDL-R (293-332) identified by SEQ ID No:1 .

176. The compound of embodiment 175, wherein the EGF(A) analogue is as defined in any of the previous embodiments 64-89. 177. A compound selected from the group of compounds defined as GLP-1/EGF(A) compounds #1 to #305.

178. A compound selected from the group of compounds defined as GLP-1/EGF(A)

compounds #1 to #314.

179. A compound selected from the group of compounds defined as GLP-1/EGF(A)

compounds #1 , 2, 21 , 22, 23, 25, 26, 27, 29, 32, 41 , 48, 51 , 52, 53,54, 69, 82, 86, 221 , 230, 287, 298 and 306.

180. A compound selected from the group of compounds defined as GLP-1/EGF(A)

compounds #1 , 2, 21 , 22, 23, 25, 26, 27, 29, 32, 48, 52, 53, 54, 69 and 306.

181. A compound selected from the group of compounds defined as GLP-1/EGF(A)

compounds #41 , #48, #69 and #306, such as #306 and #69, or such as #306 or #69.

182. Use of a compound according to any of the previous embodiments for the

preparation of a medicament. 183. A compound according to any of the previous embodiments 1 -181 for use in the preparation of a medicament.

184. A compound according to any of the previous embodiments 1 -181 for use in a

method of treatment.

185. A compound according to any of the previous embodiments 1 -181 for use in a

method of treatment of diabetes and/or overweight.

186. A compound according to any of the previous embodiments 1 -181 for use in a

method of treatment or prevention of cardiovascular diseases and/or cardiovascular risks.

187. A compound according to any of the previous embodiments 1 -181 for use in a

method of treatment for improving lipid parameters. 188. A compound according to any of the previous embodiments 1 -181 for use in a method of treatment of diabetes and cardiovascular diseases.

189. A method for treatment of diabetes and/or overweight, said method comprising administering a pharmaceutically active amount of a compound according to any of the previous embodiments 1-181 to a patient in need thereof.

190. A method for treatment or prevention of cardiovascular diseases and/or

cardiovascular risks, said method comprising administering a pharmaceutically active amount of a compound according to any of the previous embodiments 1 -181 to a patient in need thereof.

191. A method of treatment for improving lipid parameters, said method comprising administering a pharmaceutically active amount of a compound according to any of the previous embodiments 1-181 to a patient in need thereof.

192. A method for treatment of diabetes and cardiovascular diseases, said method

comprising administering a pharmaceutically active amount of a compound according to any of the previous embodiments 1 -181 to a patient in need thereof.

METHODS AND EXAMPLES List of Abbreviations

Aib: a-aminoisobutyric acid (2-Aminoisobutyric acid)

AcOH: acetic acid

Ado: 8-amino-3,6-dioxaoctanoic acid

API: Active Pharmaceutical Ingredient

AUC: Area Under the Curve

BG: Blood Glucose

BHK: Baby Hamster Kidney

BW: Body Weight

Boc: f-butyloxycarbonyl

BSA: Bovine serum albumin

Bzl: benzyl

CAS: Chemical Abstracts Service

Clt: 2-chlorotrityl

collidine: 2,4,6-trimethylpyridine

DCM: dichloromethane

Dde: 1 -(4,4-dimethyl-2,6-dioxocyclohexylidene)ethyl

DesH: des-amino histidine (imidazopropionic

acid or 3-(lmidazol-5-yl)propanoic acid), Imp)

DIC: diisopropylcarbodiimide

DIPEA: diisopropylethylamine

DMEM: Dulbecco's Modified Eagle's Medium (DMEM)

DooaSuc: 8-amino-3,6-dioxaoctyl succinamic acid

DTT: 1 ,4-dithiothreitol

EDTA: ethylenediaminetetraacetic acid

EGF: Epidermal growth factor-like

EGF(A): Epidermal growth factor-like domain A

EGTA: ethylene glycol tetraacetic acid

FCS: Fetal Calf Serum

Fmoc: 9-fluorenylmethyloxycarbonyl

HATU: (0-(7-azabenzotriazol-1-yl)-1 , 1 ,3,3-tetramethyluronium hexa fluorophosphate) HBTU: (2-(1 H-benzotriazol-1-yl-)-1 ,1 ,3,3 tetramethyluronium

hexafluorophosphate)

HEPES: 4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid

HFIP: 1 , 1 , 1 ,3,3,3-hexafluoro-2-propanol or hexafluoroisopropanol

HOAt: 1 -hydroxy-7-azabenzotriazole

HOBt: 1 -hydroxybenzotriazole

hPCSK9: human PCSK9

HPLC: High Performance Liquid Chromatography

HSA: Human Serum Albumin

IBMX: 3-isobutyl-1-methylxanthine

I C50: half maximum inhibitory concentration

Imp: Imidazopropionic acid or 3-(lmidazol-5-yl)propanoic acid) (also referred to as des-amino histidine, DesH)

Inp: isonipecotic acid

i.v. intravenously

ivDde: 1 -(4,4-dimethyl-2,6-dioxocyclohexylidene)-3-methylbutyl

IVGTT: Intravenous Glucose Tolerance Test

LCMS: Liquid Chromatography Mass Spectroscopy

LDL-R or LDLr: LDL receptor

LDL: low density lipoprotein

LDL-C: LDL cholesterol

LYD: Landrace Yorkshire Duroc

MALDI-MS: See MALDI-TOF MS

MALDI-TOF MS Matrix-Assisted Laser Desorption/lonisation Time of Flight Mass

Spectroscopy

MeOH: methanol

Mmt: 4-methoxytrityl

MRT: Mean residence time

Mtt: 4-methyltrityl

NMP: N-methyl pyrrolidone

ND: not determined

OBz: benzoyl ester

OEG: 8-amino-3,6-dioxaoctanoic acid (also termed Ado)

OPfp: pentafluorophenoxy

OPnp: para-nitrophenoxy OSu: O-succinimidyl esters (hydroxysuccinimide esters)

OtBu: tert butyl ester

Oxyma Pure®: Cyano-hydroxyimino-acetic acid ethyl ester

Pbf: 2,2,4,6,7-pentamethyldihydrobenzofuran-5-sulfonyl

PBS: Phosphate Buffered Saline

PD: Pharmacodynamic

Pen/Strep: Pencillin/Streptomycin

PK: Pharmacokinetic

QC: Quality control

RP: Reverse Phase

RP-HPLC: Reverse Phase High Performance Liquid Chromatography

RT: Room Temperature

Rt: Retention time

s.c.: Subcutaneously

SD: Standard Deviation

SEC-HPLC: Size Exclusion High Performance Liquic Chromatography

SEM: Standard Error of Mean

SPA: Scintillation Proximity Assay

SPPS: Solid Phase Peptide Synthesis

tBu: tert. butyl

TFA: trifluoroacetic acid

TIS or TIPS: triisopropylsilane

Tos: tosylate (or pare-toluenesulfonyl)

TotaGlyc: 13-amino-4,7, 10-trioxatridecayl diglycolamic acid

Tris: tris(hydroxymethyl)aminomethane or 2-amino-2-hydroxymethyl- propane-1 ,3-diol

Trt: triphenylmethyl (trityl)

Trx: tranexamic acid

TtdSuc: 13-amino-4,7, 10-trioxatridecayl succinamic acid

UPLC: Ultra Performance Liquid Chromatography

Special Materials

Eicosanedioic acid mono-tert-butyl ester

Docosanedioic acid mono-tert-butyl ester

4-(10-Carboxydecyloxy) benzoic acid tert-butyl ester Fmoc-8-amino-3,6-dioxaoctanoic acid

Fmoc-tranexamic acid

Fmoc-Lys(Mtt)-OH

Boc-His(Trt)-OH

Fmoc-Aib-OH

The preparation of eicosanedioic acid mono-tert-butyl ester, docosanedioic acid mono-tert-butyl ester, and 4-(10-carboxydecyloxy) benzoic acid tert-butyl ester are described in section 2 below, and the five last-mentioned materials are commercially available.

Methods

This section is divided in three: Section A relating to general methods of preparation of compounds of the invention, section B relating to the preparation of a number of specific compounds of the invention, and section C relating to methods of characterisation of compounds of the invention including also the results for a number of specific example compounds.

A1. General methods of preparation

This section relates to methods for solid phase peptide synthesis (SPPS methods, including methods for de-protection of amino acids, methods for cleaving the peptide from the resin, and for its purification), as well as methods for detecting and characterising the resulting peptide (LCMS and UPLC methods).

The solid phase synthesis of peptides may in some cases be improved by the use of di-peptides protected on the di-peptide amide bond with a group that can be cleaved under acidic conditions such as, but not limited to, 2-Fmoc-oxy-4-methoxybenzyl, or 2,4,6- trimethoxybenzyl. In cases where a serine or a threonine is present in the peptide, pseudoproline di-peptides may be used (available from, e.g., Novabiochem, see also W.R. Sampson (1999), J. Pep. Sci. 5, 403). The Fmoc-protected amino acid derivatives used are the standard recommended: Fmoc-Ala-OH, Fmoc-Arg(Pbf)-OH, Fmoc-Asn(Trt)-OH, Fmoc- Asp(OtBu)-OH, Fmoc-Cys(Trt)-OH, Fmoc-Gln(Trt)-OH, Fmoc-Glu(OtBu)-OH, Fmoc-Gly-OH, Fmoc-His(Trt)-OH, Fmoc-lle-OH, Fmoc-Leu-OH, Fmoc-Lys(Boc)-OH, Fmoc-Met-OH, Fmoc- Phe-OH, Fmoc-Pro-OH, Fmoc-Ser(tBu)-OH, Fmoc-Thr(tBu)-OH, Fmoc-Trp(Boc)-OH, Fmoc- Tyr(tBu)-OH, or, Fmoc-Val-OH etc. supplied from e.g. Anaspec, Bachem, Iris Biotech, or Novabiochem. Where nothing else is specified the natural L-form of the amino acids are used. The N-terminal amino acid is Boc protected at the alpha amino group (e.g. Boc- His(Boc)-OH, or Boc-His(Trt)-OH for peptides with His at the N-terminus). In case of modular albumin binding moiety attachment using SPPS the following suitably protected building blocks such as but not limited to Fmoc-8-amino-3,6-dioxaoctanoic acid, Fmoc-tranexamic acid, Fmoc-isonipecotic acid, Fmoc-Glu-OtBu and hexadecanoic acid mono-tert-butyl ester are supplied from e.g. Anaspec, Bachem, Iris Biotech, or Novabiochem. Eicosanedioic acid mono-tert-butyl ester, docosanedioic acid mono-tert-butyl ester and 4-(10-carboxydecyloxy) benzoic acid tert-butyl ester can be prepared as described below. All operations stated below are performed at 400-μηΊθΙ or 450-μηιοΙ synthesis scale.

1. Synthesis of resin bound protected peptide hydrazides Method: SPPS_P SPPS_P is performed on a Prelude or SymphonyX Solid Phase Peptide Synthesizer from Protein Technologies (Tucson, AZ 85714 U.S.A.) at 400-μηιοΙ θΓ 450-μηιοΙ scale using five fold excess of Fmoc-amino acids (300 mM in DMF with 300 mM Oxyma Pure®) relative to resin loading, e.g. 0.49 mmol/g of Fmoc-hydrazono-pyruvyl-aminomethylpolystyrene resin (PYV1000 from Iris Biotech, 95615 Marktredwitz, Germany). Fmoc-deprotection is performed using 20% piperidine in DMF or 20% piperidine in DMF with 0.1 M Oxyma Pure®. Coupling is performed using 5 : 5 : 5 : 5 amino acid/Oxyma Pure®/DIC/collidine in DMF. DMF top washes (6 cycles of 9 ml) are performed between deprotection and coupling steps. Coupling times are generally 120 minutes. Some amino acids including, but not limited to Fmoc- Arg(Pbf)-OH, Fmoc-Aib-OH or Boc-His(Trt)-OH are "double coupled", meaning that after the first coupling (e.g. 60 min), the resin is drained and more reagents are added (amino acid, Oxyma Pure®, DIC, and collidine), and the mixture allowed to react again (e.g. 60 min).

2. Synthesis of resin bound protected Cys-peptide acids

SPPS_P is performed as described above using a low load Fmoc-Glu(OtBu)-Wang (0.32 mmol/g) resin using the same coupling procedures.

3. Synthesis of albumin binder

Eicosanedioic acid mono-tert-butyl ester can be prepared as is known in the art, e.g. as described in WO 2010102886 A1 . Docosanedioic acid mono-ferf-butyl ester can be prepared as is known in the art, e.g. as described in WO2015000942 A1 . 4-(10-Carboxydecyloxy) benzoic acid tert-butyl ester can be prepared as is known in the art, e.g. as described in WO2006082204 A1

4. Attachment of side chains to resin bound protected peptide backbone When an acylation is present on a lysine side chain, the epsilon amino group of lysine to be acylated is protected with Mtt. Removal of Mtt is performed using

hexafluoroisopropanol/DCM (75:25, 3 x 10 ml, 5 min, 25 min and 25 min, respectively) followed by wash of the resin with DCM (4x 10 ml), DMF (2x 9 ml), 20% piperidine in DMF with 0.1 M Oxyma Pure® (1x 9 ml), DMF (4x 9 ml). The protracting moiety and/or linker can be attached to the peptide either by acylation of the resin bound peptide or by acylation in solution of the unprotected peptide (as described in WO2010029159 A1 ). In case of attachment of the protracting moiety and/or linker to the protected peptidyl resin the attachment can be modular using SPPS and suitably protected building blocks. Method: SC_P

The /V-e-lysine protection group is removed as described above and the chemical modification of the lysine is performed by one or more automated steps on the Prelude or SymphonyX peptide synthesiser using suitably protected building blocks as described above. Double couplings are performed as described in SPPS_P with 1 hour per coupling or single couplings with 2 hour per coupling.

5. Cleavage of resin bound peptide with or without attached side chains and purification Method: CP_M1

After synthesis the resin is washed with DCM, and the peptide is cleaved from the resin by a 2-3 hour treatment with T F A/T I S/wate r/ DTT (92.5/2.5/2.5/2.5 or 90/5/2.5/2.5) followed by precipitation with diethyl ether. The peptide is dissolved in a suitable solvent (such as water/acetonitrile) and purified by standard RP-HPLC on a C18, 5μηη column, using acetonitrile/water/TFA. The fractions are analysed by a combination of UPLC and LCMS methods, and the appropriate fractions are pooled and lyophilised. If desired the peptide counter ion can be exchanged to sodium using methods known in the art. As an example a 5 gram Sep-pak C18 column is washed with 50 ml 2- propanol, 50 ml acetonitrile and 50 ml water. A solution of approximate 70 mg protein in 21 ml 50 mM HEPES-buffer (pH 7.2) is loaded onto the Sep-pak column, which is washed with 50 ml water, 50 ml 0.1 M sodium chloride(aq) and 50 ml water. The sodium salt of the protein is eluted with 100 ml water/acetonitrile (30:70) and lyophilised.

6. Native chemical ligation of peptide hydrazide with Cvs-peptide and purification Method: NCL_M1

The peptide hydrazide (1 .0 eq) is dissolved in 0.2 M disodium phosphate/6.0 M guanidine hydrochloride (aq, pH 3.0) to a final concentration of 4.0 mM and cooled to -10°C. Sodium nitrite (0.2 M in water, 5 eq) is added, and the mixture is stirred for 20 minutes at - 10°C. A solution of 0.2 M 4-mercaptophenylacetic acid (50 eq) in 0.2 M disodium

phosphate/6.0 M guanidine hydrochloride (pH adjusted to 7.0) is added to the solution, followed by addition of the Cys-peptide (1.1 eq). pH of the solution is adjusted to 6.7 with sodium hydroxide (1.0 M, aq) and the mixture is stirred 16 hours at 25°C. 1 ,4-Dithiothreitol (100 eq) is added to the reaction mixture and stirred for 30 minutes before the pH is adjusted to 3.0 with concentrated hydrochloric acid (aq). The reaction mixture is concentrated by ultrafiltration using an Amicon Ultra-15 centrifugal filter unit with Ultracel-3 membrane from EMD Millipore (Billerica, MA 01821 U.S.A.). The concentrated solution is diluted with 0.05 M disodium phosphate/6.0 M guanidine hydrochloride (aq, pH 3.0) and concentrated by ultrafiltration again. This is repeated until the concentration of 4-mercaptophenylacetic acid is below 0.1 mM (which corresponded to >1000-fold dilution). The concentrated solution is added dropwise to a stirred solution of 50 mM tris(hydroxymethyl)aminomethane, 5 mM calcium chloride, 3 mM cysteine, 0.3 mM cystine, (aq, pH 8.2), resulting in a protein concentration of app. 0.1 mg/ml. The solution is stirred for 16 hours at 25°C. pH of the folding mixture is adjusted to app. 3 with concentrated hydrochloric acid (aq) before being purified by standard RP-HPLC on a C18, 5μηη column, using acetonitrile/water/TFA. The fractions are analysed by a combination of UPLC and LCMS methods, and the appropriate fractions are pooled and lyophilised.

7. Recombinant expression of fusion protein The fusion protein of interest is provided by heterologous expression using a suitable host. Expression plasmids are constructed using known technologies and the fusion protein expressed and purified by methods known to the person skilled in the art. In short cells are harvested and lysed in 1X PBS buffer at pH7 by cell disruptor. The insoluble fraction, containing the fusion protein, is collected and washed in the same buffer twice (6,000g/20min). 20mM ethanolamine, 2M urea, pH 10.5 is then used to solubilize the inclusion bodies to a concentration of 10 mg/mL at room temperature (22-26°C). After one hour, the solution is diluted 3 times by demineralized water, and the pH is adjusted to 8.5. Enterokinase cleavage is carried out at the same temperature for 20 hours at the ratio of 1 :1 ,000. Following that, a final concentration of 10mM CaCI ₂ and 5mM cysteine are added for refolding. After adjusting the pH to 3.0, the protein is captured from SP fast flow sepharose. The captured sample is applied onto reverse phase FeF column at pH7.5. Source 30Q column (20mM Tris, 5mM CaCI ₂ , pH 9.0) is selected as the final polishing step. 8. Incorporation of non-proteoqenic amino acid in recombinant protein

The N-terminal His-Aib dipeptide can be introduced by acylation in solution with Fmoc-His-Aib-OH followed by removal of the Fmoc-protecting group (as described in

WO2013098191 A1 ).

A2. General Methods for Detection and Characterisation

1. LC-MS methods

Method: LCMS01

LCMS01 is performed on a setup consisting of Waters Acquity UPLC system and LCT Premier XE mass spectrometer from Micromass. Eluents: A: 0.1 % Formic acid in water; B: 0.1 % Formic acid in acetonitrile. The analysis is performed at RT by injecting an appropriate volume of the sample (preferably 2-1 ΟμΙ) onto the column which is eluted with a gradient of A and B.The UPLC conditions, detector settings and mass spectrometer settings are: Column: Waters Acquity UPLC BEH, C-18, 1.7μηι, 2.1 mm x 50mm. Gradient: Linear 5% - 95% acetonitrile during 4.0 min (alternatively 8.0 min) at 0.4ml/min. Detection: 214 nm

(analogue output from TUV (Tunable UV detector)) MS ionisation mode: API-ES. Scan: 100- 2000 amu (alternatively 500-2000 amu), step 0.1 amu.

Method: LCMS34 LCMS34 is performed on a setup consisting of Waters Acquity UPLC system and Xevo G2-XS Qtof mass spectrometer. Eluents: A: 0.1 % Formic acid in water; B: 0.1 % Formic acid in acetonitrile. The analysis is performed at RT by injecting an appropriate volume of the sample (preferably 2-1 ΟμΙ) onto the column which is eluted with a gradient of A and B. The UPLC conditions, detector settings and mass spectrometer settings are: Column: Waters Acquity UPLC BEH, C-18, 1.7μιη, 2.1 mm x 50mm. Gradient: Linear 5% - 95% acetonitrile during 4.0 min (alternatively 8.0 min) at 0.4ml/min. Detection: 214 nm (analogue output from TUV (Tunable UV detector)) MS ionisation mode: API-ES. Scan: 100-2000 amu (alternatively 500-2000 amu), step 0.1 amu.

Method: LCMS27

LCMS27 is performed on a setup consisting of Agilent 1290 infinity series and an Agilent Technologies LC/MSD TOF 6230 (G6230A) detector with Agilent Jet Stream source ionization. Eluents: A: 0.02% TFA in water; B: 0.02% TFA in acetonitrile. The analysis is performed at RT by injecting an appropriate volume of the sample (preferably 2-1 ΟμΙ) onto the column which is eluted with a gradient of A and B. The UPLC conditions, detector settings and mass spectrometer settings are: Column: Aeris Widepore, C-18, 3.6μηι, 2.1 mm x 50mm. Gradient: Linear 5% - 95% acetonitrile during 4.0 min at 0.4ml/min. Detection: 214 nm (analogue output from TUV (Tunable UV detector)). Scan: 100-3200 amu.

2. UPLC method

Method: UPLC01

The RP-analysis is performed using a Waters UPLC system fitted with a dual band detector. UV detections at 214nm and 254nm are collected using an ACQUITY UPLC BEH130, C18, 130A, 1.7um, 2.1 mm x 150 mm column, 40°C. The UPLC system is connected to two eluent reservoirs containing: A: 99.95% H ₂ 0, 0.05% TFA; B: 99.95% CH ₃ CN, 0.05% TFA. The following linear gradient is used: 95% A, 5% B to 40% A, 60% B over 16 minutes at a flow-rate of 0.40 ml/min.

Method: UPLC02

The RP-analysis is performed using a Waters UPLC system fitted with a dual band detector. UV detections at 214nm and 254nm are collected using an ACQUITY UPLC BEH130, C18, 130A, 1.7um, 2.1 mm x 150 mm column, 40°C. The UPLC system is connected to two eluent reservoirs containing: A: 99.95% H ₂ 0, 0.05% TFA; B: 99.95% CH ₃ CN, 0.05% TFA. The following linear gradient is used: 95% A, 5% B to 5% A, 95% B over 16 minutes at a flow-rate of 0.40 ml/min.

A3. Characterization of selected intermediates

Peptide hydrazide:

[8Aib, 34R]GLP-1 (7-37)-GQAPGQAP-[301 L]EGF(A)(293-303) hydrazide with substituent #1 (HOOC-(CH ₂ )i6-CO-YGIu-Ado-Ado) attached via (the epsilon nitrogen of) 26K of [8Aib, 34R]GLP-1 (7-37).

Preparation method: SPPS_P; CP_M1

LCMS34: m/3 = 1970.3, m/4 = 1478.0, m/5 = 1 182.6

UPLC02: Rt = 9.3 min -peptide:

[309R, 312E, 321 E]EGF(A)(304-332)

Preparation method: SPPS_P; CP_M1

LCMS01 : m/3 = 1 1 19.8, m/4 = 840.1 , m/5

UPLC02: Rt = 8.4 min B1. Specific compounds - EGF(A) analogues and derivatives

Summary table of EGF(A) analogues and derivatives (EGF(A) compounds 1-159)

EGF(A) EGF(A) analogue Substituent Attachment compound # sites

1 299A, 301 L, 307I, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO-NH- N-terminal

309R, 31 OK CH2"(C6H4)-CH2- EGF(A) EGF(A) analogue Substituent Attachment compound # sites

2 301 L, 309R HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO-NH- N-terminal

3 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

312E, 333K

4 301 L, 309R HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 312K

5 301 L, 309R, 312E HOOC-(CH ₂ )i6-CO-gGlu-2xADO-NH- N-terminal

6 299K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 299K

309R, 312E

7 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 330K

312E, 330K

8 301 L, 309R, 312E HOS(0)2-(CH2)15-CO-gGlu-2xADO- N-terminal

NH-CH ₂ -(C ₆ H ₄ )-CH ₂ -

9 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO N-terminal,

312E, 330K 330K

10 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 332K

312E, 332K

1 1 293K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 293K

309R, 312E

12 293K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 293K, 333K

309R, 312E, 333K

13 293K, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 293K, 333K

309R, 312E, 333K 2xADO

14 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 332K, 333K

312E, 332K, 333K 2xADO

15 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 330K, 333K

312E, 330K, 333K 2xADO

16 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 321 K, 333K

312E, 321 K, 333K 2xADO

17 301 L, 309R, 333K 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 312K, 333K

2xADO

18 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

312E, 321 E, 333K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

19 301 L, 309R, 312E HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO N-terminal

20 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 321 K

312E, 321 K

21 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 324K

312E, 324K

22 301 L, 309R, 312Q HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO N-terminal

23 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 332K

312E, 321 E, 332K

24 293K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 293K

309R, 312E, 321 E

25 293K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO N-terminal,

309R, 312E 293K

26 300K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 300K

309R, 312E

27 293K, 294K, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 293K, 294K

309R, 312E 2xADO

28 293K, 301 L, 309R 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 293K, 312K

2xADO

29 301 L, 309K, 312E HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 309K

30 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 318K

312E, 318K

31 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

312E, 313K, 333K 2xADO

32 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 326K

312E, 326K

33 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 325K

312E, 325K

34 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 323K

312E, 323K

35 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 322K

312E, 322K

36 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 320K

312E, 320K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

37 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 329K

312E, 329K

38 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 313K

312E, 313K

39 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 328K

312E, 328K

40 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 316K

312E, 316K

41 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 315K

312E, 315K

42 300H, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

309R, 312R, 333K

43 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 314K

312E, 314K

44 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 31 1 K

31 1 K, 312E

45 301 L, 307K, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 307K

309R, 312E

46 301 L, 309S, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

312R, 333K

47 301 L, 309S, 312E, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

333K

48 299A, 301 L, 307I,

309R, 31 OK

49 301 L, 309R

50 301 L, 309R, 312E

51 301 L, 306Y, 309S, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO N-terminal

312E

52 293N, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO N-terminal

309S, 312E

53 301 L, 306K, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 306K

309R, 312E

54 301 L, 305K, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 305K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

309R, 312E

55 301 L, 303K, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 303K

309R, 312E

56 301 L, 302K, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 302K

309R, 312E

57 293N, 300H, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

301 L, 309R,

312R, 333K

58 301 K, 309R, 312E HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 301 K

59 298K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 298K

309R, 312E

60 293N, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

309R, 312R, 333K

61 301 L, 307I, 332K HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 332K

62 301 L, 306Y, 312E, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 332K

332K

63 301 L, 307I, 312E, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 332K

332K

64 300H, 301 L, 309R HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO-NH- N-terminal

CH2-(C6H4)-CH2-

65 300P, 301 L, 307I, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO N-terminal

309R, 312E

66 293N, 301 L, 307I, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

309R, 312D, 333K

67 293N, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

309R, 312D, 333K

68 301 L, 309R, 312E Tetrazolyl-(CH ₂ ) ₁₅ -CO-NH-S0 ₂ -(CH ₂ ) ₃ - N-terminal

CO-ADO-ADO-NH-CH ₂ -(C ₆ H ₄ )-CH ₂ -

69 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 328K

312E, 328K, 329H

70 295D, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 332K

309R, 312E, 332K

71 300H, 301 L, 309R HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 312K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

72 300H, 301 L, 307I, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO N-terminal

309R, 312E

73 296K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 296K

309R, 312E

74 294K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 294K

309R, 312E

75 292K, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 292K

309R, 312E

76 des293, 294G, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 328K

301 L, 309R,

312E, 328K

77 301 L, 306D, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

309R, 312E,

324G, 333K

78 301 L, 306D, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

309R, 312E, 333K 3xADO and 333K

4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 2xADO

79 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-0-(CH ₂ ) ₉ -CO-gGlu- 321 K, 333K

312E, 321 K, 333K 2xADO

80 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 333K

312E, 333K

81 301 L, 309R, HOOC-(CH ₂ ) ₁₈ -CO-gGlu-2xADO 333K

312E, 333K

82 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu 333K

312E, 333K

83 301 L, 309R, HOOC-(CH ₂ ) ₁₂ -CO-gGlu-2xADO 321 K, 333K

312E, 321 K, 333K

84 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 321 K, 333K

312E, 321 K, 333K

85 300H, 301 L, 4-HOOC-(C ₆ H ₄ )-0-(CH ₂ ) ₉ -CO-gGlu- 313K, 333K

309R, 312E, 2xADO

313K, 333K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

86 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 328K

312E, 313K, 328K 2xADO

87 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 324K

312E, 313K, 324K 2xADO

88 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

312E, 313K 2xADO 313K

89 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 324K, 333K

312E, 324K, 333K 2xADO

90 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 321 K

312E, 313K, 321 K 2xADO

91 des293, 300H, 4-HOOC-(C ₆ H ₄ )-0-(CH ₂ ) ₉ -CO-gGlu- 313K, 333K

301 L, 309R, 2xADO

312E, 313K, 333K

92 300H, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

309R, 312E, 2xADO

313K, 333K

93 292A, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

309R, 312E, 313K 2xADO 313K

94 des293, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

309R, 312E, 313K 2xADO 313K

95 des293, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 313K

309R, 312E, 313K

96 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 332K

312E, 313K, 332K 2xADO

97 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 328K, 333K

312E, 328K, 333K 2xADO

98 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu 313K, 333K

312E, 313K, 333K

99 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-2xgGlu 313K, 333K

312E, 313K, 333K

100 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

312E, 313K, 333K 3xGly

101 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-2xgGlu- 313K, 333K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

312E, 313K, 333K 2xADO

102 301 L, 309R, 3-HOOC-(C ₆ H ₄ )-0-(CH ₂ ) ₉ -CO-gGlu- 313K, 333K

312E, 313K, 333K 2xADO

103 299A, 301 L, 307I,

309R

104 301 L, 309R, 310K

105 301 L

106 300H, 301 L, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 333K

309R, 312E, 333K

107 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

312E, 333K 2xADO 333K

108 des293-294, 4-HOOC-(C ₆ H ₄ )-0-(CH ₂ ) ₉ -CO-gGlu- 313K, 333K

300H, 301 L, 2xADO

309R, 312E,

313K, 333K

109 300H, 301 L, 3-HO-lsoxazole-(CH ₂ ) ₁₂ -CO-gGlu- 313K, 333K

309R, 312E, 2xADO

313K, 333K

1 10 301 L, 309R, 3-HO-lsoxazole-(CH ₂ ) ₁₂ -CO-gGlu- 313K, 333K

312E, 313K, 333K 2xADO

1 1 1 301 L, 309K, 312E, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 309K, 333K

333K 2xADO

1 12 301 L, 306Y, 312E, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 324K, 333K

324K, 333K 2xADO

1 13 300H, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 314K, 333K

309R, 312E, 2xADO

314K, 333K

1 14 294W, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

309R, 312E, 333K 2xADO 333K

1 15 301 L, 309K, 312E, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 309K, 328K

328K 2xADO

1 16 301 L, 309K, 312E, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 309K, 313K

313K 2xADO EGF(A) EGF(A) analogue Substituent Attachment compound # sites

1 17 des293, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

309R, 312E, 333K 2xADO 333K

1 18 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 324K, 328K

312E, 324K, 328K 2xADO

1 19 292A, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

309R, 312E, 333K 2xADO 333K

120 301 L, 306Y, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

309R, 312E, 2xADO

313K, 333K

121 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

312E, 332K 2xADO 332K

122 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

312E, 328K 2xADO 328K

123 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

312E, 324K 2xADO 324K

124 301 L, 309K, 312E, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 309K, 332K

332K 2xADO

125 301 L, 309K, 312E, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 309K, 324K

324K 2xADO

126 301 L, 309K, 312E 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- N-terminal,

2xADO 309K

127 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 321 K, 332K

312E, 321 K, 332K 2xADO

128 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 313K, 333K

312E, 313K, 333K

129 301 L, 309R, HOOC-(CH2)14-CO-gGlu 313K, 333K

312E, 313K, 333K

130 300H, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 332K

309R, 312E, 2xADO

313K, 332K

131 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

312E, 313K, 333K TtdSuc

132 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 332K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

312E, 313K, TtdSuc

321 E, 332K

133 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

312E, 313K, 2xADO

321 E, 333K

134 301 L, 309R, HOOC-(CH ₂ ) ₁₈ -CO-gGlu-2xADO 333K

312E, 321 E, 333K

135 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 314K

312E, 313K, 314K 2xADO

136 301 L, 309R, 313K 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 312K, 313K

2xADO

137 301 L, 309R, 314K 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 312K, 314K

2xADO

138 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 31 1 K, 313K

31 1 K, 312E, 313K 2xADO

139 300H, 301 L, 4-HOOC-(C ₆ H ₄ )-0-(CH ₂ ) ₉ -CO 313K, 333K

309R, 312E,

313K, 333K

140 301 L, 309R, Tetrazolyl-(CH ₂ ) ₁₂ -CO-gGlu-2xADO 313K, 333K

312E, 313K, 333K

141 301 L, 309R, HOS(0) ₂ -(CH ₂ ) ₁₃ -CO-gGlu-2xADO 313K, 333K

312E, 313K, 333K

142 301 L, 309R, MeS(0) ₂ NH(CO)NH-(CH ₂ ) ₁₂ -CO-gGlu- 313K, 333K

312E, 313K, 333K 2xADO

143 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu 313K, 333K

312E, 313K,

321 E, 333K

144 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 313K, 333K

312E, 313K,

321 E, 333K

145 301 L, 309R, Tetrazolyl-(CH ₂ ) ₁₅ -CO-gGlu-2xADO 313K, 333K

312E, 313K, 333K

146 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu 313K, 333K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

312E, 313K,

321 E, 333K

147 300H, 301 L, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

309R, 312E, 2xADO

313K, 321 E, 333K

148 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

312E, 313K, 333K 4xADO

149 des293, 300H, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-gGlu- 313K, 333K

301 L, 309R, 2xADO

312E, 313K, 333K

150 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 328K, 333K

312E, 328K, 333K

151 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 328K, 333K

312E, 321 E,

328K, 333K

152 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 324K, 333K

312E, 324K, 333K

153 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 324K, 333K

312E, 321 E,

324K, 333K

154 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-gGlu-2xADO 328K, 333K

312E, 321 E,

328K, 333K

155 301 L, 309R, HOOC-(CH ₂ ) ₁₄ -CO-gGlu-2xADO 313K, 321 K

312E, 313K, 321 K

156 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-Trx- 313K, 333K

312E, 313K, 333K gGlu-2xADO

157 301 L, 309R, 4-HOOC-(C ₆ H ₄ )-O-(CH ₂ ) ₁₀ -CO-Trx- 313K, 333K

312E, 313K, gGlu-2xADO

321 E, 333K

158 301 L, 309R, HOOC-(CH ₂ ) ₁₈ -CO-Trx-gGlu-2xADO 333K

312E, 321 E, 333K

159 301 L, 309R, HOOC-(CH ₂ ) ₁₆ -CO-Trx-gGlu-2xADO 333K EGF(A) EGF(A) analogue Substituent Attachment compound # sites

312E, 321 E, 333K

B2. Specific compounds - GLP-1/EGF(A) compounds Preparation of compounds was performed as described above. The identity of the compounds is provided by reference to the amino acid sequence of each element as provided elsewhere herein, the substituent(s) and the specific attachment point of the one or two substituents. A few examples are shown below and a summary table is provided below. -1/EGF(A) Compound # 1

which may also be described as:

[ -1 (7-37)-GQAPGQAP-[301 L, 309R, 312E, 321 E]EGF(A) with substituent #1

attached via (the epsilon nitrogen of) 26K of [8Aib, 34R]GLP-1 (7-37).

or

[8Aib, 34R]GLP-1 (7-37)-GQAPGQAP-[301 L, 309R, 312E, 321 E]EGF(A) with substituent #1 (HOOC-(CH ₂ )i6-CO-YGIu-Ado-Ado) attached via (the epsilon nitrogen of) 26K of [8Aib, 34R]GLP-1 (7-37).

or

SEQ ID 193 with substituent #1 attached via (the epsilon nitrogen of) Lysine (K) in position 20 of SEQ ID 193 (equal to 26K of [8Aib, 34R]GLP-1 (7-37). GLP-1/EGF(A) Compound # 23

which may also be described as:

[8Aib, 34R]GLP-1 (7-37)-GQAPGQAP-[301 L, 309R, 312E, 321 E]EGF(A) with substituent #6

attached via (the epsilon nitrogen of) 26K of [8Aib, 34R]GLP-1 (7-37). or

[8Aib, 34R]GLP-1 (7-37)-GQAPGQAP-[301 L, 309R, 312E, 321 E]EGF(A) with substituent #6 (HOOC-(CH ₂ )i8-CO-Trx-YGIu-Ado-Ado) attached via (the epsilon nitrogen of) 26K of [8Aib, 34R]GLP-1 (7-37. or

SEQ ID 193 with substituent #6 attached via Lysine (K) in position 20 of SEQ ID 193.

GLP-1/EGF(A) Compound # 41

which may also be described as

[ -1 (7-37)-GQAPGQAP-[301 L, 309R, 312E, 321 E]EGF(A) with substituent #1

attached via (the epsilon nitrogen of) 26K [8Aib, 34R]GLP-1 and (the epsilon nitrogen of) 333K of [301 L, 309R, 312E, 321 E, 333K]EGF(A) or

[8Aib, 34R]GLP-1 (7-37)-GQAPGQAP-[301 L, 309R, 312E, 321 E, 333K]EGF(A) with substituent #1 (HOOC-(CH ₂ )i ₆ -CO-YGIu-Ado-Ado) attached via (the epsilon nitrogen of) 26K [8Aib, 34R]GLP-1 and (the epsilon nitrogen of) 333K of [301 L, 309R, 312E, 321 E,

333K]EGF(A) or

SEQ ID 190 with substituent #1 (HOOC-(CH ₂ )i ₆ -CO-YGIu-Ado-Ado) attached via (the epsilon nitrogen of) 26K [8Aib, 34R]GLP-1 and (the epsilon nitrogen of) 333K of [301 L, 309R, 312E, 321 E, 333K]EGF(A). or

SEQ ID 190 with substituent #1 (HOOC-(CH ₂ )i ₆ -CO-YGIu-Ado-Ado) attached via Lys in positions 20 and 80. GLP-1/EGFA) Compound # 42

which may be described as

[8Aib, 26R, 34R]GLP-1(7-37)-GQAPGQAP-[301L, 309R, 312E, 313K, 321K]EGF(A) with substituent#13

attached via (the epsilon nitrogen of)313Kand 321 K of [301 L, 309R, 312E, 313K, 321K]EGF(A). or

[8Aib, 26R, 34R]GLP-1(7-37)-GQAPGQAP-[301L, 309R, 312E, 313K, 321K]EGF(A) with substituent#13 (4-COOH-PhO-C11-yGlu-Ado-Ado) attached via (the epsilon nitrogen of) 313Kand 321 K of [301 L, 309R, 312E, 313K, 321K]EGF(A). or

SEQ ID 380 with substituent #13 (4-COOH-PhO-C11-yGlu-Ado-Ado) attached via (the epsilon nitrogen of) 313K and 321 K of [301 L, 309R, 312E, 313K, 321K]EGF(A). or

SEQ ID 380 with substituent #13 attached via Lys in positions 60 and 68 of SEQ ID 380. -1/EGF(A) Compound # 75

which may also be described as

[ -GQAPGQAP-[8Aib, 34R]GLP-1 (7-37) with substituent #1

attached via (the epsilon nitrogen of) 26K of [8Aib, 34R]GLP-1 (7-37) or

[301 L, 309R, 312E, 321 E]EGF(A)-GQAPGQAP-[8Aib, 34R]GLP-1 (7-37) with substituent #1 (HOOC-(CH ₂ )i6-CO-YGIu-Ado-Ado) attached via (the epsilon nitrogen of) 26K of [8Aib, 34R]GLP-1 (7-37) or

SEQ ID 386 with substituent #1 (HOOC-(CH ₂ )i ₆ -CO-YGIu-Ado-Ado) attached via (the epsilon nitrogen of) 26K of [8Aib, 34R]GLP-1 (7-37). or

SEQ ID 386 with substituent #1 attached via Lys in position 68 of SEQ ID 386.(7-37). The identity of the further compounds is provided by reference to the amino acid sequence of each element, as provided elsewhere herein, the substituent(s) and the specific attachment point of the one or two substituents. Summary tables of derivatives comprising a GLP-1 analogue and an EGF(A) analogue (GLP-1/EG A) compounds)

The attachment of the substituent is indicated by reference to the GLP-1 and EGF(A) analogues respectively. As noted above 26K equals position 20 in the GLP-1 (7-37) sequence and 324K of an EGF(A) analogue is an amino substitution in position 32 of an EGF(A) domain of LDL-R (293-332) analogue. The specific position for other attachment sites can be deduced in a similar manner. The specific position(s) of the substituent(s) in relation to the peptide back-bone will vary depending on the length of the spacer and possible truncations of the GLP-1 and EGF(A) analogues.

Compounds with an EGF(A) analogue in the C-terminal

Compounds with an EGF(A) analogue in the N-terminal

Analytical data for a selection of compounds are provided in below table.

Table with analytical data for GLP-1/EGF(A) compounds

GLP-1/EGF(A) Rt (min, LCMS Calc. found found found found found Compound no. UPLC02) method molweight (m+4)/4 (m+5)/5 (m+6)/6 (m+7)/7 (m+8)/8

1 8.8 LCMS34 9228.2 2308.1 1846.6 1539.1 1319.5 1 154.6

2 8.4 LCMS34 9313.3 1863.7 1553.2 1331.5 1 165.2

3 7.8 LCMS01 9200.2 1841 .1 1534.4 1315.1 1 150.8

4 8.6 LCMS34 9255.3 2314.8 1852.0 1543.5 1323.2 1 157.9

5 8.9 LCMS34 9228.2 2307.8 1846.4 1538.9 1319.2 1 154.5 GLP-1/EGF(A) Rt (min, LCMS Calc. found found found found found Compound no. UPLC02) method molweight (m+4)/4 (m+5)/5 (m+6)/6 (m+7)/7 (m+8)/8

6 9.1 LCMS34 8957.9 2240.1 1792.3 1493.8 1280.5 1120.6

7 9.1 LCMS34 8702.6 2176.3 1741.3 1451.3 1244.1 1088.7

8 9.5 LCMS34 8801.8 2201.3 1761.2 1468.0 1258.3 1101.2

9 8.1 LCMS34 9271.3 2318.8 1855.1 1546.2 1325.3 1159.8

10 8.6 LCMS34 9255.3 2314.9 1851.9 1543.6 1323.1 1157.8

11 8.4 LCMS34 9237.2 2310.3 1848.3 1540.6 1320.5 1155.6

12 8.4 LCMS34 9313.3 2329.4 1863.5 1553.2 1331.5 1165.1

14 8.4 LCMS34 9186.1 2297.1 1837.9 1532.0 1313.1 1149.1

15 8.8 LCMS34 9146.1 2287.2 1829.9 1525.1 1307.6 1144.1

16 8.7 LCMS34 9098.0 2275.1 1820.3 1517.1 1300.6 1138.1

17 8.7 LCMS34 9182.1 2296.4 1837.1 1531.1 1312.7 1148.6

18 8.9 LCMS34 8730.7 2183.3 1746.9 1455.9 1248.1 1092.2

19 9.2 LCMS34 8829.8 2208.1 1766.7 1472.4 1262.4 1104.6

20 8.8 LCMS34 8986.0 2247.1 1798.1 1498.5 1284.5 1124.1

21 8.5 LCMS34 9228.2 2307.7 1846.4 1538.8 1319.1 1154.5

22 8.5 LCMS34 9256.3 2314.9 1851.9 1543.6 1323.1 1157.9

23 8.7 LCMS34 9395.5 2349.9 1880.1 1566.8 1343.2 1175.3

24 8.4 LCMS34 9005.9 2252.1 1801.9 1501.8 1287.4 1126.6

25 8.7 LCMS34 9228.2 2307.6 1846.3 1539.0 1319.1 1154.4

26 9.0 LCMS34 9284.3 2322.0 1857.6 1548.2 1327.3 1161.5

27 8.8 LCMS34 9329.3 2333.0 1866.6 1555.8 1333.6 1167.1

28 9.6 LCMS34 9367.4 2342.2 1874.6 1562.3 1339.3 1172.0

29 8.0 LCMS34 9518.5 2380.9 1904.9 1587.4 1360.9 1191.0

30 8.0 LCMS34 9152.0 2289.0 1831.6 1526.6 1308.5 1145.1

31 LCMS34 9200.2 2301.3 1841.1 1534.6 1315.5 1150.9

32 7.0 LCMS34 9198.2 2300.6 1840.7 1534.1 1315.1 1150.8

33 8.1 LCMS34 8589.5 2148.4 1718.9 1432.6 1228.1

34 9.0 LCMS34 9496.6 2375.0 1900.2 1583.5 1357.6 1187.9 GLP-1/EGF(A) Rt (min, LCMS Calc. found found found found found Compound no. UPLC02) method molweight (m+4)/4 (m+5)/5 (m+6)/6 (m+7)/7 (m+8)/8

35 8.6 LCMS34 9214.2 2304.6 1843.9 1536.7 1317.3 1152.8

36 8.6 LCMS34 9242.3 2311.6 1849.5 1541.6 1321.4 1156.3

37 8.9 LCMS34 9212.2 2303.9 1843.2 1536.3 1316.9 1152.4

38 8.5 LCMS34 9251.3 2313.8 1851.0 1542.7 1322.5 1157.3

39 9.0 LCMS34 9319.3 2330.5 1864.8 1554.2 1332.2 1165.8

40 8.2 LCMS34 9384.4 2347.2 1877.8 1565.0 1341.6 1174.1

41 9.2 LCMS34 10072.3 2518.9 2015.3 1679.6 1439.8 1259.8

42 8.3 LCMS34 10002.1 2501.3 2001.3 1667.9 1429.8 1251.2

43 7.9 LCMS34 12055.2 3014.7 2412.0 2010.1 1723.3 1507.9

44 8.6 LCMS34 8874.9 2219.4 1775.8 1480.0 1268.7 1110.2

45 8.6 LCMS34 9581.6 2396.2 1917.2 1598.0 1369.7 1198.5

46 8.6 LCMS34 9080.0 2270.7 1817.0 1514.3 1298.0 1135.9

47 8.6 LCMS34 9194.1 2299.4 1839.6 1533.1 1314.3 1150.1

48 8.4 LCMS34 12222.5 3056.5 2445.4 2038.0 1747.0 1528.8

49 8.4 LCMS34 9353.4 2339.3 1871.4 1559.9 1337.0 1170.2

50 8.5 LCMS34 9381.4 2346.3 1877.3 1564.7 1341.2 1173.7

51 8.6 LCMS34 9395.5 2349.8 1879.9 1566.7 1343.2 1175.4

52 8.8 LCMS34 9409.5 2353.3 1882.7 1569.1 1345.2 1177.2

53 9.8 LCMS34 9423.5 2356.6 1885.5 1571.5 1347.1 1178.9

54 9.8 LCMS34 9423.5 2356.4 1885.3 1571.3 1347.1 1178.7

55 9.4 LCMS34 9381.4 2346.1 1877.1 1564.3 1341.1 1173.4

56 9.0 LCMS34 9083.1 2271.3 1817.5 1514.6 1298.4 1136.2

57 9.1 LCMS34 8937.9 2235.0 1788.3 1490.4 1277.6 1118.1

58 8.1 LCMS34 9339.4 2335.3 1868.5 1557.3 1335.1 1168.2

59 8.2 LCMS34 9383.4 2346.6 1877.5 1564.6 1341.3 1173.7

60 8.7 LCMS34 9409.5 2353.1 1882.5 1569.3 1345.0 1177.0

61 8.2 LCMS34 9480.6 2370.9 1896.7 1581.0 1355.3 1185.9

62 9.0 LCMS34 9944.1 2486.7 1989.6 1658.2 1421.4 1243.8 GLP-1/EGF(A) Rt (min, LCMS Calc. found found found found found Compound no. UPLC02) method molweight (m+4)/4 (m+5)/5 (m+6)/6 (m+7)/7 (m+8)/8

63 8.9 LCMS34 10001.2 2500.9 2001.0 1667.7 1429.6 1251.0

64 8.9 LCMS34 9975.2 2494.4 1995.8 1663.3 1425.9 1247.8

65 9.8 LCMS34 9323.4 2331.9 1865.7 1554.9 1332.8 1166.4

66 9.7 LCMS34 9324.4 2332.1 1865.9 1555.1 1333.1 1166.4

67 9.6 LCMS34 9381.4 2346.4 1877.1 1564.6 1341.2 1173.6

68 9.6 LCMS34 9323.4 2331.6 1865.7 1554.9 1332.8 1166.4

69 9.6 LCMS34 9381.4 2346.4 1877.1 1564.6 1341.2 1173.6

70 9.3 LCMS34 9266.3 2317.6 1854.3 1545.4 1324.8 1159.2

71 9.5 LCMS34 9353.4 2339.4 1871.7 1559.8 1337.2 1170.2

72 8.7 LCMS34 9099.1 2275.6 1820.7 1517.4 1300.8 1138.3

73 8.5 LCMS34 9172.1 2293.8 1835.2 1529.4 1311.1 1147.3

74 8.8 LCMS34 9186.1 2297.1 1837.9 1531.8 1313.1 1149.1

75 8.9 LCMS34 9186.1 2297.7 1838.1 1532.1 1313.4 1149.2

77 8.2 LCMS34 9540.6 2386.2 1909.1 1591.1 1363.9 1193.6

78 8.2 LCMS34 9234.3 2309.6 1847.9 1540.1 1320.2 1155.3

79 8.2 LCMS34 9250.3 2313.6 1851.1 1542.7 1322.5 1157.3

80 8.1 LCMS34 9685.8 2422.5 1938.2 1615.3 1384.7 1211.7

81 8.3 LCMS34 9105.2 2277.3 1822.0 1518.5 1301.7 1139.2

82 9.9 LCMS34 10015.2 2504.7 2004.0 1670.2 1431.7 1252.9

83 9.9 LCMS34 10001.2 2501.2 2001.1 1667.8 1429.6 1250.9

84 9.9 LCMS34 10015.2 2504.7 2004.0 1670.2 1431.8 1252.9

85 9.9 LCMS34 9944.1 2487.0 1989.8 1658.3 1421.4 1244.0

86 9.0 LCMS34 9975.2 2494.8 1996.0 1663.5 1426.0 1247.9

87 10.7 LCMS27 10071.3 2518.8 2015.3 1679.6 1439.8 1259.9

91 10.6 LCMS27 10071.3 2518.8 2015.3 1679.6 1439.8 1259.9

92 10.6 LCMS27 10000.2 2501.1 2001.0 1667.7 1429.6 1251.0

95 11.9 LCMS27 10349.7 2588.4 2070.9 1726.0 1479.5 1294.7

99 10.9 LCMS27 10349.7 2588.4 2070.9 1726.0 1479.5 1294.7 GLP-1/EGF(A) Rt (min, LCMS Calc. found found found found found Compound no. UPLC02) method molweight (m+4)/4 (m+5)/5 (m+6)/6 (m+7)/7 (m+8)/8

100 11.0 LCMS27 10278.6 2570.7 2056.7 1714.1 1469.4 1285.8

103 9.4 LCMS34 9423.5 2356.9 1885.7 1571.6 1347.2 1178.9

104 9.3 LCMS34 9480.6 2371.1 1897.1 1581.1 1355.4 1186.1

105 9.2 LCMS34 9452.5 2364.1 1891.5 1576.4 1351.4 1182.6

106 9.3 LCMS34 9404.5 2352.1 1881.9 1568.4 1344.5 1176.6

107 9.3 LCMS34 9422.5 2356.6 1885.5 1571.4 1347.1 1178.8

108 9.1 LCMS34 9480.6 2371.1 1897.1 1581.1 1355.4 1186.1

109 9.3 LCMS34 9422.5 2356.6 1885.5 1571.4 1347.1 1178.8

110 9.1 LCMS34 9365.4 2342.4 1874.1 1561.9 1338.9 1171.7

111 9.0 LCMS34 9438.5 2360.6 1888.7 1574.1 1349.4 1180.8

112 9.6 LCMS34 9395.5 2349.9 1880.1 1566.9 1343.2 1175.4

113 9.2 LCMS34 9156.2 2290.0 1832.2 1527.0 1309.0 1145.5

114 9.2 LCMS34 9157.1 2290.3 1832.4 1527.2 1309.2 1145.6

115 8.9 LCMS34 9214.2 2304.5 1843.8 1536.7 1317.3 1152.8

116 8.8 LCMS34 9214.2 2304.5 1843.8 1536.7 1317.3 1152.8

117 9.0 LCMS34 9156.2 2290.0 1832.2 1527.0 1309.0 1145.5

118 9.0 LCMS34 9214.2 2304.5 1843.8 1536.7 1317.3 1152.8

119 10.1 LCMS34 9943.2 2486.8 1989.6 1658.2 1421.5 1243.9

120 9.9 LCMS34 9944.1 2487.0 1989.8 1658.4 1421.6 1244.0

123 9.8 LCMS34 9943.2 2486.8 1989.6 1658.2 1421.5 1243.9

124 9.9 LCMS34 10001.2 2501.3 2001.2 1667.9 1429.7 1251.1

128 10.1 LCMS34 9916.1 2480.0 1984.2 1653.7 1417.6 1240.5

221 9.1 LCMS34 9943.2 2486.8 1989.6 1658.2 1421.5 1243.9

222 9.9 LCMS34 9959.1 2490.8 1992.8 1660.9 1423.7 1245.9

223 8.6 LCMS34 9944.1 2487.0 1989.8 1658.4 1421.6 1244.0

224 10.0 LCMS34 9944.1 2487.0 1989.8 1658.4 1421.6 1244.0

225 9.4 LCMS34 10128.4 2533.1 2026.7 1689.1 1447.9 1267.0

226 10.5 LCMS34 9999.3 2500.8 2000.9 1667.5 1429.5 1250.9 GLP-1/EGF(A) Rt (min, LCMS Calc. found found found found found Compound no. UPLC02) method molweight (m+4)/4 (m+5)/5 (m+6)/6 (m+7)/7 (m+8)/8

227 10.4 LCMS34 10015.2 2504.8 2004.0 1670.2 1431 .7 1252.9

229 10.6 LCMS34 10000.2 2501 .1 2001 .0 1667.7 1429.6 1251 .0

230 10.8 LCMS34 10406.8 2602.7 2082.4 1735.5 1487.7 1301 .8

281 9.1 LCMS34 8969.0 2243.2 1794.8 1495.8 1282.3 1 122.1

283 9.4 LCMS34 9887.0 2472.8 1978.4 1648.8 1413.4 1236.9

284 9.6 LCMS34 9888.0 2473.0 1978.6 1649.0 1413.6 1237.0

285 9.4 LCMS34 9945.1 2487.3 1990.0 1658.5 1421 .7 1244.1

286 9.1 LCMS34 9945.1 2487.3 1990.0 1658.5 1421 .7 1244.1

287 9.4 LCMS34 9887.0 2472.8 1978.4 1648.8 1413.4 1236.9

288 9.7 LCMS34 9945.1 2487.3 1990.0 1658.5 1421 .7 1244.1

289 9.5 LCMS34 9830.0 2458.5 1967.0 1639.3 1405.3 1229.7

290 9.2 LCMS34 9903.0 2476.8 1981 .6 1651 .5 1415.7 1238.9

291 9.7 LCMS34 9917.0 2480.3 1984.4 1653.8 1417.7 1240.6

292 9.9 LCMS34 9860.0 2466.0 1973.0 1644.3 1409.6 1233.5

293 9.3 LCMS34 9903.0 2476.8 1981 .6 1651 .5 1415.7 1238.9

294 8.6 LCMS34 9887.0 2472.8 1978.4 1648.8 1413.4 1236.9

295 8.0 LCMS34 9888.0 2473.0 1978.6 1649.0 1413.6 1237.0

296 9.3 LCMS34 9888.0 2473.0 1978.6 1649.0 1413.6 1237.0

297 8.4 LCMS34 10016.2 2505.0 2004.2 1670.4 1431 .9 1253.0

298 8.3 LCMS34 9959.1 2490.8 1992.8 1660.9 1423.7 1245.9

299 8.3 LCMS34 9888.0 2473.0 1978.6 1649.0 1413.6 1237.0

300 8.3 LCMS34 9945.1 2487.3 1990.0 1658.5 1421 .7 1244.1

301 8.3 LCMS34 9919.0 2480.8 1984.8 1654.2 1418.0 1240.9

302 8.3 LCMS34 9959.1 2490.8 1992.8 1660.9 1423.7 1245.9

303 8.3 LCMS34 9888.0 2473.0 1978.6 1649.0 1413.6 1237.0

304 8.3 LCMS34 9945.1 2487.3 1990.0 1658.5 1421 .7 1244.1

305 8.2 LCMS34 9919.0 2480.8 1984.8 1654.2 1418.0 1240.9

306 8.4 LCMS34 9242.3 231 1 .6 1849.5 1541 .4 1321 .3 1 156.3 GLP-1/EGF(A) Rt (min, LCMS Calc. found found found found found Compound no. UPLC02) method molweight (m+4)/4 (m+5)/5 (m+6)/6 (m+7)/7 (m+8)/8

307 8.4 LCMS34 12083.3 3021 .8 2417.7 2014.9 1727.2 151 1 .4

308 9.7 LCMS34 10524.8 2632.2 2106.0 1755.1 1504.5 1316.6

309 9.9 LCMS34 10496.7 2625.2 2100.3 1750.5 1500.5 1313.1

310 9.6 LCMS34 10555.8 2640.0 21 12.2 1760.3 1509.0 1320.5

31 1 9.3 LCMS34 10581.8 2646.5 21 17.4 1764.6 1512.7 1323.7

312 9.4 LCMS34 10553.8 2639.5 21 1 1 .8 1760.0 1508.7 1320.2

313 9.7 LCMS34 9367.4 2342.6 1874.5 1562.3 1339.2 1 171 .8

314 9.6 LCMS34 12208.4 2442.4 2035.6 1744.8 1527.0

C. General Methods for Characterisation

In order to characterise the compounds the functionality may be tested in various assays.

C1 - GLP-1 in-vitro potency

The purpose of this assay is to test the GLP-1 activity (or potency), of a compound, such as a derivative comprising a GLP-1 analogue in vitro. The in vitro potency is the measure of human GLP-1 receptor activation in a whole cell assay.

The potencies of the derivatives of GLP-1/EGF(A) compounds were determined as described below and data for GLP-1 (7-37) and semaglutide is included for comparison.

Principle

In vitro potency is determined by measuring the response of the human GLP-1 receptor in a reporter gene assay. The assay is performed in a stably transfected BHK cell line that expresses the human GLP-1 receptor and contains the DNA for the cAMP response element (CRE) coupled to a promoter and the gene for firefly luciferase (CRE luciferase). When the human GLP-1 receptor is activated it results in the production of cAMP, which in turn results in the luciferase protein being expressed. When assay incubation is completed the luciferase substrate (luciferin) is added and the enzyme converts luciferin to oxyluciferin to produce bioluminescence. The luminescence is measured as the readout for the assay. Cell culture and preparation

The cells used in this assay (clone FCW467-12A/KZ10-1 ) are BHK cells with BHKTS13 as a parent cell line. The cells are derived from a clone (FCW467-12A) that expresses the human GLP-1 receptor and are established by further transfection with CRE luciferase to obtain the current clone.

The cells are cultured at 5% C0 ₂ in Cell Culture Medium. They are aliquoted and stored in liquid nitrogen. Before each assay an aliquot is taken up and washed twice in PBS before being suspended at the desired concentration in the assay specific buffer. For 96-well plates the suspension is made to give a final concentration of 5x10 ³ cells/well.

Materials

The following chemicals are used in the assay: Pluronic F-68 (10%) (Gibco 2404), human serum albumin (HSA) (Sigma A951 1 ), ovalbumin (Sigma A5503), DMEM w/o phenol red (Gibco 1 1880-028), 1 M Hepes (Gibco 15630), Glutamax 100x (Gibco 35050) and steadylite plus (PerkinElmer 6016757).

Buffers

Cell Culture Medium is DMEM medium with 10% FBS (Fetal Bovine Serum;

Invitrogen 16140-071 ), 1 mg/ml G418 (Invitrogen 15140-122), 240 nM MTX (methotrexate; Sigma M9929) and 1 % pen/strep (penicillin/streptomycin; Invitrogen 15140-122).

Assay Medium is DMEM w/o phenol red, 10mM Hepes and 1 x Glutamax. The Assay Buffer consisted of 2% ovalbumin and 0.2% Pluronic F-68 in Assay Medium.

Procedure

1 ) Cell stocks are thawed in a 37 °C water bath.

2) Cells are washed three times in PBS.

3) The cells are counted and adjusted to 5x10 ³ cells/50 μΙ (1x10 ⁵ cells/ml) in Assay Medium.

A 50 μΙ aliquot of cells is transferred to each well in the assay plate.

4) Stocks of the test compounds and reference compounds are diluted to a concentration of 0.2 μΜ in Assay Buffer . Compounds are diluted 10-fold to give the following

concentrations: 2x10 ^"7 M, 2x10 ^"8 M; 2x10 ^"9 M, 2x10 ^"10 M, 2x10 ^"11 M, 2x10 ^"12 M, 2x10 ^"13 M, and 2x10 ^"14 M.

5) A 50 μΙ aliquot of compound or blank is transferred from the dilution plate to the assay plate. Compounds are tested at the following final concentrations: 1x10 ^"7 M, 1 x10 ^"8 M; 1x10 ^"9 M, 1 x10 ^"10 M, 1 x10 ^"11 M, 1 x10 ^"12 M, 1 x10 ^"13 M, and 1x10 ^"14 M. 6) The assay plate is incubated for 3 h in a 5% C0 ₂ incubator at 37 °C.

7) The assay plate is removed from the incubator and allowed to stand at room temperature for 15 min.

8) A 100 μΙ aliquot of steadylite plus reagent is added to each well of the assay plate

(reagent is light sensitive).

9) Each assay plate is covered with aluminum foil to protect it from light and shaken for 30 min at room temperature.

10) Each assay plate is read in a Packard TopCount NXT instrument. Calculations and Results

The in vitro potency assay as described above was performed on a series of compounds with and without HSA included. The data from the TopCount instrument are transferred to GraphPad Prism software. The software performs a non-linear regression (log(agonist) vs response). EC ₅₀ values which are calculated by the software and reported in pM are shown in Table 1 below.

A minimum of two replicates was measured for each sample. The reported values are averages of the replicates.

Table 1 : In vitro potency for GLP-I/EGF(A) compounds (i.e. the derivatives comprising a GLP-1 analogue and an EGF(A) analogue).

Compound no. ECso (pM) ECso (pM)

0% HSA 1 % HSA

GLP-1 (7-37) 13.2 4.1

Semaglutide 7.3 210

1 36.7 271

2 65.8 287

3 224.8 1 1 19

4 6.2 71

5 13.1 83

6 63.4 516

7 2718.8 9003 Compound no. ECso (pM) ECso (pM)

0% HSA 1 % HSA

8 23.3 253

9 421.0 2827

10 687.0 2658

1 1 164.7 1210

12 18.9 109

13 3278.0 >10000

14 378.7 1937

15 19.6 215

16 27.7 286

17 26.2 281

18 657.0 10000

19 18.6 737

20 31 .5 770

21 138.0 2019

22 20.4 453

23 26.2 689

24 15.0 309

25 13.0 538

26 5.7 198

27 101.8 931

28 203.3 4059

29 80.5 597

30 27.4 271

31 23.6 187

32 27.2 395

33 >10000 >10000

34 1 10.6 2155 Compound no. ECso (pM) ECso (pM)

0% HSA 1 % HSA

35 59.2 520

36 51 .5 597

37 18.6 205

38 31 .8 283

39 28.1 672

40 16.6 72

41 81 .2 2322

42 19.9 66

43 28.3 272

44 22.5 192

45 26.2 270

46 28.3 301

47 23.2 230

48 18.1 997

49 108.0 4520

50 55.1 1390

51 48.5 1222

52 41.2 705

53 21 .3 530

54 27.5 925

55 214.0 3723

56 20.0 188

57 27.2 293

58 9245.0 >10000

59 315.0 >10000

60 25.4 599

61 22.1 626 Compound no. ECso (pM) ECso (pM)

0% HSA 1% HSA

62 165.5 >10000

63 145.5 7974

64 145.0 9610

65 856.0 7831

66 149.0 2974

67 416.0 6518

68 21.8 783

69 30.2 1631

70 116.0 5852

71 501.0 >10000

72 276.0 1331

73 >10000 >10000

74 940.0 5123

75 1597.0 19375

77 11.4 710

78 11.2 485

79 8.4 252

80 16.7 1054

81 15.9 570

82 136.0 2086

83 191.0 3628

84 153.4 583

85 172.7 2316

86 49.5 480

87 113.0 >10000

91 160.0 3802

92 116.0 >10000 Compound no. ECso (pM) ECso (pM)

0% HSA 1% HSA

95 294.0 >10000

99 190.0 3481

100 261.0 >10000

103 5.4 138

104 8.3 93

105 3.1 109

106 52.6 818

107 609.0 2607

108 14.1 279

109 6.6 115

110 6.3 399

111 68.6 3078

112 3.0 122

113 379.3 566

114 74.8 385

115 234.7 484

116 75.7 259

117 8.3 121

118 20.0 222

119 1200.5 361

120 90.5 5318

123 20.8 176

124 119.0 5487

128 95.9 8923

221 102.7 3259

222 75.2 357

223 55.6 2174 Compound no. ECso (pM) ECso (pM)

0% HSA 1 % HSA

224 80.7 1228

225 86.4 4276

226 124.0 4880

227 131.0 1434

229 138.3 6460

230 68.1 934

281 14.2 530

283 1749.7 536

284 108.0 1378

285 213.0 320

286 971.0 266

287 41 .8 377

288 154.0 572

289 1 159.0 1 197

290 881.3 210

291 554.0 2481

292 194.5 2884

293 36.0 506

294 39.7 730

295 31 .2 977

296 36.6 539

297 35.4 730

298 37.2 993

299 55.0 1258

300 69.2 1 105

301 53.0 1268

302 87.9 722 Compound no. ECso (pM) ECso (pM)

0% HSA 1 % HSA

303 53.3 1287

304 69.7 1269

305 48.4 1088

306 21 .2 684

307 17.8 622

308 452.0 5234

309 323.0 4104

310 237.0 3990

31 1 277.0 1648

312 272.0 367

313 65.7 1245

314 54.9 673

The majority of the GLP-1 /EGF(A) compounds show GLP-1 activity. The specific potency (both in the absence and presence of HSA) is influence by amino acid variations in the analogues and the identity of the spacer as well as the substituent. The data above demonstrate that compounds with a potency comparable or reduced relatively to GLP-1 (7- 37) and Semaglutide can be obtained.

Furthermore, a significant loss of GLP-1 potency is observed when the EGF(A) analogue is attached to the N-terminal of the GLP-1 analogue (compound 75, SEQ ID 386) instead of the C-terminal of the GLP-1 analogue (compound 1 , SEQ ID 193).

C2 - GLP-1 - In vitro receptor binding

The purpose of this example is to test the receptor binding of the GLP-1 derivatives in vitro. The receptor binding is a measure of affinity of a derivative for the human GLP-1 receptor.

Principle

The receptor binding to the human GLP-1 receptor is measured in a competitive binding assay. In this type of assay a labelled ligand (in this case ¹²⁵ I-GLP-1 ) is bound to the receptor. Each derivative/compound is added in a series of concentrations to isolated membranes containing the human GLP-1 receptor and displacement of the labelled ligand is monitored. The receptor binding is reported as the concentration at which half of the labelled ligand is displaced from the receptor, the IC ₅₀ value. GLP-1 (7-37) and Semaglutide are included as comparative compound.

Materials

The following chemicals are used in the assay: Human serum albumin (HSA) (Sigma A1653), DMEM w/o phenol red (Gibco 1 1880-028), Pen/strep (Invitrogen 15140- 122), G418 (Invitrogen 10131-027), 1 M Hepes (Gibco 15630), EDTA (Invitrogen 15575- 038), PBS (Invitrogen 14190-094), fetal calf serum (Invitrogen 16140-071 ), EGTA, MgCI ₂ (Merck 1 .05832.1000), Tween 20 (Amresco 0850C335), SPA particles (wheat germ agglutinin (WGA) SPA beads, Perkin Elmer RPNQ0001 ), [ ¹²⁵ l]-GLP-1]-(7-36)NH ₂ (produced in-house), OptiPlate™-96 (Packard 6005290).

Buffer 1 consists of 20 mM Na-HEPES plus 10 mM EDTA and pH is adjusted to 7.4. Buffer 2 consists of 20 mM Na-HEPES plus 0.1 mM EDTA and pH is adjusted to 7.4. Assay buffer consists of 50 mM HEPES supplemented with 5 mM EGTA, 5 mM MgCI ₂ , 0.005% Tween 20 and pH is adjusted to 7.4. An 8% albumin stock consists of HSA dissolved at 8% (w/v) in assay buffer. An 0.02% albumin stock consists of HSA dissolved at 0.02% (w/v) in assay buffer.

Cell culture and membrane preparation

The cells used in this assay (clone FCW467-12A) are BHK cells with BHKTS13 as a parent cell line. The cells express the human GLP-1 receptor.

The cells are grown at 5% C0 ₂ in DMEM, 10% fetal calf serum, 1 % Pen/Strep (Penicillin/Streptomycin) and 1 .0 mg/ml of the selection marker G418. To make a membrane preparation the cells are grown to approximately 80% confluence. The cells are washed twice in phosphate-buffered saline and harvested. The cells are pelleted using a brief centrifugation and the cell pellet is kept on ice. The cell pellet is homogenised with ULTRA- THURRAX™ dispersing instrument for 20-30 seconds in a suitable amount of buffer 1 (e.g., 10 ml). The homogenate is centrifuged for 15 minutes. The pellet is re-suspended

(homogenised) in 10 ml buffer 2 and centrifuged. This step is repeated once more. The resulting pellet is re-suspended in buffer 2 and the protein concentration is determined. The membranes are aliquoted and stored at minus 80°C.

Procedure 1 ) For the receptor binding assay in the presence of low HSA (0.005%) 50 μΙ of the assay buffer is added to each well of an assay plate.

2) Test compounds are serially diluted to give the following concentrations: 8x10 ^"7 M, 8x10 ^"8 M, 8x10 ^"9 M, 8x10 ^"10 M, 8x10 ^"11 M, 8x10 ^"12 M and 8x10 ^"13 M. Twenty-five μΙ are added to appropriate wells in the assay plate.

3) Cell membrane aliquots are thawed and diluted to their working concentration. Fifty μΙ are added to each well in the assay plate.

4) WGA SPA beads are suspended in assay buffer at 20 mg/ml. The suspension is diluted to 10 mg/ml in assay buffer just prior to addition to the assay plate. Fifty μΙ are added to each well in the assay plate.

5) The incubation is started by adding 25 μΙ of 480 pM solution of [ ¹²⁵ l]-GLP-1]-(7-36)NH ₂ to each well of the assay plate. A 25 μΙ aliquot is reserved for measuring total counts/well.

6) The assay plate is incubated for 2 h at 30 °C.

7) The assay plate is centrifuged for 10 min.

8) The assay plate is read in a Packard TopCount NXT instrument.

Calculations

The data from the TopCount instrument are transferred to GraphPad Prism software. The software performed a non-linear regression. IC ₅₀ values are calculated by the software and reported in nM.

Results

The following results were obtained:

Table 2: GLP-1 receptor binding for GLP-1/EGF(A) compounds

GLP-1/EGF(A) Low HSA ICso (nM) GLP-1/EGF(A) Low HSA ICso (nM)

Compound no.

Compound no.

GLP-1 (3-37) 0.5 78 3.6

Semaglutide 0.6 79 3.9

1 14.5 80 8.5

2 14.8 81 3.1

3 57.4 82 56 GLP-1/EGF(A) Low HSA ICso (nM) GLP-1/EGF(A) Low HSA ICso (nM)

Compound no.

Compound no.

4 0.4 83 62.5

5 4.9 84 34.5

6 49.8 85 64.9

7 699.9 86 31.7

8 23.8 87 39.7

9 163.4 91 23.8

10 93.1 92 38.7

11 46.1 95 42.6

12 5.8 99 38.3

13 1000.0 100 33.8

14 232.2 103 0.9

15 15.1 104 1.4

16 11.4 105 3.1

17 23.4 106 75.1

18 213.6 107 59.8

19 12.1 108 5.1

20 17.8 109 1.2

21 47.8 110 4.3

22 6.7 111 45.6

23 4.3 112 2.8

24 5.8 113 310.8

25 9.2 114 132.9

26 0.8 115 233.8

27 24.7 116 89.7

28 29.4 117 11

29 27.8 118 33.1

30 11.4 119 551.6 GLP-1/EGF(A) Low HSA ICso (nM) GLP-1/EGF(A) Low HSA ICso (nM)

Compound no.

Compound no.

31 14.3 120 52.4

32 1 1.3 123 5.3

33 >1000 124 124.9

34 15.1 128 122.1

35 19.9 221 35.2

36 22.4 222 39.1

37 5.0 223 33

38 13.8 224 58.5

39 5.5 225 21.6

40 1 .6 226 25.3

41 19.1 227 19.5

42 2.2 229 32.8

43 12.0 230 18.4

44 9.3 281 10.6

45 31.4 283 576.3

46 13.6 284 105.7

47 13.4 285 288.1

48 5.6 286 425.8

49 33.1 287 51.7

50 14.5 288 184.6

51 17.7 289 456.9

52 14.6 290 489.7

53 1 .8 291 859.4

54 4.1 292 321.8

55 21.9 293 83.1

56 4.7 294 45.8

57 4.6 295 58.9 GLP-1 /EGF(A) Low HSA ICso (nM) GLP-1/EGF(A) Low HSA ICso (nM)

Compound no.

Compound no.

58 >1000 296 73.7

59 66.1 297 52.3

60 3.2 298 50.9

61 2.2 299 95

62 57.9 300 90.5

63 50.3 301 103.3

64 156.4 302 71.9

65 204.9 303 102.5

66 26.7 304 92.7

67 84.4 305 74

68 2.2 306 10

69 1 1.4 307 6.1

70 57.3 308 185.2

71 122 309 1 12.6

72 208.3 310 32.6

73 167.7 31 1 38.9

74 347.6 312 51

75 609.0 313 15.2

77 6.8 314 6.7

The data above demonstrate that the GLP-1 binding depends on the specific sequence and substituent and that various levels of GLP-1 binding activity can be obtained in order to prepare a compound with receptor binding comparable or reduced relative to GLP-1 (7-37) or semaglutide. Again, a significant loss of GLP-1 binding was observed when the EGF(A) analogue was attached to the N-terminal of the GLP-1 analogue (compound 75, SEQ ID 386) instead of the C-terminal of the GLP-1 analogue (compound 1 , SEQ ID 193).

C3 - PCSK9-LDL-R binding - Competitive (ELISA) This assay measures the apparent binding affinity to PCSK9 in competition with LDL-R. In particular the assay is used to evaluate the apparent binding affinity of EGF(A) analogue and compounds comprising an EGF(A) analogue, such as GLP-1/EGF(A) compounds, to PCSK9.

The assay is performed as follows. The day before the experiment, recombinant human Low Density Lipoprotein Receptor (rhLDL-R; NSO-derived; R & D systems # 2148- LD) is dissolved at 1 μg/ml in 50 mM sodium carbonate, pH 9.6, and then 100 μΙ of the solution is added to each well of the assay plates (Maxisorp 96, NUNC # 439454) and coated overnight at 4 °C. On the day of the experiments, 8 point concentration curves of the EGF(A) compounds containing Biotinylated PCSK9 (0.5 ug/ml, BioSite/BPSBioscience cat#71304) are made in duplicate. Test compound and biotinylated PCSK9 mixtures are prepared an incubated for 1 hour at room temperature in assay buffer containing 25 mM Hepes, pH 7.2 (15630-056, 100 ml, 1 M), 150 mM NaCI (Emsure 1.06404.1000) 1 % HSA (Sigma A1887- 25G) 0.05% Tween 20(Calbiochem 655205) 2 mM CaCI ₂ (Sigma 223506-500G). The coated assay plates are then washed 4x in 200μΙ assay buffer, and then 100 μΙ of the mixture of test compounds and biotinylated PCSK9 is added to the plates and incubated 2 h at room temperature. The plates are washed 4x in 200μΙ assay buffer and then incubated with Streptevadin-HRP (25ng/ml; VWR # 14-30-00) for 1 h at room temperature. The reaction is detected by adding 50 μΙ TMB-on (KEM-EN-TEC) and incubated 10 min in the dark. Then the reaction is stopped by adding 50μΙ 4 M H ₃ P0 ₄ to the mixture, added by electronic multi pipetting. The plates are then read in a Spectramax at 450 and 620 nm within 1 h. The 620 nm read is used for background subtraction. IC50 values are calculated using Graphpad Prism, by nonlinear regression log(inhibitor) vs. response-variable slope (four parameters), and converted into Ki values using the following formula: Ki=IC50/(1 +(Biotin-

PCSK9)/(kd(Biotin-PCSK9))), where Kd of the biotin-PCSK9 is 1 .096727714 g/ml and

[Biotin-PCSK9] = 0.5 ^g/ml).

The results are shown in Table 3.1 to 3.6 below. Higher Ki values reflects lower apparent binding affinities to PCSK9 and vice versa. It is noticed that few of the compounds display a Ki which is substantially higher than the value measured for EGF66, such as a value above 500 nM, which indicate that the observed binding is not specific. Both the amino acid substitutions of the peptide and/or the one or more side-chain derivation may contribute to the loss of binding to LDL-R. In general a large number of the tested EGF(A) compounds displayed the ability to inhibit PCSK9 in binding to the hLDL-R. PCSK9 inhibitors

Initially a group of EGF(A) analogues including various amino acids substitutions were tested as described above and the results are shown in table 3.1 . Table 3.1 - Apparent binding affinity (Ki) for selected EGF(A) analogues

EGF66 (EGF(A) compound #48) identified as the most potent peptide variant in WO 2012177741 , has 5 mutations. It was found that several of these mutations were not of great importance for the Ki value determined in the assay described C3. In particular it was found that compounds including the wild type residue Asp (D) in position 310 had higher potencies than compounds with 31 OK. It also appeared that the key amino substitution is 301 L preferably in combination with 309R. Finally 307I and 299A contributed only modestly to the affinity of the EGF(A) analogues. N-terminal attachment of substituent

In a subsequent experiment it was tested if attachment of a half-life protractor e.g. a substituent to the peptides influences the Ki as determined by the assay described in C3. As described herein a substituent may be attached by different technologies and the substituent was initially attached to the nitrogen atom of the N-terminal amino acid of the peptides by acylation or alkylation.

As seen in Table 3.2 all the tested compounds have an Ki value below 3.0 nM suggesting that the various protractor and linker elements are well tolerated. This was unusual as potency is usually negatively influence by attachment of a side chain as previously observer for peptides like GLP-1 . Table 3.2 - Apparent Ki for N-terminal substituted EGF(A) analogues

Lys attachment of substituent

In order to evaluate alternative positions for linkage of a substituent to a PCSK9 inhibitor peptide a series of compounds were prepared. A back-bone peptide including three amino acid substitutions; N301 L, N309R and K312E were used except in EGF(A) compound # 58, 29 and 4 in combination with a Lys substitution at various positions. All compounds tested included the 6 cysteine amino acids in positions 297, 304, 308, 317, 319, 331 which are usually engaged in cysteine disulfide bridges. The 312E was included to ensure site specific substitution except in EGF(A) compound # 4 where attachment to wt 312K is obtained. Extension of the peptide with one Lys is also tested (EGF(A) compound 75 and 3). The same substituent as described above including a C18 diacid protractor and a yGlu-2xAdo linker was used in all compounds and attached via acylation. The results are included in Table 3.3. Table 3.3 - Apparent Ki for EGF(A) analogue with a substituent attached via a Lys residue

The analysis showed that the majority of the PCSK9 inhibitor peptide maintain functionality. The exceptions were Lys substitution and derivation in either of position 298, 301 , 302 and 307 which gave rise to non-functional peptides. It was also observed that Lys introduction and substitution in position 296, 299,315 and 320K reduced the apparent affinity.

The data thus also confirm the result from table 3.1 indicating that the amino acid substitution of Asn(N) 301 to Leu (L) is essential for the binding.

No data was observed for Lys introduction and substitution in position 295 and 310. As described above it was previously found that maintenance of Asp in 310 was preferred above the 31 OK substitution. As seen below it was also found that binding is abolished by introduction of Asp (D) in position 295 (EGF(A) example compound 70).

In summary it was concluded that compounds which do not comprise a substituent attached in any of the positions 295, 298, 302, 307 and 310 or in any of the positions 295, 296, 298, 299, 302, 307, 310, 315 and 320 of the PCSK9 peptide are generally functional. It was further concluded that an amino acid substitution in any of the positions 295, 298, 302, and 310 is generally not attractive. As seen from table 3.1 and 3.2 the V307I mutation none the less seem to be acceptable or even attractive in combination with 301 Leu.

It is further considered that peptides with amino acid substitution in one of the positions 295, 296, 298, 302, 310 are likely to have a lower functionality, while substitutions in 299, 315 and 320 only seems to lower functionality slightly. This on the other hand also suggests that a high degree of flexibility may exist for the remaining amino acid residues as Lys substitution and attachment of a sidechain will influence the peptides as much as most other amino acid substitutions. PCSK9 inhibitors with two substituents

A series of compound with two substituents were prepared. Double substitution may be obtained by acylation, alkylation or a combination at the N-terminal or at Lys (K) residues. Again the N-terminal may be amino acid 293G or a variant amino acid residue such as 292A, 293G, 293K and 294T (in cases where 293G is deleted). The compounds were prepared with different substituents, although the two substituents on the individual compounds are identical. The back-bone used in this study again included the N301 L amino acid substitution in combination with N309R and various N-terminal and/or Lys substitutions as required to obtain the specific acylation/alkylation.

Table 3.4 - Apparent Ki for double substituted EGF(A) analogues

Again the inventors concluded that the substituents are very well tolerated in a variety of positions and combinations. Further EGF(A) derivatives

To explore further the role of various amino acid substitutions in the EGF(A) sequence further compounds were prepared and tested as shown in table 3.5 All compounds include one substituent which is attached via a Lys residue introduced by amino acid substitution or extension with 333K. The back-bone peptides all include the N301 L amino acid substitution and optionally one or more of N309R and 1312E. The substituents all includes a fatty diacid comprising 16-20 carbon atoms and a linker which is either yGlu alone or extended with Ado-Ado and/or a tranexamic acid (Trx) moiety.

Table 3.5 - Apparent Ki for further EGF(A) analogue with a substituent attached via a Lys residue.

The results in table 3.5 above shows that the internal wt lysine in position 312 can be substituted with Glu (E) as well as Gin (Q), Arg (R) or Asp (D). Based on this variation it is contemplated that a broad range of amino acid residues will be tolerated in position 312 without interfering with the inhibitory function of the peptide.

Several other amino acid substitutions were also proven to be well tolerated including G293N, T294G, D299A, N300H, H306Y, H306D, N309S, Q324G and R329H, while as mentioned above N295D and N300P are none attractive amino acid substitutions.

PCSK9 binding of comprising a GLP-1 analogue and an EGF(A) analogues

To further explore if the PCSK9 binding functionality could be combined with GLP-1 receptor agonist activity, compounds comprising a GLP-1 analogue and an EGF(A) analogue were tested in the same assay and the results included in table 3.6 below. Apparent Ki for compounds comprising a GLP-1 analogue and an EGF(A)

GLP-1/EGF(A) PCSK9 binding, 1% GLP-1/EGF(A) PCSK9 binding, 1% Compound no. HSA Compound no. HSA

Ki (nM) Ki (nM)

1 4.9 79 2.4

2 3.2 80 2.5

3 2.2 81 2.9

4 3.0 82 3.7

5 2.9 83 5.9

6 2.5 84 5.3

7 2.8 85 4.2

8 3.5 86 4.0

9 2.3 87 3.0

10 2.1 91 3.8

11 2.8 92 2.9

12 2.4 95 3.1

13 2.5 99 3.6

14 2.4 100 3.2

15 2.4 103 2.4

16 3.4 104 2.9

17 2.7 105 2.4

18 1.9 106 1.9

19 2.2 107 2.3

20 1.7 108 2.8

21 1.6 109 2.7

22 1.7 110 2.9

23 2.5 111 3.0

24 1.6 112 2.7

25 1.3 113 2.9 GLP-1/EGF(A) PCSK9 binding, 1 % GLP-1/EGF(A) PCSK9 binding, 1 % Compound no. HSA Compound no. HSA

Ki (nM) Ki (nM)

26 2.5 1 14 3.1

27 2.4 1 15 2.5

28 3.3 1 16 2.6

29 2.8 1 17 2.4

30 2.9 1 18 3.2

31 5.1 1 19 2.6

32 6.1 120 3.4

33 4.7 123 4.4

34 3.3 124 3.1

35 3.1 128 3.6

36 2.5 221 3.4

37 5.2 222 2.0

38 4.1 223 2.0

39 3.8 224 1.9

40 3.6 225 2.2

41 6.8 226 3.5

42 8.3 227 n.d.

43 3.2 229 2.1

44 6.5 230 2.7

45 6.6 281 3.1

46 6.2 283 2.5

47 5.6 284 3.8

48 3.1 285 4.4

49 5.2 286 4.2

50 3.9 287 4.3

51 4.4 288 4.0

52 4.6 289 4.6 GLP-1/EGF(A) PCSK9 binding, 1 % GLP-1/EGF(A) PCSK9 binding, 1 % Compound no. HSA Compound no. HSA

Ki (nM) Ki (nM)

53 4.6 290 3.8

54 5.1 291 3.2

55 4.8 292 3.7

56 5.3 293 2.1

57 5.0 294 2.9

58 6.0 295 2.2

59 6.9 296 2.0

60 5.9 297 3.6

61 5.5 298 3.6

62 6.5 299 4.5

63 7.0 300 5.8

64 7.1 301 3.9

65 3.9 302 4.6

66 4.3 303 4.0

67 3.7 304 3.7

68 3.2 305 3.8

69 2.8 306 2.6

70 4.0 307 2.3

71 3.7 308 4.8

72 4.6 309 3.8

73 4.8 310 3.8

74 4.6 31 1 4.2

75 4.9 312 5.2

77 2.6 313 4.5

78 2.4 314 7.9

The data shows that the compounds comprising a GLP-1 analogue and an EGF(A) analogue maintain the PCSK9 binding activities associate with the EGF(A) analogue of the compound. The data also shows that there is only very modest variation and that the orientation of the GLP-1 analogue and the EGF(A) analogue does not influence PCSK9 binding. C4 - LDL uptake assay in HepG2 cells

An alternative assay to determine the inhibitory potency of the PCSK9 peptides and derivatives thereof is to measure uptake of LDL in HepG2 cells. Assay Principle: LDL uptake is primarily mediated by the endogenously expressed hLDLRs, and thus LDL uptake capacity is an indirect measure of LDLR expression. The hLDLRs can be down-regulated by incubation with exogenous PCSK9 in a dose dependent fashion. Thus PCSK9 incubation will decrease the ability of cells to take up LDL molecules. This down-regulation of LDL uptake can then be antagonized by the addition of compounds neutralizing or inhibiting the PCSK9/LDLR binding. Consequently PCSK9 inhibitors can be characterized based on their capacity to increase LDL uptake in the presence of PCSK9 and e.g. counter act the PCSK9 mediated hLDLR down-regulation.

The assay is performed using HepG2 cells (Sigma Aldrich ECACC: Acc no.

8501 1430) grown in 10% Lipoprotein deficient Foetal Calf Serum (Sigma Aldrich #S5394) and the capacity of the cells to take up BODIPY fluorescently labelled LDL particles (Life technologies Europe BV #L3483) is measured.

Assay protocol: The 96 well plates (Perkin Elmer, ViewPlate-96 Black #60005182) are coated with Poly-D-Lysine (10mg/L, Sigma Aldrich #P6407 dissolved in PBS Gibco #14190-094) for 1 hour at 37°C in incubator. Then the plates are washed 2 x in 100 μΙ PBS (Gibco #14190-094). Test compositions for 8 point concentration curves of the EGF(A) compounds are prepared all containing PCSK9 (10 ug/ml) diluted in Assay medium (DMEM (Gibco #31966-021 ), 10% Lipoprotein deficient Foetal Calf Serum (Sigma Aldrich #S5394) and 1 % Pen Strep (Cambrex #DE17-602E)), and added on to the plates in a volume of 50ul/well.

After 30-60 minutes 50.000 HepG2 cells (Sigma-Aldrich: ECACC: Atcc no.

8501 1430 lot: 13B023), diluted in Assay medium are added in a volume of 50μΙ/ννβΙΙ, and the plates are incubated 20 hours (at 37° C, 5 % C02) in C02 permeable plastic bags (Antalis Team, LDPE bag 120/35x300x0, 025mm #281604). Hereafter, the plates are emptied and immediately hereafter 50 μΙ FL-LDL (Life technologies Europe BV #L3483) in a concentration of 10 μg/ml in Assay Medium as added to each well, and the plates are incubated for 2 hours (at 37° C, 5 % C02) in C02 permeable plastic bag using the black cover on the lid to protect from light. The plates are emptied and washed 2 times with 100 μΙ of PBS (Gibco #14190- 094). Then 100 μΙ of PBS (Gibco #14190-094) is added and within 15 min hereafter, the plates are read (bottom read) using the following filters Ex (515 nm)/Em (520 nm) on a SpecktraMax M4 (Molecular Probes, Invitrogen Detection Technologies). EC50 values are calculated using GraphPad Prism, nonlinear regression curve fit, sigmoidal dose-response (variable slope). Results

The LDL uptake assay in HepG2 cells was performed as described above for a series of compounds.

The results are shown in Table 4.1 below. Lower EC50 values reflects higher capacity to reverse the PCSK9 mediated down-regulation of LDL uptake, and inversely a high EC50 value is indicative for a compound with low capacity to inhibit the PCSK9 mediated down-regulation of LDL uptake.

As can be seen most compounds display an EC50 in the LDL uptake assay of 100- 500 nM which is indicative of compounds with a high capacity to reverse the PCSK9 mediated down-regulation of LDL uptake and i.e. to increase LDL uptake.

Table 4.1 LDL uptake data in HepG2 cells (EC ₅₀ ) - (EGF(A) analogues and derivatives

The LDL uptake was further evaluated for GLP-1/EGF(A) compounds comprising GLP-1 analogue and a EGF(A) analogue and it was again confirmed that the linkage with GLP-1 analogue did not interfere with the functionality of the EGF(A) analogue (see Table 4.2). Table 4.2 LDL uptake data in HepG2 cells (EC ₅₀ )for compounds comprising a GLP-1 analogue and a EGF(A) analogue

C5 - Pharmacokinetic (PK) in minipigs

The purpose of this study is to determine the protraction in vivo of the GLP-1 derivatives after i.v. administration to minipigs, i.e. the prolongation of their time in the body and thereby their time of action. This is done in a pharmacokinetic (PK) study, where the terminal half-life of the derivative in question is determined. By terminal half-life is meant the time it takes to halve a certain plasma concentration in the terminal elimination phase.

Female Gottingen minipigs are obtained from Ellegaard Gottingen Minipigs

(Dalmose, Denmark) approximately 8-12 months of age and weighing approximately 20-30 kg are used in the studies. The minipigs are housed individually (pigs with permanent catheters) in pens with straw as bedding and fed restrictedly once daily with Altromin 9030 minipig diet (Altromin Spezialfutter GmbH & Co. KG).

After three weeks of acclimatisation two permanent central venous catheters are implanted in vena cava caudalis in each animal. The animals are allowed 1 week recovery after the surgery, and are then used for repeated pharmacokinetic studies with a suitable wash-out period between successive dosing.

The derivatives are dissolved in a buffer containing 50 mM phosphate, 70 nM sodium chloride and 0.05% polysorbate 80, pH 7.4.

Intravenous injections (the volume corresponding to 0.05 ml/kg and dose of 2 nmol/kg) of the derivatives are given through one catheter, and blood is sampled at predefined time points for up till 14 days post dosing (preferably from the other catheter).

Blood samples (for example 0.8 ml) are collected in EDTA (8mM) coated tubes and then centrifuged at 4°C and 1942g for 10 minutes.

Plasma is pipetted into Micronic tubes on dry ice, and kept at -20°C until analysis for plasma concentration of the derivatives using LOCI. Individual plasma concentration-time profiles are analysed by a non-compartmental pharmacokinetic method in Phoenix v. 6.4 (Pharsight Inc., Mountain View, CA, USA), and the resulting terminal half-lives (harmonic mean) determined.

Results

A pharmacokinetic study was performed using minipigs as described above. The following results on terminal half-lives were obtained:

Table 5.: Pharmacokinetic study in minipigs (i.v.)

The tested compounds all have an increased terminal half-lives compared to human GLP-1 (7-37). Compound 21 comprising a GLP-1 analogue with G in position 8 has a terminal half- life of 2 hours which is a 10-25 fold shorter than the half-life of the other compounds which has an non-natural amino acid; Aib in position 8.

C6 - hPCSK9 challenge model

The aim of this study is to show the change in the LDL receptor expression level mouse liver in response to inhibiting the action of intravenously injected hPCSK9 with an EGF(A) analogue or a compound comprising an EGF(A) analogue as described herein. Method

Healthy male BalBC or NMRI mice (Charles River, Germany) are injected with an EGF(A) analogue (or a compound comprising an EGF(A) analogue ), either s.c. or i.v. 15- 120 minutes before injecting hPCSK9 (Sino Biologicals, China) intravenously in the tail vein at a dose of 0.4 mg/kg. Sixty minutes after the injection of hPCSK9, the animals are anaesthetised in isoflurane and euthanised by cervical dislocation. The liver is then quickly excised and snapfrozen in liquid nitrogen. The livers are kept at -80 °C until analysis.

LDL-R Western blotting:

Liver tissue samples (100 mg) are homogenized in 500 μΙ lysis buffer (Life

Technology, FNN001 1 ) containing phosphatase inhibitor cocktail; PhosStop (Roche, 04 906 837 001 ) and protease inhibitor cocktail; compelate (Roche, 04 693 159 001 ). After adding 1 steel bead tissues are homogenized for 2.5 min at 30 Hz. After centrifugation at 5000xg for 5 min, total protein content is determined using BCA Protein Assay Kit (Pierce, 23225). Equal amounts of proteins (60 μg) in sample buffer (Life Technology, NP0007) are boiled for 10 min and spun for 2 min at 14000 rpm before loaded onto Criterion XT 3-8 % Tris-Acetate gels (BioRad#345-0131 ) and subjected to SDS-PAGE. The proteins are transferred to nitrocellulose membranes (iBIot 2 NC Regular stacks, novex # IB23001 ) according to manufacturer's instructions (Life Technology). Equal protein transfer is confirmed by

Ponceau S (Sigma, P7170) staining of the membranes and the membranes are further blocked in blocking buffer (TBS-T, 2% Tween). LDL-r proteins are detected with Primary rabbit anti LDLr antibody (Cayman Chemical Company #10012422), whereas beta-actin proteins are detected using Primary rabbit anti beta-actin antibody (abeam # ab6276). Both proteins are further visualized with peroxidase-conjugated goat anti-rabbit secondary antibodies (Biorad #170-6516) using the WesternBright Quantum Chemiluminscent

(Advansta # K-12042-D10) and imaged using a CCD camera (LAS3000, FujiFilm). Quantitative analysis of chemiluminescent signals from Western blots is done with

MultiGauge software (Fujifilm).

Results

The LDL-R expression levels were measured by Western Blot, and the expression levels compared. The expression is decreased by "vehicle-hPCSK9" which represent the group injected with hPCSK9 alone. Groups injected with EGF(A) compound -hPCSK9" showed that expression of LDL-R was normalized as expression returned to at least 90 %.

The results show that hPCSK9 decreases the expression level of LDL-R and that this effect is inhibited by the EGF(A) compounds tested. Data are summarized in Table 6.1 and 6.2 presented as percentage change in relation to the window between baseline level in healthy control animals (set to 100 %) and the level after down regulation by hPCSK9 alone (set to 0 %) . The 6 tested EGF(A) compounds are able to inhibit the action of hPCSK9 on the LDL-R expression level and the level of inhibition observed is similar to the level of inhibition observed using the control molecule Alirocumab.

Table 6.1

Group/Test group Percentage of Dose of inhibitor (nmol/kg) baseline (%)

Vehicle-Vehicle 100 0

Vehicle-hPCSK9 0 0

EGF(A) compound # 2-hPCSK9 1 10 300

EGF(A) compound # 3-hPCSK9 1 13 300

EGF(A) compound # 5-hPCSK9 123 300

EGF(A) compound # 6-hPCSK9 96 300

EGF(A) compound # 13-hPCSK9 175 300

EGF(A) compound # 19-hPCSK9 190 300

Alirocumab-hPCSK9 157 22 Table 6.2

Conclusion

Several compound examples have shown efficacy in inhibiting the down-regulation of the LDL-R expression levels by hPCSK9.

C7 - Pharmacodynamic study in db/db mice

The purpose of this assay is to verify the acute effect on blood glucose (BG) and body weight (BW) in a diabetic setting.

The compounds are tested in a single dose study in an obese, diabetic mouse model (db/db mice) as described in the following. The derivatives are tested at different doses, namely 0.3, 1 .0, 3.0, 10, 30 and 100 nmol/kg or 1.0, 3.0, 10, 30, 100 and 300 nmol/kg The mice (from Taconic, Denmark), fed from birth with the diet NIH31 (NIH 31 M Rodent Diet, commercially available from Taconic Farms, Inc., US, see www.taconic.com), are enrolled for the study at the age of approximately 10 weeks. Upon arrival at the animal unit, mice are given free access to standard chow (e.g. Altromin 1324, Brogaarden, Gentofte, Denmark) and tap water and kept at 24°C. After 1 -2 weeks of acclimatisation, the basal blood glucose are assessed twice on one day. Only mice with a baseline bloodglucose level > 15 mM are included. The mice are allocated to treatment groups based on matching blood glucose levels and body weights (N=5-7 per group). The animals are grouped to receive treatment as follows: Vehicle, subcutaneously or GLP-1/PCSK9i derivative (0.3, 1 .0, 3.0, 10, 30 or 100 nmol/kg or 1 .0, 3.0, 10, 30, 100 and 300 nmol/kg), subcutaneously, where vehicle is 50mM sodium phosphate, 70 mM sodium chloride, 0.05% polysorbate 80, pH 7.4.

The GLP-1/EGF(A) compound is dissolved in the vehicle, to dosing concentrations of 0.05, 0.17, 0.5, 1 .7, 5.0 or 17 nmol/ml or 0.17, 0.5, 1 .7, 5.0, 17 or 50 nmol/ml . Animals are dosed once, at the start of the experiment, s.c. with a dose-volume of 6 ml/kg (i.e. 300 μΙ per 50 g mouse).

On the day of dosing, blood glucose is assessed in the morning at time -½h , the mice are weighed after this. The GLP-1/EGF(A) compound is dosed at approximately time 0. On the day of dosing, blood glucose is assessed at times 1 , 2, 4 and 8 h after dosing.

On the following days, the blood glucose is assessed at time 24h, 48h, 72h, and 96h. On each day, the mice are weighed following blood glucose sampling.

The mice are weighed individually on a digital weighing scale.

Samples for the measurement of blood glucose are obtained from the tail tip capillary of conscious mice. Blood, 5 μΙ, is collected into heparinised capillaries and transferred to 250 μΙ glucose buffer (EKF system solution, Eppendorf, Germany). The glucose concentration is measured using the glucose oxidase method (glucose analyser Biosen 5040, EKF Diagnostic, GmbH, Barleben, Germany). The samples are kept at room temperature for up to 1 h or a at 4°C for a maximum of 24 h until analysis.

Baseline subtracted blood glucose and baseline subtracted body weight are calculated in mice.

Results

GLP-1/EGF(A) compounds 1 , 2, 21 , 22, 23, 25, 26, 27, 29 and 32 were tested in a single dose study as described above. The derivatives were tested at different doses, namely 0.3, 1.0, 3.0, 10, 30 and 100 nmol/kg (compound 2, 21 , 22, 23, 25 and 26) or 1.0, 3.0, 10, 30, 100 and 300 nmol/kg (compound 1 , 27, 29 and 32).

Table 7.1 gives an overview of the maximal effect (Emax) of the highest dose on delta blood glucose and delta body weight 24 hours after dosing. If the two highest dose levels did not give a similar effect, and hence the true Emax might not have been reached yet, values are marked with an asterisk ( ^* ). Table 7.1 Emax values for the effects on blood glucose and body weight in db/db mice

To get an indication of the effect of the GLP-1/PCSK9i derivatives on blood glucose and body weight, the area under the curve for delta blood glucose from 0 until 24 hours (AUC ABG ₂ 4h) and delta body weight gain at 24 hours post dosing (ABW _24h ) were calculated. Based on the dose response curves for these parameters, the Effective Doses 50% (ED50, dose of GLP-1 derivative that gives a response halfway between baseline and maximal effect) were calculated for AUC ABG _24h and ABW _24h . The ED50 can be used as an estimate of the potency of the GLP-1/PCSK9i derivatives. The following results were obtained (averages of all individual determinations).

Table 7.2 ED50 values for the effects on blood glucose and body weight in db/db mice

GLP-1/EGF(A) ED50 AUC ABG _24h ED50 ABW _24h

Compound no (nmol/kg) (nmol/kg)

Mean ± SEM Mean ± SEM

1 2.2 ±1.3 21.3 ± 1.3

2 1.9 ± 1.7 27.2 ± 1.4

21 12.5 ± 1.4 40.7 ± 1.6

22 6.1 ±1.5 8.5 ± 1.5

23 4.1 ±1.8 18.5 ± 1.6

25 3.1 ±1.6 22.1 ± 1.5

26 3.9 ±1.3 8.8 ± 1.3

27 9.2 ±1.3 78.1 ± 1.5

29 7.9 ±1.4 54.2 ± 1.5

32 2.4 ±1.2 30.0 ± 1.5

41 16.0 ± 1.4 289.8 ± 2.2

48 9.6 ±1.4 12.7 ± 1.3

51 18.0 ± 1.2 25.7 ±2.2

52 11.3 ± 1.3 22.6 ± 1.3

53 11.5 ± 1.3 11.0 ± 1.4

54 6.0 ±1.4 37.2 ± 1.4

69 8.3 ±1.3 19.2 ± 1.2

82 31.1 ± 1.3 76.3 ±2.2

86 32.2 ± 1.3 1133 ± 2.9

221 50.3 ± 1.3 148.8 ± 1.5

230 115.5 ± 1.5 208.7 ± 1.5

287 20.4 ± 1.2 60.2 ± 1.3

298 23.9 ± 1.3 76.5 ± 1.4

306 9.9 ±1.3 19.5 ± 1.3 The tested compounds showed an effect in vivo by dose dependency decreasing blood glucose as well as body weight.

While certain features of the invention have been illustrated and described herein, many modifications, substitutions, changes, and equivalents will now occur to those of ordinary skill in the art. It is, therefore, to be understood that the appended claims are intended to cover all such modifications and changes as fall within the true spirit of the invention. C8 - Pharmacodynamic study in DIO rats

The purpose of this assay is to verify the subchronic effect on body weight (BW) and total cholesterol levels in an obese setting. The compounds are tested in a subchronic dose study for 21 days in a diet-induced obesity (DIO) rat model as described in the following. The derivatives are tested at different doses, namely 30 and 300 nmol/kg, and in some instances the 300 nmol/kg group was given a higher dose of 900 nmol/kg for the time indicated.

The Sprague Dawley rats (from Charles River, France), fed from 6 weeks of age with a 60% High Fat Diet (D12492, commercially available from Research Diets, Inc), arrive at our animal unit at 22 weeks of age. Upon arrival at the animal unit, rats are given free access to a 45% High Fat Diet (D12451 , commercially available from Research Diets, Inc), and tap water and rats are under controlled lighting (12h:12h light/dark cycle; lights on 06:00- 18:00) and temperature (22±2 °C) conditions. After 2-3 weeks of acclimatisation, rats are allocated to treatment groups based on matching body weights and fat percentages (N=10 per group).

The animals are grouped to receive treatment as follows: Vehicle, subcutaneously or GLP-1/EGF(A) compound (30 or 300 nmol/kg, in some instances rats from the 300 nmol/kg group receive 900 nmol/kg for the indicated number of days), subcutaneously, where vehicle is 50 mM phosphate, 70 mM sodium chloride, 0.007% polysorbate 20, pH 7.4. The GLP-1/EGF(A) compound is dissolved in the vehicle, to dosing concentrations of 15 (for uptitration), 50 (for uptitration), 150, 500 (for uptitration) or 1500 nmol/ml.

Animals are dosed subcutaneously once daily in the morning for 22 days with a dosing volume of 0.2 ml/kg. The doses are slowly uptitrated, so that rats receive 3 nmol/kg on the first day, 10 nmol/kg on the second day, 30 nmol/kg on the third day, and if applicable 100 nmol/kg on the fourth day and 300 nmol/kg on the fifth day. The 30 nmol/kg groups receive the full dose from the third day until the end of the experiment. The 300 nmol/kg groups receive the full dose from the fifth day until the end of the experiment. Rats dosed with 300 nmol/kg of GLP-1/EGF(A) compound 41 receive 900 nmol/kg from day 16 until the end of the experiment. Rats dosed with 300 nmol/kg of GLP-1/EGF(A) compound 48 receive 900 nmol/kg from day 20 until the end of the experiment. The 900 nmol/kg dose is achieved by increasing the dosing volume of the 1500 nmol/ml solution to 0.6 ml/kg.

Rats are weighed daily on a digital weighing scale just before dosing. The weight of the food container is weighed daily as well in order to calculate food consumption. Body composition is assessed by MR scanning 3 to 4 days before the onset of dosing and on day 20 or 21 (Echo MRI 700, Houston, TX USA). A sublingual blood sample is taken from conscious rats 5 days before the onset of dosing and at the end of the study. Blood samples are collected in EDTA tubes and mixed thoroughly by inversion. EDTA tubes are placed on ice immediately subsequent to collection. EDTA blood samples are centrifuged at 6000 G x 5 min at 4 °C, and the plasma samples are stored at -80 °C until analysis. Samples are analysed for total cholesterol levels on a Cobas analyser (Cobas6000, Roche Diagnistics, USA).

Baseline subtracted body weight and baseline subtracted total cholesterol levels are calculated for each rat and averaged per group.

Results

GLP-1/EGF(A) compounds 41 , 48 and 69 were tested in a subchronic dose study as described above. The derivatives were tested at different doses, namely 30 and 300 nmol/kg (GLP-1/EGF(A) compound 69) or 30 and 300 nmol/kg with an increase in dose to 900 nmol/kg for the last 2 days (GLP-1/EGF(A) compound 41 ) or the last 7 days (GLP-1/EGF(A) compound 48).

Table 8.1 gives an overview of the average body weight as a percentage compared to baseline body weight (mean ± SEM) and the average delta in plasma total cholesterol levels compared to baseline levels (mean ± SEM) per group.

Table 8.1 Average body weight as a percentage compared to baseline body weight and average change in plasma total cholesterol levels compared to baseline levels after 21 days

C9 - Chemical stability

Formulations are prepared of GLP-1/EGF(A) compound 69 and 313 to investigate the potential stabilizing effect (reduction of isomer formation) of the EGF(A) analogue where 321 D is substituted with 321 E. The compound concentration is 2 mg/mL in a formulation consisting of 20 mM Tris, pH 7.4, 18.4 mg/ml propylene glycol, 0.43 mM CaCI ₂ . The formulations are prepared by solubilizing freeze-dried material into MQ water containing Tris, propylene glycol, and CaCI ₂ at final concentrations. pH is adjusted using 0.1 N HCI(aq) and 0.1 N NaOH(aq). Each formulation is sterile filtered and filled on HPLC glass vials and stored quiescently in a temperature controlled cabinet at 37 °C. Upon selected time points (time 0, 1 week, 2 weeks, 4 weeks), samples are drawn from the HPLC vials and frozen for subsequent UPLC-MS analysis.

A stability indicating purity method based on a BEH C4 column (300A, 1 .7 urn,

1.0x150 mm, Waters) and a 0.1 % formic acid in water (eluent A)/0.1 % formic acid in acetonitrile (eluent B) solvent system is used to evaluate purity loss of heat-stressed formulations. The following conditions are used: Column temperature: 50°C; flow rate: 0.30 mL/min; wavelength of UV detector: 215nm. The gradient is from 31 % to 39% B over 41 minutes. The LC flow is on-line line infused to an Orbitrap Fusion Lumos mass spectrometer (Thermo Fischer Scientific) equipped with an electrospray interface operated in positive ion mode. The purity method is shown to be compatible with the aforementioned formulations, and no content/analogue loss is observed. The amount of isomer formed is determined from mass-based extraction on the total ion chromatogram of the various samples i.e. time 0 and samples incubated for 2 and 4 weeks at 37°C, and the percentage of isomers in each sample is calculated from integration of isomer peak areas against the main peak (API) area. Table 9.1 . Amount of isomer in formulation samples determined by mass-based extraction of the total ion chromatograms

The results in table 9.1 show that replacing 321 D with 321 E reduces the amount of isomer formation significantly from 20.2% to 4.2% after 4 weeks of incubation at 37 °C.

While certain features of the invention have been illustrated and described herein, many modifications, substitutions, changes, and equivalents will now occur to those of ordinary skill in the art. It is, therefore, to be understood that the appended claims are intended to cover all such modifications and changes as fall within the true spirit of the invention.